背景:骨折愈合方式有一期和二期愈合,二期愈合同自然愈合过程相接近.一些实验结果证实,即使应用非常坚硬的AO钢板,能达到胫骨一期愈合的也仅占37%.不同的内固定材料对骨折愈合过程中骨痂的形成及其含量有着不同的影响.目的:应用计算机辅助判断不同内固定材料对骨折愈合不同阶段骨痂的形成及其含量的影响.设计:随机对照观察.单位:第二军医大学长海医院骨科,第二军医大学实验动物中心.材料:实验于2000-03/2001-07在第二军医大学实验动物中心和骨科实验室完成.随机抽取新西兰兔51只,雌雄不限,按内固定物的不同分成3组,每组17只.矩形髓内钉组,Ender钉组和不锈钢接骨板组.方法:先行骨折动物模型的造模术,骨折内固定部位为兔左胫腓骨交界下2mm处,均不用外固定.每组动物于内固定术后2,3,4,8,12周分别拍摄手术侧胫骨正侧位X射线片.拍片后各组处死3只动物进行骨痂肉眼观察及骨痂的最大直径测量,对不同时期X射线片变化作定量分析,将X射线片经扫描仪扫描输入到计算机,经图像处理系统,用光标定出各实验侧骨痂区相同的面积,用积分法计算出各组不同时期的骨痂灰度密度积分.实验组各组间差异性用方差分析和SNK检验进行分析处理.主要观察指标:观测不同时期X射线片测量的骨痂的最大直径,计算各组不同时期骨痂灰度密度积分.结果:纳入实验动物51只,因腹泻死亡4只及伤口局部感染骨外露,共脱失6只.矩形髓内钉组、Ender钉组和不锈钢接骨板组各脱失2只,进人结果分析动物数45只.①骨痂直径测量结果:同组相比8周时骨痂直径最大;同期比较矩形髓内钉组的骨痂直径最大,Ender钉组次之,不锈钢接骨板组最少[4周为(11.24±0.38),(10.86±0.65),(8.12±0.36)mm;8周为(13.56±0.88),(12.84±0.20),(10.52±0.68)mm;12周为(12.66±0.65),(11.84±0.55),(9.68±0.27)mm].矩形髓内钉组、Ender钉组和不锈钢接骨板组组间均有显著差异,矩形髓内钉组和Ender钉组相比则无显著差异.②骨痂灰度密度分析显示结果:同组的骨痂灰度密度值随术后时间的增加而增大;同期比较矩形髓内钉组的骨痂灰度密度积分值最高,Ender钉组次之,不锈钢接骨板组最少[4周为89.11±1.05,86.42±3.12,47.28±1.57;8周为159.69±3.64,148.72±1.68,79.63±2.41;12周为192.46±4.96,186.53±1.84,107.34±2.37].矩形髓内钉组、Ender钉组和不锈钢接骨板组组间均有显著差异,矩形髓内钉组和Ender钉组相比,8周后组间差异显著.结论:矩形髓内钉组和Ender钉组在骨折不同时期的骨痂量较不锈钢接骨板组多,促进了骨折愈合.利用骨痂量来判断骨折的愈合程度是一传统的方法,具有直观明了、客观确实、简单实用等特点.结合计算机图像分析处理可以避免阅片时的主观性,同时进行的数字化处理不仅可以更好的帮助判断骨痂的量,而且还可以帮助判断骨痂的质.对临床治疗起着更好的指导作用.
