OBJECTIVE:To evaluate the feasibility of S2 alar iliac screw insertion in Chinese children using computerized three-dimension reconstruction and simulated screw placement technique, and to optimize the measurement of screw parameters.METHODS:A total of 83 pelvic CT data of children who underwent pelvic CT scan December 2018 to December 2020 were retrospectively analyzed, excluding fractures, deformities, and tumors. There were 44 boys and 39 girls, with an average age of (10.66±3.52) years, and were divided into 4 groups based on age (group A:5 to 7 years old;group B:8 to 10 years old;group C:11-13 years old;group D:14 to 16 years old). The original CT data obtained were imported into Mimics software, and the bony structure of the pelvis was reconstructed, and the maximum and minimum cranial angles of the screws were simulated in the three-dimensional view with the placement of 6.5 mm diameter S2 alar iliac screws. Subsequently, the coronal angle, sagittal angle, transverse angle, total length of the screw, length of the screw in the sacrum, width of the iliac, and distance of the entry point from the skin were measured in 3-Matic software at the maximum and minimum head tilt angles, respectively. The differences among the screw parameters of S2 alar iliac screws in children of different ages and the differences between gender and side were compared and analyzed.RESULTS:In all 83 children, 6.5 mm diameter S2 iliac screws could be placed. There was no significant difference between the side of each screw placement parameter. The 5 to 7 years old children had a significantly smaller screw coronal angle than other age groups, but in the screw sagittal angle, the difference was more mixed. The 5 to 7 years old children could obtain a larger angle at the maximum head tilt angle of the screw, but at the minimum cranial angle, the larger angle was obtained in the age group of 11 to 13 years old. There were no significant differences among the age groups. The coronal angle and sagittal angle under maximum cephalic angle and minimum cranial angle of 5 to 7 years old male were (40.91±2.91)° and (51.85±3.75)° respectively, which were significantly greater than in female. The coronal angle under minimum cranial angle was significantly greater in girls aged 8-10 years old than in boys. For the remaining screw placement angle parameters, there were no significant differences between gender. The differences in the minimum iliac width, the screw length, and the length of the sacral screws showed an increasing trend with age in all age groups. The distance from the screw entry point to the skin in boys were significantly smaller than that of girls. The minimum width of the iliac in boys at 14 to 16 years of age were significantly wider than that in girls at the same stage. In contrast, in girls aged 5 to 7 years and 11 to 13 years, the screw length was significantly longer than that of boys at the same stage.CONCLUSION:The pelvis of children aged 5 to 16 years can safely accommodate the placement of 6.5 mm diameter S2 alar iliac screws, but the bony structures of the pelvis are developing and growing in children, precise assessment is needed to plan a reasonable screw trajectory and select the appropriate screw length.

目的 探讨采用3D打印技术辅助跟骨外侧L形切口钢板螺钉内固定治疗跟骨关节内骨折的临床疗效及意义.方法 回顾性分析自2017-01-2019-08采用跟骨外侧L形切口钢板螺钉内固定治疗的21例Sanders Ⅱ～Ⅳ型跟骨关节内骨折,术前将患足CT扫描DICOM数据导入Mimics建模软件重建跟骨STL格式模型并输入3D打印机中,用聚乳酸材料打印等比例跟骨模型.术者详细观察对比3D模型与CT重建图像,确定骨折分型,利用模型模拟手术,确定跟骨钢板型号,设计手术方案,判断是否需要植骨.结果 21例均获得随访,随访时间平均15.3(12～18)个月.术后X线片与CT影像显示跟骨高度、跟骨宽度、Bohler角、Gissane角恢复满意,随访期间未出现感染、骨折不愈合、骨折畸形愈合、内固定断裂等并发症.骨折愈合时间3～5个月,平均3.8个月.术后12个月足踝功能Maryland评分:优10例,良9例,可2例.结论 采用3D打印技术辅助跟骨外侧L形切口钢板螺钉内固定治疗Sanders Ⅱ～Ⅳ型跟骨关节内骨折取得满意的效果,骨折复位满意,内固定可靠,可缩短手术时间,术后切口并发症明显减少.

