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Benefits of early ambulation within 24 h after total knee arthroplasty:a multicenter retrospective cohort study in China

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Military Medical Research 2021年第4期8卷 503-509页

作者： Yi-Ting Lei Jin-Wei Xie Qiang Huang Wei Huang Fu-Xing Pei Department of Orthopedics the First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Department of Orthopedics West China HospitalSichuan UniversityChengdu 610041China

Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.

关键词： Total knee arthroplasty Early ambulation Length of stay Costs Deep venous thrombosis

Outcomes of two-stage double-level rotational osteotomy in treating patients with congenital proximal radioulnar synostosis

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World Journal of Pediatric Surgery 2023年第2期6卷 118-120页

作者： Hu Bo Jingfang Xu Jianlan Lin Weiwei Zhu Zhefeng Zhen Wensong Ye Wenhao Chen Department of Orthopedics Sir Run Run Hospital Nanjing Medical UniversityNanjingJiangsuChina Department of Orthopedics Children's Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina Department of Orthopedics Fujian Children's HospitalFuzhouFujian ProvinceChina department of Pediatric Surgery Fujian Maternity and Child Health HospitalFuzhouFujianChina

Congenital proximal radioulnar synostosis(CPRUS)is a rare anomaly which is caused by abnormal fusion of the proximal radius and ulna during development.This is due to the failure of embryological separation,resulting in the fixed position of the forearm,from mild to severe pronation.1Mild deformity leads to slight disability because the shoulder and wrist can effectively compensate.2 Patients with bilateral cases and/or pronation defor-mity of>60°may be severely limited in daily activities.34 Most surgeons recommend surgical intervention when the loss of forearm rotation exceeds 60°,particularly when the forearm is fixed in pronation.

关键词： proximal rotation radius

Treatment of knee osteochondritis dissecans with autologous tendon transplantation:Clinical and radiological results

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World Journal of orthopedics 2021年第11期12卷 867-876页

作者： Ahmet Ugur Turhan Sezgin Acil Orkun Gul Kerim Oner Ahmet Emin Okutan Muhammet Salih Ayas Department of Orthopedics and Traumatology Karadeniz Technical University Faculty of MedicineTrabzon 61080Turkey Department of Orthopedics and Traumatology Tirebolu State HospitalGiresun 28100Turkey Department of Orthopedics and Traumatology Medical Park Trabzon HospitalTrabzon 61080Turkey Department of Orthopedics and Traumatology Samsun Training and Research HospitalSamsun 55100Turkey Department of Orthopedics and Traumatology Erzurum Regional Training and Research HospitalErzurum 25070Turkey

BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs.To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.METHODS Twenty patients(22 knees)with osteochondritis dissecans(OCD)lesions involving the knee were treated with autologous tendon transplantation between 2005-2018.All lesions were International Cartilage Repair Society grade IV.All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score(KOOS);and radiologically with magnetic resonance observation and cartilage repair tissue(MOCART)and Kellgren-Lawrence(KL)classification.RESULTS A total of 20 patients(22 knees)with a mean age of 25.5±6.8 years were included.The average defect size was 4.2±2.1 cm^(2),and the average defect depth was 0.9±0.4 cm.Total KOOS score was preoperatively 29.4±5.5 and was later found to be 81.5±5.9 after an average of 68.7±37.7 mo follow-up.The mean MOCART score was 56.2±10.7.Preoperatively,all of the patients had KL grades of 0-1;during the follow-up period,80% of the patients showed no radiological progress of osteoarthritis.Patients with less than 4 cm^(2) lesion had statistically significantly better overall KOOS than patients whose more than 4 cm^(2) lesion,particularly in sport and quality of life subscales.CONCLUSION The autologous tendon transplantation is a single-step,safe,simple,cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes,particularly in patients with less than 4 cm^(2) lesion.

关键词： Osteochondritis dissecans Knee Tendon Transplantation Autologous Peroneus

Plant homeodomain finger protein 23 inhibits autophagy and promotes apoptosis of chondrocytes in osteoarthritis

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Chinese Medical Journal 2019年第21期132卷 2581-2587页

作者： Xiang Li Xin Yang Talatibaike Maimaitijuma Xiang-Yu Cao Yang Jiao Hao Wu Zhi-Chao Meng Heng Liu Zhen-Peng Guan Yong-Ping Cao Department of Orthopedics Peking University First HospitalBeijing 100034China Department of Orthopedics The Second Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiang 830063China Department of Orthopedics Peking University Shougang HospitalBeijing 100144China.

