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DESIGN AND EXPERIMENTAL STUDY OF INTERNAL FIXATOR FOR THE RECONSTRUCTION OF LUMBAR ISTHMUS

Objective To investigate the cl inical appl icabil ity and value of internal fixator for the reconstruction of lumbar isthmus in the treatment of lumbar vertebral spondylolysis and to lay a fundation for its cl inical appl ication. Methods Sixteen healthy goats weighing 22.65-31.22 kg were selected to establ ish the models of vertebral spondylolysis at L5, which thereafter were randomized into two groups (n=8): bone graft group in which 0.8-1.1 g fresh autogenous bone was transplanted into the isthmus spondylolysis area, and internal fixation with bone graft group in which internal fixator was installed before transplanting 0.8-1.1 g fresh autogenous bone into the isthmus spondylolysis area. All animals were killed 8 weeks after operation to receive imaging, topographic anatomy and histology detection. Meanwhile, biomechanics test was performed by using 5 donated vertebral body specimens (4 males and 1 female aged 35-51 years old). The left isthmus of L5 vertebra was transected to serve as lumbar vertebral spondylolysis model. A mini-displacement sensor was put at the transected ends of the isthmus. Then loading was conducted with a constant velocity of 2 mm/min by electronic omnipotent tester simulating the direction of fixation force of the internal fixator, and the deformation value of the transected ends was collected by a dynamic data collector and analyzer. The loading wascontinued until the vertebra specimens were damaged. The deformation of displacement sensor and the closure of transected ends of the lumbar isthmus were observed. Results All the goats behaved normally shortly after operation, and no nerve injury induced by operation and no wound infection occurred. Bilaterally obl ique X-ray films of lumbar vertebra and topographic anatomy 8 weeks after operation showed the fusion rate of the internal fixation and bone graft group and the bone graft group was 100% and 62.5%, respectively, indicating there was a significant difference (P lt; 0.05). Histology observation showed 3 goats in the bone graft group presented empty bone trabecula, empty bone lacuna and the disappearance of osteocytes at the transected ends of lumbar isthmus; while in the internal fixation and bone graft group, the bone trabecula grew into cancellous structures with hematopoietic and fatty bone marrow tissue inside, and parts of the bone trabecula had various degrees of mosaic-l ike pattern. During the upload, the biomechanics test and data processing results showed when the external load was 40 N, the deformation of displacement sensor was identified and the gap between the transected ends of lumbar isthmus started to close; then with the increase of external load, the displacement sensor tended to ascend in a l inearity manner; while when the external load was 212 N, the displacement sensor had no further deformation, the gap between the transected ends of lumbar isthmus wascompletely closed, and the pressor effect appeared. Conclusion The internal fixator for the reconstruction of lumbar isthmus has mechanical effects of stabil izing and elevating pressure with a high fusion rate.

TREATMENT OF LUMBAR SPONDYLOLISTHESIS WITH SPONDYLOLISTHESIS REDUCTION SYSTEM INTERNAL FIXATION AND DECOMPRESSION, POSTERIOR ALONE INTERBODY CAGE FUSION AND BONE GRAFTING

Objective To investigate the cl inical outcomes of lumbar spondylol isthesis associated with lumbar spinal stenosis through decompressive laminectomy, spondylol ithesis reduction system (SRS) internal fixation, single posteriolateralVigor Spacer threaded fusion cages and intertransverse process arthrodesis bone grafting. Methods From June 2002 to June 2006, 58 cases of lumbar spondylol isthesis were treated with decompressive laminectomy, fixed by SRS instrumentation, posterior installed with interbody Vigor Spacer Cage and bone grafted between intertransverse process arthrodesis. There were 47 males and 11 females, aged 32-66 years old (45.8 on average). The course of disease was 3 months to 7 years, with an medium course of 25 months. Accoding to the Meyerding standard, 38 cases were classified as degree I and 20 as degree II. Spondylol isthesis between L4 and L5 covered 21 cases and between L5 and S1 covered 37 cases. There were 44 cases of lumbar spondylol isthesis and 14 of degenerative lumbar spondylol isthesis. The intervertebral height was 1.5-10.5 mm with the average of 5.1 mm. Results All patients’ incisions obtained heal ing by first intension after operation. The operation time was 50-90 minutes with an average of 65 minutes. The blood loss was 200-500 mL with an average of 250 mL. The patients were followed up for 10-38 months with an average of 23.6 months. According to the Macrab criteria, 54 cases were excellent, 3 good, 1 fair and the choiceness rate was 98.3%. According to the Meyerding classification, 38 cases of degree I and 19 out of 20 cases of degree II obtained complete reduction, and the rate of complete reduction was 98.3%. There were 57 (98.3%) cases which fused well 3-6 months after operation. The intervertebral height resumed to 9.6-12.5 mm with an average of 11.6 mm, and no intervertebral height loss was found. Conclusion The treatment of lumbar spondylol isthesis with decompressive laminectomy, SRS internal fixation, single posteriorolateral Vigor Spacer threaded fusion cage and bone grafting has excellent cl inical results and stable reduction.

