Purpose To evaluate the short-term clinical efficacy and advantages of surgery robot positioning system for insertion of Femoral Neck System (FNS) in the treatment of femoral neck fractures. Methods The clinical data of 52 patients with Femoral neck fracture (FNF) who had been treated with FNS between June 2020 and September 2021 were retrospectively analyzed. Among them, 26 patients were treated with traditional FNS (control group), while 26 additional patients were treated with FNS assisted by an orthopaedic robot positioning system (study group). The operation duration, frequency of key-guide needle placement, intraoperative blood loss, incision length, fracture healing rate, fracture healing time, and the Harris scores at the last follow-up were calculated and compared between the 2 groups. Results The study group had shorter operation duration, fewer numbers of placing the key-guide needle, less intraoperative blood loss, and smaller surgical incisions than the control group (all, P < 0.05). There was no significant difference in the rate of fracture healing rate between the 2 groups ( P = 0.47), while the fracture healing duration of the study group was shorter than that of the control group ( P = 0.03). At the last follow-up, compared with the control group, the Harris score and the number of excellent and good ratings were significantly higher in the study group (all, P < 0.05). Conclusions Using orthopaedic surgery robot positioning system-assisted FNS in the treatment of FNFs can effectively improve the efficiency of surgery, shorten operation time, and reduce the number of placing the key-guide needle, intraoperative blood loss, and operative trauma. Simultaneously, it shortens the duration of fracture healing and improves the recovery of hip function.

Objective Acute acromioclavicular (AC) joint dislocation is a common orthopedic injury that can significantly impair shoulder function and reduce quality of life. Effective treatment methods are essential to restore function and alleviate pain. To investigate the short-term clinical efficacy of the minimally invasive closed-loop double endobutton fixation assisted by orthopaedic surgery robot positioning system (TiRobot) in the treatment of AC joint dislocation, and to evaluate its feasibility and safety. Methods The clinical data of 19 patients with AC joint dislocation who underwent treatment with closed-loop double Endobutton fixation assisted by TiRobot between May 2020 and December 2022 were retrospectively analyzed. Visual Analog Scale (VAS) pain scores, the Constant Murley Score (CMS), and shoulder abduction range of motion were assessed and compared preoperatively and at the last follow-up. Computed tomography (CT) parameters of the acromioclavicular joint, including acromioclavicular distance (ACD), the distance between the upper and lower Endobutton (DED), the horizontal distance between the anterior edge of the distal clavicle and the anterior edge of the acromion (DACC), the diameter of the clavicular tunnel (DCT), and coracoid tunnel diameter (DC), were compared at 2 days, and 1 month after surgery, as well as at the last follow-up, along with the evaluation of intraoperative and postoperative complications. Results The postoperative VAS, CMS, and shoulder-abduction range of motion were significantly improved compared with the preoperative (all, P<0.05). The statistical analysis showed no significant difference in the CT image parameters of the acromioclavicular joint at 2 days and 1 month after surgery(all, P>0.05). Comparisons of DCT and DC revealed statistically significant differences between the last follow-up and 1 month after surgery (P<0.05), and no statistically significant difference was found in ACD, DED, and DACC(all, P>0.05). There were no complications such as infection or vascular or neurological damage, no cases of rostral or clavicle fractures, loss of reduction, heterotopic ossification, shoulder stiffness, and no loosening or breaking of internal fixations. Conclusion Closed-loop double endobutton internal fixation assisted by TiRobot is an ideal method for the treatment of acute acromioclavicular (AC) joint dislocation. This method has the advantages of relatively simple operation, more accurate localization of bone tunnel during operation, less surgical trauma, and good recovery of shoulder function.