Background:Plant homeodomain finger protein 23(PHF23)is a novel autophagy inhibitor gene that has been few studied with respect to orthopedics.This study was to investigate the expression of PHF23 in articular cartilage and synovial tissue,and analyze the relationship between PHF23 and chondrocyte autophagy in osteoarthritis(OA).Methods:Immunohistochemical staining and western blot were applied to show the expression of PHF23 in cartilage of different outbridge grades and synovial tissue of patient with OA and healthy control.The normal human chondrocyte pre-treated with rapamycin or 3-methyladenine,treated with interleukin-1b(IL-1b).IL-1b induced expression level of PHF23 and autophagyrelated proteins light chain 3B-I(LC3B-I),LC3B-II,and P62,were examined by Western blot.A PHF23 gene knock-down model was constructed with small interfering RNA.Western blot was performed to detect the efficiency of PHF23 and the impact of PHF23 knockout on IL-1b-induced expression of autophagy-related and apoptotic-related proteins in chondrocyte.Results:The expression of PHF23 was significantly increased in the high-grade cartilage and synovial tissue of patients with OA.The IL-1b-induced expression of PHF23 was gradually enhanced with time.The level of LC3B-II,P62 changed with time.After knockdown of PHF23,the level of autophagy-related proteins increased and apoptotic-related proteins decreased in IL-1b-induced OA-like chondrocytes.Conclusions:The expression of PHF23 increased in human OA cartilage and synovium,and was induced by IL-1b through inflammatory stress.PHF23 can suppress autophagy of chondrocytes,and accelerate apoptosis.

关键词： Osteoarthritis Autophagy Apoptosis Pathogenesis

A sustained release of BMP2 in urine-derived stemcells enhances the osteogenic differentiation and the potential of bone regeneration

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Regenerative Biomaterials 2022年第1期9卷 175-188页

作者： Shuang Wu Zhao Chen Xi Yu Xin Duan Jialei Chen Guoming Liu Min Gong Fei Xing Jiachen Sun Shishu Huang Zhou Xiang Department of Orthopedics Orthopedic Research InstituteWest China HospitalSichuan UniversityChengdu 610000China Rehabilitation Medicine Center West China HospitalSichuan UniversityChengdu 610000China Department of Orthopedics Affiliated Hospital of Qingdao UniversityQingdao 266000China Department of Orthopedics Hospital of Chengdu University of Traditional Chinese MedicineChengdu 610000China

Cell-based tissue engineering is one of the optimistic approaches to replace current treatments for bone defects.Urine-derived stem cells(USCs)are obtained non-invasively and become one of the promising seed cells for bone regeneration.An injectable BMP2-releasing chitosan microspheres/type I collagen hydrogel(BMP2-CSM/Col I hydrogel)was fabricated.USCs proliferated in a time-dependent fashion,spread with good extension and interconnected with each other in different hydrogels both for 2D and 3D models.BMP2 was released in a sustained mode for more than 28 days.Sustained-released BMP2 increased the ALP activities and mineral depositions of USCs in 2D culture,and enhanced the expression of osteogenic genes and proteins in 3D culture.In vivo,the mixture of USCs and BMP2-CSM/Col I hydrogels effectively enhanced bone regeneration,and the ratio of new bone volume to total bone volume was 38%after 8weeks of implantation.Our results suggested that BMP2-CSM/Col I hydrogels promoted osteogenic differentiation of USCs in 2D and 3D culture in vitro and USCs provided a promising cell source for bone tissue engineering in vivo.As such,USCs-seeded hydrogel scaffolds are regarded as an alternative approach in the repair of bone defects.

关键词： urine-derived stem cells BMP2 chitosan microspheres bone tissue engineering

Regenerative peripheral nerve interface prevents neuroma formation after peripheral nerve transection

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Neural Regeneration Research 2023年第4期18卷 814-818页

作者： Zheng Wang Xin-Zeyu Yi Ai-Xi Yu Department of Orthopedics Trauma and Microsurgery Zhongnan Hospital of Wuhan UniversityWuhanHubei ProvinceChina

Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have investigated the underlying mechanisms,and no comparative animal studies on regenerative peripheral nerve interface and other means of neuroma prevention have been conducted to date.In this study,we established a rat model of left sciatic nerve transfection,and subsequently interfered with the model using the regenerative peripheral nerve interface or proximal nerve stump implantation inside a fully innervated muscle.Results showed that,compared with rats subjected to nerve stump implantation inside the muscle,rats subjected to regenerative peripheral nerve interface intervention showed greater inhibition of the proliferation of collagenous fibers and irregular regenerated axons,lower expressions of the fibrosis markerα-smooth muscle actin and the inflammatory marker sigma-1 receptor in the proximal nerve stump,lower autophagy behaviors,lower expressions of c-fos and substance P,higher expression of glial cell line-derived neurotrophic factor in the ipsilateral dorsal root ganglia.These findings suggested that regenerative peripheral nerve interface inhibits peripheral nerve injury-induced neuroma formation and neuropathic pain possibly via the upregulation of the expression of glial cell line-derived neurotrophic factor in the dorsal root ganglia and reducing neuroinflammation in the nerve stump.

