簡介:登記號(hào)成果登記批準(zhǔn)日期科學(xué)技術(shù)成果鑒定證書鑒字2013第號(hào)成果名稱ILIZAROV技術(shù)結(jié)合中醫(yī)藥治療長骨骨不連的基礎(chǔ)與臨床應(yīng)用研究完成單位日照市中醫(yī)醫(yī)院鑒定形式會(huì)議鑒定組織鑒定單位日照市科技局(蓋章)鑒定日期2012年12月21日鑒定批準(zhǔn)日期2012年12月21日國家科學(xué)技術(shù)委員會(huì)國家科學(xué)技術(shù)委員會(huì)一九九四年制2的產(chǎn)生等。骨不連術(shù)后按中醫(yī)三期辨證治療,術(shù)后服用中藥,能使骨折端的血腫盡早消散、機(jī)化,使骨痂早期形成,骨折早期愈合。該課題應(yīng)用ILIZAROV技術(shù)結(jié)合中醫(yī)藥治療骨不連,ILIZAROV外固定器多平面交叉穿針,加壓均勻,應(yīng)力分布到骨折端也比較均勻,骨折端緊密接觸,能較好地從力學(xué)和生物學(xué)兩方面為骨不連的愈合提供優(yōu)良環(huán)境,ILIZAROV外固定器屬于彈性外固定架,并且其固定剛度可通過調(diào)整克氏針的張力及數(shù)目隨時(shí)調(diào)節(jié),是一理想的外固定器。術(shù)后通過早期功能鍛煉,使用患肢,產(chǎn)生骨折端間斷的壓應(yīng)力刺激,加速骨不連的愈合及骨重建。骨不連術(shù)后參照骨折三期分治原則進(jìn)行中藥治療,術(shù)后2周左右為初期,治用活血化瘀、理氣止痛之法,術(shù)后第3周和第4周為中期,此期瘀化腫退,骨折斷端已初步連接,治用接骨續(xù)筋,和營通絡(luò)之法,術(shù)后第5周至骨折愈合為后期,治用補(bǔ)益肝腎、強(qiáng)筋壯骨、舒筋通絡(luò)之法,配合使用促進(jìn)骨愈合的外用膏劑,內(nèi)外同治、三期分治達(dá)到促進(jìn)骨折愈合的目的。研究目的研究目的1探討ILIZAROV技術(shù)結(jié)合中醫(yī)藥治療長骨干骨折骨不連的方法2探討治療四肢長骨干骨折骨不連的手術(shù)改進(jìn)方法和療效,為臨床治療提供參考。研究方法研究方法1通過32例長骨骨不連患者隨機(jī)分成兩組,每組16例分A組實(shí)驗(yàn)組和B組對照組,A組采用ILIZAROV外固定器多平面交叉穿針,且根據(jù)骨折情況逐漸均勻加壓,使應(yīng)力均勻分布到骨折端,骨折端緊密接觸,從力學(xué)和生物學(xué)兩方面為骨不連的愈合提供優(yōu)良環(huán)境,通過調(diào)整克氏針的張力及數(shù)目隨時(shí)間調(diào)節(jié)固定剛度,術(shù)后通過早期功能鍛煉,使用患肢,產(chǎn)生骨折端間斷的壓應(yīng)力刺激,加速骨不連的愈合及骨重建。對于骨缺損和斷端硬化的患者取自體髂骨,剪成3MM3MM5MM大小的顆粒進(jìn)行骨髓內(nèi)外植骨。術(shù)后參照骨折三期分治原則進(jìn)行中藥治療,術(shù)后2周左右為初期,治用活血化瘀、理氣止痛之法,術(shù)后第3周和第4周為中期,此期瘀化腫退,骨折斷端已初步連接,治用接骨續(xù)筋,和營通絡(luò)之法,術(shù)后第5周至骨折愈合為后期,治用補(bǔ)益肝腎、強(qiáng)筋壯骨、舒筋通絡(luò)之法,配合使用促進(jìn)骨愈合的外用膏劑,內(nèi)外同治、三期分治達(dá)到促進(jìn)骨折愈合的目的。B組對照組采用鎖定加壓鋼板內(nèi)固定加自體骨植骨治療。2療效觀察方法骨愈合評定標(biāo)準(zhǔn)根據(jù)改良的ASAMI評定標(biāo)準(zhǔn)對患者預(yù)后情況進(jìn)行分級。骨愈合,無感染,成角畸形7°,下肢不等長25CM,骨愈合為優(yōu);骨愈合,但后3項(xiàng)標(biāo)準(zhǔn)有一項(xiàng)達(dá)不到為良;骨愈合,但后3項(xiàng)標(biāo)準(zhǔn)有兩項(xiàng)達(dá)不到為中等;骨不愈合或再骨折,后3項(xiàng)標(biāo)準(zhǔn)均達(dá)不到為差。功能評價(jià)標(biāo)準(zhǔn)所有術(shù)前主動(dòng)運(yùn)動(dòng)恢復(fù),無疼痛或輕度疼痛,無跛行,無局部軟組織營養(yǎng)不良,臨近關(guān)節(jié)攣縮5°,臨近關(guān)節(jié)活動(dòng)度減少15°為優(yōu);大部分術(shù)前主動(dòng)運(yùn)動(dòng)恢復(fù),無疼痛或輕度疼痛,后4項(xiàng)標(biāo)準(zhǔn)有1項(xiàng)達(dá)不到為良;部分術(shù)前主動(dòng)運(yùn)動(dòng)恢復(fù),無疼痛或輕度疼痛,后4項(xiàng)標(biāo)準(zhǔn)有兩項(xiàng)達(dá)不到為中;術(shù)后主動(dòng)運(yùn)動(dòng)明顯受限,嚴(yán)重疼痛需用麻醉藥物,后4項(xiàng)標(biāo)準(zhǔn)有3項(xiàng)達(dá)不到為差。截肢患者分級為差。
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簡介:EFFECTOFTOTALKNEEARTHROPLASTYIMPLANTPOSITIONONFLEXIONANGLEBEFOREIMPLANTBONEIMPINGEMENTHIDEKIMIZUUCHI,MD,PHD,YCLIFFORDWCOLWELLJR,MD,SHUICHIMATSUDA,MD,PHD,YCESARFLORESHERNANDEZ,BS,YUKIHIDEIWAMOTO,MD,PHD,YANDDARRYLDDLIMA,MD,PHDABSTRACTWEGENERATEDPATIENTSPECIFICCOMPUTERMODELSOFTOTALKNEEARTHROPLASTYFROM10PATIENTSTOCOMPUTEMAXIMUMFLEXIONANGLEBEFOREIMPLANTBONEIMPINGEMENTMOTIONWASSIMULATEDFOR5DIFFERENTFEMORALIMPLANTPOSITIONSAND11DIFFERENTTIBIALINSERTPOSITIONSAT4DIFFERENTTIBIALPOSTERIORSLOPESINTHENEUTRALPOSITION,THEMEANMAXIMUMFLEXIONANGLEWAS1363°THERANGEBECAUSEOFANATOMICALVARIATIONAMONGPATIENTSWAS130°ACOMBINATIONOF2MMPOSTERIORTRANSLATIONOFTHEFEMORALCOMPONENTWITHA10MMANTERIORTRANSLATIONOFTHEINSERTANDA7°POSTERIORSLOPEINCREASEDFLEXIONBYAMEANOF14°RELATIVETOTHENEUTRALPOSITIONTHERATEOFCHANGEINFLEXIONANGLEWAS04°/MMTO15°/MMWITHRESPECTTOIMPLANTPOSITIONAND15°/MMINCREASEINTHEPOSTERIORCONDYLAROFFSETKEYWORDSTOTALKNEEARTHROPLASTY,KNEEFLEXIONANGLE,COMPUTERSIMULATION,COMPONENTPOSITION,ANATOMICALVARIATION?2011ELSEVIERINCALLRIGHTSRESERVEDTOTALKNEEARTHROPLASTYTKAHASBECOMEONEOFTHEMOSTSUCCESSFULORTHOPEDICPROCEDURESWITHREPORTEDSURVIVALRATESOFGREATERTHAN90AFTER15YEARS1,2WITHTHEIMPROVEMENTOFLONGTERMOUTCOMES,THEREISRENEWEDINTERESTINMAXIMIZINGRANGEOFMOTIONAFTERTKA310THERANGEOFMOTIONINFLEXIONISEXTREMELYIMPORTANTINASIANCOUNTRIESANDFORPATIENTSWITHLIFESTYLESTHATINVOLVESITTINGONTHEFLOORINDEEPFLEXION3EVENINNORTHAMERICANPATIENTS,UPTO75IDENTIFIEDTHATACTIVITIESREQUIRINGDEEPERKNEEFLEXIONANGLESUCHASSQUATTING,KNEELING,ANDGARDENINGWEREPERFORMEDWITHGREATERDIFFICULTYAFTERTKA4MANYCLINICALSTUDIESHAVEINVESTIGATEDFACTORSAFFECTINGPOSTOPERATIVERANGEOFMOTION5,6,10,11PATIENTRELATEDFACTORSSUCHASPREOPERATIVERANGEOFMOTION,BODYMASSINDEX,DISEASE,AGE,ANDSEXGREATLYINFLUENCETHEPOSTOPERATIVERANGEOFMOTIONSIMILARLY,SURGICALTECHNIQUESCANALSOAFFECTTHEPOSTOPERATIVERANGEOFMOTIONEXAMPLESINCLUDETHEHEIGHTOFJOINTLINE,PATELLARTRACKING,APPROPRIATEGAPBALANCING,RELEASEOFPOSTERIORCAPSULE,ANDREMOVALOFTHEOSTEOPHYTESANOTHERIMPORTANTFACTORISTHEPOSTERIORCONDYLAROFFSETPCO,WHICHHASBEENASSOCIATEDWITHPOSTOPERATIVERANGEOFMOTIONINFLUOROSCOPICANALYSISINVIVO5PREVIOUSSTUDIESHAVEANALYZEDTHEEFFECTOFIMPLANTALIGNMENTANDRELATIVEPOSITIONONPOSTOPERATIVERANGEOFMOTION1215WALKERETAL12REPORTEDTHATPOSTERIORANDPROXIMALFEMORALPLACEMENTANDAGREATERPOSTERIORTIBIALSLOPEINCREASEDMAXIMUMFLEXIONANGLEINPLASTICMODELSOFTHEFEMURANDTIBIAMASSINANDGOURNAY13DEMONSTRATEDTHATGREATERPCOINCREASEDTIBIALPOSTERIORSLOPE,ANDAMOREPOSTERIORFEMOROTIBIALCONTACTPOINTCANINCREASEFLEXIONINASTUDYTHATUSED2DIMENSIONALTEMPLATESOFPROSTHETICCOMPONENTSONLATERALKNEERADIOGRAPHSHOWEVER,THECOMBINEDEFFECTOFTHE3DIMENSIONALANATOMYOFTHEPATIENTANDTHEIMPLANTPOSITIONHASNOTBEENSTUDIEDWEGENERATEDPATIENTSPECIFICANATOMICALMODELSOFIMPLANTBONEIMPINGEMENTTOEVALUATETHEEFFECTOFIMPLANTPOSITIONANDANATOMICALVARIATIONONFLEXIONANGLEOURPRIMARYHYPOTHESISWASTHATIMPLANTPOSITIONWOULDSIGNIFICANTLYAFFECTMAXIMUMKNEEFLEXIONANGLEBEFOREBONEPROSTHESISIMPINGEMENTOURSECONDARYHYPOTHESISWASTHATTHEPCOWOULDCORRELATESIGNIFICANTLYWITHMAXIMUMFLEXIONANGLEFROMTHESHILEYCENTERFORORTHOPAEDICRESEARCHANDEDUCATIONATSCRIPPSCLINIC,LAJOLLA,CAANDYDEPARTMENTOFORTHOPAEDICSURGERY,GRADUATESCHOOLOFMEDICALSCIENCES,KYUSHUUNIVERSITY,FUKUOKA,JAPANSUBMITTEDAPRIL19,2010ACCEPTEDAUGUST1,2010NOBENEFITSORFUNDSWERERECEIVEDINSUPPORTOFTHESTUDYREPRINTREQUESTSDARRYLDDLIMA,MD,PHD,SHILEYCENTERFORORTHOPAEDICRESEARCHANDEDUCATIONATSCRIPPSCLINIC,11025NTORREYPINESROAD,SUITE140,LAJOLLA,CA92037?2011ELSEVIERINCALLRIGHTSRESERVED08835403/260500113600/0DOI101016/JARTH201008002721THEJOURNALOFARTHROPLASTYVOL26NO52011INSERTACONSTANTMASSWASAPPLIEDATAFIXEDDISTANCE300MMFROMTHECLINICALEPICONDYLARAXISOFTHEFEMURTOGENERATEAFLEXIONMOMENTBECAUSEOFGRAVITYTHEFEMURWASTHENALLOWEDTOFLEX,ANDTHEMAXIMUMFLEXIONWASRECORDEDBEFOREIMPINGEMENTBETWEENTHEPOSTERIORCORTEXOFTHEFEMURANDTHETIBIALINSERTFIG2PEAKFLEXIONANGLESWERERECORDEDASTHEINSERTWASMOVEDAT2MMINTERVALSRANGINGFROM10MMANTERIORTO10MMPOSTERIORFOREACHOFTHE5FEMORALIMPLANTPOSITIONSNEUTRAL,2MMANTERIOR/POSTERIOR,AND2MMPROXIMAL/DISTALFROMTHENEUTRALTHISPROCESSWASTHENREPEATEDFOREACHOF4TIBIALPOSTERIORSLOPEANGLES0°,3°,5°,AND7°TOTHEMECHANICALAXISOFTHETIBIAWEALSOMEASUREDTHEPCOFOREACHOFTHEDIFFERENTFEMORALIMPLANTPOSITIONSASDEPICTEDINFIG1BPOSTERIORCONDYLAROFFSETWASMEASUREDASTHEMAXIMUMDISTANCEBETWEENTHEPOSTERIORSURFACEOFTHEDISTALFEMURANDTHEPOSTERIORCONDYLE5VALIDATIONOFTHECOMPUTERMODELFOURFRESHFROZENHUMANCADAVERKNEESWERETESTEDTOVALIDATETHECOMPUTERMODELCOMPUTEDTOMOGRAPHICSCANSWEREOBTAINEDAFTERIMPLANTINGFIDUCIALMARKERSINEACHTIBIAANDFEMUR3TITANIUMSCREWSINEACHBONEKNEEARTHROPLASTYWASPERFORMEDUSINGASURGICALNAVIGATIONSYSTEMSTRYKERNAVIGATION,FREIBURG,GERMANYCOMPONENTALIGNMENTWASSIMILARTOTHATDESCRIBEDFORTHECOMPUTATIONALMODELSCORPIOCRSTRYKERORTHOPAEDICSTIBIALANDFEMORALCOMPONENTSWEREUSEDTHEPATELLAWASNOTRESURFACEDALLSOFTTISSUESAROUNDTHEKNEEJOINTWEREREMOVEDASMUCHASPOSSIBLEEXCEPTTHEPOSTERIORCRUCIATELIGAMENT,THEMEDIALANDLATERALCOLLATERALLIGAMENTS,ANDTHEEXTENSORMECHANISMAFTERARTHROPLASTYTHETIBIAWASMOUNTEDVERTICALLYONACUSTOMRIG,ANDTHEFEMURWASALL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