通用型脊柱内固定系统椎弓根螺钉翻修作用的生物力学研究

目的测试自行设计的通用型脊柱内固定系统(generalspinesystem,GSS)椎弓根螺钉以及SOCON、TSRH和Diapason螺钉置入椎体的拔出力及旋入力矩,评价GSS螺钉的翻修作用。方法将36个正常成人腰椎椎体标本随机分为三组,每组12个椎体(24侧椎弓根)。各组标本每个椎体的每侧椎弓根均先拧入CCD螺钉(直径6.0mm,长45mm),行螺钉拔出试验,测试并记录螺钉的最大旋入力矩和最大轴向拔出力。然后各组标本每个椎体均随机选择一侧椎弓根经原钉道拧入GSS螺钉(直径6.5mm,长45mm);第一组另一侧拧入SOCON螺钉(直径7.0mm,长45mm),第二组另一侧拧入TSRH螺钉(直径7.0mm,长45mm),第三组另一侧拧入Diapason螺钉(直径6.7mm,长45mm)。分别测试螺钉最大旋入力矩及最大轴向拔出力。结果第一组GSS螺钉最大轴向拔出力为CCD螺钉的114%,SOCON螺钉为CCD螺钉的108%;GSS螺钉最大轴向拔出力大于SOCON螺钉,差异无显著性(P>0.05);GSS螺钉最大旋入力矩小于SOCON螺钉,差异无显著性(P>0.05)。第二组GSS螺钉最大轴向拔出力为CCD螺钉的127%,TSRH螺钉为CCD螺钉的64%;GSS螺钉最大轴向拔出力大于TSRH螺钉,差异有显著性(P<0.01);GSS螺钉最大旋入力矩大于TSRH螺钉,差异有显著性(P<0.01)。第三组GSS螺钉最大轴向拔出力为CCD螺钉的122%,Diapason螺钉为CCD螺钉的8     

提高老年骨折的临床治疗水平

本期《中华创伤骨科杂志》是以“老年骨折”为主要内容的重点刊，涉及老年股骨转子间骨折，肱骨近端骨折，桡骨远端骨折．股骨远端、髌骨、胫骨干、踝关节等部位骨折的内固定手术治疗。骨质疏松是老年人发生骨折的高危因素之一，也是骨折后导致处理棘手的原因所在。除了骨质疏松，由于老年人通常有各种并存症的存在，愈发增加了老年骨折的处理难度。如何提高骨折的治疗质量及预防再骨折的发生成为目前处理老年骨折的工作重心。     

踝关节色素沉着绒毛结节性滑膜炎误诊1例报告

患者,女性,53岁,发现左外踝无痛性肿物2年余,无外伤史。发病1个月后曾在外院诊断为“血管瘤”,建议观察随诊。近期肿物逐渐增大,查体发现肿物位于外踝尖的前后侧分为两部分,轻度压痛,有揉面感,踝关节活动无受限。超声示外踝附近两个不规则低回声影,边界清,内部回声不均匀,内可见血流信号,为实性肿物。踝关节X线片未见明显骨质破坏,关节面光滑,关节间隙较对侧稍增宽。病理报告见图1。图1滑膜上皮呈乳头状增生,间质大量纤维组织细胞增生,淋巴细胞、多核巨细胞浸润,并伴大量含铁血黄素沉积(HE染色,×20)2005年1月12日行肿瘤切除术,由外踝沿肿…     

股骨转子周围骨折的髓内钉固定

目的探讨带锁髓内钉固定在股骨转子周围骨折中的应用价值以及相关并发症的防治。方法回顾分析了自1993年12月至2001年9月间作者收治的180例(181髋)经髓内钉治疗的转子周围骨折,其中应用亚太型Gamma钉96例(97髋)、股骨重建钉54例、股骨近端钉(PFN)30例。结果平均手术时间65分钟,术中术后输血患者仅占15.6%;平均随访时间为16个月,96%的骨折获得愈合,平均愈合时间为3.5个月;按黄公怡评价标准,髋关节功能优良率为90.2%;发生9种类型的并发症。结论髓内钉固定在治疗股骨转子间骨折中具有较大的临床价值,但仍存在一定的并发症,应引起足够重视。     

Consensus Statement on the Use of Bone Turnover Markers for Short-Term Monitoring of Osteoporosis Treatment in the Asia-Pacific Region

