颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病

目的探讨颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗脊髓型颈椎病的临床疗效。方法对36例双节段脊髓型颈椎病患者采用颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗。对术前和术后6、12个月的JOA评分进行比较,计算术后6、12个月的神经功能改善率,评价术后植骨融合情况。结果 36例均获随访,时间12~18个月。JOA评分:术前为8.8分±1.0分,术后6个月为12.8分±1.6分,术后12个月为13.2分±1.4分,术后6、12个月与术前比较差异均有统计学意义(P0.01)。改善率:术后6、12个月分别为56.6%±9.8%和57.9%±10.1%。术后3个月31例(86.1%)植骨融合,术后6个月36例全部植骨融合。结论颈前路椎体次全切除钛网植骨锁定钢板内固定术治疗双节段脊髓型颈椎病疗效确切。     

Comparative study of anatomical specimens using plastination by araldite HY103, polypropylene resin, 6170H19 Orthocryl and silicone – A qualitative study

Background

Most of the organs and tissues are preserved in formalin with its own set of disadvantages. Plastination is a unique method of permanently preserving tissue in a life like state. Plastination developed by western authorities is a labour and equipment intensive affair. Most common polymer used is S10, however this study uses easily available alternative polymers for plastination.

Method

Various polymers like Epoxy resins, Polypropylene resins, Orthocryl and silicone were used in plastinating the anatomical specimens. Specific methods were used for solid, hollow organs and brain specimens. The specimens were made to undergo stages of fixation, dehydration, impregnation and curing. The results were studied and interpreted under various parameters.

Results

The results were interpreted under various parameters like shrinkage, retention of colour, odour, pliability and retention of gross anatomy. The study concluded that Orthocryl and Epoxy resins retained maximum colour with minimal shrinkage while maximum discolouration was with polypropylene plastinates. Brain sections were best preserved in Orthocryl.

Conclusion

The study concluded that indigenous methods and materials can produce quality plastinates which can be an important adjunct to traditional methods of teaching however more studies need to be done for refinement.     

比较早/晚期行钛网数字化颅骨缺损成形术的疗效和预后

目的 分析比较颅骨大骨瓣缺损早/晚期行钛网数字化成形修补术的有效性、安全性及对预后的影响.方法 选取2012年1月至2013年12月颅脑创伤或行脑出血行去大骨瓣减压术112例,76例在去大骨瓣减压术后38.9(32～52)d行钛网数字化成形修补术(早期修补组);36例在去大骨瓣减压术后114.2(90～153)d进行修补(晚期修补组).分析比较2组手术耗时、皮瓣游离时间、手术失血量、并发症,以及术后患者的日常生活活动能力(ADL)评分、Fugl-Meyery评分、神经功能缺损评分、认知功能恢复.结果 早期修补组与晚期修补组的手术时间分别为(92.33±13.71) min与(141.67±18.12)min;皮瓣游离时间为(13.29±3.43) min与(38.56±7.35) min;手术出血量分别为(352.36±21.83) ml与(523.53±32.51)ml,差异具有统计学意义(P＜0.01).早期修补组的硬膜下积液率及皮瓣游离过程中硬膜破裂率明显少于晚期修补组,差异具有统计学意义(P＜0.01).早期修补组ADL及Fugl-Meyery评分均较晚期修补组明显提高,差异具有统计学意义(P＜0.05或P＜0.01);而神经功能缺损评分明显降低,差异具有统计学意义(P＜0.05).蒙特利尔认知评估量表提示早期修补组认知功能恢复明显优于晚期修补组,差异具有统计学意义(P＜0.05).结论 颅骨大骨瓣缺损早期行钛网数字化成形修补术优于晚期,早期颅骨修补利于软组织分离,减少出血,改善预后.钛网数字化成形技术可确保修复钛网与颅骨缺损部位精确合体,显著缩短手术时间,减少手术风险;钛网数字化成形早期颅骨修补术值得临床推广.     

应用整形观念大张网状皮片联合VSD技术治疗深度烧伤

目的:探讨应用整形观念,大张网状皮片联合VSD技术治疗深度烧伤的临床效果。方法:2010年2月-2016年10月,选择40例50%TBSA(ITW30%)以下深度烧伤患者,男28例,女12例,年龄16-50岁,平均年龄32岁,烧伤部位为四肢、躯干,包括手足等关节功能部位,切削痂时间为伤后3-7天,1次手术面积控制在20%-30%以下,切削痂创面应用VSD敷料覆盖,术后2周左右,切削痂创面肉芽组织形成,予以大张网状皮片移植,VSD敷料覆盖,持续负压吸引。结果:切削痂术后2周,肉芽组织新鲜生长良好,植皮术后10-14天观察移植皮片成活率95%以上,3-4周后网状皮片扩展良好,创面全部覆盖,随访6个月-1年,外形良好,无明显瘢痕增生及肢体功能活动障碍,生活质量明显提高。结论:应用整形观念,网状皮片移植结合VSD负压吸引技术是治疗深度烧伤的有效方法。     

