Objective To evaluate the osteogenesis of bi phasic ceramic-l ike biologic bone (BCBB) with tissue engineering in repairing segmental bone defects. Methods BMSCs isolated from the femoral and tibial marrow of 2-weekold Japanese white rabbit were cultured to passage 3. Then 20 μL of the cell suspension at a concentration of 1 × 107 cells/mLwere seeded into 15 mm × 15 mm × 5 mm BCBB block; the construction of tissue engineered BCBB was completed after 8 days of compound culture. Forty-eight adult Japanese white rabbits were randomly divided into groups A, B, C and D, then BCBBs cultured with BMSCs in vitro for 8 days (group A) and only BCBBs without BMSCs (group B) were respectively implanted into the radius segmental bone defects of rabbits, autogenous il iac bone graft (group C) and empty defect (group D) were used as controls. The specimens were examined after 4, 8, 12 and 24 weeks, the osteogenesis was evaluated through X-ray radiograph and histology examination. Results X-ray examination: the border between the material and host’s bone was clear after 4 weeks, and blurred after 8 weeks in group A and group B; the density of some part of the edge of the material was similar to that of radius and there was high density imaging in the materials of group A after 12 weeks; there was much high density imaging in the materials of group B after 12 weeks. The medullary cavity of bone was formed and l ittle high density imaging in the materials of group A after 24 weeks. Some high density imaging still existed in the materials of group B after 24 weeks. The X-ray evaluated scores showed that the scores of group A was higher than that of group B, and there was significant difference between group A and group B after 12 and 24 weeks (P lt; 0.05). Histological examination: there was new bone formation in the materials and also new bone grew adhesively on the surface of BCBB in group A. While in group B only new bone grew and attached to the surface of BCBB. BCBB degraded more with the time and more new bone formed. The histological evaluation showed that the bone forming area in group A was more than that in group B, and there was significant difference between group A and group B (P lt; 0.05). Conclusion The osteogenesis of BCBB with tissue engineering was superior to only BCBB, BCBB could be used as a scaffold of bone tissue engineering.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
ObjectiveTo investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap.MethodsSixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien’s donor area, the recovery of transoral feeding function, and the presence of complications.ResultsComparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements (P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant (t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed.ConclusionThe superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.
Objective To explore the application value of Flash chest CT scan protocol in the follow-up of severe coronavirus disease 2019 (COVID-19). Methods Twenty-eight patients with severe COVID-19 who were admitted to this hospital from February 1, 2020 to March 15, 2020 were included. The follow-up CT examinations used conventional chest CT scan protocol and Flash scan protocol respectively, the image quality, signal-to-noise ratio (SNR) and effective dose of these two scan protocols were compared. Kappa test was used to evaluate the consistency of image quality scores of readers; Mann-Whitney test was used for image quality comparison; paired t test is performed for signal-to-noise ratio and effective dose comparison. Results The scores of the two readers had good consistency (Kappa=0.62, P<0.01 and Kappa=0.67, P<0.01). There was no statistically significant difference in image quality scores (Z=–0.275, P=0.783 and Z=–0.212, P=0.832). The signal-to-noise ratio of Flash protocol was statistically higher than that of conventional protocol (2.30±0.30 vs. 1.76±0.25, P<0.01). The effective dose of Flash protocol was 66.8% lower than that conventional protocol [(1.43±0.32) mSv vs. (4.31±1.36) mSv]. Conclusion Compared with conventional scan protocol, the Flash scan protocol does not require contact with COVID-19 patients, and effectively reduces the radiation dose and improves image quality of severe COVID-19 patients.
