三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较

背景：髋臼后壁骨折伴髋臼关节后脱位大多需要实施固定切开复位内固定治疗,术中可选择不同的内固定材料。 目的：观察髋臼三维记忆内固定系统在髋臼后壁骨折伴髋臼关节后脱位中的应用效果。 方法：回顾性分析山东省菏泽市立医院2010年2月至2014年2月收治的92例髋臼后壁骨折伴髋臼关节后脱位患者的临床资料,均实施固定切开复位内固定治疗,按照所使用内固定物的不同分为三维记忆内固定组45例和重建钛板组47例,固定后随访12个月。 结果与结论：重建钛板组手术时间以及术中出血量均显著长于或者大于三维记忆内固定组(P < 0.05)。三维记忆内固定组的末次随访Harris评分显著高于重建钛板组(P < 0.05)。两组患者固定后均未出现血栓并发症及深部感染等不良反应。结果表明,将三维记忆内固定系统应用于对髋臼后壁骨折伴髋臼关节后脱位的内固定治疗之中可以获得良好的应用效果。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      

Apofix颈后路内固定治疗齿状突骨折脱位

目的评价Apofix颈后路内固定治疗齿状突骨折脱位的临床疗效。方法对2000年3月-2005年7月收治的16例齿状突骨折脱位患者均行颈后路C1，2Apofix植骨内固定。结果寰枢关节及骨折复位满意，16例皆达到齿状突骨性愈合。结论Apofix内固定手术治疗齿状突骨折脱位手术操作简便，复位固定可靠，恢复快，疗效满意，勿需术中X线定位，适合基层医院推广应用。     

单切口ORIF治疗胫腓骨中远端骨折

目的　探讨单切口切开复位内固定（ORIF）治疗胫腓骨中远端骨折的手术方法及其疗效。 方法　2012 年 8 月～2014 年 8 月对40例胫腓骨中远端骨折的患者采用单切口ORIF的治疗方法,其中34 例闭合性骨折,6 例开放性骨折。 结果　对 40例患者平均随访时间18个月,发现骨折均预期愈合,切口均能一期闭合;3 例切口出现部分皮缘浅表干性坏死,予换药后痂皮自然脱落, 局部瘢痕愈合, 无感染发生。术后有4例患者由于术中牵拉出现了腓浅神经损伤的表现,但术后2~3个月后自然恢复。参照 Merchant 功能评定标准: 优28例,良 8 例,差 4例,优良率 90% 。 结论　单切口ORIF治疗胫腓骨中远端骨折损伤小,不影响骨折的愈合,其软组织覆盖以及血供均好于传统双切口, 降低了小腿皮肤软组织感染、坏死率,是一种可选择的手术入路。     

双切口双锁定钢板治疗复杂型胫骨平台骨折

目的探讨双切口双锁定钢板治疗SchatzkerⅤ、Ⅵ型复杂胫骨平台骨折的方法与临床疗效。方法对59例复杂胫骨平台骨折进行随访和回顾性分析。患者均行切开复位,双切口双锁定接骨板内固定,骨缺损者植以自体髂骨,对不同类型软组织损伤同时采取相应的处理方法。结果术后随访59例,随访时间6~24个月,平均15个月,59例骨折均获得骨性愈合,所有患者均恢复了患肢的正常力线,患肢稳定。结论该方法手术时间短,利于患者早期CPM锻炼,有利于膝关节功能恢复,临床疗效较好。     

National Trends of Surgical Treatment for Intertrochanteric Fractures in Korea

Intramedullary nailing has been reported to have better outcome compared with traditional plate fixation in surgical treatment of intertrochanteric fractures. We evaluated the trends of surgical treatment of intertrochanteric fracture in Korea. Data of patients with intertrochanteric fractures, who were operated between the years of 2006 and 2011, was obtained from the Health Insurance Review and Assessment Service. The ratio of intramedullary nailing increased from 27.9% in 2006 to 64.3% in 2011 (P < 0.001), while the ratio of plate fixation decreased. During recent 5 yr, the utilization of intramedullary nailing doubled in clinical practice of intertrochanteric fractures in Korea.     

