骨肽注射液在下肢骨折患者术后应用对骨折愈合的影响及其机制

目的探讨下肢骨折患者使用骨肽注射液对骨折愈合效果的影响及其作用机制。方法回顾性分析洛阳正骨医院骨科2015年1月—2016年6月采取切开复位内固定治疗的120例胫骨骨折患者,其中60例术后采用常规治疗措施(常规组)、60例患者术后加用骨肽注射液治疗(治疗组)。常规组男性40例,女性20例;年龄41~78岁,平均55.4岁,其中左侧32例、右侧28例,骨折后至手术时间平均(2.2±1.8)d。治疗组男性37例,女性23例;年龄39~79岁,平均54.6岁,其中左侧30例、右侧30例,骨折至手术时间平均(2.5±1.5)d。比较两组平均骨折愈合时间、术后VAS评分、肿胀程度评分以及相关血清学指标。结果治疗组平均骨折愈合时间(9.8±2.0)周显著短于常规组(10.7±2.2)周(P0.05);治疗组在术后3、7、14d的VAS评分(4.41±1.30、2.96±0.88、2.21±0.59)、肿胀程度评分(2.25±0.48、1.53±0.36、0.82±0.26)均显著低于常规组(5.60±1.48、3.72±1.09、3.08±0.77)、(2.19±0.52、1.90±0.40、1.15±0.33),P0.05;术后28d,治疗组的血清碱性磷酸酶(ALP)(98.9±14.6)U/L、骨钙素(BGP)(3.81±0.72)μg/L、骨保护素(OPG)(26.4±5.9)pmol/L、Ⅰ型胶原羧基端肽(PICP)(144.8±19.0)μg/L显著高于常规组[(90.2±11.7)U/L、(3.08±0.76)μg/L、(22.9±5.1)pmol/L、(122.0±18.5)μg/L],P0.05,Ⅰ型胶原羧基端肽β特殊序列(β-CTX)(0.37±0.09)ng/mL显著低于常规组(0.46±0.11)ng/mL(P0.05);术后3、7d,治疗组的血清白细胞介素-2(IL-2)[(9.22±2.44)μg/L、(4.84±1.88)μg/L]、白细胞介素-6(IL-6)[(76.2±20.1)μg/L、(54.9±18.5)μg/mL]、肿瘤坏死因子-α(TNF-α)[(440.8±97.2)ng/mL、(330.8±69.5)ng/mL]均低于常规组[(10.98±2.87)μg/L、(7.20±2.09)μg/L、(84.0±24.8)μg/L、(61.0±19.3)μg/mL、(498.1±114.8)ng/mL、(380.7±77.6)ng/mL],P0.05。结论下肢骨折患者使用骨肽注射液有利于减轻术后炎症反应、肿痛程度,有利于促进骨折愈合。     

股骨颈骨折术后骨折延迟愈合的危险因素及其相关性分析

【摘要】 目的 探讨分析股骨颈骨折患者术后骨折延迟愈合的危险因素及其相关性。 方法 选取 2019 年 3月至 2022 年 1 月信阳淮河骨科医院收治的 98 例拟行切开复位内固定术治疗的股骨颈骨折患者作为研究对象, 收集并统计患者性别、年龄、居住地、骨折原因、术前血清肿瘤坏死因子-α (TNF-α) 及胰岛素样生长因子-1(IGF-1) 水平等资料, 并根据股骨颈骨折术后 4 个月骨折端是否愈合将患者分为正常愈合组和延迟愈合组, 多因素 Logistic 回归分析股骨颈骨折术后骨折延迟愈合的危险因素, 点二列相关性分析各危险因素与股骨颈骨折术后骨折延迟愈合的相关性。 结果 股骨颈骨折术后 4 个月, 98 例患者中出现骨折延迟愈合 16 例 (16.33%), 设为延迟愈合组; 骨折正常愈合 82 例 (83.67%), 设为正常愈合组。 多因素 Logistic 回归分析结果显示, 血清 TNF-α高水平、IGF-1 低水平是股骨颈骨折术后骨折延迟愈合的独立危险因素 (95% CI 为 1.146 ~ 1.774、0.936 ~0.994, P =0.001、0.018); 点二列相关性分析结果显示, 术前血清 TNF-α 水平与股骨颈骨折术后骨折延迟愈合呈显著正相关性 (r =0.702, P <0.001), 术前血清 IGF-1 水平与股骨颈骨折术后骨折延迟愈合呈显著负相关性(r = -0.569, P <0.001)。 结论 股骨颈骨折术后骨折延迟愈合与术前血清 TNF-α 及 IGF-1 水平密切相关。     

