Objective To explore the methods of repairing cartilagedefects and to introduce the clinical experience with the autologous osteochondral transplantation. Methods Twenty-five patients with chondral and osteochondral defects of the weight-bearing surfaces were treated by the autologous osteochondral transplantation for the repair of the chondral and osteochondral defects of the unweightbearing surfaces under arthroscope. According to the shape of the defects, the different dimensions of the osteochondral autograft were selected. All the patients began the training of the continuous passive motion after operation. Six weeks after operation, the patients began to walk in the weightbearing habitus. However, in the control group, another 25 patients were retrospectively analyzed, who had chondral and osteochondral defects of the weight-bearing surfaces but were treated only by the cleaning and drilling procedures. The scores evaluated bythe Brittberg-Peterson scoring scale of the 2 group were 98.65±9.87 and 96.98±8.94 respectively. Results The follow-upfor 3-24 months after operation revealed that the treated knee joint had a goodmotion extent. The pain was obviously alleviated. Based on the longitudinal study with the three-dimensional spoiled magnetic resonance imaging (MRI), the signal intensity of the repaired tissues approached to the normal condition. The scores evaluated by the Brittberg-Peterson scoring scale were almost zero 3 monthsafter operation in the experimental group, and the scores were 58.48±6.98 inthe control group. There were significant differences between the experimental group and the control group(P＜0.01). Conclusion Autologous osteochondral transplanation under arthroscope is a good curative method for the cartilage defects, with advantages of minimal invasiveness and avoidanceofrejections resulting from allografts. However, its long-term effect needs to befurther studied. The conventional therapies including cleaning and drilling are useful in alleviating the symptoms.
OBJECTIVE: To investigate the effect of heterogeneous (swine) acellular dermal matrix (s-ADM) and autologous overthin split-thickness skin (auto-OTS) composite grafting in repair of deep burns at articular sites. METHODS: From May 1999 to April 2000, 19 articular sites in 16 patients, including 14 males and 2 females, were treated. In all the 19 sites of deep burn, the total burn area varied from 2% to 48% and the full-thickness burn area varied from 1% to 35%. After the primary escharectomy (1 to 5 days later) and complete hemostasis, the s-ADM was utilized to cover the exposed articular sites and the auto-OTS was transferred on the surface of sutured s-ADM. The size of s-ADM applied to each patient varied from 25 cm2 to 150 cm2. Regular skin grafting was adopted elsewhere other than the articular site. The survival rate of all skin grafting was evaluated and pathological examination was performed. RESULTS: The survival rate of the composite skin was (90.80 +/- 18.34)%, which was obvious higher than the survival rate of contiguous granulosum skin grafting (P lt; 0.05) and almost the same with that of snip skin grafting(P gt; 0.05). The survived composite skin appeared as smooth and soft as normal skin, and the function of articular site almost recovered with neglectable hypertrophic scar. The pathological examination revealed that the normal cell grew into s-ADM with regularly arranged collagen fiber and neovascularization in the matrix. CONCLUSION: The combination of s-ADM and auto-OTS graft is cheap and effective method to cover wound and minimize hypertrophic scar.
OBJECTIVE: To observe the clinical results in the anterior stabile operation of spinal fracture using red blood salvage. METHODS: Nineteen cases with spinal fracture were performed the anterior decompress operation. Blood cell salvage were used during operation. Other 20 cases were also reviewed as control group, who were received the same operation without blood cell salvage. RESULTS: In the 19 cases, average volume of autologous transfusion was 536 ml. Only two cases had homologous transfusion requirements. In the control group, all cases needed homologous transfusion (averaged 947 ml). CONCLUSION: In the anterior decompress operation, the intraoperative blood salvage is highly effective in reducing transfusion and also improves the security of operation
ObjectiveTo evaluate the effectiveness of autologous costal cartilage-based open rhinoplasty in the correction of secondary unilateral cleft lip nasal deformity.MethodsBetween January 2013 and June 2020, 30 patients with secondary unilateral cleft lip nasal deformity were treated, including 13 males and 17 females; aged 14-41 years, with an average of 21.7 years. Among them, 18 cases were cleft lip, 9 cases were cleft lip and palate, and 3 cases were cleft lip and palate with cleft alveolar. The autologous costal cartilage-based open rhinoplasty was used for the treatment, and the alar annular graft was used to correct the collapsed alar of the affected side. Before operation and at 6-12 months after operation, photos were taken in the anteroposterior position, nasal base position, oblique position, and left and right lateral positions, and the following indicators were measured: rhinofacial angle, nasolabial angle, deviation angle of central axis of columella, nostril height to width ratio, and bilateral nasal symmetry index (including nostril height, nostril width, and nostril height to width ratio).ResultsThe incisions healed by first intention after operation, and no complications such as acute infection occurred. All 30 patients were followed up 6 months to 2 years, with an average of 15.2 months. During the follow-up, the patients’ nasal shape remained good, the tip of the nose and columella were basically centered, the back of the nose was raised, the collapse of the affected side of nasal alar and the movement of the feet outside the nasal alar were all lessened than preoperatively. The basement was elevated compared to the front, and no cartilage was exposed or infection occurred. None of the patients had obvious cartilage absorption and recurrence of drooping nose. Except for the bilateral nostril width symmetry index before and after operation, there was no significant difference (t=1.950, P=0.061), the other indexes were significantly improved after operation when compared with preoperatively (P<0.05). Eleven patients (36.7%) requested revision operation, and the results were satisfactory after revision. The rest of the patients’ nasal deformities were greatly improved at one time, and they were satisfied with the effectiveness.ConclusionAutologous costal cartilage-based open rhinoplasty with the alar annular graft is a safe and effective treatment for secondary unilateral cleft lip nasal deformity.
