To evaluate the biomechanical action of lateral malleolar’s anatomical hook-plate in treatingWeber A-type ankle fracture. Methods Forty-eight cadaveric specimens of adult’s inferior extremities from June 2005to October 2006 were observed, consisting of 26 males and 22 females and aged 18-55 years. The external malleolus of the specimens were transected by using a wire saw at the ankle joint level, and then were divided into 4 groups randomly (groups A, B, C and D). Four distinct internal fixation instruments were used: lateral malleolar’s anatomical hook-plate in group A, general screws in group B , 1/3 tubular plate in group C and standard tension band in group D. Each group was further divided into 2 subgroups, A1-D1 and A2-D2. A1-D1 groups underwent anti-pressure and A2-D2 groups underwent anti-torsion biomechanically comparative analysis. Results The peak values of anti-pressure experiments in groups A1-D1 were (799.83 ± 105.47), (699.17 ± 63.81), (598.83 ± 123.14) and (453.00 ± 111.67) N respectively, group A1 was significantly higher than groups B1, C1 and D1 (P lt; 0.01); meanwhile, the peak values of anti-torsion experiments in groups A2-D2 were (37.17 ± 1.81), (30.33 ± 2.22), (20.50 ± 2.92), (24.83 ± 3.47) Nm respectively, group A2 was significantly higher than groups B2, C2 and D2 (P lt; 0.01). Conclusion The lateral malleolar’s anatomical hook-plate represents a definite biomechanical superiority, when compared with other 3 internal fixation instruments in treating fracture of external mlleolus.
Objective To investigate the osteogenic potential of four kinds of new bioactive ceramics combined with bovine bone morphogenetic proteins (BMP) and to explore the feasibility of using compounds as bone substitute material.Methods Ninety-six rats were divided into 4 groups(24 in each group). BMP was combined with hydroxyapatite(HA), tricalcium phosphate(TCP), fluoridated-HA(FHA), and collagen-HA(CHA) respectively. The left thighs of the rats implanted with HA/BMP, TCP/BMP, FHA/BMP,and CHA/BMP were usedas experimental groups. The right thighs of the rats implanted with HA, TCP, CHA, and decalcified dentin matrix(DDM) were used as control groups. The rats weresacrificed 1, 3, 5 and 7 weeks after implantation and bone induction was estimated by alkaline phosphatase(ALP),phosphorus(P), and total protein(TP)measurement. The histological observation and electronic microscope scanning ofthe implants were also made. Results The cartilage growth in the 4 experimental groups and the control group implanted with DDM was observed1 week after operation and fibrous connective tissues were observed in the other 3 control groups. 3 weeks after implantation, lamellar bone with bone marrow and positive reaction in ALP stain were observed in the 4 experimental groups. No bone formation or positive reaction in ALP stain were observed in the control groups. The amount of ALP activity, P value, and new bone formation in the experimental groups were higher than those in the control group(Plt;0.05). The amount of ALP activity, P value, and new bone formation in TCP/BMP group were higher than those in HA/BMP, CHA/BMP and FHA/BMP groups(Plt;0.05). There was no significant difference in TP between the BMP treatment group and the control groups. From 5th to 7th week, new bone formation, histochemistry evaluation, and the level of ALP、P、TP value were as high as those in the 3rd week. Conclusion New composite artificial bone of TCP/BMP, HA/BMP, CHA/BMP, and FHA/BMP all prove to be effective, but TCP/BMP is the most effective so that it is the most suitable biomaterial replacement of tissue.
