A New Three‐Dimensional Classification of Proximal Tibiofibular Fractures: A Multicenter Study

ObjectivesTo propose an updated definition of proximal tibia and fibula fracture (PTFF) and establish a three‐dimensional (3D) structure‐based classification of PTFF.MethodsIn total, 1358 adult patients (837 males and 521 females; 43.61 ± 15.13 years， 1364 affected knees) who were diagnosed with PTFF at the departments of orthopaedic surgery of four hospitals from January 2010 to December 2019 were enrolled. The new classification of PTFF, termed Wu classification, included three parts: classification of columns in the horizontal plane, regions in the frontal plane, and segments in the sagittal plane. All PTFFs were classified according to Schatzker, Luo, and Wu classification systems. Additionally, the incidence and characteristics of PTFFs were analyzed.ResultsThe major internal structural fractures of PTFF were tibial plateau fracture (TPF) only (725, 53.15%), TPF and proximal fibular fracture (274, 20.09%), and isolated avulsion fracture of the posterior cruciate ligament (PCL) (189, 13.86%). Approximately a quarter of PTFF cases could not be classified using Schatzker or Luo classifications, but all PTFF cases could be classified using Wu classification. The most frequent PTFFs included all four columns in region IV, segment 2 (235, 17.23%); the posterolateral and posteromedial columns in region II, segment 2 (191, 14.00%); and the lateral and posterolateral columns in region IV, segment 2 (136, 9.97%). Isolated avulsion fracture of the anterior cruciate ligament (ACL) was categorized as three injury types, most of which involved the lateral and medial columns in region II, segment 1 (40/63, 64%). More than 97% of cases of isolated fractures of the PCL involved the posterolateral and posteromedial columns in region II, segment 2. The most frequent combined avulsion fracture of the ACL and PCL included all four columns in region II, segment 2 (18/24, 75%). All of the isolated avulsion fractures of the ACL were located in segment 1, and all those of the PCL in segment 2. The most common type of isolated proximal fibular fracture involved the posterolateral column in region III, segment 2 (23/26, 88%). The most frequent combined TPF and proximal fibular fracture involved all four columns in region IV, segment 2 (107/274, 39.05%).ConclusionsAll cases of PTFF could be classified by the new 3D Wu classification which should be beneficial for clinical diagnosis, guidance of treatment, statistical analysis, academic communication, and prognosis, and the most frequent PTFF involved all four columns in region IV, segment 2.     

腓骨重建及小钛板固定下颌骨体部缺损的三维有限元分析

背景：临床研究中进行腓骨重建修复下颌骨缺损的力学研究是不现实的,而有限元分析法为下颌骨缺损修复重建的生物力学研究提供了新的方法。目的：建立腓骨重建小钛板固定下颌骨体部缺损的三维有限元模型,对其进行生物力学分析。方法：建立下颌骨体部缺损腓骨重建三维模型及内固定模型,在前牙、健侧第一磨牙、健侧第二磨牙加载    100 N咬合力,观察下颌骨模型重建前后的最大应力值和最大位移值情况,前牙加载和后牙加载下重建模型钛板、钛钉孔周围骨质的应力情况,前牙加载和后牙加载下腓骨前后端的最大位移值情况。结果与结论：正常下颌骨的最大应力集中在髁突颈部。在重建模型中,最大应力集中在健侧髁突颈部,加载相同咬合力的情况下重建下颌骨的最大应力值均大于正常下颌骨的最大应力值,前牙加载最大应力值大于后牙加载。在每块钛板内侧的两钉孔之间应力值最大,下颌角部位的应力比较集中,加载侧近下颌骨缺损处前上方的第一颗钛钉为下颌骨残端钛钉的最大应力集中部位,近腓骨中段后下方钛钉为腓骨端钛钉的最大应力集中部位。下颌骨残端近缺损处以及腓骨中段上板处的钉孔周围皮质骨为最大应力集中部位,前牙加载时的最大应力大于后牙加载时的最大应力。腓骨在X轴上从上缘到下缘的位移值不断减少,在Y轴上从前下方及后端至中份的位移值逐渐减少,在Z轴上从前端到后端的位移值逐渐减少。腓骨前端的最大位移值在Z轴方向,后端的最大位移值在Y轴方向上,前牙加载时的最大位移值均较后牙加载时的最大位移值大。说明下颌角后上方钛板最易折断,应对其进行加固处理;钛钉尖端和颈部应力比较大,应选择双皮质钛钉;腓骨端和下颌骨残端钛钉和钛板的应力比较大,应重视其稳定性和固位性;前牙咬合时的应力大于后牙咬合时的应力,修复后应避免前牙咬合。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Guide flange prosthesis for early management of reconstructed hemimandibulectomy: a case report

