ObjectiveTo investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury.MethodsBetween June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury.ResultsThe operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores (t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score (t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases.ConclusionThe method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.
Objective To investigate the method and clinical effect of free iliac flap grafting in repairing the tibia traumatic osteomyelitis complicated withboneskin defect. Methods From June 2001 to February 2006，28 patients with tibia traumatic osteomyelitis complicated with boneskin defect were treated with free iliac flap grafting at stageⅠ. There were 18 males and 10 females, with an average of 32.5 years(1868 years). There were traffic injury in 11 cases, bruise in 6 cases, explosive injury in 5 cases, machinery injury in 4 cases, and falling injury in 2 cases. The disease courses of patients were 1-6 months. All patients had been treated by 26 operations. The wounds located at the mid and upper tibia in 13 cases, and the inferior tibia in 15 cases. The length of free iliac was0.5-6.0 cm and the size of the flap ranged from 4.5 cm×3.5 cm to 28.0 cm×16.0 cm.The external fixation were applied in 18 cases, and steel plate were applied in 10 cases. The donor sites were sutured directly. Results All of the flaps survived completely. The wounds healed by first intention in 26 cases and by second intention in 2 cases. The donorsites healed by first intention. Twentyeight patients were followed up for 6 to 56 months(mean, 30 months).The appearances of the flaps were satisfactory and the colour was similar to recipient site. All grafted bone united 2-14 months (mean，4.6 months) after operation according to X-ray examination. In 20 patients who did not achieved union before operation, fracture healed 2 to 6 months after operation(mean, 3.2 months). Osteomyelitis recurred 12 months after operation in 2 cases and healed by nidus clearing. Conclusion Free iliac flap which used to repair tibia traumatic osteomyelitis complicated with boneskin defect, can repair the defect at stageⅠand enhance the antiinfectious ability. It isone of appropriate and effective clinical methods.
The capacity of embryonic spinal cord tissue in the repair of injured structure of spinal cord has been noted for years. In order to investigate the embryonic spinal cord graft in the repair of motor function of injured spinal cord, the embryonic spinal cord tissue was transplanted to the hemisection cavity in spinal cord in adult rat. One hundred adult Wistar Rats were used to simulate the hemisectional injury of spinal cord by drilling 2-3 mm cavity in lumbar enlargement. Sixty rats were treated with rat embryonic spinal cord tissue grafting while the other forty were chosen as control. The outcome was evaluated according the combined behavioural score (CBS) and motor evoked potential (MEP) in the 1, 2, 4 and 12 weeks. The grafting group was superior to the control as assessed by CBS (P lt; 0.05), especially within 4 weeks. (P lt; 0.01). The restoration of the latent peak of early wave(P1, N1) was better in the grafting group, too. This suggested that embryonic spinal cord graft could improve the recovery of motor function of injured spinal cord in adult rat. The effect of the embryonic spinal cord tissue graft might be concerned with its secretion of several kinds of neurotrophic factors, nerve growth factor, nerve transmitted factor, or adjustment of hormone.
ObjectiveTo explore apoptosis of acinar cells during pancreatic allograft rejection in rats.MethodsGroups of Wistar rats underwent heterotopic pancreaticoduodenal transplantation from syngenic Wistar of allogenic SD rats. The grafts were harvested on postoperative day 3, 5 and 7. All graft samples were subjected to histological examination and apoptotic cells of graft acinar cells using in situ terminal deoxynucleotidy1 transferasemediated dUTP nickend labeling (TUNEL). Histopathological rejection score and apoptotic index (AI) were analyzed. ResultsThe incidence of apoptotic cells was increased steadily over time in allografts, in contrast with syngenic grafts. The apoptotic cells in allografts were mainly acinar cells and few infiltrating lymphocytes. A significant correlation between apoptotic index and histopathological rejection score was noted.ConclusionTUNEL can display apoptosis of single cell in situ. Apoptosis is an important mechanism of tissue injury in acute pancreatic allograft rejection in rats. Acinar cell apoptosis can be used as a valuble index to estimate the injury of grafts and to monitor the acute rejection.
Objective To compare vein graft patency after endoscopic great saphenous vein harvesting (EVH) and conventional open saphenous veinharvesting (OVH) in coronary artery bypass grafting (CABG), and to identify risk factors for vein graft stenosis. Methods The great saphenous vein was harvested using an EVH method in 60 patients, 34 males and 26 females, who underwent CABG in the General Hospital of PLA between May 2006 and May 2009. The mean patient age was 66.6±9.2 years in the EVH group.The OVH group had 60 patients (40 males and 20 females with a mean age of 65.7±10.6 years), chosen to match the clinical characteristics of the EVH group. 64multislice computed tomography (64MSCT) was used to evaluate vein graft patency at six months and two years postoperatively. We also collected and analyzeddata on possible risk factors for vein graft stenosis. Results The harvesting time was longer in the EVH group than in the OVH group (52.5±13.3 minutes vs. 36.1±18.0 minutes, t=2.13, P＜0.05). The EVH group requireda greater number of repairs to veins than did the OVH group (2.2±13 vs. 0.9±0.6,t=2.60, P＜0.05). There were no statistically significant differences invein length, number of vein grafts, or vein graft flow between the two groups. There was also no significant difference in vein graft patency between the EVH and OVH groups at six months postoperatively (96.2% vs. 94.5%) or at two years postoperatively (90.2% vs. 91.5%). The average of vein graft blood flow was a riskfactor for vein graft stenosis(t=2.61, P=001). Conclusion The EVH vein graft had a good patency rate at six months and two years after the surgery.
