ObjectiveTo investigate the effectiveness of arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the ankle.
MethodsTwelve patients who were initially diagnosed as having PVNS of the ankle were treated between January 2005 and May 2012.There were 6 males and 6 females,aged 20-50 years (mean,35.4 years).Disease duration ranged from 6 months to 12 years (median,3.6 years).One case of recurrence was included.The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 55.5±7.6.According to degree and range of the PVNS lesions,4 cases of local PVNS were treated with arthroscopic debridement,and 8 cases of diffuse PVNS were treated with arthroscopically assisted arthrotomy;and local radiotherapy was given in all patients after operation.
ResultsPrimary healing of incision was obtained in all patients.The mean follow-up time was 2.8 years (range,1-6 years).At 12 months after operation,no obvious pain,swelling,and limited range of motion of the ankle were observed.The AOFAS score was increased to 84.3±3.4 at 12 months,and it was significantly higher than that at preoperation (P<0.05) and at 3 months after operation (82.8±3.8)(P<0.05).There was no recurrence during follow-up.
ConclusionArthroscopic arthrotomy combined with postoperative radiotherapy are recommended for PVNS of the ankle according to the PVNS lesion degree and range.And arthroscopically assisted surgery has many advantages of less traumas and hemorrhage,fast recovery,and less complications.
摘要:目的:探討關節鏡微創手術對膝關節色素沉著絨毛結節性滑膜炎的診斷和治療價值。方法:本組12例,男7例,女5例,年齡18～46歲,平均33歲;病史2～60個月,平均16個月;其中左膝8例,右膝4例;初次就診11例,外院開放手術后復發1例。所有病例術前均行MRI檢查,并行關節鏡檢,滑膜切除,記錄該病在關節鏡下的表現形式(局灶型或彌漫型),樣本全部送病理檢查。術后加壓包扎、局部冰敷并按計劃功能鍛煉,術后3～4周行患膝放射治療。結果:本組12例,其中局灶性病例8例,彌漫性4例,術后病理檢查確診;所有病例獲得了3~21個月,平均13個月隨訪,未見復發;術前Lysholm評分(62.3±2.4)分;國際膝關節評分委員會(IKDC)膝關節功能主觀評分(56.4±31)分;術后3月復查Lysholm評分(82.5±3.2)分;IKDC主觀評分(85.3±2.5)分。除1例開放手術后復發病例術后3月膝關節屈曲受限(80°)外,其余患者功能良好。結論:關節鏡手術創傷小,顯露充分,病灶切除徹底,術后功能恢復理想,輔以放射治療可有效降低復發率,對膝關節色素沉著絨毛結節性滑膜炎具有較高的診治價值。Abstract: Objective: To evaluate the role of arthroscopy in the diagnosis and treatment in knee joint pigmented villonodular synovitis. Methods: 12 cases of knee joint pigmented villonodular synovitis with the age of 18 to 46 years old were treated with arthroscopical synovectomy with a combined application of postoperative exercise and radiotherapy. The history of disease was 2 to 60 months, with the mean of 16 months. The clinical data were reviewed when followedup and evaluated by Lysholm score and and IKDC score. Results: 12 patients diagnosed by pathologic examination,including 8 localized and 4 diffused, were followed up for 3 to 21 months(13 months on average)with no relapses at the time of followup. Lysholm score was (62.3±2.4)points preoperatively, but (82.5±3.2) points 3 months later.The International Knee Documentation Committee (IKDC) score was (56.4±3.1) and (85.3±2.5) respectively before surgery and 3 months later. All patient remained good functions of knee joints except one who relapsed after open operation. Conclusion:In case of pigmented villonodular synovitis of the knee joint, arthroscopical synovectomy combined with postoperative radiotherapy and physical exercise is an effective treatment with less invasion and better function than open operation.
Objective To review the research appl ication and advance of synovium-derived mesenchymal stem cells (SMSCs) in tissue engineering. Methods The recent related l iterature was reviewed, concerning isolation method, characteristics of SMSCs, and its appl ication in tissue engineering. Results SMSCs are multi potent cell population with characteristics of easy isolation and high prol iferation, which have been appl icated in the cartilage, tendon, l igament, and bone tissue engineering. Conclusion SMSCs is a new member of mesenchymal stem cells family. It appears to be promising seedcells for tissue engineering, but further research is needed.
