骨折内固定表面抗生素涂层的体外观察研究

目的 研究内固定表面聚消旋乳酸(PDLLA)结合庆大霉素涂层的体外特性,包括涂层的定量、机械稳定性、无菌性和药物释放特性.方法 应用电子半微量天平和扫描电镜测定涂层的质量与厚度.通过髓腔内的插拔试验确定涂层的机械稳定性.用细菌培养的方法确定涂层过程是否无菌.最后将涂层克氏针浸泡在磷酸盐缓冲溶液中,应用称重法测定涂层在不同时间段的重量损失及用ELISA法测定溶液中释放出的抗生素浓度.结果 涂层的平均重量为(7.2±0.9)mg,涂层的厚度为(13.5±1.7)μm.插拔试验测定涂层的重量损失为(3.5±1.3)%,扫描电镜证明插拔试验后,内固定表面的涂层都是完整、规则的.所有样本在经过血培养及胰蛋白酶培养后均未发现细菌生长.在6周时涂层的重量减少约6.4%.在最初的4 h内庆大霉素呈爆发性释放,之后缓慢而稳定地释放,并且释放可以至少持续6周.结论 内固定表面的PDLLA结合庆大霉素的抗生素涂层具备手术操作所需要的机械稳定性和无菌性.     

Surgical resection of severe heterotopic ossification after open reduction and internal fixation of acetabular fractures: A case series of 18 patients

Objective

To evaluate the clinical results of surgical resection of severe heterotopic ossification (HO) after the open reduction and internal fixation (ORIF) of acetabular fractures.

Methods

A retrospective chart review was performed between October 2005 and November 2010 on patients undergoing severe HO resection following an acetabular fracture ORIF. Our primary outcome was functional status evaluated by the Harris hip score (HSS). HO resection and hip release was performed using a Kocher–Langenbeck approach in all cases, and a combined radiation and indomethacin regimen was used to prevent HO recurrence. Plain radiographs were also used to evaluate the hip joint for arthritic changes and HO recurrence.

Results

A total of 18 patients (17 males and 1 female) were included in our study analysis. The mean patient age was 36.8 (range: 22–54 years old) when HO resection surgery was performed. The mean time interval between acetabular fracture ORIF and HO resection was 9.9 months (range: 3–30 months): it was within 6 months in 7 patients, 6–12 months in 8 patients, and >12 months in 3 patients.The HO was graded as Brooker grade III in 8 patients and grade IV in 10 patients. The mean time interval between HO resection and the latest follow-up was 4.5 years (range: 2.1–7.8 years). The mean Harris hip score (HHS) was 84.5 (range: 38–100), with a clinical outcome rating of excellent in 9 patients, good in 3 patients, fair in 4 patients, and poor in 2 patients (good and excellent rating accounted for 66.7%). The mean hip joint motion arc was 194° (range: 90–260°).Complications included one intraoperative femoral neck fracture, 1 sciatic nerve injury, 2 femoral head avascular necrosis, and 6 mild HO recurrences (33.3%). There was 28.6% recurrence if HO resection was within 6 months and 36.4% if >6 months. There were no cases of severe HO recurrence, wound infections, deep vein thrombosis, or pulmonary embolism.

Conclusion

The early surgical resection of severe HO after an acetabular fracture ORIF can provide satisfactory results, however the complication rate is relatively high.     

钢板内固定加植骨治疗肱骨干骨折术后骨不愈合的疗效分析

目的评价钢板内固定结合自体松质骨植骨治疗肱骨干骨折术后骨不愈合的疗效。方法2002年2月～2004年12月对41例肱骨干骨折术后骨不愈合患者均采用钢板内固定结合自体松质骨植骨治疗。其中男32例,女9例；平均年龄37．5岁(17～67岁)。骨不愈合类型：肥大型16例,萎缩型25例。结果所有患者获平均22．6个月(8～42个月)随访。40例(97．6%)患_者骨折愈合,骨折愈合时间平均为5．8个月(3～12个月)。并发症：桡神经损伤3例,伤口感染1例,骨折不愈合1例。最终随访时,肩关节和肘关节功能恢复满意。结论对于肱骨干骨折术后骨不愈合的患者,采用钢板内固定加自体松质骨植骨治疗是有效的方法。     

加速康复外科理念下跟骨关节内骨折诊疗规范专家共识

跟骨骨折是最常见的后足骨折,通过国内外医师学者的长期研究,其在诊治方面有了长足的进步。近年来,加速康复外科(ERAS)理念的引入,更加规范了跟骨骨折围手术期的处理流程,有助于提高治疗效果,改善患者治疗体验。本共识以ERAS理念为指导,以循证医学证据为基础,经全国创伤骨科专家讨论形成。本共识从多模式镇痛、术前宣教、围手术期饮食管理、手术微创操作等ERAS涉及的多个方面进行推荐,为治疗此类骨折提供参考。     

