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1.
目的观察腰部椎旁肌肉T2值诊断骨质疏松性椎体压缩性骨折(OVCF)的价值。方法回顾性分析91例年龄>50岁腰背痛患者,其中23例临床诊断为OVCF(骨折组),68例为腰椎间盘突出症、腰椎退行性变或终板炎等且未见椎体骨折(对照组);比较2组临床资料及腰部T2 mapping成像所示左、右侧多裂肌和左、右侧竖脊肌T2值的差异,以临床诊断为标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价根据腰部椎旁肌肉T2值及椎体陈旧性骨折诊断OVCF的效能。结果组间患者年龄、性别及椎体陈旧性骨折比例差异均有统计学意义(P均<0.05)。骨折组双侧多裂肌和竖脊肌T2值均高于对照组(P均<0.05)。左、右侧多裂肌和左、右侧竖脊肌T2值诊断OVCF的AUC分别为0.79、0.76、0.71、0.70,与椎体陈旧性骨折(0.72)差异均无统计学意义(Z=1.197、0.811、0.112、0.245,P均>0.05)。结论腰部椎旁肌肉T2值可用于诊断OVCF。  相似文献   
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目的探讨后路长节段内固定治疗老年Ⅳ型陈旧性症状性骨质疏松性胸腰椎骨折(CSOTLF)后近端交界性后凸(PJK)发生的相关危险因素。方法采用病例对照研究分析2013年1月至2018年6月西安交通大学附属红会医院收治的95例老年Ⅳ型CSOTLF患者临床资料,其中男32例,女63例;年龄60~85岁[(67.4±6.5)岁]。损伤节段:T1117例,T1237例,L130例,L211例。患者均接受后路长节段内固定术治疗。按照术后是否发生PJK,将患者分为PJK组(30例)和非PJK组(65例)。采用单因素分析患者性别、年龄、体重指数(BMI)、骨密度(BMD)、吸烟史、致伤原因、合并症、损伤节段、美国脊髓损伤协会(ASIA)分级及受伤至手术时间等一般资料;交界性后凸角(PJA)、矢状垂直偏移(SVA)、骨盆入射角-腰椎前凸角差值(PI-LL)、骨盆倾斜角(PT)及骶骨倾斜角(SS)等术前影像学资料;后方韧带复合体(PLC)损伤、近端固定椎(UIV)位置、远端固定椎(LIV)位置、固定节段数等手术基本资料与术后PJK发生的相关性。采用多因素Logistic回归分析与术后PJK发生的独立危险因素。结果单因素分析结果显示,年龄、BMI、BMD、术前PJA、术前SVA、术前PI-LL、PLC损伤、UIV位置、LIV位置、固定节段数与术后PJK发生有一定的相关性(P均<0.05),而性别、吸烟史、致伤原因、合并症、损伤节段、ASIA分级、受伤至手术时间、术前PT、术前SS与术后PJK发生不相关(P均>0.05)。多因素Logistic回归分析结果表明,年龄≥70岁(OR=32.28,95%CI 3.83~272.29,P<0.01)、BMI>28.0 kg/m2(OR=7.88,95%CI 1.63~37.99,P<0.01)、BMD T值<-3.5 SD(OR=20.84,95%CI 2.36~183.93,P<0.01)、术前PI-LL>20°(OR=13.30,95%CI 1.54~113.87,P<0.05)及PLC损伤(OR=13.98,95%CI 1.37~142.34,P<0.05)与术后PJK发生显著相关。结论年龄≥70岁、BMI>28.0 kg/m2、BMD T值<-3.5 SD、术前PI-LL>20°及PLC损伤是老年Ⅳ型CSOTLF患者行后路长节段内固定术后PJK发生的独立危险因素。术中应重视软组织保护和脊柱矢状位平衡恢复,术后应注意控制体重及抗骨质疏松治疗。  相似文献   
4.
IntroductionDespite advancements in surgical techniques complications like implant failure is very common after the fixation of intertrochanteric fractures. Classifying these complex fractures based on plain radiographs underestimates the complexity of these fractures which in turn leads to complications. We propose a comprehensive classification of the intertrochanteric fractures based on 3D Non Contrast Computed Tomography (3D NCCT) scan.Material and methodsA total of 102 patients (51 males and 51 females) with intertrochanteric fractures were included in this study conducted over a time period of 22 months in a Tertiary care center in North India. NCCT proximal femur of the intertrochanteric fracture patients was done to formulate a new CT classification system and classify all fractures. Intra and inter-observer reliability was tested using kappa variance.ResultsNew classification system was proposed which included 3 main and a total of 6 groups. All the fractures were classifiable into the new system. Kappa variance of the study showed a good intra and interobserver reliability (0.95 and 0.90) proving clinical agreement of the classification.ConclusionThis new 3D-CT based classification has the advantages of being easy, comprehensible with high intra and inter-observer reliability. This 3DCT based classification can prove to be useful to detect occult intertrochanteric fractures undetectable in plain radiographs as well as choosing the optimum treatment plan.  相似文献   
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BackgroundCalcaneal fractures are among the most common foot injuries and sometimes develop manifold post-surgical complications. Restricted foot movement is one of the main functional limitations which often persists during long-term rehabilitation. Therefore, it is important to quantitatively monitor the biomechanical foot mobility after calcaneal fracture from an early stage in order to achieve an optimal therapeutic treatment.Research questionEvaluation of the Center of Pressure velocity (vCOP) in patients after intrarticular calcaneal fractures during the healing progress from three to 24 months after surgery.MethodsA total of 20 patients with unilateral calcaneal fracture were investigated by means of pedobarography and marker-based gait analysis at three, six, 12 and 24 months after surgery. Data for vCOP [m/s], maximum external dorsal extension moments during stance (DEmomentstance) and tibiotalar range of motion during mid stance (MS) and terminal stance (TS) were obtained. Functional evaluation was performed using clinical examination (e.g. calf circumference measurements) and patient-reported outcome measures (SF-36).ResultsWhen compared to the healthy side, vCOP of the injured side showed a significant reduction during MS (3 months: 48%, p < 0.001; 6 months: 13%; p = 0.040) and an significant increase during TS (3 months: 110%, p < 0.001; 6 months: 43%, p < 0.001; 12 months: 17%, p = 0.012). DEmomentstance of the fractured foot, showed a significant increase of 80% (p < 0.001) from three to 24 months after surgery, which correlated with vCOP at three and six months after surgery (p < 0.05; vCOP MS: 3 months: r = 0.876, 6 months: r = 0.685; vCOP TS: 3 months: r = −0.554, 6 months r = −0.626).SignificancevCOP might serve as an indicator for foot mobility and function during the early healing phase after calcaneal fractures. As vCOP can be obtained by pedobarography it is more readily accessible an less costly compared to foot function obtained by marker based gait analysis.  相似文献   
6.
