Experimental study of a 3D printed permanent implantable porous Ta-coated bone plate for fracture fixation

Metal plates have always been the gold standard in the clinic for internal fracture fixation due to their high strength advantages.However,high elastic modulus can cause stress shielding and lead to bone embrittlement.This study used an electron beam melting method to prepare personalized porous Ti6Al4V(pTi)bone plates.Then,chemical vapor deposition(CVD)technology coats tantalum(Ta)metal on the pTi bone plates.The prepared porous Ta-coated bone plate has an elastic modulus similar to cortical bone,and no stress shielding occurred.In vitro experiments showed that compared with pTi plates,Ta coating significantly enhances the attachment and proliferation of cells on the surface of the scaffold.To better evaluate the function of the Ta-coated bone plate,animal experiments were conducted using a coat tibia fracture model.Our results showed that the Ta-coated bone plate could effectively fix the fracture.Both imaging and histological analysis showed that the Ta-coated bone plate had prominent indirect binding of callus formation.Histological results showed that new bone grew at the interface and formed good osseointegration with the host bone.Therefore,this study provides an alternative to bio-functional Ta-coated bone plates with improved osseointegration and osteogenic functions for orthopaedic applications.

Experimental study of effect of stress-relaxation bone plate on fracture healing

To study the change of the stress shielding rate of stress-relaxation plate in vivo and its influence on fracture healing. Methods: The diaphyses of bilateral tibias in 70 New Zealand rabbits were osteotomized and fixed with stress-relaxation plates (SRP, the SRP group) and rigid plates (RP, the RP group), respectively. The fracture healing process in these 2 groups was investigated by radiography, light and polarized light microscopy and biomechanical test at 2 to 48 weeks postoperatively. Results: Early after fixation the stress shielding rate was about 70% in both groups. While in the SRP group the stress shielding rate decreased gradually as time passed, which was significantly lower than that of the RP group (P< 0.05 ) by the end of the 8th postoperative week, and stabilized at the level of about 27% at 36-48 weeks after fixation. Abundant external callus associated with the formation of cartilaginous callus could be observed in the SRP group at 2-4 weeks postoperatively. The transformation of the callus into the lamellar bone began at 8-12 weeks, the collagen gradually arranged in order, and the mechanical nature of the united bone was gradually strengthened, too. In the RP group, the external callus was scarce at the early stage of fracture healing, and the callus remodeling at the late stage of fracture healing was dominated by bone absorption. The ultimate bending strength (UBS) was only 57.95 % of that of the normal by 48 weeks. Conclusions: The decrease of the stress shielding rate of SRP in vivo was well interrelated with the time of fixation. The application of SRP could promote the callus formation and bone reconstruction thus to favor the recovery of the mechanical strength of the united bone.

Piezoelectric-Based Smart Bone Plate for Fracture Healing Progress Monitoring

Fracture healing progress monitoring techniques attract global research attention due to the importance of selecting the timing of removing the fixation device.To this end,in this research,we present a piezoelectric-based smart internal fixation device,in which a piezoelectric sandwich structure is laminated to the surface of a bone plate.In the content,we explain the reasons for utilizing piezoelectric films,elaborate the mechanism of fracture monitoring,and introduce the mechanical parameters of the sensor.The simulation and experimental results show that the electrical output of the device is associated with the elastic modulus of the filler between the tested broken bones when the working load is maintained,indicating that the bone recovery progress could be successfully detected by the developed technique.

Materials evolution of bone plates for internal fixation of bone fractures:A review

Bone plates play a vital role in bone fracture healing by providing the necessary mechanical fixation for fracture fragments through modulating biomechanical microenvironment adjacent to the fracture site.Good treatment effect has been achieved for fixation of bone fracture with conventional bone plates,which are made of stainless steel or titanium alloy.However,several limitations still exist with traditional bone plates including loosening and stress shielding due to significant difference in modulus between metal material and bone tissue that impairs optimal fracture healing.Additionally,due to demographic changes and non-physiological loading,the population suffering from refractory fractures,such as osteoporosis fractures and comminuted fractures,is increasing,which imposes a big challenge to traditional bone plates developed for normal bone fracture repair.Therefore,optimal fracture treatment with adequate fixation implants in terms of materials and design relevant to special conditions is desirable.In this review,the complex physiological process of bone healing is introduced,followed by reviewing the development of implant design and biomaterials for bone plates.Finally,we discuss recent development of hybrid bone plates that contains bioactive elements or factors for fracture healing enhancement as a promising direction.This includes biodegradable Mg-based alloy used for designing bone screw-plates that has been proven to be beneficial for fracture healing,an innovative development that attracts more and more attention.This paper also indicates that the tantalum bone plates with porous structure are also emerging as a new fracture internal fixation implants.The reduction of the stress shielding is verified to be useful to accelerate bone fracture healing.Potential application of biodegradable metals may also avoid a second operation for implant removal.Further developments in biometals and their design for orthopedic bone plates are expected to improve the treatment of bone fracture,especially the refractory fractures.