ObjectiveTo evaluate the effectivness of using high porous polyethylene lower eyelid spacers (Medpor LES) combined with the lateral tarsal-strip procedure for reconstruction of the eyelid closure function in paralytic lagophthalmus after facial palsy. MethodsBetween March 2008 and December 2012, 32 patients (32 eyelids) with hypophasis in facial palsy which all sorts of causes lead to were treated with Medpor LES combined with the lateral tarsal-strip procedure. Of 32 cases, 20 were male and 12 were female, aged from 20 to 72 years (mean, 46.8 years). The left eye was involved in 18 cases and the right eye in 14 cases with a disease duration of 1.5 months to 2 years (mean, 4.4 months). All the patients were shown as lower eyelid ectropion, lower eyelid retraction, exposure keratitis, and corneal ulcer, but no obvious upper eyelid retraction was observed. ResultsPrimary healing of incision was obtained in all patients. The edema time of the eyelid was from 5 days to 3 weeks (mean, 2 weeks). Conjunctival edema appeared in 4 cases after 2 weeks of operation, which was cured after expectant treatment. The patients were followed up 5-8 months (mean, 6 months). At 1 week, 3 and 6 months after operation, the height of palpebral fissure was reduced, and the degree of lagophthalmus and low eyelid retraction were significantly corrected (P<0.05), but no significant difference among different time points after operation (P>0.05). Outer canthus displacement occurred in 3 cases at 1 month postoperatively, and was cured after the lateral tarsal strip procedure. No lower eyelid ectropion, corneal exposure, or Medpor LES displacement and exposure occurred during follow-up. ConclusionMedpor LES combined with the lateral tarsal-strip procedure has good effectiveness for reconstruction of eyelid closure function in most cases of paralytic lagophthalmus after facial palsy.
ObjectiveTo investigate the short-term effectiveness and advantages of the orthopedic robot-assisted femoral neck system (FNS) fixation in the treatment of fresh femoral neck fractures compared with the traditional manual operation. Methods A clinical data of 74 patients with fresh femoral neck fractures, who had undergone internal fixation with FNS between April 2020 and September 2021, was retrospectively analyzed. Among them, there were 31 cases of TiRobot-assisted operation (trial group) and 43 cases of traditional manual operation (control group). There was no significant difference between groups (P>0.05) in terms of gender, age, cause of injury, time from injury to operation, fracture side and type. The fracture fixation time (intraoperative fracture reduction to the end of suture), invasive fixation time (incision of internal fixation to the end of suture), the number of placing key-guide needle, incision length, intraoperative blood loss, fracture healing, and Harris score of hip function were recorded and compared. Results All operations were performed with no neurovascular injury or incision complications. The invasive fixation time, intraoperative blood loss, the number of placing key-guide needle, and the incision length in the trial group were superior to the control group (P<0.05), and there was no significant difference in fracture fixation time between groups (P>0.05). All patients were followed up 4-16 months (mean, 7 months). The fracture did not heal in 1 patient of trial group, and the other fractures healed in 2 groups; the fracture healing time was (17.6±1.9) weeks in trial group and (18.2±1.9) weeks in control group, and there was no significant difference between groups (t=0.957, P=0.345). At last follow-up, the Harris score of the trial group was 82.4±5.8, which was higher than that of the control group (79.0±7.7), but the difference was not significant (t=–1.483, P=0.147). Conclusion Orthopedic robot-assisted FNS fixation in the treatment of fresh femoral neck fractures has the similar short-term effectiveness as the traditional method, but the former has advantages in terms of operation time, intraoperative blood loss, and the number of placing key-guide needle, making the operation more minimally invasive and quicker, and more suitable for older patients.
【摘要】 目的 对比玻璃体手术和巩膜环扎术对治疗非复杂性孔源性视网膜剥离（rhegmotogenous retinal detachment，RRD）的疗效。 方法 检索Pubmed、Embase、Cochrane对照试验中心注册数据库，对相关的随机对照临床试验（randomized controlled trialc，RCT）按Cochrane协作网推荐的方法进行Meta分析。 结果 有晶状体组包括3篇RCT共523例，人工晶状体/无状晶体组包括4篇RCT共690例。有晶状体组玻璃体手术（pars plana vitrectomy，PPV）术后白内障的发生率更高[OR=4.18，95%CI（2.75，6.35），Plt;0.000 01]。人工晶状体/无晶状体组PPV术后最终解剖复位率更高[OR=1.97，95%CI（1.04，3.73），P=0.04]。 结论 巩膜环扎术通过降低术后白内障的发生率在治疗非复杂性有晶状体眼RRD中占有优势；PPV可提高最终解剖复位率，更适合人工晶状体/无晶状体眼RRD。【Abstract】 Objective To compare the efficacy of pars plana vitrectomy (PPV) and scleral buckling (SB) in treating uncomplicated rhegmatogenous retinal detachment (RRD). Methods Randomized controlled trials (RCTs) were searched from Pubmed, Embase and the Cochrane Central Register. Meta-analysis was conducted using the methods recommended by the Cochrane Collaboration. Results Three RCTs with 523 phakic eyes and four RCTs with 690 pseudophakic/aphakic eyes were included. In the phakic group, the rate of postopertative cataract was higher with PPV [OR=4.18, 95% CI (2.75,6.35), Plt;0.000 01]. In the pseudophakic/aphakic group, final anatomic success outcome was in favor of PPV [OR=1.97, 95% CI (1.04,3.73), P=0.04]. Conclusions SB results better in terms of postoperative cataract in phakic RRDs. PPV is more likely to achieve a favorable final reattachment in pseudophakic/aphakic RRDs.
