伤害控制骨科学在脊柱损伤多发伤中的应用

"伤害控制骨科学"的理念源于伤害控制外科发展而来并且成功应用到四肢骨折的治疗上。伤害控制骨科学是一种稳定骨科损伤以使患者全身生理状态提高的方法。它的目的是避免由于"二次打击"造成患者病情恶化并且延迟确定性骨折修复直到患者全身情况达最佳状态。近来这个理念扩展到脊柱损伤合并严重损伤的患者中。本文综述了脊柱损伤多发伤手术时机、"伤害控制骨科学"应用的适应证、二次手术时机和微创技术的研究进展。     

脊髓型颈椎病的后路手术治疗

脊髓型颈椎病后路手术方法主要有椎板切除和椎板成形术,近年来各种改良的和新增的手术方法不断地得以设计和描述来进一步提高减压的安全性和有效性,同时出现了侧块钢板、椎弓根螺钉的应用。但每种手术都有其优缺点及各自的适应证和并发症。本文综述了手术方法及其优缺点、并发症及影响疗效的因素等研究进展。     

多发伤合并骨关节损伤79例救治体会

目的探讨多发伤合并骨折的处理办法。方法对79例多发伤伴骨折患者伤后及时按创伤控制骨科理论行多发伤救治及骨折手术。结果患者危及生命的危险因素及时得到处理,生命体征较早恢复正常,1例患者因严重脑挫裂伤死亡。1例患者内固定周围感染,经针对性治疗后愈合,其余患者的手术伤口Ⅰ期愈合。结论及时对多发伤伴骨折患者诊治,能减少并发症、提高救治率、降低伤残率。     

The effects of below-elbow immobilization on driving performance

IntroductionThere is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance.Methods20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1–10 analogue scoring).ResultsThe greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n = 6; p = 0.02) and left arm spica casts (n = 5; p = 0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2 ± 1.9; p < 0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5 ± 1.6; p > 0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization.ConclusionsDrivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity.     

带蒂腓骨移位修复胫骨股骨长段骨缺损

目的 总结修复胫骨上段,中段及股骨下段长段骨缺损的效果。方法 自１９７４年５月￣１９９７年８月应用四种带蒂腓骨局部移位术修复胫骨,股骨头段骨缺损２５例,其中胫骨上端良性骨肿瘤,瘤段切除后带蒂腓骨移位,膝关节融合９例,胫骨干良性长段骨肿瘤或瘤样病变者,截除后带肌蒂腓骨移位,行胫腓骨融合术９例,胫骨中下段广泛良性骨肿瘤或瘤样病变,截除后血管蒂腓骨向远端内侧移位,胫腓骨融合２例,股骨下端良性骨肿瘤,切除     

Fracture morphology of AO/OTA 31-A trochanteric fractures: A 3D CT study with an emphasis on coronal fragments

AimsThis study was designed to assess the incidence and morphology of coronal plane fragments in AO/OTA 31-A trochanteric fractures.Patients and methods156 cases of AO/OTA 31-A trochanteric fractures were retrospectively evaluated. Lateral radiographs were analyzed for the presence of coronal plane fragments followed by analysis of 3D CT reconstructions in these fractures. The incidence of coronal fragments identified on the lateral radiograph and 3D CT reconstructions were both calculated. Coronal fragment morphology was described based upon the origin and exit points of fracture lines and the number of fragments.Results and conclusionOn plain radiographs, a coronal plane fracture was identified in 59 cases, an incidence of 37.8% (59/156). In comparison, 3D CT reconstructions identified coronal plane fractures in 138 cases for an incidence of 88.4% (138/156). 3D CT reconstructions identified coronal fracture fragments in 81.9% (50/61) of AO/OTA 31-A1 cases, 94.5% (69/73) of 31-A2 cases, and 86.3% (19/22) of 31-A3 cases. Incidence of coronal fractures identified on plain radiographs of 3 AO/OTA 31-A1,A2,A3 groups was lower when compared to the incidence of coronal fractures identified on 3D CT. Of the 138 cases that had coronal plane fracture, 82 cases (59.4%) had a single coronal fragment (GT fragment 35 cases, GLT fragment 19 cases, GLPC fragment 28 cases). The remaining 56 cases (40.5%) had two coronal fragments. There is a high incidence of coronal fragments in intertrochanteric femur fractures when analyzed with 3D CT reconstructions. Our study suggests that these coronal fragments are difficult to identify on plain radiographs. Knowledge of the incidence and morphology of coronal fragments helps to avoid potential intraoperative pitfalls.     

