Surgical Treatment of Osteonecrosis of the Femoral Head Using Minimally Invasive Surgical Drilling and Cancellous Grafting at Brazzaville University Hospital

Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.

Arthroscopy Assisted Lesion Clearance and Bone Graft, Titanium Rod Support Treatment of Early Stage Osteonecrosis of the Femoral Head of the Postoperative Survival Rate Analysis

Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74 hips) were diagnosed as stage II femoral head necrosis according to the ARCO staging system during 2003-2013. In these patients, 15 hips were stage IIA, 34 hips were stage IIB and 25 hips were stage IIC. Located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. Follow-up including the pain score, the Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis. Result: The VAS score and the Harris score after operation were better THRAn THRAt of before the surgery, the difference had statistical significance (p Conclusion: Arthroscopy assisted lesion clearance, bone graft and titanium rod support to treat the stage II osteonecrosis of the femoral head are effective and can prevent the femoral head from collapsing. But for stage IIC patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.

Titanium Alloy Cage Implantation for the Treatment of Ischemic Necrosis of Femoral Head in Dogs

To study the effect of titanium alloy cage on the treatment of the ischemic necrosis of femoral head in dog, the model of the ischemic necrosis of femoral head was made with the liquid nitrogen in 15 hybrid adult dogs. The titanium alloy cage made of a hollow cylinder was driven into the subchondral bone of necrotic femoral head via central channel. The dogs were divided into 3 groups, each group was sacrificed 3, 6, 12 weeks after the operation respectively. No collapse of femoral head was observed after the operation. The position of the cages was good on radiograph. Microscopically, the cancellous bone of necrotic femoral head rebuilt gradually and grew into cage. After 12 weeks of creeping substitution, the cancellous bone filled up the hollow cavity and holes of the cages. It is concluded that the titanium alloy cage can provide structural support for the subchondral bone and prevent collapse and can be used for the treatment of the ischemic necrosis of femoral head.

Application of positron emission tomography/computed tomography in radiation treatment planning for head and neck cancers

18-fluorodeoxygluocose positron emission tomography/computed tomography(18FDG-PET/CT) provides significant information in multiple settings in the management of head and neck cancers(HNC). This article seeks to define the additional benefit of PET/CT as related to radiation treatment planning for squamous cell carcinomas(SCCs) of the head and neck through a review of relevant literature. By helping further define both primary and nodal volumes, radiation treatment planning can be improved using PET/CT. Special attention is paid to the independent benefit of PET/CT in targeting mucosal primaries as well as in detecting nodal metastases. The utility of PET/CT is also explored for treatment planning in the setting of SCC of unknown primary as PET/CT may help define a mucosal target volume by guiding biopsies for examination under anesthesia thus changing the treatment paradigm and limiting the extent of therapy. Implications of the use of PET/CT for proper target delineation in patients with artifact from dental procedures are discussed and the impact of dental artifact on CT-based PET attenuation correction is assessed. Finally, comment is made upon the role of PET/CT in the high-risk post-operative setting, particularly in the context of radiation dose escalation. Real case examples are used in these settings to elucidate the practical benefits of PET/CT as related to radiation treatment planning in HNCs.

Surgical treatment of pancreatic head cancer: concept revolutions and arguments

As we have a deeper and more thorough understanding of the biological behavior of pancreatic head cancer, surgical treatment concepts of this lethal disease are changing all the time. Meanwhile, numerous arguments emerge. Thus, we will probe into the focuses and arguments in the surgical treatment of pancreatic head cancer in this article, including the scope of lymphadenectomy, total mesopancreas excision（TMp E）, vascular resection, minimally invasive pancreaticoduodenectomy（PD）, palliative resection, surgery for recurrent disease and surgery for primary pancreatic cancer and liver metastasis.

