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胫骨上段大型骨化性纤维瘤切除后修复一例

Relationship between knee meniscus and posterior tibial slope in healthy adults and patients with anteromedial osteoarthritis in Heilongjiang province

Objective To measure and analyze the relationships among the posterior tibial slope (PTS), meniscal slope (MS), and meniscus posterior horn thickness (MPHT) of the medial and lateral tibial plateau in healthy people and patients with anteromedial osteoarthritis (AMOA) in Heilongjiang province, so as to provide reference basis for appropriate tibial osteotomy and prosthesis placement angles in knee joint surgeries. Methods A retrospective collection of imaging data from knee joint MRI examinations conducted prior to AMOA for various reasons was performed. A total of 103 healthy individuals (healthy group) and 30 AMOA patients (AMOA group) were included. There was no significant difference in the gender composition ratio, side, and body mass index between the two groups (P>0.05); however, the comparison of ages between the two groups showed a significant difference (P<0.05). The collected DICOM format image data was imported into the RadiAnt DICOM Viewer software and measured the medial PTS (MPTS), lateral PTS (LPTS), medial MS (MMS), lateral MS (LMS), medial MPHT (MMPHT), and lateral MPHT (LMPHT) with standard methods. The differences of the above indexes between the two groups and between different genders and sides in the two groups were compared, and Pearson correlation analysis was carried out. At the same time, the measured data of healthy group were compared with the relevant literature reported in the past. Results Compared to the healthy group, the AMOA group exhibited significantly smaller MPTS and LPTS, as well as significantly greater MMPHT and LMPHT, with significant differences (P<0.05). However, there was no significant difference in the MMS and LMS between the two groups (P>0.05). The differences in various indicators between genders and sides within the two groups were not significant (P>0.05). The correlation analysis and regression curves indicated that both MPTS and LPTS in the two groups were positively correlated with their respective ipsilateral MS and MPHT (P<0.05); as PTS increased, the rate of increase in MS and MPHT tend to plateau. Compared to previous related studies, the MPTS and LPTS measured in healthy group were comparable to those of the Turkish population, exhibiting smaller values than those reported in other studies, while MMS and LMS were relatively larger, and MMPHT and LMPHT were smaller. ConclusionIn healthy people and AMOA patients in Heilongjiang province, PTS has great individual differences, but there is no significant individual difference in MS. MPHT can play a certain role in retroversion compensation, and its thickness increase may be used as one of the indicators to predict the progression of AMOA. The above factors should be taken into account when UKA is performed, and the posterior tilt angle of tibial osteotomy should be set reasonably after preoperative examination and evaluation.

VASCULARIZATION IN TRANSPLANTATION OF BIODERIVED BONE COMPOUNDED WITH MARROW STROMAL STEM CELLS IN REPAIR OF GOAT TIBIAL SHAFT DEFECT

Objective To study the vascularization of the compositeof bio-derived bone and marrow stromal stem cells(MSCs) in repairing goat tibial shaft defect.Methods Bio-derived bone was processed as scaffold material. MSCs were harvested and cultured in vitro. The multiplied and induced cells were seeded onto the scaffold to construct tissue engineered bone. A 20 mm segmental bone defect inlength was made in the middle of the tibia shaft in 20 mature goats and fixed with plate. The right tibia defect was repaired by tissue engineered bone (experimental side), and the left one was repaired by scaffold material (control side).The vascularization and osteogenesis of the implants were evaluated by transparent thick slide, image analysis of the vessels, and histology with Chinese ink perfusion 2, 4, 6, and 8 weeks after operation.Results More new vessels were found in control side than in experimental side 2 and 4 weeks after implantation (Plt;0.05). After 8 weeks, there was no significant difference in number of vessels between two sides(Pgt;0.05), and the implants were vascularized completely. New bone tissue was formed gradually as the time and the scaffold material degraded quickly after 6 and 8 weeks in the experimental side. However, no new bone tissue was formed andthe scaffold degraded slowly in control side 8 weeks after operation.Conclusion Bio-derived bone has good quality of vascularization. The ability of tissue-engineered bone to repair bone defect is better than that of bio-derived bone alone.

THE APPLICATION OF TRANSPOSITION OF THE GASTROCNEMIUS MUSCLE IN THE LIMB-SALVAGE OPERATIONS OF THE PROXIMAL TIBIAL TUMORS

OBJECTIVE To evaluate the efficacy of transposition of the gastracnemius muscle in the limb-salvage operation of the proximal tibial tumor. METHODS From 1995, transposition of the gastrocnemius muscle was applied to cover the devitalized bone, bone cement or autologous bone graft in 15 cases with tumors of the proximal tibia (transposition of medial heads of gastrocnemius muscle in 12 cases, and lateral heads of gastrocnemius muscle in 3 cases respectively). Among them, there were 7 osteosarcomas, 5 giant cell tumors, 1 malignant fibrous histocytoma, 1 chondrosarcoma and 1 osteoblastoma. The operations included segmental devitalization with 95% alcohol in 7 cases, knee reconstruction of the unilateral tibial plateau with iliac graft in 5 cases, segmental devitalization with microwave in 2 cases, local resection and bone graft in 1 cases. RESULTS Apart from 2 cases whose wounds needed suturing again due to the liquefaction of the subcutaneous fat around the incision, no wound complications were occured in other 13 patients. No significant loss in the function of the leg and ankle was observed after transposition of the gastrocnemius muscle. There was no local recurrence, but 3 patients died due to lung metastases. CONCLUSION Transposition of the gastrocnemius muscle after resection of promixal tibial tumors can improve the local blood supply, cover the deep structures and prevent from the failure of limb-salvage operation due to wound complications.

