目的 建立腕关节三维有限元模型研究腕关节舟月骨间韧带(Scapholunate interosseous ligament,SLIL)在腕部不同运动中的应力分布.方法 选取正常腕关节CT数据,将其导入Mimics软件构建腕关节三维有限元模型,分析腕关节不同运动方向受力时的SLIL应力分布.结果 随背伸角度增大,SLIL应力增大,背伸角度增加到90°时,SLIL受到最大应力为1.3787 MPa.背伸角度为30°时,腕关节掌届时SLIL受到的最大应力为0.1596 MPa,掌屈角度增加到90°时,SLIL的最大应力降低至0.2452 MPa.桡偏25°时,SLIL受到的最大应力为0.8145MPa,尺偏25°时,SLIL受到的最大应力为0.1356 MPa.腕关节做桡侧受力20N时,SLIL受到的最大应力为0.4465MPa,尺侧受力20N时,SLIL受到的最大应力为0.4635MPa.结论 腕关节三维有限元模型可以模拟SLIL在腕部不同运动中的受力情况.腕关节背伸角度达90°时,SLIL的应力最大.做尺偏、桡偏动作时,相同偏转角度下,SLIL桡偏时最大应力是尺偏最大应力的6倍左右.

BACKGROUND:This systematic review was conducted to gather available evidence on the effectiveness of muscle pedicle bone flap transplantation in adult patients with femoral neck fractures.METHODS:Databases such as PubMed, EMBASE, IEEE, Web of Science, and Cochrane library were searched from their dates of inception until March 2021. Two reviewers independently selected the interventional studies on the assessment of the effectiveness of muscle pedicle bone flap transplantation for femoral neck fractures; data extraction and assessment of the methodological quality as per the Institute of Health Economics quality appraisal checklist were also performed by the reviewers. The effectiveness and complication outcomes were assessed by calculating the average rates.RESULTS:Overall, 20 studies with 1022 patients were included in this review. Notably, the methodologic quality of the included studies was typically poor. The average effective rates were as follows: good, 73.4%; fair, 15.4%; and poor, 10.9%. Moreover, the average nonunion rate, average avascular necrosis rate, average collapse rate, and the overall reoperation rate were 9.0%, 6.7%, 4.7%, and 7.3%, respectively.CONCLUSIONS:This systematic review of heterogeneous studies with varying number of patients and varying surgical techniques indicated that muscle pedicle bone flap transplantation provides promising results with low rates of avascular necrosis and nonunion. Nevertheless, further controlled studies are required to ascertain the effectiveness of muscle pedicle bone flap transplantation in treating femoral neck fracture.

目的 探讨手指皮肤脱套再植的临床效果.方法 回顾性分析2014年1月—2019年10月解放军联勤保障部队第九二O医院骨科对11例(11指)手指皮肤脱套伤患者行再植术的治疗效果,男性7例,女性4例;年龄24～45岁,平均33.6岁.均为机器绞伤,单指脱套伤.右手7例,左手4例;其中拇指1例,食指5例,中指4例,环指1例.脱套指体远端、近端指骨均相对完整,伴骨折或指间关节脱位,屈伸肌腱部分损伤,连续性存在.患者均急诊行清创和再植术,伤后至手术时间3～11h,平均7.3h.随访时间6～13个月,平均9.0个月,观察再植术后存活率及功能恢复情况.结果 11例手指脱套再植全部存活,其中2例术后出现静脉回流障碍,1例动脉供血障碍,经使用解痉药物及手术探查取栓重新吻合血管后存活.手指末端指腹两点辨别感觉5～9mm,按中华医学会手外科学会断指再植功能评定试用标准,优7指,良3指,可1指,优良率91％.结论 对远端指体完整、挫伤相对较轻的手指脱套患者行再植手术临床疗效满意.

腕骨骨折在临床上较为常见,但钩骨骨折所占比例较小,钩骨钩较钩骨体更易发生骨折.据相关报道显示,钩骨钩骨折仅占腕骨骨折2～4％[1].钩骨分为钩骨体和钩骨钩,钩骨体与第4、5掌骨基底部构成腕掌关节,钩骨钩由钩骨体向掌侧延伸形成[2-4].钩骨体骨折常由摔倒力量由掌骨传递至钩骨体的间接力量所致.钩骨钩骨折常由球拍或球杆的手柄或自行车撞击的直接力量所致[5-8].因腕骨重叠较多及腕关节解剖较其他关节更为复杂,普通X线检查常难以发现细微骨折,故临床上常导致钩骨骨折的漏诊.钩骨体骨折常伴第4、5腕掌关节脱位,钩骨钩骨折保守治疗常导致骨折不愈合,往往导致患肢握拳无力、疼痛等并发症[9-11].故本文对钩骨骨折的研究进展作一综述.

