Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

THE SYNTHESIS AND CHARACTERIZATION OFPOLY-L-LACTIDE USED FOR THE INTERNALFIXATION OF BONE FRACTURE

A high Mw of PLLA was synthesized, it intended to be used in the manufacture ofbioabsorbable screw applied in bone fracture internal fixation. The optical reactionconditions have been discussed.

Effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures

Objective:To investigate the effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures.Methods:Totally 80 cases of patients with Robinson 2A and 2B middle clavicular fractures admitted to our hospital between March 2017 and January 2019 were divided into the control group(n=41)receiving conventional kirschner wire internal fixation and the observation group(n=39)receiving locking compression plate internal fixation according to the operation plans.The differences in serum contents of inflammatory factors,oxidative stress indexes and bone metabolism indexes were compared between the two groups of patients before patients entered operating room,24 h after surgery and 48 h after surgery.Results:Before patients entered operating room,there were no statistically significant differences in the serum contents of inflammatory factors,oxidative stress indexes or bone metabolism indexes between the two groups(P>0.05).At 24 h and 48 h after surgery,serum inflammatory factors interleukin-1(IL-1),interleukin-17(IL-17),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α)contents in the observation group were lower than those in the control group;serum reactive oxygen species(ROS)and lipid hydroperoxide(LHP)contents were lower than those in the control group,while catalase(CAT)and glutathione peroxidase(GSH-Px)contents were higher than those in the control group;serum N-terminal propeptide of procollagen type I(PINP),bone gla protein(BGP)and alkaline phosphatase(ALP)contents were higher than those in the control group,while N-telopeptide of typeⅠcollagen(NTX),C-telopeptide of typeⅠcollagen(CTX)and tartrate-resistant acid phosphatase 5b(TRACP5b)contents were lower than those in the control group(P<0.05).Conclusion:Locking compression plate internal fixation can reduce the postoperative trauma extent and help promote the fracture healing in patients with Robinson 2A and 2B middle clavicular fracture.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

Proximal Femur Bionic Nail (PFBN): A Panacea for Unstable Intertrochanteric Femur Fracture

With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.

Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.

Triple-functional bone adhesive with enhanced internal fixation,bacteriostasis and osteoinductive properties for open fracture repair

At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments.Moreover,closed reduction and internal fixation during the early stage of injury can lead to potential bone infection,conducive to bone nonunion and delayed healing.Herein,we designed a bone adhesive with anti-infection,osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair.It was prepared by the reaction of gelatin(Gel)and oxidized starch(OS)with vancomycin(VAN)-loaded mesoporous bioactive glass nanoparticles(MBGNs)covalently cross-linked with Schiff bases.Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs(GOVM-gel)adhesive.Meanwhile,in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell(BMSCs)proliferation,upregulate the expression of alkaline phosphatase(ALP)and osteogenic proteins(RunX2 and OPN)and enhance the deposition of calcium nodules.Additionally,we established a rat skull fracture model and a subcutaneous infection model.The histological analysis showed that bone adhesive enhanced osteogenesis,and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced.Overall,the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects,providing the foothold for treatment of this patient population.

