中国骨与关节杂志
Chinese Journal of Bone and Joint 중국골종류골병
- 主管单位： 国家卫生和计划生育委员会
- 主办单位： 中国医疗保健国际交流促进会，北京中科康辰骨关节伤病研究所
- 影响因子： 0.66
- 审稿时间： 1-3个月
- 国际刊号： 2095-252X
- 国内刊号： 10-1022/R
- 论文标题 期刊级别 审稿状态
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自稳型零切迹颈前路椎间融合系统治疗颈椎病的早期临床观察
目的 观察应用自稳型零切迹颈前路椎间融合固定系统行颈前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)治疗颈椎病的临床疗效,探讨其应用的安全性及有效性.方法 2012年11月至2014年12月,采用自稳型零切迹颈前路椎间融合固定系统行ACDF治疗颈椎病患者73例,失随访5例.本组男41例,女27例;年龄35~68岁,平均53.4岁.脊髓型颈椎病23例,神经根型颈椎病40例,混合型5例.单节段病变32例,双节段21例,三节段11例,四节段4例,共计123个节段.术前、术后2天、术后3个月和末次随访采用改良日本骨科学会(modified Japanese orthopaedics association,mJOA)17分评分法、颈椎残障功能量表(neck disability index,NDI)评分和疼痛视觉模拟评分(visual analogue scale,VAS)评价临床疗效.采用Bazaz吞咽困难评分法对患者术后吞咽困难相关并发症的发生情况进行评估.拍摄颈椎正侧位及动力位X线片评价手术节段椎间隙高度(disc height index,DHI)、颈椎整体曲度(C2~7 Cobb's角)及内固定相关并发症情况.根据Pitzen等的颈椎间融合评价标准评定椎间植骨融合情况.采用Miyazaki颈椎间盘退变分级方法评定相邻节段椎间盘退变情况.结果 68例获得12~36个月的随访,平均20.8个月.mJOA评分术前(7.6±2.3)分,末次随访(14.9±0.6)分;NDI评分术前(16.9±3.0)分,末次随访(10.7±2.1)分;VAS评分术前为(6.0±1.7)分,末次随访(1.8±0.7)分;手术节段DHI术前(6.1±1.8)mm,末次随访(6.8±0.8)mm;C2~7 Cobb's角术前(10.8±2.3)°,末次随访(14.0±1.5)°;以上指标末次随访与术前比较差异均有统计学意义(P<0.05).5例术后第2天出现吞咽不适,3例为轻度,1例为中度,1例为重度,行对症治疗,术后3个月内症状消失.未发现椎间融合器松动、断裂、移位等并发症.术后影像学证实椎间融合率为93.5%,cage沉降率为9.76%.4例(9.8%)发生相邻节段椎间盘退变分级加重.结论 应用零切迹颈前路椎间融合固定系统行ACDF治疗颈椎病的早期临床疗效满意,其具有操作简便、手术时间短、出血少、稳定性好、对颈前组织损伤小、术后吞咽困难发生率较低、可重建颈椎生理曲度、内固定相关并发症少等优点,但仍然需要更长期的随访来进一步评价其功能和对邻近节段的影响.
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手术方式和手术时间对老年髋部骨折术后深静脉血栓发生率的影响
目的 探讨骨折手术方式和手术持续时间对老年髋部骨折术后深静脉血栓(deep vein throm-bosis,DVT)发生率的影响.方法 回顾性分析2010年7月至2015年12月诊治的老年髋部骨折276例患者资料,男140例,女136例,年龄65~85岁,平均年龄73.3岁.按照手术方式及手术持续时间不同分组,其中根据手术方式分为3组:A组(骨折闭合复位股骨近端髓内钉、骨折闭合复位空心螺钉内固定)100例,B组(骨折切开复位股骨近端锁定接骨板、骨折切开复位空心螺钉内固定)98例,C组(人工髋关节置换-非骨水泥型)78例;根据手术时间分为3组:X组(手术时间<60 min)140例,Y组(手术时间60~120 min)90例,Z组(手术时间>120 min)46例.分别比较手术方式(A、B、C)3组及手术持续时间(X、Y、Z)3组术后DVT的发生率.结果 在不同手术方式上,A组100例中2例发生DVT,发生率2%;B组98例中2例发生DVT,发生率2.04%;C组78例中9例发生DVT,发生率11.54%;C组DVT的发生率高于A组和B组,差异有统计学意义(P=0.011;P=0.012).在手术持续时间上,X组140例中2例发生DVT,发生率1.4%;Y组90例3例发生DVT,发生率3.3%;Z组46例中8例发生DVT,发生率17.4%;Z组DVT的发生率高于X组和Y组,差异有统计学意义(P<0.001;P=0.007).结论 老年髋部骨折较大创伤手术方式比较小创伤手术方式增加术后DVT的发生率,手术持续时间超过120 min明显增加了术后DVT的发生率,术后口服利伐沙班10 mg,每天1次不能完全避免DVT的形成,应重视术后DVT的综合预防及筛查.
