Effect of autocontrol micromotion intramedullary interlocking nail on fracture healing： an experimental study

Objective: To investigate the effect of autocontrol micromotion locking nail ( AMLN ) on experimental fracture healing and its mechanism. Methods: 16 goats undergoing both sides of transverse osteotomy of the femoral shafts were fixed intramedullary with AMLN and Gross-Kempf (GK) nail, respectively. The follow-up time was 7, 14, 28 and 56 days. Roentgenographic, biomechanical, histological, scanning electromicroscopic and biochemical analyses were done. Results: (1) The strength of anticompression, antiflexion and antitorsion in the fractural end in the AMLN-fixed group was higher than that of GK nail-fixed group; whereas, the rate of stress shelter in the fractured end decreased significantly (P<0.01). (2) The content of the total collagen, insoluble collagen, calcium and phosphate in the AMLN-fixed group was higher than that in the GK nail-fixed group (P<0.05). (3) Histological observation and quantitative analysis of calluses revealed that AMLN could promote the growth of bridge calluses and periosteum calluses. Hence the facture healing and remolding process achieved early, which was much better than traditional GK nail fixation. (P<0.05). (4) 7-14 days postoperation, the calluses of AMLN-fixed group was flourish and camellarly arranged and the collagen fibril formed constantly in the absorption lacuna of bone trabecula. 28-56 days postoperation, the collagen fibril was flourish around the absorption lacuna and was parallel to the bone's longitudinal axis. Active bony absorption and formation were seen, so was remolding and rebuilding. Haversian system was intact and the bony structural net was very tenacious because of the deposition of calcium salt. None of the above findings was observed in the GK nailfixed group. Conclusions: The design of AMLN accords well with the plastic fixation theory. As the geometry ametabolic system constituted by the intramedullary fixation instruments and the proximal and distal end of the fracture is very firm and stable, the disturbance to the physical stress distributed in the fractural end is light. The generation and conduct of the intermittent physical stress between the fractural parts could reach the balance between stress conduct and stress protection. The feature that the healing and remolding take place at the same time speeds up the fractural healing process.     

腰椎间孔内口狭窄的有限手术治疗

腰椎间孔内口狭窄是引起腰腿疼痛的病因之一.常用全椎板或半椎板切除减压治疗,生物力学研究表明,该术式容易导致腰椎术后不稳[1],已引起临床充分重视.自1990年2月～2003年2月,我们采用有限开窗腰椎间孔内口扩大成形术治疗该病40例,疗效满意.现总结报告如下.     

自控微动带锁髓内钉内固定对骨折愈合影响的X线平片及微血管造影观察

目的 :探讨自控微动带锁髓内钉 (AMLN )固定对骨折愈合的影响及机制。方法 :对 12只山羊两侧股骨干横断截骨 ,分别采用AMLN和GK钉固定 ,术后 7、 14、 2 8、 5 6d分批处死 ,行X线平片、微血管造影及皮质骨的血流量变化检测。结果 :AMLN固定组 ,骨痂早期数量多 ,密度高连续无中断 ,中、后期骨痂质量好 ,成熟程度高 ,骨折边愈合边改建边塑形 ,与此功能相适应 ,皮质骨骨痂内血管丰富 ,5 6d后血管基本恢复正常 ,血管均匀且扩张消失。GK钉固定组 ,骨痂数量少 ,密度低不连续有中断现象 ,骨痂内血管管径细 ,排列紊乱 ,吻合程度比较差。血液流量前者明显优于后者 ,14d后两者相差 43 % (P <0 .0 5 )。结论 :AMLN内固定所建立的有间歇性动应力刺激与传导的生物力学环境 ,使皮质骨骨痂内血管形成及血运丰富 ,骨痂的形成和强度提高 ,加快了骨质重建的速度。     

