A study of the stress distribution of the stem of the total hip prosthesis (author's transl)]

By attaching the strain gauges on the inner and outer sides of the stem of the total hip prosthesis composed of Müller, Charnley and domestic SOM type, the stress distribution was measured. At first, the center of the head of the prosthesis and the apex of the stem were adjusted to be on the vertical line, and a vertical load was placed on the uppermost end of the head, then the stress was measured. Next, the stem was fixed in the hole of a wood-block containing acrylic resin, and the load was placed on the head in neutral, 10 degrees valgus and 10 degrees varus position and in the direction same as the stem before fixation, then the stress was measured of respective position. In comparing the difference in stress distribution between the fixed and the non-fixed stem, the stress in the case of the fixed stem proved to be 17--32% that of the non-fixed one. The site where the maximum stress appeared was at the middle third of the stem in the case of the non-fixed stem, while it was at the neck and at the one fifth of the upper portion of the fixed one. In comparing the stress at the neutral, the valgus and the varus position, the stress at the valgus position was found to be minimum, and taking the stress at the neutral position as 100, it was 60--82, and at the varus position the maximum of 105--131 appeared.     

益气温阳、活血化瘀方对兔血管成形术后再狭窄PDGF-B mRNA表达的影响

目的探讨中药复方对兔实验性经皮腔内血管成形术(PTA)血管成形术后血管壁血小板衍生生长因子B链(PDGF-B)mRNA表达的影响。方法新西兰兔54只随机分为假手术组、模型组、中药组,采用一次球囊导管损伤方法制备兔颈动脉球囊损伤模型,于术后1周、2周、4周取材,HE染色进行定量组织形态学分析和RT-PCR法半定量检测分析PDGF-B mRNA的表达。结果中药组、模型对照组与假手术组相比,管腔狭窄程度明显加重,内膜与中膜面积之和明显增大;与模型组相比,中药组在2周、4周时管腔面积明显增大、管腔的狭窄程度、内膜与中膜面积之和显著降低,在1周、2周时PDGF-B的mRNA表达水平明显增高。结论益气温阳、活血化瘀方可能通过下调血管壁PDGF-B的mRNA表达水平,从而抑制平滑肌细胞的增殖和血管成形术后再狭窄。     

The operative cure of hallux valgus and bunions

The main basic factors in the etiology of hallux valgus and bunions are the adduction of the metatarsal bone of the big toe and the obliquity of its tarsometatarsal joint.The conspicuous and obvious causes of the discomfort and disability are the valgus of the big toe, bony overgrowth at the base of the big toe and the overlying bursa or bunion.The author's operation aims to correct all of the pathological changes without disturbing the function of the big toe joint or the weight bearing surface of the head of the first metatarsal.The adduction of the first metatarsal bone is corrected by the removal of a double wedge from the tarsometatarsal joint, the mobilization of the metatarsal bone and the manual approximation of the first and the second metatarsal.The overgrowth of bone on the head of the metatarsal and the bunion are excised through a separate incision.The correction of the valgus of the big toe is assured by securing to the metatarsal bone a tongue of strong tissue, consisting of bursal wall and capsule, which is attached to the base of the phalanx.Care is exercised not to remove or in any way disturb the articulating portion of the head of the metatarsal bone. This accomplishes two results, namely, the support of the forefoot is not altered and the mobility of the big toe is not diminished.By bringing the big toe into line with the inner border of the foot, the sesamoid bones are returned to their normal relation to the head of the metatarsal, and the dorsal and plantar tendons of the big toe are brought into a normal or nearly normal position, where they can function properly.     

Gas exchange and metabolic functions of the lungs in endotoxic shock

The experiments were carried out in 27 dogs with endotoxic shock under conditions of the artificial ventilation of the lungs and barbital anesthesia. It was established that under the above conditions the metabolic functions of the lungs were the first to be impaired. The artificial ventilation of the lungs fails to prevent the development of the impairment of the surfactant-synthesizing function of the lungs as well as the serotonin-inactivating function of the lungs. Two stages of the development of the shock lung syndrome were distinguished: the first one is the disturbance of the metabolic functions of the lungs; the second one is the disturbance of the gas exchange function of the lungs.     

