股骨近端异体皮质骨板组织学及生物力学的实验研究

目的 探讨深低温冷冻异体皮质骨板在兔体内的组织学及生物力学性质变化,为临床应用异体皮质骨板提供理论依据。方法将深低温冷冻异体皮质骨板植入兔股骨干外侧,于植入后2、4、8、16、24周取材,对其在体内的生物学替代过程从影像学、组织学、生物力学方面进行分析。结果x线可见异体皮质骨板在植入体内8周与宿主骨愈合。组织学可见异体骨板内表面早期即有毛细血管长入,有破骨细胞骨吸收,之后有新骨生成,术后8周异体骨5％被新生骨替代,术后16周异体骨12％被新生骨替代,术后24周异体骨21％被新生骨替代,外表面骨吸收及新骨生成不明显。在植入4—8周可见骨痂包绕异体骨,与宿主骨已开始有骨愈合,植入16周后可见宿主骨与异体骨间有骨生成。异体骨强度在植入早期下降较快,植入16周时,异体骨强度为原强度38％,之后强度下降速度较慢,到24周时为原强度36％。结论异体皮质骨板主要靠宿主骨痂包绕其边缘而愈合,异体骨板与宿主骨相接触内侧被替代且有新骨生成。     

异体皮质骨支撑植骨修复股骨头颈部肿瘤性骨缺损

股骨近端的良性病变常削弱股骨轻的支撑结构。我院１９８９年６月￣１９９５年６月用异体皮质骨支撑植骨 修复股骨头颈部肿瘤性骨肌损２６例。其中骨纤维异常增殖症１２例, 骨韧带样纤维瘤５例,骨巨细胞瘤２例,成软骨细胞瘤１例。根据肿瘤的病理诊断,病灶分别采取单纯刮除１２例;刮除结合冷冻８例;在治疗６例多发或病灶范围广泛的骨纤维异常增殖症过程中,病灶未作处理。２６例中,１４例同时行内固定手术。 所有病例术后即     

股骨近端钉治疗老年股骨粗隆间骨折

目的探讨股骨近端钉(proximalfemoralnail,PFN)治疗老年股骨粗隆间骨折的疗效。方法2001年10月~2003年9月,采用PFN治疗老年股骨粗隆间骨折患者62例,其中男42例,女20例。年龄60~92岁,平均67.3岁。均在伤后1周内施行手术。记录每例患者的手术时间、术中出血量、术中并发症、术后切口引流量、术后并发症、骨折愈合时间及髋关节功能评分等相关数据,并与文献进行比较,对该治疗方法进行评价。结果术后均随访8~22个月,平均13.6个月。2例发生术中股骨粗隆骨折部再骨折,2例术后分别死于脑栓塞和肺部感染,2例发生异位骨化,1例发生髋内翻,1例发生股骨头过度前倾,其余患者皆获满意疗效。手术时间76.5±29.1min,术中平均出血量385.7±98.4ml,术后切口引流量45.5±21.7ml,骨折愈合时间13.2±3.8周;参照Sanders髋关节创伤后的功能评分标准,术后髋关节功能恢复优良率达89.6%。结论PFN具有手术时间短、出血少且固定牢靠的优点,适用于老年股骨粗隆间骨折的治疗。     

股骨近端锁定钢板和股骨近端髓内钉治疗老年股骨转子间骨折比较

目的 探讨股骨近端锁定钢板和股骨近端髓内钉(PFN)治疗老年股骨转子间骨折中的临床疗效.方法 手术治疗80例老年股骨转子间骨折患者,其中股骨近端锁定钢板固定41例,PFN固定39例.比较两组手术时间、出血量、术前及术后Harris评分.结果 80例均获随访,时间1～2年.术后3～5个月骨折均愈合,髋关节无疼痛且功能恢复良好.两组手术时间、术中出血量、术前及术后Harris评分比较差异无统计学意义(P＞0.05).结论 根据骨折类型及解剖结构合理选择内固定,股骨近端锁定钢板和PFN治疗老年股骨转子间骨折Evans Ⅰ～Ⅲ型可以获得相同的临床效果,但股骨近端锁定钢板更适用于Evans Ⅳ型骨折.     

