Objective To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. Methods Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot amp; Ankle Society (AOFAS) score was 36.9 ± 6.4. The hallux valgus angle was (46 ± 5)°, and the intermetarsal angle was (12 ± 2)° by measuring the load bearing X-ray films preoperatively. Results All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was rel ieved. The hallux valgus angle decreased to (17 ± 4)° and the intermetarsal angle was (11 ± 2)° at 3 months postoperatively, showing significant differences when compared with preoperative values (P lt; 0.05). The improved AOFAS score was 85.3 ± 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t=4.501, P=0.001). One patient had recurrent metatarsalgia at 4 years after operation. Conclusion Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and rel ieve pain, so it can be considered as a procedure that provides improvement in the cl inical outcome.
OBJECTIVE: To observe the effect of engineered epiphyseal cartilage regenerated in vitro with 3-D scaffold by chondrocytes from epiphyseal plate in repairing the tibial epiphyseal defect, and to explore the methods to promote the confluence between engineered cartilage and epiphyseal plate. METHODS: Chondrocytes were isolated enzymatically from the epiphyseal plates of immature rabbits, and then planted into the tissue culture flasks and cultivated. The first passage chondrocytes were collected and mixed fully with the self-made liquid biological gel at approximately 2.5 x 10(7) cells/ml to form cell-gel fluid. The cell-gel fluid was dropped into the porous calcium polyphosphate fiber/poly-L-lactic acid(CPPf/PLLA)scaffold, and a cell-gel-scaffold complex formed after being solidified. The defect models of 40% upper tibial epiphyseal plate were made in 72 immature rabbits; they were divided into 4 groups: group A(the cell-gel-scaffold complex was transplanted into the defect and the gap filled with chondrocyte-gel fluid), group B (with noncell CPPf/PLLA scaffold), group C(with fat) and group D(with nothing). The changes of roentgenograph, gross and histology were investigated after 2, 4, 6, 8, 12 and 16 weeks of operation. RESULTS: In group A, the typical histological structure of epiphyseal plate derived from the engineered cartilage with a fine integration between host and donor tissues after 2 weeks. The repaired epiphyseal plate had normal histological structure without deformation of tibia after 4 weeks. The early histological change of epiphyseal closure appeared in the repaired area with varus and shortening deformation of the tibia after 8 weeks. The epiphyseal plate was closed in the repaired area with more evident deformation of tibia; the growth function of repaired epiphyseal plate was 43.6% of the normal one. In groups B, C and D, deformation of tibia occurred after 2 weeks; the defect area of epiphyseal plate was completely closed after 4 weeks. The deformation was very severe without growth of the injured epiphyseal plate after 16 weeks, and no significant difference was observed between the three groups. CONCLUSION: Engineered epiphyseal cartilage can repair the epiphyseal defect in the histological structure with partial recovery of the epiphyseal growth capability. Injecting the suspension of fluid chondrocyte-gel into the defects induces a fine integration of host and donor tissues.
OBJECTIVE: To comprehend the progress of tissue engineering research and speculate its developmental trends. METHODS: MEDLINE search was conducted to retrieve the papers published between 1987 to 1999 under the main headings of tissue engineering. Years, nationalities, languages, journals, authors and heading frequencies of 314 papers were analyzed by bibliometrics. RESULTS: Since 1990, the number of tissue engineering research literatures had doubled, and papers between 1998 and 1999 made up 57.96% of the total papers. All papers came from 15 nations, in 6 languages and 140 journals; 64.97% came from United States and 25.79% from England, Netherlands and Germany; 93.95% was in English; 42.04% was published on 15 journals. Vacanti JP and 19 other authors presented 5 to 24 papers. Heading frequencies were cytology 22.89%, transplantation 13.30%, scaffolds and extracellular matrixes 11.72%, implanting 10.60%, polymers 8.91%, potential applications 8.91%, artificial substitutes 6.88%, tissue culture 6.70% and biogenetics 4.96%. CONCLUSION: Tissue engineering literatures mainly come from United States, England, Netherlands and Germany. English is the major language. J Biomed Mater Res and 14 other journals are important journals about tissue engineering research. Vacanti JP and 19 other authors are prolific authors. Cytology, transplantation, scaffolds and extracellular matrixes and implanting are hot topics and key points on tissue engineering research.