One-stage reconstruction with open bone grafting and vacuum-assisted closure for infected tibial non-union

Introduction

Non-union of the tibia complicated by osteomyelitis is one of the most challenging problems in orthopaedic surgery. There remains a significant amount of debate and controversy regarding the optimal medical management of infected tibial non-union. There are few articles which have reported the outcomes of treatment for infected non-union of tibia from single-stage reconstruction with open bone grafting plus vacuum-assisted closure (VAC).

Material and methods

Our report covers experience between March 2007 and February 2010 of open bone grafting plus VAC in one stage for patients with infected tibial non-union. The time for bone union and wound healing to occur, the duration of hospitalisation, and the rate of resolution of infection were all analysed. The main outcome measures were based on a clinical scoring system that assessed functional ability, range of knee and ankle motion, shortening, infection and pain. Fifteen patients were involved in this study.

Results

All patients were followed up for an average of 22.6 months (range: 14–42 months). Bone union was achieved in 93.3% (14/15) of patients after a mean of 5.93 months (range: 3–10 months). All wounds healed within an average period of 5 weeks (range: 3–10 weeks), and the function and appearance of all limbs were satisfactory.

Conclusions

Open bone grafting combined with VAC in a one-stage procedure can be a feasible alternative to the treatment of infected tibial non-union, especially for those wounds which are not good candidates for microsurgery; however, further studies are required to confirm the likely benefits.     

Biomechanical study of the funnel technique applied in thoracic pedicle screw replacement

Background

Funnel technique is a method used for the insertion of screw into thoracic pedicle.

Aim

To evaluate the biomechanical characteristics of thoracic pedicle screw placement using the Funnel technique, trying to provide biomechanical basis for clinical application of this technology.

Methods

14 functional spinal units (T6 to T10) were selected from thoracic spine specimens of 14 fresh adult cadavers, and randomly divided into two groups, including Funnel technique group (n=7) and Magerl technique group (n=7). The displacement-stiffness and pull-out strength in all kinds of position were tested and compared.

Results

Two fixed groups were significantly higher than that of the intact state (P<0.05) in the spinal central axial direction, compression, anterior flexion, posterior bending, lateral bending, axial torsion, but there were no significant differences between two fixed groups (P>0.05). The mean pull-out strength in Funnel technique group (789.09±27.33) was lower than that in Magerl technique group (P<0.05).

Conclusions

The Funnel technique for the insertion point of posterior bone is a safe and accurate technique for pedicle screw placement. It exhibited no effects on the stiffness of spinal column, but decreased the pull-out strength of pedicle screw. Therefore, the funnel technique in the thoracic spine affords an alternative for the standard screw placement.     

Sialendoscopy-assisted transfacial surgical removal of parotid stones

Minimally invasive surgical approaches to parotid stones (such as extra-corporeal shockwave lithotripsy and sialendoscopy) have proved to be effective in a high percentage of cases, although success depends on factors such as the localisation of the stone, its size and its mobility. The failure rate of 10% is largely due to large and impacted stones and, in such cases, a combined external and sialendoscopic approach can be used to avoid morbidity and the risks of more invasive superficial parotidectomy. We treated eight patients with large parotid stones (>7 mm) using a sialendoscopy-assisted transfacial surgical approach that was effective in all but one case, which was successfully solved by combining this procedure with extra-corporeal lithotripsy and operative sialendoscopy. Our results confirm that the combined approach is a valid alternative to parotidectomy for large parotid stones and should be added to other minimally invasive techniques aimed at restoring the function of the affected parotid gland.     

