髋臼上区域置钉安全范围的影像学研究

目的　探究髋臼上区域螺钉的进钉位置、角度以及安全范围。 方法　收集男女骨盆CT数据各50例,利用Mimics软件重建髋臼上置钉区域三维模型（髂前下棘至髂后上棘方向）。同一横断面上,通道狭窄处中点连线方向确定为螺钉方向,沿该方向每2.5 mm为一层,逐层测量安全范围相关指标。在1/2高度层面放置中心钉,测量中心钉进钉点与髂前下棘的位置关系及螺钉方向,在水平面和矢状面上移动钉尖,测量安全倾角范围。 结果　髋臼上骨通道存在前、后两狭窄点,不同层面其宽度不同,从下至上,前狭窄由窄变宽再变窄,后狭窄逐层增宽。螺钉通道中间层较宽,上下层较窄;中心通道宽度90%的男、女性分别大于7 mm和6 mm;进钉约50 mm至前狭窄,70 mm至坐骨大切迹顶上方,100 mm至后狭窄,全程长约130 mm;螺钉为内倾、头倾方向,与矢状面和横断面的夹角均约为30°;97%的进钉点位于髂前下棘中心外侧,其中外下方占71%。 结论　髋臼上螺钉的进钉点主要位于髂前下棘外方,内倾、头倾方向,与矢状面和横断面的夹角均约为30°。     

A biomechanical and histological analysis of standard versus hydroxyapatite-coated pins for external fixation

This sheep study was designed to make a comparative evaluation of two external fixation pin types each with and without hydroxyapatite (HA) coating. The two pins had different taper, pitch, and self drilling capabilities. Twenty Orthofix standard, self-tapping pins (group A), 20 Orthofix HA-coated, self-tapping pins (group B), 20 X-caliber, self-drilling, self-tapping pins (group C), and 20 X-caliber HA-coated, self-drilling, self-tapping pins (group D) were selected. Four pins were implanted in the right femurs of 20 adult sheep that were euthanized at 6 weeks. Mean pin insertion torque was 2745 +/- 822 Nmm in group A, 2726 +/- 784 Nmm in group B, 2818 +/- 552 Nmm in group C, and 2657 +/- 732 Nmm in group D (ns). Mean pin extraction torque was 1567 +/- 541 Nmm in group A, 2524 +/- 838 Nmm in group B, 1650 +/- 650 Nmm in group C, and 2517 +/- 726 Nmm in group D. HA-coated pins (group B and D) had a significantly greater mean pin extraction torque compared to similar uncoated pins (group A and C) (p < 0.0005). Histological analysis showed good osteointegration of the two coated pin types. This study shows that HA-coating is more important for optimal pin fixation than the particular combination of design parameters used in each pin type.     

Safe zone for lateral pin placement for external fixation of the distal humerus

External fixation is a common, efficient technique used for humeral shaft stabilization and elbow fractures. There are reports of radial nerve injuries associated with this procedure. In this study, we investigated the course and variability of the radial nerve along the lateral humerus in relation to the elbow joint to determine a relatively safe zone for lateral pin placement in external fixation. Twenty upper extremities from 10 cadavers were studied. The nerve branches and course of the radial nerve along the lateral humerus were carefully dissected. Straight lines (a, b, and c) were made connecting three landmarks (the acromion, coracoid process, and anterior wall of the axilla) in the proximal upper extremity to the lateral condyle (LC) of the humerus; their intersections with the radial nerve (A, B, and C) were marked. We analyzed whether the intersection positions were correlated with the connecting line lengths. The mean lengths of the connecting lines were (a) 27.24 ± 2.57, (b) 26.18 ± 2.79, and (c) 20.95 ± 1.44 cm; the distance between the intersection points and the LC of the humerus were (Aa) 7.56 ± 1.31, (Bb) 6.90 ± 2.27, and (Cc) 5.01 ± 0.83 cm; and the measured intersection points of the radial nerve in the lateral aspect of the humerus were (A) 18.48%–34.82%, (B) 13.48%–40.00%, and (C) 19.27%–28.05% of the lengths of lines a, b, and c, respectively. Our data provide a more reliable reference to predict the course of the radial nerve on the lateral humerus and define a safe zone for pin placement. Clin. Anat., 33:637–642, 2020. © 2019 Wiley Periodicals, Inc.     

Capsular attachment to the distal radius for extracapsular placement of pins

Abstract The aim of this study was to evaluate the anatomy of the wrist joint capsule on the distal radius. As such the extent of the joint capsule and the limits of attachment in relation to the articular surface were determined. Furthermore, the study also determined whether there was any reflection of the capsule onto the distal radius. Fifty cadaveric specimens, preserved according to Thiel’s method, were assessed. After careful dissection the distance between the chondral line of the carpal articular surface and three defined points on each of the palmar and dorsal aspects of the radius were measured. In none of the specimens was there any variation in the course and extent of the joint capsule. Using external fixators for managing fractures of the distal radius, pins and wires can be placed subchondrally close to the articular capsule. The risk of intraarticular infection, due to pin tract infection in intraarticularly positioned pins, is very low.     

