GSH钉术后骨延迟愈合和骨不连原因及治疗

目的分析GSH钉术后骨延迟愈合和骨不连的原因与治疗方法。方法回顾分析41例股骨髁上骨折行GSH钉术后骨延迟愈合和骨不连病例共10例的原因,予以动力性固定,脉冲电磁场,更换内固定和植骨等综合治疗。结果骨延迟愈合8例,经动力性固定和脉冲电磁场治疗,8例全部骨性愈合,平均愈合时间30周。骨不连2例,经更换内固定后扩髓植骨、动力性固定、脉冲电磁场和注射自体红骨髓治疗,获得骨性愈合,平均愈合时间58周。结论导致GSH钉术后骨延迟愈合和骨不连的原因主要为术中对骨膜的损伤过大,内固定选择不当,术后功能锻炼失控和植骨不完善所致,根据主要的原因,需要采用动力性固定,脉冲电磁场和扩髓植骨的综合治疗。     

富血小板血浆结合锁定加压钢板内固定治疗四肢长管状骨骨折术后骨不连

运用富血小板血浆(PRP)结合锁定加压钢板(LCP)内固定治疗四肢长管状骨骨折术后骨不连患者29例(35处),术后8个月按照骨折的骨性愈合标准进行评定,29例(35处)全部愈合。此方法治疗四肢长管状骨骨折术后骨不连可以取得满意疗效。     

双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连

目的探讨双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连的临床疗效。方法分析总结15例肱骨中下段骨折术后骨不连患者的临床资料,骨不连的治疗均采用更换内固定+双钢板固定+植骨的方法。结果 14例获得随访,时间12~20个月,平均(16±2.7)个月,14例Ⅰ期愈合,平均愈合时间(5.0±1.2)个月,Ⅰ期愈合率为93.3%。按Jupiter肘关节功能评分:优8例,良5例,中1例,差0例,优良率92.9%。结论采用双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连是一种较理想的方法。     

脱钙骨基质治疗长骨骨折延迟愈合及骨不连的远期临床观察

目的 探讨脱钙骨基质治疗长骨骨折延迟愈合和骨不连的远期疗效。方法 从1984年至1994年用脱钙骨基质治疗长骨骨延迟愈合、骨不连共96例，其中采用手术植入治疗骨不连38例，经皮注射治疗骨折延迟愈合37例及骨不连21例。结果 96例患者均获随访，随访时间4-16年，平均7．5年。脱钙骨注射治疗骨折延迟愈合的37例中，骨折愈合35例，2例胚骨骨折未愈合，愈合率94．6％；脱钙骨注射治疗骨折骨不连21例中，骨折愈合17例，4例未发生愈合，其中胫骨3例、肱骨1例，愈合率81．0％，愈合时间3-8个月，平均4．5个月。脱钙骨基质移植治疗骨不连38例中，36例愈合，2例胫骨下1／3骨折未发生愈合，愈合率94．7％。结论 脱钙骨基质无论是采用注射移植还是手术方法移植，都能取得较好的效果，甚至达到自体骨移植的疗效。同时，脱钙骨基质的制备经过脱水、脱脂、脱钙、照射消毒等处理，比其他骨移植安全，免疫性小，可以长期保存，便于平时和战时应用。     

有限接触动力加压接骨板治疗长骨干骨不连和畸形愈合

2005年8月～2007年9月收治长骨干骨折术后骨不连或者畸形愈合10例，采用有限接触动力加压接骨板（LC—DCP）治疗，骨不连端在术后16～40周得到骨性愈合，无感染、内固定松动及断裂等并发症发生。     

骨膜瓣移位术治疗骨不连及骨延迟愈合89例临床分析

目的:评价骨膜瓣移位术对骨折术后骨延迟愈合或不愈合的疗效.方法:对2001-01～2006-06收治的89例骨折术后骨不愈合的患者采用骨膜瓣移位术治疗.结果:所有病例均得到随访,随访时间为8～24个月(平均18个月).13例(86.7%)患者骨折愈合,骨折愈合时间最短2个月,平均3.5个月.有2例骨折不愈合再另行手术.无感染发生.结论:对于骨折术后骨不愈合的患者,骨膜瓣移位术是一种损伤性小、风险性小、效果明显的治疗方法.     

自体骨髓间充质干细胞注射治疗骨不连19例

目的 评价自体骨髓间充质干细胞(BMSCs)复合纤维蛋白胶注射治疗骨不连的有效性.方法 从患者髂前上棘抽取骨髓10 ml,体外分离、培养、扩增获取BMSCs,与纤维蛋白胶混合后经皮注射治疗19例骨不连.所有患者均定期随访,随访时间5～24 个月,平均10.7个月.结果 注射后6个月,14例达到临床及放射学骨折愈合标准,骨折愈合时间3～6 个月,平均4.1个月.其余5例无骨折愈合征象,视为失败.注射后未发生感染,未出现供区并发症. 结论自体BMSCs复合纤维蛋白胶注射疗法可有效地治疗骨不连.     

股骨骨折骨不连的生物力学因素及其对策

目的：探讨股骨骨折骨不连的生物力学因素，并提出相应的对策。方法：68例股骨干骨折骨不连经带锁髓内钉治疗，13例股骨远端骨折骨不连实施动力髁螺钉(DCS)内固定术，治疗同时行自体髂骨髓腔内外植骨术。结果：81例股骨骨折骨不连患者随访8～24个月，平均14个月。68例股骨干骨不连治疗后，有5例出现主钉或锁钉折断，经再次行带锁髓内钉内固定加植骨术治愈，其余患者不连端全部愈合；13例股骨远端骨不连经DCS内固定术后全部愈合。81例平均愈合时间为6．5个月。根据骨折愈合及功能恢复综合指标评定疗效，本组优54例，良21例，差6例，优良率92．6％。结论：股骨骨折骨不连的主要原因为内收肌群的生物力学因素导致内固定失败造成；股骨干骨折及骨不连手术内固定应以髓内固定为主，股骨髁部骨折及不连接应选用坚强的DCS系统。     

柠檬酸钙复合材料促进骨腱愈合的实验研究

目的：本实验为研发一种新型促进骨腱愈合材料———柠檬酸钙复合材料,并在合适动物实验模型中探究材料对骨腱愈合的作用。方法实验动物选用成年日本大白兔48只,将其随机分为6组,均采用双侧兔趾长伸肌腱模型,实验侧（右侧）注射注射型海藻酸钠-明胶-柠檬酸钙复合材料,对照侧（左侧）注射等量海藻酸钠－明胶液体。术后2、4、6、8、10、12周取材,行标本组织学染色观察,采用Image-Pro Plus 8.0图像分析软件测定肌腱周围每1mm2新生骨面积,进行生物力学测试。结果术后6周内,组织学示骨腱界面中,实验侧Sharpey纤维、纤维软骨、钙化软骨出现明显早于对照侧,骨腱间间隙明显减小;2、4、6、8、10周及12周,每1mm2中新生骨面积实验组均高于对照组;术后6周内,实验侧骨腱愈合抗牵拉强度明显高于对照侧。结论可注射型海藻酸钠-明胶-柠檬酸钙对骨腱愈合具有明显的促进作用,这种作用主要发生在早期。     

高压氧综合治疗对异体髂骨再造跟骨骨愈合的影响

目的 研究高压氧治疗对异体髂骨再造跟骨术后愈合的临床价值.方法 高压氧组6例跟骨骨肿瘤患者,手术切除跟骨,应用异体髂骨再造跟骨,术后3 d行高压氧治疗,1个疗程为10 d,1次/d,间歇1周再做下一个疗程,共2个疗程.另选取8例异体髂骨再造跟骨患者,作为对照组,常规治疗,不行HBO治疗.观察软组织肿胀消失时间、骨折线模糊时间、骨折线消失时间.结果 高压氧组6例患者软组织肿胀消失时间平均(5.1±1.4)个月,骨折线模糊时间平均(2.9±0.7)个月,骨折线消失时间平均(13.7±2.3)个月,明显低于对照组(P<0.01),提示高压氧组切口愈合良好,骨折愈合良好.结论 高压氧治疗减轻异体髂骨再造跟骨术后组织的炎症反应,促进骨愈合,有着较好的临床价值,是一种简便有效的治疗手段.     

颞骨撞击生物力学变化与骨折特点

目的 探讨颞骨撞击应力分布、应力波的传播与颞骨骨折的关系. 方法 选取捐赠的新鲜尸头12具,分别在800,1 200,1 400 kPa的驱动压力进行撞击,借助64排CT的三维立体结构图像,经计算机仿真模拟计算颞骨撞击过程生物应力的分布与传播. 结果 (1)撞击驱动压力的增加,使撞击速度、撞击加速度、撞击能量、撞击锤在颅骨颞部的位移幅度均增大.(2)在颞骨撞击瞬间,形成以撞击点为中心的Von Mises应力集中区,在颅骨-脑组织耦合处急剧衰减,随之又在颅底汇聚成应力集中区域.(3)撞击驱动压力为800 kPa时,同侧线性骨折;以1 200 kPa撞击时,同侧均出现不同程度的凹陷性骨折,1例对侧颞骨形成继发性骨折;以1 400 kPa撞击颞骨时,同侧均发生混合型骨折,对侧颞骨均形成继发性骨折,并造成颅底骨折.(4)颞骨骨折线与撞击应力集中区的分布相符合. 结论 颞骨各项撞击参数、撞击应力的分布和传递与颞骨骨折相吻合.这对颢骨撞击伤的诊断和防护有重要的临床意义.     

Distinguishing between perimortem and postmortem fractures: are osteons of any help?

The distinction between perimortem and postmortem fractures in forensic anthropology is still a frequently unsolved issue. In the present study, we try to verify if there are differences in the pattern of osteon fracturing between fresh and dry bone which could be used for such a diagnosis. Fresh and dry long bones were fractured by a hammer at the mid-shaft perpendicularly to the long axis of the bone and the fracture margins examined under a light microscope as undecalcified sections. Examination of 982 osteons (505 fresh, 477 dry) showed that twice as often the fracture line crosses the osteons as opposed to travelling around them, independently of whether the bone is fresh or dry. Statistical analysis confirmed that there was no significant difference between fresh and dry bone. This seems to imply that osteon fracture pattern cannot help in the diagnosis of perimortem versus postmortem bone fractures. Further research however must be performed concerning fast and slow energy dispersal which may have an influence on the type of fracture inflicted.     

螺旋CT对眼眶内侧壁骨折的诊断价值

目的探讨SCT对眼眶内侧壁骨折的诊断价值。方法通过对48例面部外伤后眼眶内侧壁骨折行轴位、冠位扫描,同时进行多方位MPR及3D成像,综合分析影像特征。结果眼眶内侧壁骨折直接SCT征象为眶壁骨质的连续性中断、粉碎、凹陷和曲度失常。新鲜骨折36例多合并有眼球旁或球后积气、筛窦积液、内直肌增粗等间接征象,陈旧性骨折12例,表现为骨折片移位或塌陷。结论SCT容积扫描能全面准确地诊断眼眶内侧壁骨折并能区分新鲜与陈旧性骨折及骨折程度。     

环孢素A对大鼠骨折愈合的影响

目的探讨环孢素A(CsA)对大鼠骨折愈合的影响。方法 25只右侧股骨干横行骨折大鼠随机分成2组,实验组15只,对照组10只。实验组骨折当天皮下注射CsA 1.5mg/kg,对照组皮下注射生理盐水1ml,共注射8周,检测股骨干骨密度和生物力学性能检测。结果实验组和对照组右侧股骨干的骨折愈合后,其力学性能参数最大扭力、最大转角和能量吸收仍显著小于各自左侧正常股骨干。实验组右侧股骨干骨折愈合后的最大扭力、最大转角、抗扭刚度和能量吸收与对照组比较均无显著差异,骨折端骨密度也无显著差异。结论 1.5mg/kg剂量的CsA对股骨干骨折愈合无显著影响。     

犬下颌骨骨折内固定术后应力遮挡效应的实验研究

 目的 对下颌骨骨折内固定术后拆除小型接骨板前后应力遮挡效应进行动物实验研究,为下颌骨骨折愈合后内固定材料的远期处置提供理论依据。 方法 18只犬中3只犬即刻处死测定下颌骨骨密度和最大断裂力,该组设为正常组。其余15只犬人为造成双侧下颌骨骨折并行双侧小型接骨板固定（每只犬右侧为实验侧,左侧为对照侧）。固定2个月后,3只犬处死双侧取板测定骨密度和最大断裂力,该组设为0月组;其余12只犬右侧（实验侧）小型接骨板全部取出,取板后再经过1、2、3、6个月后各处死3只犬取左侧（对照侧）板,分别设为1、2、3、6个月组。比较左右两侧下颌骨在骨密度、最大断裂力上的异同。 结果 1、2、3、6个月组实验侧和对照侧骨密度值比0月组高（ P <0.05）,实验侧和对照侧比较各组之间差异无统计学意义。6个月组对照侧的骨密度值与正常组比较较低,差异有统计学意义（ P <0.05）。1、2、3、6个月组实验侧和对照侧与0月组比较最大断裂力值较高（ P <0.05）。实验侧和对照侧比较,各组间最大断裂力差异均无统计学意义; 6个月组对照侧与正常组比较最大断裂力值较低,差异有统计学意义（ P <0.05）。 结论 随着内固定时间的增加,在本实验中出现了应力遮挡效应。另外在内固定3个月时下颌骨实验侧和对照侧骨密度和最大断裂力值较高,说明内固定3个月时拆除接骨板可能最有利。     

Magnetic resonance imaging of occult fractures of the proximal femur

The evaluation of the painful hip in the elderly osteoporotic patient with normal plain radiographs can be difficult. We studied 15 osteopenic patients with normal plain radiographs and suspected hip fractures with magnetic resonance (MR) imaging and found MR to be an excellent aid in detecting occult fractures. A clear fracture was seen in 10 of the 15 patients, who then underwent surgical repair based on the MR study. The remaining patients had no MR-demonstrable fracture and were successfully treated nonoperatively. Some believe that a negative bone scan in this population of patients should be repeated within 3 days prior to a definitive no fracture decision being made. Unfortunately, bone scanning lacks spatial resolution, and increased osteoblastic activity may be caused by other pathologic processes besides fracture. Two of the 15 patients had MR-demonstrated bone infarcts near the fracture. One patient also had femoral head osteonecrosis on the side of the fracture. One patient with metastatic prostatic carcinoma had a hip fracture and one patient with metastatic breast carcinoma had no fracture. Not only is MR imaging an excellent technique for delineating occult fractures, but due to its spatial resolution, associated bone disorders adjacent to fractures can be detected in most instances. From a cost perspective, rapid diagnosis and early treatment of an occult femoral fracture is advisable. A reduced hospital stay pending diagnosis and the early institution of definitive therapy also decrease the chance that a simple non-displaced fracture will displace and require more complex management with resultant increased morbidity and cost. We propose that, especially in elderly, osteopenic patients with normal plain radiographs and a high index of suspicion for hip fracture, MR can serve as the sole additional imaging study in most instances.Presented at the Annual Meeting of the American Roentgen Ray Society, San Francisco, April 1993     

Compressive rib fracture: Peri-mortem and post-mortem trauma patterns in a pig model

