Stress and strain analysis on the anastomosis site sutured with either epineurial or perineurial sutures after simulation of sciatic nerve injury

The magnitude of tensile stress and tensile strain at an anastomosis site under physiological stress is an important factor for the success of anastomosis following suturing in peripheral nerve injury treatment. Sciatic nerves from fresh adult cadavers were used to create models of sciatic nerve injury. The denervated specimens underwent epineurial and perineurial suturing. The elastic modulus （40.96 ＋ 2.59 MPa） and Poisson ratio （0.37 ＋ 0.02） of the normal sciatic nerve were measured by strain electrical measurement. A resistance strain gauge was pasted on the front, back left, and right of the edge of the anastomosis site after suturing. Strain electrical measurement results showed that the stress and strain values of the sciatic nerve following perineurial suturing were lower than those following epineurial suturing. Scanning electron microscopy revealed that the sciatic nerve fibers were disordered following epineurial compared with perineurial suturing. These results indicate that the effect of perineurial suturing in sciatic nerve injury repair is better than that of epineurial suturing.

Laparoscopic vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large(≥3 cm)gastric submucosal tumors

BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.

Early Triassic Volcanic Rocks in the Western Yarlung Zangbo Suture Zone:Implications for the Opening of the Neo-Tethys Ocean

In this study,zircon U-Pb dating of volcanic rocks from the Zhongba ophiolite of the Yarlung Zangbo Suture Zone(YZSZ)in southern Xizang(Tibet)yielded an age of 247±3 Ma.According to whole rock geochemical and Sr-NdPb isotopic data,the Early Triassic samples could be divided into two groups:Group 1 with P-MORB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70253–0.70602,ε_(Nd)(t)values of 4.2–5.3,(^(206)Pb/^(204)Pb)_(t)ratios of 16.353–18.222,(^(207)Pb/^(204)Pb)_(t)ratios of 15.454–15.564,and(^(208)Pb/^(204)Pb)_(t)ratios of 35.665–38.136;Group 2 with OIB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70249–0.70513,ε_(Nd)(t)values of 4.4–4.9,(^(206)Pb/^(204)Pb)_(t)ratios of 17.140–18.328,(^(207)Pb/^(204)Pb)_(t)ratios of 15.491–15.575,and(^(208)Pb/^(204)Pb)_(t)ratios of 36.051–38.247.Group 2 rocks formed by partial melting of the mantle source enriched by a former plume,and assimilated continental crustal material during melt ascension.The formation of Group 1 rocks corresponds to the mixing of OIB melts,with the same components as Group 2 and N-MORBs.The Zhongba Early Triassic rocks belong to the continental margin type ophiolite and formed in the continental–oceanic transition zone during the initial opening of the Neo-Tethys in southern Xizang(Tibet).

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability:a comparison of three insertion methods

·AIM:To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens(IOL)in eyes with zonular instability.·METHODS:A total 60 eyes of 60 patients were included in this retrospective cohort study.Postoperative stability in three groups[haptic sutured IOL in the bag,IOL in the bag insertion with haptics oriented toward areas of zonulysis,IOL with capsular tension ring(CTR)in the bag insertion]were compared according to the IOL insertion methods.To evaluate the IOL stability,the changes of anterior chamber depth(ACD),refraction,contraction of anterior continuous curvilinear capsulotomy(CCC)area,and tilt of IOL were compared.·RESULTS:There was no significant difference in change of ACD(-0.04±0.01 mm in group of haptic sutured IOL,-0.07±0.01 mm in group of CTR insertion)and refraction(0.05±0.05 D in group of haptic sutured IOL,0.37±015 D in group of CTR insertion)between the group of haptic sutured IOL in the bag and CTR insertion group.But in comparison of CCC contraction and IOL tilt,CTR insertion group showed less contraction(1.00%±0.52%)and less IOL tilt(2.66°±0.11°)than the group of haptic sutured IOL in the bag(6.32%±1.36%,3.47°±0.11°,respectively).The CTR insertion group showed the least CCC contraction and the least tilt.·CONCLUSION:In eyes with zonular instability,the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion.The method of IOL only in-thebag insertion shows the largest contraction of CCC and the largest tilt of IOL.