多彩卡通輸液固定器的設計與應用

前路矯形術治療胸段脊柱側凸

目的 總結胸段脊柱側凸的前路矯形方式及臨床效果。 方法 2002 年6 月－ 2007 年4 月，采用前路矯形技術治療胸段脊柱側凸23 例。男7 例，女16 例；年齡11 ～ 17 歲，平均13 歲。特發性脊柱側凸17 例，Chiari畸形Ⅰ型或脊髓空洞伴胸段脊柱左側凸6 例。病程3 ～ 10 個月。站立正位X 線片示Cobb 角為40 ～ 78°，平均59°。Bending 相自然矯正率為50.0% ～ 67.5%，平均53.5%。 結果 患者術后均無胸腔感染，其中1 例于術后3 周發現乳糜胸、T6 螺釘松動拔出和椎體破裂，經對癥處理后治愈。術后2 周站立位X 線片示Cobb 角為3 ～ 20°，平均13.7°，矯正率為76.8%。21 例獲隨訪，隨訪時間10 ～ 60 個月，矯正丟失2 ～ 8°，平均4.6°。患者固定融合區植骨均愈合良好，均無內固定斷裂、明顯后凸加重及曲軸現象發生。 結論 只要嚴格掌握適應證，重視并及時處理并發癥，前路矯形是治療胸段脊柱側凸有效方法之一。

頸椎前路鋼板內固定術對維持椎間高度的作用

IMPROVEMENT OF TECHNIGUE IN RESTORATION OF STABILITY OF THORACO LUMBAL SPINE

A new fixator for spine was designed to restore the stability of spine in improving the treatment of thoraco-lumbar dislocation. This instrument was composed of six nails, two longitudinal connecting rods and two transverse connecting rods. On the surface of the nails, there were furrows engraved, instead of screw thread. It fixed the spine through pedicle of vertebra from the posterior approach. The fixed vertebrae were limited between two vertebrae. From 1989 th 1995, twelve patients with fracture-dislocation of thoraco-lumbar spine were reduced with this instrument. After four years follow-up, it showed that the deformity was corrected and the spine firmly fixed. Compared with Dick’s screws, it had the following advantages such as simple manipulation, increased strergth of nails and minimal damage to tissue during operation.

DEVELOPMENT AND BIOMECHANICAL STUDY OF NI-TI SHAPE MEMORY ALLOYS SCAPHOID ARC NAIL

【Abstract】 Objective To develop a new internal fixator Ni-Ti shape memory alloy scaphoid arc nail (NT-SAN)for fracture of the scaphoid waist and to test the biomechanical characteristics of NT-SAN so as to provide the biomechanicalproofs for cl inical appl ication. Methods According to the acquired measurements and anatomic features of the scaphoid in Chinese population, a special internal fixator—— NT-SAN was designed. The biomechanical intensity experiment: The 32 specimens of fractures of the waist of scaphoid were divided randomly into 4 groups (n =8). Reduction and internal fixation were carried out in each specimen, with Kirschner wires (Group A), with Kirschner wires stapl ing (Group B), with screw (Group C) and with NT-SAN (Group D). Their fixed strength was tested by a hydrol ic pressure biomechanical system AG-1. The biomechanical fatigue experiment: The models of 24 waist scaphoid fracture of adult upper l imbs specimens were made and randomly divided into 3 groups (n =8). Fracture was fixed with Kirschner wire stapl ing (Group E), with screw(Group F) and with NTSAN(Group G). Wrist joint was vertically pressured load of 98 N, palmar flexion and dorsal extension motion was simulated;the range of movement was from palmar flexion 5° to dorsal extension 30° and the frequency was 2 000 cycles. Displace data offragment were measured at every 500 cycles. Finally, the biomechanical features of NT-SAN were evaluated according to thetested data. NT-SAN was used to treated 1 patient with fracture of the waist of scaphoid, who was typed as Ⅱ b according to Herbert classification. Results The biomechanical tests showed that the traction forces were (15.18±3.55), (36.04±4.30),(64.88±11.62), (65.84±12.22) N and (20.28±12.09), (75.95±47.64), (120.91±26.68), (130.21±31.55) N when the displacements of the fracture l ines distracted in 1 mm/min were 1 mm and 2 mm; showing significant differences between Group D and groups A, B (P lt; 0.05), and showing no significant difference between Group D and Group C (P lt; 0.05). The biomechanical fatigue experiment showed that there were significant differences between Group G and groups E, F(P lt; 0.05) according to the measuredresults of the displacements of the fracture l ines. When wrist joint were circularly moved; showing significant differences between Group G and Group E(P lt; 0.05) after 500 circular movements, and showing significant differences between Group G and Group F(P lt; 0.05) after 1 500 circular movements according to the measured results of the “stage-shape” displacements in the fracture position. Incision healed by first intention and the X-ray films showed good NT-SAN fixation 3 months after followup.Conclusion The design of NT-SAN is in accordance with the anatomic features of the scaphoid. The fixed strength can meet the demand of the biomechanics and the range of fatigue strength can meet the demand of bony union.

