目的探析微创Chevron-Akin截骨术治疗轻中度拇外翻的早期效果。方法选择自2022年1月至2024年6月淮阳楚氏骨科医院收治的61例轻中度拇外翻患者作为研究对象,均采取微创Chevron-Akin截骨术进行治疗,比较手术前后拇外翻角、美国骨科足踝外...目的探析微创Chevron-Akin截骨术治疗轻中度拇外翻的早期效果。方法选择自2022年1月至2024年6月淮阳楚氏骨科医院收治的61例轻中度拇外翻患者作为研究对象,均采取微创Chevron-Akin截骨术进行治疗,比较手术前后拇外翻角、美国骨科足踝外科协会(American Association of Orthopaedic and Ankle Surgeons,AOFAS)前足评分等情况。结果治疗后患者拇外翻角、第1、2跖骨间角较治疗前降低,差异有统计学意义(P<0.05)。治疗后患者AOFAS前足评分(88.64±3.08)分较治疗前(55.85±2.53)分明显提高,差异有统计学意义(P<0.05)。结论微创Chevron-Akin截骨术治疗轻中度拇外翻可明显改善拇外翻程度,恢复时间较短,且并发症少。展开更多
BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to pat...BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.展开更多
Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to id...Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.展开更多
Background: Four factors determine the quality of an implantology kit: 1) Heat generated by the drills;2) Morphology of the osteotomy according to the diameter of the implant;3) Efficiency of collecting autologous bon...Background: Four factors determine the quality of an implantology kit: 1) Heat generated by the drills;2) Morphology of the osteotomy according to the diameter of the implant;3) Efficiency of collecting autologous bone;and 4) Osteotomy execution time. Materials and Methods: This article examines the heat produced by drills during osteotomy, focusing on the effect of the following factors: drilling technique;volume of autologous bone harvested;drilling time;implant primary stability;and the percentage of osseointegrated implants after primary healing. Discussion: The four factors mentioned above are analyzed based on the data obtained for sequential, biological, and One Drill milling techniques. Conclusions: 1) One Drill is the fastest technique for performing the osteotomy;2) All techniques stay within the biological temperature range of living bone, with the lowest increase in temperature achieved using One Drill with irrigation;3) The bone harvested showed no statistically significant differences between biological milling and the One Drill technique, both far superior to the sequential technique;and 4) There is no statistically significant difference in the number of osseointegrated implants among the three techniques analyzed.展开更多
BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been develo...BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.展开更多
BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthri...BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthritis.AIM To evaluate the efficacy of modified high tibial osteotomy(HTO)and anterior cruciate ligament reconstruction(ACLR)in the treatment of anterior cruciate ligament(ACL)injuries with varus deformities and increased posterior tibial slope(PTS)based on clinical and imaging data.METHODS The patient data in this retrospective study were collected from 2019 to 2021.A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS.All patients underwent modified open wedge HTO and ACLR.The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.RESULTS All 6 patients(6 knee joints)were followed up for an average of 20.8±3.7 months.The average age at surgery was 29.5±3.8 years.At the last follow-up,all patients resumed competitive sports.The International Knee Documentation Committee score increased from 50.3±3.1 to 87.0±2.8,the Lysholm score increased from 43.8±4.9 to 86±3.1,and the Tegner activity level increased from 2.2±0.7 to 7.0±0.6.The average movement distance of the tibia anterior translation was 4.8±1.1 mm,medial proximal tibial angle(MPTA)was 88.9±1.3°at the last follow-up,and the PTS was 8.4±1.4°,both of which were significantly higher than those before surgery(P<0.05).CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity.The short-term effect is significant,but the long-term effect requires further follow-up.展开更多
BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Ber...BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.展开更多
Background:Inferior alveolar nerve(IAN)injury is a serious potential complication of orthognathic surgery because the osteotomy cut-line during sagittal split osteotomy(SSO)of the mandible runs close to the mandibular...Background:Inferior alveolar nerve(IAN)injury is a serious potential complication of orthognathic surgery because the osteotomy cut-line during sagittal split osteotomy(SSO)of the mandible runs close to the mandibular canal.According to statistics,9%–85%of patients who undergo such surgery suffer from complications.It causes neurosensory disorders(NSD)of the lower lip and chin with a wide variety of symptoms such as numbness,hypoesthesia,hyperesthesia,hypoalgesia,hyperalgesia,and allodynia.However,the accurate planning and thorough analysis using cone-beam computed tomography helps improve the predictability of possible IAN damage by considering the specific anatomical features of each patient and all risk factors.This study aimed to review the frequency of IAN occurrence,risk factors,and diagnostic,prophylactic,and treatment methods