掌背侧联合入路锁定加压钛板内固定治疗桡骨远端粉碎性骨折

目的探讨锁定加压钛板内固定治疗桡骨远端骨折疗效。方法对2001～2006年间49例桡骨远端骨折经掌背侧联合入路锁定加压钛板内固定，钛板置于桡骨远端背侧，骨缺损严重者（20例）均置入人工骨（OsteoSet）。术后功能康复时间，6～24周，平均10.6剧。结果随访6～24个月。按Dienst功能评估标准进行评定：优40例，良7例，差2例，优良率95.9％。结论掌背侧联合入路锁定加压钛板内固定治疗移位的桡骨远端骨折疗效显著。     

Age‐ and site‐specific decline in insulin‐like growth factor‐I receptor expression is correlated with differential growth plate activity in the mouse hindlimb

The proximal and distal growth plates of the principal long bones do not contribute equally to longitudinal growth. Most forelimb elongation occurs at the shoulder and wrist, while most hindlimb growth occurs at the knee. This study examined whether insulin‐like growth factor‐I (IGF‐I), a potent growth regulator, could underlie this variation via differential receptor expression. The spatiotemporal distribution of the IGF‐I receptor (IGF‐IR) was mapped in hindlimb growth plates (overall and within regional zones) from immature mice using immunohistochemistry. Growth activity was assessed by size/morphology of the growth plate and proliferating cell nuclear antigen (PCNA) expression. Both IGF‐IR and PCNA staining declined considerably with age in the proximal femur and distal tibia (hip and ankle), but expression remained high in the more active distal femur and proximal tibia (knee) throughout growth. Growth plate size decreased with age in all sites, but the absolute and relative decline in IGF‐IR in the hips and ankles of older mice indicated a site‐specific loss of IGF‐I sensitivity in these less active regions. These results suggest that regulation of the IGF‐IR may at least partially mediate differential long bone growth, thereby providing a local mechanism for altering skeletal proportions absent modification of systemic hormone levels. Anat Rec, 2007. © 2007 Wiley‐Liss, Inc.     

经皮微创植入锁定钢板治疗胫骨远端骨折

目的探讨应用胫骨远端锁定钢板经皮微创植入治疗胫骨远端骨折的疗效。方法自2010年1月~2012年12月应用小切口植入胫骨远端锁定钢板治疗32例胫骨远端骨折,男19例,女13例,年龄13~77岁,平均39.8岁。其中开放性骨折4例,闭合性骨折28例,均为新鲜骨折。结果 29例获得随访,随访时间6~15个月,平均11.7个月。所有骨折均愈合,平均愈合时间为13.6周,均无感染、骨不连、钢板松动等并发症。按照Mazur踝关节功能评分:优19例,良8例,可2例,优良率为93.1%。结论微创钢板内固定手术创伤小,固定可靠,骨折愈合率高,符合生物学固定原则。     

一种平板流动腔重力灌流系统的力学分析

本文分析了一种采用重力灌流的平板流动腔灌流系统，并根据实验结果确定出相应的阻力系数，获得平板流动腔剪应力、雷诺数以及入口长度与流体重力灌流高度的关系。     

Failure of the rabbit tibial growth plate to respond to the long-term application of a capacitively-coupled electrical field

A continuous 5-V peak-to-peak, 60 kHz capacitively-coupled sine wave signal was applied to the proximal tibial growth plate in fifteen 9-week-old male New Zealand white rabbits for 6 weeks. A pair of flexible stainless steel "injectrodes" was held in place medially and laterally on the surface of the proximal hindlimb in each rabbit by means of tape wrappings. The electrodes were connected to a 9-V battery-operated power unit carried in a dorsal pouch in a body vest worn by each rabbit. Control animals wore the identical apparatus, only the power unit was inactive. Small Tantalum markers were inserted into the anteromedial aspect of the proximal tibial metaphysis 1 cm distal to the proximal tibial growth plate in all of the animals, control and experimental, 2 weeks prior to the onset of electrical stimulation. The distance between the proximal lateral tibial spine and the Tantalum marker, between the Tantalum marker and the apex of the distal tibial intercondylar notch, and between the proximal tibial spine and the distal notch was measured from roentgenograms made at the time of bone marker insertion, at the time of electrode application to the limb, and at the end of the stimulation period. Results indicate that there was no significant difference in tibial lengths between the stimulated and control groups. There was significantly less total body weight gain in both the experimental and control animals than that which occurred in paired normal animals during the same period of time. This failure to thrive may be responsible for the resultant lack of longitudinal growth stimulation of the capacitive coupling.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年转子间骨折角型钢板治疗失误和并发症分析

目的分析角型钢板治疗股骨转子间骨折中出现的各种失误和并发症,并提出预防措施。方法1990年10月以来共治疗股骨转子间骨折68例,逐例分析治疗失误的原因。结果术中操作失误致股骨外侧皮质崩裂2例;钢板刀口穿破股骨头进入髋臼1例,术后切口感染1例,共8例出现并发症,发生率14．7％。结论角型钢板治疗股骨转子间骨折效果好,但不应忽视可能发生的各种失误和并发症。     

骨盆前环皮下内固定支架与微创经皮钢板内固定治疗骨盆前环骨折的疗效比较

目的 比较前环皮下内固定支架（INFIX）和微创经皮钢板内固定（MIPPO）治疗骨盆前环骨折的疗效。方法 回顾性分析2016年7月至2020年5月我院收治且符合标准的48例不稳定型骨盆骨折病人的临床资料,其中INFIX组22例,MIPPO组26例。INFIX组,男15例,女7例,年龄为（36.89±11.12）岁（21~58岁）。MIPPO组,男17例,女9例,年龄为（43.70±17.66）岁（21~71岁）。比较两组手术时间、术中出血量、骨折复位质量（Matta标准）、骨折愈合时间、骨折术后功能恢复情况（Majeed评分系统）,并记录并发症。结果 两组均获得随访,随访时间为5~17个月,平均为13个月。INFIX组手术时间[（75.41±15.25） min]低于MIPPO组[（85.62±17.92） min],差异无统计学意义（t=-5.154,P=0.101）;INFIX组术中出血量[（30.27±7.67） mL]明显低于MIPPO组[（111.15±24.30） mL],差异有统计学意义（t=-14.971,P=0.006）;两组负重时间[（16.00±2.06）周vs.（15.94±2.32）周]、Majeed评分[（81.90±7.73）分vs.（83.44±3.54）分]、骨折复位优良率[81.8% vs.84.6%]比较,差异均无统计学意义（P均＞0.05）,但MIPPO组能够达到更好的解剖复位。INFIX组1例病人出现股外侧皮神经损伤,两组病人未出现内固定失败情况。结论 治疗骨盆前环骨折,INFIX具有出血少、手术创伤小等优点,钢板能够达到更好的解剖复位,两组具有相似的术后功能恢复情况。可根据术者经验和病人具体情况选择适宜的固定方式。     

Tension band plates have greater risks of complications in temporary epiphysiodesis

PurposeThis study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS).MethodsThis retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau.ResultsIn total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients.ConclusionMore implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended.Level of evidenceLevel III     

The association between caudal block and urethroplasty complications of distal tubularized incised plate repair: experience from a South China National Children’s Medical Center

BackgroundThe effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB.MethodsWe reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect.ResultsThirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients.ConclusionsOur data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications.