The radial forearm flap: a biomechanical study of donor-site morbidity utilizing sheep tibia.

The use of vascularized bone grafts to reconstruct extremity and mandibular defects is now commonplace in reconstructive surgery. Fibula, scapula, iliac crest, rib, and metatarsal as well as the radial forearm osseocutaneous flaps have all been utilized for this purpose. Troublesome spiral fractures of the distal radius are the most common fractures associated with the use of the distal radius as a vascularized bone-graft donor site. This study was proposed to investigate the effect of donor-site bone loss on the strength of the radius under torsional (rotational) loading. Previous clinical series and experimental studies have not examined this aspect of distal radius loading after harvesting the bone graft. Fifty pairs of sheep tibiae were utilized in the experiment. Five pairs were used in a pilot study and 45 pairs were used in the main experiment. Five pairs of human radii were used for the control in the pilot study. The pilot study attempted to make a comparison between the human radius and the sheep tibia for experimental purposes. For the biomechanical study of donor-site defects, four study groups were examined with random assignment and matched pairs. The control group (group 1) had no alteration to the bone. Each test condition included five matched pairs of sheep tibiae. Experiment 1 compared the difference in the depth of the osteotomy defect. In doing this, one-third of the total length of the bone was removed in each of the following specimens to include (1a) 30 percent of the cross-sectional area of the total bone, (1b) 37 percent of the cross-sectional area of the total bone, and (1c) 50 percent of the cross-sectional area of the total bone. In experiment 2, the osteotomy shape was varied. Instead of the ends of the cuts being squared, the ends were beveled or rounded. Experiment 3 compared different lengths of bone removed in the osteotomy defect and included the following: In experiment 3a the diameter of the sheep tibia was measured at the incisura fibularis. This dimension was one diameter of bone, and a one-diameter length of bone was removed. In experiment 3b, a two-diameter length of bone was removed. In experiment 3c, a three-diameter length of bone was removed. In experiment 3d, a four-diameter length of bone was removed.(ABSTRACT TRUNCATED AT 400 WORDS)     

Accuracy of specimen-specific nonlinear finite element analysis for evaluation of radial diaphysis strength in cadaver material

The feasibility of a user-specific finite element model for predicting the in situ strength of the radius after implantation of bone plates for open fracture reduction was established. The effect of metal artifact in CT imaging was characterized. The results were verified against biomechanical test data. Fourteen cadaveric radii were divided into two groups: (1) intact radii for evaluating the accuracy of radial diaphysis strength predictions with finite element analysis and (2) radii with a locking plate affixed for evaluating metal artifact. All bones were imaged with CT. In the plated group, radii were first imaged with the plates affixed (for simulating digital plate removal). They were then subsequently imaged with the locking plates and screws removed (actual plate removal). Fracture strength of the radius diaphysis under axial compression was predicted with a three-dimensional, specimen-specific, nonlinear finite element analysis for both the intact and plated bones (bones with and without the plate captured in the scan). Specimens were then loaded to failure using a universal testing machine to verify the actual fracture load. In the intact group, the physical and predicted fracture loads were strongly correlated. For radii with plates affixed, the physical and predicted (simulated plate removal and actual plate removal) fracture loads were strongly correlated. This study demonstrates that our specimen-specific finite element analysis can accurately predict the strength of the radial diaphysis. The metal artifact from CT imaging was shown to produce an overestimate of strength.     

Effects of chronic physical activity and of ultrasound treatment on bone consolidation

The objective of this study was to investigate the effects of ultrasound treatment and physical exercise on the velocity of bone consolidation and resistance to deformation. We performed osteotomy in the upper third of the right tibia of rats. Physical training consisted of swimming 1 h per day with a load of 5% b.w. for 30 days. Therapy with medium-intensity ultrasound was applied daily on the damaged area. Wistar rats were divided into the following groups: osteotomized sedentary animals with no ultrasound treatment (1.OSnUS), osteotomized trained animals with no ultrasound treatment (2.OTnUS), osteotomized sedentary animals with ultrasound treatment (3.OSwUS), and osteotomized trained animals with ultrasound treatment (4.OTwUS). The animals were sacrificed for the following analyses: muscle glycogen, serum alkaline phosphatase at the 5th, 10th, 20th, and 30th days, test of maximum resistance to flexion, rupture flexion and mean tibial rigidity at the 30th day. Muscle glycogen was increased at the 20th day; alkaline phosphatase was elevated at the 5th and 20th days in groups 3.OSwUS and 4.OTwUS, and decreased at the 10th day. Groups 1.OSnUS and 2.OTnUS did not show significant variations. In the mechanical resistance tests, we noted that ultrasound therapy and the association of physical activity used in the present study showed significant differences in bone resistance and bone rigidity after 30 days of treatment. These facts suggest that ultrasound or physical activity, or their combination may accelerate the process of bone tissue repair.     

表面改性双相陶瓷复合自体骨髓干细胞修复兔骨缺损的实验研究

目的:应用自体骨髓基质干细胞(Bone Marrow Stromal Cells,BMSCs)复合经低晶态羟基磷灰石(Low Crystalline Hydroxyap- atite,LcHA)涂层的双相陶瓷(Biphasic Calcium Phosphate,BCP)构建的组织工程化骨(LcBCP)修复兔桡骨节段性缺损。方法:体外分离培养、诱导扩增兔BMSCs,取第三代细胞复合LcBCP(实验组)后修复15只兔左侧桡骨15mm缺损;右侧桡骨缺损处植入复合BMSCs的BCP(对照组),于植入后4、8和12周处死动物,通过大体形态、组织学、影像学和扫描电镜检测骨缺损修复效果。结果:BMSCs-LcBCP复合物生长良好,随时间延长,X线显示实验组连接处骨痂形成,对照组连接处始终愈合稍差,12周大体观察实验组骨修复良好,髓腔再通;组织学显示板层骨形成,连接处骨性愈合,实验对照组连接处虽然也为骨性愈合,但尚有较多编织骨形成。结论:自体BMSCs复合LcBCP形成的组织工程化骨可修复兔桡骨节段性缺损,低晶态羟基磷灰石涂层能够增强双相陶瓷的早期成骨。     

The vascularized pig fibula bone flap model: effect of segmental osteotomies and internal fixation on blood flow

The free fibular flap is the flap of choice for reconstruction of complex mandibular defects, although two or more osteotomies may be required to recreate the normal mandibular contour. The effect of these surgical manipulations on the fibula has not been adequately investigated. This study was designed to study the effect of multiple segmental osteotomies and internal fixation techniques on blood flow in the vascularized pig fibula bone flap model. The hindlimbs of 15 Yorkshire pigs were randomized into 1 of 5 groups (n = 6 fibulae per group) consisting of: (1) a nonoperated, in situ fibula; (2) an elevated fibula flap; (3) an elevated fibula flap with two segmental osteotomies; (4) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm miniplates; (5) an elevated fibula with two segmental closing osteotomies rigidly fixed with 2-mm lag screws. Total and gradient blood flow was measured in the bone and soft-tissue components of these flaps using the 15-microm radioactive microsphere technique. The creation of two segmental osteotomies in the vascularized pig fibula bone flap model resulted in a significant decrease (p<0.05) in the gradient blood flow in the segment of bone distal to the second osteotomy. Application of miniplates or lag screws across closing osteotomies resulted in a significant decrease (p<0.05) in total and gradient blood flow to the bone component of the fibulae, as compared with the elevated and osteotomized fibulae groups. An increase in blood flow suggesting a hyperemic response was noted in the bone and soft tissue in the elevated and osteotomized flap groups as compared with the in situ, nonoperated controls. This study established the validity of the pig fibula as a suitable model for investigating the pathophysiology of blood flow changes in the face of standard surgical maneuvers necessary for the restoration of mandibular form and function. The results demonstrated that the creation of multiple segmental osteotomies and the application of internal fixation significantly decreases (p<0.05) blood flow to the distal portion of the flap. The effects of segmental osteotomies and internal fixation on healing and growth of the pig fibula bone flap model are investigated in a separate study.     

