Cartilage repair techniques of the talus: An update

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in their origin.Additionally,it is well recognised that the talar articular cartilage strongly differs from that in the knee.Despite this fact,many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee.Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans.However,depending on the size of the lesions,surgical approaches are necessary to treat many of these defects.Bone marrow stimulation techniques may achieve good results in small lesions.Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation.Autologous chondrocyte transplantation,as a restorative procedure,is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor.The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

Repairing peripheral nerve injury using tissue engineering techniques

Each year approximately 360,000 people in the United States suffer a peripheral nerve injury （PNI）, which is a leading source of lifelong disability （Kelsey et al., 1997; Noble et al., 1998）. The most frequent cause of PNIs is motor vehicle accidents, while gunshot wounds, stabbings, and birth trauma are also common factors. Patients suffering from disabilities as a result of their PNIs are also burdensome to the healthcare system, with aver- age hospital stays of 28 days each year （Kelsey et al., 1997; Noble et al., 1998）.

Application Effects of Total Percutaneous Technique in Endovascular Repair of Abdominal Aortic Aneurysm

Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.

Bicuspidization Using the Open-Sleeve Technique for Congenital Aortic Stenosis during Infancy

Congenital aortic stenosis(cAS)frequently requires intervention during the neonatal or infantile period.However,surgical repair is challenging because of the narrow surgical space.We performed bicuspidization using the open-sleeve technique for cAS with a unicuspid aortic valve in two patients.Postoperatively,the patients were doing well without reintervention for the aortic valve for 8 and 6 years,respectively.Their aortic annular diameter increased along with somatic growth.Bicuspidization for neonates or infancy can be performed safely using the open-sleeve technique as its midterm results have been satisfactory.

A modified technique for the repair of secondary unilateral cleft nasal deformity

Objective To investigate the effect of a modified technique for reparing secondary unilateral cleft nasal deformity. Methods Nasal alar cartilage was explosed through dish - like incision,and base of naris was cut to loosening and replacing the orbicularis oris,releasing

Design of axial flaps with color Doppler flow imaging technique for repairing deep wounds of heels

To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap.Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds.There were 25 flaps including 10 cases of the distal-based sural neurovascular flap,nine medial sole flap and six medial leg flap.All the axial pattern flaps were designed on the basis of traditional design ways before operation;then,CDFI appliance with high resolution was used to examine the starting spot,exterior diameter,trail and length of the flap’s major artery.The flaps were redesigned according to the results of CDFI and transferred to cover the wounds.In the meantime,both the results of operation and examination were compared.Results The major artery’s starting spot,exterior diameter,trail and anatomic layers were displayed clearly,in consistency with the results of operation.The flaps survived completely and recovered well,with perfect appearance,color and arthral function.Conclusion CDFI is a simple,macroscopic and atraumatic method for designing the axial pattern flap on lower limb,can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.10 refs,4 figs,2 tabs.

Microsurgical varicocelectomy： a review

Varicocelectomy is the most commonly performed surgical procedure for the treatment of male infertility. Although several different techniques for varicocele repair have been described in the literature, microsurgical varicocelectomy performed through a subinguinal or inguinal incision is recognized as the gold-standard approach for varicocelectomy, due to high success rates with minimal complications. Standard indications for varicocelectomy include palpable varicocele（s）, with one or more abnormal semen parameters, and, for the couple trying to conceive, in the setting of normal or correctable female infertility. However, varicocele repair is often recommended and undertaken for reasons other than infertility, including low serum testosterone, testicular pain, testicular hypotrophy and poor sperm DNA quality. This article reviews the technical aspects of microsurgical varicocelectomy, and its indications in adults and adolescents.

