新型点接触锁定加压接骨板固定骨对骨皮质下血供的影响

目的观察新型点接触锁定接骨板（PC-LCP）和动力加压接骨板（DCP）固定骨后骨皮质微循环形态学及血流量的变化。方法采用成年山羊15只,在左右侧完整胫骨中段分别用PC-LCP和DCP固定。于固定术后1天、2、4、8、12周行非放射性彩色微球测量血流量,术后1天、2、4、8周行活体双硫蓝染色。观察接骨板下与对侧骨血流量及固定段骨接骨板下骨皮质、断端染色变化。结果PC-LCP实验组接骨板下及螺钉之间于术后1天出现骨缺血区,4周时恢复,DCP固定组术后1天、2、4周板下皮质骨持续存在缺血现象,到第8周才恢复;PC-LCP实验组接骨板下血流量均高于DCP组板下血流量。结论PC-LCP对骨皮质骨微循环有明显的保护作用,有利于骨折愈合。     

坚硬接骨板固定及取出对骨力学性能的影响

目的：对接骨板固定及取出后固定骨段的力学性能变化进行观察分析．方法：实验用新西兰兔２８只，４只对照，２４只在左胫骨行不锈钢板固定，其中２０只动物术后２个月取出钢板，并在取钢板当时及取钢板后１、２、３和４个月分别有４只动物处死，另有４只动物于内固定后６个月处死，取完整胫骨作力学测试．结果：坚硬接骨板固定可诱发严重的局部骨质疏松，导致固定骨段力学性能下降．接骨板取出后固定骨段力学性能可逐步恢复，但恢复过程较缓慢．结论：接骨板取出后的骨强度恢复延迟，可能是固定骨段发生再骨折的潜在原因．     

新型点式接触动力加压接骨板固定对板下骨质及力学性能影响的实验研究

目的　探讨新型点式接触动力加压接骨板固定对板下骨质及力学性能的影响。方法　采用性成熟山羊 6只 ,双侧完整胫骨分别采用点式接触动力加压接骨板 (pointcontact dynamiccompressionplate,PC DCP)和动力加压钢板 (dynamiccompressionplate,DCP)固定。固定后 1 2周和 2 4周分批处死动物 ,每批 3只 ,取下双侧胫骨先后进行CT扫描 ,测量局部皮质骨厚度和抗扭力学性能测试。结果　固定后 1 2周 ,PC DCP组板下皮质骨厚度和骨抗扭力学强度均明显大于DCP组 (P <0 .0 5 )。固定后 2 4周 ,DCP组和PC DCP组骨皮质均变薄 ,骨髓腔扩大 ,两组间骨皮质厚度和抗扭力学性能间差异无显著性意义 (P >0 .0 5 )。结论　点式接触动力加压接骨板可避免固定后较早期局部骨质疏松的发生 ,但在后期具有与传统接骨板相似的应力遮挡作用     

坚硬接骨板固定后骨结构紊乱的组织学观察

实验选用成年新西兰兔１５只。采用３１６－Ｌ不锈钢接骨板在左胫骨作不截骨内固定。术后４、８、１２周取固定骨段标本进行偏光、荧光显微镜和电镜观察。结果表明：坚硬接骨板不仅使固定骨段皮质产生松质骨化，而且产生胶原纤维排列紊乱及结构破坏。同时，在新骨内由成骨细胞产生的胶原纤维排列极不规则。发现除了骨量减少外，骨的结构紊乱可能是导致骨力学性能下降的另一重要因素。     

锁定接骨板治疗四肢长管状骨骨折的疗效

目的观察锁定接骨板应用于四肢长管状骨部位骨折损伤症状临床治疗的效果。方法选择83例（94肢）四肢长管状骨发生骨折损伤的病患,随机分组,Ⅰ组43例（49肢）,以锁定接骨板施治,Ⅱ组40例（45肢）,以传统固定法施治,对比两组病患骨折愈合状况及并发症情况。结果Ⅰ组中患者总愈合率为93．88％（46／49）,Ⅱ组为64．44％（29／45）,相对应比较,Ⅰ组高于Ⅱ组,P〈0．05,肱骨、尺桡骨、股骨以及胫腓骨四类骨折愈合率分别对应比较,也为Ⅰ组高于Ⅱ组,P〈0．05。Ⅰ组中并发症发生率6．12％,Ⅱ组35．56％,Ⅰ组明显小于Ⅱ组,P〈0．05。结论临床医师在为四肢长管状骨发生骨折损伤的患者实施治疗时,采用锁定接骨板进行固定,可以有效提高愈合率,减少并发症发生率,加快患者康复。     