基于三维CT的模拟手术在大龄DDH患儿外科治疗中的应用研究

目的:通过对大龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿进行术前模拟手术,实现术中精确截骨及旋转角度,从而达到个体化治疗,改善患儿预后的目的。方法:本研究按照术前规划方式分为两组,一组为传统手术组;另一组为模拟手术组。共20例患儿均采用骨盆三联截骨术+股骨截骨术治疗,传统手术组10例,模拟手术组10例,手术时平均年龄为11.3岁,平均随访时间24.2个月。所有患儿均于术前行骨盆三维重建CT检查,测量CE角、股骨前倾角及髋臼指数,在mimics软件中,模拟手术方案,确定术中股骨截骨需要旋转的角度及骨盆截骨的位置,术中按照模拟手术的结果进行操作。术前评价指标使用Tonnis分级,术后评价指标使用改进的Trevor评分系统。结果:模拟手术组Tonnis分级3级4髋,Tonnis分级4级8髋;传统手术组Tonnis分级3级4髋,Tonnis分级4级9髋,两组患儿术前严重程度无显著性差异。依据Trevor评分,模拟手术组8髋(67%)优秀,3髋(25%)良好,1髋(8%)一般。传统手术组5髋(38%)优秀,5髋(38%)良好,3髋(23%)一般。两组有显著性差异。并发症:术后传统手术组3例患儿有不同程度的股骨头坏死。结论:大龄DDH患儿术前模拟手术,可以达到术中精确截骨及旋转角度,可改善患儿预后,实现该类患者的个体化治疗。     

Performance evaluation of recessed microcathodes: criteria for tissue PO2 measurement

Measurement of local tissue PO2 using recessed microcathodes has again been criticized. Therefore, we reexamined electrode performance. Sharply beveled electrodes (3 micron external diameter) were fabricated with several tip recess lengths (4-10 micron), and some recesses were filled with hydrated polymer. In vitro, 2-mm agar (3%) sheets were equilibrated with solution of known PO2 (continuously flowing). Electrode currents at 100-micron intervals through the agar and of convected superfusion solution were compared. At the longest recess lumen length-to-diameter ratio of 10, minimum response midagar (1 mm) averaged 98%. Performance improved with the use of recess polymer and increased recess length. For in vivo studies, microcathodes (ratio approximately 10) were fluid calibrated, and PO2 was measured at 10-20 micron through canine femoral artery walls. PO2 distribution fit a model for radial diffusion with medial O2 consumption. After local cyanide application to the femoral wall, PO2 fit a model for radial diffusion without tissue O2 consumption. Carefully designed microcathodes and experiments measure accurate tissue PO2.     

Reducing morbidity in the radial forearm flap donor site

The radial forearm flap, although widely used, has been criticized for the poor quality of its donor site. To investigate the causes of morbidity, 100 radial artery free-flap donor sites have been reviewed. Sixty-seven patients required skin grafting (group 1), and the remaining 33 patients were closed directly (group 2). Seventeen patients in the series had compound osteocutaneous flaps (group 3). Wound healing proved to be a significant problem in groups 1 and 3, and fracture of the radius occurred in 4 of the 17 patients in group 3 and was the most significant cause of morbidity. The radial artery was reconstructed in 12 patients, but only 6 of the arteries (50 percent) were patent at the time of review. Subjective assessment on a scale of 0 to 10 demonstrated a relatively pain-free donor site with low pain scores (2.5 of 10). The cosmetic result was acceptable in men (1.5 of 10) but was less so in women (4 of 10). Angulated fracture of the radius produced an unacceptable cosmetic result (7 of 10). In light of this experience, we no longer reconstruct the radial artery as a matter of routine. The donor defect is closed directly wherever possible using an ulnar artery-based transposition flap when required. A "boat shaped" osteotomy is used in preference to right-angled bone cuts when harvesting a segment of radius to avoid the complications and sequelae of fracture. These changes in surgical technique have improved the acceptability and minimized the problems associated with this donor site.     

