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[Research progress in Cup-cage reconstruction for patients with chronic pelvic discontinuity after total hip arthroplasty]. 【全髋关节置换术后慢性盆腔不连续的Cup-cage重建研究进展】。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408064
Xingxiao Pu, Qiuru Wang, Qianhao Li, Lijun Cai, Guangtao Han, Pengde Kang

Objective: To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA).

Methods: Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications.

Results: For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined.

Conclusion: Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.

目的:总结杯笼重建在全髋关节置换术(THA)患者慢性盆腔不连续(CPD)修复中的应用研究进展。方法:回顾近年来国内外相关文献,总结杯笼重建的原理、术前患者评估、术中技巧、临床及影像学效果、局限性及术后并发症。结果:对于CPD的治疗,cup -cage重建术通过恢复骨盆连续性实现了髋臼杯骨长入、CPD愈合和假体的生物固定。术前评估手术部位和一般情况是必要的。术中主要目的是重建骨盆连续性,恢复髋关节旋转中心,避免神经血管损伤。目前的研究已经证明了显著的临床和放射学效果以及手术后可接受的假体存活率。然而,关于CPD的分期、最佳手术入路和内固定以及影响术后假体存活的因素仍缺乏证据。结论:杯笼重建术是THA术后CPD的有效治疗方法,但仍需对CPD的分期、杯笼入路及内固定、影响假体存活的因素进行探讨。
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引用次数: 0
[Research progress on the role of dendritic cells in immune metabolism of rheumatoid arthritis]. 树突状细胞在类风湿关节炎免疫代谢中的作用研究进展
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408002
Guangtao Han, Shuo Sun, Qin Wang, Pengde Kang

Objective: To review the role of dendritic cells (DC) in immune metabolism of rheumatoid arthritis (RA).

Methods: Literature on the role of DC in the immune metabolism of RA was extensively reviewed in recent years, and the metabolic characteristics of RA, the role of DC in RA, the correlation between the immune metabolism of DC and pathogenesis of RA, and the treatment were summarized and analyzed.

Results: DC promotes the progression of RA under hypoxia, increased glycolysis, inhibition of oxidative phosphorylation, and decreased lipid metabolism. Moreover, many DCs (especially conventional DC and monocyte-derived DC) have different functions and phenotypic characteristics in RA, which are closely related to the occurrence and development of RA.

Conclusion: DC plays an important role in the immune metabolism of RA, and immunometabolism therapy based on DC can provide targeted therapy for the treatment of RA.

