Objective
To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury.
Methods
Inclusion criteria: ①Soft tissue defect far beyond the level of distal interphalangeal joints. ②The inured finger was from second to fifth. ③Single finger injury. ④ Iniury time within 8 h. Exclusive criteria: ①With tendon injury.② Multiple finger injuries. ③Followed-up time within 6 months. Between February, 2009 and September, 2016, 52 patients (52 fingers) with distal finger degloving injury were reviewed, there were 32 males and 20 females, aged from 18 to 60(36.02±11.00) years. The time from injury to operation was 2.5-8.0 (4.81±1.28) h. Affected fingers included index finger in 15 cases, middle finger in 22 cases, ring finger in 10 cases, and little finger in 5 cases. Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap). The cubital skin was grafted onto the donor sites. Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap).
Results
The patients were followed-up 6-25 (9.25±3.97) months. The operation time: group combined-flap was 80-130(98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min. There was no significant difference in two groups(P>0.05). Pedicle division time: group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45(28.31±5.12) d. There was a significant difference in two groups(P<0.05). And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap. Flap function at last follow-up, the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00% and 59.38%, respectively. There was a significant difference in two groups (P<0.05), and the flap function in group combined-flap was much better than in group abdominal-flap. Affected finger function at last follow-up, the excellent and good rate of the affected fingers was 95.00% and 71.88%. There was a significant difference in two groups(P<0.05), and the affected finger function in group combined-flap was much better than in group abdominal-flap.
Conclusion
The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap, whose texture, appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap.
Key words:
Degloved injury; Finger; Dorsal branch, proper palmar digital artery; Island flap; Cross finger skin flap; Combined skin flap; Repair
To explore the clinical efficacies and outcomes of regional method axis pedicle screw insertion technique.During the period of April 2004 to June 2010, a total of 23 cases with traumatic instability of upper cervical vertebrae were recruited. There were 19 males and 4 females with a mean age of 45.8 years. They underwent surgical operations after an excellent traction reduction of cervical vertebrae. The entry points were drawn on axial facet joint and all of them distributed in the region of upper inner 1/4 of lower articular process. So the regional method was employed to determine the entry point. All subjects underwent the reconstruction of posterior stability. Axial pedicle screws were inserted by the insertion technique of axial pedicle screw via the "regional method". The entry region was in the upper inner 1/4 area of lower articular process. The entry angle, medial inclination and superior inclination were determined by the direction of inner wall and upper wall of isthmus. Postoperative cervical radiography and CT examination were performed to confirm the screw position.Forty-six axial pedicle screws were implanted. No significant complications occurred. All screws stayed in excellent positions without the invasion of vertebral artery and spinal canal.The "regional method" insertion technique of axial pedicle screw require no memory of complex entry points and entry angle parameters. And there is no need of identifying the anatomical landmarks. Thus this approach is accurate, safe and suitable for most patients.
Objective To evaluate the results, indication and complication of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP). Methods From February 2000 to February 2008, 178 patients were treated for symptomatic vertebral haemangioma, osteolytic neoplasm, or osteoporotic fractures, including PVP for 115 cases and PKP for 63 cases. Results 1) There were 16 patients of symptomatic haemangioma, and 14 underwent PVP while the other 2 cases were performed PKP. No evident cement leakage was found, and excellent or good results were obtained in 87.5% of them. 2) For the 68 patients of osteolytic neoplasm, posterior wall of vertebrae wall was involved in 28 cases, and all of them were treated with PVP. Cement leakage was detected in 27.9% patients with CT. However, there were only 2 patients of epidural leakage experienced transitory radicular pain. At the latest follow up, the excellent and good rate of results was 70.6%. Forty-three patients were followed for an average of 10 months. Although pain relief was still obvious in 34 cases, there were 9 patients complained recurrence of pain due to the deterioration of the tumor. 3) For the 94 patients of osteoporotic fracture, posterior vertebral wall was involved in 29 cases. All of them, 33 cases were treated with PVP while the other 61 cases were dealt with PKP. Cement leakages were detected in 18.2% patients for PVP, and 9.8% patients for PKP, but no clinical symptom was complained. For PKP, the reduction of anterior vertebral body height averaged 34.2%, and correction of Cobb angle averaged 3.3~, while no evident reduction was detected for PVP. Excellent or good results were obtained in 92.6% of patients, while no significant difference was found between PVP and PKP. Sixty-four patients were followed for an average of 3 years. Two patients with PKP encountered adjacent vertebral fracture, which was treated by another PKP with good results, and the clinical results were sustained in the others. Conclusion The indications of PVP or PKP mainly consist of symptomatic haemangioma, osteolytic neoplasm and osteoporotic fracture. The similar satisfactory clinical results can be obtained and sustained after these two procedures. For osleoporotie fractures, PKP can produce void in the vertebral body and reduce the cement leakage, however, only partially restore vertebral body height.
