Objective: This study aimed to compare the biomechanical performance of an intramedullary nail combined with a reconstruction plate and a single intramedullary nail in the treatment of unstable intertrochanteric femoral fractures with a fracture of the lateral femoral wall (LFW). Methods: A three-dimensional finite element (FE) femur model was established from computed tomography images of a healthy male volunteer. A major reverse obliquity fracture line, associated with a lesser trochanteric fragment defect and a free bone fragment of the LFW, was developed to create an AO/OTA type 31-A3.3 unstable intertrochanteric fracture mode. Two fixation styles were simulated: a long InterTAN nail (ITN) with or without a reconstruction plate (RP). A vertical load of 2100 N was applied to the femoral head to simu-late normal walking. The construct stiffness, von Mises stress, and model displacement were assessed. Results: The ITN with RP fixation (ITN/RP) provided higher axial stiffness (804 N/mm) than the ITN construct (621 N/mm). The con-struct stiffness of ITN/RP fixation was 29% higher than that of ITN fixation. The peak von Mises stress of the implants in the ITN/RP and ITN models was 994.46 MPa and 1235.24 MPa, respectively. The peak stress of the implants in the ITN/RP model decreased by 24% compared to that of the ITN model. The peak von Mises stress of the femur in the ITN/RP model was 269.06 MPa, which was lower than that of the ITN model (331.37 MPa). The peak stress of the femur in the ITN/RP model was 23% lower than that of the ITN model. The maximum displacements of the ITN/RP and ITN models were 12.12 mm and 13.53 mm, respectively. The maximum displacement of the ITN/RP model decreased by 12% compared with that of the ITN model. Conclusion: The study suggested that an additional plate fixation could increase the construct stiffness, reduce the stresses in the implant and femur, and decrease displacement after intramedullary nailing. Therefore, the intramedullary nail and reconstruction plate combina-tion may provide biomechanical advantages over the single intramedullary nail in unstable intertrochanteric fractures with a fractured L F W.

Abstract Objective The pedicle screw construct and locking compression plate have been clinically investigated for the treatment of posterior pelvic ring injuries. However, few studies are available that evaluate the biomechanical performance of these two pelvic fixation techniques. The aim of this study was to compare the construct stability, model displacement and stress distribution of two implants with a finite element (FE) method. Methods A three-dimensional FE model of spine-pelvis-femur complex with ligaments was reconstructed from computed tomography images. The unstable posterior pelvic ring injury was created, which was fixed with the pedicle screw construct or locking compression plate. A follower load of 400 N was applied to the upper surface of the vertebrae to simulate upper body weight, while the ends of the proximal femurs were fixed. Results The construct stiffness of the pedicle screw model was 2 times that of the plate fixation. The maximum displacement of the pedicle screw model decreased by 51.2% compared with the plate fixation. The peek stresses of the implant and pelvis in the pedicle screw model decreased by 80.4% and 25% when compared with the plate model (44.57 MPa and 34.48 MPa in the pedicle screw model, and 227.47 MPa and 45.97 MPa in the plate model). Conclusions The study suggested that the pedicle screw construct could provide better fixation stability compared with locking compression plate, and serves as the recommended fixation method for the treatment of posterior pelvic ring injuries.

