闭合性股骨骨折伴股动脉损伤漏诊四例分析

闭合性股骨骨折是较常见的骨折类型,但合并股动脉损伤的病例并不多见,如果漏诊漏治会发生严重的后果.2000年4月～2002年12月我们曾收治4例闭合性股骨骨折伴股动脉损伤的病人,因未及时救治而导致不同平面的截肢.报告如下.     

急性闭合性脑损伤模型的建立与评估

目的建立符合临床的急性闭合性脑损伤模型。方法24只新西兰大耳白兔随机分为4组:A(标准对照组),B、C、D组(均为实验组)。采用800g·cm(100g×8 cm)的打击能量在B、C、D组兔的硬膜外造成脑损伤模型。分别在伤后1、3、5 h测量水肿区脑皮层中水、钠、钙和丙二醛(MDA)的含量及及伤后5 h的病理学改变。结果水肿区脑皮层中水、钠、钙和MDA的含量呈进行性升高并有明显的病理学改变。结论本实验所建立的脑损伤模型符合临床上闭合性颅脑损伤的病理学改变和病理生理特点。     

Feeney法建立大鼠闭合性脑损伤模型及评估

目的使用F eeney法建立符合临床研究的大鼠闭合性脑损伤模型,并对其进行评估。方法应用自行设计制造的撞击装置,按照F eeney法复制闭合性脑损伤。撞击装置由支架、套管、砝码和脚板四部分组成。采用96只3月龄SD雌性大鼠随机分为3组:对照组(A组),不给予撞击;轻伤组(B组),打击能量400 g.cm撞击一次;重伤组(C组),打击能量800 g.cm撞击一次;每组32只。分别于致伤后6、24 h,3、7 d,观察大鼠脑损伤早期生理反应、病理改变,并测定脑含水量的变化。结果B、C组大鼠伤后均表现为血压骤升后骤降、脉搏加快、呼吸深快或暂停,甚至永久停止;尤以C组明显。B、C组致伤后6 h均出现损伤灶皮质挫伤淤血、周围神经元变性等病理改变,脑含水量明显增加,7 d后大致正常;伤后12 h损伤灶有透明血栓形成,3 d伤灶周围神经胶质细胞增生,7 d伤灶局部液化坏死。而且病理损伤程度随撞击力和撞击面积上升而逐渐加重,当撞击力上升至1 200 g.cm时,大鼠多因呼吸骤停死亡。结论建立的大鼠颅脑损伤模型基本符合临床闭合性脑损伤的病理学改变与病理生理特点,是一种较为实用的方法。     

改良小鼠肝移植模型建立

目的 建立改良的小鼠原位肝移植模型,探讨较优的手术方式.方法选取体质量相近的昆明小鼠作为供、受体,在两袖套法的基础上,将小鼠肝移植术划分为:供体准备手术、受体准备手术、取肝和整肝及供肝植入手术;提高肝上下腔静脉吻合质量;改进门静脉、下腔静脉及胆总管重建方法;缩短供肝冷缺血时间.检测受体小鼠术后14 d血清谷丙转氨酶(ALT)及谷草转氨酶(AST)水平,并与正常小鼠比较.术后14 d切取移植物行病理学检查.结果 供肝冷缺血时间＜45 min,手术成功率达85%,术后小鼠远期存活率近78.5%.术后14 d受体小鼠血清中ALT含量为(35.7±5.8)U/L,AST含量为(110.3±13.9)U/L;与正常小鼠血清中ALT[(31.3±9.5)U/L]及AST[(113.3±15.0)U/L]水平比较差异无统计学意义(P＞0.05).病理学检查示未见缺血再灌注损伤表现.结论 改良的模型制作手术成功率高,供肝冷缺血时间短,是一种较为理想的小鼠肝移植研究模型.     