Alendronate disturbs femoral growth due to changes during immunolocalization of transforming growth factor-β1 and bone morphogenetic protein-2 in epiphyseal plate

BACKGROUND The epiphyseal growth plate is an important anatomical segment localized on the ends of a long bone.Despite the abovementioned atractive reasons for alendronate’s use,few data on the effect of alendronate during epiphyseal growth exist.AIM Verify the effect of alendronate on the growth epiphyseal plate,and compare its effect with the size of the femur during the double-staining of the immunolocalization of transforming growth factor-β1(TGF-β1)and bone morphogenetic protein-2(BMP2)in endochondral ossifing in specimens that have received alendronate.METHODS Forty newborn rats were randomly divided into two groups:a control group(were given applications of 1 mg/kg physiologic saline)and a group that received Alendronate(a dose of 2.5 mg/kg).These groups were then divided into two subgroups for euthanasia in two and 12 d of life.After euthanasia,the femurs were removed,and the femoral bones were measured linearly between the apex of the greater trochanter until the lower intercondylar midlle face to verify the probable bone growth between 3 and 12 d in control and alednroanto treated rats.Posteriorly,the surgical pieces were also sent to the histopathology laboratory to produce histological slides.The obtained slides were stained with hematoxylin and eosin to measure each of the cartilage zones in endochondral development.and other slides were immunohistochemically tested for anti-TGF-β1 and BMP-2 antibodies to investigate the immunolocalization of these proteins in the epiphyseal plaque area.RESULTS On the third day,some diferences between the control group and specimens treated with alendronate were verified.Macroscopiccaly,we found similarities in size between the femoral bones when we compared the control group with the specimens that received alendronate.On the 12^th day,the bone size of the mice receiving the drug was significantly smaller than those of the control group.These results coincide with changes in the TGF-β1 and BMP-2 expression.In the specimens that received alendronate,the TGF-β1 was expressed in some sites of trabecular bone that was neoformed,peripherally to the bone marrow area.The BMP-2 was also positive in proliferative chondrocytes and hypertrofic chondrocytes.On the 12^th day,all layers of chondrocytes exhibited positivity for BMP-2 in the specimens that received alendronate.In the interface between the trabecular bone and cartilage,an area of disorganized bone deposition was evident.Neoformed bone also appeared to be different at 12 d.In the control group,BMP-2 was positive in an intense area of bone trabeculae,whereas the alendronate-treated group showed TGF-β1 positive trabeculae and a greater bone area.CONCLUSION Alendronate alters the immunolocalization of TGF-β1 and BMP-2 simultaneously,a condition that changes the usual histological aspects of the cartilage zone and impairs epiphysis growth and femur growth.

SEM observation of bone interface of titanium-coated 317L plate screw

The scanning electron microscope (SEM) results of bone interface of titanium-coated 317L plate screw are reported in this article. 317L plate screw had a rough surface composed of sprayed pure titanium which formed a bone/metal interface in biointegration after implanted into the mandible of dog. Though a bone/metal interface in osseointegration was also formed on the surface of uncoated 317L plate screw after implantation, a smal1 space was seen between the bone and surface of the screw, indicating that the tissue compatibility of titanium-coated 317L plate screw may be better than that of the non-coated screw.

Comminuted olecranon fracture fixation with pre-contoured plate:Comparison of composite and cadaver bones

