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 study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
This paper reported the method tendon reconstruction on dogs. Using the pedicled fascio-tendon graft, the flexor tendon system was constructed, and comparative study was made between the vascularized fascio-tendon graft and the free fascio-tendon graft by means of oxygen tension measurement, stereology, histology and ultra-mieroseoppy. The results showed: 1. vascularized graft changed the course of healing of the conventional graft into a simplified tendon stump healing course which shortened the healing time, ahd reduced the formation of peritendinous.2. the fascia tissue could be transformed into the synovial-like tissue6 weeks postopertively under the stimulation of gliding pressure of the tendon.It was conclude that this was a new and better method in reconstructing the severely damaged flexor tendon system.
In order to evaluate coral as a bone graft substitute in repair of bone defect, particulates of coral were implanted into skull bone defect of rabbit, 1.5 cm in diameter. Hydroxyapatite and blank were taken as controls. The rabbits were sacrificed at the second, fourth, eighth and twelveth weeks after the operation. The specimens were taken and performed histological examination and histomorphometry observation. Results were as follows: at the second week many multinucleus giant cells infiltrated. As time elapsed, the coral were progressively degenerated and new bone was formed to fill the defect. Up to the twelveth week, the coral degenerated completely and new bone formed in the center of the defect. Percentage of new bone was in defect was 36.9%. Compared with the controls, there were significant differences (P lt; 0.01). It was suggested that coral had good osteoconductility. Howevel, coral underwent rapid degeneration, it might result in inconplete repair of bone defect.
Objective To summarize the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
Abstract:Objective To investigate the pattern and affecting factors of hematopoietic stem cell mobilization after off-pump coronary artery bypass grafting（OPCAB）. Methods Fifty-five patients of coronary artery disease without acute myocardial infarction （AMI） who underwent selective OPCAB were chosen for this study. Four ml blood sample was taken at 30 min before operation, and 6, 12, 24, 48, 72 and 120 h after operation. The hematopoietic stem cell count was made by flow cytometer with CD34 and CD45 double antibody. The serum myoeardium enzyme and troponin T （cTnT） were measured at the same time. Results The hematopoietic stem cell count was 0. 13%±0. 12% of all nucleated cells in the peripheral blood circulation before operation. It increased significantly witha peak value at 24 halter OPCAB（0.34%±0.20%）. It turned back to pre-operativelevelat 120h after operation. Smoking, hyperlipemia and diabetes mellitus had no effect on hematopoietic stem cell mobilization. But hypertension could reduce its mobilization significantly. The hematopoietic stem cell count was positively correlated with creatine kinase （CK）, creatine kinase-MB isoenzyme （CK-MB）, lactate de hydrogenase （LDH） and cTnT （r=0. 692,P=0. 000; r=0. 558, P=0. 000; r=0. 447, P=0. 000 and r=0. 401, P=0. 004, respectively） 24h after OPCAB. Conclusion Hematopoietic stem cells mobilize rapidly and temporarily after OPCAB. Myocardial injury and CABG risk factors take part in hematopoietic stem cell mobilization.
To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.
In order to explore a new method to treat the ischemic necrosis of the head of 2nd metatarsal bone in adult, transposition of reversed vascularized metatarsal bone graft was adopted in the treatment of 4 cases, 2 of which were followed up for one and a half years. The postoperative X-ray showed the round head of the 2nd metatarsal bone became round and even density. The clinical observation showed that there was excellent function of metatarsophalangeal joint. It was concluded that the reversed vascularized metatarsal bone graft could provide a reliable blood supply and various osteogenic factors to the avascularized head of the metatarsal bone, and the operation could also debride the joint cavity and carry out decompression.
Objective To summarize the methods and experiences of surgical treatment of aortic arch diseases with four branches aortic graft under deep hypothermia circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods In 2004 from September to December, surgical treatment of 12 patients with 7 aortic aneurysm（4 cases with ascending aorta and aortic arch aneurysm, 3 cases with aneurysm of aortic isthmus） and 5 aortic dissection（DeBakey Ⅰ 1 case, DeBakey Ⅱ 3 cases, DeBakey Ⅲ 1 case） were collected in Gunma Prefectural Cardiovascular Center. All operations were carried out under DHCA and ASCP, and four branches aortic graft were used to replace the aortic arch. The Bentall procedure, total and partial arch replacement and elephant trunk technique were undertaken in different patients. Results Total 12 patients recovered from the great vessel diseases smoothly without severe cerebral and other systematic complications, the time of operation was 5.5±1.7 h, the period of DHCA was 42.2±12.9min, 4 cases with no blood transfusion, the time of hospitalization was 22.3±7.2d. Conclusion ASCP is a safe. and effective method of cerebral protection during circulation arrest, and four branches aortic graft may shorten the time of DHCA and simplify the procedure of aortic arch replacement.
