目的 评价铆钉结合克氏针辅助固定治疗RockwoodⅢ型急性肩锁关节脱位的治疗效果.方法 回顾性分析2018年3月—2020年3月厦门大学附属第一医院收治的21例RockwoodⅢ型急性肩锁关节脱位手术患者的临床资料,均采取切开复位、铆钉固定于喙突、2条尾线分别贯穿固定于锁骨远端内侧(即斜方韧带和锥状韧带附着点)、克氏针辅助固定维持复位的手术方式.结果 术程顺利,手术时间(49.1±7.6)min,术中出血量(81.2±11.8)mL.随访时间6～9个月,平均随访时间7个月,随访期间未出现铆钉拔钉、克氏针松动、骨折或肩锁关节再脱位.术后3、6个月肩关节功能Constant-Murley评分分别为(97.4±0.9)、(97.6±0.7)分,优于术前的(41.4±7.3)分,手术前后比较,差异有统计学意义(P<0.05);Karlsson评分优良率均达100％.结论 采用铆钉结合克氏针辅助固定治疗RockwoodⅢ型急性肩锁关节脱位具有手术微创、操作简单、术后肩关节功能恢复快、无需二次手术的优点,短期疗效满意.

Objective To evaluate osteogenesis effect and degradation performance of the digital coral hydroxyapatite (CHA) artificial bone in vivo.Methods Twenty four New Zealand rabbits were respectively prepared into bilateral tibia lacunar bone models with defect of diameter of 5 mm and depth of 15 mm,and were randomly divided into the experimental group and the blank control group,12 rabbits in each group.The rabbits of the experimental group were implanted with the digital CHA artificial bone scaffold,while those of the blank control group were implanted without any material.The X-ray and histological examination and scoring,according to Lane-sandhu,were respectively performed at the 4th,8th and 12th weeks after operation.Results In the experimental group,at the first 4th week after operation,the fiber tissue packaged the digital CHA artificial bone specimens,and the specimens were soft and degraded;at the 8th week after operation,the specimens continued to degrade and new bone formed on the surface;at the 12th week after operation,there was new bone wrap around the specimen,which was closely connected with the peripheral bone and was replaced by new bone.In the experimental group,the scores of the radiological and histological grading increased gradually in 4,8,12 weeks after operation.And the scores of the experimental group were higher than those of the blank control group,with statistically significant differences (P ＜0.05).Conclusion The digital CHA artificial bone has good osteogenesis effect and suitable performance of degradation in vivo,showing good prospects as a kind of new type of artificial bone material,which can be personalized and customized.

Objective To investigate the medium-term efficacy of total hip replacement with CFP handle prosthesis.Methods Thirty-two patients (34 hips) undergoing total hip replacement with CFP handle prosthesis were selected.The preoperative diagnosis was:femoral neck fracture in 6 cases,femoral head necrosis in 12 cases,osteoarthritis in 10 cases,ankylosing spondylitis in 3 cases,and pigmentation villi nodular synovitis in 1 case.Ten days,1 month,6 months,and 1 year (a year later) after surgery,the hip joint function and X ray film performance were followed up.Results There was no complication such as infect and injury of blood vessel and nerve.Postoperative X ray film showed the femoral handle prosthesis position was good.The average Harris hip score was 32.6 (20-53) scores before surgery,and back to 95.3(90-100) scores after surgery,no patients needed revision surgery.Postoperative Engh score was above 10 scores after half a year.Conclusion The medium-term efficacy of total hip replacement with CFP handle prosthesis is good,and can be used as one of the choice of primary total hip replacement.

