Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
The canine saphaneous skin flap was used as a model in this experiment. The cutaneous autograft would give long-term survival, whereas the allograft without pretreatment would only survive 10. 2±1.9 days from its transplantation. If the pretreatment consisted of the use of immunosuppressive agent as PHA or infusion of dexamesone, the survival days of the allografts could be prolonged to 15.1±2.5 and 13.7±2.8, respectively(Plt;0.01). The histological examination gave the evidence that drug perfusion delayed the rejection.
Objective To investigate the clinical result of treatment of bonecyst by transplantation of the autologous bone marrow combined with the allograft bone. Methods From February 2004 to March 2006, 13 patients withbone cyst were treated by transplantation of the autologous bone marrow combined the the allograft bone. Among the 13 patients, 6 were males and 7 were females, ranging in age from 5 to 16 years, averaged 11.5 years. In the patients, 5 lesions were located inthe proximal humerus, 2 in the femoral neck, 3 in the femoral shaft, 2 in the proximal tibia, and 1 in the distal tibia. Among the patients, 5 had a complication of pathologic fracture. All the patients underwent an erasion of the bone cyst, and then the transplantation of the autologous bone marrow combined with the allograft bone, and 8 of them were also given an instrument fixation. Results The follow-up for 6 months to 2 years after operation revealed that 5 of the patients had an incision healing by the first intention, 5 had an effusion in the incision site, and 3 had a delayed healing of the incision. According to the Capanne criteria, the postoperative X-ray findings indicated that 10 patients had Grade Ⅰ healing, and 3 had Grade Ⅱ healing. The complete healing took 3.5-8 months,averaged 5.2 months. There was no recurrence. When the fixation instrument was removed, no pathologic fracture occurred. The function of the upper and lower limbs recovered. Conclusion Transplantation of the autologous bone marrow combined with the allograft bone is an effective and safe procedure for treatment of bone cyst.
Objective To review the details of the current effortsto reconstruct or replace the meniscus.Methods Three kinds of proceduresof reconstructing or replacing the meniscus were analyzed and evaluated by an extensive review of the latest literatures concerned. Results Three kinds of techniques were established to reconstruct the meniscus clinically, i.e., the allograft of the meniscus, meniscal reconstruction with the autotendon, and the meniscus scaffold. There were still a few defects in the meniscal replacement, and so the curative techniques would still be investigated. Conclusion Many efforts have been made to reconstruct the meniscus after its injury or its resection so as to prevent degeneration of the knee joint. The meniscal replacement has been employed for many years, but it has not worked so well. The establishment of an ideal replacement of the meniscus requires further studies. Therefore, reconstruction of the meniscus function is still a challenging problem to the surgeons concerned.
To observe the effect of allogenic transplantation of deep frozen nerve in repairing sensory nerve defect, 22 patients who had received this type of treatment were followed up for 0.5-5 years. There were 18 males and 4 females in this group, and the average age was 28 years old. Thirty-six nerve defects including the common volar digital nerve, proper volar digital nerve were repaired by allograft of nerves stored at deep frozen (-80 degrees C). The storation period was ranged from 9 days to 1 years. The length of the nerves were 2 cm-12 cm. After follow-up for 3 years (ranged from 7 months-5 years), 23 cases of nerve allograft obtained excellent and good results (63.9%), 10 cases were fair (27.7%) and 3 cases were poor (8.3%). It was concluded that (1) frozen nerve is one of nice materials for repairing the nerve defect (lt; 5 cm); (2) the immunity of allogenenic nerve is weak; (3) the deep frozen storation can reduce the immunity of nerve; (4) the dimethyl sulfoxide can prevent the nerve tissue from injury by deep frozen; (5) the best temperature and period for deep frozen storation should be studied further.
To investigate the operative treatment of displaced intra-articular calcaneal fractures (DIACFs) using a combination of small lateral incision approach and internal fixation and allograft bone transplantation. Methods From January 2005 to December 2007, 28 patients with 34 DIACFs were treated with open reduction, allograft bone transplantationand internal fixation through a small lateral incision approach. Of them, there were 18 males and 10 females, aged 16-65 years. The disease course was 2 hours to 18 days. According to Sanders classification, there were 18 cases of type II fractures, 10 cases of type III fractures and 6 cases of type IV fractures. Results 22 patients with 28 DIACFs were followed up 18.5 months (13-28 months). The wound of 26 feet achieved primary heal ing, the acute rejection was found in 2 patients and developed wound compl ications. Both patients underwent further surgery prior wound heal ing. After the internal fixation were removed, factures was fixed with external fixator, closed continuous irrigation and drainage was employed. In the meantime, both patients received antibiotics and incisional dressing change. As a result, one achieved primary heal ing, the other developed delayed heal ing. Thepreoperative X-ray film showed that Bouml;hler angle was (6.19 ± 9.66)° and Gissane angle was (103.04 ± 15.03)°; the postoperative X-ray film demonstrated that Bouml;hler angle was (34.51 ± 5.89)° and Gissane angle was (112.18 ± 10.50)°; showing statistically significant differences (P lt; 0.05). The internal fixation of 12 patients (14 DIACFs) were removed at 6 -10 months after operation, Bouml;hler angle was (32.81 ± 5.10)° and Gissane angle was (110.81 ± 9.98)°. When compared with preoperative X-ray film, statistically significantdifferences (P lt; 0.05) was found, but there was no statistically significant differences (P gt; 0.05) when compared with normal X-ray film. According to the American Orthopedic Foot and Ankle Society evaluation system for ankle-hind foot, 3 feet scored 60-70 points, 10 feet 70-80 points, 12 feet 80-90 points and 3 feet 90-100 points. Conclusion Allograft bone transplantation is an option for management of DIACFs, because it enables satisfactory reconstruction of bone defects, allows met anatomic reduction and functional recovery, maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.