两种有限接触接骨板固定不同类型骨表面特征评估

目的对比评估新研制的点接触锁定加压接骨板（PC-LCP）与有限接触加压接骨板（LC-DCP）固定不同类型骨时的表面特征。方法应用PC-LCP及LC-DCP固定人尸体标本肱骨、尺骨、桡骨及新鲜山羊胫骨，通过压力敏感膜与图像分析系统分析两种接骨板固定以上不同骨时的表面接触面积、压力及应力变化。结果PC-LCP与骨面接触面积较LC-DCP明显减少，两者有显著差异（P〈0．01），LC-DCP较PC-LCP易受骨表面形态影响。结论新研制的点接触锁定加压接骨板（PC-LCP）能有效减少与骨表面的接触面积，最大限度地保护骨皮质下骨血运。     

点式接触动力加压接骨板固定骨微循环形态学观察的实验

目的 观察点式接触动力加压接骨板（PC-DCP）和动力加压钢板（DCP）内固定后皮质骨微循环形态学的变化。方法 采用性成熟山羊13只,在左右侧完整胫骨中段分别用PC-DCP和DCP固定。分别于固定术后1天、2、6、12周进行活体双硫蓝染色,固定骨段钢板床和横切面观察。结果 PC-DCP实验侧术后1天在螺钉孔周围和钢板点接触部位出现皮质骨缺血,2螺钉孔中间骨段未观察到明显缺血区域,于术后2周完全恢复;DCP固定侧术后1天、2、6周,板下皮质骨外层持续存在缺血现象,直至术后12周微循环才恢复。结论 PC-DCP固定可明显保护局部骨微循环。     

跟骨接骨板治疗跟骨骨折56例分析

对56例累及距下关节的跟骨骨折用跟骨接骨板内固定治疗的临床资料进行回顾性分析,全组SandersⅡ、Ⅲ、Ⅳ型骨折经治疗后,47例评为优良,优良率83.9%。     

高原地区陈旧性腕舟状骨骨折治疗方法的选择

目的：在高原地区，选择更为有效的腕舟状骨陈旧性骨折的治疗方法。充分发挥骨膜移植的膜内化骨作用。方法：分别应用单纯植骨内固定，带血管蒂桡骨条移植内固定及带血管蒂骨膜面桡骨条髓内移植内固定方法（ｔｈｅｖａｓｃｕｌａｒｉｚｅｄｒａｄｉｕｓｅａｎｄｕｐｓｅｔｐｅｒｉｏｓｔｅａｌｆｌａｐｓｇｒａｆｔ，ＶＲＰＦＧ）治疗舟状骨陈旧性骨折８例，１２例及１６例，共３６例，并对上述方法的疗效进行了比较研究，结果：术后     

形状记忆合金环抱式接骨板治疗尺桡骨骨不连

回顾性分析19例尺桡骨骨不连患者的临床资料,认为记忆合金环抱式接骨板治疗尺桡骨骨不连能最大限度地保留骨膜和髓内血运,其接骨板应力分布更为均匀,固定更加牢固。     

解剖型钢板与锁定钢板治疗有移位的跟骨骨折的效果

目的：对比解剖型钢板和锁定钢板治疗有移位的跟骨骨折的临床疗效。方法选取作者医院骨伤科2011年6月～2013年6月70例因有移位的跟骨骨折（ SandersⅡ～Ⅳ型）患者,随机分为锁定钢板组（n＝35）和解剖钢板组（n＝35）进行内固定治疗。比较两组患者的手术时间和骨折愈合时间,手术前后的Bohler和Gissane角,手术前后的跟骨长度、高度和宽度。术后半年采用Maryland评分标准对跟骨功能进行评价,同时随访半年记录并发症发生情况。结果锁定钢板组的手术时间和骨折愈合时间较解剖钢板组显著缩短（P＜0.01）;两组患者术后1周的Bohler和Gissane角均显著大于术前（P＜0.01）;锁定钢板组术后1周的Bohler和Gissane角均显著大于解剖钢板组（P＜0.01）;两组患者术后1周的跟骨长度、高度均显著大于术前,而跟骨宽度显著小于术前（ P＜0.01）;锁定钢板组术后1周的跟骨长度、高度均显著大于解剖钢板组,而跟骨宽度显著小于解剖钢板组（ P＜0.05）;锁定钢板组的优良率显著高于解剖钢板组,χ2＝4.8837,P＝0.0271＜0.05;两组患者的术后并发症发生率无显著差异（P＞0.05）。结论对于有移位的跟骨骨折,锁定钢板的临床疗效更佳。     

Volar plate fractures.

Rupture of the volar plate of the proximal interphalangeal joint, usually secondary to hyper-extension injury, may be accompanied by a radiographically evident avulsion fracture at the base of the middle phalanx. Findings were reviewed in 55 patients with 58 cases of volar plate fracture. This fracture should be specifically looked for in a patient with the typical history, since it may be the only radiographic evidence of a potentially disabling injury.     

锁定加压钢板和普通T型钢板治疗桡骨远端die-punch骨折的研究

目的研究锁定加压钢板和普通T型钢板治疗桡骨远端die-punch骨折疗效和愈合情况。方法选取2006年1月~2015年10月收治的60例桡骨远端die-punch骨折患者,根据手术方法分为观察组和对照组。观察组应用锁定加压钢板治疗,对照组应用普通T型钢板进行固定治疗。分析两组患者术后骨折愈合情况及疗效。结果观察组的腕关节尺偏活动度、掌倾角、尺偏角恢复情况[(21.8±3.7)°、(9.4±2.7)°、(21.3±3.8)°]明显优于对照组[(17.8±3.1)°、(8.1±2.0)°、(18.4±3.8)°,P0.05]。术后,观察组患者的腕关节恢复优良率(90.0%)明显高于对照组(66.7%),两组比较有统计学意义(χ2=4.8118,P=0.0283)。观察组患者并发症发生率(6.7%)明显低于对照组(20.0%),两组比较有统计学意义(χ2=4.3200,P=0.0377)。结论锁定加压钢板治疗桡骨远端die-punch骨折疗效显著,愈合情况良好,值得推广。     

Differences in fixation stability between spacer plate and plate fixator following high tibial osteotomy

Purpose

Since in vivo stability following high tibial osteotomy is unknown, surgeons customize the postoperative rehabilitation to the assumed implant stability, leaving us with numerous rehabilitation protocols. The purpose of the study is to quantify the fixation stability of different open-wedge high tibial osteotomy implants. It is hypothesized that the higher fixation stability of a plate fixator justifies early weight bearing.

Methods

In this prospective 30-subject clinical trial, fixation stability was determined over a 2-year period using radiostereometric analysis (RSA). Patients were assigned to two angle-stable osteotomy plates: a spacer plate with 6 postoperative weeks of feather-touch weight bearing versus a plate fixator with 2 postoperative weeks of feather-touch weight bearing.

Results

Postoperative RSA data showed a significant higher lateral translation of the distal tibia and a significantly increased subsidence, varus and internal rotation of the tibial head in the spacer plate compared to the plate fixator group. Weight bearing following spacer plate fixation induced significant micromotion 6 weeks after surgery. Three months after surgery, bone healing was achieved regardless of the used implant.

Conclusions

Early weight bearing is appropriate for plate fixator fixation. The 6-week period of delayed weight bearing following spacer plate fixation is inadequate and should be prolonged presumably up to 8–10 weeks to avoid pseudarthrosis and/or recurrence of varus angulation.

Level of evidence

Level II, diagnostic study—investigating a diagnostic test.     

应用微创经皮钢板固定技术结合解剖钢板治疗胫骨远端粉碎性骨折

目的探讨应用微创经皮钢板固定法（MIPPO）结合解剖钢板治疗胫骨远端粉碎性骨折的临床效果。方法对25例胫骨远端粉碎性骨折采用胫骨远端解剖钢板应用微创经皮钢板固定技术（MIPPO）治疗。骨折分型按AO分型A型14例,B型2例,C型9例。结果本组病例随访5～25个月,平均14个月,伤口全部愈合,其中2例延迟愈合,皆为糖尿病患者。X线片示骨痂出现时间12周,无短缩以及旋转畸形,外观无明显畸形,膝踝关节功能正常。按Johner-Wruhs胫骨骨折疗效评定标准,优19例,良4例,中2例;优良率为92％。结论MIPPO技术结合解剖钢板治疗胫骨远端粉碎性骨折具有优势,降低了手术损伤,提高治疗成功率,有利于患者肢体功能的恢复。     

