经舟状骨骨折的背侧型月骨周围脱位诊治体会

目的分析经舟状骨骨折的背侧型月骨周围脱位的X线表现。方法8例经舟状骨骨折的背侧型月骨周围脱位,均急诊在臂丛麻醉和透视下给予手法复位。结果8例全部1次性复位成功。随访6个月～3年,无一例发生骨坏死,腕部功能无丧失。结论熟悉腕关节的正常X线表现,了解各型腕部损伤的X线特点,是正确及时诊断、治疗该型损伤的基础。     

桡骨远端骨折合并月骨脱位的治疗

目的 探讨桡骨远端骨折伴月骨脱位的治疗方法.方法 2001年1月-2006年6月,对28例桡骨远端骨折伴月骨脱位的患者,其中新鲜损伤16例,采用手法复位石膏固定6例,微创撬拨复位、克氏针加石膏固定10例.陈旧性损伤12例,采用保守治疗后月骨再脱位3例,月骨漏诊9例;其中4例行掌侧入路月骨复位术,克氏针加石膏固定,8例行背侧入路月骨复位术,修复桡月背侧韧带,克氏针加石膏固定.腕关节功能按Lidstrom评分标准评定及腕部X线片检测有无月骨坏死.结果 术后28例获得随访时间为1～4年(平均2.2年),腕关节功能评分:新鲜损伤组优良率为93.8%,陈旧性损伤组优良率为75.0%.腕部X线片显示:新鲜损伤组月骨坏死率为0,陈旧损伤组月骨坏死率为25.0%.陈旧性损伤组掌侧切口入路月骨坏死率为50.0%,背侧入路月骨坏死率为12.5%.结论 桡骨远端骨折伴月骨脱位的治疗关键在于及时诊断和处理月骨脱位,避免发生陈旧性月骨脱位,后者手术以背侧入路复位固定并同时修复桡月背侧韧带为宜.     

保守治疗与手术治疗踝关节骨折脱位的病例对照研究

目的:比较手法整复外固定与切开复位内固定治疗踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度的临床疗效。方法:自2007年9月至2008年12月对收治的踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度60例患者进行回顾性分析,其中男32例,女28例;年龄18～70岁,平均37.17岁。60例患者分别采用手法整复石膏外固定治疗(保守组30例)和切开复位内固定治疗(手术组30例)。采用Mazur标准评定踝关节功能;通过X线片观察骨折复位和移位情况;同时对两组患者住院天数与住院费用进行比较。结果:两组患者均获得随访,时间6～25个月,平均15.27个月。踝关节功能按Mazur标准:保守组优16例,良10例,可3例,差1例;手术组优20例,良8例,可2例,差0例。骨折复位和移位情况:保守组优良25例,可4例,差1例;手术组优良28例,可2例,差0例。两组患者在关节功能与X线检查结果方面的差异无统计学意义(P0.05)。保守组和手术组的住院天数分别为(7.87±3.34)、(17.37±4.64)d;治疗费用分别为(2506.67±649.10)、(11473.33±1564.90)元。两组住院天数、治疗费用有统计学差异(P0.05)。结论:踝关节骨折脱位旋后-外旋型Ⅲ、Ⅳ度采用保守治疗与手术治疗均能达到很好的治疗效果,但保守治疗安全系数高,经济费用低,能减少患者的医疗费用。     

