髋臼后壁骨折对髋臼与股骨头之间应力的影响

目的　评价髋臼后壁骨折对髋臼与股骨头之间应力的影响。　方法　 6具完整骨盆及近侧 1 3股骨标本 ,用夹具将其固定于单足站立骨盆中立位 ,在LDS - 5 0 0试验机上加载至体重的 5 6,维持 2min。用压敏片依次测量完整髋臼、后壁 1 3 ,2 3 ,3 3骨折时髋臼前壁、后壁和负重顶区的应力和应力分布变化。　结果　后壁骨折使负重顶区的平均应力显著增加 (P <0 .0 1) ,后壁完整时为 ( 1.0 9± 0 .3 1)MPa,1 3骨折时为 ( 1.5 0± 0 .3 7)MPa ,2 3骨折时为 ( 1.67± 0 .2 1)MPa ,3 3骨折时为 ( 1.72± 0 .3 2 )MPa ;而使前壁的平均应力显著减少 (P <0 .0 1) ,完整时为 ( 1.95±0 .4 5 )MPa ,1 3骨折时为 ( 1.4 3± 0 .5 0 )MPa,2 3骨折时为 ( 1.3 4± 0 .5 2 )MPa ,3 3骨折时为 ( 1.4 0±0 .61)MPa ;对残余后壁的平均应力影响不大。　结论　后壁骨折显著改变了髋臼与股骨头之间的应力和应力分布 ;后壁 1 3骨折时影响率最大 ;变化最显著的部位是负重顶区     

不同钢板内固定方式治疗髋臼横行骨折的生物力学分析

目的对不同钢板内固定方式治疗髋臼横行骨折的生物力学进行研究。方法将60具新鲜成人半骨盆标本制成髋臼横行骨折模型并随机分成A、B、C、D、E五组,每组各12具标本。采取前柱锁定重建板对A组标本进行固定,后柱锁定重建板对B组标本进行固定,前柱锁定重建板联合后柱拉力螺钉对C组标本进行固定,前柱拉力螺钉联合后柱锁定重建板对D组标本进行固定,双柱拉力螺钉对E组标本进行固定。各组标本在生物力学试验机的作用下分别接受600、1200、1800N载荷,测定各组标本骨折端水平位移及纵向位移距离,计算轴向刚度。结果 C、D、E组标本水平位移、纵向位移距离均显著小于A、B组,差异具有统计学意义(P0.05);C、D、E组轴向刚度均显著大于A、B组,差异具有统计学意义(P0.05);A组标本水平位移、纵向位移距离均显著小于B组,差异具有统计学意义(P0.05);轴向刚度显著大于B组,差异具有统计学意义(P0.05);C、D、E组间各指标相比,差异无统计学意义(P0.05)。结论髋臼横行骨折采取双柱固定所获得的稳定性高于单柱固定方式,而不同双柱固定方法所获得的稳定性接近。     

新型动力化前路方形区钛板螺钉系统在不同置钉方法下固定髋臼骨折的有限元比较

目的 采用三维有限元分析法研究新型动力化前路方形区钛板螺钉系统(DAPSQ)固定髋臼高位双柱骨折的生物力学特点,并比较其在不同方形区螺钉置钉方法 下的生物力学稳定性.方法 应用1例成年男性志愿者骨盆CT图像构建左侧髋臼高位双柱骨折的全骨盆有限元模型,并采用新型动力化前路方形区钛板螺钉系统固定.分别构建DAPSQ联合单方形区螺钉(A组)、双方形区螺钉(B组)、三方形区螺钉(C组)和四方形区螺钉(D组)固定模型,施加600 N垂直载荷或8N/m扭矩,模拟骨盆站位、坐位、站位+健侧旋转和站位+患侧旋转,比较各组内固定方法 下骨折线平均位移和内固定应力分布情况.结果 在站位、坐位、健侧旋转和患侧旋转4种工况下,方形区骨折线路径上各节点平均位移表现为A组>B组>C组>D组,组间比较显示D组位移显著低于A组和B组(P<0.05),C组和D组比较差异无统计学意义(P>0.05).应力分析结果 显示,站位和坐位下D组应力主要集中在钛板螺钉结合处,以近端第1枚方形区螺钉承担应力最大.结论 新型动力化前路方形区钛板螺钉系统固定髋臼高位双柱骨折的生物力学性能可靠,推荐在方形区应至少置入3或4枚螺钉进行固定,且靠近坐骨大切迹的方形区螺钉为关键钉.     

前路钛板加方形区螺钉治疗髋臼双柱骨折的坐位生物力学分析

目的探讨前路钛板加方形区螺钉治疗髋臼双柱骨折早期取坐位的可能性。方法取成年防腐保湿处理的全骨盆标本6具,保留韧带及髋关节囊,制作单侧髋臼高位双柱骨折模型,随机先后采用前路钛板加方形区螺钉(B组)或常规钛板加1/3管型钛板(C组)内固定,固定标本于ZWICKZ100电子万能材料试验机上,模拟坐立位以400～700N加载,采用循环多次测量的方法,每组含标本6具,先后测定完整骨盆(A组)、B组及C组后柱内壁横向位移、骨盆轴向位移,计算骨盆轴向刚度。结果随着载荷增加,位移:A组0.05),骨盆轴向位移及刚度有统计学差异(P<0.01)。结论前路钛板加方形区螺钉(B组)与常规钛板加1/3管型钛板(C组)固定髋臼双柱骨折术后均可取坐位,但前路钛板加方形区螺钉固定后骨盆髋关节稳定性更强,与完整骨盆接近,早期取坐位是更安全和可靠的。     

自体髂骨解剖性重建髋臼后壁缺损的生物力学与临床研究

目的 为严重粉碎性与陈旧性髋臼后壁骨折的重建提供一种新方法.方法 (1)生物力学研究:从稳定性及头臼应力分布两个方面进行研究.6具成人新鲜骨盆股骨标本左右侧两两对应分为实验组与对照组,造成髋臼缺损模型后,实验组用髋臼三维记忆内固定系统(acetabular three dimensional memory fixation system,ATMFS)解剖性重建缺损髋臼;对照组用钢板螺钉系统重新复位固定髋臼骨块.比较两组加载状态下在经度及纬度方向的位移,分析解剖性髋臼后壁重建的稳定性;利用压敏片计算并比较两组头臼对应面积,髋臼前壁、臼顶、后壁的平均压强与最大压强,分析解剖性髋臼后壁重建后的头臼匹配性.(2)临床研究:髋臼后壁解剖性重建:取与髋臼直径相同的髋臼锉,从髂嵴内缘旋锉形成解剖性弧面,髂嵴外缘相当于臼壁唇缘.将凿取的髂骨块用ATMFS三维锁定修复后壁缺损.2000年1月-2002年6月,共用此法治疗10例男性患者,年龄16～50岁,平均36.4岁,其中新鲜髋臼骨折7例,陈旧性髋臼骨折3例.后者从骨折至重建术的时间为58～251 d,平均137.7 d.随访平均5.8年(5.2～7.1年).结果 (1)生物力学研究:实验组与对照组相比,重建后的稳定性与头臼匹配性差异无统计学意义.(2)临床研究:全部患者术后X线片未发现骨折有再移位,下床负重时间为1.6个月(1.2～2.1个月).异位骨化2例,未影响关节功能活动.按照Modified d'Aubigne and Postal临床分级标准,优良率93 %.结论 利用ATMFS进行自体髂骨解剖性髋臼后壁重建具有良好的稳定性及头臼应力分布,临床应用疗效优良,为髋臼后壁严重粉碎与陈旧性骨折的治疗提供了一种新方法.     

