胸锁钩钢板治疗锁骨近端骨折伴胸锁关节脱位

目的:探讨新型胸锁钩钢板治疗锁骨近端骨折伴胸锁关节脱位的临床疗效.方法:回顾性分析2011年6月至2019年1月采用新型胸锁钩钢板进行内固定治疗的13例锁骨近端骨折伴胸锁关节脱位患者的临床资料,其中男9例,女4例;年龄26～78(54.08±13.91)岁.记录患者的手术时间、出血量、住院时间、术后并发症等情况.术后根...     

肩部骨折治疗进展

<正>上肢的主要作用是将手部放置在空间内任一位置,上肢功能障碍可严重影响患者生活质量。肩部作为上肢最近端的关节,对于上肢活动范围起到非常重要的作用。近年来肩部骨折的治疗较前有了较大发展。本文对近年文献和本院治疗经验做一回顾总结,对本期发表的肩部骨折相关研究     

Diffusion tensor MR imaging in spinal cord injury

BackgroundThe ability of diffusion tensor imaging (DTI) to complement conventional MR imaging by diagnosing subtle injuries to the spinal cord is a subject of intense research. We attempted to study change in the DTI indices, namely fractional anisotropy (FA) and mean diffusivity (MD) after traumatic cervical spinal cord injury and compared these with corresponding data from a control group of individuals with no injury. The correlation of these quantitative indices to the neurological profile of the patients was assessed.Material and methods20 cases of acute cervical trauma and 30 age and sex matched healthy controls were enrolled. Scoring of extent of clinical severity was done based on the Frankel grading system. MRI was performed on a 3T system. Following the qualitative tractographic evaluation of white matter tracts, quantitative datametrics were calculated.ResultsIn patients, the Mean FA value at the level of injury (0.43+/−0.08) was less than in controls (0.62+/−0.06), which was statistically significant (p value <0.001). Further, the Mean MD value at the level of injury (1.30+/−0.24) in cases was higher than in controls (1.07+/−0.12, p value <0.001). Statistically significant positive correlation was found between clinical grading (Frankel grade) and FA values at the level of injury (r value = 0.86). Negative correlation was found between clinical grade and Mean MD at the level of injury (r value = −0.38) which was however statistically not significant.ConclusionQuantitative DTI indices are a useful parameter for detection of spinal cord injury. FA value was significantly decreased while MD value was significantly increased at the level of injury in cases as compared to controls. Further, FA showed significant correlation with clinical grade. DTI could thus serve as a reliable objective imaging tool for assessment of white matter integrity and prognostication of functional outcome.     

Surgical outcome of intramedullary nailing in patients with complete atypical femoral fracture: A multicenter retrospective study

BackgroundManagement of atypical femoral fracture on bisphosphonate therapy still remains controversy and is reported high rate of complications. The aim of this study was to evaluate the outcome of intramedullary nailing in patients with atypical femoral fracture who took bisphosphonate more than one year through the multicenter retrospective study.MethodsWe gathered 75 atypical femoral fractures from seven institutions between 2009 and 2014. Among them 46 atypical femoral fractures which met the inclusion criteria was evaluated in this study. The average age was 70.1 years (53–80) and the average duration of bisphosphonate use was 5.1 years (1–15 years). Medical records and radiographs were reviewed to determine time to union, union rate, need for revision surgery, restoration of ambulatory function, and complications.ResultsTwenty-nine (63%) fractures healed within 6 months without complications. The average time to union except two non-union was 24.9 weeks (11–48 weeks). Two patients (4.3%) underwent revision surgery for non-union and there was no implant failure. Thirty-seven (80.4%) patients achieved their pre-fracture ambulatory function at the final follow up.ConclusionsAlthough the incidence of delayed bone healing is high in atypical femoral fracture on bisphosphonate therapy even treated with intramedullary nailing, the incidence of revision surgery and implant failure was relatively lower than those of extramedullary devices.     

腋后路内固定治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效分析

目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50～78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6～15个月。末次随访时9例均获得骨性愈合,愈合时间3～6个月,末次随访时患者的Constant-Murley评分为55～96分;DASH评分为3.33～33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。     

多发性骨软骨瘤致股动脉中下段压迫性闭塞1例

患者,男,44岁,2006年7月18日因右小腿挤压伤致右胫腓骨中段粉碎性骨折4h入院。入院查体除右小腿中段肿胀、畸形、压痛、异常活动、无神经血管损伤指征外,于双膝关节内侧及右膝关节后侧均可触及皮下骨性突起,无明显压痛,皮温皮色正常,双侧足背动脉可触及,足部感觉及运动均正常。追查病史:双膝形变已有多年,功能正常,无不适感。X线检查显示:①右胫腓骨中段粉碎骨折断端向内成角畸形。②双侧股骨髁远端、胫腓骨近端显示背向关节生长的骨性突起(见图1)。诊断:①右胫腓骨中段粉碎性骨折。②多发性骨软骨瘤形成。因X线片可见股骨远端后侧软骨瘤明…     

Aggrecan,versican and type VI collagen are components of annular translamellar crossbridges in the intervertebral disc

The aim of this study was to undertake a detailed analysis of the structure of the inter and intra-lamellar regions of the annulus fibrosus. A total of 30 newborn to 6 year-old lumbar ovine intervertebral discs (IVDs) were fixed and decalcified en-bloc to avoid differential swelling artifacts during processing and vertical mid-sagittal, and horizontal 4 μm sections were cut. These were stained with toluidine blue to visualise anionic proteoglycan (PG) species, H & E for cellular morphology and picro-sirius red (viewed under polarized light) to examine collagenous organization. Immunolocalisations were also undertaken using anti-PG core-protein and glycosaminoglycan (GAG) side chain antibodies to native chondroitin sulphate (CS), Δ C-4-S and C-6-S unsaturated stubs generated by chondroitinase ABC digestion of CS, keratan sulphate (KS), and with antibodies to type I, II, VI, IX and X collagens. Trans-lamellar cross bridges (TLCBs), discontinuities in annular lamellae’s which provide transverse interconnections, stained prominently with toluidine blue in the adult IVDs but less so in the newborn IVDs. In adult discs TLCBs were evident in both the posterior and anterior AF where they extended from the outermost annular lamellae almost to the transitional zone extending across as many as eight lamellar layers displaying a characteristic circuitous, meandering, serpentine type course. There were significantly fewer TLCBs in 2 week-old compared with skeletally mature sheep and there was a further increase from 2 to 6 years. Immunolocalisation of perlecan delineated blood vessels in the TLBs of the newborn but not adult IVDs extending into the mid AF. In contrast adult but not 2 week-old TLCBs were immunpositive for C-4-S, C-6-S, KS, aggrecan, versican and type VI collagen. The change in number and matrix components of the trans-lamellar cross bridges with skeletal maturity and ageing suggest that they represent an adaptation to the complex biomechanical forces occurring in the annulus fibrosus.