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经桡侧入路治疗桡骨远端粉碎性骨折

经桡侧入路治疗桡骨远端粉碎性骨折

引用

第二十届全国中西医结合骨伤科学术研讨会、第二届中国医师协会中西医结合医师分会骨伤科学术年会、第十九届浙江省中西医结合骨伤科专业委员会学术年会

作者：孙玉福胡茂忠王炳祺万东东许东浩范猛井万里周海昱姚树源姜文学

目的初步探讨经桡侧入路锁定接骨板(LCP)固定桡骨远端骨折的临床应用及其疗效。方法 2009年9月-2011年12月经桡侧入路治疗桡骨远端骨折15例,男8例,女7例,年龄38～68岁,平均51.5岁,按AO分型:A3型6例、C1型6例、C2型3例,其中畸形愈合者2例... 详细信息

目的初步探讨经桡侧入路锁定接骨板(LCP)固定桡骨远端骨折的临床应用及其疗效。方法 2009年9月-2011年12月经桡侧入路治疗桡骨远端骨折15例,男8例,女7例,年龄38～68岁,平均51.5岁,按AO分型:A3型6例、C1型6例、C2型3例,其中畸形愈合者2例(A3型与C1型各1例),所有病例均采取经桡侧入路显露桡骨远端外侧柱、中柱、桡侧缘及其背侧,同时可行背侧骨缺损植骨,最大限度恢复桡骨茎突高度、尺偏角及掌倾角。采用Gartland-Werley腕关节评分标准判定腕关节功能恢复情况。结果全部病例获得随访,平均13.5个月(12～24个月)。术后定期复查X线片显示骨折全部Ⅰ期愈合,平均愈合时间为7.5周,术后6月,1年与2年X线片测量:桡骨茎突短缩均≤2mm;掌倾角8°～17°,平均12.5°;尺偏角15°～26°,平均20.5°;关节面塌陷、移位矫正均<2mm。术后患侧腕关节运动范围为:掌屈30°～70°,平均60°;背伸30°～65°,平均55°;桡偏:10°～20°,平均17°;尺偏20°～30°,平均25.5°;前臂旋前60°～70°,平均65.5°;旋后60°～80°,平均75.5°。握力测量平均为健侧的75%(50%～95%)。伴有疼痛的2例其中偶有轻度疼痛的1例,中度疼痛的1例。根据Gartland-Werley腕关节评分标准:优11例,良2例,可1例,差1例,优良率为86.7%。术后无一例出现桡神经浅支支配区感觉异常,无感染、骨不连及钢板松动、正中神经损伤及肌腱损伤等并发症。结论桡侧入路可显露桡骨远端外侧柱、中柱、桡侧缘及其背侧,同时行背侧骨缺损植骨,有助于骨折解剖复位,是治疗桡骨远端骨折的手术入路之一。

关键词：桡骨远端骨折手术入路固定术内

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Overview of polytrauma patients in the first 10 daysafter the Sichuan earthquake:a report from the No.903Military Hospital,Jiangyou

Overview of polytrauma patients in the first 10 daysafter th...

引用

作者：高瑞杨立利上海长征医院脊柱外科

Purpose The purpose of this study was to investigate theprofile of traumas,the severity,and mortality of polytraumapatients in a front-line hospital after the 2008Sichuan earthquake. Methods Patients who had two or more injuries tophysical regions or organ systems,where at least one injuryor the combination of injuries carried a certain risk of fataloutcome,with Injury Severity Score(ISS)≥16, wereconsidered as polytrauma patients and included in *** records consisting of demographic data,distribution and type of injuries,Abbreviated Injury Scale(AIS) score of each injury,ISS,surgical procedures, mortalityrate,and features of the deaths were collected andanalyzed. Results A total of 70 earthquake-related polytraumapatients were treated in our hospital during the first 10 daysafter the *** mean ISS of these patients was26.9,and 77.1%of these patients were critically injured(ISS≥25).Among the 224 injuries,the most commoninjury site was the extremities(30.8%),81.2%of whichwere fractures.A total of 152 surgical procedures wereperformed on these patients,of which orthopedic proceduresaccounted for 85.5%.During the first 10 days,21 patients with significantly higher ISS than the survivorsdied in the hospital. Conclusions The mortality rate of the polytraumapatients in this rescue operation was *** ISS was afeasible tool to estimate the severity of *** in orthopedics,critical care,andrespiratory disorders were in great demand during themanagement of these patients in such conditions.

