大段骨移植骨接合面的生物力学研究(英文)

目的:探讨适合髓内固定的骨接合端处理方案的理论基础。方法:采用新鲜猪股骨25根,采用随机数字表法均分为横形截骨组,斜形截骨组,阶梯形截骨组,“V”形30°截骨组,“V”形45°截骨组。对所有标本进行压缩刚度,扭矩刚度,最大扭矩等生物力学实验,观察不同截骨形状的稳定性。结果:“V”形45°截骨接合的扭矩刚度值最大,横形最差。“V”形45°截骨在抗最大扭力时产生骨折;“V”形30°截骨接合部抗压缩性较好,有较强的抗扭转力,在最大扭矩实验中没有出现骨折。结论:在设计大段骨移植骨接合端时,采用“V”形30°角的处理方案,能提供这类骨接合更好的初期稳定性。

近关节股骨粉碎性骨折的“生物性”钢板骨接合术

股骨多发性粉碎性骨折的手术治疗主要在于对骨愈合的干扰和其后续问题。由于损伤明显减少了髓内血管,影响骨骼、髓内膜的血供,只能通过骨膜保持补充新的血供。骨碎片依附的软组织如关节囊、骨膜、肌肉或韧带组织,由于手术操作而遭受附加创伤,而这些组织可以决定是否维持骨骼活力。

活体内分解性骨接合材料

当前广泛用于骨接合的金属材料不锈钢316L有各种缺陷,如腐蚀、极少见的致癌可能性、骨愈合拔掉时须再做手术以及因钢板下面的骨质疏松拔除时易引起骨折等。为克服这些缺点,活体内分解性接合材料的研究有所进展。理想的材料是骨愈合完成后,接合材料很快失去强度逐渐被吸收,此种材料的临床应用尚在刚刚起步阶段,现将其开发历史、现况及存在的问题叙述如下。

骨畸形

0229924 与先天性颈椎弓缺失有关的创伤后颈椎硬膜外血肿:病例报告和文献综述/Taguchi Y//J Trauma.-2001,51(3).-579～582 医科图 0229925 颅面部错位骨生成:3278例的综述/Mofid M M// Plast Reconstr

合成碳螺钉力学性能的实验性研究

碳—碳合成物可用于制造碳螺钉作为骨接合术材料。本文对其力学性能包括合成容量纤维取向、螺纹大小和螺纹形状的作用进行了优化。碳螺钉力学性能与普通钢骨皮质螺钉进行了对比。使用了沿着螺钉轴改变纤维取向的两种碳样品型号。测定了碳螺钉的力学性能包括某一螺纹断裂力和临界剪切应力。测定碳螺钉和骨连接的破坏力。进行了碳螺钉与钢螺钉固定力的对比。拉伸试验表明，固定力比骨钢螺钉少５０％。

颧骨双L形截骨联合颧弓截骨Z形接合术矫治颧骨、颧弓过高

目的观察颧骨双L形截骨联合颧弓后端截骨Z形接合术，对颧骨、颧弓过高矫治的疗效与预后。方法32例颧骨、颧弓均过高的患者。在全身麻醉下应用颧骨双L形截骨联合颧弓后端截骨Z形接合术进行矫治。术后6个月后对所有患者进行随访，观察颧骨愈合及面型变化情况并调查患者满意度。结果32例患者截骨矫治后I期愈合，所有患暂面部消肿后颧骨、颧弓明显降低，面中份两侧颧弓问宽度明显减少。6个月后随访，骨愈合良好，所有患者均对治疗效果表示满意。结论颧骨双L形截骨联合颧弓后端截骨Z形接合术．可有效地矫治颧骨、颧弓过高，使患者面型达到一个理想的美学标准。

Three dimensional finite element analysis of anatomic distal radius Nitinol memory connector treating distal radius fracture

Objective: To study the memory biomechanical character of anatomic distal radius Nitinol memory connector (DRMC) in treating distal radius fracture. Methods: Establishing three dimensional model and finite element analysis, we calculated the stress in and around the fracture faces when distal radius fracture was fixated with DRMC. Results: Axial holding stress produced by holding part of DRMC on distal radius was 14.66 MPa. The maximum stress of holding part was 40-70 MPa, the minimum stress was 3-7 MPa,and the stress of compression part was 20-40 MPa. Conclusion: The distribution of stress produced by DRMC around the fracture line is reasonable, and axial holding stress can help stabilize fracture during earlier period. The existence of longitudal compression and memory effect can transfer fixated disused section into developed section and enhance fracture healing.

骨水泥填充内固定联合二磷酸盐治疗邻膝关节骨巨细胞瘤

[目的]探讨采用病灶内肿瘤扩大刮除、骨水泥填充并钢板内固定联合二磷酸盐治疗邻膝关节骨巨细胞瘤的临床应用可行性。[方法]回顾分析2008年1月~2010年6月本科治疗的16例邻膝关节骨巨细胞瘤。男7例,女9例,平均年龄38岁（27~78岁）。发病部位：股骨远端10例,胫骨近端6例。所有患者术前均经仔细评估确定肿瘤腔的完整性,术中仔细刮除肿瘤组织,应用磨钻及电刀处理瘤腔壁,骨水泥填充修复骨缺损,同时给予钢板内固定。术后均应用二膦酸盐类药物。[结果]本组患者全部获得随访,中位随访15个月,无局部复发及转移发生。参照Ennek ing肢体功能评分标准,本组患者平均得29分（27~30）分。复查X线片示所有患者内固定均牢靠,无软骨下骨骨折。[结论]对于膝关节周围骨巨细胞瘤可以选择病灶扩大刮除、骨水泥充填内固定联合二膦酸盐类药物治疗,该方法具有操作简单、肢体功能恢复理想、近期复发率低、病人易于接受等优点。远期疗效有待进一步观察。

