BACKGROUND: A variety of growth factors are involved in regulating cell proliferation and matrix synthesis at the tendon healing process. Vascular endothelial growth factor (VEGF) plays a powerful role on the tissue healing and regeneration. At present, few studies report the VEGF at the process of endogenous tendon healing. OBJECTIVE: To investigate the dose-effect relationship of intrinsic healing of rabbit's achilles tendon, which was topically separated by silicone tube, with the VEGF application. DESIGN, TIM E AND SETTING: Randomized control animal experiments were performed in the Central Animal Laboratory in the Second Xiangya Hospital of Central South University from November 2007 to April 2008. MATERIALS: Forty-eight healthy rabbits, weighing 2.5-3.0 kg, were used to establish the tendon rabbit injury models and were divided into 4 groups randomly, termed blank group and VEGF 100 ng, 50 ng, 10 ng groups, with 12 animals for each group. METHODS: The gastrocnemius bundle branch and soleus muscle bundle branch of the right achilles tendon were sutured after surface skin and subcutaneous tissue discission. The gastrocnemius bundle branch was transected at 2 cm above calcaneal bone insertion and a 2-cm silicone tube was applied to separate the site of suture using 5-0 modified Kessler method. The site of suture was treated with nothing in silicone tube as the blank control group. In other three groups, the site of suture was treated with 100, 50, 10 ng VEGF in silicone tube at the operation day and 7, 14, 21 days post-operation. MAIN OUTCOME MEASURES: At 2, 4, 6 weeks post-operation, the achilles tendon of 4 rabbits in each group were harvested for gross observation and histological evaluation. RESULTS: Compared with 2 and 4 weeks post-operation, the peripheral tissue's adhesion out of the silicon tube at 6 weeks was relieved and required to be separated using passive or operating knife. There were no significant differences in the grading of tendon adhesion between groups at 6 weeks post-operation (P > 0.05). The broken end of the achilles tendon in the silicon tube was connected with new-bom achilles tendon fibre tissues. The healing was well in each group, and the VEGF groups were superior to blank control group (P < 0.05). At 2, 4, 6 weeks post-operation, the fibroblast counting in the 100 ng and 50 ng VEGF groups was greater than that in the 10 ng VEGF group (P < 0.05), but no significant differences were found in the fibroblast counting between 100 ng and 50 ng VEGF groups (P > 0.05). The content of collagen fibres had no significant difference among three VEGF groups. The fibroblast counting and the content of collagen fibres in the VEGF groups were higher than that in the blank control group (P < 0.05). CONCLUSION: The exogenous application of different doses of VEGF at achilles tendon repair site can facilitate the proliferation and maturation of the fibroblasts, increase the secretion of collagen and promote the maturation of collagen fibres, thus facilitating intrinsic healing of the achilles tendon. The 100 ng and 50 ng VEGF is better than 10 ng VEGF with regard to the promotion of achilles tendon healing, and no difference is observed between 100 ng and 50 ng.

BACKGROUND:Articular capsule ligaments can lead articular surface to move normally and limit the excessive movement, especially to prevent any non-physiological movement. They are the important structures for stabilizing hip joints. It was previously thought that articular capsule should be routinely resected in the total hip arthroplasty (THA). OBJECTIVE: This study was designed to investigate the effect of retaining articular capsule in THA through posterior approach on maintaining hip stability. DESIGN, TIME AND SETTING: This study, a retrospective case analysis, was performed on 61 patients with femoral neck fracture, who received treatment in the Department of Orthopedics, Xiangya Second Hospital of Central South between January 2005 and December 2006. PARTICIPANTS: Twenty-nine patients who underwent THA with retaining articular capsule from January to December 2006 were included as retaining group, and thirty-two patients who underwent THA with routine resection of partial articular capsule were included as routine group. The two groups were kept identical in case selection, prosthesis selection, post-surgery processing and operators. METHODS: Four holes were drilled on greater trochanter on the proximal femoral bone. The superior part of articular capsule valve was sutured to the superior part of original articular capsule using No.1-0 absorbing thread, then sutured to base of femoral neck in mattress manner, and the suture was not ligated. The inferior part of articular capsule valve was sutured to the inferior part of original articular capsule using another suture. And the suture passed through two bone holes on base of femoral neck. The lower limbs were externally rotated and the suture was ligated. Subsequently, the excised extortor was repaired. Prior to and subsequent to suture, hip was slowly bent for 90° and femur was internally rotated for45°to investigate the suture of articular capsule on strengthening articular stability. MAI OUTCOME MEASURES: Operation time, bleeding volume and hip dislocation after THA. RESULTS: The operation time and bleeding volume were lower in the retaining group than in the routine group (P < 0.05). After THA, hip dislocation did not occur in any patients in the retaining group but occur in 2 patients (6.2%) in the routine group. Statistical tests could not be performed due to less data, resulting in no statistical significance.CONCLUSION: There has been no precise conclusion about the effects of retaining articular capsule or not on hip stability.But retaining articular capsule shortens operation time, reduces intrao-perative bleeding, unable raise operation risk, and re-establishes hip soft tissue balance.

