The biomechanical effect of the collar of a femoral stem on total hip arthroplasty

To investigate the biomechanical effect of collars, finite element analyses are carried out through two hip joints that are implanted using collared and collarless stems, respectively, and an intact hip joint model. For the analyses, the sacrum, coxal bone, and the cancellous and cortical bones of a femur are modelled using finite elements based on X-ray computed tomographic images taken from a 27-year-old woman. From the results, it is found that a collar with perfect calcar contact prevents stem subsidence and decreases the proximal–lateral gap and the lateral stem tilting. Therefore, it can impart reasonable biomechanical stability for total hip arthroplasty. However, its low load transmission ability and increased stem tilting effect due to the imperfect contact between the collar and the calcar are found to be serious problems that need to be solved. Results of clinical follow-up are presented for supporting the computational results.     

Bone grafts,bone substitutes and orthobiologics

The biology of fracture healing is better understood than ever before, with advancements such as the locking screw leading to more predictable and less eventful osseous healing. However, at times one’s intrinsic biological response, and even concurrent surgical stabilization, is inadequate. In hopes of facilitating osseous union, bone grafts, bone substitutes and orthobiologics are being relied on more than ever before. The osteoinductive, osteoconductive and osteogenic properties of these substrates have been elucidated in the basic science literature and validated in clinical orthopaedic practice. Furthermore, an industry built around these items is more successful and in demand than ever before. This review provides a comprehensive overview of the basic science, clinical utility and economics of bone grafts, bone substitutes and orthobiologics.     

两种途径介入治疗急性心肌梗塞疗效分析

目的：探讨对急性心梗患者行不同途径急诊经皮冠状动脉治疗（PCi）的临床疗效及预后。方法：选取我院自2011年1月至2012年12月收治的75例sT段抬高的急性心肌梗死患者作为研究对象进行回顾性调查,对比分析经桡动脉PCI（TRA—Pet）和经股动脉PCI（TFA—PCI）两组治疗疗效及出现并发症情况,包括比较两组穿刺成功率,手术时间,术中出血及术后局部及其他并发症等方面,并作统计分析,取P〈0．05为有统计学意义。结果：两组穿刺成功率及PCI手术成功率差异无统计学意义,P〉0．05。在手术操作时间上,TFA—PCI组明显长于TRA—PCI组,差异有统计学意义,P〈0．05。TFA．PCI组局部并发症发生率为11．8％．远期并发症为2．9％。TRA-PCI组局部并发症发生率为2．4％,远期并发症为7．3％,两组差别显著,P〈0．05。结论：TRA—PCI和TFA—PCI在手术时间及术后并发症上有差异,TRA—PCI术中花时间较少,术后局部并发症要轻,值得在临床上推广,但是由于有远期并发症的危险,故术后应加强肝肾功能等的监测。     

Identification of potential miRNA biomarkers for traumatic osteonecrosis of femoral head

Traumatic osteonecrosis of femoral head (TONFH) is a common orthopedic disease caused by physical injury in hip. However, the unclear pathogenesis mechanism of TONFH and lacking of simple noninvasive early diagnosis method cause the necessity of hip replacement for most patients with TONFH. In this study, we aimed to identify circulating microRNAs (miRNAs) by integrated bioinformatics analyses as potential biomarker of TONFH. mRNA expression profiles were downloaded from the Gene Expression Omnibus database. Then we combined two miRNA screen methods: Weighted gene co-expression network analysis and fold change based differentially expressed miRNAs analysis. As a result, we identified 14 key miRNAs as potential biomarkers for TONFH. Besides, 302 target genes of these miRNAs were obtained and the miRNA–mRNA interaction network was constructed. Furthermore, the results of Kyoto Encyclopedia of Gene and Genome pathway analysis, Gene Ontology function analysis, protein–protein interaction (PPI) network analysis and PPI network module analysis showed close correlation between these 14 key miRNAs and TONFH. Then we established receiver operating characteristic curves and identified 6-miRNA signature with highly diagnosis value including miR-93-5p (area under the curve [AUC] = 0.93), miR-1324 (AUC = 0.92), miR-4666a-3p (AUC = 0.92), miR-5011-3p (AUC = 0.92), and miR-320a (AUC = 0.89), miR-185-5p (AUC = 0.89). Finally, the results of quantitative real-time polymerase chain reaction confirmed the significantly higher expression of miR-93-5p and miR-320a in the serum of patients with ONFH. These circulating miRNAs could serve as candidate early diagnosis markers and potential treatment targets of TONFH.     

介入治疗成人非创伤性股骨头缺血性坏死的疗效分析

目的：分析介入治疗对于成人非创伤性股骨头缺血性坏死的疗效。方法：采用介入方法治疗95例共117髋非创伤性股骨头缺血性坏死。对比介入治疗前后DSA造影分型结果及血供异常例数。结果：117患髋中,Ia型的31病髋中,11髋（35．48％）介入治疗后动脉主干再通;Ib型的27髋中,24髋（88．89％）介入治疗后分支再通;II型的11髋中,5髋（45．45％）实质期股骨头缺损面积缩小;III型的10髋中,8髋（80．00％）静脉期见股骨头浓密染色明显减轻;Ⅳ型的33髋中,28髋（84．85％）可见动脉主干再通、分支增粗、实质期股骨头缺损面积缩小和静脉期股骨头染色减轻等。治疗前117病髋异常率为95．73％。经过介入治疗后,异常率为30．77％。治疗后异常率明显低于治疗前异常率（P〈0．01）。结论：介入治疗可有效改善非创伤性股骨头缺血性坏死血供异常,增加股骨头血供,具有操作简单、创伤小、疗效确切等优点。关键阗：股骨头缺血性坏死;介入治疗;数字减影血管造影     

跟骨骨折手术治疗并发症原因分析及预防

目的:探讨手术内固定治疗跟骨骨折发生并发症的原因及预防.方法:2007年5月～2010年9月应用切开复位跟骨钛板和闭合橇拔复位斯氏针内固定术治疗的64例跟骨骨折患者中,对出现并发症的患者进行回顾性分析,探讨其发生并发症的可能原因.结果:其中2例切口感染浅表坏死,1例腓肠神经损伤,腓骨长短肌腱断裂1例,腓骨肌腱炎4例,创伤性关节炎5例,复位丢失3例.结论:应根据骨折类型选择恰当的治疗方案,正确把握手术时机、规范操作,可有效减少并发症,获得满意的疗效.     

