Biomechanical analysis of femoral neck system in unstable femoral neck fractures北大核心

BACKGROUND: The femoral neck system is a novel fixation device for unstable femoral neck fractures. OBJECTIVE: To compare and analyze the mechanical stability of three kinds of internal fixation in Pauwels III unstable femoral neck fractures by finite element method. METHODS: On the basis of the validated femoral finite element model (intact group), the model was cut to make a Pauwels III 70° unstable fracture of the femoral neck. Different internal fixation models were implanted to simulate clinical surgery. This study established femoral neck system fixation (model A), inverted triangular cannulated screw fixation (model B) and 4 diamond-shaped cannulated screw fixation (model C). All the nodes under the distal end of the femur were restrained for the three groups of models, and 700 N, 1 400 N and 2 100 N compressive loads were applied to the femoral head. Through calculation and analysis, the Von Mises stress distribution and deformation of each group of models were observed, and the mechanical stability of each group of models was compared. RESULTS AND CONCLUSION: (1) The maximum deformation of the three groups of models under various loads occurred in the femoral head. When compressed for 2 100 N, the deformation of model A was 2.06 mm less than that of intact group 2.17 mm, while the deformations of model B and model C were both higher than that of intact group, with the distributions of 2.39 mm and 2.33 mm. (2) Under various loads, the stress in model A group was also the smallest. Under 2 100 N, the stress peak in model A was 297.31 MPa, distributed at the joint position of anti-rotation screw and locking screw, while the stress peak in model B was 543.18 MPa, distributed at the fracture joint position of the third screw in the inverted triangle. However, the deformation and stress of model C were intermediate between model A and model B, and the maximum stress peak value was distributed at the bottom hollow of the cannulated screw fracture, reaching 315.61 MPa at 2 100 N. (3) The compressive stiffness and stress analysis of models of the three groups showed that model A < model C < model B. (4) It is concluded that the mechanical stability of femoral neck system for femoral neck fracture is better than that of three and four cannulated screws fixation, and it can effectively prevent femoral neck shortening. Femoral neck system is a recommended internal fixation method for unstable femoral neck fractures. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

20 W微波照射骨骼肌卫星细胞的增殖与分化：兔骨折内固定模型研究

BACKGROUND:Low power microwave irradiation has been shown to promote the healing of fractures with internal fixation; however, its action mechanisms on the skeletal muscle around the fracture site are unclear. OBJECTIVE:To study the effects of low power microwave irradiation (20 W) on the proliferation ability of skeletal muscle satellite cells in a rabbit model of femoral fracture with internal fixation. METHODS:Forty male New Zealand rabbits were used to establish femoral fracture followed by internal fixation models, and then were equally randomized into spontaneous recovery and microwave treatment groups. Low power microwave irradiation (20 W) was given for 30 consecutive days in the microwave treatment group on day 4 after modeling, while no microwave irradiation was given in the spontaneous recovery group. Rabbit thigh muscles adjacent to the implant were obtained to isolate skeletal muscle satellite cells. Immunohistochemical staining, hematoxylin-eosin staining and quantitative RT-PCR were used to evaluate the ability of the proliferation and differentiation of skeletal muscle satellite cells. RESULTS AND CONCLUSON: Hematoxylin-eosin staining showed that there was no significant difference in the morphology and histology of skeletal muscle tissues between the spontaneous recovery and microwave treatment groups. However, the relative mRNA expression of MyoG in the cultured skeletal muscle satellite cells in vitro and the number of α-sarcometric actin-postive cells in the microwave treatment group were significantly increased compared with the spontaneous recovery group (P < 0.05). The proliferative ability of skeletal muscle satellite cells was inhibited at the early stage, but not at the later stage. Our results suggest that low power microwave irradiation (20 W) can promote the proliferation and differentiation of skeletal muscle satellite cells around the implant in a rabbit model of femoral fracture with internal fixation, and thereby confirm the efficacy and safety of low power microwave irradiation for the internal fixation of fractures. 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     

成人股骨颈的最小横截面积及其临床意义

ObjectiveTo provide anatomical basis for improving the treatment of femoral neck fracture.MethodsForty healthy adult with different heights were selectd randomly (male 20,female 20).After measuring the height,their right hips were scanned with CT and the mini-cross sectional area of femoral neck was detected.Then,the linear regression equation of height to the mini-cross sectional area of femoral neck was concluded.ResultsThere was a positive linear correlation between the mini-cross sectional area of femoral neck and height.The linear regression equation was y=-1144.60±11.25x.ConclusionsThere was difference in size of femoral neck.In fixation of femoral neck fracture,the smaller volume of implant should be chosen based on ensuring the fixation strength.     

