重建锁定双钢板结合可吸收材料治疗肱骨髁间C型骨折

目的评价重建锁定双钢板结合可吸收材料治疗肱骨髁间C型骨折临床疗效。方法对2006年1月至2010年12月30例肱骨髁间C型骨折采用经尺骨鹰嘴＂V＂形截骨入路,重建锁定双钢板结合可吸收螺钉内固定,截骨处采用可吸收张力带固定,术后行早期功能锻炼,定期随访摄片了解骨折愈合情况。结果 30例全部获得随访,时间12～36个月,平均12个月,骨折全部愈合。术后出现桡神经牵拉伤1例,经神经营养药物治疗恢复;异位骨化1例,肘关节恢复满意。根据改良Cassebaum评分系统对肘关节功能进行评定,优11例,良14例,可5例,优良率80.3%。结论经尺骨鹰嘴＂V＂形截骨入路,重建锁定双钢板结合可吸收材料内固定具有复位满意,固定坚强,可早期功能锻炼优点,功能恢复良好。     

肱骨髁上截骨术后可吸收与金属张力带固定治疗肘内翻的研究

目的:比较肱骨髁上楔形截骨术后可吸收张力带(可吸收螺钉或棒和可吸收线)与金属张力带(克氏针和钢丝)固定治疗肘内翻的疗效。方法:采用2种张力带固定肱骨髁上楔形截骨术后骨端治疗33例肘内翻。可吸收张力带固定组15例,其中男12例,女3例;年龄13~24岁,平均16岁;术前内翻角为17°~34°,平均26°。金属张力带固定组18例,其中男15例,女3例;年龄12~22岁,平均14岁;术前内翻角为17°~40°,平均29°。根据术后畸形矫正和关节功能恢复情况评定疗效。结果:本组均获随访,随访时间18~69个月,平均37个月。截骨处平均愈合时间为6周。根据疗效评定标准,可吸收张力带组优13例,良2例,差0例;金属张力带组优15例,良2例,差1例。2种治疗方法临床疗效比较无统计学差异。结论:可吸收张力带是固定肱骨髁上截骨治疗肘内翻的有效方法之一,具有无须Ⅱ期手术取出内固定物的优点,简单方便,降低感染机会。     

股骨内髁滑移截骨技术在全膝关节置换术治疗RanawatⅡ型膝外翻畸形中的应用及疗效分析

目的 分析应用股骨内髁滑移截骨技术行全膝关节置换术治疗RanawatⅡ型膝外翻畸形的手术疗效。方法 回顾性分析自2012-06—2017-06应用股骨内髁滑移截骨技术行全膝关节置换术治疗的65例RanawatⅡ型膝外翻畸形,其中31例术中行股骨内髁滑移截骨（截骨组）,34例常规方法行外侧软组织松解（常规组）。记录两组术后并发症发生情况,比较两组术后髋膝踝角、膝关节KSS临床评分、膝关节KSS功能评分、膝关节活动度。结果 所有患者均获得随访,随访时间4.0～7.8年,平均6.3年。常规组6例、截骨组4例术后出现下肢深静脉血栓形成,经抗凝、溶栓治疗后均于术后2周左右恢复。截骨组3例因骨质疏松出现部分螺钉少许退钉,其中1例因螺钉退出较多作小切口将螺钉重新置入,另2例无明显症状未做特殊处理。所有患者滑移截骨块与股骨髁均愈合,影像学检查显示截骨块骨折线消失时间为术后3～6个月,平均3.2个月,无骨折不愈合发生。末次随访截骨组膝关节KSS临床评分、膝关节KSS功能评分、膝关节活动度均优于常规组（P<0.05）,两组髋膝踝角差异无统计学意义（P>0.05）。结论 股骨内髁滑移截骨技术在全...     

股骨转子间骨折小转子固定方法探讨

目的 评价股骨转子间骨折小转子固定方法的临床效果。方法 2002年1月～2003年12月，对26例股骨转子间骨折应用动力髋螺钉或动力髁螺钉内固定，并加用皮质骨螺钉固定小转子。其中男13例，女13例；年龄47～88岁。骨折按Evans分型：Ⅰ型6例，Ⅱ型13例，Ⅲ型4例，Ⅳ型3例。结果 术后伤口Ⅰ期愈合。获随访6～14个月，X线片示患肢无明显短缩畸形，无内固定物断裂、螺钉穿出，无骨折不愈合发生，骨折平均愈合时间12周。患者均恢复行走。按照黄公怡等关节功能评定标准，优17例，良8例，差1例，优良率96．1％。结论 动力髋螺钉或动力髁螺钉加用皮质骨螺钉固定小转子，方法简便，固定可靠，是治疗股骨转子间骨折的一种理想内固定方法。     

