Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation on adjacent levels

PurposeAdjacent segment degeneration or fracture of the vertebral body was commonly reported in rigid fusion. Use of semirigid instruments such as PEEK rod system could be an alternative treatment. However, the biomechanical implications of using PEEK rod systems are not well understood. Purpose of this study was to compare a PEEK rod fixation system to traditional titanium rod fixation via a finite element analysis.MethodsA lumbar spine model from L2–L5 vertebral bodies was constructed. A fusion model, created by modifying the intact lumbar model, was used to simulate anterior interbody and posterolateral lumbar fusion. Loading was applied through flexion, extension, lateral bending, torsion.ResultsThe greatest increase in stress was estimated at the upper disc adjacent to the titanium rod with interbody fusion. The lower increase in stress on adjacent segments occurred with PEEK rod fixation without fusion and noninstrumented posterolateral lumbar fusion models. With the same fusion or nonfusion procedures, the stress on discs and facet joints of adjacent segments in the PEEK rod group decreased by 5–25% of that in the titanium rod group for all loading conditions.ConclusionIn comparison with rigid fixation, some potential advantages of using PEEK rod systems include a reduced stress on adjacent segment disc and facet joint, and the elastic ability of PEEK rod fixation allows for a greater range of motion, which may reduce the incidence of clinical complications seen with rigid fusion devices.     

两种喉罩定位方法在鼻内窥镜手术中的应用

目的 观察听诊和纤维支气管镜评分两种喉罩定位方法在鼻内窥镜手术中的应用.方法 将60例使用喉罩通气全麻的成年患者随机分为2组,分别通过听诊法(L组)和纤维支气管镜评分法(F组)评估喉罩位置,记录置人情况和纤维支气管镜评分,潮气量(Vt)、呼气末二氧化碳分压(PETCO2)、气道峰压(Peak)和最大漏气压.结果 听诊法和纤维支气管镜评分法判断喉罩对位后,两组患者最大漏气压、Vt、PErCO2、Peak差异均无统计学意义(P＞0.05).L组喉罩一次到位成功25例,明显高于F组(15例,P＜0.05).两组患者喉罩对位后纤支镜评分差异有统计学意义(P＜0.05),L组有15例患者纤支镜评分为2分,F组所有患者评分均在3分以上.结论 采用听诊法和纤维支气管镜评分定位法判断喉罩对位都可以满足临床通气需要.听诊法简单可靠,即使纤支镜评分2分,也可达到良好的通气和密闭效果,满足手术需要.     

Management of the severe cleft and syndromic midface hypoplasia

Distraction Osteogenesis (DO) has become a treatment alternative to treat severe craniofacial skeletal dysplasias. A rigid external distraction (RED) device has been successfully used to advance the maxilla as well as the maxillary, orbital and forehead complex (monobloc) in children as young as two years, adolescents and adults. This approach has provided predictable and stable results. It can be applied by itself or as an adjunct to traditional orthognathic and craniofacial surgical procedures. The technical aspects, including planning, surgical and orthodontic procedures, required to properly apply the technique are presented. For this severe group of patients the technique has been found to be simpler and safer than traditional surgical methods. Maxillary and midfacial advancement through distraction has been found to be extremely stable in the patients in whom the technique was used. The reasons for stability are discussed as well as the observed morphologic changes in the facial soft tissues, velopharyngeal mechanism and airway. However, challenges remain to be solved to improve all distraction techniques and the need for collaboration between researchers and clinicians is emphasized to maximize the benefits of this already promising and rewarding approach.     

Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis

Background contextCurrently, treatment for patients diagnosed with noncomplicated (ie, known infectious agent, no neurologic compromise, and preserved spinal stability) pyogenic spondylodiscitis (PS) is based on intravenous antibiotics and rigid brace immobilization. Since January 2010, we started offering our patients percutaneous posterior screw-rod instrumentation as an alternative approach to rigid bracing. Supposed benefits of posterior percutaneous instrumentation over rigid bracing are earlier free mobilization, increased comfort, and faster recovery.PurposeTo evaluate safety and effectiveness of posterior percutaneous spinal instrumentation for single-level PS and compare clinical and quality-of-life outcomes with standard thoracolumbosacral orthosis (TLSO) rigid bracing.Study design/SettingRetrospective observational cohort study.Patient sampleTwenty-seven patients consecutively diagnosed with single-level noncomplicated lower thoracic or lumbar PS from January 2010 to December 2011.Outcome measuresHealing rate, healing time, and changes in segmental kyphosis Cobb angle were compared in the two treatment groups. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count at regular time points until complete healing were also obtained. Self-report measures included Visual Analog Scale (VAS), Short-Form 12 (SF-12), and EuroQol five-dimension (EQ-5D) questionnaires.MethodsAt enrollment, patients were offered to choose between 24/7 TLSO rigid bracing for 3 to 4 months and bridging posterior percutaneous screw-rod instrumentation followed by soft bracing for 4 weeks after surgery. All patients underwent antibiotic therapy accordingly to isolated infectious agents. Patients were seen in the clinic at 1, 3, 6, and 9 months, and ESR, CRP, complete blood count, VAS, SF-12, and EQ-5D questionnaires were obtained. Segmental kyphosis was measured at diagnosis and at 9 months follow-up. Two-way repeated-measures analysis of variance was used to assess group and time differences across time points.ResultsFifteen patients chose conservative treatment, whereas 12 patients chose surgical treatment. Complete infection healing was achieved in all patients with no significant differences in healing time (p<.366). C-reactive protein and ESR levels decreased in both groups accordingly with positive response to therapy with no significant differences. Surgically treated patients had significantly lower VAS scores at 1 month (2.76±0.80 vs. 5.20±1.21, p<.001) and 3 months (2.31±0.54 vs. 2.85±0.54, p<.016) post-diagnosis over TLSO patients. Moreover, surgery patients also showed steeper and statistically significant improvements in SF-12 scores over TLSO patients at 1, 3, and 6 months post-diagnosis (p<.012); no significant differences were detected at the other time points. EuroQol five-dimension index was significantly higher in surgery patients at 1 month (0.764±0.043 vs. 0.458±0.197, p<.001) and 3 months (0.890±0.116 vs. 0.688±0.142, p<.001); no significant changes were observed in segmental pre- and posttreatment kyphosis between the two groups. No instrumentation-related complications were observed in any patient.ConclusionsPosterior percutaneous spinal instrumentation is a safe, feasible, and effective procedure in relieving pain, preventing deformity, and neurologic compromise in patients affected by noncomplicated lower thoracic (T9–T12) or lumbar PS. Posterior instrumentation did not offer any advantage in healing time over TLSO rigid bracing because infection clearance is strongly dependent on proper antibiotic therapy. Nevertheless, surgical stabilization was associated with faster recovery, lower pain scores, and improved quality of life compared with TLSO conservative treatment at 1, 3, and 6 months after treatment.     

电子气管镜用于食管严重狭窄支架置入的效果观察

目的：探讨气管镜用于食管严重狭窄病例支架置入的可行性与优越性。方法：将胃镜无法通过的食管严重狭窄的患者共34例,分为实验组12例在Olympus-BF260电子气管镜直视下置入食管支架;对照组22例用普通胃镜在X线透视下行食管支架置入术。结果：实验组12例患者均一次性成功放置食管支架,成功率100%,操作时间相对短,并发症少,支架位置准确;对照组22例,成功置入16例,成功率72.7%,出现并发症4例。结论：电子气管镜代胃镜行食管支架置入术,操作时间短,成功率高,并发症少,支架定位精确;且无需在X光机,不对医务人员造成辐射损害,因此电子气管镜代胃镜用于食管严重狭窄支架置入优点多,有气管镜的医院均可开展此项工作。     

新型3D打印导板辅助颈椎前路双侧椎弓根置钉的安全及可行性

文题释义：3D 打印手术导板：该导板依据手术需要,通过计算机辅助设计、3D打印制备出的一种具有术中准确定位点、置钉的位置、方向和深度,精确建立孔道、截面、空间距离、相互成角关系及其他复杂空间结构等功能的辅助手术器械,具有获取途径方便、使用方法简单、价格低廉等优点。 颈椎前路椎弓根置钉：是一种区别于传统颈椎后路椎弓根螺钉置钉技术的新型置钉技术,该技术可通过单独前方入路实现颈椎三柱损伤或多节段病变的坚强固定,无需再行后路固定,可有效减少手术创伤和并发症。 背景：下颈椎前路椎弓根螺钉固定技术可通过前方入路实现颈椎坚强固定,具有较大的应用前景。但该技术操作难度大、风险高,目前尚未得到广泛应用。 目的：改良设计一种用于下颈椎双侧前路椎弓根螺钉置钉的3D打印导板,探讨其辅助颈椎前路椎弓根螺钉置钉的可行性及安全性。 方法：选取6具正常成人颈椎标本,男女各3具,行薄层CT扫描后将影像数据以DICOM格式导入Mimics 17.0软件,三维重建后模拟设计出C₃-C₇双侧颈椎前路椎弓根螺钉钉道导孔,再以颈椎椎体前面、椎体上面前1/2及双侧钩突关节面前1/2骨性结构为标志,反向增厚设计生成导孔基座,形成颈椎前路椎弓根螺钉置钉导板。经3D打印得到导板实体后,在导板辅助下行C₃-C₇双侧颈椎前路椎弓根螺钉置钉。将置钉后的颈椎标本再次行CT扫描,通过CT断面影像评价置钉准确性。同时利用Mimics17.0软件比较实际钉道与模拟钉道在横断面的内、外偏移角度(α1、α2)差异及其在矢状面的上、下偏移角度(β1、β2)差异。 结果与结论：①双侧共计60枚颈椎前路椎弓根螺钉均顺利置入,其中57枚完全位于椎弓根皮质内,判定为0级,准确率95.0%;另外3枚破出椎弓根皮质,其中1级2枚(3.3%),2级1枚(1.7%);②真实钉道与模拟钉道相比,其横断面内、外偏移角分别为(0.867±0.787)°、(0.783±0.792)°,差异无显著性意义(P > 0.05);矢状面上、下偏移角分别为(1.362±1.380)°、(1.314±1.300)°,差异无显著性意义(P > 0.05)。③提示在设计得到的3D打印导板辅助下可顺利完成下颈椎双侧前路椎弓根螺钉置钉,且具有良好的置钉安全性。 ORCID: 0000-0003-0124-7585(肖强)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     