导杆漂移技术在经皮椎间孔镜治疗腰椎间盘突出症中的应用

目的探讨导杆漂移技术在经皮椎间孔镜治疗腰椎间盘突出症(LDH)中的有效性、安全性、可行性和应用价值。方法回顾性分析2017年10月-2018年12月该科收治的单节段LDH患者48例,分别采用常规穿刺置管(常规组,n=23)和导杆漂移技术置管(导杆组,n=25),根据术前、术后1 d、术后3个月和术后6个月的视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODI)和改良MacNab标准评估症状改善程度和临床疗效,比较两组透视次数、穿刺时间和手术时间。结果 48例患者手术均顺利完成并获随访,平均随访时间(12.0±2.3)个月。导杆组中,1例因椎间盘钙化切除不彻底,术后症状无明显改善,另有1例术中发生患侧L5行走神经根不完全性损伤,术后出现下肢肌力减弱。所有患者无硬膜囊、腹腔脏器、血管损伤和感染等并发症发生。常规组中,1例术后3 d因打喷嚏引起复发,分别于术后第5和6天相同入路再次行椎间孔镜手术,翻修后症状完全消失。导杆组透视次数、穿刺时间和手术时间均明显少于常规组(P 0.05)。两组术前术后各时点VAS评分和ODI评分比较,差异均无统计学意义(P 0.05)。两组术后各时点VAS评分和ODI评分与术前比较,均明显降低。末次随访采用改良MacNab标准评价,其中优36例,良7例,可4例,差1例,优良率为89.58%。结论导杆漂移技术应用于经皮椎间孔镜手术中,具有安全、高效和操控性强的优点,能明显减少透视次数和辐射量,缩短穿刺和手术时间,值得临床推广应用。     

肌骨超声引导下PRP技术应用于半月板损伤术后康复效果评价

目的探讨应用肌骨超声引导下富血小板血浆(PRP)技术联合康复训练对半月板损伤关节镜术后的临床疗效评价。方法选取2018年1月至10月在某院行半月板损伤关节镜手术的患者38例进行研究,按照随机数表法分成两组,两组患者均接受入院后术前床边健康与康复宣教,对照组予以关节镜手术前后的常规护理,早期常规康复锻炼,观察组在常规护理与康复的基础上术后予以在肌骨超声引导下的PRP注射并早期进入康复科训练,PRP注射于术后2周开始,1次/周,连续4次。比较两组患者在治疗前、术后6周、术后12周的Lysholm评分、视觉模拟评分法(VAS)评分及两组患者膝功能恢复评分。结果两组患者治疗前、术后6周、术后12周的Lysholm评分分别为观察组(55.7±16.2)分、(95.7±3.6)分、(96.4±3.3)分;对照组(52.3±14.1)分、(72.3±4.1)分、(74.5±6.8)分。VAS评分分别为观察组(5.4±1.7)分、(2.4±1.9)分、(1.6±0.5)分;对照组(5.6±2.8)分、(3.6±2.8)分、(3.2±1.6)分,均较术前改善(P<0.05)。两组患者膝关节功能恢复观察组评分明显高于对照组(P<0.05)。结论膝关节半月板损伤术后在肌骨超声引导下注射PRP定位更加准确,对半月板病变的愈合效果更加明显,且结合早期的正规康复训练,更能有效促进膝关节功能恢复,其操作安全,无并发症,可改善患者的生活质量。     

Treatment of panic disorder by trigeminal nerve manipulation: A case series

This is a report on two cases of patients with acute severe panic disorder relieved of their symptoms by manual manipulations of the trigeminal nerve's alveolar branches. The manipulations were performed via the oral cavity during one session, or two consecutive sessions less than a week apart. No other effective treatment was administered prior, concurrently or since the time of the treatment. The recovery from panic disorder was immediate and lasted for the entire period of observation of three years. The authors used the same procedure and achieved identical clinical results treating ten other clients over a period of three years. This was not a planned experiment or randomized study. Rather, this report presents clinical evidence and the authors' hypothesis based on clinical data and literature review.     