可吸收螺钉内固定治疗Müller B型股骨髁撕脱骨折

目的探讨可吸收螺钉内固定治疗Müller B型股骨髁撕脱骨折的临床疗效。方法回顾性分析自2017-02—2020-02采用可吸收螺钉内固定治疗的15例Müller B型股骨髁撕脱骨折,8例采用髌骨旁内、外侧入路,7例采用股后内、外侧肌后侧间隙入路。结果 15例均获得随访,随访时间平均24(10～36)个月。术后X线片与CT显示骨折复位满意、固定可靠。随访期间定期摄X线片检查,所有患者达到骨性愈合标准,骨折愈合时间60～120 d,平均90 d。未出现骨折不愈合以及排异反应。1例合并后交叉韧带损伤但术中未一期修复,术后膝关节后直向稳定性不佳,但是可以正常行走。4例膝关节活动时出现疼痛,口服镇痛药物后减轻。末次随访时根据Karlstr?m标准评定疗效:优8例,良5例,可1例,差1例。结论可吸收螺钉具有良好的生物相容性,骨折块较小的Müller B型股骨髁撕脱骨折采用可吸收螺钉内固定治疗可获得可靠疗效,无需二期手术取出,避免了再次手术损伤。     

可吸收张力带在肘内翻截骨矫形术中的应用

自1998年1月～2003年1月采用可吸收线和可吸收螺钉或棒形成可吸收张力带固定肱骨髁上截骨两端,治疗15例肘内翻,疗效满意。     

关节镜下可吸收钉治疗陈旧性股骨髁大面积骨软骨骨折

目的 ：研究关节镜下可吸收钉固定陈旧性股骨髁负重区大面积骨软骨骨折的临床效果。方法 ：自2007年3月至2011年12月采用关节镜下可吸收钉固定治疗股骨髁负重区大面积骨软骨骨折6例,其中男4例,女2例,年龄14~48岁,病程4~26周。患者膝关节疼痛肿胀,损伤部位为股骨髁负重区,损伤深度为ICRSⅣ级,损伤面积≥4 cm2。采用X线评价骨折愈合情况,采用Lysholm评分、IKDC评分和Tegner运动评级评价关节功能。结果 ：所有患者骨软骨骨折获愈合,二次探查发现软骨轻度退变。术后膝关节Lysholm评分、IKDC评分及Tegner运动评级均较术前提高。结论：关节镜下应用可吸收钉固定治疗陈旧性股骨髁负重区大面积骨软骨骨折有利于恢复关节软骨面的平整结构和骨软骨块的愈合。     

动力髁螺钉(DCS)治疗股骨髁上骨不连16例报告

目的观察动力髁螺钉(DCS)治疗股骨髁上骨不连的临床疗效。方法16例股骨髁上骨不连均采用断端修整、自体髂骨植骨及DCS内固定治疗，5例伴有膝关节粘连者同时行膝关节松解术。结果所有病例获得随访，时间12～48个月，平均18个月。在4～9个月内均获骨性愈合。合并膝关节粘连者功能也获得明显改善。参照Shelbourne疗效评定标准，优8例，良5例，功能优良率达81．3％。结论应用DCS固定 自体髂骨植骨后，骨折端可获得坚强内固定及持久的压应力，有利于早期进行膝关节功能锻炼，是治疗股骨髁上骨不连的有效方法。     

微创钢板内固定加同侧股骨髁取骨植骨治疗复杂胫骨平台骨折

目的观察微创技术钢板螺钉内固定加同侧股骨髁部取骨植骨治疗胫骨平台粉碎性骨折的临床疗效。方法采用有限的切开复位微创技术并取同侧股骨髁部植骨钢板(锁定钢板、胫骨近端外侧解剖钢板、下肢L形钢板)内固定治疗胫骨平台粉碎性骨折32例。结果所有患者随访8~20个月,骨折全部骨性愈合,愈合时间12~20周。术后膝关节功能采用Kolmer评分:优13例,良16例,可3例,优良率为90.6%。结论微创技术钢板螺钉内固定加同侧股骨髁部取骨植骨治疗胫骨平台粉碎性骨折能有效的保证骨折愈合,膝关节功能恢复理想,临床疗效满意。     

用可吸收螺钉治疗髌骨骨软骨骨折

【摘要】〓目的〓探讨髌骨骨软骨骨折用可吸收螺钉手术固定方法及其疗效。方法〓我院2004年6月~2009年12月共收治了14例急性膝关节外伤患者,年龄13~21岁(男3,女11;左膝8例,右膝6例)。经CT检查8例、MRI检查6例确诊髌骨骨软骨骨折。手术发现股骨外髁软骨挫伤及划痕;髌骨内侧松弛,骨软骨骨折。所有患者均采用手术复位及可吸收螺钉固定。术后24小时开始股四头肌收缩训练,外固定保护3周膝关节无负重活动。2~3月CT或X显示骨软骨下骨折块愈合后负重功能锻炼。 结果〓12例获得4~9年随访,平均6.5年,使用HSS标准评价优11例,良1例。结论〓髌骨骨软骨骨折早期诊断、手术复位用可吸收螺钉内固定可靠;早期功能锻炼,晚负重行走,疗效良好。     

A comparison of magnetic resonance imaging to bone scintigraphy in early traumatic ischemia of the femoral head.

In adult rabbits, a unilateral subcapital osteotomy of the femoral neck was performed to induce avascularity. One half of the osteotomy sites were fixed with a magnetic resonance imaging (MRI) compatible absorbable pin and the other osteotomies had no fixation. The femoral heads were studied at three, five, and 12 days with roentgenographs, bone scintigraphy, and MRI, and MRI only at four weeks and six weeks after osteotomy. Histologic studies were performed after imaging to evaluate the viability of the femoral heads. At three, five, and 12 days after osteotomy, bone scintigraphy showed a decrease in uptake of radioisotope in the region of the femoral head on the operated side relative to the acetabulum and greater trochanter in 17 of 18 rabbits. A comparison of the surgically treated hip to the normal hip in fixed and unfixed osteotomies showed no change in the signal behavior of T1- or T2-weighted images in all rabbits Days 3, 5, and 12 (n = 18) after operation. The rabbit femoral heads with fixation of the osteotomy 28 days after operation showed a decrease in signal intensity in the subcapital region of the femoral head. Six weeks after operation, the fixed femoral head shows a loss of signal in a portion of the femoral head near the osteotomy. The MRI signal intensity appears to increase in the unfixed femoral heads six weeks after operation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fixation of experimental osteotomies with absorbable polylactic acid screws.

Absorbable screws made of self-reinforced poly-L-lactic acid (SR-PLLA) and poly-DL/L-lactic acid (SR-PDLLA/PLLA) were used for fixation of cancellous bone osteotomies of the distal femur in rabbits. The initial molecular weight of PLLA was 260.000 and that of PDLLA 100.000. The follow-up times were from one week to 96 weeks. Seventy-two rabbits were operated on, 36 in the PLLA group and 36 in the PDLLA/PLLA group. After sacrifice, radiographic, micro-radiographic, histologic, histo-morphometric, and oxytetracycline-labelling studies were performed. In the PLLA group 34/36 (94%) osteotomies and in the PDLLA/PLLA group 31/36 (86%) osteotomies healed without delay or angular deformity. The present investigation shows that absorbable SR-polylactic acid screws are suitable for fixation of weight loading cancellous bone osteotomies in rabbits. Based on these promising results, a clinical study where cancellous bone fractures are fixed with SR-PLLA screws has been started.     

Bone growth after osteotomy and internal fixation in young rabbits

The factors leading to overgrowth following fixation of long-bone fractures in children have never been clearly understood. The amount of trauma and the type of fixation may play a role. A rabbit model was used to investigate the influence of a femoral osteotomy and plate fixation on subsequent growth. Unilateral midshaft femoral osteotomy was performed in 6-week-old rabbits, and the bone was fixed internally with a plate and screws. End-to-end reduction was performed either at full length or with a segment removed. Bone length measurements at the end of growth revealed no significant difference in growth between the control femur and the femur that had undergone osteotomy and plate fixation. Shortened plated femora also showed no tendency to grow longer or faster than full-length fixed femora or controls. Interestingly, in the ipsilateral tibia a small but statistically significant length increase, equivalent to about 2% increase in additional growth, was observed, whereas technetium-99 methylene diphosphonate uptake was reduced in the tibial physes. In the context of the rabbit experimental model chosen, these results suggest that significant femoral overgrowth does not occur following femoral osteotomy and plate fixation.     

Ectopic bone formation around the poly-<Emphasis Type="SmallCaps">l</Emphasis>-lactide screw head in rotational acetabular osteotomy for hip dysplasia

Ectopic bone formation around the poly-l-lactide (PLLA) screw head in eccentric rotational acetabular osteotomy for hip dysplasia was investigated. A total of 174 hips in 165 patients with hip dysplasia were consecutively treated with eccentric rotational acetabular osteotomy. Average age at the time of operation was 37 years. Acetabular fragments of 123 patients (132 hips) were fixed by Kirschner wires (K-wire group), and 42 hips in 42 patients were fixed with PLLA screws (PLLA group). There was no statistically significant difference between the backgrounds of the two groups. All patients were evaluated clinically and radiologically. In the K-wire group, ectopic bone formation of class 2 was observed in only 1 hip. In the PLLA group, ectopic bone formation of class 3 in 1 hip and class 2 in 3 hips was observed around the screw head 3 months postoperatively, and all hips but 1 showed class 2 at final follow-up. One hip with class 3 at 1 year developed marked reduction of range of motion, and this patient complained of moderate hip pain and stiffness. PLLA screws significantly enhanced ectopic bone formation around the screw head in eccentric rotational acetabular osteotomy.     

Healing of subcapital femoral osteotomies fixed with self-reinforced poly-L-lactide screws: an experimental long-term study in sheep

Subcapital femoral osteotomies of ten young adult sheep were fixed with two bioabsorbable, self-reinforced, poly- L-lactide (SR-PLLA) lag screws of 4.5 mm in diameter. At 3 weeks radiographs were taken to check the reduction and fixation achieved. After follow-up periods of 12 weeks, 1 year and 3 years with three sheep in each group, and of 7 years and 4 months with one sheep, the sheep were killed, and the healing of the osteotomies, degradation and tissue response of the implants were examined radiographically, histologically and microradiographically. All osteotomies healed with a firm bony union. There was no dislocation or wound infection. Histologically, there was no marked tissue response in the bone tissue. At 12 weeks the implants were grossly intact, at 1 year granulation tissue and new bone formation had started to penetrate into the implant, and at 3 years the implant area was mostly replaced by connective tissue and new bone, but implant material was still seen as little islands surrounded by some lymphocytes. At 7 years and 4 months, the implant material had been degraded and replaced by tight bone. Self-reinforced poly- L-lactide lag screws seem to possess adequate mechanical properties and good biocompatibility for this demanding fixation.     

Absorbable polyglycolide screws in internal fixation of femoral osteotomies in rabbits

In 20 rabbits, a transverse distal femoral osteotomy was fixed using a 4.5 by 30-mm absorbable screw made of polyglycolide. No postoperative external support was used. The consolidation of the osteotomy was investigated histologically, morphometrically, and microradiographically in groups of 4 to 6 rabbits that were followed for 3, 6, 12, or 36 weeks. Fourteen osteotomies showed solid bony union; and in 3, several bone trabeculae were seen to bridge a still partially ununited osteotomy. In another 3 rabbits, each with a follow-up time of 12 or 36 weeks, no convincing signs of progressing consolidation could be seen. Only 1 of these rabbits showed displacement of the distal fraament.     

Long-term tissue response to bioabsorbable poly-L-lactide and metallic screws: an experimental study

Late, clinically manifest, adverse inflammatory reactions have sometimes occurred after the use of slowly degrading bioabsorbable poly-l-lactide (PLLA) devices in clinical series of bone fixation. In this study, long-term tissue response to bioabsorbable fracture fixation screws made of poly-l-lactide and to similar metallic screws in cancellous bone was examined and compared with intact bone. The postoperative evaluation of the rabbit femora was performed by using plain radiography, microradiography, histology, histomorphometry, and oxytetracycline labeling studies. The follow-up times were 36 and 51 months in groups of 15 and 14 rabbits, respectively. A walling-off response by formation of trabecular bone which outlined the screw profile was observed in the PLLA and metallic groups both. Connective tissue between this bone front and the implant was seen only in the PLLA group. There was no difference in the thickness of the layer between the two follow-up groups. Between the surgically handled femora and the intact control bone, there was no statistically significant difference in the amount of trabecular bone. The osteoid formation activity in the tissue-implant interface showed no differences between the groups. However, active osteoblasts were visible only in the PLLA group. The amount of birefringent PLLA material diminished between the 36-month and the 51-month follow-up groups. Within the follow-up times of this study, both the PLLA screws and the metallic screws were rather inert. Also, long-term walling-off was a typical response to both PLLA and metallic screws in cancellous bone. PLLA screws did not evoke any osteostimulatory reaction over the long-term follow-up. The findings clearly demonstrated that the overall degradation process of PLLA was very slow and accompanied by fibrous tissue formation. Macrophage activity seemed to be related to the slow degradation process of PLLA and might be associated with the formation of connective tissue replacing the original implant. The results of this study showed no significant differences between the bioabsorbable PLLA screws and the metallic screws in biocompatibility, and no signs of inflammatory foreign-body reactions occurred during the follow-up.     

