Bone Groove Research Articles

Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note.

Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow. A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions. We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications. The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

Finite element analysis of artificial ankle elastic improved inserts

To discuss the influence of artificial ankle elastic improved inserts (hereinafter referred to as "improved inserts") in reducing prosthesis micromotion and improving joint surface contact mechanics by finite element analysis. Based on the original insert of INBONE Ⅱ implant system (model A), four kinds of improved inserts were constructed by adding arc or platform type flexible layer with thickness of 1.3 or 2.6 mm, respectively. They were Flying goose type_1.3 elastic improved insert (model B), Flying goose type_2.6 elastic improved insert (model C), Platform type_1.3 elastic improved insert (model D), Platform type_2.6 elastic improved insert (model E). Then, the CT data of right ankle at neutral position of a healthy adult male volunteer was collected, and finite element models of total ankle replacement (TAR) was constructed based on model A-E prostheses by software of Mimics 19.0, Geomagic wrap 2017, Creo 6.0, Hypermesh 14.0, and Abaqus 6.14. Finally, the differences of bone-metal prosthesis interface micromotion and articular surface contact behavior between different models were investigated under ISO gait load. The tibia/talus-metal prosthesis interfaces micromotion of the five TAR models gradually increased during the support phase, then gradually fell back after entering the swing phase. The improved models (models B-E) showed lower bone-metal prosthesis interface micromotion when compared with the original model (model A), but there was no significant difference among models A-E ( P>0.05). The maximum micromotion of tibia appeared at the dome of the tibial bone groove, and the ​​micromotion area was the largest in model A and the smallest in model E. The maximum micromotion of talus appeared at the posterior surface of the central bone groove, and there was no difference in the micromotion area among models A-E. The contact area of the articular surface of the insert/talus prosthesis in each group increased in the support phase and decreased in the swing phase during the gait cycle. Compared with model A, the articular surface contact area of models B-E increased, but there was no significant difference among models A-E ( P>0.05). The change trend of the maximum stress on the articular surface of the inserts/talus prosthesis was similar to that of the contact area. Only the maximum contact stress of the insert joint surface of models D and E was lower than that of model A, while the maximum contact stress of the talar prosthesis joint surface of models B-E was lower than that of model A, but there was no significant difference among models A-E ( P>0.05). The high stress area of the lateral articular surface of the improved inserts significantly reduced, and the articular surface stress distribution of the talus prosthesis was more uniform. Adding a flexible layer in the insert can improve the elasticity of the overall component, which is beneficial to absorb the impact force of the artificial ankle joint, thereby reducing interface micromotion and improving contact behavior. The mechanical properties of the inserts designed with the platform type and thicker flexible layer are better.

Comparison of patellar anchor fixation graft and graft through patellar tunnel reconstruction of medial patellofemoral ligament in the treatment of recurrent patellar dislocation: A protocol for a meta-analysis of comparative studies.

Recurrent patellar dislocation (RPD) occurs in people who have their own patellofemoral dysplasia and who have not been properly treated after their first patellar dislocation. For RPD where conservative treatment is ineffective, medial patellofemoral ligament (MPFL) reconstruction is the first choice for surgical treatment, but there are various and controversial ways of MPFL reconstruction and fixation. Initially, more scholars adopted the patellar lateral tunneling (PT) approach to contain and stabilize the graft, but with the newer materials and techniques, some experts adopted the lateral patellar anchor fixation (AF) of the graft, which can avoid the collateral damage caused by the patellar lateral tunneling and can obtain the same definite efficacy. Therefore, a meta-analysis must be performed to provide evidence whether there is a difference between AF and PT reconstruction of the MPFL in the treatment of RPD. We will search, with no time restriction, without any restriction of language and status, the time from the establishment of the database to October 2022, on the following databases: PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), and Chinese databases SinoMed (CBM) electronic databases. The electronic database search will be supplemented by a manual search of the reference lists of included articles. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. This systematic review and meta-analysis will evaluate the functional outcomes of the two fixation modalities, AF and PT, in reconstructing MPFL for RPD. The findings of this study will provide a basis for clinical judgment of whether there is a difference between the two forms of AF and PT reconstructed MPFL for RPD.