股骨近端抗旋转髓内钉内固定治疗股骨转子间骨折的安全性和有效性：前瞻性病例系列临床试验方案

BACKGROUND: The root cause of intertrochanteric femoral fracture in elderly patients is osteoporosis manifested by reduced bone strength, decreased bone mineral density, and subsequently decreased anchoring between the internal fixator and bone. This is also a major cause of ineffective internal fixation and leads to surgical failure. Because of the special anatomical structure and biomechanical requirements of the proximal femur, internal fixation must have two basic functions, to prevent inversion and rotation of the proximal fractured femur. Reducing the incidence of coxa vara is also one of the treatment objectives. OBJECTIVE: To validate the safety and effectiveness of minimally invasive proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric femoral fracture. METHODS: This is a single-center, prospective, self-controlled case series. The objective of this study is to validate the safety and effectiveness of minimally invasive PFNA in the treatment of intertrochanteric femoral fracture. Twenty patients with intertrochanteric femoral fracture scheduled to undergo PFNA implantation will be recruited from the Department of Orthopedics, Chaohu Hospital of Anhui Medical University in China. The study protocol has been approved by the Ethics Committee of Chaohu Hospital of Anhui Medical University, China and will be performed in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. All patients will provide the written informed consent. This trial was registered at ClinicalTrials.gov (NCT02880501). RESULTS AND CONCLUSION: The primary outcome measure of this study is the percentage of patients having PFNA implantation-related safety problems manifested as pain in the affected region, wound nonunion, incisional infection, and gross findings observed at the time of nail removal, including inflammatory reaction, tissue proliferation, and the appearance of a fibrous capsule wall 3 and 6 months after PFNA implantation. The secondary outcome measures are operative time, intraoperative blood loss, duration of intraoperative fluoroscopy, patients’ quality of life evaluated by the EuroQol five-dimension questionnaire and the Barthel Index of Activities of Daily Living, fracture healing examined by X-ray images, and hip joint function evaluated by Harris hip scores 3 and 6 months after PFNA implantation. The currently reported clinical studies on PFNA for the treatment of intertrochanteric femoral fracture are mainly case series, a few of which are retrospective, randomized, controlled trials. Here, we will perform a normalized prospective case series to validate the safety and effectiveness of PFNA in the treatment of intertrochanteric femoral fracture.     

跟骨骨折术后切口愈合不良原因分析及对策

目的探讨跟骨骨折术后切口愈合不良的原因,寻求预防切口愈合不良的措施。方法分析2004年11月~2012年5月本科采用切开复位钢板内固定术治疗的102例跟骨骨折,术后切口愈合不良11例,占随访病例的10.8%,其中皮缘小范围坏死7例、皮缘部分坏死伴浅表感染1例,钢板部分外露3例;对愈合不良病例进行回顾性疗效分析,寻求预防切口愈合不良的措施。结果经过换药等治疗后,9例切口瘢痕愈合,1例钢板外露伴感染经过换药后采用拆除内固定钢板,再经换药,创面愈合,1例行皮瓣转移覆盖创面后痊愈。结论为防止手术切口愈合不良,需要注意手术时机,掌握手术技巧,正规操作,防止血运进一步破坏,预防切口感染,纠正全身不良情况,提高机体抗手术打击能力,是可以有效减少切口愈合不良的发生的。     

