Therapeutic effects comparison between platelet-rich plasma and sodium hyaluronate intra-articular injection in treatment of knee osteoarthritis

目的关节腔内注射自体富血小板血浆（PRP）与透明质酸钠（SH）,观察并比较其疗效。方法于2012年2月至12月,漳州市解放军第175医院骨科收治的81例Kellgren-Lawrence（KL）分级标准为Ⅱ、Ⅲ级膝关节骨关节炎的患者,年龄48～60岁,平均（52.6±3.6）岁;男性27例,女性53例;左膝38例,右膝43例。K-L分级标准,Ⅱ级47例,Ⅲ级34例,按就诊顺序序贯随机平行分为SH组（40例）和PRP组（41例）,分别采用SH和PRP关节腔内注射进行治疗。治疗前和治疗后3、6、9、12个月对患者进行随访并进行美国西部Ontario与Mc Master大学骨关节炎指数（WOMAC）评分评估,两组间各时间点WOMAC评分比较采用t检验,两组内各时间点WOMAC评分比较采用重复测量方差分析;分别于治疗前和治疗后12个月进行膝关节磁共振检查,评价关节腔内积液的吸收情况。结果治疗前及治疗后3个月PRP组WOMAC评分[（48.42±4.95）分,（25.38±5.12）分]和SH组[（47.17±5.12）分,（25.17±5.09）分]比较,t值分别为-0.625和0.413,差异无统计学意义（P均〉0.05）;治疗后6、9、12个月PRP组WOMAC评分[（21.44±4.73）分,（20.54±4.46）分,（16.53±7.35）分]和SH组[（25.87±5.16）分,（27.22±4.21）分,（29.63±8.21）分]比较,PRP组低于SH组,t值分别为-2.765、-3.447和-4.657,差异具有统计学意义（P均〈0.05）,治疗后12个月复查磁共振,可见PRP组的关节积液吸收例数高于SH组,差异有统计学意义（P〈0.05）。结论膝关节腔内注射自体PRP,临床效果优于透明质酸钠,中长期疗效好。Objective To compare the efficacy of platelet rich plasma （PRP） and sodium hyaluronate （SH） intra-articular injection in the patients with knee osteoarthritis of grade Ⅱand Ⅲ. Methods A total of 81 patients with knee osteoarthritis of grade Ⅱ and Ⅲ （ Kellgren-Lawrence standard） were randomly assigned to the PRP and SH group. All 81 patients were treated in the 175th hospital of PLA, Zhangzhon, with the average age of （52.6 ± 3.6） years. There were 27 males and 53 females. Forty cases in SH group and 41 cases in PRP group had got the complete follow-up. Both the two groups adopted 4 ml of 5% lidocaine for intra-articular injection. All the patients were prospectively evaluated before the treatment and at the 34 , 6th , 9th and 12th month after the treatment by the Western Ontario and McMaster Universities （WOMAC） osteoarthritis index. The swelling subsiding knee was observed. Between the two groups WOMAC scores were compared using t test at each time point, within the groups the scores were compared by repeated measures analysis of variance. The absorption of accumulated fluid in the joint cavity was observed and compared by MRI before and 12 months after the treatment. Results No serious adverse event was detected in the two groups. According to the follow-up evaluations, both the groups presented clinical improvements. The comparison between the two groups showed no statistically significant difference before therapy and three months after the treatment （ t =- 0. 625, 0. 413, P 〉 0. 05 ）. Six months, nine months and 12 months after the treatment, WOMAC score in the PRP group[ （21.44 ±4. 73）, （20. 54 ± 4. 46） ,（16. 53 ± 7. 35 ） pointsl were lower than the SH group[（25.87 ±5.16）, （27.22 ±4.21）, （29. 63 ± 8.21 ） points] ; the difference was statistically signifieant（ t = - 2. 765, - 3. 447, - 4. 657, P 〈 0. 05 ）. Conclusion PRP intra-artieular injection in the treatment of knee osteoarthritis of gradeⅡ and Ⅲ may be more suitable compared to南京军区医学科技创新重点课题项目（15ZD027

Effects of a Sliding Plate on Morphology of the Epiphyseal Plate in Goat Distal Femur

The aim of this study was to observe the effects of a sliding plate on the morphology of the epiphyseal plate in goat distal femur. Eighteen premature female goats were divided randomly into sliding plate, regular plate and control groups. Radiographic analysis and histological staining were performed to evaluate the development of epiphyseal plate at 4 and 8 weeks after surgery. In the sliding plate group, the plate extended accordingly as the epiphyseal plate grows, and the epiphyseal morphology was kept essential normal. However, the phenomenon of the epiphyseal growth retardation and premature closure were very common in the regular plate group. In addition, the sliding plate group exhibited more normal histologic features and Safranin O staining compared to the regular plate group. Our results suggest that the sliding plate can provide reliable internal fixation of epiphyseal fracture without inhibiting epiphyseal growth

