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1.
Orthop Surg ; 12(1): 184-193, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31943836

RESUMO

OBJECTIVE: The aim of this study is to assess the clinical results of bifocal or trifocal bone transport using unilateral rail system in the treatment of large tibial defects caused by infection. METHODS: There were a total of 37 eligible patients with an average age of 40.11 ± 10.32 years (range, 18-57 years; 28 males and nine females) with large tibial defects due to infection who were admitted to our hospital from June 2006 to June 2016. Among the patients, 21 underwent bifocal bone transport (BF group), and the remaining 16 were treated with trifocal bone transport (TF group). The demographic data (age, sex, interval duration before bone transport, previous operation time), intraoperative outcomes (size and location of the defect, size of soft tissue defect), postoperative variables (lengthening speed, external fixation index, duration of regenerate consolidation and docking union), postoperative bone and functional outcomes evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification (muscle contraction, axial deviation, delayed consolidation, pin problems, repeated fracture, joint stiffness and others) of the two groups were recorded and compared at a minimum follow-up of 24 months. RESULTS: The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24-38 months). There was no statistically significant difference in the demographic data, intraoperative outcomes including size and location of the defect, size of soft tissue defect, as well as postoperative complications. However, postoperative functional result in the TF group were superior to those in the BF group at a minimum follow-up of 24 months, and lengthening speed, external fixation index (EFI), duration of regenerate consolidation and docking union were significantly reduced in the TF group when compared with the BF group. CONCLUSIONS: Treatment of large tibial defects caused by infection with trifocal bone transport using unilateral rail system could significantly improve postoperative functional recovery and reduce duration of regenerate consolidation and docking union. The present study provides novel insight for the treatment of large tibial defects caused by infection.

2.
J Foot Ankle Surg ; 59(1): 125-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882135

RESUMO

Macrodactyly of the foot is an extremely rare congenital malformation characterized by an increase in the size of all the elements or structures of a digit or digits. Most sources indicate that macrodactyly affects the hand more often than the foot. This rare medical condition usually requires surgical intervention with a precise preoperative plan and postoperative rehabilitation. We present a case of macrodactyly of the right foot in which surgical reduction of the foot under assistance of 3-dimensional image technology was performed with satisfying cosmetic and functional outcomes.

3.
Neural Regen Res ; 14(12): 2173-2182, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31397357

RESUMO

The intermingling of regenerated nerve fibers inside nerve grafts is the main reason for mismatched nerve fibers. This is one of the key factors affecting limb function recovery after nerve injury. Previous research has shown that the accuracy of axon regeneration can be improved by a bionic structural implant. To this aim, iodine and freeze-drying high-resolution micro-computed tomography was performed to visualize the 3D topography of the New Zealand rabbit sciatic nerve (25 mm). A series of 1-, 2-, 3-, and 4-custom anatomy-based nerve conduits (CANCs) were fabricated based on the anatomical structure of the nerve fascicle. The match index, luminal surface, and mechanical properties of CANCs were evaluated before implanting in a 10-mm gap of the sciatic nerve. Recovery was evaluated by histomorphometric analyses, electrophysiological study, gastrocnemius muscle weight recovery ratio, and behavioral assessments at 12 and 24 weeks postoperatively. The accuracy of nerve regeneration was determined by changes in fluorescence-labeled profile number during simultaneous retrograde tracing. Our results showed that the optimal preprocessing condition for high-resolution micro-computed tomography visualization was treatment of the sciatic nerve with 40% Lugol's solution for 3 days followed by lyophilization for 2 days. In vitro experiments demonstrated that the match index was highest in the 3-CANC group, followed by the 2-, 1-, and 4-CANC groups. The luminal surface was lowest in the 1-CANC group. Mechanical properties (transverse compressive and bending properties) were higher in the 3- and 4-CANC groups than in the 1-CANC group. In vivo experiments demonstrated that the recovery (morphology of regenerated fibers, compound muscle action potential, gastrocnemius muscle weight recovery ratio, pain-related autotomy behaviors, and range of motion) in the 3-CANC group was superior to the other CANC groups, and achieved the same therapeutic effect as the autograft. The simultaneous retrograde tracing results showed that the percentages of double-labeled profiles of the 2-, 3-, and 4-CANC groups were comparatively lower than that of the 1-CANC group, which indicates that regenerated nerve fascicles were less intermingled in the 2-, 3-, and 4-CANC groups. These findings demonstrate that the visualization of the rabbit sciatic nerve can be achieved by iodine and freeze-drying high-resolution micro-computed tomography, and that this method can be used to design CANCs with different channels that are based on the anatomical structure of the nerve. Compared with the 1-CANC, 3-CANC had a higher match index and luminal surface, and improved the accuracy of nerve regeneration by limiting the intermingling of the regenerated fascicles. All procedures were approved by the Animal Care and Use Committee, Xinjiang Medical University, China on April 4, 2017 (ethics approval No. IACUC20170315-02).

4.
Injury ; 48(12): 2842-2846, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29122280

RESUMO

OBJECTIVE: To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS: The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS: The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS: Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.


Assuntos
Fixadores Externos , Osteomielite/psicologia , Osteomielite/cirurgia , Fraturas da Tíbia/psicologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Desbridamento , Fixadores Externos/efeitos adversos , Feminino , Seguimentos , Humanos , Técnica de Ilizarov , Masculino , Pessoa de Meia-Idade , Osteomielite/fisiopatologia , Educação de Pacientes como Assunto , Estudos Prospectivos , Fraturas da Tíbia/microbiologia , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
5.
Injury ; 48(7): 1636-1643, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28522207

RESUMO

OBJECTIVE: To compare the therapeutic effects of the Orthofix limb reconstruction system (LRS) versus the Ilizarov external fixator on osteomyelitis of a tibial bone defect. MATERIALS AND METHODS: Among 153 patients hospitalized for bone lengthening therapy from January 1, 1996 to January 1, 2015, 129 patients were selected for a retrospective analysis. Forty-three of the candidate patients were treated using the Orthofix LRS and the other 86 were treated using an Ilizarov external fixator. The average follow-up was 96 months. We evaluated the patients at follow-up visits, and compared the length of time the patients wore the fixation devices. We also examined the scores of Activities of Daily Living (ADL) tests and a Self-rated Anxiety Scale (SAS), the range of motion, and the incidence of pin track infections. RESULTS: The results indicated that both approaches were effective for treating the bone defect. Compared with the patients who wore an Ilizarov fixator for the treatment of post-traumatic osteomyelitis, those who wore an Orthofix LRS tended to be more satisfied with their quality of life and the outcome after the operation. CONCLUSION: Although both approaches were effective for treating the bone defect, the overall patient outcomes were superior for the Orthofix LRS, suggesting that it should be considered as the first option in the treatment of traumatic osteomyelitis of the tibial diaphysis.


Assuntos
Fixadores Externos , Técnica de Ilizarov , Desigualdade de Membros Inferiores/cirurgia , Osteogênese por Distração , Osteomielite/cirurgia , Osteotomia/métodos , Tíbia/cirurgia , Adolescente , Adulto , Desbridamento , Feminino , Seguimentos , Humanos , Desigualdade de Membros Inferiores/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Osteomielite/etiologia , Osteomielite/fisiopatologia , Estudos Retrospectivos , Tíbia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 30(12): 1447-1451, 2016 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-29786331

