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Return to sport after lower limb arthroplasty-why not for all?

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World Journal of orthopedics 2019年第2期10卷 90-100页

作者： Shivan S Jassim Jenni Tahmassebi Fares S Haddad Angus Robertson trauma and Orthopaedics Royal London Hospital trauma and Orthopaedics University College London Hospital trauma and Orthopaedics Cardiff and Vale NHS Trust

BACKGROUND Total hip and knee replacements are being performed in increasing numbers in progressively younger patients with higher activity demands. Many such patients have expectations of returning to athletic activity post-operatively yet are not always able to do so and the reasons behind this have not been extensively examined. We hypothesise that any reasons for a failure to return to athletic activity post-operatively are *** To quantify the return to athletic activity following lower limb joint arthroplasty and understand qualitative reasons for altered activity *** A single centre, single surgeon retrospective questionnaire for hip and knee arthroplasty patients under age 60 years, minimum two years post-surgery with exclusion criteria of multiple degenerative joint involvement and multiple medical co-morbidities. Outcomes were validated joint-specific(Oxford hip and knee) and lifestyle questionnaires [short form 12(SF-12) and University of California, Los Angeles(UCLA)] and an activity questionnaire assessing ability participation in athletic activity post-operatively. Statistical analysis was performed on the validated outcome data, including comparison between hip and knee replacements. Frequency tables were produced to quantify the different athletic activities participated in by *** Responses were received from 64 patients(80% response rate). There was a statistically significant improvement in Oxford hip and knee scores following surgery. SF-12 scores also improved for all patients, but no statistically significant difference was seen between joints(P = 0.88). Mean UCLA scores pre-operatively were 7.67 and at two years post-operatively were 7.69, with no statistically significant change(P = 0.91). All patients reported high satisfaction and improved ability to perform athletic activity at a higher frequency compared to pre-operatively. The most common reasons for changing activity participation were not wa

关键词： Joint replacement Athletic activity Sport Outcomes

Microstructure and inclusion of Ti-6AI-4V fabricated by selective laser melting

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Frontiers of Materials Science 2016年第4期10卷 428-431页

作者： Qianli HUANG Ningmin HU Xing YANG Ranran ZHANG Qingling FENG Department of orthopedic trauma Affiliated General Hospital Ningxia Medical University Yinchuan 750004 China State Key Laboratory of New Ceramics and Fine Processing School of Materials Science and Engineering Tsinghua University Beijing 100084 China

Selective laser melting （SLM） was used in fabricating the dense part from pre-alloyed Ti-6Al-4V powder. The microstructural evolution and inclusion formation of as-fabricated part were characterized in depth. The microstructure was characterized by features of columnar prior β grains and acicular martensite α＇. High density defects such as dislocations and twins can be produced in SLM process. Investigations on the inclusions find out that hard alpha inclusion, amorphous CaO and microcrystalline Al2O3 are three main inclusions formed in SLM. The inclusions formed at some specific sites on melt pool surface. The microstructural evolution and inclusion formation of as-fabricated material are closely related to the SLM process.

关键词： metals and alloys laser processing microstructure inclusion

An electroencephalography-based human-machine interface combined with contralateral C7 transfer in the treatment of brachial plexus injury

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Neural Regeneration Research 2022年第12期17卷 2600-2605页

作者： Meng Zhang Ci Li Song-Yang Liu Feng-Shi Zhang Pei-Xun Zhang Department of orthopedics and trauma Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration Peking UniversityBeijingChina National Center for trauma Medicine BeijingChina

Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve ***,outcomes have been ***(EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury,which maintains target muscle activity and promotes the neurological rehabilitation *** review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve *** transfer may result in loss of nerve function in the donor area,so only nerves with minimal impact on the donor area,such as the C7 nerve,should be selected as the *** tendon transfer does not fully restore optimal joint function,so multiple functions often need to be reestablished *** with traditional manual rehabilitation,EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling,which facilitates neurological *** the early stages of brachial plexus injury treatment,the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external *** can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction *** cortical remodeling is also particularly important for neurological recovery after contralateral C7 *** studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical *** this mechanism should help guide the development of neurolog

关键词： arm injuries brachial plexus brain-computer interfaces nerve transfer nerve regeneration nerve tissue neurofeedback neurological rehabilitation user-computer interface

Sustained release of exosomes loaded into polydopamine-modified chitin conduits promotes peripheral nerve regeneration in rats

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Neural Regeneration Research 2022年第9期17卷 2050-2057页

作者： Ci Li Song-Yang Liu Meng Zhang Wei Pi Bo Wang Qi-Cheng Li Chang-Feng Lu Pei-Xun Zhang Department of orthopedics and trauma Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration Ministry of EducationBeijingChina National Center for trauma Medicine BeijingChina Department of orthopedics Beijing Jishuitan HospitalBeijingChina

