Objective To study the feasibility of core-binding factor α1 (Cbfa1) gene modified marrow mesenchymal stem cells (MSCs) composed with porcine acellular bone extracellular matrix in repairing the radial defects. Methods Radial defects of 1.2 cm in length were created in 40 Japanese white rabbits and they were divided into four groups. In group A, MSCs isolated from homogeneous rabbits were infected with Cbfa1 recombinant adenovirus and implanted into acellular bone exteracellular matrix, and then the complexes were implanted into defects. In group B, the complexes including the MSCs without Cbfa1 gene-modified and scaffoldmaterial were implanted into defects. In group C, only the scaffold material was implanted. In group D, defects were not treated as the control. The macroscopic, X-ray and histologic analysis were performed to evaluate the repair effect at 4, 8 and 12 weeks postoperatively. The repaired radius were examined by biomechanical test at 12 weeks postoperatively. Results By gross examination，mature hard new bone formed at grafted areas at 12 weeks postoperativelyin group A, osteotomized ends connected by much callus in group B and less callus in group C at grafted areas. In contrast, bone nonunion formed in group D. X-ray and histological examination showed that the repaired results of defects in the group A were better than those in others groups evidently in extracellular matrix degradation, new bone remodeling and marrow cavity rebuilding at 4 and 8 weeks postoperatively. At 12 weeks postoperatively, the cortical bone became mature lamellar bone, new bone remolding was complete and marrow cavity was smooth in group A. Only proximal end of defects showed that marrow cavity was remolded partially in group B. The continuous callus could be observed in bone defect, and no obvious marrow cavity remolding was observed in group C. Lots of fibrous connective tissue filled in defect and bone nonunion was shown in group D. There was no significant difference in the damage compress loading of repaired radius between groups A, B and D (Pgt;0.05), but there was significant difference between groups C and D(Plt;0.01).Conclusion These results demonstrate that Cbfa1 gene modified MSCs combined with acellular bone extracellular matrix can be used to repair rabbit radial defects.
Objective To describe the up-to-date development in spine and spine cord injuries. Methods To summarize the cl inical and basic research on spine and spine cord injuries were summarized by reviewing papers and combining them with our own experience. Results The occi pitocervical and atlantoaxial fusions by the pedicle or the lateral mass screw were widely used to treat the upper cervical fractures. The anterior cervical plate, posterior pedicle or lateral mass screw fixation techniques were used in treatment of lower cervical fractures. The cl inical appl ication of artificial cervical disc replacement showed the good biomechanical results in treatment of serious cervical disc diseases. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion model in the treatment of thoracolumbar spine fractures. Lumbar posterior dynamic fixation and artificial disc replacement for treatment of degenerative lumbar disc diseases provided the biomechanical stabil ization and reduced the morbidity of adjacent segment diseases, but there was lack of long-term follow-up results. The basic research in spine cord injuries, especially in apoptotic signal pathway, made great progress. The biological treatment including cell transplantation and gene therapy provided the sol id theoretical foundation for cl inical appl ication. Conclusion The reparative and reconstructive development in spine and spine cord injuries has made great progress in recent years.
Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
OBJECTIVE: To study the reparative and reconstructive methods for the large bone defect due to the excision of bone tumor. METHODS: According to the size and shape of the bone defect, we selected the proper bone and joint or manipulated bone segment of the profound hypothermia freezing allograft and gave locked intramedullary nails or steel plate and screws for stable internal fixation. RESULTS: In the 22 cases, 20 survived without tumor and 2 died. One patient treated with the allograft of semi-knee joint was found rejection. Then the wound did not heal. After the skin flap grafting was performed, the wound still did not heal, so the patient accepted amputation(4.5%). In the other 21 cases, the X-ray and 99mTc SPECT showed some callus or concentration of nuclein which implied bone union. According to Markin bone graft criterion, the excellent rate of function recovery was 81.8%. CONCLUSION: Allografting of bone and joint is a good and workable method in repairing and reconstructing the bone defect due to the excision of bone tumor. It should be further studied and be applied.
