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。     

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...     

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.     

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.     

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.     

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.     

MEBO治疗老年糖尿病皮肤溃疡的临床效果

目的:探讨湿润烧伤膏治疗老年糖尿病皮肤溃疡的临床效果.方法:57例老年糖尿病皮肤溃疡患者采用烧伤膏治疗.结果:本组28例创面由肉芽组织生长充填,封闭创面,26例经在培养的新鲜肉芽组织采用创面微粒皮种植术封闭创面,3例创面经积极处理后好转自动出院.结论:烧伤膏对老年糖尿病皮肤溃疡疗效显著.     

原位再生医疗技术治疗小腿骨折合并溃疡的临床观察

目的:小腿骨折合并软组织溃疡应用原位再生医疗技术治疗的效果观察.方法:小腿骨折完成骨折复位固定后,对软组织溃疡用MEBO药膏治疗,每日4～6次,直到溃疡愈合;创疡并骨质外露时,在外露骨皮质上用2.5mm钻头钻3～5个小孔,同样涂上MEBO,早期配合应用抗生素1周,加强全身营养.结果:24例小腿骨折合并软组织溃疡全部治愈.溃疡较浅,直径在5cm内者1周～3周愈合;溃疡较深,直径大于5cm者4周～6周愈合,溃疡并骨外露7周～10周愈合.仅有4例溃疡愈后有轻度瘢痕.结论:小腿骨折合并软组织溃疡,应用MEBO治疗效果显著,方法简单实用,溃疡愈合快,不留瘢痕.     

深Ⅲ度烧伤应用湿润烧伤膏培养肉芽后植皮的疗效观察

目的:为了使深Ⅲ度烧伤愈合后更美观,更接近正常皮肤组织结构。方法:我们将深Ⅲ度烧伤应用浅削法去除坏死组织,烧伤膏培养肉芽后行大张中厚皮移植,与早期切痂大张中厚皮移植进行对照研究远期效果。结果:两组经半年、1年的随访,培养肉芽植皮组患者对丰满度的满意程度、皮肤弹性、皮肤柔软度及功能方面明显比早期切痂植皮组效果佳(P<0．05)。皮肤颜色两组比较无显著性差异(P>0．05)。培养肉芽植皮组病程长、费用高(P<0．01)。结论:深Ⅲ度烧伤应用烧伤膏培养肉芽后植皮远期疗效在丰满度,皮肤弹性、皮肤柔软度、功能方面达到良好的效果。对于经济条件佳,对愈合要求美观的患者可做为有效的治疗方法。     

Dislocation arthropathy and drill hole appearance in a mid- to long-term follow-up study after arthroscopic Bankart repair

Purpose

The aim of this study was to perform a prospective mid- to long-term clinical and radiographic follow-up after arthroscopic Bankart repair using absorbable tacks with special emphasis on the development of dislocation arthropathy.

Methods

Thirty-four shoulders in 32 patients with post-traumatic shoulder instability were included in the study. Clinical and radiographic follow-ups took place after approximately 2 and 8?years.

Results

Thirty-four of 34 (100?%) shoulders in 32 patients returned for the follow-up examination after 95 (53–129) months. Pre-operatively, none of the shoulders had any arthropathy changes. At follow-up, 8/34 (24?%) had minor changes, 6/34 (18?%) had moderate changes, and none had severe arthropathy changes, a significant increment compared with the pre-operative figures (p?=?0.005). At follow-up, the drill holes in 24?% of the shoulders still had not healed radiographically. The failure rate in terms of stability was 3/34 (9?%) re-dislocations and 3/34 (9?%) subluxations.

Conclusion

Eight years after arthroscopic Bankart repair using absorbable tacks, 41?% of the shoulders displayed some degree of radiographic arthropathy changes and in 24?% the drill holes had not yet radiographically healed. There was no correlation between clinical outcome or drill hole appearance and the development of arthropathy changes.

Level of evidence

III.     

