ObjectiveMalleostapedotomy allows to completely by-pass the incus in otosclerosis surgery. Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus. However, it remains gold standard for cases of extensive necrosis, incus dislocation, or epitympanic fixation. Modern heat-crimping pistons make surgery easier and safer. This study focuses on our experience with this technique.MethodsRetrospective analysis of patient’s files and pre- and post-operative audiograms, for cases of surgically treated otosclerosis with malleostapedotomy.ResultsTwelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019. Amongst them there were 10 revision surgeries and 2 primary cases. 75% had incus long-process necrosis, 17% had epitympanic fixation and one had a history of incus transposition. Nine patients (75%) had closure of air-bone gap (ABG) of <10 dB (p < 0.001) and 11 (92%) had a threshold of 20 dB (p < 0.001). Mean pre-operative ABG was 31 dB (15 dB–55 dB), and mean post-operative ABG was 7 dB (0 dB–21 dB; p < 0.001). There was no sensorineural hearing loss nor any other post-operative complication.ConclusionsMalleostapedotomy is a safe and reliable technique, allowing an ABG closure comparable to conventional incus to vestibule prosthesis. It remains the preferred technique whenever the incus cannot be used. 相似文献
The aim of this study was to evaluate the potential for restoration of a large cartilage defect in the goat knee with hydroxyapatite (HA) loaded with chondrocytes. Isolated chondrocytes were suspended in fibrin glue, seeded on top of the HA, and then the composite graft was implanted in the defect. After transplantation, cell behaviour, newly synthesised matrix and the HA–glue interface were assessed histologically after 2, 4, 12, 26 and 52 weeks. Special attention was paid to the incorporation process of HA in the subchondral bone and interactions between this biomaterial and the fibrin-glue–chondrocyte suspension.
Chondrocytes in the glue proved to survive the transplantation procedure and produced new metachromatically stained matrix two weeks after implantation. The glue–cell suspension had penetrated the superficial porous structure of the HA. Four weeks after surgery, islands of hyaline-like cartilage were observed at the HA–glue interface. A layer of fibrous tissue was formed surrounding the HA graft, resulting in a relatively instable fixation of the HA in the defect. This instability of the graft in the defect, possibly together with early weight bearing, resulted in a gradual loss of the newly formed hyaline cartilage-like repair tissue. Progressive resorption of the HA occurred without any sign of active bone remodelling from the host site. One year after surgery part of the defect which extended down to the cancellous bone had been predominantly restored with newly formed lamellar bone. Only small HA remnants were still present at the bottom of the original defect. Resurfacing of the joint had occurred with fibrocartilaginous repair tissue.
The absence of adequate fixation capacity of the HA near the joint space resulted in a relative instability of the graft with progressive resorption. Therefore, HA is not a suitable biomaterial to facilitate the repair of large articular cartilage defects. 相似文献
Summary The sizes, shapes, and organizational states of the crystals in bone are studied by systematic disaggregation of the mineral
phase. This is achieved by oxidizing the organic phase with sodium hypochlorite, dispersing the resultant particles by sonication,
and separating the crystal aggregates from the crystal monomers by gravity setting in ethanol. Six different bones are compared.
Bones in which crystals are intimately associated with the collagen fibrils mostly disaggregate into crystal monomers. In
dense bones, where the crystals are mostly located between fibrils, they tend to persist as “fused” aggregates. All the crystals
are tabular or plate-shaped. In bones in which the majority of crystals are associated with the collagen fibrils, just less
than 90% of the crystals are shorter than about 450 ? in length. Their widths are on the average about 250 ?, almost an order
of magnitude larger than the diameters of individual gap regions within the collagen fibril. The notion that one crystal is
located in one gap region is therefore untenable and a reevaluation of the relations between collagen and mineral in bone
is necessary. 相似文献
Summary Extended X-ray absorption fine structure (EXAFS) spectra were recorded, above the Ca K edge, from powdered mouse femurs. Spectra
were interpreted on the basis of a model developed previously to explain the features of the EXAFS spectrum of fully crystalline
hydroxyapatite. Eight shells of atoms surrounding Ca out of 0.57 nm were required to explain the appearance of the EXAFS spectrum
of bone. Shell radii and Debye-Waller factors were systematically varied to obtain the best fit between observed and theoretical
spectra, calculated using exact spherical wave theory. The results were closely similar to those obtained previously from
the interpretation of EXAFS spectra from poorly crystalline hydroxyapatite prepared by maturation of amorphous calcium phosphate.
However, there appears to be slightly more disorder in bone mineral, perhaps as a result of its accommodating carbonate ions 相似文献
AbstractBackground: In recent years, biomaterials are being found and frequently utilized in bone defects. They have also gained significant precedence
in hand surgery.
Objectives: The respective requirements for such replacement material will be cited and acknowledged in this article. The individual material
groups will also be referred to in this review. An introduction to some of the customary bone replacement materials will be
cited and concluded with a corresponding recommendation.
Conclusion: The implantation of autologous cancellous bone is still regarded today as the “gold standard”. Nevertheless, the usage of
bone replacement material can be an enormous advantage in certain indications.
The original article can be found online at
There was an error in the author’s affiliation and the address for correspondence was incomplete. Please note the correct
institution and complete address:
Department of Orthopedics and Traumatology, Hand-, Foot- and Reconstructive Surgery, Kreiskrankenhaus Gummersbach GmbH, Germany.
Alexander von Friesen, MD Department of Orthopedics and Traumatology, Hand-, Foot- and Reconstructive Surgery Kreiskrankenhaus
Gummersbach GmbH Wilhelm-Breckow-Allee 20 51643 Gummersbach Germany Phone (+49/2261) 171-575, Fax -449 e-mail: Friesen@kkh-gummersbach.de 相似文献
Establishing and maintaining mature bone at the bone–device interface is critical to the long-term success of prosthesis. Poor cell adhesion to orthopaedic and dental implants results in implant failure. Considerable effort has been devoted to alter the surface characteristics of these biomaterials in order to improve the initial interlocking of the device and skeleton. We investigated the effect of surface chemistry modification of titanium alloy (Ti–6Al–4V) with zinc, magnesium or alkoxide-derived hydroxy carbonate apatite (CHAP) on the regulation of key intracellular signalling proteins in human bone-derived cells (HBDC) cultured on these modified Ti–6Al–4V surfaces. Western blotting demonstrated that modifying Ti–6Al–4V with CHAP or Mg results in modulation of key intracellular signalling proteins. We showed an enhanced activation of Shc, a common point of integration between integrins and the Ras/Mapkinase pathway. Mapkinase pathway was also upregulated, suggesting its role in mediating osteoblastic cell interactions with biomaterials. The signalling pathway involving c-fos (member of the activated protein-1) was also shown to be upregulated in osteoblasts cultured on the Mg and CHAP modified Ti–6Al–4V. Thus surface modification with CHAP or Mg may contribute to successful osteoblast function and differentiation at the skeletal tissue–device interface. 相似文献