可吸收材料在骨折内固定中的临床应用

背景：骨折治疗时选择合适的内固定物相当重要,否则极易导致治疗失败。临床上治疗骨折的内固定物以金属材料为主,在人体内易出现腐蚀和应力遮挡引起皮质骨疏松;另外骨折愈合后需二次手术拆除,可致再次骨折。 目的：分析可吸收材料的生物特性及治疗骨折的适应症,并比较可吸收材料在骨折内固定中的特点。 方法：收集不同可吸收材料治疗骨折的相关文献,找出治疗对象相似、疗效评价标准相同的病例进行分析。 结果与结论：采用可吸收材料治疗骨折具有显著优越性,可吸收材料不需要二次手术取出,对关节周围组织及关节本身损伤小,组织相容性好,并发症少,是骨折内固定治疗的发展方向之一。     

可吸收骨折内固定系统在颌面部骨折中的临床应用

目的分析自身增强型可吸收性颅颌面骨折内固定系统行一期骨折内固定修复术的临床效果。方法2006年1月～2007年8月，收治26例颌面部骨折患者共计65处骨折，用芬兰Bionx公司研制的百优BIOFIX可吸收颅颌面骨折内固定系统，各型固定板共计87枚，行一期骨折内固定修复术，通过术中复位、固定情况，术后创口愈合情况，术后反应等三项标准评估手术效果。结果本组病例96．8％的骨折部位术中复位、固定效果达优，98．1％的手术切口一期愈合，92．3％的患者无术后不良反应。结论在正确掌握适应证，选择合适病例的前提下，可吸收颅颌面骨折内固定系统能为颌面部骨折内固定提供足够的稳定和固位。     

可吸收骨折内固定物及其在颌面外科的应用

国外已就可吸收骨折内固定物进行了一系列基础研究及临床应用。颌面部骨折由于其解剖及生理结构的特殊性，更适合应用这种可吸收固定物进行内固定。本文重点综述了国外研究较为广泛的几种可吸收高分子聚合物的理化、生物学特性及其在颌面外科的动物实验和临床应用。     

生物可吸收材料在骨折内固定治疗的临床研究

目的评价生物可吸收材料在骨折内固定治疗中的作用。方法对713例不同部位骨折采用生物可吸收材料进行内固定。结果随访3个月~4年,平均18个月,骨折全部临床愈合;功能评估优良率96.5%,并发症发生率4.3%,均为异物反应。结论生物可吸收材料是治疗骨折的有效方法,正确选择适应症和手术操作是治疗成功的重要因素。     

儿童骨折治疗应用的可吸收内固定生物材料

背景：可吸收材料作为一种新型的内固定材料,具有无需二次手术取出的特点,近年来得到广泛的使用,并取得较好的疗效。 目的：对可吸收内固定材料与儿童骨折研究的文献进行多层次分析,探讨在儿童骨折中的应用及疗效。 方法：以电子检索方式对CNKI数据库学术期刊2002年1月至2011年12月收录有关可吸收内固定材料与儿童骨折研究的文献进行分析,采用检索词为“可吸收内固定材料;骨折;儿童”。分析可吸收内固定产品类型和规格,不同产品的适用症,将产品的强度和弯曲弹性率进行分析,比较可吸收内固定螺钉、固定棒和张力带在儿童骨折中的应用。 结果与结论：CNKI数据库学术期刊2002至2011年收录可吸收内固定材料与儿童骨折研究的文献共60篇。目前临床应用的可吸收内固定材料为聚乳酸以及该类聚合物,生产的厂家主要有芬兰百优、日本他喜龙、日本刚子和成都迪康。从材料的强度和弯曲弹性率来看,可吸收内固定材料优于不锈钢和钛材料,与人的皮质骨较接近,可吸收内固定螺钉、固定棒和张力带在儿童不同部位骨折中的应用均取得较好的疗效,并发症少,值得推广。     