股骨近端髓内钉治疗老年股骨转子间骨折

2010年1月~2012年3月,我科用第二代亚洲型股骨近端髓内钉(PFNA-Ⅱ)治疗35例老年股骨转子间骨折患者,取得了良好疗效.1 材料与方法1.1 病例资料本组35例,女24例,男11例,年龄75~85岁.骨折按照AO分型:A1型8例,A2型18例,A3型9例.     

股骨近端锁定钢板联合植骨治疗老年股骨转子下粉碎骨折

正2012年1月~2013年12月,我科采用股骨近端锁定钢板联合植骨治疗25例老年股骨转子下粉碎骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组25例,男17例,女8例,年龄61~75岁。骨折按Seinsheimer分型:Ⅲa型17例,Ⅳ型6例,Ⅴ型2例。伤后至手术时间5~11d。1.2治疗方法硬膜外麻醉下手术。在C臂机监视下牵引复位,从大转子至     

股骨近端髓内钉治疗股骨近端骨折疗效分析

目的 探讨股骨近端髓内钉(PFN)是否为治疗股骨近端骨折的最佳方法之一。方法 60例股骨近端骨折采用了PFN内固定手术方法。结果 随访12个月术后39例达到了接近主要骨块的解剖复位。54例达到了完全的负重，2例由于选择了太短的近端滑动螺钉导致了内固定物的退出。5例由于无法进行闭合复位而采取了开放复位钢丝内固定的方法。结论 仔细的外科技术和选择合适的PFN可以减少并发症发生的比率。当可以进行闭合复位时，PFN是一种良好且侵害小的治疗不稳定股骨近端骨折的内固定物。     

单皮质钢板固定治疗交锁髓内针固定术后股骨近端骨不连

自2002年1月～2004年12月共收治的5例股骨近端骨折，交锁髓内针内固定术后骨不连的病例，采用局部切开植骨，附加单皮质钢板内固定术治疗，取得良好效果。     

国产股骨近端髓内钉治疗老年股骨转子问骨质疏松性骨折

目的 探讨国产股骨近端髓内钉(PFN)治疗老年股骨转子间骨质疏松性骨折的I临床疗效.方法 自2003年3月～2007年3月,采用国产PFN治疗老年股骨转子问骨质疏松性骨折112例.结果 106例获得6～20个月随访.按髋关节功能评分:优65例,良31例,中8例,差2例,优良率90.6%.结论 PFN具有手术时间短,出血少,生物力学特点突出等优点,适用于老年股骨转子间骨质疏松性骨折的治疗.     

CT扫描资料间接法建立股骨上段三维有限元模型

目的 建立正常人体股骨上段三维有限元模型，作为今后该部位进一步有限元分析的基础。方法 采用活体股骨上段为对象，应用CT扫描技术，图形数字化方法获取股骨上面三维坐标，输入有限元分析软件ANSYS5．6，通过确定材料特性参数和网格化，建立完整的股骨上段三维有限元模型。结果 建立的三维有限元模型几何形状与材料特性还原良好，网格大小可根据研究者的需要在一定范围内自行调整，可以满足有限元分析的需要。结论 采用CT扫描资料建立三维有限元模型切实可靠；间接法建立三维有限元模型比直接法更加简便，高效，可以更精确地模拟复杂几何形态的实体。     

CT改良位冠扫诊断鼻骨骨折的应用价值

目的探讨CT改良位冠扫诊断鼻骨骨折的应用价值。方法收集43例2001年至2008年采用不同扫描方式扫描的鼻骨骨折病例,比较它们的影像效果。结果CT冠扫结合重建明显比横断层扫描效果好,且容易发现合并损伤;使用了改良位冠扫时,不需重建能明确诊断。结论鼻骨CT横断层面扫描仍有个别病例漏诊。鼻骨CT冠扫显示鼻骨骨折更清晰更全面,无一漏诊。鼻骨CT改良位冠扫无需重建,真实直观显示骨折,能指导临床医生制定治疗方案。     

