目的探讨改良外侧斜行小切口髋关节置换术治疗老年股骨颈骨折的可行性。方法 2006年7月至2009年5月,采用改良外侧斜行小切口治疗高龄股骨颈骨折患者38例,其中30例患者行全髋关节置换术,8例患者行单纯股骨头置换术。结果手术切口长度7~10 cm,平均9 cm;手术时间50~80 min,平均65 min;术中出血量150~350 mL,平均250 mL,术后引流量80~240 mL,平均140 mL,术后3~11 d部分负重行走。切口愈合时间12~14 d,无严重并发症。所有病例随访6~34个月,平均17.4个月。Harris评分优33例,良4例,中1例,优良率达98%。结论改良外侧斜行小切口全髋关节置换术治疗老年股骨颈骨折,具有手术时间短、创伤小、出血少、切口愈合快、并发症少、恢复快等优点。

目的探讨关节镜下清理术在膝关节骨性关节炎治疗中的临床效果。方法采用Stryker关节镜系统对35例(37膝)膝关节骨性关节炎患者行关节镜下关节清理术。全部病例获得6～28个月(平均16.5个月)的随访。参照Lysholm膝关节功能评分标准进行疗效判定。结果临床控制10例,显效15例,有效7例,无效3例。术后所有患者均未发生关节活动功能障碍。2例患者术后出现关节积血肿胀,经关节腔穿刺抽血、加压包扎后恢复。结论关节镜手术治疗膝骨性关节炎创伤小,恢复快、疗效确切、并发症少,是治疗早中期膝骨关节炎的较好方法。

Objective To discuss the surgical techniques and results of displaced complex acetabular fractures.Methods Twenty-six cases of complex acetabular fracture with dislocation were treated with open reduction an internal fixation from July 2006 to August 2009.Kocher-Langenbeck approach(9 cases),ilio-inguinal approach(6 cases) and double approachs(K-L + ilio-inguinal)(11 cases) was adopted for different fractures.Results According to Matta criterion,seventeen cases had anatomic reduction,7 cases satisfactory reduction,2 cases unsatisfactory reduction.All cases were followed up for 6 ～ 36 months.According to d'Aubigne evaluation,the results were excellent in 9,good in 9,fair in 6 and poor in 2.An excellent and good result was attained in 69.2%.Excellent and good rates for anatomic and non-anatomic reduction group were 88.2% and 33.3% respectively.The difference was very significant(P 0.01).Conclusions Open reduction and internal fixation is reliable and effective for displaced complex acetabular fractures.Correct classification of fractures before operation,appropriate selection of operative approach,timely operation,satisfactory fracture reduction and reliable internal fixation and early functional rehabilitation are essential for reaching a good clinical result of complicated acetabular fractures.

目的回顾性分析Ruedi AllgowerⅡ、Ⅲ型Pilon骨折治疗的临床疗效。方法2004年1月至2008年11月我科收治48例Ruedi AllgowerⅡ、Ⅲ型Pilon骨折患者,其中40例采用切开复位钢板内固定,8例行外固定架固定结合切开复位有限内固定。结果48例均获随访,随访时间为6～38个月(平均18.4个月)。按Mazur评分法,优29例,良10例,可7例,差2例,优良率82%。术后并发症包括皮肤坏死3例,浅表皮缘坏死5例,切口感染1例,断钉1例,骨折延迟愈合5例,创伤性关节炎1例。结论根据骨折类型和软组织条件选择适当固定方式是治疗Ⅱ、Ⅲ型Pilon骨折并取得良好手术效果的关键。

目的:对胫骨平台骨折的治疗经验进行总结。方法:对98例胫骨平台骨折的临床资料进行回顾分析。结果:本组98例患者均得到随访,随访时间6~36个月,根据雍氏评级标准评定:优38例,良46例,中10例,差4例,两组总优良率为85.7%。结论:胫骨平台骨折要掌握手术适应证,关节面解剖复位,坚强内固定和塌陷骨折复位是手术成功的3大关键要素。

目的探讨经髂腹股沟联合K-L入路治疗复杂髋臼骨折的疗效。方法自1999年7月至2007年6月,采用前后联合入路手术治疗复杂髋臼骨折28例,统计平均手术时间和出血量,术后X线表现按Matta标准评估,远期髋关节功能和异位骨化分别按d′Aubigne和Brooker标准评估。结果平均手术时间3.5h,平均失血量为1000 mL。术后以Matta复位标准评价,优18例,良7例,中3例。术后随访6个月~3年,平均16个月。髋关节功能按d′Aubigne标准评定,优19例,良7例,中2例。异位骨化按Brooker标准评定,髂腹股沟入路无一例异位骨化,K-L入路发生异位骨化6例,无一例感染。结论前后联合手术入路有利于复杂髋臼骨折的显露和复位,临床效果好,并发症少。