胫骨平台骨折中的Schatzker Ⅳ型为高能量损伤所致的严重且复杂的骨折类型，此型骨折可以是内侧平台单纯的楔形劈裂或是粉碎和压缩骨折，常伴有后方平台骨折及骨块移位，临床表现复杂，治疗较为棘手[1]。若不能达到满意的复位及稳定的固定，常遗留关节僵硬、疼痛、创伤性关节炎等并发症，单纯前路固定往往不能达到满意的手术效果。我们采用前后联合入路治疗Schatzker Ⅳ型胫骨平台骨折的患者56例，报道如下。

Objective To investigate the short-term results of treating the recurrent patellar dislocation by arthroscop-ic assisted triple surgery.Methods 23 patients of recurrent patellar dislocation patellar were treated by arthroscopic lateral retinaculum release,reconstruction of the medial patellfemoral ligament (MPFL)combined with improved Fulkerson′s osteotomy.Image examination,activity level of the patients (Tegner activity score),functional evaluation (Lysholm score and Kujala score),subjective assessment and clinical results were comprehensive evaluated in these patients.Results The patients were followed up for 12 ~36(24.3 ±7.82)months.At the end of follow-up,there were no patients with redislocation and subluxation,quadriceps angle were improved to normal range,the mean con-gruence angle(CA)were improved from 13.30°±5.15°to 5.72°±3.32°(P<0.01),the mean lateral patellofemo-ral angle(LPA)were improved from 0.70°±2.85°to 8.13°±2.75°(P<0.01),the mean Lysholm score were im-proved from 47.92 ±16.23 to 93.27 ±7.91(P<0.01),the mean Tegner score were improved from 5.32 ±1.10 to 6.37 ±0.83(P<0.01),the mean Kujala score were improved from 55.3 ±11.23 to 83.2 ±13.91(P<0.01). Conclusions The treatment of recurrent patellar dislocation through arthroscopic assisted triple surgery is effective to prevent recurrence and restore knee function to the greatest extent.

目的观察和分析可吸收螺钉内固定治疗后交叉韧带胫骨止点撕脱性骨折的疗效。方法对32例后交叉韧带胫骨止点撕脱性骨折患者行切开复位胫骨止点可吸收螺钉内固定术,术后以膝关节托外固定,指导患者功能锻炼。结果随访10~18个月,平均15个月。全部患者均获骨性愈合,关节功能恢复满意,无明显并发症。结论可吸收螺钉内固定治疗后交叉韧带胫骨止点撕脱性骨折安全可靠,疗效满意。

<正>临床上肱二头肌长头腱断裂并不少见,通常是在遭受强大外力或肌腱退变基础上发生断裂,亦或两者兼而有之。主要临床症状是突然肩痛和屈肘功能减退[1]。2008年1月—2011年1月,我院采用带线锚钉进行重建修复肱二头肌长头腱断裂29例,疗效满意,报道如下。1临床资料

Objective To compare the therapeutic effect of posterior lumbar interbody fusion(PLIF) and transforaminal lumbar interbody fusion(TLIF) with pedicle screw fixation on treatment in lumbar degenerative disease.Methods 86 patients were underwent PLIF(PLIF group) and 76 cases were underwent TLIF(TLIF group) with one cage and pedicle fixation in 162 patients with lumbar degenerative disease.Operating time and blood loss were quantified,average slip and reduction rate in spondylolithesis,average intervertebral and foramen height were evaluated in preoperation and postoperation.Pain recorded according to visual analogue scale(VAS),functional disability according to oswestry disablity index(ODI),and bone graft fusion rate according to Brantigan and Steffee criteria.Results Compared to PLIF group,it took shorter operating time and less blood loss in TLIF group,there was no statistical significance in spondylolithesis,reduction rate,intervertebral and foramen height,VAS,ODI,bone graft fusion rate between the two groups(P>0.05),but there was fewer complications in TLIF group(P<0.05).Conclusions Interbody fusion with either a PLIF technique or a TLIF technique provides good outcomes in the treatment of degenerative spondylolisthesis and instability.The TLIF procedure is simpler and as safe and effective as the PLIF technique with shorter operating time,less blood loss and fewer complications.