Surgical resection of the mandible due to presence of benign or malignant tumor is the most common cause of the mandibular deviation. Depending upon the location and extent of the tumor in the mandible, various surgical treatment modalities like marginal, segmental, hemi, subtotal, or total mandibulectomy can be performed. The clinicians must wait for extensive period of time for completion of healing and acceptance of the osseous graft before considering the definitive prosthesis. During this initial healing period prosthodontic intervention is required for preventing the mandibular deviation. This case report describes early prosthodontic management of a patient who has undergone a reconstructed hemi-mandibulectomy with modified mandibular guide flange prosthesis. The prosthesis helps patient moving the mandible normally without deviation during functions like speech and mastication.     

自体腓骨移植治疗股骨下1/3骨折伴大段缺损

<正>股骨下1/3骨折伴大段缺损常由高能量暴力所致,骨折较复杂,临床治疗难度较大。异体骨移植、人工替代物置换、骨延长转移术虽都已在临床上得以应用,但都存在各自的局限性[1-4]。我院自2003年7月至2007年4月,采用自体腓骨游     

石膏楔形填塞外固定治疗稳定性胫腓骨骨折成角畸形

<正>临床上,稳定性胫腓骨双骨折或胫骨骨折很常见,不少医院行手法复位石膏外固定,如无明显错位的骨折,即行单纯石膏外固定即可,由于各种原因如患者过早下地活动,或由于小腿肌肉拉力不平衡,石膏松动或患者自行拆除石膏等,很多患者出现胫腓骨成角畸形,自2006年3月至2009年3月有选择性地收治此类胫腓骨骨折成角畸形38例,全部使用石膏楔形填塞外固定治疗,获得满意的疗效。1临床资料     

The meniscofibular ligament: an MRI study

Aim

To describe the appearances and determine the prevalence of the meniscofibular ligament (ligamentum fibulare-MFibL) on MRI of the knee.

Subjects and methods

Retrospective observational review of 160 knee MRI studies (152 patients) which was performed for a variety of clinical presentations over a period of 31 months. The images were assessed independently by two musculoskeletal radiology Fellows.

Results

The MFibL was optimally visualised on far lateral sagittal oblique fat suppressed PDW FSE images. The MFibL appeared as a curvilinear or straight, hypointense band of variable thickness extending between the inferior margin of the posterior third of the lateral meniscus and the fibular head. The ligament was demonstrated in 42.5% (n = 68) of the total knee MRI studies, but this prevalence increased to 63% (56/88) in the presence of fluid in the posterolateral corner of the joint.

Conclusion

The MFibL is commonly seen on far lateral fat suppressed oblique sagittal PD weighted MR images, particularly in the presence of fluid in the posterolateral corner, and should be recognised as a normal structure in the posterolateral corner of the knee.     

