• 【非髋关节周围骨质疏松性骨折:流行病学和意义。】 复制标题 收藏 收藏
    DOI:10.2478/10004-1254-59-2008-1850 复制DOI
    作者列表:Korsić M,Grazio S
    BACKGROUND & AIMS: :Fractures are the most serious consequence of osteoporosis. Non-vertebral and non-hip fractures are seldom recognised as important, even though they account for the majority of all fractures. The most prevalent localisations are distal radius, proximal humerus, ribs, clavicle, and the pelvis. According to the results from large phase III clinical trials for placebo groups, their incidence ranges from 4.9 % to 12.0 %. Hospital morbidity data in Croatia in 2006 show that peripheral non-hip fractures ranked among the leading fifteen injuries, accounting for 23.7 % of all injuries in patients aged 60 years and above. Risk factors for non-hip and non-vertebral fractures are similar to other osteoporotic fractures, and the main are low bone mineral density and earlier fractures. Quality of life is considerably affected by these fractures, and medical costs are very high, soaring as high as 36.9% of all national medical costs in the USA. Non-vertebral non-hip fractures need more attention, which was also recognised by the European regulatory bodies that approve use of anti-osteoporotic drugs.
    背景与目标: :骨折是骨质疏松症最严重的后果。尽管非椎骨和非髋骨骨折占所有骨折的大部分,但很少被认为是重要的。最普遍的定位是radius骨远端,肱骨近端,肋骨,锁骨和骨盆。根据安慰剂组大型III期临床试验的结果,其发生率在4.9%至12.0%之间。 2006年克罗地亚的医院发病率数据显示,周围的非髋关节骨折在前15名患者中排名最高,占60岁及60岁以上患者受伤总数的23.7%。非髋关节和非椎骨骨折的危险因素与其他骨质疏松性骨折相似,主要是骨密度低和早期骨折。这些骨折严重影响了生活质量,医疗费用很高,高达美国所有国家医疗费用的36.9%。非椎骨非髋关节骨折需要引起更多关注,欧洲监管机构也认可使用抗骨质疏松药物。
  • 【新型近端髓内钉系统治疗肱骨脱位骨折。】 复制标题 收藏 收藏
    DOI:10.1007/s00264-007-0390-1 复制DOI
    作者列表:Füchtmeier B,Bröckner S,Hente R,Maghsudi M,Nerlich M,Prantl L
    BACKGROUND & AIMS: :A new proximal humerus nail (Sirus) for the treatment of proximal humerus fractures has become available. This paper presents the clinical and radiological outcome of the first collective study of 36 patients. Evaluation was performed prospectively. An antero-acromial approach was used for all patients. Three fixed-angle screws were inserted in a locking technique. Thirty-six fractures were fixed with the Sirus nail. These were dislocated 2- and 3-part fractures as described by Neer (J Bone Joint Surg 52:1077-1089). Outcomes were evaluated using the Constant score. Of the 36 patients evaluated 23 had sustained a 2-part fracture and 13 a 3-part fracture. The average age at surgery was 71.2 years (range, 30-93). In 75% of the cases, good to very good outcomes were achieved. Outcomes were satisfactory in 13.8% of the cases. Twenty-five fractures were treated in a closed technique. Average operating time was 41 minutes (range, 19-106) with a fluoroscopy time of 0.6 minutes (range, 0.4-2.6). Secondary fragment dislocation occurred in two cases. After 12.1 months the average Constant score was 79.2 (range, 46-100). Initial clinical experience with the Sirus nail indicates that the procedure is straightforward and has a low complication rate. Functional outcomes are predominantly good to very good. Large fragments of the greater tuberosity and 4-part fractures are beyond the scope of this application.