手术与非手术治疗桡骨远端骨折的疗效比较

目的 比较手法复位石膏外固定和掌侧钢板内固定治疗桡骨远端骨折的疗效。方法 根据患者骨折程度及手术意愿,40例桡骨远端骨折患者采用手法复位石膏外固定治疗(为非手术组),32例桡骨远端骨折患者采用掌侧钢板内固定治疗(为手术组)。治疗后摄X线片复查骨折复位情况,记录治疗1年后腕关节活动度。末次随访时,采用Gartland-Werley评分评价腕关节功能,采用腕关节功能自主评定表(PRWE)评价患者满意度。结果 患者均获得随访,时间12～24个月。两组治疗后摄X线片复查显示,骨折均对位良好,尺偏角、掌倾角、桡骨高度手术组均优于非手术组(P 0. 05)。骨折均愈合,时间3～6(3. 9±1. 5)个月。治疗后12个月腕关节、前臂活动度各项指标两组比较差异均无统计学意义(P 0. 05)。末次随访时,两组腕关节功能优良率比较差异有统计学意义(P 0. 05);两组患者满意率比较差异无统计学意义(P 0. 05)。结论 切开复位掌侧钢板内固定治疗不稳定型桡骨远端骨折的功能优于手法复位石膏外固定,但由于手法复位石膏外固定方法简单、患者痛苦少、费用低,故仍可作为稳定或相对稳定型桡骨远端骨折的首选治疗方法。     

经舟骨月骨周围脱位的治疗

目的 探讨经舟骨月骨周围脱位的治疗方法。方法 采用经皮撬拨复位月骨,舟状骨切开复位,自体桡骨茎突植骨,克氏针内固定治疗经舟骨月骨周围脱位11例,随访6-18个月,平均10个月。结果 3个月内骨折愈合,腕关节不痛,活动正常,恢复伤前所有功能7例;半年内骨折愈合,活动正常,腕关节剧烈活动后疼痛2例;1例后骨折愈合,腕关节活动度差1/3以下,腕关节存在运动性疼痛1例;骨折未愈合,或舟状骨、月骨一处坏死,腕关节疼痛,功能严重丧失1例,优良率81.82%。结论 采用经皮撬拨复位月骨,舟状骨切开复位,自体桡骨茎突植骨,克氏针内固定治疗经舟骨月骨周围脱位,具有损伤小、痛苦少、易操作、费用低、功能恢复满意的优点。     

钢针经皮撬拨复位治疗经舟状骨骨折的背侧型月骨周围脱位

经舟状骨骨折的背侧型月骨周围脱位较少见。我们采用钢针经皮撬拨复位治疗 5例 ,获得满意效果 ,报告如下。1　临床资料本组 5例男性 ;年龄 2 0～ 4 3岁 ;分别于损伤后 2、6、19、4 1、60天采用钢针经皮撬拨整复。随访 1～ 7年 ,除 1例舟状骨骨折不连接、腕关节功能轻度受限外 ,其余 4例舟状骨骨折愈合 ,腕关节伸、屈功能正常 ,全部恢复正常劳动。2　手术方法臂丛麻醉后 ,徒手对抗牵引下进行腕关节背伸、掌屈、侧向活动 ,以达到松解腕部及头状骨与月骨间粘连。在无菌条件下 ,沿头状骨背近端 ,用斯氏针穿过皮肤 ,形成针孔后 ,改用针后钝端 ,插…     

月骨周围脱位的影像学分析及临床应用

目的:分析月骨周围脱位的影像学表现,提高对月骨周围脱位的认识和诊断水平.方法:回顾性分析56例月骨周围脱位患者X线片与多层螺旋CT薄层扫描及三维重建(3D)和多平面重建(MPR)图像.其中男55例,女1例;年龄18～47岁,平均32.4岁.结果:56例月骨周围脱位,均为背侧型,其中经舟状骨月骨周围脱位11例,不伴腕骨骨折的单纯月骨周围脱位10例,经舟状骨、三角骨、月骨周围脱位26例(其中1例伴豌豆骨撕脱骨折),经三角骨、月骨周围脱位6例,经头状骨、月骨周围脱位3例.伴尺桡骨远端骨折24例,伴掌腕关节脱位4例.X线片诊断准确29例,误漏诊27例.运用CT薄层扫描及重建技术诊断全部准确.结论:熟悉腕关节的正常影像学解剖,掌握各型月骨周围脱位的影像学特点,是作出准确诊断和及时治疗的基础.多层螺旋CT薄层扫描及重建能够直观清晰地显示骨折脱位的类型,为临床确定骨折分型、选择合适的治疗方案提供了可靠而直观的依据,是避免误漏诊的关键.     

