Objective To summarize the current progress of laser-assisted cartilage reshaping (LACR) for prominent ear. Methods The domestic and abroad article concerning the LACR in treatment of prominent ear was reviewed and analyzed. Results As a new technique, there were three types of LACR therapies that been used for prominent ear. LACR with the 1 064 nm Nd/YAG laser is painful and the penetration depth of the 1 064 nm Nd/YAG laser is greater than that of the 1540 nm Er/Glass laser which is caused more tissue injury. LACR with the 1 540 nm Er/Glass laser has high absorption by the ear cartilage and produce less injury to the surrounding tissue. Use of the CO2 laser permitted cartilage reshaping combined with both vaporization and incisions, which complicates the technique, although, with low recurrence rate and definite effect. Insisting on wearing ear mold is the key to get satisfactory effectiveness for postoperative patients. The complications of LACR for prominent ear, such as the dermatitis, perforation of the skin, hematoma, or infection, should be noticed. Conclusion Application of LACR for prominent ear just has a short period of time, limited number of cases, and few relevant literature reports. Its effectiveness needs to be further studied and clarified.
Objective To investigate the morphology and biomechanics of in vivo osteogensis after repairing rabbit skull defects with plastic engineered bone which was prefabricated with alginate gel, osteoblasts and bone granules. Methods Twenty-eight rabbits were divided into group A (n=16), group B(n=8) and group C(n=4).The bilateral skull defects of 1 cm in diameter were made. Left skull defects filled with alginate gel-osteoblasts-bone granules(group A1) and right skull defects filled withalginate gel-bone granules(group A2).The defects of group B was left, as blank control and group C had no defect as normal control. The morphological change and bone formation were observed by methods of gross, histology and biomechanics. Results In group A1, the skull defects were almost entirely repaired by hard tissue 12 weeks after operation. The alginate gel-osteoblasts-bone granule material had changed into bone tissue with fewbone granules and some residuary alginate gel. The percentage of bone formation area was 40.92%±19.36%. The maximum compression loading on repairing tissue ofdefects was 37.33±2.95 N/mm; the maximum strain was 1.05±0.20 mm; andloading/strain ratio was 35.82±6.48 N/mm. In group A2, the alginate and bone granules material partially changed into bone tissue 12 weeks after operation. The percentage of bone formation area was 18.51%±6.01%. The maximum compression loading was 30.59±4.65 N; the maximum strain was 1.35±0.44 mm; and the loading/strainratio was 24.95±12.40 N/mm. In group B, the skull defects were mainly repaired bymembrane-like soft tissue with only few bone in marginal area；the percentage of bone formation area was 12.72%±9.46%. The maximum compression loading was 29.5±2.05 N; the maximum strain was 1.57±0.31mm；and the loading/strainratio was 19.90±5.47 N/mm.In group C, the maximum compression loading was 41.55±2.52 N; the maximum strain was 095±017 mm; and the l oading/strain ratio was 47.57±11.22 N/mm. 〖 WTHZ〗Conclusion〓〖WTBZ〗The plastic engineered bone prefabricated with algina te gelosteoblastsbone granule may shape according to the bone defects and ha s good ability to form bone tissue, whose maximum compression loading can reach 89 % of normal skull and the hardness at 12 weeks after operation is similar to that of normal skull.
