Objective To exploere the effectiveness and advantages of elastic stable intramedullary nail (ESIN) combined with curettage and graft for the treatment of benign lesions of humerus complicating by pathological fracture in children. Methods ESIN internal fixation combined with curettage and graft was used to treat benign lesions of the humerus complicating by pathological fracture in 11 children patients between January 2007 and January 2011. Of 11 patients, 7 were boy and 4 were girl, aged from 5 to 14 years (mean, 9.4 years). The disease duration ranged from 2 to 14 days (mean, 6 days). All fractures were closed fracture, which locations were the proximal humerus in 6 cases, the humeral shaft in 4 cases, and the distal humerus in 1 case; benign lesions of the humerus included aneurysmal bone cyst in 1 case, simple bone cyst in 7 cases, and fibrous dysplasia in 3 cases. Based on imaging studies, preoperative diagnosis was almost clear. The time from hospitalization to operation was 3-5 days Results Healing of incision by first intention was obtained in all cases, with no infection. The mean follow-up was 25.6 months (range, 12-36 months). All patients achieved pain relief at 6 weeks postoperatively and fractures healed completely at 3 to 4 months after operation (mean, 3.3 months). No recurrence or re-fracture was observed during follow-up. The ESIN was removed at 10-14 months after operation (mean, 12.5 months). The lesion disappeared completely in 8 cases and partially in 3 cases. No pain of affected limb or motion limitation of shoulder and elbows was observed. One patient had limb shortening of 2 cm at last follow-up, but he had no function problem. According to Neer shoulder and Mayo elbow function scores, the results were excellent in 11 cases. Conclusion It is a good method to treat benign lesions of the humerus complicating by pathological fracture in children to use ESIN internal fixation combined with curettage and graft. After only a single operation intervention, it can provide early mechanical stability and rapid fracture healing and allow early rehabilitation exercise.
Objective To investigate the effectiveness of the acetabular reconstruction surgery in children pathological dislocation of the hip joint. Methods Between January 2006 and January 2011, 59 patients (59 hips) with pathological dislocation were treated by open reduction combined with acetabular reconstruction surgery. There were 22 boys and 37 girls, aged from 1 to 15 years (mean, 4.9 years). There were 9 cases of hip subluxation and 50 cases of hip joint dislocation, which were caused by suppurative arthritis of the hip (33 cases) and tuberculosis of the hip (26 cases). The diseases duration ranged from 1 month to 10 years. At preoperation Harris hip score was 43-78 (mean, 61); 14 cases had normal acetabular index (AI), 32 cases had slightly increased AI, and 13 cases had significantly increased AI. The concomitant diseases included acetabular destruction in 28 cases; avascular necrosis of the femoral head in 25 cases, femoral head partial defect in 12 cases, femoral head complete defect in 6 cases, and femoral head and neck defects in 3 cases; 25 cases had increased anteversion angle; and 9 cases had varus deformity. Results Immediately postoperative X-ray films showed center reduction in all the hips. Healing of incision by first intention was achieved in 55 cases, and delayed healing in 4 cases. Fifty-three children were followed up 2 to 5 years (mean, 3 years). No re-dislocation of the hip occurred during follow-up. Thirty-eight cases had normal AI, 15 cases had slightly increased AI. The anteversion angle was 15-25 ° (mean, 20 ° ); the neck shaft angle was 110-140 ° (mean, 125 ° ); and the anatomical relation between the head and neck returned to normal. After 2 years, 18 cases had normal function of the hip joint; 30 cases had mild limitation of flexion and rotation; and 5 cases had fibrous ankylosis. The Harris hip score was 62-95 (mean, 87). Conclusion Pathological dislocation caused by neonatal acute suppurative arthritis of the hip and the hip joint tuberculosis is often associated with severe bone destruction and deformity of the acetabular and femoral head and neck. Treatment should strictly follow the principle of individual. Proper acetabular reconstruction should be selected according to pathological changes of the hip; if combined with the femoral head and neck reconstruction processing, the satisfactory results can be obtained.