胫骨骨折患者术后血清IGF-1、β-CTX、CYR61蛋白的表达与延迟愈合的关系

目的探讨胫骨骨折患者术后血清胰岛素样生长因子-1(IGF-1)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、富含半胱氨酸蛋白61(CYR61)的表达变化与骨折延迟愈合的关系。方法回顾性分析洛阳正骨医院2015年1月—2017年10月收治的胫骨骨折患者137例,男性80例,女性57例;年龄28~75岁,平均52.0岁。患者均采用切开复位内固定治疗,其中术后出现骨折延迟愈合(胫骨骨折影像学愈合评分RUST<7分)的47例患者作为病例组、骨折后正常时间愈合(6个月内)的90例患者作为对照组,分别对比两组患者骨折术后1、4、6周的血清IGF-1、β-CTX、CYR61蛋白水平,采用受试者工作曲线(ROC)分析三项指标在预测骨折延迟愈合中的价值。结果两组在术后第1周~第4周的CYR61蛋白水平[(0.46±0.14)、(1.03±0.25)、(0.52±0.20)、(1.32±0.32)]、IGF-1[(330.5±39.6)、(411.8±45.1)、(392.1±50.8)、(492.6±56.7)ng/mL]呈逐渐升高趋势(P<0.05),术后第6周CYR61蛋白水平[(0.46±0.15)、(0.62±0.20)]、IGF-1[(375.2±40.0)、(442.5±47.4)ng/mL]呈降低趋势(P<0.05)。病例组CYR61蛋白、IGF-1水平在术后第1周~第6周均低于对照组(P<0.05);对照组在术后第1周~第6周的β-CTX[(0.50±0.21)、(0.59±0.22)、(0.62±0.20)ng/mL]水平呈逐渐升高趋势(P<0.05);在术后第4、6周,病例组的β-CTX水平均低于对照组(P<0.05)。ROC曲线结果显示血清IGF-1预测骨折延迟愈合的AUC值为0.831;血清β-CTX预测骨折延迟愈合的AUC值为0.646;血清CYR61蛋白预测骨折延迟愈合的AUC值为0.698。结论胫骨骨折术后骨折延迟愈合的患者血清IGF-1、β-CTX、CYR61蛋白均低于骨折正常愈合的患者,对于预测患者骨折愈合情况具有一定的参考价值。     

恶性肿瘤患者凝血指标浓度变化特点分析

 目的 分析恶性肿瘤患者凝血指标浓度变化的特点。方法 115例肿瘤患者分为胃癌、肠癌和肺癌组,选择健康体检者50例为对照组。分别检测患者治疗前凝血指标的水平、化疗后随时间变化凝血指标的变化和对照组凝血指标进行对比。结果 肿瘤患者血浆凝血酶原时间(prothrombin time, PT)为(12.39±1.23)s,活化部分凝血活酶时间(activated partial thromboplastin time, APTT)为(30.58±7.43)s,纤维蛋白原(fibrinogen ,FIB)为(4.71±1.72)g/L,D-二聚体(D-Dimer)为(1.32±0.16)μg/ml水平明显高于对照组,差异有统计学意义(P<0.05);不同类型肿瘤患者血浆PT、APTT、FIB、D-Dimer水平均明显高于对照组,差异有统计学意义(P<0.05)。肺癌组血浆FIB水平明显高于肠癌组、胃癌组,差异有统计学意义(P<0.05),而肠癌组血浆FIB水平与胃癌组比较无统计学意义。胃癌组、肺癌组和肠癌组血浆FIB水平在化疗不同时期均未见明显变化。结论 凝血指标对肿瘤的早期诊断、疗效监测有一定帮助,是肿瘤患者排除、预防静脉血栓的良好指标。     

