目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资...目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资料,根据假体类型的不同分为研究组(n=50)和参照组(n=50)。对实施不同的假体置换后,比较两组患者的手术时间、术中出血量、术后引流量、异位骨化程度、术后假体稳定性、髋关节功能评分量表(Harris Hip Joint Function Scale,Harris)以及术后并发症发生情况。结果术后6个月,两组患者均开展X线检查,研究组假体稳定率明显高于参照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于参照组(0 vs 4.00%),差异无统计学意义(χ^(2)=0.510,P>0.05)。结论相对于骨水泥型假体,使用生物型假体进行人工髋关节置换髋关节功能恢复效果更好,能够有效降低并发症的发生率,加快术后恢复,应用价值高。展开更多
目的探讨瘤体刮除骨水泥填充保膝手术与瘤段切除肿瘤型假体置换治疗膝关节周围骨巨细胞瘤的临床疗效。方法选取膝关节周围骨巨细胞瘤患者,将采用瘤段切除肿瘤型假体置换术治疗的患者纳入至置换组,将瘤体刮除骨水泥填充保膝手术治疗的患...目的探讨瘤体刮除骨水泥填充保膝手术与瘤段切除肿瘤型假体置换治疗膝关节周围骨巨细胞瘤的临床疗效。方法选取膝关节周围骨巨细胞瘤患者,将采用瘤段切除肿瘤型假体置换术治疗的患者纳入至置换组,将瘤体刮除骨水泥填充保膝手术治疗的患者纳入至保膝组。置换组26例,保膝组34例。收集两组患者围术期指标、国际骨与软组织肿瘤协会保肢评分(musculo skeletal tumor society,MSTS)、美国纽约特种外科医院评分(hospital for special surgery,HSS)、复发情况,单因素分析影响骨巨细胞瘤术后复发的因素。结果保膝组手术时间明显短于置换组,P<0.05,保膝组患者术中出血量、住院费用均明显少于置换组,P<0.05,但两组患者住院时间比较,P>0.05。术前两组MSTS评分、HSS评分比较,P>0.05,术后6个月及末次随访,保膝组MSTS评分、HSS评分均更高,P<0.05。通过末次随访发现,复发12例(20.00%),未复发患者48例(80.00%)。单因素分析得出影响骨巨细胞瘤术后复发的因素为Campanacci分级和肿瘤体积(P<0.05)。结论瘤体刮除骨水泥填充保膝手术治疗膝关节周围骨巨细胞瘤较瘤段切除肿瘤型假体置换术疗效更优,其复发可能与病理分级或肿瘤体积相关。展开更多
Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantl...Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation.In this article we review the history and current worldwide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.展开更多
Brazing hard alloy to high strength steel, incomplete atomic diffusion and excessive brittle reaction product precipitation at the faying interface are usually suffered because of incomplete understanding the process ...Brazing hard alloy to high strength steel, incomplete atomic diffusion and excessive brittle reaction product precipitation at the faying interface are usually suffered because of incomplete understanding the process of the initial interface disappearing and diffusion layer forming and evolving. In this paper , hard alloy YG11C （ WC-11wt. %Co） and high strength steel 42CrMo were picked up as base metals and BCu64MnNi as filler metal to clarify the interfacial microstrncture evolution. The process parameters of dwell time were set as 30 s, 60 s, 120 s, and 300 s and braze temperature were set as 950 ℃, 970 ℃, 990 ℃, 1 010 ℃, the effect of which on the evolution of interfacial microstructure, tensile strength, integrated with fracture morphology analysis, were conducted. The results showed that increasing brazing temperature from 950 ℃ to 970 ℃, no signifwant difference existed in the joint interface, whereas brazed at 990 ℃, the binder phase erosion occurred, i. e. the liquid filler metal etched into Co binder phase of WC-Co base metal, which caused WC particles debonding from the base metal surface and formed an micro-anisotropic zone.. Increase temperature to 1 010 ℃, severe binder erosion happened so as to micropores appear. Through the parameters optimization, the tensile strength can reach to the maximum 589 MPa at temperature of 970 ℃. The dwell time showed similar effect on tensile strength because longer dwell time also caused erosion and porosity owing to long-time diffusion and reaction.展开更多
