空心钉在股骨颈骨折的临床应用

目的 探讨空心钉在股骨颈骨折中的临床效果。方法 对43例应用空心钉治疗股骨颈骨折的患者进行疗效观察与分析。结果 随访率100％,时间2～3年,平均2．5年。42例患者骨折愈合(96．67％),未愈合1例(2．33％),股骨头坏死5例(11．63％)。无髋内翻畸型,断钉等并发症。结论 空心钉内固定有效解决了股骨颈骨折的愈合问题,且并发症少,可视为治疗股骨颈骨折的首先疗法。     

Tibial fixation comparison of semitendinosus-bone composite allografts fixed with bioabsorbable screws and bone-patella tendon-bone grafts fixed with titanium screws

Tibial fixation remains the weak link of ACL reconstruction over the first 8–12 weeks postoperatively. This study compared the biomechanical properties of tibial fixation for a bone-patellar tendon-bone (BPTB) graft and a novel semitendinosus-bone composite (SBC) allograft with mixed cortical-cancellous bone dowels at each end. Seven paired, fresh frozen cadaveric knees (20–45 years) were stripped of all soft tissue attachments and randomly assigned to receive either the BPTB graft or SBC allograft. Grafts were placed into tibial tunnels via a standard protocol and secured with either a 10 mm×28 mm bioabsorbable (SBC) or titanium (BPTB) screw. Grafts were cycled ten times in a servo hydraulic device from 10–50 N prior to pull to failure testing at a rate of 20 mm/min with the force vector aligned with the tibial tunnel ("worst case scenario"). Wilcoxon Signed Rank Tests were used to evaluate biomechanical differences between graft types (p<0.05). Tibial bone mineral density and interference screw insertion torque were statistically equivalent between graft types. The mode of failure for all constructs was direct screw and graft construct pullout from the tibial tunnel. Significant differences were not observed between graft types for maximum load at failure strength (BPTB=620.8±209 N vs. SBC=601.2±140 N, p=0.74) or stiffness (BPTB=69.8 N/mm±29 N/mm vs SBC=47.1±31.6 N/mm, p=0.24). The SBC allograft yielded significantly more displacement prior to failure than the BPTB graft (15.1±4.9 mm vs 9.2±1.3 mm, p=0.04). Increased construct displacement appeared to be due to fixation failure, with some evidence of graft tissue tearing around the sutures: Bioabsorbable screw (10×28 mm) fixation of the SBC allograft produced unacceptable displacement levels during testing. Further study is recommended using a titanium interference screw or a longer bioabsorbable screw for SBC graft fixation under cyclic loading conditions.Arthrex Inc., Naples, FL, USA sponsored this study     

三踝骨折手术临床分析

目的探讨三踝骨折的手术治疗及疗效。方法对1998-2005年共42例三踝骨折病人施行手术治疗。手术中暴露顺序为内踝-外踝-后踝，内固定顺序为后踝-外踝-内踝，外踝予钢板螺钉内固定，后踝及内踝予加压螺钉内固定。术后功能锻炼，并根据症状及X线检查结果综合评定踝关节功能。结果全部病历均获得随访，随访时间为6～24个月，平均14个月。踝关节功能优者14例，良20例，可3例，差5例，优良率达80．9％。结论三踝骨折早期解剖复位可靠内固定，早期功能锻炼可取得优良的功能恢复。其中外踝骨折处理是关键。延期手术、严重骨质疏松以及严重踝关节周围软组织缺损者疗效差，易出现创伤性关节炎、关节僵硬等并发症。     

枢椎前后路三种螺钉内固定的安全性比较*

目的 观察计算机辅助枢椎前路椎弓根螺钉（AAPS）置钉优势,并测量AAPS、椎弓根螺钉及椎体螺钉（VBS）的最大拔出力,为临床手术操作选取适当的内固定方式,提供生物力学理论依据。方法 从2019年10月至2021年1月,收集人体实体颈椎防腐标本16例,除去畸形标本1例。剩余标本,包括男10例,女5例,行CT扫描后将数据导入Mimics软件,形成三维重建图并观察。参考Kolle法,在每节枢椎上分别采用前路椎弓根螺钉、后路椎弓根螺钉、前路椎体螺钉三种形式固定方法。在生物力学试验机上测试每种固定方式的最大拔出力。结果 Mimics软件中的三维重建图,可以从任意视角直接观察并了解结构状况。前路椎弓根螺钉最大轴向拔出力平均为（635.95±220.35）N,后路椎弓根螺钉组的最大轴向拔出力平均为（772.95±230.55）N,VBS组螺钉的最大轴向拔出力平均为（451.45±181.13）N。采用配对样本t检验,两两比较AAPS组与后路椎弓根钉组,以及AAPS组与VBS组测值。P值均<0.05,差异有统计学意义。这显示在单皮质固定的条件下,椎弓根螺钉的置钉拔出力大于前路椎弓根螺钉（AAPS）,AAPS置钉拔出力大于VBS置钉法。结论 计算机辅助有利于了解枢椎结构特点,便于个体化的AAPS置钉操作,AAPS钉道固定性能良好,有较明显生物力学优势,可作为手术内固定选择的较理想方式。     