李潆  李星  王金良 《全科护理》2022,20(1):59-61
目的:观察多味药多穴位贴敷治疗胸腰椎骨折病人术后便秘的效果。方法:选择2020年7月—2021年6月在郑州市骨科医院治疗的胸腰椎骨折病人92例。采用随机数字表法分为对照组和观察组各46例,对照组采用常规护理措施,观察组在常规护理基础上将多味药穴位贴敷贴于神阙穴、天枢穴、气海穴,疗程1周;评价两组病人治疗前后便秘症状和生活质量。结果:治疗后观察组病人便秘症状积分、便秘病人生活质量量表(PAC-QOL)总分及各维度得分明显低于对照组(P<0.05)。结论:多味药多穴位贴敷可以有效治疗胸腰椎骨折术后便秘,缓解病人的不适症状,改善负性情绪,提升病人的生活质量。  相似文献   
7.
目的:比较关节镜双后内入路与切开手术治疗急性单纯后交叉韧带胫骨止点撕脱骨折的疗效差异。方法:回顾性分析2016年6月至2020年6月经手术治疗的52例急性单纯性后交叉韧带胫骨止点撕脱骨折患者的临床资料,按手术方案不同分为两组,关节镜组27例患者行关节镜双后内入路手术治疗,其中男16例,女11例,年龄19~52(34.9±9.2)岁;切开复位组25例患者行膝关节后内侧切口手术治疗,其中男14例,女11例,年龄18~54(33.7±8.4)岁。观察并比较两组患者手术时间、切口长度、术中出血量、住院时间、住院费用、术后愈合情况、并发症以及术后12个月Lysholm、IKDC评分。结果:两组患者均顺利完成手术,无血管、神经损伤。52例均获得随访,时间6~24(15.0±1.7)个月。关节镜组手术时间、住院费用大于切开复位组(P<0.05);关节镜组术中出血量、切口长度、住院时间小于切开复位组(P<0.05);关节镜组和切开复位组术后12个月Lysholm评分分别为(95.9±1.7)分和(86.4±1.2)分,均较术前的(49.1±2.3)分和(48.9±1.1)分显著提高(P<0.05);关节镜组和切开复位组术后12个月IKDC总分分别为(96.9±1.5)分和(87.1±1.4)分,均较术前的(47.6±4.1)分和(48.1±3.9)分显著提高(P<0.05);关节镜组术后12个月膝关节Lysholm、IKDC评分均高于切开复位组(P<0.05)。结论:关节镜双后内入路治疗急性单纯后交叉韧带胫骨止点撕脱骨折,早期效果满意,疗效优于传统开放手术,具有创伤小、恢复快、操作简便等优点。  相似文献   
8.
目的:分析比较"F"形空心钉与传统倒三角3枚平行螺钉内固定治疗青壮年Pauwels Ⅲ型股骨颈骨折的临床疗效。方法:2017年1月至2020年1月收治Pauwels Ⅲ型股骨颈骨折患者38例,根据置入钉方式的不同将其分为两组,其中A组18例,采用"F"形空心钉固定,男12例,女6例,年龄37~55岁,受伤至手术时间1~3 d。B组20例,采用传统倒三角3枚平行拉力螺钉固定,男12例,女8例,年龄35~55岁,受伤至手术时间为1~3 d。比较两组患者骨折不愈合,股骨头坏死,股骨颈短缩,空心螺钉退出情况,髋关节功能Harris评分,疼痛视觉模拟评分(visual analogue scale,VAS)。结果:所有患者获得随访,时间为15~31个月。两组患者在骨折不愈合,股骨颈短缩,股骨头坏死方面差异无统计学意义(P>0.05);两组患者在螺钉退出方面差异有统计学意义(P<0.05)。两组患者术后12个月时髋关节Harris评分及VAS评分差异均无统计学差异(P>0.05)。结论:"F"形与传统倒三角3枚平行空心钉内固定治疗青壮年Pauwels Ⅲ型股骨颈骨折中短期疗效相似,但"F"形空心钉退钉率较低。  相似文献   
9.
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.  相似文献   
10.
BackgroundPeriprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations.MethodsA literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review.ResultsWe included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1).ConclusionIntraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture.Level of evidenceIV  相似文献   
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