股骨近端不同平面皮质骨厚度值、X射线灰度值与女性髋部脆性骨折的相关性

文题释义：脆性骨折：是指在无创伤或较微创伤情况下引起的骨折，一般是指在平地或人体站立高度下活动过程中发生的骨折，X射线下常可见骨骼有骨质疏松征象，也称为骨质疏松性骨折。 髋部骨折：是指发生在髋部及周围的骨折，包括股骨颈骨折、股骨转子间骨折、转子间骨折及髋臼骨折等，是骨质疏松性骨折最常发生的骨折部位，患者常因高龄且伴有基础疾病而1年内死亡率可达50%，5年存活率为20%。 背景：随着人口老龄化，脆性骨折疾病受到临床越来越多的关注，骨密度值的单独使用已经不能满足临床对脆性骨折的风险评估。目前骨皮质厚度作为评估脆性骨折发生风险的新方向和新方法之一，受到越来越多学者的研究和讨论。 目的：探讨在X射线DR摄影下，股骨近端不同平面骨皮质厚度值、X射线灰度值与50岁以上女性髋部脆性骨折的相关性，以此探寻股骨近端不同平面中，用于预测女性髋部脆性骨折发生风险最合适的测量平面。 方法：依照纳入标准收集2018年7月至2019年6月在广西医科大学第九附属医院放射科行X射线DR骨盆正位片检查的50岁以上女性患者100例的相关临床资料。所有患者对试验方案均知情同意，且得到医院伦理委员会批准。股骨近端骨皮质厚度值的测量平面设计为股骨颈中段、小转子上1 cm以内和小转子下1 cm以内，共3个测量平面。X射线灰度值测量以大转子和小转子的中点连线作为矩形对角线取矩形区域测量。 结果与结论：①50-64岁年龄组记为A组，65岁及以上年龄组记为B组，每组各50例；② B组患者的小转子上1 cm以内和小转子下1 cm以内平面的骨皮质厚度值、X射线灰度值比A组低，骨折率比A组高，差异均有显著性意义(P < 0.05)；而股骨颈中段平面的骨皮质厚度值2组间比较差异无显著性意义(P > 0.05)；③骨皮质厚度值的测量平面比较，骨皮质厚度测量值在整体上由高到低依次为小转子下1 cm以内、小转子上1 cm以内和股骨颈中段平面，差异有显著性意义(P < 0.05)；④观察对象小转子下1 cm以内及小转子上1 cm以内骨皮质厚度值、X射线灰度值、年龄，与脆性骨折相关系数依次为-0.303，-0.205，-0.272及0.346(P < 0.05)，但股骨颈中段平面皮质骨厚度与脆性骨折无明显相关性(P > 0.05)；⑤A组中骨折和非骨折患者小转子上1 cm以内和小转子下1 cm以内测量平面的骨皮质厚度值比较差异有显著性意义(P < 0.05)；B组中骨折和非骨折患者各指标比较差异均无显著性意义(P > 0.05)；在50岁以上的所有患者中，骨折和非骨折患者各测量平面的骨皮质厚度值和X射线灰度值的比较差异均有显著性意义(P < 0.05)；⑥说明骨皮质厚度值变薄，X射线灰度值变小，则髋部脆性骨折可能性变高。利用股骨近端骨皮质厚度评估50岁以上女性髋部脆性骨折风险时，推荐在股骨小转子下1 cm以内平面进行测量。 ORCID: 0000-0003-1961-7468(覃海阔) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

全国著名骨伤专家梁铁民教授学术思想和正骨经验

总结了全国著名骨伤专家梁铁民教授的学术思想和正骨经验,简述了梁老生平。梁老学术思想表现在突出整体观念,主张辨证施术;注重调理气血,强调药物接续;重视望问切触量法五诊结合等三个方面。对于梁老正骨经验先进行了综合论述,进一步佐证其学术思想;后分别从小儿桡骨头半脱位、颈椎错位、胸腰椎小关节错位、肋骨骨折等梁老研究较深入和比较擅长的几个方面进行了阐述。特别是颈椎错位这种高难度高风险的手法操作,体现出梁老高超的手法技艺。     

不同麻醉方法对超高龄髋部骨折手术患者围术期血压的影响

目的探讨不同麻醉方法对超高龄髋部骨折患者围术期血流动力学的影响。方法选择2017年5月～2019年2月在我院行髋部骨折手术的患者92例,年龄≥90岁,随机分为全身麻醉(general anesthesia,GA)组和硬膜外麻醉(epidural anesthesia,EA)组,每组46例。GA组患者行全身麻醉,EA组患者行硬膜外麻醉。记录术前静息血压(T0)、麻醉诱导或硬膜外起效后血压(T1)、切皮时血压(T2)和术后当天(Day 0)、术后第1天(Day 1)、术后第2天(Day 2)的血压及术中低血压次数。用查尔森合并症指数(Charlson Comorbidity Index,CCI)比较有和无分层情况下两组各时间点的平均动脉血压(MAP)及术中低血压次数。结果 T1、T2时间点GA组MAP低于EA组(P0.05),其余时间点MAP无统计学差异。EA组患者低血压次数少于GA组(P0.05)。亚组分析中,CCI≥3时,Day 0时间点EA组MAP低于GA组(P0.05),其余时间点MAP无统计学差异(P0.05)。CCI≥3时,两组低血压次数无统计学差异(P0.05)。结论超高龄髋部骨折手术患者硬膜外麻醉较全身麻醉在血流动力学上更稳定。但在有多个合并症的患者中,两者差异并不明显,且硬膜外麻醉术后当天容易发生低血压。     

