定制化胫骨平台系统的构建及应用

为解决传统人工胫骨平台假体个体匹配性差，结构强度与生物活性难统一等问题，提出了定制化复合增强型人工胫骨平台系统的设计制造方法。采用解剖学建模技术设计出外形匹配，内含三维网状构架的复合假体模型，利用快速成型技术制造出假体的树脂原型，并分别通过精密铸造和粉末烧结技术制造出钛合金胫骨平台和大段多孔陶瓷人工骨。结果显示，该方法能快速而精确地制造出形状复杂的人工胫骨平台系统，是实现假体定制化制造的有利保证；通过将金属假体和多孔陶瓷人工骨复合，解决了载重部位大段骨缺损的修复问题。临床应用表明，该假体能与对侧关节匹配运动，通过将机械重建与生物重建相结合可实现受损关节的功能重建。     

Customized Root-Analogue Implants: A Review on Outcomes from Clinical Trials and Case Reports

(1) It is estimated that 10% of the world’s population will need a dental implant in their lifetime. Despite all the advances in the comprehension of dental implant designs, materials and techniques, traditional implants still have many limitations. Customized root-analogue implants are, therefore, gaining increased interest in dental rehabilitation and are expected to not only preserve more hard and soft tissues but also avoid a second surgery and improve patient overall satisfaction. In this sense, the aim of this review was to collect and analyse the clinical trials and case reports on customized root-analogue implants available in the literature; (2) This review was carried out according to the PRISMA Statement. An electronic database search was performed using five databases: PubMed, Google Scholar, Medline, Science Direct, and Scopus. The following keywords were used for gathering data: custom-made, dental implants, root-analogue, anatomical, customized and tooth-like; (3) 15 articles meeting the inclusion criteria—articles reporting clinical trials, case reports or animal studies and articles with root-analogue implants and articles with totally customized implant geometries—were selected for the qualitative synthesis. The design and manufacturing techniques, implant material and surface treatments were assessed and discussed; (4) The performance of some root-analogue implants with specific features (i.e., macro-retentions) was successful, with no signs of infection, periodontitis nor bleeding during the follow-up periods.     

Fluoroscopic and Gait Analyses for the Functional Performance of a Custom-Made Total Talonavicular Replacement

The present study evaluated the restoration of joint function in a special clinical case: a professional rock climber who underwent an original total talonavicular replacement with a custom-made prosthesis after a complex articular fracture. Full body gait analysis and 3-dimensional joint kinematics using single-plane fluoroscopy were performed on the same day at the 30-month follow-up examination. Gait analysis was performed using stereophotogrammetric, dynamometric, electromyographic, and baropodometric systems. Gait analysis showed good restoration of rotation, as well as moment patterns in the main lower limb and foot joints in the operated leg. At the artificial tibiotalar joint, videofluoroscopic analysis revealed a flexion capability of about 20°, together with a few degrees of motion in the frontal and transverse planes. The neighboring joints of the foot did not present with severe kinematic abnormalities. A full talonavicular replacement can be a viable and effective solution for complex ankle injury sequelae, even in patients with highly demanding functionality.     

Running shoes for relief of plantar pressure in diabetic patients

There is a causal relationship between diabetic foot ulceration, elevated plantar pressure, and severe sensory neuropathy. Cushioned footwear intended to relieve plantar pressure is well established for prevention and healing of plantar ulcers. The aim of the present study was to investigate whether pressure relief by means of a running shoe with optimized forefoot pressure damping is comparable to that of a custom-made soft insole placed into an in-depth shoe. The in-shoe pressures were compared to an in-depth shoe with the original cork insole and with a leather-soled Oxford shoe. The maximum reduction of plantar pressure in the running shoe was 47 % under the 2nd and 3rd metatarsal heads, 29 % at the first metatarsal head, and 32 % at the great toe in comparison to the Oxford shoe. This was surpassed only by the custom-made insole, which reduced pressures at the metatarsal heads by 50 %. The specially designed running shoe yielded the same pressure relief at the central metatarsal heads as the custom-made insole. Such shoes are likely to be very useful in preventing diabetic foot ulceration in high-risk patients as a comparatively affordable and immediately available device. © 1998 John Wiley & Sons, Ltd.     

