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胸腰椎破裂骨折に対するshort segment pedicle screw fixation without fusion(non-segmental SSPSF)はmotion segmentを温存できる点で優れた方法である.一方で椎体圧潰や後彎変形の進行など許容できない悪化例の報告がある.骨折椎にpedicle screwを追加したSSPSF(segmental SSPSF)が整復位の維持に有効であるかを検討する為,implant抜去後までの経過を追跡調査した.non-segmental(group A):segmental(group B)11例:24例を対象とした.平均年齢は48.7歳:46.9歳,平均経過観察期間は36ヵ月:29.4ヵ月だった.受傷時のanterior vertebral height compression ratio(AVHC)はgroup A 41.7%:group B 38.4%(P=0.62),local kyphosisangle(KA)は14.55度:14.04度(P=0.88)だった.術直後ではAVHCは15.25%:10.88%(P=0.08),KAは1.18度:1.42度(P=0.91)と両群ともに良好な整復位が得られていた.骨癒合した時点では,AVHCは30.69%:13.61%(P

Introduction: Biomechanically proximal femoral nail (PFN) is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3) and 37 cases of AO 31 A3 (3.1, 3.2, 3.3). Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5), Z effect (n = 1), infection (n = 2), and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40) in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

У статті розглянуто питання підвищення надійності торцевих фрез. Різальні ножі фрез мають гвинтове кріплення. Кріплення ножа вдосконалено шляхом взаємодії додаткового гвинта з затискним гвинтом. В статье рассмотрены вопросы повышения надежности торцовых фрез. Режущие ножи фрез имеют винтовое крепление. Крепление ножа усовершенствовано путем взаимодействия дополнительного винта с зажимным винтом. The research is devoted to the improving the reliability of face milling cutters. Milling cutter's blades have screw fastening. The fastening of cutting blade is improved by interaction of additional screw with the screw fastening.