A new method of surgical treatment of vasculogenic impotence

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.     

游离足内侧皮瓣的解剖研究与临床应用

目的 改进和完善以足底内侧动脉深支的内侧支供血的游离足内侧皮瓣的设计和应用技术。方法 基于８只足标本的解剖观测结果,制定独特皮瓣设计方案,应用游离足内侧皮瓣修复手部皮肤缺损４例,改进如下：皮瓣静脉回流选用大隐静脉,缝合皮瓣的隐神经带,利用动脉蒂的伴行静脉与受区动脉吻合,挽救发生动脉危象的皮瓣等。结果 ４例皮瓣均完全存活,效果良好。结论 皮瓣设计例题,将该皮瓣的深静脉动脉化是动脉危象的有效补救措施,     

The muscle compressing the ureter and its role in the closure mechanism of the ureteral-bladder segment

The authors indicate an important role of the locking mechanism of the vesicoureteral segment in the prevention of the retrograde regurgitation of urine into the upper urinary tracts, namely vesicoureteral reflux. They pay special attention to the fact that the knowledge of the structure of the terminal part of the ureter helps select certain appliances preventing the development of the reflux. However, the known data fail to satisfy the clinicians and explain the appearance of the reflux in some cases. Therefore, the authors have undertaken an original morphological investigation of the terminal part of the ureter, observing the vesicoureteral complexes of 32 human cadavers. Micropreparation of the vesicoureteral segments was performed with the use of a 2.5-4X binocular magnifier. The study revealed a muscle previously undepicted. Regarding it as the ureter-pressing one, the authors designated it as "musculus appressor ureteris". Formed by the muscular fibres of the detrusor and situated 1-2 cm more proximal than the ostium ureteris, it arches through the submucosal segment of the ureter and is connected with the musculature of the urinary bladder on the both sides of the ureter. Its width is about 6-8 mm and its thickness is 1.5-2 mm. The authors explain its function and role by the locking system of the vesicoureteral segment, which is proved by the development of the reflux in case the ureteral ostium and the above muscle are dissected. The authors emphasize the fact that it is necessary to extremely accurately cut the anterior wall of the terminal part of the ureter.     

A Simple Method to Estimate the Trajectory to the Genu of the Corpus Callosum in the Interhemispheric Approach for Distal Anterior Cerebral Artery Aneurysms

In the interhemispheric approach (IHA) for the distal anterior cerebral artery (DACA) aneurysms, the surgical trajectory to a DACA aneurysm is very important because surgeons sometimes encounter the intraoperative disorientation and the premature rupture. The purpose of this study was to clarify the anatomical landmarks indicating the trajectory to the genu of the corpus callosum (GCC) at the early stage of dissection for the correct intraoperative orientation. “Point A” was defined as the crossing point between the frontal bone and the line connecting the projected external acoustic opening (EAO) and the GCC on the midline slice of the sagittal three-dimensional computed tomography angiography (3D-CTA) images. We measured the distance from the nasion to Point A using midline sagittal slice images from 50 patients who underwent 3D-CTA at our institution. The average distance was 7.0 cm (±0.3 cm). Therefore, the direction of the spatula inserted in the direction of the EAO from Point A (7 cm above the nasion) corresponds to the trajectory to the GCC. In DACA aneurysms of the A3 segment, the pericallosal artery distal to the aneurysm can be safely identified by dissecting the interhemispheric fissure distal to the trajectory to the GCC. In DACA aneurysms of the A4 or A5 segment, the parent artery of the aneurysm can be safely identified by dissection along the trajectory to the GCC. Point A and the EAO can be used as landmarks indicating the trajectory to the GCC for the correct intraoperative orientation in the IHA for DACA aneurysms.     