Endobronchial brachytherapy provides excellent long-term control of recurrent granulation tissue after tracheal stenosis

PurposeTo review the experience of using endobronchial brachytherapy (EBB) as a treatment for recurrent tracheal granulation tissue.Methods and MaterialsPatients referred for EBB at the Rabin Medical Center for benign stenosis were reviewed with institutional review board approval. Patients underwent bronchoscopic resection of granulation tissue followed by insertion of self-expanding metallic stents. After stenting, repeat laser resection was done at least 1 week before brachytherapy. After CT simulation, patients had three-dimensional brachytherapy treatment planning. A single 10-Gy dose was prescribed to 1.0 cm from the source and treatment was delivered using high-dose-rate afterloader with ¹⁹²Ir source. Patients were followedup with bronchoscopy every 3 months after the completion of therapy.ResultsFrom November 2001 to January 2009, 29 patients were treated with EBB to prevent granulation tissue reformation. Median age was 70 years and 55% of patients were male. Ninety percent of patients were treated to the trachea and the remaining patients had stenoses in the main stem bronchi. The primary cause of stenosis was prolonged mechanical ventilation (76%). The median time from stent placement to brachytherapy was 69 days. Median active length of treatment was 7 cm. With a median followup of 36 months, 66% (19 of 29) of patients remained free of granulation tissue. Forty-eight percent of patients have died, with all except 1 patient dying of their underlying condition. A single patient experienced death from tracheoesophageal fistula.ConclusionEBB is an effective and safe treatment to prevent recurrent granulation tissue formation after endobronchial resection and should be considered in patients who are unable to undergo surgical resection.     

食管良性狭窄动物模型的建立及病理学分析

目的通过胃镜下烧灼的方法建立犬食管良性狭窄模型并观察建模不同时间后的局部形态学变化。方法健康成年犬8只,麻醉后放置食管套管,胃镜下用电热活检钳（混合电流40J／s）环形烧灼距门齿32～35cm处食管,每周复查胃镜观察食管狭窄情况及黏膜变化,并钳取组织进行病理分析。术后1、2、4、8周分批处死动物,取出狭窄部位食管组织进行病理分析。结果术后1周食管黏膜充血水肿明显,溃疡形成,可见食管狭窄、局部黏膜坏死及大量炎性细胞浸润;术后2周食管黏膜充血水肿减退,食管狭窄明显,食管组织增生显著,局部有广泛肉芽组织形成及部分纤维化,炎细胞浸润明显;术后4周及8周食管狭窄达0．4～0．6cm,局部形成白色瘢痕,出现大量的纤维结缔组织,炎细胞及新生毛细血管显著减少。结论通过局部烧灼的方法可以建立稳定的犬食管良性狭窄模型,其病理表现主要为肉芽组织形成及纤维化。     

Time-dependent appearance of myofibroblasts in granulation tissue of human skin wounds

Summary Human skin wounds (66) inflicted between 20 h and 7 months prior to biopsy were studied. In order to identify the type of cellular differentiation of the fibroblastic cells in the granulation tissue, alpha-smooth muscle actin and desmin were immunohistochemically localized. The value of any presumed time-dependent appearance and/or disappearance of positively stained cells was tested for the estimation of wound age. In skin specimens with a wound age less than 5 days (n =15) no typical granulation tissue had developed and no alpha-actin-positive myofibroblasts could be detected. The first appearance of positively reacting myofibroblasts was noted in a 5-day-old wound. In 57% of the lesions with a wound age between 5 and 31 days (25 out of 44 cases) typical granulation tissue formation was present and myofibroblasts with positive reaction for alpha-smooth muscle actin could be identified. Numerous positively reacting cells could generally be found in wounds aged between 16 and 31 days, but also in wounds less than 16 days old. In 29% of the cases with a wound age of more than 31 days (2 out of 7 cases) alpha-sma-positive myofibroblasts also occured. Fibroblastic cells positive for desmin could not be seen at all in our series. Our results demonstrate the appearance of alpha-sma-positive myofibroblasts with the initial formation of typical granulation tissue in human skin lesions as early as approximately 5 days after wounding. In contrast to recent experimental results these cells remained detectable in wounds aged more than 2 months in some cases. The immunohistochemical detection of actin-positive cells, therefore, demonstrates whether an unknown skin wound is aged approximately 5 days or more. Even though a time-dependent decrease of myofibroblasts in human granulation tissue after 31 days in human wounds seems probable, the extended presence (up to about 2 months) of these cells allows no further exact age determination of older wounds. This study was supported by a grant from the “Deutsche Forschungsgemeinschaft” (grant Ei 209/3-1) and by a grant from the “Friedrich-Baur-Stiftung”, University of Munich, FRG.     