Objective
To investigate the feasibility of rabbit synovial-derived mesenchymal stem cells (SMSCs) differentiating into fibrocartilage cells by the recombinant adenovirus vector mediated by bone morphogenetic protein 2/7 (BMP-2/7) genes in vitro.
Methods
SMSCs were isolated and purified from 3-month-old New Zealand white rabbits [male or female, weighing (2.1 ± 0.3) kg]; the morphology was observed; the cells were identified with immunocytological fluorescent staining, flow cytometry, and cell cycles. The adipogenic, osteogenic, and chondrogenic differentiations were detected. The recombinant plasmid of pAdTrack-BMP-2-internal ribosome entry site (IRES)-BMP-7 was constructed and then was used to infect SMSCs. The cell DNA content and the oncogenicity were tested to determine the safety. Then infected SMSCs were cultured in incomplete chondrogenic medium in vitro. Chondrogenic differentiation of infected SMSCs was detected by RT-PCR, immunofluorescent staining, and toluidine blue staining.
Results
SMSCs expressed surface markers of stem cells, and had multi-directional potential. The transfection efficiency of SMSCs infected by recombinant plasmid of pAdTrack-BMP-2-IRES-BMP-7 was about 70%. The safety results showed that infected SMSCs had normal double time, normal chromosome number, and normal DNA content and had no oncogenicity. At 21 days after cultured in incomplete chondrocyte medium, RT-PCR results showed SMSCs had increased expressions of collegan type I and collegan type II, particularly collegan type II; the expressions of RhoA and Sox-9 increased obviously. Immunofluorescent staining and toluidine blue staining showed differentiation of SMSCs into fibrocartilage cells.
Conclusion
It is safe to use pAdTrack-BMP-2-IRES-BMP-7 for infecting SMSCs. SMSCs infected by pAdTrack-BMP-2-IRES-BMP-7 can differentiate into fibrocartilage cells spontaneously in vitro.
ObjectiveTo study the effect of transforming growth factor β3 (TGF-β3), bone morphogenetic protein 2 (BMP-2), and dexamethasone (DEX) on the chondrogenic differentiation of rabbit synovial mesenchymal stem cells (SMSCs).
MethodsSMSCs were isolated from the knee joints of 5 rabbits (weighing, 1.8-2.5 kg), and were identified by morphogenetic observation, flow cytometry detection for cell surface antigen, and adipogenic and osteogenic differentiations. The SMSCs were cultured in the PELLET system for chondrogenic differentiation. The cell pellets were divided into 8 groups: TGF-β3 was added in group A, BMP-2 in group B, DEX in group C, TGF-β3+BMP-2 in group C, TGF-β3+DEX in group E, BMP-2+DEX in group F, and TGF-β3+BMP-2+DEX in group G; group H served as control group. The diameter, weight, collagen type II (immuohistochemistry staining), proteoglycan (toluidine blue staining), and expression of cartilage related genes [real time quantitative PCR (RT-qPCR) technique] were compared to evaluate the effect of cytokines on the chondrogenic differentiation of SMSCs. Meanwhile, the DNA content of cell pellets was tested to assess the relationship between the increase weight of cell pellets and the cell proliferation.
ResultsSMSCs were isolated from the knee joints of rabbits successfully and the findings indicated that the rabbit synovium-derived cells had characteristics of mesenchymal stem cells. The diameter, weight, collagen type II, proteoglycan, and expression of cartilage related genes of pellets in groups A-F were significantly lower than those of group G (P<0.05). RT-qPCR detection results showed that the relative expressions of cartilage related genes (SOX-9, Aggrecan, collagen type II, collagen type X, and BMP receptor II) in group G were significantly higher than those in the other groups (P<0.01). Meanwhile, with the increase of the volume of pellet, the DNA content reduced about 70% at 7 days, about 80% at 14 days, and about 88% at 21 days.
ConclusionThe combination of TGF-β3, BMP-2, and DEX can make the capacity of chondrogenesis of SMSCs maximized. The increase of the pellet volume is caused by the extracellular matrix rather than by cell proliferation.