Absorbable polyglycolide screws in internal fixation of femoral osteotomies in rabbits.

In 20 rabbits, a transverse distal femoral osteotomy was fixed using a 4.5 by 30-mm absorbable screw made of polyglycolide. No postoperative external support was used. The consolidation of the osteotomy was investigated histologically, morphometrically, and microradiographically in groups of 4 to 6 rabbits that were followed for 3, 6, 12, or 36 weeks. Fourteen osteotomies showed solid bony union; and in 3, several bone trabeculae were seen to bridge a still partially ununited osteotomy. In another 3 rabbits, each with a follow-up time of 12 or 36 weeks, no convincing signs of progressing consolidation could be seen. Only 1 of these rabbits showed displacement of the distal fragment.     

Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated

The aim of this study was to examine the results of minimally invasive plate osteosynthesis (MIPO) of the femoral shaft fracture in patients where intramedullary nailing is contraindicated and evaluate the proper number of the screws for stable fixation. This was a retrospective study of 36 closed femoral shaft fractures which underwent MIPO using a conventional 4.5 broad dynamic compression plate (DCP) with 14-18 holes fixed with three or four screws in the proximal and distal fragments. Thirty-three fractures had bony union in 21.0 weeks (range, 12-28 weeks), two had delayed union that required bone graft and union at 28 and 32 weeks. Malalignment occurred in five cases. Sixty-two fragments were fixed with three screws--40 in cluster and 22 in separated positions. Ten fragments were fixed with four screws--eight in cluster and two separated. Broken screws were found in three cases; all were in the group with three screws fixed in cluster group. MIPO of the femoral shaft fracture is an alternative treatment in the patient where intramedullary nailing is contraindicated. Malalignment is the common complication that must be carefully evaluated intraoperatively. We recommend using at least three separated screws in each fragment to reduce the risk of screw breakage.     

Comparison of the tissue response to absorbable self-reinforced polylactide screws and metallic screws in the fixation of cancellous bone osteotomies: An experimental study on the rabbit distal femur

The availability of absorbable fracture-fixation devices for clinical use calls for better knowledge of the reaction of bone tissue to absorbable polyester implants as compared with similar metallic devices. To examine and compare the tissue response to biodegradable and metallic screws within cancellous bone, a transverse transcondylar osteotomy of the distal femur was fixed with absorbable self-reinforced polylevolactide screws in 35 rabbits and with stainless-steel screws in 35 rabbits. New bone formation and consolidation of the osteotomy were examined histologically, histomorphometrically, and microradiographically within standardized sample fields 1,3,6,12,24,36, and 48 weeks postoperatively. The intact contralateral femur served as the control. A vigorous osteoconductive response to the polylevolactide screws was observed at 3 weeks postoperatively, and the osteoid surface fraction was significantly higher in all follow-ups than in the contralateral femora. In the femora with metallic screws, new bone formation was seen 3,6, and 12 weeks postoperatively, but at 24,36, and 48 weeks the osteoid surface fraction did not differ significantly from that of the intact control femora. The total bone area was significantly larger in the femora with self-reinforced polylevolactide screws than in the control bone 6-48 weeks postoperatively; in the femora with metallic screws, this was found only at 6 and 12 weeks. After 48 weeks, the femora fixed with metallic screws had statistically smaller total bone area than the intact control femora. Solid bone union was seen in 84% of the osteotomies in the self-reinforced polylevolactide group and in 76% of those in the metallic group after 3 weeks or more. No signs, of degradation of the self-reinforced polylevolactide implant and only a mild foreign-body reaction with no accumulations of inflammatory cells to either self-reinforced polylevolactide or metallic screws were observed during the follow-up period. Both types of screws seemed to induce an osteostimulatory response around their threads. This phenomenon was transient for metallic screws but lasted for at least 48 weeks for self-reinforced polylevolactide screws. The polylevolactide screw does not seem to cause osteopenia at the implantation site. The fixation properties of both self-reinforced polylevolactide screws and metallic screws appear to be sufficient for the fixation of small fragments of cancellous bone.