基于体素的股骨近端骨密度和骨皮质厚度的测量及可重复性研究

目的研究基于定量CT(quantitative computed tomography,QCT)的股骨近段骨密度和骨皮质厚度体素化测量的可重复性,为髋部骨折研究提供技术支持。方法选择28例短时间内QCT扫描两次的髋部骨折患者,其中男性6例,女性22例。从QCT影像中手动分割出股骨近段结构。借助体素形态学分析(voxel-based morphometry,VBM)思想,选择一个形状和结构适中的股骨近段结构作为标准模板,通过三维弹性配准算法将其他股骨近段映射到标准模板上。采用最小二乘和列文伯格-马夸尔特(Levenberg-Marquardt)方法将CT值转化成体素化的骨密度和骨皮质厚度值。最后,使用统计参数图(statistical parametric mapping,SPM)方法对28例患者短时间内两次QCT扫描数据的股骨近段骨密度和骨皮质厚度进行统计分析,获取三维统计参数图。结果所选28例骨折患者短时间内两次QCT扫描数据的股骨近段骨密度和骨皮质厚度的测量结果差异无统计学意义(P0.05),一致性均较好,说明测量结果较为准确。结论股骨近段骨密度和骨皮质厚度的测量方法具有较好的可重复性,为髋部骨折风险评估提供有效手段。     

Repeat CT scan in closed head injury

BACKGROUND: Cranial CT scans are often repeated to observe the progress of an intracranial injury. This prospective observational study analyses the effect of repeat CT scans with the aim of formulating a guideline for their use. METHODS: One hundred and seventy-five patients with blunt head injury presenting to the trauma unit and undergoing CT scan were included. Unstable patients with polytrauma were excluded. There was no standard protocol for ordering the repeat cranial CT scans. This decision was purely based on the discretion of neurosurgeons. RESULTS: CT scan was repeated in 53 (30%) patients. The clinical indications for the repeat CT scan could be grouped into three: (i) clinical deterioration, (ii) failure of improvement, and (iii) as a follow-up scan. Nine underwent surgical intervention based on the repeat CT scan findings. They were associated with clinical deterioration and had a better survival after surgery. In others the repeat CT scan findings did not alter the management. CONCLUSION: When a head injured patient shows clinical deterioration, it is necessary to repeat the CT scan to pick up a surgically treatable lesion; which is likely in a significant number of patients. Repeat CT scan as a matter of "routine" follow-up when the patient is clinically status-quo or improving, is unlikely to yield any further information necessitating change in treatment. This guideline may be useful in settings where CT scan facility is not easily available or expenditure is an issue.     

A prospective study of discordance in diagnosis of osteoporosis using spine and proximal femur bone densitometry

 The T-score definition of osteoporosis, originally intended for epidemiologic research in this condition, is frequently used in making treatment decisions for individual patients. Discordance in classification depending on the site and type of measurement has been reported in retrospective and cross-sectional studies, but the impact of such discordance on clinical practice is unknown. This is potentially important in view of a recent proposal to confine osteoporosis diagnosis to densitometry at the hip. Having excluded those with degenerative changes in the lumbar spine, we compared the T-score classification of a prospective cohort of patients referred for their first dual-energy X-ray absorptiometry (DXA) scan, analyzing data for men and women in 10-year age groups. Total hip and neck of femur DXA identified significantly fewer osteoporotic patients than spine DXA, and this reduced sensitivity could not be improved by adjusting the T-score threshold without an unacceptable increase in non-osteoporotic cases. The majority of patients undetected by proximal femur DXA were at significantly increased risk of vertebral fracture. DXA at the lumbar spine had only moderate sensitivity and specificity for osteoporosis redefined by total hip densitometry, indicating differential rates of bone loss at the proximal femur and spine. We conclude that, as the most usual indication for bone densitometry is to aid the determination of an individual's fracture risk, both proximal femur and lumbar spine should continue to be assessed. Received: 19 November 2001 / Accepted: 2 August 2002     