阿仑膦酸钠片联合髋关节置换术治疗老年股骨颈骨折以及对患者血清SOST及IGF-1水平的影响

目的观察阿仑膦酸钠联合髋关节置换术治疗老年股骨颈骨折的疗效及其对患者血清分泌型蛋白骨硬化蛋白(SOST)及胰岛素生长因子-1(IGF-1)水平的影响。方法 2016年8月-2018年8月于宿迁市第一人民医院骨科住院治疗符合纳入标准的股骨颈骨折老年患者80例,按照随机数字表法分为对照组和观察组,各40例。对照组男性21例,女性19例,年龄65～86岁,平均76.4岁;观察组男性23例,女性17例,年龄65～88岁,平均77.0岁。对照组给予髋关节置换术,观察组在对照组的基础上给予每日10mg阿仑膦酸钠片(10mg/片,石药集团欧意药业有限公司,国药准字H10980109),口服药物治疗3个月。采用抗酒石酸酸性磷酸酶(TRAP)评价破骨细胞活性,Harris评分评价治疗有效率。比较两组患者疗效、骨密度、日常生活能力、SOST水平、IGF-1水平及并发症发生率。结果观察组治疗有效率为90.0%,高于对照组的62.5%(χ~2=8.350,P=0.004)。术前两组患者的骨密度、TRAP、日常生活能力、SOST及IGF-1水平差异无统计学意义(P0.05)。术后3个月,观察组的TRAP、SOST水平低于对照组[(2.36±0.85)μg/L vs.(2.95±0.88)μg/L、(11.37±0.94)μg/mL vs.(13.45±1.26)μg/mL,P0.05];观察组的IGF-1水平、日常生活能力、骨密度均高于对照组[(351.36±41.35)μg/L vs.(313.45±38.78)μg/L、(78.96±5.67)分vs.(67.85±4.93)分、(0.596±0.097)g/cm~(2 )vs.(0.432±0.059)g/cm~2,P0.05]。两组内固定物松动率及下肢深静脉血栓发生率差异无统计学意义(P0.05)。结论应用阿仑膦酸钠联合髋关节置换术治疗老年股骨颈骨折疗效显著,且可显著抑制患者体内钙的流失,防止骨质疏松,加速骨折修复,且内固定物松动率及下肢深静脉血栓发生率低。     

切开复位内固定联合韧带修复术治疗踝关节骨折合并三角韧带损伤的疗效及对骨代谢的影响

目的 探讨韧带修复联合切开复位内固定术(ORIF)治疗踝关节骨折合并三角韧带损伤的疗效及对骨代谢的影响。方法 采用前瞻性病例对照研究分析2015年5月—2018年5月中山市中医院骨二科收治的55例踝关节骨折合并三角韧带损伤患者的临床资料,通过随机数字表法分为观察组28例和对照组27例。两组均接受ORIF治疗,对照组术中不修补三角韧带,观察组术中使用锚钉修复三角韧带。比较两组围术期情况、VAS评分、美国矫形外科足踝协会(AOFAS)评分、骨代谢指标、临床疗效及并发症。结果观察组手术时间明显较对照组长[(110. 84±13. 61) min vs.(99. 16±9. 59) min],住院时间、骨折愈合时间明显较对照组短[(15. 64±2. 07) d vs.(18. 69±2. 42) d,(11. 36±1. 88)周vs.(13. 52±2. 04)周],P 0. 05;观察组术后1、3个月VAS评分均明显低于对照组[(3. 03±0. 56)分vs.(3. 62±0. 71)分,(1. 16±0. 20)分vs.(2. 23±0. 28)分,P 0. 5];术后6个月时,观察组AOFAS评分明显高于对照组[(86. 73±8. 60)分vs.(77. 50±7. 94)分](P 0. 05),且观察组血清骨碱性磷酸酶(BALP)、骨钙素(BGP)、1型前胶原氨基端延长肽(P1NP)明显高于对照组[(139. 34±16. 70) U/L vs.(110. 45±12. 36) U/L,(7. 45±1. 05)μg/L vs.(5. 98±0. 78)μg/L,(131. 46±12. 76)μg/L vs.(114. 74±10. 01)μg/L],血清β胶原降解产物(β-CTX)明显低于对照组[(0. 33±0. 05)μg/L vs.(0. 49±0. 06)μg/L],P 0. 05;观察组临床疗效优良率明显高于对照组(89. 29%vs. 77. 78%,P 0. 05);两组术后并发症总发生率差异无统计学意义(3. 57%vs. 3. 70%,P0. 05)。结论联合韧带修复在踝关节骨折合并三角韧带损伤患者ORIF治疗中疗效显著,可有效缓解术后疼痛,改善骨代谢,有助于促进骨质愈合及踝关节功能恢复,安全性好,值得应用推广。     

