A clinical and radiographic comparison of absorbable and non-absorbable suture anchors in open shoulder stabilisation

The aim of this study was to compare the clinical and radiographic results using either absorbable or non-absorbable suture anchors in patients with recurrent unidirectional, post-traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7-mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non-absorbable ones were used. There was one re-dislocation in each group. In group A, the Rowe and Constant scores were 89 (69-98) and 89 (76-99) points, respectively. The corresponding values in group B were 87 (44-98) (not significant; NS) and 90 (71-100) points (NS). The strength measurements revealed 8.1 (3.8-12.3) kg in 90 degrees abduction in group A and 10.0 (6.7-12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5-13.2) kg (NS A and B versus controls). The external rotation in abduction was 70 degrees (40-90) in group A and 80 degrees (40-100) in group B. The value for the controls was 90 degrees (80-120) [P < 0.001 (A versus controls), P < 0.05 (A versus B) and P < 0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non-absorbable suture anchors were used.     

生长激素、生长抑素对组织愈合影响的研究

了解在全肠外营养（TPN）条件下,生长激素、生长抑素对组织愈合的确切作用。在TPN大鼠应用生长激素、生长抑素后发现;生长激素可促进血浆总蛋白、白蛋白和羟脯氨酸浓度提高,同时增加了肉芽组织中羟脯氨酸和纤维母细胞含量。而生长抑素则可降低血浆蛋白、羟脯氨酸浓度和肉芽组织中羟脯氨酸和纤维母细胞水平。提示了生长激素可促进机体和肉芽局部蛋白合成、组织愈合,而生长抑素在TPN条件下对蛋白合成和组织愈合有一定抑制作用。     

Diffusion-weighted imaging for differentiating recurrent cholesteatoma from granulation tissue after mastoidectomy: case report

Identification of recurrent cholesteatoma and differentiation from postoperative granulation tissue is important in a patient who has undergone mastoidectomy for cholesteatoma. We describe the diffusion-weighted imaging findings and apparent diffusion coefficient values in a case of recurrent cholesteatoma. This case suggests possible differentiation of cholesteatoma from granulation tissue on the basis of diffusion-weighted imaging findings.     

应用MEBO治疗小面积骨外露创面13例报告

目的：观察不植皮用MEBO治疗范围小于5cm^2的骨外露创面的效果，探讨裸露骨皮质钻孔后培育肉芽，上皮组织生长的机制。方法：对范围小于5cm^2的骨外露创面经骨皮质钻孔后直接外用MEBO换药、每日3～4次直到创面愈合。并对不同时期的新鲜肉芽，上皮组织等分别活检切片，观察探讨其上皮组织生长的机理。结果：13例裸骨创面均有良好的肉芽生长，最终为上皮组织覆盖。创面修复的时间与部位血供有明显差异、与用药方法密切相关。结论：MEBO可促进骨质外露创面的肉芽组织生长，对范围小于5cm^2的裸骨创面，经骨皮质钻孔及MEBO规范治疗后自行上皮组织修复，血供丰富部位的创面愈合时间明显提前．该方法简单实用，是一种理想的治疗措施。     

Biodegradable and metallic interference screws in anterior cruciate ligament reconstruction surgery using hamstring tendon grafts: prospective randomized study of radiographic results and clinical outcome

BACKGROUND: The use of biodegradable screws in anterior cruciate ligament reconstruction has grown in popularity. PURPOSE: To compare the clinical and radiographic results in arthroscopically assisted anterior cruciate ligament reconstruction using 4-strand hamstring tendon grafts and either metallic (metal group) or biodegradable (PLLA group) interference screw fixation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A randomized series of 77 patients, all with a unilateral anterior cruciate ligament rupture, was included in the study. The preoperative assessments in both groups were similar in gender, Tegner activity level, Lysholm score, KT-1000 arthrometer measurements, and single-legged hop test results. In both groups, interference screw fixation of the graft was used at both ends, and 68 of 77 (88%) patients returned for a radiographic examination at 6 and 24 months, respectively. RESULTS: At follow-up, no significant differences were found between the 2 groups in KT-1000 arthrometer laxity measurements, Tegner activity level, or Lysholm score. The PLLA group had a significantly better outcome in the single-legged hop test and the final International Knee Documentation Committee classification (P = .007 and P = .03, respectively). At 6 and 24 months after the index operation, the PLLA group displayed significantly larger drill holes on the radiographs than did the metal group on both the tibial (8.1 vs 6.6 mm at 6 months [P = .0007]; 6.0 vs 3.2 mm at 24 months [P < .0001]) and femoral sides (7.8 vs 5.6 mm at 6 months [P < .0001]; 6.3 vs 1.9 mm at 24 months [P < .0001]). CONCLUSION: There were significantly larger radiographically visible drill holes on both the tibial and femoral sides in the PLLA group compared with the metal group at 6 and 24 months. Clinical examination at 2 years revealed no major differences between the groups. The larger drill holes in the PLLA group did not correlate with inferior clinical results.     

MEBO外用联合口服芪黄通络汤治疗足踝部损伤性溃疡21例疗效观察

目的 观察MEBO外用联合口服芪黄通络汤治疗足踝部损伤性溃疡的临床疗效.方法 将63例足踝部损伤性溃疡患者按入院先后顺序随机分为3组,治疗组(甲组)21例,应用MEBO外用联合口服芪黄通络汤治疗;对照组(乙组)21例,单纯应用MEBO换药治疗;对照组(丙组)21例,单纯口服芪黄通络汤治疗.疗程2 w,观察3组患者肉芽组...     

