Protective effects of Wuwei Xiaodu Drink against chronic osteomyelitis through Foxp3+CD25+CD4+ Treg cells via the IL-2/STAT5 signaling pathway / 中国天然药物

To explore the effectiveness and safety of a Chinese medicinal decoction Wuwei Xiaodu Drink (WWXDD) in inhibiting chronic osteomyelitis via regulatory T cells signaling. The effective constitutes of WWXDD and osteomyelitis related genes were screened. Target proteins were cross-validated using the Venny database. GO function and KEGG pathway analysis were performed for target proteins, while pharmacological network was constructed. The bone properties were analyzed by HE staining and the concentrations of immune factors were measured by ELISA. The expression of CTLA-4 and Foxp3 mRNA and STAT5, p-STAT5, CTLA-4 and Foxp3 protein were detected using Real-time PCR and Western blot, respectively. FACS was used to analyze the percentages of cells. A total of 117 genes overlapped between 785 target genes of the active compounds of WWXDD and 912 osteomyelitis related genes. Inflammation-related genes, including IL-6, TNFα, IL-1β and IL-2 showed high connection degree in the drug-compound-disease-target network. GO function and KEGG pathway analysis revealed that 117 intersection genes mainly enriched in virus infection related pathways, immune related pathways and chemokine signaling pathway. Furthermore, the development of chronic osteomyelitis was suppressed in model rats after treatment with WWXDD. Meanwhile, the concentrations of IL-2 and CD4+CD25+Foxp3 Treg percentages together with the levels of p-STAT5, CTLA-4 and Foxp3 were also down-regulated. Furthermore, IL-2 and WWXDD drug-containing serum exhibited opposite effects on regulating IL-2, IL-10, TGF-β1, Foxp3, CTLA4 and STAT5. In addition, a STAT5 phosphorylation inhibitor suppressed the expression of Foxp3 and CTLA-4. WWXDD can treat chronic osteomyelitis through suppressing the main regulating factors of Tregs and interfere its immunodepression. Our results bring a new solution for chronic osteomyelitis.

Surgical treatment of traumatic osteomyelitis of extremities with MRSA infection / 中国骨伤

OBJECTIVE@#To summarize and discuss the clinical efficacy and application value of intravenous drip of linezolid combined with local targeted sustained-release of vancomycin in the treatment of traumatic osteomyelitis of extremities infected with MRSA.@*METHODS@#Thirty patients with traumatic osteomyelitis of extremities infected by MRSA from March 2015 to March 2017 were analyzed retrospectively, including 21 males and 9 females; aged 25 to 64 years old, with an average age of(47.94± 6.23) years old;the course of disease ranged from 9 to 23 months, with an average of (15.68±6.23) months. The lesions were located in tibia in 18 cases and calcaneus in 12 cases. The causes of injury were fall injury in 12 cases, trafficaccident injury in 9 cases and fall injury in 9 cases. There were 22 patients with closed fractures and 8 patients with open fractures. There were 13 cases of internal fixation. Twenty-two patients had sinustract, 8 patients had soft tissue defect with bone and internal fixation exposure, soft tissue defect area ranged from 2.0 cm × 3.0 cm to 8.2 cm × 12.3 cm;10 patients had bone defect, defect area ranged from 0.5 to 3.4 cm;bacterial culture of sinus tract or wound secretion in all patients was MRSA. On the basis of thorough debridement, calcium sulfate artificial bone loaded with vancomycin was implanted in the lesion, and linezolid and glucose injection was given intravenously during the perioperative period. The patients were followed up regularly according to the time of antibiotic use, blood routine, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, liver and kidney function and other related laboratory indexes, X-ray, CT and other imaging examinations, bone healing, flap survival, joint function and McKee's osteomyelitis cure criteria.@*RESULTS@#All the patients were followed up, and the duration ranged from 3 to 6 years, with a mean of (4.23±0.76) years. No recurrence of osteomyelitis occurred. Fracture healing, infection control, wound healing and functional recovery were achieved.@*CONCLUSION@#Intravenous drip of linezolid combined with local targeted sustained-release of vancomycin for the treatment of MRSA infected traumatic osteomyelitis in limbs have significant effects and low recurrence rates.

Causes and strategies for postoperative bone nonunion after bone transport of lower limb bone of chronic osteomyelitis with bone defect / 中国骨伤

