改良双侧胫肌延长术的疗效分析

目的 探讨改良双侧胫骨延长术的治疗效果。方法 1997年5月－2000年5月对32例患者行双侧胫骨延长达到增高目的,其中8例膝内翻。手术为颈骨结节下1．0cm处骨膜下横形截断胫骨,腓骨于外踝上10cm水平处横形截断,胫肌骨置入带锁髓内钉,近端上锁,小腿外置延长器,每日缓慢牵伸延长胫骨,达到预期延长目的后2周拆除延长器,同时带锁髓内钉远端上锁,延长段骨质完全愈合约1年后取出带锁髓内钉。结果 32例术后双侧胫骨延长3．5－12．0cm,平均8．5cm,延长时间为53－180天,平均128天,延长段骨痂生长时间为120－270天,平均180天,随访1－3年,患者在增高高度、步态及关节活动度等方面满意率达98％。结论 改良后的双侧胫肌延长术,胫骨骨折愈合时间缩短,并发症少,可同时矫正膝内、外翻畸形。     

Intestinal loop lengthening: early treatment of vanishing bowel

Bianchi’s procedure experience for short bowel syndrome in children is positive. This technique is generally performed after the first year of life. Here the authors propose a case of gastroschisis with prenatal spontaneous closure of abdominal defect and vanishing gut presenting as intestinal atresia, absence of ileo-cecal valve, and residual short intestinal dilatation, treated by early gut lengthening (ILP).     

PML3 interacts with TRF1 and is essential for ALT-associated PML bodies assembly in U2OS cells

Telomerase-negative cancer cells maintain their telomeres by a mechanism known as alternative lengthening of telomeres (ALT) and achieve unlimited replicative potential. A hallmark of ALT cells is the recruitment of telomeres to promyelocytic leukemia (PML) bodies and formation of ALT-associated PML bodies (APBs). Although the exact molecular mechanism of APBs assembly remains unclear, APBs assembly requires telomere and PML body-associated proteins, including TRF1 and PML. Here, we report that PML3, one of PML isoforms, is involved in APBs formation. As a new binding protein of TRF1 (telomeric repeat binding factor 1), PML3 directly interacts with TRF1 and recruits TRF1 to PML bodies in U2OS cells. More notably, depletion of PML3 by small interfering RNA does not affect PML bodies formation, but inhibits the recruitment of both TRF1 and TRF2 to APBs. Further study shows that the recruitment of TRF1 to APBs depends on its interaction with a specific PML3 isoform. Thus, the interaction of PML3 with TRF1 is isoform specific and likely to be essential for APBs assembly in U2OS cells.     

骨节段性延长转移治疗长骨大段骨缺损的实验研究

目的 了解骨节段性延长转移（ＳＢＴＬ）对长骨大段骨缺损断端和延长区血循环的影响以及骨修复重建过程。方法 通过建立１８只山羊胫骨３５％以上长骨干缺损模型,采用ＳＢＴＴＬ进行实验性治疗,并行Ｘ线,墨汁灌注透明切片及组织学观察。结果 骨节段延长转移的长骨骨缺损断端血循环丰富,骨愈合良好,延长区血供丰富,骨修复迅速。结论 ＳＢＴＬ方法为修复长骨大段骨缺损的不植骨治疗提供了一种新的临床治疗选择。     

Taylor spatial frame-software-controlled fixator for deformity correction-the early Indian experience

Background:

Complex deformity correction and fracture treatment with the Ilizarov method needs extensive preoperative analysis and laborious postoperative fixator alterations, which are error-prone. We report our initial experience in treating the first 22 patients having fractures and complex deformities and shortening with software-controlled Taylor spatial frame (TSF) external fixator, for its ease of use and accuracy in achieving fracture reduction and complex deformity correction.

Settings and Design:

The struts of the TSF fixator have multiplane hinges at both ends and the six struts allow correction in all six axes. Hence the same struts act to correct either angulation or translation or rotation. With a single construct assembled during surgery all the desired axis corrections can be performed without a change of the montage as is needed with the Ilizarov fixator.

Materials and Methods:

Twenty-seven limb segments were operated with the TSF fixator. There were 23 tibiae, two femora, one knee joint and one ankle joint. Seven patients had comminuted fractures. Ten patients who had 13 deformed segments achieved full correction. Eight patients had lengthening in 10 tibiae. (Five of these also had simultaneous correction of deformities). One patient each had correction of knee and ankle deformities. Accurate reduction of fractures and correction of deformities and length could be achieved in all of our patients with minimum postoperative fixator alterations as compared to the Ilizarov system. The X-ray visualization of the osteotomy or lengthening site due to the six crossing struts and added bulk of the fixator rings which made positioning in bed and walking slightly more difficult as compared to the Ilizarov fixator.

Conclusions:

The TSF external fixator allows accurate fracture reduction and deformity correction without tedious analysis and postoperative frame alterations. The high cost of the fixator is a deterrent. The need for an internet connection and special X-rays to operate the fixator add to its complexity.     