个性化3D打印导板在单侧粉碎性颧骨复合体骨折治疗中的应用价值

目的 探讨个性化3D打印导板在辅助单侧粉碎性颧骨复合体骨折(ZCF)治疗中的应用价值。方法 回顾性分析2014年6月-2018年12月陆军军医大学第二附属医院口腔颌面外科收治的 37例单侧粉碎性ZCF患者的临床资料,根据术中是否使用3D打印导板分为3D导板组和常规组:3D导板组20例,术中采用3D打印导板辅助骨折复位;常规组17例,采用传统的骨折复位内固定手术方法治疗。比较两组患者术后三维重建CT影像参数测量值:△L1,双侧眶下缘点至眶上缘点间距离的差值;△L2,双侧颧突点至外耳门点间距离的差值;△L3,双侧颧弓突点至正中矢状面间距离的差值;△α,双侧颧突角差值;△β,双侧颧弓角差值。观察患者术后6个月面部对称性、张口度及术后并发症。结果 术后3D导板组与常规组△L1分别为(1.04±0.62)mm、(1.91±0.50)mm,△L2分别为(1.32±0.56)mm、(3.50±0.92)mm,△L3分别为(1.48±0.64)mm、(2.83±0.94)mm,△α分别为0.93°±0.34°、3.01°±0.56°,△β分别为0.97°±0.27°、2.73°±0.36°,差异均有统计学意义(P值均<0.01)。3D导板组中20例患者面部对称性良好,常规组中3名患者出现患侧面中部塌陷症状;所有患者术后均未出现伤口感染、钛板、钛钉松动外露、张口受限及眼运动障碍等并发症。结论 应用个性化3D打印导板辅助单侧粉碎性ZCF治疗可提高骨折复位精准度。     

Three-year outcomes of the innovative replacement of incontinence surgery procedure for treatment of female stress urinary incontinence: comparison with tension-free vaginal tape procedure

Innovative replacement of incontinence surgery (IRIS) is a polypropylene tape that is placed beneath the midurethra to restore urinary continence. We evaluated the long-term efficacy and safety of the IRIS procedure and compared it with tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence. We included all 66 consecutive women who underwent IRIS (n=34) or TVT (n=32) between February 2002 and April 2003 and followed them up for at least 3 yr postoperatively. The 3-yr success rate was 94.1% for the IRIS and 93.8% for the TVT, and the satisfaction rates were 91.2% and 90.6%, respectively. Intraoperative complications for the IRIS group included 3 cases of bladder perforation, and there were 3 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 2 patients with de novo urgency and one patient with mesh erosion. Three patients with TVT developed de novo urgency. One case of each group showed temporary voiding difficulty. On the basis of our results, the IRIS may be an effective and safe procedure as compared to TVT, with a high success rate and a low complication rate.     

胫骨近端骨折内固定数字化设计对临床修复治疗的指导

背景：CT重建骨折三维模型不能进行虚拟复位、内固定,不能制定合理的修复方案,无法完全满足临床骨科医师的需要。 目的：应用医用软件Mimics、Solidworks在胫骨近端骨折中三维重建、复位并设计内固定方案,指导临床修复手术,并观察其修复效果。 方法：纳入40例胫骨近端骨折患者,进行高速CT薄层扫描,在Mimics中对骨折进行重建、复位,以Solidworks进行内固定钢板、螺钉的选择和设计,并在骨折复位三维模型上进行虚拟内固定。临床据此方案进行骨折修复手术,术后观察患者的骨折愈合及自我评价情况(MacNab标准)。 结果与结论：所有骨折均进行了三维重建、复位,以准确的内固定钢板及螺钉进行了虚拟内固定。临床骨折修复过程顺利,按术前设计的数字化方案成功完成,效果满意。40 例患者获随访12-24 个月,骨折愈合时间12-18周,平均13.6周;完全负重时间15-17周,平均15.8周。患者自我评价依据MacNab标准：优29例,良9例,可2例,差0例,优良率95%。术中钢板和螺钉规格、进钉长度、直径、位置、角度等与术前高度一致。提示应用Mimics及Solidworks可在个人电脑上设计出胫骨近端骨折内固定的数字化方案,可以为现实手术提供良好参考。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     