<p><b>OBJECTIVE</b>To explore causes and strategies for postoperative bone nonunion after bone transport of lower limb bone of chronic osteomyelitis with bone defect.</p><p><b>METHODS</b>From June 2012 to December 2015, clinical data of 38 patients with lower limb bone of chronic osteomyelitis with bone defect were retrospectively analyzed, including 23 males and 15 females aged from 20 to 56 years old with an average of 36.5 years old; 5 cases occurred on 5 femoral osteomyelitis and 33 cases were tibial;the time from injury to bone transport ranged from 2 to 19 months with an average of 7.4 months; the distance of bone defect ranged from 4 to 12 cm with an average of 7.3 cm. Bone transport were performed at 1 week later after operations, and transport directions were from near-end to far-end for 30 cases, from far-end to near-end for 3 cases and bidirectional transport for another 5 cases. The alignment and transport speed were adjusted and weight-bearing was encouraged. Regular follow-up was performed and X-ray films were taken to observe complications such as poor mineralization in transport gaps, nonunion of docking sites, and recurrent fracture. Paley scoring was used to evaluate clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 12 to 36 months with an average of 23.1 months. No recurrence of osteomyelitis, but multiple complications associated with poor bony healing occurred. In the process of bone transport, 3 cases occurred poor mineralization in transport gaps, 17 cases occurred ununion of docking sites, 5 cases suffered fracture gap, 1 case occurred fracture without remove of external fixation, and 4 cases occurred facture after remove of external fixation. The time of taken fixation ranged from 9 to 27 months with an average of 16.3 months; index of external fixation ranged from 1.7 to 2.7 months/cm with an average of 2.24 months/cm. According to Paley's scoring, bony results showed 12 cases excellent, 16 good, 3 moderate and 7 poor;and functional results showed 14 cases excellent, 18 good, 3 moderate and 3 poor.</p><p><b>CONCLUSIONS</b>Bone transport technique could effectively solve clinical problems of long bone osteomyelitis with bone defect. However, long treatment period influence prognosis. Therefore, indications should be chosen strict, and operations should be precise and accurate, also monitored across whole process and followed up in time. Doctors should be actively guide corresponding prevention strategies.</p>

Transfer of gastrocnemius muscle flap for postoperative infection with patellar internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effect of gastrocnemius muscle flap for repairing postoperative infection of patellar internal fixation.</p><p><b>METHODS</b>From January 2011 to January 2017, 15 patients with postoperative infection of patellar internal fixation were treated, including 9 males and 6 females ranged from 31 to 66 years old with an average age of (42.5±11.2) years old. The courses of disease ranged from 2 to 8 months with an average of (4.3±1.5) months. All wounds were repaired by gastrocnemius muscle flap after debridement. The coverage of muscle flap was performed by free skin graft and donor site was closed directly. Survival of muscle flap, healing of incision were observed. HUANG Yong-xin clinical criteria and KSS score criteria were used to evaluate knee joint function 9 after operation.</p><p><b>RESULTS</b>All muscle flaps were survived without necrosis. Incision of 13 patients were healed at stageI, and 2 patients had wound dehiscence after operation and healed after symptomatic treatment. All patients were followed up from 9 months to 30 months with an average of(20.6±8.3) months. No recurrence of infection was observed, and texture of muscle flap, skin color, appearance were good. According to HUANG Yong-xin clinical criteria, 13 excellent and 2 moderate. The clinical score of KSS score was 83.3±7.8, and functional score of KSS score was 86.3±10.4.</p><p><b>CONCLUSIONS</b>Gastrocnemius muscle flap is an effective method in repairing postoperative infection of patellar internal fixation with stable curative effect and low recurrence rate, which is worthy popularizing.</p>

Treatment of osteomyelitis and bone defect of femoral shaft by external fixation and bone transport / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the clinical effects and superiority of applying external fixation and bone transport to treat osteomyelitis and bone defect of femoral bone.</p><p><b>METHODS</b>From August 2008 to December 2013,16 patients with osteomyelitis and bone defect of femoral bone were treated including 11 males and 5 females with an average age of 42 years old ranging from 13 to 62 years old. The average course of disease was 18 months ranging from 2 months to 4.5 years, and the average length of bone defect was 7.8 cm ranging from 4.5 to 15 cm. The bone defect of all cases were treated by external fixation and bone transport, the bone transport began at 1 week after operation, 1 mm per day and 4 times per day.</p><p><b>RESULTS</b>All patients were followed up for 10 to 36 months (means 22.5 months). One patient did not cooperate with treatment leads to the failure, then took the amputation. The remaining 15 cases of osteomyelitis were under control, including 12 cases of bone transport achieved one stage bone union, 3 cases achieved bone union via bone graft from iliac bone. The bone union time was 5 to 13 months(means 7.9 months). Thirteen patients almost obtained the same length of two lower extremities,2 patients had shortening of 1.5 to 2 cm. The time of moving the external fixation was from 6 to 16 months (means 9.3 months).</p><p><b>CONCLUSION</b>Application of external fixation and bone transport is an effective method in treating the osteomyelitis and bone defect that can control the infection, eradicate wounds, and be the equalization of limb length.</p>

Improvement technique of double endobutton plate for the treatment of type III acromioclavicular joint dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of improvement technique of double Endobutton plate for the treatment of Tossy III acromioclavicular joint dislocation.</p><p><b>METHODS</b>From June 2008 to June 2009, 18 patients with Tossy III acromioclavicular joint dislocation were treated with improvement technique of double Endobutton plate. There were 11 males and 7 females, with an average age of 35 years old ranging from 28 to 55 years. The time from injury to operation was 2 to 5 days (means 3.5 days). All patients were followed and the clinical outcomes were recorded.</p><p><b>RESULTS</b>These 18 patients were followed up from 4 to 8 months (averaged 6 months). All acromioclavicular joint dislocation were reduced. According to the scales of Karlsson, the post-operation function 1 of shoulder-joint in 16 patients were A grade and 2 patients were B grade.</p><p><b>CONCLUSION</b>The improvement technique of double Endobutton plate is an effective ideal treatment methods for Tossy III acromioclavicular joint dislocation due to its less invasion and convenience and good biocompatibility.</p>