C1侧块骨折Magerl技术内固定的数字化模拟及应用

目的 探讨计算机软件应用于C1侧块骨折三维重建、复位以及数字化模拟Magerl技术内固定的方法及临床意义,以指导临床应用.方法 将1具颈椎标本制作成C1侧块骨折类型,进行高速CT薄层扫描,在Mimics中对C1侧块骨折模型进行重建、复位,以Solidworks进行螺钉的设计,并在骨折复位三维模型上进行虚拟Magerl技术内固定.结果 对骨折进行了三维重建、复位,根据三维模型测量数据,完成虚拟螺钉内固定,并成功指导临床手术21例.结论 应用Mimics及Solidworks可在个人电脑上设计出C1侧块骨折数字化螺钉固定,对临床手术有很好的参考意义.     

枕颈融合内固定治疗C1 Jefferson骨折的数字化设计及意义

枕颈融合手术内固定治疗C1 Jefferson骨折具有一定风险,其骨折的三维重建及复位有助于了解伤情,虚拟内固定过程有助于选择、处理内固定钢板,从而制订更为合理的手术方案、缩短手术进程,减少手术风险。目前CT重建骨折三维模型在技术上已颇为成熟,但影像医师只能提供固定角度的三维重建图像,对于动态的三维模型的只能在CT工作站上观察,不能进行骨折虚拟复位以及三维测量,无法完全满足临床骨科医师的需要。     

从气血论治糖尿病性周围神经病变30例

糖尿病性周围神病变(DNP)是糖尿病三大合并症之一,其发病率占糖尿病患者的60%～90%;DNP虽不是糖尿病患者致死的主要原因,但却是糖尿病患者致残的主要因素。故诊治DNP,对于提高糖尿病病人的生活质量,有着很大的现实意义。笔者运用中药补气,活血化瘀治疗30例DNP患者,收到满意疗效,现报道如下。1　临床资料本组30例,均符合糖尿病性周围神经病变诊断标准。其中,男21例,女9例;年龄25～72岁,平均48.6岁;糖尿病病程5～25年,平均10.8年,空腹血糖9.1～15.7mmol/L,平均12.1mmol/L,周围神经病变病程2～15年,平均7.8年,主要临床表现均在糖尿病治疗…     

基于3D打印的腰椎椎弓根螺钉数字化置入及临床应用

背景：应用3D打印制备个体化导航模板辅助置钉可提高脊柱椎弓根螺钉的置钉准确率,有很好的临床应用前景。 目的：研究Mimics软件数字化设计结合3D打印模块进行腰椎椎弓根螺钉导航置入的方法,探讨其可行性及准确性。 方法：2012年2月至2013年8月,60例腰椎疾病患者采用3D打印模块辅助腰椎椎弓根螺钉导航置入内固定治疗。所有患者进行连续薄层CT扫描,采集Dicom格式图像,Mimics软件予以三维重建,设计腰椎椎弓根螺钉置钉钉道及支撑柱、分割可剥离骨面,设计带钉道的导航模块并3D打印。导航模块在手术中进行导航置钉,观察卡位、置钉情况,以X射线、CT扫描评价置钉效果。随访(12.17±3.21)个月,采用Oswestry功能障碍指数问卷表评价患者腰椎功能改善情况,JOA下腰痛评分系统评定疗效。 结果与结论：共制作253个导航模块,置入253枚螺钉,观察钉道及置钉后椎体周围骨质,未见爆裂。术后行X射线、CT扫描重建,发现有8枚椎弓根螺钉与术前设计相比,进钉方向稍有偏移,但均在较满意的位置,其余245枚椎弓根螺钉的进钉点,进钉方向、长度均与Mimics软件中模拟的预定理想进钉点、方向和长度一致,准确率96.84%。导航模块和相对应的椎体前方骨性结构贴合紧密,嵌合度良好,在应用时卡位及稳定性良好。末次随访时,JOA评分升高,Oswestry功能障碍指数低于术前(P < 0.01),优良率95%。提示,在导航模块的辅助下,腰椎椎弓根螺钉数字化置入精准,具有并发症少、疗效好等优点,有助于促进患者腰椎功能恢复。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

变牙厚椎弓根螺钉的生物力学测试

目的　评价不同变牙厚椎弓根螺钉（transitional thread pedicle screw, TTPS）对螺钉拔出力的影响。 方法 取新鲜小牛胸腰椎标本（T11~L4）5具,共30个椎体(60侧椎弓根),剔除周围肌肉、筋膜,注意保持骨结构完整,解离成单个椎骨。平均骨密度为（1.186±0.182）g/cm2。TTPS规格有6种：A0（牙厚保持不变）、A1（逐牙加厚0.01mm）、A2（逐牙加厚0.02 mm）、A3（逐牙加厚0.03 mm）、A4（逐牙加厚0.04 　mm）、A5（逐牙加厚0.05 mm）。每种螺钉随机置入10侧椎弓根,将标本包埋好并用夹具固定在材料试验机上,设置椎弓根螺钉长轴与拔出力轴线方向重合。设置材料试验机加载速率为0.08 mm/s进行拔出实验,结果输出拔出力-位移曲线、最大轴向拔出力（Fmax）。计算拔出刚度。 结果　A0至A5 6种螺钉的最大轴向拔出力分别为（983.99±324.19）、（1119.84±362.47）、（1067.67±398.00）、（900.04±255.89）、（799.07±406.79）、（850.71±408.11）N。6种不同规格TTPS轴向拔出力间无显著差异（组间差异P=0.216）。6种不同规格的TTPS的拔出刚度间无显著差异（组间差异P=0.07）。 结论　小范围增加螺纹牙厚,对椎弓根螺钉抗拔出力没有显著影响。     

