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1.
目的比较几种治疗踝关节骨折合并下胫腓联合韧带损伤方法的临床效果。方法选取2014年1月至2017年12月我院收治的103例踝关节骨折合并下胫腓联合韧带损伤患者,按照治疗方法分为保守治疗组(对照组),固定内外踝、下胫腓克氏针外固定手术治疗组(观察组1)以及固定内外踝、下胫腓螺钉固定、下腓联合韧带修复治疗组(观察组2),对比分析3组患者临床疗效。结果固定内外踝,下胫腓螺钉固定、下腓联合韧带修复治疗组骨愈合时间、骨不连发生率和二次治疗发生率显著低于保守治疗组及固定内外踝,下胫腓克氏针外固定手术治疗组,差异具有统计学意义(P0.05),而骨愈合优良率显著高于保守治疗组及固定内外踝,下胫腓克氏针外定手术治疗组,差异具有统计学意义(P0.05)。结论采用内外踝固定,下胫腓螺钉固定、下腓联合韧带修复治疗踝关节骨折合并下胫腓联合韧带损伤效果较好,而且骨不连发生率和二次治疗发生率低。  相似文献   

2.
目的:探讨不同方向置入下胫腓螺钉治疗下胫腓联合分离的踝关节骨折的临床应用效果.方法:回顾性分析本院2019年11月至2021年4月收治的65例踝关节骨折合并下胫腓联合分离患者的临床资料.按不同治疗方法分为对照组(30例)和研究组(35例).对照组采用经腓骨后外向胫骨前内与水平面成30°方向钻孔置钉;研究组采用胫骨平行定位法置钉.分析比较两组围手术期相关指标、踝关节功能、螺钉置入位置及并发症发生情况.结果:两组的手术时间比较无明显差异(P>0.05);但研究组踝关节活动度明显优于对照组,骨折愈合时间明显短于对照组,且术后Baird评分显著高于对照组(P<0.05).研究组螺钉置入位置优良率明显高于对照组(P<0.05).研究组的并发症发生率与对照组相比无显著差异(P>0.05).结论:胫骨平行定位法置入下胫腓螺钉治疗下胫腓联合分离的踝关节骨折效果更佳,可提高置钉优良率,促进踝关节功能恢复.  相似文献   

3.
背景:临床治疗下胫腓联合分离型不稳定踝关节骨折可以采用外科内固定方式,内固定过程中可以选择不同的材料,以往大多使用金属拉力钉,但存在断钉等风险。 目的:探讨传统金属拉力钉和高分子可吸收螺钉固定在下胫腓联合分离性不稳定踝关节骨折中的应用效果。 方法:回顾性分析陕西中医药大学附属医院2013年2月至2014年2月收治的63例下胫腓联合分离性不稳定踝关节骨折患者的临床资料,均实施外科内固定治疗,按照所使用材料的不同分为金属拉力钉组32例和可吸收螺钉组31例。于腓骨下段外侧做切口对骨折端予以复位,并利用钢板进行固定,并分别利用传统金属拉力钉和高分子可吸收螺钉进行固定。内固定后随访12个月,观察两组的踝关节功能评分(Baird-Jackson)和临床效果以及不良事件发生情况,并进行比较。 结果与结论:可吸收螺钉组患者平均下地活动时间和内固定后住院天数均显著少于金属拉力钉组(P < 0.05)。两组踝关节功能评分(Baird-Jackson)较固定前均上升,但差异无显著性意义(P > 0.05)。可吸收螺钉组治疗优良率显著高于金属拉力钉组(P < 0.05)。内固定后随访12个月,金属拉力钉组有1例患者出现螺钉断裂,可吸收螺钉组未出现任何不良事件,2组患者均未出现切口感染等情况。结果证实,利用高分子可吸收螺钉固定治疗下胫腓联合分离性不稳定踝关节骨折可以获得较之传统金属拉力钉更好的应用效果。  中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程  相似文献   

