钢板结合异体骨板治疗股骨干内固定术后再骨折

目的：探讨钢板结合异体骨板治疗股骨干钢板内固定术后再骨折的疗效。方法：股骨干钢板内固定术后再骨折13例,其中男8例,女5例;年龄14～57岁,平均31.2岁。粉碎性骨折7例,斜形骨折4例,横形骨折2例。8孔股骨有限接触加压钢板5例,8孔上肢有限接触加压钢板2例,6孔股骨有限接触加压钢板2例,8孔兰氏钢板4例。钢板断裂均发生在骨折端邻近钉孔处。全部采用有限接触加压钢板（LC-DCP）加对侧异体脱蛋白骨板股骨双固定及自体髂骨移植术。结果：13例均获得随访,时间16～40个月,平均32个月,平均骨折愈合时间为9个月,均恢复下肢行走和负重的功能。术后1年膝关节功能按Merchan标准评定：优7例,良4例,可1例,差1例,优良率84.6%（11/13）。结论：自体髂骨植骨钢板结合骨板内固定治疗股骨干再骨折效果好,可以达到骨折牢固固定的目的。     

Follow-up control of patients with unilateral posterior cross-bite treated with expansion plates or the quad-helix appliance

The aim of this study was to evaluate the long-term stability of the occlusion after correction of posterior cross-bite with either a removable expansion plate or a quad-helix appliance and to compare the transversal development of the jaws in the plate group, the quad-helix group and a control group.At the start of treatment there were 22 children in each of the treated groups. Two children in the plate group and 1 child in the quad-helix group discontinued the treatment. Two children treated with the quad-helix appliance and 1 child in the plate group could not be reached for the follow-up registration, so the collective finally consisted of 30 boys and 27 girls: 19 subjects in the plate group, 19 in the quad-helix group and 19 controls.The treatment groups were studied with the help of plaster models before treatment, immediately after treatment and at the last registration about 5.5 years after treatment. The control group was studied with the help of plaster models on 2 occasions, at the mean age of 8.8 years and 15.9 years respectively. This was about the same age as the first and the last registrations in the treatment groups.In all children, the posterior cross-bite was corrected by the end of the treatment. At the last registration, the corrected posterior cross-bite had relapsed in 1 child in the plate group and in 3 children in the quad-helix group.The degree of expansion was similar for both groups. The mean treatment time was longer in the plate group than in the quad-helix group: 12.5 months and 7.7 months respectively.Despite a transversal expansion in the treatment groups, the width of the maxillary dental arch did not reach the mean width in the control group, and even at the last registration the width of the maxillary dental arch was significantly greater in the control group than in the treated groups.The conclusions of this study are: 1. The long-term treatment effect in children with posterior cross-bite was somewhat better when they were treated with the removable expansion plate in comparison with treatment with the quad-helix appliance. 2. Both immediately after treatment and at the last registration 5.5 years later, the width of the maxillary dental arch was significantly greater in the control group than in the plate group or the quad-helix group while the width of the mandibular dental arch was equal in all 3 groups.     

计算机辅助设计数字化三维成形钛网修补颅骨缺损

目的探讨利用计算机辅助设计与制造（CAD/CAM）技术进行个性化塑形颅骨缺损修补术的临床价值。方法2007年6月～2008年6月,选择笔者所在医院颅骨缺损患者20例作为计算机辅助设计组,其中男性12例,女性8例,年龄20。57岁,平均年龄33岁。术前将其颅骨缺损前后CT数据在计算机上分别进行三维重建,采用颅骨缺损部位的三维几何模型数据．应用人工智能技术,设计补片几何形状,制作出凸凹2个模具,利用模具将颅骨修补材料钛网压制成形,用成形好的钛网修补颅骨缺损。另选20例颅骨缺损患者作为对照组。结果塑形、麻醉及手术操作时间明显减少,术后无一例出现因塑形欠佳造成的并发症,复查头颅CT修复以后的颅骨形状与原颅骨形状完全一致。结论颅骨缺损修补手术应用CAD／CAM技术塑形颅骨修补材料实现了个体化配置修补颅骨缺损,使患者颅骨修补后头颅形状最大限度恢复生理原貌,患者满意度100％。此方法重复性强,具有一定的创新性和实用性,值得在临床大力推广。     

Effects of a specially pulsed electric field on an animal model of wound healing

The possible beneficial effects of a specially pulsed electric field (PEF) on wound healing were investigated in this study. We made a pair of triangular, full-thickness, dorsal incisions in the skin of 32 healthy male mice (one control group and three exposure groups). The treatment groups were kept between parallel plates in a partially insulated exposed environment. Group I was exposed to an electric field intensity of 10 kV/m, group II was exposed to 1.9 kV/m, and group III was exposed to 0.9 kV/m. PEFs were applied to the subjects for 20–22 h and 8 consecutive days. We determined the differences in wound recovery between the groups based on the following parameters: collagen fiber density, inflammatory infiltration density, capillary proliferation, and existence of exudates. We found that a 0.9 kV/m–1.9 kV/m chopped direct current (DC) electric field with a 30 μs repetition time favorably affected collagen synthesis and wound recovery. Despite the intensity of 0.9–1.9 kV/m, PEF accelerated healing, but 10 kV/m decelerated this recovery process.     

