髋臼横行骨折经前入路不同内固定的生物力学研究

目的比较髋臼横行骨折经前侧入路给予髋臼前柱3种内固定方式的稳定性。方法将制成髋臼横行骨折模型的18个新鲜标本,随机、平均分为3组。LS组:单纯拉力螺钉固定组;RP组:重建接骨板固定组;LP组:锁定重建接骨板固定组。本实验在美国BOSE-3500型生物力学试验机上进行,依据3枚克氏针所代表的三维坐标平面,将半骨盆标本调整至人体倒置单足站立位置固定于包埋盒中,实验进行连续性轴向加载直至三组内固定均达到失效。观察3组标本在同一载荷下的纵向移位、纵向位移均2.00mm时的载荷及此时的内固定轴向刚度。结果 LS组骨折的纵向位移大于RP组、LP组,轴向刚度小于RP组、LP组,差异具有统计学意义(P0.05),RP组与LP组的纵向位移及轴向刚度之间均无统计学差异(P0.05)。结论经前侧入路给予前柱内固定治疗髋臼横行骨折时,锁定重建接骨板固定组与重建接骨板固定组稳定性相似,无统计学差异,单纯拉力螺钉固定组稳定性较弱。     

外固定支架与锁定加压钢板治疗桡骨远端C型骨折对比疗效分析

目的对比分析外固定支架和锁定加压钢板治疗桡骨远端C型骨折的临床疗效。方法锁定加压钢板治疗组(LCP组)患者38例,外固定支架治疗组(EF组)30例。其中男性32例,女性36例;平均年龄46.25岁。术后复查患肢腕关节正侧位X线片,观察并计算LCP组和EF组的桡骨高度、掌倾角、尺偏角。术后3个月和12个月计算患者腕关节的功能恢复得分。结果术后LCP组和EF组桡骨高度值分别为(9.40±0.52)mm、(9.20±0.50)mm;掌倾角值分别为(9.35±0.60)°、(9.27±0.71)°;尺偏角值分别为(20.40±0.78)°、(21.30±0.73)°,无统计学差异(P0.05)。术后3个月LCP组和EF组腕关节改良GW评分分别为(3.51±1.17)分、(5.36±1.58)分,有统计学差异(P0.05)。术后12个月LCP组和EF组腕关节改良GW评分,分别为(2.86±1.01)分、(3.12±1.00)分,无统计学差异(P0.05)。结论 LCP组短期内关节功能恢复较EF组好,远期无明显差异。     

连枷胸合并血气胸的急诊处理临床分析

目的观察连枷胸合并血气胸根据手术时机行急诊肋骨内固定术的临床效果。方法回顾性分析2013年1月~2014年2月收治的49例连枷胸合并血气胸患者的临床资料,其中男性31例,女性18例;年龄19~79岁,平均年龄(49.2±7.8)岁。按手术时机分组:受伤后2d内接受早期手术者26例为观察组,2~7d接受晚期手术者23例为对照组,分析两组患者的机械通气时间、下床时间、拔管时间、疼痛程度以及并发症情况。结果观察组机械通气时间、下床时间、拔管时间分别为(95.2±13.1)h、(48.8±11.2)h、(32.8±10.7)h,显著少于对照组的相应指标(P0.05);观察组术后疼痛视觉模拟评分(VAS)和重度疼痛比例显著低于对照组(P0.05),观察组肺不张、肺部感染发生率和死亡率明显低于对照组,而两组患者胸廓畸形和肋间神经痛发生率无明显差别。结论早期急诊肋骨内固定术治疗连枷胸合并血气胸可以及时消除胸壁软化及反常呼吸运动,改善呼吸功能,减少并发症,明显有利于病情恢复。     

锁定接骨板对老年肱骨近端骨折患者疼痛程度及关节功能的影响

目的探讨锁定接骨板对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法选择2008年8月~2014年10月就诊的老年肱骨近端骨折患者80例为研究对象,根据手术方法不同分为观察组和对照组(n=40例)。观察组:男性28例,女性12例;年龄61~78岁,平均(67.69±7.92)岁。对照组:男性29例,女性11例;年龄62~75岁,平均(68.12±7.79)岁。观察组患者接受锁定接骨板治疗,对照组患者接受常规切开复位内固定治疗,比较两组患者的手术情况、术后关节疼痛程度和关节功能。结果两组患者手术时间、术中出血量、术后制动持续时间、住院总时间比较无统计学意义(t=0.633~1.291,P0.05);术后1、2、3、4周时,观察组患者的数字评分量表(NRS)评分均低于对照组(t=7.105~9.378,P0.05);术后1、3、6、12个月时,观察组患者的关节功能评分量表(Neer)评分均高于对照组(t=2.906~4.039,P0.05)。结论锁定接骨板治疗老年肱骨近端骨折有助于减轻疼痛程度、改善关节功能。     

空心加压螺钉内固定术治疗股骨颈骨折的疗效

目的：探讨研究空心加压螺钉内固定术治疗股骨颈骨折的疗效及安全性。方法选取2013年1月～2015年2月骨科收治的70例股骨颈骨折患者,采用随机数字法分为治疗组和常规组,对照组采用DHS进行固定,观察组采用空心加压螺钉内固定治疗,并对两组患者康复情况满意度、两组患者术后发生的愈合率、两组患者股骨头坏死情况进行比较。结果观察组的患者康复情况满意度、两组患者术后发生的愈合率、两组患者股骨头未坏死情况均高于对照组,差异具有统计学意义（ P＜0．05）。结论空心加压螺钉内固定术手术的创伤面积小,无需进行术后的特殊护理,是一种较可靠、安全、理想的内固定法,值得临床的广泛推广和应用。     

Computerized tomography based 3D modeling of the clavicle

Previous studies have suggested clavicular morphology is highly variable, particularly in the lateral retrocurved section. Current clavicle fracture plating systems require three dimensional intra‐operative contouring to achieve adequate fit and necessitate variable soft tissue dissection placing fracture perfusion and muscular attachments at risk. The aim of this study was to search for a surgically relevant superficial shape pattern. This is a retrospective CT‐based analysis of 174 non‐pathological clavicles in 95 adults (45 females, 50 males). Using the principle of cylindrical parameterisation generated 3‐D computer models, we identified an implant preferred pathway (IPP), defined as a continuous linear region where the least possible soft tissue disruption would be necessary for plate fixation. The IPP mean form was within 3.04 mm (SD ± 1.34) on all clavicles. Clavicle length, and not shape, was found to be the biggest variable (correlation between size and form co‐ordinates r = 0.99, p < 0.05), accounting for 79% of overall variability. This length variation was mainly located in the medial antecurved section. Superior convexity and recurvatum were the main shape variables, however they only contributed 8% and 5% to the overall variation, respectively. Three IPP lengths were shown to match all clavicles when aligned at the acromial end first. In contrast to previous studies, we have shown that the IPP is fairly consistent with respect to the general shape with the exception of length variation which mainly affected the medial antecurved section. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1216–1223, 2016.

CLINICAL RELEVANCE

Future pre‐contoured fracture fixation systems should provide variable length plates with a constant lateral section retrocurve and a variable medial antecurve.     

Construct damage and loosening around glenoid implants: A longitudinal micro‐CT study of five cadaver specimens

The evolution of failure of bone and cement leading to loosening of glenoid components following shoulder arthroplasty is not well understood. The purpose of this study was to identify and visualize potential mechanisms of mechanical failure within cadavers, cemented with two types of components, and subject to cyclic loading. Five glenoid cadaver bones were implanted with either a three‐pegged polyethylene component, or prototype posteriorly augmented component which addresses posterior bone loss. Specimens were loaded by constant glenohumeral compression combined with cyclic anterior–posterior displacement of the humeral head relative to the glenoid. At six time points across 100,000 cycles, implant loosening micromotions were optically measured, and specimens were imaged by micro‐computed tomography. Scans were 3D registered and inspected for crack initiation and progression, and micro‐CT based time‐lapse movies were created. Cement cracking initiated at stress concentrations and progressed with additional cyclic loading. Failure planes within trabecular bone and the bone–cement interface were identified in four of the five specimens. Implant subsidence increased to greater than 1.0 mm in two specimens. Cemented glenoid structural failure can occur within the cement, along planes of trabecular bone, or at the bone cement interface. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1053–1060, 2016.     

反向微创内固定系统与股骨近端防旋髓内钉修复股骨粗隆外侧壁破裂回顾性研究

目的探讨反向倒置股骨远端微创内固定系统(LISS)及股骨近端防旋髓内钉(PFNA)治疗股骨粗隆外侧壁破裂的临床疗效。方法回顾性分析2013年6月至2015年1月中国医科大学附属第四医院骨科采用反向LISS和PFNA治疗的36例股骨粗隆骨折患者的临床资料。根据治疗方法将患者分为PFNA组20例,反向LISS组16例。比较两组患者的术前美国麻醉学会(ASA)评分、手术时间、术中出血量、骨折复位质量、住院日,术前、术后及术后10个月随访颈干角角度、术后并发症以及术后10个月髋关节Harris评分等。结果所有患者获得随访时间10~12个月,平均11.1个月。全部患者均骨折愈合,无伤口感染、内固定切出。两组患者手术时间、术中出血量比较,差异有统计学意义(P<0.05);Harris髋关节评分、术后颈干角、术后并发症发生率比较,差异均无统计学意义(P>0.05)。随访10个月后,两组患者颈干角比较,差异有统计学意义(P<0.05)。结论反向LISS及PFNA治疗老年复杂股骨粗隆间粉碎性骨折,临床疗效都比较理想,均为较好的内固定物。     

桥接组合式内固定系统治疗肱骨骨折疗效观察

目的探讨桥接组合式内固定系统治疗肱骨骨折的疗效。方法随机选取自2013年6月至2014年12月云南省第三人民医院骨伤科收治的肱骨干骨折患者50例。根据手术方法不同进行分组,其中,桥接组患者26例,钢板组患者24例。比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、内固定后并发症、肩肘关节功能评分等指标,对桥接组合式内固定系统治疗肱骨骨折的临床疗效做出评价。结果桥接组患者在手术时间、出血量、骨折愈合时间等方面均优于钢板组,差异均有统计学意义(P<0.05)。两组患者住院时间及肩、肘关节功能评分比较,差异无统计学意义(P>0.05)。两组患者术后均未出现骨不连、桡神经损伤等并发症。结论桥接组合式内固定系统治疗肱骨骨折在临床疗效、愈合时间、并发症、肩肘关节功能恢复等方面均有显著优势。另外,桥接组合式内固定系统在操作方面较锁定钢板更为简便,结构更稳固。