Удаление частичной атретической пластинки при изолированной аномалии развития среднего уха

Congenital isolated anomalies of the development of the middle ear arising from a violation of embryogenesis occur in approximately 1 in 10,000–15,000 newborns and can cause significant hearing loss from the abnormal ear, leading to a delay in psycho-speech development. In particular, one of the rare isolated anomalies of the middle ear is a partial atretic plate, the probability of its occurrence has not been specified. Unlike the full atretic plate, the partial plate is thinner and partially blocks the entrance to the tympanic cavity from the side of the external auditory canal. In this article, based on the observations, we present the identified pattern of development of partial atretic plates relative to their location. The first option is tympanosquamous, in which the plate originates from sutura tympano-squamosa; the second is the tympanicmastoidea variant, in which it is determined in the area sutura tympano-mastoidea. A developed method for the surgical treatment of isolated anomalies with partial atretic plates, with the preservation of the fibrous layer, the creation of a neoannulus by forming a circular bone groove, which made it possible to solve the main problems in the treatment of this malformation, is presented. The aim of the study of this work was to increase the effectiveness of surgical treatment of patients with anomalies in the development of the ear accompanied by the presence of a partial atretic plate. From 2009 to 2018, 16 surgical interventions (16 patients, 16 ears) were performed at the Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech for isolated anomalies in the development of the middle ear with the presence of a partial atretic plate. As a result of the study, it was determined that the method of preserving the ossicular chain, even considering its intraoperative mobilization, did not prove to be the best method of treatment due to a pronounced increase in the air-bone gap in the first months after surgery, which is due to refixation of the incus body and the malleus head in attica. The developed method for the removal of partial atretic plates in isolated congenital anomalies in the development of the middle ear has shown its high effectiveness in assessing long-term anatomical and functional results.

A modified surgical method for the treatment of ONFH: quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery

BackgroundOsteonecrosis of the femoral head (ONFH) can lead to pain and loss of function of the hip joint, which places a great burden on patients and society. Surgery is the main treatment for osteonecrosis of the femoral head, and quadratus femoris muscle pedicle bone grafting has a definite therapeutic effect as one method of surgery for the treatment of ONFH. However, the posterior superior retinacular artery is often injured during quadratus femoris muscle pedicle bone graft surgery. There is evidence that this artery is extremely important to the femoral head, as injury to this artery will seriously affect the blood supply of the femoral head. Therefore, this situation restricts the clinical application of quadratus femoris muscle pedicle bone grafts. We aimed to explore a new surgical method of quadratus femoris muscle pedicle bone grafting that can preserve the integrity of the posterior superior retinacular artery.MethodsWe modified the traditional quadratus femoris muscle pedicle bone graft and preserved the integrity of the posterior superior retinacular artery. To explore the safety and feasibility of the operation, we simulated the operation on 6 fresh frozen cadavers (12 hips) and measured the related data. We also tried this modified surgical method in the clinic and collected detailed data from the patients.ResultsBy simulating the modified quadratus femoris muscle pedicle bone graft on the hip joints of fresh frozen cadavers, we found that the posterior superior retinacular artery existed in all cadaver specimens and that the sources may be different (MFCA or IGA). In the modified operation, the joint capsule did not need to be cut during the operation; therefore, the integrity of the posterior superior retinacular artery was preserved. The quadratus femoris muscle was exposed via the posterior approach of the hip joint, and then the quadratus femoris muscle pedicle bone flap was chiseled. After the pedicle of the quadratus femoris muscle was loosened properly, the migration distance of the quadratus femoris muscle pedicle bone flap reached 5.89 ± 0.45 (χ ± s) cm. The bone flap was trimmed properly and placed on one side. Next, we drilled a bone tunnel from the external intertrochanteric aspect of the capsule of the hip joint, and the bone tunnel broke through the sclerosing zone and proceeded straight to the necrotic area of the femoral head. Next, the necrotic bone was removed with a ring saw and arc bone knife, autogenous bone or allogeneic bone was filled into the bone groove according to the situation, and the cancellous bone in the bone groove was tamped by percussion. Then, the bone flap was inserted into the bone groove, and appropriate pressurization was performed. The depth of the bone groove was determined by the location of ONFH. We found that the furthest distance between the bone groove and the femoral head was 4.76 ± 0.07 (χ ± s) cm and that the length of the bone flap was (4.91 ± 0.23) (χ ± s) cm. This means that when the depth of the bone groove reached the area of ONFH, the quadratus femoris muscle pedicle bone flap had a sufficient length and migration distance to be embedded in the area of ONFH and firmly fixed, and the quadratus femoris did not have much tension. The closest distance between the posterior superior retinacular artery and the bone groove was (1.11 ± 0.96) (χ ± s) cm. When the bone groove was created in this area, the edge of the bone groove had a safe distance of at least 1 cm from the posterior superior retinacular artery of the femoral head. We attempted to implement this modified operation clinically. During the procedure, the quadratus femoris muscle pedicle bone flap was embedded into the drilled bone groove and fixed with a magnesium nail. There was no sliding of the bone flap after the operation, and the posterior superior retinacular artery was intact. We followed the patient for 3 months and found that the patient recovered well with no weight-bearing by the affected limb. The duration of the modified operation was shorter than that of the traditional quadratus femoris muscle pedicle bone graft, the amount of bleeding was significantly reduced, the postoperative pain was lessened, and no special discomfort was reported. Postoperative imaging examination showed that the collapse of the femoral head had been partially corrected and that the bone flap had gradually fused with the surrounding bone.ConclusionsThrough this experimental study, we confirmed the feasibility of the modified method for quadratus femoris muscle pedicle bone grafting with preservation of the posterior superior retinacular artery. This modified operation not only retains the integrity of the posterior superior retinacular artery of the femoral head but also reduces the difficulty of the operation and shortens the surgical time, which is of great clinical significance.