揹景:骨摺愈閤方式有一期和二期愈閤,二期愈閤同自然愈閤過程相接近.一些實驗結果證實,即使應用非常堅硬的AO鋼闆,能達到脛骨一期愈閤的也僅佔37%.不同的內固定材料對骨摺愈閤過程中骨痂的形成及其含量有著不同的影響.目的:應用計算機輔助判斷不同內固定材料對骨摺愈閤不同階段骨痂的形成及其含量的影響.設計:隨機對照觀察.單位:第二軍醫大學長海醫院骨科,第二軍醫大學實驗動物中心.材料:實驗于2000-03/2001-07在第二軍醫大學實驗動物中心和骨科實驗室完成.隨機抽取新西蘭兔51隻,雌雄不限,按內固定物的不同分成3組,每組17隻.矩形髓內釘組,Ender釘組和不鏽鋼接骨闆組.方法:先行骨摺動物模型的造模術,骨摺內固定部位為兔左脛腓骨交界下2mm處,均不用外固定.每組動物于內固定術後2,3,4,8,12週分彆拍攝手術側脛骨正側位X射線片.拍片後各組處死3隻動物進行骨痂肉眼觀察及骨痂的最大直徑測量,對不同時期X射線片變化作定量分析,將X射線片經掃描儀掃描輸入到計算機,經圖像處理繫統,用光標定齣各實驗側骨痂區相同的麵積,用積分法計算齣各組不同時期的骨痂灰度密度積分.實驗組各組間差異性用方差分析和SNK檢驗進行分析處理.主要觀察指標:觀測不同時期X射線片測量的骨痂的最大直徑,計算各組不同時期骨痂灰度密度積分.結果:納入實驗動物51隻,因腹瀉死亡4隻及傷口跼部感染骨外露,共脫失6隻.矩形髓內釘組、Ender釘組和不鏽鋼接骨闆組各脫失2隻,進人結果分析動物數45隻.①骨痂直徑測量結果:同組相比8週時骨痂直徑最大;同期比較矩形髓內釘組的骨痂直徑最大,Ender釘組次之,不鏽鋼接骨闆組最少[4週為(11.24±0.38),(10.86±0.65),(8.12±0.36)mm;8週為(13.56±0.88),(12.84±0.20),(10.52±0.68)mm;12週為(12.66±0.65),(11.84±0.55),(9.68±0.27)mm].矩形髓內釘組、Ender釘組和不鏽鋼接骨闆組組間均有顯著差異,矩形髓內釘組和Ender釘組相比則無顯著差異.②骨痂灰度密度分析顯示結果:同組的骨痂灰度密度值隨術後時間的增加而增大;同期比較矩形髓內釘組的骨痂灰度密度積分值最高,Ender釘組次之,不鏽鋼接骨闆組最少[4週為89.11±1.05,86.42±3.12,47.28±1.57;8週為159.69±3.64,148.72±1.68,79.63±2.41;12週為192.46±4.96,186.53±1.84,107.34±2.37].矩形髓內釘組、Ender釘組和不鏽鋼接骨闆組組間均有顯著差異,矩形髓內釘組和Ender釘組相比,8週後組間差異顯著.結論:矩形髓內釘組和Ender釘組在骨摺不同時期的骨痂量較不鏽鋼接骨闆組多,促進瞭骨摺愈閤.利用骨痂量來判斷骨摺的愈閤程度是一傳統的方法,具有直觀明瞭、客觀確實、簡單實用等特點.結閤計算機圖像分析處理可以避免閱片時的主觀性,同時進行的數字化處理不僅可以更好的幫助判斷骨痂的量,而且還可以幫助判斷骨痂的質.對臨床治療起著更好的指導作用.
배경:골절유합방식유일기화이기유합,이기유합동자연유합과정상접근.일사실험결과증실,즉사응용비상견경적AO강판,능체도경골일기유합적야부점37%.불동적내고정재료대골절유합과정중골가적형성급기함량유착불동적영향.목적:응용계산궤보조판단불동내고정재료대골절유합불동계단골가적형성급기함량적영향.설계:수궤대조관찰.단위:제이군의대학장해의원골과,제이군의대학실험동물중심.재료:실험우2000-03/2001-07재제이군의대학실험동물중심화골과실험실완성.수궤추취신서란토51지,자웅불한,안내고정물적불동분성3조,매조17지.구형수내정조,Ender정조화불수강접골판조.방법:선행골절동물모형적조모술,골절내고정부위위토좌경비골교계하2mm처,균불용외고정.매조동물우내고정술후2,3,4,8,12주분별박섭수술측경골정측위X사선편.박편후각조처사3지동물진행골가육안관찰급골가적최대직경측량,대불동시기X사선편변화작정량분석,장X사선편경소묘의소묘수입도계산궤,경도상처리계통,용광표정출각실험측골가구상동적면적,용적분법계산출각조불동시기적골가회도밀도적분.실험조각조간차이성용방차분석화SNK검험진행분석처리.주요관찰지표:관측불동시기X사선편측량적골가적최대직경,계산각조불동시기골가회도밀도적분.결과:납입실험동물51지,인복사사망4지급상구국부감염골외로,공탈실6지.구형수내정조、Ender정조화불수강접골판조각탈실2지,진인결과분석동물수45지.①골가직경측량결과:동조상비8주시골가직경최대;동기비교구형수내정조적골가직경최대,Ender정조차지,불수강접골판조최소[4주위(11.24±0.38),(10.86±0.65),(8.12±0.36)mm;8주위(13.56±0.88),(12.84±0.20),(10.52±0.68)mm;12주위(12.66±0.65),(11.84±0.55),(9.68±0.27)mm].구형수내정조、Ender정조화불수강접골판조조간균유현저차이,구형수내정조화Ender정조상비칙무현저차이.②골가회도밀도분석현시결과:동조적골가회도밀도치수술후시간적증가이증대;동기비교구형수내정조적골가회도밀도적분치최고,Ender정조차지,불수강접골판조최소[4주위89.11±1.05,86.42±3.12,47.28±1.57;8주위159.69±3.64,148.72±1.68,79.63±2.41;12주위192.46±4.96,186.53±1.84,107.34±2.37].구형수내정조、Ender정조화불수강접골판조조간균유현저차이,구형수내정조화Ender정조상비,8주후조간차이현저.결론:구형수내정조화Ender정조재골절불동시기적골가량교불수강접골판조다,촉진료골절유합.이용골가량래판단골절적유합정도시일전통적방법,구유직관명료、객관학실、간단실용등특점.결합계산궤도상분석처리가이피면열편시적주관성,동시진행적수자화처리불부가이경호적방조판단골가적량,이차환가이방조판단골가적질.대림상치료기착경호적지도작용.