目的:探讨树突状细胞(DC)在类风湿关节炎(RA)免疫代谢中的作用。方法:广泛查阅近年来有关DC在RA免疫代谢中的作用的文献,总结分析RA的代谢特点、DC在RA中的作用、DC免疫代谢与RA发病机制的相关性及治疗方法。结果:DC促进缺氧条件下RA的进展,增加糖酵解,抑制氧化磷酸化,降低脂质代谢。而且,许多DC(尤其是常规DC和单核细胞源性DC)在RA中具有不同的功能和表型特征,与RA的发生发展密切相关。结论:DC在RA的免疫代谢中起重要作用,基于DC的免疫代谢治疗可为RA的治疗提供靶向治疗。
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引用次数: 0
[A comparative study of mid- and long-term effectiveness of patellar resurfacing or non-resurfacing in primary total knee arthroplasty]. [一期全膝关节置换术中髌骨置换与非髌骨置换中长期疗效的比较研究]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408057
Te Liu, Ye Tao, Junlei Song, Chengqi Jia, Runkai Zhao, Jun Fu, Jiying Chen, Ming Ni
<p><strong>Objective: </strong>To compare the mid- and long-term effectiveness of patellar resurfacing versus non-resurfacing in primary total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>Twenty-six patients who underwent bilateral TKA between March 2013 and September 2015 were selected as the study subjects. One side was randomly chosen for patellar resurfacing (resurfacing group), and the other side was not (control group). There were 4 males and 22 females, the age ranged from 51 to 65 years, with an average of 59 years. According to Kellgren-Lawrence classification, there were 21 cases of grade Ⅳ and 5 cases of grade Ⅲ in both knees. There was no significant difference in the surgical side, and preoperative clinical and functional scores of the Knee Society Score (KSS), visual analogue scale (VAS) score, and the composition ratio of anterior knee pain localization points between the two groups ( <i>P</i>>0.05). The operation time, intraoperative blood loss, postoperative abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, and the occurrence of complications were recorded and compared. Patient subjective evaluations included Forgotten Joint Score (FJS) and the degree of difficulty in high-level knee activities (including flexion with load bearing, going upstairs, going downstairs, squatting and standing up, kneeling, knee extension, and crossing legs for 7 items); KSS clinical/functional scores and VAS scores were used to evaluate the recovery of knee joint function, and the location of anterior knee pain was determined by a localization diagram.</p><p><strong>Results: </strong>The operation time of the resurfacing group was significantly longer than that of the control group ( <i>P</i><0.05), and there was no significant difference in intraoperative blood loss between the two groups ( <i>P</i>>0.05). All patients' incisions healed by first intention; the hospital stay ranged from 8 to 23 days, with an average of 12.6 days. All patients were followed up 9-11 years, with an average of 9.7 years. Except for 1 case who died of multiple organ failure due to internal diseases at 9 years after operation and 5 cases with incomplete radiological data, the rest 20 patients were assessed radiologically and found that 1 side of the knee joint in the control group had patellar dislocation; the remaining patients had no prosthetic failure (fracture, loosening, displacement, <i>etc.</i>), patellar fracture, patellar necrosis, patellar instability, patellar tendon rupture, prosthetic revision, <i>etc.</i> No patients had reoperations due to patellar-related complications or anterior knee pain in both knee joints. At 2 years postoperatively and at last follow-up, there was no significant difference in the incidence of abnormal signs such as patellar clunk, feeling of constraint, patellar tendon weakness, crepitus, or snow-on-glass sensation, the incidence of high-level knee
目的:比较原发性全膝关节置换术中髌骨置换与非髌骨置换的中长期疗效。方法:选取2013年3月至2015年9月间行双侧TKA的患者26例作为研究对象。随机选择一侧进行髌骨置换(置换组),另一侧不进行髌骨置换(对照组)。男性4例,女性22例,年龄51 ~ 65岁,平均59岁。根据Kellgren-Lawrence分级,双膝Ⅳ级21例,Ⅲ级5例。两组手术侧、术前膝关节社会评分(KSS)、视觉模拟评分(VAS)、膝关节前侧疼痛定位点组成比的临床和功能评分比较,差异均无统计学意义(P < 0.05)。记录两组的手术时间、术中出血量、术后髌骨磕碰、拘束感、髌骨肌腱无力、皱襞、玻璃感等异常体征及并发症发生情况并进行比较。患者主观评价包括遗忘关节评分(FJS)和高水平膝关节活动的困难程度(包括负重屈曲、上楼、下楼、下蹲和站起、跪下、膝关节伸展和跷二腿共7项);采用KSS临床/功能评分和VAS评分评估膝关节功能恢复情况,通过定位图确定膝关节前侧疼痛的位置。结果:表面修复组手术时间明显长于对照组(p < 0.05)。所有患者切口均一次愈合;住院时间8 ~ 23天,平均12.6天。随访9 ~ 11年,平均9.7年。除1例术后9年因内部疾病导致多器官功能衰竭死亡,5例影像学资料不完整外,其余20例患者经影像学检查发现对照组1侧膝关节有髌骨脱位;其余患者无假体失效(骨折、松动、移位等)、髌骨骨折、髌骨坏死、髌骨不稳、髌骨肌腱断裂、假体翻修等。无患者因髌骨相关并发症或双膝关节前膝关节疼痛再手术。术后2年及最后一次随访时,两组患者髌骨磕响、拘束感、髌腱无力、肌颤、雪玻璃感等异常体征的发生率、膝关节高位活动困难发生率、膝关节前侧疼痛定位构成比比较,差异均无统计学意义(P < 0.05)。两组患者KSS临床评分、功能评分、VAS评分均较术前显著提高(p < 0.05)。术后2年及最后一次随访时,两组患者FJS评分比较,差异无统计学意义(P < 0.05)。结论:髌骨表面置换与不髌骨表面置换在原发性全膝关节置换术中的中长期疗效相似。
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引用次数: 0
[Influence analysis of glenohumeral bone structure on anterior shoulder instability]. [肩胛骨结构对肩前路失稳的影响分析]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408035
Yi Chen, Mengyang Qin, Long Pang, Bin Guo, Chunsen Zhang, Xin Tang

Objective: To investigate the effect of glenohumeral bone structure on anterior shoulder instability by three-dimensional CT reconstruction.

Methods: The clinical data of 48 patients with unilateral anterior shoulder dislocation (instability group) and 46 patients without shoulder joint disease (control group) admitted between February 2012 and January 2024 were retrospectively analyzed. There was no significant difference in gender and side between the two groups ( P>0.05). The patients were significantly younger in the instability group than in the control group ( P<0.05). The glenoid joint morphological parameters such as glenoid height, glenoid width, ratio of glenoid height to width, glenoid inclination, the humeral containing angle, and glenoid version were measured on three-dimensional CT reconstruction of the glenoid. The differences of the above indexes between the two groups were compared, and the differences of the above indexes between the two groups were compared respectively in the male and the female. Random forest model was used to analyze the influencing factors of anterior shoulder instability.

Results: The comparison between the two groups and the comparison between the two groups in the male and the female showed that the ratio of of the instability group glenoid height to width was larger than that of the control group, the glenoid width and humeral containing angle were smaller than those of the control group, and the differences were significant ( P<0.05); there was no significant difference in glenoid height, glenoid inclination, and glenoid version between the two groups ( P>0.05). The accuracy of the random forest model was 0.84. The results showed that the top four influencing factors of anterior shoulder instability were ratio of glenoid height to width, the humeral containing angle, age, and glenoid width.

Conclusion: Ratio of glenoid height to width and the humeral containing angle are important influencing factors of anterior shoulder instability.

