单侧外固定治疗重度Pilon骨折的临床疗效探究

目的探讨单侧外固定治疗重度Pilon骨折的临床疗效。方法回顾性分析2017年6月-2018年12月南京中大医院江北院区骨科收治的重度Pilon骨折患者100例,男性54例,女性46例;年龄18~65岁,平均35.5岁;Ruedi-AllgowerⅡ型39例,Ⅲ型61例。按照不同固定方法分为常规固定组和单侧外固定组,各50例,比较两组患者住院时间、完全负重下地时间、骨折愈合时间,评价治疗前及治疗后3个月踝关节活动度、踝关节功能恢复情况、疼痛程度,并统计患者的治疗效果及并发症发生情况。结果单侧外固定组住院时间、完全负重下地时间、骨折愈合时间分别为(16.50±1.50)d、(132.56±10.25)d、(14.16±0.69)周,均短于常规固定组(19.25±2.35)d、(198.65±16.58)d、(17.58±1.50)周(t/P=6.975/0.001、23.970/0.001、14.650/0.001)。治疗后3个月,单侧外固定组踝关节Mazur评分为(85.67±6.59)分,显著高于常规固定组(62.78±3.45)分,VAS评分为(2.23±0.36)分,低于常规固定组(4.59±0.89)分(t/P=21.760/0.001、17.380/0.001);单侧外固定组患者踝关节活动度分别为(17.29±0.16)°、(28.36±1.23)°、(19.68±0.16)°、(16.89±2.12)°,均高于常规固定组(10.62±1.25)°、(21.57±2.58)°、(14.36±1.62)°、(14.25±0.57)°(t/P=37.430/0.001、16.800/0.001、23.110/0.001、8.503/0.001)。单侧外固定组治疗优良率为90.00%,显著高于常规固定组74.00%(χ^2/P=4.336/0.037)。单侧外固定组总并发症发生率为4.00%,显著低于常规固定组的18.00%(χ^2/P=5.005/0.025)。结论单侧外固定支架治疗重度Pilon骨折可有效减轻患者疼痛症状,提高患者踝关节活动度,恢复患者功能,治疗效果显著,安全性较高。     

Is Pseudo-Patella Baja Really a Serious Complication of Total Knee Arthroplasty?

BackgroundThe available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP. J Arthroplasty 2002;17:66-69) due to elevation of the joint line.MethodsThis study is a prospective case series of 354 patients with a mean age of 71.7 (range 52-87) years. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12-item (SF12), and range of motion. Patellar height was assessed by the Insall-Salvati and Blackburne-Peel ratios.ResultsThe mean follow-up was 3.6 (range 2.0-6.6) years. Postoperatively, 286 (80.7%) patients had a normal patellar height, 17 (4.8%) had true patella baja (TPB), and 51 (14.4%) had PPB. There were no significant differences between the 3 groups in mean KSS-function (P = .107), range of motion (P = .408), WOMAC-pain (P = .095), WOMAC-stiffness (P = .279), or SF12-mental (P = .363). Between normal and PPB groups, there were no significant differences in mean KSS-knee (P = .903), WOMAC-function (P = .294), or SF12-physical (P = .940). However, the TPB group had significantly lower mean KSS-knee (P = .031), WOMAC-function (P = .018), and SF12-physical (P = .005) as compared with either 2 other groups.ConclusionPPB was a relatively common finding, but no significant differences in terms of clinical outcomes were found as compared to patients with postoperative normal patellar height. TPB was infrequent, but these patients had significantly worse clinical outcomes than those with PPB or normal patellar height.     

Pathologic Versus Native Hip Fractures: Comparing 30-day Mortality and Short-term Complication Profiles

BackgroundA large body of research on native hip fractures has resulted in several evidence-based guidelines aimed at improving postsurgical care for these patients. In contrast, there is a paucity of data on pathologic hip fractures, and whether native hip fracture protocols are generalizable to this population is unknown. The purpose of this study was to compare mortality rates and complication profiles between patients with pathologic and native hip fractures.MethodsUsing the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database, we identified patients who underwent surgical treatment for pathologic and native hip fractures from 2007 to 2017 and 2601 matched pairs were identified using propensity scoring. Baseline covariates were controlled for, and rates of 30-day postoperative complications and mortality were compared using McNemar’s test.ResultsPathologic hip fracture patients experienced significantly higher rates of death (6.3% vs 4.3%, P < .001), serious adverse events (17.3% vs 13.5%, P < .001), minor complications (34.3% vs 29.1%, P < .001), extended postoperative lengths of stay (30.2% vs 25.9%, P < .001), readmissions (11.9% vs 8.4%, P < .001), thromboembolic complications (3.0% vs 1.6%, P < .001), and perioperative transfusions (31.5% vs 26.4%, P < .001) compared to native hip fracture patients.ConclusionPathologic hip fractures result in significantly higher complication rates than native hip fractures after surgical treatment, suggesting that guidelines for native hip fractures may not be generalizable for pathologic hip fractures. Orthopedic surgeons should closely monitor these patients for deep vein thrombosis, utilize blood sparing techniques, and employ a multidisciplinary approach to help manage and prevent a more heterogenous profile of postsurgical complications.     