Objective To introduce the treatment and clinical result of reconstructing femoral artery with external jugular vein graft. Methods From June 2002 to April 2006, 22 cases of femoral artery defects caused by pseudoaneurysm resection, were reconstructed withexternal jugular vein graft by microsurgical technique. There were 20 males and2 females, aging 25-46 years (mean 31.2 years). The length of femoral artery defects was 5-9 cm, with an average of 6.8 cm. The location was left in 14 cases and right in 8 cases.Results Ten cases achieved healing by the first intention, and 4 cases by the second intention. The other 8 cases need the regional flap repair because the wound splited open and became ulcer. Femoral artery defects were reconstructed successfully and the pulse of dorsal arteries of foot could be felt except 1 case of bleeding of anastomotic rupture. Eighteen patients were followed up 1-30 months, and no pseudoaneurysm recurred. Color ultrasound Doppler detection showed that the external jugular veins took place of the femoral artery defects in 12 cases. Conclusion External jugular vein is stable at anatomy and easy-to-obtain. Its calibre is close to that of the femoral artery. It can be used for reconstructing femoral artery defects as the vein material. The operation is easy and the clinical result is sure.
Objective To establish a new operative method to repair defects of palm and proximal fingers with double vascular pedicle flaps. Methods From August 1992 to June 2000, 20 cases of soft tissue defects of palm and fingers were repaired with double vascular pedicle flaps. Twenty patients included 9 males and 11 females, aged 17-35 years. The causes were crush,avulsion, and so on. The interval between injury and operation was 3-11 hours.The wound area ranged from 8 cm×12 cm to 10 cm×20 cm. We devised the two side flaps on pectoral-umbilical place with well-known blood vessel to cover flexion and extension regions of palm and the multi-lobes skin flap to cover defect of fingers simultaneously. Results Out of 20 patients, 19 were followed up 8-12 months with an average of 9.8 months. All the flaps survived completely. The skin colour and the contour of the palm and digits were good. Conclusion The double vascular pedicle flap is one of the best choices torepair soft tissue defect of the palm and proximal fingers; the procedure is simple and the operation is extended easily.
Objective To evaluate the curative effect of the lateral nasal artery pedicled nasolabial flap for reconstruction of nasal defects. Methods From August 2005 to March 2009, 12 cases of large nasal tip and alar defects were repaired with the lateral nasal artery pedicled nasolabial flap. There were 5 male patients and 7 female patients with a mean ageof 48.6 years (range, 35-60 years). Five cases of nasal defects were caused by trauma and other defects were caused by excision of carcinoma or hemangioma; the courses of disease were 1 to 10 years and 3 months to 40 years, respectively. The nasal defect size ranged from 2.0 cm × 1.5 cm to 4.5 cm × 2.5 cm. All defects were reconstructed with lateral nasal artery pedicled nasolabial flap in 9 cases and with island flap in 3 cases. The flap size ranged from 2.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. Five patients required cartilage grafts for alar rim support and the distal end of the nasolabial flap was thinned and folded to repair the nasal l ining. The donor sites were sutured directly. Results The mild venous stasis at the distal end of three island flaps occurred at 5-24 hours postoperatively and alleviated spontaneously. All flaps survived. Incision at donor and accepted sites healed by first intention. Flap revision was performed in 5 cases after 6-15 months because of mild swell ing at the pedicles of skin flaps. All patients were followed up 8-24 months, with an average of 13 months. All patients achieved satisfactory results in nasal appearance, flap texture and color, and ventilatory function. No obvious scar was found at donor sites. Conclusion The nasolabial flap is an excellent choice for reconstruction of defects of nasal tip and ala.
OBJECTIVE: To describe the concept of "un-controlled wound repair" and review its current progress in basic research and clinical treatment. METHODS: The literature review and comprehensive analysis methods were used in this study. RESULTS: The results showed that the normal wound repair and "un-controlled" wound repair had made big progress in cellular, molecular and genetic levels in recent years and these progresses had enhanced the treatment progress in clinic. CONCLUSION: All data indicate that the wound repair is made a big progress both in basic and clinic fields. New high techniques, such as clone, biochip and stem cell and their use will promote the deep study of "un-controlled" wound repair.