Objective To explore the mid-term effectiveness of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation. Methods Between August 2017 and May 2019, 21 patients with recurrent patella dislocation underwent combined knee extensor mechanism realigament with bone anchor and followed up more than 3 years. There were 8 males and 13 females with an average age of 19.4 years (range, 13-26 years). All 21 patients had a history of recurrent patellar dislocation for 2-5 times (median, 3 times), and the disease duration was 1-16 years (mean, 5 years). The preoperative Lysholm score was 67.5±6.3 and the Kujula score was 64.1±7.0. The defect of meniscus, anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments were excluded by MRI examination; CT examination showed that the tibial tuberosity-trochlear groove distance was 2.05-2.56 cm, with an average of 2.16 cm; X-ray examination showed that lower limb force line was abnormal. The effectiveness were evaluated by Lysholm score and Kujula score before operation and at 3 years after operation, and Insall evaluation standard at 3 years after operation. Results All the incisions healed by first intention, and there was no surgical complication such as lower extremity deep vein thrombosis, incision infection, and nerve injury. All 21 patients were followed up 3.0-3.5 years, with an average of 3.2 years. Anteroposterior and lateral X-ray films of the knee joint at 3 years after operation showed that the position of the patella was normal, and the axial X-ray films of the patella (30°, 60°, 90°) showed that the patellofemoral joint had a good relationship. During the follow-up, there was no anchor drop or fracture, no obvious pseudarthrosis formation, and no epiphyseal injury in the minor patients. The Lysholm score was 91.5±7.1 and the Kujula score was 88.1±7.6 at 3 years after operation, which were significantly improved when compared with those before operation (t=11.57, P=0.00; t=12.78, P=0.00). According to the Insall evaluation criteria, 12 cases were excellent, 4 cases were good, 4 cases were fair, and 1 case was poor, with an excellent and good rate of 76.2%. ConclusionCombined knee extensor mechanism realignment with bone anchor is a simple and reliable way to treat the recurrent patella dislocation, with a satisfactory mid-term effectiveness and less complications; however, its long-term effectiveness needs further follow-up.
Objective To investigate the characteristics of the clinical application of ulnar artery flap in the repair of oral and maxillofacial soft tissue defects. Methods The clinical data of 12 patients with oral and maxillofacial defects repaired with ulnar artery flap between June 2021 and July 2023 was retrospectively analyzed. Among them, 11 cases were male and 1 case was female; their ages ranged from 28 to 76 years, with a mean age of 54.8 years. The lesions were located in the lateral margin of the tongue in 3 cases, the root of the tongue in 2 cases, the base of the tongue in 4 cases, and the buccal region, upper gingiva, and lower lip in 1 case each. The pathological types were squamous cell carcinoma in 11 cases and adenoid cystic carcinoma in 1 case; according to the TNM staging of the International Union Against Cancer (UICC), there were 5 cases of T3N0M0, 2 cases of T3N1M0, 1 case of T4aN0M0, 1 case of T4aN1M0, 1 case of T4aN2bM0, and 2 cases of T4aN2cM0. After complete resection of the lesion, the defect ranged from 6 cm×3 cm to 8 cm×5 cm. Preoperatively, colour Doppler ultrasound was used to detect the non-dominant forearm, measure the thickness of the subcutaneous fat in the donor area, confirm and mark the ulnar artery and reflux vein, and measure the diameter of the vessels, flow velocity, and the perforator position; intraoperatively, the flap was designed, prepared, anastomosed, and positioned according to the corresponding data. The vessels were all anastommosed with one artery and two veins to form a super-reflux. After complete hemostasis, the defects were repaired with sliding flap (2 cases), direct suture (4 cases), biomembrane (2 cases), or razor thin skin graft (4 cases). Results No vascular crisis occurred after operation, and all the flaps survived in 12 cases. Wounds in the donor site healed by first intention in 10 cases and by second intention in 2 cases. Wounds in the recipient site healed by first intention in all cases. All 12 patients were followed up 5-18 months, with an average of 11.4 months. The colour and texture of the flap were normal. The function of hand and upper limb was evaluated according to the trial standard of upper limb function assessment of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the score was 65-81 (mean, 71.3), and achieved excellent in 1 case and good in 11 cases. The score of Oral Health Impact Scale (OHIP) was 9-18, with an average of 14.2, and the oral function was satisfactory. During the follow-up, 1 case had local recurrence and underwent extended resection again, while the other patients had no recurrence or metastasis. Conclusion For moderate soft tissue defects with complex oral and maxillofacial function, ulnar artery flap repair is effective.