背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素...背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素的加入会显著影响聚甲基丙烯酸甲酯骨水泥的机械性能,并且有引发不良反应的可能。另外,有学者发现抗生素骨水泥的抗生素释放率很低,局部应用抗生素骨水泥并不能有效消灭细菌,且有引起细菌耐药的可能。因此,他们对抗生素骨水泥在控制感染方面的有效性提出了质疑,并引起了广泛热议。目的:综述抗生素骨水泥的优势与问题,并总结其在临床使用中的注意事项。方法:通过计算机在PubMed、万方、中国知网数据库中以“抗生素骨水泥、聚甲基丙烯酸甲酯、PMMA;Bone Cements、Anti-Bacterial Agents、Bone and Bones、joints、elution、release、Mechanical”为中、英文检索词,检索2017-01-01/2021-12-31发表的相关文献。排除与文章内容无关的、创新性差、重复的文献后,最终纳入68篇文献进行综述。结果与结论:目前,抗生素骨水泥仍是治疗骨关节感染的最佳选择之一。随着对抗生素骨水泥研究的不断深入,许多能改善其抗生素释放方式、抗菌能力和力学性能的新方法不断涌现出来,同时其在临床上的使用也得到了拓展。但仍然有许多问题尚未得到解决,还需进一步的研究,如抗生素的选择、剂量以及最佳的混合方法等。另外,通过对可加入聚甲基丙烯酸甲酯骨水泥的改性材料和抗生素替代物的开发与局部应用有望解决细菌耐药问题。相信随着医学、药学和生物材料科学的发展,抗生素骨水泥会在临床上得到更加广泛的应用。展开更多
Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problem...Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index(< 15%) vitamin E and low index(< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan(15% w/w PMMA) and silver(1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.展开更多
文摘目的探讨分析老年股骨颈骨折应用骨水泥型人工髋关节和生物型人工髋关节置换治疗的临床疗效以及应用价值。方法回顾性选取2020年1月—2023年1月龙口市人民医院收治的100例老年骨质疏松性股骨颈骨折行人工髋关节置换术治疗的患者的临床资料,根据假体类型的不同分为研究组(n=50)和参照组(n=50)。对实施不同的假体置换后,比较两组患者的手术时间、术中出血量、术后引流量、异位骨化程度、术后假体稳定性、髋关节功能评分量表(Harris Hip Joint Function Scale,Harris)以及术后并发症发生情况。结果术后6个月,两组患者均开展X线检查,研究组假体稳定率明显高于参照组,差异有统计学意义(P<0.05)。研究组并发症发生率低于参照组(0 vs 4.00%),差异无统计学意义(χ^(2)=0.510,P>0.05)。结论相对于骨水泥型假体,使用生物型假体进行人工髋关节置换髋关节功能恢复效果更好,能够有效降低并发症的发生率,加快术后恢复,应用价值高。
文摘目的探讨瘤体刮除骨水泥填充保膝手术与瘤段切除肿瘤型假体置换治疗膝关节周围骨巨细胞瘤的临床疗效。方法选取膝关节周围骨巨细胞瘤患者,将采用瘤段切除肿瘤型假体置换术治疗的患者纳入至置换组,将瘤体刮除骨水泥填充保膝手术治疗的患者纳入至保膝组。置换组26例,保膝组34例。收集两组患者围术期指标、国际骨与软组织肿瘤协会保肢评分(musculo skeletal tumor society,MSTS)、美国纽约特种外科医院评分(hospital for special surgery,HSS)、复发情况,单因素分析影响骨巨细胞瘤术后复发的因素。结果保膝组手术时间明显短于置换组,P<0.05,保膝组患者术中出血量、住院费用均明显少于置换组,P<0.05,但两组患者住院时间比较,P>0.05。术前两组MSTS评分、HSS评分比较,P>0.05,术后6个月及末次随访,保膝组MSTS评分、HSS评分均更高,P<0.05。通过末次随访发现,复发12例(20.00%),未复发患者48例(80.00%)。单因素分析得出影响骨巨细胞瘤术后复发的因素为Campanacci分级和肿瘤体积(P<0.05)。结论瘤体刮除骨水泥填充保膝手术治疗膝关节周围骨巨细胞瘤较瘤段切除肿瘤型假体置换术疗效更优,其复发可能与病理分级或肿瘤体积相关。
文摘Total hip replacement(THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis.The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients. There has been controversy about the value of uncemented compared to cemented THR although there has been a world-wide trend towards uncemented fixation. Uncemented acetabular fixation has gained wide acceptance, as seen in the increasing number of hybrid THR in joint registries, but there remains debate about the best mode of femoral fixation.In this article we review the history and current worldwide registry data, with an in-depth analysis of the New Zealand Joint Registry, to determine the results of uncemented femoral fixation in an attempt to provide an evidence-based answer as to the value of this form of fixation.
