The Influence of Freezing on the Maximum Torque Capacity of Long Bones: An Experimental Study on Dogs

The strength of bone has often been measured in previously frozen samples and the freezing and thawing effect on the strength properties has been considered negligible. By means of a specially constructed torsion machine and a new method for fixing the test bone into the machine, previously frozen bones have been compared to fresh controls. The previously frozen samples were significantly weaker, with an average difference of -4.6 per cent.     

Torsional Strength and Geometry of Diaphyseal Bone: An Experimental Study on Dogs

A previously presented method for measuring the torsional strength of diaphyseal bones has been used to study the effect of direction of twist upon the torsional strength and stiffness of diaphyseal canine bones. No significant effect of the direction of twist upon the studied properties has been found. The reason for the observed twist direction independence of the torsional strength and stiffness is assumed to be the adaptation of the diaphyseal bone architecture to functional demands.     

Torsional Strength and Geometry of Diaphyseal Bone: An Experimental Study on Dogs

A previously presented method for measuring the torsional strength of diaphyseal bones has been used to study the effect of direction of twist upon the torsional strength and stiffness of diaphyseal canine bones. No significant effect of the direction of twist upon the studied properties has been found. The reason for the observed twist direction independence of the torsional strength and stiffness is assumed to be the adaptation of the diaphyseal bone architecture to functional demands.     

骨水泥与非骨水泥微创半髋关节置换术治疗老年股骨颈骨折的疗效分析

目的回顾性比较骨水泥和非骨水泥微创半髋关节置换术(MIS-HA)治疗老年股骨颈骨折的短期临床疗效。方法自2012-01—2013-04采用前外侧入路分别行骨水泥(70例70髋,骨水泥组)和非骨水泥(70例70髋,非骨水泥组)MIS-HA治疗140例老年移位股骨颈骨折,比较2组手术时间、术中出血量、术后引流量、总失血量、输血率、并发症、髋关节功能Harris评分。结果非骨水泥组70例获得随访,平均随访23(14~28)个月;骨水泥组术中因肺栓塞死亡1例,69例获得随访,平均随访20(14~28)个月。2组术中Sp O295%者、舒张压下降≥20 mm Hg者、术后引流量、输血率比较,差异无统计学意义(P0.05);与骨水泥组相比,非骨水泥组手术时间较短、术中出血量较少、总失血量较少,差异有统计学意义(P0.05);2组在术后3、6、12个月比较髋关节功能Harris评分,差异无统计学意义(P0.05)。2组均无血管神经损伤,并发症比较差异无统计学意义(P0.05)。结论前外侧入路MIS-HA治疗老年股骨颈骨折具有创伤小、并发症少、恢复快等优点,骨水泥和非骨水泥型MIS-HA均可获得良好的临床结果。     

Experimental Measurement of Maximum Torque Capacity of Long Bones

By means of a new method with high precision (error 3.1 per cent), the maximum torque capacity of an entire long bone from an experimental animal was measured under standardized conditions within 10 minutes after sacrifice of the animal.     

Flat vs. concave tibial joint surface in total knee arthroplasty: Randomized evaluation of 39 cases using radiostereometry

40 patients with non-inflammatory arthrosis and minor preoperative deformity (/ 5°) were operated on with an AMK type (DePuy, Johnson & Johnson) total knee arthroplasty (TKA). The posterior cruciate ligament was retained. The patients were divided into those with a flat (terminology of the manufacturer: standard) or a concave (terminology of the manufacturer: constrained) polyethylene insert (20 in each group). Radiostereometric (RSA) examinations were done postoperatively and after 3, 12 and 24 months. The median absolute rotations of the tibial inserts varied between 0.12 and 0.24 (range 0.00-1.54) degrees, with no differences between the 2 groups. The median maximum totalpoint motions (flat/concave = 0.41/0.42 mm), the maximum subsidence or lift-off did not differ. The Hospital for Special Surgery knee score and the patients' opinion about the operation, based on their preoperative expectations, showed little, if any, differences. At 2 years, 10 of 20 patients with flat and 13 of 19 with concave inserts regarded their knee function as normal or almost so.     

Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems

We performed a randomised prospective trial to compare the results of 27 cemented and 26 uncemented bipolar hemiarthroplasties in active patients with displaced subcapital fractures of the femoral neck. After a mean follow-up of 17 months, significantly more of the uncemented group were experiencing pain in the hip and using more walking aids than the patients in the cemented group. The incidence of postoperative complications, the early mortality rate and the operating time and blood loss were not significantly different. Using otherwise identical prostheses the early results were much better with a cemented Thompson stem than with an uncemented Austin Moore stem.     

股骨转子下骨折术后不愈合并内固定断裂1例

患者,女,69岁,既往高血压病史,慢性胃溃疡30余年,无糖尿病、冠心病、肝炎等病史。患者于13个月前从约1.5 m高处摔落致右大腿上部疼痛肿胀,伴髋部活动受限,在当地医院行X线检查,诊断为右股骨转子下骨折,AO分型32-A2型(见图1A)。于当地医院行切开复位动力髋螺钉内固定术治疗,术后X线片显示对位对线良好(见图1B)。术后患者能缓慢行走,定期当地门诊复查,见折端骨痂生长,但愈合迟缓,右侧股骨有逐渐内翻趋势。3 d前晨起时突发右侧大腿疼痛肿胀,中段可扪及异物感,行走困难,遂于2017年1月20日至我院门诊就诊。行X线检查提示:右股骨转子下骨折,内固定术后改变,折端部分愈合,股骨上段内固定钢板外移,螺钉断裂(见图1C)。     

Comparison of total costs between internal fixation and hemiarthroplasty for displaced femoral neck fractures

Background

There is very little information on the costs of different surgeries for displaced femoral neck fractures. This study aimed to compare the costs between internal fixation and hemiarthroplasty (HA) in the treatment of displaced femoral neck fracture.

带血运骨瓣移植内固定治疗头下型股骨颈骨折

目的 探讨带自运骨瓣移植治疗股骨颈骨折的疗效。方法 应用带血运骨瓣移植及内固定治疗股骨颈骨折,其中带旋髂深动列脉髂骨瓣10例,带缝匠肌骨瓣6例,带臂中肌骨瓣3例,带阔筋膜张肌骨瓣2例,带股方肌骨瓣3例。结果 24例均获访,时间2．5－6年,疗效评定按童星杰等制定的标准,优15例（62．5％）,良8例（33．3％）,差1例（4．2％）。结论 带血运骨瓣移植是治疗GardenⅢ、Ⅳ型股骨颈骨折方法之一。     

高龄股骨颈基底型骨折人工关节置换与内固定术后生活质量评价

背景：股骨颈基底型骨折属于股骨颈骨折,同时又是囊外骨折,治疗方法有多种选择,由于发生率低故相关研究甚少。目的：比较分析高龄（70岁以上）股骨颈基底型骨折行人工股骨头置换与闭合复位内固定患者术后生活质量差异。方法：1995年9月至2009年6月共收治38例股骨颈基底型骨折患者,男12例,女26例;年龄70-91岁,平均79．4岁;全部患者均为外伤性新鲜骨折,其中16例选择人工股骨头置换为一组,另22例选择内固定术为一组。对比两组患者手术时间、术中出血量、术后下地时间及术后1年运用Harris评分中部分项目评定患者生活质量并结合术后1年髋部正侧位X线片。结果：两组在手术时间、术中出血量、术后下地时间等比较,差异有统计学意义（P〈0．001）。人工股骨头置换组在1年后生活自理、髋部疼痛及行走距离等方面较内固定组优异。人工股骨头置换组1年后均未出现假体松动,而内固定组骨折均愈合。结论：人工股骨头置换术治疗高龄股骨颈基底型骨折近期效果较理想,具有以下优点：（1）术后可早期负重活动,较快恢复伤前活动能力;（2）降低术后并发症和内科合并症的发生几率;（3）近期感觉及功能优于内固定。但同时股骨颈基底型骨折作为囊外骨折血供较好,骨折愈合率高,对于预期生存时间超过5年、骨质量较好的老年患者考虑行内固定治疗,可避免人工关节置换后期的磨损、松动及下沉。     