Craniocerebral injury promotes the repair of peripheral nerve injury

The increase in neurotrophic factors after craniocerebral injury has been shown to promote fracture healing. Moreover, neurotrophic factors play a key role in the regeneration and repair of peripheral nerve. However, whether craniocerebral injury alters the repair of peripheral nerve injuries remains poorly understood. Rat injury models were established by transecting the left sciatic nerve and using a free-fall device to induce craniocerebral injury. Compared with sciat- ic nerve injury alone after 6-12 weeks, rats with combined sciatic and craniocerebral injuries showed decreased sciatic functional index, increased recovery of gastrocnemius muscle wet weight, recovery of sciatic nerve ganglia and corresponding spinal cord segment neuron mor- phologies, and increased numbers of horseradish peroxidase-labeled cells. These results indicate that craniocerebral injury promotes the repair of peripheral nerve injury.

Stapled transperineal repair for low-and mid-level rectovaginal fistulas:A 5-year experience and comparison with sutured repair

BACKGROUND Currently,rectovaginal fistula(RVF)continues to be a surgical challenge worldwide,with a relatively low healing rate.Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIM To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODS This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China).Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included.Among the 82 total patients,37 underwent repair with direct suturing and 45 underwent repair with stapling.Patient demographic data,Wexner faecal incontinence score,and operative data were analyzed.Recurrence rate and associated risk factors were assessed.RESULTS The direct suture and stapled repair groups showed similar clinical characteristics for aetiology,surgical history,fistula features,and perioperative Wexner score.The stapled repair group did not show superior results over the suture repair group in regard to operative time,blood loss,and hospital stay.However,the stapled repair group showed better postoperative Wexner score(1.04±1.89 vs 2.73±3.75,P=0.021),less intercourse pain(1/45 vs 17/37,P=0.045),and lower recurrence rate(6/45 vs 17/37,P=0.001).There was no protective effect from previous repair history,smaller diameter of fistula(<0.5 cm),better control of defecation(Wexner<10),or stapled repair.Direct suture repair and preoperative high Wexner score(>10)were risk factors for fistula recurrence.Furthermore,stapled repair gave better efficacy in treating complex RVFs(i.e.,multiple transperineal repair history,mid-level fistula position,and poor control of defecation).CONCLUSION Stapled transperineal repair is advantageous for management of RVF,providing a high primary healing rate and low recurrence rate.

Short-term results in canines of novel stent-graft design for chimney technique in TEVAR

Introduction:Parallel stent-stent grafting is a major endovascular technique used to preserve the supra-aortic branches during thoracic endovascular aortic repair(TEVAR)of aortic pathologies involving the aortic arch.The short-and mid-term results of this technique are satisfactory;however,endoleak remains a major concern.Thus,here we designed a new chimney stent-graft to decrease the endoleak rate.Aim:To testify the feasibility and safety of the new chimney stent-graft system in a canine model.Material and methods:Six Labrador retrievers were used.Pre-operative data were collected and all operations were performed under general anesthesia.The main and chimney stent-grafts were implanted through the abdominal aorta and left subclavian artery approaches,respectively.Completion digital subtraction angiography(DSA)was performed to confirm the immediate outcomes.All dogs were fed separately for 6 months and sacrificed after aortic angiography.The thoracic aorta and the main and chimney stent-grafts were harvested for histopathologic examination.Results:No complications were found in follow-up DSA.All branch arteries were patent.In?ammatory responses were observed around the stent-grafts in 3 experimental animals,and slight hyperplasia was observed in the surrounding tissues compared with the normal vessels.There was no mural thrombus in the stent,endothelial cells were noted on the inner surface of the stent,and thrombus was formed in the outer skirt and gutter area.The histopathologic examinations revealed similar results to those of gross necropsy observations.Conclusions:This study demonstrated the feasibility and safety of the Longuette stent-graft and the first to report a revised stent-graft specific for chimney technique.

