Objective To investigate therapeutic effects of β-TCP/PLGA scaffolds seeded bone marrow mesenchymal stem cells (BMSCs) combing with hyperbaric oxygen (HBO) on bone defect with seawater immersing in rabbit radius.Methods BMSCs were seeded into the β-TCP/PLGA scaffolds to construct tissue engineering bone.60 New Zealand rabbits were created 1.5 cm bone defect in bilateral radius,and then bilateral wound limbs were immersed in seawater for 3 h.After debridement,all rabbits were randomly divided into 4 groups.In group A nothing was implanted into the bone defect.Only BMSCs was implanted in group B.BMSCs + HBO was given in group C.β-TCP/PLGA BMSCs + HBO was given in group D.At postoperative 4,8,12 weeks rabbits were sacrificed after radiography radius.X-ray radiography,HE staining,immunohistochemical observation were used to evaluate repairing effect of bone defect with seawater immersing.Results Radiographic analysis demonstrated that the bone defects were completely repaired with recanalization of the medullary cavity in group D,bone defects were partially repaired with partal recanalization of the medullary cavity in group C,bone defects were incompletely repaired in group B;bone defect repair unfinished and the broken ends were sclerous in group A.Each time point group D＞group C＞group B＞group A in callus grey value (P＜0.05).HE staining indicated after 12 weeks,a small amount of lainellar bone formated in group A;a small amount of lamellar bone formated in group B;a large amount of lamellar bone formated in group C;a large amount of lamellar bone formated in group D.Immunohistoehemical result indicated at postoperative 4 weeks,the expressions of osteocalcin(OCN) in each group were at high levels,the expressions decreased significantly at Postoperative 8 weeks,the expressions were at a low level at postoperative 12 weeks.At postoperative 4 and 8 weeks,the expression levels of OCN were group D＞ group C＞ group B＞group A (P＜0.05),there was no significant difference at postoperative 12 weeks between the 4 groups (P＞0.05).Conelusion the β-TCP/PLGA composite BMSCs combined hyperbaric oxygen is the effective method to repair seawater immersed bone defect in rabbit.

Objective To investigate the effects of HBO on open tibial fracture coupled with seawater immersion in rabbits and the possible mechanism involved.Methods Forty-eight New Zealand rabbits were selected and randomly divided into the HBO group and the control group,each consisting of 24 animals.The animals of both groups were inflicted with unilateral open tibial fracture.The injured limbs were immersed in artificial seawater for 3 hours,and then had wound suture and internal fracture fixation after debridement.The animals in the HBO group was immediately treated with HBO,once a day for a succession of 2 weeks,whereas the animals in the Control group were left there untreated.At week 4,8 and 12 after injury,the animals were sacrificed and samples (8 limbs from each group) were collected for further study.The repair of the fractured tissues of both groups was compared by radiography,histology and immunohistochemistry.Results (1)Histopathology was performed by HE staining.At week 12 after injury,for the animals in the HBO group,osseous callus could universally be seen in the fracture zone,cell components were basically mature bone cells,and the infiltration of inflammatory cells could scarcely be seen,while for the animals in the Control group,mixed bone callus could mainly be noted in the fracture zone,but cartilage cells were still visible,and a small scale of inflammatory cell infiltration could also be observed.(2) Immunohistochemistry revealed that vascular endothelial growth factor (VEGF) was mainly expressed in the cytoplasm of osteoblast,chondrocytes and osteocyte,and significant changes could be seen at different time points.At week 4 after injury,the expression levels of the two groups were the highest.At week 8 and 12 after injury,the expression levels all gradually dropped to a relatively low level.At week 4 and 8 after injury,the expression level of the HBO group was obviously stronger than that of the Control group(P ＜0.01).However,at week 12 after injury,no significant differences could be noted in the expression levels between the 2 groups (P ＞ 0.05).(3) Radiographic imaging was performed for the detection of callus grayscale in the fracture zone.At week 12 after injury,the average value of callus grayscale in the fracture zone for the animals of the HBO group was (190.58 ± 7.52),while that of the Control group was (144 ± 8.11).Statistically significance was shown,when comparisons were made between the 2 groups (P ＜0.01).(4)At week 4 after injury,the content of malondialdehyde (MDA) in the soft tissue around the fracture zone in the animals of the HBO group was significantly lower than that of the Control group,and the activity of superoxide dismutase (SOD) in the animals of the HBO group was higher than that of the Control group.Statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.01).However,at week 8 and 12 after injury,there were no significant differences in the content of MDA and activity of SOD between the 2 groups (P ＞ 0.05).Conclusions In the treatment of open bone fracture coupled with seawater immersion,HBO could alleviate inflammatory reaction and reperfusion injury,enhance the proliferation of tissue cells,and was beneficial to the healing of bone fracture.For this reason,this regimen was a practical method for the repair of open bone fracture coupled with seawater immersion.