髋臼上方水平钢板结合排筏螺钉内固定治疗合并臼顶压缩老年髋臼骨折的疗效

目的比较髋臼上方水平钢板结合排筏螺钉与单纯螺钉内固定治疗合并臼顶压缩老年髋臼骨折的疗效。方法采用回顾性队列研究分析2013年5月至2023年1月天津市天津医院收治的20例合并臼顶压缩老年髋臼骨折患者的临床资料, 其中男5例, 女15例;年龄61～84岁[(72.2±7.3)岁]。根据Letournel & Judet分型:前柱骨折13例, 前柱伴后方横行骨折5例, 双柱骨折2例。患者均行前方入路切开复位内固定治疗, 其中11例采用髋臼上方水平钢板结合排筏螺钉固定(钢板+排筏螺钉组), 9例采用单纯螺钉固定(单纯螺钉组)。比较两组手术时间、术中出血量、术中透视次数;术后3 d采用Matta影像学标准评估骨折复位质量;术后3个月及末次随访时采用Merle D′Aubigné-Postel评分系统评价患侧髋关节功能并比较末次随访时优良率;观察术后并发症发生情况。结果患者均获随访6～18个月[(13.1±3.1)个月]。两组手术时间、术中出血量及术中透视次数比较, 差异均无统计学意义(P>0.05)。术后3 d Matta影像学标准:钢板+排筏螺钉组解剖复位6例, 满意复位5例,...     

Starr架辅助复位INFIX与前柱螺钉内固定治疗不稳定骨盆骨折临床比较分析

目的应用Starr复位架经皮复位、骨盆前环皮下钉棒系统(INFIX)与前柱拉力螺钉固定治疗Tile B/C型骨盆骨折,比较疗效并探讨操作技巧。方法回顾性分析比较2016年4月—2017年6月广西医科大学附属第四医院收治的35例Tile B/C型骨盆骨折患者,其中B1型4例,B2型10例,B3型5例,C1型10例,C2型6例;男性16例,女性19例;年龄22～66岁,平均42岁。前环损伤采用INFIX内固定系统固定19例(INFIX组),采用前柱螺钉固定16例(前柱螺钉组)。骨盆后环损伤均采用骶髂关节螺钉固定。记录各组Starr架复位时间、前环内固定置入时间、透视次数等,按Matta标准评定骨盆骨折复位质量,功能评分采用Majeed功能评分量表。结果两组患者Starr架复位时间分别为(30. 3±11. 2) min、(34. 4±5. 9) min;INFIX组内固定置入时间(25. 4±2. 1) min,前柱螺钉组(38. 0±4. 2) min,差异无统计学意义。两组透视次数分别为(30. 2±3. 5)次、(26. 1±9. 2)次,差异有统计学意义。Matta标准评定骨折复位结果显示INFIX组优10例,良8例,差1例;前柱螺钉组优9例,良6例,差1例。Majeed功能评分显示INFIX组优8例,良11例;前柱螺钉组优10例,良6例。两组骨折复位及功能评分结果比较,差异无统计学意义。结论 Starr复位架辅助复位灵活可靠,INFIX或前柱螺钉固定治疗Tile B/C型骨盆骨折操作简便、疗效确切;经皮复位微创螺钉置入技术具有明显临床优势及广阔应用前景。     

