Effects of fibrin sealant on the fixation of porous titanium and pyrolytic carbon implants

The authors investigated the potential role the fibrin sealant system may portray in the fixation of osseous implants. The application of a layer of fibrin did not interfere with the fixation of osseous implants of either pyrolytic carbon or Biolite-coated porous titanium. A greater percentage of tissue ingrowth was observed in the porous titanium implants in the presence of the fibrin sealant system; however, no significant difference in the ultimate interfacial shear stress was observed.     

Biologic fixation

One of the major problems of implant surgery is the failure of the bone-cement interface. Because of such failures, observed with increasing frequency with the passage of time, biologic fixation of total joint implants by means of bone ingrowth has become the focus of considerable interest among orthopedic surgeons. Actual bone ingrowth has been demonstrated into porous metals, resulting in a strong interface between metal and bone. Many clinical trials of biologic fixation, including endoprostheses and total hip, shoulder, and knee prostheses, are being conducted. The brief experience of such fixation in humans supports the hypothesis that bone ingrowth will provide stable fixation for load-bearing prostheses. Many questions remain to be answered about biologic fixation and the burden that falls upon the clinical scientist to identify the proper niche for this process in the care of the musculoskeletal patient.     

碳素棒组合外固定支架与钢板内固定治疗胫腓骨开放骨折疗效观察

目的比较碳素棒组合外固定支架固定与钢板内固定治疗开放胫腓骨骨折的疗效。方法 98例胫腓骨开放骨折患者中,48例采用碳素棒组合外固定支架治疗(治疗组),50例采用钢板内固定治疗(对照组),比较两组临床效果。结果 98例均获随访,时间8～20个月。疗效按Johner-Wruh评定标准进行评定:治疗组优38例,良7例,差3例,优良率为93.75%;对照组优36例,良4例,差10例,优良率为80.00%;两组比较差异有统计学意义(P<0.05)。治疗组愈合时间、深度感染及伤口延迟愈合情况明显少于对照组,差异有统计学意义(P<0.05)。结论碳素棒组合外固定支架方法治疗开放胫腓骨骨折操作简单,深度感染率低及延迟愈合率低,康复快,疗效较钢板内固定好。     

人工肘关节置换联合钢板内固定治疗严重肘关节创伤

2008年3月～2011年8月,我科采用人工肘关节置换及钢板内固定联合治疗7例严重肘关节创伤患者,初步疗效较满意,报道如下。1材料与方法1.1病例资料本组7例,男4例,女3例,年龄34～62岁。7例患者均为单侧     

螺钉固定踝关节融合术失败后钢板再固定疗效观察

目的:观察螺钉固定踝关节融合术失败后钢板固定的临床疗效。方法:自2001年8月至2011年10月对15例螺钉固定踝关节融合失败后的患者行钢板固定,其中男9例,女6例;年龄40～65岁,平均56岁;左足10例,右足5例。术中螺钉予以拆除,行钢板固定,术后予石膏外固定。采用AOFAS评分系统从疼痛、行走功能、踝关节对线等方面比较术前与末次随访AOFAS计分,X线片评估术后融合情况。结果:15例均获随访,时间4个月～4年,平均2年。切口均Ⅰ期愈合。踝关节无疼痛,无神经血管损伤,无感染和内固定失败等并发症。术后AOFAS评分中客观项目均较术前改善,总分由术前的(36.86±8.32)分提高到术后的(85.09±4.65)分(t=-26.366,P=0.000)。结论:螺钉固定踝关节融合失败后钢板固定稳定性好,操作简单,成功率高,踝关节疼痛明显减轻,功能恢复良好。     

钢板内固定治疗胸锁关节脱位

2009年1月-2010年11月,我科采用钢板内固定治疗胸锁关节脱位9例,疗效满意。1材料与方法1.1病例资料本组9例,男7例,女2例,年龄25-42（32±2.5）岁。脱位程度采用Grade分型：Ⅱ型3例,Ⅲ型6例。左侧4例,右侧5例。前脱位8例,后脱位1例。病程3 h-7 d。     