小鼠肾移植模型的建立

目的建立小鼠肾移植模型,为利用转基因小鼠研究移植免疫奠定基础.方法采用雄性C57BL/6小鼠行120例血管化的异位异体肾移植,移植肾动、静脉分别与腹主动脉及下腔静脉行端侧吻合,尿道重建采用将供肾输尿管末端引入膀胱内加外固定的方法.分二期切除受体自身肾脏.结果手术成功率为87.5%,手术时间为(121±18)min,热缺血时间约为3～6s,冷缺血时间为(55±13)min.结论细致的显微手术、正确的吻合方式、尽可能缩短肾缺血时间及动静脉阻断时间,以及坚持微创手术原则是成功建立小鼠肾移植模型的关键.     

有限内固定结合外固定支架治疗股骨骨折

[目的]探讨有限内固定结合外固定支架在治疗股骨骨折中的临床疗效。[方法]2012年6月~2015年10月从股骨骨折的患者中选取20例,男13例,女7例;年龄17~63岁,平均39岁;全部为新鲜闭合性损伤。按照AO分型:A1型5例,A2型4例,A3型2例,C1型4例,C2型3例,C3型2例。全部应用有限内固定结合外固定支架治疗。[结果]20例患者均获得12~34个月随访,平均18个月。术后均无血管神经损伤,其中2例患者出现针道感染,1例出现螺纹钉松动,给予及时换药及拔出感染及松动螺纹钉处理治愈。X线片示骨折均获得骨性愈合。膝关节活动度(与对侧比较):平均伸直受限5°(0°~8°),弯曲受限10°(0°~15°)。末次随访,患者KSS膝关节功能评分评定疗效:优17例,占85%;良3例,占15%。[结论]有限内固定结合外固定支架治疗股骨骨折可有效避免采用单一固定手术方式的缺点,并结合各种固定方式的优点,操作简单,效果可靠,功能恢复好,是一种有效的治疗方式。     

小鼠异位心脏移植模型的建立

目的：利用优良的小鼠品系，建立小鼠异位心脏移植模型，以优化实验条件，降低实验成本。方法：借大鼠腹内心脏移植Ono术式，将NIH小鼠40只随机分为供、受者，供者心脏的升主动脉和肺动脉分别与受者腹主动脉和下腔静脉行端侧吻合，成功地建立了小鼠异位心脏移植模型。结果：手术操作简便，技术可靠；小鼠异位心脏移植成功16例，失败4例，成功率达80％。结论：该模型的建立，为进一步进行移植及免疫学方面的研究奠定了良好的基础。     

闭合性胫骨骨折兔模型的建立与评估

目的：探讨改良设计的三点弯曲骨折装置用于建立闭合性胫骨骨折兔模型的效果。方法：选取6月龄SPF级健康雄性新西兰兔40只,体质量2.5~3.0 kg,制备闭合性胫骨骨折兔模型,并于术后6周进行模型验证。预造模组5只,造模前未行临时外固定,后以改良设计三点弯曲骨折装置进行骨折;正式造模组35只,造模前行穿针及夹板外固定,后以改良设计三点弯曲骨折装置进行骨折。于术后2 h及4、6周行影像学、组织病理学评估骨折模型情况及愈合进程。结果：造模后2 h,预造模组呈不同程度的斜行骨折且断端明显移位;正式造模组除1只粉碎性骨折,2只弯曲蝶形骨折,2只未显示明显骨折线外,其余均呈简单横行及斜行骨折,断端无明显移位。根据判定标准,模型成功率为85.71%。造模后4周,实验兔固定针及夹板位置良好,骨折对位对线良好,骨折线已模糊不清,骨折端周围可见大量连续骨痂生长,骨痂密度较高。造模后6周,镜下见骨折处大量粗大的新生骨小梁,边缘成骨细胞附着并见少量巨噬细胞,膜内成骨区域为编织骨阶段,骨折处髓腔已部分再通,骨痂处于吸收塑性阶段,可见大量破骨细胞。X线显示骨折线几乎消失,髓腔部分已通,周围见外骨痂减少,骨痂处于塑形期,骨皮质连续。提示骨折模型呈二期愈合。结论：改良三点弯曲骨折装置可建立稳定的闭合性胫骨骨折兔模型,且操作简便,符合骨折愈合相关基础研究对闭合性骨折模型的要求。     