动态套筒式三翼钉固定不同角度PMMA股骨颈骨折的生物力学研究

Objective To explore the biomechanical stability of dynamic sleeve three-wing screw for treatment of femoral neck fracture and to provide theoretical basis for choosing the screw in clinical application.Methods Nine artificial PMMA femoral model were prepared and divided randomly into three groups (n=3),and the specimens were saw up with a hand saw at Pauwels angle of 30° ,50° and 70° in the central neck ,respectively and then fixed with dynamic sleeve three-wing screw.Specimens were fixed at simulated uniped standing position at Instron-8874 servo-hydraulic mechanical testing machine.Linear load of 0～1 200 N was loaded at the rate of 10 mm/min and strains at 11 key points under 1 200 N load were measured,as well as head sink displacement and the strain at principal pressure side and principal tension side under different loads.Results Strengthening peaks were observed at the number six resistance strain gage under the 1 200 N load in all tree groups,and the numerical difference of the three groups was statistically significant(P＜0.01).Under the load of 600～1 200 N,head sink displacement compare were performed in each two of the three groups under the same load,respectively,and showed statistically significant difference(P＜0.01) ;the strain of principal pressure side and principal tension side of the femoral neck was higher with the increasing Pauwels angle under the same load,the difference was significant(P＜0.01).Conclusion With the increasing Pauwel's angle,the shearing force was greater,the contact area of fracture line was smaller,and the fracture was more unstable;in contrast,the shearing force was smaller with the Pauwel's angle smaller,the contact area of fracture line was larger,and the fracture was more stable.     

基于3D打印股骨远端骨折标准件库接骨板的数字化内固定

BACKGROUND: On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fully meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE: To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtually. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during follow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. All patients were followed up. According to Schagzker criterion, the efficiency of 22 cases was excellent, 6 cases good and 2 cases average, and the excellent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via 3D printing navigation module is expected to achieve implant navigation and application.   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     

早期激素性股骨头坏死过程中细胞色素c的作用

BACKGROUND: Studies have shown that apoptosis is closely related to the pathogenesis of steroid-induced femoral head necrosis. The release of cytochrome c plays a very important role in the process of apoptosis. OBJECTIVE: To observe the effects of cytochrome c on early steroid-induced femoral head necrosis. METHODS: Twenty-four healthy adult male New Zealand rabbits at 5 months old were randomly divided into model group and control group (n=12 per group). Models of early steroid-induced femoral head necrosis were established by intragluteal injection of hormone combined with ear vein injection of horse serum. In the control group, rabbits were given ear vein injection of the same amount of physiological saline. At 2, 4 and 6 weeks after model establishment, histopathological changes of bilateral femoral head were observed by optical microscope, and the ratio of empty lacuna was calculated. Apoptosis of osteocytes was determined by TUNEL assay, and apoptotic index was calculated. Immunohistochemical method was used to determine cytochrome c and to calculate cytochrome c-positive expression rate. RESULTS AND CONCLUSION: (1) The ratio of empty lacuna and apoptotic index: The model of early steroid-induced femoral head necrosis was successfully established in the experiment. Compared with the control group, ratio of empty lacuna, apoptotic index and expression rate of cytochrome c in osteocytes were significantly higher in the model group (P < 0.05 or P < 0.01). (2) Correlation analysis: Ratio of empty lacuna was significantly positively associated with apoptotic index at various time points in the model group (r=0.856, P < 0.01). Expression rate of cytochrome c was significantly positively associated with apoptotic index at various time points in the model group (r=0.824, P < 0.01). (3) These findings confirm that cytochrome c-involved apoptosis of osteocytes may play an important role in steroid-induced femoral head necrosis. Expression rate of cytochrome c in osteocytes is remarkably positively associated with the occurrence of steroid-induced femoral head necrosis in rabbits. 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     