目的 探讨"钢板联合骨折端螺钉"与"单纯钉板系统"固定老年股骨远端骨折的临床疗效.方法 回顾性分析2017年6月至2021年6月上海市浦东新区人民医院治疗且获随访的40例简单老年股骨远端骨折的患者资料.其中,20例采用"钢板联合骨折端螺钉"固定(联合组),平均年龄(70.8±5.6)岁,骨密度T值平均-1.91±0.56;20例采用"单纯钉板系统"固定(单纯组),平均年龄(69.9±6.0)岁,骨密度T值平均-1.88±0.60.比较两组患者的手术时间、术中出血量、骨痂形成时间、影像学愈合时间、术后并发症及术后3、6、12个月Neer评分.结果 40例患者随访12～36个月,平均(17.3±5.6)个月.联合组患者手术时间明显少于单纯组,差异有统计学意义(P＜0.05);两组患者术中出血量比较,差异无统计学意义(P＞0.05).两组患者的骨痂形成时间比较,差异无统计学意义(P＞0.05);但联合组患者影像学愈合时间明显少于单纯组,差异有统计学意义(P＜0.05).单纯组出现2例骨折畸形愈合,而联合组无此类并发症发生,但两组并发症发生率比较,差异无统计学意义(P＞0.05).术后3、6、12个月随访时,联合组Neer评分分别为(72.90±3.81)分、(81.45±5.68)分、(87.35±3.72)分,单纯组分别为(70.50±4.34)分、(80.35±4.68)分、(86.70±3.28)分,两组比较差异均无统计学意义(P＞0.05).结论 与"单纯钉板系统"固定相比,"钢板联合骨折端螺钉"固定老年股骨远端骨折能降低手术时间及促进骨折早期愈合.

目的 比较单纯钉板系统(单纯法)与骨折端加压螺钉结合锁定钢板(联合法)固定老年股骨远段简单骨折的生物力学强度.方法 建立AO/OTA-33 A1型老年股骨远段骨折模型,分别用102 mm工作长度单纯法(A组)和联合法(B组)、82 mm工作长度单纯法(C组)和联合法(D组)固定.施加700 N轴向和4 N·m扭转载荷,比较锁定钢板的应力分布及峰值、位移分布及峰值、骨折端剪切位移、骨折端轴向位移.结果 ①锁定钢板的应力分布及峰值情况:使用骨折端加压螺钉后,应力峰值从骨折线区域的股骨干侧方钢板转移到骨折线区域的拉力螺钉,而锁定钢板上的应力峰值明显降低.② 锁定钢板的位移分布及峰值情况:使用骨折端加压螺钉后,锁定钢板上的位移峰值明显降低,联合法模型组的位移均小于单纯法模型组.③ 骨折端剪切位移情况:联合法模型组均小于单纯法模型组.上述3项指标,700 N轴向载荷下,82 mm工作长度模型下降幅度均更大;4 N·m扭转载荷下,102 mm工作长度模型下降幅度均更大.④ 骨折端轴向位移情况:扭转载荷下可忽略不计;轴向载荷下联合法模型组均小于单纯法模型组,82 mm工作长度模型下降幅度更大.结论 对于老年股骨远段简单骨折,联合法固定能分担锁定钢板上的应力及使骨折断端更稳定,102 mm工作长度可提供更好的抗扭转稳定性,82 mm工作长度可提供更好的轴向稳定性.

双侧肩关节急性前脱位在临床上比较少见,一般需要双侧同时受力.1902年,第1例双侧肩关节前脱位被报道,因患者服用过量樟脑引起肌肉收缩导致[1],随后有更多的病例被报道.1984年,Brown[2]整理回顾了以往病例,并将双肩关节前脱位分为三种病因:急性肌肉暴力、创伤及非创伤.2013年,Ballesteros等[3]将受伤机制进一步细化为:杠杆机制、牵引机制、推入机制、未知或复杂机制、肌肉收缩机制和非创伤机制.不同机制下的损伤特点及合并症发生率有所区别.双肩前脱位一般都可早期闭合复位,但其合并症仍需重视.上海市浦东新区人民医院于2021年9月收治1例,现报告如下.

