中国修复重建外科杂志最新文献

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.

In recent years, considerable progress has been made in the specific development and practice of enhanced recovery after surgery (ERAS) for geriatric hip fracture domestically and internationally. By synthesizing domestic and international research reports, this article analyzes the current status of key development areas of ERAS for geriatric hip fracture and puts forward future prospects. The main contents include the crises and opportunities of geriatric hip fracture against the backdrop of deep aging, the specific implementation of team and model construction in the application of ERAS concept to geriatric hip fracture management, the benefits and effect evaluation of recent studies, as well as the opportunities and innovative pathways brought by the development of big data and artificial intelligence for the future development of ERAS in this field.

Objective: To review the biomechanical rationale, surgical techniques, and clinical outcomes of meniscal centralization for degenerative medial meniscus extrusion.

Methods: A comprehensive literature search was conducted on recent domestic and international studies focusing on biomechanics, surgical methods, and clinical applications of meniscal centralization.

Results: Meniscus extrusion (radial displacement ≥3 mm beyond the tibial plateau) is commonly associated with degenerative knee conditions, leading to meniscal dysfunction and accelerated osteoarthritis progression. Meniscal centralization is a surgical technique that reduces extrusion by suturing the displaced meniscus back to the tibial plateau, thereby restoring its coverage and load-sharing function. Biomechanical studies have demonstrated its efficacy in reducing extrusion and improving joint contact mechanics. Surgical techniques primarily include the Pull-out method and anchor-based fixation, often supplemented by Pie-crusting release and meniscal mobilization to facilitate reduction. Clinical evidence suggests that centralization, either alone or combined with high tibial osteotomy and/or meniscal root repair, can improve short-term functional scores, reduce extrusion, and potentially delay joint degeneration.

Conclusion: Meniscal centralization represents a promising joint-preserving technique with favorable biomechanical and early clinical outcomes. However, its long-term efficacy warrants further investigation through high-quality studies.

Severe extremity injury results from high-energy trauma and causes extensive damage to multiple tissues. Such injuries directly threaten both limb viability and patient survival and remains a major challenge in trauma orthopaedics. The cornerstone of treatment is based on comprehensive assessment by a multidisciplinary team to guide evidence-based decisions on limb salvage. In repair and reconstruction strategies, the timing of soft-tissue coverage plays a critical role. Delayed primary flap coverage, performed 3-7 days after injury, has become the preferred approach. After repeated debridement to ensure a clean wound bed, this strategy improves flap survival and reduces infection risk. Fracture fixation requires dynamic decision-making. External fixators provide damage control and temporary stabilization and allow soft tissues to recover. Once conditions permit, conversion to internal fixation, such as intramedullary nails or plates to achieve stable fixation. Complex cases with severe contamination or infection require staged management. After thorough early debridement, local antibiotic delivery using antibiotic-loaded bone cement, such as vancomycin cement, can be applied. This is often combined with negative-pressure wound therapy, and external fixation may serve as definitive treatment. Large segmental bone defects can be managed using the induced membrane technique or bone transport. In addition, emerging strategies such as recombinant Staphylococcus aureus vaccines for infection prevention and three-dimensional-printed personalised implants for bone reconstruction show promising clinical potential.

Objective: To delineate the mechanistic role of platelet-rich plasma (PRP)-derived extracellular vesicles (EVs) in tissue repair and regeneration, and evaluate their clinical translation potential.

Methods: A systematic evidence synthesis was conducted through critical analysis of contemporary domestic and international literature, focusing on PRP-EVs' biophysical properties, signal transduction networks, and multi-tissue regenerative efficacy.

Results: PRP-EVs coordinate hemostasis, anti-inflammatory modulation, angiogenesis, and tissue plasticity through mediation of cellular proliferation, migration, and differentiation. Their low immunogenicity and biostability constitute a novel cell-free therapeutic paradigm.

Conclusion: PRP-EVs exhibit substantial translational merit in regenerative medicine, yet persistent impediments in standardized isolation protocols, longitudinal biosafety verification, and clinical translation frameworks necessitate resolution.