Early patellar tendon rupture after total knee arthroplasty: A direct repair method

BACKGROUND Patellar tendon rupture after total knee arthroplasty(TKA)is a catastrophic complication.Although the occurrence of this injury is rare,it can lead to significant dysfunction for the patient and is very tricky to deal with.There has been no standard treatment for early patella tendon rupture after TKA,and long-term follow-up data are lacking.AIM To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method.METHODS During the period of 2008 to 2021,3265 consecutive TKAs were retrospectively reviewed.Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method.Mean follow-up was 5.7 years.Demographic,operative,and clinical data were collected.The clinical outcomes were assessed using the Western Ontario and McMaster Universities(WOMAC)score,the Hospital for Special Surgery(HSS)score,knee range of motion,extensor lag,and surgical complications.Descriptive statistics and paired t test were employed to analyze the data.RESULTS For all 12 patients who underwent direct repair for early patellar tendon rupture,3 patients failed:One(8.3%)for infection and two(17.6%)for re-fracture.The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery.The range of motion was 109.2°±10.6°preoperatively to 87.9°±11°postoperatively,mean extensor lag was 21°at follow-up,and mean WOMAC and HSS scores were 65.8±30.9 and 60.3±21.7 points,respectively.CONCLUSION This direct repair method of early patellar tendon rupture is not an ideal therapy.It is actually ineffective for the recovery of knee joint function in patients,and is still associated with severe knee extension lag and high complication rates.Compared with the outcomes of other repair methods mentioned in the literature,this direct repair method shows poor clinical outcomes.

Comparison between direct repair and humana cellular nerve allografting during contralateral C7 transfer to the upper trunk for restoration of shoulder abduction and elbow flexion

Direct coaptation of contralateral C7 to the upper trunk could avoid the interposition of nerve grafts. We have successfully shortened the gap and graft lengths, and even achieved direct coaptation. However, direct repair can only be performed in some selected cases, and partial procedures still require autografts, which are the gold standard for repairing neurologic defects. As symptoms often occur after autografting, human acellular nerve allografts have been used to avoid concomitant symptoms. This study investigated the quality of shoulder abduction and elbow flexion following direct repair and acellular allografting to evaluate issues requiring attention for brachial plexus injury repair. Fifty-one brachial plexus injury patients in the surgical database were eligible for this retrospective study. Patients were divided into two groups according to different surgical methods. Direct repair was performed in 27 patients, while acellular nerve allografts were used to bridge the gap between the contralateral C7 nerve root and upper trunk in 24 patients. The length of the harvested contralateral C7 nerve root was measured intraoperatively. Deltoid and biceps muscle strength, and degrees of shoulder abduction and elbow flexion were examined according to the British Medical Research Council scoring system;meaningful recovery was defined as M3–M5. Lengths of anterior and posterior divisions of the contralateral C7 in the direct repair group were 7.64 ± 0.69 mm and 7.55 ± 0.69 mm, respectively, and in the acellular nerve allografts group were 6.46 ± 0.58 mm and 6.43 ± 0.59 mm, respectively. After a minimum of 4-year follow-up, meaningful recoveries of deltoid and biceps muscles in the direct repair group were 88.89% and 85.19%, respectively, while they were 70.83% and 66.67% in the acellular nerve allografts group. Time to C5/C6 reinnervation was shorter in the direct repair group compared with the acellular nerve allografts group. Direct repair facilitated the restoration of shoulder abduction and elbow flexion. Thus, if direct coaptation is not possible, use of acellular nerve allografts is a suitable option. This study was approved by the Medical Ethical Committee of the First Affiliated Hospital of Sun Yat-sen University, China (Application ID:[2017] 290) on November 14, 2017.