Thirty-gauge needle-guided purse-string suture pupilloplasty:a new technique

AIM:To observe the clinical outcomes of 30-gauge(G)needle-guided 10-0 prolene suture purse-string pupilloplasty for atonic pupil management.METHODS:Eight patients with atonic pupils who underwent suture purse-string pupilloplasty were retrospectively analyzed.Preoperative data and at least 6mo of postoperative data were collected from all the patients.RESULTS:The corrected distance visual acuity(CDVA)before and after surgery was 0.58±0.22 and 0.20±0.10 logMAR,respectively(P=0.002).The pre-and postoperative pupil size was 7.38±0.88 and 3.09±0.71 mm(P=0.000),respectively.The corneal endothelial cell count was 2841±176/mm^(2) before and 2692±143/mm^(2) after surgery(P=0.000).No intraoperative or postoperative complications were reported.During the follow-up period of at least 6mo,all treated pupils were centered and generally or nearly round.Furthermore,the patients did not exhibit photophobia,glare,or diplopia.CONCLUSION:This technique is a simple and effective method for pupil reduction.

Transcriptomic and cellular decoding of scaffolds-induced suture mesenchyme regeneration

Precise orchestration of cell fate determination underlies the success of scaffold-based skeletal regeneration.Despite extensive studies on mineralized parenchymal tissue rebuilding,regenerating and maintaining undifferentiated mesenchyme within calvarial bone remain very challenging with limited advances yet.Current knowledge has evidenced the indispensability of rebuilding suture mesenchymal stem cell niches to avoid severe brain or even systematic damage.But to date,the absence of promising therapeutic biomaterials/scaffolds remains.The reason lies in the shortage of fundamental knowledge and methodological evidence to understand the cellular fate regulations of scaffolds.To address these issues,in this study,we systematically investigated the cellular fate determinations and transcriptomic mechanisms by distinct types of commonly used calvarial scaffolds.Our data elucidated the natural processes without scaffold transplantation and demonstrated how different scaffolds altered in vivo cellular responses.A feasible scaffold,polylactic acid electrospinning membrane(PLA),was next identified to precisely control mesenchymal ingrowth and self-renewal to rebuild non-osteogenic suture-like tissue at the defect center,meanwhile supporting proper osteointegration with defect bony edges.Especially,transcriptome analysis and cellular mechanisms underlying the well-orchestrated cell fate determination of PLA were deciphered.This study for the first time cellularly decoded the fate regulations of scaffolds in suture-bony composite defect healing,offering clinicians potential choices for regenerating such complicated injuries.

Single self-leading suture technique for iridodialysis repairment

Dear Editor,We described an innovative“single self-leading suture technique”for repairing iridodialysis.Instead of moving the needle forth and back,our method is easier to manipulate in the narrow surgical space between the cornea and lens,which will decrease the unnecessary complications related to iatrogenic injury.We provide an economical friendly and less time-taking method,which improves the suture accuracy.

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery:a technique note

AIM:To report a technique used with intermittent slidinglock-knot(ISLK)fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent(RI)fixation.METHODS:Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed.Primary outcome measures were mean duration of surgery and suture removal,degree of conjunctival hyperemia on postoperative day 1,pain score at suture removal,postoperative symptoms at 6mo,including conjunctival hyperemia,foreign body sensation,and graft stability.RESULTS:Ninety-eight patients underwent monocular surgery and were divided into ISLK(51 eyes)and RI(47 eyes)groups according to the type of conjunctiva autograft fixation method planned.There was no significant difference in mean duration of surgery between the two groups(18.59±2.39min vs 18.15±2.20min,P=0.417);however,compared to the RI group,shorter suture removal times were observed in the ISLK group[0.58min(0.42-0.87)vs 3.00min(2.21-4.15),P<0.001].The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group(P<0.001).Pain scores at suture removal were lower in the ISLK group than in RI group[1(0-3)vs 2(1-4),P<0.001].Postoperative symptoms at 6mo were comparable between the groups(P=0.487),with no recurrence.CONCLUSION:ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision.Compared to RI fixation,ISLK facilitates suture removal and reduces discomfort,with comparable surgery duration and less conjunctival hyperemia.

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament:A modified technique and case series

BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament(PCL)are challenging to treat and compromise knee stability and function.Traditional open surgery often requires extensive soft tissue dissection,which may increase the risk of morbidity.In response to these concerns,arthroscopic techniques have been evolving.The aim of this study was to introduce a modified arthroscopic tech-nique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL.This case series included 18 patients who underwent the procedure between January 2021 and December 2022.The patients were assessed for range of motion(ROM),Lysholm score and International knee documentation committee(IKDC)score.Postoperative complications were also recorded.RESULTS The patients were followed for a mean of 13.83±2.33 months.All patients showed radiographic union.At the final follow-up,all patients had full ROM and a negative posterior drawer test.The mean Lysholm score significantly improved from 45.28±8.92 preoperatively to 91.83±4.18 at the final follow-up(P<0.001),and the mean IKDC score improved from 41.98±6.06 preoperatively to 90.89±5.32 at the final follow-up(P<0.001).CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL,with excellent fracture healing and functional recovery.

Surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively.

关节镜辅助下Suture-button弹性固定治疗高位踝关节扭伤

背景:高位踝关节扭伤容易漏诊导致踝关节功能障碍,关节镜检查可发现隐匿性高位踝关节扭伤,采用Suture-button弹性固定能恢复远端胫腓联合的生物力学稳定性。目的:探讨踝关节镜辅助下采用Suture-button弹性固定治疗高位踝关节扭伤的临床疗效。方法:回顾性分析2019年8月至2021年8月武汉市第四医院足踝外科在踝关节镜辅助下进行Suture-button弹性固定治疗的40例高位踝关节扭伤患者的病历资料。所有患者均采用Suture-button弹性固定,记录患者术前及术后末次随访美国矫形外科足踝协会踝-后足功能评分、目测类比疼痛评分、踝关节活动度,将患者术前影像学数据与术中关节镜下分离程度进行相关性分析,按照Meislin标准进行疗效评估并记录术后并发症发生情况。结果与结论:①40例患者术后获16-48个月随访;②术后末次随访美国矫形外科足踝协会踝-后足功能评分为(88.95±6.64)分,目测类比评分为(1.78±1.23)分,踝背伸活动度为(33.50±5.79)°,踝跖屈活动度为(34.50±5.97)°,与术前相比差异均有显著性意义(P<0.05);③影像学分离指标与关节镜下分离程度存在低度正相关(r=0.612,P<0.01);④采用Meislin标准对疗效进行评估,优良率为95%(38/40);术后踝关节疼痛减轻,踝关节自主活动明显改善;⑤随访期间所有患者均未出现神经损伤及切口感染情况;1例患者因术后存在皮肤刺激、下蹲卡顿感取出内固定;⑥提示采取关节镜辅助Suture-button弹性固定治疗高位踝关节扭伤的临床疗效确切,能够更有效地恢复患肢足踝功能,恢复并维持关节稳定性且无需二次取出,值得临床应用。

缝合锚钉经内踝修复三角韧带深层损伤

背景:踝关节骨折合并三角韧带损伤在临床上较为常见,骨折内固定一期修复三角韧带逐渐成为主流治疗方法,明显降低了踝关节远期并发症的发生。近年来在三角韧带解剖结构特征和动态生物力学研究领域取得新进展,使三角韧带深层损伤修复技术有了较大提高,但仍存在争议。目的:探讨缝合锚钉技术与经内踝修复踝关节骨折合并三角韧带深层损伤的临床疗效。方法:选择中南大学湘雅医学院附属海口医院2017年1月至2022年1月收治的踝关节骨折合并三角韧带深浅层完全断裂的56例患者,依据带线锚钉修复三角韧带深层的方式不同分为2组,其中缝合锚钉修复组32例,经内踝修复组24例。对两组患者手术治疗前后的踝关节内侧间隙、美国矫形外科足踝协会评分进行评定。结果与结论:①56例患者均顺利完成手术并获得术后12个月以上随访,踝部骨折均愈合,骨折愈合时间8-12周,平均10.5周;②两组患者术后12个月踝关节内侧间隙较术前显著缩小,差异有显著性意义(P<0.001);术后12个月,两组踝关节内侧间隙维持在正常范围,组间对比差异无显著性意义(P>0.05);③术后6,12个月,两组患者美国矫形外科足踝协会评分较术前显著升高(P<0.001),相应时间点,两组美国矫形外科足踝协会评分相比差异均无显著性意义(P>0.05);④提示缝合锚钉技术与经内踝修复三角韧带深层损伤均能恢复踝关节内侧间隙、有效维持踝穴的稳定性,获得良好的临床疗效。

