不同程度耻骨联合分离对骨盆后环应力分布影响的生物力学研究

Objective To evaluate the effect of different degrees of pubic symphysis diastasis on the stress distribution of posterior pelvic ring. Methods Eight embalmed pelvis and articulated proximal 1/3 of the femurs were harvested for this study. The samples were positioned as both legs standing straight and loaded to 600 N on the on the CSS-44020 biomechanical machine. The strain gages were adhered to 38 sites distributed symmetrically on the two sides of sacroiliac joint, anterior sacrum and posterior ilium. The strain gages were connected to WS3811 digital strainometer to record strain changes of the intact pelvic ring and at 1,2, 2.5 cm of pubic symphysis diastasis. Results Elastic changes occurred in the cortical bone of the pelvis under 600 N load. The symmetrical sites had similar strain changes without significant difference in the intact pelvic ring and at 1,2, 2.5 cm of pubic symphysis diastasis ( P ＞0.05 ). The sites with more strain changes were distributed on the iliofemoral arch in the intact pelvis.The strain changes were increased significantly frona the posterolateral sites to the iliofemoral arch. But the strain changes on the iliofemoral arch were decreased significantly during pubic symphysis diastasis.Conclusion The conduction of vertical load runs along the sacrofemoral arch in the intact pelvic ring and redistributes posterolaterally during pubic symphysis diastasis.     

锁定钢板治疗创伤性耻骨联合分离17例

目的 探讨锁定钢板内固定治疗耻骨联合分离的临床疗效及影像学结果.方法 回顾性分析自2007年12月至2009年12月行锁定钢板内固定治疗的耻骨联合分离17例,其中男11例,女6例;年龄23～65岁,平均45.3岁.骨折类型按Tile分类:B1型5例,B2型1例,B3型1例,C1型6例,C2型3例,C3型1例.耻骨联合分离全部采用锁定钢板固定,后环合并伤采用骶髂前路重建钢板固定7例,经皮骶髂螺钉固定3例,后路M型钢板固定3例.结果 耻骨联合部位手术时间0.5～2 h,平均1.5 h.术中出血50～600 ml,平均200 ml.住院时间14～62 d,平均21d.16例获得随访,随访时间6～30个月,平均16个月.骨盆骨折术后功能按照Majeed评分:优7例,良7例,可2例.结论 锁定钢板内固定治疗耻骨联合分离具有创伤小、操作简单、固定牢靠、并发症少等优点.对于Tile B型骨盆骨折,可以单纯固定前环,如果合并后环损伤、骨盆完全不稳,应该配合后环的复位与内固定.

Abstract：

Objective To investigate the clinical and radiographic outcome of traumatic pubic symphyseal diastases fixed with the locked plate. Methods From December 2007 to December 2009,17 patients(11 males,6 females,at mean age of 45.3 years)with pubic symphysis diastasis of unstable pelvic ring injuries were treated with open reduction and fixation with the locked plate.According to Tile classification system,five patients were with type B1 fractures,one with type B2,one with type B3,six with type C1,three with type C2 and one with type C3.All operations were performed under general anesthesia.Pubic symphyseal diastasis was treated by open reduction and fixation with the locked plate.There were 13 patients with associated posterior pelvic disruption,of which seven patients were treated by open reduction via anterior approach and fixed wich the reconstruction plates,three by close reduction and fixed with percutaneoua sacroiliac cannulated screws and three by posterior approach and fixed with M type plates. Results Of all the patients,16 patients were followed up for a mean time of 16 months(6-30months),which showed mean blood loss of 200 ml(50-600 ml)and mean hospital stay of 21 days (14-62 days).The clinical outcome was measured according to Majeed scores system,which showed excellent results in seven patients,good in seven and fair in two. Conclusions The locked plate fixation takes advantages of sailsfactory clinical outcomes with less operative trauma and a lower implant failure and wound infection rate in treatment of traumatic pubis symphysis diastasis.Locked plate fixation of symphysis call be performed alone when the posterior pelvic ring is only partially disrupted (Tile B).Posterior fixation construction should be used if the pelvic ring is under complete instability(Tile C).     

