骶髂关节骨折脱位的手术治疗

目的回顾性分析26例骶髂关节骨折脱位的内固定方法和临床疗效,探讨骶髂关节骨折脱位的手术方法。方法对26例骶髂关节骨折脱位的TileC型骨盆骨折病例,16例采用经皮骶髂关节空心螺钉技术固定骨盆后环,10例采用骶髂关节前路钢板技术固定骨盆后环,所有病例同时固定骨盆前环,采用Majeed功能评分进行疗效评定。结果随访6个月～6年,平均2年3个月,本组病例术后未发生骶神经损伤、伤口感染等并发症,X线片示骶髂关节复位及内固定位置良好。根据Majeed功能评分,优9例,良10例,优良率达73.1%。结论对于骶髂关节骨折脱位的TileC型骨盆骨折,经皮骶髂关节空心螺钉和骶髂关节前路钢板均可重建骨盆后环的稳定性。而经皮骶髂关节空心螺钉固定具有固定坚强、损伤小等优点,值得推广应用,但操作技术要求高,并要注意防止手术并发症的发生。     

Ethanol vapour-fixation of rat lung for immunocytochemistry investigations

Ethanol-vapour fixation of rat lung has been successfully employed in the immunocytochemical detection of the gastrin mucin antigen termed mucin 5AC without the need of additional antigen retrieval steps. This procedure gives good morphological preservation and provides all the benefits associated with the microscopic examination of inflated lung tissue. This simple fixation technique provides another option for use in immunocytochemical investigations of rodent lung and could be adapted for other species.     

AF系统治疗胸腰椎骨折

目的探讨AF内固定系统治疗胸腰椎骨折的临床效果.方法回顾性分析1995年来29例胸腰椎骨折AF内固定后的并发症及疗效.结果神经功能除3例Frarkel分级A无恢复其余均有提高,椎体形态及椎管狭窄较术前均有改善.平均随访时间10个月,无严重并发症.结论 AF系统是目前治疗胸腰椎骨折较为理想的方法.     

AF系统治疗胸腰椎骨折

目的 探讨AF内固定系统治疗胸腰椎骨折的临床效果。方法 回顾性分析1995年来29例胸腰椎骨折AF内固定后的并发症及疗效。结果 神经功能除3例Frarkel分级A无恢复其余均有提高，椎体形态及椎管狭窄较术前均有改善。平均随访时间10个月，无严重并发症。结论 AF系统是目前治疗胸腰椎骨折较为理想的方法。     

解剖型钢板微创治疗Pilon骨折的临床观察

目的探讨应用解剖型钢板微创治疗Pilon骨折的效果及临床应用价值。方法对38例Pilon骨折患者行有限切开（微创操作）复位解剖型钢板内固定治疗,评价其治疗效果。结果 31例获得随访,平均随访时间（14.5±6.2）个月,骨折全部愈合,无需II期植骨。按Mazur等制定的评分系统,临床疗效优21例,良6例,可2例,差2例,优良率87.1%。结论解剖型钢板微创治疗Pilon骨折疗效确切,是较理想的内固定材料,在临床应用上值得推广。     

逆行髓内钉和钢板置入内固定治疗股骨远端骨折的比较

背景：以髓内钉为基础的中心型固定方法更符合股骨的生物力学特点。 目的：比较股骨远端骨折采用股骨髁上逆行交锁髓内钉治疗与股骨远端解剖型钢板治疗的临床疗效。 方法：用逆行髓内钉治疗35例股骨下端骨折患者和31例钢板内固定患者。内固定后随访1年以上,采用Neer膝关节功能评分标准对膝关节功能恢复程度指标,骨愈合速度指标予以评价。 结果：随访1年患者Neer 膝关节功能评分标准,逆行髓内钉优24例(69%),良9例(26%),可2例(6%),优良率为94%。平均愈合时间4.8个月。股骨远端解剖钢板优21例(68%),良5例(16%),可3例(10%),差2例(6%),优良率为84%,平均愈合时间6.5个月。根据结果进行分析,逆行交锁髓内钉治疗有利于早期下床活动,股骨远端钢板适应证广,对关节面的破坏相对较轻,有利于膝关节功能恢复。2种内固定都能起到较好疗效,应根据股骨远端骨折类型,选择相适应的内固定物。     