Key words:
Spinal fractures; Spinal puncture; Neoplasms
More revisionary reconstruction procedures are required following failing anterior cruciate ligament (ACL) reconstructions, which are often regarded as a technique challenge with very limited goals. This study will be performed to compare the outcomes between groups of primary and revision knee reconstruction. Two observers conducted the literature retrieval from the platforms of PubMed, Embase, and CENTRAL. Studies which compared knee function and stability between primary and revisionary reconstructions were included. The data was synthesized by meta-analysis with fixed- or random-effects models as appropriate. A total of 10 eligible studies were included with 954 subjects in the primary group and 378 in the revision group. The International Knee Documentation Committee International Knee Documentation Committee (IKDC) subscores, side-to-side difference, and Lysholm score were demonstrated to be significantly improved at final follow-up in both groups, while Tegner score was not. The overall IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scores were significantly inferior in the revision group compared to the primary group. However, knee laxity according to side-to-side difference was demonstrated to be similar between the two groups. Revision ACL reconstruction (RACLR) could provide patients with excellent restoration of knee outcomes compared to the status before revision. Also, while knee function in the revision group was inferior to the primary group, knee stability was equivalent between the two groups at the final follow-up.
Bioactive glasses (BGs) are a kind of biomaterials with osteoconductive and osteoinductive properties and are able to create a strong bond with host bone and promote osteogenesis after implantation. According to their compositions, bioactive glasses can be classified as silicate BGs, phosphate BGs, and borate BGs. Nowadays, silicate BGs are still the most common, while phosphate BGs and borate BGs have higher dissolution and degradation rates. Melt-quenching and sol-gel process are two basic methods to produce melt-derived BGs and sol-gel BGs, respectively. The latter requires lower heat treatment temperature with higher specific surface area and biological activity. Bioactive glass-ceramics can be obtained by heat treatment, which improves the mechanical strength but slightly reduces the bioactivity. Nano-bioactive glasses with the higher specific surface area can be obtained by changing the structure size of the materials by other treatment methods. On this basis, 3D BGs scaffolds can be made, and hybrid BGs scaffolds as well by combining with other biomaterials to obtain the 3D interconnected pores with the hierarchical or bionic structures, to enhance the mechanical strength, osteogenic activity and provide mechanical support suitable for the host bone. However, the bioactivity of BGs depends on the degradation rate, to some extent, which is contradictory to the mechanical strength. An appropriate porosity or controllable degradation rate can be selected to meet the common needs of early support and osteogenesis. In basic studies, it was found that BGs could act on cells by releasing ions or through the macropinocytosis pathway, up-regulating the expression of related genes or promoting osteogenesis. The degradation rates of BGs are related to their structures and compositions, which enables the quantitative prediction of the change of mechanical strength during degradation. Progress has also been made in structural mechanics and testing methods.
