Architectural remodeling of fresh meniscal allograft transplantation in a rabbit joint: Its long-term protective effect on articular cartilage

This study assessed a fresh medial meniscal allograft transplantation model in the rabbit knee. Biological characterization included assessment of collagen remodeling of the allograft and the potential protection against cartilage degeneration. Allograft transplantation was performed on the left knee, and total meniscectomy on the right knee. Forty-seven rabbits were operated on and assessed at 9, 12, and 26 weeks. Fresh medial meniscal allografts showed collagen remodeling that paralleled the revascularization and cellular proliferation of the allografts. Revascularization was shown as early as 9 weeks from the periphery, extending to the inner one-third of the allograft by 26 weeks. Viability assessment of the meniscal allograft cells showed live cells at the periphery of the allograft at 9 and 12 weeks. At time 0, i.e., the time of the transplant, few viable cells were observed within the donor tissues. Biochemically, collagen remodeling, in terms of increased reducible collagen crosslinks, i.e., dihydroxylysinonorleucine, and the percentage of collagen present, was seen throughout the 26-week observation period. At 26 weeks, the meniscal allografts inhibited degenerative changes of the femoral and tibial cartialage compared to results with total meniscectomy.     

犬头面部复合组织同种异体移植模型的建立

目的建立犬头面部复合组织同种异体移植的实验动物模型。方法①解剖研究：用4只杂种犬进行头面颈部的解剖及复合组织瓣的切取研究。②自体回植（Ⅰ组n=5）：为选择最佳的复合组织瓣移植方式，进行了三种形式的复合组织瓣白体回植。③异体移植（Ⅱ组n=6）：以第三种复合组织瓣及其改良的组织瓣形式进行了两种头面部复合组织异体移植。免疫抑制治疗方案为环孢霉素A和皮质激素联合应用，依据环孢霉素A血药浓度调整用药剂量。分别在术后4、6、12周及6个月对眼轮匝肌进行肌电图检测。结果①犬头面部的解剖特征与人相似，以颈外动静脉为血管蒂能够为头面部复合组织瓣提供良好的血供。②IC组两只犬长期存活，但出现唾液漏。③Ⅱa组中1只犬于移植术后28d免疫排斥，通过调整环孢霉素A及强的松的用量并局部应用氯倍他索涂抹，2周后治愈，现已存活309d。Ⅱb组中3只犬现已分别存活159、129和108d，无并发症，肌电图显示眼轮匝肌功能逐步恢复。结论改良犬单侧上半头面部组织瓣异体移植模型是研究头面部复合组织异体移植的理想模型。     

膝关节镜下同种异体半月板移植术(附2例初步报告)

[目的]通过对2例临床同种异体半月板移植中移植物取材、储存，手术操作技术、术后康复计划和不良反应等方面初步结果的总结，结合相关文献，讨论目前临床异体半月板移植的有关问题，为进一步开展此项临床技术提供参考。[方法]对2例外伤导致严重陈旧性半月板损伤、大部缺失的患者，在关节镜下实施同种异体半月板移植术，拟定术后康复计划，对其症状缓解、关节活动度恢复等近期随访结果作初步报告。[结果]患者无手术副损伤，术后伤口愈合良好，无明显伤口渗液，早期关节肿胀，6周左右肿胀消失。实验室检查未发现免疫排斥反应等征象。疼痛评分术前8分、6分，术后3分、2分。患者膝关节活动度恢复过程顺利。[结论]基于目前对半月板严重损伤者保留和修复半月板治疗中存在的困难，以及半月板属于免疫屏蔽器官的特点，异体半月板移植技术有可能成为治疗半月板严重损伤、缺失的一项重要技术。迄今已有的研究为其提供了充分的理论依据。但目前对其远期效果尚待进一步观察，关于移植物的消毒储存、手术操作技术、功能康复训练等临床问题也有待于进一步研究。     

Meniscal allograft transplantation for symptomatic knee after meniscectomy of torn discoid medial meniscus: Report of three cases

In symptomatic discoid medial meniscus, partial meniscectomy is the principal treatment method and can yield promising short-term results. However, unlike the nondiscoid meniscus, discoid medial meniscus is frequently associated with horizontal cleavage tears, attributable to the presence of myxoid degeneration in the intrameniscal substance, in that it may potentially occur deteriorating long-term results because of re-tearing of remaining meniscus or secondary degeneration of cartilage of the medial compartment after meniscectomy. We experienced three rare cases of retear or secondary degeneration of cartilage of the medial compartment after meniscectomy for two patients with torn bilateral meniscus. Both patients were highly active young males. Meniscal allograft transplantation in complicated discoid medial meniscus was performed. At 2 years after meniscal allograft transplantation, clinical outcomes were improved with a normal range of motion. Orthopedic surgeons should recommend activity modification to prevent possible complicated injury of the discoid medial meniscus. Meniscal allograft transplantation may be an alternative option in highly active young patients undergoing complicated discoid medial meniscus to diminish pain, improve knee function, and prevent or delay degeneration.     

