经椎弓根植骨内固定治疗胸腰椎骨折的临床分析

目的分析经椎弓根植骨内固定治疗胸腰椎骨折的临床效果。方法治疗组经病椎椎弓根植骨及TSRH、CD、AF内固定系统治疗胸腰椎骨折52例;对照组用TSRH、CD、AF内固定系统加单纯后外侧植骨治疗胸腰椎骨折24例。根据手术前后椎体前缘高度的变化及Cobb角的矫正程度比较两组的疗效。结果治疗组在改善椎体前缘高度及Cobb角的矫正程度方面均优于对照组。结论经椎弓根植骨内固定治疗胸腰椎骨折能有效防止术后矫正度的丢失和减少并发症的发生。     

后路短节段固定结合伤椎固定经椎弓根植骨治疗胸腰段骨折

[目的]探讨后路短节段结合伤椎椎弓根钉固定加伤椎经椎弓根植骨治疗胸腰段脊柱骨折的临床疗效。[方法]对本院2003~2007年收治的胸腰段骨折治疗进行回顾,总共随访到96例病例。28例采用单纯后路短节段椎弓根螺钉复位固定,68例患者采用短节段固定结合单侧伤椎螺钉固定结合经椎弓根植骨,其中38例植骨材料为人工骨,30例为自体髂骨植骨。按照美国脊柱创伤研究组提出的胸腰椎损伤严重性评分标准(thoraco lumbar injury severityscore,TLISS)分别对各组病例进行评分,术前、术后以及随访期间正侧位X线片,测量伤椎椎体前后缘高度,胸腰段后凸Cobb′s角,前后椎体高度比,应用SPSS 11.0进行统计学分析。[结果]术后平均随访16.8个月(12~20个月),所有骨折复位效果满意。单纯后路短节段固定比经椎弓根植骨结合后路短节段固定组高度丢失多,术后Cobb′s角的矫正能力差,应用人工骨与自体骨植骨组间无明显差异。[结论]经椎弓根植骨结合后路短节段固定加伤椎固定重建了椎体的高度,增加了脊柱前柱稳定性,可有效的防止内固定失败和矫正度丢失,是一种治疗胸腰段骨折的有效方法。     

经椎弓根植骨治疗胸腰椎爆裂骨折的对照研究

目的探讨经伤椎椎弓根椎体植骨在胸腰椎爆裂骨折中的作用和疗效。方法采用经伤椎椎弓根椎体植骨，GSS-Ⅱ型系统复位、内固定治疗胸腰椎爆裂骨折22例，并与前期（2004年前）及同期未行椎弓根植骨的胸腰椎爆裂骨折26例作对照研究。术前、术后及随访时行X线及CT检查，观察椎体高度及矫正Cobb角有无丢失，内固定有无断裂、松动情况发生。结果治疗组全部病例获得随访，无一例发生内固定断裂、松动，治疗组与对照组在远期椎体高度丢失率、矫正后凸Cobb角丢失度方面有显著性差异。结论胸腰椎爆裂骨折经伤椎椎弓根椎体植骨、GSS一1型内固定后，可恢复伤椎椎体高度，重建前中柱的稳定性，防止术后远期椎体高度和矫正Cobb角的再丢失以及内固定的松动、断裂。     

后路椎弓根钉内固定结合椎弓根植骨治疗胸腰椎爆裂性骨折的临床疗效观察

[目的]探讨后路椎弓根钉内固定结合椎弓根植骨治疗胸腰椎爆裂性骨折的方法和疗效。[方法]对56例胸腰椎爆裂性骨折患者行后路椎弓根钉内固定并椎弓根植骨,术前、术后及随访时测量椎体前后缘高度、Cobb后凸角,观察腰背部疼痛、胸腰段活动度、终板完整性及神经功能的变化。[结果]随访24~60个月,椎体高度无明显丢失,后凸畸形无加重,无椎间隙塌陷,无内固定物松动、断裂和游离,终板结构完整,胸腰段活动度好。[结论]后路椎弓根钉内固定结合椎弓根植骨治疗胸腰椎爆裂性骨折能重建脊柱前中柱稳定性,防止远期椎体高度及矫正角度的再丢失,维持脊柱的整体生物力学平衡。     

