Cone-beam computed tomography in orthopaedics

Orthopaedic practice is closely allied to advances in radiology. Cone-beam computed tomography (CBCT) is an established imaging modality, which is finding novel applications within the field. The principal advantages over conventional computed tomography is that CBCT scanners allow faster, accurate, three-dimensional imaging to be obtained at a fraction of the radiation dosage, using smaller imaging machines. These new scanners can bring CT imaging out of radiology departments and into clinic rooms, emergency departments, community services and operating theatres. This versatility has the potential to change how we practice. Scanners can be orientated vertically – thus allowing patients to stand. Weight-bearing scans allow some pathologies to be better demonstrated. This feature is particularly useful in the lower limb and spinal sub-specialities.This article aims to raise awareness of these new imaging tools, explaining the principles of how they work and introducing ways that they might be applied across sub-specialities within orthopaedic and trauma surgery.     

直立负重法与Hulth法建立兔膝骨关节炎模型的对比研究

目的比较直立负重法与Hulth模型法建立兔膝骨性关节炎模型的方法及效果,探讨两模型的使用条件。方法 40只新西兰大白兔分为两个模型组,甲组为直立负重法模型组,乙组为Hulth模型组,在建立模型后第1、3、5周取兔后肢股骨髁部,比较两模型组骨关节大体形态及病理变化。结果进行Mankin’s评分并作统计学分析,两模型组与空白对照组两两比较差异有统计学意义(P<0.05),两模型组间比较差异有统计学意义(P<0.05),直立负重组与直立假手术组间比较差异有统计学意义(P<0.05)。结论直立负重模型能更早的建立OA中期软骨缺损的模型,并且有较高的造模成功率。实验也证实关节受到创伤等造成关节不稳的情况,不仅仅在机械运动下能加重关节软骨退变,在直立负重状态下也能使关节内部的组织结构,特别是软骨组织在短期发生退变。     

用于髋关节置换材料的优选

髋关节是人体关节中活动度最广泛、受力最复杂的关节之一,在日常活动中时刻经受着张力、压力、扭转力以及剪切力的考验.据英国国家健康系统(NHS)统计,每年至少有5万例髋关节置换手术,而假体平均使用寿命只有20～30年(NHS,2010).骨质溶解及无菌性松动是影响髋关节置换术后假体存留以及导致二次翻修的主要原因,其产生机制...     

Reconstruction of extensive plantar forefoot defects with free anterolateral thigh flap

Purpose:The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the “like for like” reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot.Methods:Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25–64 years).Results:The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455 cm², with a mean of 197.7 cm². Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered.Conclusion:The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.     

Social support,knowledge, and self-efficacy as correlates of osteoporosis preventive behaviors among preadolescent females

OBJECTIVE: To develop and test a model based on Bandura's social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis. METHODS: Participants were 354 girls, ages 8-11 years, recruited from area Girl Scout troops. Baseline data from a randomized trial of behavioral interventions are presented. Measures of social support, knowledge, self-efficacy, dietary calcium intake, and weight-bearing physical activity (WBPA) were obtained via interviews and self-administered questionnaires. RESULTS: A structural equation model was tested and fit the data well. Family social support, perceived self-efficacy for eating a calcium-rich diet, and knowledge of WBPA significantly predicted calcium intake. Friend and family support for exercise predicted WBPA. Self-efficacy partially mediated the relationship between family support and calcium intake, as confirmed by Holmbeck's post-hoc probing strategy (2002). CONCLUSIONS: Suggestions are made for primary prevention interventions such as parent and peer involvement, health education, and problem-solving training.     

桡骨远端钢板联合拉力钉固定治疗Sander III型跟骨骨折的生物力学分析

提出并分析桡骨远端钢板（两点支撑）联合拉力钉固定治疗跟骨骨折的生物力学稳定性。在完整下肢骨骼-肌肉有限元模型的基础上,建立Sanders III型跟骨骨折模型并模拟固定,用桡骨远端钢板（两点支撑）联合拉力钉固定治疗骨折。评估该模型在静态站立和行走状态（足跟着地期、站立中期和推离期）的应力分布和位移情况。跟骨的应力集中于骨折端、跟骨与跟腱连接处,峰值为96.92 MPa。内固定的应力集中于钢板螺钉与载距突和跟骨结节接触位置,峰值为883.20 MPa。后关节面位移、Bohler角和Gissanes角均维持较好。桡骨远端钢板联合拉力钉固定治疗跟骨骨折具有良好的生物力学稳定性,体现微创原则,操作简单,术后可以早期康复训练,值得临床推广应用。     

Combination of steroids and ischial weight-bearing knee ankle foot orthoses in Duchenne's muscular dystrophy prolongs ambulation past 20 years of age--a case report

