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The Utility of Lesser Trochanter Version to Estimate Femoral Anteversion in Total Hip Arthroplasty: A Three-Dimensional Computed Tomography Study 全髋关节置换术中小转子位型评估股骨前倾的应用:一项三维计算机断层研究
Pub Date : 2022-06-28 DOI: 10.3390/std11020005
Mohamed Zaim bin Mohamed Thajudeen, Azhar Mahmood Merican, M. Hashim, Abid Nordin
Objective: Femoral anteversion is an important parameter that can prevent complication following total hip arthroplasty (THA) caused by improper positioning of the implant. However, assessing the femoral anteversion can be challenging in situations with significant defect of the femoral neck. In this study, the lesser trochanter version was nominated as alternative parameter to femoral anteversion. So, the main objective of this study is to determine whether the femoral anteversion correlates with the lesser trochanter version. Design: Retrospective study. Methods: Three-dimensional images of 100 femora were generated and their femoral anteversion and lesser trochanter version was measured. Correlation between the parameters were calculated. Results: The mean lesser trochanter version was 38.54° ± 7.86° (mean ± SD), while the mean femoral anteversion was 11.84° ± 10.06°. The lesser trochanter version was inversely correlated with the femoral anteversion with a correlation coefficient of −0.72. Conclusions: The lesser trochanter should be considered as an additional bony landmark to assess proper implant positioning in THA.
目的:股骨前倾角是预防全髋关节置换术(THA)术后假体位置不当引起并发症的重要参数。然而,在股骨颈有明显缺陷的情况下,评估股骨前倾是具有挑战性的。在本研究中,小转子变形被指定为股骨前倾的替代参数。因此,本研究的主要目的是确定股骨前倾是否与小转子前倾相关。设计:回顾性研究。方法:生成100根股骨的三维图像,测量股骨前倾角和股骨小转子内径。计算了各参数之间的相关性。结果:股骨小转子平均前倾为38.54°±7.86°(平均值±SD),股骨前倾为11.84°±10.06°。小转子前倾与股骨前倾呈负相关,相关系数为- 0.72。结论:小转子应被视为评估THA中植入物正确定位的额外骨标志。
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引用次数: 2
Inframammary Fold Banking of the Non-Dominant Superficial Epigastric Vein (SIEV) in Unilateral Autologous Breast Reconstruction: A Simple and Helpful Backup Option for Revision Surgery 单侧自体乳房重建中非优势胃上浅静脉(SIEV)的乳下折叠银行:一种简单而有用的翻修手术备用选择
Pub Date : 2022-05-19 DOI: 10.3390/std11010004
C. Hirche, U. Kneser, S. Fischer
Free flaps from the lower abdomen represent the workhorses of modern autologous, microvascular breast reconstruction. Rare signs of venous congestion often become evident during the primary index operation, but a secondary shift of the initially dominant drainage of the DIEV system to the SIEV system with consequent malperfusion is a feared, rare event requiring urgent decision, and complex skill using vein grafts and additional anastomosis to restore a sufficient venous outflow. For secondary anastomosis of the SIEV, especially in stacked flaps, a vein graft to the DIEV or retrograde IMV may be necessary, but this requires an additional donor site, thus prolonging procedure time during the emergency operation and resulting in additional scars of the graft’s donor site. We report on a versatile, easy technique of scheduled inframammary fold banking of the dissected, flushed, and clipped non-dominant superficial epigastric vein (SIEV) in unilateral autologous breast reconstruction during the index operation. The banked graft may service as an easy and convenient accessible vein graft in the rare event of secondary shifting of the initial dominant drainage of the DIEV to the SIEV system with the need for urgent re-operation. We retrospectively evaluated the management and outcome of all suitable patients receiving autologous breast reconstruction with a unilateral abdominal DIEP or MS-Tram flap accompanied by banking of the SIEV in the breast pocket between 2017 and 2020 in the present study. In two out of 42 patients (4.8%) receiving autologous breast reconstruction with an abdominal DIEP or MS-TRAM flap with banking of the SIEV in the breast pocket, secondary malperfusion of the flap with progressive venous congestion occurred during the first 48 h perioperatively, between 2 and 37 (mean: 19.5) hours after skin closure. In both cases malperfusion was due to secondary SIEV system dominance, and the banked vein was used as an interpositional graft to the retrograde IMV (case 1) or the DIEV (case 2). Revision surgery lasted between 95 and 121 (mean: 108) minutes without the need for further vein graft harvesting, and further healing was uneventful. Based on the limited cases, inframammary fold banking of the non-dominant SIEV is a versatile, beneficial, and feasible concept with scarce additional dissection time and can be done in all unilateral breast reconstructions to have a reliable graft for emergency re-exploration. It is a useful approach in the context of spare part surgery and tissue banking to safeguard against the rare instance of venous congestion and need for an interpositional graft.
