活动半月板单髁关节置换术治疗膝骨性关节炎早期疗效分析

目的：分析活动半月板单髁关节置换术治疗膝关节骨关节炎的早期临床效果。方法：2009年6月至2010年2月,采用OXFord活动半月板单髁关节治疗膝骨性关节炎患者23例25膝。结果：23例患者（25膝）随访3-8个月,无感染、假体位置不良及松动等并发症。HSS评分由术前56.9分提高至术后93.3分。结论：活动半月板单髁关节置换术治疗膝骨性关节炎短期疗效优良,成功的关键在于适应证的把握和手术技术的掌握,其远期疗效仍需观察。     

关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的：评估关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建的技术和临床效果。方法：自2003年6月～2009年10月,27例病人（28膝）经MRJ检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤（MCL）,8膝伴后外侧角损伤（PLC）,5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果：本组术后早期均未发生严重并发症。术后随访12-88个月,平均（42．67±3．34）个月,Lysholm膝关节功能评分为78-93分,平均（86．67±5．21）分。国际膝关节文件编制委员会（mDC）综合评定由术前显著异常（D级）28膝,改进为随访时正常（A级）9膝、接近正常（B级）16膝、异常（C级）3膝。结论：关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的:评估关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建的技术和临床效果。方法:自2003年6月～2009年10月,27例病人(28膝)经MRI检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤(MCL),8膝伴后外侧角损伤(PLC),5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果:本组术后早期均未发生严重并发症。术后随访12～88个月,平均(42.67±3.34)个月,Lysholm膝关节功能评分为78～93分,平均(86.67±5.21)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)28膝,改进为随访时正常(A级)9膝、接近正常(B级)16膝、异常(C级)3膝。结论:关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

不同频率电针治疗膝骨性关节炎的临床疗效观察

目的:通过临床研究探讨电针治疗膝关节骨性关节炎的最佳参数,为临床提供更加规范性的治疗,进一步提高电针疗效。方法:将符合膝关节骨性关节炎诊断标准的73例单膝患者随机分为电针疏波组、密波组两组,均针刺患侧膝眼穴,疏波组接2Hz连续波治疗,密波组接40Hz连续波治疗,采用WOMAC评分对两组治疗后疼痛、僵硬、躯体功能进行评估,同时判断1个疗程及3个疗程治疗效果。结果:经统计学处理,完成第一疗程后,两组疼痛评分比较,P均<0.01,说明两组在疼痛疗效上存在差异。而两组僵硬和躯体功能评分的比较,P>0.05,显示两组没有统计学意义。第3疗程后,两组WOMAC总分比较,P均<0.01,具有极显著性差异,第3疗程症状积分低于第1疗程,说明第3疗程后症状改善优于第1疗程。结论:电针疏波组在改善疼痛上优于密波组;第3疗程后,总体症状改善情况优于第1疗程。     

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

doi: 10.1111/j.1741‐2358.2011.00561.x Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report Objective: To describe the use of dental implants in the treatment of velopharyngeal incompetence. Background: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. Materials and methods: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. Results: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient’s quality of life. Conclusion: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant‐retained palatal lift prosthesis.     

膝骨性关节炎关节镜下分级治疗的临床应用

目的:探索膝关节骨性关节炎关节镜下分期及治疗的临床意义及效果。方法:将74例81膝骨性关节炎应用自行设计的关节镜下分级方法分为4级,并分别手术进行术后疗效观察。结果:1级21膝,优良率100%;2级23膝,优良率78.26%;3级25膝,优良率56%;4级12膝,优良率33.33%。结果 Wilcoxon秩检验,T=4.84,P<0.05,差异有显著性。结论:膝骨关节炎关节镜下分级,对于关节镜治疗膝关节骨性关节炎疗效差异显著。有助于手术适应症掌握,规范程序,避免手术盲目性及不必要损伤。     