髓外固定辅助双植骨治疗股骨转子下骨折髓内固定术后骨不连

目的探讨髓外固定股骨近端接骨板(PFP)及锁定加压接骨板(LCP)辅助双植骨头钉孔道内松质骨、异体骨混合打压植骨及骨不连断端结构植骨治疗股骨转子下骨折髓内固定术后骨不连的手术技巧和临床疗效。方法回顾性分析2018年1月至2018年12月期间西安交通大学附属红会医院创伤骨科下肢病区收治且完整随访的21例股骨转子下骨折髓内固定术后骨不连患者资料。男15例,女6例;平均年龄为52.3岁(27~65岁)。骨不连类型:萎缩型18例,缺血型3例。患者骨不连手术与骨折初次手术的时间间隔平均为10.3个月(9~13个月),骨折手术均采用髓内固定(PFNA):闭合复位10例,切开复位11例(其中钢丝捆扎8例)。骨不连均采用髓外固定(PFP+LCP)辅助双植骨(头钉孔道内松质骨、异体骨混合打压植骨+骨不连断端结构植骨)治疗。术后12个月采用Harris评分评估髋关节功能。结果21例患者术后获平均11.4个月(10~12个月)随访。所有患者术后骨不连均获愈合,平均愈合时间为5.2个月(4~6个月)。1例患者术后出现皮下血肿,再次行清创术。术后12个月Harris髋关节评分平均为85.7分(84~92分)。结论PFP接骨板能够有效纠正内翻畸形并坚强固定,LCP接骨板+皮质骨结构植骨能够提供内侧力学支撑,松质骨+异体骨混合打压植骨能够有效增加头钉孔道内骨量,增加近端螺钉的把持力。该方法可以极大地提高骨折愈合率,减少并发症的发生,且能获得较好的髋关节功能。     

Pyrolytic carbon MCP arthroplasty: a report of seven prostheses implanted in two patients

Abstract Rheumatoid arthritis most commonly affects the metacarpophalangeal (MCP) joints of the hand. Pyrolytic carbon MCP arthroplasty has lately provided a new alternative in the treatment of these patients, but reports in the literature are still few. Here, we report the mid-term results of seven such prostheses implanted in two elderly patients with rheumatoid arthritis. Pyrolytic carbon MCP arthroplasty was performed on three MCP joints in one patient and on four MCP joints in another patient. A specific postoperative mobilization protocol was applied. Range of motion, grip strength, and pinch strength were recorded, and radiographs were taken at three, six, and ten months postoperatively. Ten months after the operation, the operated joints were pain-free, and grip and pinch strengths had improved. On average, the passive range of motion had improved and the active range of motion had remained about the same. The joints were clinically stable. No adverse remodeling or bone resorption was observed radiographically. Ulnar deviation recurred in one of the two cases. These results suggest pyrolytic carbon MCP arthroplasty to be a noteworthy alternative in the treatment of MCP joints affected by rheumatoid arthritis. Early treatment, before the development of severe soft tissue destruction, seems to yield better results.     

The influence of fixation peg design on the shear stability of prosthetic implants

The variety of fixation peg designs existing on prosthetic implants indicates uncertainty regarding the optimum design of fixation pegs for the reduction of stress and relative motion at the bone-implant interface. Fixation pegs have a number of important functions on a prosthesis, one of which is to reduce shear stress and shear displacement at the bone-implant interface. This is a parametric study intended to identify trends in the shear stability of prostheses incorporating a range of fixation peg designs. The parameters varied included the number of fixation pegs on a surface, the size of the pegs, and the aspect ratio (length/diameter) of the pegs. Mechanical tests were performed on urethane foam blocks with mechanical properties comparable to trabecular bone. The results indicated the following: (a) Fixation pegs act independently in resisting shearing force if they are spaced sufficiently far apart. (b) For any given shear displacement, smaller pegs generate a greater resistive shear force per unit of peg projected area in the direction of the applied load than larger pegs having the same aspect ratio. (c) Smaller diameter pegs cause the supporting material to yield at lower displacements. (d) Pegs with a high aspect ratio provide high shear stability with a minimum amount of bone removed, but may bend if the aspect ratio becomes excessive. (e) Smaller, slender pegs generate a greater resistive shear force at a given displacement per unit of peg volume than larger, lower aspect ratio pegs.(ABSTRACT TRUNCATED AT 250 WORDS)     

髋臼假体螺钉固定安全位置的确定

人工全髋关节置换术（total hip replacernent,THR)是近年来治疗老年人髋关节疾患的首选方法，由于手术发展迅速，该手术逐渐走向成熟，随之而来的并发症日见突出，减少及避免全髋关节手术中的失误是减少术后并发症及提高手术效果的关键措施。髓臼假体螺钉固定致周围血管神经损伤报道渐渐增多。现就髋臼周围的解剖关系探讨人工全髋关节置换术髋臼假体螺钉固定安全区进行探讨，以下均以左侧为例。     

