小切口经前路腹膜后人工髓核置换术治疗退行性腰椎间盘疾患

目的：评价应用小切口技术进行人工髓核假体置换治疗退行性腰椎间盘疾患的临床初步疗效。方法：2003年6月～2004年9月共施行人工髓核（PDN）置换术12例，男4例，女8例，平均年龄28．5岁。其中腰椎间盘突出症10例，椎间盘源性腰痛2例。包容型腰椎间盘突出症和椎间盘源性腰痛采用前路PDN置换，脱出游离型椎间盘突出症采用后路椎间盘摘除、前路PDN置换；术后评价内容包括临床和影像学结果。结果：平均前路切口长度4．2cm，前路平均手术时间80min，平均术中出血量110ml。PDN置入部位均为L4／5，共置入PR925型假体12枚。所有患者术后腰痛症状得到改善。术后平均随访6．5个月，影像学检查未见假体移位和脱出。结论：应用前路腹膜后小切口进行PDN置换在减少手术创伤的同时，可以有效防止髓核脱入椎管。近期效果肯定，但长期疗效有待进一步观察。     

新型后路腰椎椎间融合器的研制和动物实验研究

目的研制一种新型镍钛形状记忆合金腰椎椎体间融合器,通过动物实验了解其生物力学和组织学性能。方法本研究分为三个步骤。第一步将12个绵羊腰椎功能单位随机分成四组,每组3个,分别为对照组、髂骨植骨组(IG组)、interfix-lumbarcage组(cage组)和镍钛融合器组(NT组),进行生物力学测试,并检测镍钛融合器的力学性能;第二步将15只成年绵羊随机分为对照组、Interfix-lum-barcage组(cage组)和镍钛融合器组(NT组),每组5只,术后定期摄X线片了解椎间隙高度变化及融合进程;第三步将上述动物在术后6个月处死进行组织学观察以了解融合情况。所有数据采用统计学分析软件处理。结果对照组和髂骨植骨组与cage组和NT组在腰椎强度和轴向刚度方面相比,差异均有统计学意义(P<0.05)。镍钛融合器的最大破坏载荷可达11200N,安全系数达到1.2以上。cage组和NT组手术6个月时手术节段高度分别丧失16%和16.5%,但仍高于正常椎间隙高度(P<0.05)。光镜下可见新生骨小梁与宿主骨小梁发生连接。结论镍钛融合器的力学性能良好,可以作为腰椎椎间融合装置应用于临床。     

磨损颗粒引发假体周围骨溶解的机制及药物治疗进展

目的对磨损颗粒引发假体周围骨溶解的机制及药物治疗进展进行了综述介绍。方法对国外近期相关文献进行综述。结果及结论人工关节置换是治疗晚期骨关节炎及老年股骨颈骨折的有效方法,能达到解除关节疼痛、重建活动功能及提高生活质量的目的。人工关节无菌性松动是影响人工关节使用寿命和远期疗效的最重要的并发症。磨损颗粒诱发假体周围组织细胞产生一系列生物学反应是导致假体周围骨溶解及假体无菌性松动的重要因素。磨损颗粒刺激假体周围的巨噬细胞、成骨细胞、成纤维细胞等产生多种细胞因子,形成破骨细胞性骨吸收,同时影响成骨细胞的分化及功能,抑制骨形成。药物在预防和治疗磨损颗粒引起的人工关节松动方面能起到积极的作用。     

Dynamic behavior of the Provox and Staffieri prostheses for voice rehabilitation following total laryngectomy

The present study evaluated the differences in aerodynamic behavior between the 1990 Provox and 1986 Staffieri voice prostheses for total laryngectomy patients. Both prostheses were submitted to in vitro laboratory testing to assess their aerodynamic behavior under different conditions of air flow through the valve and tracheal side pressure. In addition, six patients using the Provox and another six using the Staffieri prostheses were submitted to a dynamic study of phonation. This latter study evaluated the intratracheal pressure corresponding to the different intensities at which the vowel sound /a/ was pronounced. In vitro measurements revealed significant differences between the two prostheses, with the best results achieved with Provox. In contrast, the in vivo measurements did not reveal any significant differences between the two groups of patients in the 50–79 dBSPL range, although there was some difference at intensities equal to or greater than 80 dBSPL. Again, in this latter case the best results were achieved with the Provox. However, the ideal prosthesis has yet to be found. In some patients, the so-called low-resistance prostheses fail to maintain their aerodynamic performances, most likely because anatomic resistors interfere with the effort (i.e., pressure) required to produce a voice. At present the choice of prosthesis is best determined on an individual patient-to-patient basis. Received: 31 November 1996 / Accepted: 25 July 1997     

Effects of ingrowth, geometry, and material on stress transfer under porous-coated hip surface replacements

Three different interface geometries for porous ingrowth surface replacements of the hip were examined using two-dimensional linear and nonlinear contact finite element analyses. The results indicate that incorporation of a nearly flat prosthesis interface between the surface replacement and the underlying cancellous bone may reduce stress shielding and improve stress transfer from the component. For all designs analyzed, the bone stress shielding was insensitive to component material stiffness when the elastic modulus was greater than 30 MPa. The use of titanium instead of cobalt-chrome (Co--Cr) as the prosthesis material therefore had a negligible effect on stress shielding.     