背景:对于PauwelsⅢ型股骨颈骨折,内固定方式选择尚未达成共识.目的:采用三维有限元方法分析股骨颈系统治疗成人PauwelsⅢ型股骨颈骨折的生物力学特征,为其在临床实践中的应用提供理论依据.方法:利用志愿者CT影像资料建立PauwelsⅢ型股骨颈骨折模型,同时建立4种内固定模型:4枚空心拉力螺钉、双平面双支撑螺钉固定、经皮加压钢板、股骨颈系统.将内固定模型与股骨模型按照临床常用固定方法进行装配,最后使用Ansys软件进行加载、计算,分析各模型股骨与内固定的应力分布、应力峰值和最大位移.结果 与结论:①股骨近端骨折块应力主要分布在股骨颈下方靠近股骨距附近,4枚空心拉力螺钉组应力峰值最大,股骨颈系统组最小;②近端骨折块位移峰值4枚空心拉力螺钉组最大,股骨颈系统组最小;③股骨位移峰值经皮加压钢板组位移峰值最大,双平面双支撑螺钉固定组最小;④内固定应力主要分布在骨折面附近内固定装置表面,经皮加压钢板组应力峰值最大,4枚空心拉力螺钉组最小;⑤内固定位移峰值经皮加压钢板组位移峰值最大,双平面双支撑螺钉固定组最小;⑥结果表明,相较于其他3组,股骨颈系统显示出更小的近端骨折块应力及位移,内固定应力分布更均匀、分散,力的传导性更好.此外,双平面双支撑螺钉内固定位移峰值最小,但其内固定应力大于股骨颈系统,且应力相对集中,这可能会导致螺钉断裂.结果 说明,股骨颈系统生物力学稳定性更优,可以为骨折愈合创造更好的力学环境.

Objective:To investigate the early clinical effects of orthopedic surgery robot-assisted double Endobutton titanium plate internal fixation in the treatment of fresh acromioclavicular joint dislocation.Methods:Thirty-nine patients with fresh acromioclavicular joint dislocation were included from January 2020 to January 2022. A total of 19 patients were treated with double Endobutton suspension internal fixation assisted by the domestic third-generation orthopaedic surgical robot (TiRobot ? 2.0) Dimensity system. There were Rockwood type III in 11 cases, type IV in 8 cases. Twenty cases were treated with conventional incision double Endobutton internal fixation, with Rockwood type III in 13 cases, type V in 7 cases. The operation duration, blood loss volume, incision length and hospitalization time were compared between the two groups. The following CT parameters of acromioclavicular joint at 2 days and 1 year after operation, distance between distal inferior cortex of clavicle and subacromial cortex, distance between upper and lower endobuttons, horizontal distance between anterior edge of distal clavicle and anterior edge of acromion and diameter of coracoid process and diameter of clavicular tunnel were measured. The visual analogue score (VAS), Constant-Murley shoulder function score and shoulder abduction activity were also evaluated before and at 12 months after operation. Results:The follow-up duration was 10.8±2.4 months in the robot group and 11.5±3.1 months in the routine group. The VAS score of the robot group decreased from 5.3±2.1 to 0.3±0.2 at 12 months after operation ( t=10.46, P=0.014). The Constant-Murley score increased from 55.6±6.4 to 92.0±4.2. The range of shoulder abduction increased from 42.2°±5.4° to 172.6°±6.1° ( t=17.24, P<0.001). The operation duation of the robot group was 74.4±6.6 min, which was longer than that of the conventional group 61.7±7.2 min ( t=5.43, P=0.037). There was no significant difference in VAS score, Constant-Murley score, shoulder abduction activity or CT measurement between the two groups ( P>0.05). During the follow-up, two cases in the robot group had cortical osteolysis on the supraclavicular surface, one case in the conventional group had loss of reduction, one case in the supraclavicular cortical osteolysis, and 4 cases in the cortical defect on the side of the coracoid process tunnel. Conclusion:Orthopedic robot-assisted and conventional incision with double Endobutton titanium plate internal fixation in treating fresh acromioclavicular joint dislocation can achieve satisfied early clinical effects. Accurate establishment of clavicle and coracoid bone tunnel assisted by robot can overcome the defects of bone tunnel deviation in conventional incision operation and can prevent reduction and bone loss. However, robot-assisted and conventional incision Endobutton internal fixation could enlarge bone tunnel.

Objective:To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods:Data of 20 patients (22 sided) with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed. There were 11 males and 9 females with an average of 42.1±3.2 years (range, 24-68 years). There were 7 cases of unilateral acetabular anterior column fracture, 2 cases of bilateral acetabular anterior column fracture (4 sides), 7 cases of anterior column with ipsilateral sacral fracture, and 4 cases of anterior column with sacroiliac joint injury. There were 3 hips of Area I, 6 Area II, 13 Area III of acetabular anterior column fractures according to Nakatani partition. The time from injury to surgery was 5 days (range, 3-11 days). All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy, and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction. The time of operation, the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded. Matta scoring criteria were used to assess fracture reduction quality, and hip function was assessed at the last follow-up according to the modified Merle D' Aubigné and Postel scoring system.Results:The average operative time was 22±10 min (range, 20-40 min) with an average times of intraoperative fluoroscopy of 30±8 times (range, 21-45 times), and the amount of intraoperative blood loss was 20±5 ml (range, 10-40 ml). 20 patients were followed up after operation for a period of 14±3.1 months (range, 12-18 months). The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria: anatomical reduction in 18 hips, satisfactory reduction in 2 hips, unsatisfactory reduction in 2 hips, with an excellent and good rate of 91% (20/22). The fracture healing time was 13±2.2 weeks (range, 11-16 weeks). At the lastest follow-up, hip function was assessed according to the modified Merle D' Aubigné and Postel scoring system: excellent 18, good 3, fair 1, and the satisfactory rate was 95%(21/22). No major neurological, vascular injury, wound infection and ectopic ossification were found during follow-up.Conclusion:Using laser-assisted axial fluoroscopy percutaneous screw to treat acetabular anterior column fracture, the operation is simple. And there is low risk to damage important blood vessels and nerves. This method can shorten the operation time of acetabular anterior column fracture, reduce the amount of blood loss during the operation, and the outcome is satisfactory.

目的 比较关节镜下使用2枚Endobutton钢板与切开复位使用空心螺钉固定后交叉韧带(posterior cruci-ate ligament,PCL)胫骨止点撕脱骨折的临床疗效.方法 2015年3月至2018年6月我科收治急性PCL胫骨止点撕脱性骨折患者56例,其中男35例,女21例;年龄18～55岁,平均(29.51±15.02)岁.56例患者随机分为两组,26例采用关节镜下使用2枚Endobutton钢板结合高强线固定(关节镜组),30例采用改良的膝关节后内侧切口使用2枚空心螺钉固定(切开复位组).比较两组患者的手术时间、住院费用,术前、术后3d、术后1个月、术后1年膝关节疼痛评分,末次随访膝关节活动度、Lysholm评分、后抽屉试验阳性率及术后并发症等情况.结果 两组患者均获随访,随访时间12～19个月,平均(14.55±2.63)个月.末次随访所有患者骨折均愈合,无内固定失败、再次骨折发生.关节镜组较切开复位组手术时间长、住院费用高,两组比较差异有统计学意义(P<0.05).关节镜组术后3 d膝关节疼痛评分小于切开复位组,两组比较差异有统计学意义(P<0.05);两组患者术前、术后1个月、术后1年膝关节疼痛评分比较差异无统计学意义(P>0.05).两组患者末次随访膝关节活动度、ysholm评分、后抽屉试验阳性率比较,差异无统计学意义(P>0.05).结论 关节镜下使用2枚Endobutton袢钢板与改良膝关节后内侧入路使用空心螺钉治疗PCL止点撕脱骨折,均可获得良好的手术效果.关节镜组有微创、早期疼痛程度轻的优点,但手术时间较长、费用稍高.

[目的]介绍应用双螺杆骨折撑开器辅助切开复位锁定钢板内固定治疗跟骨SandersⅡ、Ⅲ型骨折的操作方法和初步疗效.[方法] 2016年2月～2017年5月,本院收治的14例(14足)粉碎性跟骨骨折患者,采用跟骨外侧“L”型切口,术中使用内外侧双螺杆骨折撑开器辅助复位,置入跟骨锁定钢板固定.[结果] 14例患者均顺利手术,无腓肠神经损伤.随访12～16个月.末次随访时AOFAS踝-后足评分为61～96分,其中优7例,良6例,可1例,优良率为92.86％ (13/14).影像方面,Bohle角由术前(14.14±5.58)°显著增加至术后(28.14±5.77)°(P＜0.05),Gissan角由术前(106.64±8.81)°显著增加至术后(124.36±5.70)°(P＜0.05).所有骨折末次随访时均已愈合,无内固定松动、退钉、断钉等发生.[结论]使用双螺杆撑开器辅助复位治疗跟骨SandersⅡ、Ⅲ型骨折,可以有效恢复跟骨高度,避免骨折复位再丢失,简化操作,减少手术并发症.