关键词： Overview of polytrauma patients in the first 10 daysafter the Sichuan earthquake:a report from the No.903Military Hospital,Jiangyou

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腰椎后路固定联合椎间融合治疗退变性腰椎管狭窄症的疗效分析

腰椎后路固定联合椎间融合治疗退变性腰椎管狭窄症的疗效分析

引用

作者：樊效鸿程尊友陈日高钟磊黄勇成都中医药大学附属医院四川省中医院骨科

目的探讨腰椎后路椎弓根螺钉固定联合椎间融合治疗退变性腰椎管狭窄症的疗效。方法 2009年7月～2012年10月,对68例退变性腰椎管狭窄症患者采用后路椎弓根螺钉固定、全椎板切除减压、椎间盘切除椎间融合进行治疗分析临床疗效及其安全性... 详细信息

目的探讨腰椎后路椎弓根螺钉固定联合椎间融合治疗退变性腰椎管狭窄症的疗效。方法 2009年7月～2012年10月,对68例退变性腰椎管狭窄症患者采用后路椎弓根螺钉固定、全椎板切除减压、椎间盘切除椎间融合进行治疗分析临床疗效及其安全性。本组共62例,男38例,女24例;年龄54～67岁,平均年龄61岁。病程9～27月,平均19月。采用全麻,后正中切口,采用"Roy-Camille"方法在C臂辅助下植入椎弓根螺钉。全椎板减压,彻底解除硬膜囊和神经根的压迫,尽量保留小关节突关节。牵开硬膜囊及神经根,铰刀切除病变间隙椎间盘,处理终板,将切除的椎板棘突剔除软组织后咬成骨粒,把部分松质骨粒置入椎间隙前1/3并压紧。通过椎弓根螺钉适当撑开椎间隙,试模测量椎间隙高度,选择大小适当Cage并装填松质骨粒,植入椎间隙。剩余骨粒进行后外侧植骨。术后放置引流管24～72 h,常规预防感染。2周后戴腰围下床活动,腰围佩戴时间为3～4月。疗效评定采用JOA(Japanese Orthopedics Association)评分。结果 62例患者完成随访,随访6～18个月,平均随访时间11月。无严重手术并发症。平均手术时间245min,平均出血量640ml。术后未出现感染及脑脊液漏,1例患者术后5天出现一侧下肢疼痛,对症治疗1周后缓解。随访过程中未出现螺钉松动断裂、cage移位等现象。根据JOA评分,其中优:40例;良:14例;可:6例;差:2例;其中优良率87.1%。结论采用后路全椎板切除充分减压、椎弓根螺钉内固定、cage椎间植骨融合治疗腰椎管狭窄症安全有效。

关键词：腰椎管狭窄症椎间融合全椎板切除

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不同强度跑台运动对大鼠膝关节软骨MMP-3、COL-Ⅱ、TIMP-3表达影响的研究

不同强度跑台运动对大鼠膝关节软骨MMP-3、COL-Ⅱ、TIMP-3表达影...