来自下腹部的游离皮瓣是现代自体微血管乳房重建的主力军。在初级指数手术中,静脉充血的罕见迹象经常变得明显,但最初主要的DIEV系统引流向SIEV系统的继发性转移,导致灌注不良是一种令人担忧的罕见事件,需要紧急决策,需要复杂的技巧,使用静脉移植物和额外的吻合来恢复足够的静脉流出。对于SIEV的二次吻合,特别是在堆叠皮瓣中,可能需要静脉移植物到DIEV或逆行IMV,但这需要额外的供区,因此在紧急手术中延长了手术时间并导致移植物供区额外的疤痕。在单侧自体乳房重建中,我们报告了一种多功能、简单的技术,即在指数手术中对剥离、冲洗和剪切的非显性上腹部浅静脉(SIEV)进行预定的乳下褶皱银行。在DIEV最初的主要引流再次转移到SIEV系统而需要紧急再次手术的罕见情况下,该移植体可以作为一种简单方便的静脉移植体。在本研究中,我们回顾性评估了2017年至2020年期间所有接受单侧腹部DIEP或MS-Tram皮瓣并在乳房口袋中放置SIEV的自体乳房重建的合适患者的处理和结果。42例自体乳房重建患者中有2例(4.8%)采用腹腔DIEP或MS-TRAM皮瓣将SIEV存储在乳房袋中,在围手术期前48小时,即皮肤闭合后2至37小时(平均19.5小时)内,皮瓣继发性灌注不良伴进行性静脉充血。在这两例中,灌注不良都是由于继发性SIEV系统占主导地位,并且将堆积的静脉用作逆行IMV(病例1)或DIEV(病例2)的间置移植物。翻修手术持续了95至121分钟(平均:108),无需进一步采集静脉移植物,并且进一步愈合顺利。基于有限的病例,非优势SIEV的乳下折叠银行是一种通用的,有益的,可行的概念,无需额外的剥离时间,可以在所有单侧乳房重建中进行,以获得可靠的移植物用于紧急再探查。这是一种有用的方法,在备件手术和组织银行的背景下,以防止罕见的情况下静脉充血和需要插入移植物。
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引用次数: 0
Report on the 9th National Congress AICPE (Associazione Italiana di Chirurgia Plastica Estetica) Held in Sorrento, Italy, 22–24 April 2022 2022年4月22日至24日在意大利索伦托举行的第九届全国代表大会报告
Pub Date : 2022-04-22 DOI: 10.3390/std11010003
E. Riggio
The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery due to the number of participants and as parterre of invited speakers chosen for their renowned scientific value [...]
意大利整形美容外科协会(AICPE)的年度大会是欧洲关于整形美容手术最相关的会议之一,因为参与者的数量和作为受邀演讲者的一部分,他们因其著名的科学价值而被选中〔…〕
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引用次数: 0
Surgical Techniques Development: A Multidisciplinary Medium for the Future Practical Surgery 外科技术发展:未来实用外科的多学科媒介
Pub Date : 2022-02-09 DOI: 10.3390/std11010002
E. Riggio
Surgical Techniques Development is an Open Access peer-reviewed journal focusing on minimally invasive surgical techniques, technical innovations such as new instruments, new technologies, new robotics applications, and other new ideas, and is open to suggestions coming from all areas of surgery [...]
《外科技术发展》是一本开放获取的同行评审期刊,专注于微创外科技术、技术创新,如新仪器、新技术、新机器人应用和其他新想法,并对来自外科各个领域的建议持开放态度[…]
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引用次数: 0
Publisher’s Note: Continued Publication of Surgical Techniques Development by MDPI 出版商说明:MDPI继续出版《外科技术发展》
Pub Date : 2022-01-29 DOI: 10.3390/std11010001
Agata Kolomanska
Surgical Techniques Development was launched in 2011 and has been focused on progressive surgical techniques and advanced technologies, such as laparoscopy, minimally invasive surgery, endoscopy, robotics, and plastic surgery [...]
外科技术开发于2011年启动,一直专注于先进的外科技术和先进技术,如腹腔镜、微创手术、内窥镜、机器人和整形外科[…]
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引用次数: 0
Successful surgical treatment of intractable post-radiation rectal bleeding 难治性放射后直肠出血的成功手术治疗
Pub Date : 2022-01-13 DOI: 10.4081/std.2021.9125
R. Mirzaei, B. Mahjoubi, J. Shoa, Roozbeh Cheraghali, Zahra Omrani
Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8-12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control.
