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Objective:To explore the long-term clinical efficacy of subtalar arthrodesis for treating sinus tarsi syndrome (STS) with peroneal spasm.Methods:Clinical informationof 32 patients with sinus tarsi syndrome complicated with peroneal spasm who were treated by subtalar arthrodesis from January 2006 to December 2016 was retrospectively analysed. There were 19 males and 13 females, aged 29.3±10.9 y (range: 13-56 y), and course of disease is 2.1±1.7 y (range: 1-10 y). All patients suffered from tarsal sinus pain and intractable peroneal spasm. The aetiology was foot or ankle inversion sprainin 25 patients, lower limb nerve injury in four patients, and ambiguous causes in three patients.The patients were divided into three groups according to their initial symptoms. Group A: Patients with simple peroneal spasm underwent tarsal sinus debridement firstly and subtalar joint fusion after symptom recurrence. Group B: Patients with peroneal spasm combined with other symptomsunderwent sinus tarsal cleansing and other symptomatic operations, and received subtalar joint fusion after symptoms recurred. Group C: Patients with peroneal spastic flat foot were treated withsubtalar joint fusion directly.Preoperative and postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, visual analogue scale (VAS) scores for pain during daily activities, and 36-item short form health survey (SF-36) scoreswere investigated.Results:32 cases were successfully completed operation, following-up 87 (40, 133) months. Group A(14 cases): The patients were treated withsinus tarsi debridement first. But their symptoms recurred in an average of 7.7 months after surgery. Later they received subtalar joint fusion. Group B (15 cases): In addition to tarsal sinus debridement, 3 cases were undergone tarsal coalitions resection, 3 cases were got denervation of tarsal sinus, 6 cases were received subtalar joint stabilization, and 3 cases were released their peroneal tendons. Their symptoms recurred in an average of 6.4 months after surgery, and they eventually were undergone subtalar arthrodesis. Group C (3 cases): Their initial symptoms were severe, manifested as rigid flat feet caused by peroneal tendons spasm, so they directly underwent subtalar joint fusion. The average AOFAS ankle and hindfoot scores for all patients increased from 27.86±10.79 points before treatment to 86.34±7.17 points at the last follow-up after operation ( t=23.505, P<0.05). The VAS scores decreased from 8.00±1.57 points before treatment to 1.91±1.06 points at the last follow-up after operation ( t=18.407, P<0.05). The SF-36 scores increased from 35.84±12.12 points before treatment to 86.20±10.32 points at the last follow-up after operation ( t=24.203, P<0.05). Conclusion:Sinus tarsi syndrome with peroneal spasm due to its complicated etiology and pathogenesis can give priority to sinus tarsal debridement or other symptomatic surgeries. If the symptoms recur, subtalar arthrodesis can be an alternative choice to achieve the long-term effects.
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Objective:To assess the influence of different surface treatment on the adhesion of the zirconia-veneering ceramic systems.Methods:28 zirconia specimens were divided into 4 groups(n =7) and treated by non-treatment(group A,the control),sandblaste(group B),hot-etching(group C) and sandblaste + hot-etching(group D).2 specimens randomly selected from each group were examined under SEM and XRD for the observation of surface structure.The veneering porcelain was layered on the remaining specimens of the 4 groups (n =5),then the shear strength of the interface was tested by a universal testing machine.Data were statistically analyzed by SPSS 13.0 software.Results:Different degrees of micro pore structure was observed on the zircomia surface of the 4 groups by SEM observation.The XRD analysis showed that all specimens emerged monoclinic phase.The shear bond strength of group A,B,C and D was (15.96 ± 3.44) MPa,(20.58 ± 2.21) MPa,(26.28 4-2.86) MPa and (22.51 ± 1.94) MPa respectively.group A vs group B,C and D,P ＜ 0.05;group C vs group A,B and D,P ＜ 0.05.Conclusion:The surface treatment of sandblaste,hot-etching and sandblasted + hot-etching can improve the shear bond strength of the zirconia-veneering ceramic systems,and the hotetching method is the most effective.
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Objective:To compare the fit of Co-Cr basal crowns fabricated by three kinds of technology. Methods:18 laser cured resin dies were divided into A, B and C groups(n=6) randomly. Co-Cr basal crowns of group A, B and C were made by traditional casting technology, CAD/CAM cutting metal technology and direct metal laser sintering technology( DMLS) respectively. The crowns were cemented to the corresponding dies and the basal crowns and dies were embedded in methyl acrylic. The thickness of the cement layer of the samples was measured under a stero microscope. Data were analyzed with SPSS13. 0 statistical software. Results:Marginal gap of group A, B and C was (66.08 ±3.90) μm, (29.21 ±3.31) μm and (24.96 ±2.99) μm respectively(P0. 05). Conclusion:DMLS technology may make the best marginal fit, CAD/CAM and DMLS technology may pro-duce better internal fit. The marginal fit and the internal fit of the crowns prepared by the 3 methods can meet the clinical requirements.
