Tibial plateau fractures often require surgical treatment .Functional outcome depends mainly on the range of knee motion, joint stability, and pain.Only a few studies evaluate the functional outcome of a tibial plateau fracture after operation .The primary aim of this study was to evaluate the results and functional outcome of surgically treated ( ORIF) tibial plateau fractures .Meth-ods:Between January 2006 and December 2013 all consecutive patients undergoing osteosynthesis of a tibial plateau fracture were includ -ed if they were discharged alive and completed the questionnaire .The primary outcome measures were functional outcome ("Knee injury and Osteoarthritis Score"(KOOS) questionnaire) andHealth-related quality of life (HrQoL) using the EuroQol-6D (EQ-6D) ques-tionnaire at the end of the study follow -up period .Conclusions: Seven years after discharge from hospital , patients still alive had a "Fair"functional knee outcome .However , HrQoL was lower in comparison to the general Dutch population.

Objective To evaluate the clinical effect of open reduction and internal fixation of intra -articu-lar calcaneal fracture fixed with allogeneic bone grafting by imaging and function reecovery .Methods Two hun-dred and twenty-nine patients with displaced intra-articular calcaneal fractures that were treated with plate osteosyn-thesis from 2005 to 2013 were reviewed.One hundred and twenty-one patients (group A) were treated by plate os-teosynthesis with allogeneic bone grafting ,and 108 patients ( group B) were treated by plate osteosynthesis without bone grafting.Patients were followed up clinically and radiologically at least for 2 years.Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width .Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society ( AOFAS) scale.Results The mean full weight-bearing time in group A (with bone grafting) was significantly less (median 3.5months) than that in group B (without bone grafting; median 5.3 months,P<0.05).Increase of Bohler's angle was more in group A than in group B(P<0.05).The average change in Gissane's angle and the average change in calcaneal height were not statistically significant for either group .The mean AOFAS score was higher in group A than in group B,but this difference was not significant (P>0.05).The occurrence rate of traumatic arthritis in group B was high-er than in group A(P<0.05).Conclusion Bohler's angle shows improved restoration and the patients return to full weight-bearing earlier when bone grafting is used in the treatment of intra-articular calcaneal fracture .However , bone grafting has a higher incidence of complications and the functional outcomes of the two groups are similar .

Objective To study the surgical treatment effects of Pilon fractures .Methods 14 patients with Pilon fractures were admitted in our department from May ,2008 to April,2008 surgery treatment and all of them belonged to type Ⅲ by Rtiedi-Allgower classification standard .The surface of tibial astragaloid joint was reestablished openly through anterolateral ankle approach and exposing tibial articular surface through post-lateral peroneal approach .Results The operation treatment of effect was satisfactory , including 11 cases with wound healing in stage Ⅰ and 3 ones in stage Ⅱ.All cases obtained synostosis and no postoperative osteomyelitis occurred .Conclusions This method can completely expose the surface of tibial astragaloid joint and is conducive to the fracture reduction and fixation ,which has a good therapeutic effect on Pilon fracture .

Objective To investigate the surgical techniques and clinical outcomes of using T-shape volar plate combined with Kirschner wire fixation for treatment of Rolando fractures.Methods Inclined or straight T-shape volar plate was used in conjunction with Kirschner wires to treat Rolando fractures in 11 patients.Postoperatively movement of the metacarpophalangeal joint was evaluated using the total active range of motion of the finger joints.Results Postoperative movement of the metacarpophalangeal joint was good.There was no needle track infection.X rays showed that anatomical reduction or near anatomical reduction was achieved in all the patients.Fracture healing time ranged from 6 to 12 weeks,with an average of 6.4 weeks.Conclusion Combination of inclined or straight T-shape volar plate and Kirschner wire fixation is an effective method for treatment of Rolando fractures.It achieves proper articular surface reduction and effective,reliable bone fixation.