脂联素对高糖环境下人肾小管上皮细胞凋亡及氧化应激水平的影响

目的探讨脂联素对体外高糖环境下培养的人近曲肾小管上皮细胞(HK-2细胞)凋亡及氧化应激水平的影响。方法将人近曲肾小管上皮细胞分为3组:正常对照组(5.5mmol/L D-葡萄糖)、高糖组(30.0mmol/L D-葡萄糖)、高糖+脂联素组(30.0mmol/L D-葡萄糖+2.5μg/ml脂联素),各组细胞分别培养24、48、72h后,采用流式细胞仪测定细胞凋亡率,黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)活性,硫代巴比妥酸法测定丙二醛(MDA)含量,实时荧光定量PCR测定细胞血红素加氧酶-1(HO-1)及衔接蛋白p66Shc mRNA表达水平。结果与正常对照组相比,高糖组细胞凋亡率增高,细胞培养液内SOD活性下降,MDA含量增高,同时诱导细胞HO-1及p66Shc mRNA表达上调,且呈时间依赖性(P<0.05)。与高糖组相比,高糖+脂联素组细胞凋亡受到抑制,细胞培养液内SOD活性增高,MDA含量降低,细胞HO-1 mRNA表达进一步增强,而p66Shc mRNA表达降低,呈时间依赖性(P<0.05)。结论随时间延长,高糖环境可引起HK-2细胞过度凋亡和高水平氧化应激;脂联素可通过延缓细胞凋亡和抑制氧化应激来发挥对肾脏的保护作用。     

特立帕肽对合并骨质疏松Garden I型股骨颈骨折非手术治疗患者的疗效观察

目的评价特立帕肽对合并骨质疏松Garden I型股骨颈骨折非手术治疗患者的疗效。方法重钢总医院骨科2014年7月—2018年7月收治合并骨质疏松的Garden I型股骨颈骨折行非手术治疗的患者58例,男性14例,女性44例;年龄56～86岁,平均64.1岁; BMI 18.2～25.4kg/m~2,平均22.7kg/m~2。两组患者均补充碳酸钙及阿法骨化醇,其中一组患者加用特立帕肽(20μg,皮下注射,1次/d)治疗,分为特立帕肽组(29例)和对照组(29例),比较两组患者治疗前后VAS评分、髋关节Harris功能评分、骨折愈合时间及骨密度。结果治疗后2周,1、3、6个月,特立帕肽组VAS评分分别为5.4±0.8、4.9±0.7、2.8±0.6、1.5±0.5,均较治疗前(7.3±1.9)明显降低(P0.05);对照组治疗后2周,1、3、6个月VAS评分分别为7.1±1.8、5.3±0.8、3.7±0.8、2.4±0.5,与治疗前(7.3±1.8)相比,治疗后1个月VAS评分明显下降(P0.05);治疗后2周,1、3、6个月,特立帕肽组VAS评分明显低于对照组(P0.05);治疗后3、6个月,特立帕肽组Harris评分分别为81.5±10.5、89.6±13.1,对照组分别为71.3±9.8、83.2±12.3,特立帕肽组明显高于对照组(P0.05);特立帕肽组平均骨折愈合时间为(8.6±0.8)周,对照组为(10.7±1.3)周,特立帕肽组明显短于对照组(P0.05);治疗后6个月,特立帕肽组髋部及腰椎骨密度较治疗前明显增高(P0.05);对照组骨密度与治疗前比较无明显变化(P0.05)。结论特立帕肽快速缓解疼痛、加速骨折愈合、提高骨密度,能有效增强合并骨质疏松Garden I型股骨颈骨折非手术治疗的效果。     

