分阶段闭合复位微创内固定与解剖型钢板内固定术治疗Pilon 骨折的疗效比较

目的:对比分阶段闭合复位微创内固定与解剖型钢板内固定术治疗Pilon骨折的临床疗效。方法:选择自2013年4月至2015年8月我院骨科收治的Pilon骨折患者122例,按照随机数表法,将患者分为对照组和研究组,每组61例。对照组患者行解剖型钢板内固定术治疗,而研究组患者行分阶段闭合复位微创内固定术治疗。统计分析两组患者的手术指标,并通过放射学及踝关节功能共同评价手术效果,术后进行半年的随访,对比两组患者并发症的发生情况。结果:研究组患者的手术时间、出血量、骨折愈合时间及住院时间均明显低于对照组,且差异均具有统计学意义(P0.05);研究组患者放射学及踝关节功能的优良率显著高于对照组(P0.01);研究组患者并发症发生率为4.92%(3/61)明显低于对照组的14.75%(9/61)(2=5.194,P=0.031)。结论:相比解剖型钢板内固定术,分阶段闭合复位微创内固定术治疗Pilon骨折临床效果更显著,并并发症的发生率低,可以作为治疗Pilon骨折的首选方法之一,值得在临床上推广使用。     

动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效比较

目的:比较动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效和安全性。方法:收集我院收治的老年股骨近端骨折患者64例,随机分为DHS组和PFN组,每组各32例。DHS组患者给予动力髋螺钉的固定方式,PFN组给予股骨近端髓内钉的固定方式。手术后对患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症以及患者临床疗效进行检测并比较。结果:与治疗前相比,两组患者治疗后的Harris评分均显著下降(P0.05);与DHS组相比,PFN组患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症的发生率以及Harris评分均较低(P0.05)。结论:股骨近端髓内钉的固定治疗老年股骨近端骨折的临床疗效较好,安全性更高。     

老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期躁动的影响因素

目的:探讨老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期发生躁动的影响因素。方法:回顾性分析我院老年股骨颈骨折行全麻全髋关节置换术患者46例,根据躁动情况分为躁动组和平静组,每组各23例。比较两组患者术前白蛋白、血红蛋白、白细胞、总胆红素、谷草转氨酶、丙氨酸转氨酶水平;术中失血量、尿量、麻醉时间、心率、舒张压、收缩压水平;躁动组患者各种不良刺激的比例。结果:术前,与平静组相比,躁动组白蛋白、血红蛋白水平较低(P0.05),白细胞计数、总胆红素水平较高(P0.05),谷草转氨酶、丙氨酸转氨酶差异无统计学意义(P0.05);术中,与平静组相比,躁动组尿量水平较低(P0.05),失血量、心率、麻醉时间、收缩压水平较高(P0.05),舒张压差异无统计学意义(P0.05);躁动组不良刺激影响中尿管刺激占比例最高,疼痛刺激其次。结论:老年股骨颈骨折患者行全髋关节置换术后麻醉恢复期躁动与术前白蛋白、血红蛋白、白细胞计数水平,术中失血量、尿量、麻醉时间、心率、收缩压水平,尿管刺激、疼痛刺激、气管导管刺激及体位不当刺激有关。     

