经伤椎单双侧置钉与不置钉治疗胸腰段骨折的疗效比较

目的比较后路短节段经伤椎单双侧置钉与不置钉治疗胸腰段椎体骨折的临床疗效。方法采用回顾性分析的方法,自 2017年 1—12月,安徽医科大学附属六安医院采用后路短节段椎弓根钉内固定术治疗胸腰段单一椎体骨折病人 98例。根据伤椎置钉多少分为三组:跨伤椎置钉组( A组) 32例,单侧伤椎置钉组( B组) 28例,双侧伤椎置钉组( C组) 38例,随访时间范围为 12~20个月,平均 16.2个月,对三组病人的术中、术后及末次随访相关指标进行比较。结果三组病人的手术时间［A组(88.00±11.75)min,B组( 87.63±11.85)min,C组( 89.97±11.28)min,F＝0.405］、术中出血量［A组( 107.81±16.09)mL,B组(111.72±20.02)mL,C组( 113.43±19.18)mL,F＝0.825］、术后疼痛视觉模拟评分( VAS)［A组( 3.19±0.93)分, B组( 3.36±0.83)分, C组(3.34±0.77)分, F＝0.383］、术后第 3天的伤椎前缘高度比［A组(96.07±2.23)%,B组(96.79±2.90)%,C组( 96.75±3.76)%,F＝0.545］及矢状位 Cobb角［A组( 5.07±1.95)°,B组( 4.40±1.34)°,C组( 4.29±1.66)°,F＝2.060］比较均差异无统计学意义( P＞0.05)。末次随访时, B、C组病人的伤椎前缘高度比［A组( 92.79±1.97)%,B组( 94.12±2.00)%,C组( 95.00±1.70)%,F＝12.079］、矢状位 Cobb角［A组( 7.77±1.87)°,B组( 6.47±1.54)°,C组( 6.38±1.58)°,F＝7.046］、伤椎复位丢失情况［高度丢失: A组( 3.01±1.18)%,B组( 2.26±0.87)%,C组( 1.83±0.60)%,F＝15.175;角度丢失: A组(2.68±1.06)°,B组( 2.07±0.85)°,C组(2.11±0.86)°,F＝4.349］与A组病人相比差异有统计学意义( P＜0.05),B组与 C组病人相比差异无统计学意义( P＞0.05)。结论经伤椎置钉与传统的跨伤椎置钉相比在治疗胸腰段椎体骨折上能更有效的降低后期复位椎体高度的丢失和减少迟发型后凸畸形的发生;单侧置钉与双侧置钉疗效相似。     

全膝关节初次单侧表面置换与双侧同时置换术后并发症的比较分析

Objective To compare postoperative complications in patients firstly undergoing primary unilateral total knee arthroplasty (UTAK) and simultaneous bilateral total knee arthroplasty (SBTKA) .Methods From November 2006 to November 2009, 339 patients underwent primary UTAK and SBTKA in our hospital and followed up. The UTKA group had 178 patients (50 men and 128 women) who were aged from 26 to 81 years (mean, 64. 2 years) and a mean American Knee Society Score (KSS) of 34. 0 ± 13. 3points before surgery. The SBTKA group had 161 patients (32 men and 129 women) who were aged from 34 to 80 years (mean, 65. 3 years) and a mean KSS of 33. 4 ± 11. 1 points before surgery. The postoperative complications were compared between the 2 groups and clinical outcomes were evaluated according to KSS system. Results The patients were followed for 18. 4 months on average (range, 3 months to 3 years) . The incidence of postoperative complications was 6. 2% (11/178) in the UTKA group and 4. 3% (7/161) in the SBTKA group, with no significant difference (x2 =0. 564, P = 0. 453) . The KSS score at the final follow-up was all increased in both groups. It was 92. 5 ± 10. 6 in the UTKA group and 91. 9 ± 11. 1 in the SBTKA group, with no significant difference (t =0.511, P = 0.610). Conclusions SBTKA is not an independent risk factor for postoperative complications. Careful operative preparation and assessment, good surgical skills, comprehensive postoperative monitoring and supporting management, and proper rehabilitation can significantly reduce complications following SBTKA. But for a patient who has been complicated with multiple internal diseases, SBTKA decision should not be made before a careful tolerance assessment of the patient.     

徒手牵引复位股骨近端防旋髓内钉治疗股骨转子间骨折

目的探讨徒手牵引复位股骨近端防旋髓内钉(PFNA)固定股骨转子间骨折的手术技巧及可行性。方法采用徒手牵引复位PFNA固定治疗37例股骨转子间骨折患者。术后3 d采用Baumgaertner改良法评价骨折复位质量,术后1年采用Harris评分评估髋关节功能。结果手术时间40～100 min,术中失血量100～300 ml。术后3 d骨折复位质量评价:优21例,良14例,差2例。29例患者获得随访,时间15～36个月。术后1年髋关节功能评价:优9例,良13例,可4例,差3例,优良率22/29。结论徒手牵引复位PFNA固定股骨转子间骨折在掌握手术技巧的前提下具有可行性。     

石韦散合八正散加减治疗泌尿系结石临床分析

目的：探讨中药治疗泌尿系结石患者治疗效果。方法：采取中药古方石韦散合八正散加减治疗的方法,对收治的30例泌尿系结石患者进行治疗。结果：采用石韦散合八正散加减治疗泌尿系结石的方法,对收治的泌尿系结石患者30例,其中治愈20例,总治愈率73％。结论：中药古方石韦散合八正散加减对于泌尿系结石的治疗疗效显著,值得临床应用。     