骨水泥型与生物型假体半髋置换治疗老年股骨颈骨折的创伤程度及骨代谢比较

目的探讨骨水泥型与生物型假体半髋置换对老年股骨颈骨折患者术后创伤程度及骨代谢的影响。方法选取2018年1月至2020年1月本院行半髋置换的老年股骨颈骨折患者60例,按假体类型分为骨水泥型组和生物型组各30例,对比2组患者术前、术后第1、7 d的炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)]、应激激素[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)]、骨代谢标志物[Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总Ⅰ型胶原氨基端延长肽(tPINP)、骨碱性磷酸酶(BALP)、全段甲状旁腺素(iPTH)]水平。结果 2组患者术前、术后第1、7 d炎症因子(TNF-α、IL-6、PCT、CRP)、骨代谢(β-CTX、tPINP、BALP、iPTH)水平比较差异均无统计学意义(P0.05)。2组患者应激激素(NE、E、COR)水平术前、术后第7天比较差异无统计学意义(P0.05),术后第1天比较差异有统计学意义(P0.05)。结论两种假体手术对老年股骨颈骨折患者的炎症因子、骨代谢影响无差异,但生物型假体对患者的应激激素影响小,对基础病多手术耐受性差者更具优势。     

Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

Background:

Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures.

Materials and Methods:

From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years).

Results:

Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN) till date.

Conclusion:

For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.     

股骨颈骨折术后股骨头坏死率及相关危险因素的Meta分析

目的: 研究2000年以后的成人股骨颈骨折患者内固定术后股骨头坏死发生率及相关危险因素以识别股骨头坏死高危人群。方法: 检索PubMed、Medline、The Cochrane Library、中国知网、万方和维普数据库,收集2000年1月1日至2020年7月1日期间有关股骨颈骨折术后股骨头坏死及其危险因素的全部研究,根据入选和排除标准剔除不符合要求的研究。使用Endnote X9和Excel 2019进行文献提取、管理以及数据录入,利用R Studio 3.6.5软件进行Meta分析。通过亚组分析、敏感性分析和发表偏倚检测来研究异质性来源及评估结果的可靠性。结果: 共纳入16篇文献,包括5 521例股骨颈骨折患者。Meta分析结果显示成人股骨颈骨折内固定术后股骨头坏死发生率为14.5%[95%CI(0.126-0.165)]。骨折移位情况[OR=0.27,95%CI(0.21-0.35)]和复位质量[OR=0.15,95%CI(0.09-0.27)]是股骨头坏死相关危险因素。亚组率分析结果显示:非移位型骨折坏死率为6.2%[95%CI(0.051-0.077)],移位型骨折坏死率为20.4%[95%CI(0.166-0.249)];骨折复位良好坏死率为8.3%[95%CI(0.072-0.095)],骨折复位不良坏死率为35.5%[95%CI(0.233-0.500)]。纳入的文献一致性较好,不存在发表偏倚。结论: 2000年以后的成人股骨颈骨折内固定术后股骨头总坏死率有所下降,而移位型骨折和复位质量不良的患者坏死率仍处于较高水平。由于各原始文献对受伤至手术时间间隔的划分不一致,没有对该指标进行分析。     

重视股骨颈骨折的评估与内固定治疗的若干问题

股骨颈骨折是临床最常见的骨折之一,可发生于任何年龄段,内固定和髋关节置换术已成为治疗股骨颈骨折的两大手术方式,其中内固定术对于中青年患者依然是首选的治疗方式.随着治疗理念和手术技术的进步、内固定材料和设计的更新,其内固定治疗的效果得到明显改善,但固定术后骨折不愈合、股骨头坏死的发生率依然较高,所以股骨颈骨折一直都是临床...     

Closed reduction and internal fixation versus total hip arthroplasty for displaced femoral neck fracture

Objective： To compare the clinical effects between closed reduction and internal fixation （CRIF） and total hip arthroplasty （THA） for displaced femoral neck fracture. Methods： In this prospective randomized study, 285 patients aged above 65 years with hip fractures （Garden III or IV） were included from January 2001 to December 2005. The cases were randomly allocated to either the CRIF group or THA group. Patients with pathological fractures （bone tumors or metabolic bone disease）, preoperative avascular necrosis of the femoral head, osteoarthritis, rheumatoid arthritis, hemiplegia, long-term bed rest and complications affecting hip functions were excluded. Results： During the had significantly higher 5-year follow-up, CRIF group rates of complication in hipjoint, general complication and reoperation than THA group （38.3% vs. 12.7%, P〈0.01; 45.3% vs. 21.7%, P〈0.01; 33.6% vs. 10.2%, P〈0.05 respectively）. There was no difference in mortality between the two groups. Postoperative function of the hip joint in THA group recovered favorably with higher Harris scores. Conclusion： For displaced fractures of the femoral neck in elderly patients, THA can achieve a lower rate of complication and reoperation, as well as better postoperative recovery of hip joint function compared with CRIF.     