Animal models used to study direct peripheral nerve repair: a systematic review

Objective:Peripheral nerve repair is required after traumatic injury.This common condition represents a major public health problem worldwide.Recovery after nerve repair depends on several factors,including the severity of the injury,the nerve involved,and the surgeon’s technical skills.Despite the precise microsurgical repair of nerve lesions,adequate functional recovery is not always achieved and,therefore,the regeneration process and surgical techniques are still being studied.Pre-clinical animal models are essential for this research and,for this reason,the focus of the present systematic review(according to the PRISMA statement)was to analyze the different animal models used in pre-clinical peripheral nerve repair studies.Data sources:Original articles,published in English from 2000 to 2018,were collected using the Web of Science,Scopus,and PubMed databases.Data selection:Only preclinical trials on direct nerve repair were included in this review.The articles were evaluated by the first two authors,in accordance with predefined data fields.Outcome measures:The primary outcomes included functional motor abilities,daily activity and regeneration rate.Secondary outcomes included coaptation technique and animal model.Results:This review yielded 267 articles,of which,after completion of the screening,49 studies were analyzed.There were 1425 animals in those 49 studies,being rats,mice,guinea pigs,rabbits,cats and dogs the different pre-clinical models.The nerves used were classified into three groups:head and neck(11),forelimb(8)and hindlimb(30).The techniques used to perform the coaptation were:microsuture(46),glue(12),laser(8)and mechanical(2).The follow-up examinations were histology(43),electrophysiological analysis(24)and behavioral observation(22).Conclusion:The most widely used animal model in the study of peripheral nerve repair is the rat.Other animal models are also used but the cost-benefit of the rat model provides several strengths over the others.Suture techniques are currently the first option for nerve repair,but the use of glues,lasers and bioengineering materials is increasing.Hence,further research in this field is required to improve clinical practice.

Reliability Evaluation of Two-Stage Directed Semi-Markov Repairable Network Systems

A two-stage directed Semi-Markov repairable network system is presented in this paper to model the performance of many transmission systems, such as power or oil transmission network, water or gas supply network, etc. The availability of the system is discussed by using Markov renewal theory, Laplace transform and probability analysis methods. A numerical example is given to illustrate the results obtained in the paper.

青年腰椎峡部裂手术直接修复治疗与非手术治疗的比较

目的回顾性分析直接修复(direct repair,DR)手术和非手术治疗对青年腰椎峡部裂患者的早期效果。方法选择2015年1月~2019年12月在该院就诊的151例青年腰椎峡部裂患者作为研究对象,根据患者治疗方法分为非手术组(79例,传统非手术治疗)和手术组(72例,螺钉固定直接修复),观察两组疼痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、12项简式健康调查量表(the 12-items short form health survey,SF-12)得分、缺损间隙距离和缺损愈合率。结果治疗后1个月、3个月、6个月、12个月时,两组患者VAS均较治疗前显著降低(P<0.05),但两组各时间段的VAS评分差异均无统计学意义(P>0.05)。治疗后1个月、3个月、6个月、12个月两组患者ODI指数呈降低趋势,SF-12评分呈升高趋势,差异均有统计学意义(P<0.05);两组患者各时间段的ODI指数和SF-12评分差异均无统计学意义(P>0.05)。治疗后12个月,非手术组腰椎滑脱发生率高于手术组(P<0.05);手术组患者峡部愈合率(75.00%)明显高于非手术组(P<0.05)。手术组并发症发生率高于非手术组(P<0.05)。结论DR手术和非手术治疗对患者腰部、功能障碍和生活质量的短期影响无显著差异,DR手术的并发症高于非手术治疗,但DR手术对抑制病变节段的前移具有积极作用。

复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果对比

目的:对比分析复合树脂多层修复技术与复合树脂直接粘接修复技术在前牙间隙美学修复中的效果。方法:纳入笔者医院2020年6月-2021年6月收治的98例(共104颗患牙)前牙间隙患者作为研究对象,按照随机数表法分为A组和B组,各49例。A组患者接受复合树脂多层修复技术,B组患者接受复合树脂直接粘接修复技术。对比两组修复效果、美学效果和治疗总费用,比较两组修复前和修复30d后、6个月后的咬合力、咀嚼效率和焦虑自评量表(Self-ratinganxietyscale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)评分。结果:修复30 d后,A组优秀率高于B组(P<0.05),两组良好率和不良率比较无统计学意义(P>0.05)。修复6个月后,A组优秀率和不良率均高于B组(P<0.05),两组良好率比较无统计学意义(P>0.05)。患者的咬合力在时间、交互作用上差异有统计学意义(P<0.05),在组间作用上差异无统计学意义(P>0.05)。患者的咀嚼效率在时间、组间、交互作用上差异均有统计学意义(P<0.05)。修复6个月后,两组患者咬合力和咀嚼效率均较修复30d后和修复前升高,且A组咬合力和咀嚼效率高于B组(P<0.05)。A组修复后的边缘密合性、颜色匹配性、修复体崩裂、继发龋损、形态匹配、修复体脱落和牙龈健康评分均低于B组(P<0.05)。患者的SAS评分和SDS评分在时间、组间、交互作用上有统计学意义(均P<0.05)。修复30d后和修复6个月后,两组患者SAS和SDS评分均较修复前降低,且A组低于B组(P<0.05)。A组治疗总花费高于B组(P<0.05)。结论:与复合树脂直接粘接修复技术相比,在前牙间隙美学修复中应用复合树脂多层修复技术可取得更佳的修复效果,有助于恢复患者咬合力和咀嚼功能,使患者获得良好美学效果,改善其心理状态。但治疗总花费相对较高,临床治疗需结合患者经济情况选择合适治疗方案。

激光定向能量沉积Al-Mg-Sc-Zr修复5083-H112铝合金的组织和性能

激光定向能量沉积增材修复技术具有时间短、效率高、成本低、力学性能好等优点,具有很大的发展潜力。采用Al-7.5Mg-0.3Sc-0.28Zr作为修复材料对轨道交通用5083-H112铝合金进行激光修复实验,得到了致密、无缺陷的修复试样,并对其组织和性能进行研究,探讨了激光修复铝合金的可行性。结果表明,熔合线附近过渡区可划分为修复区、部分熔化区、热影响区和母材。修复区为完全等轴晶,由平均晶粒尺寸为4.95μm的细晶带和18.34μm的粗晶区组成。从修复区到部分熔化区再到热影响区的过渡区域,Al元素含量逐渐升高,Mg元素含量逐渐下降,硬度逐渐下降,修复后母材未被软化。由于激光增材制造技术的快速凝固,在熔合线附近的细晶带有较大的应力集中,由于较小的热输入在部分熔化区、热影响区的残余应力较小。修复试样的屈服强度为(152±2)MPa,为母材的89.4%;抗拉强度为(305±5)MPa,为母材抗拉强度的100%;伸长率为(15.5±0.5)%,为母材的85.2%;断裂发生在强度较弱的母材。高性能的激光修复铝合金是可实现的,具有广泛的应用前景。

Water-facilitated targeted repair of degraded cathodes for sustainable lithium-ion batteries

Directly repairing end-of-life lithium-ion battery cathodes poses significant chal-lenges due to the diverse compositions of the wastes.Here,we propose a water-facilitated targeted repair strategy applicable to various end-of-life batches and cathodes.The process involves initiating structural repair and reconstruct-ing particle morphology in degraded LiMn_(2)O_(4)(LMO)through an additional thermal drive post-ambient water remanganization,achieving elemental repair.Compared to solid-phase repair,the resulting LMO material exhibits superior electrochemical and kinetic characteristics.The theoretical analysis highlights the impact of Mn defects on the structural stability and electron transfer rate of degraded materials.The propensity of Mn ions to diffuse within the Mn layer,specifically occupying the Mn 16d site instead of the Li 8a site,theoretically sup-ports the feasibility of ambient water remanganization.Moreover,this method proves effective in the relithiation of degraded layered cathode materials,yielding single crystals.By combining low energy consumption,environmental friendli-ness,and recyclability,our study proposes a sustainable approach to utilizing spent batteries.This strategy holds the potential to enable the industrial direct repair of deteriorated cathode materials.