颈椎病尸体骨赘模型的设计与建立

目的 为比较不同的手术方法对颈椎病前路骨赘切除范围的影响,特制作本模型.方法 参考临床颈椎病骨赘类型,将人工骨赘粘合于颈椎尸体标本上,建立颈椎病的骨赘模型12具,随机分为处理组和对照组,进行三维重建CT扫描.在CT影像上观察骨赘的影像学表现,并测量两组的椎体后缘骨赘和钩椎关节增生骨赘的数据,对数据进行比较和统计学分析.结果 椎体后缘骨赘和钩椎关节增生骨赘的测量均无明显的差异(P>0.05),并且模型CT表现与临床上颈椎病骨赘增生的影像学表现一致.结论 此模型比较真实地模拟了人的颈椎病增生骨赘的表现,有助于进一步研究和评价不同颈椎病前路手术方法的手术减压效果.     

Technique for gentle accurate reproducible closed reduction of intracapsular fracture of neck of femur

Non-anatomic reduction with either inferior offset or varus angulation was the strongest predictor of re-displacement of the fracture and poor outcome after fixation of intracapsular fracture of neck of femur. There are many techniques for closed reduction and can be broadly divided into non-invasive and invasive techniques. We describe a minimally invasive technique, which we believe is easy, reproducible and successful in achieving good anatomical reduction.     

手术治疗闭合性三踝骨折

二踝骨折是常见的关节内骨折，2003年3月～2006年8月，我院对81例闭合性三踝骨折患者采用手术治疗，疗效满意。     

Comparison of algorithms for automated femur fracture reduction

Purpose

We designed an experiment to determine the comparative effectiveness of computer algorithms for performing automated long bone fracture reduction.

Methods

Automated reduction of 10 3D fracture models was performed using two computer algorithms, random sample matching (RANSAM) and Z‐buffering (Z‐Buffer), and one of five options of post‐processing: none; iterative closest point algorithm (ICP); ICP‐X1; ICP‐X2; and ICP‐X3. We measured the final alignment between the two fragments for each algorithm and post‐processing option.

Results

The RANSAM algorithm combined with postprocessing algorithm ICP‐X1 or ICP‐X3 resulted in the most accurate fracture reduction in the translational plane. No discernible difference was observed in the rotational plane. Automated reduction had more accurate translational displacement than telemanipulated manual reductions.

Conclusion

This study supports the use of the RANSAM algorithm for automated fracture reduction procedures. The use of ICP algorithms provides further optimization of the initial reduction.     

Ex vivo analysis of rotational stiffness of different osteosynthesis techniques in mouse femur fracture

The various molecular mechanisms of cell regeneration and tissue healing can best be studied in mouse models with the availability of a wide range of monoclonal antibodies and gene‐targeted animals. The influence of the mechanical stability of individual stabilization techniques on the molecular mechanisms of fracture healing has not been completely elucidated yet. Although during recent years several osteosynthesis techniques have been introduced in mouse fracture models, no comparative study on fracture stabilization is available yet. We therefore analyzed herein in a standardized ex vivo setup the rotational stiffness of seven different osteosynthesis techniques using osteotomized right cadaver femora of CD‐1 mice. Uninjured femora without osteotomy served as controls. Femur stabilization with a locking plate or an external fixator resulted in a rotational stiffness almost similar to the intact femur. The use of a “pin‐clip” device, a “locking nail,” a “mouse nail,” or an “intramedullary screw” produced a lower torsional stiffness, which, however, was still significantly higher than that achieved with the widely applied conventional pin. By the use of the presented data a more specific choice of stabilization technique will be possible according to the various questions concerning molecular aspects in fracture healing. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1152–1156, 2009     

