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1.
记忆合金U形钉固定对山羊脊柱侧凸椎体的矫形度   总被引:1,自引:0,他引:1       下载免费PDF全文
目的:观察记忆合金U形钉固定对侧凸山羊的椎体矫形度,探讨记忆合金U形钉固定对侧凸脊柱椎体生长调节的可行性.方法:用单侧椎弓根钉不对称拴系的方法建立雌性幼年山羊侧凸模型.建模8~10周后山羊进展为明显的脊柱侧凸,将动物随机分为对照组和治疗组,两组山羊均取出后路拴系物,治疗组取出栓系后凸侧行前路记忆合金U形钉固定术,对照组不作处理.继续观察8~13周,定期摄X线片,记录Cobb角.处死前第18天和第3天分别给予土霉素和钙黄绿素以标记生长板的骨化前缘.处死动物后完整获取顶椎上椎间盘以及两相邻的生长板,聚甲基丙烯酸甲酯包埋,不脱钙切片;荧光显微镜下测量两荧光标记线之间的距离,分别计算椎体两侧生长板的生长率,并根据生长率差异计算记忆合金U形钉对椎体的矫形度数.结果:在治疗期内,治疗组Cobb角矫正19.2°±8.1°,与治疗前比较有显著性差异(P<0.05);对照组Cobb角无明显变化(P>0.05).治疗组凹侧生长板生长率为(3.27±0.96)μm/d,明显大于凸侧记忆合金U形钉置入侧(1.84±0.52)μm/d(P<0.05);对照组凹侧生长率为(2.83±0.61)μm/d,凸侧为(2.96±0.77)μm/d,两侧差异无统计学意义(P>0.05).记忆合金U形钉对顶椎的椎体矫形度平均为0.017°±0.006°/d,同主弯整体矫形度之间存在明显的直线相关性(R2=0.941,P=-0.006),其在整体矫形中占13.18%.结论:记忆合金U形钉固定能够对椎体产生有效的椎体矫正角度,以达到对侧凸脊柱椎体生长调节的目的.  相似文献   
2.
Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.  相似文献   
3.
目的:定量分析椎体加压钉(Staple)固定矫正山羊脊柱侧凸后椎体生长板的组织形态学变化,探讨Staple同定对侧凸椎体生长板的影响.方法:用单侧椎弓根螺钉不对称拴系的方法对10只7~10周龄雌性山羊建立脊柱侧凸模型.术前、术后均行脊柱后前位和侧位X线平片检查,术后每4周检查一次,观察山羊脊柱弯曲情况.8~10周后,将成功建立脊柱侧凸模型的山羊随机分为对照组和Staple治疗组,两组山羊均取出后路拴系,Staple治疗组取出拴系后在最大弯曲椎体的凸侧前路置入记忆合金Staple.继续观察8周后完整获取两组山羊的顶椎上生长板、顶椎上一个椎体的下生长板以及两者之间的椎间盘,聚甲基丙烯酸甲酯(PMMA)包埋,不脱钙切片,甲苯胺蓝染色,镜下测量生长板生长方向上增殖层、肥大层高度.结果:10只山羊中有9只术后8~10周内进展为明显的脊柱侧凸,Staple治疗组(n=5)和对照组(n=4)的Cobb角分别为47.2°±11.2°、51.0°±17.7°,两组无显著性差异(P>0.05).Staple治疗组在Staple置入后即刻Cobb角为34.8°±12.4°,与置入前比较无明显差异(P>0.05);置入后8周为15.6°±11.7°,与置入后即刻比较明显变小(P<0.05);对照组在拴系取出术后即刻和术后8周Cobb角无明显变化(P>0.05).Staple治疗组生长板凸侧肥大层高度为29.17±4.38μm.凹侧为42.46±8.43μm,两侧有显著性差异(P<0.05);凸侧增殖层高度为75.70±18.36μm,凹侧为81.65±12.49μm,两侧无显著性差异(P>0.05).对照组生长板肥大层与增殖层高度两侧均无显著性差异(P>0.05).结论:Staple固定矫正脊柱侧凸重要的细胞学机制可能是逆转了生长板肥大层两侧原有的差异,使凸侧高度低于凹侧.  相似文献   
4.
