Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit

The most common graft in anterior cruciate ligament (ACL) surgery involves using the central one-third of the patellar tendon. Knowledge concerning the postoperative disability after harvesting the patellar tendon is, however, limited. The aim of this study was to evaluate the impact patellar tendon suture and bone grafting of the patellar bone defect might have in terms of functional outcome and patellofemoral pain after harvesting the bone-tendon-bone graft, compared with leaving the harvested site non-sutured and non-grafted. Sixty patients, scheduled for arthroscopically assisted ACL reconstruction, were randomly allocated to two groups. In group I, suture of the patellar tendon and bone grafting of the patellar defect were performed. In group II, the tendon gap and the patellar defect were left open. Preoperatively, there was no significant difference between the groups when comparing objective knee stability, as measured with a KT-1000 laxity meter, Lysholm score, Tegner activity level, IKDC score, or patellofemoral pain score. Both groups had a significantly improved Lysholm score at the 2-year follow-up, without any difference between them. Tegner's activity level was significantly lower at follow-up, compared with the pre-injury level in both groups. The patellofemoral pain score improved significantly after the reconstruction, without any difference between the groups. Ultrasonography did not reveal any difference between the groups in terms of healing of the tendon gap. This study revealed no differences in donor site morbidity, functional outcome, patellofemoral pain score or knee joint stability between the two treatment groups. The conclusion is that suture of the patellar tendon and bone grafting of the patellar defect do not improve the functional results or reduce donor site morbidity after arthroscopically assisted ACL. Received: 17 December 1996 Accepted: 30 July 1997     

Successful management of laryngotracheosophageal cleft through an anterior approach

Laryngotracheoesophageal cleft is an uncommon disease that is difficult to diagnose and treat. Repair of the cleft depends on length and localization of the defect as well as the associated anomalies. A successful repair of a type II cleft is reported in this paper. An anterior split of the larynx and trachea was used and provided excellent exposure and safe repair without injury to the neurovascular structures. This is the best approach and should be used to correct all type II defects.     

Transient outward current (I A) in clonal anterior pituitary cells: blockade by aminopyridine analogs

Summary Whole cell voltage-clamp recordings from GH₃ cells, a clonal cell line derived from a rat anterior pituitary tumor, demonstrated a rapidly activating and inactivating (transient) voltage-dependent outward current. This current, referred to as I _A, was elicited by step depolarization from holding potentials negative to –50 mV, showed strong outward rectification at potentials positive to –30 mV, and exhibited steady state inactivation with V _1/2 near –64 mV. The current rose to a peak within < 10–20 ms following depolarization and decayed in two exponential phases, I _Af and IA _AS with time constants of 30–50 and 500–700 ms, respectively. Both I _A components exhibited similar voltage dependencies for activation and inactivation. Aminopyridines (2 mol/l – –5 mmol/l) produced a dose dependent, reversible blockade of I _A (70% inhibition at 0.5 to 2 mmol/l) with the following rank order of potencies: 4-aminopyridine > 3,4-diaminopyridine = 3-aminopyridine > 2-aminopyridine. These drugs reduced the peak conductance of I _A, and produced complex effects on its time-dependent decay. With submaximal degrees of block, there was an increase in the inactivation rate, suggesting that open channels are preferentially blocked by the drugs. It is concluded that GH₃ pituitary cells possess an aminopyridine-sensitive transient outward current comparable to the A-current in neural cells. However, this cell line is unusual in that it expresses both rapidly and slowly decaying A-current components.Abbreviations n-AP n-aminopyridine - 3,4-DAP 3,4-diaminopyridine - TEA tetraethylammonium - EGTA ethylene glycol bis(-aminoethyl ether)N,N-tetraacetic acid - HEPES 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid Send offprint requests to M. A. Rogawski at the above address     

骨桥栓桩与界面螺钉固定前交叉韧带重建移植物胫骨端的临床价值对比

对比骨桥栓桩与界面螺钉在膝关节前交叉韧带断裂重建术中的临床价值。方法 回顾性分析2019年7月—2020年12月我院700例在关节镜下行前交叉韧带重建手术的患者,股骨隧道均以横穿钉固定。按移植物胫骨端固定方式分为骨桥栓桩组（380例）及界面螺钉组（320例）。对比两组手术时间、切口长度、住院时间及费用;比较两组术后3个月、12个月胫骨隧道大小、膝关节功能Lyshlom评分及术后12个月关节松弛度。结果 两组患者手术时间、胫骨端切口长度、住院时间比较差异均无统计学意义（P＞0.05）,但骨桥栓桩组手术费用显著低于界面螺钉组（P＜0.05）。术后3个月、12个月两组患者胫骨隧道大小、膝关节功能Lyshlom评分及关节松弛度比较差异均无统计学意义（P＞0.05）,但随着时间的延长,两组患者隧道均有不同程度的扩大（P＜0.05）。结论 对于行关节镜下前交叉韧带重建术的患者,采用骨桥栓桩胫骨端固定方式可取得与界面螺钉固定相当的临床效果,但骨桥栓桩固定更具医疗经济优势,是一种可广泛推广的胫骨端固定方法     

