目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方...目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方法:回顾性分析2001年12月30日至2010年9月30日间采用PFNA内固定手术治疗的216例及采用DHS内固定手术治疗的168例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时对围手术期的显性、隐性失血情况做出评估。结果:采用PFNA治疗的患者平均术中失血(48.9±2.8)mL;术后平均显性失血量为(62.3±3.8)mL,平均隐性失血量为(385.0±6.2)mL。采用DHS治疗的患者平均术中失血(124.9±7.8)mL;术后平均显性失血量为(73.9±4.7)mL,平均隐性失血量为(243.4±6.3)mL。两组相比,DHS术中出血量及术后的显性出血量均多于PFNA(P<0.01),但PFNA术后隐性出血量及PFNA总体出血量均多于DHS(P<0.01)。结论:PFNA和DHS内固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,提醒临床医生注意术后患者的生命体征监测以减少并发症的发生。展开更多
The successful application of magnesium(Mg)alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity.This study inv...The successful application of magnesium(Mg)alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity.This study investigates the degradation pattern of an open-porous fluoride-coated Mg-based scaffold immersed in circulating Hanks’Balanced Salt Solution(HBSS)with and without in situ cyclic compression(30 N/1 Hz).The changes in morphological and mechanical properties have been studied by combining in situ high-resolution X-ray computed tomography mechanics and digital volume correlation.Although in situ cyclic compression induced acceleration of the corrosion rate,probably due to local disruption of the coating layer where fatigue microcracks were formed,no critical failures in the overall scaffold were observed,indicating that the mechanical integrity of the Mg scaffolds was preserved.Structural changes,due to the accumulation of corrosion debris between the scaffold fibres,resulted in a significant increase(p<0.05)in the material volume fraction from 0.52±0.07 to 0.47±0.03 after 14 days of corrosion.However,despite an increase in fibre material loss,the accumulated corrosion products appear to have led to an increase in Young’s modulus after 14 days as well as lower third principal strain(εp3)accumulation(-91000±6361μεand-60093±2414μεafter 2 and 14 days,respectively).Therefore,this innovative Mg scaffold design and composition provide a bone replacement,capable of sustaining mechanical loads in situ during the postoperative phase allowing new bone formation to be initially supported as the scaffold resorbs.展开更多
文摘目的:对采取股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)和动力髋螺钉(dynamic hipscrew,DHS)内固定方法治疗的老年股骨粗隆间骨折的术中及术后显性、隐性失血量进行分析,为临床围手术期处理提供必要的数据支撑。方法:回顾性分析2001年12月30日至2010年9月30日间采用PFNA内固定手术治疗的216例及采用DHS内固定手术治疗的168例股骨粗隆间骨折患者的临床资料,对患者术前、术后血常规以及术中及术后失血、输血情况等指标进行分析,同时对围手术期的显性、隐性失血情况做出评估。结果:采用PFNA治疗的患者平均术中失血(48.9±2.8)mL;术后平均显性失血量为(62.3±3.8)mL,平均隐性失血量为(385.0±6.2)mL。采用DHS治疗的患者平均术中失血(124.9±7.8)mL;术后平均显性失血量为(73.9±4.7)mL,平均隐性失血量为(243.4±6.3)mL。两组相比,DHS术中出血量及术后的显性出血量均多于PFNA(P<0.01),但PFNA术后隐性出血量及PFNA总体出血量均多于DHS(P<0.01)。结论:PFNA和DHS内固定治疗股骨粗隆间骨折均存在较多的术后隐性失血量,提醒临床医生注意术后患者的生命体征监测以减少并发症的发生。
文摘The successful application of magnesium(Mg)alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity.This study investigates the degradation pattern of an open-porous fluoride-coated Mg-based scaffold immersed in circulating Hanks’Balanced Salt Solution(HBSS)with and without in situ cyclic compression(30 N/1 Hz).The changes in morphological and mechanical properties have been studied by combining in situ high-resolution X-ray computed tomography mechanics and digital volume correlation.Although in situ cyclic compression induced acceleration of the corrosion rate,probably due to local disruption of the coating layer where fatigue microcracks were formed,no critical failures in the overall scaffold were observed,indicating that the mechanical integrity of the Mg scaffolds was preserved.Structural changes,due to the accumulation of corrosion debris between the scaffold fibres,resulted in a significant increase(p<0.05)in the material volume fraction from 0.52±0.07 to 0.47±0.03 after 14 days of corrosion.However,despite an increase in fibre material loss,the accumulated corrosion products appear to have led to an increase in Young’s modulus after 14 days as well as lower third principal strain(εp3)accumulation(-91000±6361μεand-60093±2414μεafter 2 and 14 days,respectively).Therefore,this innovative Mg scaffold design and composition provide a bone replacement,capable of sustaining mechanical loads in situ during the postoperative phase allowing new bone formation to be initially supported as the scaffold resorbs.
