Evidencebased medicine (EBM) is different fromtraditional medicine in that the practice of EBM comes from evidence and experience of the doctors. The objective evidence plays a key role in clinical practice. During the clinical teaching process, the following steps should be taken: firstly, the students should find a problem in their clinical practice; then, theyshould search for the evidence with the help of their teachers, evaluate the evidence, apply the evidence to the clinical practice, and solve the problem; finally, they should evaluate the effectiveness. An introduction of the principles and methods of EBM to the clinical practice can greatly improve the students’ ability to analyze and solve a clinical problem.
Objective To sum up the experimental and clinical history as wellas latest development of repair of growth plate injury Methods Recent articles about repair of growth plate injury were extensively reviewed and major reparative methods were introduced, especially including tissue engineering research on growth plate.Results Repair of growth plate injury was a great difficulty inexperimental study and clinical treatment of pediatric orthopedics. Transplantation of free growth plate and cartilage were unfavorably used because of lack ofblood supplement. Although circulation problem was solved by transplantation ofvascularized growth plate, autografts of epiphyseal cartilage were involved in limitation of donor, and allografts of epiphyseal cartilage induced immunological reaction. Noncartilaginous tissue and material could only prevent formation of bony bridge in small defect of growth plate and lacked ability of regenerative repair. Transplantationof tissue engineered cartilage and chondrocytes might be a choice for repair ofgrowth plate injury Conclusion Owing to lack of safe and effective methods ofrepairing growth plate injury, research on chondrocyte and tissue engineered cartilage should be further done.
OBJECTIVE: To sum up the studying course and latter development of repair of injury of growth plate. METHODS: Recent original articles about repair of injury of growth plate were extensively reviewed, focused on the progresses in understanding repair of injury of growth plate and comparison of several major reparative methods. RESULTS: Repair of injury of growth plate is a great difficulty in experimental study and clinical treatment of pediatric orthopedics. Graft of free growth plate and cartilage were unfavorably used because of lack of blood supplement. Although graft of vascularized growth plate solved circulation problem, both two kinds of grafts were involved in limitation of donor and immunologic reaction. Non-cartilaginous tissue and material could only prevent formation of bony bridge in small defect of growth plate and lacked ability of regenerative repair. Transfer of tissue engineered cartilage might be the best choice for repair of injury of growth plate. CONCLUSION: Considering source of transplanted material, reparative effect and adverse reaction, repair of injury of growth plate with tissue engineered cartilage deserves further investigation.
To investigate cl inical outcomes of percutaneous kyphoplasty with balloon in the treatment of severe osteoporotic thoracic vertebral compression fracture (SVCF). Methods From May 2006 to July 2007, percutaneous unilateral kyphoplasty with single balloon was performed in 7 vertebras of 6 SVCF patients, with 2 injured vertebras in 2 malesand 5 in 4 females, who were from 64 to 83 years old. The injured vertebras included 1 in T5, 2 in T8, 3 in T10 and 1 in T12 and the compression rates were 60% to 75% in 5 vertebras and gt; 75% in 2 vertebras. All the injured vertebras were old fractures and caused severe back pain, but without any neurotic symptoms and signs. The visual analogue scale (VAS) ranged from 6.5 to 9.0, 7.7 on average. The posterior vertebral walls were all intact in all patients under CT scan. The balloon was inset into the vertebra through pedicle of vertebral arch by percutaneous puncture under the guidance of C-type arm X-ray unit. The balloon was then extended to restore the vertebral body which was filled with bone cement later. The average volume of cement required was 3.5 mL (2.6 to 4.4 mL). Results The pain was alleviated or completely rel ieved after the operation. The mean vertebral body height restoration was 9.7% ±1.4% on the anterior border. Two cement leakages were found on X-ray. One month after the treatment, the VAS was from 0 to 2.45, 1.32 on average, and there was significant difference compared with preoperation (P lt; 0. 05). Three months after the treatment, the VAS was from 0 to 3, 2.13 on average, and there was no significant difference compared with 1 month after the treatment (P gt; 0.05). It was not found that the injured vertebras were compressed or deformed, and no new compressed fracture was found in consecutive vertebras. Conclusion Unilateral posterior-lateral puncture kyphoplasty with single balloon can rel ieve the pain and restore part of the vertebral height effectively with better outcomes.
Objective To introduce the research of cell transplantation for treating intervertebral disc degeneration. Methods The original articles in recent years about cell transplantation for treating intervertebral disc degeneration were extensively reviewed, and retrospective and comprehensive analysis was performed. Results Transplantation of intevertebraldisc-derived cells or BMSCs by pure cell transplantation or combined with collagen scaffold into intervertebral disc couldexpress nucleus pulposus-l ike phenotype. All the cells transplanted into intervertebral disc could increase extracellular matrix synthesis and rel ieve or even inhibit further intervertebral disc degeneration. Conclusion Cell transplantation for treating intervertebral disc degeneration may be a promising approach.
Objective To investigate the therapeutic effect of BMSCs- chitosan hydrogel complex transplantation on intervertebral disc degeneration and to provide experimental basis for its cl inical appl ication. Methods Two mill il iter of bone marrow from 6 healthy one-month-old New Zealand rabbits were selected to isolate and culture BMSCs. Then, BMSCs at passage 3 were labeled by 5-BrdU and mixed with chitosan hydrogel to prepare BMSCs- chitosan hydrogel complex. Six rabbitswere selected to establ ish the model of intervertebral disc degeneration and randomized into 3 groups (n=2 per group): control group in which intervertebral disc was separated and exposed but without further processing; transplantation group in which 30 μL of autogenous BMSCs- chitosan hydrogel complex was injected into the center of defected intervertebral disc; degeneration group in which only 30 μL of 0.01 mol/L PBS solution was injected. Animals were killed 4 weeks later and the repaired discs were obtained. Then cell 5-BrdU label ing detection, HE staining, aggrecan safranin O staining, Col II immunohistochemical staining and gray value detection were conducted. Results Cell label ing detection showed that autogenous BMSCs survived and prol iferated after transplantation, forming cell clone. HE staining showed that in the control and transplantation groups, the intervertebral disc had a clear structure, a distinct boundary between the central nucleus pulposus and the outer anulus fibrosus, and the obviously stained cell nuclear and cytochylema; while the intervertebral disc in the degeneration group had a deranged structure and an indistinct division between the nucleus pulposus and the outer anulus fibrosus. Aggrecan safarine O stainning notified that intervertebral disc in the control and transplantation groups were stained obviously, with a clear structure; while the intervertebral disc in the degeneration group demonstrated a deranged structure with an indistinct division between the nucleus pulposus and the anulus fibrosus. Col II immunohistochemical staining showed that the tawny-stained region in the control group was located primarily in the central nucleus pulposus with a clear structure of intervertebral disc, the central nucleus pulposus in the transplantation group was positive with obvious tawny-stained intercellular substances and a complete gross structure, while the stained color in the degeneration group was l ighter than that of other two groups, with a indistinct structure.Gray value assay of Col II immunohistochemical staining section showed that the gray value of the control, the ransplantation and the degeneration group was 223.84 ± 3.93, 221.03 ± 3.53 and 172.50 ± 3.13, respectively, indicating there was no significant difference between the control and the transplantation group (P gt; 0.05), but a significant difference between the control and transplantation groups and the degeneration group (P lt; 0.05). Conclusion The rabbit BMSCs-chitosan hydrogel complex can repair intervertebral disc degeneration, providing an experimental foundation for the cl inical appl ication of injectable tissue engineered nucleus pulposus complex to treat intervertebral disc degeneration.
