Objective To compare the clinical effects of two surgical approaches to treatment of horseshoe kidney.Methods From January 1965 to December 1982, 15 patients (11 males, 4 females; aged 14 months to 59 years with a median of 31 years) with horseshoe kidney underwent surgical treatment by the waist cretroperitoneal approach (the waist-approach group). The clinical symptoms and signs were as follows:pain in the waist and abdomen (12 patients), hematuria (7), urinary frequency (4), gastrointestinal disorder (3), and abdominal masses (2). The urography revealed urinary calculus in 10 patients, hydronephrosis in 3, renal cyst in 1, pyonephrosis in 1, renal tuberculosis in 1, and renal cell carcinoma in 1. From January 1977 to December 2005, 17patients (15 males, 2 females; aged 11 months to 56 years with a median of 29.4years) with horseshoe kidney underwent surgical treatment by the epigastric transperitoneal approach (theabdomenapproach group). The clinical symptoms and signs were as follows:pain in the waist and abdomen (15patients), hematuria (12), urinary frequency (10), gastrointestinal disorder (9), and abdominal masses (7). Theurography revealed urinary calculus in 12 patients, hydronephrosis in 10,renal cyst in 3, renal tuberculosis in 1, renal cell carcinoma in 1, and congenital spinal bifida in 1. The two surgical approaches were compared in the clinical therapeutic effects. Results There were no statistically significant differences in operating time, blood loss during operation, and the hospitalization after operation between the waistapproach group and the abdomen-approach group (129.59±23.25 min vs. 163.80±36.25min; 495.29±87.20ml vs. 553.00±92.27ml；13.17±1.14d vs. 13.75±0.21d; Pgt;0.05). Thepostoperative followup for 7 months to 6 years in 11 patients in the waistapproach group and in 6 patients in the abdomenapproach group revealed that there were statistically significant differences in postoperative complication and the recurrence rate of the renal calculus between the two groups (11.76%, 2/17 vs 26.67%, 4/15; 33.33%, 5/15 vs. 0, 0/17; Plt;0.05). The urography or CT taken 6 months to 2 years after operation in 4 patients in the waistapproach group and in 10 patients in the abdomenapproach group revealedthat there was a significant improvement hydronephrosis when compared with before operation.
Objective To study the effect of combined use of autologous micromorselized bone with bone morphogenetic protein(BMP) and type Ⅰ collagen graft on the treatment of segmental bone defects. Methods The bulk bone of rabbit iliac crest was ground into micromorselized bone, which was combined with BMP and type Ⅰ collagen. The model of 1.5 cm bone defect was established in the middle shaft of the radius. Fifty-six rabbits were assigned to four repairing methods: autologous micromorselized bone graft with BMP and type Ⅰ collagen, autologous micromorselized bone graft with type Ⅰ collagen, autologous micromorselized bone graft alone, and control group. The defect-repairing capability of each group was assessed by radiographic, histological, bone densitometry and biomechanical studies. Results X-ray manifested that at the end of 8 weeks after operation, the bone defect treated with autologous micromorselized bone graft with BMP and type Ⅰ collagen was repaired completely,and at the end of 12 weeks after operation the bone defect treated with autologous micromorselized bone and type Ⅰ collagen was cured completely, but the bonedefect treated with autologous micromorselized alone was completely repaired. No healing was found in the control group. In the bone densitometry detection, the material with BMP exhibited the best defectrepairing capability in terms of amount increased and quality of the new bone at the end of 8 weeksand 12 weeks. The group with BMP has the best mechanical strength of all groupsat the end of 12 weeks. Conclusion Autologous micromorselized bone graft with BMP/type Ⅰ collagen and autologous micromorselized bone graft with type Ⅰ collagen prove to be effective in repairing segmental bone defects. The autologousmicromorselized bone combined BMP and typeⅠcollagen is an excellent bone repairing material considering the satisfactory osteogenesis, osteoconduction, and osteoinduction seen in this method.