Treatment of Fracture Dislocation of the Femoral Head in a Resource Limited Country (Burundi)

Introduction: Fractures of the femoral head are rare injuries which generally follow a traumatic dislocation of the hip or in a poly-trauma scenario. A fracture dislocation of the femoral head is an orthopedic emergency. The most frequent complications after a fracture of the femoral head are osteonecrosis, post traumatic arthritis and heterotopic ossification. Objective: To focus on the therapeutic aspect of fracture-dislocations of femoral head and their short- and long-term prognoses. Materials and Methods: This is a prospective study conducted at Kamenge teaching hospital and Rohero Christian medical and surgical clinic from January 2013 to August 2020. All patients diagnosed with fracture-dislocations of the femoral head were included in this study. Results: Five patients were admitted for fracture dislocation of the femoral head. The mean age was 40.4 years and varied between 25 and 55 years. The dashboard injury was the most common mechanism and was found in four patients (80%). A standard x-ray was performed for the five patients as well as CT scans in two cases. All patients had posterior iliac dislocations with fractures of the femoral head classified as Pipkin I in three patients and Pipkin III in two patients. Closed reduction under general anesthesia within six hours was possible in one among the five patients and within 12 hours in two patients. These three cases were managed with open reduction and internal fixation (ORIF) via anterior approach with screw fixation of the femoral head fragment. In the two remaining patients reduction was not possible and for one of them there was a femoral neck fracture following closed manipulation, making the fracture Pipkin III. The two patients with Pipkin III injuries were managed with total hip replacement. With an average follow up of five years, standard x-rays of the three patients who had ORIF showed fracture union without avascular necrosis, posttraumatic arthritis or heterotopic ossification. The functional results for the five patients with an average follow up of four years were very good (3/5) and good (2/5). Conclusion: The diagnosis of fracture dislocations of the femoral head was based on clinical, radiographic and computed tomography criteria. Early reduction and internal fixation can restore the natural anatomy of the hip joint, especially in young adults with a good long-term prognosis. Sometimes total hip replacement is necessary for management of fracture dislocations of the femoral head.

The clinical characteristics and treatment of head trauma patients with skull defect

Objective To investigate the clinical characteristics and therapeutic of head trauma patients with skull defect. Methods A retrospective study of clinical data of 47 brain injury patients with skull defect in our hospital from Janary 1993 to Janary 2009 was performed. Results Compared with

Treatment Outcomes in Head and Neck Cancer Patients 80 Years Old and over

Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P;range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.

Current concepts on osteonecrosis of the femoral head

It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. Thelack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging(MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures(FHSP) and femoral head replacement procedures(FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated.

On-line spheroidization process of medium-carbon low-alloyed cold heading steel

Conventionally manufactured 35CrMo cold heading steel must undergo spheroidization annealing before the cold heading process In this paper, different types of deformation processes with various controlled cooling periods were operated to achieve on-line spheroidal cementite using the Gleeble-3500 simulation technique. According to the measured dynamic ferrite transformation temperature （Ad3）, the deformation could be divided into two types： low temperature deformation at 810 and 780℃; ＂deformation-induced ferrite transformation＂ （DIFT） deformation at 750 and 720℃. Compared with the low temperature deformation, the DIFT deformation followed by accelerated cooling to 680℃ is beneficial for the formation of spheroidal cementite. Samples subjected to both the low-temperature deformation and DIFT deformation can obtain granular bainite by accelerated cooling to 640℃; the latter may contribute to the formation of a fine dispersion of secondary constituents. Granular bainite can transform into globular pearlite rapidly during subcritical annealing, and the more the disperse phase, the more homogeneously distributed globular cementite can be obtained.

