1
|
Zheng H, Wang L, Jiang W, Qin R, Zhang Z, Jia Z, Zhang J, Liu Y, Gao X. Application of 3D printed patient-specific instruments in the treatment of large tibial bone defects by the Ilizarov technique of distraction osteogenesis. Front Surg 2023; 9:985110. [PMID: 36684263 PMCID: PMC9852528 DOI: 10.3389/fsurg.2022.985110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background The Ilizarov technique of distraction osteogenesis is an effective treatment for tibia defect. However, repeated attempts to reduce due to the complexity of the bone defect during the operation will increase the operation time and iatrogenic injury, and excessive radiation exposure. Three-dimensional (3D)-printed patient-specific instrument (PSI) for preoperative 3D planning and intraoperative navigation have the advantages of accuracy and visualization. The purpose of this study is to investigate whether 3D-printed PSI is helpful to correct tibial bone defects accurately and effectively. Method From May 2019 to September 2022, 19 patients with tibial bone defects were treated, including 9 males and 10 females, aged 37 to 64 years. There were 4 cases in proximal tibia, 9 in midshaft tibia and 6 in distal tibia. All were treated with Ilizarov technique of distraction osteogenesis. 3D-printed PSI was used in 9 cases, while traditional surgery was used in 10 cases. All patients underwent computed tomography before surgery. Computer software was used to analyze the measurement results, design and print PSI. During the operation, PSI was used to assist in reduction of tibia. Operation times were recorded in all cases, the number of fluoroscopy during the operation, and the varus/valgus, anteversion/reversion angle after the operation were measured. All measurement data were expressed by means ± SD, and Student's t test was used to examine differences between groups. The chi square test or Fisher's precise test was used to compare the counting data of the two groups. Result All PSI matched well with the corresponding tibia bone defect, and were consistent with the preoperative plan and intraoperative operation. The affected limb had a good reduction effect. The operation time from the beginning of PSI installation to the completion of Ilizarov ring fixator installation was 31.33 ± 3.20 min, while that in the traditional operation group was 64.10 ± 6.14 min (p < 0.001). The times of fluoroscopy in the PSI group during operation was 10.11 ± 1.83, and that in the traditional operation group was 27.60 ± 5.82. The reduction effect of tibia in PSI group was better than that in traditional operation group, with the average angle of PSI group is 1.21 ± 0.24°, and that of traditional operation group is 2.36 ± 0.33° (p < 0.001). Conclusion The PSI simplifies procedures, reduces the difficulty of the operation, improves the accuracy of the operation, and provides a good initial position when used in distraction osteogenesis to treat the tibial defects.
Collapse
Affiliation(s)
- Hao Zheng
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lili Wang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Wenbo Jiang
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’ s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiqing Qin
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’ s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyu Zhang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Zhuqing Jia
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jian Zhang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yong Liu
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China,Correspondence: Xuejian Gao Yong Liu
| | - Xuejian Gao
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China,Correspondence: Xuejian Gao Yong Liu
| |
Collapse
|
2
|
Li M, Su Y, Gao X, Yu J, Wang Z, Wang X. Transition of autophagy and apoptosis in fibroblasts depends on dominant expression of HIF-1α or p53. J Zhejiang Univ Sci B 2022; 23:204-217. [PMID: 35261216 DOI: 10.1631/jzus.b2100187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It has been revealed that hypoxia is dynamic in hypertrophic scars; therefore, we considered that it may have different effects on hypoxia-inducible factor-1α (HIF-1α) and p53 expression. Herein, we aimed to confirm the presence of a teeterboard-like conversion between HIF-1α and p53, which is correlated with scar formation and regression. Thus, we obtained samples of normal skin and hypertrophic scars to identify the differences in HIF-1α and autophagy using immunohistochemistry and transmission electron microscopy. In addition, we used moderate hypoxia in vitro to simulate the proliferative scar, and silenced HIF-1α or p53 gene expression or triggered overexpression to investigate the changes of HIF-1α and p53 expression, autophagy, apoptosis, and cell proliferation under this condition. HIF-1α, p53, and autophagy-related proteins were assayed using western blotting and immunofluorescence, whereas apoptosis was detected using flow cytometry analysis, and cell proliferation was detected using cell counting kit-8 (CCK-8) and 5-bromo-2'-deoxyuridine (BrdU) staining. Furthermore, immunoprecipitation was performed to verify the binding of HIF-1α and p53 to transcription cofactor p300. Our results demonstrated that, in scar tissue, HIF-1α expression increased in parallel with autophagosome formation. Under hypoxia, HIF-1α expression and autophagy were upregulated, whereas p53 expression and apoptosis were downregulated in vitro. HIF-1α knockdown downregulated autophagy, proliferation, and p300-bound HIF-1α, and upregulated p53 expression, apoptosis, and p300-bound p53. Meanwhile, p53 knockdown induced the opposite effects and enhanced HIF-1α, whereas p53 overexpression resulted in the same effects and reduced HIF-1α. Our results suggest a teeterboard-like conversion between HIF-1α and p53, which is linked with scar hyperplasia and regression.
Collapse
Affiliation(s)
- Min Li
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yidan Su
- Department of Plastic Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China
| | - Xiaoyuan Gao
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiarong Yu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhiyong Wang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. ,
| | - Xiqiao Wang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| |
Collapse
|