Variation in CR imaging plate readers

This study investigated computed radiography (CR) image processing to determine whether variation exists within and among CR imaging plate readers. Photostimulable imaging plates were exposed using a phantom test tool and processed in 4 CR readers located in diverse settings in an urban academic medical center. Research results indicate daily variation of S-numbers within individual CR readers did not exceed tolerance limits, although over the 3-week study period, evidence of S-number variation within individual CR readers was mixed. In addition, S-number variability among multiple CR readers was found to be statistically significant. Although the cause of the variability remains unknown, evidence of variability among multiple CR readers indicates a need for systematic quality control.     

关节镜辅助下Tightrope袢钢板与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的疗效

目的 探讨关节镜辅助下Tightrope袢钢板与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的疗效.方法 回顾性分析2016年1月—2018年12月四川省广元市中医医院骨科行RockwoodⅢ型肩锁关节脱位患者60例,男性29例,女性31例;年龄19～75岁,平均45.1岁;运动伤5例,摔伤20例,道路交通伤32例,砸伤3例.按固定方式不同分为袢钢板组(23例)和锁骨钩组(37例),袢钢板组行关节镜辅助下Tightrope袢钢板,锁骨钩组行切开复位锁骨钩钢板内固定.比较两组患者手术时间、切口长度、出血量、喙锁关节间隙及肩锁关节间隙,术后1、6个月视觉模拟评分(VAS),肩关节Constant-Murley功能评分等指标.结果 患者均获得随访,随访时间6～22个月,平均15.8个月.袢钢板组手术时间(45.82±23.91)min、切口长度(3.74±1.98)cm及出血量(30.45±6.15)mL均显著少于锁骨钩组[(54.64±30.72)min、(7.96±1.04)cm、(70.49±10.18)mL],差异有统计学意义(t=3.143,P=0.024;t=2.482,P=0.008;t=5.661,P=0.023).两组患者喙锁关节间隙、肩锁关节间隙影像学指标方面比较,差异无统计学意义(t=0.345,P=0.192;t=0.432,P=0.243).所有患者VAS与Constant-Murley评分随时间增加显著好转.袢钢板组VAS术后1个月(2.3±1.1)分、6个月(1.3±0.5)分显著低于锁骨钩组(3.9±2.1)分、(2.7±1.9)分,差异有统计学意义(t=0.824,P=0.046;t=1.834,P=0.028).Constant-Murley评分方面,袢钢板组术后1个月(72.1±15.4)分、6个月(91.3±12.9)分显著高于锁骨钩组(60.5±13.4)分、(82.1±18.4)分,差异有统计学意义(t=1.524,P=0.026;t=4.513,P=0.017).结论 关节镜辅助下Tightrope袢钢板治疗RockwoodⅢ型肩锁关节脱位安全有效,能够有效提高患者生活质量,值得临床推广.     

Neutron radiography using neutron imaging plate

The aims of this research are to study properties of a neutron imaging plate (NIP) and to test it for use in nondestructive testing (NDT) of materials. The experiments were carried out by using a BAS-ND 2040 Fuji NIP and a neutron beam from the Thai Research Reactor TRR-1/M1. The neutron intensity and Cd ratio at the specimen position were approximately 9×10⁵ ns/cm² s and 100 respectively. It was found that the photostimulated luminescence (PSL) readout of the imaging plate was directly proportional to the exposure time and approximately 40 times faster than the conventional NR using Gd converter screen/X-ray film technique. The sensitivities of the imaging plate to slow neutron and to Ir-192 gamma-rays were found to be approximately 4.2×10^?3 PSL/mm² per neutron and 6.7×10^?5 PSL/mm² per gamma-ray photon respectively. Finally, some specimens containing light elements were selected to be radiographed with neutrons using the NIP and the Gd converter screen/X-ray film technique. The image quality obtained from the two recording media was found to be comparable.     

The normal and abnormal growth plate

Skeletal growth is a dynamic process. A knowledge of the structure and function of the normal growth plate is essential in order to understand the pathophysiology of abnormal skeletal growth in various diseases. In this well-illustrated article, the authors provide a radiographic classification of abnormal growth plates and discuss mechanisms that lead to growth plate abnormalities.