可吸收螺钉内固定治疗关节内骨折

目的探讨可吸收螺钉内固定治疗关节内骨折的临床效果。方法选择四肢关节内骨折95例,行骨折切开复位可吸收螺钉内固定。结果本组骨折全部一期愈合。随访时间2～14个月,除1例胫骨髁间突骨折行后路切口脂肪液化外,其余患者恢复良好。关节功能基本恢复。结论可吸收螺钉具有自身优势,治疗关节内骨折效果确切。是一种较为理想的关节内骨折内固定的材料和方法。     

生物可吸收材料在短管状骨骨折髓内固定的临床应用

目的探讨生物可吸收材料在骨折髓内固定可行性和治疗效果。方法在31例短管状骨骨折治疗中使用可吸收棒及其缝合线的联合应用进行髓内固定。结果全组31例均获得骨性愈合，无一例发生骨折移位或骨不连。术后早期局部肿胀1例，手术部位积液1例，经对症治疗均获痊愈。结论可吸收材料（钉棒系统）对短管状骨的髓内固定，术后配合必要的短期外固定的方法是可行的。本组的疗效是满意的。     

可吸收骨折内固定物及其在颌面外科的应用

国外已就可吸收骨折内固定物进行了一系列基础研究及临床应用。颌面部骨折由于其解剖及生理结构的特殊性，更适合应用这种可吸收固定物进行内固定。本文重点综述了国外研究较为广泛的几种可吸收高分子聚合物的理化、生物学特性及其在领面外科的动物实验和临床应用。     

生物可吸收材料在关节骨折内固定中的生物相容性

BACKGROUND: In recent years, poly-L-lactic acid (PLLA)/polylactic acid copolymer (PLGA)/ hydroxyapatite (HAP) composite bioabsorbable material has achived desired effect in articular fractures. OBJECTIVE: To investigate the biocompatibility of PLLA/PLGA/HA bioabsorbable material in the internal fixation of articular fractures. METHODS: In vivo experiment: 22 New Zealand rabbits were enrolled to prepare ankle fracture models, and were then randomly divided into two groups, including composite material group fixed with PLLA/PLGA/HA bioabsorbable material, and metal material group fixed with metal stent. Therapeutic effects and complications were observed at 7 days after surgery. In vitro experiment: PLLA/PLGA/HA bioabsorbable material was co-cultured with MG-63 cells to observe the cell proliferation and adhesion. RESULTS AND CONCLUSION: In the in vitro experiment, nine rabbits healed well, and two rabbits appeared to have complications in the mental material group; rabbits in the composite material group healed well without any complications. In the in vitro experiment: fusiform-shaped cells all adhered to the composite stent after 1 day of incubation; the number of cells began to increase showing the strong growth ability, and in a tight and regular arrangement at 3 days after incubation; the cytotoxicity was grade 0 or 1 within 1-7 days of incubation. At 3 days of co-culture, fusiform or polygonal cells appeared on the composite material, and these interconnectde cells extended well, and moreover, the frizz parts on the cell surface grew into the composite material, displaying a good adherence. To conclude, as a new bioabsorbable material, PLLA/PLGA/HA exhibits a good biocompatibility.     

桡骨小头骨折应用可吸收螺钉内固定121例疗效分析

自2002～2006年以来,我院对(MasonⅡ型)桡骨小头骨折121例采用可吸收螺钉内固定治疗,疗效满意,现报告如下。1临床资料2002年1月～2006年1月我院住院诊治的桡骨小头121例,男78例,女43例。年龄最大47岁,最小15岁,平均27岁。伤后就诊时间最短半小时,最长7天,平均1天。左侧45     

后路钉棒内固定系统在不稳定性枢椎骨折治疗中进钉点与固定方式的选择☆

背景：上颈椎后路钉棒内固定过程中,放置寰椎侧块螺钉技术是关键。 目的：总结后路钉棒内固定系统在不稳定性枢椎骨折治疗中的进钉点位置。 方法：2007-01/2010-12采用Vertex颈椎后路钉棒内固定系统治疗不稳定性枢椎骨折19例,男12例,女7例,年龄21~75岁,平均49.5岁。采用寰椎侧块螺钉及枢椎椎弓根螺钉内固定6例,寰椎侧块、单侧枢椎椎弓根及颈3侧块螺钉内固定3例,寰椎侧块、双侧枢椎椎弓根及颈3侧块螺钉内固定1例,枢椎椎弓根及颈3侧块螺钉内固定9例,内固定过程中均行后侧椎板间植骨融合。 结果与结论：19例患者全部获得随访,随访时间7~43个月。患者骨折复位满意,骨折端均获得愈合,植骨部位融合率达到100%,未出现断钉、断棒等现象,未发生颈髓及椎动脉等医源性损伤。该方法治疗不稳定性枢椎骨折创伤小,固定可靠,作者根据临床经验,对螺钉进钉点的位置总结如下：①对于寰椎侧块进钉点选择在侧块中点稍偏外、椎弓的下方1/3处,进针方向为向内、上分别稍倾斜约10°,5°。②枢椎椎弓根进钉点选择在枢椎上下关节面间、下关节正中垂线的中点,进针方向为向内、上分别倾斜15°~20°,25°。③第三颈椎侧块进钉点选择在侧块中心点内侧2 mm,进针方向为向外、上倾斜20°~25°。     

The effectiveness of internal fixation in the management of acute chondral fractures. A systematic review

IntroductionChondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical treatments designed specifically for cartilage repair and restoration have been introduced. Internal fixation has demonstrated good benefits in case reports and small qualitative studies. Our systematic review aimed to evaluate the effectiveness of internal fixation in the management of acute chondral fractures.MethodsA comprehensive search strategy was carried out using the NICE Healthcare Databases Advanced Search. The systematic review was prospectively registered with PROSPERO (CRD42022302976) and was performed in accordance with the PRISMA guidelines.ResultsEleven studies consisting of fifty patients were included in this systematic review. Seventy-eight percent of patients showed good results and twenty-two percent of the cases had excellent results. Ninety-two percent of patients returned to preoperative level of sport activities at the end of the follow-up period. All of them returned to the original activity level without pain, stiffness, or restriction of movement after 1 year latest. The majority of patients had no complications at all, good recovery time and satisfactory outcomes for pain and activity level. The only complications presented were patella instability and quadriceps weakness.ConclusionInternal fixation for acute chondral fractures is an effective method to treat acute chondral fractures in both adolescents and young adults that want to get back to an active lifestyle. However, more data examining the long-term functional status, quality of life (QoL), recovery post-injury and pain free sports activity involvement are needed.     

Distal femoral replacement or internal fixation for management of periprosthetic distal femur fractures: A systematic review

BackgroundThe number of periprosthetic fractures above a total knee arthroplasty continues to increase. These fractures are associated with a high risk of morbidity and mortality. Techniques for addressing these fractures include open reduction internal fixation (ORIF) and revision arthroplasty, including distal femoral replacement (DFR). The primary aim of this review is to compare mortality and reoperation rates between ORIF and DFR when used to treat periprosthetic distal femur fractures.MethodsA systematic review including MEDLINE, Embase and Cochrane Library databases was completed from inception to April 10, 2021. Studies including a comparator cohort were meta-analyzed.ResultsFourteen studies were identified for inclusion, of which, five had sufficient homogeneity for inclusion in a meta-analysis. 30-day and 2-year mortality was 4.1% and 14.6% in the DFR group. There was no statistically significant difference between ORIF and DFR (log Odds-Ratio (OR) = -0.14, 95 %CI: −0.77 to 0.50). The reoperation rate in the DFR group was 9.3% versus 14.8% for ORIF, with no difference between groups (log OR = 0.10, 95 %CI: −0.59 to 0.79). There was no difference in rates of deep infection (log OR = 0.22, 95 %CI: −0.83 to 1.28). Direct comparison of functional outcomes was not possible, though did not appear significant.ConclusionDFR in the setting of periprosthetic distal femur fractures is equivalent to ORIF with respect to mortality and reoperation rate and thus a safe and reliable treatment strategy. DFR may be more reliable in complex fracture patterns where the ability to obtain adequate fixation is difficult.     

可吸收螺钉在胫腓骨骨折交锁髓内钉内固定中的运用效果分析

目的探讨可吸收螺钉在胫腓骨骨折交锁髓内钉内固定中的运用效果。方法选取本院2016年2月至2018年6月收治的124例胫腓骨骨折患者为研究对象,根据术中置入的螺钉类型将其分为对照组和观察组。对照组60例患者采用皮质骨螺钉联合交锁髓内钉治疗,观察组64例患者采取可吸收螺钉联合交锁髓内钉治疗。比较2组患者的手术情况、胫腓骨骨折疗效及并发症。结果患者手术时间、术中出血量组间比较,差异无统计学意义(P>0.05);对照组患者下床活动时间、骨折愈合时间长于观察组,差异有统计学意义(P<0.05)。对照组胫腓骨骨折疗效优35例、良17例、中6例、差2例,观察组优46例、良15例、中3例、差0例,2组比较差异有统计学意义(P<0.05)。对照组并发症发生率为20.00%,高于观察组的9.38%,差异有统计学意义(P<0.05)。结论可吸收螺钉可显著提高交锁髓内钉治疗胫腓骨骨折的临床疗效,促进骨折的早期愈合,降低并发症发生率。     

Principles of development and use of absorbable internal fixation

Absorbable internal fixation implants, by virtue of their temporary in situ residence and variable load sharing with the healing tissues, have the potential to yield a clinical outcome that approaches the native state. Despite the growing availability and acceptance of absorbable fixation, however, many surgeons continue to rely upon metal fixation for their patients, due, in part, to unfamiliarity with the technology. Although many of the principles of metallic internal fixation also apply to absorbable internal fixation, significant differences exist as well. This paper presents basic background in absorbable technology and proposes a set of principles that may help govern the development and use of absorbable fixation devices in clinical practice.     

膝关节镜加有限切开内固定术在严重胫骨平台骨折中的应用

目的探讨严重的胫骨平台骨折的治疗方法。方法采用有限切开内固定术加关节镜辅助治疗56例严重胫骨平台骨折。结果48例患者获得随访，随访时间为1～3年，获得满意效果。结论有限切开内固定术加关节镜辅助治疗严重胫骨平台骨折是值得推荐使用的。     

老年股骨粗隆间骨折不同内固定方式的临床意义

目的比较老年股骨粗隆间骨折不同内固定方式的选择与疗效。方法总结本院不同时期老年股骨粗隆间骨折内固定治疗182例,DHS固定58例,空心加压螺钉42例,PFN26例,解剖钢板56例。比较不同内固定方式的疗效与并发症。结果 182例中获得随访159例,随访率87.4%,随访时间8～62个月,平均19.1个月。在稳定性骨折中几种内固定临床疗效差异无显著性意义,优良率分别是:DHS82%,空心加压螺钉89%,PFN86%,解剖钢板88%,不稳定骨折术后疗效及并发症各异。结论老年股骨粗隆间骨折的治疗应根据患者全身状况、骨折类型、骨质疏松及髓腔情况,合理选择内固定方式,制定正确的康复锻炼,能有效减少并发症。     

钢板内固定与外固定架治疗桡骨远端不稳定骨折的Meta分析

背景：桡骨远端不稳定骨折的手术治疗方式主要包括钢板内固定和外固定架,但2种治疗方法各有优缺点,哪种治疗更有利于患者的康复目前仍存在较大争议。 目的：通过Meta分析系统评价钢板内固定与外固定架治疗桡骨远端不稳定骨折的临床疗效。 方法：计算机和手工检索相关数据库和杂志,收集对比钢板内固定与外固定架治疗桡骨远端不稳定骨折的随机对照试验,提取文献数据及质量评价后,用RevMan5.2软件进行系统评价,比较2组治疗后握力、DASH评分、总的并发症、感染率、畸形愈合率、尺骨变异率等结局指标。 结果与结论：纳入9篇文献,患者共524例,内固定组286例,外固定组238例。钢板内固定与外固定支架相比,握力方面2组差异无显著性意义。钢板内固定治疗后3个月及1年DASH评分较优,总的并发症较少,感染率较低,畸形愈合率较低,尺骨变异率较低。说明钢板内固定治疗桡骨远端不稳定骨折疗效优于外固定架,以上结论需要更多大样本、双盲、高质量的随机对照研究加以论证。