3D打印结合Union Plate跨弓状缘髋臼解剖钢板在复杂髋臼骨折中的应用

目的探讨术前在3D打印模型上规划后柱螺钉用于髋臼骨折内固定的可行性和安全性,评价这种联合技术对复杂髋臼骨折治疗的早期临床结果。方法回顾性分析华中科技大学同济医学院附属协和医院自2018年6月至2019年8月行复杂髋臼骨折的15例患者资料,根据CT数据行骨盆3D打印,得到1∶1(含髂血管)仿真模型,术前在三维模型上模拟手术固定,并规划后柱拉力螺钉,将螺钉消毒以备术中使用。术中采用高位髂腹股沟入路,并使用Union Plate跨弓状缘髋臼解剖钢板+后柱拉力螺钉进行固定。结果全部患者的手术均按照术前计划顺利进行,平均手术时间172 min(150~290 min),术中平均出血量620 m L(200~1 500 mL);所有后柱螺钉均成功置入,术中透视螺钉位置、长度良好。术后根据Matta标准评价骨折复位情况。其中优9例,良6例,优良率100%。按照Matta改良的Merle d'Aubigne和Postel评分评价髋关节功能,其中优8例,良5例,可2例,优良率为86.7%。围术期出现闭孔神经麻痹1例,随访3个月好转;未观察到切口感染、血栓形成、螺钉松动或断裂等并发症。结论通过术前3D打印模拟手术、规划后柱拉力螺钉,结合跨弓状缘髋臼解剖钢板治疗复杂髋臼骨折置钉成功率高,安全性好,个体化强,效果可靠。     

膝关节正中切口双钢板固定治疗股骨远端C2、C3型骨折疗效分析

目的比较外侧钢板与双钢板内固定治疗股骨远端C2、C3型骨折的临床疗效,探讨双钢板固定治疗股骨远端C2、C3型骨折的可行性和疗效优势。方法回顾性分析2012年1月至2017年6月手术治疗股骨远端C2、C3型骨折38例,其中17例采用膝关节正中切口双钢板固定,21例采用传统外侧钢板固定,患者术后均采用主动运动,并结合练习器辅助持续被动活动,以促进膝关节的功能恢复。依据Hohl临床评分标准比较两组股骨远端C2、C3型骨折患者术后6周、6个月的膝关节功能。结果术后随访10~36个月(平均20.5个月),依据Hohl标准对股骨远端C2、C3型骨折疗效进行临床评分,膝关节正中切口双钢板固定组的术后6周膝关节功能评定结果为:优12例,良3例,中1例,差1例;外侧钢板固定组为:优9例,良5例,中4例,差3例。两组的优良率分别为88.24%和66.67%,差异有统计学意义。膝关节正中切口双钢板固定组发生2例延迟愈合,外侧钢板固定组有4例延迟愈合,含1例骨不连经二次手术后愈合,两组均无骨关节感染及下肢深静脉血栓形成。结论膝关节正中切口双钢板固定法治疗股骨远端C2、C3型骨折能够解决单钢板固定偏心性固定不稳的问题,方法可行,内固定强度可靠,通过早期锻炼,相较单钢板固定在早期膝关节功能恢复方面更有优势,且并发症少。     

A comparison of techniques for fixation of the quadriceps muscle-tendon complex for in vitro biomechanical testing of the knee joint in sheep

Whilst in vitro testing can contribute to a better understanding of the biomechanical interactions at the knee joint, the application of physiological-like muscle forces in vitro remains challenging. One main difficulty seems to be the adequate fixation of the muscle-tendon complex to the mechanical apparatus that provides the forces in vitro. The goal of this study was to compare the ability of different muscle-tendon fixation mechanisms, including a new technique developed to optimise the interface grip of the soft tissues, to reliably transmit physiological in vivo loads through the muscle-tendon complex to the attached bone. The fixations of three quadriceps components in 16 right knees of skeletally mature female merino sheep were loaded to failure using four different fixation techniques (aluminium clamp, freeze clamp, suture technique and a new extension hull technique). Each technique was tested 12 times: 4 times on each individual quadriceps component. A factorial analysis for repeated measurements was undertaken to examine differences between the different fixation techniques. The extension hull technique and the aluminium clamp performed similarly, exceeding the computationally determined physiological forces in all but one trial and achieved higher failure loads than the suture technique. Although the freeze clamp reached the highest mean load to failure, it also failed more often than the extension hull technique. This comparison of the fixation techniques suggests that the new extension hull technique is a suitable fixation method for applying physiological-like muscle loading in an in vitro set-up. It cannot only be handled in a very simple manner, but also possesses a compact, lightweight construction, providing the possibility for the application of more complex loading conditions that include, e.g. the action of multiple muscles of the knee flexor and extensor group concurrently.     

Comparison of Fixatives for Histologic Evaluation of the Canine Eye

Abstract

We describe several methods for the handling, fixation, and processing of canine eyes, as well as the light microscopic results of these efforts. Fixatives included Zenker and Bouin, 4% formaldehyde-1% glutaraldehyde, and 2% and 6% solutions of glutaraldehyde. In some techniques the globe was injected with fixative; in others, a window was cut into the eye or ocular tissues were dissected and separated to facilitate fixation. Processing included ethyl or isopropyl alcohol dehydration; all eyes were embedded in paraffin. Best overall morphology was seen in specimens fixed in Zenker fluid for 5 to 8 hr and dehydrated initially in isopropyl alcohol. There was superior retinal detail with acceptable morphology of the cornea, iris and lens. Advantages and disadvantages of various techniques and common artifacts are discussed. (The J Histotechnol 14:251, 1991)     

Anatomical evaluation of the groove for the vertebral artery in the axis vertebrae for atlanto-axial transarticular screw fixation technique

Anatomical measurements were studied on 40 dry axis vertebrae to determine the suitability of the groove for the vertebral artery for atlanto-axial transarticular screw fixation technique. We measured 13 parameters including three angular and 10 linear dimensions related to the groove of the vertebral artery, pedicle, and pars interarticularis and evaluated 80 measurements for each parameter. All measurements were done after placing a Kischner guide wire through the pedicle. We found that differences between measurements on the left and right sides of each vertebra were nonsignificant. In spite of the variability in measurements such as height, width, and median angle of the pedicle, the decline angle for instrumentation, the depth of the groove for the vertebral artery, and the internal height of the pars interarticularis, all of these had good symmetry. However, there were statistically significant differences between the sides in measurements for both the width (P=0.05) and the angle (P<0.02) of the pedicle allowing instrumentation and they did not show good symmetry. The risk of vertebral artery injury was found to be 22.5% per specimen, or 16.25% per screw inserted because the internal height of the pars interarticularis at point of fixation was 相似文献   

锁定加压钢板置入修复Pilon骨折：6个月随访骨折愈合及踝关节功能评价

背景：Pilon骨折的修复方法较多,但效果往往不理想。伴随着科学技术的发展,骨折固定原则的根本性转变以及技术和观念的革新,给Pilon骨折修复带来了新的契机。其中生物学固定技术可尽量减少进一步破坏骨折端骨外膜血供,不扰乱骨折愈合的生物力学环境,是目前研究发展的新趋势。 目的：探讨采用生物学固定技术锁定加压钢板置入内固定修复Pilon骨折的效果。 方法：回顾性分析2008年6月至2013年12月佛山市南海区经济开发区人民医院官窑分院收治应用锁定加压钢板置入内固定修复Pilon骨折76例患者的临床资料,男49例,女27例;年龄19-60岁,平均39.5岁;骨折根据Ruedi-Allgower分型：Ⅱ型54例,Ⅲ型22例。根据生物学固定技术采用锁定加压钢板置入内固定修复Pilon骨折。治疗后定期随访,根据Burwell-Charnley放射学复位标准评定复位质量,复查X射线片观察骨折愈合情况,末次随访时按Baird-Jackson评分标准评定踝关节功能。 结果与结论：76例患者获6-24个月随访。根据Burwell-Charnley放射学复位标准评定复位质量：解剖复位68例,复位可8例。切口一期愈合71例,切口渗液换药后愈合5例,切口一期愈合率达93%。所有患者骨折均愈合,愈合时间4-8.5个月,平均6.25个月。末次随访时踝关节功能按Baird-Jackson评分标准评定：优69例,良5例,可2例。提示采用锁定加压钢板置入内固定修复Pilon骨折具有良好的稳定性,可有效避免破坏骨折端血供,缩短骨折愈合时间,操作简便,对软组织损伤小,是修复Pilon骨折的有效内固定方法之一。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