多学科诊疗模式下翻转课堂在头颈肿瘤临床教学中的应用

目的探讨多学科诊疗(multidisciplinary diagnosis and treatment,MDT)模式下翻转课堂在头颈肿瘤临床教学中的应用效果。方法于2022年9月—2023年3月选取重庆医科大学附属第一医院耳鼻咽喉头颈外科2020年9月、2021年9月及2022年9月入学的36名专业学位研究生,采用随机数字表法分为对照组和试验组,每组各18名。对照组采用传统的教学模式,试验组采用MDT模式下翻转课堂教学模式。教学完成后,采用试卷答题的形式评价2组的知识点掌握情况,通过问卷调查形式完成学生对教学模式的满意度的评价。结果试验组的理论成绩[(40.22±4.43)分]、临床病例分析成绩[(36.11±4.34)分]均高于对照组[(41.11±3.43)分、(34.22±4.30)分],差异有统计学意义(P<0.05)。试验组的自主学习能力[(88.06±5.10)分]、主动参与感[(88.61±4.00)分]、团队协作能力[(89.78±3.57)分]、医患沟通能力[(87.44±5.20)分]、创新实践能力[(82.83±4.21)分]、临床思维能力[(89.83±3.45)分]、理论联系实践能力[(88.28±3.67)分]、教学模式满意度[(91.00±3.51)分]、对带教老师的满意度[(90.33±4.36)分]、学习兴趣[(90.22±3.44)分]等方面的评分均高于对照组[(67.39±5.79)分、(71.44±4.07)分、(66.06±5.15)分、(78.61±4.57)分、(71.50±3.67)分、(67.89±4.23)分、(67.89±3.48)分、(78.72±4.75)分、(80.56±4.89)分、(80.94±2.30)分],差异有统计学意义(P<0.05)。结论MDT模式下翻转课堂在头颈肿瘤临床教学中的教学效果良好,能够充分调动学生的主观能动性,培养学生的自主学习能力。

Evolution of Nonmetallic Inclusion during Steelmaking Process of Cold Heading Steel SWRCH35K

In order to analyze the evolution of the inclusions in the cold heading steel SWRCH35K during the steelmaking process, a systematic sampling of the steelmaking processes in a steel plant was carried out. Both SEM-EDS and the image processing software Image-Pro-Plus6.0 were employed to analyze the chemical composition, morphology, quantity and size of non-metal inclusions in the steel samples. The results show that from BOF tapping to continuous casting tundish, the composition of inclusions in SWRCH35K steel changes from Al2O3 →MgO·Al2O3 →CaO-MgO-Al2O3-CaS, and the typical morphology of the inclusions in the steel gradually changes from irregular blocks and clusters to spherical. The number of inclusions in the BOF argon blowing station is the largest, 213#/mm2, while the number of inclusions at the end of LF refining is the least, about 12#/mm2, and there are basically no inclusions above 5 μm. In addition, LF calcium treatment will adversely affect the size and quantity control of inclusions in steel. In order to effectively reduce the large-size calcium-containing spherical oxide inclusions in cold heading steel, it is necessary to find a technical method that can replace LF calcium treatment to solve the problem of molten steel continuous casting.

头颈部血管瘤及脉管畸形手术治疗专家共识

血管瘤及脉管畸形是头颈部常见的良性脉管源性疾病,随着对非手术治疗方案的深入研究与广泛应用,大量患者在微创或无创情况下得以改善或治愈疾病,但在特定情况下,手术依然是血管瘤及脉管畸形综合序列治疗中不可替代的治疗手段。然而,针对头颈部血管瘤及脉管畸形,如何选择和应用手术诊疗技术,学术界尚未形成规范和共识。为进一步提高国内同行对头颈部血管瘤及脉管畸形的治疗水平,规范和统一手术治疗策略,本文汇集全国多所医学院校及附属医院相关专家的讨论意见,借鉴和参考国内外相关最新成果与诊治经验,从头颈部血管瘤及脉管畸形的临床诊断及术前准备、手术适应证及策略、术后护理及观察、术后常见并发症及处理、随访及社会心理支持等方面,制定此专家共识,以帮助和指导相关专业的医师开展规范化手术治疗。