经椎弓根内固定椎体植骨治疗胸腰椎骨折初步报告

目的:提高胸腰椎骨折手术治疗的植骨融合率,防止术后矫正度丢失。方法:对34例胸腰椎骨折患者行手术整复,应用椎弓根内固定、经病椎椎弓根行椎体植骨及后外侧植骨治疗。结果:术后1周X线片示伤椎椎体前缘高度由术前的平均20mm恢复至平均35mm,占上下椎体平均高度的94.5%;后凸Cobb角(病椎术后上下终板连线的夹角)由术前的平均27°矫正至平均4.5°。23例术后6个月以上的患者Cobb角丢失不超过1°,椎体前缘高度丢失不超过2mm,椎体植入骨碎块全部成活,有骨小梁形成。结论:经椎弓根内固定椎体植骨治疗胸腰椎骨折植骨融合率高,能有效防止术后矫正度丢失。     

椎弓根钉固定结合植骨治疗胸腰椎骨折

目的探讨椎弓根钉固定结合植骨治疗胸腰椎骨折的临床疗效。方法应用椎弓根钉固定结合植骨治疗27例胸腰椎骨折,经椎弓根植骨12例,经横突间植骨15例。术后及术后1年摄X线片,测量伤椎前缘高度变化及Cobb角矫正程度的丢失,评价疗效。结果伤椎前缘高度恢复程度及Cobb角的矫正程度,两种方法术后即刻无显著差异,术后1年,经椎弓根植骨变化不明显,横突间植骨变化明显,存在明显差异。结论椎弓根钉固定并经椎弓根植骨可有效维持伤椎前缘高度及减少内固定失效。     

经皮椎弓根钉固定并双侧椎弓根植骨治疗胸腰椎骨折

目的 评价采用经皮椎弓根钉固定并双侧椎弓根植骨治疗胸腰椎骨折的临床疗效.方法 对47例无脊髓神经损伤的胸腰椎骨折采用经皮椎弓根钉固定并伤椎双侧椎弓根植骨治疗.结果 47例术中出血量平均为110 ml,平均手术时间83 min,椎体前缘高度比恢复至91％,Cobb角恢复至5.2°.术后未发生内固定松动、断裂、矫正明显丢失等并发症.结论 经皮椎弓根钉固定并双侧椎弓根植骨技术具有创伤小、操作方便、有效恢复椎体高度、减少内固定失败及矫正丢失等优点.     

经椎弓根植骨内固定治疗胸腰椎爆裂性骨折体会

目的总结应用经伤椎椎弓根置钉内固定结合椎体内植骨治疗胸腰椎爆裂性骨折的临床体会。方法对32例胸腰椎爆裂性骨折患者采用经椎弓根植骨内固定治疗,回顾性分析患者的临床资料。结果术后随访12~24个月,术后1个月及12个月患者椎体前缘较术前明显增加、Cobb角较术前明显改善,差异均有统计学意义(P0.05)。复查CT显示伤椎椎管减压充分,椎体内植骨块融合良好。未出现内固定松脱断裂、椎体前缘高度及Cobb角矫正丢失等病例。根据Frankel神经功能恢复评定标准,术前有神经功能损伤患者末次随访时均有1~2级的恢复。结论经伤椎椎弓根置钉内固定结合椎体内植骨治疗胸腰椎爆裂性骨折,植骨融合良好,并发症少,伤椎高度和脊柱生理曲度恢复满意。     

椎弓根钉内固定并不同植骨方法治疗胸腰椎爆裂性骨折临床分析

[目的]通过对椎弓根钉内固定结合不同植骨方法治疗不同程度胸腰椎爆裂性骨折的疗效及其影响因素的分析,探讨椎体植骨的适应证和必要性.[方法]通过104例病例回顾分析,根据影像学结果,比较经椎弓根椎体内植骨、椎板间植骨和单纯内固定无植骨的术后即时及随访时的临床效果.[结果]椎体压缩≤Ⅱ度时经椎弓根椎体内植骨组椎体前、后缘高度,后凸成角较术前矫正良好,但与椎板间植骨组和单纯内固定无植骨组比较不具有统计学差异(P＞0.05).椎体压缩≥Ⅲ度时经椎弓根椎体内植骨组椎体前、后缘高度,后凸成角较术前矫正良好,并且与椎板间植骨组和单纯内固定无植骨组比较具有统计学差异(P＜0.05).[结论]经椎弓根椎体内植骨与其他植骨方法比较能即时增加椎体骨容量和脊柱前中柱的抗压稳定性,有效填充严重压缩导致的椎体内骨缺损,防止远期矫形丢失及内固定失效.     