Platinum concentration in sentinel lymph nodes after preoperative intra-arterial cisplatin chemotherapy targeting primary tongue cancer

Abstract Conclusion: We conclude that intra-arterially injected cisplatin passed via lymph flow into sentinel nodes (SNs) as the platinum concentration in the SNs was higher than that in the non-sentinel nodes (NSNs). It is possible that preoperative intra-arterial chemotherapy targeting primary cancer also has a therapeutic effect on subclinical metastatic SNs. Objectives: Intra-arterial chemoradiotherapy has been reported to be effective against not only primary tumors but also nodal metastases. We considered the hypothesis that intra-arterially injected cisplatin passed via lymph flow into regional nodes. This study aimed to investigate intra-arterially injected cisplatin distribution to regional nodes by comparing platinum concentrations in SNs and NSNs. Methods: Five patients with T1-2 N0 tongue cancer were treated with preoperative intra-arterial chemotherapy (cisplatin, 100 mg/m(2)) targeting primary cancer. Partial glossectomy together with SN biopsy and elective neck dissection were performed 2 weeks after intra-arterial chemotherapy. Platinum concentrations in the lymph nodes were measured using a Zeeman atomic absorption spectrometer. Results: Thirteen SNs were harvested together with eight NSNs from the areas adjacent to the SNs. Platinum concentrations were then measured, revealing a significant difference in platinum concentration between the SNs and the NSNs (mean ± SD, 0.682 ± 0.246 μg/g vs 0.506 ± 0.274 μg/g; p = 0.049).     

定制基台用于上颌后牙区倾斜种植体修复的临床研究

目的:探讨轴向不同的上颌后牙区多种植体联冠修复的方法。方法:本研究中22例上颌后牙区失牙患者,共植入79枚种植体,均存在多颗植体三维轴向不一致问题。通过使用个别定制基台矫正种植体的非平行角度,得到义齿的修复共同就位道,完成连冠或固定桥修复。结果:在1-5年的观察期内,无种植体松动脱落,所有修复体都行使了良好的功能。结论:对于严重不平行的种植体联冠修复问题,使用个别定制基台是可行的方案。     

Custom-Made Cement-Linked Mega Prostheses: A Salvage Solution For Complex Periprosthetic Femoral Fractures

Periprosthetic femoral fractures with long stem implants, poor bone stock and loosening pose a considerable surgical challenge. We describe a reconstruction technique using a custom-made mega-prosthesis, cement-linked to the femoral stem of a well-fixed existing implant. Clinical and radiological outcomes were assessed at our tertiary referral centre. There were 15 patients with a periprosthetic femoral fracture: 5 proximal and 10 distal femoral arthroplasties linked to existing femoral stems. The survival rate was 93.3% at a mean follow-up of 5.3 years (0.5–19.3) with 1 revision. We present a salvage technique with good intermediate-term outcomes for highly selected patients with complex periprosthetic femoral fractures, as another option to conventional fixation methods. Specifically, it allows immediate weight bearing and avoids some of the morbidity of total femoral arthroplasty or amputation.     

Proposal for new European pharmaceutical legislation to permit access to custom-made anti-sense oligonucleotide medicinal products

Current European pharmaceutical legislation is not adequate to meet advances in science and technologies that will lead to rapid development of custom-made medicines. Using existing legislation for custom-made medical devices as a template and anti-sense oligonucleotides as model medicinal products, we propose new European pharmaceutical legislation to permit timely access to custom-made anti-sense oligonucleotide medicinal products. The proposals may be more widely applicable to other medicinal products.     

定位弧定制镜片在角膜塑形镜中的应用

目的：观察定位弧定制镜片在夜戴型角膜塑形镜中的临床应用效果。

方法：采用前瞻性研究,观察首次夜戴型角膜塑形镜验配案例共84例165眼,随机分成两组,观察组38例76眼为定位弧定制镜片,对照组46例89眼为标准镜片,对照两组在戴镜1mo时裸眼视力、角膜地形图与角膜上皮状况。

结果：在戴镜1mo时,观察组73眼、对照组83眼共156眼(94.5%)结果良好,观察组3眼、对照组6眼共9眼(5.5%)评估不佳,需继续观察或重新验配。在各项评估中,观察组74眼、对照组85眼共159眼(96.4%)裸眼视力达到或接近最佳矫正视力; 观察组73眼、对照组84眼共157眼(95.2%)角膜地形图为可接受或接近完美; 所有患者均未发生严重的角膜上皮损害。采用定位弧定制镜片在裸眼视力、角膜地形图和角膜上皮三项评分中均优于采用标准镜片,差异均具有统计学意义(P<0.05)。

结论：夜戴型角膜塑形镜的安全性与有效性均令人满意,配戴定位弧定制镜片在戴镜1mo评估中优于标准镜片。