压迫带外固定法治疗肩锁关节脱位

肩锁关节脱位的治疗方法很多,手术方法加上非手术方法约有60余种[1],这说明对肩锁关节脱位的治疗尚未完善.本文介绍一种非手术治疗方法,利用石膏腰围压迫带,达到肩锁关节的复位与固定,使损伤的韧带,关节囊得到修复.通过对20例患者的治疗观察,评价该方法治疗肩锁关节脱位的意义及适应证.……     

可吸收双重内固定材料治疗髌骨骨折

2003年3月～2008年6月,笔者采用可吸收张力带内固定治疗髌骨骨折55例,疗效满意。1材料与方法1.1病例资料本组55例,男23例,女32例,年龄45～86岁。闭合性骨折54例,开放骨折1例;横形骨折18例,斜形和纵形骨折12例,粉碎性骨折25例;     

切开复位有限内固定治疗桡骨远端不稳定骨折

目的：探讨桡骨远端不稳定骨折切开复位有限内固定治疗的价值。方法：桡骨远端不稳定骨折34例，按AO分型为C2或C3型，采用克氏针固定29例、钢板掌侧固定3例、钢板螺钉加克氏针固定2例。结果：按改良Green和OBrien系统评估，优19例（55％），良7例（21％），一般8例（24％）。结论；切开复位有限内固定治疗桡骨远端不稳定骨折疗效好，固定方法简便，并发症少，对固定器材没有特殊的要求，是一种有实用价值的治疗方法。     

骨基质明胶防治人工关节无菌性松动的实验研究

目的：探讨骨基质明胶（ＢＭＧ）防治人工关节无菌性松动的可行性。方法：大白兔４０只,分成２组。行右人工股骨头置换。一组植入ＢＭＧ,另一组不植ＢＭＧ作对照。不同时期作生物力学测定、组织学检查、立体显微摄影、电子探针检查。结果：ＢＭＧ组各时期拔出强度明显高于对照组。ＢＭＧ组人工关节周围成骨速度及量明显高于对照组。结论：ＢＭＧ能防止无菌性桧的发生。     

寰枢椎后路固定技术研究进展

寰枢椎不稳是由炎症、创伤、先天性疾病、肿瘤或退变引起的脊柱生物力学异常改变,常常需要手术固定。最初的后路钢丝固定技术操作安全,但术后需要较长时间外固定制动,并且不融合率高。螺钉固定技术(经关节螺钉、寰枢椎侧块和椎弓根钉技术)融合率高、不需要坚强的术后制动,但是其技术要求高。枢椎椎板螺钉能坚强固定寰枢椎复合体,可作为枢椎椎弓根螺钉的补充固定技术。文中将复习寰枢椎复合体后路固定的发展史和各种技术,同时讨论各自的成功率及其并发症。     

喙肩韧带移位重建喙锁韧带结合内固定治疗肩锁关节脱位

2002年8月-2009年6月,我们采用喙肩韧带移位重建喙锁韧带结合锁骨钩钢板内固定治疗肩锁关节脱位23例,疗效满意。     

双克氏针成形固定手指末节撕脱骨折

2015年3月~2019年3月,中国人民解放军75600部队医院综合临床科采用双克氏针成形固定治疗42例手指末节撕脱骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组42例,均为驻港官兵,男36例,女6例,年龄18~36岁。左手10例,右手32例。示指8例,中指22例,环指5例,小指7例。受伤至手术时间2 h^10 d。1.2治疗方法指根部神经阻滞麻醉。先将远侧指间关节极度屈曲,C臂机透视下用1枚1.0 mm克氏针经伸肌腱中央束紧贴小骨块背侧缘,与纵向呈斜35°~45°由远向近钻入中节指骨头并穿出对侧皮质,阻滞该骨块返回背侧的伸直位。     

T型钢板内固定与石膏外固定治疗桡骨远端骨折的疗效比较

目的比较T型钢板内固定与石膏外固定治疗桡骨远端骨折的临床疗效。方法按随机数字表法将36例桡骨远端骨折患者分为两组,观察组(18例)采取T型钢板内固定治疗,对照组(18例)采取石膏外固定治疗。比较两组治疗效果。结果患者均获得随访,时间2~16(11.1±5.3)个月。复位后桡骨短缩程度、术后1周腕掌关节改善评分、术后2个月肘关节功能评分观察组均明显优于对照组(P<0.05)。结论T型钢板内固定治疗桡骨远端骨折维持桡骨长度效果好,疼痛度低,关节活动度大,可促进术后关节功能恢复。