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Objective To explore the role of a customized 3D printing guide in total hip arthroplasty (THA).Methods A retrospective analysis was performed of the 60 patients who had been treated by THA for avascular necrosis of the femoral head at Department of Orthopaedics and Traumatology,Foshan Hospital of Traditional Chinese Medicine from January 2018 to May 2019.Half of them used the personalized 3D printing guide in THA and half did not.In the guide group there were 17 men and 13 women with an age of 53.4 ± 8.9 years while in the conventional group 19 men and 11 women with an age of 54.7 ± 9.4 years.The acetabular cups were orientated at an abduction angle of 40° and an anteversion angle of 15°.The intraoperative blood loss,operation time and acetabular abduction angle were compared between the 2 groups.Results The 2 groups were comparable due to insignificant differences between them in gender,age,body mass,cause of disease or staging of avascular necrosis of the femoral head (P ＞0.05).The guide group had significantly less intraoperative blood loss (286.7 ± 150.8 mL) and operation time (90.5 ± 34.4 min) than the conventional group did (438.3 ± 292.6 mL and 115.6 ± 58.6 min) (P ＜0.05).The acetabular cup abduction was 38.9° ± 4.2° in the guide group and 37.2° ± 5.5° in the conventional group,showing no significant difference (t =1.315,P =0.194).Conclusion Use of a personalized 3D printing guide in THA can shorten the time for installation of an acetabular prosthesis and reduce the amount of intraoperative blood loss,but it leads to insignificant difference in the postoperative acetabular cup abduction compared with no use of the guide.
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Based on anatomy and clinical operation, this article discussed the anatomical structure of temporal bone and its contiguous relationship under oto-endoscope, through two approaches: the natural external auditory canal and the enlarged external auditory canal. To give an account of the anatomical characteristics of temporal bone under oto-endoscope.
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Disfunction of Eustachian tube will cause negative pressure of middle ear, which may result in tympanic membrane retraction pocket. Severe pocket can consequently cause cholesteatoma. In clinical practice it is not uncommon to find a cholesteatoma limited to epitympanum, with an otherwise normal pars tensa and mesotympanum. This review explains the theory of "selective epitympanic dysventilation syndrome" developed by endoscopic technique. In the majority of the patients, the only ventilation pathway to the epitympanum is through the tympanic isthmus. Even if Eustachian tube function has recovered, an isthmus blockage with selective epitympanic dysventilation may lead to common attic cholesteatoma.
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Objective@#To analyze the safety of endoscopic stapes surgery, and to compare the results with stapes surgery under microscopic approach.@*Methods@#This was a retrospective study. One hundred and thirty seven patients from Eye Ear Nose and Throat Hospital of Fudan University and other seven hospitals were enrolled in this study. Eighty eight patients, in whom 29 were male, and 59 were female, aged from 29 to 66 years old, with an average of 40.1±10.7, underwent endoscopic stapedotomy and 49 patients, in whom 17 were male, and 33 were female, aged from 32 to 64 yeas old, with an arerage of 38.7±9.2, underwent microscopic stapedotomy for otosclerosis. Interventions included endoscopic and microscopic stapes surgeries. Main outcome measures consisted of operating time, preoperative and postoperative hearing, intraoperative findings, and postoperative complications. SPSS 16.0 software was used to analyzed the date (t test and χ2 test) .@*Results@#Patients in the group who underwent endoscopic stapes surgery showed a mean operative time of (74.1±26.0) min. Patients in the group treated by microscopic approach had a mean operative time (66.5±15.9) min. Statistical difference was evident (t=1.279, P<0.05) . The average operative time of endoscopic surgery became shorter as the cases increased. The average duration of the last 10 cases was shorter than that of the first 10 cases in both groups. The differences were significant (t value was 3.028, 3.610, both P<0.05). No statistical difference was found in air conduction threshold improvement (t=1.074, P=0.289) , air-bone gap closure (t=-0.135, P=0.893) and bone conduction improvement (t=1.222, P=0.228) between the two groups. No difference regarding the incidence of the postoperative complications (chorda tympanum damage: 6 cases vs 2 cases, χ2=0.08,P>0.05; vertigo:18 cases vs 9 cases,χ2=0.09, P>0.05; facial paralysis: 0 case vs 0 case) between the two groups was found.@*Conclusion@#Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Endoscopic stapes surgery is safe.