复杂胫骨平台骨折的手术治疗

Ilizarov 技术分期治疗重度先天性胫骨假关节

目的总结 Ilizarov 技术分期治疗合并严重肢体短缩畸形的重度先天性胫骨假关节（congenital pseudarthrosis of tibia，CPT）的疗效。方法2014 年 5 月—2018 年 11 月，应用 Ilizarov 技术分期治疗 5 例重度 CPT 患儿。男 1 例，女 4 例；年龄 2 岁 6 个月～7 岁 1 个月，中位年龄 4 岁 7 个月。术前患侧胫骨长度较健侧短缩 4.0～6.8 cm，平均 6.06 cm。按照 Boyd 分型：Ⅰ型 1 例、Ⅱ型 3 例、Ⅴ型 1 例。一期切除胫骨假关节及病损组织，应用 Ilizarov 技术行肢体延长，矫正肢体短缩畸形；二期行骨搬移至端端对合后，行植骨内固定促进对合端愈合。结果5 例患儿均获随访，随访时间 12～60 个月，平均 41 个月。外固定架佩戴时间 210～360 d，平均 262 d。肢体延长 4.5～8.0 cm，平均 6.06 cm；患肢胫骨与健侧等长或略短（≤2 cm）。术后 7～12 个月胫骨假关节均骨性愈合；愈合指数 42～50 d/cm，平均 45.2 d/cm。均无血管神经损伤、固定针折断及不愈合等并发症发生。结论应用 Ilizarov 技术分期治疗重度 CPT，可矫正肢体短缩畸形、减少肌腱挛缩、创伤小、胫骨对合端稳定性好、愈合率高、再骨折发生率低，可最大限度改善肢体功能。

关节镜下治疗胫骨髁间隆起撕脱骨折

双侧入路双钢板治疗复杂胫骨平台骨折13 例

目的 总结双侧入路双钢板治疗复杂胫骨平台骨折的手术方法和疗效。 方法 2004 年3 月－2006 年5 月，采用手术切开复位，双侧入路双解剖钢板固定治疗13 例复杂胫骨平台骨折。男10 例，女3 例；年龄23 ～65 岁。Schatzker 分型均为Ⅳ～Ⅵ型。受伤至手术时间为4 ～ 10 d。 结果 13 例患者术后伤口均Ⅰ期愈合，无皮肤坏死、神经血管损伤、深部感染等并发症发生。术后X 线片示骨折于术后16 周内愈合，患肢正常力线及患膝骨性稳定均恢复，无内固定松动及断裂。术后12 个月可胜任日常活动。患者均获随访，随访时间12 ～ 24 个月，平均15.3 个月。根据Rasmussen 膝关节功能评分法，获优10 例，良2 例，可1 例，优良率92.3%。 结论 双侧入路软组织损伤小，术后感染几率低，双解剖钢板固定可靠，可早期行功能锻炼，是治疗复杂胫骨平台骨折的一种较好方法。

OSTEOMYOCUTANEOUS LATISSIMUS DORSI SCAPULAR COMBINED FLAP WITH VASCULARIZED RIB TO REPAIR THE LARGE DEFECT OF TIBIA

Objective To design a combined flap of subscapular axis including vascularized lateral scapular,rib and latissimus dorsi to repair the large defect of tibia. Methods The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibiaafter primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm×6 cm scar involved the proximal medial segment of tibia.After resection of scar and fibular tissue over the bone defect floor, alatissimus dorsi myocutaneous flap 14 cm×5 cm pedicled with subscapular artery-thoracodorsal artery,a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared.The tibialis posterior and saphenous vein were used for astomosis. A proximalanatomic plate was applied to the fixation of tibia. Results Thecompound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation. Conclusion This combined flap is successful and can provide alternative to the resolution of large defect of tibia.

Treatment of severe diabetic foot ulcer using tibia transverse transport combined with nose ring drain

ObjectiveTo investigate the effectiveness of tibial transverse transport (TTT) combined with nose ring drain (NRD) in the treatment of severe diabetic foot ulcer.MethodsThe clinical data of 60 patients with severe diabetic foot (Wagner grade 3 or 4) ulcer who were admitted between April 2017 and August 2020 and met the selection criteria were retrospectively analyzed. Among them, 30 cases were treated with TTT combined with NRD (TTT+NRD group), and 30 cases were treated with TTT (TTT group). There was no significant difference in gender, age, diabetes duration, preoperative glycated hemoglobin, comorbidities, wound area, and duration, side, and grade of diabetic foot (P>0.05). The wound healing time, wound healing rate, amputation rate, recurrence rate, duration of antibiotic therapy, hospital stay, number of hospitalizations, and number of operations were recoreded and compared between the two groups.ResultsNo obvious surgical complications occurred in the two groups. Patients in both groups were followed up 3-13 months, with an average of 5.7 months. The duration of antibiotic therapy and hospital stay in the TTT+NRD group were significantly shorter than those in the TTT group (P<0.05). There was no significant difference in wound healing time, wound healing rate, number of hospitalizations, and number of operations between the two groups (P>0.05). During follow-up, there was no recurrence of ulcer in the TTT+NRD group while 2 recurrent cases (6.7%) in the TTT group. The difference in recurrence rate was not significant (P=0.492). One case (3.3%) in the TTT+NRD group underwent amputation due to acute lower extremity vascular embolism, and 1 case (3.3%) in the TTT group underwent amputation due to secondary necrosis. The difference in amputation rate was not significant between the two groups (P=1.000).ConclusionTTT combined with NRD is an effective method for the treatment of severe diabetic foot ulcers with deep infections or relatively closed cavities or sinuses. It can shorten the time of antibiotic use and the length of hospitalization; and the NRD has a good drainage effect without obvious comorbidities, procedure and the postoperative care are simple and easy to obtain materials.