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作者：邢丹马信龙徐卫国陈阳杨阳朱少文马宝意马剑雄王杰冯睿天津市天津医院骨研所(天津医科大学骨科临床学院) 天津医科大学总医院骨科生物力学实验室

目的通过对成年大鼠进行不同强度的跑台训练,比较不同强度跑台运动对大鼠膝关节软骨MMP-3、COL-Ⅱ、TIMP-3蛋白及基因表达的影响,以探讨其在关节退变中的作用。方法 8周龄雄性SD大鼠24只,随机分为三组,即高强度运动组、低强度运动组和... 详细信息

目的通过对成年大鼠进行不同强度的跑台训练,比较不同强度跑台运动对大鼠膝关节软骨MMP-3、COL-Ⅱ、TIMP-3蛋白及基因表达的影响,以探讨其在关节退变中的作用。方法 8周龄雄性SD大鼠24只,随机分为三组,即高强度运动组、低强度运动组和对照组。两运动组动物按照既定的运动处方在动物跑台上进行运动训练6周后,处死所有实验动物,对全部大鼠的左侧膝关节以及右侧股骨内外侧髁软骨进行取材。对取材后的膝关节标本进行COL-Ⅱ免疫组化染色。采用Western blot技术检测各组大鼠软骨MMP-3、COL-Ⅱ及TIMP-3的表达。采用RT-RCR技术研究各组大鼠软骨MMP-3 mRNA、COL-ⅡmRNA及TIMP-3 mRNA表达。结果 COL-Ⅱ免疫组化检测结果显示高强度运动组光密度值最低,且与低强度运动组及对照组的差异有统计学意义(p<0.05)。随着运动强度的增加,MMP-3与COL-Ⅱ的mRNA表达水平上调(p<0.05),而TIMP-3的mRNA表达水平下调(P<0.05)。虽然随着运动强度的增加MMP-3和COL-Ⅱ的蛋白表达水平增加(p<0.05),TIMP-3的蛋白表达水平下降(p<0.05),但在高强度运动组COL-Ⅱ的蛋白表达却较低强度运动组降低(p<0.05)同时MMP-3的蛋白水平显著升高(p<0.05)。结论一定程度运动强度的增加会在基因转录水平调节MMP-3、COL-Ⅱ及TIMP-3的表达,使软骨基质的代谢处于活跃状态,但运动强度过大可能通过MMP-3的降解作用降低COL-Ⅱ蛋白水平的表达。适度的运动有利于关节软骨基质成分的更新,超负荷运动可能通过影响软骨基质的合成导致关节的退变。

关键词：软骨关节运动基质金属蛋白酶类胶原蛋白细胞外基质

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一期前后路联合手术治疗脊髓型颈椎病的近期疗效分析

一期前后路联合手术治疗脊髓型颈椎病的近期疗效分析

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作者：邓树才马毅郝永宏贾占华刘欣赵栋孙贵明杨海云天津市天津医院脊柱外科

目的观察一期前后路联合手术治疗前后受压脊髓型颈椎病的近期疗效及安全性并探讨其手术适应证。方法 2005年1月～2011年1月,一期颈椎前后路联合手术治疗脊髓型颈椎病225例。该组患者均同时存在两种病变,即各种原因致严重颈椎管狭窄和来... 详细信息