Objective To investigate the effects of HBO on open tibial fracture coupled with seawater immersion in rabbits and the possible mechanism involved.Methods Forty-eight New Zealand rabbits were selected and randomly divided into the HBO group and the control group,each consisting of 24 animals.The animals of both groups were inflicted with unilateral open tibial fracture.The injured limbs were immersed in artificial seawater for 3 hours,and then had wound suture and internal fracture fixation after debridement.The animals in the HBO group was immediately treated with HBO,once a day for a succession of 2 weeks,whereas the animals in the Control group were left there untreated.At week 4,8 and 12 after injury,the animals were sacrificed and samples (8 limbs from each group) were collected for further study.The repair of the fractured tissues of both groups was compared by radiography,histology and immunohistochemistry.Results (1)Histopathology was performed by HE staining.At week 12 after injury,for the animals in the HBO group,osseous callus could universally be seen in the fracture zone,cell components were basically mature bone cells,and the infiltration of inflammatory cells could scarcely be seen,while for the animals in the Control group,mixed bone callus could mainly be noted in the fracture zone,but cartilage cells were still visible,and a small scale of inflammatory cell infiltration could also be observed.(2) Immunohistochemistry revealed that vascular endothelial growth factor (VEGF) was mainly expressed in the cytoplasm of osteoblast,chondrocytes and osteocyte,and significant changes could be seen at different time points.At week 4 after injury,the expression levels of the two groups were the highest.At week 8 and 12 after injury,the expression levels all gradually dropped to a relatively low level.At week 4 and 8 after injury,the expression level of the HBO group was obviously stronger than that of the Control group(P ＜0.01).However,at week 12 after injury,no significant differences could be noted in the expression levels between the 2 groups (P ＞ 0.05).(3) Radiographic imaging was performed for the detection of callus grayscale in the fracture zone.At week 12 after injury,the average value of callus grayscale in the fracture zone for the animals of the HBO group was (190.58 ± 7.52),while that of the Control group was (144 ± 8.11).Statistically significance was shown,when comparisons were made between the 2 groups (P ＜0.01).(4)At week 4 after injury,the content of malondialdehyde (MDA) in the soft tissue around the fracture zone in the animals of the HBO group was significantly lower than that of the Control group,and the activity of superoxide dismutase (SOD) in the animals of the HBO group was higher than that of the Control group.Statistical significance could be seen,when comparisons were made between the 2 groups (P ＜ 0.01).However,at week 8 and 12 after injury,there were no significant differences in the content of MDA and activity of SOD between the 2 groups (P ＞ 0.05).Conclusions In the treatment of open bone fracture coupled with seawater immersion,HBO could alleviate inflammatory reaction and reperfusion injury,enhance the proliferation of tissue cells,and was beneficial to the healing of bone fracture.For this reason,this regimen was a practical method for the repair of open bone fracture coupled with seawater immersion.

