空心钉张力带微创治疗髌骨骨折的临床研究

目的探讨空心钉张力带微创治疗髌骨骨折的临床效果及安全性。方法将60例髌骨骨折患者随机分为两组,各30例。观察组采用空心钉张力带微创治疗,对照组采用克氏针张力带治疗,对比两组治疗效果及并发症发生情况。结果两组患者手术时间和骨折愈合时间比较差异均无统计学意义(P>0.05),观察组术中出血量少于对照组(P<0.01);观察组优良率为93.3%,高于对照组的70.0%(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论空心钉张力带微创治疗髌骨骨折效果显著,其固定牢固、并发症少、安全有效,值得临床推广应用。     

股骨近端抗旋髓内钉与锁定钢板治疗股骨粗隆间骨折的疗效比较

目的：比较股骨近端螺旋刀片抗旋转髓内钉（ proximal femur anti-rotation intramedullary nail,PFNA）与股骨近端锁定钢板（ proximal femur locking plate,PFLP）治疗股骨粗隆间骨折的疗效。方法回顾性随访2012年1月—2014年1月接受手术治疗的40例股骨粗隆间骨折患者,手术方式随机选择,其中PFNA治疗15例,PFLP治疗25例。比较两组手术时间、术中出血量、下地行走锻炼时间、术后并发症、骨折愈合时间。结果两组患者在手术时间、术中出血量、下地行走锻炼时间方面,P＜0．05,有统计学差异,PFNA治疗组优于PFLP治疗组;在骨折愈合时间、术后并发症方面,P＞0．05,无统计学差异。结论 PF-NA治疗股骨粗隆间骨折具有手术时间短、术中出血量少、下地行走锻炼时间早等优点。     

不稳定股骨转子间骨折不同内固定方法的疗效比较

目的 浅析不同内固定方法对不稳定股骨转子间骨折的疗效差异。方法 2009年1月至2013年5月行内固定手术的不稳定股骨转子间骨折患者36例,采用Gamma钉固定10例为A组,动力髋螺钉(DHS)固定11例为B组,股骨近端抗旋髓内钉(PFNA)固定15例为C组。对不同的内固定方式的术中出血量、手术时间、术后并发症、骨折愈合时间及髋关节功能评分等相关数据进行统计学分析。结果 各组患者术后均获随访,平均随访时间1年半,住院及随访期间无死亡病例。C组手术时间较A、B两组短,且有统计学意义(P<0.05)。B组术中出血量最多,愈合时间长,C组出血最少,但与A组比较差异无统计学意义(P>0.05)。术中A组发生股骨颈干角变小1例,髋内翻1例;B组发生髋内翻2例,头钉穿出1例,内固定松动1例;C组无相关并发症发生。骨折愈合时间A、B、C三组间比较差异无统计学意义(P>0.05)。A、C两组髋关节功能评分均较B组高,差异有统计学意义(P<0.05),但A、C两组间差异无统计学意义(P>0.05)。结论 PFNA是治疗不稳定股骨转子间骨折一个很好的选择,手术操作简便,损伤较小,出血少,固定牢靠,术后髋关节功能恢复较好,值得临床推广。     

PFNA 治疗老年骨质疏松性股骨粗隆间骨折的临床疗效

目的：研究防旋型股骨近端髓内钉（PFN A ）治疗老年骨质疏松性股骨粗隆间骨折的临床疗效。方法60例老年骨质疏松性股骨粗隆间骨折患者随机均分为PFNA治疗组（A组）和短重建髓内钉治疗组（B组）。随访1年,采用 Harris髋关节评分评价疗效,并观察术后并发症发生情况。结果 A组手术时间、出血量、骨痂出现时间和骨折愈合时间均少于B组（P＜0．05）。A组 Harris髋关节评分优良率高于B组（90.0％ vs ．70．0％）（P＜0．05）,术后并发症发生率低于B组（0 vs ．16.7％）（P＜0．05）。结论 PFNA治疗老年骨质疏松性股骨粗隆间骨折安全、有效。     

Diverse Pathological Findings of Interstitial Lung Disease in a Patient with Dyskeratosis Congenita

A 42-year-old man with a history of surgery for tongue cancer was referred to our hospital due to an abnormal chest shadow. High-resolution computed tomography showed lower lobe reticulation. A physical examination revealed nail dystrophy, oral leukoplakia, and reticulated hypopigmentation. Lung biopsy revealed subpleural and perilobular fibrosis, suggestive of usual interstitial pneumonia. However, multiple pathological findings, including homogenous fibrosis and cell infiltration in the centrilobular region, which were compatible with nonspecific interstitial pneumonia, and bronchiolitis were also seen. Genetic testing showed a hemizygous missense mutation in the DKC1 gene, and the patient was diagnosed with dyskeratosis congenita. Although anti-fibrotic therapy was initiated, the patient''s respiratory function has continued to decrease.     