<正>2007年3月～2011年1月,笔者应用多轴钉棒系统固定治疗11例创伤性下颈椎骨折脱位患者,临床效果满意,报道如下。1材料与方法1.1病例资料本组11例,男9例,女2例,年龄38～61岁。爆裂骨折4例,单侧脱位3例,双侧脱位2例,压缩

Objective To make comparison between the reliability and validity of both 2D-CT and 3D-CT imaging in evaluation of calcaneus intraarticular fracture,and to discuss the diagnostic superiority of CT examination.Methods Four senior doctors in the department of orthopaedics analyzed retrospectively 76 cases of calcaneus subtalar joint surface injury who were hospitalized from January 2010 to June 2011.2D-CT and 3D-CT imaging were respectively used to judge the fracture type and characteristics.Consistency check was used to analyze the raters' internal and external reliability in the judgment of fracture type,and also to analyze the standard validity of the facture judgment results(the operation record description was used as the gold standard).The differences between the 2D-CT and 3D-CT judgment results and the gold standard were compared by McNemar test.Results There was no significant difference between the typing results of calcaneus subtalar joint surface injury by 3D-CT examination and 2D-CT examination.The consistency of 3D-CT fracture judgment results with the gold standard was significantly higher than that of 2D-CT results(P=0.005).Conclusion The 3D-CT examination can increase the reliability and accuracy of the evaluation of calcaneus subtalar joint surface injury,and is helpful to guide the determination of operation schedule.

Objective To provide a better preoperative design and precise intraoperative navigation in the spinal deformity surgery by digital technique. Methods From Decenber 2006 through August 2011.58 patients with spinal defornity requiring instrumcntation were recruited for the present study.They were 21 men and 37 women.aged from 3 to 68 years (average,21 years) After a three dimensional CT senning of the deformmed spine was performed,the data were transferred via a.dicom network to a computer workstattion Mimics software was used to generate three dimensional reconstruction models of the spine.Visual prcoperational plans simulating the actual surgery were designed.And visual drill templates which potentially enabled a fit in a lock-and-key fashion similar to a physical casting of the vertebral surfaee were also dcsigned.Acrylate drill guides were manufactured using rapid prototyping.The biomodels and drill guides were sterilized and used intraoperatively to asist surgical navigation and placement of instnumentation.Results The three dimensional preopcrational plans were found to he of great assishnce in the execution of the surgery.The navigational templates provided accurate screw placcrment without instrumental complications.The designs of the first 2 templates were suboptimal as the contact surfaee was too large and eomplex.Operating time was reduced as a result of less reliance on intraoperative radiographs Conclusion The digital technique is a novel method which can produce better preoperative design and precise intraoperative navigation for pedicle screw placcment in the spinal deformity surgery.

目的:利用逆向工程原理和快速成型技术,通过尸体标本试验验证导航模板可行性及准确性.方法:选取成年男性正常颈椎骨标本1具,范围从C1～7CT连续断层扫描数据集,采用Mimics 8.1三维重建颈椎数字解剖模型.分别在Geomagic studio 9、Magics 9.5软件平台打开三维重建模型,定位三维参考平面,利用逆向工程(RE)原理寻找椎弓根的最佳进钉通道,提取椎板的表面解剖学形态,建立与椎体后部解剖学形态一致的反向模板,拟合模板和椎弓根孔道成定位模板,将导航模板通过激光快速成形技术制造出实物模型.将制作的实物模板和标本的椎板相吻合,利用导航模板的导航孔置入椎弓根螺钉,术后根据CT扫描评价椎弓根螺钉位置的准确性.结果:成功的设计并制作出与椎体后部解剖学结构一致的导航模板.术后CT扫描显示,模拟手术置入的14枚椎弓根钉位置均为Ⅰ类.结论:利用逆向工程原理和快速成型(RP)技术为颈椎弓根的定位、定向提供了一种新的方法,具有较好的应用前景.

> 髋关节表面置换术发展至今已有30余年历史。从第一代骨水泥假体固定技术和金属对聚乙烯的关节表面组合,到金属对金属假体的应用,髋关节表面置换术的成功率不断提高。髋关节表面置换术通过保留股骨头、颈恢复髋关节正常的生物力学特性及关节稳定性,与传统的全髋关节置换术相比脱位发生率低、关节活动度大、手术失血量少、深静脉栓塞发生率低、术后产生的磨损颗粒少,近期效果满意。其手术成功的关键是假体植入位置与方向的准确性,位置不准是术后关节不稳定的主要原因之一。本研究利用计算机三维重建

Objective To investigate the accuracy and feasibility of transpedicular screw placement assisted by the navigation templates in cadaveric thoracic spines.Methods Twenty thoracic cadavers specimens were randomly divided into two groups