0.05);According to average 15 months follow-up,the complication rate was 0 and the excellent rate of shoulder fuction was 97.1% in the cases fixed with CHP,both were better than those of the cases fixed with K-wire of 38.9% and 72.2% respectively(P

Objective The antibiotics resistance of common bacteria in orthopedics infection was investigated to guide rational application of antibiotics in treating infection disease.Methods Totally 500 secretions samples from orthopedic inpatients between June 2005 and June 2007 were cultured aerobically.The results of bacterial culture,antibiotics resistance of common bacteria and antibiotics application were analyzed.Results 43 kinds,248 strains of pathogenic bacteria were detected,and 52.8% of them were Gram-negative bacteria.The result of drug sensitive tests indicates that resistance of common antibiotics has been increasing.Conclusion Gram-negative bacilli dominate the pathogenic bacteria in orthopedics patients and it tends to increase;while incidence of infections by Gram-positive cocci is lower.Some pathogenic strains acquire higher resistance against those antibiotics which were effective in the past.Antibiotics application in clinical practice is far from rational,and the irrationality is characterized by high antibiotics use rate,high star point,prolonged postoperative medication,excessive drug combination etc.

Objective To investigate the unification effect of rat nerve growth factor(NGF)and adenosine triphosphate(ATP)on repair of the peripheral nerve injury and the denervated muscle.Methods Ninety-six healthy SD rats weighing(250±15)g were randomly divided into NGF+ATP group,NGF group,ATP group and NS group.The sciatic nerves were cut for 3 mm,and were connected with silicone tube to create the nerve regeneration room.Then,all rats were intraperitoneally injected with NS0.4ml,ATP0.4ml(1 mg/ml),NGF 0.4 ml(0.2 μg/ml),NGF+ATP 0.4 ml(ATP1 mg/ml,NGF 0.2 μg/ml)separately once every three days.Six rats from each group were selected at 2,4,6 and 8 weeks after operation for sciatic nerve index(SFI)detection,gross observation and electrophysiological test;the specimens were obtained from the sacrificed rats for nerve regeneration,gastrocnemius muscle wet weight,fiber diameter and cross-sectional area of the gastrocnemius muscle(by HE staining).ResultsAt 2,4,6 and 8 weeks after operation,every six rats were chosen to be tested.The SFI,nerve conduction velocity and wet weight of the muscle of NGF+ATP group were better than those of the other three groups(P ＜ 0.05).The swelling of the rat toes of NGF+ATP group was slighter than that of NGF group and ATP group,with no loss of toes found in NGF+ATP group.At the 2nd week after operation,new nerve fibers were observed in the regeneration room,with no connection of the nerve fibers.The nerve fibers crossed the regeneration room at 4,6 and 8 weeks after operation.Compared with other three groups,the nerve growth condition was better in NGF+ATP group,with slighter adhesion and inflammation of nerve fibers.The growth condition of the nerve fibers of NGF group was better than ATP group,and that of NGF group and ATP group was better than NS group.At 2,4,6 and 8 weeks after operation,the electrophysiological condition and wet weight of muscle in NGF group was better than those in ATP group.While the SFI,the cross area and diameter of the muscle in NGF group were better than ATP group at 4,6 sand 8 weeks(P ＜ 0.05).All the parameters in NGF group and ATP group were better than NS group at each time point(P ＜ 0.05).Conclusions(1)The unification effect of NGF and ATP exert apparent effect in repair of the injured nerve and on the denervated muscle.Combined application of NGF and ATP is superior than NGF or ATP used alone.(2)A certain effect of ATP in repair of the injured nerve and on the denervated muscle is detected,but it is inferior to NGF and NGF+ATP.

Objective To evaluate the clinical effect of dual-plate for treatment of comminuted distal humerus fractures in adult. Meth-ods 28 patients with distal humeral fractures were treated with condylar anatomical plate interal fixation. The supracondylar fracture was fixed with condylar anatomical plating, and the two plates were kept in 90°with each other. Results The 28 cases were followed up average-ly 26 months (12 to 34 months). All fractures healed and there was no delayed union or nonunion cases. According to Cassebaum scoring system, there were 9 cases of excellent,14 cases of good, 4 cases of moderate and 1 case of bad. According to Morrey-Chao scoring system, there were 16 cases of cases,11 cases of good. The average time of bone healing was 10 weeks. Conclusion In treatment of comminuted distal humerus fractures in adult, open reduction and dual-plate internal fixation can get good clinical results. The placement of the dual-plate may depend on surgeon experience and preference and the fracture pattern present.

Objective To compare the clinical effect of vacuum sealing drainage and traditional methods on open tibial fractures of Gustilo grade-Ⅲ.Methods Seventy-eight patients with open tibial fractures of Gustilo grade-Ⅲ were divided into two groups,43 patients in observation group were treated by vacuum sealing drainage,while 35 patients in control group were treated by traditional methods.The operative quality,postoperative recovery condition,clinical effect and rate of adverse reaction were analyzed between two groups.Results As for the hospital stays,healing time of wound and fracture,the observation group were significant shorter than control group (P＜0.05).The excellent and good rate of observation group was 83.72％,which was significantly higher than that of control group 65.71％ (P ＜0.01).The adverse reaction rate of observation group was 6.98％,which was significantly lower than that of control group 17.14％ (P＜0.05) Conclusions Vacuum sealing drainage used for treatment of open tibial fractures of Gustilo grade-Ⅲ can shorten wound and fracture healing time,reduce the incidence of adverse reaction and improve the clinical effect.It is worth of popularization and application.

