Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are different materials used for anterior cruciate ligament (ACL) reconstruction. It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement. This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System (LARS) artificial ligament.</p><p><b>METHODS</b>Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1, 3, 6, 12, 24, and 36 months after surgery, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer.</p><p><b>RESULTS</b>According to the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of (2.5 ± 0.3) mm. Forty cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were (0.8 ± 0.3) and (1.1 ± 0.3) mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points (P > 0.05). X-ray and CT measurements were consistent.</p><p><b>CONCLUSIONS</b>There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.</p>

Posterior debridement for the treatment of iatrogenic purulent lumbar spinal infection / 中国骨伤

<p><b>OBJECTIVE</b>To discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.</p><p><b>METHODS</b>From December 2006 to January 2010, 4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement. There were 2 males and 2 females, ranging in age from 50 to 66 years (respectively in 52, 66, 58, 50 years); in course of disease from 2 weeks to 2.5 months (respectively in 21, 14, 60, 75 days ). All patients had fever, lumbago, local tenderness and limited lumbar activity before operation. White blood cell count (WBC), erythrocyte sedimentation rate (ESR) were abnormal. The clinical effects were evaluated by symptoms and laboratory examination.</p><p><b>RESULTS</b>Symptoms of lumbago and fever vanished in 4 patients, of which wounds were primary healing without complications. The patients were followed up for 3 months, no infection (WBC, C-reactive protein and ESR were normal) and lumbar instability were found.</p><p><b>CONCLUSION</b>Iatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease, clinical symptoms and signs, imaging finding. In the items, magnetic resonance imaging finding have necessarily specificity, once finding abscess-formation, will promptly operate.</p>

Therapeutic effect of staged surgery for central cord syndrome of the cervical spine / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the effect of staged surgical treatment on central cord syndrome of the cervical spine.</p><p><b>METHODS</b>A retrospective analysis was conducted in 36 cases of central cord syndrome of the cervical spine treated with staged surgery. The patients (aged 50 to 79 years, mean 56.9 years) were divided into group A (50 to 64 years old, n=20) and group B (above 65 years old, n=16), and each group was further divided into 2 subgroups according to the range of decompression in the second stage, namely A1, B1 and A2, B2. ASIA motor score (AMS) was analyzed before the first-stage surgery, before the second-stage surgery and at the last follow-up after the second-stage surgery.</p><p><b>RESULTS</b>All the surgeries were performed successfully. The patients were followed up for 12 to 32 months (mean 18.4 months) after the second-stage surgery. After the first-stage surgery, the AMS was 75.8-/+14.6 in group A, 73.2-/+13.1 in group B, 78.5-/+10.2 in group A1, 76.8-/+9.5 in group A2, 72.2-/+12.6 in group B1 and 77.4-/+18.3 in group B2. The AMS at the last follow-up was 90.7-/+10.5 in group A, 89.5-/+12.4 in group B, 91.3-/+13.2 in group A1, 90.7-/+14.8 in group A2, 88.5-/+11.2 in group B1 and 92.4-/+13.6 in group B2. There was no significant difference between groups A and B or between the subgroups A1 and A2 and groups B1 and group B2. The AMS was 75.8-/+14.6 after the first-stage surgery and 90.7-/+10.5 at the last follow-up in group A, significantly higher than those in group B (73.2-/+13.1 and 89.5-/+12.4, respectively, P<0.05).</p><p><b>CONCLUSION</b>Staged surgery is effective for treatment of central cord syndrome of the cervical spine, and the effect of the surgery is not related to the patients' age or the range of decompression.</p>

Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are many different materials used for ligament reconstruction. Currently, autograft, allograft, and artificial ligaments are used in the reconstruction. The objective of this study was to explore the clinical result of cruciate ligament reconstruction under arthroscopy.</p><p><b>METHODS</b>Eighty-one cases were reconstructed with the LARS ligament under arthroscopy, including 43 cases of anterior cruciate ligament (ACL) injury, 20 cases of posterior cruciate ligament (PCL) injury, and 18 cases of ACL combined with PCL injuries of the knee. The follow up period was 10 to 49 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scales were used for functional evaluation. We examined the anterior and posterior stability of the knee with KT-1000.</p><p><b>RESULTS</b>According to the Lysholm knee function score scale, the average preoperative score of (44.6+/-1.4) increased to a postoperative score of (82.8+/-2.5) in the ACL group and from (46.6+/-2.3) to (80.8+/-2.0) in the PCL group. In the ACL combined with PCL injury group, the preoperative score increased from (45.2+/-1.2) to (85.5+/-2.3). According to IKDC score standards, in ACL group we evaluated 19 cases as C and 24 cases as D, preoperatively, and postoperatively 27 cases as A, 14 cases as B and two cases as C. In the preoperative PCL group, we had 11 cases defined as C and nine cases as D that resolved to 12 cases as A, seven as B and one case of C in postoperative evaluation. In the ACL combined with PCL injury group we defined four cases as C and 14 as D during preoperative scoring. These patients had postoperative grades of six cases as A, 10 as B, and two cases as C. All of the results have statistical significance.</p><p><b>CONCLUSIONS</b>ACL, PCL, or combined ACL and PCL reconstruction using the LARS ligament under arthroscopy is a minimally invasive, safe and effective method to treat cruciate ligament injuries of the knee. Clinical results are satisfactory in the short term.</p>