原位再生复原技术对糖尿病足溃疡创面血管化影响的相关研究

目的 探讨湿润烧伤膏（MEBO）联合创疡贴对糖尿病足溃疡创面血管形成的影响.方法 将笔者2010年6月～2011年6月收治的64例糖尿病足溃疡患者按随机数字表法分为两组,A组32例设为实验组,溃疡创面使用MEBO联合创疡贴换药治疗,每日2次;B组32例设为对照组,溃疡创面使用凡士林油纱布换药治疗,每日2次,两组患者均于创面处理当天,创面处理后7d、12d、21d分别采取创面组织标本行免疫组织化学检测CD34含量,并用MVD计数,同时观察两组患者不同时间段创面肉芽组织的生长情况.结果 两组患者创面处理当天及创面处理后7d,创面肉芽组织生长情况及CD34含量无统计学差异（P＞0 05）;创面处理后12d,A组创面肉芽组织生长面积（24 87% ±0 24%） 较B组（18 66% ±0 45%） 增大,CD34表达增强（8 34±0 48）,与对照组（4 42±0 14）相比有统计学差异（P＜0 05）;创面处理后21d,两组患者各项观察指标的统计学差异更为显著（P＜0 01）.结论 糖尿病足溃疡创面局部联合应用MEBO和创疡贴治疗,可促进创面血管形成,加速肉芽组织生长,其机理可能与激活创面内源性干细胞等因素有关.     

Experimental model of knee contracture in extension: its prevention using a sheet made from hyaluronic acid and carboxymethylcellulose

Treatment once extension contracture of the knee has completed is difficult and costly. The most effective treatment might be the prevention of contracture, especially after joint injury. In order to establish an effective method for contracture prevention we first made an extension contracture in rabbit knees, then studied the effect of a sheet made from hyaluronic acid and carboxymethyl cellulose (HA/CMC) for the prevention of knee contracture. One hundred and twenty two mature male Japanese white rabbits were divided into three groups: (1) group B (n=42), where bony holes were made at the medial and lateral epicondyles, (2) group H (n=40), where HA/CMC sheets were placed on the bony holes, and (3) group S (n=40),where only arthrotomy was performed. All surgical procedures were performed on the right knees. All right knees were fixed at 45° using external fixators; this is the maximum extension angle the rabbit is able to tolerate and still walk. At 1, 3, and 6 weeks after surgery, we measured the moment necessary to flex the knee using a special device. We defined the moment as flexion moment (FM). Forty four left knees were also tested as group N, not operated on and serving as the healthy side. In all groups, FM was increased parallel to the increment of flexion angle from 45° to 115°. At many flexion angles, the FM in group B was higher than those of group S at 3 and 6 weeks. The FM in group H was significantly lower than those of group B at 85° and 95° of flexion at 6 weeks after the operation. By macroscopic observation, the area and degree of adhesion were greater in group B than those of group S. In group H, adhesions around the bony hole were less evident than in group B at 6 weeks after the operation. By histological examination, dense granulation tissue was found adjacent to the bony hole in group B at 3 and 6 weeks after the operation. In contrast, in group H the amount of granulation tissue was smaller at 3 and 6 weeks after the operation than those of group B. The usage of HA/CMC sheet should be effective for prevention of contracture occurring after trauma such as treatment for intra-articular fracture.     

手指脱套伤原位培植肉芽组织延迟真皮下血管网皮瓣修复的体会

目的：探讨手指严重脱套伤原位培植肉芽组织，延迟实施真皮下血管网皮瓣修复手术的可行性。方法：对2005年8月-2006年8月间，收治的8例手指皮肤软组织脱套伤病人，早期采用湿润烧伤膏（MEBO）换药，原位培植肉芽组织创面，伤后5d-7d实行腹部真皮下血管网皮瓣成形术，7d-10d断蒂。结果：8例患者移植皮瓣全部成活，无皮瓣坏死、感染等并发症，外观与功能均满意。结论：MEBO能有效促进创面肉芽组织生长，真皮下血管网移植皮瓣成活率高，局部无明显臃肿，费用低，无需行二次整形手术。