Solvent-preserved,bovine cancellous bone blocks used for reconstruction of thoracolumbar fractures in minimally invasive spinal surgery—first clinical results

We investigated the osseointegration of solvent-preserved, xenogenous cancellous bone blocks in the treatment of unstable fractures of the thoracolumbar junction. In 22 patients, the anterior repair procedure was performed by thoracoscopy or minimally invasive retroperitoneal surgery. Twenty-two patients had undergone monosegmental anterior fusion and were surveyed prospectively. Solvent-preserved, bovine cancellous bone blocks were used in 11 patients; iliac crest bone graft was used in the others. Follow-up after 12 months included CT scans, which revealed successful osseointegration in eight out of 11 patients who had received autogenous iliac crest bone grafts, while three patients showed a partial integration. There were no graft fragmentations. In patients who had received solvent-preserved, xenogenous cancellous bone blocks, complete osseointegration was achieved at the graft–bone interface in only two out of 11 cases, after 1 year. Partial integration was found in three patients. In view of these results, autogenous iliac crest bone grafts are still the unrivalled standard for defect repair in spinal surgery.     

自体角膜缘干细胞移植术治疗翼状胬肉43例临床观察

目的 评价自体角膜缘干细胞移植术治疗翼状胬肉的疗效。方法采用自体角膜缘干细胞移植术治疗54眼(43例)翼状胬肉，其中原发性翼状胬肉38眼，复发性翼状胬肉16眼。16眼复发性胬肉均经过两次以上的单纯胬肉切除术或结膜下转移术。结果 术后随访6-18个月，无术后并发症发生。49眼无胬肉组织再生，5眼在术后8—11个月复发，复发率为9．3％。结论 自体角膜缘干细胞移植术能为受损的角膜缘提供新的干细胞，是一种安全、有应用前景的治疗翼状胬肉的手术方式。     

Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: a long-term histologic and biomechanical study

To assess the degree of success of anterior cruciate ligament (ACL) replacement using the patellar tendon (PT) autograft, 29 New Zealand white rabbits underwent ACL reconstruction using a medial one-third PT autograft. The femur-ligament-tibia complexes were evaluated at 0, 6, 30, and 52 weeks postoperatively for gross and histologic appearances and tensile load to failure properties. Grossly, the autografts did not resemble the control ACLs. Histologically, the autografts progressed from being hypercellular with a random collagen fiber bundle organization to having a near normal cellularity with a more parallel collagen fiber bundle pattern. Anteroposterior knee laxity was more than two times that of the control knees 52 weeks after reconstruction. Biomechanically, the PT autografts plateaued at 30 weeks postoperatively. The ultimate load and stiffness were 15 +/- 5% and 24 +/- 6% of the control ACLs, respectively. At 52 weeks, the appearance of the PT autograft had some general histologic similarities as compared with the native ACL. However, these similarities did not extend to the functional properties of the autograft.     

Patellar tendon autograft versus hamstring tendon autograft in arthroscopic anterior cruciate ligament reconstruction: appraisal of the evidence

Arthroscopy–assisted reconstruction of a torn anterior cruciate ligament (ACL) is a commonly performed surgical procedure. The type of graft used for ACL reconstruction has traditionally been an autograft; the more commonly used grafts are the bonepatellar tendon–bone (BPTP) and hamstring tendons, namely the gracilis and semitendinosus tendons (GST). We surveyed the evidence concerning the outcome of patients treated by arthroscopic reconstruction of the ACL with either BPTP or GST. On basis of several welldesigned studes, specifically 5 meta–analyses and one systematic review, we critically discuss the best evidence available today regarding ACL reconstruction. This evidence suggests that BPTP may be considered for patients performing high–demand activities not involving repetitive kneeling.     