不同内固定方式治疗股骨颈骨缺损骨折的静力学与模态分析

目的 探讨不同内固定方式治疗股骨颈骨缺损骨折的静力学特征以及固有和约束模态对内固定的影响。方法 首先基于CT图像建立伴有股骨颈内固定系统(femoral neck system,FNS)和倒三角空心钉(cannulated screw,CS)两种不同内固定装置的股骨颈骨折模型与股骨颈骨缺损骨折模型,然后模拟3倍体重载荷下,不同骨折内固定模型的应力、位移分布及峰值以及模态下的位移峰值、频率以及固有和约束模态振型。结果 两种内固定方式下,股骨颈骨缺损骨折的内固定应力峰值(337.69 MPa,618.58 MPa)显著高于股骨颈骨折模型(149.38 MPa,300.57 MPa),股骨头应力峰值(107.75 MPa,93.78 MPa)与位移峰值(5.244 mm,4.415 mm)也都高于股骨颈骨折模型[(95.73 MPa,85.64 MPa),(4.367 mm,3.478 mm)]。在骨折类型相同的情况下,FNS内固定模型相比CS内固定模型具有更低的位移峰值以及更加均匀的应力分布。模态分析结果显示,振动对于内固定的稳定性有一定影响,约束模态的振型频率范围要小于固有模态。固有模态下FNS的位移峰值较CS降低了6.99%,约束模态下位移峰值降低了14.02%。结论 骨缺损会严重破坏内固定的力学环境,无论是普通骨折模型还是骨缺损骨折模型,FNS固定的静态与动态特性都要优于CS固定。临床治疗中要考虑股骨及内固定器械的固有、约束频率所产生的影响,避免因共振而造成内固定失效等问题。

不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效研究

目的:分析不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效,以及对血清骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原羧基肽β特殊序列(β-CTX)水平的影响。方法:选取我院2020年1月-2022年6月收治的120例行微创椎弓根钉内固定术联合小针刀术干预治疗的胸腰椎创伤性骨折患者,随机分为三组。A组(40例)选择经皮入路,B组(40例)选择经Wiltse入路,C组(40例)选择经后正中入路。记录并比较三组伤椎有效性指标:Oswestry功能障碍指数(ODI)、后凸Cobb角和前缘高度比;视觉模拟疼痛(VAS)评分、血清BALP、β-CTX水平和围手术期指标(手术时间、术中出血量和术后引流量)。结果:三组患者术后7 d、30 d的伤椎ODI、后凸Cobb角和前缘高度比均优于术前,差异有统计学意义(P <0.05),但三组间伤椎ODI、后凸Cobb角和前缘高度比差异无统计意义(P>0.05);三组患者术后VAS评分均显著下降,差异有统计学意义(P <0.05),且三组术后1 d、7 d的VAS评分比较差异有统计意义(P <0.05);三组患者术后血清BALP水平均明显上升,血清β-CTX水平均明显下降,差异均有统计学意义(P <0.05),且三组术后7 d的血清BALP及β-CTX水平比较差异有统计意义(P <0.05);三组手术时间、术中出血量和术后引流量关系为A组<B组<C组,差异有统计学意义(P <0.05)。结论:经皮入路和经Wiltse入路微创椎弓根钉内固定术联合小针刀术干预治疗能有效改善胸腰椎创伤性骨折患者伤椎有效性及骨代谢水平,而传统后正中入路的有效性及对骨代谢水平的改善作用相对较差,临床可结合患者情况在经皮入路和经Wiltse入路二者之间酌情选择入路方式,并结合小针刀术进行干预治疗。

基于胸腔镜的复位内固定术治疗老年肋骨骨折患者的临床疗效研究

目的探讨基于胸腔镜的复位内固定术对老年肋骨骨折患者康复进程以及功能恢复的影响。方法选取收治的85例老年肋骨骨折患者为研究对象,按照不同治疗方案分为对照组(n=41,开胸内固定手术)和观察组(n=44,基于胸腔镜的复位内固定手术)。比较2组手术指标(血氧饱和度恢复时间、呼吸频率恢复时间、机械通气时间、住院时间和骨骼愈合时间)、疼痛评分、肺功能指标[第1秒用力呼气容积(FEV 1)、用力肺活量(FVC)和最大呼气峰流速(PEF)]、血气指标{动脉血氧分压[p a(O 2)]、动脉血二氧化碳分压[p a(CO 2)]}、临床疗效及并发症发生率。结果观察组的血氧饱和度恢复时间、呼吸频率恢复时间、胸腔引流管留置时间和住院时间及骨折愈合时间短于对照组,胸管引流量少于对照组,差异有统计学意义(P<0.05)。术后7 d,2组视觉模拟评分法(VAS)评分、p a(CO 2)水平低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。术后7 d,2组FEV 1、FVC、PEF、FEV 1/FVC水平及p a(O 2)水平高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组临床总有效率为93.18%,高于对照组的78.05%,差异有统计学意义(P<0.05)。观察组并发症总发生率为4.55%,低于对照组的19.51%,差异有统计学意义(P<0.05)。结论基于胸腔镜的复位内固定手术治疗老年肋骨骨折患者的临床疗效显著,可有效缩短康复进程,缓解患者疼痛,促进其肺功能恢复,且安全性高。