关节镜下有限清理术治疗膝关节骨性关节炎的体会

目的:探讨关节镜下有限清理术治疗膝关节骨性关节炎的疗效。方法:自2005年6月至2009年10月对62例81膝膝关节骨性关节炎患者进行关节镜下有限清理术,对其临床疗效进行分析。结果:本组病例均获随访,时间12~36个月。优28膝,良39膝,可10膝,差4膝,优良率82.7%。结论:关节镜下有限清理术治疗膝关节骨性关节炎可以有效改善病人的症状,明显改善生活质量。     

Simulation of blood flow in a small-diameter vascular graft model with a swirl (spiral) flow guider

Small-diameter vascular grafts are in large demand for coronary and peripheral bypass procedures, but present products still fail in long-term clinical application. In the present communication, a new type of small-diameter graft with a swirl flow guider was proposed to improve graft patency rate. Flow pattern in the graft was simulated numerically and compared with that in a conventional graft. The numerical results revealed that the swirl flow guider could indeed make the blood flow rotate in the new graft. The swirling flow distal to the flow guider significantly altered the flow pattern in the new graft and the ve- locity profiles were re-distributed. Due to the swirling flow, the blood velocity near the vessel wall and wall shear rate were greatly enhanced. We believe that the increased blood velocity near the wall and the wall shear rate can impede the occurrence of acute thrombus formation and intimal hyperplasia, hence can improve the graft patency rate for long-term clinical use.     

Role of cartilage collagen fibrils networks in knee joint biomechanics under compression

Collagen fibrils networks in knee cartilage and menisci change in content and structure from a region to another. While resisting tension, they influence global joint response as well as local strains particularly at short-term periods. To investigate the role of fibrils networks in knee joint mechanics and in particular cartilage response, a novel model of the knee joint is developed that incorporates the cartilage and meniscus fibrils networks as well as depth-dependent properties in cartilage. The joint response under up to 2000 N compression is investigated for conditions simulating the absence in cartilage of deep fibrils normal to subchondral bone or superficial fibrils parallel to surface as well as localized split of cartilage at subchondral junction or localized damage to superficial fibrils at loaded areas. Deep vertical fibrils network in cartilage play a crucial role in stiffening (by 10%) global response and protecting cartilage by reducing large strains (from maximum of 102% to 38%), in particular at subchondral junction. Superficial horizontal fibrils protect the tissue mainly from excessive strains at superficial layers (from 27% to 8%). Local cartilage split at base disrupts the normal function of vertical fibrils at the affected areas resulting in higher strains.Deep fibrils, and to a lesser extent superficial fibrils, play dominant mechanical roles in cartilage response under transient compression. Any treatment modality attempting to repair or regenerate cartilage defects involving partial or full thickness osteochondral grafts should account for the crucial role of collagen fibrils networks and the demanding mechanical environment of the tissue.     

Growth factor effects on costal chondrocytes for tissue engineering fibrocartilage

Tissue-engineered fibrocartilage could become a feasible option for replacing tissues such as the knee meniscus or temporomandibular joint disc. This study employed five growth factors (insulin-like growth factor-I, transforming growth factor-beta1, epidermal growth factor, platelet-derived growth factor-BB, and basic fibroblast growth factor) in a scaffoldless approach with costal chondrocytes, attempting to improve biochemical and mechanical properties of engineered constructs. Samples were quantitatively assessed for total collagen, glycosaminoglycans, collagen type I, collagen type II, cells, compressive properties, and tensile properties at two time points. Most treated constructs had lower biomechanical and biochemical properties than the controls with no growth factors, suggesting a detrimental effect, but the treatment with insulin-like growth factor-I tended to improve the constructs. Additionally, the 6-week time point was consistently better than that at 3 weeks, with total collagen, glycosaminoglycans, and aggregate modulus doubling during this time. Further optimization of the time in culture and exogenous stimuli will be important in making a more functional replacement tissue.