目的 比较加长InterTan髓内钉联合与未联合钢板内固定治疗外侧壁破裂型股骨粗隆间骨折的疗效.方法 回顾性分析自2016-10-2020-10采用加长InterTan髓内钉内固定治疗的36例外侧壁破裂型股骨粗隆间骨折,观察组17例采用钢板固定外侧壁,对照组19例未采用钢板固定外侧壁.比较两组手术时间、术中出血量、术后至开始部分负重时间、术后3个月尖顶距值、骨折愈合时间、并发症情况,以及术后12个月髋关节功能Harris评分.结果 36例均获得随访,随访时间平均15.4(12～20)个月.观察组随访期间无退钉、内固定断裂发生,对照组出现2例退钉,两组并发症发生率比较差异无统计学意义(P=0.487).与对照组比较,观察组手术时间更长,术中出血量增多,但是术后至开始部分负重时间与骨折愈合时间更短,差异有统计学意义(P＜0.05).观察组与对照组术后3个月尖顶距值比较差异无统计学意义(P＞0.05).观察组术后12个月髋关节功能Harris评分(总分、疼痛、功能、下肢畸形、关节活动度)均优于对照组,差异有统计学意义(P＜0.05).结论 加长InterTan髓内钉联合钢板内固定治疗外侧壁破裂型股骨粗隆间骨折安全、有效,辅助钢板固定重建外侧壁的稳定作用可降低术后并发症发生风险,有利于患者早期下床负重活动,缩短骨折愈合时间,最终恢复良好的髋关节功能.

目的 探讨骨折端加压螺钉对兔骨量减少股骨骨折愈合的影响.方法 36只新西兰雌兔中随机选取30只肌注甲强龙构建骨量减少模型(包括模型组6只),另外6只为对照组(肌注生理盐水).肌注后4周,模型组和对照组行骨密度,血清P1NP、CTX,Micro-CT检测.造模成功后,24只骨量减少兔建立股骨骨折模型,分为S1组(单纯钉板系统,4周)、L1组(骨折端加压螺钉结合锁定钢板,4周)、S2组(单纯钉板系统,8周)和L2组(骨折端加压螺钉结合锁定钢板,8周),每组6只.骨折术后4、8周行X线、Micro-CT、生物力学测试、组织病理及免疫组化分析.结果 肌注后4周,模型组腰椎骨密度为(216±21)mg/cm2,对照组为(251±21)mg/cm2;模型组股骨近端骨密度为(237±30)mg/cm2,对照组为(281±28)mg/cm2.与对照组比较,模型组P1NP及CTX均有提高(P<0.05).模型组腰椎三维骨密度为(208.61±18.75)mg/cm3,对照组为(243.83±21.17)mg/cm3.模型组的骨体积分数、骨小梁厚度及骨小梁数量较对照组下降,骨小梁分离度及结构模型指数较对照组上升(P<0.05).骨折术后X线示L1、L2组骨折愈合较快,S2组有1例出现骨折延迟愈合.术后4周,Micro-CT提示L1组骨痂组织的骨体积分数更高,骨小梁厚度明显、数量较多、分离度更低(P<0.05);L1组最大载荷及弹性模量更高(P<0.05);HE、Masson及番红固绿染色显示L1、L2组更早出现成熟骨组织;TRAP染色显示L1、L2组破骨细胞数量更少(P<0.05);免疫组化提示两组BMP-2表达比较差异无统计学意义(P>0.05).结论 在治疗骨量减少性长骨骨折时,骨折端加压螺钉结合锁定钢板固定有助于早期形成骨痂以及骨折的快速愈合.