急诊重症创伤患者凝血功能与疾病程度及预后的相关性分析

目的 分析急诊重症创伤患者凝血功能与疾病程度及预后的相关性.方法 回顾性分析武汉市三医院光谷院区急诊科2018年7月—2020年8月收治的101例重症创伤患者,根据患者进入ICU后14d内的预后情况将患者分为死亡组(19例)和存活组(82例),根据损伤严重度评分(ISS)将患者分为危重组(17分≤ISS≤25分,61例)和极危重组(ISS>25分,40例).患者入院后,于输血及纠正凝血功能障碍前,采用生化分析仪检测患者血浆中血小板计数(PLT)、D-二聚体(DD)水平,全自动凝血分析仪检测凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、纤维蛋白原浓度(FIB).比较不同创伤严重度、不同预后患者一般资料和凝血功能指标,多因素Logistic回归分析患者凝血功能指标与创伤严重度和预后的关系.结果 极危重组血浆PLT、FIB水平为(52.58±7.25)×109/L、(2.01±0.62)g/L,低于危重组的(161.25±18.32)×109/L、(3.24±0.58)g/L(P<0.05);极危重组失血量>2000mL患者比例50％、ISS(29.4±6.1)分、急性生理学与慢性健康状况评分(APACHEⅡ评分)(21.9±8.5)分、血浆DD水平(22.12±3.25)mg/L、PT(23.25±2.14)s、APTT(41.25±4.58)s,高于危重组的23％、(23.0±6.6)分、(14.5±5.7)分、(7.85±1.04)mg/L、(16.68±1.55)s、(38.57±4.56)s(P<0.05);多因素Logistic分析结果显示ISS、APACHEⅡ评分、DD、PT、APTT是急诊重症创伤患者病情加重的独立危险因素(OR=3.255,1.598,1.655,4.927,2.224).死亡组血浆PLT、FIB水平(64.58±6.67)×109/L、(2.14±0.52)g/L,低于存活组的(189.43±25.79)×109/L、(4.55±0.77)g/L(P<0.05);死亡组年龄(58.0±7.6)岁、失血量>2000mL患者比例63％、ISS(31.8±8.1)分、APACHEⅡ评分(21.23±11.52)分、血浆DD水平(18.59±2.29)mg/L、PT(24.56±2.64)s、APTT(54.33±4.97)s,高于存活组的(49.2±6.4)岁、27％、(24.1±6.0)分、(16.6±5.7)分、(4.24±0.69)mg/L、(14.37±1.98)s、(29.69±3.46)s,P<0.05;失血量、ISS、APACHEⅡ评分、DD、PT、APTT是急诊重症创伤患者预后不良的独立危险因素(OR=3.348,4.695,2.140,5.821,2.062,6.623).结论 凝血功能与急诊重症创伤患者疾病程度密切相关,凝血功能指标DD、PT、APTT是患者预后不良的独立危险因素,是评估患者预后的重要依据.     

骨科手术机器人与人工置钉治疗股骨颈骨折失血量比较

  目的 探讨骨科手术机器人定位下置钉治疗股骨颈骨折手术对失血的影响,寻找减少手术失血的方法。 方法 收集2016-12至2017-03医院收治的21例行机器人定位下空心钉内固定的股骨颈骨折患者为A组(机器人手术组),选取2016-06至2016-12未使用机器人定位行空心钉内固定的23例股骨颈骨折患者为B组(非机器人手术组),通过收集患者术日晨和术后第1、3、5天晨血常规,对比分析术后第1、3、5天的理论出血量、红细胞压积、血红蛋白量,及患者一般情况。 结果 A组患者术后第1、3天失血量分别为(133±101)ml、(233±78)ml,均小于B组的(302±191)ml、(451±280)ml,两组对比差异均有统计学意义(P＜0.05);A组术后1、3天的血红蛋白分别为(117.13±13.24)g/L、(123.16±12.09)g/L,均高于B组的(112.09±13.25)g/L、(117.31±13.32)g/L,差异均有统计学意义(P＜0.05)。 结论 微创闭合复位空心钉固定治疗股骨颈骨折,使用机器人定位下进行手术,定位精准,术中穿刺次数减少,减少了手术的出血,值得临床推荐。     