医养结合机构失能老人服务供需匹配问卷的研制

目的编制医养结合机构失能老人服务供需匹配问卷。方法于2019年4—5月,在文献研究、半结构访谈和专家咨询的基础上拟定问卷初稿,通过德尔菲法对14名专家进行2轮函询。根据专家函询结果对问卷进行修改和完善,形成最终版问卷。计算专家积极系数、专家权威系数、专家意见集中程度、专家意见协调系数。结果2轮专家函询问卷的有效回收率分别为93.3%和100.0%,专家权威系数为0.92。第2轮函询中,维度及条目的专家意见协调系数分别为0.638和0.407(P<0.001),变异系数均<20%。最终确立的医养结合机构失能老人服务供需匹配问卷包括5个维度,30个条目。结论医养结合机构失能老人服务供需匹配问卷的科学性和可靠性较好,内容全面,可作为有利的调查工具进行失能老人服务供需匹配研究,为制订医养结合照护服务供给方案提供参考依据。     

The Masquelet technique: Current concepts,animal models,and perspectives

Bone reconstruction within a critical‐sized defect remains a real challenge in orthopedic surgery. The Masquelet technique is an innovative, two‐step therapeutic approach for bone reconstruction in which the placement of a poly (methylmethacrylate) spacer into the bone defect induces the neo‐formation of a tissue called “induced membrane.” This surgical technique has many advantages and is often preferred to a vascularized bone flap or Ilizarov's technique. Although the Masquelet technique has achieved high clinical success rates since its development by Alain‐Charles Masquelet in the early 2000s, very little is known about how the process works, and few animal models of membrane induction have been developed. Our successful use of this technique in the clinic and our interest in the mechanisms of tissue regeneration (notably bone regeneration) prompted us to develop a surgical model of the Masquelet technique in rats. Here, we provide a comprehensive review of the literature on animal models of membrane induction, encompassing the defect site, the surgical procedure, and the histologic and osteogenic properties of the induced membrane. We also discuss the advantages and disadvantages of those models to facilitate efforts in characterizing the complex biological mechanisms that underlie membrane induction.     

评价64排螺旋CT三维重建技术评估稳定性骨盆骨折的应用价值

目的:评价64排螺旋CT三维重建技术评估稳定性骨盆骨折的应用价值。方法:回顾性分析我院2015年6月-2019年6月收治的20例骨盆骨折患者的临床资料,结合手术结果,对64排螺旋CT三维重建及X线两种影像学检查方式对各个部位骨折诊断准确率进行观察和比较。结果:在不同部位骨折检查中,64排螺旋CT三维重建诊断准确率皆比X线检查高(P<0.05),且骨折总诊断准确率明显比X线检查高(P<0.05)。结论:在骨盆骨折诊断方式中,CT检查有效率较高,而对64排螺旋CT三维重建技术加以应用,可使盆骨骨折诊断准确率得到进一步提高。     

Intrathoracic anastomosis after oesophageal resection for cancer

Cervical anastomosis has been advocated to avoid the pulmonary complications and life-threatening anastomotic disruptions following intrathoracic oesophagogastric anastomosis. This is a retrospective review of 111 oesophageal resections followed by an intrathoracic anastomosis. These resections were performed between September 1993 and August 1994 within a residency training program. The left thoracoabdominal approach was used for distal tumours and the Ivor Lewis technique for more proximal tumours. Squamous cell carcinoma accounted for 72% patients (n = 80), adenocarcinoma for 25% (n = 28), and others for 2.7% patients (n = 3). Of the patients, 69% had pathologic Stage III tumours. Operative mortality rate was 1.8% (two patients). Perioperative complications occurred in 39 patients, including anastomotic leak in 10 patients and myocardial infarction in 2 patients. In the absence of a leak, there were no major pulmonary complications requiring intensive care or ventilatory support. Of those patients with anastomotic disruption, 89% were salvaged by early clinical diagnosis and appropriate treatment. We conclude that transthoracic oesophagectomy with an intrathoracic anastomosis is a safe procedure that can be performed with low mortality and acceptable morbidity. © 1996 Wiley-Liss, Inc.