Renal transplantation combined with aortofemoral bypass using a fresh arterial allograft

Abstract Aortoiliac atherosclerosis is frequently encountered in renal failure patients waiting for renal transplantation. Staged or simultaneous surgical repair of aortoiliac lesions with renal transplantation is possible at reasonable risk. Arterial reconstruction is most commonly performed using an artificial prosthesis. Another option is the use of a fresh or preserved arterial allograft. In our institute, about 180 cadaveric transplantations are performed each year. Over the past 2 years, three patients with chronic renal failure and obliterative disease of the abdominal aorta and iliac arteries underwent aortofemoral bypass using a fresh arterial allograft combined with kidney transplantation from the same donor. The procedures as well as the postoperative course were uneventful. There was an immediate development of function of the renal transplant. Combined arterial reconstruction and transplantation, managing both conditions at a time, is convenient for the patient mainly because it means undergoing only one general anesthesia during one hospitalization. Moreover, the risk of infection of the vascular prosthesis is somewhat reduced. Disadvantages are that the availability of the arterial allograft is dependent on a suitable donor and the limited body of experience with the behavior of the arterial allograft in patients with chronic immunosuppression.     

改良犬原位背驮式肝移植的解剖学观察

目的观察犬肝脏解剖学特点,探索建立改良的犬同种异体原位背驮式肝移植模型。方法对15只杂交犬的肝脏进行活体和尸体标本的解剖观察。结果犬肝共分7叶,门静脉分左右支进入肝脏,门静脉左支供应约70%肝组织(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ叶),门静脉右支供应约30%肝组织(Ⅵ、Ⅶ叶),分别阻断门静脉左、右支后5 min左右门静脉压力达到峰值,并迅速回复至门静脉正常压力值上限范围内;肝动脉和胆管与门静脉分支伴行进入各肝叶;左肝静脉粗大,可以作为肝静脉重建的流出道,其余3~6支肝静脉可以分别结扎,肝后下腔静脉易于与肝脏分离。结论犬肝的解剖学特点适宜于建立改良的原位背驮式肝移植模型。     

Multiple freeze‐thaw cycled meniscal allograft tissue: A biomechanical,biochemical, and histologic analysis

Meniscus allografting has provided relief of meniscal injuries that were previously thought irreparable. However, meniscus allograft tissue remains limited and a significant problem. To improve allograft tissue yield, decrease processing costs, and increase graft availability, this study investigated the biomechanical changes of meniscal allograft tissue frozen and thawed multiple times. Specifically, our study compared the intrinsic compressive resistances of meniscus undergoing four Freeze‐Thaw cycles versus tissue undergoing a single Freeze‐Thaw cycle. Seven menisci that were originally procured and processed for allografting were donated for the study. Each meniscus was segmented and samples independently underwent novel constant slow‐rate compression testing, and histological and biochemical evaluation. The menisci that underwent a single Freeze‐Thaw cycle demonstrated a significantly higher Young's Modulus (14 megapascals) as compared to menisci undergoing multiple Freeze‐Thaw cycles (10 megapascals, p = 0.03). These results were maintained when medial and lateral menisci were compared independently. Histological and biochemical analyses supported, but did not provide an explanation for the change in intrinsic compressive resistance. From these results, transplantation of meniscal allograft tissue frozen and thawed four times may be compromised in its ability to resist compression; and thus may undermine its role in replacing native meniscal tissue. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:49–55, 2008     

