钛合金与不锈钢内固定材料置入修复脊柱结核的生物相容性

背景：钛合金和不锈钢是两种较为常用的内固定植入材料,但两种材料的治疗效果和生物相容性存在一定的差异。 目的：分析钛合金和不锈钢内固定材料置入治疗脊柱结核的效果及生物相容性。 方法：纳入脊柱结核患者71例,其中男35例,女36例,年龄17-81岁,35例进行钛合金内固定材料置入治疗,36例进行不锈钢内固定材料置入治疗。随访12个月,分析两组脊柱后凸畸形角度变化、治疗效果、Frankel脊髓损伤分级及材料生物相容性。 结果与结论：两组治疗前的脊柱后凸畸形角度、Frankel脊髓损伤分级比较差异无显著性意义,两组治疗后末次随访的脊柱后凸畸形角度、Frankel脊髓损伤分级均较治疗前明显改善(P < 0.05),但两组间比较差异无显著性意义;钛合金内固定组治愈34例(97%),不锈钢内固定组治愈33例(92%),两组间治愈率比较差异无显著性意义。两种材料均具有良好的生物相容性,未发生感染等不良反应。表明在脊柱结核治疗过程中,置入钛合金或不锈钢内固定材料均能获得良好的效果,并具有良好的生物相容性。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Sextant微创椎弓根螺钉内固定修复老年骨质疏松性脊柱骨折的生物相容性

BACKGROUND: Pedicle screw internal fixation is a commonly used method to treat osteoporotic fracture. Internal fixation can effectively reconstruct vertebral body height, restore physiological curvature, and maintain good spinal stability.     

可吸收螺钉与金属螺钉内固定修复踝关节骨折：生物相容性及踝关节功能比较

BACKGROUND: Previous ankle fracture surgery mainly uses the internal fixation materials such as metal screws or Kirschner wire, which can achieve a strong internal fixation, but all need to be taken out in the secondary surgery. In recent years, elastic modulus of biodegradable absorbable screw is identical to that of cancellous bone, and has been widely used in clinic.      

AO可塑形双钢板置入内固定修复老年肱骨远端骨折：效果的影响因素分析

背景：老年肱骨远端骨折的临床治疗包括保守治疗、外展支架和切开复位植入物内固定治疗,切开复位内固定方法繁多,效果评价不一,给临床治疗带来较大困难。 目的：探讨切开复位AO可塑形双钢板置入内固定修复老年肱骨远端骨折的疗效及影响因素,旨在提供最佳修复模式。 方法：纳入2009年6月至2013年6月陕西省中医学院附属医院收治的老年肱骨远端骨折切开复位内固定患者114例,采用AO可塑形双钢板置入内固定。应用自行设计的调查问卷对患者肘关节恢复效果和可能影响因素进行调查,以卡方检验和多因素Logistic回归分析对可能影响因素进行分析。 结果与结论：在114例患者中肘关节功能恢复优良85例,优良率为75%。单因素分析显示,患者在不同骨折类型、AO分型、是否合并神经损伤、血管损伤和并发症时的差异有显著性意义(P < 0.05)。多因素Logistic回归分析显示,骨折类型、AO分型和神经损伤是影响修复效果的主要因素(P < 0.05),即骨折类型为开放型、AO分型为C型、并且合并神经损伤者肘关节功能恢复更差。提示骨折类型、AO分型和神经损伤是影响切开复位AO可塑形双钢板置入内固定修复老年肱骨远端骨折效果的主要因素,应针对其影响因素进行相应干预。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     

肱骨远端骨折内固定的生物力学比较

目的：确定肱骨远端骨折最佳的固定方式。方法：用新鲜尸体肱骨远端髁上载骨后,不同标本分别应用交叉松质骨螺钉、后侧倒“Ｙ”形钢板、“Ｊ”形和１／３管形板及重建钢板内固定,生物力学测定方法为三点弯曲法,即前后弯曲及内外侧向弯曲时测定其强度。结果：又钢板平面相互垂直（内侧板置于心侧缘,外侧板置于后外侧）固定,是最坚固和稳定的固定方式（方差分析Ｐ〈０．０１）。结论：肱骨远端应用双钢板平面相互垂直固定,重建了     