3 种不同弹性模量钛合金股骨假体在羊股骨置换模型中应力分布的三维 有限元分析

目的:通过三维有限元分析方法来观察并比较3种不同弹性模量钛合金股骨假体在羊股骨置换模型中von-Mises应力分布的情况。方法:采用64排螺旋CT对一健康成年羊的下肢股骨进行全长的CT扫描,扫描层厚为0.5 mm,扫描所得的数据存储为DICOM文件。将得到的DICOM文件导入到CT图像分析软件Mimics 10.0,然后利用Mimics 10.0软件来生成股骨的骨质点云数据,再将生成的骨质点云数据导入到Simpleware分析软件,通过机械加工反求中的复杂曲面造型技术建立起精确的三维实体模型。对三维实体模型进行网格划分,确定了髓腔的形状,并根据羊下肢股骨髓腔的形状设计了作者实验用的羊股骨假体模型,然后在ANSYS 12.1软件中进行网格划分。给予加载缓慢行走载荷以及扭转载荷,分析并比较羊股骨以及3种不同弹性模量钛合金股骨假体在股骨置换模型中von-Mises应力分布的情况。结果:在缓慢行走载荷以及扭转载荷条件下,3种不同弹性模量钛合金股骨假体von-Mises应力分布变化趋势一致,假体的柄颈结合部以及假体柄上1/3为应力集中区域。3种不同弹性模量的最大应力集中点均位于柄颈结合部,60 GPa弹性模量的股骨假体植入后假体的最大应力最小(37.8 MPa、29.1 MPa),股骨的最大应力最大(12.6 MPa、24.5 MPa);80 GPa的次之,假体的最大应力(38.4 MPa、33.4 MPa),股骨的最大应力(12.5 MPa、24.5 MPa);110 GPa的股骨假体植入后假体的最大应力最大(38.9 MPa、38.1 MPa),股骨的最大应力最小(12.3 MPa、24.5 MPa)。60 GPa弹性模量的股骨假体植入后的假体最大位移和相对位移均最小(缓慢行走载荷下假体最大位移为0.551 mm、相对位移为0.008 mm,扭转载荷下假体最大位移为0.730 mm、相对位移为0.011 mm)。结论:较低弹性模量的钛合金股骨假体(60 GPa)由于其弹性模量更接近于骨组织的弹性模量,股骨假体与股骨间的"应力遮挡"效应较小,更有利于应力在股骨假体及股骨间的传递,增加了股骨假体的早期稳定性,延长了其临床寿命。     

Femoral neck fracture after removal of the standard gamma interlocking nail: a cadaveric study to determine factors influencing the biomechanical properties of the proximal femur

We retrospectively analyzed 1334 patients who were implanted standard gamma interlocking nails^® (SGN) to stabilize trochanteric femoral fractures over the years 1992–1998. Reoperation to remove the nails was performed in 37 patients, in 9 of them purely because of pain. Three out of these 9 patients with removed SGN suffered femoral neck fractures in the early postoperative course after having been mobilized to full weight-bearing capacity. This complication was not observed with other implant systems and, considering the notoriously high complication rate of femoral neck fractures, severely reduces the value of the SGN concept per se. These findings in combination with other known shortcomings of SGNs prompted us to conduct an experimental study on the fracture force of excavated femurs addressing the hypothesis that the specific design of the SGN is responsible for the occurrence of fatigue fractures of the femoral neck. Eighteen matched pairs of fresh human cadaveric proximal femurs, which were treated by insertion and removal of (i) SGNs or (ii) dynamic hip screws^® (DHS) or (iii) by excavation in the absence of an implant, were subjected to incremental loading cycles and compared to the untreated contralateral femurs. Overall, the fracture force was found to be significantly lower among the treated than among the untreated bones. However, the fracture force required after removal of the DHS system was still significantly higher than for SGN or excavation alone. In this way, our findings demonstrate that removing relatively big implants such as SGN can cause serious complications such as femoral neck fractures. We therefore recommend to leave this type of device in place even after fracture healing except in cases of deep and chronic infection.     

Biomechanical comparison of conventional and optimised locking plates for the fixation of intraarticular calcaneal fractures: a finite element analysis

Intraarticular calcaneal fractures can result in poor prognosis. Although operative fixation can improve the functional outcomes in most cases, surgical complications such as loss of reduction and wound healing problems may increase the risk of reoperation. Hence, this study aimed to design calcaneal locking plate with a lower profile and better biomechanical performance and to compare the redesigned plate with the traditional calcaneal plate via the finite element method. A Sanders’ type II-C intraarticular calcaneal fracture was simulated. Two fixation models utilising the branch-like calcaneal locking plate and the full plate were constructed. Topology optimisation was conducted to generate a new calcaneal plate design. A biomechanical comparison among the three groups of plates was performed using the finite element method. For the fracture simulated in this study, the optimised plate was superior to the traditional plate in terms of fixation stability and safety but was reduced in volume by approximately 12.34%. In addition, more rational stress distributions were observed in the redesigned plate, underscoring the superiority of this new design in terms of fatigue strength. These results demonstrate that the topology optimisation can be used to design a new implant with a minimised profile and no loss of fixation stability.     