Spherical Periacetabular Osteotomy.

Preoperative 3-dimensional planning is utilized to decide the radius of the curved osteotome, locations of the reference points for the osteotomy line, and depth of the bone groove at the teardrop area. The pelvic positioning is arranged fluoroscopically to match the neutral position based on preoperative planning. A 7-cm incision is made along the medial margin of the iliac crest. An anterior iliac crest osteotomy of 4.5 cm (length) × 1 cm (medial wedge-shaped) is performed. The operative field is maintained with aluminum retractors. The osteotomy line is completed by connecting the preoperatively planned reference points on the inner cortex of the ilium. The bone groove is made along the osteotomy line with use of a high-speed burr. A blunt osteotome is inserted into the bone groove at the teardrop area until it reaches the preoperatively planned depth. The blunt osteotome makes a pathway for the curved osteotome without breaking the quadrilateral surface (QLS) or perforating the hip joint. The special curved osteotome is inserted manually until it reaches the bottom of the groove, and the posterior cortex is cut. After the top of the teardrop is divided fluoroscopically, the anterior ischial cortex is osteotomized with a sharpened spiked Cobb elevator at the infracotyloid groove. An angled curved osteotome is used for the osteotomy of the superior area of the teardrop area. The bone fragment is rotated with a spreader and an angled retractor, and fixed with 2 absorbable screws. Beta-tricalcium phosphate blocks are inserted into the bone gap. The osteotomized wedge-shaped iliac bone is repositioned and fixed. Alternatives include the Bernese periacetabular osteotomy, rotational acetabular osteotomy, and triple innominate osteotomy. Bernese periacetabular osteotomy utilizes an anterior approach, cuts into the QLS, and preserves the posterior column. In contrast, SPO preserves the QLS and does not cut the pubis. These features of SPO have some advantages. The large osteotomized surface is advantageous for osseous fusion, and preserving the QLS and pubis protects the trunk of the obturator artery. Furthermore, the preservation of the connection between the ilium, ischium, and pubis in SPO maintains a more stable pelvic ring than in Bernese periacetabular osteotomy. The osteotomy line is arranged to prevent leg shortening caused by thin medial bone stock of the bone fragment. Although splitting the teardrop area in SPO is somewhat technically difficult, particularly in cases with a thin teardrop, it can be safely done with use of preoperative 3-dimensional planning and appropriate surgical technique.In addition, the use of our medial wedge-shaped osteotomy at the iliac crest has 2 advantages: protection of the lateral femoral cutaneous nerve and preservation of the attachment of the tensor fascia latae muscle. The advantages of SPO are a stable pelvic ring postoperatively, reduced risk of nonunion at the osteotomy site, no risk to the trunk of the obturator artery, preservation of the blood supply to the bone fragment, a small incision, and early muscle recovery. Preoperative 3-dimensional planning of the osteotomy design is essential.The special curved osteotomes are designed so that osteotomy of the posterior cortex is completed when the handles are perpendicular to the pelvis.The special curved osteotomes are made with a radius of either 50 or 60 mm, which are the most suitable sizes for the Japanese population. Larger-diameter osteotomes may be required for different races.As the rotated bone fragment is relatively small, it is difficult to obtain rigid fixation of the osteotomy site. Hence, the fragment can move slightly in the early phase after surgery. Careful rehabilitation is needed. AIIS = anterior inferior iliac spineASIS = anterior superior iliac spineLFCN = lateral femoral cutaneous nerveG.T. = greater trochanterK-wire = Kirschner wireBeta (β)-TCP = beta-tricalcium phosphate.