Fixation strength of tapered versus bicylindrical hydroxyapatite-coated external fixation pins: an animal study.

The purpose of this study was to comparatively measure the bone-pin interface strength in two types of hydroxyapatite-coated pins that differed in shape, diameter, and implantation technique. Both pin types are commonly used for tibia fixation. Thirty bicylindrical 5/4-mm stainless-steel pins (Group A) and 30 tapered 6/5-mm stainless-steel pins (Group B) were implanted in the left tibiae of 10 adult sheep. A monolateral fixator was mounted on the pins after implantation. A 5-mm-long bone segment was removed from the tibial mid-diaphysis to ensure high load at the bone-pin interface. Pin insertion torque was 830 +/- 446 N/mm in Group A and 3415 +/- 743 N/mm in Group B (p<0.0001, one-way ANOVA). Six weeks after surgery, the sheep were euthanized and pin extraction torque measured. Pin extraction torque was 1237 +/- 499 N/mm in Group A and 3367 +/- 1512 N/mm in Group B (p<0.0001, Mann-Whitney test). Morphological analysis performed at 60x magnification showed a direct bone-pin contact in both groups. Despite challenging biomechanical conditions, this study showed both pin types to be well-fixed and osteointegrated. Therefore, both pin types are recommended for tibial fixation. However, the tapered pins showed higher extraction torque, an important result for external fixation treatments.     

Measurement of insertion torque of tapered external fixation pins: A comparison between two experimental models.

The aim of this study was to compare an in vitro versus an ex vivo experimental model to test the insertion torque of two different types of external fixation pins. A torque measuring machine was developed in order to perform accurate measurements. Forty tapered pins made of stainless steel were utilized. Half of the pins were plasma-spray coated with hydroxyapatite (HA) and the other half remained uncoated. For the in vitro model 20 cylinders were used that were made of synthetic polymer according to ASTM standards. For the ex vivo model 10 fresh femora harvested from adult sheep were used. All the pins were implanted after predrilling, and insertion torque was measured. Statistical analysis of the in vitro versus the ex vivo model showed significant differences in both coated (p < 0. 0005) and uncoated (p = 0.002) external fixation pins. These results may be due to the surface roughness that caused significant friction between the HA coating and the polyvinylchloride in the in vitro model. The significant difference between the in vitro and ex vivo results lead us to state that the in vitro model does not realistically simulate the behavior of external fixation pins implanted in bone.     

Prevention of pin track infection in external fixation with silver coated pins: clinical and microbiological results

Pin tract infection is a frequent complication of external fixation; according to literature its frequency ranges from 2-30%. The recent introduction of silver coating of polymeric materials was found to decrease bacterial adhesion; its clinical use with Foley catheters and central venous catheters led to significant results. To verify the ability of the same silver coating to decrease the bacterial colonization on external fixation screws, a prospective randomized study was carried out on 24 male patients; a total of 106 screws were implanted in the lower limb to fix femoral or tibial diaphyseal fractures: 50 were coated with silver and 56 were commercially available stainless steel screws. Although the coated screws resulted in a lower rate of positive cultures (30.0%) than the uncoated screws (42.9%), this difference was not statistically significant (p = 0.243). The clinical behavior of the coated screws did not differ from that of the uncoated ones. Furthermore, the implant of silver-coated screws resulted in a significant increase in the silver serum level. These results led us to consider it ethically unacceptable to continue this investigation.     

金属铰链外固定支架与有限针钉置入内固定治疗肘关节“恐怖三联征”

背景：以往治疗肘关节后脱位伴桡骨头及尺骨冠状突骨折(肘关节恐怖三联征)的手术方法需要长期制动而常常导致肘关节复发性不稳定、肘关节僵硬等并发症的发生。 目的：观察铰链支架配合有限内固定治疗肘关节“恐怖三联征”的效果。 方法：选择2006-04/2010-06佛山市中医院收治的肘关节“恐怖三联征”患者14例,均采取肘关节内、外侧联合入路针钉置入内固定加金属铰链外固定架治疗。所有患者随访时间≥5个月,记录病情主诉、肘关节屈伸活动度、前臂旋转活动度、关节稳定性、X射线片情况,采用MEPS评分评估肘关节功能。 结果与结论：所有患者在末次随访时患侧肘关节均没有明显疼痛及不稳定,无浅表及深部组织感染发生;骨折平均愈合时间(11.30±3.25)周;肘关节平均屈伸范围为(125.42±19.66)°(75°~145°),前臂平均旋转范围为(135.43±17.07)°(80°~150°);2例颅脑损伤患者肘前软组织中出现少量骨化,未影响关节活动。MEPS评分优7例,良5例,可2例,优良率为86%。说明采用内、外侧入路通过铰链支架配合有限内固定能提高肘关节术后初始稳定性,有利于肘关节同心圆性中心复位及软组织修复,便于早期功能锻炼,免去二次手术问题。     