成骨细胞、破骨细胞与酒精性股骨头坏死的关联性： 预防与靶向治疗的新思路

BACKGROUND: Alcohol-induced femoral head necrosis is a bone metabolism disease that involves a series of alcoholism-induced pathological changes, including degeneration, necrosis and deposition of adipocytes and osteoporosis, and trabecular collapse in the subchondral bone trabeculae of the femoral head. OBJECTIVE: To introduce the correlation of osteoblasts and osteoclasts with alcohol-induced femoral head necrosis. METHODS: The first author searched relative articles in PubMed and CNKI databases published before May 2016 using the keywords of “osteoblast, osteoclast, alcohol-induced ONFH, bone metabolism” in English and Chinese, respectively. 133 literatures were retrieved and 38 literatures were in accordance with the inclusion criteria. RESULTS AND CONCLUSION: During the process of bone metabolism, osteoblasts and osteoclasts exhibit interaction in term of cell number and viability. In-depth study on osteoblasts, osteoclasts and their interaction cannot only give insight into the pathogenesis and repair of alcohol-induced femoral head necrosis, but also provide new ideas and strategies for prevention and target treatment of bone metabolic diseases. 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     

The Effect of Bone Loss Pattern on the Structural Capacity of the Proximal Femur

The effect of age-related bone loss on the structural capacity of the proximal femur were investigated by Finite Element Analysis(FEA). Four bone loss patterns were considered. These were “uniform cortical bone loss“, “neck cortical bone loss“, “intertrochanteric cortical bone loss“ and “uniform trabecular bone loss“. The results show that the two “non-uniform cortical bone loss“ patterns are more dangerous than the “uniform cortical bone loss“ pattern, and that the cortical bone loss in intertrochanteric region is associated with a greater reduction in cortical failure load than the cortical bone loss in the femoral neck. The trabecular bone loss causes a limited decrease in both cortical failure and trabecular failure loads. This research should be helpful to the clinical assessment of femur fracture risk due to age-related bone loss.     

Comparison of two kinds of tendon fixation in arthroscopy for treating proximal lesions of long head of biceps tendons北大核心

BACKGROUND: For young patients with proximal lesions of long head of biceps tendons with high requirements for upper limb movement, the commonly tendon fixation includes interface extrusion screw fixation and suture anchor ligation fixation. At present, there are few clinical reports and no conclusion on the comparison of the clinical efficacy of the two. OBJECTIVE: To compare the clinical efficacy of proximal lesions of long head of biceps tendons by interface extrusion screw fixation and suture anchor ligation fixation in arthroscopy. METHODS: Totally 52 patients with proximal lesions of long head of biceps tendons treated in Nanchang Hongdu Hospital of TCM from January 2019 to December 2020 were enrolled and randomly divided into interface extrusion screw group (n=29) and suture screw group (n=23). The patients in both groups were subjected to interface extrusion screw fixation and suture anchor ligation fixation in arthroscopy, respectively. Before, 1, 3, 6, and 12 months after operation, and during last follow-up, shoulder visual analog scale score, the American shoulder and elbow surgeons score, and range of motion in anterior flexion of shoulder and internal and external rotation at elbow flexion 90° were compared between the two groups. Elbow flexion muscle strength, reoperation rate and complication rate (Popeye sign) were compared between the two groups at the last follow-up. RESULTS AND CONCLUSION: The visual analog scale scores, the American shoulder and elbow surgeons score and shoulder range of motion in anterior flexion of shoulder and internal and external rotation at elbow flexion 90° were significantly improved after operation compared with those before operation in both groups (P < 0.05). There were no significant differences in visual analog scale scores, the American shoulder and elbow surgeons score and shoulder range of motion in anterior flexion of shoulder and internal and external rotation at elbow flexion 90° between the two groups before and at various time points after operation (P > 0.05). At the last follow-up, the elbow flexion muscle strength of the two groups reached above grade IV, and the results showed no significant difference. Popeye syndrome occurred in the interface extrusion screw group (14%) and reoperation was performed (7%). In the suture screw group, the incidence of Popeye sign was 4.3% and the reoperation rate was 0%. The incidence of Popeye sign and the reoperation rate were not significantly different between the two groups (P > 0.05). For the proximal lesion of long head of biceps tendons, both the interface extrusion screw fixation and the suture anchor ligation fixation in the arthroscopy can effectively relieve shoulder pain and improve shoulder function within one year and the clinical effects of the two methods are equivalent. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

