Objective To investigate the factors that affect platelet-rich plasma (PRP) in promoting bone regeneration and repairing. Methods Recent l iterature was reviewed, concerning the preparations of PRP, physiological mechanism and the latest appl ications in orthopedic field. Results PRP, the concentrated body of autologous platelet, was rich in platelets and was the source of autologous growth factors. Many studies had shown that PRP played an important role in promoting bone regeneration and repairing. However, a few experimental results contradicted this point. The reason might be that the biological properties of PRP were influenced by various factors, such as workmanship, vector, activation schemes, working concentration, individual difference. Conclusion The concentration and qual ity of platelet and other related factorsof PRP affect the rel iabil ity of the results and conclusions. So an efficient and stable production method of PRP should beestabl ished.
Coronavirus disease (COVID-19) is currently a world-wide major public health event. Since study sites of clinical trials are primarily at healthcare institutions and investigators are primarily clinicians, the epidemic inevitably has a huge impact on a large number of ongoing clinical trials. The proper implementation of clinical trials in key aspects and the quality of core data collection will greatly influence the validity of the final results. In this paper, we analyzed the potential impact of the outbreak of a new epidemic infectious diseases on the clinical trials from seven aspects, which involves the selection of study participants, randomization, blinding, implementation of intervention measures, follow-up of primary outcomes, safety monitoring and project management. Corresponding countermeasures were put forward.
ObjectiveTo discuss the clinical effects of micro implant anchorage combined with orthodontic positioning in the guided eruption of impacted maxilla anterior teeth. MethodsThirty-two patients with maxillary impacted teeth treated between 2010 and 2013 were selected, including 13 males and 19 females, aged from 13 to 26 years old, with an average age of (18.5±4.5) years. The extraction of the teeth and the local expansion of the extraction of the teeth were used to provide enough space for the impacted maxilla anterior teeth. The micro implant anchorage combined with orthodontic positioning was applied to treat 32 patients with 39 maxillary impacted teeth. Then, we observed the feasibility and efficacy of the therapeutic method. ResultsThe 39 impacted teeth were all successfully tracked and well aligned with good periodontal attachment. Pulp vitality test showed that 13 pulp reaction were retarded and 26 appeared normal. ConclusionThe micro implant anchorage combined with orthodontic positioning is effective in guided eruption of impacted anterior maxillary teeth.
This paper is aimed to introduce the definition and application of Population Impact Measures (PIMs). The PIMs use Number Need to Treat (NNT) for reference and generalize the variables of clinical research to interest population, which then can be used to measure the effectiveness of interventions and the harmfulness of risk factors, so as to provide evidence for making public health policy. Of the PIMs, the variables used for measuring the effectiveness of interventions include Disease Impact Number (DIN), Population Impact Number (PIN) and Number of Events Prevented in your Population (NEPP); The variables used for measuring the harmfulness of risk factors include Exposure Impact Number (EIN), Exposed Cases Impact Number (ECIN), Population Impact Number (PIN), Case Impact Number (CIN) and Population Impact Number of Eliminating a Risk factor (PIN-ER-t).
ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli. MethodsBetween January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was (5.70±4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. ResultsThe average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score (t=-27.68, P=0.00); the protrusio acetabuli was (-1.11±0.45) mm, showing significant difference when compared with preoperative value (t=5.66, P=0.00). No loosening of acetabular components was found. ConclusionFor RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.
ObjectiveTo observe the efficacy of and influencing factors for kirschner wire limited internal fixation plus external fixation for patients with tarsometatarsal fracture dislocation. MethodsThe efficacy of kirschner wire limited internal fixation plus external fixation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed,and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. ResultsTwenty patients were included,consisting of 16 male and 4 female patients,ranging from 15 to 57 years old.The mean time of follow-up was 24.5 months,ranging from 11 to 41 months.At the time of follow-up,there were 5%(1/20),10%(2/20),50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69,70~79,80~89 and 90-100,respectively;and the excellent rate was 85% in total.In this cohort,the acceptance rate of the results of treatment was 95% at discharging and 85% at the final follow-up,and the difference between the above two time-points was not statistically significant.In addition,patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. ConclusionFor patients with tarsometatarsal fracture dislocation,treatment with kirschner wire limited internal fixation plus external fixation can not only effectively restore joint function,but also has minimum surgical trauma,and it is an effective method for the treatment of tarsometatarsal joint injuries.
In this article, three research cases are introduced to show the rationale of analysis of papers cited in evidence-based guidelines and the implementation steps. The ultimate goal of medical research is to promote health; evidence-based guidelines are of most importance to medical practice, which can be directly used in clinical practice and health prevention. One of the ways in which research can influence practice is through its contribution to being references of guidelines, and it’s a new way to evaluate biomedical research’s “payback” on health.
