AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage.METHODS Twenty-nine dogs were divided in two experimental groups: Group M-leg leng...AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage.METHODS Twenty-nine dogs were divided in two experimental groups: Group M-leg lengthening with manual distraction(1 mm/d in 4 steps), Group A-automated distraction(1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30 th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peronealand tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed.RESULTS Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage(thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group.CONCLUSION Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.展开更多
The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixa...The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.展开更多
Though the lengthened shrink-fit holder (LSFH) is widely applied in high speed milling of the parts characterized by deep cavities at present, its design and selection mainly depends on the experience and lacks a corr...Though the lengthened shrink-fit holder (LSFH) is widely applied in high speed milling of the parts characterized by deep cavities at present, its design and selection mainly depends on the experience and lacks a correct theoretical guidance. In this paper, attention is focus on the radial grip rigidity of the matching of LSFH and cutter in high speed milling. Based on the experiment modal analysis (EMA) technique, an accurate finite element model of the matching of LSFH and cutter is established firstly. Subsequently, the influence of different interference, grip length and spindle speed on the grip rigidity of LSFH are analyzed. The analysis results show that there is a reasonable interference and grip length between the LSFH and cutter so that to have a steepless grip and have a good radial grip rigidity and at the same time to avoid the strength of LSFH to exceed it’s yield limit which will reduce the precision and service life of LSFH, besides when spindle speed reach a extension the weakening influence of the centrifugal force on the radial grip rigidity of the matching of LSFH and cutter should been taken into account. Finally, the finite element analysis results are verified based on the construction of measurement method of the grip rigidity and the results fit very well. The studies provide a theoretical basis for the design, selection and the serialization and standardization of the matching of LSFH and cutter.展开更多
BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported...BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Ove展开更多
AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical imp...AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.展开更多
Aim： To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length. Methods： The penoscrotal web is defined. A ＂check mark＂ incision is made with exci...Aim： To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length. Methods： The penoscrotal web is defined. A ＂check mark＂ incision is made with excision of scrotal tissue. Excellent exposure is provided for implantation of the cylinders, pump and reservoir. Wound closure is performed longitudinally. Results： This technique is a modified extension of surgeries described in the pediatric literature for webbed penis. Loss of penile length following penile implantation surgery is worrisome for patients suffering from erectile dysfunction （ED）. This technique helps with patient satisfaction, cosmetic results, and improves perception of penile length. Conclusion： Ventral phalloplasty is a safe, technically simple procedure that may be performed in concert with penile prosthesis implantation or as a stand alone procedure under＇certain circumstances.展开更多
The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult...The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.展开更多
Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this stud...Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.展开更多
基金Supported by Russian Foundation for Basic Research,No.14-4 4-00010
文摘AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage.METHODS Twenty-nine dogs were divided in two experimental groups: Group M-leg lengthening with manual distraction(1 mm/d in 4 steps), Group A-automated distraction(1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30 th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peronealand tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed.RESULTS Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage(thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group.CONCLUSION Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.
文摘The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
基金supported by National Hi-tech Research and Development Program of China (863 Program, Grant No. 2009AA44302)Scientific Research Fund of Hunan Provincial Education Department, China (Grant No. 10C1259)+2 种基金Hunan Provincial Planned Science and Technology Project of China (Grant No. 2011FJ3231)National Natural Science Foundation of China (Grant No. 51005194)Open Innovation Platform of Hunan College Fund, China (Grant No. 10K063)
文摘Though the lengthened shrink-fit holder (LSFH) is widely applied in high speed milling of the parts characterized by deep cavities at present, its design and selection mainly depends on the experience and lacks a correct theoretical guidance. In this paper, attention is focus on the radial grip rigidity of the matching of LSFH and cutter in high speed milling. Based on the experiment modal analysis (EMA) technique, an accurate finite element model of the matching of LSFH and cutter is established firstly. Subsequently, the influence of different interference, grip length and spindle speed on the grip rigidity of LSFH are analyzed. The analysis results show that there is a reasonable interference and grip length between the LSFH and cutter so that to have a steepless grip and have a good radial grip rigidity and at the same time to avoid the strength of LSFH to exceed it’s yield limit which will reduce the precision and service life of LSFH, besides when spindle speed reach a extension the weakening influence of the centrifugal force on the radial grip rigidity of the matching of LSFH and cutter should been taken into account. Finally, the finite element analysis results are verified based on the construction of measurement method of the grip rigidity and the results fit very well. The studies provide a theoretical basis for the design, selection and the serialization and standardization of the matching of LSFH and cutter.
文摘BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Ove
文摘AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.
文摘Aim： To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length. Methods： The penoscrotal web is defined. A ＂check mark＂ incision is made with excision of scrotal tissue. Excellent exposure is provided for implantation of the cylinders, pump and reservoir. Wound closure is performed longitudinally. Results： This technique is a modified extension of surgeries described in the pediatric literature for webbed penis. Loss of penile length following penile implantation surgery is worrisome for patients suffering from erectile dysfunction （ED）. This technique helps with patient satisfaction, cosmetic results, and improves perception of penile length. Conclusion： Ventral phalloplasty is a safe, technically simple procedure that may be performed in concert with penile prosthesis implantation or as a stand alone procedure under＇certain circumstances.
文摘The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.
文摘Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.
