指掌骨骨折合并软组织损伤的微型锁定钢板皮外固定应用效果及对关节活动度的影响

目的 探讨微型锁定钢板皮外固定应用于指掌骨骨折合并软组织损伤患者中的治疗效果及其对关节活动度的影响。方法 选取指掌骨合并软组织损伤的患者60例为研究对象,随机分为对照组（30例）和观察组（30例）。对照组实施常规固定手术,观察组实施微型锁定钢板皮外固定,并依照患者软组织损伤实际情况采取石膏进行外固定。术后对比两组患者骨折愈合时间、围术期指标、Jamar握力、总关节活动度（total angle of motion,TAM）、上肢功能评定（disabilities of the arm,shoulder and hand,DASH）、术后不良反应情况及生活质量。结果 两组患者手术时间比较差异无统计学意义（P>0.05）,观察组患者骨折愈合时间、住院时间和DASH评分低于对照组（P<0.05）,TAM评分、生活质量评分和Jamar握力高于对照组（P<0.05）。观察组不良反应发生率（0.67%）低于对照组（33.33%,P<0.05）。结论 采取微型锁定钢板皮外固定方式对指掌骨骨折合并软组织损伤进行治疗,再采取石膏进行外固定,虽然增加患者的手术时间,但是能够减少患者骨折愈合时间,安全性较高,另外能够更好地促进患者恢复关节功能,提升患者生活质量。     

关节镜下双后内侧入路单纯缝线联合经胫骨骨隧道二次固定治疗后交叉韧带胫骨止点撕脱骨折16例疗效分析

目的　研究关节镜下双后内侧入路单纯缝线联合经胫骨骨隧道二次固定治疗后交叉韧带胫骨止点撕脱骨折的临床效果。　方法　选取2018年5月至2020年8月收治的单纯后交叉韧带止点撕脱骨折16例,对其行关节镜下双后内入路单纯缝线复位固定联合经胫骨骨隧道二次固定技术,术后随访1年,对其临床治疗效果（Lysholm评分、IKDC评分及后抽屉试验）进行评价。　结果　手术顺利,术中无副损伤。术后1年后抽屉试验阴性,Lysholm膝关节功能评分（91.67±5.16）及IKDC评分（89.74±4.28）较术前明显增加,差异有统计学意义（P<0.05）。　结论　关节镜下双后内入路,应用单纯缝线联合经胫骨骨隧道二次固定技术治疗单纯后交叉韧带止点撕脱骨折临床效果肯定,值得普遍推广。     

气管推移训练对颈椎前路减压植骨融合内固定术术后康复影响的研究

目的 探讨术前气管推移训练对颈椎前路减压植骨融合内固定术的患者术后并发症及术后康复的影响。方法 回顾性分析江门市中心医院2017年1月到2021年7月行颈椎前路减压植骨融合内固定术的患者205例的临床资料,其中行单节段颈椎前路减压植骨融合内固定术的患者122例,行双节段颈椎前路减压植骨融合内固定术的患者83例。单节段患者中62例为术前气管推移训练组,60例为对照组。双节段患者中45例为气管推移训练组,38例为对照组。观察和分析的指标包括术后饮水呛咳、声音嘶哑、咽喉疼痛时间、咽喉疼痛程度、术后声音嘶哑及术后吞咽困难。结果 205例患者全部顺利完成手术,无患者死亡。在单节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组和对照组在术后饮水呛咳、术后声音嘶哑、术后吞咽困难等方面的差异无统计学意义（P>0.05）,但气管推移训练组比对照组术后咽喉疼痛的时间更短,术后咽喉疼痛的程度更轻（P<0.05）。在双节段颈椎前路减压植骨融合内固定术的患者中,气管推移训练组比对照组发生术后饮水呛咳、声音嘶哑、吞咽困难的患者更少（P<0.05）,术后咽喉疼痛的时间更短、程度更轻（P<0.05）。结论 颈椎前路减压植骨融合内固定术的患者术前进行气管推移训练有利于患者术后的术后快速康复,增强患者的术后舒适感,尤其对双节段颈椎前路减压植骨融合内固定术的患者更加明显。     

Comparison between suture and staple fixations as internal fixation techniques for Akin osteotomy

BackgroundSuture and staple fixations are commonly used methods for Akin osteotomy; however, there has been a paucity of studies comparing these methods without bias.Patients and methodsWe retrospectively compared the outcomes of 58 Akin osteotomies performed by a single surgeon using suture fixation and 39 Akin osteotomies performed by the same surgeon using staple fixation during the same period.ResultsBone union at the osteotomy site was achieved in all cases with no cases of complications related to the materials used. Occurrence of breakage of the lateral cortex of the proximal phalanx showed no significant difference between the suture and staple groups. The lateral cortex breakage produced greater instability at the osteotomy site with the staple fixation compared to the suture fixation.ConclusionsComparison of suture and staple fixations of Akin osteotomy demonstrated the superiority of suture fixation against staple fixation in terms of stability and cost-efficiency.     