患者通常会在完成治疗8-12个月后出现慢性放射后结肠炎和直肠炎的症状。内镜方法在治疗放疗后结肠炎和直肠炎引起的出血中起着主要作用。剩下的大约10%的患者需要手术治疗。本文报告一位患有转移性乳腺癌癌症的64岁女性,她因顽固性直肠出血被转诊给我们。全结肠镜检查和硬直肠乙状结肠镜检查显示直肠炎、直肠和乙状结肠毛细血管扩张、距肛门边缘15至30厘米的多处坏死性溃疡,以及距肛门边缘约10厘米的巨大出血性溃疡和斑片状坏死区。切除了这个异常的辐照部分,然后对残余直肠进行了经腹部和经肛门的粘膜切除术。我们采用了正常结肠近端经直肠残余壁至肛门区的牵引技术,最后进行了结肠肛门吻合。由于肛门区吻合,未进行分流造口。有了这项技术,我们可以避免冷冻骨盆中的剧烈解剖及其后果,避免腹腔内吻合,不需要分流造口,最重要的是,明确的出血控制。
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引用次数: 0
Schwannomas of ear, nose, throat and neck 耳、鼻、喉和颈部神经鞘瘤
Pub Date : 2019-08-27 DOI: 10.4081/std.2019.7550
N. Sathe, Sheetal Shelke, Ankur Pareek, K. Chavan
Schwannoma is a benign tumour of nerve sheath origin with latent malignant potential. All cranial nerves can give rise to schwannoma except for olfactory and optic nerves, which are devoid of Schwann cell. Schwanommas are usually asymptomatic and present late owing to compression of nerve of origin. We present our study of 19 cases of schwannoma arising from unusual sites in head and neck, having varied presentation and the challenges faced in management of these cases. These cases presented in detail to the department of Ear, Nose and Throat, KEM Hospital, and were thoroughly evaluated clinically and radiologically to formulate a management strategy. Schwannoma of the head and neck is a rare entity but should be considered as differential diagnosis in unilateral nasal mass cases, palatal masses, anterior and lateral neck masses. Nerve of origin may not always be clear preoperatively but the possibility of postoperative loss of nerve function should be kept in mind. Radiological investigations like computed tomography scan and magnetic resonance imaging play a pivotal role in management. In case of nonvascular neck tumours, fine needle aspiration cytology is crucial but has low accuracy in the diagnosis of neural tumors. Histopathology of excised tumour remains the gold standard in diagnosis.
神经鞘瘤是一种起源于神经鞘的良性肿瘤,具有潜在的恶性潜能。除了嗅觉神经和视神经外,所有的脑神经都会产生神经鞘瘤,因为嗅觉神经和视觉神经中没有许旺细胞。神经鞘瘤通常是无症状的,由于来源神经受到压迫而出现较晚。我们对19例由头颈部异常部位引起的神经鞘瘤进行了研究,这些神经鞘瘤的表现多种多样,在处理这些病例时面临挑战。这些病例详细提交给KEM医院耳鼻咽喉科,并进行了临床和放射学全面评估,以制定管理策略。头颈部神经鞘瘤是一种罕见的实体瘤,但应被视为单侧鼻腔肿块、腭部肿块、颈部前部和外侧肿块的鉴别诊断。术前神经起源可能并不总是清楚的,但应记住术后神经功能丧失的可能性。计算机断层扫描和磁共振成像等放射学调查在管理中发挥着关键作用。在非血管性颈部肿瘤的情况下,细针抽吸细胞学检查是至关重要的,但在神经肿瘤的诊断中准确性较低。切除肿瘤的组织病理学仍然是诊断的金标准。
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引用次数: 0
Early or late recurrences of breast carcinoma are to be researched in relation to fat grafting 研究早期或晚期乳腺癌复发与脂肪移植的关系
Pub Date : 2019-05-20 DOI: 10.4081/STD.2019.8067
E. Riggio
Not available.