Objective The aim of this study was to evaluate the strength of the locking plate and lag screw construct that is applied in two different working lengths on the simple distal femur fracture model with a finite element analysis (FEA) method. Methods From the computerized tomography scan data of a 60-year-old healthy male, the AO/OTA 33A1-type fracture model was simulated; the fracture gap was stabilized with the models of locking plate construct with (groups C and D) or without an interfragmentary lag screw (groups A and B). Furthermore, 102-mm plate (groups A and C) and 82-mm plate working lengths (groups B and D) were tested using FEA. Two loading conditions (axial compression and torsion) were applied at the center of the femoral head. Construct stiffness, interfragmentary micromotion, and the peak von Mises stress (VMS) on the plate were assessed. Results Group D provided the highest axial stiffness (1347 N/mm), and group A was the weakest (439 N/mm). With the lag screw, shear micromotion remained generally low compared with that without the screw for all axial and torsional load levels and for both plate working lengths, i.e., 0.23 mm with lag screw versus 0.43 mm without lag screw (102 mm working length, 700 N). The percentage decreases of shear micromotion under axial (350/700/1400 N) and torsional loads for the 102-mm working length were >22% and 73%, respectively; while those for the 82-mm working length were >28% and 33%, respectively. The reduction of axial micromotion was observed with the lag screw for all axial load levels as well as for both plate working lengths, i.e., 0.33 mm with lag screw versus 0.87 mm without lag screw (102-mm working length, 700 N). The percentage decreases of axial micromotion under axial loading (350/700/1400 N) for 102 mm and 82 mm working lengths were >42% and 50%, respectively. The peak VMS on the plate stayed generally low with lag screw compared with without lag screw throughout all tested load levels, as well as for both plate working lengths, i.e., 124.26 MPa versus 244.39 MPa (102 mm working length, 700 N). The percentage decreases of the peak VMS under axial (350/700/1400 N) and torsional loads for the 102-mm working length were >40% and 69%, respectively, while those for the 82-mm working length were >47% and 61%, respectively. Conclusion The current FEA concludes that in a simple distal femur fracture, adding a lag screw to a locking plate construct provides better torsional stability with a 102-mm plate working length and better axial stability with a 82-mm plate working length. Additionally, the strength of the materials is increased and implant failure can be minimized by using this technique.

目的 比较锁定钢板加拉力螺钉与不加螺钉治疗老年股骨远端骨折的临床疗效.方法 将26例老年股骨远端骨折患者根据手术方法不同分为A组(采用锁定钢板加拉力螺钉治疗,13例)与B组(采用锁定钢板不加拉力螺钉治疗,13例).记录两组手术时间、术中出血量、骨折愈合时间,比较术后1、3、6、12个月两组疼痛VAS评分、膝关节活动度及Neer评分.结果 患者均获得随访,时间12～30个月.手术时间两组比较差异有统计学意义(P<0.05),术中出血量、骨折愈合时间两组比较差异均无统计学意义(P>0.05).术后1、3、6、12个月,VAS评分、膝关节活动度及Neer评分两组比较差异均无统计学意义(P>0.05).B组1例出现股骨旋转不良.两组均无感染、下肢深静脉血栓形成、螺钉松动或钢板断裂等并发症发生,未出现明显膝关节僵硬.结论 锁定钢板加拉力螺钉治疗老年股骨远端骨折可以缩短手术时间,减小骨折间隙,利于骨折早期愈合.

目的 比较分析后向前螺钉与支撑钢板内固定治疗后Pilon骨折的临床疗效.方法 回顾性分析自2012-01-2017-12诊治的29例后Pilon骨折,14例采用后向前螺钉内固定治疗(螺钉组),而15例采用支撑钢板内固定治疗(钢板组).比较2组骨折愈合时间、踝关节背伸活动度、踝关节跖屈活动度、AOFAS踝与后足评分、疼痛VAS评分、OA评分.结果 29例均获得随访,随访时间平均18.8(12～36)个月随访.随访期间无螺钉松动断裂及内固定失效,未出现骨折畸形愈合、踝关节内外翻畸形、踝关节僵硬.螺钉组1例术后12个月出现长时间行走后踝关节疼痛、肿胀.钢板组1例术后3个月出现足拇趾屈趾畸形.螺钉组与钢板组骨折愈合时间、末次随访时踝关节背伸活动度、踝关节跖屈活动度、AOFAS评分、疼痛VAS评分、OA评分比较差异均无统计学意义(P＞0.05).结论 采用后向前螺钉或支撑钢板内固定治疗后Pilon骨折均可获得较为满意的临床疗效,但螺钉内固定力学稳定性较支撑钢板内固定差,术后建议采用石膏托保护固定,而支撑钢板内固定术后患者可早期进行功能锻炼.

