Objective Mechanic strength, pore morphology and size are key factors for the three-dimensional (3D) printing of porous titanium scaffolds, therefore, developing optimal structure for the 3D printed titanium scaffold to fill bone defects in knee joints is instructive and important. Methods Structural models of titanium scaffolds with fifteen different pore unit were designed with 3D printing computer software; five different scaffold shapes were designed: imitation diamond-60°, imitation diamond-90°, imitation diamond-120°, regular tetrahedron and regular hexahedron. Each structural shape was evaluated with three pore sizes (400, 600 and 800 μm), and fifteen types of cylindrical models (size: 20 mm; height: 20 mm). Autodesk Inventor software was used to determine the strength and safety of the models by simulating simple strength acting on the knee joints. We analyzed the data and found suitable models for the design of 3D printing of porous titanium scaffolds. Results Fifteen different types of pore unit structural models were evaluated under positive pressure and lateral pressure; the compressive strength reduced when the pore size increased. Under torsional pressure, the strengths of the imitation diamond structure were similar when the pore size increased, and the strengths of the regular tetrahedron and regular hexahedron structures reduced when the pore size increased. In each case, the compressive strength of the regular hexahedron structure was highest, that of the regular tetrahedron was second highest, and that of the imitation diamond structure was relatively low. Fifteen types of cylindrical models under a set force were evaluated, and the sequence of comprehensive compressive strength, from strong to weak was: regular hexahedron > regular tetrahedron > imitation diamond-120° > imitation diamond-90° > imitation diamond-60°. The compressive strength of cylinder models was higher when the pore size was smaller. Conclusion The pore size and pore morphology were important factors influencing the compressive strength. The strength of each structure reduced when the pore size (400, 600 and 800 μm) increased. The models of regular hexahedron, regular tetrahedron and imitation diamond-120°appeared to meet the conditions of large pore sizes and high compressive strength.
Objective To explore the comparison of clinical efficacy between femoral neck system(FNS)and hollow screw inverted triangle fixation for femoral neck fracture patients with comminuted posterior medial wall.Methods From December 2019 to August 2021,fresh femoral neck fracture patients with comminuted posterior medial wall were treated by FNS(FNS group,21 cases)and cannulated screw inverted triangle fixation(cannulated compression screw group,22 cases)in Fuyang People's Hospital.There were 19 males and 24 females,aged from 18-59 years.The observation indexes included intraoperative fluoroscopy,operation time,Garden index,Haidukewych standard score,cortical support,the fracture healing time,the time of full weight-bearing,femoral neck shortening length,failure of internal fixation and the occurrence of femoral head necrosis.Results The postoperative follow-up of the two groups was 12-24 months,with an average of(18.60±4.10)months.There was a significant difference in the frequency of intraoperative fluoroscopy between the two groups(P<0.05).There was no significant difference in operation time,Garden index,Haidukewych score and cortical support between the two groups(P>0.05).There was no significant difference in fracture healing time and Harris hip score between the two groups(P>0.05).The incisions of both groups healed first after surgery.In the cannulated screw group,there was 1 case of internal fixation failure,cannulated screw cutting,nail withdrawal,fracture displacement and coxa vara deformity.The FNS group was superior to the cannulated compression screw group in the time of full weight-bearing,femoral neck shortening,and femoral head necrosis rate(P<0.05).Conclusion For femoral neck fractures with posterior medial wall comminuted,FNS fixation can reduce intraoperative fluoroscopy and femoral neck shortening,facilitate early weight-bearing activities,and lower the rate of femoral head necrosis in early follow-up.
Objective To compare the effects and economic differences of shoulder joint range of motion,pain stress and inflammatory factors in patients with Goss-Ideberg type Ⅰa scapular glenoid fracture and open reduction and cannulated screw internal fixation assisted by shoulder arthroscopy.Methods From August 2014 to August 2022,30 patients with glenoid fracture were selected from Huangshi Love&Health Hospital Affiliated of Hubei Polytechnic University for orthopedic surgery through retrospective study.They were divided into two groups according to the treatment methods of open reduction and internal fixation and reduction and internal fixation under arthroscopy,namely,the minimally invasive group(surgery assisted by arthroscopy,n=15)and the incision group(conventional incision surgery,n=15).The operation index,shoulder joint activity 1 month and 3 months after operation,pain stress indicators before and 7 d after operation,and treatment costs were recorded.Results The incision length of the incision group was significantly longer than that of the minimally invasive group,and the intraoperative blood volume was more than that of the minimally invasive group.The operation time of the minimally invasive group was significantly longer than that of the incision group,and the treatment cost was significantly higher than that of the incision group.The levels of prostaglandin E2 and inflammatory factors including C-reactive protein in the two groups at 7 d after operation were significantly higher than those before surgery,but the level in the minimally invasive group was lower than that in the incision group.The degree of lateral and circumferential rotation of the shoulder joint in the early postoperative period(1 month)and the Constant score in the minimally invasive group were higher than that in the incision group,with a statistically significant difference(P<0.05).Conclusion Fixation of glenoid fracture with wire anchor nail under shoulder arthroscopy can significantly improve the early rotation of the shoulder joint,and help to improve its pain stress.The constant score is higher,which can improve the treatment effect of patients,improve limb function,shorten the surgical incision,and reduce intraoperative bleeding.However,the operation time is long and the treatment cost is high in the minimally invasive group.
Objective To investigate the feasibility of bone cement augmented proximal femoral anti-rotation nail in the treatment of Seinsheimer type Ⅴ subtrochanteric fractures in the elderly.Methods The CT data of one volunteer was imported into Mimics 19.0 and Geomagic studio 2017 to extract and optimize the 3D model of the right femur.Draw internal fixation model and assembled with femur model according to the standard operation technology,then imported into Hypermesh 14.0 software to simulating Seinsheimer type Ⅴ subtrochanteric fractures.The cancellous bone around the proximal helical blade was redefined as bone cement,obtaining bone cement augmented proximal femoral anti-rotation nail model.The material property parameters,boundary conditions,and applied loads were set and imported into LS-DYNA software for solution.Results ①Compared with the common proximal femoral anti-rotation nail model,the helical blade of the bone cement augmented proximal femoral anti-rotation nail model had no cutting,and the varus and rotation angle of the head and neck bone block was smaller.Although the local stress was slightly larger,the whole was more stable.②The strong anchoring force of bone cement can stabilize the helical blade,improve the inner action point of the three-point support,and transmit and disperse the pressure.Conclusion Compared with the common proximal femoral anti-rotation nail,the bone cement augmented proximal femoral anti-rotation nail could effectively reduce the varus rotation of the head and neck bone block in the treatment of Seinsheimer type Ⅴ subtrochanteric fractures in elderly patients,avoid the cutting of the spiral blade,and offer enhanced stability.
Objective To compare the efficacy of closed prying reduction and percutaneous screw internal fixation with oblique plastic plate internal fixation in the treatment of tongue shaped calcaneal fractures.Methods A total of 68 patients with tongue shaped calcaneal fracture admitted to Sichuan Orthopedic Hospital from January 2016 to May 2018 were retrospectively selected,and the patients were divided into two groups according to the different surgical methods.Among them,35 patients were treated with closed prying reduction and percutaneous screw internal fixation(closed reduction group),and the remaining 33 patients were treated with inclined contoured internal fixation(oblique plate group).The operation time,hospitalization time,fracture healing time and postoperative calcaneal height,Böhler angle,complications and long-term prognosis were observed in both groups.Results A total of 68 cases were followed up for three years after operation.The operation time,hospitalization time and fracture healing time of the closed reduction group were significantly shorter than those of the oblique plate group(P<0.05).There was no significant difference in calcaneus height and Böhler angle between the two groups(P>0.05).There was no significant difference in the total incidence of complications and long-term prognosis between the two groups(P>0.05).Conclusion Closed prying reduction and percutaneous screw internal fixation can shorten the operation time,hospitalization time and fracture healing time of tongue shaped calcaneal fracture.Compared with oblique contoured internal fixation,there is no significant difference in correcting calcaneal height,Böhler angle,short-term and long-term complications.
Objective To compare the early knee joint functional scores and forgotten joint score between unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)for the treatment of early-stage medial compartment osteoarthritis of the knee,and to evaluate and analyze the differences in early forgotten joint score between the two procedures.Methods A retrospective analysis was conducted on 296 patients who underwent TKA or UKA in the department of joint surgery of Shanghai Guanghua Hospital of Integrative Traditional Chinese and Western Medicine from October 2016 to October 2020.The patients were divided into two groups based on the different surgical procedures:TKA group(144 cases)and UKA group(152 cases).Outpatient follow-up examinations were performed at 1,3,6,12 and 24 months after discharge,and the forgotten joint score,knee joint function scores(HSS scores),and visual analog scale(VAS)scores were evaluated.Results ① All 296 patients were followed up for 24-37 months,with an average follow-up period of(30.41±6.93)months.② The HSS scores and VAS scores of both TKA and UKA groups significantly improved at 2 years postoperatively compared to preoperative scores,and the differences within each group were statistically significant(P<0.05).③ There was no statistically significant difference in the degree of improvement in knee joint VAS scores at 2 years postoperatively between the two groups(P>0.05),but the improvement in HSS scores in the UKA group was better than that in the TKA group,and the difference was statistically significant(P<0.05).④ The forgotten joint score at 1,3,6,12 and 24 months postoperatively were all higher in the UKA group compared to the TKA group,and the differences were statistically significant(P<0.05).Conclusion ① Both procedures can effectively improve the function and pain scores of late-stage knee osteoarthritis.② UKA,as an effective treatment for medial compartment destruction of the knee,not only improves the knee joint function score but also significantly enhances the patients'perception of their knee joint,making it a preferable option for treating late-stage knee osteoarthritis.
Objective To investigate the short-term clinical effect of lumbo-iliac fixation combined with percutaneous anterior pelvic ring fixation in the treatment of vertically rotating unstable pelvic ring fractures.Methods Patients with unstable pelvic ring injury who were treated with anterior subcutaneous internal fixation(INFIX)combined with posterior lumbar inter-pelvic internal fixation were collected and analyzed retrospectively from September 2018 to January 2022.The Matta standard was used to evaluate the quality of pelvic reduction,and the Majeed score was used to evaluate the clinical outcomes of patients.Further evaluation included surgical time,intraoperative blood loss,and incidence of complications.Results The average follow-up time of patients was 12.6 months(6-18 months).The average operation time and intraoperative blood loss were 117.6 min(96-162 min)and 203.6 mL(146-280 mL)respectively for anterior subcutaneous INFIX combined with posterior lumbar inter-pelvic internal fixation.The excellent and good rate of reduction quality was 86.8%(25 cases were excellent,8 cases were good,5 cases were average,and 0 case was poor).There was no sign of heterotopic ossification.At the last follow-up,the clinical results of Majeed's score showed that the excellent and good rate was 84.2%(excellent in 28 cases,good in 4 cases,general in 4 cases,poor in 2 cases).A total of 6 patients with sacral nerve root injury underwent intraoperative decompression,and the symptoms of 5 patients improved.Two cases of infection after anterior INFIX were improved after 4 weeks of internal fixation.Lateral femoral cutaneous nerve stimulation in 3 cases.Conclusion The treatment of vertically rotating unstable pelvic ring fracture with lumbo-iliac fixation combined with percutaneous anterior pelvic ring fixation has the advantages of short operation time,less bleeding and less intraoperative soft tissue damage,and the short-term clinical effect is satisfactory.
