几丁糖凝胶预防骨感染的实验研究

为了观察几丁糖凝胶对骨感染的影响，按Ｎｏｒｄｅｎ法制作兔金黄色葡萄球菌骨髓炎模型，随机分为几丁糖组、醋酸组及对照组，观察术后动物一般情况、Ｘ线片表现、骨培养及细菌计数。结果显示：几丁糖组骨感染率与其它两组无差别，但术后动物体重增加，Ｘ线片上病变程度减轻，细菌计数减少，明显优于其它两组。证明几丁糖对骨感染有一定的缓解作用。其原因可能与几丁糖具有抑菌作用、提高动物免疫机能及体内降解缓慢有关。     

Co and Cr accumulation in hair after metal-on-metal hip resurfacing arthroplasty

Background: Currently, it is unclear whether Co and Cr levels are persistently elevated in the body after hip resurfacing arthroplasty (HRA). This study aimed to evaluate Co and Cr levels in the body after HRA using hair as samples. Methods: Among 22 patients who had metal‐on‐metal HRA (m‐o‐m group) using the DePuy ASR system, scalp hair of 1.5 cm in length and 2 g in weight was collected before and at 6 and 12 months after surgery. Inductively coupled plasma‐mass spectrometry (ICP‐MS) was used to detect Co and Cr levels in the scalp hair. Another 22 patients with total hip replacements were randomly selected from a similar age range as controls (m‐o‐p group). Metal levels in hair were detected with multiple measurements and analysed by repeated measures analysis of variance. Results: Both Co and Cr levels were significantly increased in the m‐o‐m group after surgery compared with those in the m‐o‐p group (P < 0.01). Co levels at 6 months post‐operatively were 12‐fold those before surgery, and Co levels 12 months post‐operatively were lower than those at 6 months, but this difference was not significant (P= 0.0805) between the two time points in the m‐o‐m group. Cr levels were persistently elevated after surgery and were increased by 10‐fold compared with those at baseline in the m‐o‐m group. Conclusions: Co and Cr levels in scalp hair are ideal indicators for metal levels in the body after HRA. Co and Cr levels in the body were greatly increased after metal‐on‐metal HRA. Long‐term accumulation of these metals needs to be further investigated.     

胸腰椎爆裂性骨折的诊断

本文对114例120处胸腰椎爆裂性骨折进行回顾性分析。所有病例均摄胸腰椎X线片,94例行CT扫描,74例行MRI检查。结果共有27处骨折被误诊,占22.5％。作者认为,X线片常不能准确反映爆裂性骨折的病理特征,对于胸腰椎骨折应常规行CT扫描,必要时应同时行MRI检查,诊断中应注意将爆裂性骨折与压缩性骨折相鉴别。     

Radiographic evaluation of Baumann angle in Chinese children and its clinical relevance.

Normal Baumann angles in 98 children aged 2 to 13 years and abnormal Baumann angles in 71 children with supracondylar humeral fractures were evaluated. In healthy children, Baumann angles ranged from 64 degrees to 80 degrees (72.4 degrees +/- 4.6 degrees) in boys and from 65 degrees to 81 degrees (72.9 degrees +/- 5.9 degrees) in girls. A significant negative relation (P < 0.01) between Baumann angle and carrying angle was noted, but there were no significant differences in Baumann angles between boys and girls (P > 0.05) and no significant correlation of Baumann angle with increasing age (P > 0.05). In patients with fractures, the Baumann angle measured after immediate reduction correlated well with the carrying angle measured after union or at final follow-up (P < 0.01). This angle measured after reduction may be used to predict the final carrying angle so that cubitus varus deformity can be effectively prevented.     

