A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography / 中华烧伤杂志

Objective: To explore the preoperative whole perforator evaluation and intraoperative eccentric design of anterolateral thigh flap (ALTF) based on superficial fascial perforators by modified computed tomography angiography (CTA), and the clinical effects were observed. Methods: A prospective observational study was adopted. Twelve patients with oral and maxillofacial tumors and 10 patients with open injury of the upper limb with large soft tissue defects were hospitalized in the Department of Hand & Microsurgery and Department of Oral & Maxillofacial Surgery of Affiliated Hospital of Binzhou Medical University from January 2021 to July 2022, with 12 males and 10 females, aged from 33 to 75 years, an average age of 56.6 years. The wounds of the patients with oral and maxillofacial tumors were reconstructed by ALTF after the extensive tumor resection and radical cervical lymph node dissection in the same stage; the wounds of the patients with skin and soft tissue defect on the upper limb were covered by ALTF in stage Ⅱ after debridement in stage Ⅰ. After debridement, the area of wound was 3.5 cm×3.5 cm-25.0 cm×10.0 cm and the area of the required flap area was 4.0 cm×4.0 cm-23.0 cm×13.0 cm. Modified CTA scan was performed on the donor site of ALTF before the operation, with the parameters of modified CTA being set to mainly reduce the tube voltage and tube current, and increase the contrast dose and the dual phase scan. The acquired image data were sent to GE AW 4.7 workstation and adopted the volume reconstruction function for visual reconstruction and evaluation of the whole perforator. The information of perforator and source artery was marked on the body surface before operation according to the above evaluation. During the operation, an eccentric flap centered on the visible superficial fascia whole perforator was designed and cut according to the desired flap area and shape. The donor sites of the flap were repaired by direct sutures or full-thickness skin grafts. The total radiation dose was compared between the modified CTA scan and the traditional CTA scan. The distribution of outlet point of perforator of double thighs, the length and direction of superficial fascia perforators based modified CTA were recorded. The type, number, and origin of the target perforator, distribution of of outlet point of perforator, and the diameter, course, and branch of the source artery observed before the operation were compared with those observed during the operation. The healing of donor site wound and the survival of flaps in recipient site were observed after operation. The texture and appearance of flap, oral and upper limb functions, and the functions of femoral donor sites were followed up. Results: The total radiation dose of modified CTA scan was lower than that of the traditional CTA scan. A total of 48 perforators of double thighs were observed, among which, 31 (64.6%) perforators went outward and downward, 9 (18.8%) perforators went inward and downward, 6 (12.5%) perforators went outward and upward, and 2 (4.2%) perforators went inward and upward, and the average length of superficial fascia perforators was 19.94 mm. The preoperative observed type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery were basically consistent with the intraoperative exploration. The types of 15 septocutaneous (including musculoseptocutaneous) perforators and 10 musculocutaneous perforators observed before the operation was consistent with intraoperative exploration. The distance between the mark of the surface perforator point and the actual exit point of the perforator during operation was (0.38±0.11) mm. All flaps survived without vascular crisis. The donor site wounds of 5 cases of skin grafting and 17 cases of direct suturing wounds healed well. The postoperative follow-up was 2 months to 1 year, with an average of 8.2 months, the flaps were soft and slightly bloated; the function of diet and mouth closing was accessible in patients with oral and maxillofacial tumors, the speech function was mildly impaired in patients with tongue cancer, but they could complete basic oral communication; the wrist and elbow joints and forearm rotation function were not significantly limited in patients with upper limb soft tissue injuries; there was no obvious tightness in the donor sites, and the function of the hip and knee joints was not limited. Conclusions: The whole perforator and even the subcutaneous perforator of the donor site of ALTF can be evaluated by modified CTA, and the flap can be used in oral or maxillofacial reconstruction and repair of skin and soft tissue defects of upper limbs to achieve good results. By clarifying the type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery before the operation, the eccentric design of the ALTF based on the superficial fascia perforator was realized. This study has strong guiding value.

Effect of acupuncture on serum PYY and nesfatin-1 in obese patients with insulin resistance / 针灸推拿医学（英文版）

Objective: To observe the effect of acupuncture on serum peptide YY (PYY) and nesfatin-1 in obese patients with insulin resistance. Methods: Ninety-eight obese patients with insulin resistance were divided into a control group and an observation group by the random number table method, with 49 cases in each group. The control group received exercise and dietary interventions, and the observation group received additional acupuncture treatment to the exercise and dietary interventions. The body mass index (BMI), body fat percentage, fasting insulin (FINS), fasting plasma glucose (FPG), homeostasis model assessment for insulin resistance (HOMA-IR), triglyceride (TG), total cholesterol (TC), and serum PYY and nesfatin-1 levels were compared before and after treatment. The efficacy was evaluated after treatment. Results: The total effective rate was significantly higher in the observation group than in the control group (P<0.05). After treatment, the BMI, body fat percentage, and serum TG and TC levels decreased significantly in both groups (P<0.05), and were significantly lower in the observation group than those in the control group (P<0.05). The FINS, FPG, HOMA-IR, and serum PYY and nesfatin-1 levels of the control group were not significantly changed after treatment (P>0.05). The FINS, FPG and HOMA-IR of the observation group decreased significantly after treatment (P<0.05), and were lower than those in the control group (P<0.05). The serum PYY and nesfatin-1 levels of the observation group increased significantly after treatment (P<0.05), and were higher than those in the control group (P<0.05). Conclusion: Based on exercise and dietary interventions, acupuncture is effective for obese patients with insulin resistance. It can reduce the BMI, body fat percentage, blood lipids, blood glucose, and serum insulin levels and improve insulin resistance. The action may be associated with the up-regulation of serum PYY and nesfatin-1.

