背景:有限元分析作为一种新兴的数字化研究方法,在骨科应用愈加普遍,与骨科联系愈加密切。通过建立有限元三维模型应用于骨科生物力学分析及医疗器械研究设计等具有不可替代的作用。目的:综述有限元分析在骨科领域的发展前景,为推动有...背景:有限元分析作为一种新兴的数字化研究方法,在骨科应用愈加普遍,与骨科联系愈加密切。通过建立有限元三维模型应用于骨科生物力学分析及医疗器械研究设计等具有不可替代的作用。目的:综述有限元分析在骨科领域的发展前景,为推动有限元分析方法与骨科临床实践更好地结合提供依据。方法:通过计算机检索万方医学网、中国知网(CNKI)、PubMed、Embase数据库中2012-2021年发表的相关文献,中文检索词为“有限元分析”“生物力学”“脊柱”“关节”“创伤”“骨病”“医疗器械”“综述”,英文检索词为“finite element analysis”“biomechanics”“spine”“joint”“trauma”“osteopathia”“medical instrument”“review”。根据纳入标准,最终纳入47篇相关文献进行归纳总结。结果与结论:有限元分析方法可对骨关节和相关软组织损伤时的应力状态进行准确模拟分析,在辅助骨科各临床科室查明发病机制、确定治疗方案中发挥积极作用,并能通过将人体骨骼肌肉系统分解为若干个数字化模型进行生物力学分析,指导医疗器械的研发设计,极大地促进了临床诊疗技术的发展,具有良好的发展潜力。但目前有限元分析还存在着方法使用不当、有限元模型建立不准确、弹性模量标准等问题,还需进一步发展完善,使有限元分析方法更好地满足临床和科研需要。展开更多
Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods...Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.展开更多
Purpose： To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods： We retrospectively analyzed totally 425 patients with femoral shaft fractu...Purpose： To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods： We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 （ranging from 21 to 56） years old. The inclusion criteria included： （1） traumatically closed fracture of femoral shaft, with preoperative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; （2） closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; （3） complete follow-up data available. The relationship between the following factors （fracture site, reduction degree, direction of nail insertion and nail size） and nonunion was studied. Results： The incidence of femoral nonunion was 2.8%; in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail （p 〈 0.05）. There was no significant difference between antegrade nail and retrograde nail （p 〉 0.05）. Conclusions： Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.展开更多
Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical pract...Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus frac- tures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.展开更多
文摘背景:有限元分析作为一种新兴的数字化研究方法,在骨科应用愈加普遍,与骨科联系愈加密切。通过建立有限元三维模型应用于骨科生物力学分析及医疗器械研究设计等具有不可替代的作用。目的:综述有限元分析在骨科领域的发展前景,为推动有限元分析方法与骨科临床实践更好地结合提供依据。方法:通过计算机检索万方医学网、中国知网(CNKI)、PubMed、Embase数据库中2012-2021年发表的相关文献,中文检索词为“有限元分析”“生物力学”“脊柱”“关节”“创伤”“骨病”“医疗器械”“综述”,英文检索词为“finite element analysis”“biomechanics”“spine”“joint”“trauma”“osteopathia”“medical instrument”“review”。根据纳入标准,最终纳入47篇相关文献进行归纳总结。结果与结论:有限元分析方法可对骨关节和相关软组织损伤时的应力状态进行准确模拟分析,在辅助骨科各临床科室查明发病机制、确定治疗方案中发挥积极作用,并能通过将人体骨骼肌肉系统分解为若干个数字化模型进行生物力学分析,指导医疗器械的研发设计,极大地促进了临床诊疗技术的发展,具有良好的发展潜力。但目前有限元分析还存在着方法使用不当、有限元模型建立不准确、弹性模量标准等问题,还需进一步发展完善,使有限元分析方法更好地满足临床和科研需要。
文摘Objective： To propose a new technique to treat lumbar spinal stenosis with median approach endoscopic decompression combined with interspinous process implant fusion and evaluate the initial clinical outcome. Methods： This study involved 30 patients who had neurogenic commitment claudication over 2 years and were resistant to conservative therapy. All cases were treated using the median approach endoscopic decompression combined with interspinous process implant fusion in 2006. Clinical signs and radicular pain were noted and evaluated preoperatively and at the 1st month and 3rd month postoperatively. Japanese Orthopedic Association （JOA） score was used to evaluate leg and back pain. X-ray films at flexion and extension were applied to evaluate the range of motion at involved segments. Results： There was a significant increase in JOA score postoperatively, but no significant difference preoperatively or postoperatively between the two groups.The range of motion at involved segments was significantly higher in the control group. Conclusions： The median approach endoscopic decompression is an ideal method for bilateral radiculopathy resulting from lumbar spinal canal stenosis. The combination with interspinous process implant fusion can stabilize the spine. The initial clinical outcome is exllent. Preservation of adjacent level disease can be assessed only in long-term follow-up.
文摘Purpose： To explore the possible surgical factors related with nonunion in femoral shaft fracture following intramedullary nailing. Methods： We retrospectively analyzed totally 425 patients with femoral shaft fracture in level I urban trauma center, including 254 males and 171 females, with an average age of 37.6 （ranging from 21 to 56） years old. The inclusion criteria included： （1） traumatically closed fracture of femoral shaft, with preoperative films showing non-comminuted fracture, such as transverse fracture, oblique fracture or spiral fracture; （2） closed reduction and fixation with interlocking intramedullary nail at 3-7 days after trauma; （3） complete follow-up data available. The relationship between the following factors （fracture site, reduction degree, direction of nail insertion and nail size） and nonunion was studied. Results： The incidence of femoral nonunion was 2.8%; in patients with closed simple fracture undergoing interlocking intrameduallary nailing, including 11 cases of hypertrophic nonunion. Nonunion was related significantly to distal fracture, unsatisfactory reduction and unreamed nail （p 〈 0.05）. There was no significant difference between antegrade nail and retrograde nail （p 〉 0.05）. Conclusions： Nonunion in femoral shaft facture following interlocking intramedullary nailing is related to fracture site, fracture reduction and nail diameter. The choice of reamed nails or unreamed nails depends on the fracture site and reduction degree.
文摘Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures. The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice. Despite adequate surgeon experience, tibial nailing is not without complications if proper techniques are not followed. A case of iatrogenic talar neck and medial malleolus frac- tures during intramedullary nailing of tibia in a 24-year-old male is reported. It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed. To the best of our knowledge, no such case has been reported in the literature. It is possible to reduce the risk of this complication by adoption of preventive measures.
