撬顶复位植骨治疗Hill-Sachs损伤的解剖学研究

Objective To determine whether the poking reduction and bone grafting technique with guide through bony tunnel can correct a Hill-Sachs lesion. Methods A total of 30 cadaveric humeri were equally divided into three groups, 10 cadaveric humeri per group. Hill-Sachs lesions were replicated with a osseous defect involving 10% (group A ) , 20% (group B ) and 30% (group C ) of the articular surface. All the bone defects in each group were measured and the poking reduction and bone grafting technique with guide through a bony tunnel was performed in group B and group C. The preoperative and postoperative transverse arc length, longitudinal are length, depth and volume of the osseous defects in group B and group C were compared by using paired t test. Results Before reduction, the transverse arc length of the bone defects was ( 10.9 ± 1.4 )mm in group B and ( 16.3 ± 2.3 ) mm in group C ; longitudinal arc length was ( 22.4 ± 2.4 ) mm in group B and ( 28.0 ± 2.2 ) mm in group C ;depth was (6.9±0.9) mm in group B and (11. 1 ±0.9) mm in group C; volume was (708.7±93.9) mm3 in group B and (1338.3 ± 185.6) mm3 in group C. After reduction, the transverse arc length of the bone defects was (5.1 ± 2.4 ) mm in group B and ( 7.6 ± 3.6 ) mm in group C ; longitudinal arc lengthwas (10.5 ±4.9) mm in group B and (12.3 ±5.3) mm in group C; depth was (0.3±0.1 ) mm in group B and (0.4 ±0.1 ) mm in group C; volume was (48.9 ± 16.1 )mm3 in group B and (70.3 ± 37.9) mm3 in group C. The comparison of all the parameters showed statistical difference (P <0. 01 ). Conclusion The poking reduction and bone grafting technique with guide through a bony tunnel can effectively correct the Hill-Sachs lesions with humeral head osseous defects involving 20% -30% of the articular surface.     

Preoperative embolization of primary bone tumors:A case control study

AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss,intraoperative blood transfusion volume and surgical time.METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities,hip or vertebrae before resection and stabilization.The primary osseous tumors included giant cell tumors,aneurysmal bone cyst,osteoblastoma,chondroblastoma and chondrosarcoma.Twenty-six patients were included for the statistical analysis(embolization group)as they were operated within 0-48 h within preoperative embolization.A control group(non-embolization group,n = 28)with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.RESULTS:The mean intraoperative blood loss was 1300 mL(250-2900 mL),the mean intraoperative blood transfusion was 700 m L(0-1400 m L)and the mean surgical time was 221 ± 76.7 min for embolization group(group Ⅰ,n = 26).Non-embolization group(group Ⅱ,n = 28),the mean intraoperative blood loss was 1800 m L(800-6000 m L),the mean intraoperative blood transfusion was 1400 mL(700-8400 mL)and the meansurgical time was 250 ± 69.7 min.On comparison,statistically significant(P < 0.001)difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion.There was no statistical difference between the two groups for the surgical time.No patients developed any angiography or embolization related complications.CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.     

