外伤性白内障的人工晶体植入术

我院1991年1月至1992年9月对20例(20眼)外伤性白内障施行了现代白内障囊外摘除术,并一期或二期植入人工晶体,术后取得了良好的效果,无严重并发症。本文讨论了该手术的操作要点、术后并发症的原因预防和处理、人工晶体植入失败的原因及预防。强调术中充分的麻醉和软化眼球是人工晶体植入成功的保证。手术操作精细、轻巧、严格对扩大手术适应症及提高手术成功率有很重要的意义。

AN EXPERIMENTAL STUDY OF THE TUMOUR NECROSIS FACTOR LEVELSIN AQUEOUS HUMOR AFTER TRAUMATIC CATARACT AND INTRAOCULAR LENS IMPLANTATION

Purpose. This paper studies the tumour necrosis factor (TNF) levels in aqueous humor after traumatic cataract extraction and posterior chamber (PC) intraocular lens (IOL) implantation in rabbits,and discusses the effect of TNF on postoperative anterior ocular inflammation. Methods. Twenty seven pigmented rabbits were divided into three groups: for the first group, the IOL were placed in the capsular bag after traumatic cataract extraction; for the second, the Extracapsular cataract extraction without IOL implantation; and for the third, the control group without surgical intervention. On the 1st, 3rd, 7th and 14th day postoperatively, aqueous humor samples were obtained. A modified double antibodies indirect sandwich ELISA was used to detected for the presence of TNF. The data were studied by means of analysis of variance in SAS software. Result. The TNF level was increased in aqueous humor and reached its maximum on the 1st postoperative days after traumatic cataract extraction and PC IOLs implantation, and the TNF levels are significantly higher (P<0 05) on the 1st, 3rd, 7th and 14th day postoperatively in traumatic cataract extraction and PC IOL implanted group than that in the non surgical intervention group and extracapsular cataract extraction group. Conclusions. The increase of TNF levels had a close relationship with presence of the IOL itself which induces the secretion of TNF. This suggested that TNF as the principal mediators of immunological and inflammatory responses, so that may play critical role in anterior ocular inflammative response after traumatic cataract extraction and IOL implantation.

Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures

Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.

MEMS biomedical implants

The field of micro-electro-mechanical systems(MEMS) has advanced tremendously for the last 20 years.Most commercially noticeably,the field has successfully advanced from pressure sensors to micro physical sensors,such as accelerometers and gyros,for handheld electronics application.In parallel,MEMS has also advanced into micro total analysis system(TAS) and/or lab-on-a-chip applications.This article would discuss a relatively new but promising future direction towards MEMS biomedical implants.Specifically,Parylene C has been explored to be used as a good MEMS implant material and will be discussed in detail.Demonstrated implant devices,such as retinal and spinal cord implants,are presented in this article.

Cephalomedullary fixation for femoral neck/intertrochanteric and ipsilateral shaft fractures： surgical tips and pitfalls

Objective： Surgical management options for femoral shaft fracture and ipsilateral proximal fe- mur fracture vary from single-implant to double-implant fixation. Cephalomedullary fixation in such fractures has rela- tive advantages over other techniques especially because of less soft tissue dissection and immediate postoperative weight beating with accelerated rehabilitation. However, the surgery is technically demanding and there is a paucity of literature describing the surgical techniques for this fixation. The aim of the study was to describe the surgical technique of cephalomedullary fixation for femoral shaft fracture and ipsilateral proximal femur fracture. Methods： Sixteen cases （10 males and 6 females with a mean age of 41.8 years） of ipsilateral proximal femur and shaft fractures were treated by single-stage cephalomedullary fixation at tertiary level trauma center in northern India. The fractures were classified according to AO classification. An intraoperative record of duration of surgery as well as technical challenges unique to each fracture pattern was kept for all the patients. Results： The most common proximal femoral pattern was AO B2.1 observed in 9 of our patients. The AO B2.3 fractures were seen in 4 patients while the AO A1.2 fractures in 3 patients. Four of the AO B2.1 and 2 of the AO B2.3 frac- tures required open reduction with Watson-Jones approach. The mean operative time was around 78 minutes, which tended to decrease as the surgical experience increased. There was only one case of malreduction, which required revision surgery. Conclusion： Combination of ipsilateral femoral shaft fracture and neck/intertrochanteric fracture is a difficult frac- ture pattern for trauma surgeons. Cephalomedullary nail is an excellent implant for such fractures but it requires careful insertion to avoid complications. Surgery is technically demanding with a definite learning curve. Nevertheless, a majority of these fractures can be surgically managed by single- implant cephalomedullary fixation by following basic surgical principles that have been summarized in this article.

Additive manufactured metallic implants for orthopaedic applications

Metallic implants are commonly used in various orthopaedic surgeries, like fracture fixation, spinal instrumentation, joint replacement and bone tumour surgery.Patients may need to adapt to the fixed dimensions of the standard implants. It may result in suboptimal fit to the host bones and possible adverse clinical results. The standard traditional implants may not address the reconstructive challenges such as severe bone deformity or bone loss after implant loosening and bone tumour resection. With the advent of digital technologies in medical imaging, computer programming in three-dimensional（3 D） modelling and computer-assisted tools in precise placement of implants, patient-specific implants（PSI） have gained more attention in complex orthopaedic reconstruction. Additive manufacturing technology, in contrast to the conventional subtractive manufacturing, is a flexible process that can fabricate anatomically conforming implants that match the patients’ anatomy and surgical requirements. Complex internal structures with porous scaffold can also be built to enhance osseointegration for better implant longevity. Although basic studies have suggested that additive manufactured（AM） metal structures are good engineered biomaterials for bone replacement, not much peer-reviewed literature is available on the clinical results of the new types of implants. The article gives an overview of the metallic materials commonly used for fabricating orthopaedic implants, describes the metal-based additive manufacturing technology and the processing chain in metallic implants; discusses the features of AM implants;reports the current status in orthopaedic surgical applications and comments on the challenges of AM implants in orthopaedic practice.