目的观察一期前后路联合手术治疗前后受压脊髓型颈椎病的近期疗效及安全性并探讨其手术适应证。方法 2005年1月～2011年1月,一期颈椎前后路联合手术治疗脊髓型颈椎病225例。该组患者均同时存在两种病变,即各种原因致严重颈椎管狭窄和来自脊髓前方严重压迫。手术步骤:先行后路单开门椎管扩大成形术或椎板减压(根据颈椎稳定情况做或不做侧块钉棒固定),再行前路椎间盘切除或椎体次全切除、植骨或钛笼融合内固定术。对患者术前术后神经功能进行JOA评分,计算其术后改善率,并统计手术并发症、术后轴性症状、融合率、颈椎后凸畸形纠正情况。结果手术时间180～350分钟,平均240分钟,出血量300～1200ml,平均450ml,无术中死亡,无术后脊髓功能恶化。手术并发症:切口延迟愈合3例;脑脊液漏3例;术后轴性症状62例;C5神经根麻痹2例。随访时间1 8～90个月,平均30个月。至随访时所有患者前路植骨均已融合,内固定物无松动、断裂,颈椎后凸畸形得到纠正。JOA评分由术前平均8.4分增加到术后平均15.3分(P<0.05),术后改善率为65.7%。结论一期前后路联合手术治疗严重脊髓型颈椎病,近期疗效满意,该手术减压充分,能较好重建颈椎稳定性,可降低单纯前路手术脊髓损伤的风险和减少单纯后路手术的神经根麻痹发生率。其主要适应症为各种原因致严重颈椎管狭窄和脊髓前方严重压迫的颈椎病,如发育性颈椎管狭窄伴巨大颈椎间盘突出或孤立型OPLL;巨大颈椎间盘突出致椎管狭窄代偿间隙很小、前路手术脊髓损伤风险高而单纯后路手术又不能充分解除前方压迫者;颈椎不稳、后凸畸形同时合并脊髓前方压迫单纯后路手术又不能充分解除前方压迫者。

关键词：前后路联合手术颈椎病神经根麻痹后路手术疗效分析

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A methodological systematic review of early versus late stabilization of thoracolumbar spine fractures

A methodological systematic review of early versus late stab...

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作者： Xin-Long Ma Dan Xing Jian-Xiong Ma Jie Wang Yang Chen Yang Yang Department of Orthopaedics Tianjin Medical University General Hospital Department of Orthopaedics Institute Tianjin Hospital Department of Orthopaedics Tianjin Gongan Hospital

Objective The optimal timing of stabilization in patients with traumatic thoracolumbar fractures remains *** is currently a lack of consensus on the timing of surgical stabilization, which is limited by the reality that a randomized controlled trial to evaluate early versus late stabilization is difficult to ***,the objective of this study was to determine the benefits,safety and costs of early stabilization compared with late stabilization using data available in the current literature. Methods An electronic literature search was performed in Medline,Embase,Cochrane Database of Systematic Reviews,and Cochrane Central Register of Controlled Trials for relevant studies evaluating the timing of surgery in patients with thoracolumbar *** reviewers independently analyzed and selected each study on the basis of the eligibility *** quality of the included studies was assessed using the Grading of Recommendations Assessment,Development,and Evaluation system(GRADE).Any disagreements were resolved by consensus. Results Ten studies involving 2512 subjects were *** studies demonstrated that early stabilization shortened the hospital length of stay,intensive care unit length of stay,ventilator days and reduced morbidity and hospital expenses for patients with thoracic ***,reduced morbidity and hospital expenses were not observed with stabilization of lumbar *** to the very low level of evidence,no conclusion could be made regarding the effect of early stabilization on mortality. Conclusions We adhere to the recommendation that patients with traumatic thoracolumbar fractures should undergo early stabilization,which may reduce the hospital length of stay,intensive care unit length of stay, ventilator days,morbidity and hospital expenses,particularly when the thoracic spine is *** prospective studies are required to confirm whether there are benefits to early stabilization compared

关键词： A methodological systematic review of early versus late stabilization of thoracolumbar spine fractures

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A biomechanical study of the recovery in spinal stability of flexion/extension and torsion after the resection of different posterior lumbar structures in a sheep model

A biomechanical study of the recovery in spinal stability of...

