PKP术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折的疗效分析

目的探讨经皮椎体后凸成形术（PKP）术中不同注入量高粘度骨水泥治疗骨质疏松性腰椎骨折（OLVF）的疗效及安全性。 方法前瞻性收集2016年9月至2018年9月本院OLVF患者150例，男84例，女66例，年龄（60±8）岁。依据随机数字表分为高量组、中量组、低量组，每组50例，高量组、中量组、低量组PKP术中高粘度骨水泥注入量分别为5.0~7.0 ml、3~4.9 ml、<3.0 ml，比较三组疗效及安全性。 结果150例患者获得满意随访，随访时间（19±7）个月。高量组、中量组、低量组手术时间、术中出血量比较，差异无统计学意义（P>0.05）；高量组和中量组术后3、6个月椎体前缘高度[（27.3±3.1）mm、（26.0±2.7）mm和（26.9±3.0）mm、（25.7±2.8）mm]明显高于低量组[（23.8±2.8）mm、（21.3±2.5）mm]，高量组和中量组术后3、6个月Cobb角及疼痛视觉模拟评分法（VAS）、Oswestry功能障碍指数问卷表（ODI）评分[（40.2±4.7）°、（41.5±4.8）°、（2.6±0.4）分、（1.6±0.3）分、（25.8±3.5）分、（26.9±3.5）分和（40.9±4.8）°、（42.1±4.8）°、（2.6±0.4）分、（1.6±0.3）分、（26.2±3.5）分、（27.2±3.7）分]明显低于低量组[（46.3±5.3）°、（47.8±5.6）°、（3.3±0.4）分、（2.3±0.4）分、（33.3±4.1）分、（34.3±4.2）分]，差异有统计学意义（F=25.371、18.914、29.334、22.457、34.276、30.217、29.364、20.071，均P<0.001）；高量组骨水泥渗漏率（28.00%）明显高于中量组和低量组（8.00%和4.00%），差异有统计学意义（χ²=10.241，P=0.005）。 结论PKP术中不同注入量高粘度骨水泥治疗OLVF的疗效及安全性存在一定的差异，其中注入中量（3~4.9 ml）高粘度骨水泥可获得良好的疗效及安全性，值得临床推广。     

续筋接骨方治疗骨折临床观察

目的研究续筋接骨方治疗骨折的临床疗效。方法选取2018年1月—2018年6月在辽宁中医药大学附属第三医院就诊的骨折患者60例,所有患者按照随机数字表法分为对照组与观察组,每组30例。观察组口服续筋接骨方联合正骨后小夹板固定治疗,对照组患者采用正骨后小夹板固定治疗。分析2组患者干预3个月后的血清骨代谢指标、骨密度、生活质量改善情况以及疗效判定。结果干预前,2组的血清Ⅰ型前胶原羧基端肽β特殊序列(β-CTX)、血清Ⅰ型前胶原氨端肽原(PINP)、骨特异性碱性磷酸酶(ALP)水平、钙、磷及骨密度比较,差异无统计学意义(P>0.05);干预后,2组的β-CTX、PINP、骨特异性ALP水平、钙、磷及骨密度较干预前改善,观察组的改善效果优于对照组,差异均有统计学意义(P<0.05)。干预前,2组的物质生活、社会功能、躯体健康以及心理健康评分比较,差异无统计学意义(P>0.05);干预后,2组的物质生活、社会功能、躯体健康以及心理健康评分较干预前升高,观察组的各项生活质量评分高于对照组,差异均有统计学意义(P<0.05)。观察组的治疗恢复率高于对照组,差异有统计学意义(P<0.05)。结论续筋接骨方可以改善骨折患者骨代谢功能及生活质量。     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

A comprehensive 3D CT based classification of intertrochanteric fracture

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.     

Isolated bilateral fibular insufficiency fractures: Case report of an unusual entity

Insufficiency fractures are a type of stress fractures that occur due to physiological stress on weakened bones. These have certain sites of predilection of which an uncommon site is fibular shaft. Isolated bilateral fibular fractures have previously only been reported twice, where the causes were repeated trauma and fatigue fracture. Insufficiency fractures of both fibula in isolation have not previously been reported. We present this case where a young patient presented with these fractures and was found to have vitamin D deficiency on subsequent investigations.     

