可降解高纯度镁金属骨钉固定修复发育性髋关节发育不良

背景:发育性髋关节发育不良髋臼缺损患者选择接受全髋关节置换时,髋臼侧的处理对假体安放极为重要,髋臼外上方植骨被证实是一种安全可行的治疗方式,而如何进行植骨成为手术成功的关键因素。目的:探讨在髋臼外上方采用可降解高纯度镁金属螺钉固定植骨联合全髋人工关节置换治疗发育性髋关节发育不良髋臼缺损患者的临床疗效。方法:纳入大连大学附属中山医院收治的7例发育性髋关节发育不良髋臼缺损患者,其中男1例,女6例,年龄54-65岁,按Crowe分型2例Ⅰ型,1例Ⅱ型,2例Ⅲ型,2例Ⅳ型,均进行人工全髋关节置换手术,髋臼侧采用外上方植骨处理缺损增加覆盖,移植骨块采用可降解高纯度镁金属螺钉进行固定。术后随访进行影像学检查与髋关节Harris功能评分、目测类比评分。研究经过大连大学附属中山医院伦理委员会通过(批件号:2013-006)。结果与结论:(1)7例患者随访2-4.5年,患肢短缩由术前的(2.43±0.78) cm下降至术后(0.57±0.56) cm,未见切口感染及不愈合发生,未见假体周围感染出现;(2)7例患者末次随访的目测类比评分低于术前(P <0.05),髋关节功能Harris评分高于术前(P <0.05);(3)影像学检查显示,可降解高纯度镁金属螺钉在术后三四年间全部降解,移植骨块均与髋臼骨性愈合,未见移植骨块脱落及假体松动,所有病例术后未见不良并发症发生;(4)结果表明,对于发育性髋关节发育不良髋臼缺损患者,在髋臼外上方采用可降解高纯度镁金属螺钉固定植骨联合全髋人工关节置换治疗的短期效果满意。

关节镜下带袢钢板联合带线金属骨锚钉治疗前交叉韧带胫骨止点撕脱骨折的疗效

目的探讨关节镜下带袢钢板联合带线金属骨锚钉治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。方法20例前交叉韧带胫骨止点撕脱骨折患者均在关节镜下进行骨折复位,采用带袢钢板联合带线金属骨锚钉对前交叉韧带胫骨止点进行重建固定。术后积极功能康复锻炼配合中药外用熏洗。使用Lysholm评分评估膝关节功能恢复情况。结果20例患者住院10~14d,并获得随访6~12个月。患者伤口愈合良好,术后3个月膝关节活动范围在0~120度,Lachman试验和前抽屉试验为阴性,末次复查X射线片骨折线模糊。患者术后膝关节Lysholm评分优于术前[(96.1±3.5)分vs.(45.8±2.1)分](P<0.05)。结论关节镜下带袢钢板联合带线金属骨锚钉具有创伤小、稳定性高、符合生物力学原理、有利于患者早期功能康复等优点,是临床治疗前交叉韧带胫骨止点撕脱骨折的一种可靠手术方法。

Research and application of absorbable screw in orthopedics： a clinical review comparing PDLLA screw with metal screw in patients with simple medial malleolus fracture

Objective： To observe the therapeutic effect of absorbable screw in medial malleolus fracture and discuss its clinical application in orthopedics. Methods： A total of 129 patients with simple medial malleolus fracture were studied. Among them, 64 patients were treated with poly-D, L-lactic acid （PDLLA） absorbable screws, while the others were treated with metal screws. All the patients were followed up for 12-20 months （averaged 18.4 months） and the therapeutic effect was evaluated according to the American Orthopaedic Foot and Ankle Society clinical rating systems. Results： In absorbable screw group, we obtained excel- lent and good results in 62 cases （96.88%）; in steel screw group, 61 cases （93.85%） achieved excellent and good results. There was no significant difference between the two groups. Conclusion： In the treatment of malleolus fracture, absorbable screw can achieve the same result compared with metal screw fixation. Absorbable screw is preferred due to its advantages of safety, cleanliness and avoiding the removal procedure associated with metallic implants.