人工髋关节置换术中股骨假体周围骨折的防治

人工髋关节置换治疗股骨颈骨折及病变髋关节日益普及，并逐渐走向成熟，手术指征较以前有所放宽。但并发症随之日见突出。避免人工髋关节置换手术中的失误是减少术后并发症的关键，提高手术质量及疗效是医患双方均关心的问题。我们回顾2000年1月～2003年12月共行初次人工髋关节置换127例，对其中7例出现股骨假体周围骨折的并发症作总结分析。     

强直性脊柱炎股骨近段形态学改变对全髋关节置换术假体选择的意义

目的分析强直性脊柱炎股骨近段的形态学改变,及其改变对全髋关节置换术假体选择的意义。方法1999年1月~2004年6月,将13例(16髋)强直性脊柱炎患者设为选择组,患者均已出现关节强直,需行全髋关节置换术。另16例(19髋)为对照组,为非强直性脊柱炎患者而拟行全髋关节置换术。两组患者均摄髋关节正侧位X线片,测量Singh指数、髓腔张开指数、皮质形态指数及皮质骨指数,并进行统计学分析。结果选择组Singh指数、髓腔张开指数及皮质形态指数分别为3.81±0.54、2.63±0.41及2.02±0.38,对照组分别为4.63±0.62、3.03±0.27及2.76±0.28,两组比较差异均有统计学意义(P<0.05)。选择组皮质骨指数为1.69±0.69,对照组为2.12±0.24,两组比较差异无统计学意义(P>0.05)。选择组患者髓腔呈烟囱型10例13髋,普通型3例3髋;对照组烟囱型3例3髋,普通型13例16髋。结论强直性脊柱炎的全髋关节置换术应采用骨水泥型人工关节假体,并根据患者髓腔形态使用定制型骨水泥假体,以达到更好的近段固定效果。对于有严重骨质疏松者应按关节翻修术处理。     

长柄梭罗细胞毒活性部位的化学成分研究

目的 对长柄梭罗Reevesia longipetiolata树皮具细胞毒活性的醋酸乙酯部分化学成分进行研究。方法 采用常压、加压硅胶柱色谱、Sephadex LH-20凝胶柱色谱、高效液相色谱进行分离和纯化，通过理化和波谱分析方法鉴定化合物结构。结果 从其醋酸乙酯部分分离得到5个化合物，分别鉴定为β-谷甾醇(β-sitosterol，I)、胡萝卜苷(daucosterol，Ⅱ)、白桦脂酸(betulinic acid，Ⅲ)、羽扇豆醇(lupeol，Ⅳ)和( )-儿茶素[( )-catechin，V]。结论 5个化合物均为首次从该属植物中分得，并分别讨论了它们的细胞毒活性。     

人工全髋关节术后脱位的预防及治疗

术后髋关节脱位是人工全髋置换术(THR)后严重的并发症,如处理不善,常会引起严重的下肢功能障碍,导致关节手术失败.1994-2001年,我院共行THR手术436例,其中术后发生脱位有11例,加上外院转入5例,共16例,现报告如下.……     

下肢骨肿瘤带骨水泥的定制假体置换的无菌性松动

我们对１００１例骨肿瘤术后使用定制的假体置换，做了回顾性研究。股骨远侧假体４９３例，股骨近侧２６３例，胫骨近侧２４５例。无菌性松动是所见到的内植物失败的主要形式，７１个病人因带骨水泥髓内柄的无菌性松动而做了翻修术。一个病人其假体未发生无菌性松动达１２０个月的概率，在股骨近侧置换是９３．８％，股骨远侧是６７．４％，胫骨近侧是５８％。股骨远侧置换的病人中，手术时的年龄和骨切除的百分率，与无菌性松动的危险有关。有股骨远侧假体，股骨替换的百分率高的年轻病人，以后未发生无菌性松动的最少。在胫骨近侧置换组，骨去除的百分率有重要作用，但病人的年龄不重要。反之，股骨近侧置换后，年龄和骨去除的百分率都不是起作用的因素。这些发现的意义在有关机械因素方面做了讨论。     

Evaluation of Mechanical Properties of ZY-1 Maxillofacial Prosthetic Materials

Objective Maxillofacial prosthetic materials are used to replace facial parts lost through disease or trauma. Silicone rubbers are the materials of choice. The silicone elastomer A-2186 is a widely used maxillofacial prosthetic material. It is a pourable two-component silicone rubber cured by a platinum catalyst. Used as a prosthetic material, A-2186 has short working time and good mechanical properties. The purpose of this study is to evaluate the physical properties of new prosthetic materials based on addition-type silicone elastomer （ZY-1）, and compared the mechanical properties with those of A-2186, Methods Hardness, tensile strength, ultimate elongation, tear strength and adhesive bonding strength of ZY-1 and A-2186 were compared. Statistical analyses were done using a two-way analysis of variance （ANOVA）. Results The hardness and ultimate elongation of ZY-1 is similar to A-2186. However, tensile strength, tear strength of ZY-1 were higher than those of A-2186. Conclusion ZY-1 addition-type silicone elastomer processed good mechanical properties for use as a maxillofacial prosthetic material.     

骨水泥型人工股骨头假体治疗高龄股骨颈骨折

目的报告骨水泥型人工股骨头假体治疗高龄股骨颈骨折的疗效。方法131例患者(新鲜骨折101例,陈旧性骨折30例按Garden分型:Ⅱ型23例,Ⅲ型62例,Ⅳ型46例),取后外侧切口安置骨水泥型人工股骨头,术后药物预防静脉血栓。结果随访0.5～8年,优良率96.4%。结论骨水泥型人工股骨头假体置换术具有手术简单,术后恢复快等优点,适用于高龄股骨颈骨折患者。     

计算机导航对人工髋关节股骨柄假体置入的精确性验证

Objective To evaluate the accuracy of surgical navigation for localization and orientation of the femoral stem component in total hip arthroplasty, nethods In the hypothesized space, 3-D images of femoral stem were reconstructed. The coronal, sagittal and horizontal axes and scale divisions were established to calculate the displacement and rotation of the stem. Matching between the stem and its 3-D images was performed while the stem was moved in various distances and angles on the digital motion-platform. Then the actual change in the position of the implant and the caleulative data obtained from the navigation system were compared to evaluate the accuracy. Results The mean difference in displacement between the measurements and the actual changes was (1.01 ±0.47) mm, and the mean difference in the measured and actual angles was 1.09°±0.62°. The duplicate test found no significant difference (t = 0.238, P > 0.05). Conclusion Precise placement of the stem in the desired location and orientation can be achieved by the navigation system in the total hip arthroplasty.