Anatomical study on the feasibility of a new self-guided pedicle tap / 中国骨伤

OBJECTIVE@#To evaluate the accuracy and safety of pedicle screw placement using a new self-guided pedicle tap.@*METHODS@#According to the anatomical characteristics of the pedicle, a new self-guided pedicle tap was developed. Six adult spinal specimens including 4 males and 2 females were selected and tapped thread on the right and left sides of each pair of pedicles from the same segment T to L with traditional taps (control group) and new self-guided pedicle taps (experimental group), respectively. And the pedicle screws were placed. The screwing time was recorded and compared between two groups. CT scanning was completed to observe the accuracy and safety of the screw placement according to the Heary classification of imaging results.@*RESULTS@#The screwing time of thoracic and lumbar vertebrae in the experimental group were (5.87±1.25) min and(5.45±1.67) min, respectively. While those in the control group were (6.12±1.69) min and (6.22±2.13) min, respectively. Then there was no significant difference in screwing time of thoracic and lumbar vertebrae between two groups (>0.05). The Heary grade of the pedicle screw showed that Heary gradeⅠand Heary gradeⅠ+Ⅱwere respectively 86 (84.31%) and 96 (94.12%) in the experimental group, 72 (71.29%) and 84 (83.17%) in control group, and the difference between two groups was statistically significant (<0.05).@*CONCLUSION@#The new self-guided pedicle tap can accurately and safely insert the thoracolumbar pedicle screw, with low cost, easy operation, and good clinical application value.

Therapeutic effect and imaging study of directional bone cement guide for the treatment of thoracolumbar vertebral compression fractures / 中国骨伤

OBJECTIVE@#To evaluate the therapeutic effects and bone cement distribution of unilateral percutaneous kyphoplasty (PKP) with oriented bone cement injector for thoracolumbar osteoporotic vertebral compression fractures (OVCFs).@*METHODS@#The clinical data of 211 patients (211 vertebrae) with thoracolumbar osteoporotic compression fractures underwent PKP between July 2016 to July 2018 were retrospectively analyzed. All punctures were performed unilaterally:102 patients in observation group used oriented bone cement injector including 30 males and 72 females with an average age of (68.4±8.9)years old; 109 patients in regular group used traditional bone cement injector including 32 males and 77 females with an average age of (70.4±9.2) years old. The two groups were compared in terms of duration of operation, cement volume, visual analogue scale(VAS), Oswestry Disability Index(ODI), distribution of bone cement, bone cement leakage and Cobb angle modified rate.@*RESULTS@#There were no significant difference in gender, age and fracture vertebra between the two groups(>0.05). No significant difference was found between two groups in duration of operation, cement volume, VAS, ODI and Cobb angle(>0.05). In observation group, 10 cases occurred cement leakages, with leakage rate of 9.80%; and in regular group, 11 cases occurred cement leakage, with leakage rate of 10.09%. There was no significant difference in the cement leakage rate between two groups(>0.05). In observation group, proportion rate of I-IV degree in cement distribution was 60.78%, 19.61%, 9.80%, 9.80%, respectively; while 39.45%, 22.93%, 22.93%, 14.68% in regular group. The I degree of cement cross-filling rate was better in observation group than in regular group(0.05). From T10 to L₅, I degree bone cement distribution rate of both groups showed decline trend. The I degree cement cross-filling rate in L₁-L₅ was 50% in observation group and 30.23% in regular group(<0.05).@*CONCLUSIONS@#Oriented bone cement injector can control the direction of bone cement dispersion and achieve effective distribution of bilateral bone cement using unilateral puncture and satisfactory surgical results. It is feasible and effective for unilateral PKP treatment of OVCFs.

Effects of insulin glargine on fracture healing and osteocalcin expression in type 2 diabetic rats / 中国组织工程研究

BACKGROUND:Insulin analogues have been extensively applied in the treatment of diabetes mellitus.Insulin glargine has a higher affinity for insulin like growth factor 1 receptor compared with human insulin.Further research is needed to ensure whether insulin and its analogues exert same effects on fracture healing in type 2 diabetes mellitus.OBJECTIVE:To observe the osteocalcin expression and callus formation in the healing of fracture in type 2 diabetic rats induced by human insulin and insulin glargine,to observe the difference between two treatment methods,and to explore the related mechanisms.METHODS:Sixty-four Sprague-Dawley rats were randomly assigned into human insulin group (group A),insulin glargine group (group B),diabetes mellitus group (group C) and control group (group D).Rats in the groups A,B and C were fed with high-sugar and high-fat diet for 4 weeks followed by intraperitoneal injection of small-dosage streptozotocin twice,to establish the rat models of type 2 diabetes mellitus.After the right tibia of each rat was broken,insulin glargine and Novolin 30R were used in the groups A and B,respectively.Fracture healing was observed on X-ray,callus formation and number of osteoblasts were observed by microscope,and serum level of osteocalcin was measured by ELISA method at 1,2,4,and 6 weeks after modeling.RESULTS AND CONCLUSION:X-ray results revealed better fracture healing in the groups A,B and D than the group C.Osteoblast proliferation in callus was significantly better in the groups A,B and D than in the group C.Serum level of osteocalcin in each group was on the rise,which was significantly higher in the groups A,B and D than the group C (P ＜ 0.05),but had no significant difference among groups A,B and D (P ＞ 0.05).In summary,insulin glargine can increase the serum level of osteocalcin,accelerate the callus formation,and improve the healing of fracture in type 2 diabetic rats.Furthermore,there is no significant difference in the therapeutic efficacy between insulin glargine and human insulin.