CT scan in the management of acute appendicitis

BACKGROUND: Recent studies demonstrate a 98% accuracy of a CT scan in the diagnosis of acute appendicitis. We aimed to determine the accuracy and clinical value of CT scans in patients suspected of having acute appendicitis. PATIENTS AND MATERIALS: We reviewed outcomes of 125 patients over a 5-month period who had CT scans for the initial diagnosis of acute appendicitis. CT scan interpretations were correlated with surgical and pathologic findings. Follow-up was attempted in all patients who did not undergo appendectomy. RESULTS: CT scans and clinical courses were complete in 110 patients (88%); 14 patients were lost to follow-up and 1 was excluded. One patient had two CT scans. Thus, there were 111 CT scans available for review. Radiologic interpretation of these CT scans yielded 36 positive (33%), 67 negative (60%), and 8 indeterminate (7%), resulting in a sensitivity of 90%, a specificity of 89%, a PPV of 78%, and a NPV of 96%. CONCLUSIONS: CT scan may be useful in the diagnosis of acute appendicitis, but the reported high accuracy rate was not reproduced at our institution. CT scan was not clinically useful in 21% of patients. We conclude that a CT scan may be beneficial in the diagnosis of appendicitis with selected patients who have equivocal findings. Thus, at our institution, the accuracy of a CT scan does not justify its routine use in patients with clinical findings of appendicitis.     

脆性股骨颈骨折的股骨近端几何结构分析

目的研究脆性股骨颈骨折的股骨近端几何结构特点。方法将57例患者分为两组。骨折组29例,平均年龄73.6±9.9岁,性别:男10例,女19例;非骨折组28例,平均年龄64.8±9.3岁,性别:男10例,女18例。对患者股骨近端CT扫描的定位像进行健侧股骨近端几何结构参数测量。结果骨折组的股骨颈颈长较长、颈中段皮质厚度变薄、颈干角较大、颈中段皮质厚度比率下降、颈中段宽度与颈轴长比率下降、颈长与颈轴长比率升高、颈长与颈宽度比率升高,两组比较有统计学意义;颈轴长、颈中段宽度、颈中段髓腔宽度在两组比较中没有统计学意义。结论在脆性股骨颈骨折中,股骨近端几何结构的参数在其绝对数值上有着重要性,而股骨近端各部分结构在比率上的合理配置对股骨近端的骨强度也起着重要的作用。     

Longitudinal elastic properties and porosity of cortical bone tissue vary with age in human proximal femur

Tissue level structural and mechanical properties are important determinants of bone strength. As an individual ages, microstructural changes occur in bone, e.g., trabeculae and cortex become thinner and porosity increases. However, it is not known how the elastic properties of bone change during aging. Bone tissue may lose its elasticity and become more brittle and prone to fractures as it ages. In the present study the age-dependent variation in the spatial distributions of microstructural and microelastic properties of the human femoral neck and shaft were evaluated by using acoustic microscopy. Although these properties may not be directly measured in vivo, there is a major interest to investigate their relationships with the linear elastic measurements obtained by diagnostic ultrasound at the most severe fracture sites, e.g., the femoral neck. However, before the validity of novel in vivo techniques can be established, it is essential to understand the age-dependent variation in tissue elastic properties and porosity at different skeletal sites. A total of 42 transverse cross-sectional bone samples were obtained from the femoral neck (Fn) and proximal femoral shaft (Ps) of 21 men (mean ± SD age 47.1 ± 17.8, range 17–82 years). Samples were quantitatively imaged using a scanning acoustic microscope (SAM) equipped with a 50 MHz ultrasound transducer. Distributions of the elastic coefficient (c₃₃) of cortical (Ct) and trabecular (Tr) tissues and microstructure of cortex (cortical thickness Ct.Th and porosity Ct.Po) were determined. Variations in c₃₃ were observed with respect to tissue type (c_33Tr < c_33Ct), location (c₃₃(Ct.Ps) = 37.7 GPa > c₃₃(Ct.Fn) = 35.3 GPa > c₃₃(Tr.Ps) = 33.8 GPa > c₃₃(Tr.Fn) = 31.9 GPa), and cadaver age (R² = 0.28–0.46, p < 0.05). Regional variations in porosity were found in the neck (superior 13.1%; inferior 6.1%; anterior 10.1%; posterior 8.6%) and in the shaft (medial 9.5%; lateral 7.7%; anterior 8.6%; posterior 12.0%). In conclusion, significant variations in elastic coefficients were detected between femoral neck and shaft as well as between the quadrants of the cross-sections of neck and shaft. Moreover, an age-related increase in cortical porosity and a stiffening of the bone tissue were observed. These findings may explain in part the increase in susceptibility to suffer low energy fractures during aging and highlight the potential of ultrasound in clinical osteoporosis diagnostics.