ObjectiveTo discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. MethodsThe clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. ResultsSeventeen cases were diagnosed as ulna positive variation (94.6%), and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and 3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities (6 with ischemic necrosis), triquetrum osteonecrosis in 4 cases, and both necrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had different degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex (ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15). In the early stage, lesions were presented as edema of bone marrow and followed as different sizes of cystic change. Articular surface was collapsed later. ConclusionUlnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.
ObjectiveTo analyze the effectiveness of bone grafting through windowing at the femoral head-neck junction for the treatment of osteonecrosis with the segmental collapse of the femoral head. MethodThe clinical data were retrospectively analyzed from 106 patients (131 hips) with osteonecrosis with the segmental collapse of the femoral head who underwent bone grafting through windowing at the femoral head-neck junction between March 2011 and December 2013. There were 78 males and 28 females, with an average age of 31.3 years (range, 17-43 years). The body mass index ranged from 16.5 to 36.5 (mean, 24.2) . There were 53 cases of corticosteroid-induced osteonecrosis of the femoral head (ONFH), 18 cases of alcohol-induced ONFH, and 35 cases of idiopathic ONFH. According to Association Research Circulation Osseous (ARCO) classification system, 105 hips were rated as stage Ⅲa, and 26 hips as stage Ⅲb; according to the China-Japan Friendship Hospital (CJFH) classification system, 41 hips were classified as C+L1 type, 13 hips as L2 type, and 77 hips as L3 type. Harris score was used for the effectiveness evaluation. The clinical failure cases were defined as patients who need total hip arthroplasty, or had a Harris score of less than 70 points. The Cox risk model analysis and Kaplan-Meier survival curves were used for multivariate analysis and univariate analysis. ResultsThe average follow-up period was 27.9 months (range, 4-51 months). Solid fusions of bone graft were observed at 1.0-1.5 years after operation. The Harris score at last follow-up was 81.41±11.93, showing significant difference when compared with preoperative score (63.24±9.98) (t=13.710, P=0.000) . The results were excellent in 5 hips, good in 41 hips, fair in 57 hips, and poor in 28 hips, with an excellent and good rate of 35.1%. Thirty-three hips were classified as clinical failure. A progressive collapse of the femoral head was observed in 22 hips. The single factor analysis showed that preoperative ARCO stage, preoperative CJFH type, and preoperative Harris hip score were risk factors for clinical failure (P<0.05) . The Cox risk model showed that ARCO stage Ⅲb was independent risk factor for clinical failure (P<0.05) . The Kaplan-Meier survival curves showed that ARCO stage Ⅲa patients had a better effectiveness than ARCO stage Ⅲb patients. ConclusionsBone grafting through windowing at the femoral head-neck junction has a good effectiveness in patients at ARCO stage Ⅲa, while patients at ARCO stage Ⅲb and patients of CJFH types L2 and L3 have high clinical failure rates.
Objective To observe effects of the direct impaction onthe cell survival and the bone formation of the tissue engineered bone modified by the adenovirus mediated human bone morphogenetic protein 2 (Adv-hBMP2) gene and to verify the feasibility of the impacted grafting with it. Methods The marrow stromal cells (MSCs) were separated from the canine bone marrow and were cultured. MSCs were transfected with the Adv-hBMP2 gene and combined with the freeze-dried cancellous bone (FDB) to form the tissue engineered bone. Four days after the combination, the tissue engineered bone was impacted in a simulated impactor in vitro and implanted in the mouse. The cell survivals were evaluated with SEM 1 and 4 days after the combination, immediately after the impaction, and 1 and 4 days after the impaction, respectively. The bone formation and the allograft absorption were histologically evaluated respectively. Results There were multiple layers of the cells and much collagen on FDB before the impaction. Immediately after the impaction, most of the cells on the direct contact area disappearedand there was much debris on the section. Some of the cells died and separatedfrom the surface of FDB at 1 day, the number of the cells decreased but the collagen increased on the surface at 4 days. Histologically, only the fibrous tissue was found in FDB without the cells, the bone formation on FDB was even in distribution and mass in appearance before the impaction, but declined and was mainly on the periphery after the impaction in the AdvhBMP2 modified tissue-engineered bone. Conclusion The simulated impaction can decrease the cells survival and the bone formation of the AdvhBMP-2 modified tissue-engineered bone. The survival cells still function well.It is feasible to use the tissue engineered bone in the impaction graft.