Despite numerous studies on high impact fractures of ribs, little is known about compressive rib injuries. We studied rib fractures from a biomechanical and morphological perspective using 15, 5th ribs of domestic pigs Sus scrofa, divided into two groups, desiccated (representing post-mortem trauma) and fresh ribs with intact periosteum (representing peri-mortem trauma). Ribs were axially compressed and subjected to four-point bending in an Instron 3339 fitted with custom jigs. Morphoscopic analysis of resultant fractures consisted of standard optical methods, micro-CT (μCT) and scanning electron microscopy (SEM). During axial compression, fresh ribs had slightly higher strength because of energy absorption capabilities of their soft and fluidic components. In flexure tests, dry ribs showed typical elastic-brittle behaviour with long linear load-extension curves, followed by relatively short non-linear elastic (hyperelastic) behaviour and brittle fracture. Fresh ribs showed initial linear-elastic behaviour, followed by strain softening, visco-plastic responses. During the course of loading, dry bone showed minimal observable damage prior to the onset of unstable fracture. In contrast, fresh bone showed buckling-like damage features on the compressive surface and cracking parallel to the axis of the bone. Morphologically, all dry ribs fractured precipitously, whereas all but one of the fresh ribs showed incomplete fracture. The mode of fracture, however, was remarkably similar for both groups, with butterfly fractures predominating (7/15, 46.6% dry and wet).Our study highlights the fact that under controlled loading, despite seemingly similar butterfly fracture morphology, fresh ribs (representing perimortem trauma) show a non-catastrophic response. While extensive strain softening observed for the fresh bone does show some additional micro-cracking damage, it appears that the periosteum may play a key role in imparting the observed pseudo-ductility to the ribs. The presence of fibrous pull-out and grooving of the outer tensile surface associated with periosteal stretching suggests that the periosteum under tension is able to sustain very high strain and bridge the mouth of the extending butterfly crack, thereby contributing to the observed strain-softening behaviour.     

左氧氟沙星注射液两种给药方法治疗老年院内获得性肺炎的临床分析

目的比较左氧氟沙星注射液两种给药方法治疗老年病区院内获得性肺炎（HAP）的有效性与安全性。方法56例老年HAP患者随机分为2组，治疗组（n=28）用左氧氟沙星注射液0．5e,／次，1次／d；对照组（n=28）用注射用左氧氟沙星注射液0．3g，2次／d，疗程均为7。14d。结果治疗组和对照组的临床总有效率分剐为85．7％和82．1％，细菌清除率分别为80．8％和80．0％，两组不良反应发生率分别为14．3％和17．9％。结论左氧氟沙星注射液两种给药方法治疗老年HAP疗效确切、不良反应少而轻微，可作为治疗老年患者院内获得性肺炎的一线用药。     

唑来膦酸联合钙尔奇D治疗原发性骨质疏松症的研究

目的探讨唑来膦酸联合钙尔奇D治疗原发性骨质疏松症患者的临床疗效。方法选择2010年10月—2011年12月收治的原发性骨质疏松症患者31例,分为研究组16例,年龄(67±4.8)岁,对照组15例,年龄(66.4±4.3)岁。所有患者均初次诊断为骨质疏松症,且未进行系统抗骨质疏松症治疗,排除患有骨代谢性疾病或服用影响骨代谢药物情况。两组患者均给予钙尔奇D片口服,600 mg 1次/d;研究组患者则于治疗初期滴注唑来膦酸注射液5 mg 1次/d。比较两组患者治疗后药物不良反应、随访6个月后骨密度(BMD)改善程度、疼痛缓解程度、`有否合并骨折等情况。结果研究组患者BMD平均增长率为10.67%,且较对照组增长明显,疼痛及活动改善优良率为75%,无骨坏死、新发骨折。用药后不良反应:恶心54%、低热38%、全身骨关节疼痛加重23%、无症状低钙血症16%,且上述症状均于药物输注3 d后明显缓解,随访未见反复;对照组患者BMD平均增长率为2.48%,疼痛及活动改善优良率为26.7%,新发骨折2例,未见药物不良反应,两组比较,研究组优于对照组,差异有统计学意义(P<0.05)。结论唑来膦酸注射液联合钙尔奇D口服是治疗原发性骨质疏松症患者安全有效的方法。