干细胞与组织工程在肠道的研究进展

目的了解干细胞和组织工程在肠道的研究进展。方法查阅近年相关文献,总结干细胞和组织工程在肠道的研究现状。结果干细胞和组织工程在肠的研究近年来是个十分令人关注的领域,亦取得一定的进展。特别是在肠道上皮干细胞的特性、增殖、分化、小肠黏膜下层作为体内组织工程支架等方面的研究有一定的突破。但困扰研究的关键问题是小肠上皮干细胞的标记物仍未得到解决,组织工程肠的研究亦刚刚起步。结论干细胞和组织工程在肠道的研究有十分广阔的应用前景,有望在肠道炎性疾病、肿瘤发生机制、组织工程肠的研究方面取得较好的研究成果。     

Skin grafts with axial blood supply in correcting post-traumatic defect of the foot

The analysis of the results of the surgical treatment and the orthopaedic provision of 117 patients with extensive wound defects of the feet has allowed the authors to consider the most important factors to be as follows: the determination of the limits of the saving approach to the preservation of the bone matrix, the choice of the optimal method of dermatoplasty (the method of plasty, the type of the graft) and the rational prosthetic and orthopaedic provision. Such approach has allowed to work out the possible versions of the surgical treatment using the grafts with axial blood supply in 6 main types of the injuries of various segments of the foot.     

Effect of Impeller Geometry on Lift‐Off Characteristics and Rotational Attitude in a Monopivot Centrifugal Blood Pump

The effect of the flow path geometry of the impeller on the lift‐off and tilt of the rotational axis of the impeller against the hydrodynamic force was investigated in a centrifugal blood pump with an impeller supported by a single‐contact pivot bearing. Four types of impeller were compared: the FR model with the flow path having both front and rear cutouts on the tip, the F model with the flow path having only a front cutout, the R model with only a rear cutout, and the N model with a straight flow path. First, the axial thrust and the movement about the pivot point, which was loaded on the surface of the impeller, were calculated using computational fluid dynamics (CFD) analysis. Next, the lift‐off point and the tilt of the rotational axis of the impeller were measured experimentally. The CFD analysis showed that the axial thrust increased gently in the FR and R models as the flow rate increased, whereas it increased drastically in the F and N models. This difference in axial thrust was likely from the higher pressure caused by the smaller circumferential velocity in the gap between the top surface of the impeller and the casing in the FR and R models than in the F and N models, which was caused by the rear cutout. These results corresponded with the experimental results showing that the impellers lifted off in the F and N models as the flow rate increased, whereas it did not in the FR and R models. Conversely, the movement about the pivot point increased in the direction opposite the side with the pump outlet as the flow rate increased. However, the tilt of the rotational axis of the impeller, which oriented away from the pump outlet, was less than 0.8° in any model under any conditions, and was considered to negligibly affect the rotational attitude of the impeller. These results confirm that a rear cutout prevents lift‐off of the impeller caused by a decrease in the axial thrust.     

Anatomic study of the gastrocnemius-soleus junction and its relationship to the sural nerve

BACKGROUND: Gastrocnemius recession is performed for equinus contracture of the ankle and as an adjunct treatment for various foot pathologies. Successful release relies on many factors, including a thorough knowledge of the anatomy of the gastrocnemius-soleus junction and its relationship to the sural nerve which may be vulnerable to iatrogenic injury. Neither the average width of the tendon at the gastrocnemius-soleus junction, the anatomy of the sural nerve with respect to the gastrocnemius-soleus junction, nor appropriate landmarks for accurate incision placement at this level to avoid undesirable vertical extension, however, have yet to be acceptably defined. METHODS: Fourteen fresh-frozen cadavers were dissected and the width of the tendon at the gastrocnemius-soleus junction, the distance of the sural nerve from the lateral border of the tendon at this level, the length of the fibula, and the distance from the distal tip of the fibula to the gastrocnemius-soleus junction were measured. RESULTS: The average width of the gastrocnemius-soleus complex at the junction was 58 mm (range, 44-69 mm), the average distance of the sural nerve from the lateral border of the gastrocnemius-soleus complex at the level of the gastrocnemius-soleus junction was 12 mm (range, 7-17 mm), the average percentage of this distance as compared to the entire width of gastrocnemius-soleus junction was 20% (range, 13%-27%), and the ratio of the distance of the gastrocnemius-soleus junction from the distal tip of the fibula divided by the length of the fibula was 0.5 (range, 0.5-0.6). CONCLUSION: These results provide some guidelines as to the approximate size of the gastrocnemius-soleus complex at the site of gastrocnemius recession along with the location of the sural nerve at the musculotendinous junction. Also, the results indicate that the fibula can serve as a reproducible anatomic landmark to enable localization of the gastrocnemius-soleus junction at the time of gastrocnemius recession.     