Clinical Results of Arthroscopic Rotator Cuff Repair with a Tape-Attached Anchor

Objective: The purpose of this study was to evaluate the clinical results of arthroscopic rotator cuff repair with a tape-attached anchor: The HEALICOILRG with ULTRATAPE. We hypothesised that performing arthroscopic rotator cuff repair with tape-attached anchors would result in better clinical outcomes and reduce the retear rate compared with conventional suture anchors. Methods: We included 83 patients treated by arthroscopic rotator cuff repair with a minimum 1-year follow-up. We divided them into two groups: Use of the HEALICOILRG with ULTRATAPE (group T: 41 shoulders;mean patient age, 64.3 years) and use of the conventional suture anchor (group S: 42 shoulders;mean patient age, 68.9 years). We compared the University of California Los Angeles scores, Japanese Orthopaedic Association scores, range of motion, and retear rate between the two groups. The Student t test and chi-square test were used in statistical analyses. Results: At the 1-year postoperative follow-up, both groups showed improvement in the average University of California Los Angeles score, Japanese Orthopaedic Association score, and range of motion, although no significant difference was found in the retear rate between the two groups. Conclusions: Results of arthroscopic rotator cuff repair with the HEALICOILRG with ULTRATAPE were generally good. However, our results could not demonstrate efficacy of the HEALICOILRG with ULTRATAPE. Further detailed studies are needed to determine its treatment result.

Management of Acute Achilles Tendon Rupture Using the Krackow and Tendon-Bundle Techniques

Background Acute Achilles tendon rupture is a severe injury of the lower extremities;however,optimal treatment options are not yet available.This study aimed to investigate the surgical method and clinical effect of the Krackow and tendon-bundle techniques for managing acute Achilles tendon rupture.Methods This retrospective case series study analyzed 17 cases of acute Achilles tendon rupture at the Beijing Jishuitan Hospital from December 2012 to January 2020.There were 16 men and one woman,aged 27–45 years,with an average of 39.6 years.Thirteen patients were injured while playing basketball or badminton,and 4 patients were injured while participating in a football match or other sports.All injuries were repaired using the Krackow and tendon-bundle techniques.Postoperative evaluation indicators included active range of motion during ankle plantar flexion and dorsiflexion,height of single foot heel lifting,Amer-Lindholm Achilles tendon function score,and American Orthopedic Foot and Ankle Society(AOFAS)score.Results The patients were followed-up for 6–45 months(average,18.9 months).There was no re-rupture of the Achilles tendon,wound infection,or sural nerve injury.At the final follow-up,the affected and contralateral sides exhibited plantar flexion of 42.1±4.4°and 43.8±2.8°,dorsiflexion of 15.8±2.9°and 16.6±2.9°,respectively,and one foot exhibited a heel lifting height of 7.2±1.0 cm and 7.5±0.9 cm,respectively.There was no significant difference between the affected and contralateral sides(P>0.05).At the final follow-up,the Amer-Lindholm Achilles tendon function score was excellent in 94.1%(16/17)of the patients and good in 5.9%(1/17)of the patients.The AOFAS scores ranged from 90 to 100,with an average of 96.4±3.7.Conclusion Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends,and thus it is an effective repair method for closed Achilles tendon injury.

Best approach for the repair of distal biceps tendon ruptures

The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.

