Tendon Graft—Ulna Fixation in Distal Radio-Ulnar Joint Stabilisation; Biomechanical Comparison of Three Graft-Bone Fixation Methods

A common distal radio-ulnar joint (DRUJ) stabilisation procedure uses a tendon graft running from the lip of the radial sigmoid notch to the ulnar fovea and through a bony tunnel to the ulnar shaft, before being wrapped round the distal ulna and sutured to itself. Such graft fixation can be challenging and requires a considerable tendon length. The graft length could be reduced by fixing the graft to the ulna using a bone anchor or interference screw. The aim of this study was to compare the strength of three distal ulna graft fixation methods (tendon wrapping and suturing, bone anchor and interference screw). Four human cadaveric ulnae were used. A tendon strip was run through a tunnel in the distal ulna and secured by: (1) wrapping round the shaft and suturing it to itself, (2) a bone anchor and (3) an interference screw in the bone tunnel. Load to failure was determined using a custom-made apparatus and an Instron machine. Maximum failure load was highest for the bone anchor fixation (99.3 ± 23.7 N) followed by the suturing (96.2 ± 12.1 N), and the interference screw fixation (46.9 ± 5.6 N). There was no significant difference between the tendon suturing and bone anchor methods, but the tendon suturing was statistically significantly higher compared to the interference screw (P = 0.028). In performing anatomical stabilisation of the DRUJ fixation of the tendon graft to the distal ulna with a bone anchor provides the most secure fixation. This may make the stabilisation technique less demanding and require a smaller tendon graft.     

应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连疗效观察

目的观察应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连的疗效。方法53例股骨髁上骨不连患者随机分为两组：对照组（26例）和治疗组（27例）,两组均应用动力髁螺钉治疗,治疗组加用骨肽注射液治疗。随访,进行疗效评价,记录骨愈合时间和测定疼痛指数。结果治疗组疗效优于对照组。结论应用动力髁螺钉联合骨肽注射液治疗股骨髁上骨不连可提高疗效。     

椎弓根螺钉内固定及植骨融合治疗退行性腰椎滑脱的临床疗效评价

目的　评价腰椎管减压、后外侧植骨和椎弓根螺钉内固定治疗退行性腰椎滑脱的临床疗效。方法　 1993年 1月～ 2 0 0 2年 9月对 74例腰椎退行性滑脱的患者行腰椎管减压、后外侧植骨和椎弓根螺钉内固定 ,采用的椎弓根内固定技术包括Dick 8例、Steffee 10例、RF 9例、Socon 2 5例、Tenor 2 0例、Moss Miami 2例。滑脱水平在L4的患者有 4 4例、L3 有 9例、L5有 16例 ,两节水平的滑脱有 5例。Ⅰ°滑脱 37例 ,Ⅱ°31例 ,Ⅲ°6例。患者平均年龄为 5 3.6岁 (30～ 79岁 )。根据手术前、后日本骨科协会 (TDA)评分评价临床症状改善的程度。结果　平均随访时间为 4 4个月 (12～ 10 4个月 ) ,所有患者最后随访的JOA评分中客观症状为 (6 .7± 1.0 )分 ,临床体征为 (4 .7± 1.1)分 ,日常活动为 (11.8± 1.9)分 ,总评分为 (2 3.0± 2 .5 )分。手术前、后的JOA评分比较 ,术后主观症状改善 70 % ,临床体征改善 6 8% ,日常活动改善 77%。根据患者的年龄分为A组 (30～ 39岁 )、B组 (4 0～ 4 9岁 )、C组 (5 0～ 5 9岁 )、D组 (≥ 6 0岁 ) ,以JOA的评分结果 >2 5分定为满意 ,A、B、C、D组的满意率分别为91%、75 %、6 9%、6 1%。结论　椎板减压、后外侧植骨融合和椎弓根螺钉内固定是治疗不稳定腰椎滑脱的一种有效方法 ,临床疗效     

C型臂X线机引导下经皮双侧骶髂拉力螺钉固定治疗骶骨H形骨折

目的探讨骶骨H形骨折可行的治疗方法。方法运用C型臂X线机引导下经皮双侧骶髂拉力螺钉固定治疗骶骨H形骨折15例。结果15例患者均获随访，随访时间7—34个月，骨折临床愈合时间3～5个月，术后均未留下明显行走障碍，下蹲等活动接近正常。结论在C型臂X线机精确引导下，经皮双侧骶髂拉力螺钉固定技术能有效地固定骶骨H形骨折中的垂直骨折，纠正骨盆垂直方向移位，操作简洁安全，疗效可靠。     

3D kinematic analysis of the acromioclavicular joint during arm abduction using vertically open MRI.

Many researchers have evaluated the motions of the shoulder girdle, especially scapular and humeral motion. However, few reports exist that describe motions of the acromioclavicular joint. The purpose of the present study was to analyze the 3D kinematics of the acromioclavicular joint during arm abduction using 3D MR images obtained by a vertically open MRI. Fourteen shoulders of seven volunteers were examined in seven static positions from 0 degrees to the maximum abduction in a seated position. 3D surface models of the clavicle and scapula were created, and the movements of the acromioclavicular joint from 0 degrees to each position were calculated using the volume-based registration technique. From these calculations, the translations were evaluated and the rotational motions were analyzed using the concept of the screw axis. In the anteroposterior direction, the clavicle translated most posteriorly (-1.9 +/- 1.3 mm) at 90 degrees of abduction and most anteriorly (1.6 +/- 2.7 mm) at maximum abduction. In the superoinferior direction, the clavicle translated slightly superiorly (0.9 +/- 1.9 mm). When analyzing relative motion of the scapula with respect to the clavicle, the scapula generally rotated about a specific screw axis passing through the insertions of both the acromioclavicular and the coracoclavicular ligaments on the coracoid process. The average rotation was 34.9 +/- 8.4 degrees.     

动力加压髁螺钉治疗股骨髁部骨折临床与实验研究

本研究结合１４例股骨髁间、髁上骨折以动力加压髁螺钉（Ｄynamic Ｃondylar Ｓcrew ＤＣＳ）固定。目的：为临床提供应用ＤＣＳ的实验数据。方法：采用成人新鲜尸体股骨髁部标本,按照ＡＯ/ＡＳＩＦ分类,模拟Ｙ形骨折模型,以ＤＣＳ固定,置于ＷＤ－１０Ｅ万能电子力学实验机上其抗拉伸、抗扭转、抗村缩、抗剪切强度。结果：ＤＣＳ有较好的固定强度。临床应用１４例,随访６个月至１年,优良率为８５．７１％。结论：ＤＣＳ适合于     

Settlement of Soil Reinforced with Vertical Fiberglass Micro-Piles

This article is dedicated to investigating the properties of soil after its reinforcement with fiberglass elements through large-scale laboratory plate-load tests of various samples that varied in the numbers and lengths of the reinforcing elements. The investigation of the vertical elements considered the diameter increase at the bottom toe by using widening washers. The results were compared relative to each other and to the theoretical calculation results. The theoretical calculations for the settlements were undertaken based on the authors’ proposed method. The method considers the number, shape, area and material of the strengthening elements using a pre-proposed reinforcement area factor µ. This pre-established factor was calculated with reference to the elements’ geometry—the diameter of the vertical elements and the bottom’s washer diameter—which determined the reinforcement area. A comparison between the reinforced and reference soft sandy soil samples indicated a 25% increase in the deformation modulus after the reinforcement process at a pressure of 25 kPa. Samples with µ ranging from 1.20 to 1.43 were 55–65% stiffer than samples with µ equal to 0.69 at a pressure of 100 kPa. The comparative analysis of the calculated results and the actual laboratory PLT test results was adequate for use for further development.     

后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症

目的 探讨纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统对腰椎滑脱症的治疗效果。方法 33例腰椎滑脱症病人,采用后路全椎板切除减压、纯钛多孔涂层后路椎间融合器行椎间融合、新型椎弓根钉系统内固定治疗。结果 33例术后均随访,时间6~36个月,平均18.6个月。本组患者术后无神经损伤和切口感染,动态摄片观察无融合器移位、椎弓根螺钉松脱、断裂等并发症。按Brantigan评价标准评定结果:优21例、良10例、可2例、差0例。结论 纯钛多孔涂层后路椎间融合器结合新型椎弓根钉系统治疗腰椎滑脱症,具有椎管减压充分、椎体复位好、术后能立即改善疼痛症状、立即稳定椎体、病人可早期下床等优点,是一种治疗腰椎滑脱症较理想的方法。