有限制动外展支具治疗小儿先天性髋脱位的临床研究

目的:采用有限制动外展支具治疗小儿先天性髋脱位,对治疗后的患者进行1～3年随访,探讨X线结果、临床功能与治疗方式之间的关系,找出解决不同年龄、不同脱位程度患儿的治疗方法及防止并发症出现的具体措施。方法:71例共96髋复位后应用有限制动外展支具,结果随访,根据周永德评定标准,优良率为89.6 %。股骨头坏死率为4 .2 %。结论:有限制动外展支具能提高闭合复位的成功率。降低股骨头坏死率,是一种疗程短、效果好、痛苦少、并发症低的方法。     

Night-time braces for treatment of Adolescent Idiopathic Scoliosis

Purpose. This review article aims at providing an update on the basic science and clinical information underlying the use of nocturnal braces for adolescent idiopathic scoliosis.

Method. The National Institutes of Health online medical database (Medline) was used to retrieve all articles pertinent to clinical research on night-time bracing; data were also collected from manufacturing companies. Additional information was obtained from literature on pathomechanics of scoliosis.

Results. The cardinal feature of night-time braces lays in their ability to hypercorrect the scoliotic curvature, thereby eliminating the asymmetric water accumulation that occurs in the apical and adjacent intervertebral discs. Previously wedge-shaped discs resume a nearly cylindrical configuration, thus restoring a close-to-normal force application to the endplates through the Hueter-Volkmann principle and preventing curve progression. The two night-time braces mostly used hypercorrect the spine through different mechanisms.

Conclusions. On the basis of clinical results available, night-time braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 35° in magnitude. Multi-center, randomized studies using strict criteria set forth by the Scoliosis Research Society (SRS) and the Society on Spinal Orthopaedic and Rehabilitation Treatment (SOSORT) are needed to better define the role of nocturnal bracing in the conservative treatment of adolescent idiopathic scoliosis.     

Incidence of white spot lesions among patients treated with clear aligners and traditional braces

Objectives:To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces.Materials and Methods:A group of 244 aligner patients (30.4 ± 14 years) was compared to a group of 206 patients (29.2 ± 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment.Results:Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment.Conclusions:Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.     

Medical textiles in orthopedics: An overview

The use of textile in the medical field is not new; this has given rise to a new branch known as medical textiles. These are being used to repair or replace various other musculoskeletal tissues. The most common uses of biomaterials are to create aseptic conditions for protection, general health care, and hygiene including bedding and clothing, surgical gowns, face masks, head and shoe covers, sterilization wraps, suture anchors, fiber cast and braces/orthotics. These are also used as materials for preparation of wipes, swabs, wound dressings, bandages, gauzes, plasters, pressure garments, orthopedic belts and for new applications, such as heart valves, vascular grafts, artificial veins, artificial ligaments, artificial joints, artificial skin, and artificial cartilage. The truth is that nowadays the use of biomedical textiles is more rampant than anyone realizes. Commonly used materials for preparation of biomedical textiles includes Cotton, Nylon, Silk, Ultra-high molecular weight polyethylene, Polyester, Polypropylene, Poly tetra-fluoro ethylene, Polyether ether ketone, and Polyether ketone. These are prepared from various monomers in varying proportions as per the requirement of the material to be used. Various methods are used in their preparation like Braiding, Knitting, and Weaving, which helps in the development of certain kinds of materials with different specificity and character. Other important measures in the preparation of the medical textile include Denier (the filament counts in multifilament fibers), Tenacity (the strength per denier) and Heat shrink (the amount of shrinkage at a particular time and temperature).     

冻干去抗原羊松质骨支架的生物相容性评价

背景：异种骨具有与人类骨类似的天然多孔结构,在治疗骨缺损时可引导骨组织再生,但植入过程中也会引起不同程度的免疫反应。目的：采用冻干法制备去抗原羊脊椎松质骨支架材料,并评价其生物相容性。方法：取羊脊椎松质骨,制备两组去抗原异种骨支架,化学组经H2O2、甲醇/氯仿混合液等化学试剂处理;冻干组将经化学处理的羊松质骨在-80℃冰箱中低温冷冻4周,真空干燥,60结果与结论：冻干组支架无细胞毒性、急性毒性及热源反应,皮内刺激实验阴性;化学组支架有细胞毒性及轻微急性毒性反应,有致热源作用及轻度皮肤刺激性。结果表明经过化学处理羊脊椎松质骨支架的生物相容性相对较差,而化学处理配合低温冷冻、真空干燥及Co照射消毒。①细胞毒性实验：分别采用化学组材料浸提液、冻干组材料浸提液与DMEM/F12培养基培养羊骨髓间充质干细胞。②热源实验、急性毒性实验：从兔耳缘静脉分别注射化学组材料浸提液、冻干组材料浸提液与生理盐水。③皮内刺激实验：分别在兔脊柱背部皮下注射化学组材料浸提液、冻干组材料浸提液、生理盐水及乙醇。60 Co照射的羊脊椎松质骨生物相容性较好,基本能达到骨组织工程支架材料的要求。     

