尺骨鹰嘴骨折两种内固定治疗方法的比较

目的比较克氏针钢丝张力带内固定和尺骨鹰嘴解剖钢板内固定两种治疗方法治疗尺骨鹰嘴骨折的疗效。方法选取2006-01～2010-09收治的75例尺骨鹰嘴骨折患者随机分为钢板组(n=40)和张力带组(n=35),钢板组接受尺骨鹰嘴解剖钢板并加压螺钉治疗,张力带组接受普通克氏针钢丝张力带固定手术治疗,以美国特种外科医院(hospital of special surgery,HSS)肘关节功能评价标准评估两种方法的疗效。结果钢板组优秀25例,良好7例,优良率为80.0%;张力带组优秀20例,良好9例,优良率为82.9%。两组患者的术后优良率比较,差异无统计学意义(χ~2=0.66,P=0.417)。结论克氏针钢丝张力带内固定和尺骨鹰嘴解剖钢板内固定治疗尺骨鹰嘴骨折均可取得良好疗效。     

手部第V掌骨颈骨折的治疗

手部第V掌骨颈骨折在临床上较常见,多在患者握拳击打物件时发生,又称“拳击手骨折”。2000～2009年我院共收治手部第V掌骨颈骨折患者24例,根据骨折的形态采取石膏外固定及手术内固定的方法,取得满意疗效。现报告如下。     

解剖型钢板及克氏针内固定治疗Pilon骨折134例分析

2000年2月-2004年7月,我院采用胫骨远端解剖型钢板及克氏针内固定术治疗Pilon骨折134例,取得良好效果。现报告如下。     

双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的疗效比较

目的比较双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的临床疗效。方法回顾性分析2010年7月至2014年10月院内收治的36例复杂胫骨平台骨折患者的临床资料,根据手术方法的不同分为两组,观察组21例行双切口双钢板内固定;对照组15例行单侧锁定钢板内固定,比较两组临床疗效情况,分别对两组的术中情况、术后情况及院后恢复情况进行统计分析。结果两组手术时间、出血量、切口长度、术后即刻、术后3、12个月时胫骨平台内翻角(TPA)和后倾角(PA)度数,膝关节恢复优良率及HSS评分、并发症发生率比较均无显著性差异(P>0.05),对照组负重下地时间及愈合时间显著短于观察组(P<0.05),观察组膝关节开始锻炼时间及并发症发生率显著低于对照组(P<0.05)。结论双切口双钢板内固定与单侧锁定钢板内固定术式均能有效改善和缓解复杂性胫骨平台骨折病情,单侧锁定钢板内固定方法术后伤口愈合快、恢复时间短,但膝关节僵直发生率较高,而双切口双钢板内固定治疗复杂胫骨平台骨折,具有骨折复位良好、固定牢靠、可早期进行膝关节功能锻炼,减少膝关节僵直等并发症的优势,故在临床诊疗中建议用双切口双钢板固定术式治疗。     

螺钉、克氏针内固定治疗距骨颈骨折的三维有限元分析

目的 利用三维有限元法分析克氏针、螺钉内固定治疗距骨颈骨折的稳定性,为临床上研究距骨颈骨折内固定最佳力学环境提供生物力学理论依据.方法 获取健康男性志愿者左足及胫腓骨远端骨CT扫描信息,利用Mimics软件对距骨行三维建模;所有数据以点云格式输出到Geomagic软件编辑,得到模型实体,把所有数据以IGES格式输出;之后导入到Ansys软件中,利用该软件对克氏针、螺钉造模并模拟距骨颈骨折模型,分别用空心螺钉、克氏针对骨折进行固定,而后分别对模型赋予单元类型和属性建立有限元模型.在模型的胫距关节的距骨关节面垂直施加2100N的压力进行非线性分析.结果 后侧入路内固定骨折面接触压力最大为7.23 MPa,骨折间隙最小为0.199 451 mm;前侧入路内固定分别为6.991 MPa、0.249 261 mm.螺钉内固定的骨折面接触压力最大为7.23 MPa,骨折间隙最小为0.199451 mm;克氏针分别为6.958 MPa、0.242006 mm.多根固定的骨折面接触压力最大为7.23 MPa,骨折间隙最小为0.199 451 mm;单根固定分别为6.976 MPa、0.243 946 mm.结论 利用三维有限元法可对克氏针、螺钉内固定治疗距骨颈骨折的稳定性进行对比分析,得出最适用于距骨颈骨折内固定的最佳力学环境;双螺钉由后向前固定治疗距骨颈骨折的稳定性优于其他固定方式.     