经椎弓根植骨后路内固定治疗老年胸腰椎爆裂骨折

目的探讨经椎弓根植骨后路内固定治疗老年人胸腰椎爆裂性骨折的临床疗效。方法对21例老年人胸腰椎爆裂性骨折的患者行经椎弓根植骨后路内固定手术,术前、术后及随访时测量伤椎前缘高度与正常高度的比值、后凸Cobb角,了解神经功能改变及腰背疼痛变化。结果术后伤椎前缘高度与正常高度的比值、后凸Cobb角恢复满意。随访12-36个月（平均22.4个月）,无断钉及内固定物松动,伤椎前缘高度与正常高度的比值、后凸Cobb角无明显再丢失,神经功能及腰背疼痛明显改善。结论经椎弓根植骨后路内固定治疗老年人胸腰椎爆裂性骨折可重建脊柱前、中柱的稳定性,防止后期矫正角度及椎体高度的再丢失。     

Osteogenesis after Bone and Bone Marrow Transplantation: II. The Initial Cellular Events Following Transplantation of Decalcified Allografis of Cancellous Bone

An experimental study was done in rabbits to investigate the fate of allogeneic iliac cancellous bone, both non-decalcified and decalcified with hydrochloric acid, transplanted to a muscular site for up to 14 days. Some of the treated allografts were impregnated with autologous bone marrow cells, obtained from the femoral medulla by aspiration, and each was compared with allografts alone. Combined myelo-osseous grafts produced bone after 7 to 8 days implantation, as did marrow autografts alone. In addition non-decalcified implants stimulated the production of multinucleated giant cells. Three different types of wash solution were used but these did not influence the cell population seen, nor the new bone formation. It is concluded that the critical events in bone formation after transplantation occur less than 8 days after the transplantation and that marrow cells have osteogenic capacity. This has relevance to the clinical aspects of bone grafting.     

Bone cement with reduced proportion of monomer in total hip arthroplasty: Preclinical evaluation and randomized study of 47 cases with 5 years' follow-up

Bone cement with reduced amount of monomer and low curing temperature may improve implant fixation due to reduced toxicity. We analyzed the mechanical, chemical and thermal properties of such a cement (Cemex Rx) using Palacos R as control. The in vivo performance of the 2 cements was also evaluated in a prospective randomized study of 47 hips, where either of the cement types was used to fixate Lubinus SP2 prostheses with the stem made of titanium alloy. Cemex Rx had a reduced tensile strength, probably because this cement was manually mixed, as recommended by the manufacturer. A standardized laboratory test showed lower curing temperature for Cemex, but measurements at 37° and with prechilled Palacos R and Cemex Rx, as in clinical work, showed no difference. In the clinical study radiostereometric measurements of cup and stem migration showed similar values in the 2 groups up to 5 years after the operation. The cement mantle was stable in both groups, but the stems migrated similarly inside the cement mantle regardless of the type of cement used. Proximal wear was low (0.04-0.05 mm/year) and tended to be lower in the Cemex group (p = 0.02). Aluminum and vanadium levels in serum increased 5 years after the operation, but no difference was noted between the 2 groups. Collagen markers (PICP, ICTP) showed similar increases in bone turnover 6 weeks and 6 months after operation in both groups.     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月，笔者共收治28例骨囊肿患者，均采用病灶刮除，瘤腔灭活和重组合异种骨植骨治疗，获得满意疗效，体会如下。     

Building better bone: The weaving of biologic and engineering strategies for managing bone loss

Segmental bone loss remains a challenging clinical problem for orthopaedic trauma surgeons. In addition to the missing bone itself, the local tissues (soft tissue, vascular) are often highly traumatized as well, resulting in a less than ideal environment for bone regeneration. As a result, attempts at limb salvage become a highly expensive endeavor, often requiring multiple operations and necessitating the use of every available strategy (autograft, allograft, bone graft substitution, Masquelet, bone transport, etc.) to achieve bony union. A cost‐sensitive, functionally appropriate, and volumetrically adequate engineered substitute would be practice‐changing for orthopaedic trauma surgeons and these patients with difficult clinical problems. In tissue engineering and bone regeneration fields, numerous research efforts continue to make progress toward new therapeutic interventions for segmental bone loss, including novel biomaterial development as well as cell‐based strategies. Despite an ever‐evolving literature base of these new therapeutic and engineered options, there remains a disconnect with the clinical practice, with very few translating into clinical use. A symposium entitled “Building better bone: The weaving of biologic and engineering strategies for managing bone loss,” was presented at the 2016 Orthopaedic Research Society Conference to further explore this engineering‐clinical disconnect, by surveying basic, translational, and clinical researchers along with orthopaedic surgeons and proposing ideas for pushing the bar forward in the field of segmental bone loss. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1855–1864, 2017.