The accuracy of image registration for the brain and the nasopharynx using external anatomical landmarks

We investigated the accuracy of 3D image registration using markers that are repeatedly applied to external anatomical landmarks on the head. The purpose of this study is to establish a lower limit of the errors that would occur in, for instance, MRI-SPECT matching, which in some situations can only be achieved using external landmarks. Marker matching was compared with (single-modality) volume matching for 20 MRI scans. The results were compared with a published expression for the target registration error (TRE) which gives the 3D distribution of the mismatch between both scans. It was found that the main error source is reapplying the external markers on the anatomical landmarks. The published expression describes the relative distribution of the TRE in space well, but tends to underestimate the actual registration error. This deviation is due to anisotropy in the error distribution of the marker position (errors in the direction perpendicular to the skin surface are in general much smaller than errors in other directions). A simulation of marker matching with anisotropy in the errors confirmed this finding. With four reapplied markers, the TRE is 6 mm or smaller in most regions of the head.     

骨科内固定植入物影像学评价的意义

背景：随着骨组织工程在临床骨科领域的发展,内固定植入后的稳定性一直是临床研究的重点,那么通过什么途径才能更好地掌握其置入后的生物力学变化呢？ 目的：总结影像学在骨科植入物的应用级生物力学评估。 方法：应用计算机检索CNKI和Pubmed数据库中1999-01/2012-06关于影像学评估骨科植入物的文章,在标题和摘要中以“骨科,置入,钢板,螺钉,X射线、CT、MRI”或“orthopedics,implantation,steel plate,screw,X-ray,CT、MRI”为检索词进行检索。选择文章内容与骨科内固定植入物影像学评价有关者,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到172篇文献,根据纳入标准选择关于骨科植入物影像学评价的25篇文献进行综述。 结果与结论：X射线平片、CT和MRI在骨科内固定置入后的评价有非常重要的作用,通过影像学途径可以掌握植入物置入后的位置、角度、植入材料与宿主的融合、自身的腐蚀等,评价植入物的生物力学稳定性和植入宿主后的生物相容性。X射线平片显示骨结构细节最好,MRI软组织、软骨对比最好,CT介于两者之间,X射线平片、CT、MRI各有优势,放射影响科和骨科医生了解各种检查的特点、利弊,结合患者的自身情况,选择合适检查方法,才更有利于把握置入后的疗效。     

桥接外固定架联合克氏针与掌侧锁定钢板修复桡骨远端不稳定型骨折的比较

BACKGROUND: The unstable distal radius fractures are clinically treated with external fixation, open reduction and internal fixation at present. These two methods have their advantages and disadvantages.      

放置内踝螺钉安全区的解剖与临床研究

目的:报道放置内踝螺钉安全区的解剖基础及临床治疗效果.方法:在10具成人新鲜冷冻尸体内踝标本上,平行打入3枚空心螺钉,解剖观察并测量胫后肌腱与螺钉距离和胫后肌腱损伤例数.依据解剖学研究结果.手术治疗36例内踝骨折患者,按Barid-jackson评价标准,术后随访踝关节功能恢复情况.结果:解剖学研究结果显示:1区(前丘部)螺钉在全部标本卜均不与胫后肌腱接触,2区(丘间沟)螺钉距胫后肌腱平均距离3 mm(1～6 mm),3区(后丘部)螺钉均与胫后肌腱接触,并有6个标本肌腱损伤.临床手术治疗36例,术后随访6～24个月,按Barid-jackson评价,优20例,良13例,优良率91.6%.结论:内踝前丘部植入螺钉是安全区,前丘部之后植入螺钉有损伤肌腱的危险.     

外固定支架修复胫骨平台骨折的生物力学特点

BACKGROUND: Scholars have studied the three-dimensional finite element models of tibial plateau fractures with different fixation methods, but the research on three-dimensional finite element model of tibial plateau fracture fixation was not much.     