2种固定方式治疗成人肱骨远端C型骨折的疗效分析

目的比较切开复位有限内固定结合外固定架固定与AO双钢板内固定治疗肱骨远端C型骨折的疗效。方法回顾性分析自2009-03—2012-03成都体育学院附属体育医院及泸州医学院附属中医医院诊治的52例肱骨远端C型骨折,包括采用切开复位有限内固定结合桡骨远端外固定架固定治疗27例（A组）,采用肱骨远端双钢板内固定治疗25例（B组）。结果所有患者术后获得随访12-36个月,平均27个月。Cassebaum评分A组优良率为81.5%,B组优良率为52.0%,A组明显优于B组,差异有统计学意义;按Mayo评分,A组平均为87分,B组为84分,2组差异无统计学意义。结论切开复位有限内固定结合外固定架固定治疗肱骨远端C型骨折效果较好,值得临床推广和应用。     

逆行植入髋臼前柱螺钉治疗骨盆与髋臼骨折

目的研究逆行植入髋臼前柱螺钉治疗骨盆及髋臼骨折,探讨其临床应用效果。方法 2007年1月至2010年8月采用逆行植入髋臼前柱螺钉治疗骨盆及髋臼骨折19例,共置入螺钉20枚。术后根据影像学检查结果及患者恢复情况,评估螺钉的位置、骨折愈合情况及疗效。结果全部患者随访时间均在1年以上,所有螺钉均位于前柱骨性结构内,无螺钉穿出,未出现断钉、螺钉松动、骨折不愈合等并发症,19例患者疗效满意。结论逆行植入髋臼前柱螺钉治疗骨盆及髋臼骨折具有安全有效、创伤小、便于操作等特点。     

Screw fixation of radial head fractures: Compression screw versus lag screw—A biomechanical comparison

Introduction

Secondary loss of reduction and pseudarthrosis due to unstable fixation methods remain challenging problems of surgical stabilisation of radial head fractures. The purpose of our study was to determine whether the 3.0 mm Headless Compression Screw (HCS) provides superior stability to the standard 2.0 mm cortical screw (COS).

Materials and methods

Eight pairs of fresh frozen human cadaveric proximal radii were used for this paired comparison. A standardised Mason II-Fracture was created with a fragment size of 1/3 of the radial head's articular surface that was then stabilised either with two 3.0 mm HCS (Synthes) or two 2.0 mm COS (Synthes) according to a randomisation protocol. The specimens were then loaded axially and transversely with 100 N each for 4 cycles. Cyclic loading with 1000 cycles as well as failure load tests were performed. The Wilcoxon test was used to assess statistically significant differences between the two groups.

Results

No statistical differences could be detected between the two fixation methods. Under axial loads the COS showed a displacement of 0.32 mm vs. 0.49 mm for the HCS. Under transverse loads the displacement was 0.25 mm for the COS vs. 0.58 mm for the HCS group. After 1000 cycles of axial loading there were still no significant differences. The failure load for the COS group was 291 N and 282 N for the HCS group.

Conclusion

No significant differences concerning the stability achieved by 3.0 mm HCS and the 2.0 mm COS could be detected in the experimental setup presented.     

Hoffa骨折手术治疗策略

目的 探讨Hoffa骨折的治疗方法及临床疗效.方法 回顾性分析2009年2月至2011年9月收治的13例Hoffa骨折16髁.按照Letenneur分型:Ⅰ型骨折9髁,Ⅱ型4髁,Ⅲ型3髁.8例(11髁)选择松质骨螺钉固定,5例(5髁)Letenneur Ⅰ型骨折选择空心拉力螺钉联合侧方支持钢板固定治疗.结果 本组所有患者均得到随访,随访11～26个月,平均(16.4±3.27)个月,所有患者均获得骨性愈合.按Hoffa骨折术后功能恢复评估系统评估,优8例,可3例,差2例.结论 螺钉固定或侧方钢板联合螺钉固定治疗Hoffa骨折具有固定牢固可靠、允许术后早期负重锻炼的优点.     

空心加压螺钉张力带治疗髌骨骨折的生物力学评价

目的：通过实验应力分析方法比较空心加压螺钉加张力带与其他方法固定髌骨。方法：8具新鲜膝关节尸体标本,分别行空心加压螺钉和克氏针等内固定,比较它们的受力状态。结果：空心自攻加压螺钉张力带内固定治疗髌骨骨折,固定可靠,能承受高负荷,性能优于克氏针内固定等,具有显著性差异（P＜0．05）。结论：从生物力学角度看髌骨骨折以空心加压螺钉加张力带内固定是一种较为合理的治疗方法。