Minimally invasive endoscopic repair of rectovaginal fistula

BACKGROUND Surgical techniques for repair of rectovaginal fistula(RVF)have been continually developed,but the ideal procedure remains unclear.Endoscopic repair is a novel and minimally invasive technique for RVF repair with increasing reporting.AIM To review the current applications and preliminary outcomes of this technique for RVF repair,aiming to give surgeons an alternative in clinical practice.METHODS Available articles were searched according to the search strategy.And the sample size,fistula etiology,fistula type,endoscopic repair approaches,operative time and hospital stay,follow-up period,complication and life quality assessment were selected for recording and further analysis.RESULTS A total of 11 articles were eventually identified,involving 71 patients with RVFs who had undergone endoscopic repair.The principal causes of RVFs were surgery(n=51,71.8%),followed by obstetrics(n=7,9.8%),inflammatory bowel disease(n=5,7.0%),congenital(n=3,4.2%),trauma(n=2,2.8%),radiation(n=1,1.4%),and in two patients,the cause was unclear.Most fistulas were in a mid or low position.Several endoscopic repair methods were included,namely transanal endoscopic microsurgery,endoscopic clipping,and endoscopic stenting.Most patients underwent>1-year follow-up,and the success rate was 40%-93%,and all cases reported successful closure.Few complications were mentioned,while postoperative quality of life assessment was only mentioned in one study.CONCLUSION In conclusion,endoscopic repair of RVF is novel,minimally invasive and promising with acceptable preliminary effectiveness.Given its unique advantages,endoscopic repair can be an alternative technique for surgeons.

改良膜龈手术在牙龈退缩治疗中的应用

随着人们对美观需求的日益提升,治疗牙龈退缩已经成为牙周科临床常见的患者诉求。临床上主要通过手术的方式治疗牙龈退缩,常见的手术包括游离龈移植术、带蒂瓣技术和双层瓣技术,适应证选择恰当时,通常可以获得满意的效果,但上述术式仍存在一定的不足,如根面覆盖效果不理想等。近年来,学者们针对这些不足陆续提出了一些改良方案来治疗不同程度的牙龈退缩,如改良游离龈移植术,即包含龈乳头及游离龈的牙龈单元移植,可改善受体区血供,提高根面覆盖效果,其针对轻度退缩的部位可获得良好的根面覆盖,同时可增宽角化龈和加深前庭沟,但应用于上颌美学区时可能存在术后牙龈颜色、形态不协调,美学效果欠佳的问题。牙龈瓣采用半厚-全厚-半厚的技术进行制备的改良冠向复位瓣,用于多颗牙牙龈退缩时,以退缩最严重牙为中心的改良切口设计的冠向复位信封瓣技术,可提高根面覆盖效果。不离断龈乳头,使龈瓣形成隧道,以容纳移植物的隧道技术及各种改良的隧道技术,可以有效减少术区的组织损伤,并促进创面愈合。本文通过对各类术式的阐述和文献回顾,总结改良膜龈手术治疗牙龈退缩的临床应用及注意事项,并提出牙龈退缩的治疗方案建议,同时强调牙龈退缩的对因治疗,以达到稳定的根面覆盖效果。创伤小、疗效稳定的手术方式和治疗方法是今后膜龈手术的发展方向。

古籍文献老化因素分析检测及物理化学修补技术

针对中国古籍文献老化程度的分析研究,是对其进行科学评估和有效保护的一项重要基础工作。研究从2个方面探讨分析了古籍文献的老化因素,即纸张老化和字迹书写材料老化;并重点结合内因与外因分析影响古纸老化的原因,采用现代手段对古籍文献老化程度检测。并根据文物研究领域的发展现状和前沿动态,围绕纸张老化和字迹书写材料老化,介绍了光谱分析法和光学显微镜法2大类技术手段,用以测定古籍文献中纸张和墨迹的老化程度。解决和减缓古籍文献老化进程,重点梳理了纸质文物保护的无酸胶补修复及脱酸技术实现。

股外侧肌皮瓣游离移植治疗慢性顽固性脓胸的临床应用

目的报道股外侧肌皮瓣游离移植治疗慢性顽固性脓胸的疗效、优缺点及应用价值。方法回顾性分析2015年5月至2021年6月,应用股外侧肌皮瓣游离移植治疗慢性顽固性脓胸16例,男13例,女3例,年龄(51.19±17.42)岁。手术均在脓腔充分清创后,采用股外侧肌皮瓣游离移植,其中双侧股外侧肌串联移植1例,其余均为单侧。结果随访(20.94±8.27)个月,1例在术后6个月因肿瘤复发死亡。肌瓣全部成活,皮瓣部分坏死2例,清创后直接缝合。脓腔填塞良好,术后并发肺部感染1例,经支气管镜封堵胸膜瘘后治愈。患者均无胸闷等不适。下肢供瓣区均直接缝合,愈合良好,行走及膝关节活动无明显影响。结论股外侧肌血管恒定,解剖清楚,肌肉形态长而宽且体积较大,能够有效填塞脓胸形成的空腔并闭合创口。这一术式不仅拓宽了股外侧肌皮瓣的应用范围,还为顽固性脓胸的治疗提供了新的选择。

