弹性钛制髓内针固定治疗儿童四肢长骨骨折(附100例分析)

目的探讨弹性钛制髓内针在儿童四肢长骨骨折中的应用效果。方法100例不同类型的四肢长骨骨折患儿,年龄2～12岁。上肢骨折18例(包括尺桡骨骨折15例,桡骨颈骨折3例,肱骨干骨折1例),下肢骨折82例(包括股骨干骨折64例,胫骨干骨折18例)。采用弹性钛制髓内针内固定治疗。结果随访2～24个月,100例中,优93例,良5例,可2例,优良率98%,髋、膝、踝关节功能全部恢复,无畸形愈合及断针。结论弹性钛制髓内针内固定治疗儿童四肢长骨骨折,具有切口小、创伤小、操作方便、固定牢固、愈合快、取出简便等优点,临床应用疗效确切。     

低钙饮食对雌雄大鼠股骨生物力学特性的影响

目的 评价低钙饮食对雌雄大鼠股骨生物力学性能的影响,并比较雌雄大鼠间的差异。方法 3月龄SD雌雄大鼠各30只,按性别随机分成对照组(Ca1.0％)、极低钙组(VLCD)(Ca 0.1％)、低钙组(LCD)(Ca 0.3％)。三月后处死大鼠,取左侧股骨,行股骨三点弯曲实验。结果 VLCD和LCD组雌性大鼠各生物力学指标与对照组相比无显著性差异。雄性大鼠LCD组与对照组差异无显著性,而VLCD组生物力学指标如极限载荷、极限强度、破坏时能量吸收以及刚度系数均较对照组显著降低。结论 低钙饮食对雄性大鼠骨生物力学的     

Sanatmetal带锁髓内钉在四肢长骨骨折中的临床应用

目的探讨Sanatmetal带锁髓内钉在四肢长骨骨折中的临床应用及其远端锁定的准确性﹑简易性。方法 2003年1月～2008年6月对278例四肢长骨干骨折患者随机分组,其中42例股骨骨折,68例胫骨骨折,32例肱骨骨折采用Sanatmetal带锁髓内钉内固定治疗;对照组46例股骨骨折,62例胫骨骨折,28例肱骨骨折采用其它带锁髓内钉内固定治疗。比较分析其远端锁定所用时间、出血量、C臂X线机使用次数及治疗结果。结果 Sanatmetal带锁髓内钉组远端锁定时间：股骨10～30（15.8±6.2）min,胫骨5～12（7.1±2.3）min,肱骨2～4（2.5±0.7）min;出血量：股骨265～550（398.9±84.9）ml,胫骨80～215（126.5±36.0）ml,肱骨40～150（83.4±30.8）ml;C臂X线机使用次数0～2（0.9±0.8）次。对照组远端锁定时间：股骨30～80（43.8±11.0）min,胫骨20～40（29.1±6.6）min,肱骨10～30（19.1±5.5）min;出血量：股骨375～825（545.3±121.2）ml,胫骨150～450（284.4±78.2）ml,肱骨80～230（142.3±46.6）ml;C臂X线机使用次数4～10（7.5±2.0）次。所有278例均获随访9～50（36.6±11.7）月;Sanatmetal治疗组122例一期骨愈合,12例延迟愈合,8例骨不愈合,优良率85.9%;对照组101例一期骨愈合,23例延迟愈合,12例骨不愈合,优良率74.3%。结论 Sanatmetal带锁髓内钉具有比较精确的远端锁定系统,可有效缩短手术时间,减少手术创伤及X线辐射,是一种比较理想的治疗四肢长骨干骨折的内固定材料。     

儿童四肢长骨骨纤维性结构不良影像学与病理学表现对照分析

目的 探讨儿童四肢长骨骨纤维性结构不良(FDB)影像学表现特点,并与组织病理学表现进行对照分析,提高临床对该病的认识。方法 回顾性分析2011年1月—2016年12月南京医科大学附属儿童医院经手术病理证实的32例四肢长骨FDB患儿的临床资料。32例患儿中,男19例,女13例;年龄2~14(9.2±3.1)岁。其中32例行X线检查,30例行CT平扫及3D重建,14例行MRI平扫。在X线、CT及MR图像上观察FDB病灶的形状、位置、边界,有无合并病理性骨折等,并将影像学表现与病理描述进行对照分析。结果 32例患儿共35个病灶,其中单骨型27例,病灶累及股骨15例,胫骨7例,腓骨1例,肱骨2例,尺骨2例;多骨型4例中,病灶累及同侧股骨和胫腓骨2例、左股骨和枕骨1例、尺骨和桡骨1例;McCune-Albright综合征1例,病灶累及右股骨、髂骨、耻骨。11例合并病理性骨折,骨折部位:股骨近段7例、中段1例,胫骨2例,肱骨中段1例。术后病理学显示正常的骨髓组织被异常增生的纤维组织替代。影像学呈磨砂玻璃样改变时,病理表现以成熟坚韧的纤维组织为主;影像学呈囊状膨胀透亮改变时,病理表现以生长活跃的纤维组织为主,伴间质黏液样变性、囊性改变;影像学呈丝瓜瓤样改变时,其病理表现多为增生的纤维组织及新生骨小梁分布混杂。结论 儿童四肢长骨FDB,好发于股骨及胫骨,影像学表现以囊状膨胀性改变和磨玻璃样改变为主要特征,病理特征为正常的骨髓组织被大量的纤维组织替代。不同特征的影像学改变有其相对应的病理学特点。     

