Dystrophic changes in mdx muscle regenerating from denervation and devascularization

The regenerative capacity of young mdx muscle after a denervating and devascularizing injury (DD) was examined in extensor digitorum longus (EDL) and compared with that of age-matched control mouse EDL. DD of the right EDL was produced at the age approximating the onset of dystrophy in the mdx model, and mice recovered for 2 weeks. Contralateral unoperated EDLs from mdx and control mice served as internal controls for histopathology, myofiber cross-sectional area (CSA), and ultrastructure of fiber regeneration in DD-EDL. Mdx DD-EDL were composed of small, uniformly mature myofibers with mostly peripheral nuclei. This contrasted with control DD-EDL in which fibers were centrally nucleated. In addition, the unoperated mdx EDL exhibited the central nucleation of spontaneous recovery from dystrophy. The CSA distribution of mdx DD-EDL myofibers was significantly shifted toward smaller CSA compared with unoperated mdx EDL, although mean CSA did not differ between the two mdx muscle groups. The CSA distribution of control DD-EDL was significantly different and shifted toward smaller CSA from both unoperated control EDL and from mdx DD-EDL distributions. Ultrastructural features of dystrophy were present in both mdx DD-EDL and in the unoperated mdx EDL, although they appeared more prevalent in the latter. These results suggest that short-term plasticity of mdx muscle recovery from imposed injury may be greater than that of normal muscle in establishing a regenerating fiber population.     

Anatomical mismatch of the pulmonary autograft in the aortic root may be the cause of early aortic insufficiency after the Ross procedure

Objective: Early aortic insufficiency can be a problem after the Ross procedure. Anatomical mismatch and an inexact surgical technique may lead to distortion of the normal pulmonary valve geometry and subsequent incorrect leaflet coaptation and valve insufficiency. In this study, we assessed the efficacy of changing and improving the surgical technique to minimize the early pulmonary autograft valve failure. The modifications and the strategy are discussed. Methods: From January 1995 to February 1999, a total of 77 adults underwent the Ross procedure for aortic valve replacement at Sahlgrenska University Hospital. The operative technique used was full free-standing aortic root replacement with a pulmonary autograft in all cases. In the first 24 cases, the diameter of the pulmonary roots was seldom measured, eye-balling was used to exclude anatomical mismatch due to a dilated aortic root, and only one attempt of correction was made, which failed. In the other 53 cases, the technique was improved by: (1) reducing the aortic anulus diameter in cases with moderate dilatation; (2) excluding cases with severe dilatation of the aortic annulus; (3) adjusting the diameter of the sinotubular junction of the aorta to the diameter of the sinotubular junction of the pulmonary artery; (4). reimplanting the left ostium in the autograft, and (5) changing the proximal anastomosis technique. Results: In this study, we had an early aortic incompetence of grade 2 in eight patients among the first 24 patients. In the other 53 patients, postoperative echocardiography at 1 week revealed aortic insufficiency of grade 2 in two patients. Conclusions: Aortic insufficiency after the Ross procedure can be minimized by patient selection, intraoperative correction of anatomical mismatch and improved surgical technique.     

Tunnel enlargement after arthroscopic anterior cruciate ligament reconstruction: Comparison of bone-patellar tendon-bone and hamstring autografts

Bone tunnel enlargement associated with anterior cruciate ligament (ACL) reconstruction has recently become a topic of interest in the literature. This association was examined, along with the effect of femoral and tibial tunnel enlargement on the clinical results of ACL reconstruction performed with either bone-patellar tendon-bone (BPTB) or hamstring (HST) autografts. Forty-six patients underwent arthroscopic ACL reconstruction (23 receiving BPTB autograft and 23 HST) between March 1999 and July 2001. Thirty patients (13 receiving BPTB autograft and 17 HST) completed the last clinical and radiologic evaluations and were included in the study. The mean age of patients in the HST group was 29.8 years (range 18–39) and that in the BPTB group was 27.6 years (range 20–37). The mean follow-up period was 24.6 months (range 12–36) in HST group and 18.5 months (range 12–40) in BPTB group. The effect of tunnel enlargement on the clinical results was evaluated by comparing preoperative and postoperative Lysholm, Tegner, and International Knee Documentation Committee scores and ligament laxity measurements between and within the groups. Postoperative femoral and tibial tunnel diameters in both groups were significantly larger than their corresponding preoperative tunnel diameters. In an intergroup evaluation, the enlargement of the tibial tunnel was similar in both groups (P=.556), but the femoral tunnel diameter was significantly larger in the HST group than in the BPTB group (P>.001). Preoperative laxity of the knees significantly improved after the operations in both groups, but no difference between the groups was evident at the final follow-up visit. No correlation between tunnel widening and the clinical results of the BPTB and HST procedures was observed.     