目的 三维立体建模观察大、小多角骨形态及血供模式,探究其临床意义.方法 选取腕标本12例,将明胶-氧化铅灌注液注入腕标本后行Micro-CT扫描,所得数据导入Mimics软件进行三维重建,观察大、小多角骨形态,记录滋养孔数目与位置,分析骨内血管吻合及走行.结果(1)大多角骨有一定数目的滋养孔分布在3侧非关节面,桡侧(2.66±0.49)个,背侧(2.75±0.62)个,掌侧(2.33±0.65)个,3侧数目两两比较无统计学差异,骨内血管有数级分支且广泛吻合,约70％来自背侧,30％来自掌侧和桡侧;(2)小多角骨有一定数目的滋养孔分布在两侧非关节面,背侧(2.75±0.45)个,掌侧(2.42±0.51)个,两侧数目比较无统计学差异,骨内血管亦有数级分支,但分支吻合不如大多角骨丰富,约70％来自背侧,30％来自掌侧.结论(1)大多角骨内外血供丰富,可能是大多角骨相较其他腕骨不易发生缺血性骨坏死的原因;(2)小多角骨外血供较为丰富,但骨内血管吻合少于大多角骨,这可能是小多角骨相对大多角骨更易发生非创伤性缺血性骨坏死的主要原因.

目的 利用Mimics软件3D可视化分析钩骨形态及其骨内血管走行,为钩骨骨折治疗及其相关手术提供解剖学基础.方法 选用成人新鲜上肢标本12例,灌注后行Micro-CT扫描,将所得数据导入Mimics软件重建钩骨及其血供.结果 钩骨有3个非关节面.背侧和掌侧表面呈三角形,掌侧面尺侧向掌侧延伸形成钩骨钩.钩骨钩分为顶部,中部及基底部.钩骨远端关节面与第4、5掌骨基底部形成腕掌关节,桡侧与头状骨形成关节,尺侧与三角骨形成关节.在背侧非关节面由微小动脉网分支成数根滋养血管进入钩骨体内,并在各方向分支营养钩骨体.在掌侧非关节面钩骨体钩骨钩移行处,即钩骨钩基底部桡侧1-2根滋养血管直接或分支进入骨内,并分别向钩骨体及钩骨钩内走行.部分标本钩骨钩基底部尺侧出现滋养血管由此进入骨内并向钩骨钩内分支走行.钩骨钩顶端有单独的小血管进入并在骨内分支.钩骨钩基底部桡侧滋养血管骨内分支分别与由钩骨体背侧及钩骨钩顶端滋养血管骨内分支相互吻合.结论 钩骨体和钩骨钩内血供丰富,较难发生缺血性坏死.钩骨钩骨折保守治疗不愈合可能是由骨折类型及移位程度较大导致.

Background: With the development of transportation in modern China, the incidence of traumatic fracture and the global degree of fracture complexity are increasing. This study explored the use and curative effect of a novel custom-manufactured bridge combined fixation system for traumatic fractures of the femur. The bridge combined fixation system can be tailored to the specific patient's requirements by bending the rods and sliding the attachment modules. Methods: From May 2013 to August 2017, 14 patients with traumatic femur fractures were managed with the bridge combined fixation system. The operation was conducted according to the routine incision approach of femur fracture. The patients were given early postoperative functional rehabilitation exercise. The curative effect was evaluated according to clinical manifestations, postoperative imaging, and a self-developed standard for bone healing. Results: All patients were followed for 12–24 (median: 12.5) months. Fracture healing was assessed based on clinical symptoms and postoperative X-ray. After 3 months, complete weight-bearing on the affected leg was painless. X-ray showed that the fracture line had disappeared by 6–9 months postoperatively and showed bone healing. According to the self-developed standard for bone healing, 13/14 (92.8%) patients achieved excellent/good clinical outcomes. Bone union was achieved in all patients within 2 years. Conclusion: The custommanufactured bridge combined fixation system is simple and can effectively achieve tailored reduction of the fracture. The fixation was stable, with few complications after surgery and with good treatment effect for traumatic fractures.