Osteoporosis is a major health issue. By 2050, a greater than 2-fold increase in patients number with hip fractures will occur in Asia representing 50% of all hip fractures worldwide. For the Asia-Pacific (AP) region, more efforts on controlling osteoporosis and the subsequent fractures are crucial. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) is commonly used to diagnose osteoporosis and monitor osteoporosis treatment. However, the inconvenience, cost, limited availability of DXA and the delay in detection of BMD changes after treatment initiation support an important role for bone turnover markers (BTMs), as short-term tools to monitor therapy. With regards to low adherence rates of medical treatment of osteoporosis, the experts reached consensus on the use of BTMs for both raising awareness and short-term monitoring of osteoporosis treatment in the AP region. The experts endorse the use of BTMs, especially serum C-terminal telopeptide of type 1 collagen (CTX) and serum procollagen type 1 N propeptide (P1NP), as short-term monitoring tools to help clinicians assess the responses to osteoporosis therapies and appropriately adjust treatment regimens earlier than BMD. Either the absolute values or the degree of change from baseline in BTMs can be used to monitor the potential efficacy of osteoporosis therapies. The use of BTMs can be incorporated in osteoporosis care programs, such as fracture liaison service (FLS), to improve patient adherence and treatment outcomes. Encouraging sufficient reimbursement from health care systems may facilitate widespread use of BTMs in clinical practice in the AP region.     

Potential lack of “standardized” processing techniques for production of allogeneic and xenogeneic bone blocks for application in humans

In the present study, the structure of two allogeneic and three xenogeneic bone blocks, which are used in dental and orthopedic surgery, were histologically analyzed. The ultimate goal was to assess whether the components postulated by the manufacturer can be identified after applying conventional histological and histochemical staining techniques. Three samples of each material, i.e. allogeneic material-1 and -2 as well as xenogeneic material-1, -2 and -3, were obtained commercially. After decalcification and standardized embedding processes, conventional histological staining was performed in order to detect inorganic matrix, cellular or organic matrix components. Allogeneic material-1 showed trabecular bone-like structures, which were free of cellular components as well as of organic matrix. The allogeneic material-2 showed trabecular bone structures, in which connective tissue and cellular remnants were embedded. Additionally, some connective tissue, which resembled fat-like tissue, was found within this material. The xenogeneic material-1 showed trabecular bone-like structures and contained organic components comparable to that demonstrated for the allogeneic material-2. The xenogeneic material-2 showed trabecular bone structures with single cells located in lacunae. The xenogeneic material-3 also showed trabecular structures. Neither cellular nor organic matrix components were found within this material. According to the data of the present study, the allogeneic material-1 and the xenogeneic material-3 were the only investigated materials for which the obtained histological data were in accordance with the manufactureŕs advertised information. The remaining three materials showed discrepancies—although the manufacturers of all five bone substitute materials stated that their blocks were free of organic/cellular remnants. These data are of great clinical and material science interest. It seems that even patented processing techniques are not always able to deliver reproducible materials. Although the manufacturers of all five bone blocks stated that their blocks were free of organic/cellular remnants, our histological analysis revealed that three out of five bone blocks did contain such remnants. Such specimens might be able to induce an immune response within the recipient.     

A new look at osteomyelitis development – Focus on CCR5delta32. Study in patients from Northeast Brazil

IntroductionCCR5 receptor exerts an important role in the host immune response. Osteomyelitis is an inflammatory process and Staphylococcus aureus is the principal causative agent of this bone injury complication. A deletion of 32 bp (CCR5Δ32) in the CCR5 gene seems to protect against HIV-1, S. aureus and other infections. However, the CCR5Δ32 allele has been associated with an increased risk for other diseases.ObjectiveTo investigate the function of CCR5 and to gather data about the relationship of the CCR5Δ32 mutation and the risk of developing osteomyelitis as a complication in patients with bone traumas.MethodsIn a study of 153 patients with bone traumas the presence of the CCRΔ32 mutation was determined by PCR.ResultsIn this study, the CCR5Δ32 allele was present only in the heterozygous form. Osteomyelitis was more frequent in the wild type carriers (94.87%; 37/39) and most of the CCR5Δ32 carriers (87.5%; 14/16) did not present with osteomyelitis.ConclusionThe CCR5Δ32 could be associated with protection against osteomyelitis caused by S. aureus, corroborating the data from Alonzo & Torres study, in which CCR5 receptor is required for S. aureus leukotoxin ED (LukED) cytotoxicity.     

