微创牙冠延长术联合纳米树脂修复龈下楔状缺损的临床效果

目的 探讨在龈下楔状缺损修复中实施微创牙冠延长术联合纳米树脂治疗的效果。方法 选择我院 2019年5月-2023年5月收治的180例龈下楔状缺损患者为研究对象,采用随机数字表法分为对照组和研究 组,各90例。对照组采用常规牙冠延长术联合纳米树脂治疗,研究组采用微创牙冠延长术联合纳米树脂治 疗,比较两组修复效果、牙周健康水平、疼痛程度及美观满意度。结果 研究组优良率为95.56%,高于对 照组的80.00%（P＜0.05）;研究组术后3个月PD水平低于对照组,AL水平高于对照组（P＜0.05）;研究组 术后3个月BI、MD水平高于对照组,但差异无统计学意义（P＞0.05）;研究组术后1 d、3 d、7 d的NRS评 分低于对照组（P ＜0.05）;研究组美观满意度为95.56%,高于对照组的81.11%（P ＜0.05）。结论 微创牙 冠延长术联合纳米树脂修复应用于龈下楔状缺损患者中的临床效果确切,能改善牙周健康水平,改善患者 疼痛程度,进而提高美观满意度,值得临床应用。     

上颌窦内提升技术在上颌后牙缺损患者中的应用效果

目的 探讨上颌窦内提升技术应用于上颌后牙缺损患者的效果。方法 选取咸阳市口腔医院2021年2月-2022年12月收治的行口腔种植修复的上颌后牙缺损患者104例为研究对象,采用随机数字表法分为对照组和观察组,各52例。对照组实施传统种植修复术治疗,观察组实施上颌窦内提升技术治疗,比较两组临床疗效、并发症发生情况、手术指标、治疗满意度、生活质量、口腔出血指数、患牙菌斑指数及种植体周围骨吸收量情况。结果 观察组治疗总有效率为98.08%,高于对照组的76.92%（P＜0.05）;观察组并发症发生率为3.85%,低于对照组的23.08%（P＜0.05）;观察组治疗时间以及患者咀嚼功能恢复时间均短于对照组（P＜0.05）;观察组满意度高于对照组（P＜0.05）;观察组干预后生活质量评分高于对照组（P＜0.05）;两组种植体周围骨吸收量比较,差异无统计学意义（P＞0.05）;观察组口腔出血指数、患牙菌斑指数优于对照组（P＜0.05）。结论 上颌窦内提升技术应用于上颌后牙缺损患者,可获得较为满意的治疗结果,降低并发症发生率,缩减手术治疗时间,改善患者口腔出血指数。     

Unilateral endoscopic approach for repair of frontal sinus cerebrospinal fluid leak

Cerebrospinal fluid (CSF) leak closure remains one of the most difficult surgeries for skull base surgeons, particularly with frontal sinus involvement. Technological advances in endoscopic surgery increasingly allow for less morbid approaches to the frontal sinus. We describe a series of patients who underwent endoscopic frontal sinus CSF leak repair utilizing a unilateral approach, to evaluate the utility and outcomes of this method. We performed a retrospective review of four cases in tertiary care centers. Participants included patients with CSF leak involving the frontal sinus. Main outcome measures included cessation of CSF leak and frontal sinus patency. Three patients were closed on the first surgical attempt; one with a communicating hydrocephalus required a revision procedure. Leak etiologies included prior craniotomy for frontal sinus mucopyocele, spontaneous meningoencephalocele, erosion due to mucormycosis, and prior endoscopic sinus surgery. The frontal sinus remained patent in three of four patients. No patients have evidence of a leak at a minimum of 1 year after surgery. The repair of frontal sinus CSF leaks is possible in specific cases with an endoscopic unilateral approach in leaks with multiple etiologies. Surgeons should consider this approach when selecting the appropriate procedure for repair of frontal sinus CSF leaks.     