目的 观察皮质骨通道螺钉固定A3型胸腰椎骨质疏松性椎体骨折的生物力学即刻稳定性.方法 取6具新鲜老年尸体胸腰段脊柱标本,在MTS-858脊柱生物力学实验机上测试原始状态、传统固定、皮质骨通道螺钉(cortical bone trajectory,CBT)固定、骨折传统固定、骨折CBT固定五种工况下的L1～3的活动范围.结果 传统固定组、CBT固定组的三维六自由度活动范围较原始状态组明显降低(P＜0.01),传统固定组和CBT固定组之间没有显著差异.骨折传统固定组和骨折CBT固定组的三维活动总体上比原始状态组降低(P＜0.05),但是骨折传统固定组和骨折CBT固定组之间差异无统计学意义.骨折传统固定组和骨折CBT固定组的三维活动,分别比传统固定组和CBT固定组之间的三维活动有所增加,但是差异无统计学意义(P＞0.05).结论 骨折后CBT螺钉固定可获得与骨折后普通椎弓根螺钉固定相似的即刻稳定性,CBT螺钉固定可用于老年A3型骨质疏松性胸腰椎骨折的临床治疗.

目的 探讨不同内固定方式对高龄稳定股骨粗隆间骨折围手术期隐性失血的影响.方法 分析2010年1月至2015年12月应用髓外固定(dynamic hip screw,DHS)与髓内固定(proximal femoral nail anti-rotation,PFNA)治疗128例股骨粗隆间骨折患者资料,年龄80～95岁,髓外组56例,髓内组72例.比较不同内固定方式对围手术期隐性失血的影响,比较手术时间、骨折愈合时间、髋关节功能评分(FRS)及术后并发症.结果 128例患者随访12～36个月,平均18.2个月.髓外组手术时间(77.8±8.4) min和显性失血量(154.4±45.3) mL大于髓内组(70.5±11.8) min和(123.2±32.1) mL (P＜0.001);髓外组总失血量(747.3±134.3) mL和隐性失血量(592.9±134.3) mL小于髓内组(906.8±143.6) mL和(783.6±141.3) mL (P＜0.001).髓外组术后第1、3、5d血红蛋白和红细胞压积均高于髓内组(P.＜0.05).髓外组部分负重时间(9.59±2.04)周、完全负重时间(13.43±1.55)周大于髓内组(8.11±1.39)周和(11.99±1.48)周(P＜0.001);髓外组骨折愈合时间(14.30-1.53)周、FRS评分为(76.32±8.56)分,髓内组为(13.97±1.73)周和(76.75±8.96)分(P＞0.05).髓外组出现8.9％肺部感染,3.6％因心、肺、感染等并发症而死亡,1.8％下肢深静脉血栓,5.4％螺钉切割,7.1％髋内翻;髓内组分别为12.5％、5.6％、1.4％、2.8％、4.2％(P＞0.05).结论 在治疗高龄稳定股骨粗隆间骨折时,髓外与髓内固定均可获得满意的临床结果,但髓外固定在减少围手术期隐性失血上有优势,若采用髓内固定应尽量避免远端扩髓,术后3d应严密监测血红蛋白和红细胞压积变化,准确评估隐性失血情况,及时纠正贫血状态,减少高龄患者术后严重贫血带来的并发症.

目的 探讨尺骨茎突骨折与否与不同分型对桡骨远端骨折术后疗效的影响.方法 纳入自2013-12-2015-12诊治的76例桡骨远端骨折,根据是否合并尺骨茎突骨折及其类型分为3组,32例不合并尺骨茎突骨折(A组),21例合并Ⅰ型尺骨茎突骨折(B组),23例合并Ⅱ型尺骨茎突骨折(C组).结果 76例均获得随访,随访时间平均14.6(12～24)个月.复查X线片显示桡骨远端骨折均愈合,关节面恢复平整,掌倾角、尺偏角及桡骨高度恢复正常.术后无骨折畸形愈合、骨折不愈合、钢板螺钉松动或断裂等并发症发生.A组4例出现腕尺侧疼痛,B组2例出现腕尺侧疼痛,C组3例出现腕尺侧疼痛.3组桡骨远端骨折愈合时间及末次随访时掌倾角、尺偏角、桡骨高度、腕关节活动范围、腕关节功能差异无统计学意义(P＞0.05).结论 尺骨茎突骨折与否及其类型与桡骨远端骨折内固定手术预后无关,但桡骨远端骨折合并Ⅱ型尺骨茎突骨折患者应常规检查下尺桡关节稳定性,若不稳定则需要复位固定.