Objective To explore the methods of repairing cartilagedefects and to introduce the clinical experience with the autologous osteochondral transplantation. Methods Twenty-five patients with chondral and osteochondral defects of the weight-bearing surfaces were treated by the autologous osteochondral transplantation for the repair of the chondral and osteochondral defects of the unweightbearing surfaces under arthroscope. According to the shape of the defects, the different dimensions of the osteochondral autograft were selected. All the patients began the training of the continuous passive motion after operation. Six weeks after operation, the patients began to walk in the weightbearing habitus. However, in the control group, another 25 patients were retrospectively analyzed, who had chondral and osteochondral defects of the weight-bearing surfaces but were treated only by the cleaning and drilling procedures. The scores evaluated bythe Brittberg-Peterson scoring scale of the 2 group were 98.65±9.87 and 96.98±8.94 respectively. Results The follow-upfor 3-24 months after operation revealed that the treated knee joint had a goodmotion extent. The pain was obviously alleviated. Based on the longitudinal study with the three-dimensional spoiled magnetic resonance imaging (MRI), the signal intensity of the repaired tissues approached to the normal condition. The scores evaluated by the Brittberg-Peterson scoring scale were almost zero 3 monthsafter operation in the experimental group, and the scores were 58.48±6.98 inthe control group. There were significant differences between the experimental group and the control group(P＜0.01). Conclusion Autologous osteochondral transplanation under arthroscope is a good curative method for the cartilage defects, with advantages of minimal invasiveness and avoidanceofrejections resulting from allografts. However, its long-term effect needs to befurther studied. The conventional therapies including cleaning and drilling are useful in alleviating the symptoms.
Objective To compare the cl inical outcomes of the core decompression combined with autologous bone marrow mesenchymal stem cells (BMSCs) transplantation with the isolated core decompression for the treatment of earlyavascular necrosis of the femoral head (ANFH). Methods From May 2006 to October 2008, 8 patients (16 hips) with earlyANFH were treated. There were 7 males and 1 female with an average age of 35.7 years (range, 19-43 years). According to the system of the Association Research Circulation Osseous (ARCO): 4 hips were classified as stage II a, 2 as stage II b, 1 as stage II c, and 1 as stage III a in group A; 2 hips were classified as stage II a, 2 as stage II b, 3 as stage II c, and 1 as stage III a in group B. The average disease course was 1.1 years (range, 4 months to 2 years). The patients were randomly divided into 2 groups according to left or right side: group A, only the core decompression was used; group B, both the core decompression and autologous BMSCs transplantation were used. The Harris score and visual analogue scale (VAS) score were determined, imaging evaluation was carried out by X-rays and MRI pre- and post-operatively. The erythrocyte sedimentation rate, C-reactive protein, l iver function, renal function, and immunoglobul in were detected for safety evaluation. Results All incisions healed by first intention. Eight patients were followed up 12-42 months (23.5 months on average). The cl inical symptoms of pain and claudication were gradually improved. The Harris scores and VAS scores of all patients were increased significantly at 3, 6, and 12 months after operation (P lt; 0.05). There was no significant difference between groups A and B 3 and 6 months after operation (P gt; 0.05), but there was significant difference between groups A and B 12 months after operation (P lt; 0.05). The necrosis area of femoral head in groups A and B were 18.13% ± 2.59% and 13.25% ± 2.12%, respectively, showing significant difference (P lt; 0.05). In group A, femoral head collapsed 12 months after operation in 1 case of stage III. No compl ication of fever, local infectionoccurred. Conclusion The core decompression and the core decompression combined with BMSCs transplantation are both effective for the treatment of early ANFH. The core decompression combined with BMSCs transplantation is better than core decompression in the rel ief of pain and postponing head collapse.
ObjectiveTo evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.MethodsBetween January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).ResultsThe incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.ConclusionAutologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.
ObjectiveTo study the effectiveness of facial meticulous fat grafting by fat granules injection asistor.