ObjectiveTo establish a method to prefabricate titanium plate with three-dimensional (3-D) printing technique for correction of mandibular prognathism in sagittal splint ramous osteotomy (SSRO). MethodsBetween January 2012 and May 2013, 12 patients with mandibular prognathism (Angle III malocclusion) were treated. Among them, 9 cases were male and 3 cases were female. Their ages ranged from 19 to 35 years (mean, 25.6 years). With the 3-D facial CT data of these patients, 3-D printer was used to print the models for preoperational simulation. SSRO was performed on 3-D models, and the titanium plates were prefabricated on the models after the distal segments were moved backward and rotated according to occlusal splint. During operations, the proximal segments were fixed to distal segments by the prefabricated titanium plates. 3-D CT scans were taken to examine the temporomandibular joint position changes before operation and at 6 months after operation. ResultsThe skull models were manufactured by 3-D printing technique, and the titanium plates were reshaped on the basis of them. Twenty-four prefabricated titanium plates were placed during operations, and they all matched with the bone segments well. Evaluation of 3-D CT scans showed that the temporomandibular joint position had no change. All patients were followed up 7-12 months (mean, 10.6 months). The face type and dental articulation were improved greatly. All cases obtained satisfactory opening function and occlusion. ConclusionWith the titanium plate fabricated based on 3-D models, surgeons are able to improve or refine surgical planning so that the operation can be performed according to preoperative simulation precisely and the complications, such as dislocation of temporomandibular joint, can be prevented.
ObjectiveTo evaluate the correlation between the Mohawk (MKX) expression level and the collagen fiber diameter of autologous hamstring tendon graft during the stable graft remodeling phase after anterior cruciate ligament (ACL) reconstruction.MethodsBetween January 2018 and August 2018, patients who underwent arth-roscopic single-bundle anatomical ACL reconstruction with autologous hamstring tendons for at least 48 months and also underwent second-look arthroscopy were enrolled in study. During the second-look arthroscopic procedures, ACL graft biopsies were performed from the surface of central part of the ligament. MKX expressions of ACL grafts were analysed by real-time fluorescent quantitative PCR (qRT-PCR). The ultrastructure of collagen fibers of grafts were evaluated by transmission electron microscopy, which included average diameter of collagen fibers (Dc), average diameter of large-diameter collagen fibers (DL), average diameter of small-diameter collagen fibers (DS), and large-small collagen fibers ratio (RL/S). The correlation between MKX expression level and graft collagen fiber diameter was calculated.ResultsTwenty-six patients met the selection criteria and their ACL graft specimens were enrolled in the study. The interval between ACL reconstruction and second-look arthroscopy was 52-128 months, with an average of 78.6 months. Arthroscopic graft remodeling score was 3-6 (mean, 4.8). There were 17 cases of excellent remodeling and 9 cases of fair remodeling. All ACL grafts showed typical bimodal distributions of both large-diameter collagen fibers and small-diameter collagen fibers, but the ultrastructural characteristics of the graft collagen fibers were different according to different remodeling status under arthroscopy. The DC, DL, DS, and RL/S of the graft specimens were (65.2±9.3) nm, (91.6±10.5) nm, (45.7±8.6) nm, and 0.73±0.12, respectively. The relative expression level of MKX was 1.42±0.11, which was positively linearly correlated with DC, DL, and RL/S, and the correlation coefficient was statistically significant (r=0.809, P=0.000; r=0.861, P=0.000; r=0.942, P=0.000), while there was no significant correlation between DS and relative expression level of MKX (r=0.147, P=0.238). Regression analysis showed that the relative expression level of MKX could predict the DC, DL, and RL/S results of the ACL graft specimens (P<0.05).ConclusionAfter autologous hamstring tendon grafts stepped into stabilized remodeling phase, MKX expression level could predict the diameter measurement results of collagen fibers and be used as an important evaluation basis for graft collagen anabolic metabolism.
We conducted this study to explore the influence of the ocular residual aberrations changes on contrast sensitivity (CS) function in eyes undergoing orthokeratology using adaptive optics technique. Nineteen subjects' nineteen eyes were included in this study. The subjects were between 12 and 20 years (14.27±2.23 years) of age. An adaptive optics (AO) system was adopted to measure and compensate the residual aberrations through a 4-mm artificial pupil, and at the same time the contrast sensitivities were measured at five spatial frequencies (2,4,8,16, and 32 cycles per degree).The CS measurements with and without AO correction were completed. The sequence of the measurements with and without AO correction was randomly arranged without informing the observers. A two-interval forced-choice procedure was used for the CS measurements. The paired t-test was used to compare the contrast sensitivity with and without AO correction at each spatial frequency. The results revealed that the AO system decreased the mean total root mean square (RMS) from 0.356 μm to 0.160 μm(t=10.517, P＜0.001), and the mean total higher-order RMS from 0.246 μm to 0.095 μm(t=10.113, P＜0.001). The difference in log contrast sensitivity with and without AO correction was significant only at 8 cpd (t=-2.51, P=0.02). Thereby we concluded that correcting the ocular residual aberrations using adaptive optics technique could improve the contrast sensitivity function at intermediate spatial frequency in patients undergoing orthokeratology.