Gamification in rehabilitation of metacarpal fracture using cost-effective end-user device: A randomized controlled trial

Study DesignThis is a two-group randomized controlled trial.IntroductionFinger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies.Purpose of the StudyThe purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures.MethodsA 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance.ResultsThere were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P < .05). No adverse events were reported.DiscussionOur results suggest that gamification using a cost-effective device demonstrated similar effectiveness as conventional physiotherapy in post–metacarpal fracture rehabilitation.ConclusionsGamification using a mobile device is an inexpensive and safe alternative to conventional physiotherapy for hand rehabilitation after metacarpal fractures. It effectively serves as a guide for future development of cost-effective technology–enhanced therapy.     

Osteoporotic ankle fractures: A narrative review of management options

The management of Osteoporotic ankle fractures is still considered to be a challenge by many surgeons. One of the issues seems to be a lack of data focused on this special subgroup, with very little evidence of good quality. We did a narrative review of the literature in an attempt to identify the magnitude of the problem and to evaluate the evidence in support of management options.The current review of the literature has brought to light some interesting facts. Despite limited data there seems to be an in increase in the incidence of these fractures. Although we could not demonstrate any clear distinction between geriatric and osteoporotic ankle fractures from the available literature; it is clear that all geriatric fractures are not necessarily osteoporotic and neither is the reverse true. The evidence to associate osteoporotic ankle fractures with poor outcomes is weak, and factors other than osteoporosis may have a stronger influence. From this analysis, we could not establish a higher incidence of implant failure for this specific fracture group, although many modifications in technique have been proposed due to the fear of fixation failure. Hook plating and Tibia-pro fibula fixation have weak evidence in support, but posterior fibular plating is preferred due to soft tissue protection. There is weak evidence in support of Locking plates for these fractures, as publications focused on this are limited; nevertheless some advantages have been documented. Augmentation by calcium based bone graft substitutes has been reported to improve pull out strengths of screws, but again the evidence of its role in Osteoportic fractures is limited. Fibular nailing has been proposed with specific advantages in osteoporotic fibular fractures, but the concept is new and it is indicated only in a select a subgroup of cases. Some evidence exists for the use of trans-articular nails in geriatric subgroups with limited pre-injury mobility, but the technique has to be used with caution to prevent other complications.InferenceMore data needs to be accumulated before clear guidelines for management of osteoporotic ankle factures are defined; however the current literature supports the need for modifications in standard ankle facture fixation methods to improve outcomes.     

规范化疼痛护理管理在胫骨远端骨折患者中的运用效果分析

目的评估规范化疼痛护理管理干预服务实行于胫骨远端骨折患者中的临床管理效果。方法将2017年4月—2019年10月该医院纳入的74例胫骨远端骨折患者以随机数字分为两组,各37例,实验组选用规范化疼痛护理管理干预服务,参比组选用传统疼痛护理管理干预服务,对比护理管理干预前、护理管理干预后疼痛评估分数,计算护理管理干预满意统计值。结果护理管理干预后,实验组疼痛评估分数小于参比组评估结果(P<0.05)。实验组护理管理干预满意统计值大于参比组评估结果(P<0.05)。结论为胫骨远端骨折患者选择规范化疼痛护理管理干预服务体现较好临床管理效果。     

FRAX®在女性骨质疏松症诊疗中的应用研究进展

骨质疏松症是常见的骨骼疾病，绝经后女性为骨质疏松症的高危人群。骨折风险评价工具（fracture risk assessment tool，FRAX?）是一款研究、应用广泛的骨折风险评估工具。近年来研究表明，虽然FRAX?尚不完美，但对女性人群的骨折具有合理的预测能力，结合其他骨折危险因素对该工具进行调整、改进的研究也多见报道。设立符合本国国情的FRAX?阈值有助于医生更好地使用该工具和进行临床决策。美国设立了固定的FRAX?阈值，英国则是按年龄分层的阈值。国内对FRAX?的研究尚处于初级阶段，暂无特异的干预阈值，这在一定程度上阻碍了该工具在我国的推广使用。笔者回顾了国内外FRAX?对女性骨质疏松性骨折的预测能力、骨量异常的诊断能力、在合并其他疾病的女性人群中的应用和干预阈值的研究等最新成果，为临床医生了解FRAX?的研究进展、探索针对我国人群干预阈值奠定基础。