BACKGROUND:We have successfuly prepared digital coraline hydroxyapatite artificial bone scaffold in previous experiments, and it has been confirmed that it has the necessary physical and chemical properties of bone tissue engineering scaffolds. OBJECTIVE: To evaluate the sensitization of digital coraline hydroxyapatite artificial bone scaffold. METHODS:A total of 32 guinea pigs were randomly divided into saline group (negative control group, n=8), 5% formaldehyde group (positive control group,n=8), experimental A group (the mass ratio of 3:1,n=8), and experimental B group (the mass ratio of 4:1,n=8). Sensitization test at the maximal dosage was performed&nbsp;according toBiological Evaluation of Medical Devices-Part 10: Tests for Irritation and Delayed-Type Hypersensitivity, including intracutaneous induction, local induction, and provocation. Patch was removed after 24 and 48 hours, and the skin response was classified according to Magnusson and Kligman criteria. Patch was removed after 48 hours, and the skin was performed with biopsy, stained with hematoxylin-eosin, and observed under optical microscope. RESULTS AND CONCLUSION: Sensitization response was not tested in the negative control group, experimental A group and experimental B group at 24 and 48 hours after patch removal; however, moderate erythema was observed in the positive control group. Optical microscope demonstrated that spongiosis, edema, diffuse or perivascular mononuclear infiltration was not observed, and only a smal number of basicytes were seen in the experimental A and B groups. These findings indicate that the digital coral hydroxyapatite artificial bone scaffolds, with the mass ratio of 3:1 and 4:1, are biologicaly safe for sensitization.

目的:探讨膝关节单髁置换术(Unicondylar knee arthroplasty,UKA)治疗膝关节病的早期临床疗效及技术特点.方法:对15例1 7个膝关节行UKA,其中:男6例(7膝)、女9例(11膝);年龄42～90岁,平均65岁;术前诊断:骨性关节炎9例(11膝)、股骨内侧髁坏死3例(3膝)、创伤性关节炎3例(3膝).结果:15例患者均获得随访,时间3～26个月,平均15.3个月.患者术后在疼痛、功能、活动度方面改善明显,膝关节本体感觉良好,HSS评分由术前(38.5±3.5)分提高到术后(89.4±4.1)分,差异有统计学意义(P＜0.05),手术优良率90.5％.术后定期摄膝关节正侧X线片均显示膝关节假体位置、力线良好,股骨、胫骨假体周围无X线透亮线,假体无任何松动迹象,髌骨轨迹良好.结论:UKA对于治疗局限单间室的膝关节病,早期临床疗效满意,它具有切除骨质少,植入异物少,手术时间短便于翻修等特点.

Objective To compare the outcome of proximal femoral nail anti-rotation (PFNA)versus anatomical locking plate (ALP) in treatment of unstable intertrochanteric fracture.Methods The study included 89 patients who had received PFNA fixation (PFNA group,n =45) or ALP fixation (ALP group,n =44) for unstable intertrochanteric fracture between February 2008 and September 2009.Operation time,amount of bleeding,drainage volume,postoperative complications,fracture healing time and hip joint score after fracture healing were compared between two groups.Results Mean operation time in PFNA group was obviously shorter than that in ALP group (61.4 minutes vs 114.8 minutes,P ＜0.01).Mean amount of bleeding and drainage volume were significantly lower in PFNA group than in ALPgroup (119.3 mlvs 136.8ml,P＜0.01; 74.9mlvs80.3 ml,P＜0.01).While,PFNA group was not significantly different from ALP group with regard to average fracture healing time and Harris hip joint score after fracture healing (4 months vs 4.1 months,P ＞ 0.05; 91.2 points vs 89.8 points,P ＞0.05).Two patients had poor fracture reduction in PFNA group,but all patients had good fracture reduction in ALP group.No obvious adverse postoperative complications occurred in PFNA group,but one patient had fracture nonunion in ALP group.Conclusions PFNA and ALP fixation of unstable intertrochanteric fracture present insignificant differences in fracture healing time,postoperative complications and hip joint function after fracture healing.Whereas,PFNA is more suitable for the elder patients on account of shorter operation time and less intraoperative bleeding.

目的观察采用组配式假体置换治疗桡骨小头骨折的临床疗效。方法对接受组配式假体置换的桡骨小头骨折12例的资料进行回顾性分析。结果本组获得随访9～45个月,按照HSS肘关节功能评分标准评定:优8例,良2例,一般2例。结论组配式桡骨小头假体置换可以提高肘关节的稳定性,适用于治疗成人不稳定的粉碎性桡骨小头骨折。

Objective To observe the therapeutic effect of percutaneous laser disc decompression(PLDD) for protrusion of lumbar intervertebral disc in adolescents. Methods Twenty-nine 15-21 years old adolescents(25 males and 4 females) with protrusion of lumbar intervertebral disc herniation were treated with PLDD.A semiconductor laser with of wave length of 980 nm was used.The total dosage of laser ablation ranged 800 to 1 000 Joule at the level of the disc.The patients were followed up for 12-21 months.The therapentic effect was assessed according to the Macnab criteria. Results Excellent,good and poor therapeutic effect was achieved in 23,3 and 3 patients,respectively,with excellent and good therapautic effect rate of 89.7%. Conclusions PLDD is a safe and effective and minimally invasive procedure for the protrusion of lumbar intervertebral disc in adolescents.