The variation of the cross-sectional shape in the long bones of birds and mammals

The transverse and sagittal diameters of the long bones were measured in a sample of 53 species of eutherian mammals and 36 species of birds. The scaling of the transverse and sagittal diameters of each bone to body mass was calculated. For each bone the ratio of sagittal/transverse diameter was calculated, as an expression of the cross-sectional shape of the bones. The distributions of the ratios were not significantly different from normality in all the avian bones and in the mammalian femur and tibia. In most cases, the mean of the distribution was significantly different from 1 (circular shape). The analysis shows that changes in the ratio can be caused by selective factors, considering the correlation predicted between the breaking moments and the radii, but at the same time the cross-sectional shape of mammalian and avian long bones may have a phylogenetic basis. Finally, the previous assumption of relationship between bone curvature and stress predictability, is also discussed.     

Quantitative measures for fracture healing: an in-vitro biomechanical study

A method is presented to assess the functional capabilities of plated osteotomized canine femora as load bearing structures and to quantify their healing status. In this method the osteotomized bones and their intact contralateral controls are tested in nondestructive bending, in twenty-four planes of loading at 15 degree angular increments. Flexural rigidity (EI), in each of the planes, is determined by using classical beam theory. It has been found that the EI values have the expected elliptical distribution. The 24 EI values, obtained for each bone, are curve fitted by regression analysis and the characteristics of each bone are described by the three parameters defining its ellipse. The parameters of the ellipses of the osteotomized bone and of its contralateral control are used to define four new parameters that may serve as measures for the healing efficiency. One of these serves as an indicator for the fragility of the healed bone and the other three add quantitative information on its mechanical state.     

Acute and chronic dose of alcohol affect the load carrying capacity of long bone in rats

In the present investigation, the effects of acute and chronic dose of alcohol were evaluated on mechanical properties of long bones of Sprague Dawley rats. In "acute study", 18 animals were divided into three groups containing six animals each, i.e. Group A: control animals, normal saline was given to them intraperitoneally for the period of 5 days; Group B: treated animals, given 20% (v/v) absolute alcohol and Group C: treated animals, given 30% (v/v) absolute alcohol, by same route and time duration. In "chronic study", also, 18 animals were divided into three groups containing six animals each, i.e. Group A: control animals, normal saline was given to them intraperitoneally for the period of 6 weeks; Group B: treated animals, given 20% (v/v) absolute alcohol and Group C: treated animals, given 30% (v/v) absolute alcohol by same route and time duration. A significant increase was observed in bone weight of animals taking 20% alcohol but there was decrease in the same for 30% alcohol in case of acute study. For chronic study, there was a decrease in bone weight for both treated groups. During acute study, breaking strength of bone was increased in case of 20% alcohol administration but a slight decrease was shown in the same for 30% alcohol group as compared to control animals. Breaking strength of long bone in the case of chronic study was decreased in case of both groups taking alcohol, i.e. 20% and 30%. The present document is useful in understanding the functional load carrying capacity of bone during alcoholism.     

Reduced training intensities and loss of aerobic power, endurance, and cardiac growth

Twelve subjects participated in an exercise program of cycling and running 40 min/day, 6 days/wk. After 10 wk, they continued to train with either a one-third or two-thirds reduction in work rates for an additional 15 wk. Frequency and duration for the additional training remained the same as during the 10 wk of training. The average increases in maximum O2 uptake (VO2 max) were between 11 and 20% when measured during cycling and treadmill running after 10 wk of training. VO2 max was not maintained at the 6-day/wk training levels with a one-third reduction in training intensity but was still higher than pretraining levels. With a two-thirds reduction in intensity, VO2 max declined to an even greater extent than with the one-third reduction. Short-term endurance (approximately 5 min) was maintained in the one-third reduced group but was markedly reduced in the two-thirds reduced group. Long-term endurance was decreased significantly from training by 21% in the one-third reduced group (184-145 min) and by 30% in the two-thirds reduced group (202-141 min). Calculated left ventricular mass, obtained from echocardiographic measurements, increased approximately 15% after training but returned to control levels after reduced training in both groups. These results demonstrate that training intensity is an essential requirement for maintaining the increased aerobic power and cardiac enlargement with reduced training.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique

Do perforating lateral osteotomies cause less ecchymosis and edema compared with the popular continuous method? Many studies have demonstrated that perforated osteotomies cause less trauma and periosteal disruption. Numerous investigators have subjectively perceived less postoperative ecchymosis and edema, but no clinical study has compared the perforated methods versus the continuous technique in the same patient. This prospective, randomized, partially blinded study was designed to test the hypothesis that the perforating method causes less postoperative ecchymosis and edema compared with the continuous lateral osteotomy technique. The questions remain: does the type of perforating osteotomy affect the results? Does a percutaneous approach cause more ecchymosis and edema by the access maneuver of piercing the skin? The two perforating lateral nasal osteotomy techniques require the same 2-mm straight osteotome, so any genuine difference in postoperative ecchymosis or edema could only be attributed to the differing surgical approaches. Accordingly, this study also tests whether the external percutaneous perforating osteotomy causes more ecchymosis and edema than the internal transnasal perforating method. Twenty-five consecutive rhinoplasty patients (group A) requiring bilateral osteotomies (50 total lateral osteotomies) were randomized so that each patient received an internal/transnasal perforating lateral osteotomy (2-mm straight chisel) on one side and an internal/transnasal continuous osteotomy (4-mm curved, guarded osteotome) on the other. The next 25 patients studied (group B) received an external/percutaneous perforating lateral osteotomy (same 2-mm straight chisel as used in group A) on one side and the same internal/transnasal continuous osteotomy on the other. The final 25 consecutive rhinoplasty patients (group C) received an external percutaneous perforating lateral osteotomy on one side and an internal transnasal perforating lateral osteotomy on the other. The entry sites for the perforating osteotomies were either external (groups B and C) with a percutaneous skin puncture or intranasal (groups A and C) at the pyriform aperture. All 75 patients (150 total lateral osteotomies) initialed the surgical plan on the Gunter rhinoplasty worksheet, which has been approved by the Institutional Review Board of Abbott-Northwestern Hospital, Minneapolis, Minnesota (study no. 1341-1 M). All patients were evaluated for ecchymosis and edema on the left versus the right side of the face at 2 to 3, 7, and 21 days after the operation. The clinical evaluation was performed by two blinded examiners (clinic registered nurse and the patient with his or her family) and a partially blinded examiner (the surgeon, who did not refresh his memory about the randomization). To compare the two methods in each study (groups A, B, and C) for the six outcomes (edema and ecchymosis at 2 to 3, 7, and 21 days), the authors used an exact binomial test of the null hypothesis that the treatments do not differ. To compare the two methods in each study (groups A, B, and C) using all six outcomes simultaneously, the authors used a permutation test. By both testing methods, the perforating internal method was superior to the continuous technique (group A; p < 0.01 in both tests). Although the perforating external method gave better results than the continuous technique (group B) and the perforating internal method gave better results than the perforating external method (group C), neither of these differences was significant by either testing method. A lateral osteotomy technique should be precise, reproducible, and safe, and it should minimize ecchymosis and edema. Since edema and ecchymosis are comparable regardless of osteotome size, this prospective randomized study confirms the subjective clinical impression that perforating lateral osteotomies with a 2-mm straight osteotome reduce postoperative ecchymosis and edema in rhinoplasty patients compared with the continuous osteotomy (4-mm curved, guarded osteotome). These findings should encourage te the use of perforating osteotomies rather than continuous osteotomies.     

Adaptations to free-fall impact are different in the shafts and bone ends of rat forelimbs.