切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折患者的比较研究

目的:比较切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折的临床疗效,为临床治疗方式的选择提供参考。方法:选择2014年1月至2016年1月间于我院骨科就诊的桡骨远端骨折患者102例作为研究对象。按患者的治疗方式分为内固定组(n=52)和外固定组(n=50)。内固定组患者采用切开复位钢板内固定进行治疗,外固定组患者采用闭合复位外固定架固定进行治疗。术后3个月及术后1年通过影像学测量两组患者的关节面台阶、掌倾角和尺偏角,同时测量患者腕部功能情况。随访1年,比较两组患者疗效,并观察患者并发症发生情况。结果:术后3个月及术后1年,内固定组患者关节面台阶、掌倾角和尺偏角均低于外固定组患者,差异均具有统计学意义(P0.05)。术后3个月,内固定组的旋前旋后活动度、屈伸活动度、桡尺偏活动度、捏力、握力均明显高于外固定组(P0.05),但两组的上述指标在术后1年比较无统计学差异(P0.05)。内固定组患者治疗有效率为86.54%,外固定组患者治疗有效率为86.00%,差异无统计学意义(P0.05)。内固定组并发症发生率为15.38%,外固定组并发症发生率为18.00%,差异无统计学意义(P0.05)。结论:与闭合复位外固定架固定相比,切开复位钢板内固定治疗对患者关节面台阶、掌倾角和尺偏角的恢复效果较好,同时患者能及早进行腕部功能锻炼,近期疗效更加明显。     

微创经皮钢板内固定术与切开复位钢板内固定术治疗胫骨PILON骨折疗效比较研究

目的:对比微创经皮钢板内固定术与切开复位钢板内固定术治疗胫骨PILON骨折的临床疗效。方法:选取2014年11月-2016年1月在我院接受治疗的胫骨PILON骨折患者76例,根据乱数表法将患者分为观察组和对照组各38例。观察组给予微创经皮钢板内固定术,对照组给予切开复位钢板内固定术,对比两组患者手术时间、术后引流量、术后发热时间、术中出血量、骨折愈合时间、住院时间及并发症发生率,对比两组患者术后4、8、12个月膝关节功能评分(HSS)、踝关节功能评分(Baird)。结果:观察组手术时间、术后引流量、术后发热时间、术中出血量、骨折愈合时间、住院时间较对照组均显著更少(P0.05);观察组术后4、8、12个月HSS评分和Baird评分较对照组显著更高(P0.05);观察组总并发症发生率较对照组显著更低(P0.05)。结论:与切开复位钢板内固定术比较,微创经皮钢板内固定术能有效减少手术时间、术中出血量、术后引流量、术后发热时间以及住院时间,降低并发症发生率,改善患者术后膝、踝关节功能,加快骨折愈合,促进患者康复,值得临床应用。     

微创手术与传统开放手术在胸腰段脊柱骨折治疗中的应用效果

目的:分析微创手术与传统开放手术在胸腰段脊柱骨折治疗中的应用效果观察。方法:回顾性抽取我院手术治疗的130例胸腰段脊柱骨折病患信息,将应用微创手术治疗的65例病患归为微创组,将接受传统开放手术治疗的65例病患归为开放组,对比分析手术前后椎体高度、Cobb角度以及生活质量评分的变化,同时比较两组手术相关指标以及手术相关并发症的差异。结果:(1)与手术前相比,两组手术后的伤椎高度、伤椎Cobb角度以及生活质量评分显著升高(P0.05),两组间伤椎高度、Cobb角度相仿,但微创组生活质量评分显著高于开放组(P0.05);(2)微创组手术时间显著高于开放组,但术中出血、术后住院时间以及术后并发症显著低于开放组(P0.05)。结论:微创手术治疗胸腰椎骨折不仅对于伤椎复位效果与传统开放手术相仿,而且在生活质量改善、手术恢复时间、手术安全性方面具有显著优势。     

Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients: A randomized controlled study

Objective:Heamophilia is considered a disorder in both children and adolescents which may affect their quality of life seriously than their normal peers; this study investigated the impact of the Neurodynamics Nerve Flossing Technique (NFT) on femoral neuropathy in patients with haemophilia.Method:Thirty haemophilic children with Femoral Neuropathy were randomly allocated into two equivalent groups; the study group which received Neurodynamics NFT of the femoral nerve and conventional therapy program, and the control group which received only the conventional therapy program, three sessions/week for 12 weeks. Femoral nerve motor conduction velocity (MCV) and level of pain sensation according to the Visual Analogue Scale (VAS), were assessed pre and post interventions.Results:post-treatment comparison between both groups revealed that there was a significant increase in femoral nerve MCV and reduction of pain sensation of the study group compared to the control group (p<0.05).Conclusion:Neurodynamics Nerve flossing had a clear effect in the treatment of femoral neuropathy in children with haemophilia.