锁定加压钢板和动力加压钢板治疗肱骨中下段骨折的临床比较研究

目的:对比锁定加压钢板与动力加压钢板治疗肱骨中下段骨折患者的临床疗效。方法:抽取我院2010年8月~2013年12月收治的肱骨中下段骨折患者76例,按照随机数字表法分为锁定组(锁定加压钢板治疗)与动力组(动力加压钢板治疗),每组38例,随访1年。对比两组患者临床指标,治疗效果及并发症发生率。结果:锁定组患者手术时间、骨折愈合时间及住院时间均小于动力组,差异均有统计学意义(P0.05);锁定组患者优良率为89.47%,显著高于动力组的71.05%,差异有统计学意义(P0.05);锁定组的并发症发生率为10.53%,显著低于动力组的31.58%,差异有统计学意义(P0.05)。结论:锁定加压钢板应用于治疗肱骨中下段骨折患者疗效优于动力加压钢板治疗,它具有创伤小、恢复快的优点,且并发症发生率较低,值得推广。     

微创经皮钢板联合锁定加压钢板固定术治疗胫骨干骺端骨折的临床疗效

目的:探讨微创经皮钢板固定技术(MIPPO)与锁定加压钢板(LCP)治疗胫骨干骺端骨折的临床疗效。方法:选择2013年6月-2015年6月在我院接受手术治疗的胫骨干骺端骨折患者103例作为研究对象,根据手术方法不同将所选患者分为三组。其中,联合手术组(35例)患者采用MIPPO联合LCP内固定术治疗,外固定组(33例)患者采用超关节外固定支架术治疗,内固定术组(35例)患者采用切开复位钢板内固定术治疗。观察并比较三种手术方法的临床效果及对患者骨关节功能的影响。结果:与外固定术组及内固定术组比较,联合手术组患者的手术时间短,术中出血量少,骨折愈合时间早,差异具有统计学意义(P0.05);联合手术组患者的手术优良率高于外固定组和内固定组,差异有统计学意义(P0.05);内固定组手术优良率高于外固定组,差异具有统计学意义(P0.05);联合手术组患者术后并发症的发生率低于外固定组及内固定组,差异具有统计学意义(P0.05);外固定组与内固定组术后并发症的发生率比较,差异无统计学意义(P0.05)。结论:MIPPO联合LCP内固定治疗胫骨干骺端骨折具有手术切口小、术中出血量少、术后并发症发生率低、骨折愈合快、关节功能恢复较好等优点,是治疗胫骨干骺端骨折的理想方法,值得临床推广应用。     

关节镜治疗髋关节疾病的临床研究

目的:研究髋关节镜治疗髋关节疾病的方法、疗效及适应证,探讨髋关节镜在髋关节疾病中的临床价值。方法:研究对象为86例有明显髋关节疼痛的患者,包括股骨头坏死(osteonecrosis,ON)(43%)、盂唇损伤(20%)、退行性关节病变(degenerative joint disease,DJD)(10%)、股骨头骨骺缺血性坏死(Legg-Calve'-Perthes,LCP)(10%)、髋关节游离体(10%)、髋关节疼痛(100%)、机械性损伤(78%)、运动损伤(56%)。对患者采用仰卧位进行髋关节镜检查,使用牵引床,300或700,前外侧入口。观察不同疾病在治疗后的预后结果。结果:所有患者均无并发症,平均随访时间30个月,有60%的患者疼痛症状得到缓解。盂唇(91%,P0.003)或LCP(89%,P0.05)患者疗效较好,而ON和DJD患者疼痛症状缓解较差,改善率仅为40%和44%。在吻合血管游离腓骨移植(free-vascularized fibular graft,FVEG)的患者中有34%在随访期间得到改善(P=0.003)。其中18名患者(21%)进行了全髋关节置换术。结论:髋关节镜手术对于游离体、盂唇损伤、局灶性软骨病变、晚期LCP后遗症患者有良好的治疗效果;对股骨头坏死的治疗效果不佳。     

人工髋关节置换术发生股骨假体周围骨折的影响因素分析

目的:探讨人工髋关节置换术患者发生股骨假体周围骨折的相关危险因素,为临床预防和治疗提供参考资料。方法:回顾性分析2012年5月~2015年5月在我院接受人工髋关节置换术的92例患者的临床资料。根据是否发生股骨假体周围骨折将所选患者分为研究组和对照组,每组46例,比较两组患者的性别分布、年龄、骨折类型及假体固定方式等,分析影响患者发生股骨假体周围骨折的危险因素。结果:研究组患者骨折类型多为A2型,患者平均年龄、女性患者数及使用生物假体的比例均高于对照组,差异具有统计学意义(P0.05)。患者性别、年龄、骨折类型及假体固定方式是人工髋关节置换术患者发生股骨假体周围骨折的危险因素(OR=1.993、2.012和2.363,P0.05)。结论:高龄女性患者是发生股骨周围假体骨折的高危人群,骨质疏松及骨量减少是引发该并发症的主要危险因素。