Complications and death causes of peripheral blood stem cell transplantation in the treatment of thalassemia major北大核心

BACKGROUND: Allogeneic hematopoietic stem cell transplantation is the only effective method to cure thalassemia major. However, the risk factors influencing the prognosis of transplantation remain unclear. OBJECTIVE: To analyze the distribution of common complications and cause of death after allogeneic hematopoietic stem cell transplantation in children with thalassemia major, and to explore the prognostic factors so as to provide references for improving the survival rate of patients. METHODS: This retrospective cohort study included 257 patients with β-thalassemia major who underwent allogeneic hematopoietic stem cell transplantation at Department of Hematology and Oncology, Guangzhou Women and Children Medical Center between September 2013 and September 2019. There were 172 males and 85 females, with a median age of 6 years at the time of transplantation. The basic clinical data before transplantation and complications after transplantation were compared between the surviving group and dead group using single factor. The overall survival rate was analyzed by the Kaplan-Meier method, and the overall survival rate was compared by the Log-rank test. Multivariate Cox regression was used to analyze factors affecting survival. RESULTS AND CONCLUSION: The median follow-up time was 29 months, and no cases were lost to follow-up. (1) Univariate analysis results showed that there were significant differences in the risk classification between surviving patients and dead patients (P=0.033). Patients with higher risk class had an increased risk of death after transplantation. Multivariate analysis showed that risk classification and severe pneumonia were independent risk factors for overall survival after thalassemia major hematopoietic stem cell transplantation (P < 0.05). (2) Among 20 dead patients, there were 13 patients with severe pneumonia and respiratory failure, 2 patients with grade IV intestinal graft-versus-host disease, 1 patient with intracranial hemorrhage due to thrombocytopenia, 1 patient with thrombocytopenia with acute pulmonary hemorrhage, 1 patient with sepsis with shock, and 1 patient with myasthenia gravis. (3) Totally 17 cases died within 1 year after transplantation, while the rest 3 patients died of severe pneumonia more than 1 year after transplantation. (4) The incidence of bronchiolitis obliterans was significantly higher in patients who died after transplantation than in those who survived (P < 0.000 1). (5) It is concluded that the important factors that affect survival rate in thalassemia major patients after hematopoietic stem cell transplantation are infection and severe graft-versus-host disease. The risk of death increased in patients with bronchiolitis obliterans after transplantation. © 2023, Chinese Journal of Tissue Engineering Research. All rights reserved.     

股骨近端髓内钉治疗股骨转子周围骨折

目的总结股骨近端髓内钉（PFN）治疗股骨转子周围骨折的临床经验。方法应用PFN治疗股骨转子周围骨折52例。结果42例经5～18个月随访，平均10个月：所有患者均获得骨性愈合。根据黄公怡标准评定髋关节评分：优良达38例，优良率达90．4％。结论PFN是治疗股骨转子周围骨折的理想方法之一，具有操作简便、手术创伤小、固定可靠、符合生物力学要求，可早期功能锻炼等优点，运用各种类型的股骨转子周围骨折。     

股骨近端防旋髓内钉治疗股骨转子下骨折

背景：髓内钉具有优良的力学承载性能,提高了骨与内固定的整体稳定性,减少了骨折畸形愈合和内固定失败的发生率。股骨转子下骨折的内固定治疗对内植物的要求较高,因此在内植物的选择上仍存在很多争议。 目的：评价股骨近端防旋髓内钉治疗股骨转子下骨折的临床疗效。 方法：回顾性分析苏州大学附属第一医院2006年6月至2011年11月采用股骨近端防旋髓内钉内固定治疗股骨转子下骨折患者17例的病例资料。其中股骨转子下骨折合并转子间骨折9例(Seinsheimer分型Ⅴ型),股骨转子下骨折(Seinsheimer分型ⅡB 2例,Ⅲ B 1例,Ⅳ 4例)累及股骨干骨折7例,Seinsheimer分型Ⅴ型同时累及同侧股骨干骨折1例。受伤原因：高能量损伤16例,低能量损伤1例。记录固定时间、固定时出血量、骨折愈合时间及患肢功能恢复情况。 结果与结论：固定后随访8-24个月,平均16.2个月。固定后X射线片示骨折愈合时间平均5.4个月。固定后X射线片示所有患者骨折复位良好,转子下骨折、转子间及股骨干骨折均愈合,未出现骨折移位、内固定松动及髋内翻畸形,固定时仅有1例患者出现插钉困难。固定后患者Harris髋关节功能评分优良率为88.2%。结果证实,股骨近端防旋髓内钉本身设计合理,其防旋刀片对骨折端具有抗旋转和成角稳定性,疗效较好,安全可靠,是治疗股骨转子下骨折较理想的内固定物。     