比较不同方式置入椎弓根钉内固定修复胸腰椎爆裂骨折的生物相容性

BACKGROUND: During the repair of thoracolumbar fracture, pedicle screw fixation is a commonly used treatment method. In the process of fixation, the different approaches can be used.  OBJECTIVE: To compare effect and biocompatibility of pedicle screw by percutaneous approach, posterior median approach, and intervertebral space approach for thoracolumbar fracture.  METHODS: 118 cases of thoracolumbar fracture were included after pedicle screw fixation. All patients were divided into three groups according to the approach: posterior median approach group (38 cases), intervertebral space approach group (40 cases) and percutaneous approach group (40 cases). After 12 months of follow-up, perioperative conditions, pain score, vertebral height of anterior border, kyphosis correction effect, adverse events and biological compatibility were compared among three groups. RESULTS AND CONCLUSION: (1) Operation time, intraoperative bleeding and time in bed after surgery were shorter or less in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group. Postoperative drainage was better in percutaneous approach and intervertebral space approach groups than in the posterior median approach group (all P < 0.05). Except drainage in the percutaneous approach and intervertebral space approach groups, no significant difference in other indicators was found. (2) Patients received imaging examination at different time points. The percentage of anterior vertebral height and kyphosis were significantly improved immediately after treatment and in final follow-up (all P < 0.05). No significant difference was detected before treatment, immediately after treatment and in final follow-up. (3) Visual Analogue score was identical before treatment. Visual analogue score was lower in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group at 24 hours and 3 days after treatment and in final follow-up (all P < 0.05). No significant difference was detectable at 24 hours and 3 days after treatment and in final follow-up between the percutaneous approach and intervertebral space approach groups. (4) No rejection or wound non-healing was seen at 12 months after treatment. Some patients suffered from mild low back pain, which was improved by active symptomatic treatment. (5) These findings suggest that intervertebral space approach percutaneous approach obtained satisfactory outcomes compared with posterior median approach for treatment of thoracolumbar spine fractures, and good biocompatibility was found.        

两种锁定钢板置入内固定治疗老年肱骨近端骨折

背景：肱骨近端内固定锁定系统(proximal humeral internal locking system,PHILOS)和肱骨近端锁定钢板(locking proximal humerus plate,LPHP)均作为内固定锁定钢板,用于治疗肱骨近端骨折疗效显著,但目前尚不能肯定PHILOS和LPHP治疗老年肱骨近端骨折哪个更具优势？ 目的：探讨比较PHILOS和 LPHP这两种锁定板治疗老年肱骨近端骨折的近期疗效。 方法：回顾性分析具有完整随访资料的61例老年肱骨近端骨折患者,根据不同治疗方法分为LPHP治疗组(n=27)和PHILOS治疗组(n=34)。均根据Neer分类,LPHP组二部分骨折7例,三部分骨折11例,四部分骨折9例;PHILOS组二部分骨折9例,三部分骨折14例,四部分骨折11例。记录手术时间、出血量、引流量,观察骨折愈合时间、功能恢复、并发症,并进行统计学分析。 结果与结论：61例患者全部获得随访,随访时间12-36个月(平均20.6个月),PHILOS组和LPHP组手术时间、出血量、引流量,观察骨折愈合时间、功能恢复、并发症比较,差异并无显著性意义(P > 0.05)。PHILOS和LPHP治疗老年肱骨近端骨折均可获得良好的效果,随访1年时优良率分别为81.5%,82.4%;具有固定可靠、并发症少、满意率高等优点,两种锁定板目前具有较高的临床应用价值,是治疗移位和不稳定老年肱骨近端骨折有效的切开复位内置物。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：     

逆行交锁髓内钉与微创内固定钢板修复股骨远端骨折的生物力学性能比较

BACKGROUND: Distal femoral fractures are mainly treated with less invasive stabilization system (LISS) plate or retrograde interlocking intramedullary nail fixation, but choosing which method is controversial, and studies on their biomechanical properties are few.     

