Far-out syndrome is an unusual type of Bertolotti’s syndrome refers to L5 nerve root compressed by osteophyte in the extraforaminal zone, which leads to radical pain of the leg by radiculopathy. Conservative treatment is generally ineffective and requires operative decompression. We present the case of a 19-years-old patient complained of pain in the right lumbosacral and lower leg, failed for 2 months of conservative treatment. The patient was confirmed as far-out syndrome by imaging examinations showed the right L5 nerve root compressed by osteophytes from pseud arthrosis between the L5 transverse process and sacral ala. The Visual analog scale (VAS) pain score was 6 and the Oswestry disability index (ODI) was 53.33%. Then the osteophytes and pseudarthrosis were surgical removed and the L5 nerve root was decompressed through a posterior approach. The patient’s symptoms were significantly relieved after surgery immediately. The VAS score was 1 and ODI was 15.56% at 1-month postoperatively. At 1-year follow up, the VAS pain score was 1 and ODI was 11.11% and complete military trainings was resumed.

This study was aimed to use a digital design of 3D-printing technology to create a surgical navigation template. At the same time, biphasic calcium phosphate (BCP) was applied to treat osteonecrosis of the femoral head (ONFH) in animal models, based on accurate positioning of necrotic lesions in the navigation templates and observation of its therapeutic effect. Fifteen healthy adult male and female beagle dogs weighing 20 + 2 kg were randomly divided into three groups (n = 5) after establishing a model of ONFH using the liquid nitrogen freezing method. Each model underwent necrotic lesion creation and BPC implantations on one side of the femoral head and only necrotic lesion creation on the other side of the femoral head. Each group underwent CT examination, gross observation, histological examination and immunohistochemical staining at 6 weeks, 12 weeks and 18 weeks postoperatively. At weeks 6, 12, and 18, CT and gross examination showed that the necrotic area in the experimental group was basically intact and had been completely raised by BCP material. In the control group, there were signs of bone repair in the femoral head, but there were still large bone defects and cavities. At week 18, extensive collapse of the cartilage surface was observed. Through histological examination, in the experimental group at 12 and 18 weeks, a large number of new and reconstructed bone trabeculae containing a large amount of collagen fibres were observed (P < 0.05), while in the control group, there was extensive necrosis of the bone trabeculae without cellular structural areas. Immunohistochemical examination observation: A large number of CD31-positive cells were observed in the experimental group at 6 weeks, gradually decreasing at 12 and 18 weeks (P < 0.05), while a small number of CD31-positive cells were observed in the control group at 18 weeks. The 3D-printed navigation template can accurately locate ONFH lesions. Implantation of BCP material can effectively play a supporting role, prevent the collapse of the loading surface, and induce bone formation and angiogenesis to some extent.

Background and Objective The pathogenesis of osteoarthritis (OA) involves a variety of complex mechanisms, including genetic, mechanical, metabolic, and inflammatory factors. There is evidence that inflammatory factors, abnormal chondrocyte apoptosis, and extracellular matrix degradation are closely associated with the occurrence and development of OA. The best treatment for OA is still controversial, but intra-articular injection is safer and more effective than non-surgical treatments, such as physical therapy and oral analgesics. This study sought to explore the mechanism, benefits, and adverse reactions of commonly used intra-articular injection therapy in the treatment of knee osteoarthritis (KOA). Methods We analyzed the safety and adverse reactions of intra-articular injection in patients with KOA, and summarized the results. Key Content and Findings Six weeks of the corticosteroid injection contributed to improve the symptoms of OA patients in short time. However, their symptoms did not improve significantly after this period. Using corticosteroids for a long time may result in oxidative stress, leading to adverse reactions, such as cartilage toxicity, and accelerate the progress of OA. Due to its high frequency, the local injection of hyaluronic acid can result in more adverse reactions when compared with the corticosteroids. Due to the lack of standardized factors for platelet-rich plasma (PRP) preparation, leukocyte-rich or leukocyte-free variants may be produced. Adverse reactions include injection-site pain, joint stiffness. Conclusions Thus, it is necessary to promote further clinical trials to promote the clinical application of PRP.

The current research on seed cells and scaffold materials of bone tissue engineering has achieved milestones. Nevertheless, necrosis of seed cells in center of bone scaffold is a bottleneck in tissue engineering. Therefore, this study aimed to investigate the in vivo inosculation mechanism of recipient microvasculature and prevascularized outgrowth endothelial progenitor cells (OECs)-demineralized bone matrix (DBM) complex. A dorsal skinfold window-chamber model with tail vein injection of Texas red-dextran was established to confirm the optimal observation time of microvessels. OECs-DBM complex under static and dynamic perfusion culture was implanted into the model to analyze vascularization. OECs-DBM complex was harvested on 12th day for HE staining and fluorescent imaging. The model was successfully constructed, and the most appropriate time to observe microvessels was 15 min after injection. The ingrowth of recipient microvessels arcoss the border of OECs-DBM complex increased with time in both groups, and more microvessels across the border were observed in dynamic perfusion group on 3rd, 5th, 7th day. Fluorescent integrated density of border in dynamic perfusion group was higher at all-time points, and the difference was more significant in central area. Fluorescent imaging of OECs-DBM complex exhibited that no enhanced green fluorescent protein-positive cells were found beyond the verge of DBM scaffold in both groups. In vitro prevascularization by dynamic perfusion culture can increase and accelerate the blood perfusion of OECs-DBM complex obtained from recipient microvasculature by internal inosculation. Accordingly, this approach may markedly contribute to the future success of tissue engineering applications in clinical practice.

The study focused on the application value of Algebraic Reconstruction Techniques (ART) based magnetic resonance imaging (MRI) in the diagnosis of cartilage injury in patients with patellar dislocation, as well as the treatment effect of platelet-rich plasma (PRP). 50 patients with patellar dislocation admitted to the hospital were selected as the research subjects, and they were randomly divided into the experimental group (lateral retinaculum plasty and PRP treatment) and the control group (lateral retinaculum plasty), with 25 cases in each group. The ART-based MRI technology was used to judge the recovery of patients after surgery and analyze the differences in clinical data between the two groups. The results showed that the running speed under ART algorithm was significantly faster than the traditional Joseph algorithm and Siddon algorithm, and the image reconstruction effect was better. The visual analog scale (VAS) scores of preoperative and postoperative pain and the Hospital for Special Surgery (HSS) score in the experimental group were better than those of the control group ( P < 0.05 ). In conclusion, the ART-based MRI technology can clearly show cartilage injury and the PRP treatment can effectively relieve postoperative pain, with reliable curative effects and simple operations.

Abstract Purpose: This systematic review aimed to identify the available evidence regarding the comparative effectiveness and safety of various operative treatments in adult patients with osteochondral lesions of the talus (OLT). Materials and methods: The PubMed, Embase, ISI Web of Knowledge, and the Cochrane Controlled Trial Register of Controlled Trials were searched from their inception date to September 2019. Two reviewers selected the randomized controlled trials (RCTs) and non-RCTs assessing the comparative effectiveness and safety of various operative treatments for OLT. The meta-analysis was performed using Revman 5.3. Results: Eight studies (1 RCT and 7 non-RCTs) with 375 patients were included in this review. The difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between the cartilage repair and replacement was not significant. The cartilage regeneration with or without cartilage repair had significant superiority in improving the AOFAS score compared with the cartilage repair. The difference in the magnetic resonance observation of cartilage repair tissue score between the cartilage repair and replacement and between cartilage repair and cartilage repair plus regeneration was significant. Conclusions: Cartilage regeneration and cartilage repair plus regeneration had significant superiority in improving the ankle function and radiological evaluation of OLT, although the trials included did not have high-level evidence. Moreover, which treatment between the 2 was safer could not be addressed in this review as most of the trials did not report the safety outcome. Further studies are needed to define the best surgical option for treating OLT.

Objective To explore the clinical efficacy of Ilizarov technique for infected-bone defect in lower extremity.Methods From January 2013 to December 2016,data of 31 consecutive patients with lower limb infected bone defect were retrospectively analyzed.There were 23 males and 8 females,with an average age of 35.8 years (range,5-57 years).16 cases of infected bone defect were on femur while the other 15 were on tibia.The infected bone defects were developed from blood-borne osteomyelitis in 3 cases,from open fracture (according to Gustlio classification,Gustilo Ⅱ 8,Ⅲ a 5,Ⅲ b 4) surgery in 17 cases (12 cases after external fixation and 5 cases after internal fixation),and from closed fracture surgery of plate or intramedullary nail fixation in 11 cases.Soft-tissue defects were observed in 5 cases,including 1 femur and 4 tibia.The previous operations were performed with an average operation time of 3.2 (range,2-5 times) and treatment duration of 9.6 months (range,3-21 months).The operation process was one stage debridement,external fixation,combined with bone osteotomy and transportation.Bone transportation started 7 to 10 days after osteotomy with a speed of 1 mm/d,and 0.25 mm/time.Healing rate and complications were recorded during the follow-up period and were assessed by Paley fracture healing score.Results The length of bone defect after debridement was 6.9 cm (range,3-13.5 cm).There were 27 cases positive in bacterial culture,who were treated by sensitive antibiotics.The other 4 cases were negative and treated by broad-spectrum antibiotics.The bone lengthening speed was 0.76 mm/d (range,0.56-0.86 mm/d).All bone and soft-tissue defects healed,with average bone healing time of 11.5 months (range,6-18.5 months).All patients were followed-up for 12 to 48 months (average,25.5 months).Pin infection appeared in 11 cases (8 cases on femur and 3 cases on tibia)who were cured by oral antibiotics,serial dressing and debridement.Axial displacement was presented in 4 cases on femur and were corrected by external fixation adjustment.No recurrent infection was observed and the limb length restored normal.Postoperative complications in femur were 106.3％ (17/16) comparing 46.7％ (7/15) in tibia.According to Paley fracture healing score,12 cases were excellent,14 were good and 5 were fair,yielding an excellent to good rate of 83.9％ (26/31).Conclusion Ilizarov technique is an effective way in the treatment of infected-bone defects.The complication rates on femur observed in this study were slightly higher than that on tibia.