Avulsion fracture of the medial collateral ligament association with Segond fracture

The Segond fracture is a tibial avulsion injury of the insertion of the middle third of the lateral capsular ligament that is typically associated with anterior cruciate ligament and meniscal tears. The classically assigned mechanism of injury is a combination of internal rotation and varus stress. We report two cases of Segond fractures that presented with a variant pattern including osseous avulsion injuries of the medial collateral ligament at the femoral origin, anterior cruciate ligament tear, and pivot shift-type osseous contusion pattern, suggesting an alternative mechanism of injury that includes dominant valgus stress and external rotation components. Awareness of this pattern may aid radiologists, surgeons, and sport medicine physicians in the accurate diagnosis of this injury complex and initiation of appropriate treatment in a timely fashion.     

尺骨茎突骨折并发桡骨骨折发病机制X线分析

尺骨茎突骨折常为腕关节部骨折、脱位的合并损伤,尺骨茎突骨折合并桡骨骨折在临床较为常见.本文收集132例尺骨茎突骨折X线片资料进行总结分析,意在探讨尺骨茎突骨折与桡骨骨折的相互关系及机制,以便提高对尺桡骨骨折的诊断水平.     

Experimental fracture investigations concerning the hyoid bone fracture

IntroductionExtensive literature exists concerning the etiology and morphology of fractures of the hyoid bone (h.b.) in cases of fatal strangulation. There is an agreement to the effect that fractures are mostly located within the distal third of the cornua majora (c.m.). Although several predictors have been described very accurately, the fracture analysis has neither been based on the osseous construction nor on the stress distribution of the c.m. under strangulation resulting from the configuration and its details. This especially applies to the apex of the distal ends of the big horns, the bulbi. The objective of the experimental break tests that were performed was to contribute to elucidating the biomechanics of the horizontal and vertical fractures and to fractures of the bulbi.Materials and methodsBreak tests in the a.p. direction line were carried out on 28 unfixed h.b. of adults on a specially constructed test bench by continuously increasing the tension until a fracture/dislocation occurred. The test arrangement followed the constellation of typical-symmetrical hanging. The selection criteria were the symmetry of the h.b. and the gender. Before and after the experiments, a radiological depiction (DIMA system 20 kV, 10 sec; Institute for Diagnostic Radiology, University-Hospital Goettingen) was carried out, followed by a preparative depiction under magnifying glass control. The h.b. configuration was classified according to the following types: hyperbole-, parabola-, and horseshoe-type. Following this classification, the results were related to the findings achieved by the photo-elastic model experiments. By this, the results of the experimental fracture tests could be specifically compared to the tension distribution within the model.ResultsA total of 70 % of the experimentally-produced fractures were located within the distal third of the c.m. This matches with the frequency distribution in real typical symmetrical hanging. Following the radiological and preparative investigations that were carried out, the c.m. have to be viewed as tubular bones. The transition regions of different osseous strength/elasticity are thus to be considered as areas of increased vulnerability. For the distal third of the c.m., it is the level at which the dense spongiosa/compacta of the shaft part turn into wide-meshed spongiosa and tender compacta of the bulbi. Additionally, the bulbi themselves represent a locus of reduced strength in which the fractures were located basally and/or apically in the transition. It was not only in the whole c.m. that the direction in which the fragment was snapped off or fractured was not random, as all fractures were located on the broad side of the horn, following the applied force.ConclusionsThe experimental fracture tests explained the known accumulation of fractures in the distal third of the c.m. in cases of hanging with the knot of the rope located against the neck. It could be demonstrated radiologically and preparatively that, anatomically, the big horn of the h.b. is a tubular bone. From this, a new approach to the forensic reconstruction of trauma can be derived. The transitional area from the shaft into the bulbus represents a locus minoris resistentiae. In case of pressing the h.b. towards the cervical spine under ventral application of force, one could expect a point load of the bulbi. Two different types of bulbus fractures showed that this load is diagnostically relevant.The fracture direction is also of diagnostic value. It depends on the angle that is formed by the c.m. with their broad side towards the horizontal. This angle may even change for about 90° for the c.m. in the course from proximal to distal movement.By adjustment of the alignment of the broad side with the stress distribution within the different types of the h.b., a mechanically justified answer can be given to the question of why a horizontal fracture appears in the one case and a vertical fracture in the other.     

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis.     

Longitudinal tibial fatigue fracture: an uncommon stress fracture with characteristic features

PURPOSE: The author reports three cases of longitudinal tibial fatigue fractures, reviews the literature, and discusses characteristic features that suggest the diagnosis may be made by bone scintigraphy. METHODS: Radiographs and two- or three-phase bone scintigraphs with Tc-99m MDP were obtained in three runners who had exercise-related leg pain and whose clinical symptoms suggested either stress fractures or shin splints. The literature was reviewed and previously reported scintigraphic findings were compared with those seen in these three cases. RESULTS: In contrast to the focal, elliptical, cortex-based abnormal activity usually seen in the upper or middle tibia in patients with tibial stress fractures, all three patients had a long area of abnormal diffusely increased tibial activity that extended from the tibiotalar region proximally. This finding was seen on the 3-hour delayed static images of all three patients and was suggested on the blood-pool (tissue phase) images. The literature also contained reports of these same scan characteristics. Radiographs subsequently disclosed a longitudinal tibial stress fracture in one patient, computed tomography was positive in the second patient, and findings of clinical follow-up and radiographs were consistent with this diagnosis in the third patient. CONCLUSION: In the appropriate clinical setting and with normal or nondiagnostic radiographs, the presence of a long area of diffusely increased activity in the distal tibia extending proximally from the tibiotalar junction is indicative of a longitudinal fatigue fracture.     

胫骨下1/3螺旋骨折合并后踝隐匿性骨折的影像分析

目的 分析、评价X线、MSCT、MRI对胫骨下1/3螺旋骨折合并后踝隐匿性骨折的诊断价值.方法 对151例胫骨下1/3螺旋骨折进行了X线检查,未发现后踝骨折的患者行MSCT及MR检查.MSCT与MRI对于后踝骨小梁骨折和骨皮质骨折的显示能力比较采用二项分布检验.结果 151例胫骨下1/3螺旋骨折患者中有126例(83.4％)发现合并后踝骨折,其中X线检出27例(21.4％).124例行MSCT和MR检查,MRI检出后踝隐匿性骨折有99例,其中MSCT检出81例.MRI诊断后踝隐匿性骨折的敏感度、特异度、准确度分别为100％ (99/99)、100％ (25/25)、100％(124/124),MSCT分别为81.8％ (81/99)、100％( 25/25)、85.5％ (106/124).MRI对后踝隐匿性骨折的诊断准确度高于MSCT(Z=2.56,P=0.01).MSCT和MRI检出的99例后踝隐匿性骨折中,MSCT检出骨折累及骨皮质78例,MRI检出51例,MSCT诊断后踝隐匿性骨折累及骨皮质的敏感度、特异度、准确度分别为100％( 78/78)、100％ (21/21)、100％( 99/99),MRI分别为65.4％ (51/78)、100％ (21/21)、72.7％(72/99),MSCT对后踝隐匿性骨折累及骨皮质的诊断准确度高于MRI(Z=4.02,P=0.00).结论 MRI对胫骨下1/3螺旋骨折合并后踝隐匿性骨折的诊断准确度高于MSCT,MSCT对后踝隐匿性骨折累及骨皮质的诊断准确度高于MRI.     

微型外固定器治疗髌骨骨折

用微型外固定器治疗髌骨骨折32例,随访1～3年,优良率达90．6％。微型外固定器治疗髌骨骨折具有固定坚实、操作方便、简单易行、创伤小、取出方便等优点。