Objective To investigate the clinical result of treatment of bonecyst by transplantation of the autologous bone marrow combined with the allograft bone. Methods From February 2004 to March 2006, 13 patients withbone cyst were treated by transplantation of the autologous bone marrow combined the the allograft bone. Among the 13 patients, 6 were males and 7 were females, ranging in age from 5 to 16 years, averaged 11.5 years. In the patients, 5 lesions were located inthe proximal humerus, 2 in the femoral neck, 3 in the femoral shaft, 2 in the proximal tibia, and 1 in the distal tibia. Among the patients, 5 had a complication of pathologic fracture. All the patients underwent an erasion of the bone cyst, and then the transplantation of the autologous bone marrow combined with the allograft bone, and 8 of them were also given an instrument fixation. Results The follow-up for 6 months to 2 years after operation revealed that 5 of the patients had an incision healing by the first intention, 5 had an effusion in the incision site, and 3 had a delayed healing of the incision. According to the Capanne criteria, the postoperative X-ray findings indicated that 10 patients had Grade Ⅰ healing, and 3 had Grade Ⅱ healing. The complete healing took 3.5-8 months,averaged 5.2 months. There was no recurrence. When the fixation instrument was removed, no pathologic fracture occurred. The function of the upper and lower limbs recovered. Conclusion Transplantation of the autologous bone marrow combined with the allograft bone is an effective and safe procedure for treatment of bone cyst.
Objective To evaluate the cl inical effect of local autogenous bone chips extended with allogeneic bone grafts in the posterolateral lumbar fusion. Methods From March 2005 to April 2007, 22 cases which underwent posterolaterallumbar fusion with allograft bone mixed with local autograft bone were analyzed retrospectively. The postoperative temperature, drainage flow and heal ing time of the incision were analyzed; postoperative lumbar pain was evaluated by visual analog scale (VAS) and JOA score; the postoperative efficacy was assessed by MacNab criteria and Oswestry disabil ity index (ODI); the fusion rate was defined by Jorgenson fusion criteria. Results All cases were followed up for 17-35 months with an average of 21 months, the wound all healed by first intention; no red swell ing, exudation and infection occurred. The excellent and good rate was 81.8% for JOA score (excellent in 4 cases, good in 14 cases, fair in 4 cases), 77.3% for MacNab criteria (excellent in 4 cases, good in 13 cases, fair in 5 cases) and 90.9% for ODI index (excellent in 3 cases, good in 17 cases, fair in 2 cases). The postoperative X-ray fusion rate within 1 year was 90.9%. Conclusion Allograft bone mixed with local autograft bone can achieve good efficacy and fusion rate in posterolateral lumbar fusion.
Objective To determine the effectiveness and safety of autologous platelet-rich gel in the management of diabetic foot ulcer. Methods We searched Cochrane Central Register of Controlled Trails (CENTRAL), MEDLINE or PubMed, EMbase, OVID Database, Chinese Biological Medicine Database (CBMDisc), CNKI, Chinese VIP Database and WANFANG Database. We also handsearched the bibliographies of retrieved articles and correlated proceedings. The systematic review was conducted using the method recommended by the Cochrane Collaboration. Results Four trials involving 216 patients were included. Meta-analyses showed (1) Diabetic foot ulcer healing rate: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (2) Diabetic foot ulcer reduction rate: Autologous platelet-rich gel was superior to the standard care (P=0.000 3); (3) Diabetic foot ulcer healing time: Autologous platelet-rich gel was superior to the standard care (Plt;0.000 01); (4) Complications: No patient in these trials had complications. Conclusions The limited current evidence shows that autologous platelet-rich gel is safe and effective in the short-term treatment for diabetic foot ulcer.