目的通过不同型号、不同数量记忆合金加压钉矫正山羊脊柱侧凸模型效果的比较,探讨其调节脊柱生长的最佳干预方式。方法20只山羊用不对称拴系的方法建立脊柱侧凸模型。成模后解除拴系,随机分为4组(n=5)进行处理:3个治疗组行开胸手术,将相应型号的Staple钉植入椎体凸侧,对照组仅解除拴系。术后定期摄胸椎X线片,比较Cobb角变化。结果3个治疗组术后即刻矫形效果明显(P〈0.01),且侧凸的Cobb角随时间减小。各治疗组的有效矫形角度(矫形术后即刻Cobb角-术后2个月Cobb角)均较对照组大(P〈0.05),其中双排单间隙钉组的有效矫形角度最大,数据也较集中,但各治疗组之间差异无统计学意义(P〉0.05)。结论3种Staple钉的植入方式均可以有效的矫正脊柱侧凸,且矫形效果无显著差异。  相似文献   
5.
目的 探讨外固定器在前臂复合组织缺损皮瓣修复重建中的应用价值.方法 2005年5月至2008年12月,共收治创伤所致前臂复合组织缺损,且联合应用外固定器行皮瓣修复治疗的患者17例,其中男性11例,女性6例;年龄19~47岁,平均25.6岁.所有病例均有深部肌腱、骨骼外露.皮肤缺损面积7 cm×4 cm~19 cm ×9 cm,全部采用带蒂皮瓣移植修复,皮瓣面积10 cm×6 cm~20 cm × 15 cm.带蒂皮瓣蒂端缝合成管状,应用外固定器保持蒂部位置.固定针分别位于尺骨和髂骨者5例,位于桡骨和髂骨者12例.固定时间3~8周,平均5.1周.结果 所有患者均获随访,随访时间3~20个月,平均11.3个月.带蒂皮瓣全部成活,无压疮、腋窝糜烂、筋膜间隔综合征及骨髓炎等发生.术后4~6周断蒂,1例断蒂端存在表浅感染,经换药后创面愈合,其余16例断蒂后创面顺利愈合.骨折愈合时间8.5~15周,平均13.5周.二期皮瓣整形与功能重建者11例次.所有患者手及前臂功能恢复满意,感觉恢复至S3~S4级(1954年英国医学研究会感觉恢复分级标准),手外在肌和腕部肌肉肌力约Ⅳ~Ⅴ级.11例返回原工作岗位,6例满足日常生活需要.结论 在前臂复合组织缺损带蒂皮瓣修复中,应用外固定器可稳定地保持蒂部位置,代替石膏贴胸位固定,减少皮瓣血管痉挛的发生,便于皮瓣观察、护理和换药,利于前臂各关节主动及被动活动,最大程度恢复肢体功能.  相似文献   
6.
不对称力学负荷对山羊脊柱生长板影响的组织学观察   总被引:2,自引:1,他引:1  
目的:观察不对称力学负荷对山羊脊柱生长板的影响,探讨机械性因素调节脊柱生长的可能机制。方法:9只未成年雌性山羊随机分为实验组(n=6)和对照组(n=3),实验组采用单侧椎弓根螺钉不对称拴系的方法建立脊柱侧凸模型;对照组只作相同切口暴露,不进行固定。8周后获取侧凸顶椎(对照组相应节段)上下椎间盘及生长板,聚甲基丙烯酸甲酯(PMMA)包埋,不脱钙切片,Giemsa染色,镜下观察生长板情况。结果:对照组两侧生长板无明显差异;实验组非加压侧生长板增殖肥大层高度明显大于加压侧。实验组加压侧增殖肥大层软骨细胞数量少、形态异常、排列不规则,非加压侧软骨细胞增殖活跃,肥大层明显增厚:加压侧生长板最边缘的骺板内软骨细胞朝应力方向向外排列。结论:不对称力学负荷可导致生长板两侧软骨细胞增殖、肥大、形态及排列等的差异,并改变软骨内成骨方向,最终可能改变脊柱的生长方向。  相似文献   
7.