不可用。
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引用次数: 0
True orthodontic intrusion using three-piece intrusion arch for correcting excessive gingival exposure 使用三件套侵入弓矫正牙龈过度外露的正畸侵入
Pub Date : 2018-10-26 DOI: 10.4081/STD.2018.7762
Kavitha Odathurai Marusamy, Saravana K. Ramasamy, B. Akondi, G. Cherackal
The combination of proclined upper anteriors with high gingival exposure is challenging for the orthodontist. Correction of proclined upper anteriors sometimes leads to deepening of the bite and loss of posterior anchorage resulting in worsening of gingival exposure. Routinely correction of high gingival exposure was done prior to space closure resulting in increased treatment duration. However, application of sound biomechanical strategies can help us overcome these challenges without compromising treatment time. This presentation will describe the meticulous orthodontic biomechanics using a 3-piece intrusion arch to simultaneously correct excessive gingival exposure as well as accomplish space closure. The patient presented with Class I malocclusion with proclined upper anterior teeth, crowding in upper and lower arches and an excessive gingival exposure. Fixed orthodontic therapy was initiated with first premolar extractions and the primary strategies after correcting of the crowding was the effective use of a 3-piece intrusion arch for simultaneous intrusion and retraction of proclined anterior teeth. Biomechanics strategies utilizing the 3 piece intrusion arch effectively aided in closure of spaces, correction of high gingival exposure, intrusion of the upper anteriors and controlling posterior anchorage. All desired treatment outcomes were achieved without prolonging treatment time. Proper biomechanics strategies can effectively bring about true intrusion of the upper anteriors as well as correct the upper incisor proclination without prolonging treatment time. The use of threepiece intrusion arch to achieve orthodontic correction assures the attainment of predictable treatment results. Loss of anchorage is seldom observed because of the tip back moment on the posterior teeth. Another advantage of intrusion mechanics is the control of the vertical dimension.
对于正畸医生来说,直肠上前方与高牙龈暴露的结合是具有挑战性的。矫正前上颚有时会导致咬合加深和后部固定缺失,从而导致牙龈暴露恶化。在间隙闭合前对高牙龈暴露进行常规矫正,从而延长治疗时间。然而,应用合理的生物力学策略可以帮助我们在不影响治疗时间的情况下克服这些挑战。本演示将描述使用三件式侵入弓的精细正畸生物力学,以同时纠正过度的牙龈暴露并实现间隙闭合。患者表现为I类错牙合,上前牙前倾,上下牙弓拥挤,牙龈过度暴露。固定正畸治疗是从第一前磨牙拔除开始的,矫正拥挤后的主要策略是有效使用三件式侵入弓,同时侵入和缩回前牙。利用3件式侵入弓的生物力学策略有效地有助于间隙的闭合、牙龈高暴露的矫正、前上牙的侵入和后锚定的控制。在不延长治疗时间的情况下实现了所有期望的治疗结果。适当的生物力学策略可以在不延长治疗时间的情况下有效地实现上前牙的真正侵入,并纠正上切牙的向内旋。使用三件式侵入弓进行正畸矫正,确保了可预测的治疗结果。由于后牙的后倾力矩,很少观察到锚定缺失。入侵机制的另一个优点是对垂直维度的控制。
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引用次数: 1
Sewing needle migrating from esophagus into prevertebral space: A challenging case 缝衣针从食道迁移到椎前间隙:一个具有挑战性的病例
Pub Date : 2018-06-20 DOI: 10.4081/std.2018.7073
N. Sathe, Sheetal Shelke, R. Priya, K. Chavan
Oesophageal foreign body presents as a medical emergency and requires immediate evaluation and treatment. We are reporting a rare case of sewing needle in esophagus migrating into the prevertebral space at thoracic inlet level. A 13-year-old mentally retarded female child was brought in emergency at midnight with complaint of accidental ingestion of sewing needle with the thread. Patient was posted for rigid esophagoscopy under general anaesthesia, no needle could be visualised and only thread of the sewing needle was removed. So patient was taken up for neck exploration along with gastroenterologists. Further careful dissection confirmed the needle in the pre vertebral space, which was removed successfully with artery forceps. Patient was given IV antibiotics for 10 days. Patient had an uneventful recovery and was discharged after 10 days. Pointed metallic slender foreign bodies can perforate and migrate very fast in the neck or chest and can lead to morbidity and mortality. Multidisciplinary approach offers a great advantage in surgical planning and proper patient management.
食道异物表现为急症,需要立即评估和治疗。我们报告一例罕见的食道缝衣针在胸椎入口水平迁移到椎前间隙的病例。一名13岁智障女童因不慎误食带线的缝纫针而于午夜被紧急送医。患者在全身麻醉下行刚性食管镜检查,未见穿刺针,仅取下缝线。所以病人和胃肠病学家一起被带去做颈部检查。进一步仔细解剖证实椎前间隙中有针,并用动脉钳成功取出。患者静脉注射抗生素10天。病人顺利康复,10天后出院。尖锐的金属细长异物可在颈部或胸部迅速穿孔和迁移,并可导致发病率和死亡率。多学科方法在手术计划和适当的患者管理方面具有很大的优势。
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引用次数: 1
期刊
Surgical Techniques Development
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