胸腰椎不稳定骨折前后路短节段内固定有限元生物力学研究

目的通过建立前、后路内固定模型,比较前、后路固定后的力学稳定关系,指导临床选择前路或后路固定。方法分别建立胸腰椎三维有限元力学模型和前、后路固定器械模型及L1骨折模型,分别加载,对不同固定组的L1前柱、中柱、前中柱骨折的应力进行比较。结果①椎体前柱损伤的工况下,前路固定组的L1平面的Mises stress小于后路固定;②椎体前中柱共同损伤的工况下,前路固定组也优于后路固定组。结论胸腰椎前柱与前中柱不稳定骨折损伤,前路固定都优于后路。     

骨骺生长滑动钢板的设计及动物实验影像学研究

目的设计一种骨骺生长滑动钢板,在有效固定骨折的同时,又能减轻对骨骼纵向生长的抑制,减少肢体畸形的发生,并通过动物实验进行评估。方法根据青少年股骨髁部的解剖特点设计出适用于青少年儿童股骨髁部骨折的内固定滑动钢板。动物实验选24只健康幼年山羊,8只山羊为正常对照组,余16只为钢板内固定组,其中右后肢采用普通钢板固定,左后肢采用滑动钢板固定。术后1 d,1、2、3、6个月5个时相点对所有山羊双侧股骨进行X线摄片检查,并通过fPAX系统测量左右股骨的长度进行统计学分析。结果正常对照组山羊双侧股骨在5个时相点长度统计学均无显著性差异,钢板内固定组,在术后1 d、1个月双侧股骨长度统计学均无显著性差异,在术后3、6个月双侧股骨长度统计学存在显著性差异,滑动钢板侧股骨长度明显长于普通钢板侧,股骨长度术后1、2、3、6个月分别与术后1 d增长的数值进行比较分析,普通钢板侧和正常对照组右侧股骨长度存有显著性差异,滑动钢板侧和正常对照组左侧股骨长度无显著性差异。结论本组实验证实滑动钢板在动物体内随骨骺的生长过程中可自动延长,符合发育期青少年儿童骨骺生长的生理特点,可进行进一步的研究。     

跟骨解剖支持板的研制及临床应用

目的 设计跟骨解剖支持板并研究其治疗跟骨骨折的临床应用价值.方法 通过对跟骨生物力学和骨折机理的探讨,设计了一种用于跟骨骨折内固定治疗的新型跟骨解剖支持板,并应用该钢板治疗跟骨骨折38例(46足).其中39足经过6个月以上随访(6～46个月,平均14.6个月).均行跟骨侧、轴位X线片和印横轴位、冠状位检查,按Sanders分型,其中Ⅱ型骨折10足,Ⅲ型骨折17足,Ⅳ型骨折12足.手术前后对Bohler角、Gissane's角、跟骨水平全长、丘部总高、轴长和体宽等多项指标进行比较,采用Marryland足部评分系统评价术后功能.结果 术后4例切口延迟愈合,2例腓肠皮神经损伤,1例腓骨长短肌腱滑脱,对症处理后均痊愈.术后功能评价显示:优21足,良15足,可3足,优良率达92.3%.结论 跟骨解剖支持板设计合理,结构性能良好,对其进行的多项生物力学测定表明该板可达到跟骨骨折固定的要求.可有效减少并发症,为治疗跟骨骨折提供了一种新的内固定方法.     

综合护理干预在老年桡骨端骨折手法整复夹板固定术中的应用

目的：探究并分析综合护理干涉应用于老年桡骨端骨折手法整复夹板固定术的临床效果。方法：在我院随机选取60例老年桡骨端骨折患者行手法整复夹板固定术,并随机分配到采用常规治疗与一般护理的对照组和在常规治疗与护理的基础上采用综合护理干预的观察组,各30例。术后护理一段时间后,观察两组患者的临床疗效的总有效率,对比两组患者的愈合时间的长短。结果：术后两组的患者接受各自的护理配合一段时间后,发现观察组的患者临床疗效的总有效率远远高于对照组,两组的总有效率存在差异。结论：老年桡骨端骨折手法整复夹板固定术应用综合护理干涉能明显地提高愈合率,促进骨骼的恢复。     

Pilon骨折的手术治疗体会

目的回顾性分析治疗P ilon骨折的适宜手术方法、最佳手术时机及其手术疗效。方法对2001年至2004年接受手术治疗的52例单侧P ilon骨折患者进行随访,平均年龄36.5岁,伤后至手术时间平均6.8 d。骨折类型:Ⅰ型4例、Ⅱ型36例、Ⅲ型12例。40例行切开复位三叶型(或T型)钢板内固定;12例行有限切开内固定并辅以外固定,其中应用外固定支架者2例,辅以石膏托者10例。术后平均随访16个月。结果采用Mazur评分系统评估手术疗效,52例患者中,优43例,良6例,可3例。术后并发症包括创面不愈合4例,感染2例,延迟愈合1例和关节退行性变7例。结论正确选择手术时机,根据骨折类型和条件灵活选择固定方式是取得良好手术效果的关键。     

单边外固定架治疗胫骨骨不连的疗效

目的 探讨单边外固定架治疗胫骨骨不连的疗效.方法 回顾性分析2010年1月至2013年12月我院收治的28例胫骨骨不连患者的临床资料,均行外固定架植入、胫骨截骨、骨延长.截骨术后l0d开始延长,每天延长1mm.结果 随访时间1～4年,平均2.5年.所有患者均获得骨和软组织缺损修复.根据改良Paley骨延长评分,18例为优,8例为良,2例为可.结论 单边外固定架操作简便、创伤小、预后良好,是胫骨骨不连患者的有效治疗方法.     