Objective To discuss experiences in reconstruction of severe tibial shaft fractures by using different flaps and external fixations.Methods The study involved 190 patients with type GustiloⅢB Ⅲ C (160 patients) and GustiloⅢC (30 patients) tibial shaft fractures treated from 1990 to 2007.There were 169 males and 21 females,at average age of 42.5 years.The injury causes included traffic accidents in 132 patients,machine accidents in 32 and stone smashing in 26.The management procedure consisted of administration of antibiotics,serial debridement and different flap grafting (including free thoracoumbilical flaps in 20 patients,sural neurocutaneous vascular flaps in 108,saphenous neurocutane ous vascular flaps in 12,superficial peroneal neurocutaneous flap in two,fasciocutaneous flaps in 26 and gastrocnemius muscular flaps in 22) and different external fixators (half-ring fixators in 84 patients,unilateral axial dynamic fixators in 12,AO fixators in 10,Weifang fixators in 42 and hybrid fixators in 40).The average follow-up was 7.3 years.Results All flaps survived.Of all,186 patients obtained fracture healing,with mean fracture healing time varying in different patients treated with different external fixators:7.5 months for 84 patients treated with half-ring fixators,11.2 months for eight with unilateral axial dynamic fixators,8.5 months for 12 with AO fixators ,8.1 months for 42 with Weifang fixators and 7.8 months for 40 with assembly fixators.Except for half-ring fixation,the other fixators needed necessary bone graft.Four patients treated with unilateral axial dynamic fixators resulted in nonunion due to osteo myelitis.The latest follow up showed that the function of the ankle and knee was normal,with no pain.Conclusion Combination of half-ring external fixators with various flaps provides good method for treatment of Gustilo ⅢB and ⅢC tibial shaft fractures.

OBJECTIVE:To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique.METHODS:Pelvis image data were obtained from three-dimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The three-dimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the three-dimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction (total reduction, half reduction and non-reduction) were simulated using Imageware 9.0 software. The best direction and location of extract iliosacral lag screws were defined using reverse engineering according to these three situations and navigation templates were designed according to the anatomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping. Drill guides were sterilized and used intraoperatively to assist in surgical navigation and the placement of iliosacral lag screws.RESULTS:Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate.CONCLUSION:The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.

OBJECTIVE To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. METHODS A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engineering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its corresponding vertebra were manufactured using the rapid prototyping technique. RESULTS The accuracy of the drill template was confirmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to customize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill template fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the personalized template. During surgery, no additional computer assistance was needed. CONCLUSIONS The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.

病历摘要 患者,男性,45岁,因"石矿爆炸敛左上肢畸形、剧痛、流血6 h"于2006年5月15日凌晨1:00至本科就诊.

Objective To determine the accuracy of a novel method of spinal pedicel stereotaxy which is developed by Reverse Engineering and rapid prototyping.Methods A 3-D CT scan of L1-L3 vertebrae of an old man cadaver was performed.The CT data were transferred via a DICOM network to a computer workstation.Three dimensional software amira3.1 was used to establish the L1-L3 3-D model.The 3-D model was preserved by STL code.The 3-D model was processed in UG imagewarel2.0 and the 3D coordinate system was located.The best pedicle channel was designed according to the Reverse Engineering.A template was established which accorded with the laminar anatomic traits.The best pedicle channel and the template were integrated into a navigational template.An exact vertebral and navigational template was manufactured by rapid prototyping(SLA technique).The accuracy of pedicel instrumentation was confirmed by X-ray and CT scan.Results A new method of spinal pedicel stereotaxy was established by Reverse Engineering and rapid prototyping.The navigational template was found to be highly accurate.Conclusion The spinal stereotaxy developed by Reverse Engineering and rapid prototyping provides a new method for pedicle screw insertion.