腹腔镜腹股沟疝修补术中直视下经皮穿刺置管引流积液预防术后血清肿的技巧与应用

目的探讨在腹腔镜下经腹膜腔腹股沟疝修补术(TAPP)中直视下行经皮穿刺置管引流术,引流远端疝囊积气积液的操作技巧,以预防或干预治疗疝修补术后的血清肿。方法把2020年1月至2021年12月收治的85例腹股沟疝(坠入阴囊疝及巨大直疝)患者随机分为观察组及对照组,由同一术者行TAPP手术治疗,对照组行常规TAPP手术,观察组在行TAPP术中直视下,于腹壁经皮穿刺,将一直径12Ga一次性中心导管从腹膜外置入远端疝囊内,通过比较两组患者的手术指标、近期疗效指标及住院时间的差异,介绍腹腔镜疝修补术中直视下经皮穿刺置管的操作技巧、安全性、应用特点及优缺点。结果85例腹股沟疝患者全部手术成功,与对照组相比,观察组的近期血清肿发生率低、血清肿范围小、患者舒适度及满意度高,差异有统计学意义(均P<0.05),而两组的手术时间、住院时间、远期血清肿发生率等方面的差异无统计学意义(均P>0.05)。所有病例随访6个月至1年,均无复发,无发生术后感染。结论在TAPP中直视下经皮穿刺置管引流远端疝囊积气积液,穿刺操作安全、有效并微创,可有效预防术后血清肿的发生或减轻其的严重程度,减轻术后肿胀及患者的不适感,提高患者术后的舒适度及满意度,可广泛推广及应用。

公路隧道中心水沟非开挖修复技术研究

以甘肃省某高速公路隧道中心水沟结晶堵塞、无法疏通等问题为研究对象,通过中心水沟检查井、路面钻孔、探坑检查等手段,揭示了隧道病害的主要原因,通过综合比选,采用水平定向钻非开挖修复中心水沟的处治方案。应用结果表明,水平定向钻非开挖技术施工便捷、环保、经济、不需要中断交通,能够实现隧道中心水沟的微创重构,具有良好的推广应用价值。

直埋蒸汽管道技术研究

随着国家对集中供热的大力推广,工业生产对于蒸汽使用的需求愈来愈大,工业管道的直埋技术变得愈来愈重要。为解决蒸汽管道复杂的热应变受力、较大的热位移和较高温度等问题,保温材料和相应的结构形式的运用显得尤为重要。对于早期已敷设的老旧管道,由于市场材料、相关工艺的局限性,导致管道的运行未达到理想中的效果、使用寿命降低、受到地域限制腐蚀、保温失效等问题。文章针对这些问题进行探讨,以达到在实际使用年限内管道安全运行的目的。

关节镜下肩袖修补术结合中药定向透药治疗肩袖损伤临床观察

目的:观察关节镜下肩袖修补术结合中药定向透药治疗肩袖损伤的临床疗效。方法:选取2020年11月至2022年10月宁都县中医院收治的肩袖损伤患者66例,按照随机数字表法分为对照组和研究组,每组33例。对照组在关节镜下进行肩袖修补术治疗,研究组在对照组治疗的基础上给予中药定向透药治疗。观察两组患者治疗前后Neer肩关节功能评分(疼痛程度、日常生活能力、运动范围、上肢肌力)、肩关节活动度(前屈、后伸、内旋、外旋)、生活质量评分及临床疗效。结果:研究组治疗后疼痛程度、日常生活能力、运动范围、上肢肌力评分均高于对照组,差异有统计学意义(P<0.05);两组治疗后前屈、后伸、内旋、外旋活动度高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组治疗后生活质量评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);研究组有效率为96.97%,对照组有效率为75.76%,研究组有效率高于对照组,差异有统计学意义(P<0.05)。结论:关节镜下肩袖修补术结合中药定向透药治疗肩袖损伤疗效显著,可有效改善患者肩关节活动度、肩关节功能,提高患者生活质量。

激光成形修复定向凝固DZ125镍基高温合金的组织研究

对铸造定向DZ125镍基高温合金进行单道多层的激光成形修复实验。通过光镜、扫描电镜及透射电镜对修复区进行微观组织观察,使用电子探针测定不同相及修复区枝晶干的成分。结果表明:通过激光成形修复的方法可以获得自原基材外延生长的细小定向γ柱状晶修复组织,仅在修复区顶部存在部分取向杂乱的等轴晶组织;相比铸造定向基材,沉积态修复区呈现快速外延定向凝固特征,导致修复区的成分偏析减轻,枝晶间MC型碳化物相比基材显著细化,呈块状或正八面体状,枝晶间同时分布有γ+γ′共晶组织;另外,在γ枝晶干分布着近100 nm的球形γ′相,且部分γ′相颗粒有相互连接的现象。总体上,修复区一次枝晶间距、碳化物及γ′相尺度比修复基材显著细化。

两种方法治疗新鲜闭合跟腱断裂

目的比较跟腱断裂通道微创修复和传统开放切口直视下修复治疗新鲜闭合跟腱断裂的疗效。方法将43例新鲜闭合跟腱断裂患者根据治疗方法不同分为微创组(采用跟腱断裂通道微创修复术治疗,25例)和传统组(采用传统开放切口直视下修复术治疗,18例)。比较两组切口长度、手术时间、切口愈合时间、术后并发症、疼痛评分及踝关节功能评分。结果患者均获得随访,时间12~24个月。切口长度、手术时间、切口愈合时间、术后疼痛评分、踝关节功能评分微创组均优于传统组(P<0.05)。微创组患者切口无感染,无皮缘坏死,均一期愈合。传统组患者切口均无感染,15例一期愈合,2例切口皮缘发生部分坏死,经多次换药后愈合;1例于术后4周发现缝线排异反应,经清创反复换药后愈合。结论跟腱断裂通道微创修复术治疗新鲜闭合跟腱断裂临床效果满意。

基于指纹纹线形态特征的方向图修正算法研究

指纹图像存在着各种各样的噪声,直接取得的指纹方向图并不准确,需要修正后才能使用。传统修正方法如加权平均、直方图等块方向图算法具有较强的局部限制性,修正能力较弱。大量研究结果表明,在一个较大窗口中,指纹图像上绝大多数点的方向与该点垂向上各点的方向近似平行,因此提出了一种新的方向图修正算法。此算法的处理窗口是目前常用块方向算法的3至5倍,一定程度上摆脱了局部限制性,大大提高了修正能力,并在大量的实验中显示出优越性。

海底电缆在埕岛油田的应用及发展趋势

随着埕岛油田原油产量逐年递增,电力需求不断增加,海底电缆不断发展。文中主要介绍了埕岛油田采用的海底电缆的结构类型及特点,并对在海底电缆的维修、铺设中应注意的问题进行了分析,较为系统地对整个海上油田海底电缆进行了描述,并对今后埕岛油田海底电缆的发展方向进行了分析。

场面信道特征重构的非视距多点定位性能研究

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针对现有孔洞修补算法对复杂孔洞修补效果差的问题,提出了一种适用于岛屿类孔洞修补的新型多向波前法。首先检测孔洞边界与岛屿边界并对其进行预处理,以孔洞边界与岛屿边界为波前,插入顶点与三角面填充孔洞;然后对新增顶点与新增三角面进行合理性检验;最后根据法矢与曲率调整新增顶点,使其最大程度拟合原有曲面特征。实验结果验证了所提算法的可行性和有效性。

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蒙药的炮制工艺具有民族特色,是蒙古族人民智慧与文化的代表。本文通过查阅大量书籍及文献,对蒙药的传统炮制方法(直接修制、水制、火制、水火共制等)进行综述,以期为蒙药的传统炮制理论与现代科技方法相结合的炮制工艺提供参考。

青年性腰椎弓根崩裂直接修复后TSRH钩钉系统固定12例初步报告

[目的]评价TSRH钩钉系统对青年患者腰椎弓崩裂直接修复后固定的临床疗效。[方法]自2001年7月~2003年10月,对12例男性单纯腰椎弓崩裂患者（16~31周岁）行腰椎弓崩裂自体骨直接修复峡部裂后TSRH椎板钩、椎弓根钉固定术。术后随访,根据术后X线、CT结果评价修复效果,并根据MacNab＇s标准进行临床评价。[结果]经过6~19个月随访,所有患者腰椎弓崩裂影像学全部融合;临床下腰痛显著缓解,按MacNab＇s标准,优8例,良3例,一般1例;无手术及内固定相关并发症发生。[结论]直接修复后TSRH钩钉系统固定治疗青年性腰椎弓崩裂能充分保留腰椎运动节段,在减少融合节段的同时能有效恢复腰椎稳定,操作简便、安全,固定可靠,是一种合乎逻辑的治疗青年性腰椎弓崩裂方法。