Cause-Specific Stem Revision Risk in Primary Total Hip Arthroplasty Using Cemented vs Cementless Femoral Stem Fixation in a US Cohort

BackgroundWe sought to evaluate the cause-specific revision risk following hybrid (cemented stem mated to a cementless acetabular implant) vs cementless total hip arthroplasty (THA) in a US cohort.MethodsPrimary elective THA for osteoarthritis was identified using Kaiser Permanente’s Total Joint Replacement Registry (2001-2018). Multivariable Cox regression was used to evaluate cause-specific revision, including aseptic loosening, infection, instability, and periprosthetic fracture (PPF), for hybrid vs cementless THA. Analysis was stratified by age (<65, 65-74, and ≥75 years) and gender.ResultsThe study cohort comprised 88,830 THAs, including 4539 (5.1%) hybrid THAs. In stratified analysis, hybrid THA had a higher revision risk for loosening in females in all 3 age subgroups. A lower risk of revision for PPF was observed following hybrid THA in females aged ≥75 years. For females ≥75 years, cementless THA had an excess PPF risk of 0.9% while hybrid THA had an excess loosening risk of 0.2%, translating to a theoretical prevention of 10 PPF revisions but a price of 3 loosening revisions per 1000 hybrid THAs. No difference in revision risk was observed in males.ConclusionWe observed differences in cause-specific revision risks by method of stem fixation which depended upon patient age and gender. Although the trend toward all cementless fixation continue, there may be a role for hybrid fixation in females ≥75 years to mitigate risk for revision due to PPF at the potential cost of a slight increase in longer term aseptic loosening.Level of EvidenceLevel III.     

Cemented Femoral Fixation in a High-Risk Cohort Diminishes Risk of Early Postoperative Periprosthetic Fracture

BackgroundEarly periprosthetic fractures (PPFx) following primary total hip arthroplasty (THA) create significant morbidity. Established risk factors for early PPFx include age, gender, body mass index, surgical approach, and implant fixation. We investigated the role of femoral fixation on early PPFx (<90 days postoperatively) in a high-risk cohort undergoing direct anterior approach (DAA) THA.MethodsThe final cohort comprised 344 consecutive patients (390 hips) with risk factors for PPFx (age >68 years and body mass index <25 kg/m²) who underwent primary DAA THA between May 4, 2009 and December 31, 2019 and had 90-day follow-up. Noncemented fixation was used in 229-hips, while cemented fixation was used in 161 hips. The primary outcome was early PPFx. Fisher’s exact test was used for categorical variables, while t-tests were used to compare continuous variables.ResultsWe observed 8 early PPFx (2.1%), all fractures occurring in the noncemented group. Baseline demographics were similar but not equal, with the cemented group being older (78.0 versus 76.3 years; P = .004) with a greater proportion of females (91.9% versus 69.4%; P < .001). The rate of early PPFx was significantly higher with noncemented fixation compared to cemented fixation (3.5% versus 0.0%; P = .023). A post hoc power analysis confirmed sufficient power (1?β = 0.81).ConclusionAlthough baseline risk factors for early PPFx are not easily modifiable, surgical factors can be modified. Cemented fixation has the potential to markedly reduce the risk of early PPFx in high-risk patients undergoing DAA THA.     

空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣治疗青壮年股骨颈骨折

目的探讨采用空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣治疗青壮年股骨颈骨折的临床疗效。方法回顾分析2013年2月—2019年2月收治的11例青壮年股骨颈骨折患者临床资料。男7例,女4例;年龄32~58岁,平均45岁。致伤原因:高处坠落伤6例,交通事故伤4例,运动损伤1例。左髋7例,右髋4例。Pauwels角55°~75°,平均64°。均采用空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣进行治疗。术后复查骨盆X线片以及髋关节侧位X线片、CT及三维重建,评估骨折愈合及内固定物在位情况。采用Harris评分评价髋关节功能恢复情况。结果术后切口均Ⅰ期愈合,均未出现感染、股外侧皮神经损伤等症状。术后次日复查示骨折对位、对线良好,内固定物位置良好。11例患者均获随访,随访时间18~36个月,平均29个月。骨折均获骨性愈合,愈合时间16~23周,平均18.2周。术后30个月1例患者(9.1%)发生股骨头坏死(osteonecrosis of the femoral head,ONFH)。末次随访时采用Harris评分评价髋关节功能,获优9例、良1例、可1例,优良率90.9%。结论空心拉力螺钉加内侧支撑钢板固定结合缝匠肌蒂骨瓣治疗青壮年股骨颈骨折生物力学稳定性强,能够有效改善术后股骨头、颈血运,减少ONFH发生,但须严格掌握手术适应证。     

双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折

目的：探讨采用双钢板技术同时进行肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折的临床疗效。方法：2018年5月至2020年12月采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折患者38例,其中男23例,女15例;年龄41~89（67.00±9.76）岁;Neer 3部分骨折23例,Neer 4部分骨折15例;伤后至手术时间5~12（8.00±2.86） d。术后第3天采用单维度疼痛数字评分法（numeric rating scale,NRS）评估疼痛程度;比较术后2 d及1年时肱骨头高度、肱骨颈干角变化情况;术后1年采用Neer评分评定术后肩关节恢复情况。结果：38例患者均获得随访,时间12~19（14.00±1.59）个月。术后3 d时NRS评分（1.95±0.73）分。骨折愈合时间2.2~3.2（2.60±0.27）个月。术后2 d与1年时肱骨头高度、肱骨颈干角比较,差异无统计学意义（P>0.05）。4例Neer 4部分骨折出现肱骨大结节吸收、肱骨头出现部分囊性变,但肩关节活动功能良好。术后1年Neer评分（89.50±5.19）分,其中优20例,良16例,中2例。结论：采用双钢板技术及肱二头肌长头腱固定治疗肱骨近端Neer 3~4部分骨折,治疗效果良好,术后疼痛较轻,手术无须特殊器械。