Objective To assess the variation and its significance of messenger ribonucleic acid(mRNA) expression of endothelial nitric oxide synthase (eNOS) in allografts of common carotid transplantation model in white rabbits. Methods To establish an animal model of common carotid transplantation in vivo, 30 rabbits were divided into four groups with random number table. Group A (n=3): autografts; group B (n=9): allografts with the least treated; group C (n=9): allografts treated by penicillin/streptomycin and preserved under room temperature; group D (n=9): allografts treated by penicillin/streptomycin and cryopreserved in liquid nitrogen. All the transplanted grafts were harvested 1-3 weeks later, then compared and evaluated the histomorphological variation and eNOS mRNA expression. Results The vascular structures of autografts in group A were kept approximately normal, only a few infiltration of inflammatory cells could be found. The structural variations of allografts in other trial groups behaved similarly as, intima proliferation in the 1st week, intima hyperplasia in the 2nd week, and both intima and media hypertrophy in the 3rd week. And also there seemed that luminal thrombosis could be found in all the allografts. Allografts in group B were destructed utmost the worst in all the groups. The expression of eNOS mRNA in allografts of group B was significantly less than that in other groups (Plt;0.05). Conclusion The down-regulation of eNOS mRNA expression might lead to intima hyperplasia and thrombosis of allografts.
Objective To evaluate the incidence of heterotopic ossification (HO) after single-level Bryan cervical artificial disc replacement, and to identify the relationship between HO and the effectiveness. Methods The cl inical data of 48 patients undergoing single-level Bryan cervical artificial disc replacement between October 2005 and October 2007 were reviewedretrospectively. There were 27 males and 21 females with an average age of 40.5 years (range, 33-51 years), including 8 cases of cervical myelopathy, 27 cases of nerve root cervical spondylosis, and 13 cases of mixed cervical spondylosis with an average disease duration of 10.3 months (range, 2-14 months). The involved segments included C3, 4 in 3 cases, C4, 5 in 6 cases, C5, 6 in 30 cases, and C6, 7 in 9 cases. The outcomes were evaluated using Visual Analogue Scale (VAS) score, the neck disabil ity index (NDI), and cervical range of motion (ROM). According to patients with or without HO, 48 patients were divided into 2 groups (HO group and no HO group). VAS score, NDI, and cervical ROM were compared between 2 groups at 1, 2, 3, and 4 years after operation. Results No severe complication occurred during and after operation in all patients. Forty-eight patients were followed up 48-72 months (mean, 56.6 months). VAS score and NDI were significantly improved when compared with preoperative values at all time points (P lt; 0.05); except at 3 days after operation, no significant difference was found in cervical ROM at the other time points when compared with preoperation (P gt; 0.05). Thirteen patients (27.08%) had HO at 4 years after operation, including 8 cases of grade 1, 3 cases of grade 2, and 2 cases of grade 3. There was no significant difference in VAS score, NDI, and cervical ROM between 2 groups at 1, 2, 3, and 4 years (P gt; 0.05). Conclusion The incidence of HO after single-level Bryan cervical artificial disc replacement is relatively high. However, HO has no effect on the cervical ROM and the effectiveness.
Objective To analyze the clinical features, treatment methods, and recurrence factors of giant cell tumor of the bone and to investigate the surgical therapy choice for the tumor around the knees. Methods Thirty-eight patients (13 males and 25 females; average age 31.1 years, range 14-59 years) withgiant cell tumor of the bone were treated and followed up from January 1993 to January 2005. The patients’ diagnoses were established by biopsies of the specimens from the preoperative punctures or operations. The clinical features and the radiological and laboratory data from the 38 patients were reviewed. By the Campanicci’s radiological grading system, 5 patients were in Grade Ⅰ, 22 in GradeⅡ, and 11 in Grade Ⅲ. By the Enneking classification, 9 patients were in Grade Ⅰ, 21 in Grade Ⅱ, and 8 in Grade Ⅲ. By the Jaffe’s classification, 7 patients were in Grade Ⅰ, 24 in Grade Ⅱ, and 7 in Grade Ⅲ. The intralesional excision (curettage) with the bone grafting was performed on 4 patients; the curettagewith some adjuvant treatments (highspeed burring, phenol, alcohol, cement, hydrogen peroxide, 50％ ZnCl2, 3% iodine tincture, or bone cement) was used in 26 patients; and resection of the whole tumor was performed on 8 patients. Results The follow-up of the 38 patients for 12-144 months (average, 67 months) revealedthat giant cell