胸椎椎弓根外内固定技术的临床应用

目的:研究胸椎椎弓根外内固定技术的安全性和有效性。方法:应用胸椎椎弓根外内固定技术在2004年至2010年治疗13例患者,术前采用CT加密扫描测量进钉点、进钉点至椎体前缘的深度、进钉角度和直径,根据测量结果术中椎弓根钉入钉点为横突尖,进钉方向为平均向头侧倾斜10°～20°、内倾角26°～40°,顺椎弓根外侧皮质进入椎体。结果:术后CT加密扫描观察螺钉周围的皮质骨是否完整,是否靠近节段血管,是否穿透皮质骨。评价置入钉的准确性和安全性。13例患者共置入64枚椎弓根螺钉,术后CT加密扫描和X线片观察到60枚(93.7%)螺钉置入准确,4枚(6.3%)螺钉发生错置。结论:实验结果表明,胸椎椎弓根外内固定与胸椎椎弓根内固定相比,具有更宽的置入宽度、更长的螺钉长度及更大的螺钉直径,具有安全可靠、简单实用的优点,并具有生物力学优越性,是胸椎后路内固定的一种良好选择。     

围手术期康复宣教与训练对股骨干骨折患者的影响

目的 探讨康复宣教与训练等干预手段对股骨干骨折患者围手术期的影响.方法 2010年6月-2011年3月收治股骨干骨折患者90例,其中男48例,女42例;年龄17~58岁,平均38岁.开放性骨折28例,闭合性骨折62例.股骨骨折部位:上1/3骨折33例,中1/3骨折35例,下1/3骨折20例,多段骨折2例.横形骨折20例...     

不同硬对硬摩擦界面全髋关节置换术后血清钴、铬浓度及临床疗效比较

目的 比较全髋关节置换术(total hip arthroplasty,THA)中使用3种不同硬对硬界面后,2年内血清钴、铬金属离子浓度的变化,以及临床疗效有无差异.方法 90例THA患者分为陶瓷对陶瓷(COC)、陶瓷对金属(COM)、金属对金属(MOM)3组,每组30例.术前,术后3、6、12、24月检测血清钴、铬金属离子浓度,进行Harris评分,对患髋进行X片连续性观察和彩超检查.结果 3组术后24月患髋Harris评分达优率均为100％,连续X片显示髋臼假体周围未见透亮线、骨溶解等,彩超均未发现炎性假瘤.术后COM组和MOM组内金属离子浓度迅速升高,至12月时变化趋于平稳,并表现出下降趋势.但MOM组中铬离子浓度则继续上升,24月与12月时比较差异具有统计学意义(上升了0.48 μg/L,P=0.021).术后各时间点COC组相对恒定,MOM组钴、铬金属离子浓度大于COC组和COM组(P＜0.05).结论 3种硬对硬界面术后功能恢复好,无炎性假瘤、骨溶解的发生,都取得了满意的临床效果.COM血清钴、铬金属离子浓度低于MOM,高于COC.     

Development of a machine learning algorithm for prediction of failure of nonoperative management in spinal epidural abscess

BACKGROUND CONTEXTData regarding risk of failure of nonoperative management in spinal epidural abscess (SEA) are limited. Given the potential for deterioration with treatment failure, a tool that predicts the probability of failure would be of great clinical utility.PURPOSEWe primarily aim to build a machine learning model using independent predictors of nonoperative management failure. Secondarily, we aim to develop an open-access web-based application that provides a patient-specific probability of treatment failure.STUDY DESIGN/SETTINGRetrospective, case-control study.PATIENT SAMPLEPatients 18 years or older diagnosed with SEA at 2 academic medical centers and 3 community hospitals.OUTCOME MEASURESFailure of nonoperative management.METHODSThis is a retrospective cohort study of 367 patients with SEA initially managed nonoperatively between 1993 and 2016. The primary outcome was failure of nonoperative management defined as neurologic deterioration, worsened back and/or radicular pain, or persistent symptoms despite initiation of antibiotic therapy. Five machine learning algorithms were developed and assessed by discrimination, calibration, and overall performance.RESULTSNinety-nine (27%) patients failed nonoperative management. Factors determined for prediction of nonoperative management were: motor deficit, diabetes, ventral component of abscess relative to thecal sac, history of compression or pathologic vertebral fracture, sensory deficit, active malignancy, and involvement of 3 or more vertebral levels. The elastic-net penalized logistic regression model was chosen as the final model given its superior discrimination, calibration, and overall model performance. This model was incorporated into an open access web application.CONCLUSIONBy building a discriminative and well-calibrated model in a user-friendly and open-access digital interface, we hope to provide a prognostic tool that can be used to inform clinical decision-making in real-time.     

