3D打印辅助胫骨高位开放截骨联合关节镜治疗膝内翻畸形临床疗效分析

目的观察3D打印截骨导板辅助胫骨高位开放式截骨术(OWHTO)联合关节镜清理治疗膝关节内翻畸形的临床疗效。方法回顾性分析2017年1月至2018年5月本院骨伤科膝关节内翻畸形患者15例(16膝)。术前利用3D打印截骨导板模拟OWHTO,根据理想的术后下肢力线(WBL),确定截骨部位、合页、高度、宽度、胫骨平台后倾角(PTS)及锁定钢板模型,进行截骨内固定。对术前术后WBL、Lysholm评分、PTS、髌骨高度指数(Caton指数)进行比较。结果随访15~24个月,WBL术前为(19.27±1.55)%,3D打印设计为(61.91±0.24)%,术后WBL恢复到(60.54±0.84)%,术前术后有统计学差异,3D打印设计与术后实际对比无统计学差异;术前术后PTS分别为(10.01±2.89)°,(10.06±0.09)°,无统计学差异;术后1年Lysholm评分(82.31±1.22)分,与术前(34.75±1.87)分比较差异有统计学意义。结论3D打印截骨导板辅助OWHTO,可实现精确截骨,显著改善下肢力线,减少术中透视,节省手术时间,是治疗膝关节内翻畸形安全有效的方法。     

Endobutton悬吊钢板在拇外翻畸形中的新应用

背景:拇外翻是一种复杂的畸形,尚无治疗金标准,截骨治疗目前得到推崇,但并发症较多,能否进行不截骨矫正拇外翻是作者所在课题组进行的一项新尝试。目的:探讨Endobutton钢板悬吊固定治疗拇外翻畸形的效果。方法:2013年4月至2018年8月苏州大学附属常州肿瘤医院骨科采用Endobutton钢板悬吊固定治疗拇外翻26足,不截骨。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。术前、术后测量拇外翻角及第1,2跖骨间角,术后12个月评估美国足踝外科协会评分。结果与结论:①所有患者均获满意随访,随访周期8-38个月;②术后患者拇外翻角[(14.15±3.60)°vs.(28.95±4.12)°,P<0.01]及第1,2跖骨间角均显著小于术前[(7.88±0.90)°vs.(15.82±1.81)°,P<0.01]:③术后12个月患者美国足踝外科协会评分为(89.15±7.81)分,显著高于术前(62.08±7.10)分(P<0.01);④提示Endobutton钢板悬吊固定第1,2跖骨间是治疗拇外翻是一种可行的方案。     