AIM: To determine whether use of a precontoured olecranon plate provides adequate fixation to withstand supraphysiologic force in a comminuted olecranon fracture model.METHODS: Five samples of fourth generation composite bones and five samples of fresh frozen human cadaveric left ulnae were utilized for this study. The cadaveric specimens underwent dual-energy X-ray absorptiometry(DEXA) scanning to quantify the bone quality. The composite and cadaveric bones were prepared by creating a comminuted olecranon fracture and fixed with a pre-contoured olecranon plate with locking screws. Construct stiffness and failure load were measured by subjecting specimens to cantilever bending moments until failure. Fracture site motion was measured with differential variable resistance transducer spanning the fracture. Statistical analysis was performed with two-tailed Mann-Whitney-U test with Monte Carlo Exact test.RESULTS: There was a significant difference in fixation stiffness and strength between the composite bones and human cadaver bones. Failure modes differed in cadaveric and composite specimens. The load to failure for the composite bones(n = 5) and human cadaver bones(n = 5) specimens were 10.67 nm(range 9.40-11.91 nm) and 13.05 nm(range 12.59-15.38 nm) respectively. This difference was statistically significant(P ? 0.007, 97% power). Median stiffness for composite bones and human cadaver bones specimens were 5.69 nm/mm(range 4.69-6.80 nm/mm) and 7.55 nm/mm(range 6.31-7.72 nm/mm). There was a significant difference for stiffness(P ? 0.033, 79% power) between composite bones and cadaveric bones. No correlation was found between the DEXA results and stiffness. All cadaveric specimens withstood the physiologic load anticipated postoperatively. Catastrophic failure occurred in all composite specimens. All failures resulted from composite bone failure at the distal screw site and not hardware failure. There were no catastrophic fracture failures in the cadaveric specimens. Failure of 4/5 cadaveric specimens was defined when a fracture gap of 2 mm was observed, but 1/5 cadaveric specimens failed due to a failure of the triceps mechanism. All failures occurred at forces greater than that expected in postoperative period prior to healing.CONCLUSION: The pre-contoured olecranon plate provides adequate fixation to withstand physiologic force in a composite bone and cadaveric comminuted olecranon fracture model.

The Effects of Bone Screw Configurations on the Interfragmentary Movement in a Long Bone Fixed by a Limited Contact Locking Compression Plate

The locking compression plates (LCP) are efficient tools in open reduction and internal fixation (ORIF), especially in osteoporotic bones. Two important factors of screw density and screw position can affect the functionality of the bone plate. Several studies have assessed the influence of the screw configurations on the bone-plate stiffness, but the effects of screw positions on the interfragmentary strain, εIF of LCP construct have not been investigated yet. In this study, finite element method was used to investigate the influence of screws number and position on the interfragmentary strain of LCP-femur system for a mid-shaft fracture. Results of this study showed that by insertion of screws closer to the fracture site, εIF decreases by 2nd degree polynomial function versus screw position, but by adding the screws from the ends of the plate, or by moving and placing the screws towards the fracture site, the reduction of εIF will be linear. Results of this study were compared and are in agreement with some studies in the literature, even though their scope was mostly stability of the bone-implant system, whereas our scope was focused on the interfragmentary strain.

Epdemiology and Treatment of Pseudarthrosis of Long Bones in the Servce D Orthopedics-Traumatology of the University Hospital of Donka

Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.

纤维带与无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤

背景:Lisfranc韧带是维持足部横弓与纵弓的重要结构,Lisfranc损伤为一种严重的中足损伤。Lisfranc韧带损伤是复杂的,其治疗以及首选的固定方法有争议。目的:比较钢板联合Suturetape与钢板联合无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤的短期疗效。方法:回顾性分析东莞市中医院骨七科2019年1月至2022年6月因第1,2跖骨近端粉碎性骨折Lisfranc损伤患者48例,其中25例采用钢板联合Suture tape固定(观察组),23例采用钢板联合无头加压螺钉固定(对照组)。术前参照影像学资料,根据Myerson分类系统进行分型;术后随访根据骨折愈合时间、目测类比评分、美国足踝外科学会标准评估足功能恢复情况,并对两组术后并发症进行比较分析。结果与结论:①两组患者均顺利完成手术并获得随访,随访时间12-36个月,平均(18.0±5.42)个月;②两组患者手术时间、术中出血量比较差异均无显著性意义(P>0.05);③观察组较对照组骨折愈合时间稍长,差异有显著性意义(P<0.05);④术后3,6,12个月随访,观察组较对照组目测类比评分明显降低(P<0.05);⑤术后6,12个月,观察组术后各时间点随访足功能AOFAS评分较螺钉组明显改善(P<0.05),且均较术前显著提高(P<0.05);⑥术后观察组出现1例创伤性关节炎,对照组出现1例切口感染、1例螺钉断裂及2例创伤性关节炎,两组比较差异无显著性意义(P>0.05),考虑与样本量偏少有关;⑦提示对于第1,2跖骨近端粉碎性骨折Lisfranc损伤,实施钢板联合Suture tape内固定治疗Lisfranc关节损伤效果可靠,可改善患者足关节功能,且具有手术创伤小、术后并发症少、远期医源性创伤性关节炎风险低的优势,较无头加压钉更有利于足功能的恢复。

