Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
目的 观察和评估一期手术治疗肛门直肠周围脓肿的临床疗效。方法 回顾性分析我院2001年1月至2006年10月期间107例实施一期手术的肛门直肠周围脓肿患者的临床资料。结果 所有患者均行一次性根治手术，术后切口换药。住院时间9～28 d，平均18.5 d。术后随访3～36个月，平均19.5个月，1例术后形成瘘管，2例术后脓肿复发，此3例经再次手术治愈，无复发； 术后一次性治愈率达97.2%（104/107）。结论 一期手术治疗肛门直肠周围脓肿较单纯切开引流手术能明显地缩短术后感染控制时间，降低术后脓肿的复发率和肛瘘的发生率，减轻患者的痛苦。
Objective To review the progress of a disintegrin and metalloproteinase with thrombospondin motif 4 (ADAMTS-4) and ADAMTS-5 in osteoarthritis. Methods Recent literature about the ADAMTS-4 and -5 in osteoarthritis was analyzed; the structure, function, inhibitors of the ADAMTS-4 and -5, and the relationship between the proteases and osteoarthritis were analyzed and summarized. Results ADAMTS-4 and -5 can reduce chondrocyte and extracellular matrix by degrading aggrecan and cartilage oligomeric matrix protein, which induced the pathogenesis of osteoarthritis. Conclusion ADAMTS-4 and -5 have been demonstrated to play important roles in osteoarthritis. It can better guide treatment and prevention of osteoarthritis to further study related mechanism of ADAMTS-4 and -5, and to promote the establishment of a clinical drug targets.
Objective To review the progress of in vivo study on degradable magnesium alloys application as bone-implant materials. Methods Recent literature was extensively reviewed and summarized, concerning the in vivo study on degradable magnesium alloys as orthopaedic implants. Results Magnesium alloys possess a natural ability to degrade via corrosion in vivo, which is promising candidate material for orthopaedic medical device applications. A great progress has been made to improve in vivo performance and integration with bone tissue. However, the degradation mechanism of magnesium-based materials in the physiological environment and long-term effect on body are not available. The modulation of the corrosion rate of magnesium alloys must also be accomplished. Conclusion Magnesium alloys have the potential to serve as degradable implants for orthopaedic applications, but a great deal of further investigation is still necessary.
Objective To investigate whether combining use of platelet-rich plasma (PRP) and decalcified bone matrix (DBM) has synergistic action on promoting bone consol idation and heal ing. Methods Forty male New Zealand rabbits (weighing 2.2-2.8 kg) were randomly divided into 4 groups (n=10). The whole blood was extracted from the central aural artery and PRP was prepared with the Landesberg’s method. An 1 cm-defect was made below the tibiofibular joint of the lefttibia through osteotomy. In group A, defect was repaired by distraction osteogenesis (1 cm); in group B, defect was repaired with 0.5 cm DBM and then by distraction osteogenesis (0.5 cm); in group C, defect was repaired by distraction osteogenesis (1 cm) and local injection of 1 mL PRP; in group D, defect was repaired by 0.5 cm DBM combined with 1 mL PRP and then by distraction osteogenesis (0.5 cm). Then lengthening started at 7 days after operation, at a rate of 1 mm/day and 0.5 mm every time for 10 days (groups A and C) or for 5 days (groups B and D). After the lengthening, the consolidation was performed. The X-ray films were taken at 0, 12, 17, 27, and 37 days after operation. At 37 days after operation, the tibial specimens were harvested for Micro-CT scanning, three-dimensional reconstruction and biomechanical test. Results The X-ray films showed that new bone formation in groups B and C was obviously better than that in groups A and D at 37 days. The bone mineral density (BMD), bone mineral content (BMC), and bone volume fraction (BVF) of groups B and C were significantly higher than those of groups A and D (P lt; 0.05); the BMD and BMC of group C were significantly higher than those of group B (P lt; 0.05); the BVF had no significant difference between groups B and C (P gt; 0.05). There was no significant difference in BMD, BMC, and BVF between groups A and D (P gt; 0.05). The trabecula number (Tb.N) of group C was significantly more than that of other groups (P lt; 0.05), and the trabecula spacing (Tb.Sp) of group C was significantly smaller than that of other groups (P lt; 0.05), but no significant differencewas found among other groups (P gt; 0.05). There was no significant difference in the trabecula thickness among 4 groups (P gt; 0.05). The ultimate angular displacement had no significant difference among 4 groups (P gt; 0.05). The maximum torque of groups B and C was significantly higher than that of groups A and D (P lt; 0.05); the maximum torque of group C was significantly higher than that of group B (P lt; 0.05); no significant difference was found between groups A and D (P gt; 0.05). Conclusion In the rabbit bone defect/lengthening model, local injection of PRP can enhance bone consol idation effectively during consol idation phase. In normal distraction rate, DBM can promote bone consol idation during distraction osteogenesis. In the early stage of distraction osteogenesis, combining use of DBM and PRP can not further promote bone consolidation and healing.
