Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin thre...Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.展开更多
This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with po...This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.展开更多
目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,...目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。展开更多
目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和...目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和内固定组。CO接骨架组25例,男7例,女18例;年龄37~56(52.6±11.3)岁;车祸伤7例,跌伤18例;闭合性骨折25例,开放性骨折0例;采用闭合复位CO接骨支架治疗。内固定组23例,男8例,女15例;年龄41~59(53.3±13.7)岁;车祸伤8例,摔伤15例;闭合性骨折23例;采用切开复位钢板内固定方法。评价两组的围手术期资料(受伤至手术时间、手术时长、失血量、住院时间)、术后1年上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、活动范围及握力评估、影像学表现(掌倾角、尺偏角、桡骨长度、关节面台阶、关节内间隙)和并发症等情况。结果:两组术后均获随访,时间0~24(16.0±3.8)个月。CO接骨架组和内固定组比较,CO接骨架组受伤至手术时间[(2.4±3.3)dvs(7.4±3.7)d]短,手术时间[(56.27±15.23)min vs(74.10±5.26)min]短、失血量[(14.52±6.54)ml vs(32.32±10.03)ml]少、住院时间[(14.04±3.24)d vs(16.45±3.05)d]少(P<0.05)。术后12个月两组QuickDASH评分比较[(9.21±1.64)分vs(7.04±3.64)分],差异无统计学意义(P>0.05)。术后6周及1、3个月两组VAS比较,差异均无统计学意义(P>0.05)。末次随访两组活动范围及握力比较,差异均无统计学意义(P>0.05)。术后12个月与内固定组影像学比较,CO接骨架组掌倾角[(17.90±2.18)°vs(19.87±3.21)°]更小、关节面台阶[(0.11±0.03)mm vs(0.17±0.02)mm]更少、桡骨长度[(8.16±1.11)mm vs(9.59±1.02)mm]更短(P<0.05);两组尺偏角度数、关节内间隙比较,差异均无统计学意义(P>0.05)。其中CO接骨架组(25例中的23例)和内固定组(23例中的21例)存在允许范围内的缩小,差异无统计学意义(P=0.29);两组并发症比较,差异无统计学意义(P>0.05)。结论:CO接骨架和切开复位钢板内固定均是治疗不稳定型桡骨远端骨折的有效疗法,且接骨支架术从受伤至手术的等待时间更短、术中出血更少、耗时更短;钢板内固定术控制桡骨短缩更优。展开更多
目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时...目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version6.3,2022)进行信息提取、文献质量评价,采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。结果:(1)共纳入28项研究,患者共计2192例,包括1096例钢板内固定组和1096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93,95%CI(-48.54,-27.31),P<0.00001]、手术时间[MD=-31.58,95%CI(-48.96,-14.20),P=0.0004]、住院时间[MD=-4.58,95%CI(-5.44,-3.71),P<0.00001]、骨折愈合时间[MD=-0.88,95%CI(-1.35,-0.41),P=0.0002]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17,95%CI(-0.95,0.61),P=0.68]、尺偏角[MD=0.22,95%CI(-0.73,1.17),P=0.65]、桡骨高度[MD=-0.24,95%CI(-1.15,0.67),P=0.60],屈伸[MD=-5.63,95%CI(-11.85,0.58),P=0.08]、旋转[MD=-5.80,95%CI(-12.77,1.17),P=0.10]、尺桡偏[MD=-2.86,95%CI(-10.87,5.15),P=0.48],并发症发生率[RR=0.96,95%CI(0.63,1.46),P=0.83],Gartland-Werley腕部临床评分[MD=0.13,95%CI(-0.80,1.06),P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93,95%CI(0.87,1.01),P=0.08]、Cooney腕关节评分优良率[RR=0.99,95%CI(0.62,1.59),P=0.98]、腕关节DASH评分[MD=-4.67,95%CI(-14.96,5.62),P=0.37]的差异均无统计学意义(P>0.05)。结论:与钢板内固定相比,外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间,其影像学解剖指标、腕关节活动度、并发症发生率和腕关节功能评分两者相当。展开更多
目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架...目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架联合克氏针内固定治疗。对比两组的疗效和手术指标(手术时间、骨折愈合时间、住院时间),术后4周使用肩臂手功能障碍评分量表(Disabilities of the arm,shoulder and hand,DASH)评价患肢功能,使用视觉模拟评分法(Visual simulation scoring,VAS)评价患处疼痛程度并记录并发症。结果:观察组的治疗优良率高于对照组,手术时间长于对照组,骨折愈合时间、住院时间均比对照组缩短(P<0.05)。与治疗前相比,各治疗组DASH评分和VAS评分均明显降低(P<0.05),其中观察组DASH评分下降更为显著(P<0.05),但两组的VAS评分和并发症发生率均无差异(P>0.05)。结论:微型外固定架联合克氏针内固定治疗能提高疗效,促进掌骨骨折患者功能恢复,且不增加疼痛程度和并发症发生率。展开更多
文摘Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.
文摘This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.
文摘目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。
文摘目的:比较外固定支架术和外固定支架术后行微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗胫骨干开放性骨折的临床疗效。方法:自2020年1月至2022年6月收治行外固定支架术治疗的胫骨干开放性骨折患者151例,根据手术方式不同分为外固定组和联合组。外固定组81例,男48例,女33例;年龄21~68(42.58±7.44)岁;Gustilo分型Ⅱ型49例,ⅢA型32例;伤后至就诊时间2.5~10(4.25±0.74)h;行外固定支架术。联合组70例,男42例,女28例;年龄20~69(41.39±7.02)岁;Gustilo分型Ⅱ型35例,ⅢA型35例;伤后至就诊时间3~9(4.31±0.85)h;行外固定支架术后行MIPPO治疗。比较两组骨痂形成时间、骨折愈合时间和并发症情况,并于术后6个月采用Rasmussen评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分评价膝关节功能恢复情况。结果:两组患者均获得随访,时间6~13(10.17±2.33)个月。联合组骨痂形成时间、骨折愈合时间分别为(13.98±4.02)d、(70.26±12.15)d,优于外固定组(18.56±4.37)、(79.87±15.41)d,差异有统计学意义(P<0.05)。术后6个月,联合组Rasmussen、HSS评分为(26.79±3.11)、(83.36±9.44)分,高于外固定组(24.51±4.63)、(79.63±8.46)分,差异有统计学意义(P<0.05)。外固定组切口感染、钉道感染各2例,支架松动、骨折移位、延迟愈合、畸形愈合各1例;联合组生物相容性反应1例;两组比较差异有统计学意义(P<0.05)。结论:胫骨干开放性骨折患者中外固定支架术后行MIPPO可加快骨痂形成及骨折愈合,改善膝关节功能,提高临床疗效,减少并发症。
文摘目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和内固定组。CO接骨架组25例,男7例,女18例;年龄37~56(52.6±11.3)岁;车祸伤7例,跌伤18例;闭合性骨折25例,开放性骨折0例;采用闭合复位CO接骨支架治疗。内固定组23例,男8例,女15例;年龄41~59(53.3±13.7)岁;车祸伤8例,摔伤15例;闭合性骨折23例;采用切开复位钢板内固定方法。评价两组的围手术期资料(受伤至手术时间、手术时长、失血量、住院时间)、术后1年上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、活动范围及握力评估、影像学表现(掌倾角、尺偏角、桡骨长度、关节面台阶、关节内间隙)和并发症等情况。结果:两组术后均获随访,时间0~24(16.0±3.8)个月。CO接骨架组和内固定组比较,CO接骨架组受伤至手术时间[(2.4±3.3)dvs(7.4±3.7)d]短,手术时间[(56.27±15.23)min vs(74.10±5.26)min]短、失血量[(14.52±6.54)ml vs(32.32±10.03)ml]少、住院时间[(14.04±3.24)d vs(16.45±3.05)d]少(P<0.05)。术后12个月两组QuickDASH评分比较[(9.21±1.64)分vs(7.04±3.64)分],差异无统计学意义(P>0.05)。术后6周及1、3个月两组VAS比较,差异均无统计学意义(P>0.05)。末次随访两组活动范围及握力比较,差异均无统计学意义(P>0.05)。术后12个月与内固定组影像学比较,CO接骨架组掌倾角[(17.90±2.18)°vs(19.87±3.21)°]更小、关节面台阶[(0.11±0.03)mm vs(0.17±0.02)mm]更少、桡骨长度[(8.16±1.11)mm vs(9.59±1.02)mm]更短(P<0.05);两组尺偏角度数、关节内间隙比较,差异均无统计学意义(P>0.05)。其中CO接骨架组(25例中的23例)和内固定组(23例中的21例)存在允许范围内的缩小,差异无统计学意义(P=0.29);两组并发症比较,差异无统计学意义(P>0.05)。结论:CO接骨架和切开复位钢板内固定均是治疗不稳定型桡骨远端骨折的有效疗法,且接骨支架术从受伤至手术的等待时间更短、术中出血更少、耗时更短;钢板内固定术控制桡骨短缩更优。