手法复位石膏外固定与克氏针内固定治疗儿童闭合性肱骨髁上骨折的比较

目的比较手法复位石膏外固定与克氏针内固定治疗儿童肱骨髁上骨折的临床疗效。方法回顾性分析自2016-01—2018-01诊治的157例肱骨髁上骨折,63例采用手法复位石膏外固定治疗(非手术组),94例采用闭合复位或切开复位克氏针内固定治疗(手术组)。结果 157例患儿在骨折复位过程中未出现血管、神经损伤。所有患儿均获得随访,非手术组随访时间为(13.8±2.6)个月,手术组随访时间为(14.3±2.2)个月。非手术组与手术组骨折愈合时间、末次随访时肘关节活动度及肘关节功能Flynn评分差异无统计学意义(P0.05)。结论手法复位石膏外固定与闭合或切开复位克氏针内固定治疗儿童肱骨髁上骨折均可取得良好的疗效。对于不合并神经、血管损伤的儿童闭合性肱骨髁上骨折,临床医师有责任做好与患儿家长的沟通工作,在获得同意后试行手法复位石膏外固定治疗将有可能避免手术创伤。     

早期切开复位Herbert螺钉内固定治疗经舟骨月骨周围脱位

目的 评价早期切开复位、Herbert螺钉内固定治疗经舟骨月骨周围脱位的临床效果.方法 早期采用切开复位、Herbert螺钉内固定治疗新鲜经舟骨月骨周围脱位8例,术后随访X线片了解骨折愈合情况及腕关节轴线恢复情况.Cooney腕关节评分法评价术后腕关节功能恢复程度,DASH问卷调查表行术后腕关节功能自我评价.结果 术后随访时间为7～35个月,平均14个月.根据Cooney腕关节评分:优3例,良2例,中2例,差1例;平均评分值为76.DASH评分值为27.X线片检查舟骨完全愈合,腕关节轴线恢复好.结论 早期切开复位Herbert螺钉内固定能达到舟骨解剖复位、恢复腕关节轴线,术后功能恢复较好,是治疗新鲜经舟骨月骨周围脱位较好的方法.     

非手术与手术治疗不稳定桡骨远端骨折的效果评价

目的比较手法复位石膏托外固定与切开复位内固定治疗不稳定桡骨远端骨折的效果,为临床选择治疗方案提供参考。方法回顾性分析自2015-01—2016-06诊治的54例不稳定桡骨远端骨折,采用手法复位石膏托外固定治疗29例(非手术组),采用切开复位内固定治疗25例(手术组)。比较2组住院时间、骨折愈合时间、末次随访时腕关节功能Green评分,以及并发症情况。结果 54例均获得随访6~12个月,平均8.4个月。与非手术组比较,手术组住院时间、骨折愈合时间更短,腕关节功能Green评分优良率更高,并发症发生率更低,差异有统计学意义(P0.05)。结论切开复位内固定治疗不稳定桡骨远端骨折可以更好地恢复解剖结构,早期进行功能锻炼,减少并发症的发生,对于能够耐受手术者可以作为首选的治疗方案。     

削骨痂植骨治疗胫骨骨搬运后期对合端骨不连的经验

目的探讨削骨痂植骨治疗胫骨骨搬运后期骨不连的疗效和经验。方法回顾性分析2012年1月至2016年6月应用骨搬运技术治疗的胫骨骨缺损患者,选取在骨搬运后期对合端未能顺利愈合的患者22例,行切开手术,清除骨端软组织卡压、清理硬化骨,削取对合端或延长段骨痂回植于胫骨对合端,使对合端最终骨性愈合。结果 22例患者术后获5~18个月(平均8个月)随访,其中18例削痂植骨术后顺利愈合,2例术后发生伤口感染,经清抗感染治疗,最终愈合;1例患者植骨吸收,经历再次植骨后愈合;1例患者途中外固定松动,导致骨折,更改为内固定+植骨,最终愈合;其余21例根据Paley等骨不连愈合评分标准评定结果:优18例,良1例,中1例,差1例,优良率为86.36%。结论胫骨骨搬运后期胫骨骨不连通过非手术方法不能愈合的患者,可尝试削取骨痂植骨的方治疗使对合端愈合。     