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椎弓根螺钉结合椎体成形术治疗椎管狭窄症伴老年性骨质疏松性压缩骨折
目的 探讨椎弓根螺钉结合椎体成形术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折疗效.方法 2009年1月至2014年5月,我院收治椎管狭窄症伴狭窄节段老年性骨质疏松性压缩骨折患者15例,其中男9例,女6例.年龄58~81岁,平均(69.9±7.26)岁.所有患者在压缩性骨折椎体经椎弓根注入骨水泥,行椎弓根螺钉强化,其它减压范围的椎体直接拧入椎弓根螺钉,后行椎管减压.评价术前1天、术后1周及末次随访时疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(oswestry disability index,ODI)评分,评估患者腰痛、下肢痛及生活质量改善情况;对比病椎后凸畸形角度(Cobb's角)和骨折椎体高度恢复情况.结果 所有患者均顺利完成手术,置入螺钉过程中发生骨水泥渗漏4例,无放热效应及毒性反应引起的并发症;术后腰痛及下肢痛明显缓解,腰痛VAS评分由术前(8.43±1.34)分下降至术后1周(3.21±0.91)分,末次随访时为(2.36±0.79)分;腿痛VAS评分由术前(7.53±1.72)分下降至术后1周(2.64±0.85)分,末次随访时为(1.84±0.60)分;ODI评分由术前(58.63±4.53)分下降至术后1周(28.40±2.45)分,末次随访时为(26.40±2.14)分.腰、腿痛VAS评分、ODI评分术后与术前比较差异均有统计学意义(P<0.05).Cobb's角变化、椎体高度变化术后与术前比较差异无统计学意义(P>0.05).15例获得12~36个月随访,平均(22.4±8.5)个月,随访中无椎弓根螺钉松动、断裂或拔出,无相邻椎体的压缩骨折,螺钉周围未见透亮线的出现.结论 骨折椎体注入骨水泥并椎弓根螺钉锚定的椎管扩大减压内固定术治疗椎管狭窄症伴狭窄节段骨质疏松性压缩骨折效果良好,能有效地缓解腰背部疼痛,改善患者功能,提高生活质量.
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施万细胞移植治疗脊髓损伤的研究进展
The incidence of spinal cord injury is very high, which often brings disastrous consequences to the patients and their families. And there is no ideal treatment. In recent years, with the in-depth study on molecular biology and genetic engineering technology, cell transplantation as the biotherapy strategy and treatment for spinal cord injury has been developed. Schwann cells have become the focus of research because of their obvious advantages for nerve repair. Schwann cells are easy to obtain and culture, and can reduce the immune rejection after autologous transplantation, which lead to no ethical restrictions. Schwann cells transplanted into the damaged spinal cord can swallow necrotic tissues, reduce tissue defects and secrete neurotrophic factors, adhesion molecules and extracellular matrices, which can promote the growth of axons and myelins, and further improve the sensory and motor function. However, due to the bad local micro environment, the promotion of axonal growth and remyelination is limited by the transplantation of only Schwann cells into the spinal cord. Therefore, the researchers have used Schwann cells with other cells / molecules and the technological transformation of genetic engineering has been realized. And furthermore, a rapid development has been achieved in the treatment of spinal cord injury, as well as the clinical application of Schwann cells. This review made a summary on the research of Schwann cell transplantation.
