Three-column plate internal fixation for the treatment of complex tibial plateau fracture through antero-midline and postero-medial approaches / 中国骨伤

<p><b>OBJECTIVE</b>To study technique and clinical therapeutic effects of internal fixation with three-column plates for the treatment of complex tibial plateau fractures through antero-midline and postero-medial approaches.</p><p><b>METHODS</b>From January 2010 to December 2012, 28 patients with complex tibial plateau fractures were treated with internal fixation using three-column plates through antero-midline and postero-medial approaches. There were 17 males and 11 females, with an average age of 45.3 years old (ranged, 28 to 64 years old). Twelve patients had injuries in the left side and 16 patients had injuries in the right side. According to Schatzker classification, 12 patients were type V, 16 patients were type VI. According to three-column classification, all the patients had injuries of lateral, medial and posterior columns. The mean interval from injury to operation was 9.4 days (ranged, 6 to 15 days). The main clinical symptoms were knee joint swelling, deformity and limitation of motion before operation. The X-ray and CT showed all patients had complex tibial plateau fractures, which involved in the lateral, medial and posterior columns. The therapeutic effects were evaluated by fracture healing time, hospital for special surgery knee score (HSS) at one year after operation. The indexes such as tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FfA) were compared between immediate postoperation and one year after operation.</p><p><b>RESULTS</b>All incisions primarily healed without postoperative complications such as infection and cutaneous necrosis. All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of 18.1 months. The bone union time ranged from 5 to 10 months (mean, 7.8 months) after operation. Knee joint swelling and pain disappeared after bony union, and joint function completely recovered. The results of hospital for special surgery knee score (HSS) was 27.81 ± 2.17 in pain, 19.52 ± 2.05 in function,15.82 ± 1.73 in passive range of motion, 8.51 ± 1.32 in muscle strength, 8.33 ± 1.08 in flexion deformity, 9.36 ± 0.52 in joint stability, and the total mean score was 89.35 ± 3.19. According to results of HSS, 20 patients got an excellent result, 5 good,2 fair and 1 poor. There were no significant differences in tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FTA) between immediate postoperation and one year after operation.</p><p><b>CONCLUSION</b>Three-column plate internal fixation for the treatment of complex tibial plateau fractures through antero-midline and posteromedial approaches is effective to achieve anatomic reduction,rigid internal fixation and early functional exercise.</p>

Effects of Huoxue Zhitong decoration on transmembrane protein I and II induced apoptosis of signal transmission of the epidural scar tissue / 中国骨伤

<p><b>OBJECTIVES</b>To study the effect of Houxue Zhitong decoration on the expression of the mitochondria-initiated apoptosis pathway and transmembrane protein I an II of the epidural scar tissue.</p><p><b>METHODS</b>A total of 60 New Zealand rabbits (weight: 2.5-3.0 kg) were randomly divided into four groups, sham operation group (D, n=15), control group (B, n=14), sodium hyaluronate group (C, n=15), Houxue Zhitong decoration group (D, n=15). Except for group A, 1.0 cm x 1.0 cm dura mater uncovered area laminectomy was performed at I (4) and I(5), covered with 0.5 ml sodium hyaluronate in group C, covered with same amount of saline in group B and D. First 2 weeks after operation, animals in group D were lavaged with 2.5 ml/kg Houxue Zhitong decoction by one a day for 14 days. Five rabbits of each group selected randomly were killed in the 2,4,8 weeks after laminectomy. The specimens were prepared for determination of the expression of Fas and FasL, at scar tissue by semiquantitative reserve transcription-polymerase chain reaction (RT-PCR). The degree of scar adhesion was evaluated according by Rydell method.</p><p><b>RESULTS</b>The adhesion area in group B was larger than of group C and D in the 4th and 8th week. However, the number of fibroblasts and inflammantory cells in group D was the least among the three groups in the 8th week. At 2, 4, 8 weeks after operation, as compared with group B the expression of Fas, FasL of group C and D were decreased (P < 0.05). Especially, at 2 weeks, as compared with group B the expression of this two cytokines of group D was significant decreased (P < 0.05), too. In group C and D the duramater adhesion was decreased (P < 0.05). The proliferation of fibroblast and fibroblastic function were inhibited (P < 0.05).</p><p><b>CONCLUSION</b>Huoxue Zhitong is able to down-regulated the expression of Fas, FasL, which inhibited the proliferation of fibroblast, the fibroblastic function and the synthesis of extracellular matrix in the epidural scar tissue. It is an effective way of reducing peridural scar formation and prevent the failed back surgery syndrome.</p>

Effects of Huoxuezhitong recipe on the pathway of mitochondrial apoptosis and the expression of related gene in epidural scar tissue / 中国骨伤

<p><b>OBJECTIVE</b>To study the effect of Huoxuezhitong recipe on the pathway of mitochondrial apoptosis and the expression of related gene (Caspase-3, -9, Bax, Bcl-2) in epidural scar tissue.</p><p><b>METHODS</b>A total of 60 New Zealand rabbits, ranging in weight from 2.5 to 3.0 kg, were randomly divided into sham operative group (group A), control group (group B), sodium hyaluronate group (group C), Huoxuezhitong recipe group (group D, included Danggui 20 g, Chishao 20 g, Honghua 20 g, Ruxiang 15 g, Myrrh 15 g etc.) with 15 rabbits in each group. Except for group A, L4,5 vertebral plate were resected leading to 1.0 cm x 1.0 cm dura mater exposed area, which were covered with 0.5 ml sodium hyaluronate in group C, covered with same amount of saline in group B and D. At 2 weeks after operation, the rabbits of group D were administered with Huoxuezhitong recipe (2.5 ml/kg, once a day, continuous 14 d). Five rabbits of each group were selected randomly and were killed at 2, 4 and 8 weeks after operation; and the expression of Caspase-3, -9, Bax, Bcl-2 in scar tissue were surveyed by semiquantitative reverse transcription-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The results by RT-PCR showed significant different in expressions of Caspase-3, -9, Bax, Bcl-2 of group A and others groups at each period (P < 0.01). At 2, 4, 8 weeks after operation, compared with group B, the expressions of Caspase-3, -9, Bcl-2 in group C and D were decreased (P < 0.05), but the expression of Bax in group C and D were increased (P < 0.05). At 8 weeks after operation, the expressions of Caspase-3, -9, Bax, Bcl-2 in group D was significant decreased compared with group C (P < 0.05).</p><p><b>CONCLUSION</b>Huoxuezhitong recipe can regulate the levels of expression of Caspase-3, -9, Bax, Bcl-2 mRNA and further induce the pathway of mitochondrial apoptosis, thereby, achieve the effect of prophylaxis for the proliferation and conglutination of epidural scar tissue.</p>