MethodsBetween January and August 2015, 46 patients received facial autologous fat grafting for rejuvenation. There were 7 males and 39 females, aged 21-65 years (mean, 34 years). Firstly, the faces were divided into 10 cosmetic zonations according to facial aesthetic criteria, then autologous fat grafting was carried out by fat granules injection asistor. The autologous fat was filled into 1, 2, 3, 4, 5, 6, 7, 8, and 9 cosmetic zonations in 3, 7, 5, 3, 8, 4, 2, 10, and 4 cases respectively; the injected fat amount was 2-110 mL (mean, 47 mL).
ResultsThe swelling period was from 5 to 15 days after operation (mean, 7 days), and there were no complications of infection, cyst, introvascular thrombogenesis, and so on. They were followed up 1-7 months (mean, 3 months). The effect of face rejuvenation was satisfactory.
ConclusionCosmetic zonation of face is helpful for preoperative evaluation of autologous fat grafting, and the fat granules injection asistor is beneficial to reach better effect of face rejuvenation.
ObjectivesTo systematically review the efficacy and safety of autologous bone marrow cells therapy for patients with diabetic foot. GRADE system was used to evaluate the evidence quality of outcomes.MethodsWe searched databases including PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI for randomized controlled trials (RCTs) about bone marrow cell transplantation in patients with diabetic foot from inception to February 28th 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. The evidence quality was evaluated by using GRADE profiler 3.6 software.ResultsFour RCTs were included. Meta-analysis showed that the bone marrow cell transplantation could decrease the rate of amputation (RR=0.08, 95%CI 0.00 to 1.32, P=0.08) and rest pain score (MD=–1.89, 95%CI –2.24 to –1.55, P<0.000 01), increase the rate of ameliorate ulcer healing (RR=2.01, 95%CI 1.45 to 2.79,P<0.000 1) and the quantity of new collateral vessels (MD=1.33, 95%CI 0.60 to 2.05,P<0.000 3). Besides, bone marrow cell transplantation could improve ankle-brachial index (MD=0.16, 95%CI 0.10 to 0.22,P<0.000 01) and transcutaneous arterial oxygen tension (MD=18.81, 95%CI 16.06 to 21.57,P<0.000 01). No adverse event was reported for all included studies. The qualities of evidence for all outcomes were rated as "low" to "very low".ConclusionBased on the current evidence, autologous bone marrow cells transplantation therapy has a certain effect and it is safe for patients with diabetic foot. However, due to the limited quantity and quality of included studies, the above conclusions are still needed more multicenter clinical trials with large sample size to confirm.
Objective To determine the effectiveness and safety of autologous platelet-rich gel in the management of diabetic foot ulcer. Methods We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, EMbase, OVID Database, Chinese Biological Medicine Database (CBMDisc), CNKI, Chinese VIP Database and WANFANG Database. We also handsearched the bibliographies of retrieved articles and correlated proceedings. The systematic review was conducted using the method recommended by the Cochrane Collaboration. Results Four trials involving 216 patients were included. Meta-analyses showed (1) Diabetic foot ulcer healing rate: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (2) Diabetic foot ulcer reduction rate: Autologous platelet-rich gel was superior to the standard care (P=0.000 3); (3) Diabetic foot ulcer healing time: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (4) Complications: No patient in these trials had complications. Conclusions The limited current evidence shows that autologous platelet-rich gel is safe and effective in the short-term treatment for diabetic foot ulcer.