Platelet-rich Plasma Reverses the Inhibition of Tenocytes and Osteoblasts in Tendon-Bone Healing

The purpose of this study was to investigate the effect of platelet-rich plasma on the proliferation of osteoblasts and tenocytes in tendon-bone healing. We cultured osteoblasts and tenocytes in an indirect coculture system with Transwell filters (Merck Millipore, Billerica, Massachusetts). The proliferation was examined using Cell Counting Kit-8 (Dojindo Chemistry Research Institute, Kumamoto, Japan). Four groups were studied: group 1, one cell type cultured without platelet-rich plasma; group 2, two cell types cultured together in an indirect coculture system without platelet-rich plasma; group 3, cells in the outer chamber and platelet-rich plasma in the inner chamber; and group 4, two different cell types in each of the 2 chambers with platelet-rich plasma in the inner chamber. The proliferation rates of groups 3 and 4 were the highest, followed by group 1 and then group 2, which was the lowest. Platelet-rich plasma abolishes the inhibition of osteoblasts or tenocytes in an indirect coculture system and improves the cell proliferation rate

Weak link of tendon-bone healing and a control experiment to promote healing

This study aims to observe the mechanical weak point and histological features of tendon-bone interface after anterior cruciate ligament reconstructive surgery and to explore the tendon-bone healing effects of the platelet-rich gel (PRG) + deproteinized bone (DPB) compound. A total of 48 New Zealand white rabbits were randomly divided into normal group, model (without embedding), experimental (embedded with the PRG + DPB compound), and control (embedded with DPB) groups. The rabbits were executed at 2, 4, 8, and 12 weeks after the operation. Then, micro-computed tomography scan and uniaxial tensile test were conducted. The fractured specimens were subjected to histological observation. At 4, 8, and 12 weeks after the operation, the bone density of the tendon-bone bound section of the experimental group was higher than that of the other groups (P < 0.05). At 4 and 8 weeks, the maximum tensile load of the experimental group was obviously higher than that of the control and model groups (P < 0.05). Histological observation indicated that the tendon-bone interface in the experimental group had more cartilage and bone tissue growing toward the internal tendon, but the fracture layer mainly occurred in the non-ankylosed part. The mechanical weak point of the early tendon-bone interface was in the immature fibrous tissue. The PRG + DPB compound can effectively trigger tendon-bone healing by promoting the maturation and ossification of the tendon-bone tissue. This compound improved the tensile strength of the healing interface and reduced bone tunnel enlargement

Results of a bone splint technique for the treatment of lower limb deformities in children with type I osteogenesis imperfecta

Nanjing Military Region during the 11th Five Year Plan Period [06MA97]Background: Children with osteogenesis imperfecta (OI) can suffer from frequent fractures and limb deformities, resulting in impaired ambulation. Osteopenia and thin cortices complicate orthopedic treatment in this group. This study evaluates the clinical results of a bone splint technique for the treatment of lower limb deformities in children with type I OI. The technique consists of internal plating combined with cortical strut allograft fixation. Materials and Methods: We prospectively followed nine children (five boys, four girls) with lower limb deformities due to type I OI, who had been treated with the bone splint technique (11 femurs, four tibias) between 2003 and 2006. The fracture healing time, deformity improvement, ambulation ability and complications were recorded to evaluate treatment effects. Results: At the time of surgery the average age in our study was 7.7 years (range 5-12 years). The average length of followup was 69 months (range 60-84 months). All patients had good fracture healing with an average healing time of 14 weeks (range 12-16 weeks) and none experienced further fractures, deformity, or nonunion. The fixation remained stable throughout the procedure in all cases, with no evidence of loosening or breakage of screws and the deformity and mobility significantly improved after surgery. Of the two children confined to bed before surgery, one was able to walk on crutches and the other needed a wheelchair. The other seven patients could walk without walking aids or support like crutches. Conclusions: These findings suggest that the bone splint technique provides good mechanical support and increases the bone mass. It is an effective treatment for children with OI and lower limb deformities

Modified technique using allograft-prosthetic composite in the distal femur after bone tumor resection