计算机导航引导下经皮置入骨盆及髋臼拉力螺钉技术的应用研究

Objective To simulate the process of lag screw insertion on intact pelvises under guidance of conventional fluoroscopes or 2D and Iso-C3D computer-assisted navigations and evaluate the accuracy and practicability of the computer-assisted navigation. Methods Six dried intact adult pelvic specimens were selected and divided into three groups randomly. A total of 54 hollow screws were placed in bilateral pedicles of S1 and S2, anterior column of bilateral acetabulum, anterior column of bilateral acetabulum and pubic symphysis of intact adult dried pelvic specimens of three groups under guidance of conventional fluoroscopy, 2D and Iso-C3Dcomputer assisted navigations, respectively. The accuracy of the screw positions, the average operating time of each screw insertion and the average time of radiation exposure during the insertion of each screw were compared among three groups. Results There were significant differences in the accuracy of the screw positions, the average operating time and the average time of radiation exposure among three groups (P＜0.01). The navigation with Iso-C3D appeared to provide the highest accuracy and the shortest operating time of all guidance techniques. The mean operating time and the average time of radiation exposure of the conventional fluoroscope were the longest among three groups. The average time of radiation exposure of the 2D computer-assisted navigation was the shortest.Conclusions Iso-C3D computer-assisted navigation is the most accurate and expeditious means of all guidance techniques. The time of radiation exposure can be significantly reduced by both 2D and Iso-C3D computer-assisted navigations.     

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

AIM: To investigate the frequency, typical and atypical locations and patterns of melanoma metastases identifiable by computed tomography (CT) in the abdomen and pelvis. METHODS: We performed a retrospective review of index CT examinations of the abdomen and pelvis in patients with melanoma and recorded all findings suggestive of metastatic disease. RESULTS: Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases. Pelvic metastases are more common with lower extremity primaries (accounting for 70% of cases with pelvic metastases) but 5% of patients with supraumbilical primaries also had pelvic metastases. CONCLUSION: The distribution of metastatic melanoma in the abdomen and pelvis that we have defined should help guide the interpretation of CT exams in these patients.     

胫骨平台后侧解剖型钢板治疗胫骨平台后侧骨折的生物力学研究

Objective To investigate the biomechanical properties of the posterior tibial anatomic plate. Methods A total of 25 fresh frozen adult tibial top and matching femur specimens were randomly divided into four groups. One specimen was used as normal control ( N group), and the remaining 24specimens were with Schatzker Ⅵ tibial plateau fracture and accompanied by rear split and backward fracture displacement. The lateral margin of the tibia was fixed with a L-type plate, and the medial margin was fixed with the same plate after remodeling. The 24 specimens were divided into three groups, eight specimens per group. The posterior margin of the tibia was fixed by posterior tibial anatomic plate ( Group A), T-type plate ( Group B) or straight reconstruction plate ( Group C). The strength, stiffness, torsional biomechanics and failure load performance of the plates in each group were evaluated. Results The strength and stiffness of test groups was superior to that of Group N ( P ＞ 0.05 ), and the torsional biomechanics of test groups was close to that of Group N ( P ＞ 0.05 ). The posterior tibial anatomic plate was superior to T-type plate and straight reconstruction plate in aspects of strength, stiffness, torsional biomechanics and failure load performance ( P ＜ 0.05 ). Conclusions Posterior tibial anatomic plate has excellent biomechanical properties, and it is superior to other materials in treating posterior tibial plateau fracture and restoring the stability of the knee.     

电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

电离辐射致股骨头坏死早期病理特点和机制的研究

Objective To observe the earlier pathological character and mechanism of radiation osteonecrosis in femoral head, in order to provide evidences for the earlier diagnosis and prevention of radiation osteonecrosis of femoral head. Methods Single femoral head of rats were irradiated singly with 30 Gy of 137 Cs γ-ray. The rats were executed after 2, 6 and 12 weeks, then the femurs were stained with HE and histopatholngical changes were observed by light microscope. The bone marrow mesenchymal stem cells (BMSCs) were cultured after 2 weeks and its proliferation and the colony formation were observed. The rats were endo-perfused with microfili contrast medium 12 weeks later, and the 3-dimensional structure of capillaries by Micro-CT was re-estabhshed to detect the pathological changes of capillaries after irradiation. Result The irradiated femur showed deranged cbondrocyte, decreased osteocyte, shrinking nucleus, increased empty bone lacuna and reduced bone trabocnla (P < 0.05). Micro-CT showed the discontinued small vessels and absence(6.65 %) capillaries in irradiated femur were obviously less than those of the unirradiated (12.3 %)(P < 0.001). The proliferation of BMSCs was slowed, the number of colony in irradiated group (10 %) was less than that of control (21 %) (P < 0.001). Conclusions The preliminary histopathological changes of osteoradionecrosis on femoral head could be increased the empty bone lacuna, and the bone lacuna above 30 % was the sign of the earlier period of osteoradionecrosis. The osteonecrosis of femoral head induced by radiation is not only correlated to the damages to the bone, but also to the damages to BMSCs and capillaries.     