Pedicle screw fixation with translaminar facet joint screws for the treatment of thoracolumbar fracture

Objective: To evaluate the efficacy of Cotrel-Dubeusset （CD） instrumentation combined with translaminar facet joint screw （TLS） in the treatment of thoracolumbar fracture.Methods: A total of six L2-L4 spines were used to establish unstable fracture model with three-dimensional range of motion （ROM） of the spines measured. Fixation with CD and fixation with CD combined with translaminar facet joint screw were achieved to compare their stability. Thirty cases of thoracolumbar fracture, in whom the anterior edge of vertebral body was compressed to 59% and the posterior edge compressed to 88%, were treated by pedicle screw fixation combined with TLS. Among them, 19 received posterolateral or anterior-posterior bone graftingResults: There was significant difference in ROM between the two techniques except that in extension. In Group CD+TLS, ROM was （5.38）% lower, lateral bending （4.91）% lower and axial rotation （11.85）% lower than those in Group CD respectively. In the clinical group, the average anterior edge restored to 97% and posterior edge to 98%. The duration of follow-up was 5-24 months （mean, 10 months）. The rate of correction loss on the anterior edge was （4.5）%. Among the 19 cases of bone grafting, all of them achieved bony fusion （mean fusion time, （4.3） month） with a correction loss rate of （3.4）%.Conclusions: In the treatment of thoracolumbar fracture, pedicle screw fixation combined with TLS can strengthen the stability of pedicle screws, especially anti-rotation stability and enhance fusion rate and reduce correction loss.

Interface contact profiles of a novel locking plate and its effect on fracture healing in goat

Objective： To evaluate the interface characteristics of the new-designed locking plate （LP） and limited contact-dynamic compression plate （LC-DCP） and compare the fracture healing between LP and LC-DCP in a goat tibia fracture model. Methods： Eight-hole LP and LC-DCP were applied to fix fresh goat tibiae in a reproducible manner. The average pressure, force and interface contact area were calculated using Fuji prescale pressure sensitive film interposed among the plate and the bone and image analysis system, Eighthole LP and LC-DCP were applied to each tibia in a goat tibia fracture model. The fracture healing was evaluated by X-ray photography at postoperative 8 weeks. The goats were sacrificed at postoperative 12 weeks. Three-point bending test was conducted in the tibiae. Results： The interface contact of LP system was smaller than that ofLC-DCP （P〈0.05）, while interface contact force of LP system was higher than that of LC-DCP （P〈0.05）. Radiographs revealed that the fracture line disappeared in the LP group, while the fracture line was visible in DCP group at postoperative 8 weeks. At postoperative 12 weeks, the bending strength and bending load of fractured tibia were higher in LP group than in DCP group, respectively.

Posterolateral dislocation of the knee joints:analysis of 9 cases

Objective: To analyze the traumatic pathological characteristics of posterolateral dislocation of knee joints and its treatment.Methods: Nine cases of posterolateral dislocation of knee joint ,5 cases of fresh injuries (the fresh injury group) and 4 cases of old injuries ( the old injury group) were reviewed and analyzed. In the fresh injury group 4 cases failed in close reduction due to "buttonholing" through the medial jo int,among them 3 cases underwent repair of the damaged ligaments. In the old in jury group 2 cases underwent ACL and MCL repair only in acute stage,but re-dis located. Of the rest 2 cases 1 was associated with peroneal nerve injury and the other was not treated in acute stage. One case was associated with comminuted f racture of the tibial condyle and popliteal artery injury. Open reduction was pe rformed in 3 cases. One case was fixed with 2-crossed pin and another was fixe d with one pin through the tibial and femoral condyle and second pin with olecra nization fixation. Plaster immobilization for 6-8 weeks respectively was requir ed. In the old injury group in 1 case ACL and PCL repair (Augustine method) and posterolateral structure were performed and olecranization fixation and plaster immobilization for 6 weeks was needed. Arthrodesis of the knee was done for the patient with comminuted fracture of the tibial condyle and popliteal artery inj ury. Results: All the cases were followed up for 1-23 years (averag e 6 years). Knee stability in 4 cases with repair of the ligaments was improved,although PDT showed (+) with different degrees. The results of the patients tre ated with ligamentous reconstruction were much better than those of the patients without any repair. Conclusions: Well understanding of the traumatic pathological c haracteristics,repair of the damaged ligaments,augmentation of olecranization fixation and postoperative immobilization for 6 weeks are the key points of succ essful treatment.

Synthesis, structure, and magnetism of three manganese-organic framework with PtS topology

Three 3D manganese-organic frameworks, Mn2(BPTC)(DMF)2(H2O)·DMF·3H2O(1), Mn2(BPTC)(bipy)(DMF)·DMF·H2O(2), and Mn2(BPTC)(phen)(DMF)·EtOH(3), have been solvothermally synthesized using 3,3′,5,5′-biphenyltetracarboxylic acid(H4BPTC). All complexes are characterized by PXRD, EA, IR and TG. The results show that they all bear the PtS topology with(42.84)(42.84) for the vertex symbols of the planar and tetrahedral nodes, in which the BPTC ligand is considered as a square-planar 4-connected linker, and every binuclear SBU connected to the four BPTC ligands is simplified into tetrahedral 4-connected nodes. Because the three coordination sites of one metal center of SBU are occupied by the coordinated solvent molecules, complex 1 exhibits low stability. After substituting 2,2′-bipy or 1,10-phen for two coordinated solvent molecules, complexes 2 and 3 display evidently higher structure stability. The magnetism property of complex 2 is also discussed in detail.