联合应用Y27632和TDZD-8促进大鼠DRG神经元轴突再生

目的 探讨联合应用ROCK II(Rho-associated coiled-coil-containing protein kinase II,ROCK II)和糖元合成酶-3β(glycogen synthase kinase,GSK-3β)抑制剂对新生大鼠背根神经节(dorsal root ganglion,DRG)神经元轴突再生和延长的影响.方法 (1)取新生SD(Sprague-Dawley,SD)大鼠(<5 d)2只,显微操作下取胸腰段背根节,进行原代培养.(2)健康雌性成年SD大鼠15只,随机数字表法分为:手术瘫痪组(5只)、假手术对照组(5只)和正常组(5只),瘫痪组用WD(weight-drop,WD)法制成SD大鼠T9平面完全性截瘫的脊髓损伤动物模型,假手术组仅做椎板切除,造模7 d后取T8-10节段脊髓制作脊髓提取液.(3)将Y27632(ROCK II抑制剂)、TDZD-8(GSK-3B抑制剂)及伤后7 d全瘫脊髓提取液与新生大鼠DRG神经元分组培养2 d.A组:DRG神经元+PBS,B组:DRG神经元+全瘫脊髓提取液,C组:DRG神经元+全瘫脊髓提取液+不同浓度的Y26732,D组:DRG神经元+全瘫脊髓提取液+不同浓度的TDZD-8,E组:DRG神经元十全瘫脊髓提取液+Y26732+TDZD-8,观察并比较各组新生大鼠DRG神经元轴突平均长度和微管蛋白βⅢ(TubulinβⅢ)荧光表达强度.结果 (1)与A组比较,B组轴突长度明显减小(P<0.01),轴突远端TubulinβⅢ表达强度明显减弱(P<0.01).(2)C组中,5、10μmol/L Y27632治疗组轴突长度以及轴突远端和生长锥TubulinβⅢ表达强度比B组有所增加,但小于A组(P<0.05);20～50μmoL/L Y27632治疗组轴突长度以及轴突远端和生长锥TubulinβⅢ表达强度较B组增加明显(P<0.01),其中30 μmol/L Y27632治疗组最明显.(3)D组中,0.5～3 μmol/L TDZD-8治疗组轴突长度比A和B组明显增加(P<0.01),其中1μmol/L TDZD-8治疗组轴突长度最长;而5～25μmol/L TDZD-8治疗组轴突长度明显缩短,与B组比较,差异无统计学意义,且明显小于A组(P<0.01);TDZD-8各浓度组轴突干和生长锥TubulinβⅢ表达均明显增强,与A和B组比较差异有统计学意义(P<0.01).(4)E组联合应用30 μmol/LY27632和1 μmot/LTDZD-8,其轴突长度明显长于B组(P<0.01)和A组(P<0.01),且轴突的分枝更多;与A组比较,E组轴突干和生长锥TubulinβⅢ表达更强(P<0.05).结论 完全瘫痪脊髓提取液能明显抑制DRG神经轴突生长,导致生长锥塌陷;高浓度比低浓度的Y27632能明显促进轴突生长,形成细长的生长锥;低浓度比高浓度的TDZD-8能促进轴突生长,形成粗大的生长锥;适当浓度的Y27632和TDZD-8联合应用可促进轴突延长与轴突分枝形成,有利于形成神经环路.

Abstract：

Objective To explore the effect on effect of combined use of Y27632 (ROCK II inhibitor)and TDZD-8(GSK-3β inhibitor)on axonal regeneration of dorsal root ganglion (DRG) neurons in neogenetic rats. Methods All the thoracolumbar DRGs of two neogenetic Sprague-Dawley (SD)rats(<5 days)were harvested under the stereopsis raicrostat,and then the DRG neurons were cultured,purified and indentified.Fifteen adult female SD rats were randomly divided into three groups,ie,complete paraplegia group(5 rats),sham operation control group(5 rats)and normal group(5 rats)respectively.The T8-10 spinal cord extracts (SCEs) were harvested in the complete paraplegia group,sham operation control group and normal group respectively at day 7 after spinal cord injury.The experiment was divided into group A(DRG neurons + PBS),group B(DRG neurons + complete paralysis SCE),group C(DRG neurons + complete paralysis SCE + different concentration Y27632),group D(DRG neurons + complete paralysis SCE + different concentration TDZD-8)and group E(DRG neurons + complete paralysis SCE + proper concentration Y27632 and TDZD-8).The average axonal length and expression intensity of Tubulin βⅢ at distal end of neuronal axons were observed after two days of co-culture respectively in intro. Results (1)The average axonal length and expression intensity of Tubulin βⅢ at axon shaft and growth cone in the group B were significantly shorter and weaker than that in the group A,with statistical difference.(2)In the group C,the average axonal length and expression intensity of Tubulln βⅢ at axon shaft and growth cone in 5-10 μmol/L Y27632 treatment groups were more than that in the group B but lower than that in the group A.The average axonal length and expression intensity of Tubuhn βⅢ at axon shaft and growth cone in 20-50 μmol/L Y27632 treatment group were longer and stronger than that in the group A and the group B,especially the group B.Among different concentration Y27632 treatment groups,there was a longest average axonal length and strongest expression intensity of Tubulin βⅢ in 30 μmol/L treatment group.(3) In the group D,there was a longer average axonal length in 0.5-3 μmol/L TDZD-8 treatment group than that in the group A and the group B,with the longeat average axonal length in l μmool/L TDZD-8 treatment group.In 5-25 μmol/L TDZD-8 treatment groups,the average axonal length showed no difference compared with the group B but wns shorter than that in the group A.In all different concentration TDZD-8 treatment groups,the expression intensity of Tubulin βⅢ at axon shaft and growth cone was significantly stronger than that in the groups A and B.(4) In the group E,although the average axonal length was increased in the group E,there was no statisilcal difference compared with the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8treatment group.There was a significantly longer average axonal length in the group E than it in the group B and the expression intensity of Tubulin βⅢ at axon shaft and growth cone was stronger in the group E compared to the group A,30 μmol/L Y27632 treatment group and l μmol/L TDZD-8 treatment group.Conclusion The complete paralysis SCEs obviously inhibits DRG axonal growth,induces axonal retraction and growth cone collapse.High concentration of Y27632 can more obviously promote the axon growth compared with the low concentration,while the low concentration of TDZD-8 can obviously promote the axon growth.Combined use of appropriate concentration of TDZD-8 and Y27632 can promote the axon growth and induce the axons branching,as facilitates the formation of the axon circuit.     

盐酸肾上腺素在骨水泥型髋关节置换术中预防骨水泥植入综合征发生的作用

Objective To investigate the clinical application of epinephrine hydrochloride in the prevention of bone cement implantation syndrome in the cemented hip replacement. Methods The clinical data of 48 patients treated with cemented hip replacement from July 2008 to April 2009 were retrospectively analyzed. All the patients were divided into control group and intervention group. The bone marrow cavities of 24 patients in the control group were not pretreated with saline epinephrine hydrochloride before implantation of bone cement; the bone marrow cavities of 24 patients in the intervention group were pretreated with saline epinephrine hydrochloride before implantation of bone cement. Systolic blood pressure (SBP), diastolic blood pressure (DBP), the mean arterial pressure (MAP), heart rate (HR)and pulse oxygen saturation ( SPO2 ) were compared between the two groups before bone cement implantation and 1,2, 3, 4, 5, 6, 7, 8, 9, 10 minutes after bone cement implantation. The data were analyzed with variance analysis and Q test. Results (1) In the control group: the blood pressure was decreased in control group one minute after bone cement implantation and a significant decrease of the blood pressure was observed at 2-6 minutes after the implantation ( P ＜ 0. 01 ). The blood pressure was increased seven minutes after the implantation, with the most significant increase of DBP ( P ＜ 0.05 ).The blood pressure recovered to normal 10 minutes later. The SPO2 was decreased significantly ( P ＜0.05 ) but no significant change was observed in HR ( P ＞ 0.05). (2) In the intervention group: the bone marrow cavity was pretreated with saline epinephrine hydrochloride before implantation of bone cement.ity. No significant difference was found in SBP, DBP, MAP, HR and SPO2 at different time points before and after bone cement implantation (P ＞0.05 ). Significant decrease of blood pressure and SPO2 was observed in control group and a significant hemodynamic change was detected at 2-6 minutes after the bone cement implantation. In the intervention group, no hemodynamic change was found in all the patients except that one patient was found with decrease of blood pressure and another one with the occasional premature ventricular contractions. Conclusion Pretreatment of bone marrow cavity with saline epinephrine hydrochloride can effectively prevent bone cement implantation syndrome.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

Clinical Value of Interventional Embolization for Sacral Chordoma before Surgical Treatment

Objetive:To evaluate the efficacy of preoperative transcatheter arterial embolization in the treatment of sacral chordoma,and to explore the choice of embolization timing.Methods:32 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma.Intraoperative bleeding amount of each patient was recorded and compared between-group differences at different operation times.Results:After embolization,12 patients were received resection within 24 hours(group A),that of 10 cases between 24~48h(group B),of another 10 cases between 48~72h(group C).All of the 32 tumors were removed intact with intraoperative bleeding about(894±199)ml,without any shock or death,nor injuries on abdominal organs such as rectum and ureter.There was no statistical significance in tumor size among group A,B and C(P>0.05).Data gave statistical significance in intraoperative blood loss between group A and B(P<0.01),there was no statistical differences between group B and C(P>0.05),in spite of group B slightly less than group C.Conclusion:Preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss,make the surgical field clear,and facilitate the maximal removal of the sacral chordoma.It would be best to select the embolization timing within 24 hours before surgical operation.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

多层螺旋CT对食管鱼刺异物的诊断价值

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.     

