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Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

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World Journal of Orthopedics 2024年第5期15卷 457-468页

作者： Madhan Jeyaraman Naveen Jeyaraman Tarun Jayakumar Swaminathan Ramasubramanian Rajni Ranjan Saurabh Kumar Jha Ashim Gupta Department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennaiTamil Nadu 600077India Department of Biotechnology School of Engineering and TechnologySharda UniversityGreater NoidaUttar Pradesh 201310India Department of orthopaedics and Regenerative Medicine South Texas Orthopaedic Research InstituteLaredoTX 78045United States Department of orthopaedics KIMS-Sunshine HospitalHyderabadTelangana 500032India Department of orthopaedics Government Medical CollegeOmandurar Government EstateChennaiTamil Nadu 600002India Department of orthopaedics School of Medical Sciences and ResearchSharda UniversityGreater NoidaUttar Pradesh 201306India Department of Zoology Kalindi CollegeUniversity of DelhiNew Delhi 110008India Department of orthopaedics and Regenerative Medicine Regenerative OrthopaedicsNoida 201301Uttar PradeshIndia Department of orthopaedics and Regenerative Medicine Future BiologicsLawrencevilleGA 30043United States Department of orthopaedics and Regenerative Medicine BioIntegrateLawrencevilleGA 30043United States

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powe

关键词： Knee osteoarthritis Adipose tissue Stromal vascular fraction Regenerative medicine Orthobiologics

Paratricipital two window approach for complex intraarticular distal humerus fractures: A prospective analysis of 27 patients

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Chinese Journal of Traumatology 2019年第6期22卷 356-360页

作者： Harveer Singh Naman Kanodia Rahul Singh Department of orthopaedics GSVM Medical CollegeKanpurIndia Department of orthopaedics Sir Ganga Ram HospitalNew DelhiIndia Department of orthopaedics Mayo Institute of Medical SciencesBarabankiIndia

Background:To investigate the utility and complications of paratricipital 2 window approach for complex intra articular distal humerus fractures(AO/OTA type C).Methods:Between December 2012 and September 2016,27 patients(male-14,female-13)having mean age of 39 years(range,22-62 years)with closed intra articular fracture(AO/OTA 13 type C)were surgically managed using paratricipital 2 window approach.Fractures were fixed as per AO principles.All patients were followed up for 21 months(range,12-28 months)prospectively.Functional outcome was measured using Mayo Elbow Performance Score(MEPS)and complications were observed.Student ttest,Pearson co-relation coefficient and Kruskal Wallis test used for statistical evaluation.Result:All cases unite by the end of 3 months.Mean flexion achieved was 120°and extension lag was 10°.Mean arc of motion was 111°.Mean pronation and supination was 70°and 77°respectively.MEPS and motion arc were weak negatively co-related with surgical delay and advancement in age.Postoperative transient ulnar nerve palsy and heterotrophic ossification(HO)was noted in 3.7%cases and infection occurred in 7.4%cases.Hardware prominence noted in 11.1%cases.Mean MEPS was 82.MEPS was excellent in 18.5%,good in 62.9%,fair in 11.1%and poor in 7.4%cases.Conclusion:Paratricipital 2 window approach for these fractures had good functional outcome with fewer complications.We advocate paratricipital 2 window approach when dealing with these complex fractures particularly,in type C1 and type C2.

关键词： Intra-articular fractures Lower end humerus Surgical management

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Bone–cartilage crosstalk:a conversation for understanding osteoarthritis

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Bone Research 2016年第3期4卷 121-132页

作者： David M Findlay Julia S Kuliwaba Discipline of orthopaedics and Trauma The University of Adelaide

Although cartilage degradation is the characteristic feature of osteoarthritis （OA）, it is now recognized that the whole joint is involved in the progression of OA. In particular, the interaction （crosstalk） between cartilage and subchondral bone is thought to be a central feature of this process. The interface between articular cartilage and bone of articulating long bones is a unique zone, which comprises articular cartilage, below which is the calcified cartilage sitting on and intercalated into the subchondral bone plate. Below the subchondral plate is the trabecular bone at the end of the respective long bones. In OA, there are well- char described p.rogressive destructive tges in the ~cular cartilage, which parallel characteristic changes in the underlying hone, This review examines the evidence that biochemical and biomechanical signaling between these tissue compartments is important in OA disease progression and asks whether such signaling might provide possibilities for therapeutic intervention to halt or slow disease development.

关键词： OA Bone

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

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Chinese Journal of Traumatology 2013年第6期16卷 355-360页

作者： Saurabh Jain Anti Kumar Jain Ish Kumar Department of orthopaedics Mahaveer HospitalIndore India Department of orthopaedics UCMS and GTB HospitalDelhi India

ObjectiveDebate 关于跟骨的破裂的管理继续，在开的减小和内部固定和关上的治疗之间。因此，我们瞄准在与锁跟骨的 plate.MethodsIn 修理的跟骨的破裂的代替的联合消沉类型评估开的减小和内部固定的放射学、功能的结果这个系列， 28 ... 详细信息

ObjectiveDebate 关于跟骨的破裂的管理继续，在开的减小和内部固定和关上的治疗之间。因此，我们瞄准在与锁跟骨的 plate.MethodsIn 修理的跟骨的破裂的代替的联合消沉类型评估开的减小和内部固定的放射学、功能的结果这个系列， 28 个病人( 26 单方并且 2 双边)与跟骨的破裂的联合消沉类型，作为每 Essex-Lopresti ，分类系统与在 3 星期损害以内锁跟骨的板被操作。病人们以 anteroposterior 的联系损害和 X 光被评估， calcaneum 的侧面、轴的看法。CT 扫描被做估计粉碎和关节的消沉的数量。病人们被跟随在上面临床上并且放射学地至少为 1 年。放射学的评价被 Bohler’s 角度和 Gissane’s 角度与跟骨的高度和宽度的测量一起做。功能的结果用 14.5 个月的美国 orthopaedics 英尺和脚关节社会( AOFAS ) scale.ResultsAt 一般水准后续被估计，平均 AOFAS 分数是 86.3 (范围 66～97 )，与86%有对好结果优秀并且 2 (7.7%)并且 1 (3.7%)分别地有公平、差的结果。所有病人让稳定的脚关节与所有有的背屈和脚底的屈曲连接超过 30 ° 。运动的平均 subtalar 范围是 17 ° 。吝啬的 Bohler’s 角度，吝啬的 Gissane’s 角度，跟骨的高度和宽度是 25.47 ° ， 121.3 ° ， 4.32 ；厘米和 3.81 ；厘米分别地在最后的后续。三个病人在切口地点有拍动坏死，一个人有表面、深的感染。Subtalar 关节炎在 5 个病人被看见，而在 1 个病人的小腿腹的神经 hypoaesthesia。任何一个都没病人有分隔空间症候群，脚跟垫问题，小腿侧的 tendinitis，反射同情的 dystropy 或与锁住植入 failure.ConclusionOpen 减小和内部固定跟骨的板给声音功能的结果，即解剖地恢复高度，宽度， Bohler’s 和 calcaneum 的 Gissiane’s 角度的重建，并且允许早动员。

关键词：骨折内固定踝关节跟骨锁定复位钢板移动平均交感神经

Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases

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Chinese Journal of Traumatology 2019年第2期22卷 103-107页

作者： PNVSV Prasad Amit Nemade Rashid Anjum Nilesh Joshi Department of orthopaedics Srujan Ortho and Accident Care Hospital Khammam AP India Department of orthopaedics Children Orthopaedic Centre Mumbai India Department of orthopaedics MM Institute of Medical Sciences and Research. Ambala India Department of orthopaedics. N K P Salve Institute of Medical Sciences Nagpur. India

Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications relate

关键词： Distal tibia fractures Extra-articular Pilon fractures Interlocked nailing

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Percutaneous elevation of depressed lunate fossa： A surgical technique

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Chinese Journal of Traumatology 2018年第5期21卷 304-307页

作者： Atin Jaiswal Yashwant Singh Tanwar Department of orthopaedics Vivekanand Polyclinic and Institute of Medical Sciences Lucknow India Department of orthopaedics Indraprastha Apollo Hospital New Delhi India

远侧的半径的死穿孔机破裂或装紧破裂关节的表面对对待并且努力困难完成令人满意的减小。我们在场提高沮丧的半月形的窝并且在这没有 grafting 的需要维持提高的碎片的减小的一种唯一、经皮、最低限度地侵略的技术断裂。这种技术简单，... 详细信息

远侧的半径的死穿孔机破裂或装紧破裂关节的表面对对待并且努力困难完成令人满意的减小。我们在场提高沮丧的半月形的窝并且在这没有 grafting 的需要维持提高的碎片的减小的一种唯一、经皮、最低限度地侵略的技术断裂。这种技术简单，可再现并且能与简单乐器学被执行。我们认为它在远侧的半径破裂的处理值得许多含意。

关键词：技术月形外科破裂穿孔机半径

Digital blinding of radiographs to mask allocation in a randomized control trial

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World Journal of Orthopedics 2017年第10期8卷 785-789页

作者： Gerard P Slobogean Lukasz Soswa Giuliana Rotunno Peter J O'Brien Kelly A Lefaivre Department of orthopaedics University of Maryland School of Medicine Department of orthopaedics University of British Columbia University of Maryland School of Medicine