犬同种异体腰椎间盘移植的手术技术

[目的]研究并描述一种在无内固定辅助条件下建立犬同种异体椎间盘移植模型的手术技术。[方法]选取1岁龄健康杂种犬25只,处死其中的5只,在无菌条件下取L1~6椎间盘共25个液氮保存,剩余20只犬用于建立L5、6椎间盘移植模型的研究。术中,术后1、4、6、8、12周进行X线检查,观察移植椎间盘的位置、高度变化以及相邻椎体的愈合情况。[结果]椎间盘移植术前选取合适大小的供体椎间盘,术中注意保留前、后纵韧带及对侧纤维环,可以实现在无内固定条件下成功建立同种异体椎间盘移植模型。本研究椎间盘移植成功17例,其余2例出现椎间盘脱出,1例出现椎间盘感染。术后3个月影像学检查示移植椎间盘的上下终板与相邻椎体形成骨性愈合。与术前相比,术后3个月随访椎间盘高度无明显变化(P>0.05)。[结论]采用恰当的手术技术,有助于在无内固定辅助下成功实施同种异体椎间盘移植手术。本研究提供了一种建立犬同种异体椎间盘移植模型的可行的手术方案。     

异体半月板库的建立及临床初步应用

[目的]建立同种异体半月板库，为半月板移植的临床应用研究打下基础。[方法]作者利用组织库供体来源的优势，结合低温冷冻技术保存半月板，初步建立了异体半月板库。临床进行半月板移植时，根据患者的需要和半月板库的记录资料合理选择，并注名有关操作规程。[结果]从2005-2006年底，作者已经建立了大约有300个不同大小半月板的半月板库，为临床提供了14个同种异体半月板。[结论]半月板库的建立为临床半月板移植的开展打下了基础；异体半月板移植手术的近期疗效是令人满意的，远期疗效尚需更进一步观察和更多病例的积累。     

关节镜下应用全内缝合法修复半月板撕裂

目的分析关节镜下采用全内缝合技术修复半月板撕裂的临床疗效。方法关节镜下采用全内缝合技术修复68例半月板撕裂患者。随访时进行体格检查和MRI检查。采用改良Lysholm评分评估膝关节功能,采用Barrett标准评价临床愈合情况,根据MRI检查评价影像学愈合情况。结果 68例患者获得随访,时间18~68个月。患者交锁、打软腿、积液等症状体征完全消失,疼痛及关节功能明显改善。改良Lysholm评分由术前35~64(39.8±12.1)分提高至末次随访时85~100(91.8±7.3)分,差异有统计学意义(P0.001)。根据Barrett标准,59例(86.8%)获得半月板临床愈合。末次随访时MRI检查:58例(85.3%)完全愈合,8例(11.8%)部分愈合,2例(2.9%)未愈合。结论应用全内缝合技术修复半月板撕裂,半月板愈合率高,并发症发生率低,疗效满意。     

改良腹腔多器官簇移植外科技术:临床应用前的大动物实验

目的通过大动物实验,施行改良腹腔多器官簇移植外科技术,训练手术团队,为临床开展改良腹腔多器官簇移植做技术准备。方法选用杂交长白猪作供受体。高渗枸橼酸盐腺嘌呤液经腹主动脉原位灌注,整块切取胃、十二指肠、小肠和胰腺器官簇。血管重建是将移植物的腹主动脉远侧端与受体肾下腹主动脉作端侧吻合,将移植物门静脉与受体肠系膜上静脉残端作端端吻合。消化道重建采用受体十二指肠残端侧侧吻合于移植物的近侧空肠,移植胃前壁、移植小肠末端拖出腹壁造口作观察窗用。结果 25例次供体切取手术中18例次成功完成,平均手术时间为(149.44±22.09)min。在没有完善的围麻醉期和围手术期支持条件下,18例次受体手术顺利完成12例次,平均手术时间(236.67±36.76)min,移植物平均冷缺血时间(212.92±21.26)min。12例存活2～126h,其中7例存活超过24h(2例超过72h,1例达126h)。结论猪改良腹腔多器官簇移植实验表明这一技术在临床上是可行的。     

An immunosuppressive regimen using FTY720 combined with cyclosporin in canine kidney transplantation

FTY720 induces apoptosis, specifically in lymphocytes, and prolongs allograft survival in rats and dogs. The purpose of this study was to define an effective range of FTY720 doses that could be combined with a suboptimal dose (10 mg/kg) of cyclosporin for canine kidney allograft recipients. The combination significantly prolonged allograft survival in all groups receiving FTY720 at a dose of 0.1, 0.3, 1.0, or 3.0 mg/kg. None of the recipients died due to notable side effects of the drug. In peripheral blood, the number of lymphocytes was extremely low, whereas the percentage of granulocytes increased during FTY720 administration. No significant difference in cyclosporin trough levels was observed between the cyclosporin-alone group and the combination groups. We conclude from the present study that FTY720 has a potent effect at an extremely low dose and a wide therapeutic window when combined with cyclosporin in canine kidney transplants. Received: 16 May 1997 Received after revision: 6 October 1997 Accepted: 19 November 1997     