Objective To investigate factors related to avascular necrosis of femoral head through a retrospective study of old patients with femoral neck fractures treated with cannulated screws.Methods One hundred and fifteen old patients with femoral neck fracture were admitted from January 2000 to January 2006 and treated with cannulated screws.We analyzed statistically the multiple factors:age,gender,Garden classification,time interval from injury to surgery,quality of reduction(Garden Index),and base disease by SPSS 10.0 statistic system.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence:Garden classification,age,time interval from injury to surgery,Garden Index and base disease.Gender was found to have little impact on the prognosis of femoral neck fracture.Conclusion Fracture displacement is the most critical factor that influences the prognosis.Time interval from injury to surgery and Garden Index,as important controllable factors,influence the prognosis of femoral neck fracture.High age and base disease will lead to increased incidences of avascular necrosis.

Objective To evaluate the clinical outcome of open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus with T-plate.Methods Sixty-three patients with a three or four-part fracture of the proximal part of the humerus had undergone open reduction and internal fixation with T-plate.Results Of the 63 cases,56 were followed up from 3 to 8 years(averaging 5 years).According to Neer's criteria,forty-six patients had a good or excellent result whereas two patients had a moderate result and eight patients a poor result.nineteen patients had development of avascular necrosis of the humeral head,and fourteen of these nineteen patients had a good or excellent Constant score.Conclusion Open reduction and internal fixation with T-plate yields good functional results in most patients.This option should be considered even for patients with fracture-dislocation patterns that are associated with a high risk for avascular necrosis of the humeral head,as this complication did not preclude a good result.

目的:探讨固骼生在骨缺损应用中的临床效果。方法:对41例骨缺损患者应用固骼生进行手术植入治疗,并连续6～13个月进行临床观察随访。结果:41例中1例失访,获随访的40例患者无不良反应。X线片显示术后1～3个月材料植入区与缺损周围的骨组织间界限模糊有新骨形成,3～6个月材料植入区内有明显的新骨长入,骨缺损已基本修复。结论:应用固骼生修复骨缺损,成骨速度快,具有骨传导性和骨诱导性及良好的生物相容性,是一种理想的替代骨移植修复骨缺损的高生物活性材料。

目的了解距下关节融合术在治疗跟骨SandersⅣ型骨折的效果。方法对51例跟骨SandersⅣ型骨折的患者采用随机对照研究。结果在为期36个月的随访中,内固定+距下关节融合手术组的功能评分无明显波动(P值>0.05);在随访后期(36个月)内固定+距下关节融合手术组的功能评分要明显高于内固定手术组,有显著性差异(P值=0.033)。结论SandersⅣ型跟骨骨折行切开复位内固定术同时行距下关节融合术治疗,手术效果良好稳定。

Objective To investigate the feasibility of directionally induced differentiation of adult human mesenchymal stem cells(hMSCs) toward osteoblasts in vitro under the specified condition,being potentially taken as seed cells for bone tissue engineering. Methods hMSCs were extracted from the bone marrow and cultured immediately in DMEM medium containing 100 mL/L fetal bovine serum. hMSCs were analyzed by the flow cytometry to detect the surface antigens. The subcultured cells was induced to differentiate into osteoblasts with an osteoinductive medium containing dexamethasone,beta-sodium glycerophosphate and ascorbic acid. Cellular morphologies were observed under phase-contrast microscope and the growth curve was drawn accordingly. The collagen typeⅠ and osteocalcin was detected by immunohistochemistry,alkaline phosphatase in the hMSCs stained by NAP,the calcified nodules were stained by von Kossa method. Results The hMSCs proliferated rapidly in in vitro culture. Flow cytometry analysis showed that in vitro expanded hMSCs expressed mesenchymal cell marker,including the positive expression of CD105 and CD44,and the negative expression of CD14,CD34 and CD45. The staining of the alkaline phosphatase,collagen typeⅠ,osteocalcin and calcified nodules were positive after osteoinduction. Conclusions hMSCs can be induced to differentiate into osteoblasts through relatively simple procedures. Therefore,the hMSCs can be taken as idealand perfect seeding cells for bone tissue engineering.