     

The benefit of bone marrow concentrate in addition to a glass‐reinforced hydroxyapatite for bone regeneration: An in vivo ovine study

This study evaluates the ability of a Glass Reinforced Hydroxyapatite Composite (GRHC), in a new microporous pellet formulation with autologous bone marrow concentrate (BMC), to enhance bone regeneration and new bone formation. Ninety non‐critical sized bone defects were created in the femurs of nine Merino breed sheep and randomly left unfilled (group A), filled with GRHC pellets alone (group B) or filled with GRHC pellets combined with BMC (group C). The sheep were sacrificed at 3 weeks (three sheep), 6 weeks (three sheep) and 12 weeks (three sheep) and histological analysis (Light Microscopy‐LM), scanning electron microscopy (SEM) and histomorphometric analysis (HM) were performed. At 3, 6, and 12 weeks, HM revealed an average percentage of new bone of 48, 72, 83%; 25, 73, 80%, and 16, 38, 78% for Groups C, B and A respectively (significantly different only at 3 weeks p < 0.05). LM and SEM evaluation revealed earlier formation of well‐organized mature lamellar bone in Group C. This study demonstrates that the addition of a bone marrow concentrate to a glass reinforced hydroxyapatite composite in a pellet formulation promotes early bone healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1176–1182, 2017.

     

Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: An HR‐pQCT study

Bone is a complex structure with many levels of organization. Advanced imaging tools such as high‐resolution (HR) peripheral quantitative computed tomography (pQCT) provide the opportunity to investigate how components of bone microstructure differ between the sexes and across developmental periods. The aim of this study was to quantify the age‐ and sex‐related differences in bone microstructure and bone strength in adolescent males and females. We used HR‐pQCT (XtremeCT, Scanco Medical, Geneva, Switzerland) to assess total bone area (ToA), total bone density (ToD), trabecular bone density (TrD), cortical bone density (CoD), cortical thickness (Cort.Th), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular spacing standard deviation (Tb.Sp SD), and bone strength index (BSI, mg²/mm⁴) at the distal tibia in 133 females and 146 males (15 to 20 years of age). We used a general linear model to determine differences by age‐ and sex‐group and age × sex interactions (p < 0.05). Across age categories, ToD, CoD, Cort.Th, and BSI were significantly lower at 15 and 16 years compared with 17 to 18 and 19 to 20 years in males and females. There were no differences in ToA, TrD, and BV/TV across age for either sex. Between sexes, males had significantly greater ToA, TrD, Cort.Th, BV/TV, Tb.N, and BSI compared with females; CoD and Tb.Sp SD were significantly greater for females in every age category. Males' larger and denser bones confer a bone‐strength advantage from a young age compared with females. These structural differences could represent bones that are less able to withstand loads in compression in females. © 2010 American Society for Bone and Mineral Research     

感染性骨缺损的治疗及研究进展

感染性骨缺损由于存在感染及骨缺损双重病变,治疗棘手,疗程长,且易出现肌肉萎缩、局部瘢痕而致肢体功能受到严重影响.近年来随着外固定技术、显微外科技术、生物材料技术及骨组织工程技术等的发展,感染性骨缺损的治疗取得明显进步,短缩了治疗时间,且效果显著,笔者对其研究进展综述如下.     

Oxyphenbutazone (Tanderil®) in Surgery for Herniated Discs: A Double Blind Trial

Background and purpose In detection of glenoid labrum pathology, MR arthrography (MRA) has shown sensitivities of 88-100% and specificities of 89-93%. However, our practice suggested that there may be a higher frequency of falsely negative reports. We assessed the accuracy of this costly modality in practice.

Patients and methods We retrospectively reviewed MRA reports of 90 consecutive patients with clinical shoulder instability who had undergone shoulder arthroscopy. All had a history of traumatic anterior shoulder dislocation and had positive anterior apprehension tests. All underwent arthroscopy and stabilization during the same procedure. We compared the findings, using arthroscopic findings as the gold standard in the identification of glenoid labrum pathology.

Results 83 of the 90 patients had glenoid labrum tears at arthroscopy. Only 54 were correctly identified at MRA. All normal glenoid labra were identified at MRA. This gave a sensitivity of 65% and a specificity of 100% in identification of all types of glenoid labrum tear. 74 patients had anterior glenoid labral tears that were detected at an even lower rate of sensitivity (58%).

Interpretation The sensitivity of MRA in this series was substantially lower than previously published, suggesting that MRA may not be as reliable a diagnostic imaging modality in glenohumeral instability as previously thought. Our findings highlight the importance of an accurate history and clinical examination in the management of glenohumeral instability. The need for MRA may not be as high as is currently believed.     

The Penetration of Lincomycin into Normal Human Bone: Determinations of Penetration into Compact Bone, Spongy Bone and Bone Marrow

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum.