Adaptive optics (AO) is a technique to improve the performance of optical systems by reducing the influence of optical aberrations. Combined with scanning laser ophthalmoscope (AOSLO), the aberration of human refractive system can be corrected. Thus, the resolution and quality of imaging can be greatly improved to the cellular level in vivo retina (such as photoreceptor, nerve fibers, vascular parietal cell), therefore the earlier changes of the diseases can be detected. At the same time, microstructure changes of retinal can also be observed during the follow-up of the disease. Due to inherent technical defects of AOSLO, its wide application in clinical practice is limited. With the continuous progress of AO technology and the further improvement of related software functions, the function of the system will become more stronger and will play a more and more important role in scientific research and clinic.
目的评价三排钉倾碟头吻合器在食管癌、贲门癌根治术中的临床应用价值，评价其吻合口成形后的效果。 方法回顾性研究分析江苏大学附属武进医院及河北省邯郸市中心医院2012年10月至2014年5月使用新型三排钉吻合器行食管胃吻合术260例患者的临床资料。其中男185例、女75例，年龄48～75（63±8）岁，均在全身麻醉下行食管癌切除+食管胃吻合术。统计其术后吻合口狭窄、吻合口瘘、吻合口出血的发生率并分析总结其临床意义。 结果全组260例患者均吻合成功，无机械故障，无术后死亡。术后发生吻合口狭窄3例，发生率10%，均为早期吻合口加固缝合的30例，后期未加固缝合的病例无狭窄发生。吻合口瘘8例，发生率3.1%，均发生于食管胃颈部吻合病例。无吻合口出血发生。 结论三排钉倾碟头吻合器使用安全、方便，吻合后不需外层加固，尤其适用于难以暴露的吻合部位。
Objective To investigate the effectiveness of compression screw combined with Buttress plate through direct axillary approach for Ideberg typeⅡ scapular glenoid fractures. MethodsA retrospective analysis was conducted on 11 patients with Ideberg type Ⅱ scapular glenoid fractures treated with compression screws combined with Buttress plate fixation through the direct axillary approach between January 2014 and June 2022. There were 7 males and 4 females, aged from 34 to 75 years, with an average of 56.0 years. The causes of injury included 4 cases of falling from height injury, 4 cases of heavy object injury, and 3 cases of traffic accident injury. The time from injury to operation was 2-5 days, with an average of 3.8 days. The operation time, intraoperative blood loss, hospital stay, complications, and fracture healing time were recorded. The Constant-Murley score, American Society of Shoulder and Elbow Surgeons (ASES) score, and shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion were used to evaluate shoulder joint pain and function. ResultsThe operation time was 45-105 minutes, with an average of 79.0 minutes; the intraoperative blood loss was 80-200 mL, with an average of 99.2 mL; the hospital stay was 3-8 days, with an average of 5.8 days. One patient had poor wound healing after operation, and the wound healed after strengthening dressing change; the rest wounds had primary healing, and no axillary nerve paralysis occurred. Except for 1 patient lost follow-up, the remaining 10 patients were followed up 10-54 months, with an average of 26.4 months. The postoperative X-ray film examination showed that the fractures healed well within 8-15 weeks, with an average of 11.0 weeks. There was no complication such as fracture displacement, internal fixator failure or fracture during follow-up. At last follow-up, the patient’s shoulder joint flexion, abduction, external rotation (neutral position), and internal rotation (neutral position) range of motion, Constant-Murley score, and ASES score significantly improved when compared with those before operation (P<0.05). ConclusionCompression screw combined with Buttress plate through direct axillary approach is an effective way to treat Ideberg typeⅡ scapular glenoid fracture, with advantages of small trauma, concealed incision, and good effectiveness.
Objective To investigate the effect of tibial rotation on knee and ankle function in the patients with extra-articular distal tibial fractures after minimally invasive plate osteosynthesis (MIPO) treatment. Methods A retrospective analysis was conducted on 45 patients with extra-articular distal tibial fractures who underwent MIPO between January 2021 and December 2022. There were 20 males and 25 females, aged from 19 to 68 years (mean, 43.6 years). The causes of fractures included falling from heights in 11 cases, traffic accidents in 15 cases, bruising by a heavy object in 7 cases, and falling in 12 cases. The time from injury to hospitalization was 1-6 hours (mean, 3.7 hours). There were 28 cases of simple tibial fractures and 17 cases of tibial fractures combined with ipsilateral fibular fractures; 9 cases of open fractures and 36 cases of closed fractures. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, the distal tibial fractures were classified as type 43A1 in 12 cases, type 43A2 in 17 cases, and type 43A3 in 16 cases. During follow-up, the Lower Limb Function Score (LEFS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Knee Injury and Osteoarthritis Score (KOOS) were used to evaluate the lower limb, ankle, and knee joint functions, respectively. The range of motion (ROM) of the knee and ankle joints was measured. The Short Form Health Survey (SF-36) was used to assess the quality of life of the patients. The fracture healing was observed by anteroposterior and lateral X-ray films of the ankle joint. The bilateral tibial rotation angles were measured on CT and the differences between the affected and healthy sides were caculated. The difference ≥10° was judged as tibial malrotation. According to whether there was tibial malrotation, the patients were allocated into a normal group and a malrotation group for efficacy comparison. Results The incisions of all patients healed by first intention without any early complications. All patients were followed up 12-26 months (mean, 18.6 months). Imaging re-examination showed that all fractures healed, with a healing time of 9-14 weeks (mean, 11.2 weeks). At last follow-up, the LEFS score was 60-68 (mean, 62.3); the AOFAS score was 89-97 (mean, 92.6); the KOOS score was 158-164 (mean, 161.3). The ROM of ankle was 40.0°-45.0° (mean, 42.8°) in flexion and 10.5°-22.0° (mean, 17.7°) in extension; the ROM of knee was 130.0°-135.0° (mean, 132.6°) in flexion and –8.8°- –5.0° (mean, –7.1°) in extension. The SF-36 score was 89-93 (mean, 90.7). The absolute value of difference of tibial rotation angle was 2.6°-17.3° (mean, 8.9°) in 45 patients, and the malrotation was observed in 15 patients (33.3%), including 10 cases of internal rotation and 5 cases of external rotation. There was no significant difference (P>0.05) in the proportion of patients with fibular fractures before operation between the malrotation group and the normal group, as well as in the AOFAS score, KOOS score, LEFS score, SF-36 score, and ROMs of knee and ankle joints at last follow-up. ConclusionThe incidence of tibial malrotation after MIPO treatment for extra-articular distal tibial fractures is relatively high, but it has no significant effect on knee and ankle functions. However, careful manipulation and precise evaluation should be performed during operation to avoid the occurrence of malrotation.