近年,股骨头坏死患者逐年递增,其好发于中青年男性,严重影响患者身体健康.吻合血管游离腓骨移植(FVFG)是治疗股骨头坏死保髋手术方法之一,适用于各种原因导致的中青年股骨头坏死患者,尤其对早期的非激素性股骨头坏死患者具有较好的保髋疗效.FVFG能提高患者的髋关节功能评分,对改善患者生活质量具有较好效果.FVFG较其他保髋术式有其自身优点,但需做好手术适应证筛选.此外,缺少有效的植骨区血供测定方法,难以了解术后植骨区骨细胞血运情况,仍是需要解决的问题.
跟腱病(AT)是常见的足踝疾病之一,其特点为跟腱内血管增生,多发于老年人和运动员.近年来,由于AT发病率和流行率不断上升,AT相关研究越来越受到重视,但对AT流行病学、生物力学、功能评估方法和临床治疗方案等方面的系统梳理总结仍相对不足.该文就AT发病情况、解剖结构特征、生物力学改变、病因以及临床诊疗方法与手段等方面的研究现状进行综述.
经皮椎体成形术(PVP)作为治疗骨质疏松性椎体压缩骨折(OVCF)的重要手段,研究其不同穿刺入路具有重要意义.双侧椎弓根入路可使骨水泥在椎体内弥散更加均匀;单侧椎弓根入路具有出血少、透视次数少、时间短等优点;弯角椎弓根入路以单侧椎弓根入路进针,骨水泥在椎体内多点注射,同时保留了单侧椎弓根入路与双侧椎弓根入路的优点;横突-椎弓根入路骨性标志定位明确,穿刺成功率高,关节突损伤风险低;单侧后外上方入路、横突上缘椎体外侧壁入路和横突-椎弓根极外侧入路穿刺不受椎弓根约束,有利于骨水泥在椎体内均匀分布,为PVP提供了更加灵活和安全的选择;肋横突间椎弓根入路和前外侧入路在胸椎和颈椎PVP治疗中具有明显优势;Kambin三角入路通过经典手术入路区域进行穿刺,具有较好的应用价值.该文就PVP手术入路研究进展进行综述.
全膝关节置换术是一种治疗膝关节退行性疾病的方式,是改善并纠正膝内翻以及重建膝关节稳定的理想方法之一.全膝关节置换术后疗效与下肢机械轴角度相关,目前临床上对于中立位对线与运动学对线的选择颇有争议,也是当前研究的热点及难点.该文从生理性生物力学重建、术后步态生物力学、关节活动度、患者术后满意度、假体生存时间等方面对膝内翻全膝关节置换术下肢机械轴进行综述.
三角纤维软骨复合体(TFCC)作为腕关节重要的解剖结构,承担着不可替代的生物力学作用,损伤后如果不治疗可能会导致腕部尺侧慢性疼痛和不稳定.经保守治疗后症状仍未缓解的TFCC损伤患者需要行进一步的手术治疗.然而,目前对于TFCC损伤的分型和治疗方法仍没有统一的标准,这给其诊治带来了一系列难题.该文以TFCC损伤的Palmer及Atzei分型为基础,在关节镜技术发展的前提下,详细阐述了各类型损伤的治疗方式及预后结果,为TFCC损伤提供了临床诊疗思路及参考依据.
Objective To compare the recent clinical efficacy of a hollow nail with medial support plate with the efficacy of the femoral neck system(FNS)using a dynamic cross nail in the treatment of Pauwels type Ⅲ femoral neck fracture in young adults.Methods A total of 40 young and middle-aged patients with type Ⅲ femoral neck fracture treated in Jining First People's Hospital between January 2019 and December 2021 were included as study subjects,of whom 20 patients were treated with three hollow nails plus a medial support plate for internal fixation(group A)and 20 others treated with FNS internal fixation(group B).Patients in both groups were followed up for at least 1 year,and the operation status,postoperative recovery quality,postoperative complications,Harris hip function score(HHS score),Barthel index,and ADL score of the two groups were recorded and compared.Results The mean incision length and operation time in group A was longer than that in group B,and the mean intraoperative blood loss was greater than that in group B;however,the intraoperative fluoroscopy times in group A were shorter than those in group B,and the intraoperative reduction quality was significantly higher(P＜0.05).The visual analogue scale(VAS)score of group A was higher than that of group B within 14 days after surgery,but this difference in VAS score was not significant(P＞0.05).The times to weight-bearing exercise and fracture healing in group A were shorter than those in group B(P＜0.05).There were only two postoperative complications in group A(one case of fracture nonunion and one case of femoral head necrosis),fewer than the eight cases in group B(one case of fracture nonunion,two cases of femoral head necrosis,two cases of infection,and three cases of internal fixation failure)(P＜0.05).The HHS score,Barthel index,and ADL score of group A were all significantly higher than those of group B at 6 and 12 months after operation(P＜0.05).Conclusion For young adults with Pauwels type Ⅲ femoral neck fracture,compared with FNS internal fixation,hollow nail plus medial support plate internal fixation results in more satisfactory intraoperative reduction,and although the surgical trauma is greater,the short-term postoperative hip functional recovery is better,and both the postoperative femoral head necrosis rate and internal fixation failure rate are lower,which can accelerate the recovery process and improve patients’quality of life.