稀土Ce对20MnTiB冷镦钢中夹杂物演变的影响

工业化实验生产不同稀土(Ce)含量的20MnTiB冷镦钢,通过实验观察和热力学计算,研究了在Ca处理的基础上,Ce对20MnTiB冷镦钢生产过程中夹杂物演变的影响。结果表明,经Ce处理后,大尺寸类球状Al_(2)O_(3)·MgO·CaO·CaS夹杂物被变质分解为1μm左右类球状的CeAlO_(3)·MgO·CaO·CaS夹杂物,2μm左右不规则状的该类型夹杂物被变质球化。热轧后,0Ce试样盘条中夹杂物沿轧制方向拉长,夹杂物尺寸更大,形状愈发不规则,此外,还发现长条状MnS夹杂物。而在27Ce试样中,经Ce处理后w[S]降低40%,抑制了凝固过程中MnS夹杂物的形成,且经轧制后,盘条中夹杂物小尺寸、类球状的特性并未发生改变。热力学计算结果与实验结果相吻合。Ce处理后,大尺寸、不规则夹杂物的变质分解、小尺寸、不规则状夹杂物的变质球化以及MnS夹杂物的消失,避免了在冷镦过程中由于夹杂物不规则形貌引起的应力集中,从而有利于实验钢冷镦性能的提升。研究结果可为进一步开发新型稀土微合金化冷镦钢提供技术和理论支撑。

自体股骨头结构植骨重建髋臼辅助THA在改良CROWE Type ⅣB型DDH中的临床疗效分析

目的:分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术(total hip arthroplasty,THA)治疗改良Crowe TypeⅣB型成人髋关节发育不良性脱位(developmental dysplasia of the hip,DDH)患者的临床疗效。方法:按照改良Crowe分型,选取山东大学齐鲁医院德州医院关节外科2015年8月至2023年3月收治的TypeⅣB型DDH患者26例,其中男25例,女1例,采用自体股骨头结构植骨重建髋臼辅助THA,记录患者手术时间、术中失血量、术中术后输血量、术后血红蛋白、手术相关并发症和骨愈合时间等,并行骨盆正位X线片了解假体位置、假体骨长入、假体松动以及骨愈合情况等,采用视觉模拟评分表(visual analogue scale,VAS)评价髋关节的疼痛不适,采用髋关节Harris评分和Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)来评价髋关节功能及临床疗效。结果:所有患者的平均随访时间(9.73±8.35)个月,术中出血平均为(715.38±143.37) mL,术中平均输血(415.38±282.41) mL,手术时间平均为(118.62±18.27) min,术后平均输血为(192.31±236.51) mL。所有患者转子下骨端、自体股骨头和假臼之间均骨愈合良好。髋关节VAS评分从术前6.73±0.45,至术后末次随访时VAS评分1.73±0.53,差异有统计学意义(P=0.000),髋关节活动度均较术前明显改善,髋关节Harris评分从术前24.27±1.66,至术后末次随访时Harris评分74.77±2.89,差异有统计学意义(P=0.000),WOMAC术前术后评分分别为130.08±5.72和67.85±3.23,差异均有统计学意义(P=0.000)。结论:自体股骨头结构植骨重建髋臼辅助THA治疗改良Crowe TypeⅣB型DDH,具有操作相对简单、固定牢固、手术相对安全和疗效确切的优点。

循经排刺配合马氏功能锻炼法治疗股骨头缺血性坏死72例

目的:观察循经排刺配合马氏功能锻炼法对股骨头缺血性坏死(Avascular Necrosis of Femoral Head,ANFH)的临床疗效,通过针刺配合功能锻炼法减轻患者病痛,改善髋关节活动度,使其可完成简单的基本生活动作。方法:采用随机数字表法分为针刺组、功能锻炼组和综合治疗组。针刺组采用循足三阴经针刺,功能锻炼组采用名老中医马在山教授独创功能锻炼法(松髋解凝法、点穴拨筋法、展筋环摇法、抗阻力运髋法、理筋舒筋法、拔伸牵摇法),综合治疗组结合上述两种方法。分别于治疗前、治疗7次、14次及21次后采用视觉模拟评分法(Visual Analogue Scale,VAS)及髋关节功能评分(Harris评分)指标进行评定。结果:通过对三组患者7次、14次、21次治疗VAS评分比较,三组7次、14次治疗后在改善疼痛中均无统计学意义,21次治疗后综合组明显优于针刺组。功能锻炼组,差异具有统计学意义(P<0.01)。三组患者7次、14次、21次治疗后Harris评分比较,差异无统计学意义;总有效率比较显示,综合治疗组疗效明显优于针刺组和功能锻炼。结论:通过循足三阴经排刺,依据“经脉所过,主治所及”理论,疏通局部经络气血,行气活血通络止痛,与马氏功能锻炼相结合,可有效改善患髋的血液循环,减轻关节囊内压力和髓腔水肿。同时缓解因疼痛造成的肌肉痉挛,使紧张、拘急的肌肉松弛,从而增加关节活动度。