Treatment outcome of the Masquelet technique in 195 infected bone defects–A single-center,retrospective case series

BackgroundThe Masquelet technique is a surgical procedure for the reconstruction of bone defects. During the first step, an osteosynthetically stabilized defect is filled with a cement spacer. The spacer induces a foreign body membrane, called a Masquelet membrane. In a follow-up procedure, the spacer is replaced by a bone graft, which ossifies in the subsequent phase.Material and MethodsA total of 171 patients with 195 septic bone defects on the extremities that had been treated with the Masquelet procedure at the BG Klinikum in Hamburg, Germany, from 2011 to 2021 were retrospectively analysed, comparing patients who reached full weight and load bearing on the affected extremity to those who failed to do so. Defect size and configuration, microbiological results and treatment methods as well as comorbidities and epidemiologic data were analysed for factors influencing the treatment outcome.ResultsIn all, 113[66%] of the patients were male, and 58[34%] were female, with an age distribution of 52 +/-16 years. Out of 171 patients, 24 patients had two defects. The number of patients that reached full weight bearing was 152[89%], the follow-up period was 2 +/-1 years (median +/- SD). Full weight bearing capability was negatively by the defect size as defects >62 mm tended to be less likely to reach full weight bearing than smaller defects. A secondary stabilization with an internal stabilization was applied in 58[34%] of all patients and positively influenced the attainment of full weight and load bearing.DiscussionWith 171 patients and 195 septic bone defects treated at a single centre with the Masquelet Technique, this study represents a comparably large cohort. Demographics, defect characteristics and treatment outcomes did not differ from those of other cohorts described in the literature. Defects larger than 62 mm showed lower chances to reach full weight bearing and can be defined as "critical defect size" for the Masquelet technique based on our data.     

The perceptions of clinicians using low-intensity pulsed ultrasound (LIPUS) for orthopaedic pathology: A national qualitative study

IntroductionLow-intensity pulsed ultrasound (LIPUS) is a non-invasive treatment modality for delayed union or non-union of acute fractures. We aimed to assess the current use of LIPUS at a national level in the United Kingdom, why and how clinicians use it, what treatment protocols are followed, and what the current perceptions are on this technology.MethodologyUsing a detailed online survey compromised of 20 questions delivered to known LIPUS users, we were able to collect qualitative data on indication of use, type of machine used, personal views on the technology, frequency of usage, and treatment protocols. Each question was peer-reviewed to exclude bias.ResultsA total of 70 respondents completed the survey. LIPUS was used by most clinicians for cases of non-union (N = 55, 78.5%) and delayed union (N = 51, 72.8%). The majority of respondents personally used a LIPUS device between 1 and 5 times in 12 months (N = 38, 54.3%). Most considered LIPUS a failure after three to six months of treatment without clinical improvement (N = 39, 55.7%). A total of 32 respondents (45.7%) mentioned the need for funding approval before accessing LIPUS technology. Poor revision surgery candidates (N = 48, 68.6%) and atrophic non-union (N = 46, 65.7%) were the most frequently cited reasons for using LIPUS technology as treatment. Most participants (N = 48, 68.6%) considered LIPUS to be cost-effective. Despite most clinicians being comfortable with the use of LIPUS, some respondents did not understand the basic science underpinning the technology nor could explain the need for LIPUS to patients comfortably.ConclusionLIPUS technology may have a significant role to play in the treatment of orthopaedic fracture related pathology. Regular users perceived the technology to be cost-effective and efficacious. Further research should standardize treatment protocols and aim to establish a national LIPUS registry     