经皮微创锁定钢板内固定对老年肱骨近端骨折患者的临床疗效

目的探讨经皮微创锁定钢板内固定(MIPPO)对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法前瞻性选取2017年6月-2018年6月治疗的肱骨近端骨折患者105例,依据手术方法将其分为MIPPO组(n=55)和传统切开复位组(n=50),MIPPO组患者行微创锁定钢板改良内固定治疗,传统切开复位组患者行传统切开复位内固定治疗,比较两组患者围术期指标、治疗效果、治疗前后VAS评分及不良事件发生情况。结果MIPPO组患者手术时间[(69.1±16.4)min vs.(101.4±30.5)min]、术中出血量[(85.3±24.5)m L vs.(163.5±40.8)m L)]、术后引流量[(18.3±4.6)m L vs.(23.4±5.3)m L]、住院时间[(2.8±0.9)d vs.(4.5±1.0)d],骨折愈合时间[(11.6±2.3)周vs.(16.8±3.5)周],可负重时间[(8.1±2.1)周vs.(9.6±2.0)周]均短(少)于传统切开复位组,差异有统计学意义(P<0.05)。MIPPO组、传统切开复位组患者治疗有效率分别为94.55%、80.00%,MIPPO组优于传统切开复位组(P<0.05)。治疗前两组患者VAS评分比较差异无统计学意义(P>0.05);术后2、4周,MIPPO组患者VAS评分均低于传统切开复位组(P<0.05)。传统切开复位组患者术后3例发生骨折延迟愈合,2例发生外展受限;MIPPO组患者术后1例发生骨折延迟愈合,1例发生外展受限;两组患者不良事件发生率比较差异无统计学意义(10.00%vs.3.64%,χ^2=1.538,P=0.173)。结论微创锁定钢板改良内固定治疗老年肱骨近端骨折治疗效果显著,不增加不良事件发生风险,值得临床推广使用。     

股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化

目的分析老年男性股骨颈骨折合并抑郁患者骨密度和骨代谢生化指标变化，探讨抑郁对骨质疏松骨代谢的影响。 方法选取于北京医院骨科2017年1月至2019年1月住院的老年男性股骨颈骨折患者102例。排除病理性骨折、认知功能障碍等患者。依据老年抑郁量表(GDS)将老年男性股骨颈骨折患者分为抑郁组和对照组。通过测定并比较两组患者的骨密度(BMD)、血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基-维生素D[25(OH)D]、骨钙素(OC)、Ⅰ型原胶原氨基端前肽(P1NP)、血清Ⅰ型胶原羧基末端肽交联β特殊序列(β-CTX)水平，分析抑郁严重程度(GDS评分)与骨密度及骨代谢生化指标的相关性。分类变量的比较采用卡方检验，连续变量的比较采用t检验，两组连续性变量的相关性应用Pearson相关分析。 结果抑郁组患者BMD明显低于对照组(腰椎t ＝5.964、髋部t ＝2.845，P <0.05)。与对照组相比，抑郁组血清25(OH)D水平下降(t ＝3.077，P <0.05)，抑郁组血清OC水平低于对照组(t ＝2.013，P <0.05)，而血清β-CTX水平高于对照组(t ＝2.938，P <0.05)，P1NP水平与对照组差异无统计学意义(t ＝0.684，P >0.05)。抑郁严重程度(GDS评分)与BMD(r＝-0.456，P <0.05)、25(OH)D(r＝-0.546，P <0.05)、OC(r＝-0.215，P <0.05)呈负相关，与P1NP(r＝-0.115，P>0.05)相关性不显著，与β-CTX(r＝0.372，P<0.05)呈正相关。 结论抑郁症患者的骨形成标志物水平降低和骨吸收标志物水平升高，抑郁症是低骨密度和骨折的危险因素。应重视老年抑郁症患者骨代谢指标和25(OH)D的检测，及时进行维生素D的补充和有效的抗骨吸收药物治疗。