个体化开放楔形胫骨高位截骨治疗内侧间室膝骨关节炎的优势

文题释义：开放楔形胫骨高位截骨：是一种治疗内侧间室膝骨关节炎合并膝内翻的保膝术式。通过胫骨近端内侧切口,在水平面、冠状面双截骨后,进行楔形撑开、钢板固定。其治疗意义在于将内翻的下肢力线转移至相对正常的膝外侧,以缓解内侧症状,延长关节寿命,延缓骨关节炎进展,甚至避免关节假体置换。 个体化力线矫形：根据膝骨关节炎的多阶段性,针对不同退变程度的膝内侧间室,施行不同的力线矫形方案。通过术前规划截骨后的楔形撑开角度或距离,可以将内翻的下肢力线矫正至中线或偏外侧,以达到临床治疗效果。 背景：开放楔形胫骨高位截骨对于内侧间室膝骨关节炎合并膝内翻患者疗效明确,但目前关于力线矫正点的选择仍以Fujisawa点作为参考,个体化力线矫形是否能获得更优越的临床疗效？ 目的：探讨开放楔形胫骨高位截骨术中个体化下肢力线矫形治疗内侧间室膝骨关节炎的短期疗效。 方法：选择2016年6月至2018年5月无锡市人民医院骨科因内侧间室膝骨关节炎行开放楔形胫骨高位截骨治疗的46例患者。根据X射线片、MRI综合评估患膝并划分退变等级(Ⅰ-Ⅲ级),其中Ⅰ,Ⅱ级患者随机分为个体化组及对照组,每组16例;14例Ⅲ级患者作为Fujisawa组。个体化组轻度退变Ⅰ级矫正下肢力线至胫骨平台50%点,中度退变Ⅱ级矫正至胫骨平台外侧55%点;对照组、Fujisawa组均矫正力线至62.5%点。测量评估术后下肢力线,比较术前、术后膝关节活动度、股胫角、胫骨近端内侧角;随访术前及术后3,6,12个月患膝的美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数,比较患者术后综合满意度的自评分。结果与结论：①所有患者均获得12个月随访;②3组下肢力线矫形结果满意,术后膝关节活动度、胫骨近端内侧角较术前明显增加,股胫角明显减少(P < 0.05);③随着随访时间延长,3组患者的美国特种外科医院评分显著增加,西安大略和麦克马斯特大学骨关节炎指数显著减少,组内不同时点差异有显著性意义(P < 0.05);个体化组术后3,6个月美国特种外科医院评分高于对照组,西安大略和麦克马斯特大学骨关节炎指数低于对照组,差异有显著性意义(P < 0.05);个体化组及对照组术后12个月美国特种外科医院评分、西安大略和麦克马斯特大学骨关节炎指数差异无显著性意义(P > 0.05);④所有患者对手术矫形效果满意,个体化组术后综合满意评分高于对照组,差异有显著性意义(P < 0.05);⑤结果表明,个体化开放楔形胫骨高位截骨通过准确地力线矫形,有利于膝关节早期功能恢复,提升患者满意度。 ORCID: 0000-0003-0566-2858(俞颖豪) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

Severe unilateral scissor bite and bimaxillary protrusion treated by horseshoe Le Fort I osteotomy combined with mid-alveolar osteotomy

This report describes an orthognathic surgical case employing horseshoe Le Fort I osteotomy (HLFO) combined with mid-alveolar osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) for a patient with severe unilateral scissor bite and bimaxillary protrusion. A female patient (aged 26 years, 2 months) presented with a chief complaint of dysmasesis caused by scissor bite on the right side. The clinical examination revealed difficulty in lip closure and a convex profile. Overerupted right maxillary premolars and molars and lingual tipping of the right mandibular premolars and molars were indicated before treatment. After 3 months of presurgical orthodontic treatment, two-jaw surgery involving a combination of HLFO with mid-alveolar osteotomy and BSSRO was performed. A good interdigitation in the right side was established by superior-posterior-medial movement of the dento-alveolar segment of the maxilla. Next, both the maxilla and mandible were moved superiorly and posteriorly to correct the improper lip protrusion, thereby improving the patient''s profile. Our results suggest that this new orthognathic surgery technique—achieved by combining HLFO with mid-alveolar osteotomy and BSSRO—is effective for adult patients exhibiting severe unilateral scissor bite and bimaxillary protrusion.     

New horizontal v-shaped osteotomy for correction of protrusion of the zygoma and the zygomatic arch in East Asians: indication and results

Protrusion of the zygoma is commonly considered undesirable and unattractive among East-Asians, and many try to achieve a harmonious oval midface by having various cosmetic operations. However, effective contouring for a severe protruding zygoma has rarely been reported .The objectives of this study therefore were to investigate the feasibility and effectiveness of a horizontal V-shaped ostectomy for correction of protrusion of the zygoma and zygomatic arch, and to discuss its indications. From January 2008 to December 2011 we treated 27 patients by contouring of the zygoma with a horizontal V-shaped ostectomy through intraoral and preauricular incisions. The effectiveness was then evaluated with cephalometric radiographs, 3-dimensional computed tomography, and standard facial photographs taken before and after operation. The postoperative appearance of all 27 patients showed that the protrusion had been effectively reduced with no serious complications, and the facial contour had improved. The ?nal aesthetic outcomes were satisfactory for both surgeons and patients. The horizontal V-shaped osteotomy is a good technique for the reduction of protrusion of the zygoma and zygomatic arch, and it has the advantages of more convenient multishifting, better results, and fewer complications. It also ensures the integrity of the structure of the malar complex.     