脊柱小关节骨关节炎(FJOA)是老年人群腰背痛的常见原因,且随着年龄的增大,其患病率也逐步增加.目前对于FJOA的治疗主要分为保守治疗和手术治疗.保守治疗主要是药物、理疗等,其主要作用于疾病早期,效果有限,主要是缓解患者症状,但不能阻止疾病进展.手术治疗主要包括关节突撑开和固定术、关节突置换术、关节突关节置换联合人工椎间盘置换术.随着疾病的进一步进展,由于FJOA晚期往往合并脊柱失稳、滑脱及神经受压,常需行脊柱融合术,不仅增加了治疗的难度,也增加了患者治疗费用,因此在FJOA早期进行手术值得关注.该文就FJOA手术治疗进展进行综述.
组织工程通过协调细胞、生物材料支架和信号分子进行体内外组织或器官再生,随着该领域技术的不断发展,其已成为较大骨缺损或骨再生能力受损患者可能的治疗方案.对支架进行功能化改造,可在克服各种不利因素影响的同时促进骨再生.该文对不同骨病环境中有治疗潜力的骨再生组织工程设计方案进行综述,希望为促进该领域研究由基础实验转向临床应用提供理论依据.
Objective To investigate the clinical efficacy of combined full-thread cannulated screw fixation and traditional plate internal fixation in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods The data of 80 patients with calcaneal fractures admitted to Shanghai Gongli Hospital between January 2016 and December 2022 were retrospectively analyzed.Thirty-nine cases were treated with combined hollow threaded screw fixation,while 41 cases were treated with traditional plate internal fixation.The follow-up data from the perioperative period,imaging,and long-term recovery were compared between the two groups.Results There were no significant differences in preoperative general data between the two groups(P＞0.05).The preoperative preparation time was(3.7±2.1)days in the cannulated screw group and(4.6±2.2)days in the plate group.The postoperative hospital stay was(5.1±3.0)days and(10.9±6.6)days,respectively,while the overall hospital stay was(8.8±3.7)days and(15.9±7.3)days.The operation time was(129.9±34.5)min and(140.7±34.4)min,respectively,while intraoperative blood loss was(37.4±25.9)mL and(65.5±53.6)mL.All of the above items differed significantly between the two groups(P＜0.05).There were four cases(10.2%)of wound complications in the cannulated screw group and nine cases(21.9%)in the plate group,but the difference was not statistically significan(P＞0.05).The postoperative Bohler's angle,Gissane's angle in both groups were significantly better than those measured preoperatively(P＜0.05),and there was no significant difference in Gissane Angle and Bohler Angle between the two groups before and after surgery(P＜0.05).All patients were followed up for a mean of(14.9±3.65)months(range,12-26 months).At 12 months after operation,the American orthopedic foot and ankle society score was(89.0±7.8)in the cannulated screw group,with excellent scores in 22 cases,good in 14 cases and fair in three cases,and the excellent and good rates equaled 92.3%of the total.In the plate group,the score was(87.8±9.6),with 18 rated excellent,19 good,and 4 fair,and the excellent and good rate was 90.2%.There was no significant difference in the score between the two groups(P＞0.05).Conclusion Compared with the traditional plate internal fixation,the follow-up results of treatment with a combined cannulated threaded screw have the same excellent and good rates,with the benefits of reduced trauma and preoperative preparation and shorter overall hospital stay.
关节假体周围感染(PJI)是全关节置换术(TJA)后严重的并发症之一,日益受到关注.尽管目前PJI的诊断方法有很多种,但仍缺乏金标准.已有研究发现,引入局部取材标本和提高病原检出率的方法有望提高PJI的诊断准确率.该文在讨论现有PJI诊断方法的基础上,提出临床和未来研究中诊断PJI的新视角,并重点介绍基因测序与超声裂解2种PJI诊断方法.
Objective To compare the clinical efficacy between robot-assisted puncture versus freehand puncture for percutaneous vertebroplasty(PVP)to treat Genant Ⅲ osteoporotic vertebral compression fracture(OVCF).Methods A retrospective study on 23 patients with Genant Ⅲ OVCF who underwent PVP surgery was performed in our hospital using data collected between Jan 2020 and June 2022.Twelve patients were treated by robot-assisted PVP(group A)and another 11 patients were treated by freehand PVP(group B).The two groups were compared with regard to number of punctures,operation time,number of fluoroscopies,cement leakage,and visual analogue scale(VAS),as well as Oswestry disability index(ODI)evaluated before operation,on post-operative day 1 and at the last follow-up after surgery.Results The mean operation time of group A was 37.25±2.60 minutes,which was not significantly shorter than that of group B(39.55±6.85 minutes)(P＞0.05).However the number of punctures and fluoroscopies and rate of cement leakage in group A were all significantly less and lower,respectively,than those in group B(both P＜0.05).The VAS and ODI scores on post-operative day 1 and at the last follow-up after surgery were both significantly lower than those before surgery(P＜0.05),however,were no significant differences in these parameters between the two groups(P＞0.05).Conclusion Robot-assisted puncture PVP to treat Genant Ⅲ OVCF improves puncture accuracy,reduces the number of fluoroscopies required,and reduces bone cement leakage.
儿童急性血源性骨髓炎是儿童最常见的骨骼肌肉感染性疾病,如果延误治疗,可能导致严重后果,如深静脉血栓、骨骼畸形和慢性骨髓炎等,对患者、家庭和社会都带来极大负担.因此,儿童急性血源性骨髓炎的早期准确诊断和及时合理治疗非常重要.该文对儿童急性血源性骨髓炎早期诊断和治疗的研究进展进行综述,以期改善该疾病的治疗规范性,提高疗效.
骨巨细胞瘤是一种临床多见的原发性骨肿瘤,具有较强的侵袭性.骨巨细胞瘤通常位于长骨骨端,桡骨远端是骨巨细胞瘤的第三大好发部位,但局部复发率较高.桡骨远端骨巨细胞瘤整块切除术后腕关节重建一直是巨大挑战,腕关节成形术(包括自体腓骨移植、同种异体骨关节移植及全腕关节或部分腕关节假体置换)可使患者获得灵活的腕关节.近年来,随着 3D打印技术的成熟,人工假体更加个性化,为骨科医师带来了更优选择.该文就桡骨远端骨巨细胞瘤整块切除术后腕关节重建方法研究进展进行综述.
骨关节炎(OA)是一种常见的慢性关节疾病,以关节软骨退行性变和继发性骨质增生为特点,主要影响老年人,引起关节疼痛、僵硬等症状,严重者可发生关节畸形甚至残疾.目前OA治疗多以疼痛管理和关节置换为主,不能达到修复受损软骨或恢复组织稳态的目的.诱导多能干细胞(iPSC)具有很强的向软骨细胞分化的潜能,且具有可通过对体细胞重编程获得、来源较多、不涉及伦理问题等特点.iPSC的出现为软骨修复提供了新的途径,并有望在OA早期治疗中发挥重要作用.该文就iPSC在OA治疗中的应用进展进行综述.
骨缺损是骨科的常见疾病之一,随着骨组织工程技术的不断发展与进步,越来越多的骨修复材料被应用于临床,为骨组织修复提供了新型的治疗策略.水凝胶因具有良好的生物相容性和生物降解性,有望成为一种有潜力的骨组织修复材料.近年来,更多有关水凝胶的研究和应用聚焦于对水凝胶进行改性.改性后的水凝胶一方面可以更高效地释放负载因子并发挥作用,另一方面其力学性能也变得更优异,从而更符合组织工程支架的要求.该文就近年来在新型杂化纳米颗粒水凝胶负载细胞因子促进骨修复、水凝胶预防和治疗骨科细菌感染及开发性能更好的骨组织工程支架和3D打印支架等方面的最新进展进行综述.
目的 探讨肩关节镜手术中采用超声引导下选择性臂丛神经阻滞对围手术期镇痛的有效性及安全性.方法 选取 2021 年 1 月至 2021 年 12 月于联勤保障部队第 910 医院行单侧肩关节镜手术患者共 88 例,分为两组:选择性阻滞组 46 例,接受超声引导下选择性臂丛神经阻滞;传统阻滞组42 例,接受超声引导下肌间沟臂丛神经阻滞.结果 选择性阻滞组患者神经阻滞起效时间明显低于传统阻滞组(P＜0.05);选择性阻滞组患者的术后不同时间点疼痛视觉模拟评分(VAS)均明显低于传统阻滞组(P＜0.05);选择性阻滞组患者术后不同时间点屈肘、屈腕肌力均明显优于传统阻滞组(P＜0.05);选择性阻滞组患者术后膈肌麻痹程度明显低于传统阻滞组(P＜0.05);选择性阻滞组患者术后霍纳综合征的发生率明显低于传统阻滞组(P＜0.05),而主观满意率明显优于传统阻滞组(P＜0.05).结论 在肩关节镜手术中采用超声引导下选择性臂丛神经阻滞可起到更好的围手术期镇痛效果,患者满意度较高,术后可早期开展康复训练.
骨关节炎(OA)是以关节疼痛、肿胀、活动障碍为特征的退行性骨科疾病.除软骨磨损外,滑膜炎症在OA病理改变中的作用同样值得关注,其与疼痛症状密切相关,并具有判断预后的价值.关节内外多种因素均可导致滑膜炎症的产生,OA发生时关节内多种结构炎症因子产生增多,与软骨退变后释放的磨损颗粒、含钙晶体、细胞外囊泡等共同构成关节腔的炎症微环境,可上调滑膜中成纤维细胞和巨噬细胞的炎症基因表达.此外,滑膜受力异常、滑膜中衰老细胞增多也可参与滑膜炎症的发生,而肥胖、糖尿病引起的全身代谢紊乱则可通过激活炎症通路、影响胰岛素敏感性等加剧滑膜炎症.该文就OA中滑膜炎症致病因素的研究进展进行综述.
股骨假体周围骨折是全髋关节置换术的严重并发症,Vancouver分型是指导股骨假体周围骨折临床治疗最常用的分型.股骨假体周围骨折的处理需要考虑骨折、假体、骨量、患者情况以及医师经验等.该文从股骨假体周围骨折的流行病学入手,分析导致骨折的危险因素,通过Vancouver分型探讨其治疗原则及常用方法,以期对股骨假体周围骨折的诊疗有所帮助.
目的 比较颈椎零切迹椎间融合器与传统颈前路减压植骨融合内固定(ACDF)手术治疗颈椎病的疗效.方法 选取 2017 年 5 月至 2021 年 4 月在遂宁市中心医院脊柱外科接受手术治疗的 116 例单节段脊髓型颈椎病患者作为研究对象,采用随机数字表法将患者分为研究组和对照组各 58 例,研究组患者采用颈前路颈椎零切迹椎间融合器实施手术治疗,对照组患者采用传统ACDF手术实施治疗.比较两组患者的手术时间、出血量、住院时间;比较两组患者手术前后的影像学参数(椎间隙高度、Cobb角、颈椎曲度指数)、视觉模拟疼痛评分(VAS)、日本骨科协会(JOA)评分及手术并发症发生率.结果 研究组手术时间少于对照组(P＜0.05),两组患者出血量、住院时间无明显差异(P＞0.05).两组患者术前、术后 3个月、术后 6个月的椎间隙高度、Cobb角、颈椎曲度指数均无明显差异(P＞0.05);术后 3 个月、6 个月,两组患者的椎间隙高度、Cobb角、颈椎曲度指数均较术前显著升高(P＜0.05).两组患者术前VAS评分、JOA评分无显著差异(P＞0.05);术后 3 个月、术后 6 个月研究组患者JOA评分均高于对照组(P＜0.05),VAS评分两组间无差异(P＞0.05);术后 3 个月和 6 个月,两组患者的VAS评分均较术前降低(P＜0.05),JOA评分均较术前升高(P＜0.05);研究组患者术后发生并发症 3 例(5.17%),对照组患者术后发生并发症 6 例(10.34%),两组间无统计学差异(P＞0.05).结论 颈椎零切迹椎间融合器与传统ACDF手术治疗单节段脊髓型颈椎病均能取得较好的临床效果,颈椎零切迹椎间融合器治疗方式能取得更好的恢复效果.
包括经皮椎体成形术和经皮椎体后凸成形术在内的椎体强化术可通过向骨折椎体内注入骨水泥来达到短时间内重建椎体强度和缓解疼痛的目的,是目前骨质疏松性椎体压缩骨折治疗中应用最广泛的微创技术.然而,越来越多的研究认为骨质疏松性椎体压缩骨折椎体强化术后,骨水泥弥散情况与临床预后之间存在相关性,但基于不同研究中观察角度的不同,其内在联系尚存争议.该文就椎体强化术后骨水泥分布情况对临床预后的影响进行综述.