切开复位空心螺钉固定并自体植骨治疗股骨颈骨折

2003年5月～2008年5月,我科采用切开复位、空心螺钉固定、自体髂骨植骨治疗股骨颈骨折26例,效果较好。 1材料与方法1．1病例资料本组26例,男14例,女12例,年龄17～71岁,其中≤30岁2例,31～40岁4例,41～60岁14例,〉60岁6例。按骨折线分型：头下型18例,头颈型5例,经颈型3例（均骨折移位明显）。新     

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

Background:Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals.Results:The mean followup is 12.5 years (range 3-35). The union of fractures occurred in 202 (82.8%), delayed union in 18 (7.3%), and established nonunion in 24 (9.8%) patients. Full weight bearing was permitted at 16–22 weeks after union of fractures. Mean Harris hip score at the longest followup was 85.5. Among the complications, superficial wound infection occurred in 20 (8.2%), deep infection in seven (2.9%), and coxa vara in 39 (16%) patients. Preoperative radiodensity of femoral head disappeared mostly after the union of fracture whereas fresh radiodensity of femoral head appeared in 20 (8%) patients; nine (45%) of them developed segmental collapse.Conclusion:Ununited femoral neck fractureis characterized by absorption of femoral neck, posterior cortical defect, smoothening and overriding of fracture surfaces with intervening fibrous tissues associated with or without AVN of femoral head. The above method of osteosynthesis rectified the above pathology and provided satisfactory results with union of fractures in 90.1% patients at long term followup.     

Uncemented Austin-Moore and cemented Thompson unipolar hemiarthroplasty for displaced fracture neck of femur--comparison of complications and patient satisfaction

Austin-Moore and Thompson monobloc prostheses are both commonly used for hemiarthroplasty for displaced fractures of the neck of femur in adults. There is an ongoing debate about, which of these prostheses should be preferred. We present a comparison of two groups of patients with this fracture treated using cemented Thompson prosthesis and uncemented Austin-Moore prosthesis. Mortality, morbidity and patient satisfaction in the two groups were compared. Cemented Thompson hemiarthroplasty was associated with significantly better patient satisfaction scores. There was no difference in the mortality rates and hospital stay. Patients preferred cemented unipolar Thompson hemiarthroplasty over the uncemented unipolar Austin-Moore hemiarthroplasty. A larger randomised prospective trial is needed to confirm this finding.     

人工股骨头置换与髓内固定治疗脑卒中后老年股骨转子间骨折的疗效比较

目的 比较人工股骨头置换与髓内固定治疗脑卒中后老年股骨转子间骨折的疗效.方法 对2005年6月至2011年6月期间收治的32例脑卒中后老年股骨转子间骨折患者资料进行回顾性分析,男8例,女24例;年龄为65 ～91岁,平均80.3岁;骨折AO分型:AI型8例,A2型14例,A3型10例.根据治疗方式不同分为两组:股骨头置换组(采用人工股骨头置换治疗,12例)和髓内固定组(采用髓内钉固定治疗,20例).记录并比较两组患者的切口长度、术中出血量、手术时间、术后下地时间、围手术期及术后1年并发症发生情况、术后1年髋关节Harris评分. 结果 股骨头置换组和髓内固定组患者的切口长度平均分别为(10.0±2.1)、(5.1±2.3)cm,术中出血量平均分别为(301.8±98.2)、(156.3±45.1)mL,术后下地时间平均分别为(6.4±2.9)、(30.5±8.7)d,围手术期并发症发生率分别为33.3％ (4/12)、65.0％ (13/20),术后1年髋关节Harris评分总分平均分别为(61.3±5.4)、(57.4±4.6)分,差异均有统计学意义(P＜0.05).股骨头置换组和髓内固定组患者的手术时间平均分别为(54.1±12.5)、(65.2±15.7) min,术后1年并发症发生率分别为25.0％ (3/12)、26.3％(5/19),差异均无统计学意义(P＞0.05). 结论 人工股骨头置换治疗脑卒中后老年股骨转子间骨折在降低围手术期并发症发生率、提早术后下地时间和改善髋关节功能方面较髓内固定有优势.