弹性髓内钉在儿童四肢骨折中的应用

目的研究弹性髓内钉对儿童四肢骨折患儿骨折愈合和并发症的影响。方法 40例儿童四肢骨折患儿,采用随机数字表法分为观察组与对照组,每组20例。观察组患儿采用弹性髓内钉固定,对照组患儿采用小切口复位。比较两组患儿骨折愈合和邻近关节活动情况、手术指标、骨折愈合时间及并发症发生情况。结果观察组患儿骨折愈合优良率为100.00%、邻近关节活动优良率为100.00%,均高于对照组的60.00%、70.00%,差异有统计学意义(χ^2=10.000、7.059, P=0.002、0.008<0.05)。观察组患儿手术时间、切口长度、住院时间和骨折愈合时间均短于对照组,出血量少于对照组,差异有统计学意义(P<0.05)。观察组患儿并发症发生率为10.00%,低于对照组的45.00%,差异具有统计学意义(P<0.05)。结论弹性髓内钉治疗儿童四肢骨折愈合和邻近关节活动效果显著,且其手术简便、手术时间短、患儿创伤小,治疗后并发症较少,值得临床应用。     

Strain response of an instrumented intramedullary nail to three-point bending

Objectives:?An experimental biomechanical evaluation of an instrumented intramedullary nail (TriGen® META Nail, Smith&Nephew®) was undertaken. The objectives were two-fold. The first was to identify the most sensitive strain gauge positions and orientations on the nail, and the second was to demonstrate that the nail was capable of detecting changes in stiffness of the nail–bone composite. The function of the instrumented nail is to quantify fracture healing objectively and directly, and so to predict delayed repair or non-union 2 months before current methods.

Methods:?Eight flat pockets were machined onto the surface of the nail and three strain gauges attached in each pocket. The instrumented nail was inserted into fourth generation biomechanical grade Sawbones® tibiae with three different fracture configurations as well as into a non-fractured bone. The nail–bone composite was loaded in three-point bending at five positions to determine the strain changes in each of the eight strain gauge pockets located along the length of the nail. To simulate callus in the simplest way and to increase the stiffness of the nail–bone composite, loops of duct tape in multiples of four were applied over the fracture locus. A three-point loading jig was used to obtain the change in strain with increasing stiffness. Relative displacement of the bone ends was quantified using radiostereometric analysis.

Results:?There was no single position of greatest strain sensitivity for all fracture types. The greatest change in strain occurred when the strain gauge pocket and fracture line were closest. Applying the loading moment directly over the strain gauge pocket also maximised its sensitivity. The duct tape callus simulation showed that the instrumented nail was able to detect a change in stiffness of less than 4.1 Nm/°.

Conclusions:?It has been shown that the instrumented nail can detect physiologically relevant changes in stiffness, and so to provide a useful function as an objective monitor of fracture repair.     

关节镜辅助下可吸收软骨钉固定急性髌骨脱位合并膝关节骨软骨骨折的临床疗效观察

[摘要] 目的 探讨关节镜辅助下可吸收软骨钉固定急性髌骨脱位合并膝关节骨软骨骨折的临床疗效。方法 回顾性分析西宁市第一人民医院2016年3月至2020年1月通过关节镜辅助下可吸收软骨钉固定治疗的33例急性髌骨脱位合并膝关节骨软骨骨折患者,随访7 ～ 28个月,平均（15.15±5.54）个月,术前及术后6个月时完善X线、CT评价骨折复位愈合情况,并用Lsyholm评分、HSS评分评价膝关节功能。结果 术后33例骨折均获得满意的复位,术后6个月复查时均达到骨性愈合,膝关节屈伸活动良好,未发生感染、骨块移位、关节僵硬等并发症,Lsyholm评分从术前（19.33±6.86）分提高到术后6个月（89.72±5.11）分,差异有统计学意义（P<0.01）;HSS评分从术前（38.63±7.40）分提高到术后6个月（92.15±4.42）分,差异有统计学意义（P<0.01）。结论 关节镜辅助下可吸收软骨钉固定急性髌骨脱位合并膝关节骨软骨骨折,可微创、准确、安全地恢复关节面完整性,无需二次手术取出内植物,治疗效果确切,是髌骨脱位合并骨软骨骨折的良好的治疗方式。     

A Homozygous Frameshift Mutation in the HOXC13 Gene Underlies Pure Hair and Nail Ectodermal Dysplasia in a Syrian Family

Pure hair and nail ectodermal dysplasia (PHNED) is a rare genetic disorder characterized by hypotrichosis or complete alopecia, as well as nail dystrophy. Mutations in the type II hair keratin gene KRT85 and the HOXC13 gene on chromosome 12q have recently been identified in families with autosomal‐recessive PHNED. In the present study, we have analyzed a consanguineous Syrian family with an affected girl having complete alopecia and nail dystrophy since birth. The family clearly showed linkage to chromosome 12q13.13–12q14.3, which excluded the KRT85 gene. Sequencing of another candidate gene HOXC13 within the linkage interval identified a homozygous frameshift mutation (c.355delC; p.Leu119Trpfs*20). Expression studies in cultured cells revealed that the mutant HOXC13 protein mislocalized within the cytoplasm, and failed to upregulate the promoter activities of its target genes. Our results strongly suggest crucial roles of the HOXC13 gene in the development of hair and nails in humans.