Suture Button装置修复下胫腓联合损伤的初步报告

[目的]探讨Suture Button装置治疗下胫腓联合损伤后的手术方法及临床效果。[方法]对截止于2007年9月利用Suture Button装置固定的下胫腓联合急、慢性损伤的13例病人进行连续随访观察,通过术后X线片数字化测量和标准的踝足功能评分,评估其疗效并探讨临床应用前景。[结果]除1例病人因术后短期再次创伤意外,行2次手术更换为传统螺钉内固定外,其余病人均在术后6周开始部分负重功能锻炼,术后第3个月功能平均评分达到满意,术后第6、12个月功能平均评分达到优良,X线片未发现内固定失效。[结论]Suture Button装置治疗下胫腓联合损伤具有技术简单、手术时间短、内固定器物理特性符合人体正常解剖生理、固定强度足够、无需2次手术取出等多项优势,可能成为下胫腓联合损伤新的治疗标准。

关节镜下Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折

目的 ：探讨关节镜下复位、Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折的手术方法及临床疗效。方法：2010年3月至2012年9月,对6例膝关节前交叉韧带（ACL）胫骨端止点撕脱骨折患者,在关节镜下行撕脱骨块解剖复位、Suture-Bridge线桥技术ACL止点胫骨端足印重建术。ACL止点撕脱骨折Meyers-Mc KeeverZaricznyj分型：Ⅲ型2例,Ⅳ型4例;其中男2例,女4例;年龄14～52岁,青少年2例,分别为男14岁和女15岁）。术前患膝前抽屉试验及Lachman试验均呈阳性。结果：所有患者获随访,时间均超过2年。术后患膝前抽屉试验及Pivotshift均阴性,无伸膝受限。术后影像学复查示ACL止点撕脱骨折均愈合,骨折复位良好,ACL走行正常。术后3个月及1、2年的Lysholm及IKDC评分均较术前改善。结论 ：关节镜下复位、Suture-Bridge线桥技术止点足印重建前交叉韧带撕脱骨折的手术方式安全有效,实现ACL胫骨止点解剖重建,尤其适用于撕脱骨块碎裂严重或胫骨骨骺未闭合的青少年患者。

Suture-anchor锚钉在Weber C型踝关节骨折合并下胫腓联合损伤中的应用

目的 研究Suture-anchor锚钉修复下胫腓前韧带在Weber C型踝关节骨折合并下胫腓联合损伤中的临床应用效果。方法 回顾性分析延安大学附属医院2017年3月至2021年3月间收治的84例Weber C型踝关节骨折合并下胫腓联合损伤患者的临床资料,根据患者下胫腓前韧带修复方法将其分为锚钉组(Suture-anchor锚钉修复,n=39)与螺钉组(皮质骨螺钉内固定,n=45),比较两组患者围术期相关指标、复位质量以及术后6个月美国足踝外科协会(AOFAS)踝足评分系统和踝关节Baird-Jackson功能得分情况。结果 锚钉组患者的手术耗时和术中透视次数分别为(103.69±17.79) min、(14.49±3.36)次,明显短(少)于螺钉组的(126.41±20.15) min和(18.41±4.15)次,差异均具有统计学意义(P<0.05);锚钉组患者的下胫腓联合前间距(ITFACS)为(1.86±0.26) mm,明显短于螺钉组的(2.79±0.32) mm,差异有统计学意义(P<0.05),但两组患者的下胫腓联合后间距(ITFPCS)比较差异无统计学意义(P>0.05);锚钉组患者的骨折愈合时间及术后恢复正常工作时间分别为(3.26±0.43)个月和(3.43±0.63)个月,明显短于螺钉组的(3.61±0.39)个月和(3.79±0.71)个月,差异均有统计学意义(P<0.05);术后6个月,两组患者的Baird-Jackson功能评分系统得分及AOFAS踝足功能量表得分比较差异均无统计学意义(P>0.05);锚钉组患者术后并发症发生率为2.56%,略低于螺钉组的17.78%,但差异无统计学意义(P>0.05)。结论 与皮质骨螺钉内固定比较,带线骨锚钉内固定在治疗Weber C型踝关节骨折合并下胫腓联合损伤中更具优势,其可有效增加下胫腓联合前切迹的解剖复位率,且安全性高。