保留后韧带复合体及伤椎固定在胸腰椎骨折中的应用

目的探讨保留后韧带复合体及伤椎固定治疗胸腰椎骨折的可行性。方法对40例胸腰椎骨折患者于伤后1周内行后路保留后韧带复合体椎管减压椎弓根螺钉复位固定术。全部病例随访6个月～2年,术后根据临床（丹尼斯疼痛量表,Frankel分级）、影像学（骨折椎体度压缩百分比,后凸畸形指数,内植物松动或断裂）、功能（丹尼斯工作量表）标准评估治疗效果。结果疼痛度：23例（57.5%）Ⅰ度疼痛,12例（30%）Ⅱ度疼痛,2例（5%）Ⅲ度疼痛,2例（5%）Ⅳ度疼痛,1例（2.5%）Ⅴ度疼痛。Frankel分级：20例维持E级,14例由D级恢复至E级,6例由C级恢复至D级。骨折椎体高度压缩百分比由术前的（29.12±11.47）改善为（21.9±10.02）;后凸畸形指数术前为【（20.81±6.23）°】,术后为【（10.72±4.41）°】。将术后的骨折椎体高度压缩百分比及后凸畸形指数同术前进行比较,两者差异均具有统计学意义（P值分别为0.006和0.002）。所有病例未见内植物松动或断裂。工作能力：26例（65%）具有Ⅰ级工作能力,10例（25%）具有Ⅱ级工作能力,4例（10%）具有Ⅲ级工作能力。结论保留后韧带复合体及伤椎固定治疗胸腰椎骨折在操作技术上是可行的,可有效恢复椎体高度,改善后凸畸形。     

Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: A meta-analysis

OBJECTIVE:

The aim of this article was to determine the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.

METHOD:

Literature searches of the Cochrane Library, PubMed, EMBASE, the Chinese Biomedical Literature database, the CNKI database, Wanfang Data, and the Weipu Journal database were performed up to August 2013. Only randomized and quasi-randomized controlled clinical trials comparing the use of percutaneous plates and interlocking intramedullary nails for tibial shaft fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.

RESULTS:

Eleven trials were included. Compared with interlocking intramedullary nailing, minimally invasive percutaneous plates shortened fracture healing time and resulted in lower rates of postoperative delayed union and pain. There was no significant difference between the two methods with regard to the rates of excellent and good Johner-Wruh scoring, the rate of reoperation, and other complications.

CONCLUSIONS:

Overall, insufficient evidence exists regarding the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults. Low-quality evidence suggests that minimally invasive percutaneous plates could shorten fracture healing time, decrease the rate of postoperative delayed union, and decrease pain levels compared with interlocking intramedullary nailing. There is no significant difference between the two groups in terms of functional recovery scores, reoperation, and other complications. Further research that includes high-quality randomized controlled, multicenter trials is required to compare the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.     

单臂外固定架下肱骨髁上截骨术治疗外伤性肱骨外髁骨不连性肘外翻畸形

目的 探讨单臂外固定架下肱骨髁上截骨术治疗外伤性肱骨外髁骨不连性肘外翻畸形的疗效。方法 回顾性分析2008年2月—2014年8月郑州大学第三附属医院骨科采用单臂外固定架下肱骨髁上截骨术治疗的13例外伤致肱骨外髁骨不连性肘外翻畸形患者临床资料,其中男9例、女4例,左侧8例、右侧5例;均有明确外伤史,并经保守治疗或手术治疗后出现骨不连及肘外翻畸形,排除发育性及肱骨外髁骨骺早闭性肘外翻畸形。13例患者术后分别随访9个月～6年,比较手术前及末次随访时肘关节疼痛、活动度、稳定性、功能等情况,进行配对t检验分析。结果 与术前比较,末次随访时患者肘关节疼痛、稳定性得到明显改善,差异均有统计学意义(P值均<0.05);肘关节活动度、功能未见明显降低,差异均无统计学意义(P值均>0.05)。 末次随访时患者Myao肘关节功能评分总分(92.69±7.25)分、肘外翻角32.38°±8.88°,较术前(76.54±18.86)分、11.31°±2.81°差异均有统计学意义(t=3.914、8.01,P值均 <0.05)。末次随访时患者Myao肘关节功能优11例,良2例,优良率13/13。结论 单臂外固定架下肱骨髁上截骨术治疗外伤致肱骨外髁骨不连性肘外翻畸形具有操作简便、有效、可重复且并发症少的优点。     