Design and research of a miniaturized four notch UWB antenna

In order to effectively suppress the interference of narrow-band communication systems such as WiMAX band, international satellite band, X band and the ITU band, this paper designs a miniature ultra wideband (UWB) antenna. The improved rectangle is used as the radiation patch. The semicircular groove is dug in the upper part of the rectangle and the two corners below are cut off. The long triangle is also cut on both sides of the end of the microstrip line. The fish bone groove is well modified in the middle of the rectangular ground plate to obtain the perfect ultra wideband characteristics. By digging a semi-circular groove on the radiation patch to introduce T-shaped branches, and opening an inverted U-shaped groove in the center of the radiation patch, introducing symmetrical C-shaped open branches on both sides of the feeder line and etching U-shaped narrow gaps on the feeder line, four band notch characteristics of 3.24−3.8 GHz, 4.5−4.97 GHz, 7.24−7.76 GHz and 8.0−8.54 GHz are produced, which better suppresses the interference in the notch band, shows that the antenna can work normally in the frequency band of 3.0−13.09 GHz, and the four notch baud property of the antenna also expands the application field, which is suitable for many ultra wideband communication systems.

Extracellular matrix scaffold crosslinked with vancomycin for multifunctional antibacterial bone infection therapy

The treatment of acute and chronic bone infections remains a major clinical challenge. The various factors released by the bacteria, acidic environment, and bacterial colonies in the bone grooves and implanted synthetic materials collectively promote the formation of biofilms. Dormant bacteria and biofilms cause infections that are difficult to cure and that can develop chronically. Therefore, a new antibacterial material was synthesized in the present study for multifunctional bone infection therapy and consists of specific demineralized extracellular cancellous bone (SDECM) crosslinked with vancomycin (Van) by means of electrostatic interactions and chemical bonds. It was verified in vitro that the new material (Van-SDECM) not only has pH-sensitive release and biofilm inhibition properties, but also maintains sustained bactericidal ability accompanied by the degradation of the scaffold, which does not affect its favorable osteogenic performance. The infectious bone defect in vivo model further confirms the comprehensive anti-infective and osteogenic ability of the Van-SDECM. Further, these favorable properties are due to the pH-sensitive sustained release sterilization and scaffold contact antibacterial properties, accompanied by osteoclast activity inhibition, osteogenesis promotion and immunoregulation effects. This study provides a new drug-scaffold composite preparation method based on a native-derived extracellular matrix scaffold.

How to identify the anterior cribriform plate in the medial approach to the frontal sinus

Draf III frontal sinusotomy is one of the most complex surgical procedures on the frontal sinus, designed to limit the risks of restenosis by ensuring unification of the two ostia and resection of the floor of the sinus. This procedure requires a good knowledge of anatomy and sufficient surgical expertise to avoid the risk of CSF leak and to limit the risk of restenosis. The surgeon can use various landmarks, consisting of foramina, bone grooves and arteries located on the anterior part of the cribriform plate to guide the procedure. The purpose of this technical note is to explain the use of these landmarks to ensure safe Draf III frontal sinusotomy via a medial approach.