4.
背景:下胫腓联合韧带对维持踝关节稳定性的作用较大,现在越来越多的学者开始注重下胫腓联合韧带的生物力学研究,但单独对下胫腓前韧带、骨间韧带、下胫腓后韧带、横韧带的生物力学研究报道较少.目的:建立一个包括下胫腓联合韧带、胫腓骨远端及距骨的踝关节三维有限元的仿真模型,研究下胫腓联合韧带对踝关节稳定性的影响.方法:基于计算机断...  相似文献   

5.
目的观察以聚对苯二甲酸乙二酯(PET)为材料的人工韧带重建术治疗下胫腓联合体损伤的临床疗效。方法回顾性分析2013年3月至2014年3月18例应用PET人工韧带重建术治疗下胫腓联合体损伤患者的临床资料,其中14例采用双侧悬吊固定技术,4例单侧悬吊固定加可吸收挤压螺钉固定技术。通过随访测量踝关节活动度,采用美国骨科足踝外科协会(AOFAS)踝关节功能评分,并对结果进行评价。结果 18例均获得随访,随访时间12~17个月,平均13.5个月。影像学显示术后下胫腓联合间隙正常,至术后1年无复位丢失。取出PET人工韧带,手术中人工韧带与骨组织牢固结合,韧性良好,病理学检查发现有纤维组织长入人工韧带。AOFAS踝关节功能评分评定疗效,优11例,良6例,一般1例。结论 PET人工韧带重建术能够短时间恢复下胫腓联合体的铰链功能,早期恢复患者的踝关节背伸跖屈活动范围。不同固定韧带的方式对功能恢复无影响,但是采用挤压螺钉技术可缩短手术时间。  相似文献   

6.
目的 建立踝关节骨折固定后遗留下胫腓前韧带损伤,用锚钉加强修复结合螺钉固定的有限元模型,比较其受力及变形情况.方法 选取1例正常男性青年志愿者踝关节CT图像,建立踝关节骨折固定后遗留下胫腓前联合损伤有限元模型,对损伤模型置入锚钉固定为实验组,使用螺钉固定为对照组.通过有限元分析计算,观察两组模型在各种载荷工况下的最大应...  相似文献   

7.
目的 探讨下胫腓联合损伤复位施加压力与位移变化的关系,探索最佳复位力度。 方法 选取10例新鲜冻融尸体小腿标本,解剖下胫腓联合复合体,依次切断下胫腓联合前方结构(下胫腓前韧带)、后方结构(下胫腓后韧带和下胫腓横韧带),以及下胫腓联合上方10 cm的骨间膜,在同一标本上建立不同程度的下胫腓损伤模型,每个模型分别接受CT扫描,通过Mimics软件测量外踝嵴(A)和内踝表面中心(B)在不同模型中的距离。循AB连线方向复位,记录位移与压力大小的关系。 结果 分别切断下胫腓前联合、前后联合、前后联合及上方10 cm骨间膜后,AB平均距离均有增大,与下胫腓联合完整时差异有统计学意义,P<0.05;但每组损伤模型间AB距离对比无明显统计学差异,P>0.05。使用生物力学压力测试仪测出下胫腓解剖复位所需压力为40~70 N。下胫腓前后联合断裂复位所用压力与单纯下胫腓前联合断裂复位对比差异无统计学意义,P>0.05。下胫腓前后联合及上方10 cm 骨间膜断裂复位所用压力与下胫腓前后联合断裂复位对比差异无统计学意义,P>0.05;但与单纯下胫腓联合前韧带断裂复位对比差异具有统计学意义,P<0.05。 结论 下胫腓联合不同程度损伤后,下胫腓之间分离的距离较完整时存在显著性差异,需用不同大小的力量进行复位。  相似文献   