Objective To investigate the feasibility and short term clinical efficacy of early minimally invasive treatment of complex pelvic trauma with Starr reduction frame combined with O?arm navigation system. Methods From June 2017 to De?cember 2018, thirty two patients with Tile C complex pelvic fractures were prospectively divided into two groups according to the random number table. The open treatment group included 17 cases (open reduction and internal fixation group; 10 males and 7 fe?males, age 24-60 years, average 37±6.5 years;according to Tile classification, 8 cases of C1 type, 8 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 9 cases in zone I, 6 cases in zone II and 2 cases in zone III). The combined treatment group included 15 cases (Starr reduction frame group combined with O?arm navigation system, 8 males and 7 females, age 32-57 years, average 40±5.2 years; according to Tile classification, 8 cases of C1 type, 6 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 8 cases in zone I, 5 cases in zone II and 2 cases in zone III). The ilioinguinal and Stoppa approaches were used in the open treatment group, and the anterior and posterior ring injuries were fixed with reconstruction plate screws and hollow screws, respectively. In the combined treatment group, starr frame was used to assist reduction, combined with "O" arm navigation technique, infix internal fixation frame, superior pubic branch screw, sacro?ilium screw were used to fix the anterior and posterior ring injury. The quality of pelvic fracture reduction was evaluated by the Matta scoring system, and the Majeed score was used to evaluate the clinical efficacy. Results All patients were followed up for 6 to 12 months. The hospitalization time (45±11 d), operation time (220.0±49.4 min) and fracture healing time (24.0±5.6 weeks) in the open treatment group were longer than those in the combined treatment group (21±9 d, 180.0±24.2 min, 16.1±3.8 weeks), and the intraoperative blood loss (820.0±140.4 ml) was significantly higher than that in the combined treatment group (24.0±10.4 ml) (t=6.651, 2.772, 6.128, 22.874; all P<0.05). According to Matta scoring system, in the open treatment group, there are 8 excellent cases, 6 good cases, 2 fair cases, 1 poor case, thus the excellent and good rate was 82.4%(14/17). While 9 cases were excellent, 5 good, 1 fair, and the excellent and good rate was 93.3% (14/15) in the combined treatment group. At the latest follow?up, Majeed score was 51-85 points in the open treatment group, including excellent in 8 cases, good in 6 cases, fair in 2 cases, poor in 1 case, thus the excellent and good rate 82.4% (14/17), and the Majeed score was 75-95 points in the combined treatment group, includ?ing excellent in 9 cases, good in 5 cases, fair in 1 case, thus excellent and good rate 93.3% (14/15). There was a statistically signifi?cant difference between the two groups of Matta score and Majeed score (χ2=0.034, 0.040; P<0.05). Surgical infection occurred in 4 cases in the open treatment group and healed after debridement and treatment with sensitive antibiotics. The incidence of compli?cations was 23.5% (4/17). In the combined treatment group, 2 cases had anterolateral thigh skin sensory loss after operation, and the symptoms were relieved after mannitol, mecobalamine treatment and removal of internal fixations. One patient had hematoma of the gluteus maximus muscle after operation. The result of angiography showed that the INFIX screw was too long and perforated near the foramen of the ischium, resulting from the injury of the superior gluteal artery. After stopping the use of anticoagulant, in?travenous infusion of tranexamic acid, blood transfusion, etc., the patient was cured and discharged from hospital. The incidence of complications was 20.0% (3/15). There was no significant difference in the incidence of complications between the two groups. Conclusion With the help of starr reduction frame, the early reduction and minimally invasive treatment of pelvic fracture can be realized, and the amount of intraoperative bleeding can be reduced. The combined application of "o" arm navigation can im?prove the accuracy and safety of sacroiliac screw and anterior column screw placement, reduce the radiation dose and frequency of operators and patients, shorten the operation time and improve the curative effect.

