内侧与外侧经皮微创钢板内固定治疗A型闭合性胫骨远端骨折的疗效比较

目的比较分析应用外侧与内侧微创经皮钢板接骨术(MIPPO)联合锁定加压钢板(LCP)内固定治疗AO分型中A型闭合性胫骨远端骨折的临床疗效。方法自2007-06—2010-08,应用MIPPO技术联合LCP内固定治疗60例A型闭合性胫骨远端骨折,其中采用胫骨远端内侧锁定钢板内固定30例(内侧组),采用胫骨远端外侧锁定钢板内固定30例(外侧组)。记录并比较2组临床指标(手术时间、术中出血量、骨折愈合时间、并发症、AOFAS评分、背屈活动范围、跖屈活动范围、短缩长度)及影像学指标(内翻畸形、外翻畸形、前向成角、后向成角)。结果内侧组获得随访平均14.8(12~18)个月,外侧组获得随访平均16.7(12~20)个月。内侧组手术时间及术中出血量均少于外侧组,差异有统计学意义(P0.05)。2组骨折愈合时间,并发症发生情况,内、外翻畸形,前、后向成角,背、跖屈活动范围,肢体短缩长度,以及AOFAS评分差异无统计学意义(P0.05)。结论 MIPPO技术结合LCP钢板内固定治疗胫骨远端骨折时,内侧固定相对于外侧固定更符合骨折愈合的生物环境,具有创伤小、血运损伤小等优点。但是2种固定方法的短期疗效差异不大,临床治疗过程中仍需根据患者实际情况选择合适的手术方式。     

术中胫骨腓骨角和股骨腓骨角预测胫骨内侧开放高位截骨术后下肢冠状位力线的有效性研究北大核心CSCD

目的探讨以胫骨内侧开放高位截骨术(medial open-wedge high tibial osteotomy,MOWHTO)中截骨后的胫骨腓骨角(tibia fibular angle,TFA)、股骨腓骨角(femoral fibular angle,FFA)预测术后下肢冠状位力线的有效性。方法回顾分析2019年9月—2020年9月20例采用MOWHTO治疗的膝关节内侧间室骨关节炎患者临床资料。其中男9例,女11例;年龄46~69岁,平均56.0岁。身体质量指数(body mass index,BMI)21.3~35.7 kg/m^(2),平均26.7 kg/m^(2)。骨关节炎累及左膝11例、右膝9例;病程2~6年,平均3.8年;KellgrenLawrence分级:Ⅰ级7例,Ⅱ级9例,Ⅲ级4例。术前使用截骨大师软件设计截骨撑开高度和角度,测量模拟截骨撑开后的TFA、FFA;术中参考术前模拟撑开后TFA、FFA调整实际撑开高度。测量并比较术前及术后第2天股骨远端外侧角(lateral distal femoral angle,LDFA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、关节线汇聚角(joint line convergence angle,JLCA)、股骨胫骨机械轴夹角(mechanical femorotibial angle,mFTA)、关节承重线(weight-bearing line,WBL)比率、TFA、FFA。计算TFA、FFA术中测量值与术前计划值差值(X),术后WBL比率与目标力线(62.5%)差值(Y),采用Pearson检验分析两指标相关性。根据患者BMI中位数(25.81 kg/m^(2)),将患者分为高BMI组(>25.81 kg/m^(2),n=10)以及低BMI组(≤25.81 kg/m^(2),n=10),通过直线回归分析WBL比率的影响因素。结果手术前后LDFA、JLCA比较,差异无统计学意义(P>0.05);MPTA、mFTA、WBL比率比较,差异有统计学意义(P<0.05)。TFA术中测量值为(89.5±4.0)°,术后为(87.7±4.7)°,差异有统计学意义(t=2.991,P=0.008);TFA术中测量值与术前计划值差值(X)与术后WBL比率与目标力线差值(Y)成正相关(r=0.595,P=0.006)。FFA术中测量为(86.9±4.3)°,术后为(85.7±4.4)°,差异无统计学意义(t=1.760,P=0.094);FFA术中测量值与术前计划值差值(X)与术后WBL比率与目标力线差值(Y)成正相关(r=0.536,P=0.015)。经过BMI分层,在低BMI组X是Y的影响因素(P<0.05),但在高BMI组中X不是Y的影响因素(P>0.05)。结论术中截骨撑开后的FFA和TFA可以预测术后下肢冠状位力线,对于BMI≤25.81 kg/m^(2)的患者预测更准确。     