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Objective@#To explore the efficacy of ossiculoplasty surgery under oto-endoscope in patients of conductive hearing loss with intact tympanic membrane.@*Methods@#A retrospective study was conducted. The clinical data of 45 patients with conductive hearing loss who had undergone simple ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China (West China Hospital of Sichuan University, General Hospital of the People′s Liberation Army, Shanghai Ninth People′s Hospital, Shanghai JiaoTong University School of Medicine, Xijing Hospital, Fourth Military Medical University and Shenzhen Sixth People′s Hospital) were collected. There were 28 males and 17 females, with the age ranging from 12 to 69 years old. The tympanic membranes of those patients were intact before surgery. The lesion only occurred in the ossicular chain from CT and intraoperative exploration. The cases of otosclerosis, tympanosclerosis, cholesteatoma of middle ear, chronic suppurative otitis media, and tumor of middle ear were excluded. The postoperative complications, hearing improvements and operation time were observed. SPSS 23.0 software was used for statistic analysis.@*Results@#There was neither sensorineural hearing loss nor facial paralysis after surgery in this group. Seven patients had transient mild tinnitus after surgery and gradually relieved during the follow-up period. Nine patients developed dysgeusia after surgery. Two patients developed dizziness after surgery, and the symptoms were mild and relieved during 1 week without special intervention. The air-bone gap (ABG) range of pre-operation was 22.5-45.7 dB, and the average ABG was (25.3±8.6) dB. The ABG range in the third month after surgery was 5.7-26.8 dB, and the average ABG was (9.3±8.6) dB. The mean value of ABG was significantly lower in the third month after surgery compared with that of pre-operation (t=2.31, P<0.05). The operation time of the surgeons in each research center was similar. The overall average of operation time was (43.56±18.25) min. There was no significant difference in the duration of operation between the centers (F=3.26, P>0.05).@*Conclusion@#The ossiculoplasty surgery under oto-endoscope has good efficacy.
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Objective@#To summarize and discuss the characteristics of endoscopic approach to manage the middle ear cholesteatoma, and to evaluate the operative safety and outcomes based on the data from the multicenter study.@*Methods@#The data of 242 cases diagnosed with the middle ear cholesteatoma and received operation through endoscopic approach between June 2016 and June 2017 in six tertiary hospitals in China were analyzed in this work. There were 130 males and 112 females, with the age ranging from 3 to 72 years old. We evaluated the strategy about how to manage the cholesteatoma, discussed the detailed techniques about how to remove the cholesteatoma and to improve the efficiency under endoscopic visualization. Meanwhile, the recurrence rate and residual rate of cholesteatoma as well as the complications in endoscopic approach were summarized.@*Results@#A total of 158 cases were operated in exclusively endoscopic transcanal approach, 72 cases operated in combined approach, and 12 cases operated majorly under microscope and minorly under endoscope. 219 cases were operated in one stage surgery, 23 cases received second look. In the second look, 3 cases were detected with residual cholesteatomas. Among them, 2 cases were found by MRI-DWI examination after the first-stage operation. With endoscopic examination after operation, 17 cases showed retracted pocket recurrence (7%,17/242). With introduction of endoscope in cholesteatoma, 153 cases were achieved canal wall-up operation (63%, 153/242). The complications in endoscopic approach included chord tympani never injury in 27 cases, skin injury of ear canal in 11 cases, tinnitus in 13 cases, vertigo in 7 cases, external ear canal stenosis in 1 case.@*Conclusions@#Using otoendoscope in cholesteatoma surgery would help keeping the normal structures of middle ear as much as possible, benefit to remove the hiding pathologies, help reducing residual cholesteatoma and lowering the rate of canal wall-down operation as well. This study showed good safety of otoendoscopic cholesteatoma surgery, however, strict evaluation of indication and quite good surgical techniques and skills are necessary for avoiding unexpected complication.
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Objective@#To explore the role of a customized 3D printing guide in total hip arthroplasty (THA).@*Methods@#A retrospective analysis was performed of the 60 patients who had been treated by THA for avascular necrosis of the femoral head at Department of Orthopaedics and Traumatology, Foshan Hospital of Traditional Chinese Medicine from January 2018 to May 2019. Half of them used the personalized 3D printing guide in THA and half did not. In the guide group there were 17 men and 13 women with an age of 53.4±8.9 years while in the conventional group 19 men and 11 women with an age of 54.7±9.4 years. The acetabular cups were orientated at an abduction angle of 40° and an anteversion angle of 15°. The intraoperative blood loss, operation time and acetabular abduction angle were compared between the 2 groups.@*Results@#The 2 groups were comparable due to insignificant differences between them in gender, age, body mass, cause of disease or staging of avascular necrosis of the femoral head (P>0.05). The guide group had significantly less intraoperative blood loss (286.7±150.8 mL) and operation time (90.5±34.4 min) than the conventional group did (438.3±292.6 mL and 115.6±58.6 min) (P< 0.05). The acetabular cup abduction was 38.9°±4.2° in the guide group and 37.2°±5.5° in the conventional group, showing no significant difference(t=1.315, P=0.194).@*Conclusion@#Use of a personalized 3D printing guide in THA can shorten the time for installation of an acetabular prosthesis and reduce the amount of intraoperative blood loss, but it leads to insignificant difference in the postoperative acetabular cup abduction compared with no use of the guide.