经皮重建钢板与经皮骶髂螺钉固定治疗Tile C型骨盆后环骨折

目的 对比经皮重建钢板和经皮骶髂螺钉两种内固定方法 治疗Tile C型骨盆后环骨折的临床疗效.方法 2002年3月至2007年10月,治疗Tile C型骨盆后环骨折患者58例.采用经皮重建钢板内固定治疗29例,男20例,女9例;年龄(37.3±11.3)岁.采用经皮骶髂螺钉固定29例,男21例,女8例;年龄(39.3±10.4)岁.致伤原因:车祸伤38例,高处坠落伤17例,挤压伤3例.记录患者的手术时间、X线暴露次数、术中出血量、切口长度、术后Majeed功能评价、术后并发症等相关数据,进行统计学分析.结果 58例均获得随访,随访时间12～36个月,平均21.3个月.两组患者在手术时间、X线暴露次数、切口长度、术中出血量等方面差异有统计学意义.术后Majeed功能评价:经皮重建钢板组优9例,良16例,可4例,优良率为86.1%;经皮骶髂螺钉组优10例,良16例,可3例,优良率为88.2%.结论 经皮重建钢板和经皮骶髂螺钉两种内固定方法 治疗Tile C型骨盆后环骨折疗效相当,但经皮重建钢板较经皮骶髂螺钉固定无神经及血管损伤风险,且术中透视少.     

股骨髁部支撑钢板修复股骨远端骨折效果评价

背景：股骨远端骨折多为粉碎性、不稳定性骨折,并伴有局部软组织及微循环的严重损伤,骨折愈合较为困难,髁部支撑钢板为临床广泛应用的治疗手段,但影响其预后的相关因素多样,各方报道亦不一。目的：探讨股骨髁部支撑钢板对股骨远端骨折治疗效果的影响因素。方法：回顾性分析股骨髁部支撑钢板置入治疗股骨远端骨折84例患者的临床资料,收集相关数据,应用单因素分析和Logistic回归分析筛查可能的影响因素。结果与结论：84例患者中,Neer评分优良患者63例（75%）,单因素分析显示,年龄、骨折类型、损伤类型、手术时机、复位质量、CPM锻炼各组间临床疗效差异存在显著性意义（P〈0.05）,Logistic回归分析显示,年龄越大,临床疗效越差（OR=0.797）,复位满意者、A型骨折和CPM锻炼者临床疗效好,OR分别为2.275,1.756,2.885。结果可见对于股骨远端骨折患者,髁部支撑钢板置入过程中良好的解剖复位和关节嵌合,置入后早期的CPM功能锻炼可有效的促进膝关节功能恢复,对于C型骨折患者,可考虑双钢板强化固定提高疗效。     

双重建钢板治疗肱骨髁间骨折

目的探讨双重建钢板治疗肱骨髁间骨折的临床疗效。方法 60例肱骨髁间骨折AO/ASIF分型均为C型,随机分为治疗组与对照组,各30例,治疗组采用双重建钢板内固定治疗,对照组采用克氏针内固定手术治疗,术后2组均随访1年,观察术后骨折愈合时间、肘关节活动范围、功能恢复及治疗效果。结果治疗组骨折愈合显著优于对照组,组间比较差异有统计学意义（P〈0.05）;治疗组术后1,6,12月随访肘关节活动范围均显著高于对照组,组间比较差异有统计学意义（P〈0.05）;治疗组术后12月随访肘关节功能恢复优良率显著高于对照组,组间比较差异有统计学意义（P〈0.05）。结论双重建钢板治疗肱骨髁间骨折,患者术后可行早期康复训练,能明显促进肘关节功能恢复,提高患者肘关节活动范围,缩短骨折愈合时间。     

实体眼眶模型及个性化三维预塑成型钛网在眶区骨折重建中的应用

目的 评价实体眼眶模型及个性化三维预塑成型钛网在眶区骨折重建中应用的价值.方法 经眼眶CT扫描数据创建虚拟眼眶模型,将数据输入快速成型机制备出实体眼眶模型,以此为模板预塑个性化三维形态钛网,对12例眶区骨折患者施行眶区整复手术.结果 眶重建手术后,9例复视完全消失,3例极周边残存复视,眼球突出度基本一致,取得了较为满意的疗效.结论 眼眶实体模型、三维预塑成型钛网技术能够提供更为完备及个性化的术前计划和治疗,有助于略去术中反复塑形以及试验性植入的冗余操作,有助于取得良好的眼眶重建疗效.     

Third-Order Theory for the Bending Analysis of Laminated Thin and Thick Plates Including the Strain Gradient Effect

The aim of the paper is the development of a third-order theory for laminated composite plates that is able to accurately investigate their bending behavior in terms of displacements and stresses. The starting point is given by the corresponding Reddy’s Third-order Shear Deformation Theory (TSDT). This model is then generalized to consider simultaneously the Classical Laminated Plate Theory (CLPT), as well as the First-order Shear Deformation Theory (FSDT). The constitutive laws are modified according to the principles of the nonlocal strain gradient approach. The fundamental equations are solved analytically by means of the Navier methodology taking into account cross-ply and angle-ply lamination schemes. The numerical applications are presented to highlight the nonlocal effects on static behavior.     

Advantages of performing mentoplasties with customized guides and plates generated with 3D planning and printing. Results from a series of 23 cases

Purpose

To evaluate the benefits of performing mentoplasty using custom guides and plates in a series of 23 patients.