目的观察保留股骨颈型全髋关节置换术(THA)治疗青壮年晚期股骨头坏死的中期疗效。方法分析27例(28髋)接受保留股骨颈型THA的青壮年晚期股骨头坏死患者中期随访资料,评价疗效。结果本组获50～85个月随访,平均69个月。无一例行髋关节翻修。Harris评分术前平均46.7分,末次随访时平均91.3分。结论保留股骨颈型全髋置换术治疗青壮年晚期股骨头坏死中期疗效满意。

目的探讨侧卧位置入股骨近端髓内钉(PFN)内固定治疗股骨粗隆间骨折方法的可行性。方法分别采取自然侧卧位(30例)和传统平卧位(21例)行PFN内固定手术,对两组手术时间和术后复位优良率进行统计学分析。结果侧卧位组与平卧位组平均手术时间分别为(61.3±18.6)、(89.4±26.8)min,差异有统计学意义(P<0.05);术后复位优良率分别为90.2%、90.9%,差异无统计学意义(P>0.05)。结论侧卧位置入股骨近端髓内钉内固定治疗股骨粗隆间骨折方法可行,可缩短手术时间,同时可保持术后骨折复位优良率。

Objective To determine if the 120 KDa Fn-f is able to induce rabbit disc degeneration in vivo.Methods Thirty New Zealand white rabbits underwent injection of 120KDa Fn-f and PBS as the control substance into the central region of separate lumbar discs using a fine needle. Euthanasia was performed at the 2-, 4-, 8-, 12-, and 16-week time points and the discs were examined radiographically, histologically, electron microscope and with gene expression. Results In the experimental groups the sagittal T2-weighted imaging firstly showed loss of disc hydration at 8 weeks time point. The high light density almost disappeared at 16 weeks time point. All the control groups hadn’t the same changes. Radiographs demonstrated anterior osteophyte formation at 120KDa Fn-f injected disc spaces by the 12-week time point. Histology demonstrated a progressive loss of the normal architecture of the nucleus pulposus and anulus fibrosus over the 16-week study period. Gene expression studies demonstrated a significant down-regulation of both aggrecan mRNA between the 8- and 16-week time points.Conclusion 120KDa Fn-f appears to induce a progressive degenerative process within the intervertebral disc after injection that resembles degenerative disc disease. Further studies are warranted to elucidate the mechanism and molecular events associated with Fn-f-mediated disc degeneration.

Objective To investagate the effect of surgery on less common pediatric Gartland I Ⅳ-type supracondylar humerus fractures.Methods 8 cases of children with severe humerus supracondylar fractures(Gartland Ⅳ type),admitted from March 2008 to August 2010 in Department in Pediatric Orthopaedics of the First Hospital of Xiamen,were investigated and evaluate the efficacy of surgical treatment.Results 8 patients with Gartland Ⅳ supracondylar humerus fractures underwent both open reduction and Kirschner wire fixation,and received functional exercise of the elbow in the early stages.The effect of surgery was good for all patients,as showed no case of nonunion,cubitus varus and nerve damage in one to three years follow-up time.Conclusion Open reduction is still the main means for children with Gartland Ⅳ supracondylar humerus fractures.In addition,early functional exercise is to improve the efficacy of the types of fractures and prevent cubitus varus deformity.