Anatomical double-bundle medial patellofemoral ligament reconstruction in recurrent patellar dislocation using autologous gracilis tendon graft

Background Recurrent lateral instability of the patella after traumatic patellar dislocation always involves injury to the medial patellar soft tissue restraints. The purpose of the study was to assess the results of double-bundle medial patellofemoral ligament (MPFL) reconstruction in the management of recurrent lateral patellar dislocations. Patients and methods Between January 2012 and November 2014, MPFL reconstruction was performed in 25 knees in 19 patients (12 females and seven males) at Benha University Hospital. The inclusion criteria included patients with recurrent dislocations of the patella (more than two times) with deficient medial retinacula. Autogenous gracilis graft was used as double bundle. Graft was fixed at the femoral side using interference screws and at the patellar side using incomplete tunnels and bone groove in the medial half of the patella. Results Average follow-up period was 32.16±5.8 months. At the final follow-up, average postoperative Lysholm score improved significantly from 58.88±5.87 to 90.68±2.77 (P Conclusion Anatomical double-bundle MPFL reconstruction is a simple and cheap technique used in the current case series that provides accurate femoral and patellar anatomical insertion points at the insertion sites and allows proper tensioning of the graft maintaining normal patellar glide, with overall favorable outcome results.

Evaluation of a bone groove geometry for fixation of a cochlear implant electrode.

Electrode migration is a rare, but relevant complication in cochlear implant (CI) surgery. An effective countermeasure is to create a bone groove in the facial recess to secure the electrode lead. We use this method routinely since 2013, but still experienced sporadic electrode migration events most likely due to an improper surgical execution. The aim of this study was to determine the optimum groove geometry. Grooves of defined geometry were created in specimens of fresh porcine femur compacta by use of a CNC milling machine. Electrode dummies were fixed in the groove and then exposed to tensile stress. Force measurements were carried out to examine the effect of groove diameter and opening width on the holding force. The mechanical impact on the electrode cable during insertion into the groove was recorded and the electrode lead was examined under microscopic magnification to assess potential structural damage. Optimum groove geometry (diameter 1.10mm, opening width 0.90mm) ensured an average holding force of 830mN which is equivalent to the established fixation by use of a titanium clip. None of the microscopic inspections revealed any morphological deterioration of the electrode lead. The fixation of a CI electrode in a bone groove in the facial recess appears to be effective and safe. Furthermore, this method does not require additional costs or foreign material. The optimum geometry defined in this study helped us to refine our surgical standard produce and to generate more consistent results.

Treatment of chronictibial osteomyelitis with irrigation sequential Flow-through type anterolateral thigh chimeric myocutaneous flap

Objective To investigate the clinical effects of irrigation sequential Flow-through type anterolateral thigh chimeric myocutaneous flap in the treatment of chronic tibial osteomyelitis. Methods From January, 2012 to December, 2017, trench grooved sequential Flow-through anterolateral femoral chimeric flaps were used to treat chronic tibial osteomyelitis. On the basis of sensitive antibiotics, bone grooving and VSD grooved sequential Flow-through anterolateral thigh chimeric flaps were used to fill the bone cavity and cover the wound. The patients received the follow-up care in outpatient office and telephone regularly after hospital discharge. Results Among the 18 cases in this group, 2 cases were positive and 16 cases were negative in secondary bacteriological detection. The flaps and donor sites survived in one stage. Fifteen cases healed in one stage, and extravasate occurred in 3 cases after operation. After dressing change, the wounds healed in 25 days, 32 days and 43 days after flap operation, respectively. All the patients were followed-up for 12 to 30 months, with an average of 25 months. Local low toxicity infection symptom occurred again in 1 case with delayed healing 6 months after operation. After 1 week of antibiotic treatment, the symptom subsided. After 1 more week of antibiotic use, the patient was discharged from hospital. And followed-up for 1 year, no recurrence occurred. During the follow-up period, no recurrence of infection and no fracture occurred after primary fracture healing in other 17 cases. One year after the second operation, there was no obvious stenosis in the bridged vessels examined by Doppler ultrasonography and the blood flow velocity was the same as that of the contralateral limbs. Conclusion The application of irrigation and sequential Flow-through type anterolateral thigh chimeric myocutaneous flap for treatment of chronic tibial osteomyelitis can achieve good therapeutic effect and is worth popularizing. Key words: Tibial osteomyelitis; Chimeric myocutaneous flap, anterolateral thigh flap; Flow-through flap; Microsurgical technique