Tendon transplantation is one of the most commonly used procedures for patients with injured tendons. The materials used for tendon transplantation include the tendon autograft, tendon allograft, xenogenic tendon and artificial ligament.Of these, the allogeneic tendon has become more and more widely accepted because of the abundant donor source, absence of complications at donor sites and reduced operation time. However, it would meanwhile increase the risks of immunological rejection, disease transmission and delayed tendon-bone integration. A lot of studies have reported many processing technics to solve thementioned drawbacks of tendon allograft. Regarding to the immunological rejection, many approaches have been proposed including physical freezing (such as deep freezing, freeze drying and cryopreservation using the vitrification method) and chemical decellularization (such as deoxyguanosine culture solution, trinbutyl phosphate, chloroform/methyl alcohol, sodium dodecyl sulfate, 95% ethanol and Triton X-100). Among the physical freezing methods, freeze-drying could remove the immunogenicity of tendon more effectively, but it also tends to cause damage to the mechanics, structure and histology of the tendon. And it is more likely to cause damage to tendon especially when the method is used in combination with irradiation sterilization. Deep freezing has less damage to the mechanical and histological characteristics of tendon, and this method is currently the mostcommonly used in clinical and scientific research. The vitrification preservation method has unique advantages in protecting thetendon mechanical properties and cell activity. It retains similar mechanical properties to fresh tendons. However, the complicated preparation procedures involved in this method, the high cost and the cytotoxicity of the cryoprotectant have always restrictedits application in actual production. Different chemical decellularization methods have their own advantages and disadvantages when used to reduce the immunogenicity of tendons. In order to achieve more thorough removal of cellular components in tendonswhile maximally retaining the structural and mechanical integrity of tendons, strict control on the concentration of the decellularizing agent and the treatment time is often required.
Objective
To assess the clinical value of cross raft screws technique in preventing postoperative collapse of tibial plateau fracture.
Methods
From September 2014 to November 2017, data of 14 patients with tibial plateau fracture who were treated by cross raft screws technique were retrospectively analyzed. There were 9 males and 5 females aged from 30-65 years old (average, 44.4±1.7 years). There were 8 patients that the thickness of subchondral cancellous bone measured preoperatively by CT data was less than 4 mm, and 6 patients that the thickness of subchondral cancellous bone measured intraoperatively was less than 4 mm. 1/4 tubular plate was placed along the anterior rim of lateral tibial plateau, and the 3.5 mm cortical bone screws were fixed as bamboo raft from anterior to posterior through the plate. The collapse of tibial plateau after surgery were measured by CT scan after union of the fracture. The function of knee was evaluated by Rasmussen Anatomical and Functional Grading.
Results
The time of tubular plate procedure was 18 to 35 min (average, 24.1±5.4 min). All 14 patients were successfully followed-up for 13.8±5.1 months. The height of collapse preoperatively by CT scan was 5-21 mm (average, 8.00±1.40 mm). 3 days after the operation, the height between articular line and lateral articular surface was 0-2 mm (average, 0.80±0.06 mm). Compared with CT data preoperatively, the collapse was corrected postoperatively that was proved by CT scan (P< 0.05). After the fracture was healed, according to CT data, the height between articular line and lateral articular surface was 0-2 mm (average, 0.70±0.08 mm). Compared with CT data postoperatively, there was no postoperative collapse happened (P=0.466). The position and length of nails were placed appropriately. The average healing time of fracture was 3.6 months. There were no infection, nonunion and pain of tendon happened. The plate could be touched subcutaneously in 2 patients, who had no discomfort feelings. The patient's postoperative Rasmussen Anatomical Grading were 13-18 (average, 16.7), including 8 cases excellent and 6 cases good. The postoperative Rasmussen Functional Grading was 18-28 (average, 25.7), including 11 cases excellent and 3 cases good.
Conclusion
The cross raft screws technique is a good way to prevent the postoperative collapse of the lateral articular surface of tibial plateau.