Prediction of early allograft dysfunction using serum phosphorus level in living donor liver transplantation

Serum phosphorus is greatly affected by liver surgeries, but its change after liver transplantation has not yet been clarified. We investigated the predictive role of serum phosphorus for early allograft dysfunction (EAD) after living donor liver transplantation (LDLT). Perioperative factors, including serum phosphorus level, of 304 patients who underwent LDLT were retrospectively studied and compared between patients with and without EAD after LDLT. Potentially significant factors (P < 0.15) in univariate comparisons were subjected to multivariate logistic regression analysis to develop a prediction model for EAD. A total of 48 patients (15.8%) met the EAD criteria. Patients with EAD experienced more severe preoperative disease conditions, higher one‐month mortality and more elevated serum phosphorus concentrations during the first week after surgery compared with patients without EAD (P = 0.016). Multivariate analysis showed that a serum phosphorus level ≥4.5 mg/dl on postoperative day 2 was an independent predictor of EAD occurrence after LDLT (relative risk: 2.36, 95% confidence interval [1.18–4.31], P = 0.017), together with a history of past abdominal surgery, emergency transplantation and preoperative continuous veno‐venous haemodiafiltration. These data indicate that hyperphosphataemia during the immediate postoperative days could be utilized as a predictor of EAD after LDLT.     

Arthroscopic repair of the meniscal injury using meniscal repair device

Background:

Total meniscus resection after meniscus tear usually leads to faster degeneration and osteoarthritis of the knee joint. Preservation and repair of the injured menisci are therefore of great clinical importance. The aim of this study was to evaluate the clinical effects of arthroscopic repair of meniscal injuries using the Fast-Fix device.

Materials and Methods:

96 patients (58 males, 38 females) with mean age of 24.3 years (range 12–46 years)) with a meniscus injury were treated with the Fast-Fix device under arthroscopy between July 2007 and June 2009. The right and left knees were involved in 46 and 50 patients respectively. In 12, 46 and 38 patients, the injury was located in the anterior horn, body and posterior horn respectively. In 38, 45 and 13 patients, it was in the red, red-white, and white regions, respectively. All-inside and outside-in techniques were used for these meniscal injuries. Criteria for successful surgery were no locking pain or swelling and a negative McMurray test.

Results:

The mean followup period was 3.7 years (range 2–5 years). The surgical success rate was 91.7% (n = 88). The mean Lysholm score increased from 47.8 ± 10.4 preoperatively to 85.7 ± 12.8 postoperatively. The mean Tegner activity score was 7.4 ± 1.6 (range 5–9) preinjury, 2.1 ± 0.9 (range 0–4) preoperatively and 7.2 ± 2.2 (range 4–10) postoperatively (P < 0.001). A total of 92 patients (95.8%) returned to full-time work. The International Knee Documentation Committee score increased from 32.7 ± 10.7 (range 10.3–51.7) preoperatively to 82.5 ± 5.1 (range 65.1–91.2) postoperatively (P < 0.001).

Conclusions:

The Fast-Fix system is an efficient, safe and effective suture technique for meniscal repair.     

霉酚酸酯治疗慢性移植物功能减退的多中心研究

目的　探讨霉酚酸酯 (MMF)治疗慢性移植物功能减退 (CAD)的疗效和安全性。方法　应用霉酚酸酯 (MMF)替换硫唑嘌呤 (Aza)或环磷酰胺 (CTX) ,并联合小剂量环孢素A(CsA)和泼尼松 (Pred )治疗 78例CAD患者的方案。平均随访 9.84个月 ,研究并分析该方案的效果和并发症。结果　应用MMF联合小剂量CsA和Pred治疗后 ,有 74例患者的血清肌酐 (SCr)下降 ,随访时与应用前比较 ,差异有显著性 (P <0 .0 5 ) ;治疗有效率达 94 .9% ;4例治疗无效。用MMF转换治疗后 ,尿蛋白减轻或消失 ,血压下降。贫血、腹泻等不良反应发生率为 33.3%。结论　MMF联合小剂量CsA和Pred治疗CAD是有效和安全的。贫血、腹泻是转换治疗的主要副作用。