【Abstract】 Objective To summarize the recent progress in related research on transforming growth factor β1 （TGF-β1）/Smad3 signal transduction pathway and post-traumatic scar formation. Methods Recent related literature at home and abroad on TGF-β1/Smad3 signal transduction pathway and post-traumatic scar formation was reviewed and summarized. Results TGF-β1 is an important influence factor of fibrotic diseases, and it plays biological effects by TGF-β1/Smad3 signal transduction pathway. The pathway is regulated by many factors and has crosstalk with other signal pathways at cellular and molecular levels. The pathway is involved in the early post-traumatic inflammatory response, wound healing, and late pathological scar formation. Intervening the transduction pathway at the molecular level can influence the process of fibrosis and extracellular matrix deposition. Conclusion TGF-β1/Smad3 signal transduction pathway is an important way to affect post-traumatic scar formation and extracellular matrix deposition. The further study on the pathway will provide a theoretical basis for promotion of wound healing, as well as prevention and treatment of pathological scar formation.
Objective To investigate the operative procedure and the effectiveness of eosinophil ic granuloma (EG) of long bones in children. Methods Between January 2005 and December 2009, 14 patients with EG of long bones were treated. There were 9 boys and 5 girls, aged from 1 to 13 years (mean, 6.5 years). The locations were femur in 5 cases, humerus in 4 cases, tibia in 2 cases, fibula in 1 case, and femur compl icated with tibia in 2 cases. The disease duration was7 days to 10 months (median, 2 months). X-ray films showed that osteolytic destruction had clear boundary, which did notinvolve the epi physeal plate. Of 14 cases, 12 cases of tumor were treated by curettage, autologous il iac bone or combined artificial bone graft repair, and 2 cases were treated by resection, autologous il iac reconstruction, plate and screw fixation. Five cases compl icated with pathological fracture underwent reduction and fixation. Results All cases were diagnosed pathologically as having EG. All incisions healed by first intention. A total of 12 patients were followed up 1 to 4 years (mean, 2 years). The X-ray films showed tumor focus and pathological fracture healed within 3 to 4 months (mean, 3.5 months). Tibial lesion was found in 1 case of femoral tumor after 8 months, and was curred after reoperation. No recurrence occurred in other 11 cases. According to comprehensive assessing standard of X-ray film and joint function, the results of all cases were excellent. Conclusion EG of long bones in children is more common in the femur and humerus. Tumor curettage and autologous il iac bone graft repair is an effective method, and postoperative prognosis is good. There may be multiple lesions, so long-term follow-up is needed.
Objective To investigate the efficiency ofintracystic allograft fixed with bone plate and steel plate in management of long bone cyst merging pathologic fracture. Methods Twelve cases of long bone cysts with pathologic fractures were treated from January 1996 to April 2002. The median dimension of the cyst on the radiograph was 3.6 cm×8.1 cm. We regularly revealed the sites of cysts, cutthe anterior wall, got cystic membrane away, implanted allo-bone fibula, ulna or radius shafts which were defatted and deproteined. The auto-bone and the alloboneof all cases were fixed with bone plate and steel plate; external fixation was managed for 3 weeks after operation. Results All incisionsachieved primary healing. All cases were followed up 2.7 years on average. According to Capanna’s standard, 9 cases completely healed, 3 cases basically healed, no cases recurred. The function in shoulder joint was slightly limited in 2 cases that cysts were located on the upper humerus, while that of the other 10 cases were recovered completely. Conclusion Intracystic allograft fixed with bone plate and steel plate is safe and effective in management of long bone cyst merging pathologic fracture.