ObjectiveTo evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling. MethodsA total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana three-port vitrectomy (23G PPV). The macular ERM alone was removed in 20 eyes (non-ILM peeling group). Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group). All patients underwent removal of ERM with assistance of triamcinolone acetonide. For patients who underwent ILM peeling, indocyanine green dye was used to stain the ILM. ILM was peeled off up to the marginal of macular vessels arch. The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively. There were no significant differences in gender, age, OD/OS, preoperative best-corrected visual acuity (BCVA), preoperative central macular thickness (CMT), preoperative total macular volume (TMV) and follow-up time between the two groups (P > 0.05). Intraoperative or postoperative complication was recorded during the follow-up period. At the final visit, the differences in BCVA, CMT and TMV between the two groups were analyzed, so did the correlations between BCVA and CMT or TMV in each group at the same time. ResultsThere was no recurrence of an ERM or severe complications, such as retinal detachment and endophthalmitis in either group. The mean BCVA of ILM peeling group and non-ILM peeling group was 0.53±0.27 and 0.54±0.26 respectively at the final visit. Postoperative BCVA improved significantly in both groups with significant difference (t=5.035, 4.964; P < 0.05). The was no difference of postoperative BCVA between two groups (t=0.176, P > 0.05). The mean CMT was (343.55±48.74) μm and (311.70±42.48) μm, and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3. CMT (t=9.508, 8.549) and TMV (t=11.098、15.372) revealed a significant decrease in both groups with significant difference (P < 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203, P < 0.05). No difference was found between the two groups in terms of TMV (t=0.755, P > 0.05). Furthermore, no correlation was observed between postoperative BCVA and CMT (r=0.244, 0.266; P > 0.05) or TMV (r=-0.096, 0.157; P > 0.05). Conclusions23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM. ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling, combined with much thicker postoperative CMT.
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
Objective To evaluate the clinical features of macular retinoschisis (MRS) and macular retinal detachment without hole (MRDH) in highly myopic eyes. Methods The clinical data of 19 patients (24 eyes) with MRS and MRDH from 186 patients (349 eyes) with high myopia were retrospectively analyzed. All of the patients had undergone the examinations of subjective refraction, binocular indirect ophthalmoscope, slit lamp microscope combined with Goldmann threemirror contact lens, fundus images, A/Bscan ultrasonography, and optical coherence tomography (OCT). Results In 349 eyes, 24 (6.9％) had MRS and (or) MRDH at the posterior pole. The results of ocualr fundus examinations showed that all of the 24 eyes (100%) had posterior scleral staphyloma (PS), 2 (8.3%) had vitreomacular traction (VMT), 2 (8.3%) had macular local superficial retinal detachment, and 1 (4.2%) had fullthickness macular hole. The results of Bscan ultrasonography also indicated PS in all 24 eyes (100%), macular local superficial retinal detachment in 7 (29.2%) with a bowlike configuration formed by the detached retina and the coneshaped roof of PS, and VMT in 2 (8.3%). The results of OCT revealed macular outerlayer retinoschisis (ORS) in 22 eyes (91.7%) in which 8 (36.4%) also had macular innerlayer retinoschisis (IRS); MRDH in 5 eyes (20.8%) in which ORS was found in 3 (60.0%) and simplex MRDH in 2 (40.0%) including 1 with VMT; VMT in 13 eyes (54.2%); cystoid macular edema (CME) in 3 eyes (12.5%); and lamellar macular hole in 4 eyes (16.7%). Conclusions MRS and MRDH are common complications in highly myopic eyes with posterior scleral staphyloma.OCT is more sensitive and accurate in detecting MRS and MRDH than routine ophthalmoscopic examination and B-scan ultrasonography.