Objective To explore a new type of fracture reduction and fixation system and to find a new treatment method for clinical fracture reduction and fixation.Methods A new type of adjustable locking reduction fixation system for long bone fractures was developed by analyzing the concept of existing fracture fixation techniques and various clinical fracture types.Taking the locking structure of the locking plate as a prototype,the fixing system was divided into two parts.Combining the existing fixing technology concept and mechanical principle,the connecting rod had the function of adjusting the length.The fracture end was reduced by lifting nail,combined with clinical fluoroscopy assisted fracture line alignment.Full-length X-rays of partial normal adult limbs of the Suzhou Hospital of Medical College,Nanjing University,from January 2019 to July 2022 were selected to measure the length between their bony markers,which was used as the length reference for this design.The data were measured by the ruler of the imaging system.Results The reduction fixation system could treat long bone fracture from a new perspective.During surgery,the surface bony mark was used as the fixation point.The percutaneous septum of the lifting nail was used to reduce the fracture:The length of the fracture end was adjusted by the main nut,and the reduction rack could reduce the fracture,thus realizing the design method of three-dimensional reduction and fixation of the fractures.Conclusion The adjustable locking reduction fixation system had the advantages of convenient operation such as minimally invasive fixation and one-time operation to fix long bone fractures.There was no need for a second operation after bone healing.
Objective To design and prepare an injectable hydrogel with the biomimetic rheological characteristics of a normal synovial fluid,and the effect of this hydrogel on inhibiting cartilage degeneration after knee trauma and its possible mechanism are also studied.Methods An injectable tissue adhesive hydrogel(PWN)was synthesized using polyvinyl alcohol solution,starch,and sodium chloride as the primary constituents.The rheological properties,injectability,degradability,cyto-compatibility,anti-bacterial adhesion performance,and tissue adhesion of PWN and HA injections were analyzed using rheological,injection force,in vitro degradation,CCK-8 test,Live/Dead staining,bacterial adhesion test and tissue adhesion tests.A knee joint mechanical instability model was created in rats,and 1 week post-surgery,PWN and HA were administered into the joint cavity.The rats were categorized into four groups:The normal,PWN,hyaluronic acid(HA),and non-treated groups.After four weeks of treatment,the knee joint samples of the rats underwent Micro-CT and histological staining analyses for assessing and comparing the protective effects on articular cartilage and subchondral bone in vivo.Results PWN exhibited good cell compatibility and injectability.In comparison to HA,PWN displays rheological characteristics more akin to normal joint synovial fluid.Moreover,PWN had a slow degradation behavior,enhanced tissue adhesion performance,and an anti-bacterial adhesion performance.The Micro-CT analysis results showed that the bone density and bone volume/tissue volume of subchondral bone in the PWN group were significantly higher than those in the untreated and HA groups(P<0.05).Meanwhile,compared to HA,the safranine and fast green staining results showed that the cartilage surface in the PWN group exhibited good continuity and no obvious damage or erosion,and the abundance of distributed proteoglycan was similar to that in the normal group.Conclusion Compared to clinically used HA products,the PWN displays rheological properties similar to natural synovial joint fluid,slow degradation,and superior tissue adhesion performance.This may effectively prevent the degeneration of articular cartilage and subchondral bone remodeling caused by mechanical instability in the knee joint of rats.Therefore,this hydrogel is anticipated to be utilized independently or in conjunction with HA for the clinical management of articular cartilage ailments like OA.