On Injuries to the Acromio-Clavicular Joint: Treatment and Results

A study was made of bone ingrowth into fiber metal composite prostheses used to replace large segments of the femur in baboons. Bone grafts of two different types were used to cover the segment: chips of bone with large particle size and ground bone with a smaller particle size. The prosthetic segment was bridged by bone at 3 and 6 months in all cases irrespective of the structure of the transplant. In animals sacrificed at 6 months bone ingrowth occurred, with a marked difference between specimens with the two different grafts. In the ground bone specimens ingrowth occurred over the total surface area, and bone penetrated deep into the composite. With the chip grafts ingrowth was more irregular occurring only in some areas and it was always superficial. The difference is believed to be due to the improved contact between the fiber metal surface and the transplant. The lesser bulk of the ground transplant is advantageous when the soft tissue cover of the bone is thin.     

非编码RNA在骨质疏松症预测和防治中的作用研究进展

骨质疏松症（osteoporosis,OP）严重影响着中老年人群的生活质量,因此OP患病前的有效预测和患病后安全有效的治疗措施极为重要。研究发现非编码RNA（non-coding RNAs,ncRNAs）作为表观遗传调节剂与骨代谢关系密切,能够在基因层面调控OP的发生发展,可作为OP预测、诊断的生物标志物和治疗的新靶点。非编码RNA的功能及表达水平异常可导致骨形成和骨吸收平衡失调,引起OP。本文将重点介绍4种常见非编码RNA（circRNA、lncRNA、miRNA和siRNA）的作用机制以及对骨代谢过程中骨形成和骨吸收的影响,旨在为OP的诊断和防治提供理论依据。     

Osteogenesis After Bone and Bone Marrow Transplantation: Studies of Cellular Behaviour Using Combined Myelo-osseous Grafts in the Subscorbutic Guinea Pig

In order to study factors influencing osteogenesis after bone and bone marrow transplantation, we have caused guinea pigs to become scorbutic, and looked at the cell morphology at sites of bone formation. We had previously studied normal guinea pigs and found that autologous marrow in intermuscular implants was associated with bone production by the ninth day, regardless of the type of stored allogeneic bone transplanted with it. in subscorbutic guinea pigs, using identical implants, bone did not appear within the first 13 days, and the cell population around the implants was different. These experiments support the dominant role of bone marrow cells in osteogenesis and cast further doubt on the primary role of devitalised bone as an inducer of bone formation. Interference with cell function by deprivation of a single essential molecule, Vitamin C, produces great change in the ability of cells to synthesise bone, or pre-osseous matrix.     

Pelvic ramus fractures in the elderly

Background Whilst it is well known that fractures of the pelvic rami in the elderly are frequently associated with posterior ring injuries, the extent of this second injury is less well known. We evaluated this question by MRI scanning a group of elderly patients presenting at our unit with pelvic rami fractures.

Patients and methods We investigated 50 consecutive elderly patients (45 women) with fractures of the pelvic rami using an MRI scan of the pelvis in order to assess the competency of the pelvic ring.

Results On MRI, 45 (95% CI 42–48) patients had a sacral fracture. At 5-month follow-up, 39 (of 41 reviewed) still complained of posterior sacral tenderness.

Interpretation Pelvic rami fractures in the elderly are nearly always associated with posterior ring injuries. This probably explains why these patients take longer to rehabilitate than might be expected if only the anterior injury is considered, and it also explains why they experience long-term back pain.     