32P-磷酸铬-聚 L-乳酸缓释粒子的制备及其放射性释出和生物分布

Objective The aim of this study was to prepare the 32P-chromic phosphate-poly(L-lac-tide) (32P-CP-PLLA) particles with different ratio of the materials and further examine their performance in-dex in vivo and in vitro and their intracorporeal distribution. Methods The erosion, degrading rates, de-layed release velocity and radioactivity self-absorption coefficient (RSAC) of 32P-CP-PLLA particles made from different materials were investigated and compared. After the implantation of 32P-CP-PLLA particles and the injection of 32P-CP colloids in the muscular tissues, the weight loss rate and the radioactivity release rate (RRR) of the particles were calculated. The intracorporeal distribution, radioactive half-life and bio-logical effect of 32P in the targeting sites were further studied. Statistical analysis was performed with SPSS 12.0, and one-way analysis of variance and t-test were used. Results 32P-CP-PLLA particles were of green cylinder, with regular shape and radionuclide distribution. The RSAC of the particles was of little re-lation with molecular weight of PLLA and proportional to the ratio of PLLA to CP. The extracorporeal release rate increased with the reduction of molecular weight of PLLA and with the increase of the ratio of PLLA to CP. The RRR reached peak when PLLA was 3 times of CP. The 32P-CP, released with the degradation and corrosion of the particle distributed mainly in the surrounding muscles of the particle. And the peak of per-centage activity of injection dose per gram of tissue (% ID/g) in liver, spleen and bone were 1. 7887, 1. 6401 and 1. 9470 respectively, much lower than that in the 32P-CP group (4.7523, 3.9712 and 4.3174 ; all t > 2.7, all P < 0.05). The % ID/g in other organs was much less. The radioactivity effective half-life in the targeting sites increased to about 13 d. There was widespread necrosis around the particles with no ex-istence of normal tissues among them. And no abnormality in spleen and liver was found. Conclusion As a better dosage form of pure β-particle emitter, 32P-CP-PLLA, which can increase the targeting radioactive dosage and effective half-life in the implanting sites, can be served as an potential implanting agent for onco-therapy with a better perspective.     

32P-磷酸铬-聚 L-乳酸缓释粒子的制备及其放射性释出和生物分布

Objective The aim of this study was to prepare the 32P-chromic phosphate-poly(L-lac-tide) (32P-CP-PLLA) particles with different ratio of the materials and further examine their performance in-dex in vivo and in vitro and their intracorporeal distribution. Methods The erosion, degrading rates, de-layed release velocity and radioactivity self-absorption coefficient (RSAC) of 32P-CP-PLLA particles made from different materials were investigated and compared. After the implantation of 32P-CP-PLLA particles and the injection of 32P-CP colloids in the muscular tissues, the weight loss rate and the radioactivity release rate (RRR) of the particles were calculated. The intracorporeal distribution, radioactive half-life and bio-logical effect of 32P in the targeting sites were further studied. Statistical analysis was performed with SPSS 12.0, and one-way analysis of variance and t-test were used. Results 32P-CP-PLLA particles were of green cylinder, with regular shape and radionuclide distribution. The RSAC of the particles was of little re-lation with molecular weight of PLLA and proportional to the ratio of PLLA to CP. The extracorporeal release rate increased with the reduction of molecular weight of PLLA and with the increase of the ratio of PLLA to CP. The RRR reached peak when PLLA was 3 times of CP. The 32P-CP, released with the degradation and corrosion of the particle distributed mainly in the surrounding muscles of the particle. And the peak of per-centage activity of injection dose per gram of tissue (% ID/g) in liver, spleen and bone were 1. 7887, 1. 6401 and 1. 9470 respectively, much lower than that in the 32P-CP group (4.7523, 3.9712 and 4.3174 ; all t > 2.7, all P < 0.05). The % ID/g in other organs was much less. The radioactivity effective half-life in the targeting sites increased to about 13 d. There was widespread necrosis around the particles with no ex-istence of normal tissues among them. And no abnormality in spleen and liver was found. Conclusion As a better dosage form of pure β-particle emitter, 32P-CP-PLLA, which can increase the targeting radioactive dosage and effective half-life in the implanting sites, can be served as an potential implanting agent for onco-therapy with a better perspective.     