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3D打印技术在骨科及手外科领域的应用研究进展
3D printing technology is a kind of rapid prototyping. With 3D-printers and associated computer programs, required 3D models could be built by plastics, nylon, metals et al. This recently developing technique is widely used in orthopedics and hand surgery fields. For example, a 3D-printed model has positive effect on fracture classification, preoperative planning and operation practicing. Intraoperative guidance based on 3D printing technology could guide the accurate placement of internal fixation, shorten the operation time, and improve the accuracy and safety of operation. Additionally, this rapid prototyping technique could be used in designing of internal/external fixation materials, clinical education, and bio-printing. In this review, we introduced the common types of 3D printing technology, gave a detailed description of SLA, FDM, and SLS techniques, summarized the application of this technique in orthopedics and hand surgery fields. In addition, deficiencies were summarized and prospects were analyzed briefly.
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儿童脊柱术后手术区域感染的临床现状
Surgical site infection ( SSI ) after pediatric spinal deformity surgery is a complication that results in a high morbidity. SSI can be divided into superficial and deep SSI, or acute and delayed SSI. The highly related risk factors include urinary or bowel incontinence, positive preoperative urine culture, inappropriate antibiotic prophylaxis, prominent implants, first-generation stainless steel implants and so on; the lowly related risk factors include malnutrition, obesity, blood loss, blood transfusion, increased number of levels fused, extension to the pelvis / sacrum, increased operative time, no use of drain and so on. Identification of the most common causative organisms is very important to guide antibiotic prophylaxis protocols and individualize treatment regimens. Acute SSI is traditionally caused by gram-positive organisms, and delayed SSI is usually caused by low virulent skin flora. The preventative strategies of SSI after pediatric spine surgery include the application of best practice guideline ( BPG ), antibiotic prophylaxis during the perioperative period and usage of vancomycin powder during the operation. The commonly used diagnostic methods include the related physical signs, such as high fever, and laboratory examinations. In the principle of treatment, acute deep SSI is typically treated with aggressive debridement, retention of implants and long-term antibiotic therapy. However, delayed SSI is usually treated with implant removal after that fusion mass has been confirmed. Up till now, long-term and high-quality studies are still needed to further evaluate the efficacy of infection prevention strategies and treatment tactics to reduce the rate of SSI after pediatric spine surgery.
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FicatⅢ 期股骨头坏死并滑膜软骨瘤病一例报告
Objective To investigate the clinical, imaging, pathological features and diagnosis and treatment of the femoral head necrosis combined with synovial chondromatosis. Methods A patient with femoral head necrosis complicated with synovial chondromatosis was reported. We reviewed the relevant literatures and conducted an analysis. Results According to the X-rays, CT, MRI findings and clinical manifestations, the patient was diagnosed as femoral head necrosis and was treated with total hip arthroplasty; We found the loose bodies in acetabula with full view. The loose bodies were pathologically diagnosed as synovial chondromatosis. Eventually this patient was diagnosed as femoral head necrosis complicated with synovial chondromatosis. Conclusions Femoral head necrosis can coexist with synovial chondromatosis. Either of these diseases can also exist independently or appear one after another. Clinical diagnosis should be made based on clinical manifestations, imaging and pathological examinations, so that the correct final diagnosis, and appropriate treatment option can be obtained.