自体角膜缘移植羊膜移植治疗翼状胬肉

目的：观察自体角膜缘移植术或／和羊膜移植术治疗翼状胬肉的临床效果。方法：206眼翼状胬肉患者分3组分别采用显微手术切除局部病灶联合自体角膜缘移植术或／和羊膜移植术治疗，并给予定期随访、裂隙灯检查及照相。结果：术后随访3－17月，视力均有所提高，眼表愈合迅速，且复发率低。结论：胬肉切除后联合羊膜移植及自体角膜缘移植术对治疗翼状胬肉，降低术后复发率，恢复和重建眼表很有帮助。     

自体角膜缘干细胞移植联合准分子激光治疗性角膜切削术治疗翼状胬肉的临床观察

目的探讨自体角膜缘干细胞移植联合准分子激光治疗性角膜切削术（PTK）治疗翼状胬肉的临床疗效。方法将翼状胬肉患者174例（192只眼）随机分为A组（94只眼）,行自体角膜缘干细胞移植术;B组（98只眼）,行自体角膜缘干细胞移植联合PTK。术后随访6~24个月,对比观察角膜修复时间、瘢痕形成情况、复发率、术后视力提高、角膜散光变化情况。结果 B组患者早期角膜修复时间、瘢痕形成、术后视力提高、角膜散光减少优于A组,术后复发率B组略低于A组。结论自体角膜缘干细胞移植联合PTK治疗翼状胬肉效果好、恢复快、复发率低,值得推广应用。     

Patients' attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction

Surgeon recommendation is the primary influence for patients choosing a graft for their ACL reconstruction. However, it is unknown if demographic factors also play a role. We hypothesize that education, age, and living in an urban setting may influence a patient's graft choice. Patients who had an ACL reconstruction from 2005 to 2009 were identified retrospectively, and received a written survey on their demographics and the factors affecting graft choice. They also rated their perception of those factors based on a Likert scale. Out of 471 surveys distributed, 151 responses were received. The mean follow-up time was 19 months (range, 1 to 63 months). Autograft was used in 57%. Surgeon recommendation was the primary factor in graft choice (63%). 87.4% of patients felt they made the right choice; only 4.6% would have picked a different graft if they could choose over again. More than half (51.7%) of patients did significant personal research, and used mostly medical websites (41.1%). 67.6% of patients were not adverse to allograft. The primary factor for patients in graft choice was surgeon recommendation. Still, the use of medical websites was widespread, and patients in an urban environment were less likely to rely solely on their surgeon's recommendation. Older patients were more concerned with autograft donor site morbidity, and patients with a higher level of education were less averse to allograft.     

The level of compressive load affects conclusions from statistical analyses to determine whether a lateral meniscal autograft restores tibial contact pressure to normal: a study in human cadaveric knees.

This study addressed the question of whether the level of compressive load would affect the conclusions from statistical analyses aimed at determining how well a lateral meniscal autograft restores tibial contact (as indicated by the maximum contact pressure, mean pressure, and contact area) to that of the intact knee. If statistical analyses indicated that normal tibial contact was not restored with a higher, more physiologic load, then a secondary question was whether an autograft surgically implanted with bone plugs would improve tibial contact compared to that in a meniscectomized knee. Nine, fresh-frozen human cadaveric knees were subjected to a low, non-physiologic compressive load of 400 N and a higher, more physiologic compressive load of 1200 N under three conditions (lateral meniscus intact, lateral meniscus removed and reimplanted as an autograft, and lateral meniscus removed). Contact pressure on the lateral plateau was measured with pressure sensitive film at 0 degrees, 15 degrees, 30 degrees, and 45 degrees of flexion. At 400 N, p-values from statistical analyses indicated that both the maximum and mean pressures with the autograft were comparable to those of the intact knee (p> or =0.685). However, at 1200 N, p-values from statistical analyses indicated that both the maximum and mean pressures with the autograft were significantly greater than those of the intact knee (p< or =0.0001). Therefore studies designed to evaluate tibial contact pressure for a meniscal transplant should use a higher, more physiologic compressive load, because lower loads overestimate the transplant's effectiveness. Although none of the contact variables was restored to normal when the compressive load was increased to 1200 N, all of the contact variables were more normal than those of the meniscectomized knee. Thus, lateral meniscal allografts implanted using bone plugs can significantly improve contact pressure relative to a meniscectomized knee at the time of implantation.