股前外侧皮瓣:万能皮瓣,修复利器——历38年逾千例临床应用研究经验体会

股前外侧皮瓣由于其解剖学特点的优异性及广泛的适用性,被誉为“万能皮瓣”。本文是作者38年逾千例股前外侧皮瓣临床应用的心路历程和总结。文中分享了作者学习、研究、应用股前外侧皮瓣的经历,介绍了拓展该皮瓣应用范围和发现高位穿支的过程,总结了手术适应证和术中操作技巧。以期为股前外侧皮瓣更好的研究、发展和推广,作出绵薄的贡献。

高温测量降本增效实践与研究

旨在研究高温测量过程降本增效的关键策略:聚焦加热炉测温优化、热偶使用管理降本方法、计量过程数据高效处理。在探究这些策略的过程中,炉顶穿孔引导测温方法、热偶维修技术以及帆软数据分析展示模块成为实现高温测量过程降本增效目标的重要手段。穿孔引导测温方法操作便捷,不仅提升了测温效率,还提升了测温过程的稳定性和准确性。同时,针对热电偶使用,开发出了热电偶维修裁剪工艺,增加了热电偶循环利用率,减少了热电偶使用成本。在数据处理方面,帆软数据报表模块的应用彰显了其在实现计量过程数据高效处理上的优势。通过该平台,生产数据可以更为直观、清晰地呈现,同时也提供了对数据进行深入分析的功能。通过实际生产案例的验证,这些优化措施显著提高了生产效率、降低了成本。更重要的是,这些策略的实施对于冶金行业的可持续发展和提升竞争力具有重要意义。

经通道微创修复急性闭合性跟腱断裂的疗效分析

目的探讨行通道辅助微创修复系统缝合术修复急性闭合性跟腱断裂的临床疗效。方法将2017年3月至2021年9月收入成都体育学院附属体育医院的90例急性闭合性跟腱断裂患者进行回顾性分析。根据术前医患沟通结果,分为微创组(45例)和开放组(45例)。微创组采用微创跟腱断裂通道吻合器吻合术,开放组采用切开改良Kessler断端吻合术。比较两组患者的手术时间、切口长度、并发症;分别比较两组患者术后1、6、12个月的疼痛视觉模拟评分(visual analogue scale,VAS)、美国骨科足踝协会后足与踝评分(American Orthopaedic Foot and Ankle Society,AOFAS)和足跖屈-背伸活动度(range of motion,ROM)。结果微创组及开放组患者均获12~24个月的随访,平均为(18.4±5.6)个月。微创组的手术时间较开放组手术时间明显少,微创组手术切口长度较开放组手术切口长度明显短,两组比较差异有统计学意义(P<0.05)。微创组术中、术后并发症明显低于开放组,两组比较差异有统计学意义(P<0.05),微创组及开放组患者术后1个月的VAS评分,差异有统计学意义(P<0.05);术后6、12个月的VAS评分,差异无统计学意义(P>0.05)。两组患者术后1、6个月的AOFAS评分,差异有统计学意义(P<0.05);术后12个月AOFAS评分比及术后6、12个月的足跖屈-背伸活动度比较,差异无统计学意义(P>0.05)。结论采用微创跟腱断裂通道吻合器修复急性闭合性跟腱断裂,具有微创、并发症少、早期康复等优势。