Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
This paper reported the method tendon reconstruction on dogs. Using the pedicled fascio-tendon graft, the flexor tendon system was constructed, and comparative study was made between the vascularized fascio-tendon graft and the free fascio-tendon graft by means of oxygen tension measurement, stereology, histology and ultra-mieroseoppy. The results showed: 1. vascularized graft changed the course of healing of the conventional graft into a simplified tendon stump healing course which shortened the healing time, ahd reduced the formation of peritendinous.2. the fascia tissue could be transformed into the synovial-like tissue6 weeks postopertively under the stimulation of gliding pressure of the tendon.It was conclude that this was a new and better method in reconstructing the severely damaged flexor tendon system.
ObjectiveTo explore advantages and feasibility of a new prosthesis implantation method after breast cancer surgery by reacquaint breast anatomy. MethodsThe clinicopathologic data of patients with breast cancer were retrospectively collected. The patients underwent the breast cancer surgery and prosthesis implantation with cricoid breast ligament in the Xuzhou Cancer Hospital from January 1, 2021 to May 30, 2023. ResultsA total of 10 patients were collected, with age ranging from 31 to 59 years old. Three patients received postoperative analgesia, 2 patients occurred infection, 1 patient occurred fat liquefaction. All patients did not experience capsular contracture, flap necrosis, or removal of the prosthesis. Two patients had sentinel lymph node metastasis. All patients followed-up 3 to 24 months after surgery. The BREAST-Q questionnaire was used to assess the quality of life and satisfaction after surgery, 3 patients were very satisfied, 5 were satisfied, and 2 were basically satisfied. ConclusionFrom the results of limited cases analysis in this study, it is safe and feasible to implant the prosthesis with cricoid breast ligament in selected patients after breast cancer surgery.
Objective
To establish the three-dimensional (3D) finite element model of the knee joint including posterolateral complex (PLC), and to simulate the reconstruction biomechanical analysis in this model.
Methods
The knee of a 26-year-old healthy man was scanned by MRI to obtain the image data of the knee in the coronal, sagittal, and axial position. First, Mimics10.01 and Hyperworks 8.0 softwares were used to extract each slice profile data of the knee joint in a two-dimensional image data respectively and to establish 3D geometric model of bone, meniscus, articular cartilage, and ligament. Second, Unigraphics software NX 4.0 was used to establish a 3D finite element model of knee joint, which had the functions of Mesh, material properties, component connection, and contact definition. Third, displacement measurement on the model and reconstructing biomechanical analysis for PLC simulation were performed.
Results
The 3D finite element model of the knee joint including PLC was established successfully. Under 134 N forward force, the tibia forward displacement was 4.83 mm. PLC simulation reconstruction biomechanical analysis of the 3D finite element model of the knee joint showed that under 10 N·m varus and external rotation torque conditions, the knee varus and external rotation angles of simulation reconstruction were greater than those of the intact knee, and less than those of PLC missing.
Conclusion
The 3D finite element model of the knee joint including PLC can be established by the reverse engineering, and it is valid and can be used as the basis for the biomechanical properties to analog reconstruction of PLC.
Objective
To evaluate the biomechanical effect of a self-made iliac screw plate on the stability of lumbo-iliac fixation construct before and after fatigue loading.
Methods
Twelve fresh lumbo-pelvic specimens from donated adult cadavers with formalin embalm were used in the study. According to whether use the iliac screw plate or not, the specimens were randomly assigned into group A (with iliac screw plate, n=6) and group B (without iliac screw plate, n=6). The bone mineral density (BMD) of L1-4 was measured using dual-energy radiograph absorptiometry. The pedicle screw and iliac screw fixation were given at L3-5, and bilateral facetectomy and diskectomy at L5, S1 level were performed to prepare the model of the intervertebral destabilization. The biomechanical testing was conducted on a material testing machine under 0-600 N compression and
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7-7 N
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m torsion loading modes for the initial compressive stiffness and torsional stiffness evaluation. And then 20 000 cyclic compressive loading of 40-400 N was given to the specimen, the stiffness evaluation was repeated. Then the maximum pull-out strength of screws at every level was measured and compared. Gross observation and radiological observation were performed during experiment.
Results
The BMD values of groups A and B were (1.15 ± 0.13) g/cm2 and (1.12 ± 0.11) g/ cm2 respectively, showing no significant difference between 2 groups (t=0.428, P=0.678). All pedicle screws and iliac screws were inserted in good position; no loosening or breaking of screw was observed during loading. After fatigue loading, the incidence of halo ring around the iliac screws of groups A and B was 16.7% (1/6) and 50.0% (3/6), respectively. The compressive stiffness and torsional stiffness after fatigue loading were significantly lower than those in initial state in groups A and B (P lt; 0.05); there was no significant difference in compressive stiffness and torsional stiffness between groups A and B before fatigue loading (P gt; 0.05). However, group A had higher compressive stiffness than group B (t=2.664, P=0.024) after fatigue loading, and there was no significant difference in torsional stiffness between 2 groups (t=0.410, P=0.690). No significant difference was found in screw pull-out strength of pedicle screws at L3, L4, and L5 levels between groups A and B (P gt; 0.05); however, the pull-out strength of the iliac screws in group A was significantly higher than that in group B (t=3.398, P=0.007). In groups A and B, the pull-out strength of L3 screw was significantly lower than that of L4 and L5 screws (P lt; 0.05). In group A, pull-out strength of the iliac screws was significantly higher than that of L3, L4, and L5 screws (P lt; 0.05); in group B, the pull-out strength of iliac screws was significantly lower than that of L4 and L5 screws (P lt; 0.05).
Conclusion
In the lumbo-iliac reconstruction, the use of iliac screw plate could resist iliac screw loosening, therefore, it has the potential to increase the stability of lumbo-iliac fixation construct.
Objective To evaluate the effectiveness of interference screw and flexor hallucis longus tendon as augmentation material in repair of chronic Achilles tendon rupture. Methods From October 2004 to June 2007, 32 patients (35 feet) with chronic Achilles tendon rupture were treated, including 21 males (22 feet) and 11 females (13 feet) and aging 32-85 years. The disease course was 4-132 days. There were 29 patients with hoofl ike movements history and 3 patients withoutobvious inducement. The result of Thompson test was positive in 31 cases (33 feet). The score was 56.09 ± 7.25 according to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system (AOFAS). MRI indicated that the gap of the chronic Achilles tendon rupture was 0.5-5.0 cm. Medial foot incision associated with medial heel incision or only medial heel incision was made to harvest flexor hallucis longus tendon. The tendon should be 3 cm longer than the end of the Achilles tendon, then fix the tendon to the calcaneus. Results Wound dehiscence occurred and wound healed after dressing change in 1 case; wound healed by first intention in other patients. Thirty-two patients were followed up for 12-32 months (mean 19.4 months). The AOFAS score was 94.22 ± 4.63, showing statistically significant difference when compared with that before operation (P lt; 0.01). The results were excellent in 28 cases, good in 3 cases and fair in 1 case. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury and lateral plantar nerve injury occurred. Conclusion Flexor hallucis longus tendon transfer offers a desirable outcome in operative recovery, tendon fixation and compl ications.
Objective To evaluate the feasibility and short-term effectiveness of three-dimensional (3D) printed titanium-alloy prosthesis reconstruction after the distal tibia tumor segment resection. Methods The clinical data of 6 patients with bone defect after distal tibia tumor segment resection treated with 3D printed titanium-alloy prosthesis reconstruction and tibiotalar joint fusion between January 2020 and December 2021 were retrospectively analyzed. There were 2 males and 4 females; the age ranged from 12 to 35 years, with an average of 18.5 years. Among them, 4 cases were osteosarcoma, 1 case was Ewing sarcoma, and 1 case was giant cell tumor of bone. The Enneking staging was stage ⅡA in 3 cases, stage ⅡB in 2 cases, and stage Ⅲ in 1 case. The disease duration was 2-5 months (mean, 3.2 months). All patients received preoperative neoadjuvant therapy, and patients with osteosarcoma and Ewing sarcoma started chemotherapy at3 weeks after operation. The systemic and local tumor conditions and prosthesis conditions were evaluated regularly after operation. The Musculoskeletal Tumor Society (MSTS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were used to evaluate the lower extremity and ankle function. Results All patients were followed up 8-26 months, with an average of 15.6 months. There was no local recurrence and distant metastasis during the follow-up. The ankle joints of 5 cases were all in 90° functional position at last follow-up, and there was no complication such as prosthesis loosening and fracture; the ankle joint fusion was stable, the local bone ingrowth was good, and the daily activities could be completed, but the ankle range of motion was limited and the ankle joint was stiff. The MSTS score ranged from 22 to 26, with an average of 24, and 3 cases were evaluated as excellent and 2 cases were good; the AOFAS score ranged from 71 to 86, with an average of 80.6, and 4 cases were evaluated as good and 1 case was fair. One patient had severe periprosthetic infection at 2 months after operation, resulting in failure of prosthesis implantation, pain in limb movement, and poor ankle function; MSTS score was 12, AOFAS score was 50, and both were evaluated as poor; distraction osteogenesis was performed after removal of prosthesis and infection control, at present, it was still in the process of distraction osteogenesis, and local osteogenesis was acceptable. Conclusion Using 3D printed titanium-alloy prosthesis and tibiotalar joint fusion to reconstruct the bone defect after distal tibia tumor segment resection has satisfactory mechanical stability and function, and is one of the effective distal tibial limb salvage methods.