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<p><b>OBJECTIVE</b>To analyze the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane, and summarize the key diagnostic points, differential diagnosis and observe the effects of surgical treatment.</p><p><b>METHODS</b>We reviewed data from 82 patients with unilateral conductive hearing loss with intact tympanic membranes who accepted the exploratory tympanotomy from April 2011 to September 2013. There were 41 males and 41 females, aged from 7 to 66( averaged 26.5±13.7)years, with a history of one month to 50 years. The history, clinical symptoms, audiological evaluation, high resolution temporal bone CT, the results of surgical exploration and hearing reconstruction were analyzed.</p><p><b>RESULTS</b>The exploratory tympanotomy revealed 43 cases of congenital middle ear malformations (52.4%), 22 cases of otosclerosis (26.8%), eight cases of congenital cholesteatoma (9.8%), six cases of trauma induced conductive hearing loss (7.3%), three cases of congenital ossicular malformations with congenital cholesteatoma (3.7%). Progressive hearing loss was common in patients with otosclerosis and congenital cholesteatoma, and patients with congenital middle ear malformations described their hearing loss since childhood. High resolution temporal bone CT of congenital middle ear malformation, trauma induced conductive hearing loss, congenital cholesteatoma diagnosis rate was 40.0%, 50.0%, and 83.3% respectively. The preoperative air-conductive threshold of patients with absence of the oval window were increased to (66.9±1.1)dBHL, the preoperative bone-conductive threshold achieved (28.3±10.4)dBHL at 2 000 Hz. While patients with stapes fixation and that with ossicular chain discontinuity were (27.2±9.7)dBHL and (17.8±8.8)dBHL(P=0.000)respectively. Through the tympanic exploration with endaural incision under the microscope, different hearing reconstruction were applied according to different lesions. After the operation, the hearing level of 52 patients with return visit were improved, the mean air-conductive threshold were decreased from (60.0±11.4)dBHL to (32.2±12.1)dBHL(P=0.000); and the mean ABG were decreased from (43.2±12.0)dB to (16.3±9.4)dB(P=0.000).</p><p><b>CONCLUSIONS</b>Congenital middle ear malformations, otosclerosis, congenital cholesteatoma are the most common causes in unilateral conductive hearing loss with an intact tympanic membrane. The diagnosis rate can be improved by analyzing the clinical features. Through exploratory tympanotomy and hearing reconstruction, we can clarify the diagnosis and achieve a satisfying hearing recover.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Audiometry , Cholesteatoma , Pathology , Diagnosis, Differential , Ear Ossicles , Pathology , Ear, Middle , Congenital Abnormalities , Hearing Loss, Conductive , Pathology , General Surgery , Middle Ear Ventilation , Otosclerosis , Pathology , Tympanic MembraneABSTRACT
Objective:To analyze the etiology and clinical symptoms and to investigate the therapeutic strategies of cerebrospinal fluid otorrhea. Method:A retrospective analysis of 37 cases of patients with cerebrospinal fluid otorrhea.The clinical symptoms, auxiliary examination, intraoperative findings, surgical methods and postoperative follow-up were analyzed. Result:In 37 cases, 35 patients underwent the plugging surgery once and cured, 1 patient with inner ear malformation underwent another operation and cured, 1 patient didn't have the operation. No cerebrospinal fluid leakage or meningitis recurrence was reported by the followed up from 1 months to 7 years after operation. Conclusion:Surgical repair is an effective method to treat the cerebrospinal fluid otorrhea. It is significant to take appropriate surgical approach to expose and to find the leak, according to the etiological factor and imaging examination.
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OBJECTIVE@#To investigate the clinical features of labyrinthine fistula and obtain the diagnosis, treatment and prognosis of different types of fistula.@*METHOD@#A retrospective analysis of 42 cases (43 ears) with labyrinthine fistula in our hospital from January 2007 to November 2014 was conducted. Data of preoperative clinical manifestation, auditory function, CT image, operative findings, treatment and postoperative recovery were collected and statistically analysed.@*RESULT@#Thirty-nine cases (40 ears) of the 42 cases (43 ears) which were diagnosed as labyrinthine fistula according to operative findings occurred in the lateral semicircular canal, 1 case occurred in the posterior semicircular canal, 1 case occurred in the superior semicircular canal, and 1 case occurred both in lateral and posterior semicircular canal. Before operation, 24 ears (55.8% ) experienced vertigo and 14 ears (32.6%) showed impaired bone conduction hearing threshold. According to Dornhoffer classification standard, 22 cases (23 ears) were diagnosed as type I fistula, 9 cases as type II fistula and 11 cases as type III fistula. There was no statistical difference among the 3 groups on type of hearing loss, vertigo, CT, facial nerve canal damage before operation and bone conduction hearing threshold, vertigo after operation.@*CONCLUSION@#An accurate diagnosis of labyrinthine fistula relies on the operative findings rather than preoperative clinical manifestation, auditory function or CT The surgical intervention should be individualized. There is no significant difference on postoperative recovery among different types of labyrinthine fistula.
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Humans , Bone Conduction , Cholesteatoma, Middle Ear , Deafness , Facial Nerve Injuries , Fistula , Labyrinth Diseases , Otitis Media , Postoperative Period , Prognosis , Retrospective Studies , VertigoABSTRACT
OBJECTIVE@#To analyze the diagnosis, therapy and prognosis of the rare cases of malignant tumors in external auditory canal.@*METHOD@#Eight cases of rare malignant tumors in external auditory canal were collected except squamous cell carcinoma and adenoid cystic carcinoma. The clinical manifestation, staging, surgical method, secondary treatment and prognosis were analysed.@*RESULT@#There were 5 cases of basal cell carcinoma and 2 cases of mucoepidermoid carcinoma and 1 case of myoepithelial carcinoma. Three cases of the 5 basal cell carcinoma in external auditory canal have been misdiagnosed for a long time. After admission, 4 of the 5 basal cell carcinoma were T1 stage and cured only by a complete resection of tumor. One case of T2 stage basal cell carcinoma was found recurrence 2 years later after the first excision of tumor, and was treated with radiotherapy. Tumor was controlled. Two cases of mucoepidermoid carcinoma had been misdiagnosed as a benign tumor and received a resection. One case was found metastasis to the parapharyngeal space and nasopharynx and was treated with concurrent chemotherapy. Tumor was also controlled after 5-years follow-up. Another case was found metastasis to parotid gland and received an expanding tumor resection. No recurrence was detected after a 1-year followed up. One case of T4 stage myoepithelial carcinoma in external auditory canal was a metastasis of parotid and received a partial temporal bone resection. No-recurrence was found 1 year later.@*CONCLUSION@#Because the tumors above have a very low incidence in external ear canal and the location of tumors are hidden, they are often misdiagnosed and delayed in treatment. Therefore, otologists should pay more attention to avoid the misdiagnosis. To the treatment, complete surgical resection of early-stage tumor is important and for late-stage tumor, a supplemented by chemoradiotherapy may be needed.
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Humans , Carcinoma, Adenoid Cystic , Diagnosis , General Surgery , Carcinoma, Basal Cell , Diagnosis , General Surgery , Carcinoma, Squamous Cell , Diagnosis , General Surgery , Ear Canal , Pathology , Ear Neoplasms , Diagnosis , General Surgery , Neoplasm Recurrence, Local , Neoplasm Staging , Parotid Gland , Pathology , Prognosis , Retrospective Studies , Temporal Bone , General SurgeryABSTRACT
Objective To assess the feasibility of adenoviral vectors mediate cochlear gene transfer by postau-ricular microinjection through the round window membrane in mouse. Methods Twelve 5-week old C57BL/6J mice were selected for the study: 8 were implanted with Ad-EGFP by postauricular microinjection through the round window membrane, and 4 with artificial perilymphatic fluid. On postoperative days 5 and 14, the animals were sac-rificed and the surface preparation of cochleae was observed. Results Two animals died after operation. Bright green fluorescence in the cochleae was observed in Ad- EGFP groups. Gene expression on day 14 after operation was higher than that on day 5. However, the control group was free of fluorescence. Oonclusion The postauricular route of the cochlear gene transfer in mice is simple to operate with little side-effect. The technique of transgenic delivery into the inner ear through RWM by mieroinjection is feasible and effective.