腰椎间盘突出症患者的下肢压痛点及其临床意义

目的：研究腰椎间盘突出症患者的下肢压痛点并探讨其临床意义。方法：检查１７４名腰椎间盘突出症患者下肢臀中肌,臀大肌,股四头肌,股二头肌。半腱半膜肌,胫骨前肌,腓肠肌内侧头和腓肠肌外侧头以及坐骨神经,胫神经共计１０个压痛点。结果：１２７名患者（７３％）存在下肢压痛点,但Ｌ４－５椎间盘突出与Ｌ５－Ｓ１突出患者的阳性率无显著差别（Ｐ〉０．０５）,压痛点总数与年龄成正相关（Ｐ〈０．０５）,与直腿胎高试验阳性     

交锁髓内钉在治疗肱骨干骨折中对肩关节功能的影响

目的　报告 1996～ 1998年间应用多种型号的交锁髓内钉治疗肱骨干骨折 2 5例的疗效。方法　对肱骨干骨折 2 5例采用交锁髓内针治疗。得到随访 2 1例。随访时间 8～ 32个月 ,平均 17个月。伤者年龄 18～ 70岁 ,平均 39岁。骨折类型 :横断形9例 ,粉碎形 2例 ,斜形 5例 ,螺旋形 5例。肱骨上 1/3骨折 4例 ,中 1/3骨折 16例 ,下 1/3骨折 1例。结果　按Neer评分法测定肩关节功能 ,13例 (6 2 % )合并有不同程度的功能障碍。结论　认为目前的交锁髓内针在治疗肱骨干骨折时会损伤到肩袖 ,因此在选用时应慎重。     

枕颈部畸形减压和植骨融合术远期疗效评价(10年以上随访)

目的探讨枕颈部发育畸形及脊髓压迫症应用枕颈后路手术减压和植骨融合术的远期疗效及评价。方法对114例枕颈部畸形及其不稳实施寰椎后弓和 /或枕骨大孔后缘切除扩大减压 ,并采用自体髂骨作枕骨与第二颈椎棘突基底部间植骨融合固定 ,并进行 10年以上随访。结果　 114例中 ,10 2例获得骨性愈合 ,4例因移植骨骨折致畸形愈合 ,8例移植骨吸收并形成假关节 ;脊髓功能 95例明显恢复 ,14例无明显改善 ,5例手术后病情继续加重。结论枕颈部扩大减压和自体髂骨移植治疗枕颈部畸形及不稳 ,经 10年以上临床观察 ,对枕颈稳定和功能恢复以及头颈运动功能保存有良好作用 ,本项技术是一种有效的治疗方法。     

应用多线结构钛缆行喙锁间固定术后锁骨应力性骨折：个案报道

Acromioclavicular （AC） dislocations are common shoulder injuries. The classic mechanism of injury to AC joint is direct trauma caused by falls or blows to acromion with the arm abducted. According to Tossy et al,1 the degrees of AC dislocations are classified into types Ⅰ, Ⅱ, and Ⅲ. Tossy Ⅰ and Ⅱ are incomplete dislocations. Tossy Ⅲ is a complete dislocation with complete disruption of the AC and coracoclavicular （CC）ligaments, accompanied by marked upward migration of the lateral end of the clavicle. Typically, surgical treatment is needed for patients with Tossy Ⅲ.     

Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation

Purpose

The most appropriate procedure for surgical treatment of severe acromioclavicular (AC) joint dislocation was still not clear. The purpose of this study is to evaluate the outcomes of coracoclavicular (CC) reconstruction with ligament augmentation and reconstruction system (LARS) artificial ligaments for the treatment of acute complete AC joint dislocation.

Methods

Twenty-four patients (16 male and 8 female, ages ranged from 21 to 45) with acute complete AC joint dislocations were treated with CC reconstruction using LARS artificial ligaments. All these dislocations were unstable injuries. Clinical evaluation was used by the Constant scores and VAS. The radiographic evaluation consisted of Zanca radiographs for bilateral AC joint and axillary radiographs for the injured shoulder.

Results

All patients had follow-up times of 36 months (range 6–60). The Constant scores rose from 62.3 ± 6.9 preoperatively to 94.5 ± 9.3 at final evaluation (P < 0.05). Preoperative VAS scores were 5.1 ± 1.7, and the VAS scores at the last review were 0.7 ± 1.4 (P < 0.05). Follow-up radiographs showed anatomical reduction in 20 patients and slight loss of reduction in 4 patients. Calcification of CC ligament in 4 patients, degenerative change around the AC joint in 2 patient and clavicular osteolysis around screws in one patient were found.

Conclusions

LARS artificial ligament for reconstruction of CC can provide immediate stability and allow early shoulder mobilization with good functional results and few complications. This procedure was an effective and safe method to treat grade III and more AC joint dislocations.

Level of evidence

IV.