目的:通过三维CT重建探讨盂肱骨结构对肩关节前路失稳的影响。方法:回顾性分析我院2012年2月至2024年1月收治的48例单侧肩关节前脱位(不稳定组)和46例无肩关节疾病(对照组)的临床资料。两组患者性别、侧位差异无统计学意义(P < 0.05)。结果:两组比较及男女两组比较,不稳定组肩关节高度与宽度之比均大于对照组,肩关节宽度和肱骨夹角均小于对照组,差异均有统计学意义(p < 0.05)。随机森林模型的精度为0.84。结果表明,肩关节前路失稳的前4个影响因素为肩关节高宽比、肱骨夹角、年龄、肩关节宽度。结论:肩关节高宽比和肱骨夹角是影响肩关节前路失稳的重要因素。
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引用次数: 0
[Research progress of Schöttle's method for femoral tunnel localization in medial patellofemoral ligament reconstruction]. [Schöttle方法在髌股内侧韧带重建中股骨隧道定位的研究进展]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202409056
Yuqiao Wei, Chongxiao Sun, Fan Lu, Peng'an Yan, Yayi Xia

Objective: To review the research progress of Schöttle's method in medial patellofemoral ligament reconstruction (MPFLR), and provide the latest knowledge and suggestions for surgical treatment.

Methods: The studies on Schöttle's method at home and abroad in recent years were extensively collected, then summarized the problems affecting the accuracy of Schöttle's method and the new ideas to improve the accuracy of localization.

Results: It's vital to accurately locate the femoral tunnel during MPFLR. Malposition of the femoral tunnel is the main cause of postoperative complications and surgical failure. Schöttle's method is the most well studied and most reproducible method for femoral tunnel localization, which is widely used as the "gold standard". However, there are still problems that affect the accuracy of Schöttle's method, including the impact of the internal/external rotation and varus/valgus of the knee on localization accuracy, unclear requirements for X-ray imaging and anatomical landmark reference line drawing standards, no suitable for patients with anatomical variations, and lack of further research on pediatric patients. In recent years, some new ideas are proposed to improve the Schöttle's method to improve the localization accuracy.

Conclusion: Future research should combine new technologies such as three-dimensional (3D) printing and intraoperative navigation to develop personalized and intelligent Schöttle's method, further improving their localization accuracy.

目的:综述Schöttle方法在髌股内侧韧带重建术(MPFLR)中的研究进展,为手术治疗提供最新知识和建议。方法:广泛收集近年来国内外对Schöttle方法的研究,总结影响Schöttle方法准确度的问题及提高定位准确度的新思路。结果:在MPFLR术中,准确定位股骨隧道至关重要。股骨隧道错位是术后并发症和手术失败的主要原因。Schöttle的方法是研究最充分、重复性最好的股骨隧道定位方法,被广泛用作“金标准”。但是,Schöttle方法的准确性仍然存在一些问题,包括膝关节内外旋和内翻外翻对定位精度的影响,对x线成像和解剖地标参考线绘制标准的要求不明确,不适合解剖变异的患者,缺乏对儿科患者的进一步研究。近年来,为了提高定位精度,对Schöttle方法进行了一些改进。结论:未来研究应结合三维打印、术中导航等新技术,发展个性化、智能化Schöttle定位方法,进一步提高其定位精度。
{"title":"[Research progress of Schöttle's method for femoral tunnel localization in medial patellofemoral ligament reconstruction].","authors":"Yuqiao Wei, Chongxiao Sun, Fan Lu, Peng'an Yan, Yayi Xia","doi":"10.7507/1002-1892.202409056","DOIUrl":"10.7507/1002-1892.202409056","url":null,"abstract":"<p><strong>Objective: </strong>To review the research progress of Schöttle's method in medial patellofemoral ligament reconstruction (MPFLR), and provide the latest knowledge and suggestions for surgical treatment.</p><p><strong>Methods: </strong>The studies on Schöttle's method at home and abroad in recent years were extensively collected, then summarized the problems affecting the accuracy of Schöttle's method and the new ideas to improve the accuracy of localization.</p><p><strong>Results: </strong>It's vital to accurately locate the femoral tunnel during MPFLR. Malposition of the femoral tunnel is the main cause of postoperative complications and surgical failure. Schöttle's method is the most well studied and most reproducible method for femoral tunnel localization, which is widely used as the \"gold standard\". However, there are still problems that affect the accuracy of Schöttle's method, including the impact of the internal/external rotation and varus/valgus of the knee on localization accuracy, unclear requirements for X-ray imaging and anatomical landmark reference line drawing standards, no suitable for patients with anatomical variations, and lack of further research on pediatric patients. In recent years, some new ideas are proposed to improve the Schöttle's method to improve the localization accuracy.</p><p><strong>Conclusion: </strong>Future research should combine new technologies such as three-dimensional (3D) printing and intraoperative navigation to develop personalized and intelligent Schöttle's method, further improving their localization accuracy.</p>","PeriodicalId":23979,"journal":{"name":"中国修复重建外科杂志","volume":"38 12","pages":"1524-1529"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Effectiveness of stepwise progressive ultra-tension-reducing suture method in treatment of high-tension wounds on chest, back, and limbs]. [渐进式超减压缝合法治疗胸、背、四肢高张力伤口的疗效]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202409048
Hang Liu, Ming Hu, Mingjun Rao, Feng Li, Qi Zhang, Xiujun Tang

Objective: To investigate effectiveness of a novel suture method-stepwise progressive ultra-tension-reducing suture method in closing high-tension wounds on the chest, back, and limbs.