髌骨针和FiberWire编织缝线张力带联合固定治疗髌骨骨折

背景：克氏针钢丝张力带是治疗髌骨骨折最常见的方式,但易引起与金属植入物相关的并发症。基于上述原因,有学者开始在张力带固定中应用高强度缝线替代钢丝固定来治疗髌骨骨折。 目的：观察髌骨针和FiberWire编织缝线张力带联合固定治疗髌骨骨折的效果。 方法：对髌骨针和FiberWire编织缝线张力带固定治疗26例髌骨骨折患者的资料进行回顾性分析,其中男16例,女10例;年龄36-54岁,平均44.6 岁。 结果与结论：随访6-18个月,平均12个月。所有患者切口均一期愈合。骨折愈合时间为8-16周,平均12周。无骨折移位,无固定松动、断裂或突出于皮下刺激皮肤等并发症发生。按Lysholm&Gillquist 膝关节评分标准评定,优18例,良4例,可4例,优良率85%。结果可见应用髌骨针和FiberWire编织缝线张力带固定治疗髌骨骨折达到了满意的结果,且并发症少。     

髋臼上方置钉骨盆外固定的应用解剖

目的:为髋臼上方置钉进行骨盆外固定手术提供应用解剖学参考资料.方法:对20例40侧尸体骨盆的髂前下棘区域进行观察测量,获取髂前下棘与股动脉、股神经、股外侧皮神经、旋髂深动脉等毗邻血管神经的距离.对髋臼上置钉的钉道进行测量,获取钉道的长度、宽度,钉道与髋臼边缘及坐骨大切迹的距离等.所得数据按性别分组进行统计学处理.结果:髂前下棘为股直肌起始部,表面为髂肌覆盖,缝匠肌由外上至内下斜行越过髂前下棘外下方.男性股动脉位于髂前下棘内侧(27.54±3.53)mm,女性为(27.15±0.81)mm;男性股神经位于髂前下棘内侧(17.61±3.47)mm,女性为(19.26±4.21)mm.男性股外侧皮神经位于髂前下棘外侧(23.24±5.33)mm,女性为(17.82±3.26)mm;男性旋髂深动脉位于髂前下棘上方(16.26±1.77)mm,女性为(14.06±2.16)mm.男性髋臼上钉道长度为(147.76±7.39)mm,女性为(142.75±6.36)mm;男性钉道位于髋臼上方(25.10±4.43)mm,女性为(19.35±3.54)mm;男性钉道位于坐骨大切迹上方(25.01±3.61)mm,女性为(21.34±3.17)mm.结论:髋臼上方置钉骨盆外固定手术,应选取在腹股沟韧带外侧1/4下方约1 cm处作一平行切口,采用纵形钝性劈开髂肌的方式,以套筒保护下在髂前下棘处置入固定钉,避免损伤周围组织.由髂前下棘到髂后上棘间的钉道为一完整连续的骨性钉道,可为骨盆外固定提供足够的钉道长度和固定强度.     

外固定支架结合手法复位治疗桡骨远端骨折

 背景：外固定支架结合手法复位治疗桡骨远端骨折具有较好的效果。目的：对外固定支架结合手法复位治疗桡骨远端骨折进行文献计量学分析。方法：检索CNKI数据库2003至2012年收录外固定支架复位治疗桡骨远端骨折的应用研究文献,采用检索词“外固定支架;桡骨远端骨折”,排除重复文献以及与研究内容无关的文献,共检索文献408篇。从文献出版时间与数量、学科类别、来源期刊、研究机构以及被引频次、下载频次等角度对408篇文献进行文献计量学分析。结果与结论：外固定支架结合手法复位治疗桡骨远端骨折的文献研究呈上升趋势,2012年发表相关文献85篇,并且多以外科学为主。近10年的文献研究中,以《中医正骨》发表文献量最多,共发表文献18篇。而各研究单位对此进行的研究均不多,仅发表文献1-7篇,并且仅有5篇文献获得基金项目资助。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

植入物与Halo-vest内外固定联合治疗下颈椎骨折脱位

背景：对于外伤性下颈椎骨折脱位及脊髓损伤,选择何种治疗方式目前尚存争议。 目的：评价植入物内固定与Halo-vest外固定联合应用治疗下颈椎骨折脱位后稳定性的临床效果。 方法：回顾分析汕头大学医学院第二附属医院骨科2009年1月至2011年12月收治下颈椎骨折脱位的17例患者,男13例,女4例,年龄21-65岁,平均年龄41.6岁,高处坠落伤6例,重物压砸伤3例,道路交通伤8例,伤后入院时间2 h-5 d,平均2.5 d,所有患者均在局麻下行Halo-vest外固定,然后逐步撑开,在复位情况下,行前路减压植骨、钛板螺钉内固定,通过Frankel分级与影像学检查评价治疗效果。 结果与结论：所有患者获得随访,随访12-24个月,平均15.4个月,常规X射线正侧位片显示骨折脱位均复位,恢复颈椎的正常序列及生理弧度,CT显示植骨融合,未发现内固定断裂及松动,按Frankel分级,显效(降低2级)5例,有效(降低1级)10例,无效2例。植入物与Halo-vest内外固定联合对下颈椎骨折脱位失稳固定的效果不仅安全可靠,并且能更好的恢复脊柱的矢状位对线。