股骨重建髓内钉治疗复杂股骨骨折的评价

目的：评价股骨重建髓内钉治疗股骨干骨折合并同侧股骨颈、转子间骨折或转子下粉碎性骨折的临床疗效。方法：对2000年10月至2004年6月采用股骨重建髓内钉治疗的15例股骨干合并同侧股骨颈、转子间骨折或转子下骨折的病例进行回顾性分析。结果：所有病例随访7～28个月，平均15．4个月，骨折平均愈合时间7．2个月。无术后感染、股骨头缺血坏死及内固定材料断裂等并发症发生，远期疗效按马元璋评定标准优良率达85．7％。结论：股骨重建髓内钉固定复杂股骨骨折，使股骨头、颈、干重新成为一个相对牢固的整体，有利于患肢早期功能锻炼、早期负重，促进了骨折的愈合。     

股骨近端抗旋髓内钉置入和骨水泥型人工股骨双动头置换治疗老年转子间骨折

背景：针对高龄股骨转子间骨折的治疗方法选择尚存在争议。 目的：比较股骨近端抗旋髓内钉置入和人工股骨头置换治疗高龄股骨转子间骨折的疗效。 方法：2007-10/2009-06入选老年转子间骨折患者79例,股骨近端抗旋髓内钉置入内固定34例,年龄65~81岁;人工股骨头置换45例,年龄67~94岁。对住院时间,手术时间,出血量,固定/置换后并发症和髋关节功能进行评价。 结果与结论：79例固定/置换后随访6~24个月,平均(17.5±4.9)个月。两组在住院时间,固定/置换后并发症和关节功能Harris评分方面差异无显著性意义(P > 0.05),在手术时间和术中出血量方面股骨近端抗旋髓内钉置入较股骨头置换有较大优势  (P_手术时间 < 0.001,P_{术中出血量}< 0.000 1),但股骨近端抗旋髓内钉组下地时间较股骨头置换组晚(P < 0.000 1)。结果表明股骨近端抗旋髓内钉置入和人工股骨头置换是治疗高龄股骨转子间骨折的有效方法,与人工股骨头置换比较,股骨近端抗旋髓内钉置入固定具有手术时间短,术中出血少的优点,但卧床时间较长。应严格掌握病例选择标准,选用合适的技术治疗。     

股骨髁部支撑钢板修复股骨远端骨折效果评价

背景：股骨远端骨折多为粉碎性、不稳定性骨折,并伴有局部软组织及微循环的严重损伤,骨折愈合较为困难,髁部支撑钢板为临床广泛应用的治疗手段,但影响其预后的相关因素多样,各方报道亦不一。 目的：探讨股骨髁部支撑钢板对股骨远端骨折治疗效果的影响因素。 方法：回顾性分析股骨髁部支撑钢板置入治疗股骨远端骨折84例患者的临床资料,收集相关数据,应用单因素分析和Logistic回归分析筛查可能的影响因素。 结果与结论：84例患者中,Neer评分优良患者63例(75%),单因素分析显示,年龄、骨折类型、损伤类型、手术时机、复位质量、CPM锻炼各组间临床疗效差异存在显著性意义(P < 0.05),Logistic回归分析显示,年龄越大,临床疗效越差(OR=0.797),复位满意者、A型骨折和CPM锻炼者临床疗效好,OR分别为2.275,1.756,2.885。结果可见对于股骨远端骨折患者,髁部支撑钢板置入过程中良好的解剖复位和关节嵌合,置入后早期的CPM功能锻炼可有效的促进膝关节功能恢复,对于C型骨折患者,可考虑双钢板强化固定提高疗效。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：     

