切开复位动力髋加抗旋螺钉治疗粗隆间粉碎性骨折体会

目的：探讨动力髋加压螺钉（ dynamic hip screw,DHS）结合单枚防旋螺钉治疗股骨粗隆间骨折的疗效。方法：采用切开复位动力髋螺钉加单枚防旋螺钉治疗60例股骨粗隆间骨折,术后常规抗感染、抗凝等处理。结果：随访60例患者,均无并发症发生,无畸形愈合,无断钉及螺钉切割。结论：动力髋加单枚防旋螺钉仍是治疗股骨粗隆间骨折一种较好的方法,尤其适合基层医院。     

闭合复位经皮空心螺钉内固定治疗后踝骨折临床疗效评价

目的：分析评价闭合复位经皮空心螺钉内固定治疗后踝骨折的临床效果。方法分析该院2009年1月—2014年5月收治的62例后踝骨折采用闭合复位经皮空心螺钉内固定治疗患者的临床资料,评价临床效果。结果所有患者均得到随访,平均随访时间为（21.5±6.5）个月,62例患者骨折平均愈合时间为（9.5±2.5）周,按照美国AOFAS推荐的评分系统有43例为优,17例为良,2例为可,优良率为96.8%。结论闭合复位经皮空心螺钉内固定治疗后踝骨折疗效满意,值得临床推广应用。     

两枚加压钛螺钉交叉内固定对股骨颈骨折疗效的中长期研究

目的：观察两枚双头加压钛螺钉前后交叉内固定对股骨颈骨折中长期疗效。方法：选取2010年1月至2013 年12月在中南大学湘雅二医院骨科进行诊治的股骨颈骨折患者80例,分为实验组(n=50)和对照组(n=30)。实验组患者 接受2枚加压钛螺钉前后交叉内固定法治疗,对照组患者接受3枚加压钛螺钉内固定法治疗。对比分析两组患者手术 时间、术中出血量、术后Harris髋关节评分。结果：实验组手术时间为(41.6±6.4) min,短于对照组(50.1±7.2) min;术 后出血量为(20.2±8.1) mL,少于对照组(31.4±9.8) mL,差异均有统计学意义(均P﹤0.05)。实验组Harris髋关节评分优良 率为94.0%,对照组Harris髋关节评分优良率为93.3%,差异无统计学意义(P﹥0.05)。结论：两枚双头加压钛螺钉前后交 叉内固定对股骨颈骨折中长期疗效良好,具有重要的临床价值,值得推广应用。     

关节镜下两种固定方式治疗前交叉韧带胫骨止点撕脱骨折的临床研究

目的探讨关节镜下螺钉与缝线固定治疗前交叉韧带(ACL)胫骨止点撕脱骨折临床疗效差异。方法研究对象选取ACL胫骨止点撕脱骨折患者共80例,以随机数字表法分为A组(40例)和B组(40例),分别在关节镜下行缝线与螺钉固定治疗;比较两组患者手术时间、随访Lysholm膝关节评分、国际膝关节评分委员会(IKDC)膝关节功能主观量表评分、患健侧位移差值及屈曲挛缩发生率。结果 B组患者手术时间明显短于A组(P0.05);两组患者随访Lysholm评分、IKDC评分及患健侧位移差值比较差异无统计学意义(P0.05);两组患者随访屈曲挛缩发生率比较差异无统计学意义(P0.05)。结论关节镜下螺钉与缝线固定治疗ACL胫骨止点撕脱骨折在提高复位稳定性和改善关节活动功能方面效果接近,但关节镜下螺钉固定方案应用可有效缩短手术时间,降低操作难度。     