RESUMO

OBJECTIVE: To determine the feasibility of fabricating molds using a three-dimensional (3D) printer for producing customized bone cement for repairing bone defect. METHODS: Between February 2015 and March 2016, 13 patients with bone defects were treated. There were 9 males and 4 females with an average age of 38.4 years (range, 20-58 years), including 7 cases of chronic osteomyelitis, 3 cases of bone tuberculosis, 2 cases of bone tumor, and 1 case of ischemic necrosis. The defect located at the humerus in 3 cases, at the femur in 4 cases, and at the tibia in 6 cases. The defect ranged from 4.5 to 8.9 cm in length (mean, 6.7 cm). Before operation, Mimics10.01 software was used to design cement prosthesis, 3-matic software to design shaping module which was printed by 3D technology. After removal of the lesion bone during operation, bone cement was filled into the shaping module to prepare bone cement prosthesis for repairing defect. RESULTS: The measurement result from Image J software showed that the match index of interface between the mirror restored digital and bone interface was 95.1%-97.4% (mean, 96.3%); the match index of interface between bone cement prosthesis and bone interface was 91.2%-94.7% (mean, 93.2%). It was one time success during separation between formed bone cement and shaping module without any shatter or fall off. All incisions healed by first intention. The cases were followed up 5-17 months (mean, 9.4 months). X-ray films and CT scans showed good position of bone cement prosthesis without any fracture; no peripheral fracture occurred. CONCLUSIONS: 3D printing customized bone cement shaping module can shorten the operation time, and customized bone cement prothesis has good match with bone interface, so it can avoid further adjustment and accord with the biomechanical rules of surgical site.


Assuntos
Cimentos para Ossos , Doenças Ósseas/terapia , Impressão Tridimensional , Feminino , Fraturas Ósseas , Humanos , Masculino , Osteomielite , Procedimentos Cirúrgicos Reconstrutivos , Tíbia
7.
J Cardiovasc Dis Res ; 4(1): 51-4, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24023474

RESUMO

Wellens' syndrome is a pattern of electrocardiographic T-wave changes associated with critical stenosis of proximal left anterior descending artery (LAD). T-waves abnormalities were found in precordial leads, especially in V2-V3 during pain-free periods, and ECG obtained during episodes of pain demonstrates upright T-waves with possible elevated or isoelectric ST segments. Early recognition and appropriate intervention carries significant diagnostic and prognostic value. We reported a case of Wellens' syndrome with different etiology and prognosis. Although the ECG showed typical T-wave changes in V2-V5 leads, patient's coronary angiography revealed moderate stenosis in proximal LAD, and coronary artery spasm was suggested. Unlike the classic Wellens' syndrome, which needs aggressive coronary intervention, our patient fared well with conservative medical therapy (diltiazem and nitrates) and showed favorable prognosis.

8.
Heart Vessels ; 26(6): 654-62, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21240508

RESUMO

Electrical stimulation of the rostal cerebellar fastigial nucleus (FNS) has been proved to have neuroprotective effects, but it is not known whether FNS also has a cardioprotective effect. One hundred Sprague-Dawley rats were randomly allocated into four groups, including a sham-operation group (Sham group), rats whose coronary arteries were ligated but the FNs were sham stimulated (AMI group), rats in which both coronary arteries were ligated and FNs were stimulated (FNS group), and rats whose fastigial nuclei were lesioned 5 days before ligation, then their coronary arteries were ligated and FNs were stimulated (FNL group). Heart rate variability parameters were monitored 6 h, 24 h, 7 days and 21 days after ligation, and mortality rates, hemodynamic parameters and infarction sizes were compared after 21 days. FNS improved the survival of rats, and this may be due to the increased vagal and decreased sympathetic tone. FN stimulation does not affect infarction size and hemodynamic parameters. FN stimulation may have a protective effect on surgically induced myocardial infarction rats.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Núcleos Cerebelares/fisiopatologia , Terapia por Estimulação Elétrica , Frequência Cardíaca , Coração/inervação , Infarto do Miocárdio/terapia , Animais , Sistema Nervoso Autônomo/metabolismo , Modelos Animais de Doenças , Infarto do Miocárdio/sangue , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Norepinefrina/sangue , Ratos , Ratos Sprague-Dawley , Fatores de Tempo
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