海水浸泡对兔胫骨开放性骨折愈合进程的影响

目的 观察海水浸泡对兔胫骨开放性骨折愈合进程的影响.方法 44只新西兰兔按数字表法随机分为实验组和对照组,每组22只,均造成双侧胫骨横行骨折.实验组伤口浸泡于人工海水中3 h,对照组旷置3 h,清创后依次缝合伤口.电镜和光镜下观察2组第7、14、21、28天成骨细胞损伤情况、组织中血管内皮生长因子(VEGF)、转移生长因子-β1(TGF-β1)的表达及骨痂形成过程.结果 (1)电镜下,实验组骨折处成骨细胞在骨折后第7～14天可见明显损害,表现为胞膜及核膜破坏、线粒体肿胀空泡变、胞核溶解坏死,第21天及第28天成骨细胞形态恢复正常.(2)免疫组化显示,对照组VEGF及TGF-β1的表达于骨折后逐渐增强,至第14天时达到高峰,之后呈减弱趋势;实验组表达未见延迟,但各时段表达强度均明显弱于对照组.(3)第28天时,对照组骨痂完全为骨性骨痂者共15肢,占75%;为混合性骨痂(即软骨骨痂与骨性骨痂共存)者共5肢,占25%.实验组骨痂完全为骨性骨痂者共6肢,占30%;为混合性骨痂者共14肢,占70%.2组比较差异有统计学意义(χ2=8.12,P<0.01).结论 肢体开放性骨折经海水浸泡3 h后,膜内成骨及软骨内成骨进程延缓,骨折愈合延迟.

Abstract：

Objective To observe the effects of seawater immersion on the healing process of open tibial fracture in rabbits.Methods Forty-four New Zealand rabbits were randomly divided into two groups: the experimental group (group A) and the control group (group B), each consisting of 22 animals. The 2 groups of animals all had bilateral open fracture of tibia. The wounded limbs of the animals in group A were immersed in the artificial seawater for 3 hours. And the animals in group B were left there untended for 3 hours. Following debridement, wounds were sutured. Lesion of osteoblast, vascular endothelial growth factor (VEGF),the expression of transforming growth factor-β1 (TGF-β1) and the process of porosis in the animals of both groups were observed on the 7th,14th,21st and 28th days respectively under the electron and optical microscopes.Results (1) Under the electron microscope, obvious lesion of osteoblast in the animals of group A was observed at the fractured sites, 7-14 days after the fracture, displaying cell membrane and nuclear membrane damage, mitochondrial swelling and vacuolation, cell nucleus dissolution and necrosis. On the 21st and 28th days, morphology of osteoblasts in the animals of group A returned to normal. (2) Immunohistochemistry indicated that the expression of VEGF and TGF-β1 in the animals of group A increased and gradually rose to the peak on the 14th day after fracture, and then decreased. The expression of VEGF and TGF-β1 was not delayed in the animals of group A, but their expression intensity at various times was all obviously weaker than that of group B.(3)On the 28th day, for the animal in group B, 15 limbs were of complete osseous callus, accounting for 75%, while 5 limbs were of mixed type osseous callus, accounting for 25%. For the animal in group A, 6 limbs were of complete osseous callus, accounting for 30%, while 14 limbs were of mixed type osseous callus, accounting for 70%. Significant statistical differences could be seen, when a comparison was made between the groups(P<0.01).Conclusions The process of intramembranous/cartilaginous ossification and fracture healing delayed, following open fracture of limbs coupled with 3-hour seawater immersion.     

Anterior Shoulder Instability Repair and Reconstruction: An Algorithm for Patients with Bone Defects

Most cases of instability of the shoulder do not involve a significant osseous lesion. Bony lesions of the glenoid and humeral head, however, can be a major cause of recurrent anterior glenohumeral instability. Unrecognized bony glenoid defects and Hill-Sachs lesions can lead to failure after arthroscopic soft tissue stabilization procedures for anterior instability. However bony defects can usually be identified and effectively treated, if an appropriate protocol and workup is followed. Current indications for the treatment of anterior glenohumeral instability with a bony augmentation procedure include anteroinferior glenoid bone loss of greater than 20%-30%, an engaging Hill-Sachs lesion, or an Instability Severity Index Score greater than 6. A variety of procedures have been described for treating bony instability, including both arthroscopic and open techniques. Here we discuss the evaluation, workup, and treatment of anterior shoulder instability related to bone deficiency of the glenohumeral joint.     