通络生骨胶囊加微创内固定术治疗非创伤性股骨头缺血性坏死患者的护理

对185例口服中药通络生骨胶囊加微创植骨支撑内固定术治疗围塌陷期非创伤性股骨头缺血性坏死患者进行护理,认为术前做好各项检查及心理护理,术后注意观察病情变化,保持术肢体位正确,加强基础护理,预防并发症,正确指导患者服用中药及功能锻炼,并做好出院指导工作,对患者恢复髋关节功能起重要作用。     

Humoral immunity induced by a live Francisella tularensis vaccine. Complement fixing antibodies determined by an enzyme-linked immunosorbent assay (CF-ELISA)

A complement-fixing enzyme-linked immunosorbent assay (CF-ELISA) with bacterial sonicate as the antigen, human AB serum as the source of complement and alkaline-phosphatase-labelled anti-(human C3e) as the conjugate was developed for detecting antibodies to Francisella tularensis. Humoral responses after inoculation with a live attenuated tularemia vaccine were studied in 13 subjects by this method. Twelve responded with CF antibodies, which in most cases appeared 4 weeks after vaccination, the response time varying from 1 week to 2 months. The highest individual CF titres, of 140–9990, were reached 1–4 months after vaccination (average 2.4 months). The CF titres tended to decrease with time, and at 10 months two of the 12 subjects with an earlier CF positive response were negative again. CF antibodies were nevertheless still detectable in all three subjects studied 1.5 years after vaccination.     

Comparison of the Effectiveness of Simple Plate Fixation and Plate Combined with Local Fixation of Broken Ends in the Treatment of Oblique Fracture of Midshaft Clavicle

ObjectiveTo compare the clinical efficacy of performing simple plate fixation with that using a plate combined with fracture end fixation to investigate the necessity of fracture end fixation outside the plate in cases of oblique fracture of the middle clavicle.MethodsThis was a retrospective follow‐up study of patients with middle clavicle oblique fractures (Robinson types 2A1 and 2A2) between 2015 and 2020. Patients were divided into two groups according to their treatment options: the simple plate fixation (SPF) group (n = 79; 43 men and 36 women; average age, 46.37 ± 14.54 years) and the plate combined with fracture local fixation (PLFP) group (n = 81; 36 men and 45 women; average age, 48.42 ± 12.55 years). Intraoperative blood loss, operation time, postoperative fracture healing time, postoperative shoulder function score (Constant–Murley and disabilities of the arm, shoulder, and hand [DASH] scores), clinical complications, and postoperative subjective satisfaction were compared between the two groups.ResultsOne hundred sixty patients with a sufficient follow‐up period were included in the final analysis: 79 in the SPF group (follow‐up time: 16.24 ± 3.94 months) and 81 in the PLFP group (follow‐up time: 16.15 ± 3.43 months). Age, sex, body mass index, follow‐up duration, fracture classification, and cause of injury were not significantly different between the two groups. There was no significant difference in blood loss, Constant–Murley and DASH scores, follow‐up period, and postoperative subjective satisfaction between the two groups (P > 0.05). The fracture healing time was shorter in the PLFP group than in the SPF group (4.41 ± 0.99 vs. 4.87 ± 1.60 months, P < 0.05), but the operation duration was longer in the PLFP group than in the SPF group (65.48 ± 16.48 min, P < 0.05). There were seven (complication rate, 8.86%) and five (complication rate, 6.17%) cases that had complications in the SPF and PLFP groups, respectively. There was no significant difference in the complication rates between the two groups (P > 0.05).ConclusionAlthough the healing time was shorter in the PLFP group than in the SPF group, the clinical efficiency of the two methods in the treatment of oblique fracture of the middle clavicle was similar.     

中老年股骨颈骨折全髋关节置换术和中空加压螺钉内固定术临床比较

目的比较全髋关节置换术和中空加压螺钉固定术治疗中老年股骨颈骨折的疗效。方法对55～65岁有移位新鲜股骨颈骨折患者85例的治疗情况进行回顾分析，其中51例行中空加压螺钉内固定术，34例行全髋关节置换术，进行了住院情况，术后1年，术后3年功能评估。结果全髋关节置换组在手术时间，术后早期下床活动等方面具有一定的优越性，但全髋关节置换假体费用较贵，3年后有2例出现假体松动。中空加压螺钉固定组有45例3年后无任何并发症发生，髋关节功能活动良好，且能够从事正常体力劳动。结论中老所股内颈骨折患者手术治疗应首选中空加压螺钉内固定术治疗。