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??Abstract?? Objective To study balloon dilatation with cryotherapy under bronchoscope for subglottic stenosis in infants and young children??and to explore the efficacy of this new technology??the timing of treatment and safety. MethodFrom July 2009 to May 2014 in 28 SGS cases aged from 1 month to 3 years?? bronchoscopic balloon dilatation treatment with CO2 cryotherapy was performed?? and different types of SGS treated by minimal invasi were assessed regarding efficacy, complications and outcome. Results The infant SGS were divided into ??°~??° by severity?? and soft membrane SGS and scarring SGS by the causes of stenosis. ??° SGS included 16 cases, in which 8 cases soft membrane SGS were treated by balloon dilatation effectively?? 9 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 4 cases after combined therapy; ??° SGS included 8 cases?? soft membrane SGS were treated effectively in 2 cases?? 4 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 2 cases after combined therapy; ?? °SGS included 4 cases?? 1 case of soft membrane SGS and 1 case of scarring SGS responded well to integrated treatment .Conclusion MSCT and bronchoscopy assessment is used in grading the extent and causes of stratification in infants with subglottic stenosis?? and then we can select the appropriate treatment programs to improve the prognosis of the disease and improve life quality of SGS children.     

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study

Purpose

The present study was carried out to evaluate the usefulness of mini retromandibular approach on accessibility, scarring and stability in open reduction and internal fixation of sub condylar fractures.

Materials and Methods

Fifteen patients underwent open reduction and rigid fixation of middle and low subcondylar fractures, with mini-retro mandibular approach.

Results

No signs of infection were observed in any patient postoperatively. Surgical scar was imperceptible and esthetically acceptable in all the cases. Out of 15 patients, only one patient had discrepancy in occlusion and after 2 months satisfactory centric occlusion was achieved. Salivary fistula (parotid fistula) was observed in 3 cases within 1 week postoperatively, which was treated spontaneously with the use of hypertonic saline. Transient facial nerve weakness was observed in 2 patients, in one patient it resolved in 4 weeks postoperatively and in second patient 3 months postoperatively. Mouth opening increased in all the patients with time. Average mouth opening at 1 week interval was 19.6 mm, at 2 months interval 28.2 mm, and after 6 months 38.33 mm suggesting that mouth opening gradually increased with time. At the end of 2 months postoperatively none of the patients had any restriction in lateral movements. At 2 months postoperatively 4 patients had deviation but none of the patients had any deviation 6 months postoperatively.

Conclusion

It is evident from the results of our study that open reduction and internal fixation using mini-retromandibular approach is good treatment option in management of mandibular condylar fractures.     

改良头皮冠状切口在颧骨复合体骨折中的应用

目的:探讨改良头皮冠状切口在各类颧骨复合体骨折坚固内固定术中的应用。方法:将87例颧骨复合体骨折病例分为改良组和传统组,分别应用改良冠状切口(42例)与传统切口(45例)进行复位和固定,对比分析改良冠状切口的优越性、可能并发症及预防措施。结果:改良组切口均Ⅰ期愈合,随访3⁶个月,面部瘢痕不明显,开口度恢复理想,咬合关系正常,术后秃发率及颞部凹陷率较低,无1例出现面神经功能障碍。传统组中,2例术后第5天出现创区感染,切口延期愈合,术后肿胀反应明显;4例患者术后3月时仍存在面神经功能障碍,术后秃发率及颞部凹陷率较高。结论:改良冠状切口较传统切口具有切口隐蔽、术野暴露好、复位精确、美观效果好、面神经损伤率低等优点,值得推广应用。