中国修复重建外科杂志最新文献

Hypospadias is a common congenital external genital structural malformation in the males, where significant deviations in appearance primarily affect the psychosocial health of the entire family during childhood, ultimately harming the patient's social integration, leading to high expectations for normal appearance from the patients and their families. The anatomical abnormalities of hypospadias exhibit considerable individual differences, and the difficulty of surgical repair largely depends on the experience of the surgeon, with high rates of complications and reoperations. Therefore, surgeons' expectations for surgical outcomes are more focused on functional reconstruction and reducing complication rates, creating a gap between the expectations of both doctors and patients. By measuring anatomical abnormalities, it may be a feasible approach to set normal appearance goals to achieve normal appearance outcomes. This article introduces the use of anthropometric assessment methods to accurately describe the anatomical abnormalities of hypospadias and proposes specific morphological goals for the reconstruction of various parts, implementing surgical operations in a goal-oriented manner. The aim is to establish a unified baseline decision-making system for hypospadias surgery, shorten the learning curve, improve the quality of clinical research, and achieve integrated reconstruction of structure, function, and aesthetics for patients.

The extracellular matrix (ECM) plays a pivotal role in regulating cellular behavior and driving tissue regeneration. Its unique structural characteristics and bioactivity not only provide physical support for cell growth, but also orchestrate tissue repair and functional reconstruction through multiple signaling pathways. This review systematically synthesizes preparation strategies for natural and engineered ECM materials from the perspective of ECM-mediated tissue regeneration mechanisms, with particular emphasis on recent advances in component preservation, structural biomimicry, and functional optimization. Furthermore, it delves into the application potential of cutting-edge technologies-including artificial intelligence, flexible electronics, and organoids-in ECM engineering, while critically analyzing the standardization and safety challenges hindering clinical translation. This article aims to provide a theoretical foundation and reference for constructing next-generation ECM-based regenerative medicine platforms.

Reconstructive surgery is fundamentally dedicated to restoring tissues and organs damaged by trauma, disease, or congenital anomalies, with the goal of re-establishing both physiological function and anatomical form. Facial reconstruction, as one of the most representative and technically demanding areas of the discipline, embodies the evolution of its concepts and technological progress. Using facial reconstruction as the point of departure, this article systematically delineates the scientific underpinnings and developmental frontiers of the field. Centered on four core elements-donor construction, vascular reconstruction, precision transplantation, and functional recovery, this article articulates the internal logic and technical considerations of both autologous and allogeneic reconstructive methods. Further, from the perspectives of regenerative donor fabrication, the digital and intelligent transformation of reconstructive surgery, breakthroughs in immune tolerance strategies, and the integration of engineering technologies to enhance functional outcomes, the article envisions potential paradigm shifts that may redefine the discipline. By leveraging facial reconstruction as a highly integrated lens, this work aims to elucidate the key drivers of innovation and chart the future directions of reconstructive surgery.

Objective: To review the research progress on lactylation modification in the pathogenesis of osteoarthritis (OA).

Methods: Relevant studies published in recent years on lactate metabolism and lactylation modification in OA were retrieved and analyzed, summarizing the molecular mechanisms of lactylation and its regulatory roles in different cells and pathological processes.

Results: Lactate, as the major metabolic product of glycolysis, not only participates in energy metabolism but also plays a crucial role in OA progression through lactylation modification. Lactate-driven histone and non-histone lactylation regulate gene transcription and cellular functions, contributing to chondrocyte metabolic reprogramming, extracellular matrix (ECM) synthesis and degradation, cell proliferation and apoptosis, as well as ferroptosis. In fibroblast-like synoviocytes, lactylation modification promotes cellular senescence and the release of inflammatory factors; in immune cells, lactylation regulates inflammatory responses by influencing macrophage polarization and intercellular communication. Overall, lactylation modification exhibits a dual effect in OA: it aggravates ECM degradation and inflammation on the one hand, but under specific microenvironments, it also promotes repair and regeneration. However, the site-specificity, cell-type heterogeneity, and cross-talk of lactylation with other epigenetic modifications remain to be further clarified.

Conclusion: Lactylation modification provides a novel perspective for understanding the metabolic and epigenetic mechanisms of OA and may serve as a potential biomarker and therapeutic target. Future studies combining multi-omics approaches to map the global lactylation landscape, together with small-molecule inhibitors, epigenetic editing tools, and regenerative medicine strategies, may enable precise regulation of lactylation, offering new strategies to delay or even reverse OA progression.

Postoperative stability reconstruction following spinal tumor resection is a critical step to ensure functional recovery and quality of life for patients. This article systematically reviews the current status of anterior and posterior column reconstruction techniques after spinal tumor resection, including strategies such as bone cement augmentation, titanium mesh cage and artificial vertebral body implantation, and three-dimensional-printed personalized prostheses. It emphasizes the need for individualized treatment plans based on tumor type, anatomical location, and the patient's overall condition. The article also highlights the importance of restoring sagittal balance, multidisciplinary collaboration, and complication prevention for long-term outcomes. In the future, innovations in biomaterials, along with the minimally invasive and intelligent evolution of surgical techniques, will further advance the goal of achieving stable, pain-free, and functionally effective spinal reconstruction for each patient, ultimately enhancing their quality of life.

Objective: The advantages, mechanisms, and advances in nanocomposites for delivering bioactive substances in bone tissue engineering were systematically reviewed.

Methods: This review provides a comprehensive analysis by conducting an in-depth retrieval of relevant literature and integrating it with related work from our research team.

Results: Capitalizing on their inherent size effects and tunable structures, nanocomposites exhibit high drug-loading capacity and controlled/targeted delivery, allowing for the co-delivery of diverse molecules. This smart delivery capability, responsive to specific pathological or external cues, facilitates on-demand precision release to execute multiple therapeutic functions, including osteogenesis, antibacterial action, and immunomodulation.

Conclusion: Nanocomposites demonstrate high delivery efficiency and controlled release kinetics, with the potential for future clinical translation of their multi-signal responsive and spatiotemporally precise drug release capabilities.

Objective: To review the application and research progress of mandibular distraction osteogenesis (MDO) in the treatment of craniofacial microsomia (CFM).

Methods: Recent domestic and international literature on MDO for CFM was extensively reviewed, with systematic summarization of its indications, device development, key technical points of MDO, complication management, digital surgical applications, biological enhancement strategies, and controversies regarding early intervention.

Results: MDO stimulates new bone formation through the "tension-stress" principle, serving as an effective method to elongate the mandible in CFM patients and early improve airway and occlusal functions. Digital technology has enhanced its precision, while biological strategies show potential for optimizing osteogenesis. However, challenges such as postoperative relapse and the long-term efficacy of early intervention remain.

Conclusion: MDO is a core component of the sequential treatment for CFM. Future efforts should focus on intelligent technologies and high-quality clinical studies to optimize individualized treatment plans and improve long-term stability.

Objective: To review the research progress on the application of digital orthopedic technology in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH), thereby providing a reference for clinical decision-making.

Methods: A comprehensive literature review was conducted to summarize the effectiveness of various emerging digital orthopedic technologies in the context of THA for DDH.

Results: Digital orthopedic technologies have significantly enhanced the precision and safety of THA for DDH. Specifically, artificial intelligence-based preoperative planning systems have demonstrated superior accuracy in prosthesis size matching and positioning compared to conventional methods. Additive manufacturing technologies have provided personalized solutions for reconstructing complex bone defects in DDH. Furthermore, robot-assisted and navigation-assisted techniques have effectively improved the accuracy of prosthesis placement and lower limb length restoration in THA. However, each of these digital orthopedic technologies still possesses its own limitations.

Conclusion: Through the integration of multiple technologies, digital orthopedics effectively addresses the challenges of precise reconstruction in THA for DDH. Future efforts should focus on further integrating diverse intelligent technologies and equipment to establish a comprehensive digital diagnosis and treatment system, aiming to achieve superior long-term effectiveness.

Objective: To summarize recent clinical advances in intra-abdominal vascularized lymph node transfer (VLNT) for treatment of limb lymphedema.

Methods: A comprehensive review of the literature on intra-abdominal VLNT was conducted, outlining its historical development, relevant anatomy, and clinical applications, with emphasis on clinical outcomes.

Results: Intra-abdominal donor sites, such as the omentum and mesentery, are rich in lymphoid tissue and exhibit favorable anti-infective properties. Intra-abdominal VLNT has been widely applied in clinical practice internationally, while reports from China remain limited. Clinical studies indicate that the intra-abdominal VLNT can effectively reduce limb swelling, lower incidence of infection, and improve quality of life in patients with limb lymphedema. It can also be combined with lymphaticovenular anastomosis, reductive procedures, and breast reconstruction to further alleviate symptoms and enhance patient-reported outcomes.

Conclusion: Intra-abdominal VLNT holds clinical application potential for the treatment of limb lymphedema, but more rigorous, standardized clinical studies are needed to further verify its feasibility and efficacy.

Objective: To review the application progress of internal brace ligament augmentation (IBLA) technology in the repair and reconstruction of anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, and to clarify the development trends of IBLA technology.

Methods: A comprehensive review of recent domestic and international in vitro and in vivo biomechanical studies, animal experiments, and clinical research on IBLA technology was conducted. The effects of this technology on postoperative biomechanics, histological changes, and clinical outcomes following ACL and PCL repair and reconstruction were analyzed and summarized.

Results: IBLA technology provides enhanced knee stability in the early postoperative period after ACL and PCL repair and reconstruction. It promotes healing at the ligament injury site and increases the biomechanical strength of tendon grafts, thereby reducing postoperative failure rates. IBLA demonstrates good histocompatibility in vivo. Clinical follow-up shows that IBLA improves early postoperative knee stability, range of motion, and functional scores. Patients undergoing rapid rehabilitation achieve more satisfactory outcomes, with no reported serious complications.

Conclusion: The combination of IBLA with ACL and PCL repair and reconstruction promotes rapid early postoperative recovery and shows promising application prospects. However, further optimization of IBLA material properties and related surgical techniques is needed. Additionally, the long-term effectiveness, structural remodeling of the grafts and repaired ligaments, and the underlying biomechanical functional mechanisms require further clarification.