髓内固定与髓外固定治疗Evans-JensenⅢ型股骨转子间骨折疗效比较

目的比较髓内固定与髓外固定治疗股骨转子间骨折的疗效。方法 2005年6月-2011年6月对骨转子间骨折Evans-Jensen分型为Ⅲ型的32例患者,分别选用髓内固定系统的股骨近端髓内钉（PFNA）和重建交锁钉（Gamma钉）,以及髓外固定系统的髋动力加压钢板（DHS）和股骨近端锁定钢板（LCP）进行固定治疗,比较各组的手术时间、术中出血量、负重时间、Harris髋关节评分和术后并发症等指标的差异。结果髓内固定系统的手术方法中的Gamma钉组和PFNA组明显比髓外固定系统的DHS组和LCP组的手术时间缩短,术中出血量减少,术后引流量减少（P〈0.05）。两种固定系统住院时间比较差异无统计学意义（P〉0.05）。Gamma钉组和PFNA组之间,DHS组和LCP组之间在手术时间、术中出血量和术后引流量上的比较差异均无统计学意义（P〉0.05）。结论对于Evans-JensenⅢ型股骨转子间骨折的手术治疗,髓内固定系统明显优于髓外固定系统。     

Anterior locking plate reduces trochanteric fracture migrations during hip extension

Background

Greater trochanter fractures or osteotomies fixed with lateral plates still present high rates of complications. Unblocked greater trochanter anterior movement during hip extension might be a possible cause of failure. This study aimed to determine, under stair climbing conditions, the biomechanical behaviour of a greater trochanter fragment and the impact of an anterior locking plate on its migration.

Methods

Eighteen femurs paired from nine fresh frozen cadaveric specimens were tested on a quasi-dynamic stair climbing cycling test bench. Left and right sides with greater trochanter fractures were randomly fixed either with an antero-lateral locking plate or with a lateral locking plate. Migrations, defined as the remaining movements of the unloaded greater trochanter fragment, were measured for all 18 femurs.

Findings

During hip extension, multi-directional greater trochanter fragment movements occurred and showed a back-and-forth anterior rotation. The lateral locking plate failed due to greater trochanter fragment rotation around the superior axis and anterior translation. The antero-lateral locking plate significantly reduced greater trochanter anterior migration (− 0.9 mm ± 1.6) compared to the lateral locking plate (9.6 mm ± 9.5).

Interpretation

Hip extension provides a plausible explanation for the high rate of post-operative failures of greater trochanter fixations. An antero-lateral locking plate represents an efficient surgical alternative counteracting the multi-directional greater trochanter movements occurring during hip extension.     

The effect of interlocking parallel screws in subcapital femoral-neck fracture fixation: a cadaver study

Background

A new locking-plate for femoral-neck fractures that provides angular stability to three screws in an inverted triangle configuration was evaluated. The plate is not fixed to the lateral cortex and therefore represents a new treatment principle.

Methods

Twelve pairs of cadaver femurs (mean T-score − 1,95 (range − 4,5–0)) with subcapital femoral-neck fractures angulating 60° were randomly allocated to fracture-fixation using either three individual screws or three interlocked screws. Subject-specific axial force and torque were applied by a hip simulator and three-dimensional migrations were recorded. The femurs underwent 10,000 cycles of simulated partial weight-bearing, followed by 10,000 cycles of simulated full weight-bearing and stair climbing.

Findings

On average interlocking reduced femoral-head centre migrations 1.6 mm (95% CI 0.1–3.1, P = 0.04). The intra-pair correlation of migration was 0.953 (Pearson's r). Interlocking did not change rotational stability (P = 0.87). Adding a locking plate did not affect the risk of failure, however all failed femurs were fixed using the smallest-sized aiming guide.

Interpretations

Adding a lateral interlocking plate to three screws might improve the fracture stability. However, none of the implants were able to resist the unwanted deformation of the proximal femur. Regardless of the fixation, female sex, reduced bone quality and small sized femurs appear to increase risk of failure.     

重建钢板治疗髋臼骨折的疗效分析

目的探讨切开复位重建钢板内固定治疗髋臼骨折的疗效。方法选取邢台医专第二附属医院2009年9至2013年1月收治的髋臼骨折患者28例,运用切开复位重建钢板内固定术治疗。结果全部患者均获得随访,随访时间为12-18个月,平均15个月,其中优14例,良9例,可4例,差1例,优良率为82.14%。结论运用重建钢板切开复位内固定治疗髋臼骨折,可以有效避免因长期卧床而引起并发症,促进骨折愈合,术后恢复快。     