Methods: A retrospective analysis was conducted on 25 patients with high-tension wounds on the chest, back, and limbs who were treated with stepwise progressive ultra-tension-reducing suture method between January 2022 and December 2022. Among the patients, there were 8 males and 17 females, with an average age of 30.5 years (range, 18-56 years). All wounds after scar or tumor resection were located on the chest, back, upper limbs, and lower limbs in 8, 6, 9, and 2 cases, respectively. The size of wounds ranged from 3.5 cm×2.8 cm to 40.0 cm×15.0 cm. All patients were advised to use topical silicone-based treatments postoperatively. The protrusion of the incision, the height of the protrusion, and the duration of the tension reduction effect were observed. The scar formation at the incision site at 6 months after operation was observed, the scar appearance was evaluated by Vancouver Scar Scale (VSS) score, and the scar width was measured. The patient's satisfaction and adverse reactions to incisions were also evaluated.

Results: The incisions significantly elevated, with a height of 0.3-2.5 cm, and the tension reducing effect lasted for 8.5-18.0 weeks after operation, with an average of 13.6 weeks. All incisons healed by first intention. One patient experienced transient hyperpigmentation, which resolved spontaneously. Three keloid patients showed localized redness postoperatively, and 2 experienced local recurrence, which improved significantly after treatment with triamcinolone, 5-fluorouracil injections, and laser therapy. All patients were followed up 6.0-13.5 months, with an average of 10.1 months. At 6 months after operation, all patients had linear scars, with VSS scores ranging from 1.0 to 3.5 (mean, 2.0). The width of the scars ranged from 0.5 to 3.0 mm (mean, 1.4 mm). The patients expressed satisfaction with the effectiveness.

Conclusion: The stepwise progressive ultra-tension-reducing suture method for high-tension wounds can effectively reduce the tension at the wound edges, providing a prolonged tension-reducing effect and satisfactory effectiveness.

目的:探讨一种新型缝合方法-渐进式超张力减压缝合法在胸、背、肢高张力创面缝合中的应用效果。方法:回顾性分析2022年1月至2022年12月间采用渐进式超张力减压缝合法治疗的25例胸、背、肢高张力创面患者。患者中男性8例,女性17例,平均年龄30.5岁,年龄范围18-56岁。瘢痕或肿瘤切除后创面均位于胸部8例,背部6例,上肢9例,下肢2例。伤口大小为3.5 cm×2.8 cm ~ 40.0 cm×15.0 cm。建议所有患者术后使用局部硅酮治疗。观察切口的突出程度、突出高度、张力缓解效果持续时间。观察术后6个月切口部位瘢痕形成情况,采用温哥华疤痕量表(Vancouver scar Scale, VSS)评分评价瘢痕外观,并测量瘢痕宽度。同时评估患者对切口的满意度和不良反应。结果:切口高度明显升高,高度为0.3 ~ 2.5 cm,术后张力降低效果持续8.5 ~ 18.0周,平均13.6周。所有的伤口都是第一次愈合的。一名患者经历了短暂的色素沉着,并自行消退。3例瘢痕疙瘩术后出现局部红肿,2例局部复发,经曲安奈德、5-氟尿嘧啶注射及激光治疗后明显好转。所有患者随访6.0 ~ 13.5个月,平均10.1个月。术后6个月,所有患者均出现线形疤痕,VSS评分在1.0 ~ 3.5之间(平均2.0)。疤痕宽度为0.5 ~ 3.0 mm(平均1.4 mm)。患者对治疗效果表示满意。结论:采用逐级递进式超降压缝合法治疗高张力创面,可有效降低创面边缘张力,降压效果持久,效果满意。
{"title":"[Effectiveness of stepwise progressive ultra-tension-reducing suture method in treatment of high-tension wounds on chest, back, and limbs].","authors":"Hang Liu, Ming Hu, Mingjun Rao, Feng Li, Qi Zhang, Xiujun Tang","doi":"10.7507/1002-1892.202409048","DOIUrl":"10.7507/1002-1892.202409048","url":null,"abstract":"<p><strong>Objective: </strong>To investigate effectiveness of a novel suture method-stepwise progressive ultra-tension-reducing suture method in closing high-tension wounds on the chest, back, and limbs.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 25 patients with high-tension wounds on the chest, back, and limbs who were treated with stepwise progressive ultra-tension-reducing suture method between January 2022 and December 2022. Among the patients, there were 8 males and 17 females, with an average age of 30.5 years (range, 18-56 years). All wounds after scar or tumor resection were located on the chest, back, upper limbs, and lower limbs in 8, 6, 9, and 2 cases, respectively. The size of wounds ranged from 3.5 cm×2.8 cm to 40.0 cm×15.0 cm. All patients were advised to use topical silicone-based treatments postoperatively. The protrusion of the incision, the height of the protrusion, and the duration of the tension reduction effect were observed. The scar formation at the incision site at 6 months after operation was observed, the scar appearance was evaluated by Vancouver Scar Scale (VSS) score, and the scar width was measured. The patient's satisfaction and adverse reactions to incisions were also evaluated.</p><p><strong>Results: </strong>The incisions significantly elevated, with a height of 0.3-2.5 cm, and the tension reducing effect lasted for 8.5-18.0 weeks after operation, with an average of 13.6 weeks. All incisons healed by first intention. One patient experienced transient hyperpigmentation, which resolved spontaneously. Three keloid patients showed localized redness postoperatively, and 2 experienced local recurrence, which improved significantly after treatment with triamcinolone, 5-fluorouracil injections, and laser therapy. All patients were followed up 6.0-13.5 months, with an average of 10.1 months. At 6 months after operation, all patients had linear scars, with VSS scores ranging from 1.0 to 3.5 (mean, 2.0). The width of the scars ranged from 0.5 to 3.0 mm (mean, 1.4 mm). The patients expressed satisfaction with the effectiveness.</p><p><strong>Conclusion: </strong>The stepwise progressive ultra-tension-reducing suture method for high-tension wounds can effectively reduce the tension at the wound edges, providing a prolonged tension-reducing effect and satisfactory effectiveness.</p>","PeriodicalId":23979,"journal":{"name":"中国修复重建外科杂志","volume":"38 12","pages":"1505-1509"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Biomechanical study of knee joint based on coronal plane alignment of the knee]. 基于膝关节冠状面排列的膝关节生物力学研究。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408048
Yunxin Wang, Ping Xu, Ning Lu, Wenjin Li, Shisen Xu