The Effect of a Bone Groove Against Cochlear Implant Electrode Migration.

The risk of electrode migration in cochlear implant (CI) surgery can be reduced by securing the electrode lead in a bone groove in the chorda-facial angle. Electrode migration is an important complication in CI surgery, which affects hearing performance, may induce pain and facial nerve stimulation, and requires surgical revision. A potential method to secure the electrode is to use a bone groove created in the facial recess to fixate the electrode lead. This surgical measure is a standard procedure for lateral wall electrodes (LWE) in our clinic since 2013. Retrospective analysis of consecutive CI cases of a tertiary referral center from 2006 to 2016 and comparison of incidence rates between group A (without bone groove, years 2006-2012) and group B (with bone groove fixation, years 2013-2016). Clinical cases were reviewed with respect to electrode type, migration length, time interval to migration, and findings during revision surgery. Seventeen cases of electrode migration were found in a total of 1,603 cochlear implantations. Only LWE designs were affected by migration. The cumulative incidence for LWE in group B (0.5%) was significantly lower than in group A (3.7%, p < 0.01). The two migration cases in group B revealed insufficient geometric design of the bone grooves. Only one patient experienced a remigration after revision surgery. The fixation in a bone groove in the chorda-facial angle is an effective measure against migration of LWE. Proper surgical execution is mandatory to ensure a tight and enduring fit.

Anatomy research of cervical laminoplasty with preservation of the posterior ligament complex.

Objective: To evaluate the feasibility of cervical laminoplasty with preservation of the posterior ligament complex for enlarging the spinal canal. Methods: Six up-to-standard human corpse specimens were divided into two groups by simple randomization (start from C4 group, S4; start from C5 group, S5; 3 corpses in each group). Decompression operation of C3-C6 level was performed in a predetermined sequence by using the new procedure with preservation of the posterior ligament complex.The basic depth of spinal canal was measured with a depth gauge at fixed point after the right bone groove of single level was completed.The operation of the contralateral bone groove was continued, and then the spinal canal was measured again when the spinous process was pulled backward by using a tissue forceps until the ligament complex was just tight.Retreat value (RV) of vertebral lamina was obtained by calculating the difference between the two measurements.The earlier measured levels needed to be remeasured when the operation area increased by one level. Two independent sample and one-sample t test were used to analyze the measurement results. Results: RV of vertebral lamina was small after finishing the first level of the decompression operation [S4: (0.87±0.72) mm; S5: (1.83±0.29) mm], and the value reached its maximum after the completion of C3-C6 level.The overall average RVmaxs from C3 to C6 level were (2.37±0.52) mm, (4.27±0.78) mm, (3.73±0.93) mm and (2.16±0.77) mm, respectively.The overall average retreat rates (RR) were 17%±7%, 32%±9%, 29%±10% and 16%±6%, respectively. The overall average RVmax of C4 and C5 level reached or exceeded the decompression threshold value of 4 mm (t=0.839, -0.703, both P>0.05). The average RVmax of C4/C5 level was similar in the two groups (t=-1.204, 1.189, both P>0.05); however, the difference of average RVmax between C3 and C6 level was significant (t=-4.429, 4.196, both P<0.05). Conclusions: Cervical laminoplasty with preservation of the posterior ligament complex can enlarge the sagittal diameter of spinal canal and relieve the compression of spinal cord.In addition, RV of each level increases as the number of the operation level increases, and the ability of vertebral lamina to retreat is quite different from C3 to C6 level.The decompression effect in the middle of the operation area is better than that on the cranial and tail side.

