ObjectiveTo investigate the safety and efficacy of human umbilical cord mesenchymal stem cells (MSCs) by intra-articular injection for degenerative knee osteoarthritis. MethodsBetween January 2015 and January 2016, 36 patients with moderate or severe degenerative knee osteoarthritis were randomly devided into 2 groups (n=18). Intra-articular injection of 2.5-3.0 mL human umbilical cord MSCs suspension containing (2-3)×107 cells was performed once a month for 2 times as a course of treatment in the cell treatment group; sodium hyaluronate by intra-articular injection was used once a week for 5 times as a course of treatment in the control group. There was no significant difference in gender, age, body mass index, side, stage of osteoarthritis, course of disease, and preoperative Lysholm score of the knee joint, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and SF-36 scale score between 2 groups (P > 0.05). The clinical efficacy was evaluated by SF-36 scale score, Lysholm score, and WOMAC score. ResultsAll patients of 2 groups received a course of treatment. The patients were followed up for 6 months. After injection, the incidences of pain and swelling in the cell treatment group were significantly higher than those in the control group (χ2=16.200, P=0.000; χ2=11.688, P=0.000), but no significant difference was found in the incidence of effusion (χ2=2.118, P=0.146). In the cell treatment group, Lysholm score at 1-6 months after treatment, WOMAC score and SF-36 scale score at 2-6 months after treatment were significantly better when compared with scores before treatment (P < 0.05), and no recurrence of knee pain was observed during follow-up. In the control group, there was no significant difference in Lysholm score and SF-36 scale score between pre-and post-treatment (P > 0.05); there were significant differences in WOMAC score between pre-treatment and at 1, 2, 3 months after treatment (P < 0.05); at 3 months after treatment, 11 patients had joint pain symptoms again. No significant difference was found in the knee joint function score and SF-36 scale score at 1 and 2 months after treatment between 2 groups (P > 0.05), but the scores of the cell treatment group were significantly better than those of the control group at 3 and 6 months (P < 0.05). ConclusionIt can significantly improve the joint function and quality of life to use intra-articular injection of human umbilical cord MSCs for treating degenerative knee osteoarthritis. It takes effect after 1 month and the treatment effect can be sustained for 6 months.
ObjectiveTo discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. MethodsA retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ResultsSixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845). Böhler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P < 0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05). ConclusionLimited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.
Objective To summarize the preliminary effectiveness of I.T.S. locking plate for intra-articular calcaneal fractures. Methods Between July 2010 and July 2011, 18 cases of intra-articular calcaneal fractures were treated. There were 10 males and 8 females with an average age of 46 years (range, 25-64 years). According to Sanders classification system, there were 3 cases of type II, 9 cases of type III, and 6 cases of type IV. The disease duration was 5-11 days (mean, 6 days). Open reduction and internal fixation with I.T.S. locking plate were performed via an L-shaped lateral extending incision. Results Superficial infection occurred in 1 case, and was cured after dressing changing; healing of incision by first intention was obtained in the other cases. Sixteen cases were followed up 14 months on average (range, 12-18 months). X-ray films demonstrated the bone union in all cases with an average union time of 12 weeks (range, 10-14 weeks). No implant failure or irritation of peroneal tendon occurred during follow-up. X-ray films showed subtalar post-traumatic arthritis with mild pain in 1 case at 11 months after operation, which was relieved by conservative treatment. At last follow-up, the Bouml;hler angle was improved from (12.9 ± 3.2)° preoperatively to (33.8 ± 4.0)° postoperatively, showing significant difference (t=22.78, P=0.00); the Gissane angle was improved from (83.6 ± 6.4)° preoperatively to (119.9 ± 8.5)° postoperatively, showing significant difference (t=17.02, P=0.00). The visual analogue scale (VAS) score was 1.3 ± 1.2, and the ankle and hindfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS) was 80.3 ± 7.9 at last follow-up. Conclusion Treatment of intra-articular calcaneal fracture with I.T.S. locking plate can obtain a stable fixation, which is a safe and effective method.
OBJECTIVE: To investigate the treatment results of fracture involved articular surface with absorbable screws and rods. METHODS: From October 1995 to May 2002, 32 patients with fracture involved articular surface were treated with absorbable screws and rods with the materials of SR-PGA and SR-PLLA. Bone traction or plaster external fixation were carried out postoperatively. RESULTS: The followed-up period varied from 3 months to 78 months, with an average of 18.5 months. According to the articular function evaluation criteria, the results were excellent in 24 patients, good in 6 patients and fair in 2 patients. The excellent and good rate was 93.7%. The fractures healed, without dislocation, infection and local effusion. CONCLUSION: Internal fixation of absorbable screws and rods is a perfect procedure for treating fracture involved articular surface, which avoided the pain of taking out internal fixation materials of the second operation.
Objective To investigate the treatment and therapeutic efficacy of intra-articular meniscal cysts by arthroscopy. Methods From January 2005 to December 2009, 9 cases of intra-articular meniscal cysts were treated by arthroscopy, including 5 males and 4 females, with an average age of 33.8 years (range, 24-46 years). Six patients suffered in left knees, 3 in right ones. Just 1 case had trauma history, the others had no obvious predisposing causes. The average course of the disease was 24.2 months (range, 4-36 months). The Lysholm score was (74.2 ± 11.6) points. Arthroscopy showed that the locations of cysts were the anterior horn of lateral meniscus in 8 cases and the anterior horn of medial meniscus in 1 case; all being single cyst (of them, 3 being multilocular cyst). Results All incisions healed primarily with no compl ications of infection and joint effusion. All 9 patients were followed up from 3 to 48 months with an average of 12.7 months. Preoperative symptoms disappeared or reduced and the range of motion of the knee returned to normal. TheLysholm score was (95.1 ± 3.4) points after 3 months of operation, showing significant difference (P lt; 0.01) when compared with the socre before operation. According to assessment standard described by Choy, the treatment outcome was excellent in 6 cases, good in 2 cases, and general in 1 case; the excellent and good rate was 88.9%. No recurrence was found during follow-up. Conclusion Arthroscopic surgery shows the advantages to maintain good function of knee for the treatment of meniscal cyst, it is the best choice for intra-articular meniscal cysts because of its mini-trauma, rapid recovery, thorough treatment and less recurrence. Simultaneously, partial or tatol meniscectomy or menicus repairing under arthroscopy is performed.
Objective To evaluate the effects of T-shaped plate internal fixation in treatment of intra-articular fracture of distal radius. Methods From January 2005 to March 2008, 52 cases of intra-articular fracture of distal radius were treated, including 32 males and 20 females and aging 21-60 years old (mean 47 years old). Fracture was caused by tumbl ing in 30 cases, by fall ing from height in 8 cases, by traffic accident in 11 cases, and by a crashing object in 3 cases. Of 52 cases,there were 50 cases of closed fracture and 2 cases of open fracture. According to AO standard of classification, there were 14 cases of B2 type, 16 cases of B3 type, 15 cases of C1 type, 6 cases of C2 type, and 1 case of C3 type. According to the Cooney’ s general standard of classification of unstable fracture, there were 5 cases of type II, 10 cases of type III, and 37 cases of type IV. The time from injury to operation was 3-14 days (mean 5 days). All patitents received open reduction and T-shaped plate fixation. Seven patients having bone defect were given 6-15 g autologous il ium or 5 mL calcium sulphate artificial aggregate after reduction. Results All incisions healed by first intention. All the patients were followed up for 15 to 30 months postoperatively (mean 24 months). The X-ray films showed good anatomical reduction, even articular surface and no lossening of internal fixation in all the cases. The fractures healed within 9-15 weeks after operation (mean 12 weeks). At last follow-up, the mean palmar tilt was 8° and the mean ulnar variance was 21°, showing statistically significant differences when compared preoperation (— 5° and 5°, P lt; 0.05). The radial length were not abbreviated. According to Dienst assessment, the results were excellent in 42 cases, good in 3 cases, fair in 5 cases and poor in 2 cases 12 weeks after operation, and the excellent and good rate was 86.5%. Conclusion T-shaped plate fixation is rel iable and effective in treatment of intra-articular fracture of distal radius because it has less coml ication of infection, loosening of internal fixation, reduction failure and tendon rupture.