轴向旋转对胫骨近端内侧角测量的影响

目的:通过在负重位X线片上测量并比较双下肢不同轴向旋转角度(中立位、内旋30°位、外旋30°位)下的胫骨近端内侧角(medial proximal tibial angle,MPTA),探讨胫骨不同轴向旋转位置MPTA测量值变化及其意义。方法:自2018年1月至2018年12月选取40例膝骨关节炎(knee osteoarthritis,KOA)患者,共计80侧,其中男12例,女28例;年龄29~73(59.6±12.7)岁。分别拍摄胫骨中立位、内旋30°位和外旋30°位双下肢负重全长X线片,测量其MPTA并对其结果进行组内和组间比较。结果:左下肢胫骨中立位、内旋30°位和外旋30°位MPTA分别为(86.08±2.48)°、(88.62±2.94)°和(83.47±3.10)°,右下肢MPTA分别为(86.87±1.97)°、(89.02±2.39)°和(83.80±2.77)°,同旋转角度组内MPTA测量值比较,差异无统计学意义(P＞0.05);同侧肢体组间MPTA比较,差异有统计学意义(P＜0.05)。在内旋30°位时,左、右下肢MPTA较胫骨中立位增加(2.54±1.74)°、(2.15±1.78)°;在外旋30°位时,左、右下肢MPTA较胫骨中立位减少(2.61±2.03)°、(3.07±1.75)°。结论:拍摄双下肢负重位全长X线片时,若胫骨存在轴向内旋或者外旋,测得的MPTA会较中立位产生增大或者减少的变化,使临床工作中需要基于MPTA准确测量而进行的手术操作可能出现一定程度的偏差。但这种偏差导致的临床手术效果受影响的程度尚需验证。此外,受限于样本总量及测量分组数量,MPTA的偏差与胫骨轴向旋转之间是否存在线性关系有待进一步研究。     

胫骨远端前外侧锁定钢板治疗胫骨远端骨折

目的：探讨胫骨远端前外侧锁定钢板治疗胫骨远端骨折的临床疗效。方法使用胫骨远端前外侧锁定钢板微创手术复位固定治疗120例胫骨远端骨折患者。结果患者均获随访,时间6～23（13．5±2．7）个月。骨折均骨性愈合。按照 Johner-Wruhs 方法评价功能：优75例,良38例,中5例,差2例,优良率为94．17％。结论应用胫骨远端前外侧锁定钢板微创手术复位治疗胫骨远端骨折,能够获得满意的临床疗效。     

An evaluation of the EOS X-ray imaging system in pelvimetry

ObjectivesTo demonstrate the reliability of the EOS imaging system in measuring the internal diameters of the bony pelvis.Materials and methodsA prospective study comparing the results of the pelvimetry of 18 dry pelvises carried out on the EOS imaging system to measurements taken manually and using the two current gold standard CT methods. Pelvimetric measurements of each pelvic bone were obtained using four methods and compared: direct manual measurements, spiral and sequential CT pelvimetry, and 2D-3D low-dose biplanar X-rays. The various obstetric diameters were measured to the millimetre and compared.ResultsThere was no significant difference in the different diameters assessed, with the exception of the interspinous diameter. There was a highly significant correlation (P < 0.001) between the values measured manually and by EOS for the Magnin index (Pearson = 0.98), the obstetric conjugate diameter (Pearson = 0.99), and the median transverse diameter (Pearson = 0.87).ConclusionThe EOS imaging system allows for an ex vivo determination of the obstetrical diameters that is reliable enough to estimate obstetric prognosis, producing comparable measurements to CT. In view of concerns about protection from radiation, this low-dose imaging technique could become, after in vivo prospective validation, the new gold standard for pelvimetry and therefore a good alternative to CT.     

钢板与髓内钉内固定治疗胫骨远端骨折的疗效比较

目的探讨钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折的疗效。方法79例患者根据内固定方式分为钢板组(采用锁定解剖钢板内固定,45例)和髓内钉组(采用髓内钉内固定,34例)。比较手术时间、术中出血量、骨折愈合时间、并发症、末次随访时踝关节活动度及Lowa评分。结果患者均获得随访,时间12~28周。手术时间、术中出血量、骨折愈合时间、末次随访时踝关节活动度及Lowa评分髓内钉组均优于钢板组,差异均有统计学意义(P<0.01)。并发症发生例数两组比较差异无统计学意义(P>0.05)。结论钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折均有效。髓内钉在AO-A型骨折的治疗中有一定的优势,但需要严格掌握手术适应证。     