Objective To investigate the efficacy of the pedicle screw fixation and allograft bone in posterior spinal fusion for the treatment of thoracolumbar vertebral fractures. Methods From September 2006 to March 2008, 105 cases of thoracolumbar vertebral fractures were treated with allograft bone in posterior spinal fusion after the pedicle screw fixation,including 75 males and 30 males aged 15-65 years (mean 37 years). The mixture which consisted of spinous process and vertebral plate sclerotin and homogeneity variant bone was used as bone graft to implant into articular process and processus transversus space or vertebral plate space. The time from injury to surgery varied from 8 hours to 21 days, with an average of 3 days. There were 52 cases of fall ing injuries from height, 35 cases of traffic accident injuries, 11 cases of bruise injuries and 7 cases of tumbl ing injuries. Before operation, the primary cl inical symptoms of patients included local pain combined with l imitation of activity, 30 cases compl icated by various degrees of spinal cord and nerve root functional disturbance. According to Mcaffee classification, there were 7 cases of flexion depressed fractures, 86 cases of blow-out fractures, 9 cases of Chance fractures and 3 cases of dislocation-fracture. According to Frankel grade, there were 11 cases of grade A, 2 cases of grade B, 7 cases of grade C, 10 cases of grade D and 75 cases of grade E. The X-ray examination of all patients denoted that the bodies of injuryed vertebra were compressed and wedge-shaped, and the CT scan showed that 98 cases had spinal stenosis. After 2 weeeks and 3, 6, 12 months, the X-ray films were taken to evaluate bone graft fusion. The Cobb angle was measured. The recovery of nerve function was analyzed. Results The operation time was 55-180 minutes (mean 90 minutes) and the blood loss was 100-900 mL (mean 200 mL). All patients achieved heal ing by first intention with no compl ication. After operation, 93 cases were followed up for 6-15 months with an average of 11 months. Except for 11 patients who were at grade A before operation, one to two grade recover was observed in other patients. The average Cobb angle of injury segment was improved from preoperative 32.1° to postoperative 5.2°. The height of anterior border of injuried vertebral body was recovered from the preoperative average compressed remaining height 61.5% to postoperative 96.8%. The vestigial degree of canal is spinal is anteroposterior diameter was recovered from preoperative 65.7% to postoperative 89.9%. Imageology examination showed that all the patient achieved bone union within 6 months. The fusion rate of bone graft in spinal fusion was 100%. No loosening and breaking of nails occurred. Conclusion Pedicle fixators can restore and fix the thoracolumbar fractures, and the combination of autograft and allograft bone transplantation is a safe, rel iable and effective method.
Objective To compare the recovery of proprioception between autograft and allograft for anterior cruciate l igament (ACL) reconstruction. Methods Between January 2008 and January 2010, 40 patients underwent ACL reconstruction with autologous tendon (autograft group, n=20) and allogeneic tendon (allograft group, n=20). No significant difference was found in gender, age, disease duration, and function scores between 2 groups (P gt; 0.05). All the patients underwent the ACL reconstruction with single-bundle technique. The knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were measured after operation. The proprioception was assessedby the joint position sense (JPS) at 3 and 12 months postoperatively. The normal knee was used as control. Results Thepatients of 2 groups achieved heal ing of incision by first intention without compl ication of infection or haemarthrosis. Allpatients were followed up 12-18 months (mean, 13.5 months). There were significant differences in knee ROM, IKDC score, and Lysholm score between preoperation and 12 months postoperatively in 2 groups (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in autograft group at 3 months postoperatively (P gt; 0.05). No significant difference was found in JPS 30° between affected knees and normal knees in allograft group at 3 months postoperatively (P gt; 0.05); but significant differences were found in JPS 60° and JPS 90° between affected knees and normal knees in allograft group at 3 months postoperatively (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in 2 groups at 12 months postoperatively (P gt; 0.05). Significant differences were also found in JPS 60° and JPS 90° between affected knees of 2 groups (P lt; 0.05) at 3 months postoperatively, whereas no significant difference was found in JPS 30° between affected knees of 2 groups (P gt; 0.05). No significant difference was found in JPS 30°, JPS 60°, and JPS 90° between affected knees of 2 groups at 12 months postoperatively (P gt; 0.05). Conclusion Autologous andACL reconstruction is better than allogeneic ACL reconstruction in the recovery of proprioception at early time after surgery.