Objective To explore the clinical efficacy of minimally invasive posterior reconstructive plating by parallel Kirschner wires in the treatment of unstable posterior pelvic fractures.Methods From January 2013 to December 2016,29 patients with unstable posterior pelvic fracture were treated at Trauma Center,Liuzhou Workers' Hospital.They were 22 men and 7 women,aged from 19 to 65 years (mean,44.2 years).By the Tile classification,10 cases were classified as type B and 19 as type C.The delay from injury to surgery ranged from 4 to 14 days (mean,8.7 days).All the patients received minimally invasive posterior fixation with a U-shaped reconstructive plate and parallel Kirschner wires.The length of incision,intraoperative bleeding,operation time,quality of fracture reduction,curative effects and complications at the last follow-up were recorded.Results The length of intraoperative unilateral incision ranged from 2.3 to 3.4 cm (average,2.99 cm);the volume of intraoperative bleeding ranged from 47 to 88 mL (average,69.9 mL);the average operation time ranged from 17 to 34 min (average,25.2 min).One patient was lost to the follow-up.The other 28 patients were followed up for 14 to 26 months (average,18.3 months).The fracture healing time ranged from 8 to 15 months (average,10.1 months).According to the Matta criteria for fracture reduction,17 cases were rated as excellent at the last follow-up,9 as good,one as fair and one as poor,giving an excellent to good rate of 92.9％.According to the Pohlemann functional scoring,14 cases were rated as excellent,11 as good,2 as fair and one as poor,giving an excellent to good rate of 89.3％.Conclusion In the treatment of unstable posterior pelvic fractures,minimally invasive posterior reconstructive plating by parallel Kirschner wires presents advantages of high security,limited surgical trauma,good curative effects and limited postoperative complications.

Objective To explore the feasibility and clinical value of Ilizarov bone transport technique combined with bone graft and internal fixation at the docking site in the treatment of large segmental bone defect of the lower limbs.Methods Thirty patients with large lower limbs bone defects were prospectively divided into two groups according to the random number table:pure bone transport group (Ilizarov bone transport technique alone,n=lS,10 males and 5 females,average age 34.4±4.6 years old,2 cases bone defect of femur,13 cases tibia,and the length of bone defect 6.2±2.4 cm),and combined bone transport group (Ilizarov bone transport technique with bone graft and internal fixation at the docking site,n=lS,12 males and 3 females with the average age of 33.8±5.2 years,1 case of bone defect and 14 tibia,and the length of bone defect 6.5±2.2 cm).The preoperative hospital for special surgery (HSS) knee functional scores,Baird-Jackson ankle function scores,external fixation time,external fixation index,bone union time,bone union index,postoperative ASAMI scores and incidence of complications were compared between the two groups.Results All patients were followed up for 9 to 24 months (mean 16.2 months).Pure bone transport group was followed up for 9 to 24 months (mean 16.2 months),and combined bone transport group was 10 to 24 months (mean 16.4 months).In pure bone transport group,the external fixation time was 17.6±5.4 months,and the bone union time was 11.2±3.1 months with the average bone union index 42.4±4.6 d/cm.While in combined bone transport group,the external fixation time of group B was 8.4± 2.1 months,and the bone union time was 7.2±2.1 months with the average bone union index 21.1±2.7 d/cm.The external fixation index of pure bone transport group was 32.4±2.1 d/cm,while in combined bone transport group it was 32.1±2.5 d/cm,and there was no significant difference between these two groups (t=0.812,P=0.884).According to the bone and function score of the ASAMI,in pure bone transport group,bone healing:excellent 6 cases,good 6 cases,fair 2 cases,poor 1 case,excellent rate was 80％.While in combined bone transport group:excellent in 8 cases,good 6 cases,fair 1 case,excellent rate was 93.3％.The difference between the two groups was statistically significant (X2=10.6,P=0.032).The lower limb function in pure bone transport group:excellent in 5 cases,good in 5,fair in 4,poor in 1,excellent rate was 66.7％;while in combined bone transport group:excellent in 6 cases,good in 7,fair in 2,excellent rate was 86.7％.There was also a significant difference in the incidence of complications between the two groups.Conclusion Both the pure Ilizarov bone transport technique and the Ilizarov technique with bone graft and internal fixation at the docking site could satisfactorily treat the large bone defect and shortening of the lower limb.But the latter technique had shorter healing time,higher healing rates,better limb function and fewer complications.

