Closed/open reduction and titanium elastic nails for severely displaced proximal humeral fractures in children

Purpose

The aim of the study was to evaluate the clinical outcome of closed/open reduction and titanium elastic nails (TENs) in children with severely displaced proximal humeral fractures.

Methods

A retrospective study was performed on 37 children suffering from proximal humeral fracture between April 2009 and July 2012. All these patients were treated by closed or open reduction with TEN fixation. The healing process was assessed by radiographic and clinical follow-up for up to 36 months. Radiographic assessment was performed on the scheduled follow-ups to examine fracture healing, remodelling, bone growth and residual deformity. The clinical outcomes were evaluated using the Neer shoulder score and patients’ satisfaction report at the final follow-up. Complications related to the treatment were also recorded.

Results

All patients had a mean follow-up period of 24 months (12–36) after surgery. All fractures were healed, radiologically, at a median time of eight weeks (seven to ten weeks). There were no major complications related to the treatment. Two patients complained about skin irritation around the sides of the prominent distal ends of the nails. Implant removal took place at an average of 5.8 months post-operatively as an outpatient procedure. There were no observed complications in association with the removal of the hardware. At the final follow-up, the mean Neer shoulder score was 96.65 (range 83–100). Thirty patients were very satisfied with their surgical outcomes and the remaining seven were satisfied. Function of the affected arm returned to normal at the end of the follow-up period in all cases.

Conclusions

Combining closed or open reduction with TEN fixation is recommended for treating severely displaced proximal humeral fractures in children. Our data showed evidence of satisfactory outcomes with a low complication rate and a fast return to normal mobility of the affected arms.     

钛制弹性髓内钉内固定治疗肱骨近端骨折的初步观察

目的 探讨钛制弹性髓内钉内固定治疗成人不稳定肱骨近端骨折的可行性及疗效。方法 回顾性分析自2009-06-2012-12采用钛制弹性髓内钉内固定治疗的42例成人肱骨近端骨折的临床资料。结果 本组42例平均随访17.2个月（10-30个月）。平均手术时间28 min（20-60 min）,平均出血量45 ml（20-100 ml）。骨折均获愈合,平均愈合时间为8.8周（6-12周）。末次随访时,VAS疼痛评分平均0.7分（0-4分）;Constant-Murley绝对值评分平均86.7分（68-100分）,优17例,良20例,可4例,差1例,优良率88.1%。未发生神经血管损伤、感染、骨折不愈合及肱骨头坏死等并发症。结论采用钛制弹性髓内钉内固定治疗成人肱骨近端骨折效果良好,具有创伤轻微、固定可靠、并发症少等优点,适用于肱骨外科颈骨折以及部分合并大结节骨折的3部分骨折。     

Grain-to-Grain Interaction Effect in Polycrystalline Plain Low-Carbon Steel within Elastic Deformation Region

A grain is surrounded by grains with different crystal orientations in polycrystalline plain low-carbon steel. The grain is constrained by its adjacent grains in the tension process. The interaction of the grain with the adjacent grains was investigated within the elastic deformation region. The following results have been obtained: (1) the Young’s modulus of a grain without consideration of grain-to-grain interaction is denoted as the inherent Young’s modulus; when the inherent Young’s modulus of a grain is equal to the Young’s modulus of the bulk material, there is almost no interaction between the grain and its adjacent grains; when a grain has a great difference between its inherent Young’s modulus and the Young’s modulus of the bulk material, its grain-to-grain interactions increase significantly; (2) the grain-to-grain interaction is mainly caused by the difference in the inherent Young’s modulus between the grain and its adjacent grains; the misorientation angle between the grain and its adjacent grains has almost no effect on the grain-to-grain interaction.     

On the Determination of Elastic Properties of Single-Walled Boron Nitride Nanotubes by Numerical Simulation

The elastic properties of chiral and non-chiral single-walled boron nitride nanotubes in a wide range of their chiral indices and diameters were studied. With this aim, a three-dimensional finite element model was used to assess their rigidities and, subsequently, elastic moduli and Poisson’s ratio. An extensive study was performed to understand the impact of the input parameters on the results obtained by numerical simulation. For comparison, the elastic properties of single-walled boron nitride nanotubes are shown together with those obtained for single-walled carbon nanotubes.     

健康人与高血压患者动脉弹性功能比较

目的　比较不同年龄、血压水平的健康人和高血压患者动脉弹性功能。方法　选取健康志愿者和高血压患者共551人 ,其中男性 30 3人 ,女性 2 4 8人 ,平均年龄为 56 9± 1 3 4岁。分别根据年龄和血压水平分组 ,使用DO 2 0 2 0动脉功能测定仪检测桡动脉脉搏波形和动脉弹性指数C1 和C2 ,进行比较研究。结果　随着年龄不断增高 ,健康人和高血压病人的C1 和C2 值逐渐下降。健康组和高血压组男性的C1 和C2 均高于女性 ,P <0 0 1。校正年龄因素影响后 ,随着血压水平的升高 ,大小动脉弹性指数下降。高血压病人大动脉弹性明显比正常血压者低。处于正常高限者小动脉弹性指数C2 显著低于理想和正常血压者 ,与 1级高血压组无明显差别。简单相关分析表明年龄、收缩压、舒张压、脉压和心率与动脉弹性指数C1 和C2 存在明显负相关 ,其中脉压与C1 相关性 (r =- 0 60 2 ,P <0 0 1 )最为显著 ,而C2 与年龄相关性 (r=- 0 457,P <0 0 1 )最为明显。结论　 (1 )年龄增大、血压升高与血管弹性下降密切相关 ,血管弹性检测可能比测量血压更为有效反映血管功能状态。 (2 )小动脉弹性指数 (C2 )为一敏感反映动脉损害的指标 ,有助于筛选出处于亚临床状态的心血管病人。     

弹性纤维在皮肤光老化进程中变化的相关研究

目的:观察不同年龄阶段,光暴露以及光保护皮肤中弹性纤维的变化,研究皮肤弹性纤维在紫外线作用下的改变。方法:收集30例不同年龄阶段患者(年龄为9~78岁)正常皮肤标本,观察弹性纤维在醛品红法染色后的结果。结果:在光暴露部位,中老年与青少年人相比,真皮层弹性纤维明显增多、增粗,同时出现扭曲、排列紊乱的现象,真皮上层与表皮之间出现不染区;反之,在光保护部位,两个年龄阶段患者皮肤的弹性纤维均减少。结论:在紫外线的长时间作用下,皮肤弹性纤维会出现增多变性,其变化的特征及程度与日晒时间程度之间呈正相关。     

腋窝瘢痕挛缩畸形植皮术后包扎方法的改进

目的:改进传统的腋窝瘢痕挛缩畸形植皮术后包扎技术。方法:分析腋窝形态结构的特殊性而对基于普通弹性绷带的传统"8"字包扎技术进行2方面改进:①加一段弹性绷带在腋下水平缠绕胸、背部一圈,而使腋窝内侧壁包扎到;②在肩峰、上臂上端外侧、腋窝前、下、后侧用7号丝线将绷带相邻边缘缝扎固定一起,形成全腋窝弹性加压包扎法,并将此法用于13例(16侧)腋窝因广泛瘢痕增生并挛缩或粘连畸形而进行全厚皮片移植的患者。结果:手术切口均一期愈合,无血肿及皮片坏死发生,畸形改善明星,每次包扎后可维持7天不松散。全腋窝弹性加压包扎法使对术区包扎达到全方位、长久牢靠。结论:基于对腋窝结构特殊性而新创的全腋窝弹性加压包扎法牢固可靠,其用于腋窝植皮包扎预防皮片坏死效果确切有效。     

自制胰岛素注射腹带在居家糖尿病患者胰岛素治疗中的应用

目的 探讨提高居家糖尿病患者胰岛素注射部位准确性、减少注射相关不良反应的有效方法.方法 将103例初次使用胰岛素注射治疗的出院糖尿病患者随机分成观察组52例,对照组51例.两组均采用腹部注射,对照组常规给予胰岛素注射相关知识的指导,观察组除常规指导外,注射胰岛素时佩戴自制胰岛素腹部注射定位腹带.结果 治疗12周后观察组皮下硬结发生率显著低于对照组（P＜0.05）.两组血糖比较,差异无统计学意义（P＞0.05）.结论 胰岛素腹部注射定位腹带能帮助患者在进行腹部注射胰岛素时按照指示部位和位置顺序规律注射,减少皮下硬结发生率.     

弹性髓内钉与钢板内固定治疗移位型锁骨中段骨折的Meta分析

文题释义： 重建钢板：是指接骨板的形状不符局部骨骼的具体形态,需要时应该根据骨骼的具体形状进行塑形、重新建立符合骨骼解剖形态的接骨板。 弹性髓内针：又称钛合金弹性针,是基于长骨干骨折治疗中使用的髓内针经过演化、改进而来,为钛合金带有特殊弯头的金属圆条,具有一定弹性。 背景：弹性髓内钉和钢板是现今治疗锁骨骨折常用的2种器材,但两者的优缺点对照研究相对较少。 目的：系统评价弹性髓内钉与钢板内固定治疗移位型锁骨中段骨折的临床疗效。 方法：使用计算机检索PubMed、Embase、Science Direct、Cochrane Library、知网、万方、VIP数据库,检索从建库到2017年3月的关于弹性髓内钉和钢板内固定治疗移位型锁骨中段骨折的治疗效果报道文献。2名研究员根据纳入和排除标准独立筛选文献,提取数据和评估文献中的偏倚风险。纳入文献使用RevMan 5.3软件完成Meta分析。 结果与结论：①通过数据库检索并按纳入标准排除后检索出价值文献21篇,其中文献中859例患者采用弹性髓内钉治疗,831例患者使用钢板内固定治疗;②Meta分析结果表明,在手术时间[MD=-18.62,95%CI (-20.75,-16.49)]、失血量[MD=-56.23,95%CI(-68.02,-62.44)]、切口长度[MD=-5.53,95%CI(-6.56, -4.49)]、住院时间[MD=-1.01,95%CI (-1.13,-0.89)]、骨折愈合时间[MD=-1.39,95%CI(-1.98,-0.80)]方面弹性髓内钉组均优于钢板组;③弹性髓内钉组术后6个月上肢功能评分优于钢板组(P < 0.05),但是术后12个月随访2组上肢功能评分差异无显著性意义;④主要并发症方面[OR=0.61,95%CI(0.39,0.93)],弹性髓内钉组较钢板组明显减少;2组内固定再取出发生率接近;⑤Meta分析结果提示,弹性髓内钉治疗移位型锁骨中段骨折在手术相关指标、功能恢复和骨折愈合方面均优于钢板内固定,以上结果可为临床使用弹性髓内钉固定治疗移位型锁骨中段骨折提供有力证据。 ORCID: 0000-0002-9448-9454(梁杰) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程