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.

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.

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。

多节段脊髓型颈椎病单开门椎管扩大成形术纳米骨板固定的疗效和影响因素

目的探讨多节段脊髓型颈椎病(multi-segment cervical spondylotic myelopathy,MCSM)单开门椎管扩大成形术(expansive single open-door laminoplasty,EOLP)术中应用纳米骨板固定的疗效和影响因素。方法选取2018年5月~2020年6月诊治的84例MCSM患者临床资料进行回顾性分析,均予以EOLP纳米骨板固定,依照末次随访结果评估治疗效果,根据JOA改善率分为A组(JOA改善率≥50%,n=59)与B组(JOA改善率<50%,n=25),分析影响JOA改善率的相关因素。结果84例随访优良率为70.24%,术后7 d的C5节段椎管矢状径大于术前(P<0.05),术后7 d、术后12个月的JOA评分高于术前(P<0.05)。两组在性别、年龄、压迫节段、术前JOA评分比较中,差异无统计学意义(P>0.05);而在病程、术前Yukawa信号等级分级、术前脊髓受压段横断面积、术前脊髓受压比、术前最大脊髓受压程度(maximum spinal cord compression,MSCC)、术前最大椎管容积(maximum canal compromise,MCC)比较中,差异存在统计学意义(P<0.05)。二分类Logistic回归分析显示,病程≥6个月、术前Yukawa信号等级分级为2级/1级、术前脊髓受压段横断面积、术前脊髓受压比、术前MSCC、术前MCC是影响MCSM患者JOA改善率的独立危险因素(P<0.05)。Spearman相关性分析显示,术前Yukawa信号分级与术前MSCC、术前MCC呈正相关(r=0.289/0.234,P<0.05)。结论EOLP纳米骨板固定治疗多节段脊髓型颈椎病能改善颈椎功能,病程≥6个月、术前Yukawa信号分级为2级/1级、术前脊髓受压段横断面积、术前脊髓受压比、术前MSCC、术前MCC是影响MCSM患者JOA改善率的独立危险因素。

胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡的疗效分析

目的 观察胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡(diabetic foot ulcer,DFU)的疗效。方法 选取自2021年1月至2022年12月在湖南中医药大学第一附属医院四肢关节科拟进行胫骨横向骨搬移手术的50例DFU患者为研究对象,随机分为观察组与对照组,各25例。对照组采用胫骨横向骨搬移微创导板技术结合常规基础治疗;观察组在对照组基础上,术后第1天开始服用桃红四物汤,均连续治疗4周。比较治疗前和治疗后3个月两组患者的疼痛视觉模拟量表(visual analogue scale,VAS)评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数以及溃疡创面面积、愈合时间,评估临床疗效。结果 治疗3个月后,观察组临床有效率为92%,高于对照组的76%(P<0.05);观察组溃疡创面愈合时间较对照组明显缩短(P<0.05);两组患者的VAS评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数均较治疗前明显改善(P<0.05),且观察组上述各项指标较对照组改善更明显(P<0.05)。结论 胫骨横向骨搬移微创导板技术联合桃红四物汤治疗DFU的临床疗效显著,创伤小,创面愈合快,可明显缓解患肢疼痛,加速溃疡创面修复。

基于传力路径的接骨板结构拓扑优化设计

目的 提出一种相对于传统拓扑优化方法能有效降低应力集中,并进一步提高断骨愈合效果的接骨板拓扑优化设计方法。方法 依据接骨板在断骨-接骨板系统中的载荷约束条件,采用改进的基于传力路径的拓扑优化方法对接骨板结构进行优化设计。随后采用基于偏应变的骨再生模拟模型,对胫骨骨干横向骨折情况进行骨再生模拟,依据骨再生过程数据对优化接骨板的受力状态、固定稳定性及愈合性能进行评估。结果 使用基于传力路径优化方法的优化接骨板在体积分数f=0.55、0.65时,接骨板最大应力分别为55.68、42.23 MPa,相较于传统拓扑优化方法优化接骨板分别降低32.96%、29.95%;骨愈合过程后骨痂平均弹性模量分别为1 439.47、1 355.71 MPa,相较于传统接骨板分别提升145.86%、131.06%。结论 提出的改进基于传力路径的拓扑优化方法,可以用于接骨板结构优化设计,优化后接骨板相比传统拓扑优化方法优化接骨板受力更加均匀,使用安全性更高,骨愈合性能相较传统接骨板有明显提升。研究结果为骨折内固定植入物的优化设计提供了一种新思路和方法。