8.
目的探讨可吸收骨螺钉内固定与带线铆钉缝合下胫腓韧带手术治疗下胫腓联合分离的效果。方法对2012年以来手术治疗的26例下胫腓联分离患者,于下胫腓联合上2 cm平行于胫距关节面固定胫腓联合,术中解剖下胫腓前韧带,以带线铆钉缝合。随访2~5个月,平均3个月。结果踝关节功能根据Baird-Jackson评分标准,优18例,良7例,差1例,优良率96.2%。结论合并下胫腓联合分离患者术中以可吸收骨螺钉内固定,带线铆钉缝合下胫腓前韧带,受诸韧带愈合或瘢痕粘连形成影响,功能恢复较好。  相似文献   

9.
背景:下胫腓联合韧带损伤如诊断或治疗不及时,常易引起创伤性关节炎以及踝关节不稳定等后遗症,目前对于双股带线锚钉系统能否治疗下胫腓联合损伤尚无明确报道。目的:回顾性分析双股锚钉线固定治疗下胫腓联合损伤的临床疗效以及安全性。方法:选择2016年7月至2018年10月上海交通大学附属第一人民医院南院收治的踝关节骨折伴下胫腓联合损伤患者30例,随机分2组,每组15例。试验组采用双股锚钉线固定下胫腓联合,对照组采用下胫腓联合螺钉固定。术前记录患者年龄、性别、踝关节术前肿胀程度,拍摄踝关节三维CT以及踝关节正、侧位X射线片,术后1d及1.5,3,6,12个月拍摄踝关节正、侧位X射线片,并评估术后3,6,12个月美国足踝外科协会评分。结果与结论:①所有患者手术切口均Ⅰ期愈合,术后未出现下肢静脉血栓、感染、骨不连、锚钉松动等并发症;②术后3,6,12个月时,2组之间美国足踝外科协会评分相比,差异均无显著性意义;2组美国足踝外科协会评分均显著高于术前(P<0.05);③术后1年内,试验组有5例(33%)出现下胫腓联合增宽,对照组有2例(13%)出现下胫腓联合增宽;④结果表明,双股锚钉线固定治疗下胫腓联合损伤疗效确切,安全性高,但患者术后发生下胫腓联合再分离概率较高。  相似文献   

10.
下胫腓联合分离内固定术式的生物力学研究   总被引:2,自引:0,他引:2  
目的 探讨下胫腓联合分离采用新型内固定术式———下胫腓钩板固定器 (Hook -platefixation ,HPF)的生物力学特性 ,与螺钉、钢板和带钩固定器三种内固定方式比较 ,为临床提供科学依据。方法 采用新鲜成人尸体足标本 6具 ,运用生物力学实验应力分析方法和压敏片技术 ,测量不同内固定术式的远端胫腓骨强度、应变、负重面积、接触应力和足弓承载能力及踝关节稳定性的变化。结果 新型下胫腓钩板固定器内固定术式无论在胫腓骨强度和刚度、负重面积、接触压力、足弓的变形、移位强度和刚度、承载能力以及踝关节的稳定性方面均优于其它三种内固定术式 ,具有显著性差异 (P <0 .0 1)。结论 实验结果表明 ,采用下胫腓钩板固定器 (HPF) ,既有利于提高生物力学性能 ,又有利于改善踝关节的稳定性 ,与传统手术方式相比可减少一次手术 ,避免了断钉等并发症 ,且能有效地提高足部承载能力 ,是下胫腓联合分离内固定的一种优良术式  相似文献   

11.
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries.  相似文献   

12.
目的:对微创动力髋螺钉(dynamic hip screw,DHS)内固定和传统DHS内固定治疗老年股骨粗隆间骨折的效果进行比较.方法:将91例老年股骨粗隆间骨折患者随机分为两组,传统组46例采用传统方式置入内固定物治疗,微创组45例采用微创方式置入内固定物.对两组手术创伤大小、术后并发症、骨折愈合及功能恢复情况进行比较.主要通过考察手术切口长度、出血量、输血量、血红蛋白下降幅度、术后术区肢体肿胀情况、血沉变化等来反映手术创伤大小.结果:两组手术创伤差异有统计学意义,传统组大于微创组(P<0.05).微创组有2例复位不良,传统组有3例复位不良,两组均无深部血肿发生.传统组围手术期死亡2例,其余患者均顺利出院,获12~30个月随访,平均17.1个月.两组各有1例在随访期间死于其它内科疾病,其余骨折均获愈合.术后平均骨折愈合时间微创组3.6个月,传统组3.8个月.术后1年髋关节功能优良率微创组84.1%,传统组79.1%,两组差异无统计学意义(P>0.05).结论:微创DHS内固定治疗老年股骨隆间骨折,手术创伤小,有利于围手术期恢复和髋关节功能康复.  相似文献   

13.
微创张力带固定治疗横断型髌骨骨折的基础与临床研究   总被引:14,自引:1,他引:14  
目的:为微创张力带固定治疗横断型髌骨骨折提供基础依据并探讨临床效果。方法:24个膝关节标本制成横断型骨折模型,随机分为6组,分别选用微创或开放手术克氏针张力带、空心钉张力带或可吸收钉张力带固定。检查髌骨关节面的复位程度,关节面错位>2 mm为复位不良。应用微创克氏式针张力带治疗23例,切开复位克氏针张力带治疗35例;两组间在骨折复位程度、关节活动度及膝关节功能方面比较。结果:实验组均达解剖复位,组问无显著性差异(x2=1.269,V=5,P=0.938,>0.05)。临床均骨性愈合,膝关节功能恢复良好;两组间在骨折复位程度(Z=-0.701,P=0.483)、关节活动度(Z=-0.29,P=0.977)和膝关节功能(Z=-0.87,P=0.930)无显著性差异(P>0.05)。结论:微创张力带固定治疗横断型髌骨骨折能达到解剖复位,临床效果优良。  相似文献   

14.
Samples of neoplastic and nonneoplastic human urothelium were immediately frozen, incubated in Krebs' saline and then frozen, or incubated in 10-5 mol/L ouabain in Krebs' saline and then frozen. The frozen specimens were then planed in a cryoultramicrotome and examined by low-temperature scanning electron microscopy. X-Ray microanalysis was performed on the superficial urothelial cells. Neoplastic cells immediately frozen and those incubated in Krebs' saline had significantly higher K+/Na+, K+/P, and K+/Cl- ratios and lower Na+/P and Cl-/P ratios than nonneoplastic cells. Incubation in ouabain led to a fall in the K+/Na+, K+/P, and K+/Cl- ratios and a rise in the Na+/P and Na+/Cl- ratios in both neoplastic and nonneoplastic cells and effectively nullified the difference between them. These results are consistent with the concept that in neoplasia a primary event is stimulation of Na+/H+ exchange, which leads to secondary stimulation of the ouabain-sensitive Na+/K+ ATPase pump.  相似文献   

15.
The INK4a/ARF locus encodes two cell cycle-regulatory proteins, p16INK4a and p14ARF. These share an exon using different reading frames, and act through Rb and p53 pathways. Recently, it has been found that silencing of p16INK4a and p14ARF expressions by aberrant methylation of the CpG islands in the promoter regions is an alternative mechanism that inactivates possible tumor suppressor functions in various tumors. To clarify the features of gastric cancers with promoter methylation of p16INK4a and p14ARF, we investigated the methylation status in gastric cancer cell lines and primary gastric cancers using methylation-specific PCR (MSP), and correlated the methylation status with microsatellite instability (MSI), DNA ploidy pattern, p53 immunohistochemistry, and various clinicopathologic factors, paying attention to the correlations with the histologic types. Of 10 cell lines studied, silencing of the expression of p16INK4a and p14ARF due to promoter methylation was detected by MSP and RT-PCR in six (60%) and two (20%) cell lines, respectively. p14ARF silencing was detected only in cell lines derived from gastric cancer of the diffuse type, while p16INK4a silencing was found in cell lines derived from both diffuse and intestinal types. In 59 primary gastric cancers, promoter methylation of p16INK4a and p14ARF was found in 10 (17%) and 14 (24%) of the tumors independently, there being an association with DNA diploidy, but not with p53 immunohistochemistry. p16INK4a methylation was found irrespective of tumor stages and histology. Whereas p14ARF methylation was found more frequently in intestinal type cancers in an early stage and in diffuse type cancers in an advanced stage, MSI tended to be related especially to p14ARF methylation in cancers of the intestinal type. Thus, the significance of p14ARF methylation differed between intestinal and diffuse types, while such a difference was not observed in p16INK4a methylation.  相似文献   