目的 定量分析Staple对侧凸山羊椎体生长板生长率的影响,进一步探讨Staple矫正脊柱侧凸的可能机制.方法 取健康2~3月龄雌性山羊10只,体重6.0~8.5 kg,用单侧椎弓根钉不对称栓系的方法建立脊柱侧凸模型,将动物随机分为对照组和Staple治疗组,每组5只.建模8~10周后,两组山羊均取出后路栓系,Staple治疗组在最大弯曲椎体的凸侧前路植入4~5枚Staple,对照组不作处理.继续观察8~13周,X线片记录Cobb角,观察脊柱侧凸矫正情况.处死前第18天和第3天分别给予士霉素和钙黄绿素以标记生长板的骨化前缘;完整获取项椎上椎间盘以及两相邻的生长板,聚甲基丙烯酸甲酯包埋,不脱钙切片;生物显微镜下测量两荧光标记线之间的距离,分别计算椎体凹凸两侧生长板的生长率.结果 有9只山羊建模术后8~10周内进展为明显的脊柱侧凸(Staple治疗组5只,对照组4只).Staple治疗组术后即刻Cobb角为(34.8±12.4)°,治疗最终时Cobb角减少至(15.6±11.7)°,二者差异有统计学意义(P<0.05);对照组术后即刻与治疗最终时的Cobb角分别为(49.3±18.0)°及(49.0±17.6)°,比较差异无统计学意义(P>0.05).在低倍生物显微镜下,两组标本凹凸侧的荧光亮度无明显差异;在高倍镜下见生长板骨化前缘有黄绿2条波浪形荧光带,黄色荧光较弱.Staple组凹侧两荧光线间的平均距离明显大于凸侧(Staple侧),凹侧生长板生长率为(3.27±0.96)μm/d,凸侧为(1.84±0.52)μm/d,差异有统计学意义(P<0.05);对照组凹侧生长率为(2.83±0.61)μm/d,凸侧为(2.96±0.77)μm/d,比较差异无统计学意义(P>0.05).结论 Staple可明显改变脊柱侧凸椎体生长板两侧的生长率,使凹侧生长率超过凸侧,以达到有效矫形.  相似文献   
8.
Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.  相似文献   
9.
【目的】通过对比双节段与单节段Staple钉对未成年山羊特发性脊柱侧凸模型的矫形效果,探讨长节段Staple钉对脊柱生长的调节作用。【方法】5~8周龄,体重6~8kg的健康雌性山羊15只,采用椎弓根钉不对称栓系加凸侧肋骨部分切除的方法建立脊柱侧凸动物模型,观察至少2个月。建模成功后手术解除拴系,随机分为单间隙钉组、双间隙钉组和对照组3组(n=5)分别进行处理:2个实验组行开胸手术,将记忆合金加压钉以侧凸顶椎为中心,纵跨与其毗邻的4~5个椎间盘,沿主弯的凸侧(右侧)纵行植入椎体,单间隙钉组植入跨单个椎间隙的Staple钉,双间隙钉组植入跨两个椎间隙的Staple钉,对照组不予治疗。术后即刻及其后每隔4~6周摄胸椎正侧位X线片(观察期至少2个月),测量Cobb角,比较角度的变化。【结果】成模14只。X线片显示2个实验组在矫形术后即刻矫形效果明显(P<0.01),侧凸的Cobb角随着时间推移有逐渐减小的趋势。在观察期内,实验组的Cobb角比矫形初期明显减小(P<0.01),对照组则没有显著的变化(P>0.05)。双间隙钉组的有效矫形角度(矫形术后即刻角度-观察期结束时角度)为17.8°±4.0°,较单间隙钉组(14.0°±7.6°)高,而且数据分布范围比较集中。两个实验组的有效矫形角度均比对照组大(P<0.05),但两实验组之间则无统计学差异(P>0.05)。【结论】两种记忆合金加压钉均可以有效地矫正脊柱侧凸的进展,双间隙钉能够达到甚至超过常规单间隙钉的矫形效果,但二者没有统计学差异。  相似文献   
10.
Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.  相似文献   
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