四肢创伤骨折病人术后低蛋白血症的危险因素分析及风险预测模型的构建

目的 探讨四肢创伤骨折病人术后低蛋白血症的危险因素,并构建四肢创伤骨折病人术后低蛋白血症的风险预测模型。方法 选取2018年3月至2022年8月池州市人民医院手术治疗的226例四肢创伤骨折病人作为研究对象。应用Lasso分析筛选四肢创伤骨折病人术后低蛋白血症的预测因素,应用logistic回归分析筛选四肢创伤骨折病人术后低蛋白血症的危险因素,应用R软件构建四肢创伤骨折病人术后低蛋白血症的列线图模型,并对四肢创伤骨折病人术后低蛋白血症的列线图模型进行验证。结果 logistic回归分析结果显示,女性、年龄≥65岁、术中出血量≥300 mL、胃肠功能损伤、肺部感染、术前白蛋白<35 g/L、衰弱、输注胶体液及蛋白等是四肢创伤骨折病人术后低蛋白血症的危险因素(P<0.05)。四肢创伤骨折病人术后低蛋白血症的列线图模型的校正曲线显示预测值与实际值的拟合度较好;模型的AUC是0.84[95%CI:(0.80,0.87)];决策曲线显示阈值概率在2%~75%范围内时,应用该列线图预测四肢创伤骨折病人术后低蛋白血症净获益值较高。结论 女性、年龄≥65岁、术中出血量≥300 mL、胃肠功能损伤、肺部感染、术前白蛋白<35 g/L、衰弱、输注胶体液及蛋白等是四肢创伤骨折病人术后低蛋白血症的危险因素,本研究基于以上8项危险因素构建的列线图能够对四肢创伤骨折病人术后低蛋白血症的防治工作起到帮助作用。

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。

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。

ERAS在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的应用

目的评价加速康复外科(ERAS)在双平面机器人辅助经皮骶髂关节螺钉固定治疗骶骨骨折中的临床效果。方法选取2018年12月至2020年12月内蒙古医科大学附属医院采用双平面机器人辅助经皮骶髂关节螺钉固定治疗的24例骶骨纵形骨折患者作为研究对象,随机分为ERAS组与常规组(n=12),其中常规组采取常规围手术期管理模式,ERAS组在常规管理基础上实施ERAS精细化围手术期管理方案,对两组患者围手术期指标、影像学结果和疗效指标进行对比分析。结果对两组患者螺钉置入位置进行影像学检查(X线、CT扫描),均达到满意程度;Matta影像评分两组相近(P>0.05)。ERAS组术后2 d疼痛视觉模拟量表评分、术后3 d Braden压疮评分和末次随访Majeed评分均优于常规组,住院时间短于常规组,两组比较,差异具有统计学意义(P<0.05)。结论在机器人辅助经皮骶髂关节螺钉固定围手术期管理中运用ERAS理念,疼痛缓解更加有效、压疮风险更低、住院时间更短,更有利于骶骨骨折患者术后骨盆功能恢复,可在脊柱外科机器人手术中推广和应用。

抗生素骨水泥被覆重建钢板治疗感染性骨盆前环骨折

目的:探讨抗生素骨水泥被覆重建钢板治疗感染性骨盆前环骨折的临床疗效。方法:自2017年1月至2022年3月应用抗生素骨水泥被覆重建钢板治疗感染性骨盆前环骨折患者11例,男7例,女4例;年龄27~49岁;骨盆骨折Tile分型:C1型4例,C2型4例,C3型3例。2例前环内固定术后感染,9例患者均因早期清创不彻底导致前环感染,按创伤严重度评分标准(injury severity score,ISS)评分为24~38分。前环经扩大清创、冲洗、抗生素骨水泥被覆重建钢板内固定,后环骨折均采用闭合复位,骶髂螺钉内固定。结果:11例均获得随访,时间13~20个月。2例术后感染复发,1例经再次清创更换抗生素骨水泥涂层内固定,1例感染较轻,未累计髓腔,清创后保留钢板仅更换抗生素骨水泥,感染得到控制。2例出现切口渗液,术后3个月取出内固定后愈合。所有患者在随访期内未见骨盆骨折再移位、再发感染。最终11例均骨性愈合。末次随访,按照Matta骨折复位标准,优6例,良4例,可1例;按照Majeed功能评分,优6例,良3例,可2例。结论:抗生素骨水泥被覆重建钢板有效治疗感染性骨盆前环骨折,具有术中安全性高和感染复发率低的特点,有利于术后早期康复锻炼,明显缩短病程。

不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响

目的 比较不同手术治疗髋部骨折的疗效及对患者髋关节功能、骨代谢指标的影响。方法 采用随机数字表法将108例髋部骨折患者分为内固定组和置换组,各54例。内固定组以股骨近端髓内钉-螺旋刀片内固定治疗,置换组予以人工关节置换术治疗,2组术后均随访6个月。比较2组临床疗效、本体感觉平衡功能相关指标、骨代谢指标、髋关节功能、并发症。结果 术后6个月,置换组优良率高于内固定组(P <0.05);与术前比较,术后6个月2组血清骨钙素(BGP)、甲状旁腺激素(PTH)、骨碱性磷酸酶(BALP)水平、Harris髋部评分、髋部功能恢复量表(FRS)评分升高,置换组高于内固定组(P <0.05);2组Berg平衡量表评分升高,但置换组Berg平衡量表评分低于内固定组(P <0.05);置换组骨密度升高,且高于内固定组(P <0.05);随访期间,置换组总并发症发生率低于内固定组(P <0.05)。结论 股骨近端髓内钉-螺旋刀片内固定可改善髋部骨折患者平衡能力,但人工关节置换术可有效改善患者骨代谢指标,促进其髋关节功能恢复,降低并发症的发生,疗效相对更好。

3种3D打印模型辅助治疗RobinsonⅡB2型锁骨骨折

背景:随着3D打印技术在医学中的应用及发展,使得骨科内固定手术迈向精准化、个体化,通过3D打印技术获得的等比例骨折模型进行术前模拟、规划,实现了由传统的2D图像向更加形象、精细的立体实物的跨越,让术者提前了解骨折类型、预演复位顺序,进而实现骨折手术的个体化实施,优化了手术过程,带来更佳的术后恢复效果和更少的手术并发症。目的:比较3种3D打印模型结合计算机虚拟复位技术辅助切开复位接骨板内固定和传统切开复位接骨板内固定治疗RobinsonⅡB2型锁骨骨折的临床疗效。方法:将80例RobinsonⅡB2型锁骨骨折患者随机分为试验组(40例)和对照组(40例),试验组利用3种3D打印模型(患侧锁骨骨折模型、计算机模拟锁骨骨折复位后模型、健侧锁骨镜像模型)结合计算机虚拟复位技术在术前进行体外手术预演,最后利用健侧锁骨镜像模型进行3D打印来提前弯折和选择接骨板进行内固定,对照组直接进行切开复位接骨板内固定。比较两组患者入院至手术时间、术中出血量、手术时间、透视次数、对接骨板的折弯次数、骨折愈合时间、并发症发生情况及两组患者治疗前后目测类比评分、Constant肩关节功能评分。结果与结论:试验组患者入院至手术时间长于对照组(P<0.05);试验组患者手术时间、术中透视次数及对接骨板的折弯次数均小于对照组(P<0.05);试验组患者骨折愈合更快,并发症更少(P<0.05);两组患者术中出血量无统计学差异(P>0.05);两组患者Constant评分均有随时间延长而上升的趋势(F=613.50,P<0.001),但组间比较差异无显著性意义(F=0.08,P=0.78),测量次数与分组无交互效应(F=0.27,P=0.66)。两组患者目测类比评分随时间延长而下降(F=1149.55,P<0.001),但组间比较差异无显著性意义(F=0.02,P=0.88),测量次数与分组无交互效应(F=1.02,P=0.36)。结果表明使用3D打印模型结合计算机虚拟复位技术进行术前预演,可以缩短手术时间、减少术中透视及对接骨板折弯的次数,同时具有骨折愈合更快、并发症更少的优势,并能达到与传统切开复位接骨板内固定相似的功能恢复。

髋关节置换术治疗髋臼骨折继发创伤性关节炎的临床观察

目的:深入研究全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折继发创伤性关节炎的临床疗效。方法:回顾性分析2019年10月至2022年6月,采用THA治疗15例髋臼骨折继发创伤性关节炎患者,男8例,女7例,年龄40~76(59.20±9.46)岁。记录术前及术后假体松动、髋关节脱位、髋关节活动度、神经损伤等情况,采用Harris评分、视觉模拟评分(visual analogue scale,VAS)、影像学检查评价髋关节功能及手术疗效。结果:15例均顺利完成手术,术中无神经、血管损伤,术后切口均Ⅰ期甲级愈合,无感染。随访时间6~39(18.33±9.27)个月。其中1例术后半年发生髋臼侧假体松动,经过翻修手术后恢复良好;1例髋关节脱位,经切开复位处理后治愈,无不良后果。术后末次随访Harris评分(88.60±4.01)分,与术前(47.20±11.77)分相比,差异有统计学意义(P<0.05)。术后末次随访VAS评分1(1)分,与术前8(2)分相比,差异有统计学意义(P<0.05)。末次随访时,本组所有患者疼痛症状减轻或消失,关节功能满意;末次随访影像学资料显示关节假体贴合良好,无异位骨化发生,假体无松动。结论:THA治疗髋臼骨折继发创伤性关节炎疗效可靠,能有效提高患者的生活质量。术前对患者全面评估、骨缺损评估,术中髋臼、股骨、内固定物与骨缺损的处理是手术成功的关键因素。

带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果比较

目的:比较带锁髓内钉与锁定钢板内固定术治疗肱骨近端Neer二部分骨折患者的效果。方法:选取2021年2月至2022年2月该院收治的64例肱骨近端Neer二部分骨折患者进行前瞻性研究,按照随机数字表法将其分为观察组与对照组各32例。对照组采用锁定钢板内固定术治疗,观察组采用带锁髓内钉内固定术治疗,比较两组手术时间、术中出血量、住院时间、骨性愈合时间、ConstantMurley肩关节功能评分量表(CMS)评分、健康调查简表(SF-36)评分和并发症发生率。结果:观察组术中出血量少于对照组,住院时间和骨性愈合时间短于对照组,差异均有统计学意义(P<0.05);术后6个月,两组SF-36各维度评分高于术前,且观察组高于对照组,差异均有统计学意义(P<0.05);观察组并发症发生率为3.12%,明显低于对照组的25.00%,差异有统计学意义(P<0.05);两组手术时间和手术前后CMS评分比较,差异无统计学意义(P>0.05)。结论:带锁髓内钉内固定术治疗肱骨近端Neer二部分骨折患者可提高术后SF-36评分,缩短住院时间和骨性愈合时间,以及降低术中出血量和并发症发生率,效果优于锁定钢板内固定术治疗。