微创经皮锁定钢板治疗胫骨骨折34例疗效分析

目的：探索微创经皮锁定钢板治疗胫骨骨折的疗效。方法：采用微创经皮锁定钢板治疗胫骨骨折34例,其中男性21例,女性13例,胫骨上段骨折8例,中下段骨折26例,按AO分型,A型24例,B型6例,C型4例。结果：手术用时30~57min,平均48min;术中出血50~150mL,平均100mL,术后肿胀消退时间2~7d,平均4d,临床愈合时间为12~19周,平均15周。有1例发生切口处湿疹,1例切口处感染,所有患者均一期愈合,无钢板螺钉松动断裂,无骨髓炎等。临床近期治疗效果按Johner-Wruhs标准评定：本组病例优23例,良8例,中2例,差1例,优良率91.2%。结论：微创经皮锁定钢板固定法治疗胫骨骨折具有手术创伤小,软组织破坏少,固定可靠,术后并发症少,骨折愈合快,愈合率高,临床疗效好。     

AGFA ADC SOLO CR的质量控制

目的总结SOLO CR(computed rad iography)系统高效、可靠、稳定运行,获取高质量的数字图像质量控制方法。方法结合实际情况(如工作环境、使用频率等)对3套AGFA ADC SOLO CR制定详细的质量控制计划,适时监控,实施有效地保养与维护,使系统保持在正常运转状态。结果2年内保证了3套CR系统工作正常、稳定地运行,获得了比较好的预期效果。结论得当的、行之有效的质量控制是非常必要的,为输出高质量的数字图像提供了可靠的保障。     

Experimental study of the participation of the vertebral endplate in the integration of bone grafts

The surgical technique of anterior vertebral arthrodesis has been modified by the introduction of cages in spinal surgery. The classical technique recommends removal of the vertebral endplate and exposure of bleeding cancellous bone. However, after the observation of cage subsidence during postoperative follow-up, the vertebral endplate is no longer removed, due to its greater mechanical resistance which can prevent cage subsidence. The mechanical characteristics of the vertebral endplate are well known, in contrast to its osteogenic potential, which was investigated in the present experimental study. The study was conducted on mongrel dogs of both sexes, which were submitted to anterior corpectomy at the cervical spine level. A cortico-cancellous bone graft removed from the tibia was used for the reconstruction of the vertebral segment, which was used with osteosynthesis plates. At the site of contact between the surface of the vertebral body and the bone graft, the vertebral endplate was completely removed and cancellous bone was exposed in the inferior vertebra, whereas in the superior vertebra of the arthrodesed vertebral segment only curettage was performed, and the vertebral endplate was preserved, as recommended for cage implantation. Twenty adult dogs of both sexes were divided into four experimental groups according to time of sacrifice (15, 30, 90, and 180 days). The consolidation of the bone graft with the vertebral body was evaluated by histology using hematoxilin-eosin and Gomori trichrome staining. In the interface between the bone graft and the vertebral body surface in which the vertebral endplate was not removed, graft consolidation was not observed in any of the group I animals (sacrificed after 15 days), and was observed in 1/5 animals of group II (30 days), in 2/5 animals of group III (90 days), and in 4/5 animals of group IV (180 days). In the interface between the graft and the vertebral body in which the vertebral endplate was removed, bone-graft consolidation was observed in all animals of all experimental groups (15, 30, 90, and 180 days). Bone-graft consolidation with the surface of the vertebral body was influenced by the removal or maintenance of the vertebral endplate. Due to the importance of this structure in current surgical procedures, this phenomenon deserves to be studied in more detail in order to understand the basic events involved in this process.Research carried out in the Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14048-900 Ribeirão Preto, SP, Brazil.     

颈椎前路带锁钢板临床应用的失误原因分析

目的：分析颈椎前路带锁钢板螺钉系统临床应用并发症的产生原因并提出预防措施。方法：随访颈椎前路带锁钢板治疗颈椎骨折脱位、脊髓型颈椎病和颈椎体肿瘤共42例，观察带锁钢板螺钉系统应用的并发症。结果：有关的并发症包括固定螺钉进入椎间隙、单一螺钉退出、钢板拔出等，共6例患者，多数与手术操作不当有关。结论：严格掌握颈椎前路带锁钢板固定的适应症和熟练手术操作是预防其并发症发生的关键。     

The Pathogenesis of Anorectal Malformation Induced by All-Trans Retinoic Acid in Mice

The pathogenesis of anorectal malformations has been discussed for more than 100 years, however, much remains to be elucidated. We studied the pathogenesis of high-type anorectal malformations induced by all-trans retinoic acid (all-trans RA) in mice. Pregnant females were injected intraperitoneally once with all-trans RA, suspended in corn oil (5 mg/ml), at a dose of 100 mg/kg on day 9 of pregnancy. The all-trans RA-treated females were killed on one of days 10 to 18 of pregnancy. All fetuses examined on day 18 of pregnancy following in utero exposure to all-trans RA had anorectal malformations. In the affected male fetuses, the rectum was positioned away from the retroperitoneum toward the ventral side leading to the opening of the urethra just underneath the urinary bladder. Deficiency of the cloacal plate at the dorsal part was also observed in the affected embryos during days 10–11 of pregnancy. The cloacal plate is considered to bring the cloacal cavity to the anus, and thus the deficiency of the dorsal part may be the major cause of the hightype anorectal malformations.