自体微粒皮移植术在大面积深度烧伤并发症防治中的作用

目的 探讨自体微粒皮移植术在大面积深度烧伤并发症防治中的作用。方法 比较性研究我院1993-2002收治的大面积深度烧伤患者64例,根据早期创面处理方法的不同分为切痂自体微粒皮移植术组和切痂邮票状植皮术组,两组患者的一般情况具有可比性。自体微粒皮移植术组行一次性大面积切痂自体微粒皮和大张异体皮联合移植术,切痂邮票状植皮术组分次行部分Ⅲ度创面切痂自体邮票状皮片移植术。观察自体微粒皮移植术后的临床过程,并比较两组患者脓毒症和MODS的发生率。结果①5-7 d,异体皮表皮层出现疱状变性;2周左右,异体真皮出现黑色斑点;4-6周,形成痂皮脱落,其下为新生表皮覆盖。②自体微粒皮移植术组脓毒症和MODS的发生率分别为34.4％和18.8％,明显低于切痂邮票状植皮术组的62.5％和43.8％,差异有显著性(P<0.05)。结论 自体微粒皮移植术治疗大面积深度烧伤切实可行、疗效确切,能有效降低MODS的发生率。     

Comparison of Autograft vs Allograft in Opening-Wedge High Tibial Osteotomy

Opening-wedge high tibial osteotomy (HTO) is used to treat isolated medial knee joint arthritis. A benefit of using allograft instead of autograft is avoiding a second surgical site, thereby decreasing operative time, blood loss, and pain. Our study objective was to evaluate allograft vs autograft in the failure and complication rates of HTO using the same technique and implant system (Arthrex HTO plate system, Arthrex, Inc, Naples, Fla). Seventy knees in 65 patients were evaluated. There was a 6-fold higher failure rate for the allograft group. When there was no lateral cortical breach, construct failure did not occur in 87.8% of the knees (P = .0006); with lateral cortical breach, construct failure occurred 53% of the time (P = .0006). Seventy-six and a half percent of breached cortices and 75% of failures were associated with large wedge sizes (≥11 mm); this may suggest a role for closing-wedge osteotomy or alternative osteotomies when larger alignment corrections are needed.     

自体骨髓移植治疗儿童股骨头缺血性坏死

目的：探讨自体骨髓移植治疗儿童股骨头缺血性坏死（简称Perthes病）的疗效。方法：对1994～2004年我院采用自体骨髓移植治疗Perthes病14例（16髋）患者的临床资料进行分析。所有患者均获随访,随访时间4～13年,平均8．3年。结果：16髋中,优6髋,良8髋,可2髋,差0髋,优良率为87．5％。结论：自体骨髓移植是治疗Perthes病的有效方法。     

羊膜移植与角膜缘上皮移植治疗翼状胬肉的Meta分析

目的比较角膜缘上皮移植与羊膜移植治疗翼状胬肉的有效性和安全性。方法计算机检索MEDLINE（1996年至2008年6月）、中国期刊全文数据库（1994年至2008年6月）、中国科技期刊全文数据库（1989年至2008年6月）等数据库。纳入比较自体角膜缘上皮移植和羊膜移植治疗翼状胬肉的随机对照试验,由两名评价者独立检索、评价、提取资料并进行交叉核对。数据统计分析采用Cochrane协作网提供的RevMan4．2．10软件。结果共纳入41项研究,有41项研究报告了术后翼状胬肉的复发率,共4148只眼：14项研究报告了术后睑球粘连发生率．共1475只眼。Meta分析结果显示,自体角膜缘上皮移植组翼状胬肉复发率为5．03％,羊膜移植组翼状胬肉复发率为10．60％,两组差异有统计学意义（比值比0．45,95％可信区间0．36～0．58,Z=6．42,P〈0．00001）;自体角膜缘上皮移植组术后睑球粘连发生率为0．26％,羊膜移植组术后睑球粘连发生率为1．73％．两组差异有统计学意义（比值比0．21,95％可信区间0．07～0．68,Z=2．60,P=0．009）。结论自体角膜缘上皮移植术在预防翼状胬肉复发及术后睑球粘连的发生方面优于羊膜移植术。     

Reconstruction with pasteurized autograft-total hip prosthesis composite for periacetabular tumors

BACKGROUND: With the development of preoperative adjuvant treatment, imaging techniques, and improvement of surgical technique, limb salvage is now possible even in patients with pelvic tumors. However, reconstruction after periacetabular resection is complicated and challenging. METHODS: We retrospectively evaluated the usefulness of pasteurized autograft-total hip composite in pelvic reconstruction with regard to graft survival, union, graft-related complications, and functional outcome in 14 patients with periacetabular tumor. RESULTS: The 5-year and 10-year survival rates of the pasteurized bones were 64.3% and 32.1%, respectively. Major complications that necessitated graft removal included infection in three, fracture in two, and loosening in three patients. The average functional score of seven long-term successful patients was 25.6 (85.2%). CONCLUSIONS: In spite of the high complication rate, pasteurized autograft can be considered as an option for periacetabular reconstruction in the selected patients who meet the following criteria. First, iliopectineal and ilioischial lines are radiologically intact; second, the tumor volume is small (preferably less than 100 ml).