Depiction of low-contrast detail in digital radiography: comparison of powder- and needle-structured storage phosphor systems

PURPOSE: We sought to evaluate the low-contrast performance of a newly developed needle image plate/line scanner (NIP) computed radiography system in comparison with a standard powder image plate/flying-spot scanner (PIP) system. MATERIALS AND METHODS: A total of 36 images of a CDRAD phantom, simulating low-contrast structures with different drill holes of different diameters, were obtained with both imaging systems using 9 different exposure variables. All images had window and level set to generate consistent density and contrast. In addition, multiscale contrast-dependent contrast amplification was applied to some of the images. All images obtained were printed and presented to a total of 10 observers (5 radiologists, 5 engineers/physicists), who were blinded to both the image plate and parameter setting used. The smallest detectable drill hole depth (= contrast) correctly identified was recorded for each diameter. The median values observed were calculated and tested for statistical differences between PIP and NIP using Student t test for matched pairs (level of significance P < or = 0.05). RESULTS: At all but 2 settings of the variables, NIP images depicted significantly lower contrast levels (= lower depth of drill holes) compared with PIP images. The 2 settings also showed a trend towards better low contrast depiction with NIP. In no case was low contrast performance better using PIP images. CONCLUSION: Images obtained with needle image plate/line scanner provide superior low contrast performance compared with the images obtained with powder image plate/flying-spot scanner.     

Local demineralization as a model for bone strength reductions in lytic transcortical metastatic lesions.

The structural consequences of bone density changes associated with lytic metastatic lesions were investigated using an experimental model of regular, lytic metastatic lesions in bone. Circular holes were drilled in the mid-diaphyseal cortex of paired adult canine femora. The region around the defect was demineralized in one bone of each pair with 0.8 N HCl. Specimens were tested to failure in four-point bending. Defect size was determined from conventional planar radiographs as the maximum apparent defect diameter divided by the periosteal diameter. Demineralization resulted in irregular defect geometries, which increased the maximum defect dimension 33% to 57% with respect to the original drill hole diameter. Demineralization resulted in additional strength reductions beyond those expected from the original drill hole alone. Despite the irregular demineralization patterns observed, strength reductions were in close agreement with those predicted from data for regular, nondemineralized holes (r2 = 0.93). The results demonstrate that irregular diaphyseal defect borders may not require more complex fracture risk predictors than can be determined from analytic and experimental studies of regular defect geometries. Our results also demonstrate that errors of over 100% can occur when measuring diaphyseal defect size from radiographs that are not optimally aligned with respect to the defect.     

The anatomy of the proximal tibia in pediatric and adolescent patients: implications for ACL reconstruction and prevention of physeal arrest

Although the treatment of anterior cruciate ligament (ACL) tears in skeletally immature patients is still controversial, several studies have advocated ACL reconstruction in selected patients to prevent secondary injury. The proximal tibial physis is a structure at risk during ACL reconstruction in young patients, and physeal growth complications have been reported after surgery in this area. The relationship between the ACL and the proximal tibial physeal/apophyseal regions is poorly understood. This study examined the MRI anatomy of the ACL and the proximal tibia apophysis and epiphysis. MRIs of 59 skeletally immature knees were reviewed (Average age = 12.75 years, range 6–15) to define the anatomy of the epiphyseal and apophyseal regions. Measurements were recorded in three parasagittal planes: (1) at the lateral border of the patellar tendon, (2) the lateral edge of the ACL insertion, and (3) the medial edge of the ACL insertion. A single three-dimensional (3D) computed tomography (CT) scan was used to evaluate the position of standard drill holes used in ACL reconstruction to assess for potential degree of injury to the epiphyseal and apophyseal growth plates. In the parasagittal planes, the average height of the epiphysis was 19.6, 20.7, and 21.5 mm at the lateral border of the patellar tendon, the lateral border of the ACL, and the medial border of the ACL, respectively. At the level of the same landmarks, the apophysis extended below the physis at an average of 20.2, 16.8, and 7.0 mm, respectively. Expressed as a percentage of epiphysis height this was an average of 104, 82, and 33%, respectively. Examination of 3D CT images revealed that variations in drill hole placement had effects on the volume of injury to the proximal tibial physis and apophysis. Drill holes that started more medial, distal, and with a steeper angle of inclination reduced the amount of physis and apophysis violated when compared with holes placed more lateral, proximal, and with a shallow angle of inclination. The proximal tibial physis and apophysis is vulnerable to injury by drill hole placement during ACL reconstruction in skeletally immature patients. This paper defines the anatomic relationship of the apophyseal and epiphyseal regions of the physis in the proximal tibia. The volume of injury to the physis can be reduced by avoiding tunnel placement that is too lateral or too proximal on the tibia. A better understanding of these relationships may guide the placement of tibial drill holes, which have a lower risk of producing significant physeal damage. The preliminary work on this topic was presented at the 2000 Meeting of the Pediatric Orthopaedic Society of North America, Vancouver, Canada, and the 2001 American Academy of Orthopaedic Surgeons Annual Meeting in San Francisco.