32P-磷酸铬-聚 L-乳酸缓释粒子的制备及其放射性释出和生物分布

Objective The aim of this study was to prepare the 32P-chromic phosphate-poly(L-lac-tide) (32P-CP-PLLA) particles with different ratio of the materials and further examine their performance in-dex in vivo and in vitro and their intracorporeal distribution. Methods The erosion, degrading rates, de-layed release velocity and radioactivity self-absorption coefficient (RSAC) of 32P-CP-PLLA particles made from different materials were investigated and compared. After the implantation of 32P-CP-PLLA particles and the injection of 32P-CP colloids in the muscular tissues, the weight loss rate and the radioactivity release rate (RRR) of the particles were calculated. The intracorporeal distribution, radioactive half-life and bio-logical effect of 32P in the targeting sites were further studied. Statistical analysis was performed with SPSS 12.0, and one-way analysis of variance and t-test were used. Results 32P-CP-PLLA particles were of green cylinder, with regular shape and radionuclide distribution. The RSAC of the particles was of little re-lation with molecular weight of PLLA and proportional to the ratio of PLLA to CP. The extracorporeal release rate increased with the reduction of molecular weight of PLLA and with the increase of the ratio of PLLA to CP. The RRR reached peak when PLLA was 3 times of CP. The 32P-CP, released with the degradation and corrosion of the particle distributed mainly in the surrounding muscles of the particle. And the peak of per-centage activity of injection dose per gram of tissue (% ID/g) in liver, spleen and bone were 1. 7887, 1. 6401 and 1. 9470 respectively, much lower than that in the 32P-CP group (4.7523, 3.9712 and 4.3174 ; all t > 2.7, all P < 0.05). The % ID/g in other organs was much less. The radioactivity effective half-life in the targeting sites increased to about 13 d. There was widespread necrosis around the particles with no ex-istence of normal tissues among them. And no abnormality in spleen and liver was found. Conclusion As a better dosage form of pure β-particle emitter, 32P-CP-PLLA, which can increase the targeting radioactive dosage and effective half-life in the implanting sites, can be served as an potential implanting agent for onco-therapy with a better perspective.     

肿块深度对乳腺超声弹性成像检查结果的影响分析

目的探究超声弹性成像(UE)中肿瘤深度对于判断乳腺肿物的良、恶性影响。方法选取本院2017年1月~2018年10月间收治的178例因乳腺肿块行手术切除患者为观察对象,纳入病灶200个。依据肿瘤深度不同分4组。对所有的患者在术前均予以常规超声检查以及超声弹性成像检查,对比不同深度肿瘤的UE成像情况、分析诊断效能(准确度、特异度、灵敏度以及阴、阳性预测值),对比良恶性乳腺肿瘤UE成像检查的阳性率。结果诊断良性病灶114个、恶性病灶86个;D组成像效果与A、B、C组相比的UE成像效果更差(P<0.05);A组特异度与B、C、D组的对比差异有统计学意义(P<0.05);A组准确度显著高于D组,差异有统计学意义(P<0.05),UE成像技术对恶性病灶的诊断阳性率显著更高(P<0.05)。结论在乳腺超声弹性成像检查中,对于乳腺肿物的良、恶性成像质量,诊断的特异度与准确度均受到肿瘤深度的影响。     

Evaluation of the usefulness of the limited cone-beam CT (3DX) in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint

OBJECTIVES: The purpose of this study was to evaluate the usefulness of the limited cone-beam X-ray CT (3DX) (Morita Co., Japan) in measuring the thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty-one TMJs removed at autopsy from 21 cadavers were investigated macroscopically using dissection and 3DX imaging. A Digimatic Outside Micrometer and a 3DX-image tool were used to measure the minimum thickness of the RGF. Multiple measurements were made to identify the thinnest area. Once the thinnest areas had been identified, three linear measurements were made and the average value was used for statistical analysis. RESULTS: The average macroscopic examination measurement was 1.37 mm (range 0.55-3.6 mm) and the average 3DX image measurement was 1.22 mm (range: 0.51-3.0 mm). There was no significant difference between these two groups using the Mann-Whitney U-test (P < 0.05). The Spearman's correlation coefficient by rank between these two groups was r = 0.93(P < 0.001). CONCLUSION: These results suggest that bone thickness measurements of the RGF by 3DX imaging was effective.     

Tendinopathy of the tendon of the long head of the biceps

Pathologies of tendon of the long head of the biceps (LHB) are an important cause of shoulder pain. They include tendinopathy, rupture, superior labrum anterior and posterior lesions, pulley tears, and tendon instability. Conservative management of symptomatic LHB tendinopathy is commonly accepted as the first-line treatment. It consists of rest, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and physical therapy. Biceps tenotomy and tenodesis are the most common surgical procedures to manage both isolated LHB pathology and biceps-glenoid complex tears combined with rotator cuff tears. However, controversy persists about the superiority of one of them because there is no evidence of significant differences in functional scores or patient satisfaction between the 2 techniques. This article provides an overview on biomechanical function of the LHB and current strategies for treatment of LHB disorders.