青壮年股骨颈头下型骨折治疗的临床分析

目的 分析头下型股骨颈骨折治疗效果。方法 ７０例患者随机分为Ａ、Ｂ两组。Ａ组４０例,采用透下复位经皮三根针内固定治疗。Ｂ组３０例采用切开复位带血管蒂髂骨移植三根针内固定治疗,随访１￣７年。结果 Ａ组治愈率６５％。Ｂ组治疗率８６．７％。结论带血管髂骨移植治疗头下型股骨颈骨折提高了愈合率,降低股骨头缺血性坏死率。     

股骨颈骨折患者并发股骨头坏死的预后相关影响因素

创伤引发的股骨颈骨折是临床上常见的骨科疾病之一,而其后续发生的以股骨头缺血坏死为代表的并发症是导致患者出现下肢运动功能障碍的主要原因之一。目前对于创伤后股骨颈骨折具体的损伤及修复机制仍不甚明了,因此研究股骨颈骨折后患者身体的各项指标及临床上针对的治疗措施对预后产生的影响,可为预测股骨颈骨折患者未来的预后打好基础,并为采取相应的干预手段提供思路。目前主要认为创伤后股骨颈血供不足和相关炎性重建反应是创伤性股骨头坏死的主要作用机制,而作用于相关机制的因素则被认为是其可能的危险因素。本文整理了近年来对于股骨颈骨折后续发生坏死相关影响因素的报道。学界主要认为受伤原因、Garden分型等骨折分型方式、内固定方式及复位质量等因素被认为是导致预后不良的可能危险因素。     

Prediction of the femoral neck-shaft angle from the length of the femoral neck

A total of 171 adult South Indian femora, devoid of gross pathology, are used to measure the neck-shaft angle, length of the neck, intertrochanteric apical axis length, maximum vertical diameter of the head, kinematic radius, and maximum femoral length. The neck-shaft angle ranges from 120° to 136° with a mean of 126.7° and no significant side difference. The angle significantly and positively correlates with neck length, intertrochanteric apical axis length, kinematic radius, and minimum femoral length (P < 0.001) but not with the vertical diameter of the head. Regression equations for the neck-shaft angle against the correlated parameters are derived but only that against the length of the neck is strongly significant. From those correlations, 1) the neck-shaft angle can be estimated from a proximal femoral fragment, and 2) the required size of the length of the neck can be determined to design prostheses for the restoration of normal neck-shaft angle. Further, any estimated defective angle can be of help for forensic identification of an individual with pathological changes leading to an abnormal gait. Clin. Anat. 10:318–323, 1997. © 1997 Wiley-Liss, Inc.     

Radiation-induced femoral arteritis

Radiation arteritis is currently an uncommon sequalae of external beam radiation, however because of the increasing use of radiotherapy in the management of neoplastic conditions its recognition is increasingly important. We present two cases of debilitating femoral occlusive disease, secondary to radiation exposure, at a long period post irradiation and review the pathophysiolgy and management options for this condition.     

股骨头表面置换对正常股骨头组织学的影响

背景：拟通过建立动物模型探讨目前的髋关节表面置换的假体设计是否达到成熟、是否能引起股骨头坏死。 目的：观察健康新西兰大白兔股骨头表面置换后的组织形态变化。 方法：60只健康大白兔行左股骨头表面置换,右侧为正常对照侧。分3,6,9,12周共4次分批处死取股骨头标本行大体、光镜、扫描电镜观察。 结果与结论：股骨头表面置换后,股骨头骨质仅在与骨水泥接触界面(骨-水泥界面)有小范围的骨细胞坏死和肉芽组织增生纤维化、以及骨吸收;与金属假体接触的界面(骨-假体界面)亦有轻度小范围骨细胞坏死和肉芽组织增生纤维化,但无骨吸收表现;在远离骨水泥和假体的股骨头中心部位既无骨坏死表现,亦无骨吸收表现,组织表现与正常未手术骨质相同。结果可见股骨头表面置换不会引起正常股骨头的坏死,股骨头坏死与术式及假体本身无因果关系,在一定程度上肯定了表面置换治疗髋关节疾患的安全性和优越性。