锁定加压钢板内固定治疗肱骨近端骨折

目的探讨锁定加压钢板内固定治疗肱骨近端骨折的疗效。方法 2005-06～2008-06月对39例肱骨近端骨折患者采用锁定加压钢板内固定治疗,并于术后早期进行功能锻炼。结果术后平均随访9个月,按Constant评分标准,平均88分(41～95分),其中优26例,良10例,中2例,差1例,优良率92.3%。结论锁定加压钢板治疗肱骨近端骨折是一种安全、有效的手术方法。     

Pilon骨折三种固定方法疗效比较

Pilon骨折是指胫骨远端累及关节面的骨折。由于胫骨远端皮肤软组织与骨骼紧密相连 ,血运较差 ,所以 Pilon骨折是较难处理的骨折之一。1 997年 1月至 2 0 0 1年 1 2月 ,我院对 80例 Pilon骨折患者分别采用钢板内固定、外固定架固定、有限内固定加外固定架固定的方法治疗 ,并对三种固定方法的疗效进行了对比观察。现报告如下。1　资料与方法1 .1　临床资料　 Pilon骨折患者 80例 ,均为闭合性骨折 ,其中男 5 1例 ,女 2 9例 ;年龄 1 5～ 47岁 ,平均 2 7.3岁。将 80例患者随机分为三组 ,按 Ruedi和 Allgower分型 ,A组 型 1 5例 , 型 9例 , 型…     

手法整复外固定加经皮克氏针内固定治疗儿童肱骨髁上骨折20例分析

目的探讨手法整复外固定+经皮克氏针内固定治疗儿童肱骨髁上骨折的临床疗效。方法在C臂机透视下,采用手法整复外固定+经皮克氏针内固定治疗儿童肱骨髁上骨折20例。结果随访时间3～6个月,骨折全部愈合,无并发症发生。20例中治愈18例,好转2例。结论采用手法整复外固定+经皮克氏针内固定治疗儿童肱骨髁上骨折,具有创伤小、并发症少等特点,适合临床开展。     

锁定加压钢板内固定治疗肱骨近端骨折39例分析

目的探讨锁定加压钢板内固定治疗肱骨近端骨折的疗效。方法取肩关节前侧人路,采用切开复位锁定加压钢板内固定治疗肱骨近端骨折39例,术后早期功能锻炼。结果 39例患者术后随访6～12个月,平均9个月。伤口全部一期愈合,钢板无折断,螺钉无松脱,无再移位发生。肩关节功能评估优26例,良8例,可5例,优良率为87.2%。1例发生肱骨头无菌性坏死。结论应用锁定加压钢板内固定治疗肱骨近端骨折,固定牢固,操作简单,允许早期功能锻炼,肩关节功能恢复良好,是一种理想的手术方法。     

克氏针内固定治疗跖跗关节骨折脱位13例疗效观察

跖跗关节骨折脱位 (亦称 L lisfranc' s损伤 )临床少见 ,治疗不当或不及时可引起患足创伤性关节炎等并发症。 1996～2 0 0 1年 ,我们应用克氏针内固定治疗 13例本病患者 ,现报告如下。临床资料 :本组 13例患者 ,均为男性 ,年龄 3 2～ 5 3岁 ,平均 41岁。 12例为高速交通伤 ,1例为高处坠落伤 ;13例均为闭合性多发性、复合伤 ,同时行其他急症手术。 13例患者均有跖跗关节周围骨折伴跖跗关节脱位。骨折类型 ( Myserson标准 )为 A型 5例 ,B型 8例。治疗方法 :10例在连续硬膜外麻醉下行切开复位多根克氏针内固定术固定骨折脱位 ,术中均达到解剖…     

Comparison of the fixation ability of headless compression screws and locking plate for metacarpal shaft transverse fracture

Metacarpal shaft fractures are common hand fractures. Although bone plates possess strong fixation ability, they have several limitations. The use of headless compression screws for fracture repair has been reported, but their fixation ability has not been understood clearly.This study aimed to compare the fixation ability of locked plate with that of headless compression screw for metacarpal fracture repair.A total of 14 artificial metacarpal bones (Sawbones, Vashon, WA, USA) were subjected to transverse metacarpal shaft fractures and divided into 2 groups. The first group of bones was fixed using locked plates (LP group), whereas the second group was fixed using headless compression screws (HC group). A material testing machine was used to perform cantilever bending tests, whereby maximum fracture force and stiffness were measured. The fixation methods were compared by conducting a Mann–Whitney U test.The maximum fracture force of the HC group (285.6 ± 57.3 N, median + interquartile range) was significantly higher than that of the LP group (227.8 ± 37.5 N; P < .05). The median of the HC group was 25.4% greater. However, no significant difference in stiffness (P > .05) was observed between the HC (65.2 ± 24.6 N/mm) and LP (61.7 ± 19.7 N/mm) groups.Headless compression screws exhibited greater fixability than did locked plates, particularly in its resistance to maximum fracture force.     