Thirtysix patients with a total of 89 places of skin wounds which was involved with various depths of skin were treated by application of autogenous whole layer skin mash, in which the ratio betweenepidermis and dermis was 3∶1 and the ratio between the donor area and that of the recipient ranged from 1∶5 to 1∶20. The patients were followed from 6 months to 18 months. The results were excellent in 58, good in 15, fair in 11 and bad in 5. Different depths of the skin wounds such as superficial dermis, deep dermis, subcutis and deep fascia were responsible in seqence for the decreasing percentage of survival of the microcutaneous particle graft. It was shown that a considerably high survival might be obtained in both wounds down to fat or fascial layer.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
【Abstract】Objective To investigate the effect of donor blood transfusion on inducing pancreatic allograft tolerance in outbred rat model. Methods Wistar male rats were used as blood and pancreas donor, and diabetic recipients. One ml of donor blood injected into abdomen of diabetic recipients on the day of transplantation and azathioprine given 2 days pretransplant and continued for three days. Results Pancreas allograft survival was significantly prolonged (28 to 112 days, media survival time 64.2 days). One ml of donor blood alone injected into the abdomen and azathioprine given alone 2 days pretransplant did not improve allograft survival (media survival time 9.8 vs 10.2 days). Conclusion Donor blood injected on the day of transplantation and a 3 days course of azathioprine started 2 days pretransplant have b synergism in inducing long term graft survival in this rat model.
Objective To explore an effect of the artificial nerve graft wrapped in the pedicled greater omentum on the early revascularization and an effectof the increased blood supply to the artificial nerve graft on the nerve regeneration. Methods Seventy-five rabbits were randomized into 3 groups, in which there were 2 experimental groups where the rabbits were made to abridge respectively with the artificial nerve grafts wrapped in the pedicled greater omentum (Group A) and with the artificial nerve grafts only (Group B), and the control group where the rabbits were abridged with the autologous nerve (Group C).On the 3rd, 7th and 14th days after operation, the evans blue bound to albumin (EBA) was injected into the vessels in all the grafts to show their revascularization. Twelve weeks after operation the nerve regeneration was evaluated with theelectrophysiological and histological observations on the serial sections, and was evaluated also with the transmission electron microscope. Results The artificial nerve grafts wrapped in the pedicled greater omentum in Group A and the autologous nerve grafts in Group C showed a beginning of revascularization on the3rd day after operation, and the revascularization was increased on the 7th and14th days. Compared with Groups A and C, the artificial nerve grafts in Group Bshowed a delayed revascularization on the7th day after operation. At 12 weeks after operation, there were no significant differences in the motor never conduction velocity, density of the regenerated myelinated nerve fibers, myelin sheath thickness, and diameter between Group A and Group C(Pgt;0.05). However, both Group A and Group C were superior to Group B in the above variables, with significant differences(Plt;0.05). Conclusion Utilization of the pedicled greater omentum to wrapthe artificialnerve grafts can promote an early revascularization of the artificial nerve graft and an early nerve regeneration of the artificial nerve graft because of an enhanced blood supply to the nerve graft.
Objective To assess the mid-term effectiveness of anterior decompression and fusion with nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage in treatment of cervical spondylotic myelopathy. Methods A retrospective study was made on 48 patients with cervical spondylotic myelopathy who underwent anterior decompression and fusion with n-HA/PA66 cage between August 2008 and January 2010. There were 33 males and 15 females with an average age of 54.5 years (range, 42-72 years). The disease duration was 3-12 months (mean, 6 months). The affected segments included 35 cases of single segment (C3, 4 in 7, C4, 5 in 18, and C5, 6 in 10) and 13 cases of double segments (C3-5 in 7 and C4-6 in 6). Of 48 patients, 28 was diagnosed as having intervertebral disc protrusion, 12 as having ossification of posterior longitudinal ligament, and 8 as having vertebral osteophyte; 35 patients underwent single segmental anterior corpectomy and fusion, and 13 patients underwent single segmental anterior discectomy and fusion. The pre- and post-operative radiographs (cervical anteroposterior and lateral X-ray films and three-dimensional CT scans) were taken to measure the segmental height and lordosis angle. Brantigan et al assessment standard and visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the graft fusion and the improvement of clinical symptoms, respectively. Results All patients were followed up for 46 months on average (range, 36-54 months). No cage breaking, displacement, or sliding was found. At last follow-up, 36 cases were rated as Brantigan grade E, 10 cases as grade D, and 2 cases as grade C; the fusion rate was 96%. Both segmental height and lordosis angle were corrected significantly at immediate and 6 months after operation and last follow-up than those before operation (P lt; 0.05), but no significant difference was found among different time points after operation (P gt; 0.05). At last follow-up, the cage subsidence was (1.3 ± 1.0) mm. The VAS and JOA scores at 6 months after operation and last follow-up were significantly improved when compared with preoperative scores (P lt; 0.05), and the scores at last follow-up were superior to ones at 6 months after operation (P lt; 0.05). Conclusion The mid-term effectiveness of anterior decompression and fusion with the n-HA/PA66 cage in patients with cervical spondylotic myelopathy is satisfactory because it can effectively restore and maintain segmental height and lordosis angle and promote osseous fusion.