生长棒撑开术中经颅刺激运动诱发电位和体感诱发电位监测的应用价值

目的:分析生长棒撑开术中经颅刺激运动诱发电位(MEP)和体感诱发电位(SEP)神经功能监测的应用价值。方法:回顾性分析2010年10月~2015年1月我院进行的65例141次生长棒撑开手术,在生长棒撑开术中,运用MEP和SEP进行神经功能监测。MEP监测采用经颅刺激C3、C4,记录外周肌源性MEP,SEP监测采用刺激双侧胫后神经,记录电极采用Cz-CPz。阳性诊断标准:与基线相比,MEP波幅下降75%,SEP波幅下降50%或潜伏期延长10%。结果:141例次撑开手术中成功获得具有监护价值且重复性较好MEP 139例次,检出率98.6%,全程失败2例次(占1.4%);SEP成功监测140例次,检出率99.3%,失败1例(占0.7%)。所有患者均能成功记录到一种以上的诱发电位。本组141例次手术中未出现MEP及SEP监测阳性。所有患儿术后神经系统检查均无异常发现,神经功能监测结果均为真阴性。结论:生长棒撑开术是简单安全的手术操作,但是,运用MEP和SEP进行术中神经功能监测可以为生长棒撑开术提供客观的安全评估指标。     

膝关节弥漫型色素沉着绒毛结节性滑膜炎的手术治疗

目的比较开放性滑膜切除术与关节镜下滑膜切除术治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎(PVNS)的治疗效果。方法回顾性分析北京协和医院1994年3月至2013年10月手术治疗的有完整随访资料的膝关节弥漫型PVNS患者47例,所有患者根据手术方式分为开放性手术组和关节镜手术组,其中开放性手术组17例(接受开放性滑膜切除术)、关节镜手术组30例(接受关节镜下滑膜切除术),两组术后常规放疗。术后平均随访时间(15.7±16.3)个月(10~30个月),记录所有患者手术前及末次随访时的关节活动度、国际膝关节评分委员会(IKDC)评分和Lysholm评分以及两组患者复发率,比较两组患者治疗效果和复发率。结果随访期间共8例患者复发,复发率17.0%;其中开放性手术组3例复发,复发率17.6%;关节镜手术组5例复发,复发率16.7%;两组复发率比较差异无统计学意义。开放性手术组末次随访和术前的膝关节活动度、IKDC评分和Lysholm评分分别为(97.5±14.3)°和(69.7±12.6)°,(74.5±6.1)和(38.6±5.4)分,(77.5±5.8)和(42.4±4.6)分,关节镜手术组末次随访和术前的膝关节活动度、IKDC评分以及Lysholm评分分别为(128.6±13.9)°和(64.9±13.2)°,(87.4±6.7)和(37.2±4.9)分,(86.2±6.2)和(41.9±5.3)分,末次随访均较术前显著增加(P均<0.05),关节镜手术组末次随访的关节活动度、IKDC评分和Lysholm评分均较开放性手术组显著增加,差异有统计学意义(P均<0.05)。结论开放性滑膜切除术与关节镜下滑膜切除术治疗弥漫型PVNS的复发率相当,但后者膝关节活动度、膝关节功能评分显著高于前者,所以关节镜治疗膝关节弥漫型PVNS是一个较好的选择。     

鲑鱼降钙素对老年骨科手术后患者骨代谢的影响

目的：观察老年患者骨科围术期骨代谢变化特点及术后应用鲑鱼降钙素对骨代谢的影响。方法年龄＞60岁老年患者90例纳入本研究,男性21例,女性69例。其中行髋关节手术37例,膝关节手术38例,腰椎手术15例。将研究对象随机分为2组,治疗组45例,术后应用鲑鱼降钙素＋碳酸钙片＋活性维生素D抗骨质疏松治疗;对照组45例,术后应用碳酸钙片＋活性维生素D治疗。分别于术前、术后1周、术后3个月测定静脉血骨钙素（OC）及Ⅰ型胶原交联C端肽（β-CTX）水平;于术前、术后3个月采用DEXA双能X线骨密度仪测定患者腰椎及髋部骨密度。结果共78例患者完成随访,对照组（n＝37）术后1周β-CTX均值较术前明显升高（P＜0.001）,术后3个月较术前变化无统计学意义（P＞0.05）;治疗组（n＝41）术后1周β-CTX均值较术前明显升高（P＜0.001）,术后3个月较术前明显降低（P＜0.05）;对照组术后1周OC均值较术前明显降低（P＜0.05）,术后3个月较术前无明显变化（P＞0.05）;治疗组术后1周OC均值较术前明显降低（P＜0.001）,术后3个月较术前无明显变化（P＞0.05）;治疗组与对照组腰椎、髋部BMD术前与术后3个月差异均无统计学意义（均P＞0.05）。结论老年患者接受骨科手术前后骨代谢发生改变,手术后1周骨吸收过程活跃,骨形成过程受抑制;术后应用鲑鱼降钙素3个月抗骨质疏松治疗能有效抑制骨吸收,但对促进骨形成无明显影响。