BACKGROUND: Fracture healing occurrs by two ways: healing by first intention and healing by second intention, with the latter one similar to natural healing process. It has been proved that only 37% tibial farcture can reach healing by first intention, even it is fixed with strong AO steel plate. Different materials for intramedullary fixation have different influences on callus formation and callus content in the process of fracture healing.OBJECTIVE: To explore the influences of different internal fixations on callus formation and content in the course of fracture healing analysis with X ray computer image.DESIGN: Randomized controlled trialSETTING: At the Department of Orthopeadics of Changhai Hospital Affiliated to the Second Millitary Medical University of Chinese PLA and the Experimental Animal Center of the Second Millitary Medical University of Chinese PLA.MATERIALS: This study was carried out at the Experimental Animal Center and Orthopeadic Laboratory of the Second Millitary Medical University of Chinese PLA between March 2000 and July 2001. Totally 51New Zealand rabbits were randomly selected without gender limitation and divided, accccording to intermeduallry nails, into three groups with 17 rabbits in each group: rectangle-shaped intramedullary nails (RIN), Ender's nails (END) and stainless steel plates (SPL) groupsMETHODS: Fracture models were succccesufly established on rabbits.And then intramedullary nails were fixed 2 mm below the border of left tibial and fibula without exopexy. Positve and lateral X-ray films of each operational tibia were obtained at postoperational 2,3,4,8,12 weeks.Three rabbits in each group were killed for callus observation with naked eyes, and the maximal callus diameter at different time points was measured. The X-ray films at different periods were read carefully and quanatatively analyzed with computor image analysis system (lAS). The difference was compared with the analysis of variance and SNK test.MAIN OUTCOME MEASURES: The maximal callus diameter was determined with X-ray image at different time points so as to calculate the corrssponding integral of callus grey level.RESULTS: Totally 51 rabbits were enrolled in this study, 6 missed the experiment because 4 died for diarrhea and other two has exposed bone due to local infection, and then two rabbits were derived from each group; thereby, data of 45 rabbits were subjecte to the final statistical to the epak at postoperational 8 weeks; it was the longest in RIN group of the same stage,followed by Ender group and SPL group [(11.24±0.38), (10.86±0.65), (8.12±0.36) mm at postoperatively 4 weeks; ( 13.56±0.88 ), (12.84±0.20), (10.52±0.68) mm at postoperatively 8 weeks; ( 12.66±0.65 ), ( 11.84±0.55 ), (9.68±0.27) mm at postoperatively 12 weeks]. The difference between RIN, Ender and SPL was statistically significant, but the difference between the former two was unobvigroup; at the same postoperational time point, the intergral of callus grey level was the highest in RIN group, followed by Ender group and SPL group (89.11 ± 1.05,86.42±3.12,47.28 ± 1.57 at postoperatively 4weeks;159.69 ±3.64,148.72 ±1.68,79.63 ±2.41 at postoperatively 8 weeks;192.46 ±4.96,186.53 ±1.84,107.34 ±2.37 at postoperatively 12 weeks),The difference between RIN, Ender and SPL was obvious and moreover,the difference between RIN and Ender was significant at 8th week.CONCLUSION: The callus content in RIN and Ender group were higher than that in SPL group at each postoperational time point, which benefited for fracture healing. Callus content examination is a traditional means for the judgement of fracture healing. It prossesses that properties of intuition and persicuity, reliability, simplicity and practicibility. Moreover, subjectivity could be avioided if used in combination with X-ray image analysis system, since the digital management can help judging not only callus content but also callus quality, which may provide guidance for clinical treatment.