中西医治疗股骨头坏死的研究进展

股骨头坏死(ONFH)是一类股骨头局部血供受损或中断,引起骨细胞及骨髓成分死亡,继而导致骨结构改变,股骨头塌陷,造成关节功能障碍的疾病。主要临床表现为髋关节疼痛,活动障碍,治疗不及时或治疗不当往往导致病情加重,严重影响生活。中医治疗主要包括中药汤剂、针刀、熏洗等,西医治疗以手术干预或关节置换为主。本文旨在对相关的治疗手段进行简要介绍,为临床治疗方式的选择提供参考。

犬神经源性肺水肿病例报告

本院接诊1例因头部创伤后呼吸急促患犬,为了对其所患疾病进行诊治,通过体格检查、实验室检查和影像学检查进行诊断,并根据诊断结果进行治疗。X线检查结果提示,该患犬为非心源性肺水肿,结合病史和实验室检查结果最终诊断为神经源性肺水肿(NPE)。采取直流式吸氧、注射布托菲诺镇静和呋塞米利尿进行治疗,18 h后患犬症状明显缓解。该病例诊疗结果表明,头部创伤引起NPE的动物,采取恰当的对症治疗,预后良好。

头颈癌治疗诱发的淋巴水肿:临床因素和预后分析

目的:探讨头颈部恶性肿瘤患者淋巴水肿的严重程度与其相关临床数据之间的关系。方法:对接受多模式治疗的79例头颈癌患者进行回顾性研究。基于术后6个月以上的磁共振成像结果进行淋巴水肿诊断和分级,通过查阅电子病历和电话随访获取相关信息。采用SPSS 26.0软件包对数据进行统计学分析。结果:随着TNM分期、颈淋巴清扫范围的增加,患者淋巴水肿重度率增加。术前接受药物诱导化疗的患者与未接受化疗的患者相比,淋巴水肿重度率更高。不同严重水肿程度患者无瘤生存期无统计学差异。结论:头颈部淋巴水肿的发生与肿瘤分期、淋巴清扫的程度以及综合治疗方式有一定相关性,仍需进一步关注和研究。

活血化瘀合滋补肝肾法对肾虚血瘀证早中期股骨头缺血性坏死患者的临床疗效

目的 探讨活血化瘀合滋补肝肾法对肾虚血瘀证早中期股骨头缺血性坏死患者的临床疗效。方法 82例患者随机分为对照组和观察组,每组41例,对照组给予常规治疗,观察组在对照组基础上加用活血化瘀合滋补肝肾法,疗程3个月。检测临床疗效、Harris评分、VAS评分、骨密度、血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度)、骨代谢指标(OPN、OPG、OST、CTX-Ⅰ)变化。结果 观察组总有效率高于对照组(P<0.05)。治疗后,2组Harris评分、VAS评分、血液流变学指标、OPN、OST、CTX-Ⅰ降低(P<0.05),骨密度增加(P<0.05),OPG升高(P<0.05),以观察组更明显(P<0.05)。结论 活血化瘀合滋补肝肾法可提高肾虚血瘀证早中期股骨头缺血性坏死患者髋关节功能,增加骨密度,减轻疼痛,改善血液流变学、骨代谢水平。