Anatomical variations of the straight sinus on magnetic resonance imaging in the infratentorial supracerebellar approach to pineal region tumors.

Anatomical variations of the straight sinus (SS) were examined on magnetic resonance imaging (MRI) in 108 control cases and five cases with a pineal region tumor. The data of the latter were compared with the operative findings in the infratentorial supracerebellar approach. In the 108 control cases, the length of the SS was 51 +/- 5.2 mm. The angle of the SS to the nasion-tuberculum sellae line, the tuberculum sellae-inion line, and the nasion-inion line was 51 +/- 6.7 degrees, 44 +/- 5.0 degrees, and 47 +/- 5.0 degrees, respectively. The SS was inclined 1.4 +/- 4.5 degrees posteriorly to the bregma-inion line. The anatomical relationship between the SS and the corpus callosum was subgrouped into three types: in the common type (63%), the extended line of the slope of the SS is tangential to the upper aspect of the splenium of the corpus callosum; in the high-angle type (26%), the extended line is far above the tangent line; and in the low-angle type (11%), the extended line is far below the tangent line. The operative field was restricted by the steeply inclined tentorium in the case of the high-angle type, and the tumor was located much lower than the direction of the operative approach. In contrast, the tumor was easily exposed in the center of the wide operative field in the cases of low-angle type. The present study suggests that the preoperative MRI analysis of the angle of the SS is indispensable before taking the infratentorial supracerebellar approach to the pineal region tumors.     

成人髋臼发育不良伴骨关节炎行髋臼结构性植骨重建关节置换术的力学分析

目的：利用三维有限元力学分析方法,研究髋关节发育不良患者髋臼外上缘结构性植骨重建髋臼、增加臼杯假体包容对髋臼假体-骨界面间的应力分布情况的影响。方法选取髋关节发育不良患者的骨盆为实验对象,用螺旋CT做全长连续扫描,然后利用计算机仿真技术对CT图像进行三维重建,建立髋关节发育不良骨盆模型。在计算机环境中对重建模型进行髋臼外上缘结构性植骨重建髋臼并臼杯植入的模拟手术,利用有限元分析软件对重建模型进行有限元网格化及力学分析。结果髋臼植骨重建后,臼杯置入无需突破髋臼底,髋臼外上缘得到植骨块的包容覆盖,臼杯接触面积增大,单位面积所受应力相对较少,应力集中的情况得到明显改善。同时,植骨块及原髋臼外上缘区域承担了臼杯较多的应力。结论结构性植骨重建髋臼使骨床与臼杯接触面积较大,单位面积所受应力较小且均匀,有利于臼杯的稳定,植骨块承担了臼杯较多的应力,若臼杯外上缘外露面积过大,而过多的靠植骨块来弥补骨床的覆盖,使植骨块所受应力过大则臼杯松动的风险较大。     

面神经额支的分布与面部上提术的关系

目的 明确面神经额支在颧部的软组织走行层次的分布。方法 对９人尸头（１８例）颜面行大体解剖观察。结果 面神经额支的分支数目为３￣７支，平均５支，无恒定的行径及体表投影。将颧弓均分成三段，统计跨过各段表面的额支分支数，发现额支交非仅限于颧弓的中后段，而是近全颧弓均有额支分支跨过，其分布密度以中１／３段最高，占总数的４４．４％（４０／９０）；前１／３段次之，中３８．８９％（３５／９０）；后１／３段又次     

Surgical correction of cryptotia using Medpor.

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.     

Clinical and morphological substantiation of the surgical treatment of post-traumatic neurogenic deformations of the limbs in children

The authors have analysed and determined the role of such clinical factors as the age of the patients, the level of the nerve lesion, the period of time since the moment of the injury, the lesions of the arterial vessels and the individual regenerative capacity of various nerves with the aim of defining the optimal period of time for surgical correction of neurogenic deformations of the extremities in children in cases of the peripheral nerve lesions. Morphological investigation of the paralysed muscles of 56 patients with lesions of the peripheral nerves was carried out. Characteristic structural and functional changes in the denervated muscles were established and the terms of appearance of irreversible changes were determined.A conclusion about the necessity of surgical treatment within the period of 1 year and more since the time of the nerve injury has been made on the basis of the investigation. Positive results of the treatment of 180 patients confirmed the correctness of the authors' conclusions.     