OBJECTIVE To study the effect of combined application of external cyclosporine A (CsA) and CTLA4Ig in inhibiting rejection and inducing immune tolerance in composite tissue allograft. METHODS: The auricles with vessel pedicle were transplanted from Lewis rats to BN rats under microsurgery. CsA was spreaded on the surface of grafts in combination with administration of CTLA4Ig intraperitoneally after transplantation. The rejection response and survival time of grafts were observed, and the IL-2 level in serum was measured. RESULTS: The mean survival time was (7.8 +/- 1.7) days in control group. It was (15.2 +/- 1.9) days when recipients treated by CsA and (16.6 +/- 2.1) days by CTLA4Ig. Under the combination of CsA and CTLA4Ig, the mean survival time was significantly prolonged to (28.8 +/- 3.5) days (P lt; 0.05) with the lowest level of IL-2 in serum of recipients. CONCLUSION: The combined application of external CsA and CTLA4Ig inhibits rejection of allograft effectively, which can be a favorable therapy on composite tissue allo-transplantation.
OBJECTIVE To explore the healing mechanism of full-thickness wound treating by the intermingled skin transplantation of large sheet allograft with autograft through studying the expression of laminin (LN). METHODS Thirty-six SD rats with 10% to 15% of total body surface area (TBSA) full-thickness were made. After 3 days, the devitalized tissue were excised and transplanted a large sheet of allograft from Wistar rats and islets of autografts were implanted 3 days later. On day 3, 5, 7, 14, 21 after allografting, the expression of LN in the grafts were detected by immunohistochemistry. RESULTS On the 7th day postallografting, LN, which played positive action of epidermal cell adhesion, still retained in the allodermis after the rejection of alloepidermis occurred. On the 14th day postallografting, there appeared scattered LN underneath the epidermal cells migrating from islets of autografts. On the 21st day postallografting, LN in the basement membrane of skin grafts had completely formed. CONCLUSION The intermingled transplantation of large sheet allograft with autograft may provide components of basement membrane for wound healing, which may help to improve the appearance and function of skin.
Objective o study the feasibility of homologous vascularized nerve transplantation after ultra deep cryopreservation. Methods Vascularized sciatic nerve from 12 female dogs was transplanted after ultra deep cryopreservation. Fortyeight male dogs were divided into 4 groups: ultra deep cryopreservation homologous vascularized nerve (group A), ultra deep cryopreservation homologous nerve (group B), fresh homologous vascularized nerve (group C), and fresh autologous vascularized nerve (group D). The gross appearance, patency rate of arteryand morphological transplanted nerve were observed 1, 4 and 12 weeks after transplantation respectively. Immunological analysis was performed using IL 2 assay and T lymphocyte subpopulations assay after 4 weeks. Image pattern analysis andelectromyogram were observed after 12 weeks. Results In groups A and D, no toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were restore significantly in the postoperative 12th week. In groups B and C, toe ulcer occurred, the atrophy of later limb and the sense of pain from skin of calf were not restored significantly in the postoperative 12thweek. The vessel patency rate of groups A and D was 83.3%, which was significantly higher than that of group C (50%,Plt;0.05). The changes of IL2 and Th, Ts in group C were significantly higher than that in groups A,B,D(Plt;0.01). There were increased vessel and regenerated nerve in transplanted nerve under optical microscope and image pattern analysis in groups A and D. There were shorter latent period of motor evoked potential, greater amplitude of action potenlial and faster motor nerve conducting velocity in groups A and D after 12 weeks. Conclusion The antigenicity of the homologous never and vessel may be reduced significantly by being frozen, and cryopreserved vascularized nerve can transferred successfully without the use of immunosuppressive agents. Vascularized nerve may restore good significantly for the thick nerve.
Objective To study the relation between changes of the hepatic energy metabolism and allograft viability in early phase after orthotopic liver transplantation, arterial blood ketone body ratio (AKBR) was measured in pre- intra and post-operative phase. Methods The monkeys were divided into two groups in accordance with survived times. A group (＞24h), 5 monkeys survived 29—168 postoperative hours; B group (＜24h), 9 monkeys survived only 5—22 hours. Results AKBR in all models immediately decreased to extraordinarily low state in anhepatic-phase (versus preanhepatic phase, Ｐ＜0.01), and A group recovered rapidly to the normal levels, and maintained continuously for 12 postoperative hours above the level of 0.7. In contrast in B group, AKBR decreased below 0.7 rapidly and failed to restore to the normal level. Within 12 hours postoperatively, in B group, AKBR was lower than 0.4. Conclusion AKBR is a sensitve indicator to the allograft viability in the early phase after hepatic transplantation.
