The role of hip arthroplasty in management of the hip fracture patient

Hip fractures are becoming increasingly common in a growing elderly population, and are associated with significant morbidity and mortality. Displaced intracapsular femoral neck fractures are usually treated with either total hip arthroplasty (THA) or hemiarthroplasty, although the indication for each operation remains an area for debate. THA has been associated with longer operative time, increased risk of dislocation and a slight increase in general complications compared with hemiarthroplasty. However, it has also been associated with a modest improvement in functional outcomes and quality of life. Guidelines have been created within the UK to aid the decision-making process based upon current available literature. The principal focus of these has been to identify patients suitable for THA, and include patients who are cognitively intact, mobile outside their home with the use of no more than one stick, and who are medically fit enough for the procedure. However, implant selection must also be taken into consideration in order to achieve the best outcomes for patients. Options for implants include use of dual mobility cups and choice of femoral head size in THA, bipolar versus unipolar hemiarthroplasty, and cemented versus uncemented implants. Further research is required into this area to make additional recommendations.     

136例老年高能量股骨转子间骨折的临床治疗分析

目的明确高能量股骨转子间骨折对老年患者的影响。方法高能量创伤老年患者319例,排除伴有外伤性脑损伤及伴有神经症状的脊柱损伤患者。分为骨折组及对照组:骨折组136例,有股骨转子间骨折,平均年龄(70.84±8.06)岁。对照组183例,无股骨转子间骨折,平均年龄(69.09±7.64)岁。记录患者的住院死亡率,6个月及1年死亡率,并发症,ICU时间,住院时间,出院情况,伴随骨折,手术干预情况。采用x~2检验、Fisher's精确概率法、t检验、KaplanMeier评估法以及Cox回归分析对数据进行分析。结果两组间住院死亡率、6个月死亡率、1年死亡率比较,差异无统计学意义(P0.05)。高能量股骨骨折的老年患者并发症增加(P0.05),多伴有长骨骨折(P0.05)和非长骨骨折(P0.05),更多需要外科手术治疗(P0.05),住院时间较长(P0.05),两组患者平均ICU天数相似。结论高能量股骨转子间骨折增加了老年患者的并发症发生率,但并没有增加死亡率。对这一群体,伴随损伤可能发挥着更为重要的作用。     

Micro computed tomography features of laryngeal fractures in a case of fatal manual strangulation

Cases of subtle fatal neck compression are often complicated by the lack of specificity of the post-mortem signs of asphyxia and by the lack of clear signs of neck compression.Herein we present a forensic case of a 45-year-old schizophrenic patient found on the floor of the bedroom of a psychiatric ward in cardiopulmonary arrest and who died after two days in a vegetative state. The deposition of the roommate of the deceased, who claimed responsibility for the killing of the victim by neck compression, was considered unreliable by the prosecutor.Autopsy, toxicological analyses, and multi-slice computed tomography (MSCT), micro computed tomography (micro-CT) and histology of the larynx complex were performed. Particularly, micro-CT analysis of the thyroid cartilage revealed the bilateral presence of ossified triticeous cartilages and the complete fragmentation of the right superior horn of the thyroid, but it additionally demonstrated a fracture on the contralateral superior horns, which was not clearly diagnosable at MSCT. On the basis of the evidence of intracartilaginous laryngeal hemorrhages and bilateral microfracture at the base of the superior horns of the larynx, the death was classified as a case of asphyxia due to manual strangulation.Micro-CT was confirmed as a useful tool in cases of subtle fatal neck compression, for the detection of minute laryngeal cartilage fractures, especially in complex cases with equivocal findings on MSCT.     

对比观察跨伤椎固定与经伤椎固定在治疗胸腰段脊柱骨折的临床疗效

目的对比观察跨伤椎固定与经伤椎固定在治疗胸腰段脊柱骨折的临床疗效。方法将患者平均分为实验组和对照组,对照组行跨伤椎固定,实验组行经伤椎固定。结果经过治疗后实验组JOA为(23.4±1.8)分,VAS为(2.6±0.8)分,与对照组相比,P0.05,差异不具有统计学意义。实验组手术后与手术前伤椎前后缘之差,以及半年后测量值与术后前后缘之差对比,P0.05,差异具有统计学意义。结论与跨伤椎固定相比,采用经伤椎固定的方法治疗胸腰段脊柱骨折具有更好的临床效果。     

Panoramic radiomorphometry and vertebral fractures in Spanish postmenopausal women

ObjectiveTo evaluate the relationship between panoramic radiomorphometric indexes, and the presence of osteoporotic fractures in a Spanish postmenopausal women.MethodsA sample of 120 women (60 with fragility spine fractures and 60 healthy), aged 55–70 years, with fragility spine fractures, were included in this cross-sectional study that was conducted from 2008 to 2011. All the women were referred to undergo a radiological spine examination, spinal densitometry and a panoramic radiograph for assessing osteoporosis using 3 radiomorphometric indexes: Panoramic Mandibular Index (PMI), Mental Index (MI) and Mandibular Cortical Index (MCI). According to mandibular cortical shape, in MCI, three groups were defined: C3 (osteoporosis), C2 (osteopenia), C1 (health).ResultsSignificant differences were found between all the MCI groups due to their composition between fractures and non-fractures. C1 group (healthy) has less fractures women than C2 (Bonferroni p < 0.001), C1 has less fractures than C3 (Bonferroni p < 0.001) and finally, C2 has less fractures than C3 (Bonferroni p < 0.006). PMI and MI values were significantly lower in cases than in controls (U Mann–Whitney p < 0.001).ConclusionsPanoramic radiomorphometrics mandibular indexes such as MCI, PMI, and MI, may be useful for identifying the population at higher risk for fracture. The relationship between panoramic index and osteoporosis remains unclear and further studies using fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.     

锁定钢板与人工肱骨头置换治疗成人肱骨近端骨折疗效的Meta分析

目的对采取锁定钢板与人工肱骨头置换治疗成人肱骨近端骨折的临床疗效进行Meta分析,探讨两种手术方式的治疗效果。方法通过计算机检索中国生物医学文献数据库(CBM)、中文万方数据库、维普数据库(VIP)、中国知网(CNKI)及外文PubMed、Science Direct等数据库2004年1月至2013年12月期间发表的相关治疗肱骨近端骨折的各种对照研究,进行Meta分析。结果共纳入符合标准的文献9篇,采用Review Manager 5.2软件进行Meta分析,结果显示:锁定钢板与人工肱骨头置换比较Neer评分优良率方面差异无统计学意义(OR=0.84,95%CI:0.33~2.14,P=0.72),在ASES评分优良率方面无显著差异(OR=0.80,95%CI:0.26~2.44,P=0.69)。结论目前认为锁定钢板与人工肱骨头置换对特定骨折类型各有利弊。对于高龄粉碎性的肱骨近端骨折患者,多数倾向于人工肱骨头置换。对于老年粉碎性的肱骨近端骨折的患者,现有文献中没有足够的对照试验证明人工肱骨头置换的优越性。     

Biomechanical analysis of fractures in the mandibular neck (collum mandibulae)

After treatment of fractures in the neck of the mandible by means of immobilization of the dentition, often more or less severe manifestations of malocclusion remain. It was hypothesized that this is caused by an altered articulation in the jaw joint on the affected side. Furthermore, it was hypothesized that an anteriorly displaced condyle, as observed frequently as a side effect of the treatment, is caused by pull of the lateral pterygoid muscle, despite maxillomandibular fixation.Intervention experiments were performed in silico to test these hypotheses. With a biomechanical model of the human masticatory system alterations were applied mimicking a fractured mandibular neck and configurations that had been observed after healing.It was predicted that the altered articulation in the jaw joint caused asymmetrical jaw movements despite symmetrical muscle activation. The jaw was predicted to close with an open bite similar to clinical observations. The predicted laterodeviations, however, were not in accordance with clinical observations. Despite maxillo-mandibular fixation the lateral pterygoid muscle was able to pull the mandibular condyle out of its fossa in anterior direction. Consequently, despite some methodological limitations, in general the predictions corroborated the hypotheses.     