    背景与目标: :一种用于治疗肱骨近端骨折的新型肱骨近端钉(Sirus)已面市。本文介绍了首次对36例患者进行集体研究的临床和影像学结果。评估是前瞻性进行的。所有患者均采用前房顶入路。在锁定技术中插入了三个固定角度的螺钉。用Sirus钉固定了36处骨折。如Neer(J Bone Joint Surg 52:1077-1089)所述,这些骨折分为两部分和三部分骨折。使用恒定评分评估结果。在评估的36位患者中,有23位发生了2部分骨折,而13位发生了3部分骨折。手术的平均年龄为71.2岁(范围30-93)。在75%的情况下,取得了很好到非常好的结果。在13.8%的病例中,结果令人满意。采用封闭技术治疗了25处骨折。平均操作时间为41分钟(范围19-106),透视时间为0.6分钟(范围0.4-2.6)。继发性碎片脱位发生在两个案例中。在12.1个月之后,平均Constant得分为79.2(范围46-100)。 Sirus指甲的初步临床经验表明该过程简单易行,并发症发生率低。功能结果主要是良好至非常好。较大的结节和四部分裂缝的大碎片超出了本申请的范围。
  • 【[远端radius骨骨折。有什么新功能?]。】 复制标题 收藏 收藏
    DOI:10.1007/s00104-012-2341-7 复制DOI
    作者列表:Meiners J,Jürgens C,Mägerlein S,Wallstabe S,Kienast B,Faschingbauer M
    BACKGROUND & AIMS: :The demographic development will result in an increase of up to 30 % of distal radius fractures. There are various therapy options but what is new? Conservative therapy: conservative therapy is reserved for stable fractures only. Osteosynthesis by K-wires: due to low biomechanical stability in older patients, insufficient functional and radiological results were achieved. External fixator: external fixators are used in compound and complex fractures and show better results than K-wire osteosynthesis. Angular stable plate osteosynthesis: with angular stable plates it is possible to achieve good results with complex fractures and they are currently the method of choice. Intramedullary osteosynthesis: intramedullary nails result in a faster functional improvement than angular stable plates but have limitations. New is that 90% of osteoporotic distal radial fractures are treated with angular stable plates which have shown good results in single study groups.
    背景与目标: 人口统计学的发展将导致distal骨远端骨折增加多达30%。有多种治疗选择,但有什么新功能?保守疗法:保守疗法仅适用于稳定的骨折。通过K线进行骨合成:由于老年患者的生物力学稳定性低,因此无法获得足够的功能和放射学结果。外固定器:外固定器用于复合型和复杂型骨折中,其效果比K线骨固定术更好。角稳定板的骨合成:利用角稳定板可以对复杂的骨折取得良好的效果,目前是首选方法。髓内接骨术:髓内钉的功能改善比角稳定板快,但有局限性。新的特点是使用角稳定钢板治疗90%的骨质疏松性远端radial骨骨折,在单个研究组中已显示出良好的效果。
  • 【双侧股骨骨折不再是死亡的标志吗?】 复制标题 收藏 收藏
    DOI:10.1097/BOT.0b013e3182a83fdf 复制DOI
    作者列表:OʼToole RV,Lindbloom BJ,Hui E,Fiastro A,Boateng H,OʼBrien M,Murphy L,Copeland CE
    BACKGROUND & AIMS: OBJECTIVES:To determine whether previously reported high mortality rates associated with bilateral femoral fractures have decreased over time. DESIGN:Retrospective review. SETTING:Urban academic trauma center. PATIENTS: STUDY GROUP:54 adults with bilateral femoral fractures treated at our center from 2000 to 2006. The 108 fractures were initially treated with external fixation (11%), reamed antegrade nailing (23%), and reamed retrograde nailing (67%). Unilateral control group: 461 patients with unilateral femoral fractures treated at our center from 2002 to 2005. INTERVENTION:Univariate analysis compared our results with those of a published historical control group from the same center approximately 15 years ago (study period, 1984-1990). MAIN OUTCOME MEASUREMENTS:Mortality rates. RESULTS:We noted marked differences between the current mortality rate associated with bilateral femoral fractures and that of the historical control group. The mortality rate decreased over time at our center for both bilateral (26%-7%, P = 0.002) and unilateral (12%-2%, P = 0.0001) fractures. Mortality rates were still significantly higher (P = 0.037) for bilateral (7%) than for unilateral (2%) fractures. CONCLUSIONS:Mortality rates and Injury Severity Scores were reduced for bilateral and unilateral femoral fractures compared with data reported 15 years ago from the same center. The improved outcome might be related in part to changes in resuscitation, triage, intensive care, and orthopaedic management of the patients. However, considering that the Injury Severity Score also significantly decreased, the improvement might have occurred because of changes in injury patterns, perhaps secondary to improved safety features in motor vehicles. LEVEL OF EVIDENCE:Prognostic level III. See instructions for authors for a complete description of levels of evidence.
    背景与目标: 目的:确定先前报道的与双侧股骨骨折相关的高死亡率是否随时间降低。
    设计:回顾性审查。
    单位:城市学术创伤中心。
    耐心:
    研究小组:2000年至2006年,我们中心对54例成年人的双侧股骨骨折进行了治疗。最初对108例骨折进行了外固定(11%),顺行扩钉(23%)和逆行扩钉(67%)。单侧对照组:2002年至2005年在我中心接受治疗的461例单侧股骨骨折患者。
    干预:单变量分析将我们的结果与大约15年前(研究期,1984-1990年)同一中心的已发表历史对照组的结果进行了比较。
    主要观察指标:死亡率。
    结果:我们注意到当前与双侧股骨骨折相关的死亡率与历史对照组之间存在显着差异。在我们中心,双侧(26%-7%,P = 0.002)和单侧(12%-2%,P = 0.0001)骨折的死亡率均随时间降低。双侧(7%)的死亡率仍显着高于单侧(2%)的骨折(P = 0.037)。
    结论:与15年前同一中心报道的数据相比,双侧和单侧股骨骨折的死亡率和严重程度评分降低。改善的结局可能部分与患者的复苏,分诊,重症监护和整形外科治疗有关。但是,考虑到伤害严重性评分也显着降低,可能是由于伤害模式的改变而导致的改善,这可能是机动车安全性得到改善之后的结果。
    证据级别:预后等级III。有关证据水平的完整说明,请参见作者说明。
  • 【在膝部磁共振成像中检测到孤立的皮质下小梁骨折(骨挫伤)的临床结果。】 复制标题 收藏 收藏
    DOI:10.1177/03635465000280050701 复制DOI
    作者列表:Wright RW,Phaneuf MA,Limbird TJ,Spindler KP
    BACKGROUND & AIMS: :Isolated subcortical trabecular bone injury (bone bruise) has rarely been described. Our purpose is to report a series of patients who had a history of traumatic injury, knee effusion, normal radiographs, and initial equivocal physical examination for ligament and meniscal integrity, and who were found to have isolated injury of the trabecular bone on magnetic resonance imaging. We evaluated demographic data, physical examination findings, radiographs, magnetic resonance imaging, and clinical outcome for 23 patients. Follow-up data included time to return to preinjury activity level, International Knee Documentation Committee activity level rating before and after injury, and postinjury Lysholm scores. All magnetic resonance imaging scans were negative for associated grade III meniscal lesions and ligament injury. Time to return to preinjury activity level was under 7 months in 96% of the patients. Postinjury International Knee Documentation Committee rating was unchanged in 91% of patients. Postinjury Lysholm score was 90 or more in 91% of patients. We propose that the recognition of these injuries is important because magnetic resonance imaging can distinguish them from meniscal or ligament injury requiring surgical intervention (arthroscopy). If detected on magnetic resonance imaging as an isolated injury, surgical arthroscopy is unnecessary since these patients can be expected to recover well in the short term with restricted weightbearing and initial activity modification.
    背景与目标: :很少描述皮质下小梁下骨损伤(骨挫伤)。我们的目的是报告一系列有外伤史,膝关节积液,X线片正常,对韧带和半月板完整性进行初步模棱两可的身体检查,并在磁共振成像中发现小梁骨孤立性损伤的患者。 。我们评估了23例患者的人口统计学数据,体格检查结果,X线照片,磁共振成像和临床结局。随访数据包括恢复伤前活动水平的时间,受伤前后国际膝关节委员会的活动水平评分以及伤后Lysholm评分。所有相关的III级半月板病变和韧带损伤的磁共振成像扫描均为阴性。 96%的患者恢复到损伤前活动水平的时间不到7个月。受伤后国际膝关节文献委员会的评分在91%的患者中没有变化。 91%的患者受伤后Lysholm评分为90分或更高。我们建议识别这些损伤很重要,因为磁共振成像可以将它们与需要手术干预(关节镜)的半月板或韧带损伤区分开。如果在磁共振成像中检测为孤立的损伤,则无需进行关节镜检查,因为可以预期这些患者短期内恢复良好,并且负重和初始活动受到限制。
  • 【第五fifth骨近端急性骨折和不愈合的治疗策略。】 复制标题 收藏 收藏
    DOI:10.5435/00124635-200009000-00007 复制DOI
    作者列表:Rosenberg GA,Sferra JJ
    BACKGROUND & AIMS: :There are at least three distinct fracture patterns that occur in the proximal fifth metatarsal: tuberosity avulsion fractures, acute Jones fractures, and diaphyseal stress fractures. Each of these fracture patterns has its own mechanism of injury, location, treatment options, and prognosis regarding delayed union and nonunion. Tuberosity avulsion fractures are the most common in this region of the foot. The majority heal with symptomatic care in a hard-soled shoe. The true Jones fracture is an acute injury involving the fourth-fifth intermetatarsal facet. These injuries are best treated with non-weight-bearing cast immobilization for 6 to 8 weeks. The rate of successful union with this treatment has been reported to be between 72% and 93%. For the high-performance athlete with an acute Jones fracture, early intramedullary-screw fixation is an accepted treatment option. Nonacute diaphyseal stress fractures of the proximal fifth metatarsal and Jones fractures that develop into delayed unions and nonunions can both be managed with operative fixation with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting. Early results with the use of electrical stimulation are promising; however, prospective studies are needed to better define the role of this modality in managing these injuries.
    背景与目标: :在fifth骨近端至少发生三种不同的骨折类型:结节撕脱性骨折,急性琼斯骨折和骨干应力骨折。这些骨折类型中的每一种都有其自身的损伤机制,部位,治疗选择以及关于延迟愈合和不愈合的预后。结节撕脱性骨折最常见于脚部区域。大部分人在对鞋硬底的情况下对症治疗。真正的琼斯骨折是涉及第四至第五间间小平面的急性损伤。这些损伤最好用非承重石膏固定器治疗6至8周。据报道,采用这种治疗方法的成功结合率在72%至93%之间。对于具有急性琼斯骨折的高性能运动员,早期的髓内螺钉内固定是一种可以接受的治疗选择。近端第五meta骨的非急性干phy端应力性骨折和发展为延迟性联合和骨不连的琼斯骨折都可以通过闭合性轴向髓内螺钉内固定或自体皮质突状骨移植术进行手术固定。使用电刺激的早期结果很有希望;但是,需要进行前瞻性研究,以更好地定义这种方式在管理这些伤害中的作用。
  • 【可归因于骨质疏松症的骨折:国家骨质疏松症基金会的报告。】 复制标题 收藏 收藏
    DOI:10.1359/jbmr.1997.12.1.16 复制DOI
    作者列表:Melton LJ 3rd,Thamer M,Ray NF,Chan JK,Chesnut CH 3rd,Einhorn TA,Johnston CC,Raisz LG,Silverman SL,Siris ES
    BACKGROUND & AIMS: To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

    背景与目标: 为了评估预防骨质疏松症的干预措施的成本效益,有必要估算用于治疗骨质疏松性骨折的总医疗保健支出。可以使用相关的诊断代码从辅助数据库中估计用于治疗许多疾病的资源,但是这些代码并未表明哪些骨折本质上是骨质疏松的。因此,召集了一个专家小组,根据患者的年龄,性别和种族,判断不同类型的骨折可能与骨质疏松症有关的可能性。采用三轮Delphi程序来估计与骨质疏松症相关的骨折比例(即骨质疏松症的归因概率)在72种类别中划分,该类别由四种特定的骨折类型(髋部,脊柱,前臂,所有其他部位组合)组成,按年龄划分为三个年龄层组(45-64岁,65-84岁,85岁及以上),三个种族组(白人,黑人,所有其他种族)和男女(女性,男性)。据估计,在老年白人妇女中,至少有90%的所有髋部和脊柱骨折应归因于骨质疏松症。其他骨折的比例要小得多,归因于骨质疏松症。不论骨折类型如何,男性的归因概率均低于女性,非白人的归因概率通常低于白人。这些概率将用于估算与美国骨质疏松症相关的骨折相关的直接医疗总费用。

  • 【三种弧形骨折固定技术的比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.injury.2019.09.038 复制DOI
    作者列表:Hodax JD,Cohen BH,DeFroda SF,Sobel AD,Fadale PD
    BACKGROUND & AIMS: PURPOSE:Proximal fibula avulsion fractures, or "arcuate fractures", are an often discussed but poorly defined injury pattern which represent a destabilizing injury to the posterolateral corner of the knee. Historical and recent literature discussing reconstruction and repair techniques exist, but there has been little biomechanical evaluation of repair techniques. The purpose of this study was to evaluate the strength of three type of fixation techniques for arcuate fractures: bone tunnels, a screw and washer, and a novel suture anchor technique. METHODS:A laboratory model of the arcuate fracture pattern was developed. This was used to create an arcuate fracture in 24 cadaveric specimens. Knees were randomized into fixation with either suture tunnel (ST), screw and washer (SW), or suture anchor (SA) repair. A previously published model for inducing varus stress was applied and a MTS testing system was used to assess fixation ultimate and yield strength. RESULTS:Fibular fracture occurred during the fixation of one specimen from the ST group and one from the SA group. Analysis of the remaining 22 specimens revealed a mean ultimate strength of 2422.48 N for the ST group, 2271.78 for SW, and 3041.66 for SA (p = 0.390). Yield strengths were 2065.28 for ST, 1882.43 for SW, and 2871.92 for SA (p = 0.224). Analyses of stiffness and total energy applied were not statistically different (p = 0.111 and 0.601, respectively). CONCLUSION:Biomechanical analysis of three types of arcuate fragment fixation revealed robust fixation among all methods, supporting surgeon preference for fixation. Fixation may depend on the size of bony fragment and whether or not the injury is a bony or soft tissue injury.
    背景与目标: 目的:腓骨近端撕脱性骨折或“弓形骨折”,是一种经常讨论但定义不明确的损伤方式,代表了膝盖后外侧角的不稳定损伤。存在关于重建和修复技术的历史文献和最新文献,但是对修复技术的生物力学评估很少。这项研究的目的是评估弓形骨折的三种固定技术的强度:骨隧道,螺钉和垫圈以及新型缝合锚固技术。
    方法:建立了弓形断裂模式的实验室模型。这被用来在24个尸体标本中产生弧形断裂。将膝关节随机分为缝合隧道(ST),螺钉和垫圈(SW)或缝合锚钉(SA)修复固定。应用了先前发表的诱发内翻应力的模型,并使用了MTS测试系统来评估固定极限和屈服强度。
    结果:ST组1例和SA组1例在固定过程中发生腓骨骨折。对其余22个样品的分析显示,ST组的平均极限强度为2422.48N,SW的平均极限强度为2271.78,SA的平均极限强度为3041.66(p = 0.390)。 ST的屈服强度为2065.28,SW的屈服强度为1882.43,SA的屈服强度为2871.92(p = 0.224)。刚度和施加的总能量的分析无统计学差异(分别为p = 0.111和0.601)。
    结论:对三种弓形碎片固定的生物力学分析显示,所有方法均具有牢固的固定方式,从而支持外科医生对固定方式的偏爱。固定可能取决于骨碎片的大小以及损伤是骨损伤还是软组织损伤。
  • 【坐骨骨折治疗条件下坐骨神经病的病因和发病机制的实验研究。】 复制标题 收藏 收藏
    DOI:10.1007/s10517-012-1623-x 复制DOI
    作者列表:Varsegova TN,Antonov NI
    BACKGROUND & AIMS: :Surgical (with external fixation device; series I) and conservative (series II) treatment of experimental unilateral transverse fracture of the body and ramus of ischium was carried out in 35 mongrel dogs. Roentgenometry, pathological, and histological studies showed sciatic nerve injury in both series, a complication of the fracture emerging at the moment of primary lesion. Further damage to the nerve due to its compression in an anatomical narrowings with fibrous degenerative tissues and bone fragments under conditions of conservative therapy, tunnel neuropathy, was paralleled by more pronounced destructive changes persisting for one year after the experiment.
    背景与目标: :对35只杂种犬进行了实验性的单侧横向骨折和坐骨裂隙的外科手术(使用外部固定装置; I系列)和保守治疗(II系列)。放射线照相法,病理学和组织学研究均显示两个系列均发生坐骨神经损伤,这是原发病变时出现的骨折并发症。在保守治疗的条件下,由于在神经纤维变性组织和骨碎片的解剖学狭窄处受压,进一步损害神经,隧道神经病伴随着实验后一年持续的更为明显的破坏性变化。
  • 【正畸治疗多发性颌面部骨折后的口腔康复。】 复制标题 收藏 收藏
    DOI:10.1016/j.ajodo.2006.10.028 复制DOI
    作者列表:Nakamura Y,Ogino TK,Hirashita A
    BACKGROUND & AIMS: :We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.
    背景与目标: :我们介绍了整形外科后因交通事故引起的多发颌面骨折的咬合功能障碍患者的正畸治疗。该患者的下颌向右偏位是由于骨折骨的不适当重新定位和固定以及两个下颌中切牙的完全撕脱所致。还怀疑双侧下颌切牙,犬齿和前磨牙部分撕脱或牙槽骨骨折。对这些牙齿进行了一些测试,包括敲击和牙科X线断层扫描,以排除强直和确认牙齿运动。通过上颌弓的扩张,两个弓的对齐以及下颌侧切牙之间的空间封闭来进行伪装正畸治疗,以改善咬合。获得了良好的遮挡和交叉指型。正畸治疗对多发颌面部骨折引起的咬合功能障碍的康复很有用。
  • 【同侧粗隆间和股骨干骨折的生物力学:5种骨折固定技术的比较。】 复制标题 收藏 收藏
    DOI:10.1097/BOT.0b013e31817d97bc 复制DOI
    作者列表:McConnell A,Zdero R,Syed K,Peskun C,Schemitsch E
    BACKGROUND & AIMS: OBJECTIVES:The aim of the present study was to examine biomechanically 5 different construct combinations for fixation of ipsilateral intertrochanteric and femoral shaft fractures. METHODS:Twenty-five fresh-frozen adult human femora (age range = 58-91 years, average age = 75.4 years) were tested in physiological bending and in torsion to characterize initial bending and torsional stiffness and stiffness following fixation of combined intertrochanteric and femoral shaft fractures. Five fracture fixation device constructs were assessed-construct A: long dynamic hip screw (long DHS); construct B: reconstruction nail; construct C: DHS plus low-contact dynamic compression plate; construct D: DHS plus retrograde intramedullary nail; and construct E: long intramedullary hip screw. Axial stiffness, torsional stiffness, and axial load-to-failure were the main measurements recorded. RESULTS:There were no differences between constructs in terms of axial stiffness (P = 0.41), external rotation stiffness (P = 0.13), and axial load-to-failure (P = 0.16). However, there was a borderline statistically significant difference in internal rotation stiffness between the constructs (P = 0.048). Specifically, construct C was significantly stiffer than construct E (P = 0.04). CONCLUSIONS:All constructs showed no statistical differences when compared with one another, with the exception of construct E, which provided the least torsional stiffness. However, the current in vitro model did not simulate fracture healing or support offered by soft tissues, both of which would affect the stiffness and load-to-failure levels reached.
    背景与目标: 目的:本研究的目的是用生物力学方法检查5种不同的结构组合,以固定同侧股骨粗隆间和股骨干骨折。
    方法:对二十五个新鲜冷冻的成人股骨(年龄范围为58-91岁,平均年龄= 75.4岁)进行了生理弯曲和扭转测试,以表征股骨转子间和股骨固定后的初始弯曲和扭转刚度和刚度。轴骨折。评估了五种骨折固定装置的构造。构造A:长动髋螺钉(长DHS);构造B:重建钉;结构C:DHS加低接触动态压缩板;结构D:DHS加逆行髓内钉;并构造E:长髓内髋螺钉。记录的主要测量指标是轴向刚度,扭转刚度和轴向破坏载荷。
    结果:结构之间在轴向刚度(P = 0.41),外部旋转刚度(P = 0.13)和轴向破坏载荷(P = 0.16)方面没有差异。但是,在构造之间,内部旋转刚度在统计学上有明显的界线差异(P = 0.048)。具体而言,构建体C明显比构建体E坚硬(P = 0.04)。
    结论:所有结构在相互比较时均无统计学差异,但结构E除外,其扭转刚度最小。但是,当前的体外模型并未模拟软组织提供的骨折愈合或支撑,这两者都会影响刚度和达到的负荷-破坏水平。
  • 【影响受虐待婴儿后肋骨骨折可视化的因素。】 复制标题 收藏 收藏
    DOI:10.2214/ajr.150.3.635 复制DOI
    作者列表:Kleinman PK,Marks SC,Adams VI,Blackbourne BD
    BACKGROUND & AIMS: :Rib fractures frequently are encountered in abused infants and commonly occur in the posterior rib arcs. Fractures occurring near the costovertebral articulations are rarely identified radiographically in the acute phase, and callus formation usually is the first indication of injury. To assess the factors influencing the visibility of fractures near the costovertebral articulations in abused infants, 103 posterior rib fractures occurring in 16 abused infants were studied radiologically. The plain radiologic studies were correlated with the pathologic findings in 15 ribs from four patients. The limited visibility of fractures relates to (1) the frequent superimposition of the transverse process over the rib fracture site, (2) a fracture line that crosses at an obliquity to the radiographic beam, and (3) nondisplacement of rib fragments due to preservation of the posterior periosteum. Fresh fractures invisible on a frontal projection are clearly defined when the rib is viewed axially with postmortem radiography. These findings explain the reported superior sensitivity of radionuclide bone scans vs radiography in the identification of fresh posterior rib fractures. A knowledge of the factors influencing the visibility of these important injuries is useful in planning an appropriate diagnostic evaluation in cases of suspected infant abuse.
    背景与目标: :受虐婴儿经常会发生肋骨骨折,通常发生在肋骨后弧。肋骨关节附近发生的骨折很少在急性期通过影像学方法鉴定出来,而愈伤组织的形成通常是损伤的第一个迹象。为了评估影响受虐婴儿肋骨关节附近骨折可见性的因素,对16名受虐婴儿中发生的103处后肋骨骨折进行了放射学研究。普通的放射学检查结果与4例患者的15条肋骨的病理结果相关。骨折的可见性有限涉及(1)横突在肋骨骨折部位上的频繁叠加,(2)一条与放射线束倾斜的交叉点的骨折线,以及(3)由于保存而导致的肋骨碎片未移位骨膜后部。当用尸体放射照相法轴向观察肋骨时,可以清楚地定义在额骨上看不见的新鲜骨折。这些发现解释了放射性核素骨扫描相对于放射照相在鉴定新鲜的后肋骨骨折方面具有更高的敏感性。了解影响这些重要伤害的可见性的因素对于计划在怀疑婴儿虐待的情况下进行适当的诊断评估很有帮助。
  • 【经皮短节段椎弓根螺钉置入不融合治疗胸腰椎爆裂骨折:是否有效?:开放性短节段椎弓根螺钉固定并后外侧融合的比较研究。】 复制标题 收藏 收藏
    DOI:10.1007/s00701-013-1859-x 复制DOI
    作者列表:Lee JK,Jang JW,Kim TW,Kim TS,Kim SH,Moon SJ
    BACKGROUND & AIMS: BACKGROUND:Since introduction of the pedicle screw-rod system, short-segment pedicle screw fixation has been widely adopted for thoracolumbar burst fractures (TLBF). Recently, the percutaneous pedicle screw fixation (PPSF) systems have been introduced in spinal surgery; and it has become a popularly used method for the treatment of degenerative spinal disease. However, there are few clinical reports concerning the efficacy of PPSF without fusion in treatment of TLBF. The purpose of this study was to determine the efficacy and safety of short-segment PPSF without fusion in comparison to open short-segment pedicle screw fixation with bony fusion in treatment of TLBF. METHODS:This study included 59 patients, who underwent either percutaneous (n = 32) or open (n = 27) short-segment pedicle screw fixation for stabilization of TLBF between December 2003 and October 2009. Radiographs were obtained before surgery, immediately after surgery, and at the final follow-up for assessment of the restoration of the spinal column. For radiologic parameters, Cobb angle, vertebral wedge angle, and vertebral body compression ratio were assessed on a lateral thoracolumbar radiograph. For patient's pain and functional assessment, the visual analogue scale (VAS), the Frankel grading system, and Low Back Outcome Score (LBOS) were measured. Operation time, and the amount of intraoperative bleeding loss were also evaluated. FINDINGS:In both groups, regional kyphosis (Cobb angle) showed significant improvement immediately after surgery, which was maintained until the last follow up, compared with preoperative regional kyphosis. Postoperative correction loss showed no significant difference between the two groups at the final follow-up. In the percutaneous surgery group, there were significant declines of intraoperative blood loss, and operation time compared with the open surgery group. Clinical results showed that the percutaneous surgery group had a lower VAS score and a better LBOS at three months and six months after surgery; however, the outcomes were similar in the last follow-up. CONCLUSIONS:Both open and percutaneous short-segment pedicle fixation were safe and effective for treatment of TLBF. Although both groups showed favorable clinical and radiologic outcomes at the final follow-up, PPSF without bone graft provided earlier pain relief and functional improvement, compared with open TPSF with posterolateral bony fusion. Despite several shortcomings in this study, the result suggests that ongoing use of PPSF is recommended for the treatment of TLBF.
    背景与目标: 背景:自椎弓根钉杆系统引入以来,短节段椎弓根钉固定已被广泛用于胸腰椎爆裂骨折(TLBF)。最近,在脊柱外科手术中已经引入了经皮椎弓根螺钉固定(PPSF)系统。它已成为治疗退行性脊柱疾病的一种流行方法。但是,很少有关于不融合的PPSF治疗TLBF疗效的临床报道。这项研究的目的是确定与开放短节段椎弓根螺钉固定加骨融合术治疗TLBF相比,不进行融合的短节段PPSF的疗效和安全性。
    方法:本研究包括59例患者,他们于2003年12月至2009年10月间接受了经皮短段(n = 32)或开放(n = 27)短节段椎弓根螺钉固定以稳定TLBF。 ,并在最后的随访中评估脊柱的恢复情况。对于放射学参数,在胸腰椎X线片上评估Cobb角,椎体楔角和椎体压缩比。对于患者的疼痛和功能评估,测量了视觉模拟量表(VAS),弗兰克尔(Frankel)评分系统和低腰成果评分(LBOS)。还评估了手术时间和术中出血量。
    结果:与术前区域性后凸畸形相比,两组患者术后均立即发现区域性后凸畸形(Cobb角),并一直持续到最后一次随访。在最后一次随访中,两组的术后矫正损失无明显差异。与开放手术组相比,经皮手术组的术中失血量和手术时间明显减少。临床结果表明,经皮手术组在术后三个月和六个月时,VAS评分较低,LBOS较好。然而,最后一次随访的结果相似。
    结论:开放式和经皮短节段椎弓根固定术治疗TLBF是安全有效的。尽管两组在最后的随访中均显示出良好的临床和放射学结果,但与开放式TPSF与后外侧骨融合术相比,无骨移植的PPSF可以更早地缓解疼痛和改善功能。尽管这项研究存在一些缺陷,但结果表明建议继续使用PPSF来治疗TLBF。
  • 【论文集:髓内钉治疗胫骨复合骨折。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Harvey FJ,Hodgkinson AH,Harvey PM
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【使用2.4 / 2.4毫米和2.0 / 2.4毫米双重微型碎片钢板组合固定移位的骨锁骨骨折的安全性和有效性。】 复制标题 收藏 收藏
    DOI:10.1016/j.injury.2020.01.014 复制DOI
    作者列表:Chen MJ,DeBaun MR,Salazar BP,Lai C,Bishop JA,Gardner MJ
    BACKGROUND & AIMS: PURPOSE:The purpose of this study was to evaluate the safety and efficacy of using lower profile 2.4/2.4 mm and 2.0/2.4 mm dual mini-fragment plate constructs for fixation of diaphyseal clavicle fractures. METHODS:This was a retrospective case series of all displaced diaphyseal clavicle fractures treated with 2.4/2.4 and 2.0/2.4 dual mini-fragment plate constructs at a single level-one trauma center. Postoperative complications and fracture healing rates were recorded. A subset of patients with long-term follow up was used to determine the rate of reoperation for symptomatic implant removal. RESULTS:All 36 identified fractures healed without loss of reduction or implant failure. There was one superficial infection and no deep infections or cases of wound dehiscence. Twenty patients from the entire cohort had longer-term follow up available to assess the reoperation rate for symptomatic implant removal. Two patients (10%) underwent symptomatic implant removal, and one patient with retained implants was planning on future removal due to soft-tissue irritation; this combined to a projected reoperation rate of 15% for symptomatic implant removal. CONCLUSION:Dual mini-fragment plating of diaphyseal clavicle fractures, using 2.4/2.4 mm and 2.0/2.4 mm plate combinations, creates a lower profile construct that reliably maintains fracture reduction to healing, and has a low rate of reoperation for symptomatic implant removal.
    背景与目标: 目的:这项研究的目的是评估使用低轮廓2.4 / 2.4毫米和2.0 / 2.4毫米双重微型碎片板结构固定骨锁骨骨折的安全性和有效性。
    方法:这是回顾性病例系列病例,所有移位的2.4骨锁骨骨折均在一个一级创伤中心接受了2.4 / 2.4和2.0 / 2.4双微型碎片板结构治疗。记录术后并发症和骨折愈合率。长期随访的患者子集用于确定有症状植入物去除的再手术率。
    结果:所有36例已鉴定的骨折均愈合,而复位没有损失或植入失败。仅存在一种表面感染,没有深层感染或伤口裂开的情况。整个队列的20名患者进行了长期随访,以评估有症状植入物去除的再手术率。 2例患者(10%)接受了有症状的种植体切除术,其中1例保留了种植体的患者由于软组织刺激而打算将来进行切除术。合并有症状种植体的预计再手术率达到15%。
    结论:使用2.4 / 2.4毫米和2.0 / 2.4毫米钢板组合对骨锁骨骨折进行双微型碎片镀覆,可形成较低轮廓的结构,可可靠地保持骨折复位直至愈合,并且有症状的种植体切除术的再手术率较低。

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