BACKGROUND: BrdU is a simple marker with high labeling rate, but there are various reports concerning its toxity. OBJECTIVE: To observe the effects of BrdU labeling on proliferation and osteogenic potentiality of bone marrow mesenchymal stem cells (BMSCs) of Sprague Dawley rats. METHODS: Rat BMSCs were isolated and cultured by direct adherent method. The ability of monoclone and proliferation was detected after labeling with 0.2% BrdU. Following 3 weeks of culture with osteogenic inducer, changes in osteogenic ability of BMSCs were observed using alizarin red staining, fluorescence immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) before and after labeling. RESULTS AND CONCLUSION: The proliferation and monoclone of BMSCs were decreased obviously after BrdU labeling. The number and area of clones in BrdU labeling group were less than the normal control group (P < 0.05). The proliferation of the BrdU labeling group was slower when entering increased logarithmic phase at day 4, and the peak level was low (P < 0.05). Regarding osteogenic ability, BMSCs expressed osteocalcin, type I collagen following osteogenic induction in the labeling and normal control group, with significant calcium nodules. However, the RT-PCR analysis showed that there was no significant difference in the expression of osteocalcin gene in BMSCs before and after labeling (P > 0.05). Above-mentioned results indicated that BrdU labeling inhibited proliferation and monoclone of BMSCs, but could not decrease its ability of osteogenic differentiation, and could be widely used as a tracer in research of BMSCs as seed cells.

回顾性分析15例严重广泛脱套污染创面使用负压封闭式引流技术(VSD)治疗的临床病例资料,14例得到了随访,其中3例出现皮肤坏死,2例股骨干骨折延迟愈合,2例膝关节僵硬。应用VSD技术治疗广泛污染脱套创面疗效远优于常规治疗方法。

Objective To observe the clinical effect and safety of nano2 hydroxyapatitepolyam ide 66(n2HAPA66)composite in the ilium due to Developmental Dysplasia of Hip(DDH).Methods From January 2007 to May 2009,10 patients(2 males,10 females;age,1.5～3.5 years,averaged 2.5 years) with Developmental Dysplasia of Hip(DDH).were treated with the n2HAPA66 pieces.1 of the patients had bilateral DDH.The osteotomy sites were filled up w ith the n2HAPA66 grains.The incision healing,local inflammatory reaction,rejection,toxic reaction,osteotomy site healing,and function recovery of the limbs were all observed after operation.Results All the patients were followed up for 5～28 months,and all the incisions healed by the first intention.There were no inflammatory reactions,and no rejection or general toxic reaction.At 1.5～2 months(mean 1.75 months)after operation,osteogenesis was found in the space filled with the n2HAPA66 grains.3 months after operation,the patients′ lower limbs could bear weight.Conclusion The n2HAPA66 grains have great biological safety,good biocompatibility,and good bone conduction,which are good materials for the bone repair and reconstruction,and can be safely,and effectively used during in the ilium due to Developmental Dysplasia of Hip(DDH).

Objective To study whether CT imaging technology combined with computer program-ming can be used to quantitatively evaluate the initial stability of the tapered femoral component at the proximal femur. Methods Thirty patients who had undergone total hip arthroplasty were included in this study.Anteroposterior and lateral radiographs and spiral CT scans were taken for their tapered stems of femoral component inserted into their medullary cavities of Type A or Type B. The sectional views of CT scans were programmed on computer for calculation of the contact areas between the 4 zones of the tapered stems and the cancellous and cortical bone at the medullary cavity. Results The X-rays and the sectional views of CT showed the 3-point fixation pattern was obtained by the femoral stems in the medullary cavity. The contact areas between the 4 zones of the tapered stems and the cancellous and cortical bone at the medullary cavity were 22. 9%, 13.6% 7.9%, and 3.3% respectively. Conclusion It is possible to use CT imaging combined with computer programming as a quantitative method to evaluate the contact areas between the tapered com-ponent and the proximal femur following total hip arthroplasty.

目的观察人工髋关节置换治疗老年人股骨颈骨折的临床疗效。方法采用人工髋关节置换术治疗符合纳入标准的股骨颈骨折患者96例,观察并记录手术时间、术中失血量、卧床时间、住院时间及临床疗效。结果本组96例患者经过治疗后疗效优32例,占33.33%;良52例,占54.17%;可9例,占9.38%;差3例,占3.13%;优良率87.50%。其中有1例患者在术后2年假体出现了松动。本组96例患者手术时间平均为(45.8±11.9)min,术中出血量平均为(245.8±38.9)mL,住院时间平均为(14.5±3.8)d,卧床时间平均为(5.5±1.2)d。结论人工髋关节置换治疗老年股骨颈骨折术后髋关节功能优良率高,且具有手术时间短、术中出血少、住院时间及卧床时间短等特点。

目的 采用异种骨脱细胞基质(heterogenous bone acellular matrix,HBACM)复合细胞构建组织工程骨并植入动物体内,观察其对骨缺损的修复作用.方法 培养与鉴定兔成骨细胞(osteoblast,OB)、血管内皮细胞(vascular endothelial cell,VEC)以及两种细胞的混合细胞.使用猪肋骨制备HBACM,并分别与OB、VEC以及两种细胞的混合细胞共同培养制备组织工程骨.27只新西兰大白兔随机分为三组,切除兔双前肢桡骨制成骨缺损动物模型,左侧植入HBACM与各组细胞复合培养的组织工程骨,右侧植入HBACM为对照.分别于术后3、6、12周取材,观察骨折愈合情况.结果 大体形态观察和X线检查表明,组织工程骨修复骨缺损的速度和程度为:联合培养细胞组＞OB组＞VEC组＞单纯HBACM组.BrdU标记细胞示踪检测结果显示:6周时,HBACM上仍可检测到体外培养的标记细胞,并可见新生软骨形成.常规组织学检查可见12周时组织工程骨与正常骨之间的髓腔再通,骨折愈合.Ⅰ型胶原免疫组化研究发现三组均表达Ⅰ型胶原,VEC组略弱.组织切片图像分析示血管面积联合培养细胞组＞VEC组＞OB组,差异有统计学意义.结论 联合培养细胞作为组织工程骨种子细胞可以缩短骨折愈合时间、促进骨缺损的修复.

<正>先天性肌性斜颈是小儿骨科常见病,早期治疗效果好,面部畸型可以完全纠正。我院自1998年至今,收治68例,均经手术治疗,疗效满意。现报道如下:1资料与方法1.1一般资料本组68例患孩,男38例,女30例;年龄1~8岁,1~2.5岁43例,2.5~8岁25例;左侧44例,右侧24例;臀位产史23例,剖腹产史16例。常规拍颈椎X片,排除骨性畸形。

AIM: To observe the biocompatibility, antigenicity and cytotoxicity of acellular matrix porcine ribs as the scaffold material combined with rabbit osteoblast and vascular endothelial cells (VECs). METHODS: The experiment was conducted in the Key Laboratory for Biotherapy of Human Diseases of Ministry of Education, West China Hospital of Sichuan University from April to October 2003. The acellular matrix porcine ribs were prepared by physical and chemical methods. Rabbit osteoblast and VECs were cultured in vitro. There were three groups in this study. ①Osteoblast group, which compounded the osteoblast with acellular matrix bone. ②VECs group, which compounded VECs with acellular matrix bone material. ③Osteoblast+VECs group, which compounded the osteoblast+ VECs with acellular bone material. ④Control group, which was the simple osteoblast. On days 1, 3, 5 and 7, the biocompatibility and antigenicity of acellular matrix xenograft were observed by inverted phase contrast microscope, histological sections and scanning electron microscope; the effects of the materials on cell cycle and DNA content were detected by flow cytometry to identify if the materials had toxic effect on cells. RESULTS: ①Scanning electron microscope observation of acellular matrix bone suggested that the trabecular bone structure of acellular matrix bone was complete with empty bone lacuna, and no cell components were found. ②The observation of the growth, differentiation and proliferation of cells under inverted phase contrast microscope appealed that when co-cultured with the acellular matrix bone material for 12 hours, the cells of three groups attached and grew on the material surface and in pore. ③Histological observation: MASSON straining showed that the cell of each group massively proliferated on the material surface and in pore, and secreted extracellular matrix. The number of attached cells was the most in the osteoblast+VECs group. Histological stained sections appealed the cells could attach the material border tightly with good histocompatibility. ④The observation of the growth, differentiation and proliferation of cells under scanning electron microscope found that when co-cultured with the material for 5 days, the cells of each group attached the material surface. Osteoblasts were fusiform or polygon, and the cells were connected by ecphyma. VECs were ellipse with cornua, and adhered with material closely. A plenty of cells in the osteoblast+VECs group were attached the material surface, and lots of collagen was found. Little collagen was observed in the VECs group. ⑤On days 1 and 3, the DNA synthesis period of osteoblast+VECs group was longer than the osteoblast group and VECs group, and no heteroploid cells were found.CONCLUSION: Acellular matrix bone displays good biocompatibility, low antigenicity, and no cytotoxicity or oncogenicity. Osteoblast co-cultured with VECs has strong proliferative potential in acellular matrix heterogenous bone.