股骨髁支持钢板在股骨髁上和髁间骨折的应用

目的探讨股骨髁上与髁间骨折手术用股骨髁支持钢板内固定方法。方法治疗股骨髁上与髁间骨折35例,采用手术用股骨髁支持钢板内固定,术后早期指导功能锻炼。结果所有患者随访观察时间10个月～24个月,大部分病例恢复较好,经评分标准评定,优良率为94.3％。结论股骨髁上与髁间骨折以手术用股骨髁支持钢板内固定为可靠的治疗方法,功能恢复较好。     

Co-existing ipsilateral subcapital and subtrochanteric fracture of the proximal femur

Background  Co-existing subcapital and subtrochanteric fracture on the same side of the hip is rare. We are not aware of a similar case reported in the literature. Case study  We present a rare case of co-existing ipsilateral subcapital and subtrochanteric fracture in a 67-year-old woman. The mechanism of injury was low energy. Therapeutic implication  The outcome of internal fixation using a Proximal Femoral Nail was satisfactory. This work was carried out in the Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, UK.     

Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture

Total femur arthroplasty procedures have previously been used after tumor excision and as a last resort for failed revision arthroplasty. The patient in this case presented with massive loss of femoral bone stock, a periprosthetic fracture, and recurrent Staphylococcus epidermidis infection. A specially designed total femoral spacer impregnated with antibiotics was created for a 2-stage revision procedure that successfully restored functional ability and eradicated the infection. Although 2-stage protocols with spacers have been used to treat persistent infections after hip and knee arthroplasty, this is the first reported instance of the creation of a total femur antibiotic-impregnated cement spacer and subsequent total femoral arthroplasty as a 2-stage protocol at our institution.     

不同方法治疗老年性股骨粗隆间骨折的临床分析

目的 探讨不同方法治疗老年性股骨粗隆问骨折安全有效的内固定方法、临床效果及其临床适应证.方法 对58例老年性股骨粗隆间骨折分别采用股骨近端解剖型锁定钢板固定14例,动力髋螺钉(DHS)固定24例,股骨近端解剖型钢板固定20例,比较3组术中失血量、手术时间、骨质劈裂情况及骨折愈合时间,随访Sanders评分结果和并发症发生情况,并进行临床和统计学分析.结果 术后全部得到随访,随访8个月～3年,平均1.5年,3组术式的优良率分别为92.9%、92%和90%.结论 不同方法治疗老年性股骨粗隆间骨折的临床效果都很满意,但各有其适应证,手术方式应根据骨折类型、年龄、体质因素及患者骨质疏松程度,结合各内固定特点选择最佳治疗方案,对伴有严重骨质疏松的高龄患者适合选用应用解剖型锁定钩板(ALHP)固定,对Evans Ⅰ、Ⅱ型和部分EvansⅢ型适合选用DHS固定,对Ⅳ、Ⅴ型适合选用股骨近端解剖型钢板固定.     

Intracapsular fracture of the proximal femur——Operative versus nonoperative management

Taken together, these reports do not provide strong evidence in favor of either internal fixation or arthroplasty over the other relative to mortality in the treatment of intraeapsular fracture of the proximal femur. However, they do suggest a higher rate of reoperations in those receiving internal fixation compared with arthroplasty. Differing patient characteristics at baseline make direct comparisons difficult.     

Fatigue fracture of the distal femur arising in the elderly

Fatigue fractures most frequently involve the tibia and metatarsal bones in the young. We report a very unusual case of fatigue fracture in the distal femur of a 62-year-old man. The differential diagnosis was a pathological fracture due to a metastatic bone tumor. The diagnosis of fatigue fracture was based on the fact that the patient walked every day for a long time, together with the following radiological features: no definite cortical destruction, a radiolucent area surrounded by sclerosis on CT, no extraskeletal mass, and sharp linear low signal intensities in the center of the lesion on MR images. Rest and restricted walking improved his symptoms and fracture healing. Fatigue fracture should be ruled out even in the elderly, especially those who engage in sports activities for long periods.