胃镜监视下食管内支架置入术

目的：本文是经胃镜作食管内支架置入术治疗食管癌伴狭窄或伴食管瘘的临床研究。方法：选择18例中、晚期食管癌伴狭窄或伴食管瘘不能耐受手术患者，在胃镜监视下置入食管记忆合金支架管。结果：18例患者吞咽困难缓解或食管瘘消失，支架管到位准确。结论：食管内支架置入术是姑息治疗中、晚期食管癌伴狭窄或伴食道瘘有效的方法。在胃镜监视下置入食管支架到位准确，操作方法简单。     

Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry.

Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6 +/- 114.7 AU. The signal significantly decreased by 71% (p = 0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1 +/- 120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18 +/- 10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3 +/- 104.8; p = 0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems.     

钢丝环扎联合新式张力带固定治疗髌骨骨折

目的 探讨钢丝环扎联合自行设计的新式张力带固定治疗各种类型髌骨骨折的疗效。方法 以髌骨的功能解剖和生物力学为理论基础，应用钢丝环扎联合新式张力带固定治疗各类骨折102例。结果 原有骨折均愈合，愈合时间7－13周，平均8．2周，关节功能恢复良好无并发症。结论 本法将钢丝环扎与张力带有机结合，形成钢丝环扎联合张力带固定治疗髌骨骨折，操作简便、固定可靠、疗效优良、适合各种类型髌骨骨折。     

不同手术方法治疗习惯性髌骨脱位的随访分析

以6种不同手术方法治疗习惯性髌骨脱位29例,36个膝关节。本文报告其中17例病人,20个膝关节治疗的随访结果表明。小年龄患几复位后膝关节如同正常,大年龄者症状减轻,复发者症状加重,髌骨切除者关节稳定。本文着重分析了失败病例的病因和提高疗效的措施。     

Structural parameters of the vastus medialis muscle and its relationship to patellofemoral joint deterioration

Vastus medialis (VM) muscle dysfunction and abnormal limb alignment are commonly observed in patients who experience changes in patellofemoral joint (PFJ) function, leading many clinicians to assume that there is a direct relationship between VM structural parameters, leg alignment, and PFJ dysfunction. This study tested the hypothesis that there is a relationship between structural parameters of the VM muscle, limb alignment, and the location and severity of patellofemoral joint deterioration (PFJD). The dissection study used 32 limbs from 24 intact cadavers. Data were collected on limb alignment, angle of VM muscle fibers below the superior aspect of the patella, length of VM inserting on the medial aspect of the patella, and severity and location of PFJD. Parametric and nonparametric statistical analyses illustrated that PFJD was most commonly located on the middle third of the medial half of the patellar articular surface. The severity of PFJD did not vary with location. There was no significant correlation between any of VM insertion length, VM fiber angle, limb alignment, and PFJD location and severity lpar;r(2) < 0.34). The results of this study did not support the hypothesis of a relationship between structural parameters of the VM muscle, limb alignment, and the location and severity of PFJD in this subject group. Future research should examine the relationship between functional parameters of the entire quadriceps muscle group and PFJ dysfunction.     

去神经化术在髌股关节炎膝前痛治疗中的应用

目的探究膝关节镜下清理术联合去神经化术对髌股关节炎膝前痛的疗效。方法选取2012年9月-2015年9月该院收治的60例髌股关节炎膝前痛患者为研究对象,采用随机数表法将患者分为观察组和对照组,各30例。给予对照组患者关节镜清理术治疗,给予观察组患者关节镜清理术联合髌骨周围去神经化术治疗。对比观察组和对照组患者术前和术后3个月的美国西部Ontario和McMaster大学骨关节炎指数(WOMAC)评分、Lysholm评分和Kujala评分。结果术前观察组和对照组患者各项评分差异均无统计学意义(P0.05)。观察组和对照组患者术后3个月的各项评分较术前均显著改善,且观察组患者的WOMAC评分、Lysholm评分和Kujala评分较对照组患者均较佳,差异有统计学意义(P0.05)。术后3个月观察组30例患者出现2例感染和1例血管神经损伤,对照组30例患者出现1例感染和1例关节活动受限,两组患者术后不良反应差异无统计学意义(P0.05)。结论给予髌股关节炎膝前痛患者关节镜清理术联合髌骨周围去神经化术治疗能够缓解疼痛,改善髌股关节功能和临床疗效,可以在临床上进一步推广和使用。     

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??Nickel-titanium instruments are the mainstream in the root canal preparation??and are widely used in the modern root canal treatment. But some researchers believe that the preparation process may cause or aggravate dentinal microcracks of the root canal wall. Dentinal microcracks will lead to bacteria colonization??microleakage and even vertical root fracture??and reduce the long-term outcome of root canal treatment. This article elaborated the hazard??etiology??prevention and controversy of the formation of dentinal microcracks in the process of root canal preparation with nickel-titanium instruments.     

Impacts of Contracted Endodontic Cavities on Primary Root Canal Curvature Parameters in Mandibular Molars

Introduction

The purpose of this study was to provide information regarding the debate on contracted endodontic cavities (CECs); their impacts on angle, location, and radius of the primary canal curvature (PCC) were assessed in type IV mesial root canals of mandibular molars at different stages of instrumentation. Impacts on treatment time were also assessed.

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??Objective??To test the effect of the cyclic fatigue fracture resistance of Nickel-Titanium??NiTi?? files after the magnetron sputtering TiN coating??and to provide basis for clinical application. Methods??The KV4 rotary NiTi files of type 20 and 30??0.04 tapers??25 mm??were selected??40 of each type. The files of type 20 were randomly divided into group A1 and group B1??and the files of type 30 were randomly divided into group A2 and group B2??each group having 20 files. The group A1 and A2 were collectively called coated group??and group B1 and B2 were collectively called uncoated group. A homogeneous layer of 0.6 μm was deposited on the surface of coated group but uncoated group did not underwent any processing. Scanning electron microscopes??SEM??were used to examine surface morphology of NiTi instruments with and without coating. All files were tested for resistance to cyclic fatigue failure inside copper artificial canal. Record the time to fracture from the start of the test until the moment of file breakage and the length of the fractured tip for each file. The number of cycles to fracture??NCF??was calculated according to the rotating speed and fracture time. SEM was used to observe the sectional morphology of each instrument after test. Results????1??NCF of NiTi instruments with TiN coating was significantly higher than NiTi instruments without TiN coating. The difference was statistically significant??P < 0.05??. There was no statistical significance??P > 0.05??in the length of the fractured tip of each group.??2??The surface morphology of coated group and uncoated group were observed under low and high power SEM before the treatment??and the surface of the coated instruments was more smooth??without obvious cutting marks??than the surface of uncoated instruments. After the cyclic fatigue test??in addition to the main fatigue striations??there were relatively more fatigue lines on the surface of the uncoated instrument than coated instrument. Conclusion??The cycle fatigue resistance of KV4 rotary NiTi endodontic instruments has been improved remarkably after the magnetron sputtering TiN coating.     

Comparative Evaluation of Stress Distribution in Experimentally Designed Nickel-titanium Rotary Files with Varying Cross Sections: A Finite Element Analysis

Introduction

Single cross-sectional nickel-titanium (NiTi) rotary instruments during continuous rotations are subjected to constant and variable stresses depending on the canal anatomy. This study was intended to create 2 new experimental, theoretic single-file designs with combinations of triple U (TU), triangle (TR), and convex triangle (CT) cross sections and to compare their bending stresses in simulated root canals with a single cross-sectional instrument using finite element analysis.