3D打印导向模板辅助下置入空心钉治疗股骨颈骨折的临床研究

目的 探讨3D打印导向模板辅助下置入空心钉治疗股骨颈骨折的临床效果。方法 回顾性分析2015年3月至2017年12月在我院诊断为股骨颈骨折且需手术的病人，根据手术方式不同进行分组，每组40例。观察组采用3D打印导向模板植入3枚空心钉，对照组采用传统置钉导向器植入空心钉。两组病人均在骨科牵引床辅助“C”型臂X线机透视下完成手术，比较两组的置钉时间、术中导针穿针次数、术中X线透视次数和术中出血量。测量观察组术中所用置钉长度，并与术前通过3D打印模型测量所得的结果进行比较。结果 80例病人均顺利完成手术，未造成血管、神经损伤。观察组术中所用置钉长度与术前通过3D打印模型测量所得的结果相比，准确率在95%以上；观察组病人的置钉时间明显短于对照组，术中穿针次数、术中平均透视次数、术中出血量明显少于对照组（P＜0.05）。结论 3D打印导向模板辅助下置入空心钉治疗股骨颈骨折，有利于缩短手术时间，减少术中出血量，提高手术精度，达到良好的手术治疗效果，值得临床推广。     

Treatment of brittle nail with a hydroxypropyl chitosan‐based lacquer,alone or in combination with oral biotin: A randomized,assessor‐blinded trial

We evaluated in a randomized, assessor‐blinded, study the efficacy of a hydroxypropyl chitosan‐based nail lacquer (HPC‐NL) alone or in combination with oral biotin (HPC‐NL + B) in the treatment of brittle nail syndrome (BNS). Fifty subjects (21 men; mean age 64 years) with BNS were enrolled. Twenty‐six were randomly assigned to HPC‐NL and 24 to the HPC‐NL and biotin, 10 mg/daily (+B). Topical and oral treatments lasted for 4 consecutive months. The primary outcome was the evolution of the Onychodystrophy Global Severity Score (OGSS) assessing nail dystrophy, lamellar and longitudinal splitting, dyschromia, and pitting. At baseline, the OGSS, mean (SD), was 8.4 (2.1) in the HPC‐NL group and 11.8 (2.3) in the HPC‐NL + B group. The OGSS was significantly reduced during treatments in both groups. At Month 4, OGSS was reduced by 57% (HPC‐NL) and 62% (HPC‐NL + B). At the end of study period, the percentage of subjects with an OGSS reduction of ≥50% in comparison with baseline was 53% in the HPC‐NL group and 80% in the HPC‐NL + B group (p = .05). Both treatments were well tolerated. In subjects with BNS, HPC‐NL alone is associated with a clinically relevant improvement of nail appearance. The combination of HPC‐NL and oral biotin is associated with further clinical improvement.     

Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails

ObjectiveThe aim of this study was to compare the biomechanical resistance to rotational and axial forces of a conventional locking nail with a newly designed intramedullary humeral nail developed for humeral shaft fractures with a secure locking mechanism through the distal part of the nail.MethodsInSafeLOCK humeral nail system (group 1, TST, Istanbul, Turkey) and Expert humeral nail system (group 2, DePuy Synthes, Bettlach, Switzerland) of the same size (9 × 300 mm) were examined. In total, 24 fourth-generation humerus sawbones were used in the experiment. Osteotomy was performed at the humerus shaft, and a defect was created by removing 1 cm of bone. After pre-loading 5000 cycles at a frequency of 2 Hz and a force of 50–250 N for axial loading and 5000 torsion torques between 0.5 Nm and 6.5 Nm at a 2 Hz frequency for torsional loading, the failure load values of each load were recorded. Distal interlocking was performed with an endopin in group 1, while a double cortex screw was used in group 2.ResultsAll samples successfully passed the cyclic loading. The initial and final stiffness values were similar between the groups after axial loading (p = 0.873 and p = 0.522, respectively). The mean axial failure load values in groups 1 and 2 were 2627 ± 164 N and 7141 ± 1491 N, respectively. A significant difference was found in the axial failure load values (p = 0.004). Significant differences were observed between the initial and final torsional stiffness between the two groups (p = 0.004 and p = 0.004, respectively). No significant difference was found in the failure load values after torsional loading (11791 ± 2055 N.mm and 16997 ± 5440 N.mm) (p = 0.055).ConclusionThese results provide a biomechanical demonstration of the adequate stability of both nails after axial and rotational loading. The reliability of the newly developed InSafeLOCK humeral nail system, which does not require fluoroscopic control and an additional incision for distal locking, supports its use in the clinic.     

Ankle arthrodesis using a modified Masquelet induced membrane technique for open ankle fracture with a substantial osteochondral defect: A case report of novel surgical technique

Reconstruction of a bone defect using the Masquelet induced membrane technique has been well described. However, there are few reports of arthrodesis using this technique. In this case report, we describe a modified Masquelet technique for ankle arthrodesis with nailing. The patient was a 32-year-old man who sustained an open fracture of the right ankle with a substantial osteochondral defect as a result of a fall. Immediately after the injury, a staged procedure using the Masquelet technique was planned. The bone defect was filled with bone cement in the acute stage, but replacement of the cement was needed 6 months after the injury because of a prolonged inflammatory reaction. Ten months after the injury, the bone cement was removed, and ankle arthrodesis was performed using an IM nail with a combination of autologous and artificial bone. As a modification of the Masquelet technique, the anterior surface of the transplant site was covered with a large but thin layer of cortical bone instead of suturing the incised membrane. At 1 year postoperatively, firm bony union was achieved and the implant was removed. At follow-up 3 years after his injury, the patient is able to walk, undertake physical work, and has no clinical signs of infection. Our experience suggests that a modified induced membrane technique may be useful when treating an open limb fracture with an extensive osteochondral defect where preservation of the joint is difficult and arthrodesis is considered.     

TRIGEN股骨髓内钉在股骨骨折中的应用

目的探讨TRIGEN股骨髓内钉在股骨骨折中的应用效果。方法对54例股骨骨折患者采用TRIGEN股骨髓内钉治疗,记录髓内钉远端锁钉时间、透视次数、一次锁钉成功率及骨折愈合时间。结果54例均获得随访,时间8~36个月。患者骨折均愈合,愈合时间3~14个月。均无伤口感染、血管神经损伤。Sureshot远端瞄准系统远端锁钉时间为142~412 s,一次锁钉成功率为97.2%,透视次数为1~6次。结论TRIGEN股骨髓内钉治疗股骨骨折治疗效果满意,具有损伤小、固定简便、并发症少等优点;Sureshot远端瞄准系统一次锁钉准确率高、操作时间短、放射量小。     

研究分析交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗效果

目的研究分析交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗效果。方法将2017年4月-2018年4月本院收治的180例创伤性下肢长管状骨骨折患者进行本次研究,按挂号先后顺序均分为参照组和观察组,各90例。参照组用钢板内固定术治疗,观察组用交锁髓内钉内固定术治疗,比较两组的愈合情况和并发症发生情况。结果治疗后,参照组的愈合情况显著差于观察组;参照组的并发症发生情况高于观察组,采用有统计学意义(P<0.05)。结论交锁髓内钉内固定术对创伤性下肢长管状骨骨折的治疗有非常好的效果,保障了患者的恢复情况,减少了患者治疗后的并发症情况。