文摘目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version6.3,2022)进行信息提取、文献质量评价,采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。结果:(1)共纳入28项研究,患者共计2192例,包括1096例钢板内固定组和1096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93,95%CI(-48.54,-27.31),P<0.00001]、手术时间[MD=-31.58,95%CI(-48.96,-14.20),P=0.0004]、住院时间[MD=-4.58,95%CI(-5.44,-3.71),P<0.00001]、骨折愈合时间[MD=-0.88,95%CI(-1.35,-0.41),P=0.0002]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17,95%CI(-0.95,0.61),P=0.68]、尺偏角[MD=0.22,95%CI(-0.73,1.17),P=0.65]、桡骨高度[MD=-0.24,95%CI(-1.15,0.67),P=0.60],屈伸[MD=-5.63,95%CI(-11.85,0.58),P=0.08]、旋转[MD=-5.80,95%CI(-12.77,1.17),P=0.10]、尺桡偏[MD=-2.86,95%CI(-10.87,5.15),P=0.48],并发症发生率[RR=0.96,95%CI(0.63,1.46),P=0.83],Gartland-Werley腕部临床评分[MD=0.13,95%CI(-0.80,1.06),P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93,95%CI(0.87,1.01),P=0.08]、Cooney腕关节评分优良率[RR=0.99,95%CI(0.62,1.59),P=0.98]、腕关节DASH评分[MD=-4.67,95%CI(-14.96,5.62),P=0.37]的差异均无统计学意义(P>0.05)。结论:与钢板内固定相比,外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间,其影像学解剖指标、腕关节活动度、并发症发生率和腕关节功能评分两者相当。
文摘目的:探究微型外固定架联合克氏针内固定治疗掌骨骨折的临床疗效。方法:选取2020年7月至2023年4月期间本院收治的100名掌骨骨折患者作为研究对象。随机分为对照组和观察组各50例。对照组实施微型钢板内固定治疗,观察组实施微型外固定架联合克氏针内固定治疗。对比两组的疗效和手术指标(手术时间、骨折愈合时间、住院时间),术后4周使用肩臂手功能障碍评分量表(Disabilities of the arm,shoulder and hand,DASH)评价患肢功能,使用视觉模拟评分法(Visual simulation scoring,VAS)评价患处疼痛程度并记录并发症。结果:观察组的治疗优良率高于对照组,手术时间长于对照组,骨折愈合时间、住院时间均比对照组缩短(P<0.05)。与治疗前相比,各治疗组DASH评分和VAS评分均明显降低(P<0.05),其中观察组DASH评分下降更为显著(P<0.05),但两组的VAS评分和并发症发生率均无差异(P>0.05)。结论:微型外固定架联合克氏针内固定治疗能提高疗效,促进掌骨骨折患者功能恢复,且不增加疼痛程度和并发症发生率。