Objective To investigate the effect of ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage. Methods The clinical data of patients with frozen shoulder diagnosed in Zigong Fourth People’s Hospital from January 2020 to January 2021 were collected retrospectively. The patients were divided into three groups according to the clinical stage of frozen shoulder (stage Ⅰ, stage Ⅱ and stage Ⅲ). All patients volunteered to receive ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation for 3 consecutive times, with a 2-week interval for each treatment, and followed up for 6 months. Before treatment and 2 weeks, 4 weeks, 2 months, 4 months and 6 months after treatment, the patients were scored with Visual Analog Scale (VAS) and Active Range of Shoulder Motion (AROM), and the capsule thickness of shoulder were measured, respectively. Results A total of 150 patients were included, including 61 patients in stage Ⅰ, 74 patients in stage Ⅱ and 15 patients in stage Ⅲ. The thickness of shoulder joint capsule on the affected side was thicker than that on the healthy side (t=24.384, P<0.001). After treatment, the thickness of shoulder joint capsule and VAS score decreased (P<0.05), and the AROM score increased (P<0.05). Before treatment, the thickness of shoulder joint capsule in stageⅡpatients was higher than that in stageⅠand Ⅲ patients [(4.3±1.0) vs. (2.9±0.5) vs. (3.1±0.4) mm; F=57.195, P<0.001]. Four weeks, 2 months, 4 months and 6 months after treatment, the decrease of shoulder joint capsule thickness was the largest in stageⅡpatients (P<0.05). Compared with stageⅡand Ⅲ patients, stageⅠpatients had the highest VAS score before treatment (7.7±0.7 vs. 5.1±0.8 vs. 4.5±0.7; F=233.560, P<0.001). There was no significant difference in VAS scores among the three groups 4 weeks (F=1.679, P=0.190), 4 months (F=1.348, P=0.263) or 6 months (F= 0.940, P=0.393) after treatment, while there were significant differences in VAS scores among the three groups 2 weeks (F=66.924, P<0.001) and 2 months (F=9.598, P<0.001) after treatment. Compared with stageⅠand Ⅲ patients, stageⅡpatients had the lowest AROM score before treatment (15.2±1.8 vs. 23.5±1.9 vs. 26.1±3.5; F=343.718, P<0.001). Four weeks (F=0.034, P=0.967), 2 months (F=0.222, P=0.801), 4 months (F=0.634, P=0.532) or 6 months (F=0.001, P=0.999) after treatment, there was no significant difference in AROM scores among the three groups, while there was significant difference in AROM scores among the three groups 2 weeks after treatment (F=177.135, P<0.001).Conclusions Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilation has good efficacy in the treatment of frozen shoulder in different clinical stage. Early injection treatment can shorten the course of the disease and relieve the pain of patients during the course of the disease.
Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
Objective To assess the treatment effect of intra-articular fracture with absorbable screws and rods.Methods From June 1998 to August 2004， 35 patients with intra-articular fracture were treated by absorbable screws and rods made of self-reinforcedpolyglycolicacid (SR-PGA) and self-reinforcedpoly-L-Lacticacid (SR-PLLA). Of 35 patients, 30 were males and 5 were females (aged from 4 to 62 years). All cases had intra-articular or periarticular fracture. The interval between injury and operation was 3 hours to 29 days. Fracture were fixed with full thread screws of SR-PGA in 9 cases, with tensile screws of SR-PLLA in 26 cases, with rods of SR-PLLA in 15 cases. Bone traction orplaster external fixation were carried out postoperatively. Results The patients were followed from 3 months to 60 months with an average of 28 months．The wounds healed by first intention, and the healing time of bone was 1－3 months. No dislocation, infection and local effusion occurred. Functional recovery was satisfactory．According to AASO articular function standard, the results were excellentin 26 cases, good in 7 cases, fair in 1 case, and poor in 1 case; the total excellent and good rate was 94.3%. Conclusion Internal fixationof absorbable screws and rods are a perfect procedure in treating intraarticular and periarticularfracture, which can avoid the pain of taking out internal fixation materials because of second operation．
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.