Exosomes derived from mesenchymal stem cells are of therapeutic interest because of their important role in intracellular communication and biological *** the basis of previously studied nerve conduits,we designed a polydopamine-modified chitin conduit loaded with mesenchymal stem cell-derived exosomes that release the exosomes in a sustained and stable *** vitro experiments revealed that rat mesenchymal stem cell-derived exosomes enhanced Schwann cell proliferation and secretion of neurotrophic and growth factors,increased the expression of Jun and Sox2 genes,decreased the expression of Mbp and Krox20 genes in Schwann cells,and reprogrammed Schwann cells to a repair ***,mesenchymal stem cell-derived exosomes promoted neurite growth of dorsal root *** polydopamine-modified chitin conduits loaded with mesenchymal stem cell-derived exosomes were used to bridge 2 mm rat sciatic nerve *** release of exosomes greatly accelerated nerve healing and improved nerve *** findings confirm that sustained release of mesenchymal stem cell-derived exosomes loaded into polydopamine-modified chitin conduits promotes the functional recovery of injured peripheral nerves.

关键词： exosome mesenchymal stem cells modification strategy nerve conduits peripheral nerve injury peripheral nerve regeneration polydopamine reprogramming state Schwann cells sustained release

The anatomical,electrophysiological and histological observations of muscle contraction units in rabbits:a new perspective on nerve injury and regeneration

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Neural Regeneration Research 2022年第1期17卷 228-232页

作者： Ting-Min Xu Bo Chen Zong-Xue Jin Xiao-Feng Yin Pei-Xun Zhang Bao-Guo Jiang Department of trauma and orthopedics Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration(Peking University) Ministry of EducationBeijingChina trauma Center Peking University People’s HospitalBeijingChina National trauma Medical Center BeijingChina Department of Rehabilitation Peking University People’s HospitalBeijingChina

In the conventional view a muscle is composed of intermediate structures before its further division into microscopic muscle *** experiments in mice have confirmed this intermediate structure is composed of the lamella cluster formed by motor endplates,the innervating nerve branches and the corresponding muscle fibers,which can be viewed as an independent structural and functional *** this study,we verified the presence of these muscle construction units in *** results showed that the muscular branch of the femoral nerve sent out 4–6 nerve branches into the quadriceps and the tibial nerve sent out 4–7 nerve branches into the *** each nerve branch of the femoral nerve was stimulated from the most lateral to the medial,the contraction of the lateral muscle,intermediate muscle and medial muscle of the quadriceps could be induced by electrically stimulating at least one nerve *** stimulating each nerve branch of the tibial nerve from the lateral to the medial,the muscle contraction of the lateral muscle 1,lateral muscle 2,lateral muscle 3 and medial muscle of the gastrocnemius could be induced by electrically stimulating at least one nerve *** stimulation of each nerve branch resulted in different electromyographical waves recorded in different muscle ***-eosin staining showed most of the nerve branches around the neuromuscular junctions consisted of one individual neural tract,a few consisted of two or more neural *** muscles of the lower limb in the rabbit can be subdivided into different muscle subgroups,each innervated by different nerve branches,thereby allowing much more complex muscle activities than traditionally ***,the nerve branches and the innervated muscle subgroups can be viewed as an independent structural and functional *** study was approved by the Animal Ethics Committee of Peking University People’s hospital(approval No.2019 PHE027)on October 20,2019.

关键词： anatomy electrophysiology femoral nerve hematoxylin-eosin staining gastrocnemius motor endplate muscle contraction unit peripheral nerve quadriceps rabbit skeletal muscle tibial nerve

Cortical plasticity and nerve regeneration after peripheral nerve injury

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Neural Regeneration Research 2021年第8期16卷 1518-1523页

作者： Ci Li Song-Yang Liu Wei Pi Pei-Xun Zhang Department of orthopedics and trauma Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration Peking UniversityBeijingChina National Center for trauma Medicine BeijingChina

With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because of the subsequent impairment or absence of sensorimotor function. Uncomfortable complications of peripheral nerve injury, such as chronic pain, can also cause problems for families and society. A number of studies have demonstrated that the proper functioning of the nervous system depends not only on a complete connection from the central nervous system to the surrounding targets at an anatomical level, but also on the continuous bilateral communication between the two. After peripheral nerve injury, the interruption of afferent and efferent signals can cause complex pathophysiological changes, including neurochemical alterations, modifications in the adaptability of excitatory and inhibitory neurons, and the reorganization of somatosensory and motor regions. This review discusses the close relationship between the cerebral cortex and peripheral nerves. We also focus on common therapies for peripheral nerve injury and summarize their potential mechanisms in relation to cortical plasticity. It has been suggested that cortical plasticity may be important for improving functional recovery after peripheral nerve damage. Further understanding of the potential common mechanisms between cortical reorganization and nerve injury will help to elucidate the pathophysiological processes of nerve injury, and may allow for the reduction of adverse consequences during peripheral nerve injury recovery. We also review the role that regulating reorganization mechanisms plays in functional recovery, and conclude with a suggestion to target cortical plasticity along with therapeutic interventions to promote peripheral nerve injury recovery.