Outcomes between older adults with atypical and typical femoral fractures are comparable

IntroductionAtypical femoral fractures (AFFs) are rare but a serious complication associated with prolonged use of bisphosphonates. However little is known about clinical outcomes of AFFs. The aim of this study is to compare the characteristics and postoperative outcomes between older patients with AFFs and typical femoral fractures (TFFs).MethodsA retrospective matched cohort study (each AFF was age- and sex-matched with three TFFs) of patients aged 65 years or older who were admitted to The Queen Elizabeth Hospital, South Australia between January 2011 and December 2013 was undertaken. Baseline characteristics of both groups were compared. The primary outcomes evaluated were level of independence in mobility at discharge and 3 months after surgery. Secondary outcomes included length of hospital stay, post-operative complications, rate of surgical revision, discharge destination (after acute hospital stay or rehabilitation), 28-day hospital readmission and 12-month mortality.ResultsTen patients (mean age: 78.1 years) with AFFs were compared with 30 matched TFFs. Patients with AFFs were predominantly female (90%) and 80% had been taking oral bisphosphonate. Nine of the AFFs had their fractures fixed with an intramedullary (IM) nail. The level of independent mobility at discharge (OR 0.31; 95%CI: 0.06–1.71; p = 0.26) and at 3 months (OR 0.51; 95%CI: 0.10–2.53; p = 0.47) were comparable between the two groups. Only one AFF patient treated with plate and screws required surgical revision, compared with none in the TFF group. Secondary outcomes were not significantly different between the two groups.ConclusionRecovery of mobility and reoperation rates after surgery of patients with AFFs were favourable and did not differ significantly from TFFs. Further consideration should be given to using IM fixation in the management of AFFs in older people.     

The outcomes of pediatric femoral shaft fractures treated surgically by different types of orthopedists

BackgroundThe objective of this study was to compare the outcomes of pediatric femoral shaft fractures treated with titanium elastic nail (TEN) by pediatric orthopedists and non-pediatric orthopedists.MethodsFrom May 2006 to June 2014, 88 children with femoral shaft fractures were randomized to operative stabilization either by pediatric orthopedists (Group A, 44 cases) or by non-pediatric orthopedists (Group B, 44 cases). Demographic data and clinical characteristics (age, sex, weight, fracture side and type, cause of injury, associated injuries and interval from injury to surgery) were comparable between the two groups before surgery. Peri-operative data, clinical and functional outcomes between the two groups were recorded.ResultsThe mean follow-up period was 20.9 ± 4.5 months for Group A and 20.0 ± 3.6 months for Group B (P = 0.356). There was no significant difference in the time to union, length of hospitalization, full weight-bearing time and TEN scores between the two groups (P = 0.785, P = 0.835, P = 0.803, P = 0.940, respectively). However, the mean operating time and radiation time was longer in Group B than in Group A (P = 0.001 and P = 0.047, respectively). Also, there was a trend for patients of Group B to have a higher rate of open reduction (P = 0.047). When comparing the total complications, no significant difference existed between the groups (P = 0.978).ConclusionsThis study indicated that both pediatric and non-pediatric orthopedists provided satisfactory clinical and functional results in treating these common injuries.     

Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Background:Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM).Each posterior technique has its own advantages and disadvantages.In the presen...     

椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂

目的：观察应用椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂的临床疗效。方法：自2002年6月以来．使用椎弓根钉-椎板钩系统治疗单纯腰椎峡部裂15例，均为男性，年龄19～36岁，平均27岁。L46例，L59例，均为双侧病变。所有患者均主诉明确的腰痛，持续6个月以上。术前腰痛疼痛评分（VAS）7．8分，采用后正中入路，暴露烈侧病灶，将峡部裂中的纤维瘢痕组织彻底清除，咬除骨残端硬化部分至出血为止，髂后上棘取骨行峡部裂局部植骨。安放病椎竹弓根螺钉及椎板钩，放置连杆后将同定系统锁紧。结果：术后疼痛症状明显缓解，VAS评分2．4分。随访12～26个月，峡部裂植骨均骨性愈合，末见骨不连及内同定断裂。结论：对于年轻的、单纯峡部裂患者可以采用椎弓根钉-椎板钩系统进行峡部修复，避免脊柱融合术：椎弓根钉-椎板钩系统是一种安全、有效的内同定装置。