BACKGROUND: Total knee arthroplasty (TKA) has been extensively applied in treatment of advanced knee joint disease, because it can effectively alleviate pain and reconstruct knee function. However, whether drainage is needed after TKA remains controversial. OBJECTIVE: To evaluate the clinical curative effect and complications whether drainage placement after primary TKA by meta-analysis . METHODS: PubMed, Embase, Cochrane Library, WanFang and CNKI databases were retrieved for the randomized controlled trials (RCTs) and quasi-randomized controlled trial (qRCTs) concerning whether drainage placement is needed after primary TKA. Data from the relevant studies were collected and analyzed by Revman 5.3 software. The outcome indexes included postoperative hemoglobin, blood transfusion rate, blood loss, allogeneic blood transfusion, Visual Analogue Scale score, range of motion of the knee joint, knee function score, complications, and deep venous thrombosis. RESULTS AND CONCLUSION: (1) Twelve articles were included, including 9 RCT trials and 3 qRCT trials, involving 836 patients (429 cases of receiving drainage, 407 cases receiving no drainage). (2) The results of meta-analysis showed that the postoperative hemoglobin (MD=-7.20, 95% CI (-11.02, -3.38), P=0.000 2), blood transfusion rate (RR=1.93, 95 %CI (1.50, 2.49), P < 0.000 01), blood loss (MD=293.73, 95%CI (217.47, 369.99), P=0.000 01), and allogeneic blood transfusion (MD=284.70, 95%CI (77.64, 491.76), P=0.007) showed significant differences between groups. However, the postoperative 1 st day Visual Analogue Scale score (MD=-0.02, 95%CI (-0.38, 0.34), P=0.92), the 7 day Visual Analogue Scale score (MD=-0.06, 95%CI (-0.27, 0.15), P=0.86), Knee Society Score (MD=0.10, 95%CI (-2.03, 2.23), P=0.93), range of motion of the knee joint (MD= -2.77, 95%CI (-8.27, 2.72) , P=0.32), postoperative complications (RR=0.77, 95%CI (0.57, 1.05), P=0.10), and deep venous thrombosis (RR=1.60, 95%CI (0.64, 3.96), P=0.31) did not differ significantly between groups. (3) In summary, drainage placement in primary TKA will increase the postoperative blood loss, blood transfusion rate and blood transfusion, but it will not improve the function of the knee, alleviate postoperative pain and postoperative complications, so postoperative drainage is not recommended. Subject headings: Arthroplasty, Replacement, Knee; Drainage; Randomized Controlled Trial; Meta-Analysis 0 引言 Introduction 全膝关节置换作为治疗膝关节终末期疾病的有效手 段,它可以缓解膝关节的疼痛、重建膝关节的功能,目前 已被人们所认可。在中国每年有(5-7)万的患者进行全膝 关节置换。在骨科大手术中临床医师常规放置引流装置 来减少切口血肿的形成、预防切口的感染等相关并发症。 有文献报道全膝关节置换后失血量可达800-1 800 mL,其 中包括显性失血以及隐性失血。有学者认为全膝关节置 换后放置引流管可能会增加显性失血,因为引流管的存在 会为细菌入侵提供门户增加感染的机会。因此,全膝关 节置换后是否放置引流装置仍存在一定的争议。 随着目前全膝关节置换后是否放置引流管的临床随机 对照试验研究的增多,为临床提供了更多的证据。然而 由于样本量较少,并且研究报道的结果不一致,存在着一 定的局限性。课题组应用Meta分析的方法通过检索收集高 质量的随机对照试验来探讨全膝关节置换是否放置引流管

Objective To explore the efficacy of platelet-rich plasma( PRP) combined with allograft bone transplantation for typeⅠlong bone defect. Methods Sixty-two patients with long bone defect were divided into two groups using the random number table method. Thirty-two cases in the observation group received PRP plus allograft bone transplantation,while 30 cases in the control group underwent autogenous bone grafting. The patients in the two groups were followed up for 12 months. The operation duration,intraoperative blood loss, hospital stay,incidence rate of complications,success rate of bone grafting,rate of bone healing,and time to bone healing were compared between the two groups. Results No statistically significant difference was found among the two groups in the operation duration,intraoperative blood loss,hospital stay,incidence rate of complications,success rate of bone grafting,rate of bone healing,or time to bone healing(all P>0. 05). Conclusion PRP combined with allograft bone transplantation has similar efficacy compared to autogenous bone grafting for typeⅠlong bone defect,and it is worth of clinical application.

