Clinical Applications of 3‐Dimensional Printing Technology in Hip Joint

Three‐dimensional (3D) printing is a digital rapid prototyping technology based on a discrete and heap‐forming principle. We identified 53 articles from PubMed by searching “Hip” and “Printing, Three‐Dimensional”; 52 of the articles were published from 2015 onwards and were, therefore, initially considered and discussed. Clinical application of the 3D printing technique in the hip joint mainly includes three aspects: a 3D‐printed bony 1:1 scale model, a custom prosthesis, and patient‐specific instruments (PSI). Compared with 2‐dimensional image, the shape of bone can be obtained more directly from a 1:1 scale model, which may be beneficial for preoperative evaluation and surgical planning. Custom prostheses can be devised on the basis of radiological images, to not only eliminate the fissure between the prosthesis and the patient's bone but also potentially resulting in the 3D‐printed prosthesis functioning better. As an alternative support to intraoperative computer navigation, PSI can anchor to a specially appointed position on the patient's bone to make accurate bone cuts during surgery following a precise design preoperatively. The 3D printing technique could improve the surgeon's efficiency in the operating room, shorten operative times, and reduce exposure to radiation. Well known for its customization, 3D printing technology presents new potential for treating complex hip joint disease.     

X线片测量髌骨外倾角在髌股关节病诊断中的应用

目的观察髌股关节病患者,髌骨外倾角的大小范围对髌股关节病诊断的意义。 方法实验组收集年龄27～65岁,平均年龄(50±4)岁。临床上就诊于哈尔滨市第一医院骨科患者,不同程度的膝关节疼痛及屈伸活动受限,排除类风湿性关节炎,关节感染,关节外伤,符合髌股关节病诊断标准病例214例,共计214膝。拍摄X光下膝关节屈膝髌骨30°时轴位片,测量髌骨外倾角的大小。对照组收集年龄28～77岁,平均年龄(51±3)岁,无膝关节病及疼痛的病例60例,共计60膝,拍摄X光下膝关节屈膝髌骨30°时轴位片,测量髌骨外倾角的大小。 结果实验组测得髌骨外倾角在18.5°～35.2°之间,髌股关节病患者X光下膝关节屈膝髌骨30°时轴位片髌骨外倾角增大。对照组测得髌骨外倾角在7.7°～18.7°之间,X光下膝关节屈膝髌骨30°时轴位片髌骨外倾角在正常范围。 结论髌骨外倾角的测量对于髌股关节病的诊断有重要意义,X光下膝关节屈膝髌骨30°时轴位片见髌骨外倾角增大并伴有关节疼痛患者可以考虑髌股关节病诊断,可行关节镜手术治疗。     

上颈椎不稳前路内固定方式的选择

目的:探讨上颈椎不稳前路内固定手术方式的选择及治疗效果。方法:自2000年3月至2010年9月,采用寰枢椎前路内固定手术治疗上颈椎不稳83例,男59例,女24例;年龄20～68岁,平均42岁。其中齿状突螺钉内固定36例,寰枢椎前路经关节螺钉内固定16例,C2,3前路钢板内固定23例,齿状突螺钉联合寰枢椎经关节螺钉内固定5例,齿状突螺钉联合C2,3钢板内固定2例,寰枢椎经关节螺钉联合C2,3钢板内固定1例。结果:1例颈脊髓完全损伤患者,行寰枢椎经关节螺钉内固定,术后1个月死于肺部感染。其余病例获得随访,时间8个月～3年,平均15个月。无椎动脉及脊髓损伤,所有病例寰枢椎获得稳定。36例齿状突螺钉内固定及5例齿状突联合寰枢椎经关节螺钉内固定者,未植骨,齿状突骨性愈合。寰枢椎经关节螺钉内固定病例:1例并发肺部感染死亡;1例齿状突ⅡC型粉碎性骨折并寰枢关节前脱位,齿状突及植骨未骨性愈合,但寰枢关节纤维连接无不稳定表现;1例寰枢椎陈旧性前脱位Ⅰ期前路寰枢椎经关节螺钉内固定,Ⅱ期后路Brooks钢丝内固定后路植骨,寰枢椎骨性融合。其他病例均植骨并获骨性融合。结论:上颈椎不稳患者,根据不同的骨折及不稳类型,选择相应的前路内固定,可取得较好疗效。     

枢椎逆向椎弓根螺钉在经口咽入路治疗寰枢椎脱位中的应用

目的 探讨枢椎逆向椎弓根螺钉在经口咽入路治疗寰枢椎脱位中的应用价值.方法 选择2009年3月至2011年10月收治的25例寰枢椎脱位患者,男11例,女14例;年龄17～65岁,平均39岁;其中创伤性寰枢椎脱位17例,游离齿状突合并寰枢椎脱位8例.均实施经口咽入路松解、复位、内固定手术,寰椎采用前路侧块螺钉固定,枢椎采用逆向椎弓根螺钉固定.术后CT扫描观察术后钉道情况,测量螺钉的外倾角、下倾角、螺钉长度等.通过比较手术前、后日本矫形外科学会(JOA)评分、寰齿间隙(ADI)评估疗效.结果 25例患者共置入枢椎逆向椎弓根螺钉50枚,平均手术时间145 min,平均出血量94 mL.枢椎椎弓根螺钉的平均外倾角为20°、下倾角为15 °、螺钉长度为28 mm.24例患者术后获得10～25个月(平均16个月)随访,术后3个月JOA评分(15.7±1.1)分和末次随访时(16.0±0.7)分较术前(8.9±1.7)分均明显提高,差异有统计学意义(P＜0.05).ADI由术前(8.7±1.5) mm改善为术后(0.8±0.9)mm,差异有统计学意义(t=2.937,P＜0.05).结论 经口咽入路实施枢椎逆向椎弓根螺钉是可行的,但该技术具有一定风险,可以在有条件的医院审慎开展.     

经皮前路侧块螺钉内固定植骨融合治疗C1,2不稳

目的　创建一种经皮前路侧块螺钉内固定植骨融合治疗C1,2 不稳的手术方法。方法　取 4 0名正常人影像学测量寰枢椎正位、侧位片的标准角、安全角、椎动脉内壁至寰椎上下缘中点连线的距离等相应数据 ,并用自行研制手术器械 ,对 15例C1,2 创伤性不稳的患者。男 10例 ,女 5例 ;寰枢椎 (半 )脱位 7例 ,陈旧齿状突骨折伴脱位 1例 ;Jefferson骨折 3例 ;C1前弓骨折 4例。在C臂X光机监视下行经皮前路侧块螺钉内固定前路植骨融合技术治疗 ,并分析其治疗结果。结果　正位片上其标准角右侧为 2 4 0°± 3 7° ,左侧为 2 3 8°± 1 8°;安全角右侧为 15 2°～ 30 3° ,左侧为 14 8°～ 32 1°;椎动脉内壁至寰椎上下缘中点连线的距离右侧为 (5 6± 2 2 )mm ,左侧为 (5 8± 1 9)mm ;侧位片的标准角为 2 4 1°± 1 8° ;安全角为 12 6°～ 2 6 8°。 15例患者内固定均获得了满意效果 ,螺钉位置佳。无脊髓、椎动脉和食管损伤等并发症发生。穿刺创口无感染。结论　经皮前路侧块螺钉内固定治疗C1,2 不稳操作简单 ,出血少 ,创伤小 ,恢复快 ,可一期行侧块关节固定植骨融合。手术有一定风险 ,如使用合理的配套器械 ,并熟悉其解剖特点 ,在X线透视下正确选择进针点、角度和深度 ,操作规范 ,此技术是安全的。     

基于快速成型技术的个体化人工股骨髁关节面的设计与应用

目的设计、制造一种基于快速成型技术、复合异体半关节移植的个体化人工股骨髁关节面,探讨解决异体半关节移植中异体关节软骨坏死和异体-自体关节形状不匹配的方法。方法对异体半关节和骨肿瘤患肢股骨髁外表面行螺旋CT扫描,将CT断层图像进行矢量转换后在Surfacer 9．0软件进行矢量化三维重建,提取出合适的异体骨软骨下骨和患者关节软骨表面轮廓的三维图像,在计算机辅助下设计人工关节面,应用LPS600快速成型机制出快速成型树脂模型,以钛合金为材料铸造关节面假体主件,通过融合笼将关节面固定于关节上,抛光后获得人工关节软骨面成品。2002年2月对1例男性14岁右股骨下段骨肉瘤患者,行右股骨下段瘤段切除、人工股骨髁关节面复合大段同种异体骨移植重建股骨下端骨缺损术。结果新型复合异体半关节移植的个体化人工股骨髁关节假体与异体骨、对侧关节匹配良好;应用后随访16个月,膝关节功能良好。结论个体化股骨髁关节面明显改善了异体半关节移植患者的膝关节功能,为异体半关节移植中存在的异体关节软骨坏死和异体一自体关节形状不匹配提供一种解决方案。     

用Gallie术式治疗寰枢关节不稳定的临床问题研究

目的研究寰枢椎后路内固定融合术治疗寰枢关节不稳或脱位的相关临床问题。方法回顾138例由创伤或畸形所致的寰枢关节不稳或脱位的外科治疗,其中齿突发育畸形伴寰枢椎脱位62例,齿突骨折或横韧带断裂伴寰枢关节不稳或脱位54例,寰枢椎半脱位伴旋转畸形22例,全部采用Gallie技术,6例合并使用侧块经关节螺钉固定,此6例患者术后采用简易颌胸围领固定,其余患者均采用头颈胸石膏或颌胸石膏固定。随访1～12年,平均3年5个月。结果根据Sumi评价标准：优70例(50．7％),良40例(29．0％),中15例(10．9％),差13例(9．4％)。9例植骨延迟愈合,经加强外固定治愈,2例植骨不愈合者行翻修手术,1例出现脊髓损伤并发症。结论Gallie融合术是治疗寰枢椎不稳或脱位的有效术式,术前的牵引复位及术后可靠的外固定是治疗成功的必要的辅助手段。精细的穿钢丝或钛缆技术、寰椎后弓去皮质、寰枢椎后弓间植骨块维持生理高度是手术成功的关键。寰枢椎后路融合失败者必须在明确适应证和目的的情况下采取翻修手术。     

肱骨近端骨折的治疗理念与思考

肱骨近端骨近是临床上常见的骨折之一,约占全部骨折的4%～5%,在人群中的总年发病率为6.6/1000;65岁以上老年人大多存在骨质疏松,其肱骨近端骨折发病率排在髋部骨折和桡骨远端骨折之后,位列第3位,占全部骨折的10%,以每年13.7%的速度增加;如果这种趋势继续,未来30年,其发生率将是目前的3倍[1]。伴随着肱骨近端骨折发生率不断升高,如何选择最合理的治疗方式,以缓解肩关节疼痛,恢复肩关节功能,并降低医疗费     

Relations between specific and global outcome measures in a social-communication intervention for children with autism spectrum disorder

Assessment of relevant outcomes is a key challenge in evaluating effects of social-communication interventions. However, few studies have investigated in what ways specific and more global measures may influence reported results of social-communication interventions for children with autism spectrum disorder (ASD). In this study both a specific and a global, more global autism symptom measure were used to assess effects of a brief social-communication intervention. Fifty-nine children (2–4 years) diagnosed with autistic disorder were assessed with the Joint Engagement (JE) states coding procedure and a preliminary version of the Brief Observation of Social Communication Change (BOSCC). A statistically significant difference was found between intervention and control groups from baseline to intervention endpoint on JE but not on BOSCC. Degree of change on the measures was moderately related, and both were independent of language level and non-verbal mental age. This study adds to the knowledge of what may be expected of different outcome measures and provides suggestions to how measures may be deployed to investigate underlying mechanisms and developmental pathways.     

Staphylococcus aureus infection complicating haemarthroses in elderly patients

Summary The case histories of 3 elderly patients who developed haemarthrosis of osteoarthritic joints with subsequent infection with staphylococcus aureus, are described. Trauma to the affected joints was a predisposing factor in 2 patients and, while only one patient developed clinical signs of sepsis, all had marked elevation of the erythrocyte sedimentation rate. Although suspicion of joint sepsis was obscured by the presence of a coexistent haemarthrosis, routine culture of joint aspirates showed infection with staphylococcus aureus and all patients recovered well with antibacterial therapy.