Patients with Duchenne muscular dystrophy (DMD) lose ambulation by age 12. Long-term steroids have lengthened ambulation by 2–5 years. Ischial weight-bearing knee ankle foot orthoses prolong ambulation for 2–3 years. We report the outcome of the ambulatory status of a patient with DMD treated with daily steroid therapy and orthoses. This male patient was diagnosed with DMD at age of 2. He has been treated with daily steroids since age 7 years. He lost the ability to arise from the floor and walk up steps at age 14 and lost ambulation by age 16. He was fitted with orthoses at age 16 following surgical correction of his lower extremity contractures and regained independent ambulation. At age 20, he was able to stand independently in his orthoses and take steps with moderate support. We conclude that a combination of daily steroids and orthoses prolongs ambulation beyond that of the natural history DMD.     

牡蛎肉提取物对小鼠抗疲劳和耐缺氧能力的影响

目的:探讨牡蛎肉提取物对小鼠抗疲劳和耐缺氧能力的影响。方法:分别以高、中、低剂量的牡蛎肉提取物给小鼠连续灌胃,不同剂量的干预时间均有2周和4周两种方案,干预后通过负重游泳实验观察小鼠负重游泳时间和免疫器官指数,常压耐缺氧实验观察小鼠耐缺氧能力,强迫游泳实验观察小鼠运动后肝糖原和血乳酸含量变化。结果:与对照组相比,牡蛎肉提取物干预组小鼠负重游泳时间和缺氧死亡时间显著延长(P0.05),肝糖原含量增加(P0.05),血清血乳酸含量降低(P0.05),免疫器官指数提高(P0.05),并且小鼠抗疲劳能力随着干预时间的延长和干预浓度的增加而逐渐提高,以4周干预时间效果较好。结论:牡蛎肉提取物可以提高小鼠的抗疲劳能力和耐缺氧能力,增强小鼠的免疫能力。     

腰椎间盘突出症患者斜面站立平衡稳定性研究

摘要 目的：探讨腰椎间盘突出症(LDH)对在斜面上静止站立时平衡稳定性的影响。 方法：10例腰椎间盘突出症患者,10例性别、年龄与患者相匹配的健康志愿者,在三种平面条件（下降面、水平面和上升面）下,睁眼和闭眼静止站立在Zebris压力平板指定位置各30s。使用健患肢承重比评价身体体重分配情况,使用全身、健肢、患肢的压力中心点(COP)轨迹的95%置信椭圆面积来评估身体的摆动情况,并对COP面积和功能障碍量表得分进行相关性分析。 结果：LDH组的健患肢承重比高于健康对照组且大于1,并且具有较高的变异性。LDH组的全身、健肢、患肢COP面积在所有平面及视觉条件下均高于对照组（P<0.05）,但在闭眼时组间差异更加显著。在下降面、闭眼条件下,COP面积与功能障碍量表得分表现出显著的相关性（P<0.05）。 结论：LDH患者健肢承受的体重比例增加,COP面积增大,身体平衡控制能力下降,姿势稳定性降低,跌倒风险增加。闭眼、下降面的站立平衡测试设置有对LDH进行定量诊断和评估的潜力。本研究揭示了LDH对在斜面上静止站立时平衡稳定性的影响,可为LDH的诊断和治疗评估提供新的思路。     

个性化 Bego 种植体负重方案选择及稳定性影响因素简

背景：目前关于种植体即刻负重或延期负重方案的选择尚存在一定的争议。 目的：探讨基于种植体稳定系数值的Bego种植体负重方案选择,并分析影响种植体稳定性的相关因素。 方法：选择植入后种植体稳定系数值≥50的单个Bego种植体患者62例,共74颗种植体。随机分为试验组31例36颗种植体,予以种植后即刻负重;对照组31例38颗种植体,予以延期负重。比较两组Bego种植体负重后1,2,3,4,6,8,12周种植体稳定系数值,分析影响Bego种植体稳定性的相关因素。 结果与结论：试验组即刻负重的最低稳定系数出现在负重后第二三周,对照组延期负重的最低稳定系数出现在负重后第三四周。两组Bego种植体负重后1,2,3,4,6,8,12周种植体稳定系数值差异均无显著性意义（P 〉0.05）。经回归分析,患者年龄、骨质类型和种植体长度与Bego种植体稳定性呈正相关,口腔卫生情况与Bego种植体稳定性呈负相关。说明Osstel 测量种植体稳定系数值≥50的单个Bego种植体采用即刻负重与延期负重对种植体具有相似的稳定性,临床可以根据患者自身状况,在Osstel 测量种植体稳定系数值的指导下,选择个体化的Bego种植体负重方案。