四肢长骨骨缺损治疗的进展

鉴于临床骨科常见病四肢长骨骨缺损的治疗尚有不足之处,本文概括的描述了近年来长骨骨折治疗的一些研究进展,包括有自体,异体,胚胎骨移植和最新的基因治疗,最后提出对长骨骨缺损治疗领域的展望,希望能有一定的帮助作用。     

螺旋形长型PHILOS接骨板治疗肱骨中上段骨折的生物力学研究

目的比较长型PHILOS接骨板(Synthes公司,瑞士)扭转成螺旋形前后的生物力学特性,为临床治疗肱骨中上段骨折提供生物力学依据。方法 12例Synbone人工骨(SYNBONE公司,瑞士)的右侧肱骨平均分为两组,对照组(n=6)采用10孔的长型PHILOS接骨板固定,实验组(n=6)采用相同的接骨板扭转成螺旋形后固定。肱骨中上段骨折造模后,利用万能力学试验机分别检测并比较两组接骨板固定后的整体构件在轴向拉伸和压缩、同向和反向扭转、前后及内外向三点弯曲6种加载方式下的生物力学特性。结果在100~500 N拉伸和压缩载荷下,实验组骨折断端位移分别较对照组增加约95%和58%;在0.6~3 N·m反向扭矩下,实验组扭转角度始终明显小于对照组,减少幅度达到55%~64%;在0.6~3 N·m的同向扭矩和1.5~7.5 N·m的前后向弯矩下,实验组的扭转角度和桡度均大于对照组,差异有显著性意义(P0.05);当内外向弯矩为1.5、3 N·m时,实验组与对照组的桡度差别无显著性意义(P0.05),而内外向弯矩为4.5、6、7.5 N·m时,实验组的桡度较对照组小20%~30%。实验组与对照组构件相比,拉伸和压缩刚度分别低49%和36%,同向和反向扭转刚度分别低19%和高150%,内外向和前后向弯曲刚度分别高18%和低70%,差异均有显著性意义(P0.05)。结论长型PHILOS接骨板扭转成螺旋形后固定肱骨中上段骨折的总体力学性能有所改善,可以满足临床对该类骨折的手术固定和术后康复需要。结合微创手术的优势,该技术有望在临床得到广泛应用。     

成人四肢长骨的非对称性

本文测量了乌鲁木齐地区出生土的200副成年四肢长骨,在左、右两侧长度相差大于0.1厘米时,四肢六骨(男性腓骨外)均以非对称性为主,若以肱骨加桡骨、股骨加胫骨长作为上、下肢长,则右上肢与左下肢占优势,上、下肢单侧优势呈交叉关系。在左右侧重相差大于1%时,四肢六骨不论男女也均以非对称性为主,其中上肢以右大于左的占优势,而下肢也以右大于左的居多,在重量上看不出上、下肢单侧优势呈交叉关系。     

浅析肱骨髁上骨折好发于儿童的生物力学原因

根据儿童到成人骨发育过程中期肱骨下端前倾角的变化,从生物力学角度,在理论上分析了同样的俯卧跌仆上肢撑地,儿童易产生肱骨上骨折,而成人则易发生肱骨中上部骨折的原因。     