INTRODUCTION:Male genital dysfunction was recognized as a complication following anterior approach lumbar surgery. Disruption of efferent sympathetic pathways such as the abdominal aortic plexus (AAP) and superior hypogastric plexus (SHP) which lied pre-abdominal aorta and iliac artery had been thought as the main reason. Though there were some clinical reports of retrograde ejaculation, the applied anatomic study of the autonomic nerve anterior to the lumbar was little. The purpose was to find out a lumbar surgery approach which was ejaculation preservation through the detailed study of the anatomy and histology observation of the autonomic nerve anterior to the lumbar vertebrae.METHODS:The lumbar region of ten male cadavers was dissected and analyzed. We investigated the relationship between the peritoneum and abdominal aorta, iliac artery and sacral promontory fascia, as well as the trend and distribution of the autonomic nerve and SHP anterior to the L5-S1. We also observed the distribution of autonomic nerve at retroperitoneum through hematoxylin and eosin (HE)-stained tissues pre-aorta, para-aorta, and pre-vertebrae sacrales.RESULTS:Superior hypogastric plexus, which deviated to left, located in a triangle formed by the common iliac arteries and its bilateral branches, its truck sited anterior to the lumbarsacral space in seven cases (70%), and anterior to sacrum in three cases (30%); at the aortic bifurcation, SHP strided over left iliac artery from left-hand side, then located in front of sacrum in four cases (40%), and sifted to the left at the lumbar sacral promontory in six cases (60%); from both anatomic and histological view, the autonomic nerve plexus lying in an fascia layer of retroperitoneum.CONCLUSION:At the anterior approach lumbar surgery of trans-peritoneum, we should choose the right-hand side incision; the SHP should be pushed aside carefully from right to left along intervertebral disc. The accurate surgical plane was at the deeper layer of autonomical nerve fascia; we also could lift the complete autonomical nerve layer which lies behind the aorta and lumbar sacral promontory, so that the autonomic nerve could be preserved.

Objective To provide accurate location for pedicle fixation with the help of computerassisted navigational template in hangman fracture surgery. Methods CT scanning of patients with Hangman fracture was performed, and three dimensional (3D) model of Hangman fracture was constructed by using software MIMICS 10.01. The 3D model was then exported in STL format, and opened in a workstation running software UG imageware12.0. The optimal pedicle channel was located according to reverse engineering. A virtual navigational template was established according to the laminar anatomic trait. The physical vertebrae and navigational template were manufactured by using rapid prototyping. The navigational template was sterilized and used to assist the placement of Hangman fracture pedicle screw. The C3 navigational template was made with the same method. The placement of the screws was confirmed by postoperative X-ray and CT scanning. Results Four patients were involved in the study, of whom two patients received C2 and C3 fusion and the other two patients received C2 pedicle fixation. A total of eight C2 pedicle screws and four C3 pedicle screws were inserted. The navigational template was found to be highly fit with the lamina of vertebra. No nerve or blood vessel complication was observed during and after operation. Conclusions The navigational template designed according to reverse engineering and made by rapid prototyping can facilitate cervical pedicle location and make posterior operation for Hangman fractures safer.

我院为大型综合性三甲医院,担负着军队、云南省部分地区及少部分贵州地区人员的医疗任务.而作为全军骨科中心的门诊,每日面临着上百人的门诊患者.我院骨科开设普通门诊3间,专家门诊2间,每天的门诊量多达两百余人,每月近三千人.为进一步了解骨科门诊患者的常见病及多发病情况,以便为门诊医师的诊治提供依据,提高诊治水平.笔者随机抽取了2008年8月份门诊登记的446例就诊患者进行了相关调查分析,现报告如下.

OBJECTIVE:To observe the primary clinical result of digital template as navigation to the upper cervical pedicle instrumentation.METHODS:CT scan of upper cervical vertebrae was performed. 3-D model of upper cervical vertebrae was reconstructed by software Amira 3.1 and was preserved in STL format. Then 3-D model was run in software UG Imageware 12.0, the best pedicle channel was extracted according to the reverse engineering principle. A virtual navigational template was established according to he lamina anatomic trait, and the best pedicle channel. The virtual vertebrae and navigational template were manufactured using rapid prototyping. The navigational template was sterilized and used intra operative to assist with the placement of pedicle screw. The Accuracy of screw placement was confirmed with postoperative X-ray and CT scanning.RESULTS:The digital navigational template had been established and used in the 3 cases, the good trajectory of cervical pedicle had been showed by the CT scan of post operation. There were not complications of related pedicle screw insertion.CONCLUSIONS:A novel method of upper cervical pedicle location using Reverse Engineering and rapid prototyping has been developed; the navigational template is found to be highly accuracy and has great expectation.