Objective To compare the clinical efficacy between percutaneous coaxial large-channel endoscopic lumbar interbody fusion(PE-LIF)and Wiltse-approach transforaminal lumbar interbody fusion(MIS-TILF)in the treatment of degenerative lumbar spinal stenosis.Methods A retrospective analysis was performed on the clinical data of 65 patients who underwent lumbar decompression and interbody fusion surgery in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2021 to December 2021 for degenerative lumbar spinal stenosis,according to different surgical methods,it was divided into PE-LIF group(24 cases)and MIS-TLIF group(41 cases).The operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital days and complications of the two groups were compared.The levels of whole blood C-reactive protein(CRP)and serum phosphocreatine kinase(CK)before surgery,and at 1 d and 7 d after surgery were compared between the two groups to evaluate the degree of paravertebral muscle damage.The visual analogue score(VAS)of low back and lower extremity pain before surgery,and at 3 d,1 month,3 months and 12 months after surgery,and the Oswestry disability index(ODI)at preoperative,and at 3 months and 12 months of postoperation were recorded and compared between the two groups to assess the surgical efficacy,and the improved MacNab criteria were used to evaluate the excellent and good rates of the two groups at the last follow-up.The Brantigan criteria was used to evaluate the interbody fusion in the two groups.Results Patients in both groups were followed up for 12 to 22 months,with an average of 17.1 months.The intraoperative blood loss,postoperative drainage volume and postoperative hospital stays of PE-LIF group were less than the MIS-TLIF group(P<0.05),but the PE-LIF group had a longer operation time(P<0.05).There was no significant difference in the content of CRP before surgery and at 1day after surgery between the two groups(P>0.05),but the content of CRP in the PE-LIF group was lower than that in the MIS-TILF group at 3 d of postoperation(P<0.05).There was no significant difference in serum CK between the two groups before surgery(P>0.05),but the serum CK of the PE-LIF group at 1 d and 7 d after surgery was lower than that in the MIS-TILF group(P<0.05).The VAS score of low back and lower extremity pain and the ODI score at each time point after surgery in the two groups decreased significantly compared with the preoperative period(P<0.05),but there was no significant difference between two groups(P>0.05).At 12 months after surgery,the interbody fusion of the surgical segment between two groups were all reached to 3 level or above,and there was no significant difference in the interbody fusion rate between the two groups(90.2%VS 87.5%,P>0.05).There was no significant difference in postoperative complications and the efficacy evaluation of MacNab criteria between the two groups(P>0.05).Conclusion The surgery of PE-LIF and MIS-TLIF can both effectively relieve pain,improve lumbar spine function,and have a satisfied intervertebral fusion rate in the treatment of degenerative lumbar spinal stenosis.Moreover,PE-LIF has less intraoperative blood loss and postoperative drainage,and less damage to paravertebral muscles,which is more in line with the concept of minimally invasive spine surgery.
目的 研究自制拉钩辅助下经椎间孔外侧入路椎间融合术(extraforaminal lumbar interbody fusion,ELIF)在腰椎临床治疗过程中的效果.方法 从2019年1月至2021年12月于武汉中西医结合骨科医院就诊需要行腰椎手术治疗的腰椎退行性病变患者中,选取28例患者行自制拉钩辅助下ELIF.其中,男15例,女13例,年龄39～78岁(60.57±10.51)岁.分别记录患者的手术切口大小、手术时间、术中出血量、术后引流量,术前和术后7 d、1个月及3个月的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、术后融合率,并进行统计学处理.结果 28例患者均顺利完成手术,术中无改变手术方式病例.28例患者均完成随访,随访时间5～18个月,平均(10.61±3.25)个月,手术切口为(5.21±1.23)cm,手术时间87～118 min(102±8.98)min,术中出血量为(112.14±26.44)mL,术后引流量为(90.35±20.17)mL.术后7 d、1个月及3个月视觉模拟评分(VAS评分)、Oswestry功能障碍指数(ODI)和术前相比,差异具有统计学意义(P＜0.05).术后27例患者脊柱融合,1例患者融合欠佳.结论 自制拉钩辅助下经椎间孔外侧入路椎间融合术效果好,融合率高、微创,为退行性腰椎病变治疗提供了一个良好的方案.
Objective To evaluate the clinical efficacy of rh-BMP2-loaded hydroxyapatite(HA)prosthetic material in the repair of tibial plateau fractures in comparison with HA bioceramic prosthetic material.Methods A retrospective analysis was performed on 53 patients with Schatzker type Ⅳ and Ⅵ tibial plateau fractures admitted to department of orthopedics,the 920th Hospital of the Joint Logistics Support Force of PLA from October 2014 to September 2019.All patients underwent open reduction and internal fixation and intraoperative bone grafting.Among them,27 patients were treated with hydroxyapatite artificial bone loaded with rh-BMP2(study group),and the other 26 patients were treated with hydroxyapatite bioceramic bone grafting(control group).The fracture healing time,HSS score,Rasmussen and complications were used to compare the clinical efficacy of the two groups of materials.Results All the patients were followed up for(10.45±2.31)months and all patients finally achieved bone union.The fracture healing time of the study group[(13.46±3.38)weeks]was significantly shorter than that of control group[(16.67±6.51)weeks](P<0.05).The HSS score of the study group[(85.53±5.30)scores]was better than that of control group[(80.58±6.40)scores]at 6 months after operation(P<0.05).However,there was no significant difference in Rasmussen imaging score at 6 months after operation between the two groups(P>0.05).At the same time,there was no significant difference in the incidence of complications(fracture-related infection,fracture recollapse,delayed bone union,joint stiffness)between the two groups(P>0.05).Conclusion Compared with conventional artificial bone in the treatment of tibial plateau fracture defect,hydroxyapatite artificial bone loaded with rh-BMP2 has a shorter fracture healing time and is more conducive to the early recovery of knee joint function,but without increasing the risk of complications.It can be considered as a good alternative material for bone repair.
As an age-related chronic disease and a major cause of low back pain,intervertebral disc degenerative diseases(IDDDs)have attracted increasing attention nowadays.Due to the lack of a thorough understanding of the molecular mechanisms behind the pathogenesis of IDDDs,there is no effective treatment or intervention for these diseases so far.Compared with clinical samples and cell culture models,experimental animal models which are designed to mimic human IDDDs have been established and widely used for the biomedical researches in this field.Therefore,in this article,we reviewed the commonly used IDDDs animal models which include age-induced spontaneous IDDDs model,induced IDDDs model by physical and chemical changes,genetic modification models,nutrition supply modification models,etc.The general treatment or surgical procedures,and the advantages and limitations of each model are discussed in this review.
Objective To create a personalized guide template through digital orthopedic technology,and insert pedicle screws on the lower cervical physical model under the guide of the guide plate,and compare the difference between the method and the traditional manual screw placement method in the accuracy of screw placement.Methods The CT data of 30 patients hospitalized in Wuhu Second People's Hospital from January 2021 to December 2021 who underwent 3D reconstruction of cervical spine CT were randomly selected.The 3D reconstruction was performed by using the Mimics software to simulate the pedicle screw placement,and the optimal approach was designed.Then the individualized reverse template was extracted and designed by reverse engineering software,and the vertebral body model and the guide template with nail path were produced by 3D printing.On the C3-C6 vertebral body model,the random number method was used to randomly place pedicle screws on one side(group A)with the aid of guide templates,and the screws on the other side(group B)with bare hands.The accuracy of screw placement was checked and compared between the two groups.Results All cervical vertebrae models successfully completed bilateral screw placement,a total of 240 screws.In group A,116 screws(96.7%)were Grade Ⅰ,and 4 screws(3.3%)were Grade Ⅱ.In group B,the position of 73 screws was Grade Ⅰ(60.8%),17 screws(14.1%)were Grade Ⅱ,11 screws(9.2%)were Grade Ⅲ,and 19 screws(15.8%)were Grade Ⅳ,with significant difference between the two groups(P<0.05).Conclusion In this study,the individualized guide template was created by computer-assisted software and 3D printer,and the nail placement was successfully completed on the physical model under the guidance of the guide plate.The accuracy rate of the nail placement was significantly superior to that of the manual nail placement method,which has a good prospect of clinical application.
Functional orthopedic biomaterials are emerging in accordance with a better understanding of bone regeneration and progress of tissue engineering scaffolds.Inorganic polyphosphate(polyP)is a physiologically occurring biopolymer with high-energy phosphoric anhydride bonds that exists in osteoblasts and platelets,whose degradation products such as phosphate ions and energy can participate in bone regeneration and metabolism.Inspired by such events,polyphosphate biomaterials have been explored as novel bone substitutes in both amorphous and crystalline forms,along with impressive outcomes both in vitro and in vivo.This review summarizes the characteristics,physiological effects,cellular mechanisms,and material science progress of such unique biomaterial,providing basis of the application of high-energy polyphosphate in bone regeneration.In spite of its fundamentals and advances,challenges and controversies of polyphosphate are also discussed as an effort to promote its bench to bedside clinical translation in the future.
The problem of bone to tendon joint healing after tendon or ligament reconstruction operations has not been solved.In recent years,there have been more and more studies on the application of tissue engineering scaffold materials,especially artificial scaffold materials,to promote bone to tendon joint healing,which have achieved good results.This article summarizes the research progress of artificial scaffold materials and their application in promoting tendon joint healing,providing reference ideas for the design of synthetic scaffold and clinical application.
In recent years,the relationship between biological clocks and osteoporosis has attracted great interest from researchers in various fields.Biological clocks regulate the rhythm of the body and maintain its physiological functions.Many studies have confirmed that bone metabolism is also regulated by the circadian clock genes.Once the rhythm is disrupted,bone mass is lost,and the signs and symptoms of osteoporosis appear.The close link between the circadian rhythms and osteoporosis also provides new ideas for the clinical prevention and treatment of osteoporosis.By reviewing previous articles,this paper summarizes the ways in which the biological clocks affect bone metabolism and the new ways in the treatment of osteoporosis,in order to provide references for clinical practice.
Objective To explore the difference in therapeutic effect of two different exposure methods for proximal humeral fractures through the anterior approach of the shoulder joint.Methods The data of 47 cases of proximal humeral fractures treated in our department from April 2018 to March 2020 were retrospectively analyzed,using the anterior approach of shoulder joint.The deltoid space of the pectoralis major muscle was used in 26 cases,with an average age of(62.5±2.2)years.According to Neer's classification,there were 4 cases in the second part,9 cases in the third part,and 13 cases in the fourth part;and the other entered into the deltoid muscle space in 21 cases,from about 0.5-1.0 cm outside the front edge of the deltoid muscle,with an average age of(61.3±2.2)years.According to Neer's classification,there were 4 cases in the second part,7 cases in the third part,and 10 cases in the fourth part.The operation time,intraoperative blood loss,healing time,shoulder joint function score,pain score and postoperative complications of the two different exposure methods were compared.Results All 47 patients were followed up for 10-25 months,with an average of(15.6±4.7)months,all fractures healed in the first stage.There was no statistically significant difference in surgical time,intraoperative bleeding,and healing time between the deltoid muscle space of pectoralis major muscle group and the deltoid muscle space group(P>0.05).The last follow-up Constant-Murley score was(81.2±1.5)points in the deltoid muscle space of pectoralis major muscle group and(79.4±2.1)points in the deltoid muscle space group,there was a statistically significant difference between the two groups(P<0.05),the shoulder joint function of the deltoid muscle space of pectoralis major muscle group was better than that of the deltoid muscle space group.There was no statistically significant difference between the deltoid muscle space of pectoralis major muscl group and the deltoid muscle space group in the last follow-up VAS score(P>0.05).There was 1 postoperative complication in the deltoid muscle space of pectoralis major muscle group and 7 complications in the deltoid muscle space group,with a statistically significant difference(P<0.05),there was a higher incidence of postoperative complication in the deltoid muscle space group,which affected the surgical efficacy.The exposure of the deltoid muscle space of pectoralis major muscle group was satisfactory and did not damage the deltoid muscle.The deltoid muscle space group had some difficulties when it needed better exposure of the shoulder swelling,and the front deltoid muscle might be broken during the traction process,affecting the forward flexion and lifting function of the shoulder.Conclusion The exposure of the deltoid space between the pectoralis major muscle is more thorough than the exposure of the deltoid split muscle,resulting in less damage to the deltoid muscle and more satisfactory recovery of shoulder joint function.
Objective To investigate the merits and demerits and clinical efficacy of ultrasonic bone knife under microscope in anterior cervical decompression compared with traditional lamina bone-biting forceps in anterior ossification of cervical spondylosis.Methods The 32 patients who underwent anterior cervical decompression and fusion in the Second Affiliated Hospital,Air Force Medical University from May 2017 to June 2019 were retrospectively analyzed.There were 18 cases in the ultrasonic bone knife group and 14 cases in the lamina bone-biting forceps decompression group.The operation time,bleeding volume,postoperative drainage volume,hospitalization days,complications,JOA score and NDI score,imaging spinal canal occupancy rate,cervical Cobb angle and fusion rate were recorded and compared between the two groups.Results Two groups of patients were successfully completed surgery,the patients in the two groups were followed up for 12-24 months,with an average of(16.18±3.33)months.One case of recurrent laryngeal nerve injury occurred in the ultrasonic bone knife group after operation,there were 2 cases of cerebrospinal fluid leakage and 2 cases of recurrent laryngeal nerve injury in the lamina bone-biting forceps decompression group,no serious complications occurred in both groups.The operation time,intraoperative blood loss and postoperative drainage volume of the ultrasonic bone knife group were less than those of the lamina bone-biting forceps decompression group(P<0.05).At the last follow-up,the NDI index of the two groups was significantly lower than that before operation(P<0.05),and the JOA score was significantly higher than that before operation(P<0.05).There was no significant difference in NDI index between the two groups at the last follow-up(P>0.05).The JOA score and the JOA improvement rate of the ultrasonic bone knife group was better than that of the lamina bone-biting forceps decompression group,and the difference was statistically significant(P<0.05).The postoperative spinal canal occupation rate of the two groups was significantly lower than that before operation(P<0.05),and the cervical Cobb angle were significantly increased before operation(P<0.05).There was no significant difference in spinal canal occupation rate between the two groups at the last follow-up(P>0.05).The cervical Cobb angle of the ultrasonic bone knife group were better than those of the lamina bone-biting forceps decompression group(P<0.05).Conclusion Microsurgical anterior cervical decompression with ultrasonic bone knife can significantly reduce bleeding,shorten operation time,reduce complications and improve functional recovery.
目的 应用有限元分析方法,比较一种新型外固定支架与钢板在治疗Sanders ⅢAB型跟骨骨折的应力分布及生物力学的稳定性.方法 获取一位正常成人踝及跟骨CT图像,应用软件构建跟骨Sanders ⅢAB型骨折模型及其外固定模型、钢板模型,经材料赋值及力学加载,记录各模型的骨折块位移情况,并分析其应力分布情况.结果 模型载荷加载后,钢板模型中,钢板及螺钉位移峰值为0.13 mm,跟骨骨块位移峰值为0.26 mm;钢板及螺钉应力峰值为281.10 MPa,跟骨骨块应力峰值为297.40 MPa.外固定模型中,外支架位移峰值为0.17 mm,跟骨骨块位移峰值为0.27 mm;外固定及克氏针应力峰值为125.40 MPa,跟骨骨块应力峰值为38.13 MPa.结论 该新型外固定支架在治疗Sanders ⅢAB型骨折时,固定牢靠、有效,能提供足够的生物力学稳定性,为跟骨骨折的治疗提供了新思路.