Increased expression of insulin-like growth factor in intestinal lengthening by mechanical force in rats

Introduction

A segment of the jejunum could double its length by the application of an axial mechanical force. We hypothesize that this growth is correlated with an increased expression of insulin-like growth factor (IGF-I) in the jejunum.

Methods

Adult Sprague-Dawley rats underwent the isolation of a 1.5-cm segment of the jejunum. The isolated jejunal segment was either lengthened using mechanical force or left alone for 3 weeks. The jejunal segments were analyzed by quantitative polymerase chain reaction and immunofluorescence for the expression of IGF-I.

Results

Whereas jejunal segments that underwent isolation alone did not change their length, isolated jejunal segments that were stretched by applying a gradual mechanical force doubled their initial length. Both groups increased their muscular thickness 5 folds as compared to the normal jejunum. The mRNA level of IGF-I in the lengthened jejunum was 6 folds higher than that in the normal jejunum, but the IGF-I mRNA level in the isolated jejunum without mechanical lengthening was unchanged. By immunofluorescence, the increased IGF-I expression in the lengthened jejunum was localized to the intestinal smooth muscle cells.

Conclusions

Insulin-like growth factor I may be an important signal induced by the applied axial force that mediates longitudinal intestinal growth.     

残根不同断面水平的牙周处理的疗效研究

目的 探讨残根不同断面水平的牙周处理的疗效作用,分析残根保留牙周手术适应证。 方法 85例患者(187颗患牙)入选本研究,根据残根断面位置和牙周手术方式分成三组：治疗1组（T1）67颗,PD≥3 mm,牙槽嵴顶至残根断缘距离≥4 mm,实施牙龈切除术;治疗2组（T2）71颗,PD<2 mm,牙槽嵴顶至残根断缘距离<3 mm,实施牙冠延长术;对照组49颗,PD<2 mm,牙槽嵴顶至残根断缘距离<3 mm,实施牙龈切除术;术后常规桩冠修复,观察术前、术后1周、4周、6个月和1年的SBI、GI和松动度,比较各组术后1周和1年成功率。 结果 残根保存率为97.3%;T1组和T2组在术后各时间点SBI、GI与对照组比较明显降低,在术后6个月和1年时松动牙所占比率比术前降低,对照组在6个月和1年时松动牙所占比率比术前增加;T1组和T2组术后1周和1年成功率显著高于对照组。 结论 残根不同断面水平采取不同牙周处理对残根保存修复有重要意义,可显著提高成功率。     

Tissue restoration after improper laser gingivectomy: A case report

We report the case of 27-year-old female patient applied to our clinic with several pain at her upper teeth and weakness complaints. Anamnesis revealed that she experienced laser gingivectomy to have remarkable teeth. Clinical examination showed that maxillar alveolar bone was partially uncovered with gingivae and periosteum. Interproximal necrosed area was observed. She had sensitivity at her maxillar anterior teeth. Furthermore, she was so anxious and depressed. In order to ensure more blood supply and clot formation, perforations on uncovered cortical bone was prepared. Avoiding from infection antibiotic, antiseptic gel and for epithelization vitamin E gel were prescribed. During one month she was recalled every third day. Recall times diminished periodically, as new tissue evolves. Although laser’s irreversible photothermal effects on soft and hard tissue, after a year all denuded areas were covered with healthy tissues without any surgical procedures. Histopathologic comparing showed severe lymphocyte infiltration and increased fibrosis and kollagenization in restored gingiva, additionally epithelial loss was observed. Since there is not a case report about the complications of laser gingivectomy in literature, we tried to represent a treatment plan that may be elucidative for clinicians.     

牙冠延长术模板的计算机辅助设计与制作

目的：将计算机辅助设计与快速成型技术相结合,应用于牙冠延长术手术模板的设计与制作,初步探索可行的方案。方法：利用三维扫描仪对1位需行牙冠延长术患者的上颌牙列石膏模型进行扫描。遵循龈缘形态的美学原则,结合患者口腔实际情况,对点云数据进行编辑,生成代表龈缘形态的3D曲线。按照曲线位置确定模板区域,通过抽壳等操作获取模板的三维数据模型。最后将数据导入快速成型机,加工出树脂模板。结果：初步实现了牙冠延长术手术模板的计算机辅助设计与制作;提高了术中定位切口的速度和准确性。结论：计算机辅助设计与快速成型技术相结合制作牙冠延长术模板,为科学设计龈缘的位置和形态提供了一种可行的方法。     

Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

BACKGROUNDLimb lengthening techniques play an increasingly important role in the pediatric orthopedic field. The principles of the osteogenesis distraction bonded traditionally with external fixators; however, the recent deployment of fully implantable systems has been able to overcome severities related to external fixators. The PRECICE^® is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.AIMTo review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.METHODSOnly five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs. The clinical and radiological outcomes of interest were: the main lengthening obtained, the distraction rate, the period of time to full weight bearing, the consolidation index, and the Association for the Study and Application of Methods of Ilizarov score.RESULTSIn conclusion, data collected from the articles under investigation were comparable with the exception of the consolidation index. Unfortunately, the study population was too small and the patients’ follow-up was too short to make definitive conclusions. CONCLUSIONThis review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons; however, careful pre-operative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.