螺钉置入内固定修复后踝骨折的适应证

背景：累及到后踝的踝关节骨折多存在踝关节不稳定,若不恢复踝关节的稳定性,则后期容易出现创伤性踝关节炎。然而目前后踝骨折内固定的指征仍存争议。 目的：通过比较踝关节骨折中后踝骨折内固定与否的临床疗效差异,探讨后踝骨折切开复位内固定的适应证。 方法：重庆医科大学附属第一医院在2007年1月至2012年1月共收治42例累及后踝的踝关节骨折患者,将治疗前踝关节CT检查中后踝骨折块累及胫骨远端关节面大于10%,或/和移位大于2 mm的27例患者行后踝切开复位螺钉置入内固定治疗(后踝内固定组),将后踝骨折块累及胫骨远端关节面小于10%且移位小于 2 mm的15例患者的后踝行非手术治疗(后踝非内固定组)。治疗后随访两组骨折愈合时间、治疗后并发症及美国足踝外科协会踝与后足评分并进行比较。 结果与结论：42例患者的踝关节骨折均在随访6个月内获得骨性愈合。后踝内固定组中1例患者于治疗后出现踝关节内外侧伤口浅表感染,经抗感染治疗后伤口完全愈合。另外在两组中分别有1例患者治疗后出现伤口皮缘浅表坏死,经换药后伤口愈合。其余患者在随访中无伤口感染、内固定松动、断裂、失效等不良事件发生。根据美国足踝外科协会踝与后足评分标准对治疗后1年踝关节功能进行评价,后踝内固定组为(83.74±10.35)分,其中优10例,良12例,可5例,差0例,优良率为82%;后踝非内固定组为(85.60±10.40)分,其中优7例,良5例,可3例,差0例,优良率为80%,两组踝关节功能评分比较差异无显著性意义(P > 0.05)。提示可将后踝骨折块累及胫骨远端关节面大于10%,或/和移位大于2 mm作为踝关节骨折中后踝内固定的适应证。 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：     

克氏针与钢板置入内固定修复老年桡骨远端骨折安全及有效性的Meta分析

BACKGROUND: There are many ways for surgical treatment of distal radius fractures. Both volar locking plates and Kirschner wires are common methods. Doctors have considerable flexibility in the choice of the ways of fixation, but both at home and abroad there is no comparison between the effects of the two operations for treating distal radius fractures. OBJECTIVE: To systematically review the differences in effectiveness and safety of volar locking plates versus Kirschner wires for distal radial fracture. METHODS: Databases such as CBM, CNKI, VIP, PubMed and Cochrane Library were electronically searched. Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, Chinese Journal of Trauma and Journal of Practical Orthopaedics were searched by hand. In strict accordance with inclusion and exclusion criteria, articles were screened. Methodological quality of included studies was evaluated according to Cochrane Handbook. Data were extracted, and then analyzed with RevMan 5.2 software. RESULTS AND CONCLUSION: Nine randomized controlled trials were included. Meta-analysis results demonstrated that upper limb function scores were better in the volar locking plate group than in the Kirschner wire group [MD= -4.55(-7.89, -1.21), P=0.008] at 3 months of follow-up and [MD= -3.13(-6.08, -0.18), P=0.004] at 12 months. The incidence of infection was lower in the volar locking plate group than in the Kirschner wire group [OR= 0.42(0.23, 0.79), P=0.007]. No significant difference in incidence of complex regional pain syndrome [OR=0.28(0.05, 1.38), P=0.12], incidence of carpal tunnel syndrome [OR=0.75(0.20, 2.76), P=0.66] and tendon injury [OR= 1.66(0.51, 5.41), P=0.64] was detected between the volar locking plate group and Kirschner wire group. These results indicated that compared with the Kirschner wire, volar locking plate fixation for the repair of distal radial fracture is safe and effective. In the permission of economic circumstances, it is suggested that elder osteoporosis patients with distal radial fracture should receive plate fixation.       

羟基磷灰石涂层钛合金材料生物相容性研究初探

目的探讨一种新型的代骨材料--羟基磷灰石涂层的钛合金材料的生物相容性。方法制备羟基磷灰石涂层钛合金材料浸提液后,采用细胞毒性实验以观察实验样品浸提液对L929小鼠成纤维细胞的毒性反应;通过对小鼠尾静脉及腹腔注射试验样品浸提液后,观察其对小鼠的急性全身毒性反应;Ames实验及迟发型超敏反应实验对其遗传毒性及致敏性进行安全性评价。结果羟基磷灰石涂层钛合金材料浸提液对L929小鼠成纤维细胞的相对增殖率(RGR)为96.9%,细胞毒性反应为1级,无细胞毒性反应;对小鼠亦无明显的急性全身毒性作用,实验样品组与阴性对照组动物体质量差异无统计学意义(P0.05);遗传毒性Ames实验表明,在活化与非活化条件下,该材料浸提液对鼠伤寒沙门氏菌株的回变菌落数与对照组比均未增加2倍,对该菌株无诱变性;迟发型超敏反应实验显示,该材料浸提液无潜在的皮肤接触致敏性。结论羟基磷灰石涂层的钛合金材料具有良好的生物相容性。     

金属植入物固定与修复新鲜不稳定型桡骨远端骨折合并腕舟状骨骨折：半年随访

BACKGROUND: Healing time and plaster used in fixed position and fixed time are different between distal radius fractures and scaphoid fracture. When both fractures occur simultaneously, you cannot choose a fixed position and determine a fixed time. One-stage internal fixation for the distal radial fractures and scaphoid fractures simultaneously can obtain a good function.  OBJECTIVE: To retrospectively analyze the effects of titanium locking compression plate and Herbert screw fixation for fresh unstable distal radial fractures with scaphoid fracture. METHODS: A total of 12 patients with fresh unstable distal radial fractures combined with scaphoid fracture were treated in the Shanxi Dayi Hospital from November 2011 to June 2014. All cases received open reduction and locking compression plate fixation of the distal radius, open reduction of scaphoid fracture or percutaneous Herbert screw fixation. Fracture healing was observed during follow-up. At 6 months after treatment, wrist joint function was evaluated with modified McBride score. Range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength were measured. The distal radial shortening (difference in height of styloid process of radius and ulna), and angles of ulnar deviation and palmar tilt were measured with X-ray films. The data of healthy side and affected side were compared. RESULTS AND CONCLUSION: (1) 12 cases were followed up for 6-24 months. (2) The distal radius and scaphoid fractures healed. The healing time of distal radius was 6-12 weeks, with an average of seven weeks. Healing time of scaphoid fracture was 3-6 months, with an average of 4.2 months. (3) Wrist score was evaluated using modified McBride scoring criteria at 6 months after treatment. There were excellent in 5 cases, good in 6 cases, and average in 1 case, with the excellent and good rate of 92%. (4) No significant difference in range of motion of palmar flexion, dorsiflexion, ulnar deviation, radial deviation, pronation and supination and grip strength, angles of ulnar deviation and palmar tilt, difference in height of styloid process of radius and ulna and modified McBride score was detected between healthy side and affected side (P > 0.05). (5) The median nerve injury in two patients was recovered within 6 months after postoperative exploration decompression. No complications appeared, such as infection, dorsal muscle tendon irritation symptoms, carpal tunnel syndrome, and internal fixation failure. (6) These findings confirm that fresh unstable distal radial fractures with scaphoid fractures can be treated with open reduction of the distal radius and locking plate fixation, open reduction of scaphoid bone or percutaneous Herbert screw fixation, with reliable fixation, high fracture healing rate, and good wrist function recovery rate; the repair effect is satisfactory.      

纯钛种植体表面微弧氧化涂层的生物相容性

背景：各种纯钛种植体表面微弧氧化涂层效果不尽相同。 目的：观察3种不同微弧氧化涂层种植体钛片对小鼠成骨细胞的细胞增殖、碱性磷酸酶活性和β1-integrin的基因表达水平的影响。 方法：采用国际常用小鼠成骨细胞系(MC3T3-E1),3种不同涂层钛片作为影响因素,纯钛作为对照,采用MTT法和电镜法观察细胞附着和细胞增殖,PNPP法测定碱性磷酸酶的活性,RT-PCR法检测β1-integrin在小鼠成骨细胞中的表达。 结果与结论：MTT值、碱性磷酸酶值、β1-integrin的基因表达水平和电镜观察均显示含钙、磷、镁、锌元素的二氧化钛涂层钛片生物相容性最好,含钙磷盐的二氧化钛涂层钛片次之,二氧化钛涂层钛片最差。小鼠成骨细胞在其多孔,含有钙、磷、镁、锌元素表面的黏附及增殖最优。     

Biocompatibility of corrosion-resistant zeolite coatings for titanium alloy biomedical implants

Titanium alloy, Ti6Al4V, is widely used in dental and orthopedic implants. Despite its excellent biocompatibility, Ti6Al4V releases toxic Al and V ions into the surrounding tissue after implantation. In addition, the elastic modulus of Ti6Al4V (～110 GPa) is significantly higher than that of bone (10–40 GPa), leading to a modulus mismatch and consequently implant loosening and deosteointegration. Zeolite coatings are proposed to prevent the release of the toxic ions into human tissue and enhance osteointegration by matching the mechanical properties of bone. Zeolite MFI coatings are successfully synthesized on commercially pure titanium and Ti6Al4V for the first time. The coating shows excellent adhesion by incorporating titanium from the substrate within the zeolite framework. Higher corrosion resistance than the bare titanium alloy is observed in 0.856 M NaCl solution at pHs of 7.0 and 1.0. Zeolite coatings eliminate the release of cytotoxic Al and V ions over a 7 day period. Pluripotent mouse embryonic stem cells show higher adhesion and cell proliferation on the three-dimensional zeolite microstructure surface compared with a two-dimensional glass surface, indicating that the zeolite coatings are highly biocompatible.     

肱骨远端解剖型锁定接骨板治疗老年肱骨远端骨折

目的　探讨肱骨远端解剖型锁定接骨板（DHP）治疗老年肱骨远端骨折的治疗方法及疗效。 方法　 2007年7月~2010年2月,采用切开复位DHP内固定治疗老年肱骨远端骨折30例,其中男12例,女18例;年龄60～80岁,平均72 岁,骨折按AO分型：A型 1 例,B型 7 例,C1型 5 例,C2型 　10 例,C3型 7 例。均采用DHP固定,术后第3d开始功能锻炼,所有患者按照Mayo肘关节功能评分评估疗效。 结果　24例患者获得11～30个月（平均 17 个月）随诊。骨折均获愈合。肘关节平均屈、伸(78±17.08)°（10°～135°）：屈曲(102±11.35)° （90°～135°）、伸直(20±8.20)°（0°～60°）。Mayo评分平均85.3分（60～100分）,其中优 11例,良 10 例,可 2 例,差 1 例,优良率为87.5%。3例出现暂时性尺神经麻痹,3例出现创伤性关节炎表现,1例骨折延迟愈合导致肘关节僵硬,2例发生异位骨化,3例发生轻度肘关节内翻畸形。 结论　DHP内固定治疗老年肱骨远端骨折能达到满意的稳定固定,允许早期功能锻炼,在骨折愈合及功能恢复方面取得满意效果。     

新型含铜钛合金的生物相容性

背景：为提高钛材料的抗菌性及生物相容性,前期研究制备了铜钛合金材料。目的：参照GB/T16886-ISO10993所规定的原则和实验方法对铜钛合金进行较为全面、系统的生物相容性评价。方法：根据预实验结果,选择含铜量10%的铜钛合金材料,通过口腔黏膜刺激实验、皮肤刺激实验、短期全身毒性实验、溶血实验、血浆复钙时间实验、凝血酶原时间实验及动态凝血实验验证铜钛合金的生物相容性。结果与结论：铜钛合金材料无口腔黏膜刺激性、无短期全身毒性、无溶血性、无皮肤致敏反应,具有良好的血液相容性。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

跨腕关节钢板治疗桡骨远端粉碎骨折

目的探讨跨腕关节钢板在治疗桡骨远端粉碎骨折中的应用及临床治疗效果。方法 2007年3月～2008年10月采用跨腕关节钢板治疗桡骨远端粉碎骨折16例。男11例,女5例。年龄21～56岁,平均40.3岁。按AO分类,C2型4例,C3型12例。采用背侧跨腕关节钢板固定的方法治疗桡骨远端粉碎骨折。从掌倾角、尺偏角、桡骨茎突长度、关节面台阶方面对桡骨远端影像学进行评估。采用Jakim评分对腕关节功能进行评估。结果所有患者均获得随访,随访时间12～18个月,平均14.3月。掌倾角由术前-10.69°±19.43°改善至术后8.125°±4.72°,尺偏角由术前7.125°±9.025°改善至术后20.500°±4.097°,桡骨茎突长度由术前(4.731±3.597)mm改善至术后(11.931±1.514)mm,关节面台阶由术前(4.294±1.594)mm改善至术后(0.563±0.550)mm。根据Jakim评分标准,优7例,良6例,可1例,差2例。结论跨腕关节钢板治疗桡骨远端粉碎骨折,特别是累及干骺端和骨干的桡骨远端粉碎骨折时,是一种较为有效的方法 。     

解剖型接骨板治疗肱骨远端粉碎性骨折

目的评估成人肱骨远端粉碎骨折使用新型解剖型接骨板内固定的手术方法及疗效。方法回顾分析本院2006年9月~2010年1月成人肱骨远端复杂粉碎性骨折37例,骨折按AO∕ASIF分型法分型均为C型,其中C1型21例,C2型9例,C3型7例。经肱三头肌双侧入路或尺骨鹰嘴V形截骨入路,采用肱骨远端解剖接骨板内固定,术后早期积极功能锻炼。结果全部患者获得随访,时间6~31个月,平均14个月。骨折全部获得愈合。参照MEPS评分系统进行肘关节功能评定:优23例,良10例,可3例,差1例,优良率89.2%。结论采用双侧解剖型接骨板治疗肱骨远端粉碎性骨折,能获得坚强固定,有利于早期肘关节功能锻炼从而获得优良治疗效果。