股骨远端锁定微创内固定系统不同运动状态下的有限元分析

BACKGROUND: Traditional distal femoral fixation plate screw breakage is relatively common. Designing good anatomical and attached fixation system is the key for clinical application.     

防旋股骨近端髓内钉小切口置入修复老年股骨转子间骨折的可行性评价

背景：目前内固定方法在老年股骨转子间骨折的修复中取得了不错的成绩,临床比较常见的内固定方法主要有以动力髋螺钉为代表的髓外固定和股骨近端髓内钉为代表的髓内固定。虽然动力髋螺钉因为价格便宜和操作简单等原因,得到了广泛使用,但是其固定失效的概率较大,而髓内固定弥补了髓外固定的不足。 目的：对小切口置入防旋股骨近端髓内钉修复老年股骨转子间骨折进行可行性评价,并与动力髋螺钉进行对比分析。 方法：选择2012年8月至2013年6月收治的40例老年股骨转子间骨折患者作为研究对象,按随机数字表法分成观察组和对照组,观察组行小切口置入防旋股骨近端髓内钉治疗,对照组行动力髋螺钉内固定治疗。治疗后比较两组患者的相关指标以及髋关节功能Harris评分。 结果与结论：治疗后两组患者髋关节功能Harris评分差异无显著性意义(P > 0.05),但是手术时间、住院时间、出血量、并发症等指标方面,小切口置入防旋股骨近端髓内钉修复效果更加显著(P < 0.05)。提示与动力髋螺钉内固定相比,小切口置入防旋股骨近端髓内钉修复效果好,并发症发生率低,对患者的创伤小,骨折愈合率高,更适合老年患者股骨转子间骨折的治疗。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;组织工程全文链接：     

Experience of congenital choledochal cyst in adults:treatment, surgical procedures and clinical outcome in the Second Affiliated Hospital of Harbin Medical University

This study was undertaken to analyze and evaluate the diagnosis and principal treatment methods for congenital choledochal cyst, focusing on various surgical procedures and clinical outcome. A comprehensive, retrospective study was conducted on 72 adult patients who presented with choledochal cyst from 1985 to 2002. Surgical procedures were cyst excision with hepaticojejunostomy in 25 cases for type I or type IV-B, extrahepatic cyst excision with hepaticojejunostomy in 8 cases for type IV-A, extrahepatic cyst excision with modified hepaticojejunostomy in 2 cases for type IV-B, non-cyst excision with or without hepaticojejunostomy in 27 cases for types I, II, IV-A, IV-B. The early postoperative morbidity and mortality rate were 16.1% (9/62) and 6.5% (4/62) respectively, and the complication rate related to surgical procedure was 30.6% (19/62). The incidence of cholangiocarcinoma with non-cyst excision or non-operated congenital choledochal cyst was 10.8% (4/37). One patient died of primary hepatocellular carcinoma after cyst excision with hepatojejunostomy. In conclusion, our results showed that complete excision of choledochal cyst for types I, II, and IV-B and complete excision of extrahepatic choledochal cyst from the hepatic hilum in type IV-A with hepaticojejunostomy or modified hepaticojejunostomy are the treatment of choice for choledochal cyst in adult patients.     