肱骨干骨折延迟愈合及不愈合的相关因素分析

目的：探讨导致肱骨干骨折延迟愈合及不愈合的相关因素。方法：回顾性分析93例肱骨干骨折患者的病例资料，其中31例肱骨干骨折延迟愈合及不愈合患者纳入观察组，62例肱骨干骨折骨性愈合患者纳入对照组。比较2组患者的骨折粉碎、骨折端软组织损伤、骨折复位、固定不稳、感染及不合理功能活动情况。结果：观察组中23例为严重粉碎性骨折患者，对照组中26例为严重粉碎性骨折患者；观察组中严重粉碎性骨折患者的比例大于对照组（χ^2=8.627，p =0.003）；其相对危险度是对照组的3.981倍。观察组中固定不稳25例，对照组中固定不稳13例；观察组中固定不稳患者的比例大于对照组（χ^2=30.459，p =0.000）；其相对危险度是对照组的15.705倍。观察组中不合理功能活动患者26例，对照组中12例；观察组中不合理功能活动患者的比例大于对照组（χ^2=35.598，p =0.000）；其相对危险度是对照组的21.667倍。观察组在骨折端软组织损伤情况、骨折复位和感染三方面与对照组相比，组间差异均无统计学意义（χ^2=1.902，p =0.168；χ^2=0.939，p =0.332；χ^2=0.661，p =0.416）。结论：肱骨干骨折后发生延迟愈合及不愈合主要与不合理的功能活动、固定不稳及严重粉碎性骨折有关联，但骨折延迟愈合及不愈合的发生绝不是单一因素作用的结果，而是混杂了多种因素的交叉作用结果。对于各因素间有无交互效应及其相关性，我们将继续收集资料做进一步分析研究。     

胫骨平台后内侧骨折的内固定治疗

目的探讨钢板内固定治疗胫骨平台后内侧骨折的疗效。方法回顾性分析2008年8月至2012年6月在我院行钢板内固定治疗且获得随访的23例胫骨平台后内侧骨折患者的病例资料。所有病例均采用后内侧入路,行钢板内固定治疗,术后进行临床和影像学随访。结果 23例患者均获得随访,随访时间14.0~54.0个月,平均20.2个月。无患者发生血管、神经损伤、内固定松动、断裂等情况。所有骨折均获得愈合,愈合时间为14.0~27.0周,平均17.3周。患者的完全负重时间平均为术后18.2周。骨折愈合后,根据Rasmussen膝关节功能评分标准评定疗效:优15例,良5例,中3例,优良率为87.0%。结论胫骨平台后内侧骨折采用后内侧或内侧入路进行钢板内固定治疗,并发症少,疗效满意。     

桥接钢板治疗胫骨干超长节段粉碎性骨折

目的探讨桥接钢板治疗胫骨干超长节段粉碎性骨折的疗效。方法回顾性分析自2010年1月至2013年3月应用微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术结合桥接钢板治疗胫骨干超长节段粉碎性骨折患者24例的临床资料,其中男16例,女8例;年龄19.0~58.0岁,平均(34.6±2.2)岁。开放性骨折3例(根据Gustilo分型,均为Ⅰ型),闭合性骨折21例。伤后至手术时间7.0~13.0d,平均(8.0±1.3)d。观察术后软组织恢复及骨折愈合等情况。结果术后随访13.0~18.0个月,平均(14.2±2.7)个月。骨折愈合时间3.0~6.0个月,平均(3.8±1.4)个月。所有切口均Ⅰ期愈合,未发生神经、血管、软组织并发症。根据Johner-Wruhs方法评价:优17例,良5例,可2例。结论应用MIPPO技术结合桥接钢板治疗胫骨干超长节段粉碎性骨折的临床效果良好。