累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位

背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙状切迹背侧骨块螺钉固定的数量比较差异有显著性意义(P<0.05)。③Logistic多因素回归分析显示,乙状切迹骨块螺钉固定的数量是影响尺背侧乙状切迹骨块移位唯一的危险因素(P<0.05)。④提示在累及桡骨背侧的桡骨远端关节内骨折中,Ⅱ型最常见,Ⅲ型和Ⅰ型次之,大部分患者均存在乙状切迹背侧骨块。而乙状切迹背侧骨块其受下尺桡关节韧带影响易发生术后移位,术中至少1枚有效螺钉固定能降低其移位风险并有助于提高治疗效果。

血小板衍生生长因子BB参与生长板损伤修复的作用与机制

背景:在生长板损伤炎症初期,血小板衍生生长因子BB通过促进间充质祖细胞浸润、软骨形成、成骨反应以及调控骨重塑来促进生长板损伤的修复。目的:总结血小板衍生生长因子BB在生长板损伤修复中的作用机制。方法:检索PubMed、维普、万方数据和中国知网数据库,中文检索词为“生长板损伤,骨桥形成,血小板衍生因子BB,修复”,英文检索词为“growth plate injury,bone bridge,PDGF-BB,repair”,最终筛选66篇文章进行综述。结果与结论:生长板损伤经历早期炎症、血管重建、纤维骨化、结构重塑等病理进程,伴随着软骨细胞、血管内皮细胞、干细胞、成骨细胞、破骨细胞多种细胞交叉对话。血小板衍生生长因子BB作为损伤早期炎症反应的重要因子通过介导多种细胞炎症反应调控损伤修复过程,靶向血小板衍生生长因子BB介导的炎症刺激可能通过改善破骨细胞、成骨细胞、软骨细胞功能活性延缓生长板损伤骨桥形成进程,实现生长板损伤修复。血小板衍生生长因子BB对生长板损伤部位的血管生成和骨修复组织形成以及未损伤生长板的软骨内骨延长功能具有重要作用,抑制血小板衍生生长因子BB启动的血管形成与软骨内成骨之间的偶联效应将有可能实现生长板损伤修复。

前路病灶清除加钛网植骨、Z-plate内固定治疗多节段腰椎结核临床观察

目的：探讨前路病灶清除加钛网植骨、Z形前路钢板内同定治疗多节段腰椎结核的意义及疗效。方法：总结2002—2006年期间收治的12例多节段腰椎结核患者，并采用前路病灶清除，椎体间钛网植骨、Z形前路钢板内固定进行治疗。结果：随访8-29个月（平均17个月），脊髓神经功能得到不同程度的恢复，植骨融合满意，钛网无松动、移位和塌陷，无内固定失败和脊柱结核复发，后凸角度平均矫正16．5（°）。2年后随访患者临床症状好转，脊柱畸形矫正情况满意。结论：前路病灶清除加钛网植骨、Z—plate内固定治疗多节段腰椎结核的术式有术野显露清楚、病灶清除更彻底、脊柱稳定性重建可靠、植骨融合率和结核治愈率高等特点，是目前外科治疗多节段腰椎结核的可靠方法之一。

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate

Objective To discuss the clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion.Neurological signs and symptoms were evaluated before and after surgery, and mean follow up time was 11.3 months.Result In all cases,radiography demonstrated a solid bony fusion.Additional general complications include a large wound hematoma in one and hoarseness in one.All patients’ neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.

Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus

Purpose: The purpose of this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct are used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. Patients & Methods: Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study, conducted between March 2015 and December 2019. Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed up for a mean time of 16.3 months (range: 13 to 40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. Results: Union at the fracture site was achieved in all patients at a mean of 8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n = 11, this difference was found to be statistically significant (p < 0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p < 0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. Conclusions: An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.

