游离髂骨联合腹股沟皮瓣带蒂移植修复手指背侧骨皮缺损

目的观察游离髂骨联合腹股沟皮瓣移植修复手指背侧骨皮缺损的临床效果。方法自2008年2月至2011年12月我中心收治的7例手指背侧骨皮缺损的患者,手术方案为:3例污染较轻者经急诊清创后Ⅰ期给予修复,4例感染者Ⅰ期彻底清除病灶,控制感染后,Ⅱ期行游离髂骨植骨微型接骨板内固定手指于功能位,腹股沟皮瓣修复软组织缺损。结果术后3⁴周断蒂,皮瓣全部成活;临床植骨愈合时间为8周3例,9周4例,平均8.5周;术后3个月复查全部病例均达到骨性愈合。随访104周断蒂,皮瓣全部成活;临床植骨愈合时间为8周3例,9周4例,平均8.5周;术后3个月复查全部病例均达到骨性愈合。随访10³6个月,皮瓣质地良好,外观满意,髂骨塑形良好,未出现骨髓炎、骨不愈合等情况。结论游离髂骨联合腹股沟皮瓣移植修复手指骨皮缺损是一种理想方法,简单易行,值得临床推广。     

Tantalum Cones in Revision Total Knee Arthroplasty. A Promising Short-Term Result With 29 Cones in 21 Patients

Twenty-nine porous tantalum metaphyseal cones were implanted in 21 patients (14 women and 7 men) during revision TKA. The average age at the time of the procedure was 73.3 years. Sixteen revisions were considered aseptic and 5 were reimplantations after sepsis. Eight patients had stemmed revision implants and thirteen primary designs. According to the Anderson Orthopaedic Research Institute bone defect classification, femoral defects were rated as F3 in 14 knees and F2B in 3 knees. Tibial defects were rated as T2A in 3 cases, T2B in 3 cases and T3 in 5 cases. A femoral cone was inserted in 10 patients, a double cone (femur and tibia) in 8, and a single tibial cone in 3. A rotating hinge knee prosthesis (RHK, Zimmer) was inserted in 10 patients and a constrained condylar prosthesis (LCCK, Zimmer) in 11 patients. The diaphysis was cemented in 9 cases and, in 11 cases, just the metaphysis. At an average follow up of 36 months only one reconstruction was removed due to persistent infection. All metaphyseal cones showed evidence of stable osseointegration. According to the Knee Society Score the results were rated as excellent in 12 cases, good in 5 cases, fair in 3 and poor in 1 case. In the short term, porous tantalum metaphyseal cones provided structural support for large femoral and tibial defects. They also provided the environment for bone graft osseointegration, repair of femoral fractures and effective interdigitation of cement mantle into the trabecular metal cone.     

全身骨显像联合超声检查在肺癌骨转移诊断中的价值

目的 探讨全身骨显像联合超声检查在肺癌骨转移诊断中的价值.方法 选择150例肺癌患者进行全身骨显像检查,并对可疑病灶进行超声检查,与CT、MRI或病理活检结果对照.结果 150例患者经全身骨显像检查后共有65例患者221个可疑骨转移灶,联合超声检查后,对于可穿透探查的133个病灶,超声拟诊其中5个病灶为良性病变,与临床确诊4个良性病变比较,误诊1个;联合超声和临床确诊结果均表明,肺癌骨转移多位于胸部.结论 骨全身显像联合超声检查诊断肺癌患者骨转移可以优势互补,值得推广.     

Positional change of hyoid bone after anesthesia in anterior surgery of upper cervical spine

Background contextThe hyoid bone is used as a landmark in anterior upper cervical spine operations and is supposed to represent the level of C3 body. However, this correspondence between hyoid bone position and cervical level is not static and changes during surgery (extension after anesthesia).PurposeTo find the cervical level corresponding to the position of hyoid bone before and after anesthesia and to evaluate the adequacy of its usage as a surgical landmark.Study designA retrospective study.Patient sampleOne hundred twenty-eight patients with degenerative cervical diseases who had undergone anterior cervical discectomy and fusion.Outcome measureRadiologic measure.MethodsFor each patient, preanesthesia neutral, preanesthesia extension, and postanesthesia induction extension C-spine lateral image were obtained. The level of cervical vertebra that midline of hyoid bone indicated was measured by radiological method. A cervical vertebra was divided into three segments, consisting of upper half, lower half, and disc space, and each of these segments was considered as one level. The differences between pre- and postanesthesia induction hyoid positions were classified as minimal change (one level or less) and significant change (two levels or greater). Relationship between positional change of hyoid bone to gender, obesity, and age were respectively investigated.ResultsThere were 20 cases of one-level distal displacement of the hyoid bone, 40 cases of two-level distal displacement, 34 cases of three-level distal displacement, 16 cases of 4-level distal displacement, and two cases of five-level distal displacement. In eight cases, there was no level change, and in the remaining 8 cases, the hyoid bone had been displaced proximally. There were 34 cases of minimal change. The remaining 94 cases (73.4%) had significant changes. No respective relationship was found between sex, obesity, age and pre-and postanesthesia induction positional change of hyoid bone.ConclusionsAmong the 128 cases studied, 73.4% hyoid bone positions had changed by more than one cervical vertebra body between the pre- to postanesthesia induction X-ray images. Sex, age, and body mass index were not associated with statistically significant differences in these positions. The hyoid bone should not be trusted as a landmark for upper cervical operations, and the cervical level to be operated should be confirmed by a radiological method before a skin incision is made.     

Development and evaluation of novel biodegradable chitosan based metformin intrapocket dental film for the management of periodontitis and alveolar bone loss in a rat model

ObjectiveThe aim of this study was to develop a chitosan-metformin based intrapocket dental film (CMIDF) for applications in the treatment of periodontitis and alveolar bone loss in an rat model of periodontitis.DesignCMIDF inserts were fabricated by the solvent casting technique. The fabricated inserts were evaluated for physical characteristics such as folding endurance, surface pH, mucoadhesive strength, metformin content uniformity, and release. X-ray diffraction analysis indicates no crystallinity of metformin in presence of chitosan which confirmed successful entrapment of metformin into the CMIDF. Fourier-transform infrared spectroscopy revealed stability of CMIDF and compatibility between metformin and chitosan. Periodontitis was induced by a combination of Porphyromonas gingivalis- lipopolysaccharide injections in combinations with ligatures around the mandibular first molar. We divided rats into 5 groups (8 rats/group): healthy, untreated periodontitis; periodontitis plus CMIDF-A (1.99 ± 0.09 mg metformin; total mass-4.01 ± 0.05 mg), periodontitis plus CMIDF-B (2.07 ± 0.06 mg metformin; total mass-7.56 ± 0.09 mg), and periodontitis plus chitosan film (7.61 ± 0.08 mg). After four weeks, mandibles were extracted to evaluate alveolar bone loss by micro-computerized tomography and histological techniques.ResultsAlveolar bone was intact in the healthy group. Local administration of CMIDF resulted in significant improvements in the alveolar bone properties when compared to the untreated periodontitis group. The study reported here demonstrates that novel CMIDF showed good antibacterial activity and effectively reduced alveolar bone destruction in a rat model of experimental periodontitis.ConclusionsNovel CMIDF showed good antibacterial activity and improved alveolar bone properties in a rat model.     

Adéquation en dialyse péritonéale : mise au point

The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the “corner-stone” of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane.