胫骨平台伴髁间棘骨折术后关节功能康复的影响因素分析

目的 Logistics回归分析胫骨平台伴髁间棘骨折患者术后关节功能康复效果的影响因素,建立风险模型预测,进一步为术后膝关节功能康复奠定基础。 方法 选取胫骨平台伴髁间棘骨折患者328例作为研究对象,美国特种外科医院膝关节评分（Hospital for Special Surgery Knee Score,HSS）评估患者术后膝关节功能康复效果,Logistics回归分析术后关节功能康复效果的影响因素,建立Logistic回归预测模型,进一步评估该模型预测术后关节功能康复效果的敏感度和特异度。 结果 胫骨平台伴髁间棘骨折患者328例,术后膝关节功能恢复良好82.93%,术后膝关节功能恢复不良17.07%;Logistic回归方程分析得知,年龄、体重指数、术前（American Society of Anesthesiologists,ASA）分级、手术时间、骨质疏松、术前膝关节活动度、术后疼痛是胫骨平台伴髁间棘骨折患者术后关节功能康复效果的影响因素（P＜0.05）;当Logistic（P）＞3.87时预测价值最优,敏感度为67.9%,特异度为93.5%。 结论 受年龄、体重指数、术前ASA分级、手术时间、骨质疏松、术前膝关节活动度、术后疼痛等因素影响,胫骨平台伴髁间棘骨折患者术后存在膝关节功能恢复不良风险,临床应加强预防性干预,以提高康复效果,改善预后。     

Biomechanical analysis of femoral neck system in unstable femoral neck fractures北大核心

BACKGROUND: The femoral neck system is a novel fixation device for unstable femoral neck fractures. OBJECTIVE: To compare and analyze the mechanical stability of three kinds of internal fixation in Pauwels III unstable femoral neck fractures by finite element method. METHODS: On the basis of the validated femoral finite element model (intact group), the model was cut to make a Pauwels III 70° unstable fracture of the femoral neck. Different internal fixation models were implanted to simulate clinical surgery. This study established femoral neck system fixation (model A), inverted triangular cannulated screw fixation (model B) and 4 diamond-shaped cannulated screw fixation (model C). All the nodes under the distal end of the femur were restrained for the three groups of models, and 700 N, 1 400 N and 2 100 N compressive loads were applied to the femoral head. Through calculation and analysis, the Von Mises stress distribution and deformation of each group of models were observed, and the mechanical stability of each group of models was compared. RESULTS AND CONCLUSION: (1) The maximum deformation of the three groups of models under various loads occurred in the femoral head. When compressed for 2 100 N, the deformation of model A was 2.06 mm less than that of intact group 2.17 mm, while the deformations of model B and model C were both higher than that of intact group, with the distributions of 2.39 mm and 2.33 mm. (2) Under various loads, the stress in model A group was also the smallest. Under 2 100 N, the stress peak in model A was 297.31 MPa, distributed at the joint position of anti-rotation screw and locking screw, while the stress peak in model B was 543.18 MPa, distributed at the fracture joint position of the third screw in the inverted triangle. However, the deformation and stress of model C were intermediate between model A and model B, and the maximum stress peak value was distributed at the bottom hollow of the cannulated screw fracture, reaching 315.61 MPa at 2 100 N. (3) The compressive stiffness and stress analysis of models of the three groups showed that model A < model C < model B. (4) It is concluded that the mechanical stability of femoral neck system for femoral neck fracture is better than that of three and four cannulated screws fixation, and it can effectively prevent femoral neck shortening. Femoral neck system is a recommended internal fixation method for unstable femoral neck fractures. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

经皮加压钢板联合唑来膦酸治疗老年骨质疏松性股骨颈骨折疗效分析

目的探讨经皮加压钢板联合唑来膦酸治疗老年骨质疏松性股骨颈骨折（OFNF）的临床疗效。 方法选取2014年6月至2019年6月常熟市第一人民医院收治的98例老年OFNF患者,其中48例采用经皮加压钢板+唑来膦酸治疗（观察组）,50例采用全髋或半髋关节置换+常规治疗（对照组）。比较两组患者手术前后的骨密度与骨代谢标志物变化,临床疗效,术后视觉模拟评分法（VAS）疼痛评分、Harris髋关节功能评分,以及并发症的总体发生率。计量资料的比较采用t检验和重复测量方差分析,计数资料的比较采用χ²检验。 结果与对照组患者比较,观察组患者住院时间明显缩短、手术时间和术中出血量明显减少、术后血红蛋白下降量明显降低（t=-3.050、-10.379、-21.032、-31.908,P<0.05）。两组患者术前髋部骨密度和T值、Ⅰ型前胶原氨基端肽（PⅠNP）和β-Ⅰ型胶原羧基末端肽（β-CTX）水平均无明显差异,术后的差异均呈现出时间效应、组间效应及其交互效应（骨密度：F=28.491、15.609、6.128,P<0.01;T值：F=45.358、27.736、6.133,P<0.01;PⅠNP：F=73.84、88.812、16.991,P<0.01;β-CTX：F=101.431、724.919、44.086,P<0.01）。两组患者术后VAS评分的差异呈现出时间效应、组间效应及其交互效应（F=1678.032、552.403、32.493,P<0.01）,术后Harris评分的差异呈现出时间效应和组间效应（F=33.344、14.169,P<0.01）。 结论采用经皮加压钢板结合唑来膦酸治疗老年OFNF,不仅能够早期重建髋关节功能,而且术后疼痛较轻,功能恢复快。