"Reverse J Shaped " Skin Flap and Cranial Bone Groove for Shunt Hardware: A New Technique for Patients with Fragile Skin.

Shunt systems are not perfect devices and can cause severe complications. Complications may originate from problems related to the valve, the patient, or the surgery and are more common in neonates, infants, especially preterm, by reason of the special characteristics of these patients. We, therefore, have successfully developed a useful and viable surgical technique in order to provide helpful aspects to the surgical issues mentioned above. This technique includes a "reverse J shaped" skin incision nonintersecting the shunt's hardware and distal catheter to reduce wound problems to a minimum by opening a "bone groove". We believe that the above technique described by us will both reduce issues such as scalp ulceration, wound dehiscence, and shunt exposure in premature and pediatric hydrocephalus cases with a friable scalp, and eliminate a cosmetic problem in hydrocephalic patients of all ages.

Twist removal of healed vs. nonhealed implants-a mechanical and histological study in mini pigs.

PurposeThe objective of this study was to evaluate the effect of removal torque (reverse torque) of titanium implants in peri-implant bone.MethodsThe P1-M1 teeth were extracted bilaterally of 6 mini pigs (BR-1). Each animal received 6 titanium implants, three for each side of mandible. On the right side of mandible, 3 implants reminded 9 months (9M) under masticatory activity and on the left side, other 3 implants were placed and immediately removed (IR). All 36 implants were removed by removal torque, and the recorded values were statistically analyzed. Animals were euthanized right after the removal torque and recording. Each third (cervical, medium, and apical) of peri-implant bone was extracted and analyzed histological and immunohistochemically. Student’s t test was used to determine statistical differences in the values between the 9M and IR samples. Data were presented as means with standard deviations. The level of significance was set at 5% (P < 0.05).ResultsRemoval torque was higher in 9M experimental situation than in IR. Histological characteristics of mature bone were presented in the 9M experimental condition, and immature bone characteristics were presented in the IR experimental condition. Removal torque caused small fractures and rounding in the bone grooving. Immunohistochemical analysis reinforced the histological results; Student’s t test provided statistically significant differences to osteocalcin expression in 9M samples and no statistically significant differences expression to collagen I in both experimental conditions (P < 0.05).ConclusionsRemoval torque caused microscopical fractures and smoothing in the peri-implant bone grooves, but it does not compromise the bone healing.

Medial patellofemoral ligament reconstruction using a bone groove and a suture anchor at patellar: a safe and firm fixation technique and 3-year follow-up study.

BackgroundGraft fixation is critical to the restoration of the medial patella of femoral ligament function and long-term success. Numerous fixations at the patella have been described, while the complications including patellar fractures, violation of the posterior patella and delay of tendon-to-bone healing remain significant challenges. Here, we describe a safe and firm fixation at the patellar for medial patellofemoral ligament (MPFL) reconstruction and explore the safety angle of drilling the suture anchor at different morphology of the patellar. Moreover, we evaluate the results at a 3-year follow-up.MethodsCombined bone groove and suture anchor fixation at the patella was performed on 26 patients (16 females, 10 males; mean age 26.3 ± 4.7 years) diagnosed with recurrent patellar dislocation. The drilling direction of the suture anchor referred to the safety angle according to the Wiberg type classification. The safety angle was defined as the angle between the drill tunnel and a line that connected the medial and lateral margins of the patella and was established following computed tomography assessment of 117 patients who were diagnosed with patellar dislocation in our hospital according to the Wiberg type classification (I:29, II:65, III:23). X-ray, Lysholm, Kujala and Tegner scores were obtained preoperatively and at the time of final follow-up.ResultsThere were no patellar complications, including fracture and redislocation. Average congruence, patella tilt angles and lateral patella angle were significantly changed (P < 0.01). The Lysholm, Kujala and Tegner scores were significantly increased (P < 0.01). The safe angles of male and female patients according to the patellar Wiberg type classification were less than 45.32 ± 1.76 and 41.20 ± 1.33, 69.74 ± 1.38 and 63.66 ± 1.45 and 84.11 ± 1.67 and 80.26 ± 1.73, respectively.ConclusionsWe achieved encouraging results with this fixation at the patellar. When drilling from Wiberg type I to type III patellar, the suture anchor should be more vertical. When fixing the patellar of female patients, the drilling suture anchor should be more sloping.