人体腰椎松质骨的生物力学性质

本文以三具新鲜男性尸体的Ｔ１２～Ｌ４椎体的松质骨为材料，通过准静态压缩试验，分析了应变率（ε）表观密度（ρａ）和组织密度（ρｔ）对松质骨弹性模量、强度和终应变的影响。试验采用了５个应变率１．０×１０－５，５．０×１０－５，１．０×１０－４，５．０×１０－４，１．０×１０－３Ｓ－１。松质骨的表观密度和组织密度范围分别为０．４６～０．７１ｇ／ｃｍ３，１．０２～１．５４ｇ／ｃｍ３。以弹性模量、强度和终应变为因变量（Ｙ），以应变率和表观密度或组织密度为自变量。利用以下模型进行了非线性回归分析：Ｙ＝ａρｂａεｃ。当ｂ分别取１．８８，２和３时，弹性模量与应变率的关系均可用上面模型表达，其指数ｃ分别为０．０７，０．１，０．１。弹性模量与表观密度呈１．８８次方关系，强度与表观密度呈１．２９次方关系。终应变作为独立变量不受表观密度和应变率的影响。组织密度的平方和立方均与弹性模量正相关     

Isolated congenital bowed long bones

An infant with prenatal bowed long bones is reported. History of bowed leg bones in the mother during her infancy and improvement of the bowed bones in the child and mother support benign nature of the condition and probable A.D. inheritance.     

人体下肢长骨负重关节软骨下松质骨显微硬度分布特征的研究

目的:探讨人体下肢长骨负重关节软骨下松质骨显微硬度的分布特征。方法:选取3具年龄大于40岁的新鲜冰冻尸体标本,取出所有标本的右侧股骨和胫骨,分别于股骨头、股骨内髁、股骨外髁、胫骨内髁、胫骨外髁、胫骨远端距负重区关节软骨面1 cm处,垂直于下肢机械轴切下3 mm厚松质骨样本。使用维氏显微硬度测量系统测量骨组织显微硬度。比...     

Quantitative analysis of histological parameters in giant cell lesions of the jaws and long bones

Stereological techniques have been used to compare histological parameters of the giant cell component in 10 giant cell tumours of long bones, 10 central giant cell granulomas of the jaws and 10 peripheral giant cell granulomas of the jaws. The giant cell parameters investigated were: mean profile diameter, mean diameter, mean profile axial ratio, volume-to-surface ratios, nuclear numerical density, profile area and cell volume. Serial sections were cut at 4 micron from routinely fixed, paraffin-embedded specimens of each case and two sections, separated by 100 micron, were stained with haematoxylin and eosin. Random fields were photographed until at least 25 giant cell profiles had been recorded from each of the two sections of each lesion. The processed film was projected for point and intersect counting, the entire procedure ensuring double-blind assessment of the cases under investigation. In general there was no significant difference for any of the parameters between the giant cells of central and peripheral jaw lesions. There was a significant difference, however, between the giant cells of central jaw lesions and long bone tumours in respect of both nuclear numerical density and mean absolute cell volume.     

Biomechanical changes in long limb bones of HAN-Wistar rats during postnatal development

Summary From a total of 648 male and 638 female HAN-Wistar rats the bones of 12 males and 12 females were examined at seven week intervals from the 35th to the 1129th day after birth. Biomechanical properties of the femora, tibiae and humeri were defined in a bending test using a tension testing machine. Load deflection diagrams in bending were produced, and the values of maximum bending load, bending breaking load, maximum deflection and ultimate deflection were correlated to age, body weight and bone length. The mean values of weight, bone length and biomechanical data are significantly higher in male rats. In both sexes biomechanical properties show a clear dependence on age. Up to the age of 330 days the tibia is more flexible than the femur or humerus. Values of partial correlation coefficients demonstrate that weight exerts more influence on the biomechanical properties of bones than age or bone length. With increasing weight, the loading capacity of bones rises in both sexes.This study was supported by the Deutsche Forschungsgemeinschaft     

Location, number and clinical significance of nutrient foramina in human long bones

Nutrient arteries, the main blood supply to long bones, are particularly important during the active growth period, as well as during the early phases of ossification. In the present study, 569 adult human long bones of the upper (101 humeri, 93 radii, 102 ulnae) and lower (100 femora, 100 tibiae, 73 fibulae) limbs were investigated to determine the number and location of their nutrient foramina. For each bone, a foraminal index was calculated giving the location of the nutrient foramen in relation to its proximal end. In the upper limb, foramina were located on the diaphysis 15-69% of the overall length of the humerus, 22-46% for the radius and 27-54% for the ulna. In the lower limb, foramina were located on the diaphysis 29-69% of the overall length of the femur, 27-63% for the tibia and 26-83% for the fibula. In addition, the number and the distribution of the foramina in relation to specific regions/surfaces of the diaphysis were identified. This study provides additional and important information on the location and number of nutrient foramina in the long bones of the upper and lower limbs in the Turkish Caucasian population.     

Biomechanical properties of anuran long bones: correlations with locomotor modes and habitat use

Long bones are subjected to mechanical loads during locomotion that will influence their biomechanical properties through a feedback mechanism (the bone mechanostat). This mechanism adapts the spatial distribution of the mineralized tissue to resist compression, bending and torsion. Among vertebrates, anurans represent an excellent group to study long bone properties because they vary widely in locomotor modes and habitat use, which enforce different skeletal loadings. In this study, we hypothesized that (a) the cortical bone mass, density and design of anuran femur and tibiofibula would reflect the mechanical influences of the different locomotor modes and habitat use, and (b) the relationships between the architectural efficiency of cortical design (cross-sectional moments of inertia) and the intrinsic stiffness of cortical tissue [cortical mineral density; the 'distribution/quality' (d/q) relationship] would describe some inter-specific differences in the efficiency of the bone mechanostat to improve bone design under different mechanical loads. To test this hypothesis, we determined tomographic (peripheral quantitative computed tomography) indicators of bone mass, mineralization, and design along the femur and tibiofibula of four anuran species with different modes of locomotion and use of habitat. We found inter-specific differences in all measures between the distal and proximal ends and mid-diaphysis of the bones. In general, terrestrial-hopper species had the highest values. Arboreal-walker species had the lowest values for all variables except for cortical bone mineral density, which was lowest in aquatic-swimmer species. The d/q relationships showed similar responses of bone modeling as a function of cortical stiffness for aquatic and arboreal species, whereas terrestrial-hoppers had higher values for moments of inertia regardless of the tissue compliance to be deformed. These results provide new evidence regarding the significant role of movement and habitat use in addition to the biomechanical properties of long bones within a morpho-functional and comparative context in anuran species.     

跟骨的形态结构特点及其临床意义

目的：为跟骨骨折的治疗提供形态学的依据和标准。方法：观察成人正常跟骨的形态特征和骨小梁分布情况，测量跟贩的长、宽、高和Ｂｏｈｌｅｒ’ｓ角、Ｂｉｓｓａｎｅ‘ｓ角等。结果：（１）骨形态结构较复杂，骨皮汪，骨松质多，跟骨前部跟骨沟下方骨小梁稀疏，后梁侧骨小梁密集。（２）正常跟骨各指标左右俩则无明显差异，而不同性别暗除Ｇｉｓｓａｎｅ’ｓ角外，其他各项指标均有显著差异；有高／长的比值〉１／２。结论：（１）跟     

Blood circulation of long bones in trained growing rats and mice

The effect of physical training on the blood circulation of long bones was studied in growing rats and mice of NMRI-strain. The animals to be trained and their controls were about 2 weeks old at the beginning of the training. The training took place on a 5° inclined treadmill 5 days a week for 3 weeks in experiment I and 7 weeks in experiments II and III. The duration of the daily exercise was progressively increased over 3 weeks. The final exercise bouts were 80 min for moderate and 180 min for intensive training programs. The circulating red cell volume (ml/100 g bone) of the humeral, femoral and tibial bones of the trained animals was lower compared to the controls in all three experiments mainly due to reduced hematocrit values. The circulating blood volume (ml/100 g bone) decreased in the tibial bones of the trained animals in experiment I and showed a decreasing tendency in experiment III, but no significant differences between the groups were observed in the humeral and femoral bones. Yet, when related to the volume of the bones the circulating blood volume (ml/100 ccm bone) was significantly higher in the femoral bones of the trained animals, while the changes in the humeral bones were negligible (experiment III). The results suggest that the vascularity of long bones is affected by physical training. The varying responses in different bones are perhaps due to the amount of mechanical stress during physical activity.     

Nutrient foramina in the shafts of lower limb long bones: Situation and number

Summary The location and number of the diaphysial dominant nutrient formina in 305 specimens of the human lower limb long bones were examined. The diaphysial nutrient formaina on the femur were located at between 26.7-84.4% of the total length; while on the tibia between 11.0-67.2%; and on the fibula between 29.8-67.8% of the total length. The number of the diaphysial nutrient formaina and their distribution on the faces of each bone was also studied.

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Les foramen nourriciers des diaphyses des os longs du membre inférieur : nombre et situation

Résumé La situation et le nombre des principaux trous nourriciers diaphysaires de 305 os longs de membres inférieurs humains ont été examinés. Sur une échelle allant de 0 à 100, partant de l'extrémité craniale de l'os, les trous nourriciers de la diaphyse fémorale sont localisés entre les points 26,7 et 84,4; au niveau du tibia, ces trous sont situés entre 11 et 67,2 et, enfin, au niveau de la fibula entre 29,8 et 67,8. Le nombre de ces trous nourriciers et leur distribution sur les différentes faces des os ont été également étudiés.