拔除下颌近中水平完全埋伏阻生牙保留颊侧骨板的效果探讨

目的:探讨微创手术拔除下颌近中水平完全埋伏阻生牙时保留颊侧骨板的效果。方法 :选取近中低位水平埋伏阻生牙86颗,随机分为2组,试验组以球钻开窗,暴露牙冠远中面,保留颊侧骨板,使用仰角手机配合加长车针行多次T形截冠,去除牙冠,微创拔除。对照组采用球钻去除远中及颊侧骨板,暴露远中及颊部牙冠,T形截冠,其余操作均一致。观察2组患者术后肿胀程度、开口受限程度以及疼痛视觉模拟量表(VAS)评分,检测C反应蛋白水平以及抗溶血链球水平;1个月后检查邻近第二磨牙牙周探诊深度(probing depth,PD)、出血指数(bleeding index,BI)及临床附着丧失(clinical attachment loss,CAL)水平。采用SPSS 25.0软件包对数据进行统计学分析。结果:试验组术后肿胀程度显著轻于对照组(P<0.05),开口受限与疼痛程度无显著差异(P>0.05)。试验组C反应蛋白水平显著高于对照组(P<0.05),抗溶血链球菌水平2组之间比较无显著差异(P>0.05)。术后1个月,对照组PD和CAL均显著高于试验组(P<0.05),2组BI比较无显著差异(P>0.05)。结论:保留颊侧骨板微创拔除下颌近中水平完全埋伏阻生牙患者术后反应更轻,创口愈合更好。

辅助治疗股骨干骨折缺损数值模拟分析

针对股骨干断裂骨折患者手术治疗康复治疗问题,使用医学影像处理和逆向工程技术,依据股骨CT扫描数据,重构股骨干2mm横断缺损和股骨干10°楔形缺损断裂模型。为了分析接骨板、螺钉应力、应变变化规律及股骨整体应力集中状况,在700N轴向载荷和15N·m扭转载荷条件下,建立锁定型和锁定加压型接骨板数值模拟系统进行数值模拟分析。结果发现:锁定加压型内固定系统适用于股骨干2mm横断模型,螺钉不易发生失效断裂;锁定型内固定系统适用于股骨干10°楔形缺模型,螺钉未出现失效断裂现象,便于患者康复。

自体髂骨和同种异体骨植入治疗SchatzkerⅡ型胫骨平台骨折的疗效比较

目的 比较SchatzkerⅡ型胫骨平台骨折应用自体髂骨和同种异体骨植入治疗的临床疗效。方法 74例SchatzkerⅡ型胫骨平台骨折患者,按手术植骨治疗方法不同分为自体髂骨组和异体骨组,各37例。两组均采用胫骨近端外侧锁定钢板内固定,自体髂骨组胫骨平台塌陷处植入自体髂骨,异体骨组胫骨平台塌陷处植入异体骨。比较两组手术相关指标,术后3、6个月的美国特种外科医院(HSS)评分及膝关节屈曲活动度,并发症发生情况。结果 自体髂骨组术中出血量(62.70±3.34)ml多于异体骨组的(44.50±3.03)ml,手术时间(86.50±5.87)min、骨折愈合时间(18.40±3.20)周长于异体骨组的(77.30±2.98)min、(14.80±2.29)周,差异有统计学意义(P<0.05)。两组术后3、6个月的HSS评分比较,差异无统计学意义(P>0.05)。两组术后3、6个月的膝关节屈曲活动度比较,差异无统计学意义(P>0.05)。异体骨组并发症发生率为5.4%(2/37),与自体髂骨组的8.1(3/37)比较,差异无统计学意义(P>0.05)。结论 同种异体骨较自体髂骨在骨折愈合时间、手术时间、出血量方面相对具有优势,但在术后膝关节功能、膝关节活动度方面效果相当,说明同种异体骨与自体髂骨植骨治疗schatkzerⅡ型胫骨平台骨折各有优势,可根据患者具体情况进行手术的选择。

经皮微创接骨板内固定术治疗四肢骨折的并发症发生率及临床效果分析

目的探究为四肢骨折患者提供经皮微创接骨板内固定术治疗的并发症发生率及临床效果。方法选取2021年5月—2023年5月山东省寿光市人民医院收治的106例四肢骨折患者为研究对象,按随机数表法分为两组。对照组(53例)施以切开复位内固定治疗,研究组(53例)施以经皮微创接骨板内固定术治疗,比较两组的治疗效果。结果研究组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。研究组的临床相关指标均低于对照组,差异有统计学意义(P均<0.05)。治疗前两组骨代谢指标相近,差异无统计学意义(P均>0.05);治疗后,研究组的骨钙素、骨保护素水平高于对照组,胶原C端肽水平低于对照组,差异有统计学意义(P均<0.05)。研究组的并发症总发生率(5.66%)低于对照组(18.87%),差异有统计学意义(χ^(2)=4.296,P<0.05)。结论经皮微创接骨板内固定术治疗四肢骨折的效果确切,可缩短术后恢复时间,减少并发症,安全性高。