3种不同创基准备程序性治疗方法在慢性难愈性创面中的效果观察

目的 探讨清创换药、负压引流、富血小板血浆治疗的创基准备程序性治疗在慢性难愈性创面中的效果。方法 回顾性分析2017年5月—2021年5月江南大学附属医院收治的83例创基准备程序性治疗的慢性难愈性创面患者的临床资料,根据治疗方法不同分为清创换药组25例、负压引流组35例、富血小板血浆组23例。比较3组患者创面愈合时间、创面完全愈合患者占比,临床疗效,治疗前后视觉模拟疼痛评分（VAS）差值、温哥华瘢痕评定量表（VSS）评分,治疗前后创面感染指标差值,创面细菌阳性率及复发情况。结果 富血小板血浆组创面愈合时间短于清创换药组和负压引流组（P <0.05）,富血小板血浆组与清创换药组和负压引流组创面完全愈合患者占比比较,差异无统计学意义（P>0.05）;富血小板血浆组与清创换药组和负压引流组总有效率比较,差异无统计学意义（P>0.05）;富血小板血浆组治疗前后VAS评分差值高于清创换药组和负压引流组（P <0.05）,富血小板血浆组VSS评分低于清创换药组和负压引流组（P <0.05）;富血小板血浆组治疗前后C反应蛋白差值、白细胞计数差值均高于清创换药组和负压引流...     

Ligament tissue engineering: an evolutionary materials science approach

The anterior cruciate ligament (ACL) is important for knee stabilization. Unfortunately, it is also the most commonly injured intra-articular ligament. Due to poor vascularization, the ACL has inferior healing capability and is usually replaced after significant damage has occurred. Currently available replacements have a host of limitations, this has prompted the search for tissue-engineered solutions for ACL repair. Presently investigated scaffolds range from twisted fiber architectures composed of silk fibers to complex three-dimensional braided structures composed of poly (l-lactic acid) fibers. The purpose of these tissue-engineered constructs is to apply approaches such as the use of porous scaffolds, use of cells, and the application of growth factors to promote ligament tissue regeneration while providing mechanical properties similar to natural ligament.     

Neurosurgical anatomy of the anterior interhemispheric approach for aneurysms of the anterior communicating artery (26.6.92)

Summary The anterior interhemispheric approach for aneurysms of the anterior communicating artery was studied in ten cadavers. This approach presents several advantages over the pterional approach widely used in neurosurgery. It allows direct access to the region of the anterior communicating artery complex with minimal retraction of the brain and preservatioin of the olfactory tract and the gyrus rectus.

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Bases anatomiques de l'abord inter-hémisphérique antérieur lors de la chirurgie des anévrysmes de l'artère communicante antérieure

Résumé Ce travail concerne l'abord neurochirurgical des anévrysmes de l'artére communicante antérieure par voie frontale interhémisphérique. L'étude anatomique a été réalisée sur dix sujets. Cette exposition possède de nombreux avantages comparée à la voie ptérionale habituelle : voie d'abord reduite médiane permettant une visualisation directe et symétrique du complexe artériel de l'artére communicante antérieure ; avec le moindre manipulation et retraction du cerveau en respectant les voies olfactives et le gyrus rectus.

     

阴囊前外侧岛状皮瓣再造尿道的解剖学研究及临床应用

目的 为阴囊前外侧岛状皮瓣的设计提供解剖学基础。方法 对20具成人男尸采用少量氨水经股动脉冲洗后，灌注红色乳胶逐段解剖阴部外动脉及其分支。结果 阴囊前外侧皮瓣的血供来自阴囊前动脉，阴囊前动脉的发起点恒定，血供范围大，故该皮瓣有充足的营养及较大的范围，也便于皮瓣的松解和转移。结论 利用此皮瓣重建尿道，适用于阴茎型尿道下裂病例。     

Personalized volumetric assessment of lower body muscles in patients with knee injuries: A descriptive case series

BackgroundPatients with knee joint pathology present with variable muscular responses across the muscles of the lower limb and pelvis. Conventional approaches to characterizing muscle function are limited to gross strength assessments that may overlook subtle changes both in the thigh, hip and shank musculature.PurposeTo describe individualized patterns of lower extremity muscle volumes in patients with knee pathologies.MethodsThis was a retrospective case series performed in a University medical center. Nine patients diagnosed with meniscus tear recommended to undergo meniscectomy volunteered. Participants underwent 3.0 Tesla magnetic resonance imaging (MRI) of the lower extremities. Thirty-five MRI-derived muscle volumes were compared between limbs and expressed as percentage asymmetry. For additional context, z-scores were also calculated for mass- and height-normalized muscles and pre-determined muscle groupings relative to a normative database.ResultsThere were no consistent patterns observed when considering between-limb asymmetries among all patients. The ankle musculature (dorsiflexors, plantar flexors, and invertors) was the only muscle group to be consistently smaller than normal for all patients, with the psoas major and flexor hallucis longus being the only individual muscles. The severity or chronicity of injury and presence of surgical intervention did not appear to have a clear effect on muscle volumes.ConclusionPatients with a history of meniscal pathology demonstrate inconsistent patterns of lower extremity muscle volumes about the hip, knee, and ankle between limbs and in comparison to uninjured individuals. These data support the need for individualized assessment and intervention in this population.