Impact exercise can have beneficial effects on the growing skeleton. To understand what changes it promotes in the shafts and ends of weight-bearing bones, we measured the effects of impact from repetitive free falls in growing rats. Fischer 344 female rats, 6.5 wk old, were assigned to one of three groups (n = 10 each). Controls were not dropped, whereas those subjected to impact were dropped from 30 or 60 cm. Rats in both free-fall groups were dropped 10 times per day for 8 wk. Leg bones were mechanically tested, and their cross-sectional area (CSA), cross-sectional moments of inertia, and volumetric bone mineral density (BMD) were measured by peripheral quantitative computed tomography. In the shafts of the forelimbs, but not the hindlimbs, free-fall impact resulted in greater ultimate breaking force, minimum and maximum second moments of area, and CSA but not BMD. In the bone ends of the forelimb and tibial bones, trabecular BMD increased but CSA did not. Landing from 30 and 60 cm produced peak impact forces of 12.0 and 16.7 times the standing forefoot weight for each front leg and of 4.5 and 7.7 times the standing hind foot weight for each hind foot. Overall, free-fall impact affected the forelimbs by increasing trabecular bone density in the bone ends and improving the strength at the shaft as a result of geometric improvements. These results indicate that adaptation to impact may occur by different mechanisms in bone end and shaft regions.     

Teratogenic effect of cocaine and diazepam in CF1 mice

This study was conducted to determine the teratogenic effect of cocaine hydrochloride, alone or in combination with diazepam. Pregnant mice were administered cocaine hydrochloride at 10 and 20 mg/kg body weight intravenously (tail), and/or diazepam at 20 or 40 mg/kg b.w. by gavage. Combinations of diazepam and cocaine (20/10 and 40/20, respectively) were used. Significant reductions of fetal weight and length were found in the group treated with diazepam and cocaine (40/20). The incidences of incomplete ossification of sternebrae and skull bones, as well as delayed ossification of the paws, were significantly increased in the combination groups. Hydronephrosis and cryptorchidism were observed in the cocaine-treated groups, with the incidence of these malformations increasing significantly when diazepam was co-administered.     

Regional sensitivity for shape discrimination

In a task where subjects had to detect smooth deviations from circularity, we assessed whether performance varied with eccentricity. Our stimuli were circular 4th derivatives of Gaussian contours (CD4s) whose radii were sinusoidally modulated. We used D4s of different peak spatial frequencies and overall diameters. Although performance declined with eccentricity for all radial frequencies tested, once scaling was taken into account, sensitivity was similar at all eccentricities. This was the basis of the scale-invariance also exhibited by this task. Thus, shape discrimination does not appear to be a specialized function limited to central vision.     

Gene expression of TGF-beta, TGF-beta receptor, and extracellular matrix proteins during membranous bone healing in rats