【摘要】 目的 評價聚四氟乙烯人工聽骨在慢性中耳炎聽力重建中的應用效果。 方法 回顧性分析2008年8月〖CD3/5〗2009年12月慢性中耳炎手術中接受聚四氟乙烯部分/全人工聽骨贗復物(Partial/Total ossicular replacement prostheses,PORP/TORP,美國美敦力公司)行聽骨鏈重建的50例患者50只耳的臨床資料及隨訪結果。比較聽力學資料完整的39例39只耳手術前及手術后3～6個月語言頻率(05、1.0、2.0 kHz)氣導平均聽力及氣骨導差(airbonecap,ABG)。 結果 隨訪3～16個月,50只耳手術后1～3個月均干耳,手術后1個月鼓膜愈合良好。9只耳手術中人工聽骨表面未置入耳屏軟骨,其中1只耳手術后3個月人工聽骨脫出,1只耳手術后2個月鼓膜內陷,人工聽骨外端盤面外突。39只耳手術前氣導聽力為3667～9500 dB,平均為(5970±1433) dB;骨導聽力為330～5170 dB,平均為(2278±1161) dB;手術后氣導聽力平均為(4660±1703) dB,與手術前比較,差異有統計學意義(Plt;001)。手術前ABG為10～60 dB,平均為(3700±1212) dB。手術后ABG平均為(2620±1156) dB,與手術前比較,差異有統計學意義(Plt;001)。手術后氣導聽力提高1000～3000 dB者(手術后聽力提高有效)共24只耳,有效率為615%(24/39)。 結論 聚四氟乙烯人工聽骨是慢性中耳炎體重建聽骨的理想材料,手術后取得良好的聽力結果,遠期療效需進一步觀察。【Abstract】 Objective To evaluate the effects of hearing reconstruction in chronic otitis meadia with prothesis. Methods Retrospective reviews were performed in 50 patients(50 ears)who had undergone Teflon Partial/Total ossicular replacement prostheses (PORP/TORP) implants from August 2008 to December 2009. Audiometric measurements (the average hearing threshold at 05, 10, 20 kHz) were taken in 39 patients (39 ears) preoperatively and postoperatively. Comparisons of preoperative and postoperative mean air condition and air bone gap (ABG) were performed. Results All patients were followed up for three to 16 months, and the surgery resulted in a dry ear and a healing drum without perforation in all 50 patients. Of the nine patients without tragus cartilage interposed between the drum and the prosthesis, one patient occured prothesis extrusion, and one patient had retraction of the eardrum. The mean air conduction of the 39 patients before and after surgery were (5970±1433) dB and (4660±1703) dB. The mean air bone gap (ABG) was (3700±1212) dB before operation, while it was elevated to (2620±1156) dB when followed up (Plt;001). The surgical treatments were found to be successful (postoperative mean air condition improved 10.0030.00 dB) in 24 ears (615%). The effectiveness was 615%. Conclution Teflon could be an ideal material for ossicular reconstruction in chronic otitis media, and the hearing improvement is obtained after operation, but the problem of extrusion has not been solved at present, and the longterm effects should be surveyed.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction.
MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups.
ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267).
ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.
Motor function was investigated by constant perfusion manometry in the Roux limb of ten patients who had undergone total gastrectomy and Roux-en-Y anastomosis. Results showed that in the fasting state, the migrating motor complex (MMC) was comletely absent, retrograde in direction or bursts of nonphasic pressure activity. Reduced motor activity patterns occurred after the meal in some patients. Four patients failed to convert fasting state into the feeding state. Total gastrectomy with Roux-en-Y anastomoses provakes a relatively severe distubance in motor function, which could contribute to postoperative upper abdominal distress.