Four children having the main features of limp, pain in the hip, limitation of motion and external rotation of the affected limb going through MRI assessment, surgical exploration of the affected hip and the responses to various methods of treatment. It was found that the impingement of synovium in between the femoral head and the acetabulum was the chief pathology. The nomenclature, classification and clinical importance, pathogenesis and the differential diagnosis were diseussed. This specific group of patients were given under the nomenclature as specific type of transient synovitis of hip in children-intraaticular synovial impingement type.
Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combinedwith postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. Methods BetweenSeptember 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 femaleswith a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left kneesand 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 ± 2.3)° and (122.9 ± 5.6)°,respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee (IKDC) score was53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posteriorsynovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticularlesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, andstaging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Poplitealartery was injuryed in 1 case and the branch of popl iteal veins were injuryed in 3 cases during operation. Intra-articularhemorrhage occurred in 1 case at 3 days after operation. The other patients achieved heal ing of incision by first intentionwithout nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months(median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extentionand flexion of the knee joint were (0.2 ± 1.3)° and (135.9 ± 6.6)°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDCscore was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones (P lt; 0.05). At 6 monthsto 8 years postoperatively, 8 cases had occurrence, and they had sl ight limitation of the range of motion but had no pain andswelling of the knees after reoperation. Conclusion According to the scope and degree of the knee joint lesions, arthroscopyand/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
ObjectiveTo explore the conditions of synovial derived mesenchymal stem cells (SMSCs) differentiating into the fibrocartilage cells by using the orthogonal experiment.
MethodsThe synovium was harvested from 5 adult New Zealand white rabbits, and SMSCs were separated by adherence method. The flow cytometry and multidirectional differentiation method were used to identify the SMSCs. The conditions were found from the preliminary experiment and literature review. The missing test was carried out to screen the conditions and then 12 conditions were used for the orthogonal experiment, including transforming growth factor β1 (TGF-β1), bone morphogenic protein 2 (BMP-2), dexamethasone (DEX), proline, ascorbic acid (ASA), pyruvic acid, insulin+transferrin+selenious acid pre-mixed solution (ITS), bovin serum albumin (BSA), basic fibroblast growth factor (bFGF), intermittent hydraulic pressure (IHP), bone morphogenic protein 7 (BMP-7), and insulin-like growth factor (IGF). The L60 (212) orthogonal experiment was designed using the SPSS 18.0 with 2 level conditions and the cells were induced to differentiate on the small intestinal submucosa (SIS)-3D scaffold. The CD151+/CD44+ cells were detected with the flow cytometry and then the differentiation rate was recorded. The immumohistochemical staining, cellular morphology, toluidine blue staining, and semi-quantitative RT-PCR examination for the gene expressions of sex determining region Y (SRY) -box 9 gene (Sox9), aggrecan gene (AGN), collagen type I gene (Col I), collagen type Ⅱ gene (Col Ⅱ), collagen type IX gene (Col IX) were used for result confirmation. The differentiation rate was calculated as the product of CD151/CD44+ cells and cells with Col I high expression. The grow curve was detected with the DNA abundance using the PicoGreen Assay. The visual observation and the variances analysis among the variable were used to evaluate the result of the orthogonal experiment, 1 level interaction was considered. The q-test and the least significant difference (LDS) were used for the variance analysis with a type Ⅲ calibration model. The test criteria (α) was 0.05.
ResultsThe cells were certified as SMSCs, the double-time of the cells was 28 hours. During the differentiation into the fibrocartilage, the volume of the SIS-3D scaffold enlarged double every 5 days. The scaffolds were positively stained by toluidine blue at 14 days. The visual observation showed that high levels of TGF-β1 and BMP-7 were optimum for the differentiation, and BMP-7 showed the interaction with BMP-2. The conditions of DEX, ASA, ITS, transferrin, bFGF showed decreasing promotional function by degrees, and the model showed the perfect relevance. P value was 0.000 according to the variance analysis. The intercept analysis showed different independent variables brought about variant contribution; the TGF-β1, ASA, bFGF, IGF, and BMP-7 were more remarkable, which were similar to the visual observation.
ConclusionIn the process of the SMSCs differentiation into the fibrocartilage, the concentrations of TGF-β1, ASA, bFGF, and IGF reasonably can improve the conversion rate of the fibrocartilage cells. The accurate conditions of the regulatory factor should be explored further.