两种内固定方法治疗老年人股骨粗隆间骨折的比较

目的比较动力髋螺钉(DHS)与DHS联合粗隆拉力螺钉对老年人股骨粗隆间骨折的治疗效果。方法分析59例老年人股骨粗隆间骨折后治疗情况,其中28例采用DHS内固定(单纯DHS组),31例采用DHS联合粗隆拉力螺钉内同定(联合螺钉组),对两种内固定方法进行比较。结果经过6～16个月的随访,联合螺钉组手术时间为(1．4±0．7)h,单纯DHS组为(1．6±0．5)h;两组出血量分别为(250±45)ml和(270±55)ml,差异均无统计学意义(P＞0．05)。单纯DHS组骨性愈合时间为(130±27)d,联合螺钉组为(114±20)d,差异有统计学意义(P＜0．05)。联合螺钉组关节功能优良率优于单纯DHS组(P＜0．05)。关节变化情况:髋内翻和肢体缩短,联合螺钉组均少于单纯DHS组(P＜0．05)。结论联合螺钉治疗老年人股骨粗隆间骨折较单纯DHS具有并发症少、关节功能优良率高,是一种较好的内固定术式。     

枢椎三维有限元模型的建立

目的建立并验证枢椎三维有限元模型,以期应用于临床相关的生物力学实验研究。方法对健康成年男性颈部进行CT扫描,层厚0.6 mm,无间隔。将DICOM图像数据导入Mimics软件中,生成网格化的枢椎表面三维图像,再经Ansys Icem CFD处理,生成包括皮质骨和松质骨的实体模型。模拟体外生物力学试验进行验证模型。结果所建模型外观清晰逼真,几何相似性好。所建的枢椎有限元模型能够通过验证,与体外生物力学实验结果基本吻合,可进一步行各种上颈椎有限元力学分析。结论枢椎有限元三维模型的建立为临床提供了一种便捷而精确的方法,为下一步生物力学分析提供了条件。     

全髋关节置换术和切开复位内固定术治疗中老年人股骨颈骨折患者的疗效比较

目的探讨全髋关节置换术治疗中老年人股骨颈骨折的临床疗效。方法将该院2012-01~2015-06收治的68例中老年股骨颈骨折患者按随机数字表法分为置换组(n=35)和内固定组(n=33),内固定组采取切开复位内固定手术治疗,置换组采取全髋关节置换术治疗,比较两组治疗效果。结果置换组手术时间、术中失血量长于或多于内固定组(P0.01),但卧床时间明显短于内固定组(P0.01),两组住院时间比较差异无统计学意义(P0.05);置换组Harris评分为(73.15±5.27)分,内固定组为(52.08±3.62)分,两组比较差异有统计学意义(P0.05);两组并发症发生率比较差异无统计学意义(P0.05)。结论全髋关节置换术治疗中老年股骨颈骨折关节功能恢复更快、更好,可明显改善患者患肢功能,提高生活质量。     

A coupled fluid-structure finite element model of the aortic valve and root

BACKGROUND AND AIM OF THE STUDY: The study aim was to develop a three-dimensional coupled fluid-structure finite element model of the aortic valve and root. This model extends previous purely structural finite element models, and represents a significant step toward realistic simulation of the complex interactions among tissue material properties and valvular function. METHODS: The aortic root and valve geometry were extracted from magnetic resonance images and imported into the LS-Dyna explicit finite element package. Leaflet and root tissue were modeled with elastic material properties, and blood was modeled as a Newtonian liquid. A dynamic, fully unsteady analysis was performed in which blood flow through the valve was computed along with the motion of the leaflets and root in response to standard physiologic pressure wave profiles. RESULTS: The opening and closing of the aortic valve under physiological loading conditions was successfully simulated, and feasibility of the model illustrated. The motion of the simulated leaflets was consistent with that seen in intact hearts. Analysis of fluid flow patterns revealed eddy structures in the sinus regions and flow into the coronary circulation. CONCLUSION: The addition of blood flow to structural models of the aortic valve and root is a significant advance in modeling, and allows a closer simulation of valvular function. The model will be used to further assess normal and abnormal physiology as well as the effects of surgical intervention.     