椎弓根外穿刺撬拨复位椎弓根钉固定治疗胸腰椎骨折

目的探讨经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗胸腰骨折的可行性和有效性。方法回顾性分析2012年2月—2015年3月深圳平乐骨伤科医院收治的64例胸腰椎骨折患者,观察组和对照组各32例,观察组采用经椎弓根外穿刺撬拨复位、植骨、椎弓根钉内固定治疗,对照组采用椎弓根钉棒撑开复位固定、经伤椎椎弓根穿刺植骨治疗。记录手术时间、术中出血量、术后引流量、住院时间;测量术前、术后伤椎体前、后缘高度比和后凸Cobb角;同时对两组患者进行手术前、后VAS评分和Oswestry功能障碍指数评分。结果观察组与对照组相比较,术前VAS评分[(6.782±1.821)%vs.(6.827±1.762)%]、术前伤椎体前缘高度百分比[(57.658±23.645)%vs.(58.162±24.852)%]、术前伤椎体后缘高度百分比[(88.645±8.624)%vs.(87.927±7.848)%]、术前后凸Cobb角[(28.665±4.824)°vs.(29.134±5.508)°]、手术时间[(135.675±23.318)min vs.(130.731±21.761)min]、术中出血量[(456.214±63.525)m L vs.(461.532±60.753)m L]、术后引流量[(43.847±16.358)m L vs.(42.971±15.523)m L]、住院时间[(10.878±2.148)d vs.(11.323±2.512)d]、术后末次随访VAS评分(0.184±0.263 vs.0.195±0.325)和Oswestry功能障碍指数(2.463±0.652 vs.2.624±0.765),差异均无统计学意义(P0.05)。观察组与对照组相比较,术后末次随访伤椎体前缘高度百分比(98.083±1.635)%vs.(93.157±2.019)%、后缘高度百分比[(98.504±2.572)%vs.(96.248±4.824)%]和后凸Cobb角[(3.623±2.563)°vs.(7.626±3.613)°],差异均有统计学意义(P0.05)。结论经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗Denis B型、D型胸腰椎体压缩骨折、B型椎体爆裂骨折,可较好恢复椎体前、后缘高度,矫正后凸Cobb角。     

Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft

Seventy-five patients underwent unilateral anterior cruciate ligament reconstruction with an ipsilateral bone-patellar tendon-bone autograft at our institution. The graft was harvested using a two-transverse-incision technique, and patellar and tibial bony defects were repaired with cored bone grafts collected by reaming the femoral socket and the tibial socket or tunnel. We evaluated the incidence of anterior knee pain, donor site tenderness, and sensory disturbance after use of these procedures. We also analyzed the correlation between anterior knee pain and age, sex, bone plug length, range of motion, postoperative stability, patellar tendon shortening, infrapatellar nerve injury, and the size of the patellar defect. Thirteen patients reported anterior knee pain. Donor site tenderness was detected in 10 patients and was located on the inferior pole of the patella, the tibial tubercle, or both. Sensory disturbance was found over the infrapatellar nerve area in 13 patients. Statistical analysis showed that anterior instability (side-to-side difference of >3 mm) and residual patellar bony defect (depth >2 mm) were risk factors for anterior knee pain. The results of our study suggest that cored cancellous bone grafting for complete restoration of the donor site bony defects and the two-transverse-incision technique to preserve the infrapatellar branch of the saphenous nerve contribute to prevention of anterior knee symptoms.     

转基因骨髓间充质干细胞复合纤维蛋白凝胶修复兔桡骨缺损

目的：探讨以复制缺陷重组腺病毒介导人骨形态发生蛋白(BMP)-2转基因的骨髓间充质干细胞(MSCs)复合纤维蛋白凝胶来修复节段性骨缺损的可行性。方法：于14只日本大耳白兔双侧桡骨中段造成10mm骨缺损，采用四种方法进行处理：A组植入转基因MSCs与纤维蛋白凝胶的复合物；B组植入单纯MSCs与纤维蛋白凝胶的复合物；C组植入纤维蛋白；D组不做处理，留作空白对照。每组7条桡骨。术后12周进行组织学、放射学检查及生物力学检测。结果：A组缺损区在成骨活跃程度、骨再生量和再生髓腔结构等方面均显著优于B组，其骨缺损得到了较彻底的修复。C、D两组均不能产生骨性愈合。结论：转基因MSCs复合纤维蛋白凝胶修复节段性骨缺损可达到较好的效果。     

Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length

Tibial bone tunnels were examined with bone scans 2 years after patella ligament ACL reconstruction in 68 patients. At 2 years, scan uptake at the tibial tunnel was increased in 29% of patients. Marked increase of scintigraphic uptake was associated with tibial tunnel enlargement of more than 35% and a graft length in the tibial tunnel over 14 mm. Scan uptake was correlated to tunnel enlargement (r = 0.64, P < 0.01) and tunnel enlargement was correlated to graft length inside the tibial tunnel (r = 0.59 P < 0.001). No correlation was found between scan uptake or tunnel enlargement and anterior laxity, sagittal tunnel position and subjective outcome. Scintigraphy indicates the enlarged tibial tunnels are filled with remodelling bone. Tibial fixation location influences ligament healing inside the tunnel: Return of osseous homeostasis at the tibial tunnel can take more than 2 years when fixation is more than 14 mm below the joint.     

锁定钢板与微创撬拨复位空心钉内固定治疗Sanders Ⅱ和Ⅲ型跟骨骨折临床效果对比

目的通过对术后临床结果和放射学结果进行分析,对比锁定钢板内固定和微创撬拨复位空心钉内固定在治疗Sanders II和III型跟骨骨折上的临床差异。方法选取上海市长海医院2011年4月—2015年5月收治的单侧跟骨骨折患者48例,男性40例,女性8例;年龄20~46岁,平均37.5岁;受伤至手术时间3~7d,平均5.0d。按随机数字表法分成锁定钢板内固定(锁定组,24例,其中Ⅱ型17例,Ⅲ型7例),微创撬拨复位空心钉内固定(微创组,24例,其中Ⅱ型18例,Ⅲ型6例)。随访9~12个月观察两组患者的治疗效果。结果微创组患者的手术时间长于锁定组,术中出血量、住院时间少(短)于锁定组,差异有统计学意义(P0.05);跟骨宽度、长度B9lher角及Gissane角恢复情况,两组均较术前有明显改善(P0.05),术后两组间B9lher角差异无统计学意义(P0.05)。微创组无并发症发生,锁定组并发症发生率为12.5%,前者明显低于后者(P0.05)。微创组治疗后疼痛评分值分别为第1天(4.30±0.98)、第7天(2.84±0.73)、出院前(1.03±0.11),均优于锁定组第1天(5.72±1.42)、第7天(4.05±0.82)、出院前(2.76±0.73),差异有统计学意义(P0.05)。结论在SandersⅡ和Ⅲ型跟骨骨折的治疗中采用微创撬拨复位空心钉内固定和锁定钢板内固定手术均可改明显改善患者的B9lher角,但微创手术的安全性较高,恢复速度快,值得推广。     

聚乳酸管引导性骨再生修复骨缺损的实验研究

目的　观察可降解性材料膜管引导长管状骨骨再生的现象 ,并探讨其作用机制。方法　 6 0只成年新西兰大白兔双侧桡骨中上段截去 15mm ,包括骨膜 ,造成骨缺损。左侧为实验侧 ,采用聚乳酸管桥接 ,制作长管状骨引导性骨再生动物模型 ,右侧骨缺损不做处理作为对照。 6 0只兔随机分为 2组 :A组 12只兔分别于术后 1、2、4、8、12、16周时摄X线片观察 ;B组 4 8只兔随机分为 6组 ,分别于术后 1、2、4、8、12、16周时处死取材 ,进行组织学观察。结果　A组术后 1、2周时实验侧与对照侧无明显差异 ,实验侧 4周时有骨痂开始形成 ,16周时有 10例完成骨性连接、髓腔再通及板层骨改建。对照侧 4周时骨痂生长不明显 ,16周时无 1例愈合。B组实验侧 1周时即有骨及软骨再生 ,16周时在形态学特征、组织学特性方面均类似于正常骨 ,对照侧 16周时只在两截骨端有少量软骨细胞 ,缺损区为纤维组织充填。结论　聚乳酸管能够成功引导骨再生 ,有广泛的临床应用前景     