经动脉灌注脂肪乳剂顺铂混合液行犬胰腺癌局部化疗的研究

目的 探讨经动脉灌注脂肪乳顺铂混合液,行胰腺局部灌注化疗治疗胰腺癌的效果及作用机制.方法 24只健康杂种犬,按随机表法分为A、B、C、D组,每组6只.4组顺铂用量均为4 mg/kg.A、B组以20%脂肪乳为溶剂,配制成顺铂-脂肪乳混合液,A组用量为2 ml/kg、B组用量为1 ml/kg;C、D组以生理盐水为溶剂,配制成顺铂-生理盐水溶液,C组用量为2 ml/kg、D组为1 ml/kg.置管至实验动物脾动脉开口部,根据各组的用药标准,分别将配制好的药物经动脉灌注到胰腺肿瘤区.分别于给药后即刻及3、5、10、20、30、40、50、60 min采集外周静脉血,60 min后取胰腺、胰周和肝、肾、脾等组织,测定血液和组织匀浆内顺铂的浓度,计算实验犬血液的时间-药物浓度曲线下面积(AUC)、初始药物浓度(C0)及生物半衰期(t1/2),并观察组织病理改变.组织染色采用HE染色.4组AUC、C0、t1/2间比较,采用方差分析,组间两两比较采用q检验;A、B组组织中顺铂浓度的比较用成组t检验,数据方差不齐时采用t'检验.结果 AUC、C0、t1/2在A组分别为(54.5±10.1)%、(2.6±0.5)mg/L、(16.7±3.6)min,B组分别为(18.3±6.0)%、(1.5±0.2)mg/L、(47.9±11.1)min,C组分别为(116.7±20.6)%、(6.5±0.4)mg/L、(10.5±2.8)min,D组分别为(126.6±30.7)%、(5.5±0.4)mg/L、(10.1±3.1)min,4组间比较差异有统计学意义(AUC、C0、t1/2的F值分别为42.42、249.61、12.48,P值均<0.01).A、B组的AUC和C0明显低于C、D组(A组与C组、B组与D组比较AUC,t值分别为6.64、8.49,比较C0的t值分别为16.34、22.30,P值均<0.01),t1/2明显长于C、D组(A组与C组、B组与D组比较,t值分别为3.36、3.71,P值均<0.01));B组的AUC、C0明显低于A组(t值分别为7.57、5.48,P值均<0.01),t1/2长于A组(t值为3.22,P<0.05).B组的胰左叶、胰腺角中顺铂含量较A组增高[B组分别为0.18、0.18 mg/L,A组分别为0.05、0.05 mg/L],差异有统计学意义(t值分别为2.52、2.73,P值均<0.05);胰腺右叶和脾脏组织中的顺铂浓度两组比较差异无统计学意义[B组分别为0.11、0.29 mg/L,A组分别为0.07、0.24 mg/L,P值均>0.05].病理检查所见:A、B组犬胰腺、胰周淋巴结、肝脏、脾脏有少量炎细胞浸润及血管扩张充血,血管内可见脂肪乳颗粒.其余组织及C、D组病理检查未见异常.结论 脂肪乳作为溶剂可使顺铂在胰腺的浓度显著增高、进入血循环的药物总量减少.进入组织的药物量与脂肪乳内所含顺铂的浓度有关,浓度越高,进入组织内的药物越多.     

螺旋CT经动脉门脉造影扫描时间窗的临床研究--造影剂注射速率对螺旋CTAP动态增强的影响

目的　研究造影剂注射速率对螺旋CTAP动态增强的影响 ,寻找适宜的注射速率。方法　 3 2例肝癌患者分成四组。经肠系膜上动脉注入浓度为 2 2 5mg/ml的泛影萄胺 80ml ,注射速率分别为A :3 .0ml/s ;B :2 .5ml/s ;C :2 .0ml/s ;D :1.5ml/s ,选一固定层面作 2 5次单层动态扫描 ,间隔时间 3s。测定每幅图像上肝实质和肿瘤的CT值 ,分别画出时间—密度曲线。分析肝实质和肿瘤动态增强特征。结果　①四组肝实质增强峰值时间 (s)分别为A :3 4.6± 5 .4;B :3 7.2± 4.2 ;C :3 9.1± 3 .8;D :49.7± 5 .1。A、B、C之间无显著性差异 (Ρ >0 .0 5 ) ,A、B、C与D之间有显著性差异 (Ρ <0 .0 1)。②四组肝实质增强峰值 (HU )分别为A :187.5± 13 .1;B :183 .8± 11.2 ;C :178.4± 7.8;D :165 .3± 8.9。A、B、C之间无显著性差异 (Ρ >0 .0 5 ) ,A、B、C与D之间有显著性差异 (Ρ <0 .0 1)。③四组肿瘤均无明显增强。结论　当造影剂用 2 2 5mg/ml的泛影萄胺 80ml时 ,①采用 2 .0～ 3 .0ml/s注射速率优于 1.5ml/s。②在造影剂 2 .0～ 3 .0ml/s注射速率范围内 ,螺旋CTAP增强特征与速率无关。因此选用 2 .0ml/s注射速率为佳     

颈椎柔性稳定一体化系统对维持犬颈椎间隙高度作用的研究

目的 评估人工髓核柔性稳定一体化系统对维持犬颈椎椎间隙高度的作用.方法 选择健康杂种犬40只,分成4个试验组:完整组(A组)、颈椎间盘病变组(B组)、钢板内固定组(C组)、柔性稳定组(D组).颈椎间盘病变组(B组)、钢板内固定组(C组)和柔性稳定组(D组)分别经前路行C3/4髓核摘除术、钢板内固定术、柔性稳定一体化系统...     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.