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作者： Haobo Jia Xinlong Ma Jianxiong Ma Shaowen Zhu Department of Orthopedics Tianjin Medical University General Hospital Biomechanics labs of Orthopaedics Institute Tianjin Hospital

Posterior lumbar structures are vital for spinal stability,and many researchers thought that laminectomy and facetectomy would lead to severe spinal ***,because living organisms have compensatory repair capacities,their long-term condition after posterior lumbar structure injuries may change over *** study the changes in the lumbar biomechanical stability of flexion/extension and torsion at different time points after the resection of various posterior structures,as well as to assess the capacity for self-healing in lumbar stability,sheep that had undergone laminectomy or facetectomy were used as an experimental animal *** injured sheep models included three groups:laminectomy only,laminectomy plus left total facetectomy,and laminectomy plus bilateral *** sheep that did not undergo a surgical procedure were used as the control *** 0, 6,12,24,36 weeks after the resection of the posterior lumbar structures,the lumbar specimens were harvested for biomechanical testing based on flexion/extension and torsion movements using the Instron 8874 servohydraulic biomechanical testing *** changes in the injured lumbar spine were also analyzed through radiological *** lumbar stability in flexion/extension and torsion was severely decreased after the three types of *** six weeks,the flexion/extension mechanical parameters recovered substantially;each parameter had returned to normal levels by 12 weeks and exceeded the intact group by 24 and 36 *** stiffness also recovered gradually over *** of the injury groups demonstrated decreased intervertebral space and degeneration or even fusion in the small joints of the surgical segment or in adjacent segments based on radiological *** results indicate that the body has the ability to repair the mechanical instability to a certain extent.

关键词： Lumbar posterior structures laminectomy facetectomy stability biomechanics recovery

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Factors that may affect outcome in cervical artificial disc replacement:a systematic review

Factors that may affect outcome in cervical artificial disc ...

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作者：高瑞杨立利上海长征医院

BACKGROUND Cervical artificial disc replacement(C-ADR) has been proposed as an alternative to anterior cervical discectomy and fusion for patients with symptomatic cervical degenerative disc disease. However,the correlation ofbetween the outcome after C-ADR againstand a variety of factors are still unclear. OBJECTIVE The aim of this systematic review is tTo identify the factors that may affect the outcome in C-ADR,and provide the pooled results of postoperative heterotopic ossification(HO) incidence and surgery rate for adjacent segment disease(ASD). METHODS We systematically searched Ovid-Medline and Ovid-EMBASE from 2000 to September 2012. Two independent reviewers screened and selected the primary *** questions were asked previously regardingabout the effect of patient selection issues,motion technology and sagittal alignment issues on *** in which where answers were found were included for analysis. RESULTS We included 45 studies,including 10 levelⅠ,2 levelⅡ,1 levelⅢ,and 32 levelⅣ*** showed that surgical level,patient' s' *** surgery,implanted segment range of motion,postoperative HO,postoperative cervical kyphosis,postoperative disc height had no effect on *** No difference was found between soft-disc herniation and spondylosis,between radiculopathy and myelopathy had no *** available evidence for the question of single versus multilevel surgery is *** overall incidences of postoperative grade 1 -4 HO and grade 3-4 HO in the implanted level were 51.6%and 14.8%,respectively,and the overall surgery rate for ASD was 3.0%. CONCLUSIONS The available evidence showed that most of the pre-selected factors had no effect on the outcome in C-ADR,and the incidence of HO and surgery rate for ASD are *** of limited studies for some questions,further studies addressing these factors are still needed.

关键词： Factors that may affect outcome in cervical artificial disc replacement:a systematic review

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Degradation and osteogenic potential of a novel PLA/nano-sized β-TCPscaffolds

Degradation and osteogenic potential of a novel PLA/nano-siz...

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作者： Lu Cao Shao-Jun Wang Ping-Guo Duan Feng-Lai Yuan Hui-Ren Wang Jian Dong Department of Orthopaedic Surgery Zhongshan HospitalFudan University The third hospital affiliated to Nantong University State Key Laboratory of Molecular Engineering of Polymers Fudan University

