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OBJECTIVE@#To evaluate the operability and effectiveness of a self-developed patellar bone canal locator (hereinafter referred to as "locator") in the reconstruction of the medial patellofemoral ligament (MPFL).@*METHODS@#A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group (the patellar canal was established with a locator during MPFL reconstruction) and control group (no locator was used in MPFL reconstruction), with 19 cases in each group. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, body mass index, disease duration, patella Wiberg classification, constituent ratio of cartilage injury, Caton index, tibia tubercle-trochlear groove, and preoperative Lysholm score, Kujal score, Tegner score, visual analogue scale (VAS) score, and so on. The Lysholm score, Kujal score, Tegner score, and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month, 3 months, and 6 months after operation. The ideal prepatellar cortical thickness and canal length were measured before operation, and the actual prepatellar cortical thickness and canal length after operation were also measured, and D1 (the distance between the ideal entrance and the actual entrance), D2 (the ideal canal length minus the actual canal length), D3 (the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness) were calculated.@*RESULTS@#Patients in both groups were followed up 6-8 months (mean, 6.7 months). The incision length and intraoperative blood loss in the study group were smaller than those in the control group, but the operation time was longer than that in the control group, the differences were significant ( P<0.05). There was no complication such as incision infection, effusion, and delayed healing in both groups, and no further dislocation occurred during follow-up. One patient in the study group had persistent pain in the anserine area after operation, and the symptoms were relieved after physiotherapy. The VAS score of the two groups increased significantly at 3 days after operation, and gradually decreased with the extension of time; the change trends of Lysholm score, Kujal score, and Tegner score were opposite to VAS score. Except that the Lysholm score and Kujal score of the study group were higher than those of the control group at 3 days after operation, and the VAS score of the study group was lower than that of the control group at 3 days and 1 month after operation, the differences were significant ( P<0.05), there was no significant difference in the scores between the two groups at other time points ( P>0.05). Patellar bone canal evaluation showed that there was no significant difference in preoperative simulated ideal canal length, prepatellar cortical thickness, and postoperative actual canal length between the two groups ( P>0.05). The postoperative actual prepatellar cortical thickness of the study group was significantly smaller than that of the control group ( P<0.05). D1 and D3 in the study group were significantly higher than those in control group ( P<0.05), but there was no significant difference in D2 between the two groups ( P>0.05).@*CONCLUSION@#The locator can improve the accuracy of MPFL reconstruction surgery, reduce the possibility of intraoperative damage to the articular surface of patella and postoperative patellar fractures.
Subject(s)
Humans , Patella/surgery , Patellar Dislocation/surgery , Patellofemoral Joint/surgery , Knee Joint/surgery , Joint Dislocations , Ligaments, Articular/surgeryABSTRACT
Objective To study liver function, hepatic energy metabolism, regeneration and apoptosis in obstructive jaundiced or normal liver after 70% partial hepatectomy (PH) with hepatic artery resection (HAR) in rats. Methods In this study, 133 male SD rats were enrolled, 6 rats were in sham operation group, 20 rats underwent choledochoduodenostomy after 70% PH and 20 rats did 70%- PH, choledochoduodenostomy plus HAR. The remaining 87 rats 5 days after common bile duct ligation (CBDL) were randomized into two groups: 70% PH with choledochoduodenostomy, and 70% PH with choledochoduodenustomy plus HAR. Serum TB, ALT, ALB and ALP; tissue of hepatic HGF, bcl-2 mRNA and protein expression; ATP, ADP and AMP in hepatic tissues; hepatocyte proliferation/ apoptosis index were observed postoperatively (24 h, 72 h and 7 d). MortaLity was calculated. Results Rats without obstructive jaundice could tolerate 70% PH plus HAR with good liver regeneration. Compared with other groups, the serum liver function index; ATP content and EC value; HGF,bcl-2 mRNA content of liver tissue and the hepatocyte proliferation/apoptosis index in 70% PH with HAR group significantly aggravated and the mortality signiticanfly increased in obstructive jaundice rats ( P < 0. 05). Conclusions (1) The liver regeneration and apoptosis were not significantly influenced in normal mrs undergoing 70% PH and 70% PH with HAR, moreover hepatoeyte energy metabolism and liver function recovered rapidly in both groups. (2) With the existence of severe bilirubinemia, 70% PH with HAR caused an increased mortality suggesting a rationale for a preoperative bilirubin reducing procedures before a major surgery in malignant obstructive jaundice.
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Objective To evaluate three-dimensional (3D) image of intrahepatic vessels in anatomic local resection of hepatocellular carcinoma (HCC). Methods The two-dimensional (2D) image date sets of the liver of a HCC patient, obtained by 64 row helical CT scan, were transmitted to a 3D simulation system for 3D reconstruction of intrahepafic vessels. Under the guidance of these 3D images, an actual local resection for HCC was performed. Results (1) The integrated 3D images of the hepatic artery, portal vein, hepatic vein as well as liver parenchyma and tumor were reconstructed, which visualized the detailed 3D vascular structure in the area of the tumor. (2) On the 3D images, the different cutting planes of hepatic artery, portal vein and hepatic vein were marked corresponding to different surgical margins and the involved liver volumes were calculated. (3) By balancing between the surgical margins and the liver volumes to be resected, the cutting points of hepatic artery, portal vein and hepatic vein were selected, which determined the transection plane for local resection of the HCC. (4) Based on the preoperative planning, a local resection for HCC was successfully performed with a resected specimen volume of 178 ml and a surgical circumferential margin of 9ram, which were highly in accordance with the simulating results. Conclusions Preoperative 3D imaging to visualize the anatomic structures of the tumor region make it possible to perform tumor local resection anatomically and preoperative simulation is of great value in determining an optimal transecting plane during the process of hepatectomy.
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Objective To investigate the expression of C-MET in papillary thyroid carcinoma(PTC) with (cervical) lymph node metastases, PTC without cervical lymph node metastases,follicular thyroid carcinoma and benign thyroid disease and the clinical significance. Methods The expression level of C-MET was examined by immunohistochemical analysis with C-MET monoclonal antibody in 62 cases of PTC with cervical lymph node metastases, 50 cases of PTC without cervical lymph node mestastases, 10 cases of follicular (thyroid) (carcinoma) and 30 cases of benign thyroid disease. Results PTC with cervical lymph node metastases (expressed) significantly greater level of C-MET than the other forms of thyroid carcinoma and benign thyroid disease(P