Objective To investigate auto-cortex of crystalline lens-induced neovascular epiretinal membrane（NVERM）by micro-injuring posterior c apsule of crystalline lens. Methods twenty four C57BL/6 mouse between 4-6 weeks were selected, and divided into two groups randomly: auto-cortex of crystalline group and the control group. The auto-cortex of crystalline group was treated by penetrating the posterior capsule of lens and washing out the lens cortex into the mouse vitreous using PBS (phosphate buffered solution), while the control group were injected PBS into vitreous merely. Clinical change s were followed by slit-lamp examination and photograph. The eye balls were enu cleated at the day of 3, 7, 14 and 28 after operation. Both HE and immunohistoch emistry were used to detect the pathological changes. Results postoperative one to three days, 11 of 12 mouse in autocortex of crystalline g roup, lens appear to alba turbid at different levels one after another, and then develop into highdensity chinaware white. Postoperative (po) three days, HE s taining shows cortex of lens debris transmigrated in vitreous cavity, and some o f which approached to internal limiting membrane and lead it to rough and discon tinue; Po7-14 days, the capillary in retina expanded, migrated and broke though t internal limiting membrane which got to the pro retina and became the new ves sels. And typical NVERM were observed. Po28 days, some vascularslike structure formed in vitreous cavity. None of mouse in control group developed NVERM. Conclusion Auto-cortex of crystalline lens can induced neovascular epiretinal membrane in C57BL/6 mouse. (Chin J Ocul Fundus Dis,2008,24:118-121)
Objective To observe the preventive and therapeutic effect of different times, spot reactions and spot density of argon laser photocoagulation on retinal neovas cularization of ischemic retinal vein occlusion (IRVO).Meth9al of 244 patients (268 eyes) with IRVO diagnosed by fundus fluorescein angiography (FFA) were treated by HGM argon laser photocoagulator with green-blue light with 200~500 μm lightspot, 0.1~0.5 s, 0.3~1.0 w, and II~III class spot reaction . All capillary nonperfusion areas (CNA) were photocoagulated, and so were the retinal neovascularization in some patients. The follow up periods were from 6 to 60 months. After 3 and 24 weeks after photocoagulation FFA was performed again. Photocoagulation was performed supplementarilly for the new CNA or incompletely photocoagulated areas. Ophthalmoscopic examination and FFA were performed in all the patients after half a year.Results Only 17 eyes (10.6%) with neovascularization were found after preventive photocoagulation in 160 eyes in non-neovacularization group. Sixty-nine eyes(63.9%) with neovascular atrophy and 39 eyes (36 .1%) with unsuccessful photocoagulation were found after therapeutic photocoagulation in 108 eyes in neovascularization group. There was statistical significance between the two groups (P＜0.01). Photocoagulation energy with reaction of III class and density of 1 lightspot diameter was more effective than which with reaction of II~III class and density of 1.5 lightspot diameter or reaction of ≤II class and density of 2 lightspot diameter (P＜0.01). Conclusion Efficacy of preventive photocoagulation is better than which of therapeutic photocoagulation. Photocoagulation energy with reaction of III class and density of 1 lightspot diameter is an effective method for IRVO.(Chin J Ocul Fundus Dis，2003，19：201-268)
Objective To determine the expression of the growth factors and the receptors related to angiogenesis in the intraocular tissues incarcerating in the sclerotomy sites. Methods Ten specimens from prolapsing intraocular tissues in sclerotomy sites during vitrectomy were obtained and serially sectioned in cryostate and were stained with a group of polyclonal antibodies against vascular endothelial growth factor(VEGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor-A(PDGF-A) and transforming growth factor-β1(TGF-β1) as well as their receptors by using a streptavidin peroxidase system. Results The tissues prolapsed from the sclerotomy sites were identified as retina(3 cases), vitreous tissues(3 cases), degenerated red blood cell components(2 cases), ciliary body(one case) and fibrous tissue(one case). All specimens expressed VEGF and bFGF as well as their receptors. PDGF-A, TGF-β1 and their receptors expressed in the most of specimens. The positive cells included retinal cells, ciliary non-pigmented epithelial cells and pigmented epithelial cells, fibrous cells and the cells in vitreous. Conclusions The intraocular tissues incarcerated in the sclerotomy entries express the growth factors and receptors related to angiogenesis. This might be one of the potential factors of developing anterior proliferative vitreoretinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 34-37)