冷冻灭活皮质骨移植治疗股骨头颈部侵袭性肿瘤的疗效观察

目的 评估病灶刮除液氮冷冻灭活结合皮质骨支撑治疗股骨头颈部侵袭性骨肿瘤的疗效。方法 １１例患者在诊断明确后均采取病灶刮除加液氮注入法冷冻灭活,缺损处以自体（或异体）腓骨和自体髂骨填充修复,７例辅以内固定。结果 １１例随访３～１０年（平均６年６个月）。参照Ｅｎｎｅｋ－ｉｎｇ评定标准进行功能评估,优７例,良４例。结论 该疗法是治疗股骨头颈部侵袭性肿瘤的良好方法之一。     

Comparison of the effects of adriamycin and methotrexate on orthotopic and induced heterotopic bone in rats

The effect of the two antineoplastic drugs, Adriamycin and methotrexate, on orthotopic bone, and on the induction of experimental heterotopic bone in rats was analyzed. The drugs were administered as single injections: Adriamycin in s.c. doses of 0.5 and 2 mg/kg body weight and methotrexate i.v. 100 and 250 mg/kg body weight followed by leucovorin rescue after 2 h. A passing, but significant, decrease in body weights occurred in the methotrexate-treated animals, but not in those given Adriamycin. Analysis of the amount of heterotopic bone formed 4 weeks after induction by demineralized bone matrix revealed a 30-40% decrease in the groups treated with either of the antineoplastic agents, whereas orthotopic bone was unaffected. Six weeks after the treatment the net effect on the induced bone had decreased. The present study shows that the two antineoplastic drugs Adriamycin and methotrexate inhibit heterotopic new bone formation induced by demineralized bone matrix in rats to an equal extent, although their mode of action on the cellular level is entirely different, and that the inhibitory effect of a single treatment diminishes in the presence of a continuous inductive process.     

Correlates of trabecular and cortical volumetric bone mineral density at the femoral neck and lumbar spine: The osteoporotic fractures in men study (MrOS)

The objective of this cross‐sectional analysis was to examine the correlates of trabecular and cortical volumetric bone mineral density (vBMD) in 3670 community‐dwelling men, mean age 73.6 ± 5.9 years. vBMD was measured by quantitative computed tomography (QCT) and areal BMD by dual‐energy X‐ray absorptiometry (DXA). Demographic, historical, and lifestyle information was obtained by interview, and height, weight, and neuromuscular function were determined by examination. To express the strength of the associations, percent differences (95% confidence interval) were calculated from multivariable linear regression models using the formula 100 (β × unit/mean BMD). Units for continuous variables were chosen to approximate 1 standard deviation (SD). The multivariable linear regression models predicted 15%, 21%, and 20% of the overall variance in trabecular and cortical vBMD of the femoral neck and vBMD of the lumbar spine, respectively. Diabetes was associated with a 16.5% greater trabecular vBMD at the femoral neck and 11% at the lumbar spine but less than 2% for cortical vBMD. For femoral neck trabecular vBMD, the strongest negative correlates were past smoking (?9%), fracture history (?15%), kidney stones (?7%), corticosteroids (?11%), and insulin therapy (?26%). For cortical vBMD, the strongest negative correlate was use of thyroid medication (?2.8%). The strongest negative correlates for lumbar spine trabecular vBMD were fracture history (?5%), antiandrogen use (?19%), height (?8%), and thiazoliainedione use (?22%). Bioavailable estradiol and testosterone levels were positively related and sex hormone–binding globulin was negatively related to trabecular vBMD of the spine. There was no relationship between sex hormones and femoral neck trabecular vBMD. Our conclusion is that correlates of trabecular vBMD and cortical vBMD appear to differ in older men. © 2010 American Society for Bone and Mineral Research     

The Plated Femur: Relationships Between the Changes in Bone Stresses and Bone Loss

Calculations were made of the alterations in the in vivo cyclic bone stresses due to the application of various plates on the canine femoral shaft. The plate configurations analyzed were those used by previous investigators when studying the influence of plating on bone remodeling. The magnitude of the reduction in the loads borne by the bone tissue and the degree of shift in the bone stress neutral axis during the stance phase of gait was influenced by the geometry of the plate, the plate elastic modulus, and the location of plate application. From a correlation of the calculated alterations in bone stresses with the resulting measured changes in bone mass, it appears that bone remodeling is very sensitive to small changes in cyclic bone stresses. Changes in cyclic bone stresses of 1 MPa (less than 1 percent of the ultimate strength) can cause measurable differences in bone remodeling after a period of a few months.