目的探讨伤椎置钉治疗胸腰椎单椎体爆裂性骨折的疗效。方法采用伤椎及其上下邻椎椎弓根螺钉固定治疗胸腰椎单椎体爆裂性骨折42例,随访观察患者伤椎高度、Cobb角的变化并行统计学分析。结果随访6～36个月,平均22.6个月,伤椎高度平均恢复至正常的93.1%(P<0.01),术后矢状面Cobb角,平均为3.6°,随访结束时平均为7.3°(P<0.01)。脊髓功能有显著改善。结论经伤椎置钉治疗胸腰椎单椎体爆裂性骨折是一种可行而有效的方法。

Objective To evaluate the effects of proximal locking plates for the treatment of femoral intertrochanteric fractures. Methods Twenty-three old patients with femoral intertrochanteric fractures were treated with locking plates internal fixation. All cases were followed up for 4～18 averaging (12.87±4.52) months. Results The average operation time was (69.26±15.28) min (50～105) min, the average loss of blood during the operation was (200.22±53.92) mL (95～280) mL, and the average time of fracture healing was (113.17±30.47) d (80～180) d. One case had slight coax vara. The excellent and good rate was 95.65%. Conclusion The use of proximal locking plates in the treatment of femoral intertrochanteric fractures in an elderly patient population is a feasible and effective method. Preoperative evaluation of ASA score may be helpful in the design of operative plan and in the improvement of curative effect.

脊柱骨折以胸腰段最为常见,其治疗大多可采用后路短节段椎弓根内同定系统复位固定,但若术后伤椎内的空隙不能被新骨填充,容易造成内固定物疲劳、松动和断裂,取出内固定物后可因椎体高度的再次丢失而出现顽固性腰痛,严重的可造成脊柱后凸畸形、神经损伤[1].椎体成形术能强化椎体,提高远期疗效,但填充材料多种多样,效果不尽相同.2004年10月至2006年12月笔者在椎体成形术中使用短节段椎弓根内固定系统结合经伤椎椎弓根注射医用硫酸钙的方法治疗胸腰椎骨折17例,取得满意效果,现报道如下.

Objective To investigate the curative effect of percutaneous fixation for treatment of odontoid fracture with cannulated compression screws.Methods 7 cases of odontoid fracture were reduced by skull traction and percutaneous fixed with cannulated compression screws.Results All the cases were followed up range from 6 to 24 months with an average of 13±3.2 months.The odontoid fracture showed bony union by CT examination in all cases and their clinical symptoms disappeared in 7 months.Conclusions Percutaneous fixation for treatment of odontoid fracture with cannulated compression screws has a good clinical result;And good reduction pre-operation as well as appropriate patients selection will be the keys to the successful surgery.

对于胸腰椎单椎体爆裂性骨折常规行短节段椎弓根螺钉内固定技术,即伤椎的上位正常椎体和下位正常椎体各使用2枚椎弓根螺钉(3椎体4枚螺钉)固定进行纵向撑开,达到复位,术中易出现复位高度不够,术后恢复过程中出现内固定失败,复位高度丢失.