Objective To evaluate the long-term function of the traumaticallydamaged joint after its repair with transplantation of a fresh or a frozen allogenic joint. Methods From March 1977 to September 1993, 13 patients (9 males, 4females; age, 17-55 years) with traumatically-damaged joints underwent transplantation of the fresh or the frozen allogenic joints. Five patients had 5 damagedmetacarpophalangeal joints, 6 patients had 9 damaged interphalangeal joints, and 2 patients had 2 damaged elbow joints. So, the traumatic damage involved 13 patients and 16 joints. All the metacarpophalangeal joints and the interphalangeal joints were injured by machines and the 2 elbow joints were injured by road accidents. The patients were randomly divided into 2 groups: Group A (n=7) andGroup B (n=6). The 7patients with 8 joints in Group A underwent transplantation of fresh allogenic joints; the 6 patients with 8 joints in Group B underwent transplantation of frozen allogenic joints. The allogenic joint transplants were performed in the period from immediately after the injuries to 6 months after the injuries. The motion ranges of the transplanted joints and the X-ray films were examined after operation, and the immunological examination was performed at 8 weeksafter operation. Results The time for synostosis was 5-8 months in Group A, but4-6 months in Group B. In Group A, at 2 years after operation the metacarpophalangeal flexion was 30-40° and the interphalangeal flexion was 20-30°; however,at 6 or 7 years after operation the interphalangeal flexion was only 10-20°. The patients undergoing the transplantation with fresh elbow joints had the elbowflexion of 60° and the elbow extension of 0°, and had the forearm pronation of 30°and the forearm supination of 30°. But in Group B, at 2 years after operation the metacarpophalangeal flexion was 6070° and the interphalangeal flexionwas 40-50°; at 6 or 7 years after operation the interphalangeal flexion was still 40-50°. However, the patients undergoing the transplantation with frozen elbow joints had the elbow flexion of 90° and the elbow extension of 0°, and hadthe forearm pronation of 45° and a forearm supination of 45°. The joint motion ranges, the Xray findings, and the immunological results in the patients undergoing the transplantation of the frozen allogenic joints were significantly better than those in the patients undergoing the transplantation of fresh allogenicjoints. There was a significant difference in the immunological examination between Group A and Group B (IL2, 21.64±3.99；CD4/CD8,3.88±0.82 vs.IL-2,16.63±3.11；CD4/CD8, 2.53±0.23, P＜0.01). Conclusion Repairing the traumatically-damaged joints with frozen allogenic joints is a better method of regaining the contour, movement, and complex motion of the hands.
Objective To research the mechanisms, diagnosisand repair methodof venous trunk injuries without accompanied arterial injuries in extremities. Methods From January 1993 to June 2002, 12 cases of venous trunks injuries without accompanied arterial injuries in extremities were treated. All the patientswere males, their ages ranged from18 to 35 years. The interval between injury and operation was 30 minutes to 2 hours. The cause of injury was stab wound. Along with the antishock, the injured vessels were mended in 7 cases, end-to-end anastomosis wasperformed in 5 cases, and the operations were given in the patients with red wounds of the skull, chest or abdomen. Results One case died of severe cerebral trauma, the other 11 cases obtained primary healing. Dopplersonograpy showed that the blood vessels were patent. After a follow-up of 1 -5 years(2 years and 4 months on average), 8 cases recoveredthe function and circulation of extremities; and 3 cases accompanied with red injuries of nerves recovered the circulation of extremities, but did not recover the function with sensory disability and dyskinesia. Conclusion Emergent hemostasis, antishock, repair of the injured vessels as soon as possibleand treatment of associated injuries are important measures to save patients’ life in treating venous trunk injuries without accompanied arterial injuries in extremities.