骨组织工程支架材料：脱矿骨基质

背景：脱矿骨基质是目前研究较多的具备骨诱导及骨引导的生物支架材料之一。 目的：总结脱矿骨基质作为骨组织工程支架材料的研究进展,并展望其发展趋势。 方法：由第一作者检索1965年1月至2013年5月PubMed数据库、中国生物医学数据库、万方数据库及FMJS数据库有关脱矿骨基质及其作为骨组织工程支架材料的相关文献。英文检索词为＂Demineralized Bone Matrix,Scaffold material, Groowth factor, Cells,drugs＂,中文检索词为＂脱矿骨基质,支架材料,生长因子,细胞,药物＂,根据纳入标准排除重复性研究,保留34篇密切相关文献进行归纳总结。 结果与结论：骨组织工程支架材料是组成组织工程骨的主体,而脱矿骨基质既具备骨诱导性又具备骨引导性,可为骨组织细胞的修复提供空间,又可与生物活性因子、活细胞、抗生素等在体外构建成复合体,植入骨内促进骨缺损的愈合。但这一技术也面临着脱矿骨基质与各种物质的配比、消毒、保存成骨活性及抗原性的消除等问题,充分了解脱矿骨基质作为骨组织工程支架的研究,可为其服务于临床提供理论依据。     

煅烧与冻干制备去抗原异种骨支架材料的性能

背景：异种骨因其结构及生物特性与人体骨相似,经理化处理后抗原性降低,具有多孔结构,并且来源丰富、可以长期保存等特点,被认为是解决自体骨与异体骨来源不足的有效方法。目的：比较2种不同处理方法处理后去抗原异种松质骨支架材料的各项理化特性。方法：将经过化学方法处理的羊松质骨放入马弗炉中,在1 000℃高温下煅烧2 h制备成煅烧骨,将另一组经过化学处理的羊松质骨放入-80℃冰箱中冷冻4周,然后在真空仪器中干燥制备成冻干骨,将经过超纯水冲洗干净的羊松质骨当做对照组。结果与结论：3组样品均保留与人体骨组织类似的多孔三维结构,通过微观观察,它们的框架保存完整,有较小的孔隙（55-650μm）和较高的孔隙率（65%-80%）,煅烧后的支架材料韧性降低而脆性明显增加,冷冻干燥处理后力学性能则下降不大,经过衍射分析仪测定它们的主要成分为羟基磷灰石,但煅烧组中还含有少量的β-磷酸三钙,而能谱分析则证实3组的钙磷含量比均接近人体的钙磷比。结果提示经过这两种方法处理的松质骨与人体骨组织结构相似,其中各主要元素的含量比也与人体接近,而且具有足够小的孔隙和较高的孔隙率,但是煅烧处理对支架材料的力学性能影响比较大,而经过冷冻干燥处理力学性能下降不大但无法完全去除材料中的抗原成分,它们基本能达到骨组织工程支架材料的基本要求。     

快速成型钛板结合自体骨移植修复犬下颌骨缺损

背景：近年来,快速成型技术被迅速的应用于医学重建领域,利用快速成型技术可为组织缺损患者制作个体化的植入物,可达到空间尺寸上的精确修复。 目的：利用快速成型技术制作个体化钛板,结合自体松质骨移植,修复犬下颌骨节段性缺损。 方法：9只杂种犬行螺旋CT扫描获取头颅骨骼数据,建立数字3D模型,在模型上模拟右侧下颌骨体部切除术,并制作个体化板状修复体,经快速成型加工制造,获得个体化的钛板。然后行动物实验,手术制造右侧下颌骨体部4 cm长节段性缺损,同期手术切取自体髂骨块固定于快速成型钛板的舌侧,修复下颌骨缺损。采用核医学、力学、影像学和组织学等方法评估骨移植后的转归。 结果与结论：应用快速成型支架重建了左右对称的下颌骨形态,自体髂骨移植后逐渐皮质化,植骨和钛板之间形成纤维结缔组织间隔层。在下颌骨缺损修复中,应用快速成型钛板能够达到形态和功能兼顾的效果。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Nickel allergy in relation to piercing and orthodontic appliances – a population study

Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization. Objectives & Method. In a cross‐sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records. Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi‐containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel‐releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization. Conclusion. High nickel‐containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.     

Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

Abstract. The aim of this study was to investigate in patients with neurogenic orthostatic hypotension the mechanism and usefulness of abdominal compression to increase standing blood pressure. In three protocols, 23 patients underwent abdominal compression. Protocol 1 evaluated in a 40–60° head-up-tilt position, the effect of abdominal compression on caval vein and femoral diameter, arterial blood pressure and hemodynamics. Protocol 2 documented the relationship between the level of compression and the arterial pressure response. Protocol 3 investigated the ability to maintain standing blood pressure by an elastic binder. During head-up-tilt, compression (40 mm Hg) resulted in a reduction in diameter of the caval vein (mean –2.6mm, range –1.4 to 0.6), without a change in femoral vein diameter. Stroke volume increased by 14 % (range –1 to 23) and blood pressure (systolic/diastolic) by 30/14 mmHg (range 7/2 to 69/36), both p < 0.05; 40 mmHg compression was associated with a higher pressure response than 20 mmHg (mean 18/8 mmHg, range 6/2 to 43/20 vs. mean 9/4 mmHg, range –1/0 to 18/8, p < 0.05). Elastic abdominal binding increased standing blood pressure with 15/6mmHg (range –3/3 to 36/14, p < 0.05). We conclude that in patients with neurogenic orthostatic hypotension, abdominal compression increases standing blood pressure to a varying degree by increasing stroke volume.