The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
Objective To evaluate the mid-term outcome of impacting bone graft and strut graft in treating osteonecrosis of the femoral head (ONFH) and to compare the effects of fibular autograft and allograft for strut graft. Methods From August 2004 to December 2004, 40 cases (58 hips) of ONFH were treated with impacting bone graft and nonvascular fibular autograft (autograft group) or allograft (allograft group). In the autograft group, 20 cases (27 hips) included 17 males (23 hips) and 3 females (4 hips) with an average age of 41 years (22-53 years); 22 hips were at stage II and 5 hips at stageIII according to the classification system of Association Research Circulation Osseous (ARCO). In the allograft group, 20 cases (31 hips) included 17 males (25 hips) and 3 cases females (6 hips) with an average age of 40 years (18-55 years); 23 hips were at stage II and 8 hips at stage III according to the classification system of ARCO. The outcome was evaluated both cl inically by Harris hip score (HHS) and radiologically by X-rays. The related compl ications were recorded. The end-point of observation was determined when further salvage operation or total hip arthroplasty was needed. Results All cases were followed up for 36-40 months (mean 37.5 months), 25 hips (92.6%) preserved femoral heads in autograft group and 28 hips (90.3%) in allograft group. Harris score in autograft and allograft groups was increased significantly from 70.82 ± 8.26 and 69.94 ± 9.59 before operation to 86.36 ± 6.27 and 87.45 ± 7.03 at the last follow-up, respectively, indicating a significant difference between before and after operation in two groups (P lt; 0.05), but no significant difference between two groups (Pgt;0.05). The radiological results showed that 17 hips (63.0%) in autograft group and 21 hips (67.8%) in allograft group improved or had no further collapse; and 20 hips (74.1%) in autograft group and 22 hips (71.0%) in allograft group were in good repair, indicating no significant difference between two groups (P gt; 0.05). The postoperative compl ication occurred after weight-bearing walk in the autograft group and during wound heal ing stage in the allograft group. Conclusion For selected cases of femur head necrosis, the treatment with modified impacting bone graft and strut graft has a satisfactory mid-term outcome. The results of fibular autograft and fibular allograft had no significant difference.
Objective To explore the effective autologous bone marrow stem cell dosage for treatment of severe lower limb ischemia. Methods From December 2003 to December 2004, 22 cases of bilateral lower limb ischemia were treated with autologous bone morrow cell transplantation. All the patients were randomly divided into two groups according to ischemia degree. In group A(severe ischemia side), the amount of transplanted autologous bone marrow cells was more than 1×108, and ingroup B(mild ischemia side), the amount was less than 1×105. A series of subjective indexes, such as improvement of pain, cold sensation and numbness, and objective indexes, such as increase of ankle/brachial index (ABI) and transcutaneous oxygen pressure (TcPO2), angiography, amputation rate, and improvement of foot wound healing were used to evaluate the effect of autologous bone marrow stem cells implantation. Results The rates of pain relief were 90.0% in group A and 16.7% in group B (Plt;0.01); the rates of cold sensation relief were 90.5% in group A and 5.3% in group B（Plt;0.01）;the improvement of numbness was 62.5% in group A and 9.1% in group B（Plt;0.01）. Increase of ABI was 31.8% and 0 in groups A and B respectively（Plt;0.01） at 4 weeks after implantation. Increase of TcPO2was 94.4% and 11.1% in groups A and B respectively（Plt;0.01） at 4 weeks after implantation. Twelve cases of angiography showed rich new collateral vessels in 100% of the limbs in group A while no remarkable new collateral vessel in group B. The amputation rates were 4.5% in group A and 27.3% in group B（Plt;0.05） at 4 weeks after implantation. The rate of improvement of foot wound healing was 75% in group A and there was no changein wound healing in group B after 4 weeks of implantation. Conclusion The effectiveness of autologous bone marrow stem cell implantation depends on the number of implanted stem cells. Effectiveness is expected in most patients if the implanted stem cell is more than 1×108, whereas there would be little effect if the cell number is less than 1×105.