手部多发掌骨骨折术后的功能康复指导疗效评价

目的探讨手部多发掌骨骨折患者术后进行功能康复指导的临床疗效。方法 92例手部多发掌骨骨折患者依据是否早期行康复治疗分成康复组(50例)与普通组(42例)。普通组采取常规治疗,康复组在普通组治疗基础上进行功能康复指导。对比两组治疗效果及并发症发生情况。结果康复组治疗总有效率为92.0%高于普通组的76.2%,差异有统计学意义(P<0.05)。康复组并发症发生率为8.0%低于普通组的23.8%,差异有统计学意义(P<0.05)。结论手部多发掌骨骨折患者术后尽早进行康复锻炼,可有效减少并发症发生,可最大程度的恢复手部功能,对提升患者生活质量,恢复正常生活作用显著,建议临床应用。     

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早期疗效对比

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。     

Selective fixation of the medial malleolus in unstable ankle fractures

BackgroundWhilst the lateral malleolus appears to be crucial in controlling anatomical reduction of the talus, the role of the medial malleolus is less clear. Medial sided complications including infection, damage to local structures and symptomatic hardware are not without morbidity. This study compares the outcomes of patients with bimalleolar or trimalleolar ankle fractures who underwent fibular nail stabilisation with or without medial malleolar fixation.MethodsFrom a prospective single-centre trauma database, we identified 342 patients over a nine-year period who underwent fibular nail insertion to stabilise a bimalleolar or trimalleolar ankle fracture. Isolated lateral malleolar fractures were excluded. Demographic data, clinical outcomes, radiographic evaluation, return to work and sport, and patient reported outcomes, including Olerud-Molander Ankle Score (OMAS), EuroQol-5D (EQ-5D) and Manchester-Oxford Foot Questionnaire (MOXFQ) were collected.ResultsThis study included 247 patients with a mean age of 66.7 years (range, 25–96 years), of whom 200 were female (81%). Medial malleolar fixation was not performed in 54 cases (22%). There was no significant difference between groups with respect to failure of fixation (p = 0.634) or loss of talar reduction (p = 0.157). No patient required surgery for a symptomatic medial malleolar non-union. Medial sided complications occurred in 32 (16%) of the fixation group, of whom 20 (10%) required further surgery. At a mean mid-term follow-up of 4.8 years (range, 8 months – 9 years) there was no significant difference between the non-fixation and fixation groups with respect to the median OMAS (85 vs 80; p = 0.885) or median EQ-5D (0.80 vs 0.81; p = 0.846). Patient satisfaction was not significantly different between the two groups (85/100 vs 87/100; p = 0.410).ConclusionNon-operative management of the medial malleolar component of an unstable ankle fracture treated with a fibular nail may reduce the rate of post-operative complications without compromising the patient reported outcome.     

极易误诊为胫骨平台外侧撕脱性骨折1例

<正>患者,男,58岁,主因左膝部肿痛伴活动不利2 d于2016年7月10日入院。患者2 d前不慎摔倒致左膝部内翻及内旋,出现左膝部肿痛伴活动不利,当时无胸闷气急,无恶心呕吐,无头痛头晕。随即由家人送至当地医院诊治,拍摄X线片示左胫骨平台外侧撕脱性骨折,予以患肢过膝长腿石膏固定。为求进一步治疗,转入我院就诊,门诊以"左胫骨平台外侧撕脱性骨折"收住院。患者既往体健,无高血压、糖     

Ipsilateral proximal and distal radius fractures with unstable elbow joint: Which should we address first?

Simultaneous ipsilateral fractures involving radial head and distal end of radius are uncommon. We present our thoughts on which fracture should be addressed first. A 68-year-old lady sustained an ipsilateral fracture of the right radial head and distal end of radius following a fall. Clinically her right elbow was posteriorly dislocated and right wrist was deformed. Plain radiographs showed an intraarticular fracture of the distal end of radius and a comminution radial head fracture with a proximally migrated radius. Magnetic resonance imaging (MRI) showed no significant ligament injuries. We addressed her distal radius first with an anatomical locking plate followed by her radial head with a radial head replacement. Our rationale to treat the distal end radius: first was to obtain a correct alignment of Lister's tubercle and correct the distal radius height. Lister's tubercle was used to guide for the correct rotation of the radial head prosthesis. Correcting the distal end fracture radial height helped us with length selection of the radial head prosthesis and address the proximally migrated radial shaft and neck. Postoperative radiographs showed an acceptable reduction. The Cooney score was 75 at 3 months postoperatively, which was equivalent to a fair functional outcome.