不稳定股骨转子间骨折不同内固定方法的疗效比较

目的 浅析不同内固定方法对不稳定股骨转子间骨折的疗效差异。方法 2009年1月至2013年5月行内固定手术的不稳定股骨转子间骨折患者36例,采用Gamma钉固定10例为A组,动力髋螺钉(DHS)固定11例为B组,股骨近端抗旋髓内钉(PFNA)固定15例为C组。对不同的内固定方式的术中出血量、手术时间、术后并发症、骨折愈合时间及髋关节功能评分等相关数据进行统计学分析。结果 各组患者术后均获随访,平均随访时间1年半,住院及随访期间无死亡病例。C组手术时间较A、B两组短,且有统计学意义(P<0.05)。B组术中出血量最多,愈合时间长,C组出血最少,但与A组比较差异无统计学意义(P>0.05)。术中A组发生股骨颈干角变小1例,髋内翻1例;B组发生髋内翻2例,头钉穿出1例,内固定松动1例;C组无相关并发症发生。骨折愈合时间A、B、C三组间比较差异无统计学意义(P>0.05)。A、C两组髋关节功能评分均较B组高,差异有统计学意义(P<0.05),但A、C两组间差异无统计学意义(P>0.05)。结论 PFNA是治疗不稳定股骨转子间骨折一个很好的选择,手术操作简便,损伤较小,出血少,固定牢靠,术后髋关节功能恢复较好,值得临床推广。     

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study

Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.     

Anatomical study of the ideal cortical bone trajectory in the lumbar spine

Background:To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications.Methods:Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory.Results:T-Bc and T-Bb are the ideal screw trajectories for L1–L2 and L3–L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2–4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events.Conclusion:CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.     

关节镜辅助下无头加压螺钉固定治疗髌骨横型骨折?

目的：探讨关节镜下采用无头加压螺钉(HCS)固定治疗髌骨横型骨折的临床疗效。方法选择髌骨橫型骨折患者19例,采用关节镜辅助下无头加压螺钉固定治疗,术后复查并随访。结果术后3~5周行 X 线片骨折线模糊或消失,髌骨关节面平整无位移,术后骨折愈合时间平均8周;患侧膝末次膝关节活动范围[(135.42±5.82)°]与健侧活动范围[(139.38±6.55)°]差异无统计学意义(P >0.05)。末次随访膝关节 Lysholm 评分86~100分,平均(93.7±4.14)分,显著高于术前评分65.7分(P <0.05);随访期内无骨折移位,内固定物脱落、断裂等并发症。结论关节镜辅助下 HCS 固定治疗髌骨横行骨折,关节功能恢复快,且术后并发症少,是治疗髌骨橫型骨折的有效方法之一。     

眼眶骨折修复的人工材料的研究进展

眼眶骨折的治疗常需要植入修复材料,但修复材料的选择仍然是临床上一个争论性问题。目前有多种材料可以用于眶壁重建,但都有不同的并发症。与其他材料相比,人工材料更能缩短术中时间,并且用之不竭。其中可吸收人工材料还具有不可比拟的优势—即避免了不可吸收材料植入后终身都有发生并发症的风险。由于单个材料的优势有限,近年来相继出现的由两种或两种以上材料组成的复合材料开始频繁的应用于临床。本文旨在探讨用于眼眶骨折修复的各种人工材料的优势和局限性以及未来的发展方向。     

Shell-core bi-layered scaffolds for engineering of vascularized osteon-like structures

Bottom-up assembly of osteon-like structures into large tissue constructs represents a promising and practical strategy toward the formation of hierarchical cortical bone. Here, a unique two-step approach, i.e., the combination of electrospinning and twin screw extrusion (TSE) techniques was used to fabricate a microfilament/nanofiber shell–core scaffold that could precisely control the spatial distribution of different types of cells to form vascularized osteon-like structures. The scaffold contained a helical outer shell consisting of porous microfilament coils of polycaprolactone (PCL) and biphasic calcium phosphates (BCP) that wound around a hollow electrospun PCL nanofibrous tube (the core). The porous helical shell supported the formation of bone-like tissues, while the luminal surface of nanofibrous core enabled endothelialization to mimic the function of Haversian canal. Culture of mouse pre-osteoblasts (POBs, MC 3T3-E1) onto the coil shells revealed that coils with pitch sizes greater than 135 μm, in the presence of BCP, favored the proliferation and osteogenic differentiation of POBs. The luminal surface of PCL nanofibrous core supported the adhesion and spreading of mouse endothelial cells (ECs, MS-1) to form a continuous endothelial lining with the function similar to blood vessels. Taken together, the shell–core bi-layered scaffolds with porous, coil-like shell and nanofibrous tubular cores represent a new scaffolding technology base for the creation of osteon analogs.