Key words:
Tibial fractures; Fracture fixation, internal; Treatment outcome
To explore the potential effect of three allogenic bone substitute configurations on the viability, adhesion, and spreading of osteoblasts in vitro.Freeze-dried cortical bone were ground and fractions were divided into three groups with different sizes and shapes, defined as bone fiber (0.1 mm × 0.1 mm × 3 mm), bone powder (0.45-0.9 mm), and bone granule group (3-6 mm). MC3T3-E1 cells were divided and co-cultured within groups to induce cell adhesion. The configuration of allogenic bone was captured by scanning electron microscopy and confocal laser scanning microscopy, and substrate roughness values were quantified. Cell adhesion rate was assessed using the hemocyte counting method, cell viability was determined by CCK-8 assay and live/dead staining, and cell morphology was visualized by Phalloidin and DAPI, and the mRNA expression of adhesion-related gene (vinculin) of different substitutes were determined with quantitative real-time polymerase chain reaction.The roughness values of bone fiber, bone powder, and bone granule group were 1.878 μm (1.578-2.415 μm), 5.066 μm (3.891-6.162 μm), and 0.860 μm (0.801-1.452 μm), respectively (bone powder group compared with bone granule group, H = 18.015, P < 0.001). Similar OD values of all groups in CCK-8 assay indicated good biocompatibility of these substitutes (bone fiber, 0.201 ± 0.004; bone powder, 0.206 ± 0.008; bone granule group, 0.197 ± 0.006; and the control group, 0.202 ± 0.016, F = 0.7152, P > 0.05). In addition, representative cell adhesion rates at 24 h showed significantly lower cell adhesion rate in bone fiber group (20.3 ± 1.6%) compared to bone powder (29.3 ± 4.4%) and bone granule group (27.3 ± 3.2%) (F = 10.51，P = 0.009 and P = 0.034, respectively), but there was no significant difference between the latter two groups (P > 0.05). Interestingly, the expression of vinculin mRNA steadily decreased in a time-dependent manner. The vinculin expression reached its peak at 6 h in each group, and the vinculin levels in bone fiber, bone powder, and bone granule group were 2.119 ± 0.052, 3.842 ± 0.108, and 3.585 ± 0.068 times higher than those in the control group, respectively (F = 733.643, all P < 0.001). Meanwhile, there was a significant difference in the expression of target gene between bone powder and bone granule group (P = 0.006).All allogenic bone substitutes presented an excellent cell viability. Moreover, bone powder and bone granule group were more likely to promote cell adhesion and spreading compared to bone fiber group.
Objectives To describe the technique of the aorta balloon occlusion, and evaluate the blood loss in lumbar spine tumor surgery assisted by aortic balloon occlusion, and to observe the balloon‐related complications. Methods Six patients with lumbar spine tumor underwent resuscitative endovascular balloon occlusion of the aorta prior to tumor resections in our institution between May 2018 to January 2021. Medical records including demographic, diagnosis, tumor location, surgical approach, intraoperative blood loss, surgical duration, and perioperative balloon‐related complication were evaluated retrospectively. Results This series included four males and two females, with a median age of 50 years (range 22 to 69). Of these, three primary tumors were plasmacytoma, giant cell tumor of bone, and osteosarcoma, while recurrence of undifferentiated pleomorphic sarcoma (UPS), recurrence of giant cell tumor of bone (GCT), and metastatic thyroid cancer were diagnosed in cases 1, 6, and 2, respectively. L 2 was involved in cases 1 and 5. L 3 was involved in case 6. L 4 was involved in case 2, 3, and 6. L 5 was involved in case 4. One‐stage total en bloc resection surgery (TES) was accomplished in all patients; of this series, signal anterior approach was conducted in case 1, signal posterior approach was utilized in cases 2, 3, and 6, while combined anterior and posterior approach was performed in cases 4 and 5. The median intraoperative blood loss was 1683 mL and ranged from 400 to 3200 mL with a median surgical duration of 442 min and a range from 210 to 810 min. During the perioperative period, no serious balloon‐related complications occurred. Conclusions Endovascular balloon occlusion of the aorta successfully controls intraoperative exsanguination, contributing to a more radical tumor resection and a low rate of tumor cell contamination in lumbar tumor surgery.
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