A novel radiological projection of the pelvis to evaluate the sitting imbalance in pelvis nonunions and malunions

IntroductionInadequate initial management of unstable pelvic injuries is usually associated with a fracture non-union and/or mal-union. Complete clinical and imaging evaluation is mandatory for a correct preoperative planning. Among other symptoms, sitting discomfort may arise from asymmetry of the ischial tuberosities or pressure from a prominent bony projection. Conventional radiographs are usually taken with the individual in a supine position and not in position where the symptoms are referred. We attempted to define a new radiological projection different than the regular pelvis views to study the position of pelvis of a normal person in sitting position. The second objective was to demonstrate its utility in the evaluation of a pelvic deformity.Material and methodsFifteen healthy individuals were evaluated with a radiological projection in a sitting position. One patient with a vertically migrated pelvis nonunion was also evaluated with the same radiological protocol.ResultsIn each volunteer’s radiological study, a parallel line could be drawn between the sitting table and both distal aspects of the ischial tuberosities, sacral alas and superior aspect of the iliac wings. A plumb line perpendicular to the above mentioned ones could be drawn uniting the vertebras’ spinous processes. A 90⁰ line intersection confirms the absence of deformity. In the pathological case, a pseudo scoliosis of the thoracolumbar spine is detected trying to compensate the pelvis obliquity and maintain equilibrium.ConclusionsWe determined normal and pathological radiological features in the sitting imbalance of the pelvic in the anteroposterior plane of the pelvis. The study helps to understand the biomechanics and compensation of the pelvis to define surgical indications and predict post correction anatomy.     

突破骨不连与骨缺损治愈的瓶颈

骨折愈合是一种普遍存在的可以稳定遗传的自然生命现象,而细胞是遗传信息的载体和执行者,其生物学过程与胚胎时期骨发育过程极为相似,有精准的基因程序配合调节骨的生成、凋亡与骨重塑。其信号传导、神秘的系统调控机制令人敬畏[1]。因此对于骨不连和骨缺损的治疗,医生的职责是创造条件,帮助启动已经损伤、休眠、缺乏活力的病变组织,使其重新激发再生的活力,完成肢体残缺     

抗旋钢板治疗股骨干骨折髓内针术后肥大型骨不连临床疗效分析

目的抗旋钢板治疗股骨干骨折骨髓内针术后肥大型骨不连的远期临床疗效分析。方法 2006年5月～2009年10月,15例股骨干髓内钉术后肥大型骨不愈合患者纳入本次研究,几乎所有内固定患者都发生了髓内钉的松动、拔出或折断。15例患者均采用有限切口切开骨折端应用小钢板加植骨治疗。结果 15例患者均获随访,平均随访时间15.8个月(12.0～16.0个月),均获得骨性愈合,平均愈合时间为3.2个月(2～6.2个月)。术后患者切口无感染、内固定松动或断裂、骨折畸形愈合等情况。结论采用微创小钢板、自体松质骨植骨技术是治疗交锁髓内针固定后肥大型骨不连的重要方法,因其满足了骨折端的力学稳定性、血供破坏小、技术成熟、并发症少,值得在临床推广。     

儿童股骨骨折弹性髓内钉治疗术后骨不连原因分析

目的:探讨儿童股骨骨折微创钛制弹性髓内钉内固定术后骨不连的原因。方法:选择采用微创切口,置入钛制弹性髓内钉内固定治疗儿童股骨骨折,经x线照片证实骨不连的8例患者临床资料进行回顾性分析。分别从弹性髓内钉的针选择、骨折类型、手术操作过程、功能锻炼等方面分析骨不连原因。结果:8例骨不连患儿:3例主要与克氏针粗细有关;2例存在骨折类型选取不当;3例存在功能锻炼不正确。结论:微创钛制弹性髓内钉治疗儿童股骨骨折必须严格掌握适应证,术后功能锻炼及术后负重时间不能太早,这样才能减少骨不连的发生。     

锁定加压钢板结合髂骨植骨治疗肱骨干下1/3骨不连

目的探讨锁定加压钢板结合髂骨植骨治疗肱骨干下1/3骨不连的疗效。方法对19例肱骨干下1/3骨不连患者,取出原内固定,自体髂骨植骨,锁定加压钢板(LCP)固定,术后行X线片检查和肩、肘关节功能评估。结果本组19例均随访8个月~33个月,平均15.6个月,所有患者术后均骨折愈合,平均愈合时间4.9个月(3个月~8个月),术后并发桡神经麻痹2例。根据X线片及肩肘并节功能疗效判定:优13例,良4例,差2例,功能优良率为89.5%。结论肱骨干骨不连的最主要原因是固定装置不稳定,采用锁定加压钢板(LCP)结合髂骨植骨可提高固定强度,促进骨折愈合,能够获得较好的肩、肘功能。     

Low-intensity electromagnetic and mechanical modulation of bone growth and repair: are they equivalent?

 Signals from both electromagnetic fields (EMF) and ultrasound (US) have a clinically significant effect upon bone repair. Both modalities are now a common part of the orthopedist's armamentarium for the care of delayed union, nonunion, and fresh fractures. Dynamization or controlled weight bearing also enhances bone repair. Consideration of the dosimetry of both EMF and US modalities suggests a possible unifying mechanism for the bioeffects from EMF, US, and strain-generated potentials (SGP) signals based on the time-varying electric field, E(t), associated with each type of stimulus. The E(t) field is directly induced with EMF devices and indirectly induced via the streaming potentials associated with the mechanical movement of ionic fluids within bone caniculi or directly past cell surfaces from US and SGP signals. It is shown that both electrically and mechanically induced E(t) have common waveform characteristics at the treatment site and thus can deliver similar doses of electrical stimulation. It is proposed that the time-varying endogenous electric field, E(t), from a time-varying change in the mechanical environment of healing or remodeling bone, can act as a dose-dependent growth stimulus. Thus, the primary messenger affecting cellular activity is E(t), suggesting that bone repair or remodeling may be interchangeably modulated using mechanical (including US) or electromagnetic signals. Received: December 8, 2001     

手术治疗四肢骨折后骨不连263例

目的回顾性分析四肢骨折后骨不连的发生原因及手术治疗结果。方法1996年5月～2005年8月共收治263例四肢骨折后骨不连患者。骨不连部位：股骨近端13例,股骨干57例,胫骨81例,肱骨51例,尺桡骨44例,锁骨5例,髋臼2例,舟骨3例,距骨4例,其它3例。本组患者全部采用手术治疗,其中交锁髓内钉固定157例,钢板螺钉固定72例,外固定架固定34例。植骨方法：单纯自体松质骨移植189例,自体松质骨混合其它材料移植57例,带血管蒂的游离骨瓣移植10例,自体骨髓移植4例,骨加压延长术3例。结果本组患者发生骨不连的主要原因为应力干扰和局部血供差,其次为感染、骨缺损及骨折复位不良、对位差、骨折间隙过大。242例患者获平均14．3个月(4～48个月)随访。242例患者均获骨性愈合,骨折愈合时间平均为5．3个月(3～18个月)。其中220例患者(90．9%)肢体功能优,无跛行等后遗症；22例患者(9．1%)遗留邻近关节活动受限、肢体短缩及跛行等许发症。结论骨不连的发生原因是多方面的,如果在治疗骨折时足够重视,多数骨不连可以避免。骨不连采用手术重新固定加自体植骨可获得良好疗效。