目的 探讨在创伤骨科教学中应用学生标准化病人(SSP)的效果.方法 根据医学院实际情况,以2016级两个班学生为研究对象,随机将其分为SSP教学组与传统教学组.选拔高年级临床医学生,将其培训成SSP,并应用于SSP教学组创伤骨科教学中,比较两组问卷调查结果 及考核成绩.结果与传统教学相比,SSP教学能激发学生对于创伤骨科的学习兴趣,课堂学习氛围更好,能提高学生与患者沟通能力、知识掌握程度、病例分析及临床技能考核成绩与对带教教师的满意度.结论 在创伤骨科教学中应用SSP,有助于提高教学质量.

[目的]对比皮质骨通道螺钉(CBT)内固定术和经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩性骨折的效果.[方法]回顾性分析2015年12月～2017年3月在本院接受手术治疗的单节段骨质疏松性胸腰椎骨折患者60例.其中,30例采用CBT椎弓钉内固定(CBT组),30例采用椎体成形术(PVP组).对比两组患者手术时间、术中出血量、术中透视次数、并发症情况,采用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价临床疗效,测量伤椎前缘高度比、伤椎后凸Cobb角.[结果]CBT组手术时间、术中出血量显著大于PVP组,差异有统计学意义(P＜0.05),但CBT组术中透视次数显著少于PVP组,差异有统计学意义(P＜0.05).PVP患者出现7例骨水泥渗漏.两组患者随访时间12～23个月,平均(15.20±8.80)个月.末次随访时两组的VAS、ODI评分差异无统计学意义(P＞0.05).两组的伤椎前缘高度比、伤椎后凸Cobb角差异无统计学意义(P＞0.05).CBT患者随访期间无内固定失败发生. [结论] CBT螺钉对比PVP治疗骨质疏松性胸腰椎压缩性骨折,影像学指标及临床疗效指标相似,但术中透视次数更少,无骨水泥渗漏风险.

目的 探讨采用带线锚钉固定粉碎性大结节骨块对治疗肱骨近端骨折的临床疗效的影响.方法 回顾性分析2012年1月至2015年12月我院采用切开复位锁定钢板内固定治疗且获得随访的38例合并粉碎性大结节的肱骨近端骨折患者的临床资料,男12例,女26例;年龄25~86岁,平均(58.7±17.0)岁.Neer分型:三部分骨折25例,四部分骨折13例.根据是否采用带线锚钉固定大结节骨块分为两组:带线锚钉固定组(锚钉组,14例)和未采用锚钉固定组(非锚钉组,24例).随访记录并比较两组患者的肩关节功能Constant评分、末次随访时大结节移位距离及术后并发症发生情况.结果 术后38例患者均获得随访,随访时间6~42个月,平均(22.9±12.5)个月.锚钉固定组与非锚钉固定组平均Constant评分分别为(77.7±13.2)分、(69.5±10.9)分,末次随访大结节移位距离分别为(2.2±2.2)mm、(5.1±3.9)mm,术后肩峰撞击征发生率分别为0、33.3%,以上项目两组比较差异均有统计学意义(P>0.05),术后感染率两组比较差异无统计学意义(P>0.05).结论 在处理复杂肱骨近端骨折中,用带线锚钉固定粉碎性大结节可以有效的避免对骨折块的二次损伤,减少大结节再移位,降低肩峰撞击征的发生率,从而获得较好的术后肩关节功能,具有一定的临床优势.