Transorbital Neuroendoscopic Management of Sinogenic Complications Involving the Frontal Sinus,Orbit, and Anterior Cranial Fossa

Transnasal endoscopic surgery has remained at the forefront of surgical management of sinogenic complications involving the frontal sinus, orbit, and anterior skull base. However, the difficulty in accessing certain areas of these anatomical regions can potentially limit its use. Transorbital neuroendoscopic surgery (TONES) was recently introduced to transgress the limits of transnasal endoscopic surgery; the access that it provides could add additional surgical pathways for treating sinogenic complications involving the frontal sinus, orbit, and anterior cranial fossa. We describe a prospective series of 13 patients who underwent TONES for the management of various sinogenic complications, including epidural abscess, orbital abscess, and fronto-orbital mucocele or mucopyocele, as well as subperiosteal abscess presenting with orbital apex syndrome. The primary outcome measurement was the efficacy of TONES in treating these pathologies. TONES provided effective access to the frontal sinus, orbit, and the anterior cranial fossa. All patients demonstrated postoperative resolution of initial clinical symptoms with well-hidden surgical scars. There were no ophthalmologic complications or recurrence of pathology. Based on our experience, TONES appears to provide a valuable addition to the current surgical armamentarium for treating selected complications of sinusitis.     

Piriformis-Sparing Minimally Invasive Versus the Standard Posterior Approach for Total Hip Arthroplasty: A 10-Year Follow-Up of a Randomized Control Trial

Background

Despite the popularity of minimally invasive approaches in total hip arthroplasty, studies regarding their impact on soft tissues and long-term benefits are lacking. This study aims to compare the 10-year functional outcome of the piriformis-sparing minimally invasive approach to the standard posterior approach for total hip arthroplasty surgery.

Preoperative Posterior Tilt Increases the Risk of Later Conversion to Arthroplasty After Osteosynthesis for Femoral Neck Fracture

BackgroundFemoral neck fractures (FNFs) are one of the most common injuries in the elderly. Treatment is either internal fixation or primary arthroplasty. The main aim of this study is to assess the risk factors associated with fixation failure leading to further arthroplasty in FNFs treated with cannulated screws.MethodsData on internal fixations of FNFs performed at Turku University Hospital between January 1, 2012 and December 31, 2017 were collected retrospectively from the patient database. Radiographical measurements were performed for preoperative displacement and posterior tilt, postoperative displacement, reduction quality, and implant shaft angle.ResultsAltogether 301 cases were included in the study. The overall reoperation rate was 25% and conversion to arthroplasty was performed in 16% of cases. In the multiple variant analysis, adjusted for age and gender, nondisplaced fractures with a 0°-20° preoperative posterior tilt had a significantly lower risk of later conversion to arthroplasty than did nondisplaced fractures with a ≤0° or ≥20° posterior tilt (odds ratio [OR] 4.0, 95% confidence interval [Cl] 1.8-8.6, P = .0005) and displaced fractures (OR 7.2, 95% CI 3.0-17.4, P < .0001). No statistically significant association was found between preoperatively nondisplaced fractures with a <0° or ≥20° posterior tilt and displaced fractures (OR 0.6, 95% Cl 0.2-1.3, P = .2).ConclusionDisplaced fractures and fractures with a preoperative posterior tilt of <0° or ≥20° have a considerably increased risk of reoperation and conversion to arthroplasty. Primary arthroplasty should be considered as treatment for displaced FNFs and fractures with >20° or <0° posterior tilt, especially in fragile patients, to avoid further operations.     

Non‐Anatomical Arthroscopic All‐Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment

ObjectiveTo describe a non‐anatomical arthroscopic all‐inside repair of medial meniscus posterior root tear (MMPRT) to posterior cruciate ligament (PCL) technique for patients with normal lower limb alignment and to evaluate the short‐term clinical and radiologic outcomes.MethodsMMPRT directly to PCL was repaired with all‐inside horizontal mattress suturing technique rather than by the transtibial pullout suture technique or anchor suturing repair technique in 20 Laparade Type II MMPRT patients with normal lower limb alignment during 2018–2019. The clinical and radiological outcomes were evaluated retrospectively for at least 2 years follow‐up. The VAS score, Lysholm score, Tegner activity score were evaluated preoperatively and at the final follow‐up. The status of the medial meniscus posterior root were assessed on magnetic resonance imaging (MRI) preoperatively and at the final follow‐up.ResultsTwenty patients (mean age 54.5 ± 19.5 years) were included in the present study. The mean follow‐up duration was 32.5 ± 5.8 months. The VAS score was significantly decreased from preoperative 6.5 ± 1.5 to 2.1 ± 1.4 at the final follow‐up (P < 0.01). The mean Lysholm score was significantly improved from 43.7 ± 10.9 preoperatively to 85.7 ± 10.8 (P < 0.01). The median Tegner activity score was improved from 1.0 (range 1–4) to 3.0 (range 2–4, P < 0.01). On MRI, a total of 12 cases (60%) had complete healing, while eight cases (40%) had partial healing.ConclusionNon‐anatomical arthroscopic all‐inside repair of MMPRT to PCL may yield beneficial clinical outcomes and a higher rate of clinical healing in Type II MMPRT patients with normal lower limb alignment. It is an easy and reliable alternative technique to the transtibial pullout suture or anchor suture repair technique.     

Simple Technique to Place the Lateral Mass Screws in the Revision Surgery after Cervical Laminoplasty for Ossification of the Posterior Longitudinal Ligament

A lateral mass screw (LMS) is one of the standard anchor screws in posterior cervical fixation. Although the advantage of cervical LMS is that it is easier and safer to place than pedicle screw, it is sometimes difficult for surgeons to confirm the exact point for screw entry and accurate angle in cases of revision surgery. When LMS fixation is performed as revision surgery after cervical laminoplasty or laminectomy, it might be complicated to secure safe placement of the LMSs. We present a simple but practical technique involving a caliper and angle device for revision surgery after cervical laminoplasty for ossification of the posterior longitudinal ligament. In this technique, the distance between the bilateral entry points is ascertained using preoperative CT. Insertion of the screw is guided using the angle device set to 25 degrees. The technique presented here is easy and allows accurate placement of the LMSs in the posterior cervical spine, and is practical even for revision surgery.     

Bilateral PECS II Block is Associated with Decreased Opioid Consumption and Reduced Pain Scores for up to 24 hours After Minimally Invasive Repair of Pectus Excavatum (Nuss Procedure): A Retrospective Analysis

Objective(s)Compared to the open surgical technique, the minimally invasive repair of pectus excavatum (MIRPE; Nuss procedure) is a thoracoscopic technique designed to minimize intraoperative tissue damage. It still causes severe postoperative pain due to the insertion and pressure of the retrosternal bar used to raise the sternum and stabilize the chest. This study aimed to identify associations between ultrasound-guided PECS-II block and postoperative analgesia after the Nuss procedure.DesignA retrospective cohort studySettingSingle-center, training and research hospital affiliated with a universityParticipantsFrom Jan 1, 2018 to Nov 15, 2021, 171 consecutive patients were identified who underwent MIRPE surgery under general anesthesia. All patients received intravenous (I) patient-controlled analgesia (PCA) with or without PECS-II blocks for postoperative analgesia. One hundred twenty-five patients who met the inclusion criteria were evaluated.InterventionsDemand-only morphine intravenous PCA was used for postoperative pain management in the PECS and control groups. Bilateral PECS-II block with 0.25% bupivacaine was performed in to the PECS group.Measurements and main resultsThe primary outcome was postoperative opioid consumption, calculated as mg/kg of IV morphine. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest (static) and with movement (dynamic) recorded 1, 4, 8, 12, 24 h after surgery. Postoperative morphine consumption was significantly lower in the PECS group than in the control group over the first 24 hours postoperatively: 0.325 mg/kg vs. 0.425 mg/kg (p<0.001). Static and dynamic NRS values were significantly lower in the PECS group for the first 12 postoperative hours (p <0.05).ConclusionsBilateral PECS-II block is associated with decreased pain scores for up to 12 hours, and with decreased opioid consumption for up to 24 hours, following minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents. PECS-II block in this context has not been previously described.