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Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation.Methods From March 2006 to October 2012,21 patients (15 male,6 female) with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove.In this group:Ⅰ grade 5 cases;Ⅱ grade 9 cases;Ⅲ grade 5 cases;Ⅳ grade 2 cases.All patients were followed up for at least 24 months.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score and visual analogue score (VAS) were used to evaluate the clinical outcomes.Operation time,time to heal and complications were also recorded.Results The average operation time was 50 minutes (30-70 minutes).The blood loss was 30-60 ml,average 40 ml.All incisions healed after operation,no case of incision infection,skin necrosis and sural nerve,vascular injuryed.Mean AOFAS score was significantly increased from (55.2±7.1) preoperative to (93.6±5.6) postoperative.15 patients with excellent,good for 1 cases.The excellent and good rate was 100％ (16/16).VAS score by an average of (5.3±2.1) points down to (1.2±1.1) points postperative.All the patients can wear normal shoes postoperative,waking with normal gait.No patients had peroneal tendon tenosynovitis,tendon adhesion,fracture of lateral malleolus and other serious complications,no dislocation recurrent,strength of the peroneal muscle returns to normal.Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.
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Objective:To explore the influence of the veneering porcelain thickness on the compressive strength of zirconia all-ceramic crown.Methods:25 zirconia basement crowns with the thickness of 0.5 mm were made by CAD-CAMsystem,and then were divided into 5 groups randomly with the veneering porcelain thickness of 0.5(A),1.0(B),1.5(C),2.0(D)and 2.5 mm(E)respectively. The compressive strength of the samples was measured by a testing machine.Statistical analysis was conducted by SPSS13.0 software. The microstructure of the fractured bonding interface of the specimens was observed by scanning electron microscope(SEM).Results:The compressive strength in group A,B,C,D and E were:(1 279.96 ±42.85)N,(2 235.44 ±50.14)N,(2 216.38 ±48.97)N, (2 169.22 ±60.40)N and (2 028.70 ±47.37)N respectively(A or E vs B,C or D,P 0.05;C vs D,P >0.05).SEMobservation found that in group A and E the bonding interface was uneven and loose,the cracks and spores in veneering porcelain appeared more and larger,and had a more intensive distribution.Conclusion:When the veneering porce-lain is too thick or too thin,the compressive strength of zirconia all-ceramic crown decreases,the thickness of the veneering porcelain should be controled in an appropriate range.
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Objective:To evaluate the accuracy of Cerec Bluecam and Cerec Omnicam with 3D printed resin models.Methods:A metal master model including 4 cylindrical metal preparations on the model base,respectively simulating the maxillary canine and the first molar preparations,was prepared.The right canine and the right first molar were respectively marked as A and B,and the left as C and D.The master model was scanned respectively by Cerec Bluecam and Cerec Omnicam for 10 times,10 digital models were genera-ted in Bluecam group and Omnnicam group respectively.Resin models were obtained by a 3D printer based on the digital models,the distance of AB,AC,BD and the diameter(d)of A were respectively measured.Statistical analysis was conducted by SPSS 13.0 soft-ware.Results:The distance of AB,AC,BD of master model and Bluecam group showed significant difference(P 0.05);the distance of AC,BD of master model and Omnicam group showed significant difference(P 0.05).All the distances of the Bluecam group and Omnicam group showed significant difference(P <0.05).Conclusion:The scanning accuracy of Cerec Bluecam is higher than that of Cerec Omnicam in a single preparation scanning.When the scanning area ex-tending,the scanning accuracy of Cerec Omnicam is higher than that of Cerec Bluecam.