The effect of increasing nano-sized P -tricalcium phosphate(P -TCP) content on the biological performance of polylactic acid(PLA) composite scaffold was investigated by in vitro degradation and in vivo model of heterotopic bone ***-sized P -TCP was prepared by wet grinding method,PLA/nano-sizedβ-TCP scaffold with increasingβ-TCP(0-50wt%) contents were fabricated by freeze-drying method. The degradation behavior was carried out by determining the microstructure,the change of pH,weight and comprehensive strength in 26 weeks of *** study in vivo was performed by cutting the composite scaffold contain0,10,30,50%β-TCP and pureβ-TCP into blocks(5mm×5mm×3mm),and then implanting into subcutaneous tissue of back in rabbits after loading recombinant human bone morphine protein-2 (rhBMP-2),each rabbit received 4 *** in vitro results indicated a marked pH buffering effect as nano-sized 0 -TCP filler increased,however,comprehensive strength of composite scaffolds decreased *** the other hand the findings in vivo demonstrated that increasing percentage of nano-sizedβ-TCP to PLA scaffolds enhanced their *** scaffold containing 50%β-TCP possessed a similar biological performance to pureβ-TCP in terms of osteoconductivity,but scaffold containing 30%β-TCP exhibited better mechanical properties,which can meet the demand of bone repair in load-bearing *** supports the potential future application of PLA/30n-β-TCP scaffold as ideal scaffold for bone tissue engineering.

关键词： bone tissue engineering polylactide tricalcium phosphate nano-sized porous scaffold

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计算机辅助骨科手术系统在股骨颈骨折经皮空心拉力螺钉内固定中的应用实验

计算机辅助骨科手术系统在股骨颈骨折经皮空心拉力螺钉内固定中的...

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作者：韦庆军韦积华广西医科大学第一附属医院创伤骨科手外科

目的通过用标本模拟手术实验,探讨计算机辅助骨科手术导航系统结合"手术安全区"在股骨颈骨折经皮空心拉力螺钉内固定中应用的方法和价值,并比较这一新术式与传统术式的优劣。方法将30侧去除软组织后的成人股骨防腐标本(不区... 详细信息

目的通过用标本模拟手术实验,探讨计算机辅助骨科手术导航系统结合"手术安全区"在股骨颈骨折经皮空心拉力螺钉内固定中应用的方法和价值,并比较这一新术式与传统术式的优劣。方法将30侧去除软组织后的成人股骨防腐标本(不区分标本来源于男女或左右侧)随机分成两组,A组B组各15例。A组采用结合上述股骨颈"手术安全区域"的CAOS(Computer Assisted orhopedic Surgery)方式,B组采用传统手术方式进行模拟手术,每例标本置入3枚空心钉,通过测量正、侧位x线片上空心钉与颈干角、前倾角的偏离角度和直接测量空心钉在股骨颈截面分散度及钉尖在股骨头软骨下的位置精度来评价计算机辅助骨科手术系统的准确性,并与15例传统透视方法的测算结果比较;同时比较两种操作方法所需的钻孔次数。然后用统计分析软件SPSS13.0进行统计分析,其中对计量资料用x±Sx表示,正态分布的均数比较用t检验,非正态分布数据比较用非参数检验的Mann-Whitney U法,比较不同组间螺钉的位置精度的优劣比例,采用两样本比较的秩和检验(Wilcoxon rank sumtest),检验水准0.05。结果采用计算机导航系统组空心钉在颈干角和前倾角的钉道偏离角度均小于传统透视组,螺钉在股骨颈截面分散度也明显优于传统组,差异均有统计学意义(p<0.05);在钻孔次数上,计算机导航系统组也明显少于传统透视组(p<0.05);钉尖在股骨头的位置精度二者差异无统计学意义(p>0.05)。结论 CAOS技术结合股骨近端的"手术安全区域"可以用于辅助股骨颈骨折经皮空心拉力螺钉内固定操作,该方法使术中引导螺钉的植入更容易、更准确,并且可明显减少钻孔次数,从而减少手术对骨折部位的创伤。

关键词：股骨颈骨折空心螺钉内固定计算机辅助骨科导航系统微创外科

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