Objective To review the progress and clinical application of malleable bone paste/putty. MethodsRecent literature about malleable bone paste/putty was reviewed and analyzed. ResultsThe preparation and clinical application of malleable bone paste/putty have become increasingly mature. Many kinds of malleable bone paste/putty have been applied extensively and the good clinical results have been achieved in the treatment of the irregular bone defects. The materials and methods for preparing malleable bone paste/putty are different. Then they have different bone repair abilities. ConclusionMalleable bone paste/putty provides effective method to treat irregular bone defects. But the malleable bone paste/putty still has some shortage, so further researches should be carried out.
ObjectiveTo systematically review the efficacy of defocus incorporated multiple segments (DIMS) spectacle lenses and orthokeratology (Ortho-K) in controlling myopia. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from January 2000 to June 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 8 RCTs and 7 cohort studies were included. The results of meta-analysis showed that both Ortho-K lens and DIMS had better axial control effects than the single vision control group (MD=−0.18, 95%CI −0.21 to −0.15, P<0.01; MD=−0.21, 95%CI −0.27 to −0.15, P<0.01). The Ortho-K had a smaller one-year growth in axial length compared to the DIMS (MD=−0.06, 95%CI −0.08 to −0.04, P<0.01). ConclusionCurrent evidence suggests that Ortho-K and DIMS have better myopia control effects than single lens lenses, while Ortho-K has better myopia control effects than DIMS, but the advantages are not significant. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo develop a new type of internal fixation device which can be used to treat the minor avulsion fracture of the medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process, and investigate the reliability and effectiveness of the device through biomechanical test.MethodsEighty human’s bone specimens with complete medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process were selected and measured the anatomic indexes (the height, width, and thickness of medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process). The CT three-dimensional reconstruction data of 200 healthy adults which including medial malleolus, lateral malleolus, the base of the fifth metatarsal, and the ulnar styloid process was also selected and measured the anatomic indexes by Mimics software. The plastic rod-hook plate was designed according to the measured results and prepared. Forty fresh porcine lower limb specimens were randomly divided into groups A and B (20 in each group), and 8 adult lower limb specimens including 4 left and 4 right were also randomly divided into groups A and B (4 in each group). All specimens were prepared for avulsion fracture of medial malleolus. Then, the fractures were fixed with plastic rod-hook plate in group A and wire anchor in group B. The load and axial torsion test of ankle joint were carried out by universal biomechanical testing machine.ResultsAccording to the anatomical characteristics, a plastic rod-hook plate was designed successfully. The biomechanical test results between animal and human specimens were consistent. There was a linear relationship between load and displacement in the ankle distal load test. The displacement when loaded to the maximum load was significantly lower in group A than in group B (P<0.05). The torsion angle and torque were significantly higher in group A than in group B when the internal fixation failed in the axial torsion test of the ankle joint (P<0.05), and the torsion angle was significantly smaller in group A than in group B when the torque was 1 N·m (P<0.05), and the maximum torque was also significantly higher in group A than in group B (P<0.05). However, there was no significant difference in torsion angle between the two groups in the maximum torque (P>0.05).ConclusionThe biomechanical properties of plastic rod-hook plate is obviously better than wire anchor, and the fixation of avulsion fracture with plastic rod-hook plate is easy to operate, which is expected to be used in the clinical treatment of minor avulsion fractures such as medial malleolus, lateral malleolus, base of the fifth metatarsal, and ulna styloid process.
ObjectiveTo summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.MethodsThe clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.ResultsAll DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.ConclusionIt is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.