T 型鋼板支撐植骨在橈骨遠端塌陷粉碎性骨折中的應用

【摘 要】 目的 總結橈骨遠端塌陷粉碎性骨折采用T 型鋼板內固定、支撐植骨聯合石膏外固定的治療效果。 方 法 1999 年1 月－ 2006 年7 月，采用切開復位、T 型鋼板內固定、支撐植骨聯合石膏外固定治療38 例橈骨遠端塌陷粉碎性骨折患者。男24 例，女14 例；年齡20 ～ 74 歲，平均41 歲。閉合骨折30 例，開放骨折8 例。陳舊性骨折11例，新鮮骨折27 例。根據AO 分型：C2 型18 例，C3 型20 例。尺偏角－ 13 ～ 17°。29 例Colles 骨折掌傾角平均－ 45.2°；與健側比較，橈骨縱軸掌側平均短縮4.5 mm；背側平均短縮8.2 mm。9 例Smith 骨折掌傾角平均27.6°，掌側平均短縮6.5 mm，背側平均短縮5.1 mm。 結果 患者均獲隨訪，隨訪時間9 ～ 20 個月，平均13 個月。無鋼板斷裂和醫源性神經血管損傷。X 線片示骨折于術后5 ～ 9 周愈合，平均 7 周。橈骨縱軸長度恢復（與健側比較），關節面平整；尺偏角16 ～ 24°，平均21.2°；掌傾角7 ～ 16°，平均10.6°。根據Dienst 等功能評估表進行評定，優24 例，良14 例。 結論 T 型鋼板內固定、支撐植骨聯合石膏外固定治療橈骨遠端塌陷粉碎性骨折，可有效恢復橈骨遠端解剖結構、功能及良好外形。

氣管插管固定器在中毒洗胃中的應用

目的研究在洗胃過程中應用氣管插管固定器固定胃管的可行性。 方法將2014年1月－2015年1月就診的急性中毒需要洗胃的80例患者隨機分為研究組和對照組，每組各40例。研究組洗胃采用氣管插管固定器固定胃管，對照組采用傳統手持牙墊固定，觀察比較兩種固定方法的穩妥性、安全性、口腔損傷例數、意外拔管率。計數資料采用χ2檢驗進行分析。 結果研究組的固定性（97.5%）、方便性（90.0%）均優于對照組（分別為22.5%、20.0%），惡心發生率（5.0%）、嘔吐發生率（5.0%）、咽喉部刺激反應發生率（25.0%）和并發癥發生率（12.5%）均低于對照組（分別為72.5%、65.0%、85.0%、40.0%），差異均有統計學意義（P＜0.05）。兩組一人獨立操作性、一次性插管成功率、堵管率、胃管脫出率、輔助器材使用率比較，差異無統計學意義（P＞0.05）。 結論在洗胃中使用氣管插管固定器固定胃管優于傳統固定方式，值得在臨床推廣應用。

創傷性浮膝合并血管損傷的治療

目的 總結創傷性浮膝合并血管損傷的手術方法及療效。 方法 2001 年3 月－ 2008 年3 月收治23 例創傷性浮膝合并血管損傷。男14 例，女9 例；年齡21 ～ 63 歲。車禍傷15 例，高處墜落傷5 例，重物砸傷3 例。開放骨折16 例，按照Gustilo 分型：Ⅰ型8 例，Ⅱ型6 例，Ⅲ型2 例。血管損傷類型：橫行斷裂12 例，縱行裂傷4 例，挫傷缺損4 例，內膜損傷栓塞3 例。受傷至入院時間為30 min ～ 4 h，平均2 h。采用小切口復位股骨逆行交鎖髓內釘聯合脛骨外固定器固定，同時修復血管。 結果 骨折均獲解剖復位。術后外固定針道感染3 例。4 例于術后7 ～ 10 d 出現切口淺表感染，其余切口均Ⅰ期愈合。1 例于術后12 d 因缺血壞死、感染行截肢術，余22 例保全肢體。22 例術后獲隨訪，隨訪時間14 ～ 38 個月，平均18.5 個月。骨折均愈合，愈合時間為15 ～ 24 周。術后1 年肢體功能按Karlstrouml;m 等評價標準，優10 例，良8 例，中3 例，差1 例。 結論 小切口復位股骨逆行交鎖髓內釘聯合脛骨外固定器固定，同時修復血管，是治療創傷性浮膝合并血管損傷的一種較好選擇。