老年人股骨颈骨折治疗原则与治疗方法的选择

目的　探讨老年人股骨颈骨折的治疗原则与治疗方法的选择依据。　方法　回顾性分析老年人股骨颈囊内骨折２４８ 例的临床资料,其中头下型９７ 例,头颈型８３例,经颈型６８ 例。ＧａｒｄｅｎⅠ型６例,Ⅱ型４０ 例,Ⅲ型７３ 例,Ⅳ型１２９ 例。有２０１ 例（８１．０％ ）存在一种以上的并存症。全身健康状况综合评定：良好、中等和差者分别占５０．８％ 、２９．８％ 和１５．７％ ;有手术禁忌证者占３．６％ 。其骨密度（ＢＭＤ）均明显降低。非手术疗法２３例,内固定术８３例,人工股骨头置换术４３例,全髋置换９９例。　结果　经平均５．８年随访,并发症发生率为７．３％ ,无手术死亡。２４８例中,２２７ 例（９１．５％ ）恢复行走功能,达到伤前生活活动能力;非手术治疗组中需手术者２例（８．６％ ）,内固定组需再次手术者８ 例（９．６％ ）,人工股骨头假体松动或中央脱位需再次手术者４例（９．３％ ）。　结论　老年人股骨颈骨折治疗方法的选择取决于患者全身健康状况、年龄、骨折类型及程度、骨的质量等因素,外科治疗的同时不应该忽视全身性并存症的治疗、重要脏器功能的改善以及骨质疏松症的治疗。     

Factors affecting healing following percutaneous intramedullary fixation of metacarpal fractures

Although percutaneous intramedullary nailing of metacarpal fractures is a straightforward and reliable technique, it is not without complications, and patients experience different outcomes. This study analyzed factors affecting fracture healing time and complication rates in patients who underwent percutaneous intramedullary fixation of metacarpal fractures.This study was a retrospective review of the 25 patients who underwent retrograde percutaneous Kirschner wire (K-wire) nailing for fracture of the metacarpal shaft or neck at a military hospital between May 2016 and October 2018. Correlation study and multiple regression analysis were performed to evaluate variables (age, smoking history in pack-years, body-mass index, fracture site, number of K-wires used) that affect time to bone union. Clinical features of patients with metacarpal neck fractures and those with metacarpal shaft fractures were also compared.The metacarpal shaft fractures (as opposed to metacarpal neck fractures) and higher number of K-wire used were associated with longer time to bone union. Mean union time was significantly longer for metacarpal shaft fracture (8.6 weeks) than for metacarpal neck fracture (6.1 weeks) and for patients who received more K-wires than for those who received less (regression coefficient 1.307). One patient suffered fixation failure and required revision operation, and another experienced superficial infection which was treated with intravenous antibiotics.Percutaneous intramedullary nailing is an effective technique for metacarpal fractures, but fracture site and number of K-wire used affect time to achieve bone union.     

External fixation for the fracture repair

External fixation has made remarkable progress in the field of orthopaedic surgery in recent years. The concept of distraction histogenesis made it possible to treat for the difficult case without bone graft, such as shortening and deformities of the limbs, pseudarthrosis, bone loss and osteomyelitis etc. These advances have led to the cure of many unsolved fractures. It is likely that external fixators are constantly being improved and the method of fracture repair will progress in the future.     

肘关节三维有限元模型的建立及意义

目的建立肘关节三维有限元模型,并验证其在分析肘关节应力分布中的价值。方法选取1名正常成年男性为研究对象,使其左肘关节处于旋前伸直位,行螺旋CT断层扫描,得到CT数据二维图像,采用Mimics10.0软件系统处理,利用Abaqus6.7建立肘关节三维有限元模型,模拟施加1000N冲击载荷,分析冠状突及桡骨小头内应力分布情况。结果所构建的肘关节三维有限元模型共129341单元。在腕部冲击载荷作用下,肘关节矢状面显示尺桡骨出现纵向移位及以关节间隙为轴心的旋转（即尺骨冠状突中上部应力集中）,并随肘关节屈曲逐渐增强;冠状面显示桡骨小头处出现较明显的应力集中、强于冠状突,但此现象随肘关节屈曲及旋后逐渐减弱。结论本研究建立的肘关节三位有限元模型与人体解剖实际相符,此为临床肘关节疾病的诊治提供了新的思路;肘关节的稳定还涉及到周围侧副韧带维持及肌肉的牵拉,模型有待进一步完善。