Precision grip with congenital hypoplasty or hypofunction of the thumb

We tested the grip in four patients with congenital defects of the hand and either a hypoplastic thumb or a thumb with impaired inervation. Small objects were taken by a scissors grip between the fingers. In a hand with radial duction in the manus vara congenita, during strengthening of the wrist, the grip from the ulnar side between the fourth and fifth fingers was changed to the radial side between the second and third fingers. Large objects were gripped by all the three-phalanx fingers into the palm in a horizontal position. In case 4 with hypoplasia of the thumb grade IIIC by the classification of Blauth and Buck-Gramcko, we describe a transposition of the index finger to the site of the thumb and the hypoplastic thumb to the site of the index finger. It is obvious that the precision grip is affected by the thumb length and strengthening of the ulnar side of the wrist. We assume that the scissors grip is the earliest precision grip in the evolution of the primate hand.     

The posterior interosseous artery in the distal part of the forearm. Is the term "recurrent branch of the anterior interosseous artery" justified?

In 1993 Angrigiani raised the question as to whether the distal part of the posterior interosseous artery (AIP) is a recurrent branch of the anterior interosseous artery (AIA) and forms a "choke"--anastomosis with the AIP in the middle of the forearm. A dissection study was conducted on 66 upper extremities to evaluate the diameters of the dorsal branch of the anterior interosseous artery, the anastomotic branch, the diameter of the posterior interosseous artery at the point of origin of the septocutaneous perforators in the middle of the forearm and the diameter of the posterior interosseous artery at the point of emergence in the dorsal compartment. We further tried to identify different forms and types of the "distal" anastomosis and the connections to the dorsal carpal arch and the ulnar artery. A distal anastomosis between the AIA and AIP was found in 65 of the 66 upper extremities. Three different types of anastomosis could be identified. The smallest diameter was found at the middle of the forearm (mean diameter AIA 1.28 mm; anastomotic branch 0.6 mm; AIP at the middle of the forearm 0.39 mm; AIP prox. 1.35 mm). A branch through the fifth extensor compartment was present in all of our specimens (mean diameter 0.54 mm). A branch through the forth extensor compartment could be found in 16 specimens. Based on our findings and the embryological development, we conclude that the AIP is only present in the proximal half of the forearm. In the distal part, the dorsal branch of the anterior interosseous artery forms a vascular arcade, which gives off branches to the dorsal carpal arch, the ulnar head and the ulnar artery. This arcade anastomoses with the posterior interosseous artery in the middle of the forearm by means of a choke anastomosis. We also conclude that the term "recurrent branch of the anterior interosseous artery" for the distal part of posterior interosseous artery is correct.     

股骨头不同区域囊变对力学承载的影响

目的探索股骨头不同部位囊变对股骨头力学承载的影响。方法取新鲜人体股骨上段标本,行螺旋CT断层扫描,得到CT数据二维图像,采用Efilm软件系统处理,人工识别股骨头边缘轮廓,将数据输入计算机,利用Ansys-5.7大型计算机软件建立股骨上段三维有限元异物同构模型,模拟股骨头内不同部位直径1cm的囊变灶。施加3种不同载荷,分析股骨头内应力分布情况及应力/强度比值,预测股骨头塌陷的危险性。结果所构建股骨头三维有限元异物同构模型共有21852个节点,10472个单元。囊变区强度降低导致应力下传受限,在其边缘区产生应力集中。股骨头负重区下方及其内侧和外侧的囊变应力集中最明显,表现为张力集中,其上方骨板下松质骨应力/强度比值明显升高,易引起股骨头塌陷。当囊变位于股骨头的前方、后方或下方时,塌陷风险小。结论股骨头囊变灶位于股骨头负重区的下方或其内、外侧时,可行带血运的髂骨瓣植入,骨瓣应与软骨下骨板接触。如果坏死范围较大,负重区下方及其内外侧均受累,髂骨瓣应位于负重区的下方。