tumor of the bone was found around the knees in 29 of the 38 patients (13 at the distal femur, 16 at the proximal tibia), at the proximal femurin 2, at the proximal ulna in 2, at the distal radius in 2, at the sacroiliac area in 2, and at lumbar spine in 1. Of the 38 patients, 4 had a recurrence after simple curettage, 8 had no recurrence after resection of the whole tumor, and 8 of the remaining 26 patients had a recurrence after curettage with some adjutant treatments. Five patients in Grade Ⅰ (Campanicci’s radiological grading) hadno recurrence, 6 of the 11 patients in Grade Ⅱ had a recurrence, and 6 of the 11 patients in Grade Ⅲ had a recurrence. Two of the 9 patients in Grade Ⅰ (Enneking grading) had a recurrence, 6 of the 21 patients in Grade Ⅱ had a recurrence, and 4 of the patients in Grade Ⅲ had a recurrence; all the recurrent lesions were around the knee, with a duration of the recurrence ranging from 2 months to 36 months (average,14.3 months). Of the patients with the recurrence, 12 underwent reoperations (8 by the total resection of the recurrent tumor, 4 by the curettage with adjuvant treatments), and there was no recurrence after the reoperation. Conclusion Giant cell tumor of the bone usually recurs around the knee joint, especially at the proximal tibia, usually graded as Grade Ⅱ or Ⅲ bythe Campanicci’s radiological grading system. Simple curettage has a higher recurrence rate; therefore, extensive curettage and resection of the lesions combined with some adjuvant treatments after the correct diagnosis can beused to reduce the high recurrence rate of giant cell tumor of the bone.
Objective To explore the value of color Doppler ultrasonography and plasma D-dimer in diagnosis of lower limb deep venous thrombosis (DVT).Methods The clinical data of 70 cases of patients with lower limb DVT diagnosed clinically were retrospectively studied. The lower limb venous of each patient was examined by color Doppler ultrasonography and the plasma level of D-dimer were measured, furthermore the plasma levels of D-dimer in different phase and different type of thrombosis were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plasma D-dimer and ultrasonography examination in lower limb DVT were 100%, 66.7%, 97.0%, 100%, and 97.1%, and 98.4%, 83.3%, 98.4%, 83.3%, and 97.1%, respectively. The plasma D-dimer in acute phase 〔(6 451±4 012.22) μg/L〕 and subacute phase 〔(2 063±1831.35) μg/L〕 of lower limb venous thrombosis were significantly higher than that in normal control group 〔(310±66.70) μg/L〕, Plt;0.01 and Plt;0.05, which was not different from that in chronic phase 〔(466±350.52) μg/L〕. Meanwhile, the plasma D-dimer in mixed limb venous thrombosis group 〔(4 464±3 753.16) μg/L〕 and central limb venous thrombosis group 〔(2 149±1 911.53) μg/L〕 were significantly higher than that in control group (Plt;0.05 and Plt;0.01), which was not different from that in peripheral limb venous thrombosis group 〔(560±315.62) μg/L〕. Conclusion Color Doppler ultrasonography is an optimal method and the plasma D-dimer is a predictive index in diagnosis of lower limb DVT.
Objective To compare the treatment effect of patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty. Methods We identified eligible studies in PubMed (1950 to 2008.6), OVID MEDLINE (1950 to 2008.6), OVID CINAHL (1950 to 2008.6), OVID EBM (2nd Quarter 2008), CBMdisk (1978 to 2008.6), and CNKI (1981 to 2008.6), and handsearched some Chinese orthopedic journals to identified randomize controlled trials (RCTs) comparing patellar resurfacing versus patellar non-resurfacing in total knee arthroplasty. Data were extracted and methodological quality was critically assessed by two reviewers independently. Meta-analyses were performed using Stata 10.0 software. Outcomes of interest included the number of reoperations for patellofemoral problems, the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score. Results Thirteen RCTs involving 1 566 patients were included. The scores of methodological quality respectively were more than 13. The results of meta-analyses showed that patellar resurfacing could decrease the re-operation rate for patellofemoral problems (RR=0.30, 95%CI 0.14 to 0.62, Plt;0.01). The rate of postoperative anterior knee pain and the improvement in HSS knee score were comparable between patellar resurfacing and patellar non-resurfacing. Conclusion The outcome identified is re-operations for patellofemoral problems. The resurfaced patella performs better, and we find an increased relative risk for re-operation when the patella is left un-resurfaced. No differences are observed between the two groups for the prevalence of postoperative anterior knee pain, and the improvement in HSS knee score. Further well-designed and large-scale RCTs are required to determine the effects of patellar resurfacing and non-resurfacing on these outcomes.