3D打印数字化导航模块辅助股骨颈中空拉力螺钉的精准置入

BACKGROUND: Computer-assisted orthopedic technique can help physicians develop more accurate preoperative planning and surgical simulation. 3D printing technology erects a bridge for the virtual design and implementation, and the design of the surgical program will be accurately put into practice.     

中药治疗糖尿病性周围神经病变60例

糖尿病性周围神经病变(DPN)是糖尿病患者三大合并症之一,且发病率极高,大约60%～90%糖尿病患者会合并周围神经病变.DPN虽然不是糖尿病患者致死的主要原因,但却是糖尿病患者致残的主要因素.所以,针对DPN的治疗对提高糖尿病患者的生活质量,尤为重要.中药治疗DPN已广泛运用于临床实践.笔者自2003-2006年用补气、活血、化痰法治疗DPN 60例,小有心得,愿与同道共飨.     

封闭式负压引流患者采用专科护理的效果分析

封闭式负压引流(VSD)是一种新技术,具有使创面与外界隔绝、及时吸附渗出物、增加局部血液循环和刺激肉芽组织增生的特点,与传统的反复清创和换药相比有不可替代的优势[1].目前,VSD已成为处理较深创面的标准治疗模式[2];但在实际运用过程中,经常出现堵管、漏气等现象.为了更有效地使VSD应用于临床,我科建立VSD专科护理小组,现将临床实践情况报告如下.     

基于3D打印股骨远端骨折标准件库接骨板的数字化内固定

BACKGROUND: On CT reconstruction of three-dimensional (3D) model, fracture virtual reduction and internal fixation cannot be achieved, and reasonable operation scheme cannot be formulated. Digital design can fully meet the needs of clinical orthopedics physicians. Standard parts database can provide the possibility to choose the ideal internal fixation. 3D printing makes the reasonable operation scheme accurate in clinical implementation. OBJECTIVE: To discuss the feasibility, accuracy and minimal invasion of internal fixation in treatment of the distal femoral fracture with digital design of standard parts database by 3D printing. METHODS: (1) Nine adult lower extremity specimens were selected to take continuously thin-layer CT scanning. After Dicom images were imported into the mimics software, the model was established. According to the AO classification, they were classified into A1-3, B1-3 and C1-3 types of distal femoral fracture by virtual design. Internal fixation with plate and screw formed standard parts database virtually. It was printed out the pilot hole of the navigation module design by three-dimensional printing forming technique. Plate and screw were inserted assisted by the module. X-ray and CT scan were taken postoperatively to access the position. (2) 30 patients with distal femoral fracture were subjected to above fixation. The operation time, intraoperative blood loss and postoperative drainage were recorded. Imaging and curative effects were evaluated during follow-up. RESULTS AND CONCLUSION: (1) Nine samples underwent X-ray and CT scan. 3D reconstruction results revealed plate position, screw entry point, nail direction, length and diameter were consistent with presetting data in Mimics software. The navigation models were designed to fit the lateral bony structure of distal femur. There were good fitting degree, good card position and good stability when the navigation was applied. It could guide plant and screw implantation. (2) In 30 cases, the operation time was (104.63±26.12) minutes, intraoperative blood loss was (121.74±11.49) mL, and postoperative drainage volume was (30.29±6.38) mL. All patients were followed up. According to Schagzker criterion, the efficiency of 22 cases was excellent, 6 cases good and 2 cases average, and the excellent and good rate was 93%. The parameters of length, diameter, orientation and angle were consistent with that preoperatively. (3) Internal fixation formed by standard parts database assisted by 3D printing navigation model has advantages of high accuracy, short process, lessened blood loss, high safety, less complications, and precise fixation. Digital design of standard parts database via 3D printing navigation module is expected to achieve implant navigation and application.   中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

循证护理对减少全膝关节置换术后出血的影响

目的 研究全膝关节置换术后采用循证护理对控制切口出血、减少不必要输血的应用效果。方法 选取2015年3~5月未建立循证护理小组前行全膝关节置换术患者45例作为对照组,另选取2015年8~10月建立循证护理小组后行全膝关节置换术患者47例作为观察组。对照组采用常规护理,观察组采用循证护理,比较两组患者术后切口引流量、输血率及医生对护士的护理满意度。结果 观察组切口引流量及输血率明显少于对照组,差异有统计学意义(P<0.05或P<0.01)。观察组医生对护士护理满意度上升到97.87%,与对照组的66.67%比较,差异有统计学意义(P<0.05)。结论 循证护理使护理更具科学依据,能显著减少全膝关节置换术后出血量及输血率,促进患者康复,也使得医生对护士护理满意度大大提高,值得推广。