Objective: To establish a finite element model of the knee joint based on coronal plane alignment of the knee (CPAK) typing method, and analyze the biomechanical characteristics of different types of knee joints.

Methods: The finite element models of the knee joint were established based on CT scan data of 6 healthy volunteers. There were 5 males and 1 female with an average age of 24.2 years (range, 23-25 years). There were 3 left knees and 3 right knees. According to the CPAK typing method, the knees were rated as types Ⅰ to Ⅵ. Under the same material properties, boundary conditions, and axial loading, biomechanical simulations were performed on the finite element model of the knee joint. Based on the Von Mises stress nephogram and displacement nephogram, the peak stresses of the meniscus, femoral cartilage, and tibial cartilage, and the displacement of the meniscus were compared among different types of knee joints.

Results: The constructed finite element model of the knee joint was verified to be effective, and the stress and displacement results were consistent with previous literature. Under the axial load of 1 000 N, the stress nephogram showed that the stress distribution of the medial and lateral meniscus and tibial cartilage of CPAK type Ⅲ knee joint was the most uneven. The peak stresses of the lateral meniscus and tibial cartilage were 9.969 6 MPa and 2.602 7 MPa, which were 173% and 165% of the medial side, respectively. The difference of peak stress between the medial and lateral femoral cartilage was the largest in type Ⅳ knee joint, and the medial was 221% of the lateral. The displacement nephogram showed that the displacement of the medial meniscus was greater than that of the lateral meniscus except for types Ⅲ and Ⅵ knee joints. The difference between medial and lateral meniscus displacement of type Ⅲ knee joint was the largest, the lateral was 170% of the medial.

Conclusion: In the same type of joint line obliquity (JLO), the medial and lateral stress distribution of the knee was more uniform in varus and neutral positions than in valgus position. At the same time, the distal vertex of JLO subgroup can help to reduce the uneven medial and lateral stress distribution of varus knee, but increase the uneven distribution of valgus knee.

目的:建立基于膝关节冠状面排列(CPAK)分型法的膝关节有限元模型,分析不同类型膝关节的生物力学特征。方法:基于6例健康志愿者的膝关节CT扫描数据,建立膝关节有限元模型。男5例,女1例,平均年龄24.2岁,年龄范围23 ~ 25岁。有三个左膝和三个右膝。根据CPAK分型法,将膝关节分为Ⅰ~Ⅵ型。在相同的材料特性、边界条件和轴向载荷下,对膝关节有限元模型进行生物力学模拟。基于Von Mises应力云图和位移云图,比较不同类型膝关节的半月板、股骨软骨和胫骨软骨的峰值应力以及半月板的位移。结果:建立的膝关节有限元模型验证了模型的有效性,应力和位移结果与文献一致。在1 000 N的轴向载荷下,应力云图显示CPAK型Ⅲ膝关节内侧、外侧半月板和胫骨软骨的应力分布最不均匀。外侧半月板和胫骨软骨的峰值应力分别为9.969 6 MPa和2.6027 MPa,分别占内侧的173%和165%。Ⅳ型膝关节股骨软骨内侧与外侧的峰值应力差异最大,内侧为外侧的221%。位移云图显示,除Ⅲ和Ⅵ型膝关节外,内侧半月板位移大于外侧半月板位移。Ⅲ型膝关节内侧半月板移位与外侧半月板移位差异最大,外侧半月板移位为内侧半月板移位的170%。结论:同一类型关节线倾角(JLO)下,内翻位和中立位的膝关节内侧和外侧应力分布比外翻位更均匀。同时,JLO远端顶点亚组有助于减少膝内翻内侧和外侧应力分布不均匀,但增加了外翻膝关节分布不均匀。
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引用次数: 0
[A comparative study of dynamic versus static rehabilitation protocols after acute Achilles tendon rupture repair with channel assisted minimally invasive repair technique]. [通道辅助微创修复技术对急性跟腱断裂修复术后动态与静态康复方案的比较研究]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202408024
Zhonghe Wang, Lingtong Kong, Wenhao Cao, Junjun Tang, Hongzhe Qi, Meijing Dou, Haoyu Liu, Chen Chen, Hua Chen

Objective: To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique through a prospective comparative trial, aiming to provide a reference for clinically selecting a feasible treatment regimen.

Methods: Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study, with 60 patients meeting the selection criteria. They were randomly divided into a dynamic rehabilitation group ( n=30) and a static rehabilitation group ( n=30) using a computer-generated random number method. There was no significant difference in baseline data such as gender, age, body mass index, smoking history, injured side, cause of injury, and disease duration between the two groups ( P>0.05). After Achilles tendon anastomosis by using CAMIR technique, the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks, while the static rehabilitation group maintained a non-weight-bearing status during this period. Complications in both groups were recorded. At 3 and 6 months after operation, the Achilles tendon total rupture score (ATRS) was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb, and the 12-Item Short Form Health Survey (SF-12 scale) was used to assess the patients' quality of life, including physical component summary (PCS) and mental component summary (MCS) scores.

Results: No sural nerve injury occurred during operation in both groups. All patients were followed up 12-18 months (mean, 14 months). The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group ( P<0.05). At 3 months after operation, the dynamic rehabilitation group had significantly lower PCS, MCS, and SF-12 total scores compared to the static rehabilitation group ( P<0.05). At 6 months, all quality of life scores in the two groups were similar ( P>0.05). Two cases (6.6%) in the dynamic rehabilitation group and 5 cases (16.7%) in the static rehabilitation group developed complications, with no significant difference in incidence of complications ( P>0.05).

Conclusion: For acute Achilles tendon rupture, the dynamic rehabilitation protocol after Achilles tendon anastomosis by using CAMIR technique can improve early functional recovery and maintains comparable safety and effectiveness compared to static rehabilitation.

目的:通过前瞻性对比试验,探讨通道辅助微创修复(CAMIR)技术治疗急性跟腱断裂后动态康复方案与传统静态康复方案的疗效差异,为临床选择可行的治疗方案提供参考。方法:纳入2021年6月至2022年6月收治的急性跟腱断裂患者,符合入选标准的患者60例。采用计算机生成随机数法随机分为动态康复组(n=30)和静态康复组(n=30)。两组患者的性别、年龄、体重指数、吸烟史、损伤侧、损伤原因、病程等基线资料比较,差异均无统计学意义(P < 0.05)。CAMIR技术跟腱吻合后,动态康复组在跟腱靴辅助下进行早期部分负重训练,控制踝关节运动6周,静态康复组在此期间保持非负重状态。记录两组患者的并发症。术后3、6个月采用跟腱总断裂评分(ATRS)评估患肢跟腱功能受限程度,采用12项健康问卷(SF-12)评估患者生活质量,包括身体成分总结(PCS)和精神成分总结(MCS)评分。结果:两组患者术中均未发生腓肠神经损伤。所有患者均随访12-18个月(平均14个月)。动态康复组术后3、6个月ATRS评分明显高于静态康复组(PPP>0.05)。动态康复组出现并发症2例(6.6%),静态康复组出现并发症5例(16.7%),并发症发生率差异无统计学意义(P < 0.05)。结论:对于急性跟腱断裂,CAMIR技术跟腱吻合术后动态康复方案可提高跟腱早期功能恢复,且与静态康复相比具有相当的安全性和有效性。
{"title":"[A comparative study of dynamic versus static rehabilitation protocols after acute Achilles tendon rupture repair with channel assisted minimally invasive repair technique].","authors":"Zhonghe Wang, Lingtong Kong, Wenhao Cao, Junjun Tang, Hongzhe Qi, Meijing Dou, Haoyu Liu, Chen Chen, Hua Chen","doi":"10.7507/1002-1892.202408024","DOIUrl":"10.7507/1002-1892.202408024","url":null,"abstract":"<p><strong>Objective: </strong>To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique through a prospective comparative trial, aiming to provide a reference for clinically selecting a feasible treatment regimen.</p><p><strong>Methods: </strong>Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study, with 60 patients meeting the selection criteria. They were randomly divided into a dynamic rehabilitation group ( <i>n</i>=30) and a static rehabilitation group ( <i>n</i>=30) using a computer-generated random number method. There was no significant difference in baseline data such as gender, age, body mass index, smoking history, injured side, cause of injury, and disease duration between the two groups ( <i>P</i>>0.05). After Achilles tendon anastomosis by using CAMIR technique, the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks, while the static rehabilitation group maintained a non-weight-bearing status during this period. Complications in both groups were recorded. At 3 and 6 months after operation, the Achilles tendon total rupture score (ATRS) was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb, and the 12-Item Short Form Health Survey (SF-12 scale) was used to assess the patients' quality of life, including physical component summary (PCS) and mental component summary (MCS) scores.</p><p><strong>Results: </strong>No sural nerve injury occurred during operation in both groups. All patients were followed up 12-18 months (mean, 14 months). The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group ( <i>P</i><0.05). At 3 months after operation, the dynamic rehabilitation group had significantly lower PCS, MCS, and SF-12 total scores compared to the static rehabilitation group ( <i>P</i><0.05). At 6 months, all quality of life scores in the two groups were similar ( <i>P</i>>0.05). Two cases (6.6%) in the dynamic rehabilitation group and 5 cases (16.7%) in the static rehabilitation group developed complications, with no significant difference in incidence of complications ( <i>P</i>>0.05).</p><p><strong>Conclusion: </strong>For acute Achilles tendon rupture, the dynamic rehabilitation protocol after Achilles tendon anastomosis by using CAMIR technique can improve early functional recovery and maintains comparable safety and effectiveness compared to static rehabilitation.</p>","PeriodicalId":23979,"journal":{"name":"中国修复重建外科杂志","volume":"38 12","pages":"1492-1498"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Biomechanical study of screw implant angle in reconstruction of tibiofibular syndesmosis injury]. [胫腓联合损伤重建螺钉植入角度的生物力学研究]。
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202406079
Lei Zhang, Minghui Li, Mengyao Zhang, Jixiang Xiong, Junqiu Wang, Xin Zhou, Houyin Shi, Guoyou Wang