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Objective:To compare the compressive strength of porcelain crown with Co-Cr,CAD/CAMpure titanium and CAD/CAM zirconia respectively.Methods:Metal models of simulating crown core of the ideal premolar were manufactured,digital data of the met-al model were obtained by CAD/CAMsystem,the basement crowns of Co-Cr,CAD/CAMpure titanium and CAD/CAMzirconia were respectively made(n =5),size of each crown was kept the same and the spcimens were set as group A,B and C respectively.Then masking porcelain and body porcelain were fired on basement crowns according to the instructions.The thickness of the porcelain was kept the same.All of the porcelain crowns were located on the Instron testing machine,the compression strength force values were measured.Data were statistically analysed by SPSS 1 3.0 software.The bonding surface of basement material and porcelain was observed by SEMafter compressive failure.Results:The compressive strength(N)of group A,B and C was 2 990 ±1 88,2 305 ±1 57,2 1 50 ± 1 31 ,A vs B or C,P 0.05.Conclusion:All the 3 base materials with porcelain crown satisfy the clinical require-ments.The compressive strength of Co-Cr porcelain crown is stronger than that of CAD/CAMpure titanium porcelain crown and CAD/CAMzirconia porcelain crown.
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Objective:To compare the titanium-porcelain bonding strength between CAD/CAM and cast pure titanium.Methods:Pure titanium samples were prepaired by CAD/CAMand casting respectively and fused with porcelain.The bond strength between tita-nium and porcelain of the samples was measured with three-point test.The titanium-porcelain interface was investigated under scanning electronic microscope(SEM).Results:The bond strength of CAD/CAMpure titanium to porcelain was (35.95 ±3.74)MPa and cast pure titanium to porcelain was (28.37 ±1 .98)MPa(P <0.05).SEMobservation showed that there was thin transition layer between titanium substrate and ceramic in CAD/CAM bond interface,titanium and porcelain combined closely,no obvious pores.However, there was thicker transition layer and small pore in cast pure titanium to porcelain bonding interface.Conclusion:The bonding strength of porcelain to CAD/CAMpure titanium is greater than that of porcelain to casting pure titanium.
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Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinosus tendon autograft and tendon allograft.Methods Data of 68 patients with chronic ankle instability who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed.In the group of semitendinosus autograft,there were 32 patients (19 males,13 females) with an average age of 32.4 years old.Semitendinosus was harvested through 2 small knee incisions.While in the group of tendon allograft,there were 36 patients (22 males,14 females) with an average age of 34.2 years old.For the ankle reconstruction,4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip,the talar neck,and the middle of the calcaneus.Anatomical reconstruction of the anterior talofibular ligament and calcaneofibular ligament was then performed through these small incisions.AOFAS questionnaires were used to measure clinical outcomes,donor site morbidity and patients' satisfaction.Preoperative and postoperative stress tests were performed and radiographic parameters were measured.Results The average operation time of the autograft group 85.5 ± 11.5 min was significantly longer than that in the allograft group 58.1±10.2 min,but the fever days in the latter 5.5±1.5 d was significantly longer than in the former 2.5±1.2 d.In autograft group,23 patients got followed up,and the mean period of follow-up was 33.5±6.7 months.The mean AOFAS score increased from 62.3±8.2 to 95.1 ±7.5.In allograft group,26 patients got followed up,and the mean period of follow-up was 28.5±6.7 months.The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5.There were 5 patients (3 of autugraft group and 2 of allograft group) with residual instability on uneven ground.One case of the autologous group had instability in daily life.No patient presented weakness or disability in the donor site.The satisfaction level of the autograft group was excellent in 16,good in 5 and bad in 2.Significant improvement in stress radiographic parameters was noted for the talar tilt angle,with reduction from a mean of 14.0° to 3.8°; anterior talar displacement reduced from a mean of 12.3 to 4.6 mm.The satisfaction level of the allograft group was excellent in 17,good in 5 and bad in 4.The talar tilt angle reduced from 13.0° to 3.6°; anterior talar displacement reduced from 11.5 to 4.3 mm.Conclusion There is no differences in efficacy could we found in using these 2 kinds of materials.The process of healing and rehabilitation of tendon autograft is slightly faster than the tendon allograft,but the allograft tendon has many advantages such as limited injury,simple procedure andavoiding of donor site morbidity.
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Objective To evaluate the significance of weight-bearing lateral radiographs in evaluation of malunited frac-tures of the ankle. Methods 17 patients with malunited fractures of the ankle were treated by different reconstructive operations be-tween March 2010 and October 2012, including 9 females and 8 males, aged from 17 to 64 years. According to the Takakura classifi-cation of ankle arthritis, there were 7 patients in grade 1, 4 in grade 2 and 6 in grade 3. Simple open reduction and internal fixation were performed in 5 patients, supramalleolar tibial osteotomy in 5, lengthening osteotomy of the fibula in 2, supramalleolar tibial and fibular osteotomy in 5. Tibiofibular clear space on the anteroposterior radiograph. Medial clear space, tibiofibular clear space and tib-iofibular overlap on ankle mortise radiographs were compared preoperatively and at last follow-up. Tibial lateral surface angle (TLS), the offset of the center of talar rotation from the tibial axis, and the displacement of tibiotalar articular surface center on weight-bear-ing lateral X-ray were also compared preoperatively and at last follow-up. AOFAS score was used to evaluate the function of the ankle. Results The duration of follow-up was 9 to 32 months. Bone healing was observed in all patients, and the average healing time was 11 to 14 weeks. Ankle joint degeneration grade had no exacerbation. The medial clear space, tibiofibular clear space and tibiofibular overlap had no significant difference between the pre and postoperative. Statistically significant change was seen postoperatively in the values of TLS (76.9°±4.1° vs 80.9°±5.2°). The offset of the center of rotation from the tibial axis and the displacement of tibiotalar articular surface center were changed from 10.8 ± 2.1 mm to 2.0 ± 0.5 mm and 4.5 ± 1.5 mm to 2.2 ± 1.0 mm, respectively. The average AOFAS score was improved from 45.7 ± 15.9 points preoperatively to 82.0 ± 9.9 points postoperatively. Conclusion Weight-bearing lateral radiographs can be used to judge the ankle restoration. Even if the mortise radiograph had relative good realignment, it may ap-pear obvious deformity on lateral radiographs. Good reduction of lateral radiographs requires that the mid axis of the tibia should pass through the center of talar rotation and tibiotalar articular surface be parallel on the lateral radiograph.
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Background and purpose: Thyroid carcinoma cells spread mainly through lymph node metastasis, and lymphangiogenesis plays an important role during the lymph node metastasis, but it is not very clear to understand the formation mechanism. This study was to investigate the correlative expressions of HPSE, VEGF-C, D2-40 and lymphangiogenesis in thyroid carcinoma. Methods: Immunohistochemistry SP method was used to detect the expressions of HPSE, VEGF-C and D2-40 in 77 patients with thyroid carcinoma including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC),medullary thyroid carcinoma (MTC), 32 of them with lymph node metastasis was enrolled into the study, D2-40 stained the lymphatic vessels, and lymphatic vessel density (LVD) was scanned under the light-microscope, and the correlation among the above indexes in different thyroid carcinoma types were analyzed respectively. Results: The expressions of HPSE, VEGF-C and D2-40 were observed to have a different degree in thyroid carcinoma, and the highest expression of the protein could be seen in the patients with papillary carcinoma (P<0.05),The expression ratios of HPSE,VEGF-C and D2-40 in different carcinoma types were 54.9%, 68.6%, 12.8±5.7 for PTC, 37.5%, 50%, 8.6±1.7 for FTC, 20% and 20%, 4.9±0.8 for MTC, respectively. There were significant different expressions of HPSE, VEGF-C and D2-40 between the patients with lymph node-positive group and node-negative group (P=0.014, P=0.048, respectively). In addition, the expressions of them were positively correlated (P<0.001, r=0.616). Conclusion: HPSE, VEGF-C and D2-40 have a close relationship with lymph node metastasis, HPSE and VEGF-C are related to the lymphangiogenesis.
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Bone mesenchymal stem cell is a kind of multi-potential stem cells and can differentiate into osteoblast. The differentiation has membrane bone formation and enchondral bone formation two channels, and is regulated by numerous signal transduction pathways. According to related literatures, we review the signal transduction pathways of BMP/Smads, Runx2/osterix, Hedgehog, Wnt/β-Catenin and MAPK.
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Objective To observe the expression of transforming growth factor beta(TGF-?)in rats’ spinal cords of acute contusive injury model and try to explore the possible mechanism.Methods 20 Sprague Dawley rats were randomly divided into two groups. Ten rats underwent spinal cord contusive injury opration as the experimental group by using modified Allen’s method (using a weight-drop device) after the T10 spinous process and the corresponding vertebral lamina were removed. The other ten rats received only T10 laminectomy without spinal cord injury as the sham-operated control group. The injured spinal cord in the two groups was taken out respectively at 24h after injury.Results Pathological alterations were detected by H-E staining and the expression of TGF-? was analyzed by immunohistochemistry analyses. From H-E staining, we could see the microstructure of spinal cord was norma1 in sham-operated control group and the pathological alterations were apparent in the injured spinal cord area in the experimental group as a central core lesion which consisted of spared fibers, variable cyst formations, gliosis and scarring with a spare peripheral rim of tissue. We also found TGF-? expression of spinal cord was increased in experimental group when compared with sham-operated control group (P