防滑动空心螺钉内固定治疗髌骨骨折疗效观察

目的 观察防滑动空心螺钉内固定治疗髌骨骨折的疗效.方法 采用防滑动空心螺钉内固定治疗髌骨骨折患者16例.结果 本组手术均获成功,手术切口均一期愈合,无感染等并发症.随访3～40个月,X线片显示术后6 ～10个月骨折愈合.结论 应用防滑动空心螺钉内固定治疗髌骨骨折效满意.     

关节镜下后外侧入路可吸收螺钉固定治疗老年踝关节骨折的疗效

目的分析关节镜下后外侧入路可吸收螺钉固定用于踝关节骨折的价值。方法选择90例踝关节骨折老年患者,根据随机数字表法将其分为对照组与观察组,各45例,患者均接受关节镜下后外侧入路内固定术治疗,对照组使用金属螺钉内固定治疗,观察组使用可吸收螺钉内固定治疗。术后2个月评价并对比两组骨折愈合情况,记录患者手术情况,记录并对比两组术后切口感染等并发症发生情况;术后随访1年,评价并对比两组踝关节功能恢复情况。结果两组患者术后2个月骨折愈合情况比较,各并发症发生率比较,差异均无统计学意义(P0.05)。观察组开始负重时间、骨折愈合时间明显短于对照组,住院花费明显少于对照组,差异有统计学意义(P0.05)。观察组踝关节功能恢复优良率明显高于对照组,差异有统计学意义(P0.05)。结论关节镜下后侧入路可吸收螺钉内固定治疗老年踝关节骨折,患者术后早期开始负重时间缩短,更利于术后骨折愈合与踝关节功能恢复,并发症少,安全可靠。     

可吸收螺钉治疗四肢松质骨及关节内骨折

2001-2004年,我们应用可吸收螺钉治疗四肢松质骨及关节内骨折33例,取得了良好疗效。现报告如下。     

可吸收螺钉治疗后交叉韧带撕脱性骨折11例

后交叉韧带（ＰＣＬ）是膝关节屈伸及旋转活动的主要稳定结构,损伤后易引起膝关节失稳及载荷传导紊乱,进而膝关节功能丧失。１９９８年５月～２０００年 １０月,我院应用可吸收螺钉治疗ＰＣＬ胫骨附着部撕脱性骨折１１例取得了良好效果,现报告如下。１临床资料１．１一般资料　本组男９例,女２例,年龄１５～５６岁,平均３２岁。左膝４例,右膝７例。伤后１周内手术８例,伤后２～４周手术２例,伤后８周明确诊断后再手术１例。伤因：机动车伤８例,坠落伤１例,体育课摔伤１例,重物砸伤１例。本组病例屈膝９０°后抽屉试验（ＰＤＴ…     

经皮空心螺钉内固定术治疗老年髌骨骨折18例

髌骨骨折是临床常见的关节内骨折,以前多采用切开复位内固定术治疗,手术创伤大,关节僵硬、创口感染、关节内感染、皮肤坏死等时有发生.近几年国外文献报道,在X线机透视下经皮空心螺钉固定治疗髌骨骨折疗效佳,并发症少.     

可吸收螺钉治疗SchatzkerⅠ～Ⅳ型胫骨平台骨折

目的观察可吸收螺钉治疗SchatzkerⅠ-Ⅲ胫骨平台骨折的临床疗效。方法采用可吸收螺钉治疗Schatzker Ⅰ～Ⅳ胫骨平台骨折19例,术后行主被动功能锻炼,逐步负重。结果术后随访6—22个月,骨折均临床愈合。疗效按Rasmussen膝关节功能评价标准,优13例,良4例,中1例,差1例,优良率为89．5％。结论配合合理的功能锻炼,用可吸收螺钉治疗SchatzkerⅠ-Ⅳ型胫骨平台骨折可获得满意疗效。     

可吸收螺钉在交锁髓内钉内固定治疗胫腓骨骨折中的应用

目的观察交锁髓内钉远端锁入可吸收螺钉在内固定治疗胫腓骨骨折中的作用。方法采用交锁髓内钉内固定联合腓骨固定治疗46例胫腓骨骨折患者,内固定过程中交锁髓内钉远端锁入可吸收螺钉,观察骨折愈合及并发症发生情况。结果手术时间为55—85min、平均71．2min;术中失血量40—100mL、平均65mL,均无神经血管损伤。术后X线片示骨折均对位对线良好,无旋转移位。随访时间5～13个月、平均8．5个月。所有患者骨折均顺利愈合,愈合时间为12～16周、平均14．2周。无1例发生感染及内固定物松动、断裂,无旋转移位、骨折不愈合等并发症发生。采用Johner-Wruh评分评定结果：优38例、良8例,优良率100％。结论交锁髓内钉内固定时远端锁入可吸收螺钉治疗胫腓骨骨折避免了常规金属锁钉断裂的风险,并且无金属锁钉动力化时需增加一次手术的缺点,减少了患者的痛苦。     