Clinical and radiographic assessment of a non-constrained total shoulder

Summary This paper presents the early post-operative results of a non-constrained total shoulder joint prosthesis of the UCLA design in ten patients. Substantial relief of pain was achieved in eight patients. Half the patients showed an increased range of shoulder movement and only one prosthesis was unstable requiring reoperation.Radiolucent zones at the cement-bone interface of the glenoid developed in several patients. The significance of these with regard to joint mobility, resultant forces and incipient loosening of the polyethylene component are discussed. No clinical signs of loosening occured in the observation period.

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Résumé Cet article rapporte les résultats à court terme d'une prothèse totale d'épaule, de glissement, type UCLA, chez dix malades. Une diminution spectaculaire des douleurs a été obtenue chez huit malades. La moitié de ceux-ci ont eu une augmentation de la mobilité de l'épaule et une seule prothèse s'est montrée instable, nécessitant une réintervention.Des zones claires entre ciment et os sont apparues chez plusieurs malades au niveau de la cavité glénoïde. Leur signification est discutée vis-à-vis de la mobilité de l'épaule, de la résultante des forces et du descellement inapparent de la pièce de polyéthylène. Aucun signe clinique de descellement n'est apparu au cours de la période d'observation.

     

A microcomputer-based prosthetic limb controller: Design and implementation

This paper describes the design and implementation of a microcomputer based myoelectric limb controller. This controller was constructed for use as a feasibility study of, and a development tool for, microcomputer-based myoelectric limb controller applications. Features of this approach include flexibility and computational power. The present design uses low-power CMOS technology to provide a system in which most of the new computationally and decision orientated myoelectric signal processing algorithms can be used. Two CMOS microprocessors, a CD80C86 and a MC146805E2, are used, but microcomputer power consumption is only 120 mA.     

囊袋内人工晶状体重度移位或脱位的原因分析及处理

目的探讨人工晶状体移位或脱位的发生原因及发病机制。方法1995年12月至2004年5月在本院行超声乳化白内障吸除术的患者共31例,散瞳后在裂隙灯显微镜或手术显微镜下观察晶状体囊袋结构异常的位置、大小、形态及人工晶状体的位置变异,对已移位或脱位的人工晶状体的手术复位、置换或取出。结果共31例,早期移、脱位者20例,晚期移、脱位者11例;其中5例（16．1％）患者晶状体后囊膜大部破损致人工晶状体半脱位于玻璃体前端,9例（29．0％）患者晶状体后囊膜下方破损致人工晶状体下移,1例（3．2％）患者晶状体囊上方赤道小破口致人工晶状体上移,2例（6．5％）患者晶状体前囊膜放射状撕裂致人工晶状体部分脱人前房,人工晶状体与囊袋大小不匹配2例（6．5％）,人工晶状体襻严重变形1例（3．2％）,2例（6．5％）患者上方晶状体后囊膜破损致人工晶状体全脱位于玻璃体内,2例（6．5％）患者外伤性悬韧带断裂致人工晶状体侧移,6例（19．4％）患者晶状体囊收缩不均、缩窄致人工晶状体移位或拱曲,1例（3．2％）患者人工晶状体半脱位系假性囊剥脱征所致。结论囊袋内人工晶状体重度移位或脱位在手术后不同时期有其不同的发生原因和发病机制,处理及时、得当则预后良好。（中华眼科杂志,2006,42：396-399）     

Large Chest Wall Reconstruction Using a Pedicled Osteomuscle Composite Flap: Report of a Case

A 67-year-old man with diabetes mellitus and chronic renal failure underwent resection of a grade 1 chondrosarcoma. We performed chest wall reconstruction of the massive defect, using a pedicled osteomuscle composite flap comprising the 6th, 8th, and 10th ribs, and the latissimus dorsi and serratus anterior muscles. This flap is ready to mobilize as a pedicled graft to cover a large chest wall defect; it is strong enough to buttress the chest cage without the need for artificial materials, and it is associated with a lower risk of infection than prosthetic materials.     

Breast cancer after breast augmentation with silicone implants

Background: Although epidemiological studies have failed to demonstrate an increased incidence of breast cancer in women who had undergone prior prosthetic augmentation mammoplasty (PAM), it has been reported that when breast cancer arises in this group it presents mostly in a palpable form and at a more advanced stage. This is thought to be secondary to suboptimal mammographic evaluation caused by the masking effect of the implant. This study was undertaken to determine, in our experience, whether breast cancer arising in women who had undergone PAM could be detected in a prepalpable form by mammography and whether it presented at a more advanced stage as compared with nonaugmented women with breast cancer. Methods: The charts of 22 patients, treated by at least one of the authors, in whom 23 breast cancers developed after PAM (group A) were retrospectively reviewed. The comparison groups consisted of 611 nonaugmented patients who underwent 636 procedure for the treatment of primary breast cancer at our institution (group B) and the surveillance, epidemiology, and end results (SEER) data (group C). Parameters studied were mode of detection, tumor size, axillary lymph node involvement, and histopathology. Results: No significant differences between the groups were found in mean tumor size (group A vs. group B), the incidence of preinvasive cancer (group A vs. group B), or axillary lymph node involvement (group A vs. group B and group A vs. group C). Breast-preserving surgery was performed significantly less in augmented patients (group A vs. group B). Conclusion: We conclude that prepalpable and preinvasive breast cancer can be detected in the PAM patient by mammography and that the stage of presentation in this group is not significantly different than in nonaugmented patients. Total mastectomy is preferred over breast-preserving procedures for the treatment of breast cancer in the PAM patient. Presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, March 18–21, 1993.