固有免疫系统在骨关节炎发病机制中的作用及研究进展

目的综述固有免疫系统在骨关节炎（osteoarthritis，OA）发病机制中的作用及研究进展。方法查阅国内外相关文献，对固有免疫系统介导的炎症及巨噬细胞、T 细胞、补体系统在 OA 发病机制中的作用、潜在治疗靶点及研究进展进行总结。结果随着研究深入，OA 逐渐被认为是一种低度炎症状态，固有免疫系统在其发生发展过程中发挥了重要作用。目前研究主要集中于 OA 滑膜组织巨噬细胞亚群极化方面，结果显示 M1 亚群向 M2 亚群转换失败是 OA 进展的关键环节。而 T 细胞及补体系统也参与了 OA 的病理过程。结论目前有关固有免疫系统对 OA 进展作用的研究仍处于探索阶段，具体机制尚未明确。现有研究结果提示，巨噬细胞亚群极化是早期防治 OA 的潜在靶点。     

关节镜手术治疗对早期膝骨关节炎的中期临床疗效

目的：比较关节镜手术治疗与保守治疗对中老年人早期膝关节骨关节炎（early knee osteoarthritis,EKOA）的中期临床疗效,为中老年EKOA的个体化治疗提供临床依据。方法：回顾性纳入2015年1月至2016年12月行关节镜手术治疗或保守治疗的145例（182膝）中老年EKOA患者,其中男35例、女110例,年龄47~79（57.6±6.9）岁,病程6~48（14.6±8.9）个月。根据治疗方式分为关节镜治疗组（47例,58膝）和保守治疗组（98例,124膝）。治疗前患者主要临床症状包括膝关节疼痛、肿胀、交锁、屈伸受限及膝关节无力等,膝关节X线主要表现为关节间隙无狭窄或可疑狭窄、少量骨赘形成,膝关节MRI主要表现为关节软骨和半月板退变或损伤、关节内游离体及滑膜充血水肿等。收集两组患者治疗前的膝关节症状持续时间、半月板是否合并损伤、是否合并关节内游离体、是否存在膝关节交锁等机械性症状,以及治疗前和治疗后的疼痛视觉模拟评分（visual analogue scale,VAS）和Lysholm膝关节功能评分。统计分析组内和组间治疗前后VAS和Lysholm评分差异。结果：两组患者均获随访,时间60~76个月;关节镜手术组患者切口愈合良好,未发生手术并发症。两组间的年龄、性别、身体质量指数（body mass index,BMI）及随访时间差异无统计学意义（P>0.05）。治疗前,关节镜治疗组与保守治疗组相比,关节镜治疗组的症状持续时间更长（P<0.001）,合并半月板损伤（P<0.001）、游离体（P=0.001）及机械性症状（P<0.001）的比例更高,VAS评分（P<0.001）及Lysholm评分（P<0.001）更差。治疗后末次随访时,各组VAS评分、Lysholm评分均较治疗前明显改善（P<0.05）。末次随访时,VAS评分,关节镜治疗组（1.5±1.2）分,保守治疗组（1.6±1.0）分（P=0.549）;Lysholm评分,关节镜治疗组（84.9±12.5）分,保守治疗组（84.2±9.9）分（P=0.676）。结论：对中老年EKOA患者,关节镜手术治疗与保守治疗均具有较满意的中期临床疗效。尽管两组末次随访时疗效差异无统计学意义,但关节镜手术治疗组术前症状较重,多合并半月板损伤或游离体所导致的机械性交锁症状,故对于合并机械性交锁症状或保守治疗效果较差的中老年EKOA患者可考虑关节镜手术治疗。