Objective To investigate the effect of closed reduction and percutaneous hollow screw fixation for the treatment of scaphoid fractures with slight displacement.Methods The 15 cases of scaphoid fractures of type B 1 and type B2 according to Herbert classification were treated with closed reduction and percutaneous hollow screw fixation.The positive and lateral and oblique radiographs of the wrist were taken regularly to evaluate the fracture healing.The modified Mayo wrist function score and VAS were used to evaluate function results.Results All 15 patients were followed up for 6~24 months.All patients achieved bone union without nonunion or osteonecrosis.The Mayo score was 80~100 points at the last follow-up.Among them, 11 cases were excellent , 4 cases were good.The VAS was 0~3 points.Conclusions Closed reduction and percutaneous hollow screw fixation can minimize soft issue dissection to protect peripheral blood supply , which effectively avoid the bone necrosis , allow patients to do early functional exercise after operation , which is an effective method for the treatment of Herbert type B 1, B2 of wrist fracture of scaphoid bone.

目的 观察富血小板血浆(PRP)促进纤维多孔钛椎体间融合器(fiber porous titanium Cage,FPT Cage)的骨长入作用.方法 健康成年比格犬6只,体质量12.5～15.0 kg,雌雄各3只.取比格犬前肢外周静脉血20.0 mL,采用二次离心法制备PRP,同时对外周静脉血及PRP行血小板计数.行颈椎前路C4/C5/C6椎间盘切除FPT Cage椎间融合术,C4/C5节段单纯使用FPT Cage,C5/C6节段采用激活的PRP浸泡的FPT Cage.术后4个月处死比格犬后行硬组织切片检查,观察C4/C5/C6节段FPT Cage中骨长入的情况.结果 C4/C5节段椎间隙FPr Cage-骨界面附近可见少量软骨细胞和成骨细胞;FPT Cage中央孔隙内发现少量成骨细胞,类骨质较少,大部分孔隙内仍然为纤维组织.C5/C6节段椎间隙FPT Cage-骨界面可见成熟骨组织形成;FPT Cage边缘孔隙内可见骨组织长入;FPT Cage中央孔隙内发现大量成骨细胞;大部分中央孔隙内为类骨组织,少部分中央孔隙内仍然为纤维组织.结论 在比格犬体内实验研究中,复合PRP可以促进FPT Cage内的骨长入.

Objective To evaluate the effects of absorbable implants in treatment of ankle and foot fractures.Methods A total of 76 cases with ankle and foot fracture were operated with absorbable implants from Jun 2006 to Jun 2010.There were 49 males and 27 females,with average age of 46.6 year(s 18 to 62 years).There were 25 ankle frctures,6 calcaneal and 45 metatarsal and phalange fractures.Results All cases were followed up for 10 to 48 months(average 22 months).All fractures healed.The rate of excellent and good clinical results according to AOFAS system was 96%.The incidence of complications was 4% all were foreign-body reactions.Conclusion The absorbable implant was suitable for ankle and foot fractures.Appropriate indication and operative procedure were important for the successful treatment.

Objective To evaluate the effects of Sanders type Ⅱ and type Ⅲ of the calcaneus treated with open reduction and internal fixation with plate.Methods 78 calcaneal fractures of Sanders type Ⅱ and type Ⅲ in 74 patients were treated with open reduction and internal fixation with plate through a L-shaped lateral incision.Preoperative and postoperative Bhler angle and Gissane angle were measured and the effects were evaluated according to Maryland foot score system.Results 74 cases were followed up from 6 to 24 months(average 15.1±5.6 months).The Bhler angle was recovered from-23 °~30°(12.2°±9.7°) to 12 °~45°(32.6°±7.0°) and the Gissane angle was recovered from 83 °~139°(113.1°±11.6°) to 102°~145°(120.8°±9.6°).36 fractures showed excellent results,34 good,and 8 fair,and the excellent and good rate was 89.7%,92.3% of type Ⅱ and 87.2% of type Ⅲ.3 fractures showed necrosis of superficial part of the incision,1 fracture occurred infection of the deep part and 4 fractures appeared sural nerve injury.Conclusions Open reduction and internal fixation with plate is an effective method to treat Sanders type Ⅱ and type Ⅲ of the calcaneus by grasping correct opportunity of operation and perfect operative technique.