【Objective】To evaluate the clinical result of two-bundle reconstruction of anterior cruciate ligament (ACL) with autologous hamstring tendons. 【Methods】Ruptured ACLs were reconstructed in 35 patients under arthroscope with autologous hamstring tendons in a two-bundle and four-tunnel way. The grafts were fixed with suspending technique by mini-buttons and absorbable screws. The clinical results were evaluated according to KT-2000 examination, 2000 IKDC, Lysholm, and Tegner rating scales.【Results】The patients were followed up for 9 to 30 months (mean, 18 months). At the last follow-up for 34 patients, the lachman test was negative. The KT-2000 examination showed side difference was averaged from(6.4±2.9) mm before operation to (2.1±0.6) mm after operation. According to the 2000 IKDC knee examination form, 34 cases (97.1%) were graded normal or nearly normal. The average 2000 IKDC, Lysholm and Tegner scores increased from preoperative (42.6±5.9), (47.8±6.2), (3.7±0.3) to (95.6±3.4), (93.8±2.7), (6.7±0.6) at the last follow-up, respectively (P 0.05).【Conclusion】Arthroscopic two-bundle reconstruction of ACL with autologous hamstring tendons is a reliable procedure to restore the stability of the knee.

目的探讨应用锁定钢板治疗老年骨质疏松性肱骨近端三部及四部骨折的疗效。方法应用锁定钢板切开复位内固定治疗老年骨质疏松性肱骨近端三部、四部分骨折21例,按Neer分型,3部分骨折12例,4部分骨折9例。结果所有患者术后随访12~24个月,骨折全部愈合,未发生肱骨头坏死,以Neer评分评估其功能,优7例,良10例,优良率达80.95%。结论锁定钢板治疗老年骨质疏松性肱骨近端三部及四部骨折疗效满意,值得推广。

2001年1月至2005年12月本院采用撬拨复位加钢板内固定治疗跟骨关节内骨折32例,经6～20个月的临床观察,效果满意,现报告如下.

目的探讨支持钢板加自体髂骨植骨结合CPM治疗胫骨平台骨折的疗效。方法对34例胫骨平台骨折,采用切开复位解剖型支持钢板内固定,加自体髂骨植骨,并结合CPM早期行关节功能锻炼。结果34例患者均获得随访,随访时间6~36个月,平均18个月。按照Rasmussen评分标准,优15例,良14例,可5例,优良率达85.3%。结论合理选择切口切开复位,加解剖型支持钢板内固定自体髂骨植骨,并早期结合CPM功能锻炼治疗胫骨平台骨折疗效满意。

目的探讨桡骨头骨折的临床诊疗方法及治疗效果。方法从2003~2007年治疗49例桡骨头骨折,其中MasonⅠ型15例采用上肢石膏托固定,MasonⅡ型21例、MasonⅢ型13例均采用切开复位微型指骨螺钉内固定,并早期行关节功能锻炼。结果34例患者获得随访,随访时间为1~3年,平均24个月。按照Metaizeau等[1]评分标准,优29例,良5例。结论准确判断桡骨头骨折类型及损伤情况,及时采用合理的治疗方案,并早期行关节功能锻炼治疗桡骨头骨折,可取得满意疗效。

2002-2004年本院共收治不稳定骨盆骨折患者23例,均急诊采用骨盆外固定支架治疗,疗效满意,现报道如下.

目的探讨施沛特治疗膝关节骨性关节炎(膝骨关节炎)的临床疗效。方法对患者一侧或双侧膝关节腔内注射施沛特注射液,每个关节腔每次注射2 mL,每周1次,连续注射5周,观察患者的临床疗效。结果60例患者70膝均获得随访,其中临床缓解29膝,显效20膝,有效18膝,无效3膝,总有效率96%。结论施沛特关节腔内注射治疗膝骨关节炎疗效确切。

肩锁关节脱位是较为常见的损伤,约占肩部损伤的12%[1],而Tossy Ⅲ型肩锁关节脱位,尤其是新鲜脱位,目前以手术治疗为主.以往有很多治疗肩锁关节脱位的方法,但都有可能遗留疼痛、功能障碍、残余畸形等不良后果[2].