16.
The objective of this study was to evaluate whether an increased hazard of developing ischemic heart disease (IHD) is associated with any of the three genotypes A560T832/A560T832, A560T832/A560G832 and A560T832/T560T832, defined by variations in two non-coding SNPs in the 5' promoter region of the apolipoprotein E ( APOE) gene. These genotypes were selected because they distinguished between high and low levels of HDL-C, TG and/or T-C in our earlier study of multiple samples defined by gender and population. We found a significant increase (p<0.05) in the hazard of IHD in females with the A560T832/T560T832 genotype that remained significant after fitting the effects of dyslipidemia, other established risk factors, and the structural isoform variations of the ApoE molecule. We discuss why this statistically significant genetic predictor may not be an appropriate screening test for IHD in the Danish population at large.  相似文献   

17.
目的:观察新生期卡介苗(BCG)和乙肝疫苗(HepB)联合接种对哮喘小鼠干扰素γ(IFN-γ)、白细胞介素4(IL-4)和白细胞介素17A(IL-17A)表达的影响,探讨BCG和HepB联合接种对气道炎症的影响及可能机制。方法:BALB/c小鼠随机分为BCG和HepB联合接种造模[卵清蛋白(OVA)所致哮喘模型]组(B/H/O组)、BCG接种造模组(B/O组)、HepB接种造模组(H/O组)、BCG和HepB联合接种组(B/H组)、造模组(OVA组)、BCG组、HepB组和生理盐水对照(NS)组,每组6只。B/H/O组和B/H组于第0、7和14天分3次皮下注射1×105CFU的BCG,同时第0和28天分2次下肢腿部肌肉注射HepB 1.5μg,其它组单独接种BCG或HepB。OVA致敏和雾化吸入激发建立哮喘模型;末次激发24 h后取肺组织HE染色;收集支气管肺泡灌洗液(BALF)进行细胞总数计数和嗜酸性粒细胞(EOS)计数;ELISA法检测血清IFN-γ和IL-4及肺组织匀浆IL-17A的水平。结果:肺组织病理观察发现,OVA组、B/O组、B/H/O组和H/O组支气管周围大量炎症细胞浸润,气道上皮细胞增生肥大,B/H/O组和H/O组的炎症程度较OVA组重,B/O组则较OVA组轻。B/H/O组、B/O组和H/O组BALF细胞总数与OVA组比较均下降(P0.05);EOS计数在B/H/O组比B/H组上升(P0.05),B/O组比BCG组上升(P0.05),H/O组比HepB组上升(P0.05)。分别与H/O组、OVA组和NS组比较,HepB组的血清IFN-γ/IL-4比值均升高(P0.05);分别与B/H/O组、B/O组、OVA组和NS组比较,B/H组的血清IFN-γ/IL-4比值均升高(P0.05)。与OVA组比较,B/H/O组和B/O组的肺组织匀浆IL-17A水平均下降(P0.05);与B/O组比较,B/H/O组的肺组织匀浆IL-17A水平进一步下降(P0.05)。结论:卡介苗和乙肝疫苗联合接种有助于减轻哮喘模型小鼠肺部的炎症反应,其机制可能与降低IL-4分泌、提高IFN-γ/IL-4水平和抑制IL-17A的表达有关。  相似文献   