Objective To explore the effectiveness of conservative dressing change method in treating skin necrosis after open reduction with internal fixation (ORIF) of calcaneal fracture. Methods Between November 2007 and June 2010, 21 cases of skin necrosis after ORIF of calcaneal fracture were treated, including 18 cases of Sanders type II and 3 cases ofSanders type III. There were 20 males and 1 female with an average age of 33.1 years (range, 23-60 years). All fractures were close fractures and were treated by ORIF with plate. Skin necrosis occurred at 3-5 days (mean, 4 days) after internal fixation. The interval of internal fixation and conservative dressing change was 3-10 days (mean, 6 days). Of 21 cases, 10 cases had superfacial skin necrosis with a size range of 1-10 cm in length and 0.5-1.5 cm in width, and 11 cases had deep skin necrosis with a size range of 1-8 cm in length and 0.5-1.5 cm in width. The conservative dressing change method was performed. Alcohol (75%) was used at the edge of the zone of skin necrosis, whereas sal ine in the central of the wound every 2-3 days. The necrosed tissue in the wound was reserved as more as possible. No patient was given antibiotic. Results Scab formed and subcrust heal ing was observed after 6-30 days (mean, 16 days) in 20 patients, 1 patient failed for discontinue treatment. No case had deep infection or osteomyl itis. The mean treatment time was 7.8 days (range, 6-14 days) in 10 cases of superfacial skin necrosis, and was 23.1 days (range, 14-30 days) in 10 cases of deep skin necrosis. All cases were followed up 92 days on average (range, 54-123 days). The scar was usually dark red and hard, protruding from the normal skin. No patient had difficulty in weight bearing or walking. Conclusion Skin necrosis after ORIF of calcaneal fracture can be cured by the conservative dressing change method, and this conservative method is effective and economic.
Objective To investigate the surgical resection and reparation of heel with malignant melanoma. Methods Eight patients with malignant melanoma were treated from May 2001 to December 2003. The patients included 5 males and 3 females, and their ages ranged from 28 to 56 years. All lesions were located in theheel and were proved by pathological examination. According to Breslow classification, there were 2 cases of Grade Ⅰ, 5 cases of Grade Ⅱ, and 1 case of GradeⅢ. Local extensive resection was performed in all cases. Lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied bysural nutrition blood vessel were respectively applied in the reparation according to the size of heel soft tissue defect. The treatment with interferon was delivered before and after the operation. Results The surgical reparation was successful in all 8 cases. The postoperative follow-up was conducted from 18 monthsto 4 years. All patients remained alive and no tumor recurrence was observed. Considering the recovery of the function and sense, the best result was acquired with plantar medial artery island skin flap and lateral pedal skin flap, good with retrograde skin flap supplied by sural nutrition blood vessel. Conclusion Local extensive resection is essential for the heel with malignant melanoma. Reparative reconstruction should be made on negative operative margin. Satisfactory clinical outcome is achieved by using lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel.
In order to obtain the anatomical basis of transferring the anterior interosseous nerve to repair the injury of thenar or ulnar nerve at the wrist level, ten fresh cadaveric forearms were dissected. The pronator quadratus branch of the median nerve was (1.5 +/- 0.4) mm in diameter with (866 +/- 144) nerve fibers. The recurrent branch of median nerve was (1.7 +/- 0.3) mm in diameter with (1,120 +/- 97) nerve fibers. The deep branch of ulnar nerve was (2.1 +/- 0.4) mm in diameter with (1,318 +/- 120) nerve fibers. To repair the thenar recurrent branch, nerve graft should be used to bridge between the distal end of the anterior interosseous nerve and the origination of the recurrent branch. The deep branch of the ulnar nerve could be repaired by direct suture after being dissected proximally. In patients, the technique was applied to repair 17 cases of injury of thenar branch and 3 cases of injury of deep branch of ulnar nerve. Among them, seventeen cases were followed up from 2 to 7 years. On electromyogram it was normal in 10. The myodynamia was restored in different degree: M2 in 2, M3 in 5, M4 in 7, M5 in 3. The procedure of the operation and the matters needed attention during the operation were discussed.
ObjectiveTo summarize the research progress of microRNA (miRNA) in the osteoarthritis (OA) cartilage matrix degradation. MethodsThe domestic and foreign related literature about the miRNA in the OA cartilage matrix degradation was reviewed, summarized, and analyzed. ResultsOA is a common chronic joint disease characterized by cartilage degeneration, its etiology and pathogenesis are still not completely clear. miRNA, a kind of small single stranded non-coding RNA molecule, is closely correlated with inflammatory mediators and various cytokines during the cartilage matrix degradation, suggesting that miRNAs have important regulatory functions at the molecule and cellular levels. ConclusionmiRNA can serve as potential biomarkers and will give new insight into diagnosis and therapeutic strategies in OA.