外伤性髌骨关节内脱位并嵌入股骨外髁骨折端一例

外伤性髌骨关节内脱位为少见的脱位类型,髌骨关节内脱位疳嵌入股骨外髁骨折端目前报道极少。我院收治1例,疗效满意,现报告如下。     

椎间盘镜下等离子刀髓核消融的临床研究

目的：探讨、总结椎间盘镜下等离子刀髓核消融治疗腰椎间盘突出症的临床效果。方法：将150例腰椎间盘突出症患者随机分为两组分别进行微创椎间盘镜下髓核摘除术（MED）。A组：常规MED手术;B组：常规MED手术后,同时应用等离子刀对椎管内残余组织进行消融、皱缩,成形。随访最长12～24个月,平均18个月。分别于术后3、12个月进行疗效评定比较,并行CT复查。结果：B组临床疗效较A组有显著性差异（A组与B组术后3、12个月统计学χ2值分别为4.13、4.81;P〈0.05）,优于A组,CT影像学复查示B组优于A组。结论：椎间盘镜下等离子刀髓核消融治疗腰椎间盘突出症,较单纯的MED手术临床疗效好,是治疗腰椎间盘突出症的较佳选择。     

全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的疗效观察

目的 探讨全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的临床疗效.方法 将强直性脊柱炎髋关节骨性强直患者43例遵照知情同意原则随机分为观察组（23例）和对照组（20例）,分别采用全髋关节置换术与保守治疗,比较分析两组患者的临床疗效.结果 观察组患者的术后髋关节Harris评分及VAS疼痛评分均明显优于对照组,组间差异均有统计学意义（均P＜0.05）.两组优良率分别为91.3%、60.0%,差异有统计学意义（x2=4.328,P＜0.05）.结论 全髋关节置换术治疗强直性脊柱炎髋关节骨性强直的临床疗效佳,可以提高患者的生活质量,值得临床推广应用.     

基于3D打印股骨远端骨折标准件库接骨板的数字化内固定

BACKGROUND: On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fully meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE: To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtually. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during follow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. All patients were followed up. According to Schagzker criterion, the efficiency of 22 cases was excellent, 6 cases good and 2 cases average, and the excellent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via 3D printing navigation module is expected to achieve implant navigation and application.   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     

基于精确三维测量股骨干骨折髓内钉内固定的数字化设计及临床应用

背景：传统的髓内钉手术的局限性在于依赖医生的个人经验,而且扩髓会导致髓腔内生物学环境的破坏,影响骨的愈合。 目的：观察数字化技术辅助髓内钉内固定治疗股骨干骨折的疗效分析。 方法：2010 年1 月至2014 年1月莆田学院附属医院骨科收治股骨干骨折患者80 例,均应用数字化技术辅助治疗,术前建立股骨干骨折的三维数字模型,对三维数字骨折端进行虚拟复位,测量髓腔的直径,按测量数据选取合适规格的髓内钉,然后按照数字化技术制定的手术方案进行闭合复位髓内钉内固定治疗。 结果与结论：80例患者随访12-24个月,骨折全部获得骨愈合,随访12个月时按骨科临床疗效标准评价,优62例,良15例,可3例,优良率为96%。无感染、内固定物断裂或松动等并发症发生。提示,数字化技术辅助髓内钉内固定治疗股骨干骨折疗效确切,能明显缩短手术时间,减少手术创伤,减少患者和医护人员术中透视的放射量。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     

腰椎失稳症的中西医治疗概况

对近10年来腰椎失稳症的中西医治疗方法从治疗原则、非手术治疗、手术治疗3方面做一系统性综述,指出非手术与手术治疗均有临床疗效,各有优缺点。在临床上,治疗方法应根据患者具体症状、体征等进行选择。     

显微椎间盘镜手术的应用解剖学

目的　为MED手术操作提供解剖学依据。方法　 2 0具成人尸体标本 ,测量下 3个腰椎棘突下缘点与下位椎板上缘距离、椎板间隙外缘点与后正中线、椎间盘与椎板下缘的距离及其生理成角。结果　L3 、L4、L5的棘突下缘点与下位椎板上缘关系及其椎间盘与相应椎板下缘关系均有位于其上方、下方和持平 3种 ,椎板间隙外缘点距后正中线平均 1 1～ 1 5cm。矢状面上 ,L3、4、L4、5和L5S1椎间盘多呈 8 5°± 4°、 11°± 6 3°和 2 7 8°± 6 9°的头倾角 ;工作通道外展角 ,L3、4为 13°± 3°,L4、5为17°± 3 5°,L5S1为 2 8 8°± 6 3°。结论　棘突下缘点可作为MED手术切口中心点 ,工作通道放置角度应与椎间盘的生理倾角相符。     

125Ⅰ粒子前列腺永久性组织间植入治疗前列腺癌的临床观察

目的：探讨直肠超声引导下经会阴植入^125I粒子近距离放疗治疗前列腺癌的临床效果。方法：对12例前列腺癌患者采用直肠超声引导下植入^125I粒子近距离放疗的情况进行回顾分析。结果：12例患者均手术成功，术后3个月血清PSA浓度值均已下降至正常水平，术后3个月复查直肠超声全部病人前列腺肿瘤缩小。结论：^125I粒子前列腺永久性组织间植入治疗前列腺癌，患者创伤痛苦小，并发症少，术后恢复快，疗效确切，值得临床推广应用。     

3D打印导航模块辅助腰椎弓根螺钉数字化置入的实验精度

目的:探讨3D打印导航模块技术辅助下实施腰椎椎弓根螺钉置人数字化设计的实验精度及准确度的评价方法,探讨影响准确度的关键技术。方法:14具成人尸体腰椎标本,经过薄层CT扫描,三维编辑分离椎骨,按照钉道对称原则设计钉道,根据骨面可剥离范围设计具有定位面及稳定面的导航模块,高精度3D打印导航模块,在尸体标本上实施导航模块辅助下腰椎椎弓根螺钉置入。术后腰椎与术前设计进行三维配准,采集术前设计以及术后螺钉的钉道的进、出钉点三维坐标值,以其差值的绝对值为实验精度指标,统计不同等级精度下的合格钉点,设计组和手术组进行卡方检验。结果:128根腰椎椎弓根螺钉无1例穿出骨质外。进钉点X、Y、Z轴精度分别为0.60 mm±0.44 mm、0.66 mm±0.64 mm及0.48 mm±0.36 mm,出钉点则为1.13 mm±0.82 mm、0.51 mm±0.44 mm及0.67 mm±0.62 mm。结论:腰椎椎弓根螺钉数字化置入的精度可用术前设计和术后的进、出钉点的三维坐标值的差值绝对值衡量,实施的准确度可以用不同等级精度评判;根据骨面可剥离范围设计具有定位面以及稳定面的卡位模块,可实现术中唯一卡位位置;钉道对称是手术设计及实施都要遵循的原则。