关节镜下自体四股腘绳肌腱和可吸收界面螺钉固定重建前交叉韧带

目的探讨自体四股膪绳肌腱和可吸收界面螺钉固定重建前交叉韧带（ACL）的手术方法及疗效。方法21例ACL断裂患者,于关节镜下施术,自体四股腘绳肌腱为ACL重建替代物（保留少许ACL下止点残端作为定位标志物）,可吸收界面螺钉固定重建ACL。结果21例术后平均随访18．4个月。Lachman试验（＋）2例、（±）5例、（-）16例。术后平均膝关节活动度为127°（100°-140°）。所有患膝术前抽屉试验均阳性,术后均阴性,能自如上下楼梯,进行单腿屈膝跳跃及慢速奔跑等活动。Lysholm评分术前为52（35～76）分,术后为91（85—100）分,手术前后相比,P〈0．05。结论关节镜下自体四股腘绳肌腱及可吸收界面螺钉固定重建ACL是恢复膝关节稳定性较好的方法,是治疗急慢性ACL损伤断裂的有效方法。准确的关节内入口、定位是手术成功的关键,术后实施正确合理的功能训练也是保证疗效的重要环节。     

闭合复位空心螺钉内固定治疗股骨颈骨折

在C形臂X光透视下牵引床牵引复位,经皮穿入2—3枚导针,顺导针拧入空心螺钉治疗股骨颈骨折110例。术后随访2—6a。平均3a8个月。结果除1例术后第6天因突发心肌梗死死亡、2例骨折不愈合外,其余107例均获得愈合。远期出现股骨头缺血坏死及塌陷29例。认为闭合复位空心螺钉内固定治疗股骨颈骨折方法简单,创伤小,固定牢固,治疗效果好。     

经皮拉力螺钉内固定治疗胫骨骨折患者39例

1997～1999年,我们采用经皮拉力螺钉内固定治疗胫骨骨折39例,疗效较好,报告如下.     

Recurrent arthritis as presenting symptom of osteomyelitis

We present a patient who had one episode of prepatellar bursitis and subsequently several episodes of arthritis of his right knee. Cultures of several punctures of his knee remained sterile, but the patient had been taking oral antibiotics on each of these occasions against our medical advice. Ultimately a diagnostic puncture revealed growth of Staphylococcus aureus. An X-ray demonstrated an osteolytic lesion of the patella, but no defect in the articular surface of the patella could be visualised. MRI demonstrated a communication between the osteomyelitic focus through the medial retinaculum to the bursa suprapatellaris and the knee joint. Osteomyelitis of the patella is mainly a disease of childhood. This case is, to our knowledge, the first report on the association between bursitis, osteomyelitis of the patella and recurrent septic arthritis of the knee in an adult. The literature is reviewed and discussed briefly.     

不同术式治疗有移位髌骨骨折疗效比较

为探讨有移位髋骨骨折的有效治疗方法,对行改良ＡＯ张力带钢丝固定,环形,横Ｕ形,竖Ｕ形钢丝固定,髋骨部分和全切者的骨折愈合时间及疗效进行了对比分析。结果显示,改良ＡＯ张力带钢丝固定术式的骨折愈合时间为４￣１４周,优良率为８８．５％,与其它术式相比有显著差异。提示改良ＡＯ张力带钢丝固定治疗有移位髌骨骨折优于传统方法。     

Therapeutic efficacy of arthroscopy-assisted transosseous fixation with the Versalok suture anchor for tibial eminence fractures in adults

To investigate the clinical outcomes of arthroscopy-assisted transosseous fixation of tibial eminence fractures with the Versalok suture anchor in adults.A total of 23 adult cases of tibial eminence fractures treated between June 2016 and March 2019 were retrospectively analyzed. The results of the preoperative drawer test and Lachman test were positive. Radiography and computed tomography were performed before and after the procedure. Magnetic resonance imaging was performed in every patient after admission. Arthroscopy-assisted fracture reduction and Orthocord high-strength suture fixation with two Versalok anchors were performed in all the patients. The International Knee Documentation Committee scale and the Lysholm Knee Scoring Scale were used to evaluate outcomes during the follow-up period. Additionally, the KT-2000 knee stability test was performed.At the final follow-up, all the fractures had proceeded to bony union and no wound infection was observed. The average Lysholm Knee Score of the affected knees was 93.1 (range, 90–98), which was not significantly different from that of the healthy knees (t = 0.732, P = .132). Based on the International Knee Documentation Committee scale results, 21 patients were graded as normal and the other 2 patients were graded as nearly normal. The KT-2000 test showed that the anterior displacement of the affected side and the healthy side was less than 3.6 mm in all cases.The outcomes indicated firm fixation and good fracture healing with minimal trauma. Thus, arthroscopy-assisted transosseous fixation with Versalok suture anchors for adult tibial eminence fractures seems to have satisfactory clinical outcomes.     

可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折36例临床效果探讨

目的探讨可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折的治疗效果。方法选取该院2008-03～2011-10收治的36例儿童尺骨鹰嘴骨折患者,均采用切开复位可吸收线结扎固定手术治疗。结果36例均获随访,平均随访时间13个月。骨折全部愈合,平均愈合时间1.2个月。按HSS2肘关节评分进行肘关节功能评定,优良率为94.4%。结论应用可吸收线结扎固定手术治疗儿童尺骨鹰嘴骨折具有固定效果可靠、治疗效果良好、费用低廉、操作简便等优点,是一种治疗儿童尺骨鹰嘴骨折切实可行的方法。     

History of knee surgery is associated with higher prevalence of neuropathic pain-like symptoms in patients with severe osteoarthritis of the knee

Objective

Neuropathic pain (NP) mechanisms contribute to the pain experience in osteoarthritis (OA). We aimed to characterise the factors that contribute to NP-like symptoms in knee OA patients.

Patients and methods

A total of 139 patients with knee OA were recruited from secondary care, and completed a nurse- administered PainDetect questionnaire (PD-Q ), a visual analogue scale (VAS) for pain intensity, and the Western Ontario MacMaster questionnaire (WOMAC). Cases with any previous history of total joint replacement were excluded.

Results

Almost 75% of patients had non-zero PD-Q scores, and 34% had PD-Q scores corresponding to possible NP. No association was seen between PD-Q scores and duration of symptoms, gender, and radiographic severity. Possible NP was strongly associated (p < 1 × 10⁻³) with worse quality of life scores, worse sleep scores, higher pain intensity, worse WOMAC pain, stiffness and function scores. A history of previous knee surgery (arthroscopy, ligament repair or meniscectomy) was strongly associated with possible NP (odds ratio [OR] = 6.86; 95% CI = 1.78–26.43; p < 0.005). This association remained statistically significant after adjustment for pain intensity (OR = 6.37; 95% CI = 1.55–26.11; p < 0.010) whereas an association between history of knee surgery and the other measures of pain was found to be mediated by PD-Q scores.

Conclusions

NP-like symptoms are highly prevalent in patients with clinically severe painful OA and are a significant contributor to decreased quality of life and higher pain intensity. The cross-sectional association with previous history of knee surgery suggests that some of the NP-like symptoms may result from nerve damage.     

Which radiograph is most accurate for assessing hip joint penetration in infra-acetabular screw placement?

Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration.This retrospective review was performed between January 2015 and December 2020. We evaluated the records of patients with acetabular or pelvic fractures who underwent open reduction and internal fixation with infra-acetabular screw placement. We collected demographic data and described infra-acetabular screw placement as follows: ideal placement, articular penetration, and out of the bone. Articular penetration was assessed independently on each pelvic radiograph and compared statistically with the CT scans. Sensitivity, specificity, correct interpretation rate, and prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for each radiograph.Thirty-nine patients underwent infra-acetabular screw placement. The mean age of patients was 55 years (range, 27–90 years); there were 29 men and 10 women. One patient underwent bilateral infra-acetabular screw placement; therefore, 40 infra-acetabular screws were included in total. Six (6/40, 15%) infra-acetabular screws showed articular penetration on CT and two (2/40, 5%) showed infra-acetabular screws extending out of the bone. Hip joint penetration was correctly identified at a rate of 92.5% (95% confidence interval [CI], 79.6–98.4%) on the outlet view and 87.5% (95% CI, 73.2–95.8%) on the anteroposterior (AP) view. The PABAK for the agreement between pelvic radiographs and CT scans was 0.85 in the outlet view and 0.75 in the AP view.The outlet view is an accurate method for detecting articular penetration of infra-acetabular screws. We recommend the insertion of an infra-acetabular screw under fluoroscopic outlet view to avoid articular penetration intraoperatively.     

