Tissue fixation security in transosseous rotator cuff repairs: A mechanical comparison of simple versus mattress sutures

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.     

Trephination and suturing of avascular meniscal tears: A clinical study of the trephination procedure

On the basis of animal studies, an arthroscopic surgical system and procedure of trephination plus suturing were designed for clinical practice. The system consists of a trephine with a tooth-like tip, a guide, and an ordinary arthroscopic power handle. The guide introduces the trephine to the tear without abrading articular cartilage and controls the depth of the trephination. The power handle connected to a suction system provides an inside-out cut core of meniscal tissue. Thirty-six patients with meniscal tears underwent arthroscopic trephination plus suturing (group TS) and 28 patients had suturing alone (group S). The follow-up was 25 to 78 months. Two symptomatic retears have occurred in group TS and 7 symptomatic retears in group S. The symptomatic retear rate of group TS was significantly smaller than group S (P < .01). It is indicated that the patients treated with trephination have fewer symptoms and lower clinical failure rate. Arthroscopic trephination is a safe and easy procedure.     

膝关节髌下脂肪垫囊肿的诊断及关节镜治疗4例报告

我所共收治 4名膝关节髌下脂肪垫囊肿患者 ,发现膝关节前方肿物后逐渐出现伸膝时疼痛 ,经MRI检查诊断为膝关节髌下脂肪垫内囊肿。 2例囊肿为多房性 ,2例为单房性。 4例患者均接受关节镜下囊肿切除术。手术前囊肿内注射美蓝以帮助确定切除范围。由于囊肿后壁与半月板前角相邻 ,手术中半月板前角滑膜边缘处破裂 ,其中 2例因破口大于 1cm予以关节镜下缝合修补半月板前角 2针。所有患者均经伸膝夹板固定 2周 ,经关节功能康复后 ,症状消除。     

Standford B型主动脉夹层腔内修复术后主动脉重塑效果

目的 系统性回顾Standford B型主动脉夹层腔内修复术(TEVAR)后主动脉重塑结果.方法 检索已发表的评估TEVAR术后主动脉重塑文献,系统性回顾Standford B型主动脉夹层形态学测量方法及结果.共纳入19篇文献,其中仅3篇文献采用三维重建软件进行测量.各文献测量变量多为夹层真腔、假腔直径或面积,仅有少数文献计算了真假腔体积.结果 各文献测量的主动脉平面、术后随访时间及测量方法不同,无法进行数据整合.但总体趋势为急性B型夹层患者术后主动脉重塑效果(胸主动脉假腔血栓化比率为80％～90％)优于慢性患者(38％～91.3％),且更具有一致性;降主动脉术后假腔完全血栓化比率高于腹主动脉,降主动脉近端的主动脉重塑效果良好,膈肌角平面以下重塑效果较差.结论 尽管TEVAR术后主动脉重塑的描述方式各异,但多数文献显示夹层累及主动脉范围广者术后重塑效果差,与夹层远端裂口旷置有关.覆膜支架长度、治疗时间等因素对术后重塑均有影响.统一的评估标准有利于评估主动脉重塑效果,并为临床决策提供更有力的科学支持.     

桥式吻合小腿内侧皮瓣修复四肢毁损性离断伤

目的 探讨应用桥式血管吻合的小腿内侧游离皮瓣修复四肢毁损性离断伤的临床疗效.方法 本组12例,小腿5例,大腿2例,前臂3例,上臂2例,均为肢端无血运且合并软组织大块缺损,根据创伤部位、创面大小均选用小腿内侧游离皮瓣,皮瓣面积最小为10cm×7cm,最大为17cm×12cm,急诊行桥式吻合修复肢体主干血管及皮肤软组织缺损.结果 12例断肢及12块游离皮瓣全部成活,术后随访3～ 18个月,皮瓣外观满意,血运好,断肢功能及感觉恢复较满意.结论 对于四肢严重毁损性离断伤,应用该术式进行保肢,急诊修复主干血管缺损的同时修复了皮肤软组织的缺损,操作可靠,疗效满意.     

神经干细胞、丙戊酸联合应用对成鼠脊髓损伤的修复作用

目的观察神经干细胞（NSCs）和丙戊酸（VPA）联合应用对成年大鼠脊髓损伤后的修复作用。方法SD大鼠随机分为单纯损伤组、NSCs移植组和NSCs＋VPA治疗组。采用半切脊髓损伤模型,损伤后进行病理染色和神经诱发电位检测。结果NSCs＋VPA治疗组损伤处空洞闭合情况优于其余两组,移植物和宿主脊髓建立的纤维联系较其余两组多,排列有序。NSCs＋VPA治疗组诱发电位各项指标匀优于其余两组,8周时最显著,其中以运动诱发电位（MEP）的优化最明显。结论NSCs和VPA联合应用对成鼠脊髓损伤具有良好的修复作用。     

腔内修复术治疗113例主动脉夹层瘤的临床分析

目的 评价腔内修复术治疗主动脉夹层的疗效,探讨主动脉夹层的治疗策略.方法 回顾分析2002年3月 - 2010年6月,113 例采用腔内修复术治疗的主动脉夹层患者的临床资料、治疗和随访结果.结果 腔内修复术治疗主动脉夹层的手术成功率99.1%(112/113),围手术期无严重并发症发生,术后30 d病死率1.8%(2/...     

Laparoscopic Nephrectomy,Ex Vivo Repair,and Autotransplantation for a Renal Artery Aneurysm: Report of a Case

A 57-year-old woman was hospitalized with a left renal artery aneurysm (RAA). The aneurysm measured 35 mm in diameter and was located at the renal artery bifurcation. We performed a laparoscopic nephrectomy using a retroperitoneal approach and performed an ex vivo repair of the renal artery. The reconstructed kidney was then autotransplanted at the left iliac fossa. The patient's postoperative course was uneventful. A laparoscopic nephrectomy and ex vivo repair are both considered to be effective for treating complex RAA.     

兔股骨头缺血性坏死手术治疗方法的比较

目的 建立股骨头缺血坏死动物模型，研究不同术式的治疗效果。方法 标准白兔40只，制作股骨头坏死模型，将股骨头离断后埋于皮下组织中4周后，分成5组：A组为无处置对照组，B组采用带血运肋骨瓣植入治疗，C组采用股深动脉植入治疗，D组采用带血运骨瓣与游离骨膜植入治疗，E组采用植入血管加游离骨膜治疗。对各组的治疗效果进行对照研究。结果 B、C、D、E组骨小梁细胞充满，有明确的血供重建，D、E两组因植入骨膜生发层细胞，可见到骨小梁间隙内有大量的骨髓细胞出现，电镜下骨基质排列整齐，有周期性横纹，骨细胞发育正常，在促进骨修复方面取得了更好的效果。结论 截断股骨头皮下埋藏是制作股骨头缺血坏死动物模型的有效方法，所采用的4种方法对改善缺血坏死均有一定效果，以血运重建加骨膜生发层细胞(D组和E组)的方法最佳。