关键词： autotomy dorsal root ganglia glial cell line-derived neurotrophic factor nerve injury neuropathic pain peripheral nerve regeneration regenerative peripheral nerve interface retrograde axonal transport traumatic neuroma

Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure

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World Journal of orthopedics 2017年第5期8卷 385-393页

作者： Saumitra Goyal Monappa A Naik Sujit Kumar Tripathy Sharath K Rao Department of Orthopedics Kasturba Medical College Manipal University Department of Orthopedics All India Institute of Medical Sciences

AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

关键词： Compartment syndrome Leg Tibial fracture Deep posterior compartment Intracompartmental pressure Functional outcome

Neuroprotective effect of rapamycin on spinal cord injury via activation of the Wnt/β-catenin signaling pathway

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Neural Regeneration Research 2015年第6期10卷 951-957页

作者： Kai Gao Yan-song Wang Ya-jiang Yuan Zhang-hui Wan Tian-chen Yao Hai-hong Li Pei-fu Tang Xi-fan Mei Department of Orthopedics First Affiliated Hospital of Liaoning Medical University Department of Orthopedics Chinese PLA General Hospital

The Wnt/β-catenin signaling pathway plays a crucial role in neural development, axonal guid- ance, neuropathic pain remission and neuronal survival. In this study, we initially examined the effect of rapamycin on the Wnt/β-catenin signaling pathway after spinal cord iniury, by intraperitoneally injecting spinal cord injured rats with rapamycin over 2 days. Western blot analysis and immunofluorescence staining were used to detect the expression levels of β-catenin protein, caspase-3 protein and brain-derived neurotrophic factor protein, components of the Wnt/β-catenin signaling pathway. Rapamycin increased the levels of β-catenin and brain-derived neurotrophic factor in the injured spinal cord, improved the pathological morphology at the injury site, reduced the loss of motor neurons, and promoted motor functional recovery in rats after spinal cord injury. Our experimental fndings suggest that the neuroprotective effect of rapamycin intervention is mediated through activation of the Wnt/β-catenin signaling pathway after spinal cord injury.

关键词： nerve regeneration spinal cord injury rapamycin Wnt/β-catenin signaling pathway apoptosis caspase-3 brain-derived neurotrophic factor neuroprotection loss of neurons NSFC grants neural regeneration

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism

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Chinese Journal of Traumatology 2023年第3期26卷 178-182页

作者： Jun-Kun Zhu Feng-Feng Wu Rui-Feng Yang Fen-Fen Xu Ya-Li Lin Miao-Fang Ye orthopedics Rehabilitation department Lishui Central HospitalLishuiZhejiang Province323020China Rehabilitation department Huzhou Central HospitalHangzhou310020China orthopedics and Trauma department Lishui Central HospitalLishuiZhejiang Province323020China

Purpose:Static progressive stretch(SPS)can be applied to treat chronic joint stiffness.However,the impacts of subacute application of SPS to the distal lower limbs,where deep vein thrombosis(DVT)is common,on venous thromboembolism remain unclear.This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.Methods:A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022.Patients with unilateral lower limb comminuted para-articular fractures,transferred to rehabilitation ward for further treatment within 3 weeks after operation,followed up more than 12 weeks since initial manual physiotherapy,and diagnosed DVT by ultrasound before rehabilitation course were included in the study.Patients with polytrauma,without evidence of previous peripheral vascular disease or incompetence,had medication for thrombosis treatment or prophylaxis before the operation,detected with paralysis due to nervous system impairment,infected after operation during the regime,or with acute progression of DVT were excluded.The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation.Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups.SSPS 28.0 and GraphPad Prism 9 were used for data processing.Ap<0.05 was set significant difference.Results:In total of 154 patients with DVT participating in this study,75 of them were treated with additional SPS for postoperative rehabilitation.The participants in the SPS group showed improved range of motion(12.3°±6.7°).However,in the SPS group,there was no difference in thrombosis volume between the start and termination(p=0.106,p=0.787,respectively),although difference was seen intra-therapy(p<0.001).Contingency analysis revealed the pulmonary embolism incidence(OR=0.703)in the SPS group compared to the mean physio

关键词： Trauma Deep vein thrombosis Rehabilitation Musculoskeletal manipulations Physical therapy modalities