极半髋股骨柄两种固定方式的近期疗效比较

目的评价应用骨水泥和非骨水泥双极半髋关节置换术治疗老年股骨颈移位骨折的近期疗效。方法 2003年5月-2009年9月,应用骨水泥和非骨水泥双极半髋关节置换术治疗股骨颈移位骨折患者55例,其中骨水泥组28例,非骨水泥组27例。两组病例的随访期为12～48个月。结果两组平均手术时间及术中出血分别为：骨水泥组,78.6min,380.5ml;非骨水泥组,62.3min,268.0ml,差异均有统计学意义（P〈0.05）。两组Harris髋关节功能评分及假体柄松动率分别为：骨水泥组,78.4,7.1%;非骨水泥组,81.4,3.7%,差异均无统计学意义（P〉0.05）。结论对于老年股骨颈移位骨折,在手术时间和术中失血方面,应用非骨水泥半髋关节置换术具有一定的优势。从近期疗效来看,术后髋关节功能和股骨柄松动率没有差别。     

高血压患者人工膝关节置换的护理与康复

目的:观察高血压患者人工膝关节置换的护理和康复效果。方法:对45例接受TKR的患者进行术前术后护理及康复训练。结果:45位患者伤口愈合良好,血压控制良好,无心血管系统并发症发生,术后关节功能良好。结论:对于高血压患者实施TKR的术前术后护理,可减少术后感染,减少心血管系统并发症的发生,正确的康复训练有助于关节功能的恢复,提高生活质量。     

CAD／CAM锆瓷冠在后牙种植修复中的临床应用

目的探讨CAD／CAM锆瓷冠在后牙种植体修复中的临床应用。方法选取种植术后患者30例,采用CAD／CAM全瓷冠修复,随访2年,检查患者锆瓷冠完整情况及修复体情况。结果30例患者共修复缺失牙43颗,经2年随访观察发现,1颗磨牙面瓷破损,其余修复体均正常,失败率为2．3％,修复体形态、表面质地,边缘适合性能、修复体颜色等级等修复效果满意。结论采用CAD／CAM锆瓷冠进行后牙种植修复,种植体周围无不良刺激,咀嚼效果良好,稳定不脱落,舒适美观,患者可取得良好的修复效果。     

Sensitivity of knee soft-tissues to surgical technique in total knee arthroplasty

Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone cuts have been made and the trial components inserted. We have sought to quantify how altering the polyethylene thickness may affect post-operative soft tissue tension for a range of prosthetic designs.Four different prosthetic designs were implanted into fresh-frozen cadaveric knee joints. All four designs were implanted in the standard manner, with a 100 Newton distraction force used to set soft tissue balance. The tibiofemoral force was then recorded at 15° intervals throughout the passive flexion range. After the standard implantation of each prosthesis, the tibial component was raised or lowered to mimic increasing and decreasing the polyethylene thickness by 2 mm and the force measurements repeated.Tibiofemoral force in extension correlated with implantation tightness for all prosthesis designs. Between 15° and 90°of knee flexion, all four designs were insensitive to changes in implantation tightness. Beyond 90° the effect was more notable in rotating platform mobile-bearing and cruciate-retaining prostheses than in posterior-stabilised mobile-bearing designs.The findings of this research may be useful in assisting surgical decision-making during the implantation of TKA prostheses.     

Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results

Aim  The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA) unicondylar knee arthoplasty (UKA). Method  The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7–13.1 years). Results  Survival rate of the prosthesis was 86.6% (95% CI 73.7–99.6) at 7 years. The mean clinical and functional Knee Society Scores had increased from 51 and 62 points preoperatively to 76 and 93 points (P < 0.001) postoperatively. Five of the 46 knees were revised because of excessive wear of the polyethylene liner, and three due to progression of the osteoarthritis in the lateral compartment of the knee. Conclusion  Survival of this fixed-bearing UKA was not as good as previously reported and polyethylene wear seems to be a more common problem than previously assumed.     

Biomechanical study of mandible bone supporting a four-implant retained bridge: Finite element analysis of the influence of bone anisotropy and foodstuff position

Purpose The aim of this work was to study the biomechanical behavior of a “All-on-four” implant-supported prosthesis through a finite element analysis using either isotropic or anisotropic properties of bone. The influence of foodstuff position during mastication was also analysed.Materials and methods A three-dimensional finite element model of a mandible with a prosthesis supported by four implants was developed. The geometry of the edentulous mandible and prosthesis was generated from computed tomography. Four MKIII^® implants (two vertical and two tilted) were modeled. The bone elastic properties used in the anisotropic simulations were orthotropic. The comparison of isotropic and anisotropic models was carried out in the loading condition of mastication with a foodstuff positioned on molar. Three distinct configurations, corresponding to three foodstuff positions, were then studied. MSC/Marc code was used to perform all computations.Results Significant differences in stress, strain, and strain energy densities were found in the comparison of isotropic and orthotropic models. Molar position was revealed to be the most critical one, from a stress and strain level point of view, for implants and framework and consequently for peri-implant bone. It was also observed that implant tilting leads to high stress concentrations in bone for the “All-on-four” concept.Conclusion This study showed that the anisotropic behaviour of bone cannot be neglected in the numerical simulations. The actual design of the prosthesis is not optimal concerning the capacity of all metallic parts to support loads. Finally, it was demonstrated that the tilting of implants induced a high stress level at bone-implant interface.     

Total Distal Radioulnar Joint Arthroplasty in Adults with Symptomatic Madelung’s Deformity

Madelung’s deformity is a well-known congenital anomaly of the wrist. A number of procedures have been described to correct the deformity and thus improve function at the wrist. Most of these procedures have to a large extent addressed the alignment and consequent function of the radiocarpal joint but not the persistent problem of painful stiffness at the distal radioulnar joint (DRUJ). The availability of a total DRUJ prosthesis appears to provide a solution to this problem. This article discusses our early experience with total DRUJ arthroplasty using the Scheker prosthesis for managing pain and decreased range of motion in three adult patients with symptomatic Madelung’s deformity.     

桡骨小头三维解剖研究及其对假体设计的影响

目的 通过数字化三维重建正常中国人桡骨小头大体形态,测量解剖参数,为选择、设计假体提供解剖学依据. 方法对45例正常中国人进行单侧肘关节CT扫描,利用Mimics 10.0软件进行数字化三维重建来测量桡骨小头的解剖形态,并与国外相关资料进行比较. 结果桡骨小头的形状和大小有明显的个体差异,各形态参数接近正态分布,桡骨小头冠状面最大直径平均(22.34±2.46)mm,髓内冠状面直径平均(9.04±1.50)mm,桡骨小头矢状面最大直径平均(22.63±2.50)mm,髓内矢状面直径平均(9.34±1.51)mm,颈于角平均166.80°±2.20°,头颈长平均(18.71±2.44)mm.身高与桡骨小头直径成正相关(P<0.05). 结论测量所得桡骨小头解剖资料与欧美人种的桡骨小头解剖存在差异,应对进口假体适当改进,以提高疗效.三维数字化重建对解剖学测量和定制假体的意义重大.     

国产AK后稳定型全膝关节假体置换的近期疗效分析

目的 观察国产AK后稳定型全膝关节假体置换的近期疗效.方法 回顾2004年3月～2006年7月初次膝关节置换患者80例(101膝).国产组使用AK假体29例(34膝),进口组使用GenesisII假体51例(67膝).全部患者获术后随访,并对住院情况作统计分析.结果 平均随访时间国产组25.7个月,进口组24.3个月.术后HSS和WOMAC评分、患者满意度、关节活动度两组间均无统计学差异.平均单膝住院费用国产组23 112元/每膝,进口组41 252元/每膝,两组间有统计学差异.结论 国产AK后稳定型全膝关节假体置换术后近期疗效满意,并能显著降低治疗费用,但其远期疗效仍有待观察.