Poorly healing mandibular fractures and osteotomies can be troublesome complications of craniomaxillofacial trauma and reconstructive surgery. Gene therapy may offer ways of enhancing bone formation by altering the expression of desired growth factors and extracellular matrix molecules. The elucidation of suitable candidate genes for therapeutic intervention necessitates investigation of the endogenously expressed patterns of growth factors during normal (i.e., successful) fracture repair. Transforming growth factor beta1 (TGF-beta1), its receptor (Tbeta-RII), and the extracellular matrix proteins osteocalcin and type I collagen are thought to be important in long-bone (endochondral) formation, fracture healing, and osteoblast proliferation. However, the spatial and temporal expression patterns of these molecules during membranous bone repair remain unknown. In this study, 24 adult rats underwent mandibular osteotomy with rigid external fixation. In addition, four identically treated rats that underwent sham operation (i.e., no osteotomy) were used as controls. Four experimental animals were then killed at each time point (3, 5, 7, 9, 23, and 37 days after the procedure) to examine gene expression of TGF-beta1 and Tbeta-RII, osteocalcin, and type I collagen. Northern blot analysis was used to compare gene expression of these molecules in experimental animals with that in control animals (i.e., nonosteotomized; n = 4). In addition, TGF-beta1 and T-RII proteins were immunolocalized in an additional group of nine animals killed on postoperative days 3, 7, and 37. The results of Northern blot analysis demonstrated a moderate increase (1.7 times) in TGF-beta1 expression 7 days postoperatively; TGF-beta1 expression returned thereafter to near baseline levels. Tbeta-RII mRNA expression was downregulated shortly after osteotomy but then increased, reaching a peak of 1.8 times the baseline level on postoperative day 9. Osteocalcin mRNA expression was dramatically downregulated shortly after osteotomy and remained low during the early phases of fracture repair. Osteocalcin expression trended slowly upward as healing continued, reaching peak expression by day 37 (1.7 times the control level). In contrast, collagen type IalphaI mRNA expression was acutely downregulated shortly after osteotomy, peaked on postoperative days 5, and then decreased at later time points. Histologic samples from animals killed 3 days after osteotomy demonstrated TGF-beta1 protein localized to inflammatory cells and extracellular matrix within the fracture gap, periosteum, and peripheral soft tissues. On postoperative day 7, TGF-beta1 staining was predominantly localized to the osteotomized bone edges, periosteum, surrounding soft tissues, and residual inflammatory cells. By postoperative day 37, complete bony healing was observed, and TGF-beta1 staining was localized to the newly formed bone matrix and areas of remodeling. On postoperative day 3, Tbeta-RII immunostaining localized to inflammatory cells within the fracture gap, periosteal cells, and surrounding soft tissues. By day 7, Tbeta-RII staining localized to osteoblasts of the fracture gap but was most intense within osteoblasts and mesenchymal cells of the osteotomized bone edges. On postoperative day 37, Tbeta-RII protein was seen in osteocytes, osteoblasts, and the newly formed periosteum in the remodeling bone. These observations agree with those of previous in vivo studies of endochondral bone formation, growth, and healing. In addition, these results implicate TGF-beta1 biological activity in the regulation of osteoblast migration, differentiation, and proliferation during mandibular fracture repair. Furthermore, comparison of these data with gene expression during mandibular distraction osteogenesis may provide useful insights into the treatment of poorly healing fractures because distraction osteogenesis has been shown to be effective in the management of these difficult clinical cases.     

Children with repaired bilateral cleft lip/palate: effect of age at premaxillary osteotomy on facial growth.

This study compared facial growth in three groups of patients with bilateral complete cleft lip/palate: those who had (1) no premaxillary osteotomy, (2) premaxillary osteotomy before age 8 years, and (3) premaxillary osteotomy after age 8 years. Of 24 children with bilateral complete cleft lip/palate, 7 had early premaxillary osteotomy (mean age, 6.1; range, 3.7 to 7.6 years), 10 had late osteotomy (mean age, 11.2; range, 8.3 to 20.7 years), and 7 did not require premaxillary repositioning and served as controls (mean age, 12.4; range, 6.4 to 17.8 years). Presurgical and postsurgical lateral cephalograms were digitized using the Dentofacial Planner software; most current lateral cephalograms comprised the control group. Forty-one bony and 25 soft-tissue landmarks were digitized, and 8 angles were measured: SNA, (sella-nasion-A point), SNPg (sella-nasion-pogonion), ANB (A point-nasion-B point), NAPg (nasion-A point-pogonion), ST convexity (glabella-subnasale-soft-tissue pogonion), Sn-G vertical (line perpendicular to the horizontal plane dropped from glabella and distance measured from subnasale to this vertical), Cm-Sn-Ls (columella-subnasale-abial superioris), and Sn-Gn-C (subnasale-soft-tissue gnathion-chin point). Statistical difference in mean preoperative and postoperative values were measured with analysis of variance. Tests of significance were adjusted for multiple comparisons using the Bonferroni correction. Mean age at follow-up for early, late, and control groups was 11.8, 14.0, and 12.4 years, respectively. Mean follow-up for early and late groups was 5.7 and 2.8 years. There was a significant preoperative difference among the three groups for mean SNA (p < 0.01), ANB (p < 0.01), and NAPg (p < 0.01). Bonferroni analyses revealed that the early group had significantly greater SNA, ANB, and NAPg angles than the late (p < 0.01) and control groups (p < 0.05). There was a significant postoperative difference among groups for ANB (p < 0.05); Bonferroni analyses also showed that the control group had a significantly greater ANB than the late group (p < 0.05). The t test for equity of means established postoperative change for SNA (p < 0.01), ANB (p< 0.01), NAPg (p < 0.01), and ST convexity (p < 0.01) for the early group was significantly greater than for the late group. Children who required early premaxillary positioning had more significant preoperative deformity; however, this group's postoperative profile was not, on average, significantly different from either the late or control groups. Our findings that the early group had more significant change with premaxillary osteotomy than the late group suggest that premaxillary positioning can be done before completion of facial growth without compromise.     

腓骨近端截骨术与胫骨高位截骨术治疗内侧间室性膝关节骨关节炎的比较研究

目的:对比内侧间室性膝关节骨关节炎(KOA)患者应用腓骨近端截骨术与胫骨高位截骨术治疗的疗效。方法:选取2016年11月到2017年12月在我院接受治疗的内侧间室性KOA患者32例,采用随机数字表法将所有患者分为腓骨近端截骨组与胫骨高位截骨组各16例,比较两组患者的手术时间、住院时间、术中出血量和住院费用,比较两组患者术前、术后3个月、术后6个月的美国特种外科医院膝关节评分(HSS)、美国膝关节协会评分(KSS)、视觉模拟疼痛评分(VAS)和股胫角(FTA),比较两组患者术后出现的并发症的发生率。结果:腓骨近端截骨组患者的手术时间、住院时间短于胫骨高位截骨组,术中出血量和住院费用均显著少于胫骨高位截骨组(P0.05);术后3个月、术后6个月两组患者的HSS评分、KSS评分均明显高于术前,VAS评分、FTA均明显低于术前(P0.05);术前、术后3个月、术后6个月两组患者的HSS评分、KSS评分、VAS评分、FTA比较均无统计学差异(P0.05);两组患者的并发症发生率比较无统计学差异(P0.05)。结论:腓骨近端截骨术和胫骨高位截骨术均可有效治疗内侧间室性KOA,改善患者的膝关节功能和疼痛感,纠正内翻畸形,但腓骨近端截骨术手术时间和住院时间更短,术中出血量和住院费用更少。     

尺骨鹰嘴截骨和内外侧入路非截骨入路治疗肱骨髁间骨折的效果比较分析

目的:比较尺骨鹰嘴截骨和内外侧非截骨入路治疗肱骨髁间骨折的效果。方法:前瞻性选取2016年9月至2018年9月在本院进行治疗的76例肱骨髁间骨折患者作为研究对象,按照数字表法随机分为截骨组和非截骨组各38例,截骨组采用尺骨鹰嘴截骨入路进行治疗,非截骨组采用内外侧入路非截骨入路进行治疗。比较两组患者手术时间、术中出血量、术后24 h出血量、X线暴露时间,术后12个月骨折延迟愈合、尺神经麻痹、关节挛缩、骨关节炎等并发症的发生率以及疗效。结果:截骨组手术时间、术中出血量、术后24 h出血量、X线暴露时间明显低于非截骨组,差异均有统计学意义(P0.05)。截骨组并发症的发生率为13.16%,非截骨组并发症发生率为26.32%,两组比较差异无统计学意义(P0.05)。截骨组优良率为84.21%,非截骨组优良率为71.05%,两组比较差异无统计学意义(P0.05)。截骨组C1、C2、C3型肱骨髁间骨折术后肘关节评分优良率分别为78.57%、88.23%、85.71%,非截骨组C1、C2、C3型肱骨髁间骨折术后肘关节评分优良率分别为86.66%、73.33%、62.50%,非截骨组C1型肱骨髁间骨折术后肘关节评分优良率略高于截骨组,截骨组C2、C3型肱骨髁间骨折术后肘关节评分优良率略高于非截骨组,但两组不同AO分型优良率比较差异无统计学意义(P0.05)。结论:肱骨髁间骨折患者应用尺骨鹰嘴截骨入路手术较肱三头肌内外侧非截骨入路手术具有一定的临床优势,可显著减少手术时间、术中出血量、术后24h出血量以及术中X线照射时间,并且术后肘关节功能恢复较好,在粉碎较为严重的C2、C3型肱骨髁间骨折中推广使用。