used for inferior alveolar nerve regeneration and IAN sensory disturbance recovery following SSO of the mandible.Methods:We conducted a comprehensive literature search(2020–2024)across PubMed,Scopus,Google Scholar,and ScienceDirect,focusing on mandibular SSO complications,IAN damage,nerve regeneration,and treatments such as corticosteroids,vitamin B12,platelet concentrates,and low-level laser therapy.All systematic review,randomized controlled trial,controlled clinical trial,or retrospective/prospective study involving both animals and humans were included.Results:Surgeons prescribed medicines for general therapy before surgery and applied intraoperative treatment methods to minimize the degree of NSD manifestation after surgery.Fortunately,majority instances of NSD recover spontaneously by 6 months after the operation;however,if symptoms persist after 1 year,it is considered permanent NSD,which may cause a significant decrease in quality of life.In the postoperative period,assessing neurosensory disturbances with subjective(questionnaires)and objective tests(light touch,2-point discrimination tests,and others),or their combination,is necessary for determining the management.According to recent studies,dexamethasone,a complex of vitamin B,melatonin,and low-level lasers,is actively used in inferior alveolar nerve regeneration during and after SSO.Moreover,isolated studies have reported the intraoperative use of platelet concentrates during SSO.Conclusion:The mentioned treatment methods demonstrated positive results in decreasing NSD.However,their effectiveness for IAN regeneration has not been sufficiently studied.展开更多
背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,...背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,分析总结其优势与不足,并探讨未来进一步研究的方向及应用前景。方法:应用计算机在Pub Med、SCI、CBM和中国知网数据库中检索2014年1月至2023年11月发表的相关文献,以“developmental dysplasia(dislocation) of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children”为英文检索词,以“发育性髋关节发育不良,发育性髋关节脱位,髋关节发育不良,儿童,有限元,Pavlik吊带,人字型固定,生物力学,骨盆截骨术,髋臼周围截骨术”为中文检索词,同时纳入少量远期文献,通过筛选最终纳入62篇文献进行分析。结果与结论:(1)儿童发育性髋关节发育不良髋关节力学环境异常,髋臼内部压力不均匀、应力增大并集中,关节接触面积减小,股骨颈局部应力集中;(2)在Pavlik吊带及人字型固定位患髋力学环境改善,集中的高应力区域消失,关节接触面积增加,但外展角度过大会导致髋臼及股骨头外侧应力增加;(3)骨盆截骨术治疗后髋关节及骶髂关节应力环境得到改善,3种截骨术没有单一的铰链,其应力负载部位因患儿年龄而存在差异;(4)髋臼周围截骨术治疗后关节接触压力接近正常,而非球形股骨头者恢复困难;(5)术后X射线片表现不能说明关节接触力学达到最佳;(6)提示利用有限元法可以获得体内无法测量的信息,其在虚拟环境中操作不受时间和伦理的限制;能直观地看到正常与发育性髋关节发育不良患者髋关节应力变化的区域,从力学角度说明治疗的有效性,为需要截骨手术治疗的患者建立特定的有限元模型、量身定做手术计划;发育性髋关节发育不良的有限元建模及儿童髋关节材料特性参数尚无规范、统一的标准,由于有限元固有的局限性,目前还不能分析同时包含骨骼、软骨、韧带、肌肉等元素的模型;有限元分析操作难度较大,虽有优势但不具普适性,且目前的研究样本量较少,还需进一步扩大及验证。展开更多
文摘目的探析微创Chevron-Akin截骨术治疗轻中度拇外翻的早期效果。方法选择自2022年1月至2024年6月淮阳楚氏骨科医院收治的61例轻中度拇外翻患者作为研究对象,均采取微创Chevron-Akin截骨术进行治疗,比较手术前后拇外翻角、美国骨科足踝外科协会(American Association of Orthopaedic and Ankle Surgeons,AOFAS)前足评分等情况。结果治疗后患者拇外翻角、第1、2跖骨间角较治疗前降低,差异有统计学意义(P<0.05)。治疗后患者AOFAS前足评分(88.64±3.08)分较治疗前(55.85±2.53)分明显提高,差异有统计学意义(P<0.05)。结论微创Chevron-Akin截骨术治疗轻中度拇外翻可明显改善拇外翻程度,恢复时间较短,且并发症少。
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
文摘Background: Despite the conservative treatment of tibio-femoral osteoarthritis through realignment osteotomies, the rate of total knee replacements following an osteotomy is increasing. The aim of this study was to identify the factors associated with the progression of knee osteoarthritis after a medial closing-wedge distal femoral osteotomy. Methods: Hospital-based observational study on 20 patients who underwent a medial closing-wedge distal femoral osteotomy evaluating the progression of osteoarthritis using the Kellgren and Laurence classification. The Wilcoxon test was used to compare the variation in the progressive stage of the Kellgren and Laurence classification of knee osteoarthritis preoperatively and at the final follow up. Univariate analysis made it possible to determine the factors associated with progression. The final significance threshold for statistical tests was set at 5% (p Results: Overall, the mean follow-up of 46 months ± 6.6 months, with a mean age of 43 years (range: 27 - 69 years) and a female predominance (M: F = 3/7). The progression of tibiofemoral osteoarthritis following a medial closing-wedge distal femoral osteotomy is associated with valgus or varum malalignment been a moderate valgus (OR 6.2 [1.5 - 42.7] at 95% CI;p-value = 0.02), a correction of the mechanical deviation angle with a valgus alignment (OR 2.7 [0.9 - 8.3] at 95% CI), and loss of correction (OR 3.8 [1.3 - 11.6] at 95% CI;p -value) for the lateral compartment while varus alignment (OR 1.7 [0.9 - 8.3] 95% CI, p-value = 0.05) and with rupture of the lateral cortex (OR 2.8 [1.7 - 11.5] 95% CI, p-value = 0.02) were those of the medial compartment. Conclusion: Distal femur closing wedge osteotomy does not definitively interrupt the progression of valgus knee osteoarthritis. The factors associated with the progression of this pathology are modifiable. Taking them into account when performing this surgical technique could improve the osteotomy survival curve.
文摘Background: Four factors determine the quality of an implantology kit: 1) Heat generated by the drills;2) Morphology of the osteotomy according to the diameter of the implant;3) Efficiency of collecting autologous bone;and 4) Osteotomy execution time. Materials and Methods: This article examines the heat produced by drills during osteotomy, focusing on the effect of the following factors: drilling technique;volume of autologous bone harvested;drilling time;implant primary stability;and the percentage of osseointegrated implants after primary healing. Discussion: The four factors mentioned above are analyzed based on the data obtained for sequential, biological, and One Drill milling techniques. Conclusions: 1) One Drill is the fastest technique for performing the osteotomy;2) All techniques stay within the biological temperature range of living bone, with the lowest increase in temperature achieved using One Drill with irrigation;3) The bone harvested showed no statistically significant differences between biological milling and the One Drill technique, both far superior to the sequential technique;and 4) There is no statistically significant difference in the number of osseointegrated implants among the three techniques analyzed.
文摘BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
文摘BACKGROUND It has been confirmed that the increased posterior tibial slope over 12 degrees is a risk factor for anterior cruciate ligament injury,and varus deformity can aggravate the progression of medial osteoarthritis.AIM To evaluate the efficacy of modified high tibial osteotomy(HTO)and anterior cruciate ligament reconstruction(ACLR)in the treatment of anterior cruciate ligament(ACL)injuries with varus deformities and increased posterior tibial slope(PTS)based on clinical and imaging data.METHODS The patient data in this retrospective study were collected from 2019 to 2021.A total of 6 patients were diagnosed with ACL injury combined with varus deformities and increased PTS.All patients underwent modified open wedge HTO and ACLR.The degree of correction of varus deformity and the PTS was evaluated by radiography and magnetic resonance imaging.RESULTS All 6 patients(6 knee joints)were followed up for an average of 20.8±3.7 months.The average age at surgery was 29.5±3.8 years.At the last follow-up,all patients resumed competitive sports.The International Knee Documentation Committee score increased from 50.3±3.1 to 87.0±2.8,the Lysholm score increased from 43.8±4.9 to 86±3.1,and the Tegner activity level increased from 2.2±0.7 to 7.0±0.6.The average movement distance of the tibia anterior translation was 4.8±1.1 mm,medial proximal tibial angle(MPTA)was 88.9±1.3°at the last follow-up,and the PTS was 8.4±1.4°,both of which were significantly higher than those before surgery(P<0.05).CONCLUSION Modified open wedge HTO combined with ACLR can effectively treat patients with ACL ruptures with an associated increased PTS and varus deformity.The short-term effect is significant,but the long-term effect requires further follow-up.
文摘BACKGROUND Extracorporeal shock wave therapy(ESWT)is increasingly being recognized as an advantageous alternative for treating non-union due to its efficacy and minimal associated complications.Non-union following Bernese periacetabular osteotomy(PAO)is particularly challenging,with a reported 55%delayed union and 8%non-union.Herein,we highlight a unique case of ischial non-union post-PAO treated successfully with a structured ESWT regimen.CASE SUMMARY A 50-year-old patient,diagnosed with left ischial non-union following the PAO,underwent six cycles of ESWT treatment across ten months.Each cycle,spaced four weeks apart,consisted of five consecutive ESWT sessions without anesthesia.Regular X-ray follow-ups showed progressive disappearance of the fracture line and fracture union.The patient ultimately achieved a satisfactory asymptomatic recovery and bone union.CONCLUSION The results from this case suggest that this ESWT regimen can be a promising non-invasive treatment strategy for non-union following PAO.