骨关节炎患者股骨后髁角与股骨髁外翻角、胫骨平台内翻角、股胫角的相关关系

[目的]发展一种膝关节术中直接测量股骨后髁角的新方法,并分析股骨后髁角与股骨髁外翻角、胫骨平台内翻角、股胫角的相关性,探讨各角度在膝关节置换术中的意义.[方法]研制股骨后髁角测定仪.对29例(30膝)在本院行人工膝关节置换术的骨关节炎患者,术前测量患膝负重前后位X线片上股骨髁外翻角、胫骨平台内翻角、股胫角,术中用股骨后髁角测定仪测量后髁角;分析股骨后髁角与股骨髁外翻角、胫骨平台内翻角、股胫角的相关关系.[结果]该组股骨后髁角为5.2°±2.6°,股骨髁外翻角为8.6°±2.9°,胫骨平台内翻角为4.1°±4.0°,股胫角为4.1°±7.3°,股骨后髁角和股骨髁外翻角、胫骨平台内翻角之间存在正相关关系,和股胫角尤相关关系.[结论]股骨后髁角测定仪提供了术中测苗股骨后髁角的新方法,为股骨假体旋转对线提供依据;股骨后髁角和股骨髁外翻角、胫骨平台内翻角之间存在正相关关系,术前测量股骨髁外翻角和胫骨平台内翻角,可为股骨假体旋转角度提供参考.     

内侧钢板与外侧钢板治疗胫骨远端闭合骨折的疗效比较

目的比较内侧钢板与外侧钢板内固定治疗胫骨远端闭合骨折的临床疗效。方法对56例胫骨远端闭合骨折患者应用钢板内固定治疗,根据钢板置于胫骨内侧或前外侧的不同分为内侧组(35例)和外侧组(21例)。比较两组患者手术时间、住院时间、骨折愈合时间、感染率、畸形愈合、延缓愈合等并发症情况。应用Johnner-Wruhs评分系统评价术后患肢功能,比较两组患者的疗效。结果骨折愈合时间:内侧组(17.57±3.27)周,外侧组(21.14±4.54)周,差异有统计学意义(P0.05);内侧组中23例经皮微创锁定钢板内固定的骨折愈合时间为(15.22±4.67)周。骨折延缓愈合:内侧组1例,外侧组5例;畸形愈合:内侧组无,外侧组3例;Johnner-Wruhs评分优良率:内侧组88.57%(31/35),外侧组66.67%(14/21);以上3项两组比较差异均有统计学意义(P0.05)。两组患者在手术时间、住院时间、感染率比较差异无统计学意义(P0.05)。结论内侧钢板和外侧钢板用于治疗胫骨远端闭合骨折均能取得较好的疗效,内侧钢板尤其是经皮微创锁定钢板内固定术在缩短骨折愈合时间和减少骨折畸形愈合、延缓愈合方面相对于外侧钢板有一定的优势。     

Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures

The authors reviewed 31 distal tibial fractures (16 involving the tibial plafond) treated with Ilizarov external fixation. The study population was composed of 19 males and 12 females, with an average age of 54. The fractures were classified according to the AO classification: A1 (3), A2 (6), A3 (6), C1 (2), C2 (8), C3 (6). There were six open injuries. In 14 pilon cases, open reduction of the intra-articular fragments and bone grafting via a limited incision was performed. Clinical follow-up averaged 28 months (range 18-42). All but one fracture united with an average healing time of 13.9 weeks. Nearly all patients with AO type A fracture had excellent or good functional scores. The 14 cases of AO C2 and C3 group had five (38%) good results, five (38%) fair results and three (24%) poor results. This method yielded results comparable with previous studies using open reduction and internal fixation. Twenty-nine percent of the patients had pin track infection, which remained the most important complication of this method.     

Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity

BackgroundThe objective of this study was to evaluate the correlation between Weightbearing CT (WBCT) markers of pronounced peritalar subluxation (PTS) and MRI findings of soft tissue insufficiency in patients with flexible Progressive Collapsing Foot Deformity (PCFD). We hypothesized that significant correlation would be found.MethodsRetrospective comparative study with 54 flexible PCFD patients. WBCT and MRI variables deformity severity were evaluated, including markers of pronounced PTS, as well as soft tissue degeneration. A multiple regression analysis and partition prediction models were used to evaluate the relationship between bone alignment and soft tissue injury. P-values of less than .05 were considered significant.ResultsDegeneration of the posterior tibial tendon was significantly associated with sinus tarsi impingement (p = .04). Spring ligament degeneration correlated to subtalar joint subluxation (p = .04). Talocalcaneal interosseous ligament involvement was the only one to significantly correlate to the presence of subfibular impingement (p = .02).ConclusionOur results demonstrated that WBCT markers of pronounced deformity and PTS were significantly correlated to MRI involvement of the PTT and other important restraints such as the spring and talocalcaneal interosseus ligaments.LEVEL OF EVIDENCE: Level III, Retrospective comparative study.     