基金This work was supported by the National Natural Science Foundation of China （ Grant No. 51475376 and No. 51575451 ） and the Research Fund of the State Key Laboratory of Solidification Processing （NWPU）, China （Grant No. 109-QP-2014）.
文摘Brazing hard alloy to high strength steel, incomplete atomic diffusion and excessive brittle reaction product precipitation at the faying interface are usually suffered because of incomplete understanding the process of the initial interface disappearing and diffusion layer forming and evolving. In this paper , hard alloy YG11C （ WC-11wt. %Co） and high strength steel 42CrMo were picked up as base metals and BCu64MnNi as filler metal to clarify the interfacial microstrncture evolution. The process parameters of dwell time were set as 30 s, 60 s, 120 s, and 300 s and braze temperature were set as 950 ℃, 970 ℃, 990 ℃, 1 010 ℃, the effect of which on the evolution of interfacial microstructure, tensile strength, integrated with fracture morphology analysis, were conducted. The results showed that increasing brazing temperature from 950 ℃ to 970 ℃, no signifwant difference existed in the joint interface, whereas brazed at 990 ℃, the binder phase erosion occurred, i. e. the liquid filler metal etched into Co binder phase of WC-Co base metal, which caused WC particles debonding from the base metal surface and formed an micro-anisotropic zone.. Increase temperature to 1 010 ℃, severe binder erosion happened so as to micropores appear. Through the parameters optimization, the tensile strength can reach to the maximum 589 MPa at temperature of 970 ℃. The dwell time showed similar effect on tensile strength because longer dwell time also caused erosion and porosity owing to long-time diffusion and reaction.
文摘背景:聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力,是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染,是目前解决骨关节感染难题的常用手段。但是,抗生素的加入会显著影响聚甲基丙烯酸甲酯骨水泥的机械性能,并且有引发不良反应的可能。另外,有学者发现抗生素骨水泥的抗生素释放率很低,局部应用抗生素骨水泥并不能有效消灭细菌,且有引起细菌耐药的可能。因此,他们对抗生素骨水泥在控制感染方面的有效性提出了质疑,并引起了广泛热议。目的:综述抗生素骨水泥的优势与问题,并总结其在临床使用中的注意事项。方法:通过计算机在PubMed、万方、中国知网数据库中以“抗生素骨水泥、聚甲基丙烯酸甲酯、PMMA;Bone Cements、Anti-Bacterial Agents、Bone and Bones、joints、elution、release、Mechanical”为中、英文检索词,检索2017-01-01/2021-12-31发表的相关文献。排除与文章内容无关的、创新性差、重复的文献后,最终纳入68篇文献进行综述。结果与结论:目前,抗生素骨水泥仍是治疗骨关节感染的最佳选择之一。随着对抗生素骨水泥研究的不断深入,许多能改善其抗生素释放方式、抗菌能力和力学性能的新方法不断涌现出来,同时其在临床上的使用也得到了拓展。但仍然有许多问题尚未得到解决,还需进一步的研究,如抗生素的选择、剂量以及最佳的混合方法等。另外,通过对可加入聚甲基丙烯酸甲酯骨水泥的改性材料和抗生素替代物的开发与局部应用有望解决细菌耐药问题。相信随着医学、药学和生物材料科学的发展,抗生素骨水泥会在临床上得到更加广泛的应用。
文摘Polymethylmethacrylate(PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950 s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index(< 15%) vitamin E and low index(< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan(15% w/w PMMA) and silver(1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.