老年股骨转子间骨折诊疗指南

老年股骨转子间骨折是一种常见且严重的骨质疏松性髋部骨折,致死、致残率高。近年来,国际上在老年股骨转子间骨折的诊疗方面有很多的研究和进展,加速康复外科(enhanced recovery after surgery,ERAS)理念的引入进一步提高了治疗效果。但我国目前的诊疗现状并不乐观,缺乏相应的规范和指南。遵循科学性、实用性和先进性的原则,经全国数百位创伤骨科专家讨论通过,制定本指南。本指南仅适用于≥65岁低能量损伤造成的新鲜非病理性股骨转子间骨折患者。     

What factor induces stress in patients with AIS under brace treatment? Analysis of a specific factor using exploratory factor analysis

BackgroundStress from brace treatment in patients with adolescent idiopathic scoliosis (AIS) can deteriorate their quality of life. A Japanese version of the Bad Sobernheim Stress Questionnaire–Brace (JBSSQ–brace) was developed to assess the stress from brace treatment for Japanese patients with AIS. However, the specific factors causing stress under brace treatment have remained unknown.MethodWe enrolled 69 consecutive Japanese patients with AIS. Stress from brace treatment was assessed by JBSSQ–brace and Scoliosis Research Society–22 (SRS–22) instruments. The correlations of JBSSQ–brace with SRS–22 score, patient demographics and Cobb angle were analyzed by Spearman's rank correlation. Exploratory factor analysis was used to determine the psychological factor causing stress from brace treatment.ResultsJBSSQ–brace score was correlated with total score of SRS–22, self-image and mental health domain, but not age, degree of curvature, or other domains of the SRS–22. Factor analysis detected one underlying factor, which was more related to Questions 4 or 5 with the factor loadings of 0.8 than Questions 1 or 6 with loadings of 0.65.ConclusionStress from brace treatment was not associated with age, spinal curve severity, pain, or satisfaction of treatment. Exploratory factor analysis suggested “anxious feeling about how we are perceived by others” induces the stress from brace treatment in Japanese patients with AIS.     

Intelligent robot-assisted minimally invasive reduction system for reduction of unstable pelvic fractures

ObjectiveCurrently, minimally invasive internal fixation is recommended for the surgical treatment of unstable pelvic fractures. The premise and difficulty of minimally invasive internal fixation are minimally invasive reduction of fractures. This review aimed to investigate the indications, surgical strategy and techniques, safety, and efficacy of intelligent robot-assisted fracture reduction (RAFR) system of pelvic ring injuries.MethodsThis retrospective study reviewed a case series from March 2021 to November 2021. A total of 22 patients with unstable pelvic fracture injuries underwent minimally invasive internal fixations. All pelvic ring fractures were reduced with our intelligent RAFR system. The robot system intelligently designs the optimal position and reduction path based on the patient's preoperative 3D CT. During the operation, the three-dimensional visualization of the fracture is realized through image registration, and the Robot completes the automatic reduction of the fracture. The global 3D point cloud error between the preoperative planning results and the actual postoperative reduction results was calculated. The postoperative reduction results of residual displacement were graded by the Matta Criteria.ResultsMinimally invasive closed reduction procedures were completed in all 22 cases with our RAFR system. The average global 3D point cloud reduction error between the preoperative planning results and the actual postoperative reduction results was 3.41mm±1.83mm. The mean residual displacement was 4.61mm±3.29mm. Given the Matta criteria, 16 cases were excellent, five were good, and one was fair, with an excellent and good rate of 95.5%.ConclusionOur new pelvic fracture reduction robot system can complete intelligent and minimally invasive fracture reduction for most patients with unstable pelvic fractures. The system has intelligent reduction position and path planning and realizes stable pelvis control through a unique holding arm and a robotic arm. The operation process will not cause additional damage to the patient, which fully meets the clinical requirements. Our study demonstrated the safety and effectiveness of our robotic reduction system and its applicability and usability in clinical practice, thus paving the way towards Robot minimally invasive pelvic fracture surgeries.     

髋臼骨折术后异位骨化的手术治疗

目的 探讨髋臼骨折术后严重异位骨化手术切除松解的疗效.方法 2005年10月至2007年4月共收治髋臼骨折术后严重异位骨化患者5例,均为男性,平均年龄34岁(22～45岁).髋臼骨折手术后平均14.2个月(3～30个月)发生异位骨化.原始手术入路分别为:Kocher-Langenbeck入路4例,前后联合入路1例.根据Brooker分型,Ⅳ级4例,Ⅲ级1例.5例患者术前患髋活动范围平均为8°.所有患者手术前后均接受一次放射治疗,剂量为7～8 Gy.所有患者均取KoeherLangenbeck入路,术中使用神经探测仪探查并保护坐骨神经.完全切除异位骨化的骨组织,1例患者因股骨头和髋臼发生融合而行全髋关节置换.所有患者术后即开始无痛下功能锻炼,口服吲哚美辛预防异位骨化发生.结果 所有患者均获随访,平均随访时间8个月(4～22个月),伤口均Ⅰ期愈合,最终复查时均无异位骨化复发,患髋总活动范围平均为160°.结论 对于髋臼骨折术后严重异位骨化而导致髋关节活动障碍的患者,在骨折愈合后尽早手术切除,并配合药物和放射治疗可获得满意疗效.