Reduction of adhesion formation after knee surgery in a rat model by botulinum toxin A.

Adhesion of the knee is a major concern after knee surgery, the treatment of which is difficult. Botulinum toxin A (BTX-A) injection is demonstrated as efficient in treating knee adhesion after surgery. However, the treatment outcomes and the mechanism of action are not yet determined. The aim of the present study was to examine the effects and molecular mechanism of a BTX-A treatment in preventing adhesion of the knee. Twenty-four Wistar rats were randomly divided into a BTX-A treatment group and a control group. BTX-A or saline was injected into the cavity of the knee in the BTX-A treatment or control group respectively. Gross and histopathological examinations of interleukin 1 (IL-1) and fibroblast growth factor (FGF) levels, as well as fibroblast cell numbers, were assessed in the knee intra-articular adhesions in each group 6 weeks after recovery from the surgery. Macroscopic observations showed a significant reduction in adhesion severity in the BTX-A treatment group compared with the control group. In addition, the levels of IL-1 and FGF were lower and the number of fibroblasts was smaller in the BTX-A treatment group compared with those in the control group. BTX-A prevented intra-articular adhesion of knee in the rats, which might be associated with reduced expressions of IL-1 and FGF.

[Manipulative reduction and percutaneous Kirschner wire internal fixation for grade IV supination-external rotation ankle fractures].

OBJECTIVE: To investigate surgical skills and clinical effects of manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures. METHODS: From May 2013 to October 2016, 35 patients with grade IV supination-external rotation ankle fractures were treated with percutaneous Kirschner wire internal fixation, involving 22 males and 13 females with an average age of 38.2 years ranged from 18 to 65 years old. The time from injury to operation ranged from 2 h to 10 d with an average of 5 d. Reduction quality was assessed by Burwell-Charnley radiological criteria. Baird-Jackson ankle scoring system was used to assess clinical effects. RESULTS: Thirty-three patients were followed up from 10 to 28 months with an average of 14 months. Fracture healing time ranged from 10 to 18 weeks with an average of 12 weeks. According to Burwell-Charnley radiological criteria, 30 cases were obtained anatomic reduction, 3 cases moderate. According to Baird-Jackson ankle scoring system, total score was 93.8±5.4, 17 cases got excellent result, 12 good, 2 fair and 2 poor. CONCLUSIONS: Manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures has advantages of reliable efficacy, less complications. But higher require techniques were required for closed reduction. It is not suitable for severe crushed fracture and compressive articular surface fracture.

[Comparative study on impacted high tibial osteotomy and conventional high tibial osteotomy for the treatment of flexional medial knee osteoarthritis in aged patients].

OBJECTIVE: To compare the therapeutic effect of impacted high tibial osteotomy and conventional high tibial osteotomy for the treatment of flexional medial osteoarthritis of knee joint in aged patients. METHODS: From July 2003 to July 2006, 30 patients with flexional medial knee osteoarthritis were treated with impacted high tibial osteotomy or conventional high tibial osteotomy randomly. All patients,aged from 60 to 82 years,were suffered from 7 degrees to 19 degrees knee flexion deformities and 3 to 20 years medical histories. The bone healing periods, the recover of flexion and inversion deformities, and the recover of the knee joint function were observed postoperatively. The patients were followed up at 4, 6, 8, 9, 10, 12 and 16 weeks, and 5, 7, 9 and 12 months postoperatively. The bone healing periods and the recover of flexional and inversion deformities were evaluated and compared. Twelve months postoperatively,the knee joint function were assessed with the Lysholm scoring criteria, and the therapeutic effects were compared between the two groups. RESULTS: There was a significant difference in the average bone healing period between the impacted high tibial osteotomy group (9.26 +/- 2.23) weeks and the conventional high tibial osteotomy group (11.53 +/- 3.15) weeks. The knee joint function were evaluated according to the Lysholm clinical rating scales. One year postoperatively,the average Lysholm score were (88.5 +/- 4.4) points in the impacted high tibial osteotomy group,and the results showed excellent in 14 cases, good in 1. The average Lysholm score were (78.1 +/- 5.7) points in the conventional high tibial osteotomy group. The results showed 8 cases excellent, 5 good, 2 fair, accordingly. Postoperatively, the flexion deformities of the knee in the impacted high tibial osteotomy group were -1.1 degrees to 0 degrees and was corrected averagely (130 +/- 3.30) after surgery, and that in conventional high tibial osteotomy group (140 +/- 3.30) (the same as preoperation). The average postoperative femorotibial angle (FTA) were 170.2 degrees (ranged from 169.1 degrees to 172.3 degrees) and was corrected 12.3 degrees to 12.5 degrees after surgery in both groups. CONCLUSION: Compared with conventional high tibial osteotomy, impacted high tibial osteotomy can significantly shorten the bone healing period, improve the knee flexion, varus deformity, and the knee function.