Comparison of mid-term clinical results between lag screw fixation and Kirschner wire fixation after close reduction in adolescent triplane distal tibia epiphyseal fracture

ObjectiveTo compare the mid-term clinical results of lag screw and Kirschner wire fixation(KWF) for close reduction in triplane distal tibia epiphyseal fracture.MethodsA retrospective analysis of 25 cases of triplane fractures of the distal tibia treated in our department from Jan 2017 to Dec 2019 was performed, Lag screw fixation(LSF) was used in 14 cases and Kirschner wire fixation in 11 cases, the clinical results were evaluated by premature epiphyseal closure(PPC) rate, the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-hindfoot foot scoring system, the lateral distal tibial angle (LDTA) from X-ray.ResultsAll the 25 children were followed up for a mean of 34(ranging 26–52) months. AOFAS scores improved from a mean of 33(ranging 29–43) pre-op, to 82(ranging 77–88) at three month follow up, to 92 (ranging 88–98) at last follow-up in all 25 cases. Till last follow up there was no cases premature physeal closure in LSF group but 4 cases in KWF group, LDTA in both groups at last follow up shows no ankle varus or valgus deformity, and the ankle joint function was not limited in all cases.ConclusionLag screw and Kirschner wire fixation methods can both achieve good clinical effects for triplane distal tibia epiphyseal fracture. Lag screw fixation provide lower PPC rate but Kirschner wire fixation save one anesthesia and surgery.     

基于3D打印技术的数字化设计在胫骨远端粉碎性骨折内固定手术中的疗效及安全性分析

目的：探究基于3D打印技术的数字化设计在胫骨远端粉碎性骨折内固定手术中的疗效及安全性。方法：选择2019年2月—2022年2月于徐州市肿瘤医院收治的148例单侧胫骨远端粉碎性骨折患者;采用随机数字表法均分为观察组（数字化设计结合3D打印技术辅助手术）和对照组（传统切开复位内固定术）,每组74例。比较两组患者的临床疗效,采用随机行走模型评价两种手术方法的疗效和安全性。结果：与对照组相比,观察组的疗效优良率、术后6个月美国矫形外科足踝协会（AOFAS）评分和Barthel指数均更高（P <0.05）,手术时间及骨折愈合时间均更短（P <0.05）,术中出血量更少（P <0.05）,术后6个月疼痛视觉模拟评分（VAS）、术后24 h肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-8水平均更低（P <0.05）。随机行走模型评价结果显示,观察组患者治疗后手术指标、术后关节功能、疼痛、生活质量及炎症反应的改善情况均更优于对照组。两组术后6个月并发症发生率差异无统计学意义（P>0.05）。结论：基于3D打印技术的数字化设计的内固定手术可有效改善胫骨远...     

交锁髓内钉与经皮锁定加压钢板内固定治疗胫骨远端骨折的疗效比较

目的比较交锁髓内钉(IMN)与经皮锁定加压钢板(LCP)内固定治疗胫骨远端骨折的临床疗效。方法手术治疗87例胫骨远端骨折患者,其中42例行经皮LCP固定,45例行IMN固定。比较两组手术时间、术中出血量、并发症、骨折愈合时间及末次随访足踝功能AOFAS评分。结果患者均获得随访,时间12~45个月。两组手术时间、术中出血量、骨折愈合时间、末次随访AOFAS评分比较差异均无统计学意义(P0.05)。膝关节疼痛、骨折畸形愈合发生率IMN组高于经皮LCP组,差异有统计学意义(P0.05)。术后感染发生率经皮LCP组高于IMN组,差异有统计学意义(P0.05)。结论 IMN和经皮LCP内固定治疗胫骨远端骨折均可取得满意疗效。术后膝关节疼痛、骨折畸形愈合等并发症方面经皮LCP内固定更具有优势,但应注意预防感染。     

Correlations of calcaneal QUS with pQCT measurements at distal tibia and non-weight-bearing distal radius

Quantitative ultrasound (QUS) is used for prediction for risks of osteoporotic fractures at various skeletal sites, irrespective of weight-bearing or non-weight-bearing skeletons. In the current study, we investigated the correlation between calcaneal QUS measurements (BUA, VOS, and Soundness) and volumetric trabecular, cortical, and its integral bone mineral density (tBMD, cBMD, and iBMD) using peripheral quantitative computed tomography (pQCT) of the weight-bearing distal tibia and non-weight-bearing distal radius in 198 healthy Chinese women between 40 and 62 years of age. Results showed that BUA, VOS, and Soundness measured by calcaneal QUS were significantly correlated with tBMD, cBMD, and iBMD of both distal tibia and distal radius (r = 0.210–0.447; all P < 0.01). The correlation coefficients of all the individual parameters between calcaneus and distal tibia were correspondingly higher (r = 0.214–0.447; all P < 0.01) than that of distal radius (r = 0.210–0.368; all P < 0.01). QUS Soundness showed the highest correlation (r = 0.447; P < 0.01) with tBMD of distal tibia when comparing with all other parameters between these two measurement devices. Stronger within-device correlations (r = 0.640–0.764; all P < 0.01) were found in pQCT measurements between distal tibia and radius. In addition, the largest and significant age-related decline was found in tBMD of the distal radius measured by pQCT and Soundness of the QUS measurement in the postmenopausal group. In conclusion, heel QUS measurement demonstrated slightly better correlation with trabecular bone of the weight-bearing skeleton than that of the non-weight-bearing skeleton measured by pQCT.     

Comparison of closing-wedge and opening-wedge high tibial osteotomies for medial compartment osteoarthritis of knee in Asian population: Mid-term follow-up

BackgroundValgus high tibial osteotomy (HTO) is a well-established treatment option for patients with early osteoarthritis of the medial compartment of the knee. It is achievable with either open-wedge or closed-wedge technique. The aim of the study was to compare the radiological and clinical outcomes following HTO done with open- and closed-wedge techniques.Material and methodsTwo groups of patients undergoing HTO and fixation with locking plates were compared. Twenty-five patients were operated using medial open-wedge technique and 23 using closed-wedge technique between January 2000 and June 2014. They were compared on the basis of Hospital for Special Surgery (HSS), knee score, preoperative and postoperative range of motion, femoro-tibial angle and duration required for full-weight bearing. Early and late postoperative complications were noted.ResultsMedian HSS score at 6 months and 1 year post-surgery was better in the open-wedge technique group. The range of motion was also higher at early follow-up in the open-wedge technique group, with shorter duration for full-weight bearing. Delayed union was seen in two patients in the open-wedge technique group and four patients in closed-wedge group. Peroneal nerve palsy was noted in two patients in the closed-wedge group.ConclusionBoth open-wedge and closed-wedge HTO lead to good and comparable results. However, the technique of open-wedge osteotomy provided better outcome in terms of functional scores in early as well as late follow-up with decreased duration required for full-weight bearing.     

EOS成像系统的介绍及其评估下肢力线临床价值的研究现状

介绍EOS成像系统的原理和技术背景,结合该技术的宣传说明和现有的文献报道,了解到低剂量EOS技术可以将检查过程中的辐射剂量降低5～10倍,而微剂量EOS甚至可以将辐射剂量降低至45倍;在成像质量方面相较于CR的图像质量只高不低;系统自带有EOS 2D和3D工作站,2D工作站可以帮助临床医生轻松实现对下肢冠状位和矢状位力线的测量和评估,在3D工作站进行三维模型重建后可以三维测量肢体的倾斜和扭转,利用这些测量结果,在进行术前评估、完善术前规划以及术后测量评估手术效果等方面给临床医生提供了极大的帮助。在测量的准确性方面,大量的文献报道认为EOS 2D测量和普通放射学测量精确度相当,而EOS 3D重建测量的精确度可媲美CT以及MRI。基于EOS的技术特点和优势,对其在评估下肢力线准确性方面的文献报道和研究进展作一综述。     

单张X线片法与CT法测量股骨颈前倾角的比较

目的 比较单张X线片一次成像测量股骨颈前倾角法与CT法的差异。方法 将31例受检者62髋，利用普通透视摄X片线机，使受检者双下肢固定于屈膝屈髋90。外展60。位，双髋对称，双侧股骨干中轴与骶正中嵴垂直后摄片。测量前倾角，并与CT法测量结果行统计学处理?结果 单张X线片法与CT法测量结果无明显差异，并高度相关。结论 单张X线片法测量股骨颈前倾角与CT法准确度相同。     

Techniques of open reduction internal fixation of Salter-Harris type II, III, and IV fractures of the distal tibia in children

Salter-Harris type II, III, and IV fractures of the distal tibia are common and have a propensity to developpremature physeal closure. Parents should be advised of this potential occurrence and its implications. Management of these fractures is directed at reducing this complication.