By virtue of its excellent bioactivity and osteoconductivity, calcium phosphate cement (CPC) has been applied extensively in bone engineering. Doping a trace element into CPC can change physical characteristics and enhance osteogenesis. The trace element lithium has been demonstrated to stimulate the proliferation and differentiation of osteoblasts. We investigated the fracture-healing effect of osteoporotic defects with lithium-doped calcium phosphate cement (Li/CPC) and the underlying mechanism. Li/CPC bodies immersed in simulated body fluid converted gradually to hydroxyapatite. Li/CPC extracts stimulated the proliferation and differentiation of osteoblasts upon release of lithium ions (Li + ) at 25.35 ± 0.12 to 50.74 ± 0.13 mg/l through activation of the Wnt/β-catenin pathway in vitro . We also examined the effect of locally administered Li + on defects in rat tibia between CPC and Li/CPC in vivo . Micro-computed tomography and histological staining showed that Li/CPC had better osteogenesis by increasing bone mass and promoting repair in defects compared with CPC (P < 0.05). Li/CPC also showed better osteoconductivity and osseointegration. These findings suggest that local release of Li + from Li/CPC may accelerate bone regeneration from injury through activation of the Wnt/β-catenin pathway in osteoporosis.

目的:评价带线锚钉治疗踝关节骨折合并三角韧带损伤的临床效果.方法:选取2013年1月至2015年1月我院收治的31例踝关节骨折合并三角韧带损伤患者作为研究对象.31例患者均行骨折切开复位内固定联合带线锚钉修复三角韧带.术后通过影像学检查,以及美国足踝外科协会(AOFAS)踝与后足评分评价治疗效果.结果:患者伤口均Ⅰ期愈合,无感染、螺钉松动等并发症发生.31例患者的踝关节骨折均达到骨性愈合,愈合时间12 ～ 24周,平均愈合时间15.7周.术后1年AOFAS踝与后足评分平均91.1分(s=5.7),其中优23例,良6例,中2例,差0例,优良率为93.6％.结论:带线锚钉治疗踝关节骨折合并三角韧带损伤,能够获得满意的治疗效果.

Objective To investigate the effects of arthroscopic Bankart repair using suture anchors and surgical experi-ence. Methods From March 2010 to March 2014,a total of 38 patients of Bankart lession were treated with arthroscopicrepair using suture anchors. 31 of them were male,7 were female,the average age were 29. 5 years old(range 20 ~ 39 years). Among them,12 cases were primary dislocation,26 cases were recurrent dislocation,the average postoperative follow - up period were 23 months(range 13 ~ 40 months). All patients had a history of shoulder joint dislocation. Before surgery,the average ASES scores were(83. 7 ± 12. 8),average Rowe score(36. 2 ± 7. 8),average Constant-Murley score(85. 4 ± 8. 8). All patients were treated with arthroscopic Bankart repair using 3 or 4 metal suture anchors. Results Postoperative shoulder function of 38 cases,incluing flexion lift,body side external rotation and internal rotation were not obviously changed,while abduction and ex-ternal rotation were significantly improved. Postoperative ASES score(96. 8 ± 4. 6),Rowe scoring(90. 2 ± 11. 7)and constant Murley score(97. 9 ± 7. 7)were significantly improved(P ﹤ 0. 01). A total of 2 patients had a recurrent shoulder dislocation, failure rates were 5. 3%(2 / 38). Conclusion Arthroscopic repair using suture anchors were effective methods for the treat-ment of Bankart lessions. Appropriate operation time,full release,pulling suture of articular capsule and ligament complex,rea-sonable distribution of anchors were the key factors for the success of operations.