文摘Background:Inferior alveolar nerve(IAN)injury is a serious potential complication of orthognathic surgery because the osteotomy cut-line during sagittal split osteotomy(SSO)of the mandible runs close to the mandibular canal.According to statistics,9%–85%of patients who undergo such surgery suffer from complications.It causes neurosensory disorders(NSD)of the lower lip and chin with a wide variety of symptoms such as numbness,hypoesthesia,hyperesthesia,hypoalgesia,hyperalgesia,and allodynia.However,the accurate planning and thorough analysis using cone-beam computed tomography helps improve the predictability of possible IAN damage by considering the specific anatomical features of each patient and all risk factors.This study aimed to review the frequency of IAN occurrence,risk factors,and diagnostic,prophylactic,and treatment methods used for inferior alveolar nerve regeneration and IAN sensory disturbance recovery following SSO of the mandible.Methods:We conducted a comprehensive literature search(2020–2024)across PubMed,Scopus,Google Scholar,and ScienceDirect,focusing on mandibular SSO complications,IAN damage,nerve regeneration,and treatments such as corticosteroids,vitamin B12,platelet concentrates,and low-level laser therapy.All systematic review,randomized controlled trial,controlled clinical trial,or retrospective/prospective study involving both animals and humans were included.Results:Surgeons prescribed medicines for general therapy before surgery and applied intraoperative treatment methods to minimize the degree of NSD manifestation after surgery.Fortunately,majority instances of NSD recover spontaneously by 6 months after the operation;however,if symptoms persist after 1 year,it is considered permanent NSD,which may cause a significant decrease in quality of life.In the postoperative period,assessing neurosensory disturbances with subjective(questionnaires)and objective tests(light touch,2-point discrimination tests,and others),or their combination,is necessary for determining the management.According to recent studies,dexamethasone,a complex of vitamin B,melatonin,and low-level lasers,is actively used in inferior alveolar nerve regeneration during and after SSO.Moreover,isolated studies have reported the intraoperative use of platelet concentrates during SSO.Conclusion:The mentioned treatment methods demonstrated positive results in decreasing NSD.However,their effectiveness for IAN regeneration has not been sufficiently studied.
文摘背景:发育性髋关节发育不良常易导致患儿肢体畸形,其诊疗的相关研究已逐渐明确;近来有限元法因其优势在发育性髋关节发育不良的相关研究中受到学者重视。目的:通过文献检索综述有限元法在儿童发育性髋关节发育不良及治疗中的研究进展,分析总结其优势与不足,并探讨未来进一步研究的方向及应用前景。方法:应用计算机在Pub Med、SCI、CBM和中国知网数据库中检索2014年1月至2023年11月发表的相关文献,以“developmental dysplasia(dislocation) of the hip,dysplasia of the hip,finite element analysis(method),pavlik harness,fixation in herringbone position,biomechanics,pelvic osteotomies,pemberton,salter,dega,periacetabular osteotomy,children”为英文检索词,以“发育性髋关节发育不良,发育性髋关节脱位,髋关节发育不良,儿童,有限元,Pavlik吊带,人字型固定,生物力学,骨盆截骨术,髋臼周围截骨术”为中文检索词,同时纳入少量远期文献,通过筛选最终纳入62篇文献进行分析。结果与结论:(1)儿童发育性髋关节发育不良髋关节力学环境异常,髋臼内部压力不均匀、应力增大并集中,关节接触面积减小,股骨颈局部应力集中;(2)在Pavlik吊带及人字型固定位患髋力学环境改善,集中的高应力区域消失,关节接触面积增加,但外展角度过大会导致髋臼及股骨头外侧应力增加;(3)骨盆截骨术治疗后髋关节及骶髂关节应力环境得到改善,3种截骨术没有单一的铰链,其应力负载部位因患儿年龄而存在差异;(4)髋臼周围截骨术治疗后关节接触压力接近正常,而非球形股骨头者恢复困难;(5)术后X射线片表现不能说明关节接触力学达到最佳;(6)提示利用有限元法可以获得体内无法测量的信息,其在虚拟环境中操作不受时间和伦理的限制;能直观地看到正常与发育性髋关节发育不良患者髋关节应力变化的区域,从力学角度说明治疗的有效性,为需要截骨手术治疗的患者建立特定的有限元模型、量身定做手术计划;发育性髋关节发育不良的有限元建模及儿童髋关节材料特性参数尚无规范、统一的标准,由于有限元固有的局限性,目前还不能分析同时包含骨骼、软骨、韧带、肌肉等元素的模型;有限元分析操作难度较大,虽有优势但不具普适性,且目前的研究样本量较少,还需进一步扩大及验证。
