中西医结合治疗开放性胫腓骨骨折的疗效及术后感染分析

目的分析中西医结合治疗开放性胫腓骨骨折的临床疗效及术后感染等并发症。方法选取开放性胫腓骨骨折患者164例,随机分为观察组和对照组各82例,观察组予中西医结合治疗,对照组仅予抗菌药物等西药治疗,比较两组患者骨痂生长情况、治疗优良率及并发症发生率。结果观察组术后10周内骨痂出现率为91.46%,对照组为67.07%,观察组患者术后10周内骨痂出现率明显高于对照组;观察组患者临床疗效优良率为92.68%,明显高于对照组的78.05%;观察组并发症总发生率为12.41%;明显高于对照组的25.61%,差异均有统计学意义(P<0.05)。结论中西医结合方法治疗开放性胫腓骨骨折,骨痂生长快,疗效优良率高,术后并发症少,较少出现术后感染。     

倒LISS钢板治疗高龄股骨转子间骨折22例临床分析

目的探讨高龄患者股骨转子间骨折的手术方法及疗效。方法回顾性分析倒置LISS钢板治疗后的22例高龄(75岁以上)股骨转子间骨折患者的临床资料。年龄75～93岁,平均82岁。按Tronzo-Evans分型:Ⅲ型7例,Ⅳ型11例,Ⅴ型4例。术后定期复查X片,根据Kuderna改良的MerleD,Aubigne score标准评价髋关节疗效。结果随访12～48个月,平均22.6个月。骨折全部愈合,愈合时间7～12个月,平均9.6个月。术后无骨不连、钢板螺钉断裂脱出或股骨头坏死。髋关节功能:优16例,良6例。结论倒置LISS钢板具有手术操作简单、固定牢靠、损伤小、骨折愈合率高等优点,适合高龄股骨转子间骨折患者的手术要求,是一种值得临床推广的手术方法。     

股骨干骨折合并胸部损伤患者326例观察

目的探讨股骨干骨折合并胸部损伤患者的疗效方式。方法回顾分析1998年5月至2010年10月该院收治的326例股骨骨折合并胸部损伤患者的临床资料。结果术中、术后患者均未出现脂肪栓塞综合征(FES),2例病情不稳定患者外固定架固定后出现急性呼吸窘迫综合征(ARDS)。结论股骨干骨折合并胸部损伤患者应根据实际情况选择不同的术式和手术时机。     

经皮加压钢板治疗股骨粗隆间骨折

目的:探讨经皮加压钢板(percutaneous compression plate,PCCP)在治疗股骨粗隆间骨折的临床疗效。方法:自2008年9月至2009年3月应用PCCP治疗股骨粗隆间骨折24例,其中男13例,女11例。致伤原因:交通伤8例,摔伤12例,高处坠落伤4例。骨折按照Evans分型:I型6例,Ⅱ型10例,Ⅲ型4例,Ⅳ型4例;我们通过记录手术时间、术中出血量、术后并发症、骨折愈合情况和术后髋关节功能Harris评分来评价临床疗效。结果:手术时间55～85min,平均65min;出血量50～160ml,平均85ml。所有病例均获得5～11个月随访,平均随访9.3个月。所有患者骨折均愈合,骨折愈合时间2～5个月,平均9.5W。无髋内翻、股骨头切割、旋转移位、感染、内固定断裂、松动等并发症发生。患髋Harris评分70～97分,平均84分。结论:PCCP治疗股骨粗隆间骨折具有生物力学更合理、操作简便、创伤小、恢复快、固定有效牢靠、骨折愈合率高、并发症少的特点,尤其适用于伴有骨质疏松的老年患者。     

老年患者Colles骨折的治疗分析

目的:探讨老年人Colles骨折的治疗方法。方法:手术治疗30例,非手术治疗46例。分别进行2~3年的随访,评价X线片及功能。结果:非手术治疗组19例功能优良,手术组23例功能优良。结论:老年人Colles骨折属于不稳定骨折,手术治疗能更好地维持复位并获得更好的功能。     

颌间牵引钉在髁突囊内骨折保守治疗中的应用

目的:评价颌间牵引钉在治疗髁突囊内骨折中的应用价值。方法:以颌间牵引钉颌间牵引固定,治疗18例髁突囊内骨折患者。结果:18例患者均恢复良好的外形和功能,骨质愈合好,效果满意。结论:颌间牵引钉治疗髁突囊内骨折为一种安全有效、简便易行的治疗手段。     

Resur®-Splint Fixation for Cross-Leg Flaps

Methods for the fixation of cross-leg flaps are reviewed, and an improved form of splint fixation is presented. The fixation is based on pre-operatively constructed splints of the plastic material Resur Trovidur PE. The splints can easily be removed and remounted, the material can be sterilized, the fixation can be employed and adjusted during the operation. The method has been used in 2 cases and proved applicable both during the operation and in the subsequent immobilization period.     

Assessing the risk of bone fracture among postmenopausal women who are receiving adjuvant hormonal therapy for breast cancer

ABSTRACT

Objective: To understand better the true impact of wide­spread adoption of adjuvant aromatase inhibitor (AI) therapy on postmenopausal breast cancer patients’ risk of bone fracture.

Methods: Data from three different studies were used to estimate the relative risk of bone fracture for each of the following groups of women (i.e., versus a control group of healthy postmenopausal women): (a) healthy postmenopausal women receiving tamoxifen; (b) post­menopausal women who had received treatment for early breast cancer; (c) postmenopausal breast cancer patients on adjuvant tamoxifen therapy; (d) postmenopausal breast cancer patients on adjuvant anastrozole therapy. The results of these analyses were then used to estimate the likely incidence of clinical fracture among such popula­tions in ‘real-life’ clinical practice.

Results: Breast cancer survivors were calculated to be at increased risk of clinical bone fracture (i.e., RR 1.15 vs. control group over 5 years). Breast cancer patients initiated on adjuvant anastrozole were also calculated to be at increased risk of bone fracture (RR = 1.36 vs. control group over 5 years), while the calculated risk of fracture among tamoxifen-treated breast cancer patients was similar to that observed in the control population (RR = 0.91).

Conclusion: Breast cancer patients are at increased risk of clinical bone fracture (compared with the general postmenopausal population) and adjuvant anastrozole therapy slightly adds to this risk. Importantly, however, the absolute risk of bone fracture appears to remain low in each of the evaluated patient populations, suggesting that fear of fracture should not prevent the initiation of adjuvant aromatase inhibitor therapy.     

肿瘤刮除植骨术治疗股骨干良性骨肿瘤后早期发生病理性骨折的相关因素

目的探讨刮除植骨术治疗股骨干良性骨肿瘤后早期发生病理性骨折的相关因素。方法对53例股骨干良性骨肿瘤行刮除植骨治疗的患者的临床资料进行回顾性分析，根据是否发生术后早期病理性骨折分为骨折组和非骨折组，比较两组的临床资料，分析导致术后早期病理性骨折的相关因素。结果单因素分析结果显示，骨窗缺损长／宽比和肿瘤学分级两组差异有统计学意义（P〈0．01）。多因素分析结果显示骨窗缺损长／宽比和肿瘤学分级与股骨干良性骨肿瘤患者性刮除植骨术后发生早期病理性骨折的具有相关性（P〈0．05）。结论骨窗缺损长／宽比值大、肿瘤学分级中活跃期、侵袭期是导致术后发生病理性骨折的危险因素，在临床工作中应根据情况注意预防。