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安陆德免荷一号矫形器治疗内侧膝关节骨关节炎的研究
目的 评估安陆德免荷一号矫形器对内侧膝骨关节炎患者活动、疼痛、膝关节功能、日常生活以及生活质量的影响.方法 36例骨关节炎患者.按平均、计算机随机、双盲方法将患者分为A、B、C三组.A组以安陆德免荷一号矫形器加非甾体抗炎药(non-steroidal antiinflammatory drugs,NSAIDs)美洛昔康联合治疗,B组单用安陆德免荷一号矫形器治疗,C组单用美洛昔康治疗,每组12例.从入组起,每3周门诊随访,通过Lysholm膝关节评分表、KOOS评分表、SF-12生活质量评价量表、过去24 h VAS疼痛评分表以及Tegner活动积分表对患者进行评估,总疗程为12周.结果 (1)治疗后12周,A组患者Lysholm膝关节评分:85.64±4.74,KOOS评分症状:73.17±8.29、疼痛:70.33±5.96、日常生活:77.08±4.32、体育及娱乐:81.67±5.77、生活质量:80.58±5.76,SF-12生活质量评分:19.08±1.88,过去24 h VAS疼痛评分1.25±0.754,Tegner活动积分:7.45±1.08,各项评分较开始改善显著,差异有统计学意义(P<0.05).B组患者Lysholm膝关节评分:85.33±4.68,KOOS评分症状:71.33±10.63、疼痛:68.83±5.01、日常生活:75.92±5.18、体育及娱乐:80.00±7.07、生活质量:78.17±6.63,SF-12生活质量评分:18.83±2.52,过去24 h VAS疼痛评分1.4±0.809,Tegner活动积分7.55±1.31,各项评分较开始改善显著,差异有统计学意义(P<0.05).C组患者Lysholm膝关节评分:76.17±5.557,KOOS评分症状:60.92±7.75、疼痛:57.67±8.69、日常生活:68.17±4.61、体育及娱乐:70.00±8.53、生活质量:69.33±8.24,SF-12生活质量评分:14.18±1.81,过去24 h VAS疼痛评分2.2±0.669,Tegner活动积分:4.36±0.91,各项评分较开始改善显著,差异有统计学意义(P<0.05).B组评分与A组差异无统计学意义(P≥0.05),疗效较C组显著,差异有统计学意义(P<0.05).(2)从整体趋势而言:C组患者症状好转快,终疗效不如A、B组.B组起效慢,终疗效比C组好.A组起效快,终疗效较C组好,但与B组差异无统计学意义(P≥0.05).(3)使用后3周,C组患者Lysholm膝关节评分:71.08±7.63,KOOS评分症状:56.25±12.22、疼痛:41±10.24、日常生活:55.5±10.7、体育及娱乐:57.08±14.22、生活质量:55.5±10.7,SF-12生活质量评分:10.92±2.11,过去24 h VAS疼痛评分2.08±1.08,Tegner活动积分:3.67±1.23,较疗效较B组显著,差异有统计学意义(P<0.05),C组与A之间差异无统计学意义(P≥0.05).(4)使用后6周,A组Lysholm膝关节评分:81.25±8.95,KOOS评分症状:69.5±11.33、疼痛:62.5±9.8、日常生活:69.5±9.35、体育及娱乐:72.92±10.97、生活质量:69.5±9.35,SF-12生活质量评分:16.58±2.84,过去24 h VAS疼痛评分1.58±0.79,Tegner活动积分:6.58±1.56,疗效明显优于C组,差异有统计学意义(P<0.05),C组疗效较3周前差异无统计学意义(P≥0.05),但与B组相比疗效差异有统计学意义(P<0.05).(5)在第9周时,A组Lysholm膝关节评分:85.08±4.91,KOOS评分症状:71.17±10.53、疼痛:65.67±7.33、日常生活:72.42±6.1、体育及娱乐:77.5±7.54、生活质量:72.42±6.1,SF-12生活质量评分:18.92±2.07,过去24 h VAS疼痛评分1.46±0.54,Tegner活动积分:7.42±0.9,疗效明显优于C组,差异有统计学意义(P<0.05);C组疗效较第6周差异无统计学意义(P≥0.05),且与B组疗效差异无统计学意义(P≥0.05).结论 (1)安陆德免荷一号骨关节炎矫形器治疗内侧膝骨关节炎具有较好的疗效.(2)单独使用安陆德一号骨关节炎矫形器起效较NSAIDs缓慢,但终能全面改善患者症状、膝关节功能、日常生活以及生活质量.(3)矫形器联合使用NSAIDs在短期内可以缓解疼痛症状,且终治疗效果良好,但终疗效与单用矫形器差异无统计学意义.
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腰椎间盘突出症与腰椎休门病及休门样改变影像学表现的相关性研究
目的 通过影像学观察探讨腰段椎间盘突出症(lumbar disc herniation,LDH)和腰椎休门病(lumbar Scheuermann's disease,LSD)及休门样改变的内在联系以及LSD在LDH发病中的作用.方法 将2011年3月至2014年3月,我院收治的75例LDH(T12/L1~L5/S1)患者(共计450个运动节段)作为研究对象,其中存在腰椎间盘突出的143个节段作为研究组(LDH组),无腰椎间盘突出的307个节段作为对照组(N组).通过复习其CT、MRI和X线片,对比两组合并各种影像学休门样改变的比例及LSD的比例,进一步在LDH组内分别对比存在各种休门样改变的节段和无休门样改变节段合并腰椎间盘突出的比例.结果 LDH组出现各种休门样改变的比例均高于N组,分别为Schmorl结节23.8%(34/143)和5.5%(17/307;χ2=32.29,P<0.001),终板不规则55.9%(80/143)和4.2%(13/307;χ2=159.10,P<0.001),椎体后缘离断27.3%(39/143)和0.3%(1/307;χ2=87.47,P<0.001),椎体楔形变7.0%(10/143)和0.7%(2/307;χ2=12.77,P<0.001).LDH组34.26%(49/143)的节段符合腰椎休门病诊断,而N组仅为0.98%(3/307;χ2=105.78,P<0.001).存在Schmorl结节(66.7%,34/51;χ2=82.61,P<0.001)、终板不规则(86.0%,80/93;χ2=191.51,P<0.001)、椎体后缘离断(97.5%,39/40;χ2=152.47,P<0.001)、椎体楔形变(83.3%,10/12;χ2=41.05,P<0.001)的节段发生椎间盘突出的比例均高于无休门样改变的节段(12.2%,39/320).结论 LDH与LSD关系密切,LSD可能参与LDH的发病.Schmorl结节、终板不规则、椎体楔形变以及椎体后缘离断,与腰椎间盘突出的发生有关.
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3D打印在脊柱外科的应用现状与未来
The latest and fast-growing innovation in the orthopedic field has been the advent of 3D printing ( 3DP ) technology, which has been recently applied in the production of low-cost, patient-specific medical implants. As the development of clinical medicine and other interdisciplinary areas, digital design and 3DP get combined, and the individualized treatment in the orthopedic field has been significantly improved. Currently, the applications of 3DP are cutting-edge in the field of spinal surgery widely. Spinal surgery is very complex and the risk is extremely high considering its complicated anatomical structure and adjacency to important nerves and blood vessels. Significantly, 3DP applications in spinal surgery have potential to improve surgical outcomes through the establishment of the preoperative diagnosis and surgical planning, surgery simulation, intraoperative neuronavigator, surgical education, custom manufacturing ( implants, prosthetics and surgical guides ) and bone tissue engineering. The 3DP technology can provide innovative ideas for developing individual treatment programs, improving the accuracy and safety of surgery, simplifying the surgical process and reducing the operation time. However, the development level of 3DP at present is not balanced, and there is no standard to follow, difficulty in charging and other problems. The problems about policies and techniques are urgent to be resolved.
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峡部裂伴轻度腰椎滑脱原位融合与复位融合临床疗效的Meta分析
目的 系统评价原位融合与复位融合治疗轻度(Ⅰ、Ⅱ 度)峡部裂型腰椎滑脱症的临床疗效.方法 计算机全面检索PubMed、Cochrane Library、Emabse databases、Sinomed、中国知网数据库、万方数据库、维普数据库,检索时间截止至2016年4月.纳入峡部裂伴轻度腰椎滑脱症术中原位融合与复位融合的随机对照研究(randomized controlled trial,RCT)和队列研究,对RCT研究采用改良Jarad评分进行质量评价,对非RCT研究采用NOS评价方法,由2名作者(陈佳海、白雪东)独立提取及分析数据,采用Review Manager 5.3软件对所得的数据进行Meta分析.结果 经过系统检索和筛选,共有4篇符合条件的文献纳入本研究,包括2篇RCT以及2篇队列研究.Meta分析结果表明,复位后融合患者其滑脱程度较原位融合者明显改善[SMD=-1.58,95%CI(-2.09~-1.06),P<0.00001],并在2年以上的随访时得到有效维持[MD=20.05,95%CI(17.71~22.38),P<0.00001],差异有统计学意义;然而,在Oswestry功能障碍指数(oswestry disability index,ODI)[MD=1.136,95%CI(-1.34~3.60),P=0.37]、疼痛视觉模拟评分(visual analogue scale,VAS)[MD=0.06,95%CI(-0.21~0.32),P=0.67]、优良率[RR=1.01,95%CI(0.92~1.10),P=0.87]、融合率[RR=0.99,95%CI(0.93~1.06),P=0.81]以及手术并发症发生率方面[RR=0.78,95%CI(0.36~1.72),P=0.54],复位后融合组与原位融合组之间差异无统计学意义.结论 在峡部裂伴轻度腰椎滑脱症的手术方式选择上,复位后融合可使滑脱椎体良好复位并得到有效维持复位,但与原位融合相比在临床疗效方面差异无统计学意义.两种手术方式均能减轻患者腰痛程度、获得良好的椎间融合率,提高患者治疗满意度.选择何种治疗方式应根据患者的具体病情以及手术医师对具体技术的熟练程度而定,远期临床疗效及矢状平衡问题需进一步深入研究.
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3D打印技术在复杂创伤骨科教学中的应用
目的 将3D打印技术应用于复杂骨折临床教学中,探究教学效果.方法 选取本科五年级80名实习生,对每个学生编号,再通过计算机随机赋值,再将计算机赋得值按升序列排序,前40名为对照组,后40名为实验组.采用3D打印技术根据患者的影像学资料打印出复杂骨折模型,采用数字化真实地再现骨折的分型,以及预采用的骨折复位方式,对试验组40名实习生进行临床教学;对照组40名学生则采用传统的仔细分析患者病史、影像学资料结合临床解剖的教学方法进行临床教学.结果 骨折的理解程度实验组(8.75±0.57)、对照组(7.65±0.74),术前术后骨折一致性判断实验组(8.31±0.47)、对照组(6.48±0.58),骨折类型表述实验组(85.56±0.54)、对照组(6.13±0.54),操作能力成绩实验组(87.56±0.43)、对照组(78.47±0.34);试验组学员对均高于对照组,差异均有统计学意义(P<0.05);两组专业兴趣以及理论考试成绩差异无统计学意义.结论 3D打印技术对复杂骨折教学有一定的帮助,具有较好的临床教学应用前景.
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3D打印截骨槽导板与定位钉导板在全膝关节置换术中的对比研究
目的 探讨比较3D打印截骨槽导板与定位钉导板在人工全膝关节置换术(total knee arthrop-lasty,TKA)中的临床效果.方法 选取2015年1月至2016年1月,42例于南京医科大学附属南京医院骨科行单侧TKA的患者采用电脑随机抽样法分为两组,每组21例,A组为截骨槽组,B组为定位钉组,分别对两组患者行下肢全长CT扫描,局部膝关节MRI扫描,所得数据均存为Dicom格式.将Dicom数据导入到Mimics 17.0软件中,利用CT、MRI数据建立具有局部软骨厚度的膝关节三维模型.将模型导入到3-matic软件中,根据模型特征进行模拟截骨,截骨后A组设计为截骨槽导板,B组设计为定位钉导板,后进行导板的3D打印并记录两组导板打印时间.记录并比较两组术中断裂率、手术时间、术后引流量、术后髋-膝-踝角(hip knee ankle,HKA)、冠状面股骨组件角(frontal femoral component,FFC)、冠状面胫骨组件角(frontal tibial component,FTC)、矢状面胫骨组件角(lateral tibial component,LTC)偏移值及术后1、3、6、12个月的膝关节协会膝关节评分(knee society score,KSS).结果 截骨槽组和定位钉组导板打印时间分别为(152±25)min和(156±23)min(P>0.05)、断裂率分别为14.3%和0%(P<0.05)、手术时间分别为(38.1±7.3)min和(31.2±6.5)min(P<0.05)、术后出血量分别为(197.3±46.4)ml和(220.5±38.5)ml(P>0.05),两组术后的假体特征角度:HKA偏差[(1.7±1.3)°vs.(1.6±1.5)°](P>0.05)、FFC偏差[(1.2±0.8)°vs.(1.3±1.2)°](P>0.05)、FTC偏差[(1.2±1.4)°vs.(1.4±1.5)°](P>0.05)、LTC偏差[(3.2±1.3)°vs.(3.5±1.6)°](P>0.05).术后1、3、6、12个月的KSS评分差异无统计学意义(P>0.05).结论 3D打印截骨槽导板与定位钉导板在TKA中均可获得较好的临床效果,但定位钉导板稳定性更好.
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3D打印技术在复杂肩胛骨骨折修复术中的辅助应用
目的 探讨3D打印技术在复杂肩胛骨骨折手术中的临床应用价值.方法 从我院2016年1月至2016年12月收治的肩胛骨骨折患者中,选取6例复杂肩胛骨骨折病例,应用3D打印技术制备患者的肩胛骨骨折模型.根据模型设计手术方案、手术入路、复位顺序;在模拟手术过程确定重建接骨板的放置位置、长度并预弯塑形;确定螺钉长度及钉道方向.将结果 与实际手术情况进行对比,并记录手术时间.结果6例手术均顺利完成,完全符合术前设计的手术方案,术中选取的重建接骨板、螺钉数与螺钉长度均与模拟手术完全一致.术后复查影像资料显示骨折复位满意.所有患者均获8~12个月的随访,平均10个月,优良率达87%.结论 3D打印技术应用于复杂肩胛骨骨折的治疗,有助于术前制订手术计划并模拟手术操作;能有效缩短手术时间,提高手术质量,降低手术难度.
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3D打印半骨盆假体重建骨盆 Ⅱ 区或 Ⅱ+Ⅲ 区肿瘤切除后骨缺损的回顾性病例对照研究
目的 探讨 Ⅱ 区或 Ⅱ+Ⅲ 区骨盆肿瘤切除后,使用3D打印半骨盆假体重建骨缺损的可行性及优越性.方法 2014年12月至2016年11月,共有40例骨盆 Ⅱ 区或 Ⅱ+Ⅲ 区肿瘤患者于本中心进行骨盆肿瘤切除、3D打印标准型半骨盆假体重建手术,将其纳入病例组.根据上述病例的性别、年龄、身高、体重、肿瘤大小及肿瘤分区、分期的资料,从2009年1月至2015年5月于我科行骨盆肿瘤切除、普通半骨盆假体置换的 Ⅱ 区或 Ⅱ+Ⅲ 区骨盆肿瘤患者中,选取40例纳入对照组.其中,各组均含男23例,女17例;平均年龄43岁;根据Enneking骨盆外科分区方法确定切除及重建部位,各有 Ⅱ 区6例,Ⅱ+Ⅲ 区34例.结果 80例均为整块切除.3D打印半骨盆假体组肿瘤边界达广泛切除22例,边缘切除18例,术后均获得随访,随访时间3~25个月,中位随访时间9个月.其中,无瘤生存33例,带瘤生存5例,余2例因肿瘤转移死亡;38例存活患者MSTS-93评分为(21.1±2.8)分;术后并发症包括6例伤口愈合不良及1例关节脱位,无一例深部感染.对照组肿瘤边界达广泛切除21例,边缘切除19例,术后均获得随访,随访时间5~77个月,中位随访时间17.5个月;其中,无瘤生存27例,带瘤生存5例,余8例因肿瘤转移死亡.32例存活患者MSTS-93评分为(18.9±2.6)分,术后并发症包括6例伤口愈合不良、2例关节脱位、2例深部感染.两组病例在手术时间、术中出血量、并发症谱及术后MSTS功能评分方面差异无统计学意义.回顾两组病例术后6个月复查的CT资料,测量患侧骶髂关节间隙并与健侧对比,结果提示3D打印半骨盆假体可维持骶髂关节稳定性.结论 应用3D打印半骨盆假体重建 Ⅱ 区或 Ⅱ+Ⅲ 区骨盆肿瘤术后骨缺损安全性高,不增加额外并发症,可获得良好的功能状态,并可维持骶髂关节稳定性.
| 年 | 期数 |
| 2019 | 02 |
| 2018 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2017 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2016 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2015 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2014 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2013 | 01 02 03 04 05 06 07 08 09 10 11 12 |
| 2012 | 01 02 03 04 05 06 |
| 2011 | 01 02 03 04 05 06 |
| 2010 | 01 02 03 04 05 06 |
| 2009 | 01 02 03 04 05 06 |
| 2008 | 01 02 03 04 05 06 |
| 2007 | 01 02 03 04 05 06 |
| 2006 | 01 02 03 04 05 06 |
| 2005 | 01 02 03 04 05 06 |
| 2004 | 01 02 03 04 05 06 |
| 2003 | 01 02 03 04 05 06 |
| 2002 | 01 02 03 04 05 06 |