Management of Cochlear Implant Electrode Migration.

The present study reviewed a cochlear implant (CI) patient population after surgery, which received a free-fitting electrode carrier designed for hearing preservation. The aim was to determine the rate of electrode migration of the CI electrodes and present clinical and surgical implications. Retrospective patient review. Tertiary referral university hospital. Two hundred seventy-eight patients implanted uni- or bilaterally with lateral wall electrodes designed for hearing preservation (358 implants). The control group was 323 patients implanted uni- or bilaterally with preformed perimodiolar electrodes (468 implants). Determination of CI electrode migration was conducted according to a clinical test protocol. Revision surgery was offered in confirmed patients of electrode migration. A bone groove was considered to improve the fixation of the electrode. Audiological testing including speech audiometry, subjective sound quality rating, and bilateral pitch comparison in bilateral patients, as well as radiological examinations, were conducted. Electrode migration was observed solely in patients implanted with lateral wall electrodes; 10 of 358 patients with free-fitting electrodes (2.8%) had electrode migration, which was successfully confirmed by the proposed clinical test protocol. Nine of the 10 confirmed patients underwent reinsertion surgery. Mean perception score decreased from 75.0% to 62.1% after electrode migration and recovered completely after reinsertion surgery. A flowchart to detect electrode migration was designed for clinical practice. Although electrode migration is a rare complication in CI surgery, long-term follow-up diagnostics should include a test protocol to detect electrode shifts of lateral wall electrode arrays. A reinsertion surgery should be conducted in confirmed patients to recover speech perception.

Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique

BackgroundThe medial collateral ligament (MCL) is the main static stabilizer of the medial knee. The surgical treatment was recommended in cases with serious medial collateral ligament insufficiency combined with multi-ligament injuries and chronic symptomatic medial instability. Several surgical techniques have been described for the MCL reconstruction, while potential problems including donor site morbidity, complicated procedure, and high risk of femoral tunnel collision were reported. In order to minimize such potential limitations, we describe a new medial reconstruction technique for MCL injury using bone-patellar tendon-bone (BPTB) allograft.MethodsA longitudinal incision at the medial knee was made. The centers of femoral and tibial attachments were gained through repeated isometricity test. Then, the bone grooves were made around the femoral and tibial centers. The appropriate BPTB allograft was selected, and both ends were trimmed. The prepared bone blocks were embedded into the grooves and fixed with cancellous screws. The programmed rehabilitation exercises were performed after the operation.ResultsA strong graft and bone-to-bone healing on both femoral and tibial attachment sites were obtained, and femoral tunnel collision during multi-ligament reconstruction was avoided. Satisfactory valgus and rotatory stability were gained.ConclusionsThis novel MCL reconstruction technique using BPTB allograft can be safely performed, and the clinical outcome was favorable with satisfactory valgus and rotatory stability. More cases and additional follow-up results are needed to verify the overall effect of this technique.

Conflicts, snapping and instability of the tendons. Pictorial essay

Conflicts, snapping and instability of the tendons are common, and ultrasound (US) is the method of choice for evidencing these conditions thanks to the possibility to perform dynamic maneuvers during imaging studies. A conflict can occur between a tendon and a bone structure, other tendons, the retinacula or pulleys. Snapping can occur due to instability caused by rupture of the retinaculum, conflict between a thickened retinaculum and a bone prominence or due to an abnormal position of the tendon. Instability can occur due to insufficient ability of the retinaculum to keep the tendons in the bone groove or its failure to hold the tendons applied to the bone.The technique for evidencing conflicts, snapping and instability of the tendons is very demanding because it requires a thorough knowledge of the US appearance and dynamic maneuvers. However, at the present time US examination completed with dynamic maneuvers is the investigation of choice for evidencing these disorders and providing the clinicians with the necessary information.