BACKGROUND:Osteoprotegerin and nitrogen monoxidum play a key role in the prevention and treatment of osteoporosis. However, the correlation of the two in inhibiting the proliferation and differentiation of osteoclasts remains unclear.
OBJECTIVE:To observe the effect of different doses of osteoprotegerin on nitric oxide production and endothelial nitric oxide synthase activity in osteoclasts.
METHODS:Tartrate resistant acid phophatase staining was used to test whether the induced cells are osteoclasts. Osteoclasts were divided into six groups:blank control group (no reagent);negative control group (DMEM);four osteoprotegerin groups (10, 25, 50, 75μg/L of osteoprotegerin). Annexinv-FITC kit and flow cytometry were used to test the apoptosis rate of osteoclasts. Real-time PCR was used to detect the expression of osteoclasts marker gene, TRAP mRNA and protein kinase K mRNA. Nitric oxide production and nitric oxide synthase activity were determined using the corresponding kits. Four osteoprotegerin groups were added with L-NAME, a kind of nitric oxide synthase inhibitor, to test the changes of the apoptosis rates of osteoclasts and the changes of the expression of TRAP mRNA and protein kinase K mRNA of osteoclasts.
RESULTS AND CONCLUSION:Osteoprotegerin inhibited the differentiation of osteoclasts and induced the apoptosis. Osteoprotegerin concentration had a positive correlation with the apoptosis rate of osteoclasts, and a negative correlation with the numbers of osteoclasts and expression of marker gene TRAP mRNA and protein kinase K mRNA in osteoclasts. Osteoprotegerin boosted the nitric oxide production and endothelial nitric oxide synthase activity, and osteoprotegerin concentration was positively correlated to the nitric oxide production and endothelial nitric oxide synthase activity. After Raw264.7 cells were in vitro cultured, osteoprotegerin and nitric oxide play a synergic role in inhibiting osteoclasts production and promoting the apoptosis. We speculate that there is osteoprotegerin/endothelial nitric oxide synthase/nitric oxide signal pathway.

BACKGROUND:Nano-hydroxyapatite/collagen (NHAC) is an ideal substitute for tissue engineered stent. Vascular endothelial growth factor (VEGF) is a kind of growth factor that can promote vascularization and slowly release NHAC. This indicated a good bone tissue repair function. OBJECTIVE:To investigate the effect of NHAC combined with VEGF in repairing bone defects. DESIGN,TIME AND SETTING:The randomized controlled animal study was performed at the Animal Laboratory,Xiangya Medical College,Central South University from October 2008 to January 2009. MATERIALS:Nano-hydroxyapatite powder and collagen protein powder were mixed and prepared into NHAC artificial bone according to the ratio of 8:2. 2 ?g of VEGF and NHAC were mixed and prepared into NHAC/VEGF artificial bone according to the ratio of 1.8:1. Each artificial bone contained 0.5 g nano-hydroxyapatite powder,0.125 g collagen protein and 150 ng VEGF. METHODS:Thirty-six healthy rabbits whose left radiuses were cut off 1 cm were divided into three groups. The wounds of the rabbits in blank group were sewed up directly without any treatment of the bone. The bone defects of the rabbits in NHAC group were repaired with NHAC artificial bones and the NHAC/VEGF group with NHAC/VEGF artificial bones. MAIN OUTCOME MEASURES:After 2,4 and 8 weeks,4 rabbits in each group were killed to evaluate whether they have significant differences of bone healing according to general observation,radiograph,pathological section and bone density test. RESULTS:Radiograph showed that osteotylus growth and the repairing of bone defects in the NHAC/VEGF group were better than in the blank group and NHAC group. It was better in the NHAC group than in the blank group. The difference in bone density of two groups in the same time was significant (P

Objective To evaluate of the clinical effect of triple arthrodesis and bone grafting combined with plat screw internal fixation for treatment of necrosis of talus. Methods The clinical data of 24 patients with necrosis of talus who were treated by triple arthrodesis and bone grafting combined with plat screw internal fixation from April 2011 to January 2015 in Xiangya Second Hospital of Central South Univer-sity were retrospectively analyzed. And the clinical effect were measured by AOFAS Ankle Hind-foot Scale System. Results The 24 patients were followed up for 26 months averagely (12~36 months). According to AOFAS Ankle Hind-foot Scale System, there were 4 cases of mod-erate and 20 cases of bad before treatment, and there were 18 cases of excellent, 4 cases of good, and 2 cases of moderate after the treat-ment. Conclusion It can achieve good clinical results in treatment of necrosis of talus through triple arthrodesis and bone grafting combined with plat screw internal fixation.