肱骨干骨折外固定架治疗96例分析

目的：探讨应用外固定架治疗肱骨干骨折并发症的防治办法。方法：通过对96例肱骨骨折患者应用骨外固定架治疗结果进行分析，以求获得并发症的防治策略。闭合性骨折91例，单环横形、斜形或螺旋形骨折54例，粉碎性骨折37例。开放性骨折5例，Gustilo Ⅰ型3例，Ⅱ型2例。结果：82例得随访，随访时间为4～26个月。61例顺利临床愈合，功能恢复满意。26例出现骨折延迟愈合、桡神经损伤等不同类型并发症。结论：通过术中准确无误的操作及术后科学细致的管理，手术并发症可以有效防治。     

垂直提升联合整形术治疗眼睑松弛

目的：从整体上解决眼周松驰的状况，改善眼眉形态，一次性完成眼周整形。方法：根据眼睑松驰程度，选择重睑，眉部、眼袋切口去除松驰的眼睑皮肤、多余脂肪；悬吊轮匝肌韧带，对眶缘新月形凹陷，释放眶脂充填、固定，紧缩眶隔筋膜，垂直向上、外上提升松驰之上睑，固定轮匝肌于眉弓骨膜或眶外缘骨膜上，皮肤切口向上垂直提升缝合，一次完成上、下睑松驰的矫正。结果：经治疗的34例上、下睑松驰患者术后上、下睑松驰均得到矫正，眉位置得到上提，下睑眶缘凹陷得到充填。眼角额部皱纹减少。结论：上、下睑松驰经联合手术垂直提升皮肤、肌肉、改善眉位置后，一次性完成了眼周整形，达到了较好的美学效果。     

后路显微内窥镜治疗非发育性腰椎管狭窄症

目的应用后路脊柱显微内窥镜治疗非发育性腰椎管狭窄症。方法通过一个后正中微小切口，采用游离皮瓣和手术通道倾斜，实现多阶段减压和神经根通道松解，使用METRX完成非发育性腰椎管狭窄的手术治疗。结果术后疗效评定优良率为97．8％。结论METRX手术是传统开放式腰椎管狭窄手术的微创化和内窥镜化，可以彻底解除神经压迫，达到微创手术的目的，取得满意临床效果。     

腰椎间盘突出症再手术的有限化治疗

为探讨与腰椎间盘突出症有限化治疗相关的定位定性诊断及手术操作方法,减少手术失败率及致残率。术前定位定性诊断采用CTE、CTM与数字图像处理技术相结合,清楚了解硬膜囊受压及粘连的程度和范围。手术采用原手术部位的侧方入路有限化操作技术,不扩大减压范围去除瘢痕组织及神经根受压的诸多因素,重建上下关节突,恢复椎管后方有屏障及生物力学功能。结果显示38例腰椎间盘突出症再手术患者随访1~5年,优良率92%。认为有限化手术兼顾到了神经根的彻底松解及上下关节突的生物力学功能,使手术的创伤降低到最小,再次手术的成功率明显提高,有推广应用价值。     

论误诊标准制定中的相关问题

误诊学作为一门学科体系经过十几年的发展已经被越来越多的医学工作者认识和接受。随着对该学科研究的深入 ,目前误诊标准的制定已成为误诊学研究整体进程中的核心问题 [1] ,同时也是社会关注的热点 [2 -4 ]。由于误诊与诸多因素有关 ,很多疾病又错综复杂 ,因此 ,制定科学规范的误诊标准是一项艰苦、漫长、细致的工作 [5]。近年来大量误诊学专著和误诊学期刊从临床实践到科学研究、从临床经验到理性思维、从医德医风到社会环境、从临床现实到医学发展等 ,以大量翔实的临床资料 ,百家争鸣的态势正在将误诊学研究引向深入[6-12 ] ,并为制定误…     

有限双开窗法治疗腰椎软骨板破裂症

为保留腰椎后部结构的完整性,又能充分显露,彻底减压,采用根据椎板分型,倒U或V型椎板开窗,扩大侧隐窝治疗腰椎软骨板破裂症12例。手术尽可能地保留腰椎全部结构的完整性,可防止术后腰椎不稳,同时使神经根管代偿间隙明显增大,减低了术后DFC连锁变异现象所引起的椎管狭窄。经1～3.5年随访效果满意。并就12例腰椎软骨板破裂症的特点进行了讨论。