AIM To demonstrate the effectiveness of a digital radiographic altering technique in concealing treatment allocation to blind outcome assessment of distal femur fracture fixation.METHODS Digital postoperative anteroposterior and lateral radiographs from a sample of 33 randomly-selected patients with extra-articular distal femur fractures treated by surgical fixation at a Level 1 trauma center were included. Using commercially available digital altering software, we devised a technique to blind the radiographs by overlaying black boxes over the implant hardware while preserving an exposed fracture site for assessment of fracture healing. Three fellowship-trained surgeons evaluated a set of blinded radiographs twice and a control set of unblinded radiographs once. Each set of radiographs were reviewed independently and in a randomly-assigned order. The degrees of agreement and disagreement among evaluators in identifying implant type while reviewing both blinded and unblinded radiographs were assessed using the Bang Blinding Index and James Blinding Index. The degree of agreement in fracture union was assessed using kappa statistics.RESULTS The assessment of blinded radiographs with both the Bang Blinding Index(BBI) and James Blinding Index(JBI) demonstrated a low degree of evaluator success at identifying implant type(Mean BBI, far cortical locking:-0.03, SD: 0.04; Mean BBI, standard screw: 0, SD: 0; JBI: 0.98, SD: 0), suggesting near perfect blinding. The assessment of unblinded radiographs with both blinding indices demonstrated a high degree of evaluator success at identifying implant type(Mean BBI, far cortical locking: 0.89, SD: 0.19; Mean BBI, standard screw: 0.87, SD: 0.04; JBI: 0.26, SD: 0.12), as expected. There was moderate agreement with regard to assessment of fracture union among the evaluators in both the blinded(Kappa: 0.38, 95%CI: 0.25-0.52) and unblinded(Kappa: 0.35, 95%CI: 0.25-0.45) arms of the study. There was no statistically significant difference in fracture union agreement between the blind

关键词： Methods Randomized controlled trials Patient outcome assessment Fracture healing Femoral fractures

Subtalar dislocations:Mechanisms,clinical presentation and methods of reduction

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World Journal of Orthopedics 2023年第6期14卷 379-386页

作者： Manikandar Srinivas Cheruvu Sanjay Narayana Murthy Raheel Shakoor Siddiqui Department of Trauma and orthopaedics Royal Stoke University Hospital NHS TrustStoke-On-Trent ST46QGUnited Kingdom Department of orthopaedics Birmingham Heartlands HospitalBirmingham Birmingham Heartlands HospitalUnited Kingdom

Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly.Subtalar dislocations are high-mechanism injuries,which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints,without major fracture of the talus.They are usually classified as medial(most common),lateral,anterior and posterior dislocations,based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury.They are usually diagnosed by X rays,but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively.Majority being closed injuries,can be managed in ED by closed reduction and cast immobilisation,but if they are open,have poor outcomes.Complications that ensue open dislocations are post-traumatic arthritis,instability and avascular necrosis.

关键词： Joint Subtalar Joint dislocations Flatfoot Clubfoot Talus

Bone microenvironment regulative hydrogels with ROS scavenging and prolonged oxygen-generating for enhancing bone repair

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Bioactive Materials 2023年第6期24卷 477-496页

作者： Han Sun Juan Xu Yangyufan Wang Siyu Shen Xingquan Xu Lei Zhang Qing Jiang State Key Laboratory of Pharmaceutical Biotechnology Division of Sports Medicine and Adult Reconstructive SurgeryDepartment of Orthopedic SurgeryNanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical School321 Zhongshan RoadNanjing210008JiangsuPR China Branch of National Clinical Research Center for Orthopedics Sports Medicine and RehabilitationPR China Co-innovation Center of Neuroregeneration Nantong University9 Seyuan RoadNantong226019JiangsuPR China Articular Orthopaedics The Third Affiliated Hospital of Soochow University185 Juqian RoadChangzhou213003JiangsuPR China

Large bone defects resulting from fractures and disease are a major clinical challenge,being often unable to heal spontaneously by the body’s repair mechanisms.Lines of evidence have shown that hypoxia-induced overproduction of ROS in bone defect region has a major impact on delaying bone regeneration.However,replenishing excess oxygen in a short time cause high oxygen tension that affect the activity of osteoblast precursor cells.Therefore,reasonably restoring the hypoxic condition of bone microenvironment is essential for facilitating bone repair.Herein,we designed ROS scavenging and responsive prolonged oxygen-generating hydrogels(CPP-L/GelMA)as a“bone microenvironment regulative hydrogel”to reverse the hypoxic microenvironment in bone defects region.CPP-L/GelMA hydrogels comprises an antioxidant enzyme catalase(CAT)and ROS-responsive oxygen-releasing nanoparticles(PFC@PLGA/PPS)co-loaded liposome(CCP-L)and GelMA hydrogels.Under hypoxic condition,CPP-L/GelMA can release CAT for degrading hydrogen peroxide to generate oxygen and be triggered by superfluous ROS to continuously release the oxygen for more than 2 weeks.The prolonged oxygen enriched microenvironment generated by CPP-L/GelMA hydrogel significantly enhanced angiogenesis and osteogenesis while inhibited osteoclastogenesis.Finally,CPP-L/GelMA showed excellent bone regeneration effect in a mice skull defect model through the Nrf2-BMAL1-autophagy pathway.Hence,CPP-L/GelMA,as a bone microenvironment regulative hydrogel for bone tissue respiration,can effectively scavenge ROS and provide prolonged oxygen supply according to the demand in bone defect region,possessing of great clinical therapeutic potential.

关键词： Bone defect Hypoxic microenvironment Reactive oxygen species responsiveness Prolonged oxygen generation Brain and muscle arnt-like protein 1