Patient-proxy response comparability on measures of patient health and functional status

The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.     

Nasal fractures in children

Summary A group of thirty children with nasal fractures was evaluated retrospectively by means of a questionnaire and hospital records. Age at the time of injury ranged from age 3 to 12 (mean = 8.6) years and mean follow-up period was 9 years. Eight patients reported some degree of nasal obstruction post reduction, but only one patient required submucous resection and two patients underwent septorhinoplasty for appearance. No patients reported class III malocclusion, or required orthodontic treatment or maxillofacial corrective surgery for maxillary hypoplasia. We concluded that a childhood nasal fracture treated by closed reduction does not have deleterious effects on facial or nasal growth.This work was supported in part by the Brigham Surgical Group Foundation, Inc., Boston, Massachusetts, USA     

手术治疗跟骨塌陷性骨折

目的　评估跟骨塌陷性骨折手术治疗的效果。方法　 1996年 5月～ 2 0 0 0年 6月共手术治疗跟骨塌陷性骨折 15例 ,8例内固定 ,7例植骨 ,平均随访 14个月 ,参照AOFAS评分对患者有否疼痛、步态、距下关节活动 ,是否支架辅助、术后X线照片等加以评估。结果　两组结果无明显差异。 2例手术切口皮缘坏死 ,6例疗效为优 ,9例为良。结论　跟骨塌陷性骨折手术解剖复位能取得好的效果     

Mutational analysis of HOXD13 and HOXA13 genes in the triphalangeal thumb-brachyectrodactyly syndrome.

The triphalangeal thumb-brachyectrodactyly syndrome is a very rare autosomal dominant disorder of unknown etiology characterized by an unusual pattern of limb malformations: triphalangeal thumbs and brachyectrodactyly in the hands, and ectrodactyly in the feet. In a previous report, we described the clinical and radiographical features of three related subjects with the disease and suggest that due to the unusual combination of limb defects and to its phenotypic similarity with the limb malformative pattern induced by disrupting the Hoxd13 gene in mouse, the triphalangeal thumb-brachyectrodactyly syndrome might be caused by mutations in a HOX gene. After sequencing the entire coding region of HOXD13 and the highly conserved homeodomain encoding region of HOXA13, we do not detect any deleterious mutation in any of the patients excluding that alterations at these sequences are responsible for the disease. Mutations in regulatory regions of these genes or in other genes involved in limb development might be responsible for the disease.     

关节镜监视下治疗胫骨平台骨折

2004—2006年，我院采用关节镜监视和定位治疗胫骨平台骨折，获得了良好的效果。     

Safety and reliability of external fixation for basicervical and intertrochanteric fractures in high-risk elderly patients

Forty elderly patients with basicervical and pertrochanteric fractures were managed with uniplanar AO external fixator under regional anaesthetic block of the femoral nerve and lateral cutaneous nerve of the thigh from April 2003 to March 2006. The mean age of the patients was 67.9 ± 5.5 years. External fixator application was performed under radiological control after closed reduction had been obtained. Comorbid factors, duration of surgery, duration of hospitalisation, complications, walking ability, time to union and mortality rate were recorded. Patients were followed up for a mean period of 12 ± 4.5 months. Superficial pin tract infection occurred in 13 patients, healing in varus >10° and with shortening >2 cm occurred in six patients, and one patient suffered a spontaneous ipsilateral femoral neck fracture after removal of the fixator. The mean time for union was 10.4 ± 1.2 weeks. Rapid union rate and minor complications obtained in the present study are comparable to those obtained with standard internal fixation techniques. Minimal intraoperative blood loss, short operative time and early patient mobilisation are advantages signifying uniplanar external fixator application under regional anaesthetic block to be a viable option in treatment of basicervical and pertrochanteric fractures in high-risk elderly patients.     

粒细胞集落刺激因子治疗下肢缺血性疾病

目的探讨粒细胞集落刺激因子(rhG-CSF)对下肢缺血模型血管新生的影响。方法制作兔左下肢缺血模型,术后随机分为rhG-CSF治疗实验组(n=24)和对照组(n=24);应用流式细胞学技术、动脉造影、免疫组织化学染色检查,比较两组外周血CD34 细胞的含量、缺血下肢侧枝血管计数及肌肉毛细血管密度。结果治疗后3 d实验组CD34 含量(%)为(0.7150±0.0873)明显高于对照组(0.3983±0.0853),差异有统计学意义(P<0.01);实验组在第15、30天时侧枝血管计数(6.33±0.82、9.17±0.75)均高于对照组(3.33±0.52、4.17±0.75)(P<0.01);第40天实验组内收肌毛细血管密度平均为8.5/HP,明显高于对照组4.2/HP(P<0.01)。结论rhG-CSF可以增加兔缺血下肢的毛细血管数量,有促进血管新生的作用。     

单侧入路椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折临床研究

目的：探讨单侧入路椎体后凸成形术治疗老年骨质疏松性胸腰椎压缩性骨折的临床疗效和安全性。方法：将15例老年骨质疏松性胸腰椎压缩性骨折患者，行单侧入路穿刺椎体后凸成形术。记录手术时间和透视次数，观察术后患者背痛缓解程度及日常活动恢复情况，比较术前、术后伤椎高度和脊柱后凸畸形Cobb’S角。结果：15例患者均顺利完成手术，手术时间25～43min，平均28．6min；透视次数15～23次，平均19．8次；术后伤椎前部、中部高度，脊柱后凸畸形Cobb’S角与术前比较，差异有统计学意义（P〈0．05）；术后24h患者背痛均明显缓解，与术前比较差异有统计学意义（P〈0．05）。患者均能在术后次日下床行走，未发现神经损伤等手术并发症。结论：单侧入路穿刺球囊扩张椎体后凸成形术能有效地治疗老年骨质疏松性胸腰椎压缩性骨折，且操作简便、安全，能明显地减少患者和术者的放射暴露。     

股骨干粉碎性骨折的治疗

近年来随着交通运输业的发展,由于高能伤所导致创伤骨科中骨折粉碎程度愈来愈重,甚至使骨骼失去完整形态,尤其在股骨干部位,治疗极其困难,开放复位损伤大且达不到满意的固定,疗效不佳。我们最大限度地使用外固定器,很好地解决了这一难题,同样适用于肱骨和胫骨骨折。1临床资料本组12例,均为男性,年龄18~40岁,平均31.3岁。左侧5例,右侧7例。其中交通事故伤8例,高处坠落伤3例,摔伤1例。闭合伤10例,开放伤2例。骨折均为粉碎性,无软组织及血管神经损伤。2治疗方法患者麻醉后仰卧于骨科牵引手术床上,注意使患肢靠外,消毒铺巾后,保持下肢中立位轻度…     

Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine

A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age, 41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of bone fusion and minimal loss of correction.