Systematic review of changes in maxillary incisor exposure and upper lip position with Le Fort I type osteotomies with or without cinch sutures and/or VY closures

The aim was to systematically review the maxillary incisor exposure and upper lip position changes with Le Fort I type osteotomies for advancement ± impaction with rigid internal fixation, taking into account the use of cinch sutures and VY closures. Electronic databases (Cochrane Library, Medline, Embase, and Web of Science) were searched using medical subject headings (MeSH), key words, truncations, and Boolean operators. Hand searching was also undertaken. Of 979 articles identified, 15 were included (11 retrospective, two prospective, and two unspecified). Relevant study details and outcomes were recorded on a spreadsheet, along with an assessment of their quality. In total, these studies assessed 419 patients (266 female, 118 male) with a mean age of 26.4 years (range 14–57 years). Soft tissue changes were assessed on lateral cephalometric radiographs. The mean maxillary hard tissue advancement and impaction ranged between 0.94 and 8.77 mm and −0.56 and 4.2 mm, respectively. The ranges of ratios demonstrated that from pronasale (0.24–0.35) to labrale superius (0.36–1.43), the soft tissues followed the underlying horizontal hard tissue movement increasingly more closely. Alar base cinch sutures and VY closures tended to increase these ratios. The soft tissue response was more variable vertically. None of the studies reported on maxillary incisor exposure change. More good quality prospective studies are needed.     

Mandibular reconstruction in the growing patient with unilateral craniofacial microsomia: a systematic review

The purpose of this systematic review is to provide an overview of the surgical correction of the mandible in unilateral craniofacial microsomia (UCM) performed in the growing patient, and its long-term outcome and stability. The following databases were searched: PubMed, Embase, Cochrane, and Web of Science. Articles reporting prospective and retrospective studies of patients not older than 16 years (N ≥ 4) who had undergone surgical correction of a craniofacial microsomia spectrum condition using grafts, osteotomies, distraction, or combinations of these, were reviewed. The period of follow-up was selected to be ≥1 year. After inclusion, the articles were evaluated on short- and long-term outcomes, relapse, and any increase in asymmetry following treatment. Thirty of 1611 articles were included in the qualitative synthesis. Analysis of the surgical mandibular correction of UCM showed that the outcome is not so much treatment-dependent, but patient-dependent, i.e. deformity gradation-dependent. The type I–IIa Pruzansky–Kaban patient had the best results with regard to minimal relapse and/or minimal increase in asymmetry. Single-stage correction of the asymmetry should be postponed until the permanent dentition stage. It can be concluded that in the treatment of the severely hypoplastic mandible, the patient will benefit from a multi-stage treatment protocol if indicated for functional or psychological problems.     

Management of superolateral dislocation of the mandibular condyle: A retrospective study of 10 cases

IntroductionSuperolateral dislocation of the mandibular condyle (SDMC) is rarely described. The best treatment for superolateral dislocation of the fractured mandibular condyle (SDMC) is debated. This study investigated selection of the timing and techniques used in treating these fractures.Patients and methodsA retrospective clinical study was conducted on clinical data from 10 SDMC patients. Maximum mouth opening and occlusal relationships were compared following treatment using different techniques.ResultsThe 10 patients were followed for 6–25 months. Patients who had dislocation for less than 1 week had condylar reduction and rigid internal fixation of the fractures.Mandibular sagittal split ramus osteotomy and articular reduction and fixation were performed in seven cases. Postoperative mouth opening and occlusal relationships were satisfactory in all patients with the exception of one case with mouth opening of only 27 mm.ConclusionsFor all patients with superolateral dislocation, our first approach was to reduce the bone stump through surgery. When the dislocated joint had become adherent to the surrounding tissues and ankylosis developed, mandibular sagittal split ramus osteotomy was performed with good results.