Objective: To investigate ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury by using a biomechanical test.

Methods: A total of 24 ankle specimens from adult cadavers were used as the tibiofibular syndesmosis injury model. According to the angle of screw placement, the tibiofibular syndesmosis injury models were randomly divided into groups A (0°), B (10°-15°), C (20°-25°), and D (30°-35°), and the screws were placed at a level 2 cm proximal to the ankle joint. The displacement of fibula was measured by biomechanical testing machine at neutral, dorsiflexion (10°), plantar flexion (15°), varus (10°), and valgus (15°) positions, with axial load of 0-700 N (pressure separation test). The displacement of fibula was also measured at neutral position by applying 0-5 N·m torque load during internal and external rotation (torsional separation test).

Results: In the pressure separation test, group C exhibited the smallest displacement under different positions and load conditions. At neutral position, significant differences were observed ( P<0.05) between group A and group C under load of 300-700 N, as well as between group B and group C under all load conditions. At dorsiflexion position, significant differences were observed ( P<0.05) between group A and group C under load of 500-700 N, as well as between groups B, D and group C under all load conditions, and the displacements under all load conditions were significantly smaller in group A than in group B ( P<0.05). At plantar flexion position, significant differences were observed ( P<0.05) between group D and group C under all load conditions. At valgus position, significant differences were observed ( P<0.05) between group A and group C under load of 400-700 N, as well as between groups B, D and group C under all load conditions. In the torsional separation test, group C exhibited the smallest displacement and group B had the largest displacement under different load conditions. During internal rotation, significant differences were observed ( P<0.05) between group B and group C under all load conditions, as well as between group D and group C at load of 3-5 N·m. During external rotation, significant differences were observed between groups B, D and group C under all load conditions ( P<0.05). No significant difference was detected between groups at the remaining load conditions ( P>0.05).

Conclusion: The ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury was 20°-25°, which has a small displacement of fibula.

目的:通过生物力学试验探讨胫腓联合损伤重建的理想螺钉植入角度。方法:采用24例成人尸体踝关节标本作为胫腓联合损伤模型。根据螺钉置入角度,将胫腓联合损伤模型随机分为A组(0°)、B组(10°-15°)、C组(20°-25°)、D组(30°-35°),螺钉置入距踝关节近2 cm水平。在0-700 N轴向载荷(压力分离试验)下,采用生物力学试验机测量腓骨在中性、背屈(10°)、足底屈(15°)、内翻(10°)和外翻(15°)位置的位移。在内外旋转过程中施加0-5 N·m的扭矩载荷(扭转分离试验),在中性位置测量腓骨的位移。结果:在压力分离试验中,C组在不同位置和载荷条件下的位移最小。中性位差异有统计学意义(PPPPPPPP>0.05)。结论:胫骨腓骨联合损伤重建的理想螺钉植入角度为20°~ 25°,具有较小的腓骨移位。
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引用次数: 0
[Clinical application of mineralized collagen scaffolds in surgical treatment of skull defects]. 矿化胶原蛋白支架在颅骨缺损外科治疗中的临床应用
Q3 Medicine Pub Date : 2024-12-15 DOI: 10.7507/1002-1892.202405012
Tuoyu Chen, Shuo Wang, Bo Li, Kaiyuan Yang, Weitao Man, Xiumei Wang

Objective: To explore the clinical application value of mineralized collagen (MC) bone scaffolds in repairing various types of skull defects, and to assess the suitability and repair effectiveness of porous MC (pMC) scaffolds, compact MC (cMC) scaffolds, and biphasic MC composite (bMC) scaffolds.

Methods: A retrospective analysis was conducted on the clinical data of 105 patients who underwent skull defect repair with pMC, cMC, or bMC between October 2014 and April 2022. The cohort included 63 males and 42 females, ranging in age from 3 months to 55 years, with a median age of 22.7 years. Causes of defects included craniectomy after traumatic surgery in 37 cases, craniotomy in 58 cases, tumor recurrence or intracranial hemorrhage surgery in 10 cases. Appropriate MC scaffolds were selected based on the patient's skull defect size and age: 58 patients with defects <3 cm² underwent skull repair with pMC (pMC group), 45 patients with defects ≥3 cm² and aged ≥5 years underwent skull repair with cMC (cMC group), and 2 patients with defects ≥3 cm² and aged <5 years underwent skull repair with bMC (bMC group). Postoperative clinical follow-up and imaging examinations were conducted to evaluate bone regeneration, the biocompatibility of the repair materials, and the occurrence of complications.

Results: All 105 patients were followed up 3-24 months, with an average of 13 months. No material-related complication occurred in any patient, including skin and subcutaneous tissue infection, excessive ossification, and rejection. CT scans at 6 months postoperatively showed bone growth in all patients, and CT scans at 12 months postoperatively showed complete or near-complete resolution of bone defects in all patients, with 58 cases repaired in the pMC group. The CT values of the defect site and the contralateral normal skull bone in the pMC group at 12 months postoperatively were (1 123.74±93.64) HU and (1 128.14±92.57) HU, respectively, with no significant difference ( t=0.261, P=0.795).

Conclusion: MC exhibits good biocompatibility and osteogenic induction ability in skull defect repair. pMC is suitable for repairing small defects, cMC is suitable for repairing large defects, and bMC is suitable for repairing pediatric skull defects.

目的:探讨矿化胶原(MC)骨支架在修复各类颅骨缺损中的临床应用价值,并评价多孔型MC (pMC)支架、致密型MC (cMC)支架和双相型MC复合(bMC)支架的适用性和修复效果。方法:回顾性分析2014年10月至2022年4月间采用pMC、cMC或bMC修复颅骨缺损的105例患者的临床资料。其中男性63例,女性42例,年龄3个月~ 55岁,中位年龄22.7岁。缺损原因包括外伤性手术后开颅37例,开颅58例,肿瘤复发或颅内出血手术10例。根据患者颅骨缺损的大小和年龄选择合适的MC支架。缺损患者58例。结果:105例患者均随访3-24个月,平均13个月。所有患者均未发生与物质相关的并发症,包括皮肤和皮下组织感染、过度骨化和排斥反应。术后6个月CT扫描显示所有患者骨生长,术后12个月CT扫描显示所有患者骨缺损完全或接近完全消退,pMC组修复58例。pMC组缺损部位与对侧正常颅骨术后12个月CT值分别为(1 123.74±93.64)HU和(1 128.14±92.57)HU,差异无统计学意义(t=0.261, P=0.795)。结论:MC在颅骨缺损修复中具有良好的生物相容性和成骨诱导能力。pMC适用于修复小缺损,cMC适用于修复大缺损,bMC适用于修复小儿颅骨缺损。
{"title":"[Clinical application of mineralized collagen scaffolds in surgical treatment of skull defects].","authors":"Tuoyu Chen, Shuo Wang, Bo Li, Kaiyuan Yang, Weitao Man, Xiumei Wang","doi":"10.7507/1002-1892.202405012","DOIUrl":"10.7507/1002-1892.202405012","url":null,"abstract":"<p><strong>Objective: </strong>To explore the clinical application value of mineralized collagen (MC) bone scaffolds in repairing various types of skull defects, and to assess the suitability and repair effectiveness of porous MC (pMC) scaffolds, compact MC (cMC) scaffolds, and biphasic MC composite (bMC) scaffolds.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 105 patients who underwent skull defect repair with pMC, cMC, or bMC between October 2014 and April 2022. The cohort included 63 males and 42 females, ranging in age from 3 months to 55 years, with a median age of 22.7 years. Causes of defects included craniectomy after traumatic surgery in 37 cases, craniotomy in 58 cases, tumor recurrence or intracranial hemorrhage surgery in 10 cases. Appropriate MC scaffolds were selected based on the patient's skull defect size and age: 58 patients with defects <3 cm² underwent skull repair with pMC (pMC group), 45 patients with defects ≥3 cm² and aged ≥5 years underwent skull repair with cMC (cMC group), and 2 patients with defects ≥3 cm² and aged <5 years underwent skull repair with bMC (bMC group). Postoperative clinical follow-up and imaging examinations were conducted to evaluate bone regeneration, the biocompatibility of the repair materials, and the occurrence of complications.</p><p><strong>Results: </strong>All 105 patients were followed up 3-24 months, with an average of 13 months. No material-related complication occurred in any patient, including skin and subcutaneous tissue infection, excessive ossification, and rejection. CT scans at 6 months postoperatively showed bone growth in all patients, and CT scans at 12 months postoperatively showed complete or near-complete resolution of bone defects in all patients, with 58 cases repaired in the pMC group. The CT values of the defect site and the contralateral normal skull bone in the pMC group at 12 months postoperatively were (1 123.74±93.64) HU and (1 128.14±92.57) HU, respectively, with no significant difference ( <i>t</i>=0.261, <i>P</i>=0.795).</p><p><strong>Conclusion: </strong>MC exhibits good biocompatibility and osteogenic induction ability in skull defect repair. pMC is suitable for repairing small defects, cMC is suitable for repairing large defects, and bMC is suitable for repairing pediatric skull defects.</p>","PeriodicalId":23979,"journal":{"name":"中国修复重建外科杂志","volume":"38 12","pages":"1427-1432"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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中国修复重建外科杂志
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