纤维带与无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤

背景:Lisfranc韧带是维持足部横弓与纵弓的重要结构,Lisfranc损伤为一种严重的中足损伤。Lisfranc韧带损伤是复杂的,其治疗以及首选的固定方法有争议。目的:比较钢板联合Suturetape与钢板联合无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤的短期疗效。方法:回顾性分析东莞市中医院骨七科2019年1月至2022年6月因第1,2跖骨近端粉碎性骨折Lisfranc损伤患者48例,其中25例采用钢板联合Suture tape固定(观察组),23例采用钢板联合无头加压螺钉固定(对照组)。术前参照影像学资料,根据Myerson分类系统进行分型;术后随访根据骨折愈合时间、目测类比评分、美国足踝外科学会标准评估足功能恢复情况,并对两组术后并发症进行比较分析。结果与结论:①两组患者均顺利完成手术并获得随访,随访时间12-36个月,平均(18.0±5.42)个月;②两组患者手术时间、术中出血量比较差异均无显著性意义(P>0.05);③观察组较对照组骨折愈合时间稍长,差异有显著性意义(P<0.05);④术后3,6,12个月随访,观察组较对照组目测类比评分明显降低(P<0.05);⑤术后6,12个月,观察组术后各时间点随访足功能AOFAS评分较螺钉组明显改善(P<0.05),且均较术前显著提高(P<0.05);⑥术后观察组出现1例创伤性关节炎,对照组出现1例切口感染、1例螺钉断裂及2例创伤性关节炎,两组比较差异无显著性意义(P>0.05),考虑与样本量偏少有关;⑦提示对于第1,2跖骨近端粉碎性骨折Lisfranc损伤,实施钢板联合Suture tape内固定治疗Lisfranc关节损伤效果可靠,可改善患者足关节功能,且具有手术创伤小、术后并发症少、远期医源性创伤性关节炎风险低的优势,较无头加压钉更有利于足功能的恢复。

Suture Endobutton与跖肌腱重建Lisfranc韧带的生物力学对比研究

目的通过Suture Endobutton与跖肌腱重建Lisfranc韧带的生物力学对比研究,评价两种方法对恢复Lisfranc关节稳定性的作用,为临床治疗Lisfranc损伤提供理论依据。方法选取10例成人新鲜尸体小腿标本,依次制备Lisfranc韧带完整模型、损伤模型及损伤后的Suture Endobutton或跖肌腱重建模型,并分别给予轴向或外展载荷,记录内侧楔骨（C1）～第2跖骨（M2）基底的平均位移变化。结果轴向载荷和外展载荷下,完整模型C1～M2的平均位移变化分别为（0.70±0.05）mm、（1.21±0.10）mm,损伤模型为（1.59±0.07）mm、（3.73±0.11）mm,Suture Endobutton重建模型为（0.84±0.04）mm、（1.29±0.06）mm,跖肌腱重建模型为（1.01±0.05）mm、（1.34±0.05）mm。轴向或外展载荷下,完整模型和重建模型C1～M2间位移变化明显小于损伤模型,差异具有统计学意义（P〈0.05）;重建模型的位移变化略大于完整模型,但差异无统计学意义（P〉0.05）;Suture Endobutton与跖肌腱重建模型之间位移变化相似,差异无明显统计学意义（P〉0.05）;任一模型外展载荷时的C1～M2位移变化大于轴向载荷。结论 （1）在恢复Lisfranc关节稳定性上,Suture Endobutton与跖肌腱的重建方法提供的生物力学强度相似;（2）相对于轴向载荷的位移变化,外展载荷的实验结果差异更加明显,推荐使用外展载荷进行Lisfranc关节相关力学试验。

V-Locsutures与普通可吸收线在后腹腔镜肾部分切除术中应用比较

目的:比较V-Loc sutures与普通可吸收线在后腹腔镜肾癌部分切除术中的应用价值。方法:2012年5月-2013年6月,本手术组共收治了25例确诊的病理分期为T1N0M0的肾癌患者,其中12例术中肾脏创面缝合均采用V-Loc sutures,其中男9例,女3例,年龄28-68岁,平均48.2岁;肿瘤大小为0.9-4.7cm,平均2.8cm;另13例术中采用普通可吸收线缝合创面,其中男8例,女5例,年龄34-74岁,平均45.5岁;肿瘤大小为1.2-4.5cm,平均2.6cm;比较两组患者手术中的手术时间、术中出血量、肾动脉阻断时间、创面缝合时间、各组手术前后测血肌酐、胱抑素C变化,术后并发症。结果:25例手术均在后腹腔镜下顺利完成。V-Loc sutures组和普通可吸收线组手术时间、术中出血、肾动脉阻断时间、肾创面缝合时间均有差异(P<0.05);V-Loc sutures组手术前后血肌酐、胱抑素C无明显差异(P>0.05),普通可吸收线组手术前后血肌酐、胱抑素C有差异(P<0.05);V-Loc sutures组出现1例血尿,普通可吸收线组出现1例漏尿。结论:V-Loc sutures较普通可吸收线可缩短手术时间及肾创面缝合时间,减少术中出血,更好的保护小肾癌患者的肾功能。