关键词： cortical plasticity injury mechanisms nerve transfer neurorrhaphy peripheral nerve phantom limb pain recovery regeneration treatment

Autologous transplantation with fewer fibers repairs large peripheral nerve defects

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Neural Regeneration Research 2017年第12期12卷 2077-2083页

作者： Jiu-xu Deng Dian-yin Zhang Ming Li Jian Weng Yu-hui Kou Pei-xun Zhang Na Han Bo Chen Xiao-feng Yin Bao-guo Jiang Department of orthopedics and trauma Peking University People's Hospital Beijing China

Peripheral nerve injury is a serious disease and its repair is challenging. A cable-style autologous graft is the gold standard for repairing long peripheral nerve defects; however, ensuring that the minimum number of transplanted nerve attains maximum therapeutic effect remains poorly understood. In this study, a rat model of common peroneal nerve defect was established by resecting a 10-mm long right common peroneal nerve. Rats receiving transplantation of the common peroneal nerve in situ were designated as the in situ graft group. Ipsilateral sural nerves（10–30 mm long） were resected to establish the one sural nerve graft group, two sural nerves cable-style nerve graft group and three sural nerves cable-style nerve graft group. Each bundle of the peroneal nerve was 10 mm long. To reduce the barrier effect due to invasion by surrounding tissue and connective-tissue overgrowth between neural stumps, small gap sleeve suture was used in both proximal and distal terminals to allow repair of the injured common peroneal nerve. At three months postoperatively, recovery of nerve function and morphology was observed using osmium tetroxide staining and functional detection. The results showed that the number of regenerated nerve fibers, common peroneal nerve function index, motor nerve conduction velocity, recovery of myodynamia, and wet weight ratios of tibialis anterior muscle were not significantly different among the one sural nerve graft group, two sural nerves cable-style nerve graft group, and three sural nerves cable-style nerve graft group. These data suggest that the repair effect achieved using one sural nerve graft with a lower number of nerve fibers is the same as that achieved using the two sural nerves cable-style nerve graft and three sural nerves cable-style nerve graft. This indicates that according to the ‘multiple amplification＇ phenomenon, one small nerve graft can provide a good therapeutic effect for a large peripheral nerve defect.

关键词： nerve regeneration peripheral nerve injury peripheral nerve defect autologous nerve graft functional recovery nerve conductionvelocity sural nerve common peroneal nerve sleeve bridging suture neural regeneration

Comparison of commonly used retrograde tracers in rat spinal motor neurons

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Neural Regeneration Research 2015年第10期10卷 1700-1705页

作者： You-lai Yu Hai-yan Li Pei-xun Zhang Xiao-feng Yin Na Han Yu-hui Kou Bao-guo Jiang Department of trauma and orthopedics Peking University People’s Hospital Department of Gastroenterology Weifang People’s Hospital

The purpose of this study was to investigate the effect of four fluorescent dyes, True Blue（TB）, Fluoro-Gold（FG）, Fluoro-Ruby（FR）, and 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate（Di I）, in retrograde tracing of rat spinal motor neurons. We transected the muscle branch of the rat femoral nerve and applied each tracer to the proximal stump in single labeling experiments, or combinations of tracers（FG-Di I and TB-Di I） in double labeling experiments. In the single labeling experiments, significantly fewer labeled motor neurons were observed after FR labeling than after TB, FG, or Di I, 3 days after tracer application. By 1 week, there were no significant differences in the number of labeled neurons between the four groups. In the double-labeling experiment, the number of double-labeled neurons in the FG-Di I group was not significantly different from that in the TB-Di I group 1 week after tracer application. Our findings indicate that TB, FG, and Di I have similar labeling efficacies in the retrograde labeling of spinal motor neurons in the rat femoral nerve when used alone. Furthermore, combinations of Di I and TB or FG are similarly effective. Therefore, of the dyes studied, TB, FG and Di I, and combinations of Di I with TB or FG, are the most suitable for retrograde labeling studies of motor neurons in the rat femoral nerve.

关键词： nerve regeneration tracing efficacy fluorescent tracers retrograde tracing femoral nerve motor neurons

Double Arthrodesis, Postero-Medial Release and Posterior Tibial Transfer in One Step in Paralytic Inveterate Equine Varus Foot

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Surgical Science 2023年第2期14卷 122-130页

作者： Kalifa Coulibaly Cheick Oumar Sanogo Sory Ibrahim Tambassi Aboubacar Diallo Soumana Traore Laye Toure Orthopaedic trauma Department Kati University Hospital Koulikoro Mali orthopedic trauma Department Sikasso Regional Hospital Sikasso Mali

Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site

关键词： Arthrodesis Foot Ankle Posterior Tibial Muscle Equine Varus