背景:氯化锂是目前广泛应用的GSK-3β无机离子抑制剂,可通过与GSK-3β结合,激活经典Wnt/β-catenin通道进而促进人骨髓间充质干细胞、成骨细胞的增殖,促进骨细胞修复.目的:观察新型氯化锂复合磷酸钙骨水泥(Lithium chloride/calcium phosphate cement,Li/CPC)的理化性质,探索其诱导成骨的生物学性能.方法:以磷酸钙骨水泥为空白对照组,不同锂含量的Li/CPC为实验组,检测各组骨水泥的凝固时间、抗压强度,扫描电镜观察材料表面微观结构:将各组骨水泥与MC3T3-E1细胞在体外共培养,用扫描电子显微镜观察细胞在骨水泥表面的生长及黏附形态,MTT法检测骨水泥浸提液对细胞体外增殖的影响,碱性磷酸酶试剂盒检测骨水泥浸提液对细胞碱性磷酸酶活性的影响.结果与结论:LiCl的加入未改变磷酸钙骨水泥的理化性质,各组间初凝时间与终凝时间及抗压强度未见明显差异,各组电镜下微观形貌也未见明显差异;MC3T3-E1细胞能够很好地在材料表面黏附生长,MTT法检测结果表明Li/CPC较磷酸钙骨水泥更能够促进骨细胞的体外增殖,而碱性磷酸酶测试结果则表明,MC3T3-E1细胞在Li/CPC有更高的碱性磷酸酶活性.Li/CPC保持良好理化性质的同时,释放出锂离子作用于外周发挥其促进成骨作用.

Calcium phosphate cement (CPC) has been widely used in bone tissue repairing due to its physical mechanical properties and biocompatibility. Addition of trace element to CPC has shown promising evidence to improve the physical properties and biological activities of CPC. Lithium (Li) has effect on osteoblast proliferation and differentiation. In this study, we incorporated Li to CPC and examined the physical properties of Li/CPC and its effect on osteoblast proliferation and differentiation. We found that Li doped CPC maintained similar setting time, pore size distribution, compressive strength, composition, and morphology as CPC without Li. Additionally, Li doped CPC improved osteoblast proliferation and differentiation significantly compared to CPC without Li. To our knowledge, our results, for the first time, show that Li doped CPC has beneficial effect on osteoblast in cell culture while keeps the excellent physical-mechanical properties of CPC. This study will lead to potential application of Li doped CPC in bone tissue engineering. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 944-952, 2017.

目的 观察双侧卵巢切除(OVX) SD大鼠不同时期血清骨生化标志物与骨小梁三维结构变化之间的关系.方法 分别于6月龄雌性SD大鼠假手术(Sham)组和双侧卵巢切除术(OVX)组术后2、4、8、12周随机取样,每组每个时间点处死4只,取血清测量雌二醇(E2)、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRAP)水平,取胫骨用显微CT(Micro-CT)和组织学HE染色观察胫骨骨小梁微结构变化.结果 术后2周,OVX组E2较Sham组开始下降,4周时差异有统计学意义(P＜0.05),一直持续到12周,Sham组E2水平随时间变化不大;OVX组血清BALP在术后2周达峰值,然后迅速下降,12周时降至术前水平;OVX组血清TRAP活性在术后迅速升高,术后4周达峰值,然后下降,术后12周时仍高于Sham组及术前水平;Micro-CT分析胫骨干骺端相对骨体积(BV/TV)、骨小梁数目(Tb.N)、骨小梁分离度(Tb.Sp)、Conn.Dn、骨密度(BMD)在2周时与Sham组比较差异无统计学意义,第4周开始出现明显差异,12周差异更加明显,骨小梁厚度(Tb.Th)始终无明显差异;Micro-CT重建显示术后12周OVX组骨小梁较Sham组稀疏,缺失严重;HE染色显示术后12周OVX组大鼠胫骨干骺端骨骺板下骨小梁变细且排列稀疏,骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端,小梁壁厚度不一致.结论 OVX术骨质疏松模型建立过程中大鼠成骨及破骨细胞活跃度先增高后降低,破骨细胞相对而言上升周期更长且下降后能维持在更高水平,比成骨细胞更活跃,骨吸收大于骨生成导致骨质疏松,主要体现为骨小梁BV/TV、Tb.N、Conn.Dn、BMD下降,Tb.Sp升高,组织学表现为骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端.

骨质疏松症是一种全身性代谢性疾病,其主要特征为骨密度降低,易引发骨质疏松性骨折等疾病.糖原合成酶激酶-3抑制剂能够抑制糖原合成酶激酶-3活性,从而促进Wnt信号转导通路及其下游基因、蛋白的表达,主要通过促进骨髓间充质干细胞、成骨细胞增殖和分化的同时抑制破骨细胞活性,共同调节骨细胞微环境来实现对骨质疏松性疾病的治疗.现就糖原合成酶激酶-3抑制剂在骨质疏松性疾病治疗过程中的作用研究进展做一综述.