Background: The purpose of this retrospective study was to analyze the results of treatment of bone tumor resection of the distal femur with the modified technique of allograft-prosthetic composite. Methods: Twelve patients with distal femoral bone tumors were treated with deep-frozen cortical allograft struts and allograft-prosthesis composites. There were five males and seven females with a median age of 29.5 y. The minimum follow-up time was 12 mo (median, 45.7 mo; range, 12-81 mo). Diagnoses included osteosarcoma in five patients, chondrosarcoma in three patients, giant cell tumors in three patients, and malignant fibrous histiocytoma in one patient. Five osteosarcoma patients were treated with adjuvant chemotherapy. Results: At the latest follow-up examination, 11 patients were alive with no evidence of disease, and the limb was preserved in nine patients. One patient died of pulmonary metastases with no evidence of local recurrence. Seven healed without complications. A surgical procedure was performed in four patients because of complications, which included a fracture (one patient), deep infection (one patient), instability (one patient), and local recurrence (one patient). Conclusion: The modified technique of allograft-prosthetic composite is an effective treatment for bone tumor resection of the distal femur. This technique has many advantages, including augmentation of the bone stock, minimizing the risk of allograft fracture and nonunion, and decreasing the need for revision operations. Crown Copyright (C) 2013 Published by Elsevier Inc. All rights reserved

Effects of a Pediatric Physeal Slide-Traction Plate on Fracture Healing: An Experimental Study in a Goat Model

Nanjing Military Region [06Z30]Background: It has been an intractable issue for the orthopaedic surgeons to treat pediatric epiphyseal injury and surrounding bone fracture using Kirschner wires and screws, etc. Earlier research has indicated that pediatric physeal slide-traction plate (PPSP) can fix bone fracture without restricting growth. However, it is not clear whether this material can be clinically used to treat pediatric epiphyseal injury and surrounding bone fracture. Methods: The PPSP and standard plate (SP) were designed to configure to the femoral condyle. Twelve premature female goats were enrolled in this study. Fracture models were successfully established on goats, on which the right femurs were fixed with SP, and the left femurs were fixed with PPSP. Radiographic analysis and biomechanical tests were done at 4 and 8 weeks after surgery. Results: The callus gray density increased with time going on in each group, at the same postoperational time point, the PPSP group was higher than that of the SP group. The difference between PPSP group and SP group was statistically significant at the same stage (P<0.01). The biomechanical tests showed that the PPSP group was stronger than the SP group in anticompression, antibending, and antitorsion at the same stage (P<0.05). In addition, it was shown through the radiographic analysis that PPSP extended accordingly as the epiphyseal plate grows, and the epiphyseal morphology was considered normal all the time. However, epiphyseal premature closure and angular deformity were observed in the samples of the SP group. Conclusions: PPSP contributed greatly to healing of bone fracture with increased callus density and callus strength in the early stage, and did not restrict the growth of the epiphyseal plate. It may be clinically applied in the treatment of pediatric epiphyseal injury and surrounding bone fracture in the future. Level of Evidence: Therapeutic level II

Proximal Femoral Locking Plate With Cannulated Screws for the Treatment of Femoral Neck Fractures

key projects from Nanjing Military Region [10MA073]The purpose of this study was to evaluate the efficacy and safety of the proximal femoral locking plate with cannulated screws for the treatment of femoral neck fractures. A prospective study was performed in 41 patients with femoral neck fractures treated with a proximal femoral locking plate with cannulated screws between January 2005 and December 2008. Twenty-five men and 16 women had a mean age of 47 years (range, 21-65 years). The time from injury to surgery ranged from 2 hours to 7 days. Three patients had a Garden type I fracture, 9 a type II, 18 a type III and 11 a type IV. Operative time, intraoperative blood loss, fracture healing time, Harris Hip Score for hip function, and complications were recorded to evaluate treatment effects. Mean operative time was 63.6 minutes (range, 40-90 minutes), with mean intraoperative blood loss of 84.2 mL (range, 50-200 mL). Mean time to union was 15.5 weeks (range, 12-36 weeks). Two patients (Garden type III and type IV) did not achieve union, and 4 patients (1 Garden type III and 3 type IV) had avascular necrosis of the femoral head. In patients with nonunion, 1 (Garden type III) underwent intertrochanteric osteotomy, and the other underwent total hip replacement (THR). In patients with avascular necrosis, 2 required THR and the others (1 Garden type III) required no further surgery. Twenty-six (63%) patients had excellent results, 8 (20%) had good results, 3 (7%) had moderate results, and 4 (10%) had poor results. These findings suggest that the proximal femoral locking plate with cannulated screws for the treatment of femoral neck fractures is effective and results in fewer complications, especially for Garden type I, II, and III fractures