后内侧切口T形钢板治疗胫骨平台后内侧骨折

[目的]探讨后内侧切口T形钢板治疗胫骨平台后内侧骨折的手术技巧及疗效。[方法]2013年6月~2016年11月共收治23例胫骨平台后内侧骨折患者,7例为单纯后内侧骨折,16例为合并后内侧骨折的平台双髁骨折患者。对内侧平台骨折均采用后内侧切口显露,3.5 mm系统或4.5 mm系统T形钢板固定,合并外侧平台骨折的患者另取前外侧切口显露,双钢板固定。术后1年采用美国特种外科医院(HSS)膝关节评分系统评价膝关节功能。[结果]23例患者均获随访,随访时间12~30个月,平均21个月。所有患者骨折均愈合,无内固定松动及断裂发生。术后骨折复位质量Rasmussen放射学评分优8例,良10例,可5例,优良率78%。术后1年膝关节屈曲活动范围100°~130°,HSS评分65~96分,优9例,良10例,中4例,优良率83%。[结论]胫骨后内侧切口结合T形钢板能较好的复位固定胫骨平台后内侧骨折,术后膝关节功能恢复良好。     

后外侧结构重建对后外侧入路全髋关节置换术后早期脱位的影响

目的 探讨后外侧结构重建对后外侧入路全髋关节置换术（total hip arthroplasty, THA）后早期脱位的影响。方法 回顾性分析2015年1月至2018年1月于我院行后外侧入路初次THA的病人120例，根据术中是否修补关节囊及外旋肌群将病人分为两组：观察组60例，舌形切开关节囊，术中将关节囊及外旋肌群原位缝合在大转子后方及臀中肌肌腱附着处；对照组60例，切除后关节囊，术中未进行外旋肌群修补重建。术后3个月内发生的脱位定义为早期脱位，比较两种方法对术后早期脱位率的影响。记录并比较两组病人的手术时间、术腔引流量、髋关节Harris评分。结果 观察组手术时间为（51.6±9.5） min，对照组为（45.1±7.5） min，对照组手术时间短于观察组，差异有统计学意义（t=2.008，P=0.036）。观察组术腔引流量为（129.6±11.9） ml，对照组为（136.8±12.4） ml，差异无统计学意义（t=1.187，P=0.269）。观察组未发现早期脱位，对照组早期脱位4例（4/60，脱位率为6.667%），观察组术后Harris评分为（86.1±5.0）分，对照组为（85.9±5.5）分，差异无统计学意义（t=1.416，P=0.092）。结论 在后外侧入路THA过程中行后外侧结构重建的手术方式早期脱位率低，修补关节囊及外旋肌群对维持髋关节软组织平衡有一定意义。     

全膝关节初次单侧表面置换与双侧同时置换术后并发症的比较分析

目的 比较全膝关节初次单侧表面置换与双侧同时置换术后并发症的发生情况.方法对2006年11月至2009年11月收治且获得随访的339例初次行全膝关节表面置换患者的资料进行回顾性分析,根据是否行双膝关节表面置换分为两组:单膝置换组(行单侧膝关节表面置换)178例,男50例,女128例;平均年龄64.2岁(26～81岁);术前美国膝关节协会(KSS)评分平均为(34.0±13.3)分.双膝置换组(行双侧膝关节表面置换)161例,男32例,女129例;平均年龄65.3岁(34～80岁);术前KSS评分平均为(33.4±11.1)分.比较两组患者术后并发症的发生情况,并采用KSS评分评定临床疗效.结果 339例患者术后获3个月至3年(平均18.4个月)随访.单膝置换组术后并发症发生率为6.2%(11/178),双膝置换组术后并发症发生率为4.3%(7/161),两组比较差异无统计学意义(x2=0.564,P=0.453).末次随访时单膝置换组KSS评分平均为(92.5±10.6)分,双膝置换组平均为(91.9±11.1)分,两组比较差异无统计学意义(t=0.511,P=0.610).结论双膝关节置换与单膝关节置换术后并发症发生率无明显差异.术前充分准备、较好的手术技术、完善的术后监测和支持治疗及合理的康复训练,可以降低一期舣膝关节置换术后并发症的发生率;但对于术前合并多种内科疾病的患者,应认真评估手术耐受性后再进行抉择.

Abstract：

Objective To compare postoperative complications in patients firstly undergoing primary unilateral total knee arthroplasty (UTAK) and simultaneous bilateral total knee arthroplasty (SBTKA) .Methods From November 2006 to November 2009, 339 patients underwent primary UTAK and SBTKA in our hospital and followed up. The UTKA group had 178 patients (50 men and 128 women) who were aged from 26 to 81 years (mean, 64. 2 years) and a mean American Knee Society Score (KSS) of 34. 0 ± 13. 3points before surgery. The SBTKA group had 161 patients (32 men and 129 women) who were aged from 34 to 80 years (mean, 65. 3 years) and a mean KSS of 33. 4 ± 11. 1 points before surgery. The postoperative complications were compared between the 2 groups and clinical outcomes were evaluated according to KSS system. Results The patients were followed for 18. 4 months on average (range, 3 months to 3 years) . The incidence of postoperative complications was 6. 2% (11/178) in the UTKA group and 4. 3% (7/161) in the SBTKA group, with no significant difference (x2 =0. 564, P = 0. 453) . The KSS score at the final follow-up was all increased in both groups. It was 92. 5 ± 10. 6 in the UTKA group and 91. 9 ± 11. 1 in the SBTKA group, with no significant difference (t =0.511, P = 0.610). Conclusions SBTKA is not an independent risk factor for postoperative complications. Careful operative preparation and assessment, good surgical skills, comprehensive postoperative monitoring and supporting management, and proper rehabilitation can significantly reduce complications following SBTKA. But for a patient who has been complicated with multiple internal diseases, SBTKA decision should not be made before a careful tolerance assessment of the patient.