桡骨远端骨折内固定治疗预后与尺骨茎突骨折的相关临床分析

目的研究下尺桡关节(distal radioulnar joint,DRUJ)稳定的桡骨远端骨折伴或不伴尺骨茎突骨折对预后的影响。方法通过病历查询及随访获取资料,2008年1月至2014年1月在本院治疗的97例下尺桡关节稳定的桡骨远端骨折患者分为未合并尺骨茎突骨折组(53例)和合并尺骨茎突骨折组(44例),未合并尺骨茎突骨折组行切开复位内固定术治疗,合并尺骨茎突骨折组行切开复位钢板内固定治疗,对合并的尺骨茎突骨折未予固定。记录患者的一般资料、抓握力、关节活动度、GartlandWerley功能评分及影像学评分,比较两组患者治疗情况及疗效。结果合并尺骨茎突骨折组患者尺侧疼痛较未合并尺骨茎突骨折组患者明显。骨折部位的疼痛、腕关节掌屈、腕关节背屈、主动活动时疼痛、桡偏、尺偏、前臂旋前、前臂旋后、GartlandWerley功能评分和影像学评分,两组差异均无统计学意义(0.05)。结论是否合并尺骨茎突骨折不影响钢板内固定治疗下尺桡关节稳定的桡骨远端骨折的关节活动度及功能。     

内固定植入物与外固定支架修复胫骨骨折骨不连的策略及辅助治疗

BACKGROUND: Nonunion is a common clinical problem in the prognosis of tibial fracture. The treatment method of tibial fracture nonunion is extensive and develops rapidly. Different repair plans should be taken to the nonunion of tibial fractures caused by different factors.     

髌骨针和FiberWire编织缝线张力带联合固定治疗髌骨骨折

背景：克氏针钢丝张力带是治疗髌骨骨折最常见的方式,但易引起与金属植入物相关的并发症。基于上述原因,有学者开始在张力带固定中应用高强度缝线替代钢丝固定来治疗髌骨骨折。 目的：观察髌骨针和FiberWire编织缝线张力带联合固定治疗髌骨骨折的效果。 方法：对髌骨针和FiberWire编织缝线张力带固定治疗26例髌骨骨折患者的资料进行回顾性分析,其中男16例,女10例;年龄36-54岁,平均44.6 岁。 结果与结论：随访6-18个月,平均12个月。所有患者切口均一期愈合。骨折愈合时间为8-16周,平均12周。无骨折移位,无固定松动、断裂或突出于皮下刺激皮肤等并发症发生。按Lysholm&Gillquist 膝关节评分标准评定,优18例,良4例,可4例,优良率85%。结果可见应用髌骨针和FiberWire编织缝线张力带固定治疗髌骨骨折达到了满意的结果,且并发症少。     

自体植皮负压封闭引流联合外固定架修复复杂重度开放性肘关节骨折

背景：肘关节开放骨折随着工伤事故发生率增高而迅速增高,骨折往往同时伴有严重的软组织损伤。目前采用自体植皮负压封闭引流联合外固定架治疗开放性骨折已被广泛报道。 目的：探讨自体植皮负压封闭引流联合外固定架修复复杂重度开放性肘关节骨折的特点。 方法：收集天津医科大学总医院骨科2009年1月至2013年12月采用自体植皮负压封闭引流联合外固定架治疗的复杂重度开放性肘关节骨折患者41例,均一期常规清创、外固定架固定并联合负压封闭引流封闭创面,创面有新鲜肉芽组织覆盖后,二期植皮或皮瓣转移修复创面。 结果与结论：41例患者随访时间为8-22个月,平均13个月。外固定时间为8-13个月,平均9.8个月。开放性创面Ⅱ期植皮或皮瓣移植手术后均完全愈合。31例患者骨折Ⅰ期愈合,7例延迟愈合,3例不愈合,行髂骨植骨后8-12个月骨折完全愈合。41例重度开放性肘关节骨折患者肢体功能恢复优良率为73%。其中Gustilo Ⅱ型患者肢体功能恢复更佳。提示自体植皮负压封闭引流联合外固定架治疗复杂重度开放性肘关节骨折疗效满意。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程