Objective To explore the effects of HBO combined with percutaneous allogeneic bone marrow mesenchymal stem cells (BMSCs) grafting on the repair of rabbit radius open bone defect following seawater immersion.Methods Forty-eight New Zealand rabbits were randomly divided into 4 groups:the blank control group (group A),the(BMSCs) grafting group (group B),the HBO group (group C),and the HBO combined with BMSCs group (group D).A fifteen-millimeter bone defect was made in the mid-section of radius and then was immersed in the artificial seawater for 3 hours,then the wound was closed with debridement.The animals received HBO therapy the moment after completion of debridement.BMSCs grafting was administered 72 hours after debridement.The animals were sacrificed at week 4,8 and 12 to collect the samples (there were 4 rabbits from each batch of the group,and there were altogether 8 limbs).Repairs of the defect areas were compared between groups by means of radiographic scanning,histologic and immunohistochemical analyses.Results HE staining revealed that osteogenesis in the animals of group D at week 4 and 8 was the best,and group C was superior to group B.In the animals of group A,bone repair was not detected in the defect area,which was filled with scar tissue.At week 12 after injury,osteogenesis in the defect areas for the animals of group D was the best,which was mostly mature bone tissue.(2)Immunohistochemical detection indicated that VEGF and TGF-β1 were mostly expressed in the osteoblastic cells,cartilage cells and bone cell cytoplasm,and significant changes could be noted at different time points.At week 4 after injury,the expressions of VEGF and TGF-β1 all reached peak levels.At week 8,their expressions all decreased significantly,as compared with those at week 4 and 12,their expressions all decreased further to a low level.At week 4 and 8 after injury,the expression levels of VEGF and TGF-β1 for the 4 groups were in the following order:group D ＞ group C ＞ group B ＞ group A.Statistical significance could be seen,when comparisons were made between the groups (P ＜0.05).However,at week 12,no significant differences could detected when comparisons were made between the 4 groups (P ＞ 0.05).(3) Osteotylus measurement revealed that osteotylus grayness for the animals of group D,group C,group B and group A at week 12 after injury was 211.84 ± 4.31,200.31 ± 3.08,152.79 ± 4.43 and 80.88 ± 3.31 respectively,and statistical significance could be noted,when comparisons were made between the groups (P ＜ 0.05).Conclusions The effects of simple percutaneous allogeneic bone marrow mesenchymal stem cells grafting or simple HBO therapy on the repair of open bone defect following seawater immersion were not ideal.However,combined applications of these 2 treatment methods could produce synergistic effects,which could promote osteogenetic process of the affected bone and was an applicable method for the repair of open bone defect following seawater immersion.

Objective To explore the effects of HBO combined with percutaneous allogeneic bone marrow mesenchymal stem cells (BMSCs) grafting on the repair of rabbit radius open bone defect following seawater immersion.Methods Forty-eight New Zealand rabbits were randomly divided into 4 groups:the blank control group (group A),the(BMSCs) grafting group (group B),the HBO group (group C),and the HBO combined with BMSCs group (group D).A fifteen-millimeter bone defect was made in the mid-section of radius and then was immersed in the artificial seawater for 3 hours,then the wound was closed with debridement.The animals received HBO therapy the moment after completion of debridement.BMSCs grafting was administered 72 hours after debridement.The animals were sacrificed at week 4,8 and 12 to collect the samples (there were 4 rabbits from each batch of the group,and there were altogether 8 limbs).Repairs of the defect areas were compared between groups by means of radiographic scanning,histologic and immunohistochemical analyses.Results HE staining revealed that osteogenesis in the animals of group D at week 4 and 8 was the best,and group C was superior to group B.In the animals of group A,bone repair was not detected in the defect area,which was filled with scar tissue.At week 12 after injury,osteogenesis in the defect areas for the animals of group D was the best,which was mostly mature bone tissue.(2)Immunohistochemical detection indicated that VEGF and TGF-β1 were mostly expressed in the osteoblastic cells,cartilage cells and bone cell cytoplasm,and significant changes could be noted at different time points.At week 4 after injury,the expressions of VEGF and TGF-β1 all reached peak levels.At week 8,their expressions all decreased significantly,as compared with those at week 4 and 12,their expressions all decreased further to a low level.At week 4 and 8 after injury,the expression levels of VEGF and TGF-β1 for the 4 groups were in the following order:group D ＞ group C ＞ group B ＞ group A.Statistical significance could be seen,when comparisons were made between the groups (P ＜0.05).However,at week 12,no significant differences could detected when comparisons were made between the 4 groups (P ＞ 0.05).(3) Osteotylus measurement revealed that osteotylus grayness for the animals of group D,group C,group B and group A at week 12 after injury was 211.84 ± 4.31,200.31 ± 3.08,152.79 ± 4.43 and 80.88 ± 3.31 respectively,and statistical significance could be noted,when comparisons were made between the groups (P ＜ 0.05).Conclusions The effects of simple percutaneous allogeneic bone marrow mesenchymal stem cells grafting or simple HBO therapy on the repair of open bone defect following seawater immersion were not ideal.However,combined applications of these 2 treatment methods could produce synergistic effects,which could promote osteogenetic process of the affected bone and was an applicable method for the repair of open bone defect following seawater immersion.