空心钉内固定治疗1型糖尿病合并股骨颈骨折的临床观察

目的观察空心钉内固定治疗1型糖尿病合并股骨颈骨折的临床效果。方法通过2008年3月—2013年9月,该院对37例股骨颈骨折合并1型糖尿病患者行空心钉内固定术,统计其预后情况。结果 37例中有1例出现股骨头缺血坏死塌陷,1例出现骨折不愈合,其余35例全部骨性愈合,骨折愈合率94.6%,且髋关节功能恢复良好。结论空心钉内固定治疗1型糖尿病合并股骨颈骨折,具有手术操作简单、内固定可靠、愈合率高、创伤小、费用低等优点,是目前治疗1型糖尿病合股骨颈骨折较为理想的方法。     

髌骨爪联合高强度缝合线网状缝合治疗髌骨下极粉碎性骨折的临床疗效观察

目的观察髌骨爪联合高强度缝合线网状缝合治疗髌骨下极粉碎性骨折的临床疗效。方法选取该院2017-01~2018-08收治的42例髌骨下极粉碎性骨折患者,使用高强度缝合线网状缝合髌腱及髌骨下极骨块,将骨折块聚拢,重建髌骨下极的牢固性,使用髌骨爪进行骨折加压固定。采用膝关节屈伸活动度与B9stman评分系统对术后功能进行评价。结果随访12个月,所有患者术后3个月关节活动度达到120°以上。髌骨骨折功能评分优34例,良8例,差0例,优良率达到100%。结论髌骨爪联合高强度缝合线网状缝合治疗髌骨下极粉碎性骨折效果良好,值得推广。     

Impact of 2 different posterior screw fixation techniques on primary stability in a cervical translational injury model: A biomechanical evaluation

Background:In case of injuries to the subaxial cervical spine, especially in osteoporotic bone, the question of the most stable operative technique arises. There are several techniques of screw fixation available regarding dorsal stabilization. This study investigates 2 techniques (lateral mass screws (LMS) vs cervical pedicle screws (CPS)) in the subaxial cervical spine regarding primary stability in a biomechanical testing using a translational injury model.Methods:A total of 10 human formalin fixed and 10 human fresh-frozen specimens (C 4 - T 1) were investigated. Specimens were randomized in 2 groups. Fracture generation of a luxation injury between C 5 and C 6 was created by a transection of all ligamentous structures as well as the intervertebral disc and a resection of the facet joints.Dorsal stabilization of C 4/C 5 to C 6/C 7 was performed in group A by lateral mass screws, in group B by pedicle screws. In the biomechanical testing, the specimens were loaded at 2 N/s in translation direction until implant failure.Results:Formalin fixed specimen: Mean load failure was 513.8 (±86.74) Newton (N) for group A (LMS) and 570.4 (±156.5) N for group B (CPS). There was no significant difference (P = .6905).Fresh frozen specimen: Mean load failure was 402.3 (±96.4) N for group A (LMS) and 500.7 (±190.3) N for group B (CPS). There was no significant difference (P = .4206).Conclusion:In our loading model respecting the translational injury pattern and a flexion movement we could not verify statistically significant differences between lateral mass screws and cervical pedicle screws. Mean loading failure was slightly higher in the CPS group though.     

Fracture Analysis of High-Strength Screw for Highway Construction

High-strength screws represent one of the main joining or fastening components which are commonly used in the process of installation of frame constructions for information boards or signposts, relating to the traffic roads. The control of the production process may not always be a sufficient method for ensuring road safety. The backward investigation and control of the screw material processing seems to be the one of the most important procedures when there is the occurrence of any failure during the operation of the screw. This paper is mainly focused on the analysis of the failure of the high-strength screw of 10.9 grade with M diameter of 27 × 3 and a shank length of 64 mm. The mentioned and investigated screw was used as a fastener in a highway frame construction. In the paper, there is mainly the analysis of the material for a broken screw in terms of the material micropurity, the material microstructure, the surface treatment as well as chemical composition. The evaluation was based on investigation by optical microscopy, scanning electron microscopy and energy dispersive spectroscopy. Important knowledge and results were also obtained due to information on micromorphology and material contrast of the fracture surface resulting from fractographic analysis, using the method of scanning electron microscopy. In the case of the production of the high-strength screws, the tempering stands for the decisive or crucial process of heat treatment because the given process can ensure a decrease in hardness, while the required ductile properties of the material are kept and this is also reflected in the increase of strength and micromorphology of the fracture surface. From the aspect of micropurity, inclusions of critical size or distribution were not identified in the material, referring to Czech standard ČSN ISO 4967 (420471). The microstructure corresponds to tempered martensite, but the fracture surface of the broken screw was based on an intercrystalline micromechanism, which is undesirable for the given type of component. Combined with the measurement of the HV1 (Vickers hardness at a load of 1 kg) from the edge to the central area of the screw, the analysis revealed the significant drawbacks in the heat treatment of the high-strength screw.