经皮钢板与解剖锁定钢板置入内固定治疗肱骨近端骨折

背景：对于肱骨近端骨折或者严重并发症的患者,需要通过内固定物置入达到有效的固定,这样不会影响到肩关节的活动功能,而且创伤小。 目的：探讨经皮钢板内固定联合解剖锁定钢板置入内固定治疗肱骨近端骨折的生物力学特征。 方法：选取广州医科大学附属第三医院骨科2007年3月至2011年12月收治的肱骨近端骨折患者75例,观察锁定钢板治疗后的愈合以及内固定后肩关节评分。分析锁定钢板治疗肱骨近端骨折在生物力学方面的优势。 结果与结论：①75例患者治疗后均获得随访,随访时间6-24个月,平均13.3个月。②治疗后X射线片显示所有螺钉位置良好,骨折复位满意,骨折均得到了愈合,未发生神经血管损伤以及肱骨头坏死的病例,其中1例出现感染经治疗痊愈,72 例无肩痛,3例偶有肩痛。③Neer评分优57例,良11例,中7例,差0例,优良率为90.7%。与其它内固定物比较,锁定钢板治疗肱骨近端骨折的固定强度大,疗效满意,已成为临床治疗肱骨近端骨折的首选。     

一种新型撕脱性骨折固定装置在踝关节周围撕脱性骨折手术治疗中的应用*

目的 评估一种新型撕脱性骨折固定装置固定踝关节周围撕脱性骨折的临床疗效。方法 2019年1月至2020年4月,以一种新型撕脱性骨折固定装置固定踝关节周围撕脱性骨折18例,其中男12例、女6例。按照Lauge-Hansen分型,旋后内收型4例,旋后外旋型9例,旋前外旋型5例。撕脱性骨折固定装置用于固定内踝撕脱性骨折13例,用于固定外踝撕脱性骨折5例。术后进行随访,随访满1年者按照AOFAS踝-后足评分系统行踝关节功能评定并记录并发症。结果 18例患者随访12 ～ 27个月,骨折均I期愈合,末次随访AOFAS踝-后足评分93.6分（80 ～ 100分）。1例内踝骨折患者和1例外踝骨折患者偶感内/外踝轻微刺痛,1例内踝骨折患者和1例外踝骨折患者感长距离行走后内/外踝轻微疼痛,行内固定取出术。结论 新型撕脱性骨折固定装置固定踝关节周围撕脱性骨折有固定稳定、软组织友好的特点,可作为踝关节周围撕脱性骨折固定的一种选择。     

Surgical treatment for unstable distal clavicle fracture with micromovable and anatomical acromioclavicular plate

Between 2006 and 2009, 18 patients of distal clavicle fracture were treated with micro-movable and anatomical acromioclavicular plate (MAAP) in our department. According to the Neer's classification, all cases were unstable with type IIA (12 cases) and type IIB (6 cases). Functional outcome was evaluated using the Karlsson's criteria. The mean follow-up was 18 months (range, 12-36months). No postoperative plate screws complication was observed. Osseous union could be achieved at a mean time of 12 weeks after operation in 18 patients (range, 8 -16 weeks). According to Karlsson's criteria, radiographic appearances and postoperative shoulder functional recovery revealed a good and excellent rate in these cases. We conclude that surgical treatment using MAAP seems to be a good option for unstable type II fractures of the distal clavicle. This technique allows for reliable fixation with early functional exercises and functional recovery.     