Long-term effects of various cleaning methods on polypropylene/ethylene copolymer retainer material

Objectives:To evaluate long-term light transmittance, surface roughness, and flexural modulus of polypropylene/ethylene copolymer retainer material after exposure to different cleaning methods.Materials and Methods:Standardized polypropylene/ethylene copolymer retainer specimens (n = 70, 50.8 mm × 12.7 mm × 1.0 mm) were subjected to seven chemical cleaning solutions: Invisalign cleaning crystals, Retainer Brite, Polident, Listerine mouthwash, 2.5% acetic acid, 0.6% NaClO, and 3% H₂O₂ for 6 months. The specimens were exposed to the different solutions twice a week for 15 minutes or according to manufacturer''s instructions, then stored in artificial saliva at 37°C. Another group of specimens (n = 10) were brushed with a standardized toothbrushing machine for 2 minutes twice a week. At baseline and 6 months, light transmittance, surface roughness, and flexural modulus of the specimens were quantified using spectrophotometry, profilometry and three-point bend testing, respectively. Qualitative analysis was performed using a scanning electron microscope (SEM). Statistical analyses were performed at a significance level of .05.Results:The results showed that light transmittance decreased significantly from baseline for all cleaning methods at 6 months. For an individual method, no significant differences were observed between specimens at baseline and 6 months in surface roughness and flexural modulus. No discernible differences in surface features were observed on SEM images.Conclusions:The results indicate that different cleaning methods affect the long-term light transmittance of the studied polypropylene/ethylene copolymer retainer material. However, for an individual cleaning method, no significant differences were shown for surface roughness or flexural modulus values at 6-months compared to baseline.     

Transvaginal mesh,gender and the ethics of clinical innovation

On 10 October 2018, Australian Health Minister Greg Hunt issued a national apology to the Australian women who experienced ‘horrific outcomes’ following surgery using transvaginal mesh—acknowledging the ‘historic agony and pain that has come from mesh implantation’. This apology followed many decades of ‘innovative’ use of transvaginal mesh for the treatment of pelvic organ prolapse. We use the case of transvaginal mesh to explore how clinical innovation may not only harm patients, but also entrench vulnerability and exacerbate existing inequities—in this case, those relating to gender.     

The roles of knitted mesh-reinforced collagen–chitosan hybrid scaffold in the one-step repair of full-thickness skin defects in rats

Full-thickness skin defects represent a significant and urgent clinical problem. Dermal substitutes serving as a regenerative template to induce dermal reconstruction provide a promising method to treat serious skin defects. Although collagen–chitosan dermal scaffolds display good biocompatibility and a suitable porous structure for angiogenesis and tissue regeneration, their poor mechanical properties compromise their application. To develop a well-supported dermal substitute, a poly(l-lactide-co-glycolide) (PLGA) knitted mesh was fabricated and integrated with collagen–chitosan scaffold (CCS) to obtain a PLGA knitted mesh-reinforced CCS (PLGAm/CCS). The morphology of this PLGAm/CCS was investigated in vitro. To characterize the tissue response, specifically angiogenesis and tissue regeneration, the PLGAm/CCS was transplanted in combination with thin split-thickness autografts to repair full-thickness skin wounds using a one-step surgical procedure in Sprague–Dawley rats. These results were then compared with CCSs. At weeks 2, 4 and 8 after the operation, the healing wounds were imaged to analyse wound changes, and tissue specimens were harvested for histology, immunohistochemistry, real-time quantitative polymerase chain reaction and Western blot analysis. The results demonstrated that collagen–chitosan sponge in the PLGAm/CCS remained porous, interconnected and occupied the openings of PLGA mesh, and the incorporation of the PLGA knitted mesh into CCS improved the mechanical strength with little influence on its mean pore size and porosity. Following transplantation, PLGAm/CCS inhibited wound contraction, and effectively promoted neotissue formation and blood vessel ingrowth. In conclusion, the mechanical strength of the scaffolds plays an important role in the process of tissue regeneration and vascularization. The ability of PLGAm/CCS to promote angiogenesis and induce in situ tissue regeneration demonstrates its potential in skin tissue engineering.     

An Unusual Finding in the Follow-Up of a Transabdominal Pre-Peritoneal (TAPP) Implanted Mesh for Inguinal Hernia

Background: Abnormalities around titanium stapled sites are not well described in the literature. Existence

of staple granulomas or neoplasms on titanium stapled sites used in TAPP procedures is unknown.

Case: We report a case in which differentiation of suspected staple granuloma or neoplasm around a titanium staple,

used to secure the mesh in a TAPP procedure, could not be made other than by pathologic examination.

Conclusion: This case emphasises that although the appearance of the lesion may be suspected for staple granuloma,

the possibility of a malignant neoplasm should always be considered.