术中塑形与锁钉分布及术后愈合状态对接骨板生物力学的影响

目的分析塑形对接骨板弯曲强度以及不同锁钉分布情况对接骨板受力的影响,为临床上对接骨板进行塑形与选择不同的锁钉分布方式提供生物力学依据。方法根据YY/T 0342—2020标准对接骨板四点弯曲强度进行有限元仿真分析,并应用理论分析及有限元仿真方法对不同锁钉分布的假体模型进行受力分析。结果在30°折弯时,3.7 mm厚接骨板比2.7 mm厚接骨板的等效塑性应变高28%;3.7、2.7 mm厚接骨板的极限折弯角度分别为55°、67°。折痕对接骨板受力影响较小,未塑形结构四点弯曲强度为2.64 N·m,等效弯曲刚度为1.12 N·m^(2);带折痕四点弯曲强度为2.63 N·m,等效弯曲刚度为1.10 N·m^(2);正反折弯后接骨板四点弯曲强度由2.64 N·m降低至2.45 N·m,降低约7.72%,等效弯曲刚度由1.12 N·m^(2)降低至0.98 N·m^(2),降低了12%,影响较为明显。植入填塞螺钉后单孔接骨板四点弯曲强度改善较为明显,由2.64 N·m提升至3.15 N·m,提升约19.32%,等效弯曲刚度由1.12 N·m^(2)提升至1.14 N·m^(2),提升幅度为2.1%。骨折线两侧至少各留出两个锁定孔不植入锁钉比打满锁钉应力降低约50%。在未形成骨痂的情况下,术后16周下地行走,TC4材质应力达到852.7 MPa,出现屈服。结论在需要进行较大塑形的临床场景下,不适合厚度过大的接骨板,厚度大塑形后更易出现接骨板断裂问题,可指导临床基于塑形角度选择合适厚度接骨板,极端情况可选择植入填塞螺钉。建议临床固定锁钉时,避免打满螺钉的固定锁钉方式;骨折线两端各保留两个锁定孔不固定锁钉,生物力学效果最好。

单一小切口带袢钛板与锁骨钩板内固定治疗Rockwood Ⅲ型肩锁关节脱位的临床疗效

【目的】探讨单一小切口带袢钛板与锁骨钩板内固定治疗RockwoodⅢ型肩锁关节脱位的临床效果。【方法】回顾性分析本院2018年1月至2021年1月收治的33例RockwoodⅢ型肩锁关节脱位患者,根据治疗方法不同分为对照组(采用锁骨钩板内固定治疗,n=17)和观察组(采用带袢钛板内固定治疗,n=16)。比较两组手术时间、住院天数、术中失血量、手术切口长度、肩部疼痛视觉模拟评分法(VAS)评分、术后并发症、肩关节功能Constant-Murley评分。【结果】观察组患者住院时间、手术切口长度短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05)。观察组术后7 d、30 d、90 d、180 d及最后随访时肩部疼痛VAS评分均低于对照组,肩关节功能Constant-Murley评分优于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为12.5%(2/16),显著低于对照组的52.9%(9/17),差异有统计学意义(P<0.05)。【结论】单一小切口带袢钛板内固定治疗RockwoodⅢ型肩锁关节脱位术后并发症少、创伤小、肩关节功能恢复快,值得临床推广应用。

根盾术应用于美学区即刻种植即刻修复1例及文献回顾

目的探讨根盾术(socket⁃shield technique,SST)联合即刻种植即刻修复(immediate implant placement and provisionalization,IIPP)在前牙美学修复中的应用效果。方法针对唇侧骨壁菲薄的上前牙残根,应用根盾术维持唇侧软硬组织丰满度,联合即刻种植即刻临时冠修复恢复牙体外形及进行牙龈塑形。结果即刻种植即刻修复在最短时间内恢复了患牙的形态与功能,应用根盾术后18个月的随访中患者缺牙区唇侧软硬组织轮廓得到较好的保存,呈现出较佳的美学效果。文献回顾结果表明,根盾术的适应证为无保留价值的上前牙,且患牙唇侧牙体、牙周及根尖周组织健康且完整;根盾术可有效维持美学区种植体唇侧软硬组织轮廓,但关于理想根片的冠方高度及厚度、根片与种植体间间隙管理等技术细节尚未达成共识,需要更多临床研究和组织学证据指导临床决策,数字化技术有助于提高种植体植入及根片预备的准确性。结论根盾术联合即刻种植即刻修复在美学区的正确应用有助于美学效果,长期疗效尚需更多高质量的循证医学依据,临床应用时应严格把握适应证。

三维组架螺钉与环形钢板治疗Sanders ⅢAB型跟骨骨折的有限元分析

目的 探讨三维组架螺钉与环形钢板对SandersⅢAB型跟骨骨折的生物力学稳定性的影响。方法 收集1名26岁志愿者跟骨CT和MRI数据,建立SandersⅢAB型跟骨骨折的三维有限元模型,分别使用三维组架螺钉与环形钢板固定,施加700 N纵向载荷,比较不同模型骨块及内固定应力与位移变化情况。结果 在700 N纵向载荷下,两组模型骨块最大位移以及骨块与内固定最大应力均集中于后距关节面内固定与骨折线相交处。三维组架螺钉模型与环形钢板模型骨块整体位移相近。相较于环形钢板模型,三维组架螺钉模型骨块及内固定的最大应力和平均应力更小,位移与应力变化情况更接近完整跟骨模型。结论 SandersⅢAB型跟骨骨折固定时,三维组架螺钉与环形钢板两种固定方式均能提供良好稳定性。三维组架螺钉的生物力学性能优于环形钢板,更符合生物力学特点。