Objective To identify the exact origin and insertion of plantar aponeurosis and the anatomic relationship of calcaneal spur to plantar aponeurosis. Methods Fourteen specimen of feet were dissected and radiographed. Three fetus feet were observed histologically. Sonographic evaluation was carried out on 20 normal adults and 52 patients with plantar fasciitis. Results (1) Anatomic observation found that plantar aponeurosis was located under the medial process of caleaneus but not attached to it, and proximally attached to the plantar aspect of calcaneal tuborosity. The insertion (origin) of plantar aponeurosis was not a point but a face. Posteriorly the plantar aponeurosis and fascia of Archlles heel were fused or transmigrated together,entirely covered and attached very coherently to the plantar and posterior aspect of calcaneal tuborosity. (2) Histological observation of heel of fetuses found plantar aponeurosis and fascia of Arehlles heel were eosinophil band-like structure. Both continued at the plantar and posterior aspect of calcaneus and attached closely to bone at this area. There were no significant demarcation between them. (3) Sonographic evaluation:normal plantar aponeurosis showed a thin band-like echo, its orgin attached to entire plantar aspect of calcaneal tuberosity and continued with fascia coming posteriorly from Archlles heel. No distinct boundary existed between these two fascias. When plantar fasciitis occurred, the orgin of plantar aponeurosis thickened significantly,this phenomenon could be detected in wholly plantar aspect of calcaneal tuberrosity. The heel spur didn't located within plantar aponeurosis. Conclusions Plantar aponeurosis orginates from entire plantar aspect of cancaneal tuberosity. Heel spur oeeures in the orgin of the intrinsic musculature, such as flexor digitorum brevis,and doesn't locate within plantar aponeurosis.

[Objective]To evaluate the effects of percutaneous plantar fasciotomy guided by real-time B-ultrasound in the treatment of recurrent plantar fasciitis. [Method]From June 1997 to May 2007,611 feet of 472 patients suffering from recurrent plantar fasciitis were treated with percutaneous plantar fasciotomy guided by real-time B-ultrasound.All the patients were aged from 20~71 years(mean 53.4 years) with the duration of disease from 6 months to 20 years(median 12 months).There were 177 males and 295 females.One foot was involved in 285 and two feet in 187 patients.A total of 611 feet,with the illness duration more than 6 months and VAS(Visual Analog Scale) ≥6 and having B-ultrasound manisfestations such as thickening of plantar fascia on calcaneum,were underwent percutaneous plantar fasciotomy guided by real-time B-ultrasound.Before operation VAS was 6 to 10(mean 8.4).Totally 376 patients were followed from 6 to 36 months(mean 18.4 months).[Result]Postoperative VAS was 0 in 349(92.8%),1~2 in 27 patients(7.2%).The time needed to achieve best postopetative effect was 7 days to 6 months.Of all the patients,302(80.3%) achieved the best effect within 7 to 14 days,56(14.9%) within 2 to 3 months and 18(4.8%) within 4~6 months.No patients were found to have complicated incision infection or injuries to medial or lateral plantar vessels and nerves.Incision scar was not obvious in all cases.[Conclusion]It can be concluded that percutaneous plantar fasciotomy guided by real-time B-ultrasound is a simple,safe and effective operative procedure in the treatment of recurrent plantar fasciitis.