术中即时牵引与后路复位枕颈固定治疗原发性颅底凹陷症

目的评价术中即时牵引与后路钉-棒系统枕颈固定治疗颅底凹陷症的疗效。方法 2009年7月至2010年6月共收治5例颅底凹陷症患者,男1例,女4例,平均年龄45.2岁。患者均有明显神经功能损害症状J,OA评分平均10.6分。寰齿前距平均7.86 mm。齿突尖超McGregor线（腭枕线）平均15.12 mm。1例合并难复性寰枢关节脱位。全麻后头高脚低位均行（体重的1/6重量）颅骨牵引维持15 min。4例寰齿前距减小（小于4 mm）,1例无明显复位征象患者即行前路经口腔松解后寰齿前距减小至2.7 mm。轴性翻身后经后路钉-棒系统枕颈固定。术后均给予费城颈托固定3个月。结果齿状突均有较好的复位,术后寰齿前距平均3.44 mm,齿突尖超McGregor线平均6.4 mm。无术中、术后并发症。平均随访8个月,均固定满意并坚固融合,末次随访时所有患者神经功能均有较好恢复J,OA评分平均15.8分,改善率为81.25%。结论术中即时牵引与后路钉-棒系统枕颈固定是治疗原发性颅底凹陷症安全、有效的方法。     

RF固定椎管减压后外侧融合治疗腰椎滑脱症

目的：评价复位固定加椎管减压后外侧植骨融合治疗腰椎滑脱症的疗效。方法：对42例腰椎滑脱症采用复位固定椎管减压后外侧植骨融合治疗。结果：所有病例随访5．33月，平均15月，疗效优者19例，良17例，可5例，差1例，优良率85．7％。结论：RF固定椎管减压后外侧植骨融合术治疗腰椎滑脱症方法简单，疗效可靠。     

外固定支架治疗桡骨远端不稳定型骨折

目的分析外固定支架治疗桡骨远端不稳定型骨折的临床疗效。方法总结分析外固定支架治疗28例桡骨远端不稳定型骨折临床效果。结果随访时间3~12个月,平均9.5个月。X线片示骨折全部愈合,平均愈合时间6.5个月。疗效按Dienst等提出的标准进行评定,结果优18例,良8例,可2例,优良率为92.9%。结论对于桡骨远端不稳定型骨折,采用外固定支架固定,能最大限度地恢复桡骨与尺骨的相对长度、关节面的平整、掌倾角及尺偏角,术后配合有效的康复锻炼,能使腕关节功能最大限度的恢复。     

Enzyme immunoassay for pigeon breeders' disease without the use of extraneous antibody

A rapid enzyme immunoassay technique is described for the detection in human sera of antibodies of any class to pigeon antigens. The method is based on binding human antibodies in excess to polystyrene-fixed antigens from pigeon droppings or pigeon serum, followed by capture of the same antigens coupled to peroxidase. A very good correlation was found of titers obtained by means of this 60-min assay with traditional sandwich immunoassay and with precipitation- and complement - fixation tests.     

Lymph vessels of the heart. A comparative study of various techniques for light and electron microscopy

This investigation was carried out in order to find out which was the best technique, among those reported in the literature, to recognize the small lymph vessels by light microscopy, while at the same time allowing a good ultrastructural preservation of tissues. The study was performed with rabbit hearts according to the following methods: (1) injection of India ink into the wall of the heart followed by perfusion with aldehyde fixative; (2) injection of India ink into the wall of the heart followed by immersion in aldehyde fixative; (3) treatment of the animals with histamine dihydrochloride by e.v. route and aldehyde (4) fixation by immersion; (5) fixation by immersion in osmium tetroxide fixative; fixation by immersion in aldehyde fixative; (6) fixation by perfusion with the same mixture as in (5). In cases (1), (2), (3), (5), and (6), the tissue specimens were postfixed in osmium tetroxide according to conventional methods. The validity of the different methods was checked by examining semithin sections of varying thickness at the light microscope and ultrathin sections at the transmission electron microscope. A comparative examination of the preparation showed that the method allowing the promptest recognition of the small lymph vessels, together with the best ultrastructural preservation and a good reproducibility of results was perfusion of the coronary circle.