复合骨形态发生蛋白-2的人工骨与带血供组织修复羊大段骨缺损

目的研究组织工程化人工骨结合不同自体带血供组织(长段自体尺骨或屈指长肌)移植修复大段骨缺损的效果。方法手术造成绵羊桡骨30mm骨缺损,A组植入[聚乳酸-乙醇酸共聚物(PLGA)-磷酸三钙(TCP)-骨形态发生蛋白-2(BMP-2)]人工骨及带血运的长段尺骨,B组植入PLGA-TCP-BMP-2人工骨及带血运的屈指长肌肌腹,C组仅植入PLGA-TCP-BMP-2人工骨,D组不植入任何材料。4组均以钢板固定桡骨缺损区。术后24周行手术部位X线摄片,24周处死动物行组织学检查。结果术后24周时,X线检查示A、B组桡骨缺损处完全成骨修复,皮质骨与髓腔的轮廓较为清晰;C组亦能完全修复,但新生骨密度及髓腔轮廓清晰度均不如A、B组;D组无有效骨痂形成。组织学检查结果显示,A组新生骨完全修复骨缺损区;B组骨痂为较成熟的板层骨,骨陷窝较多;C组新生板层骨及骨陷窝排列较为紊乱;D组无骨连接表现。A、B、C组均未见人工骨材料残留。结论 PLGA-TCP-BMP-2人工骨结合带血供的长段自体骨或自体肌肉移植能够很好地修复绵羊桡骨30mm的骨缺损。     

Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损

目的 探讨Ilizarov技术Ⅰ期治疗胫骨大段骨缺损合并软组织缺损的可行性.方法 2003年9月-2010年9月收治胫骨大段骨缺损合并软组织缺损患者24例,均为胫骨开放性骨折(Gustilo Ⅲ B型20例,Gustilo Ⅲ C型4例).在患肢上安放Ilizarov外固定架.清创术后小腿胫前内侧软组织缺损10 cm×6 cm,胫骨骨缺损(8±4)cm.对15例胫骨骨缺损＜5 cm的患者使用Ⅰ期清创、腓骨截骨、胫骨缺损端加压.对9例胫骨缺损＞5 cm的患者采用Ⅰ期清创、骨运输-骨延长.对15例患者采用Ⅰ期清创,封闭创面或缩小创面、骨搬移,Ⅱ期清理皮肤嵌顿及清理骨折端.结果 所有患者随访10～24个月,平均14个月.骨缺损均得以重建,患肢肢体长度与健侧之差＜2 cm,骨折愈合,创面均闭合.1例术后出现腓总神经麻痹,术后3个月恢复.19例未通过额外手术进行修复.3例通过游离皮片植皮成活,2例通过局部旋转皮瓣修复覆盖创面.结论 Ⅰ期使用Ilizarov外固定架进行骨搬移肢体是治疗胫骨骨缺损合并软组织缺损的有效方法.     

组合枢椎椎板螺钉固定技术治疗颈椎损伤的临床研究

目的 探讨组合枢椎椎板螺钉固定技术治疗颈椎损伤的可行性和应用价值.方法 对32具颈椎标本行枢椎椎板轴向CT加密扫描,测量枢椎椎板的长度、高度,枢椎椎板上、中、下部的厚度,椎板轴线与欠状面的夹角.8例颈椎损伤患者中,Anderson Ⅱ型齿状突骨折伴寰枢关节向后脱位2例、向前脱位1例、齿状突骨不愈合1例,Ⅲ型齿状突骨折伴寰枢关节不稳、横韧带撕裂2例,Ⅱ型Hangman骨折伴C<,2～3>不稳1例,寰枢关节前脱位伴横韧带断裂1例.牵引复位后,根据患者病情组合枢椎椎板螺钉进行组合式固定,并行后路自体髂骨植骨融合.结果 枢椎椎板的长度为(26.2±1.2)mm,高度为(12.8±1.6)mm,枢椎椎板上、中、下部的厚度分别为(300±1.4)mm、(6.0±1.6)mm、(5.6±1.2)mm、椎板轴线与矢状面的夹角平均为43.5°.8例患者枢椎椎板螺钉位于椎板中,无偏斜.全部患者随访6～14个月,平均10.5个月.术中和术后没有任何并发症发生,获得了良好的骨性愈合.本组无一例发生螺钉松动及断裂.结论 枢椎椎板螺钉固定技术避免了螺钉置入过程中损伤椎动脉的风险.此技术操作简单,不受C2横突孔中椎动脉的位置限制.全程在直视下进行,该方法可作为传统枢椎后路螺钉固定技术的补充.