微创髓芯减压植骨支撑治疗非塌陷性股骨头无菌性坏死的疗效观察

目的　探讨一种简便的髓芯减压和植骨治疗非塌陷性股骨头无菌性坏死的效果。 方法　对46例（58髋）Ficat Ⅱ和Ⅲ 〈A〉型股骨头无菌性坏死的治疗应用了髓芯减压、病灶刮除、松质骨植骨和自体或异体腓骨的支撑术。 结果　随访2~5年,按Harris标准其优良率为83.3%。 Harris评分由术前平均61 分增加到术后5年时的平均 85 分。 结论　髓芯减压、病灶刮除、松质骨植骨及自体或异体腓骨支撑、治疗非塌陷性股骨头无菌性坏死具有良好的疗效,可使中青年患者推迟人工关节置换年龄。     

母趾腓侧皮瓣修复指掌侧软组织缺损的方法及效果

目的　探讨母趾腓侧皮瓣修复手指掌侧软组织缺损的手术方法和临床疗效。 方法　对2005年8月至2011年8月17例采用拇趾腓侧皮瓣修复手指掌侧软组织缺损患者的临床资料进行回顾性分析。 结果　17例皮瓣全部存活。术后随访12~36 个月,皮瓣质地良好、外形逼真,有罗纹,两点辨别觉4～6 mm,手指功能恢复满意,供足行走无障碍。 结论 母趾腓侧皮瓣修复手指掌侧软组织缺损疗效确切、外观功能恢复满意,是一种理想的修复手指掌侧软组织缺损的方法。     

Functional and aesthetic treatment outcomes after immediate jaw reconstruction using a fibula flap and dental implants

Purpose

Microvascular fibula flap surgery is a reliable and effective procedure for reconstructing the jaws after tumour surgery. This procedure allows the placement of dental implants after bone consolidation. This study was designed to evaluate the oral, functional, and aesthetic rehabilitation of tumour patients with immediate fibula transfer and dental implants and included assessment of diet, speech, and aesthetics.

Reconstruction of isolated mandibular bone defects with non-vascularized corticocancellous bone autograft and graft viability

Objective

The aim of this study is to discuss the use of non-vascularized bone grafts in mandibular reconstruction and their viability.

Methods

In this study, 11 patients with mandibular defect treated by surgery using non-vascularized bone grafts between 2011 and 2012 were reviewed. All patients underwent preoperative and postoperative 3-dimensional computerized tomography scan for surgical planning and evaluation of success after surgery. Grafts were used for defects caused by mandible tumors in 2 patients and firearm injuries in 9 patients. Reconstruction was achieved by using various non-vascularized bones, including iliac crest, fibula and scapula. To improve graft supply, periosteum of the grafts was spared and multiple bores were created on the graft during surgery by drilling. At the postoperative period, Dextran 70 and Bencyclane Hydrogen Fumarate was given in order to enhance micro-circulation. On the postoperative day 5, 15 and 30, Tc-99 m methylenediphosphonate scintigraph, blood-pool single photon emission computed tomography and it's bone phase were performed in order to assess viability of bone grafts greater than 3 cm.

Results

Mean age was 32. 27 ± 13.33 (min = 10–max = 56). Of the 11 patients, 10 (90. 9%) were men and 1 (9. 1%) was woman. Mandibular defects were at right corpus in 3 patients; at right ramus and angulus in 1 patient; at left corpus in 1 patient; at left ramus and angulus in 1 patient; at left ramus, angulus and corpus in 1 patient; left parasymphysis in 1 patient; at bilateral corpus in 1 patient; at symphysis in 1 patient and at whole segment from right corpus to left one in 1 patient. The following grafts were used: iliac crest grafts in 9 cases, scapula graft in 1 case and fibula graft in 1 case. The smallest graft used was 1 × 2 cm in size, while the greatest, single piece graft was 7 cm in size. The greatest multi-piece graft was a fibula graft of 14 cm in length. All grafts with a size of 3 and 7 cm had been supplied at the end of first month. No bone resorption or donor site morbidity was observed in any patient.

Conclusion

Non-vascular bone grafts can be successfully used in isolated bone defects of mandible in case of appropriate graft selection for fitting anatomical region. A single piece iliac crest grafts up to 7 cm can be revascularized in long-term.