18.
Classical swine and avian-like H1N1 influenza viruses were reported widely in swine population worldwide, but human-like H1N1 swine viruses were reported occasionally. In 2006, a human-like H1N1 swine virus (A/swine/Guangdong/96/06) was isolated from pigs in Guangdong province, which was reported in China for the first time. To get further evidence for infection of pigs with human-like H1N1 influenza viruses, we analyzed eight gene segments of three human-like swine H1N1 viruses (A/swine/Guangdong/96/06, A/swine/Tianjin/01/04 and A/swine/Henan/01/06) isolated in China. All the eight genes of the three viruses are highly homologous to recent (about 2000) and early (1980s) human H1N1 influenza viruses, respectively. Phylogenetic analyses revealed that A/Swine/Guangdong/96/06 was directly derived from about 2000 human H1N1 influenza viruses, while A/swine/Tianjin/01/04 and A/swine/Henan/01/06 seemed to be descendants of human H1N1 viruses circulating in 1980s. Seroprevalence of our isolate (A/swine/Guangdong/96/06) confirmed the presence of human-like H1N1 virus in pigs in China. Existence of these influenza viruses, especially older viruses (A/swine/Tianjin/01/04 and A/swine/Henan/01/06), indicates that human-like H1N1 influenza viruses may remain invariant for long periods in pigs and provides the evidence that pigs serve as reservoirs of older influenza viruses for human pandemics.  相似文献   

19.
Wang TT  Yuan WL  Ke Q  Song XB  Zhou X  Kang Y  Zhang HT  Lin Y  Hu YL  Feng ZT  Wu LL  Zhou XF 《Neuroscience》2006,140(4):1169-1176
This study evaluated the plastic changes of c-jun andc-fos in the right sixth lumbar dorsal root ganglion (L6 DRG), Rexed’s lamina II in representative spinal segments L3, L5, and L6 and in the nucleus dorsalis (ND) at L3 segments after electro-acupuncture (EA) in cats subjected to removal of L1–L5 and L7–S2 DRG. Following dorsal root ganglionectomy, there was a significant increase in the density of c-jun immunoreactivity in the neurons and glia in spinal lamina II and in the ND; there was also marked elevation in the expression of c-fos in ND. In both cases there was no change in the c-jun and c-fos immunoreactivity in the DRG. After EA in the operated animals, there was an up-regulation in the expression of c-jun in the L6 DRG and the associated spinal lamina II; however, increased c-fos expression was detected only in the L6 DRG. Western blot and RT-PCR were also performed to quantitatively explore the mRNA and protein expression changes in the spinal dorsal horn and associated DRG. Following partial deafferentation, there was a significant increase in the protein level of both c-jun and c-fos in the dorsal horn, while, in both cases there was no change in c-jun and c-fos protein and mRNA in the DRG. After EA in the operated animals, both c-jun protein and its mRNA in the L6 DRG as well as the associated dorsal horn of L6 spinal segment were upregulated, but increased c-fos protein and its mRNA was observed only in the L6 DRG. These findings suggested that c-jun and c-fos might be related to the acupuncture promoted spinal cord plasticity as reported previously.  相似文献   

20.
Because of the ability to induce cell death in certain conditions, the fullerenes (C60) are potential anticancer and toxic agents. The colloidal suspension of crystalline C60 (nano-C60, nC60) is extremely toxic, but the mechanisms of its cytotoxicity are not completely understood. By combining experimental analysis and mathematical modelling, we investigate the requirements for the reactive oxygen species (ROS)-mediated cytotoxicity of different nC60 suspensions, prepared by solvent exchange method in tetrahydrofuran (THF/nC60) and ethanol (EtOH/nC60), or by extended mixing in water (aqu/nC60). With regard to their capacity to generate ROS and cause mitochondrial depolarization followed by necrotic cell death, the nC60 suspensions are ranked in the following order: THF/nC60>EtOH/nC60>aqu/nC60. Mathematical modelling of singlet oxygen (1O2) generation indicates that the 1O2-quenching power (THF/nC60nC60nC60) of the solvent intercalated in the fullerene crystals determines their ability to produce ROS and cause cell damage. These data could have important implications for toxicology and biomedical application of colloidal fullerenes.  相似文献   

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