颈前入路对短节段后纵韧带骨化症的短期疗效及神经功能恢复的影响

目的:探讨颈前入路对短节段后纵韧带骨化症(OPLL)的短期疗效及神经功能恢复的作用分析.方法:选择2010年5月至2017年5月我院接诊的60例短节段后纵韧带骨化症患者,随机分为观察组和对照组各30例,观察组给予颈前入路手术治疗,对照组给予后路手术治疗.对比两组临床疗效、手术时间、术中出血量、术后并发症、日本骨科协会评估治疗分数(JOA评分)、神经功能恢复率、脊髓压迫率.结果:术后,观察组临床疗效明显比对照组高(P<0.05);术中,观察组手术时间和术中出血量均比对照组低(P<0.05),观察组术后并发症明显比对照组低(P<0.05);术后,观察组JOA评分、神经功能恢复率、脊髓压迫率均比对照组高(P<0.05).结论:颈前入路手术在OPLL中治疗效果显著,可有效调节患者术后JOA评分、神经功能恢复率、脊髓压迫率的表达,减少并发症的出现,安全性高,值得应用推广.     

微创经皮与传统开放椎弓根螺钉置入固定胸腰椎骨折的文献荟萃

BACKGROUND: Open reduction pedicle screw fixation for thoracolumbar fracture could obtain satisfactory effects, and has been extensively used. However, it has potential risk during and after repair. Minimally invasive percutaneous pedicle screw technique minimizes the trauma and complications of soft tissue. It remains poorly understood which is better minimally invasive percutaneous or conventional open pedicle screw fixation for the repair of thoracolumbar fracture. OBJECTIVE: To perform quality evaluation and meta-analysis on curative effect and postoperative complications of minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures. METHODS: A detailed search of several electronic databases, including Cochrane Library, PubMed, WanFang, CNKI, VIP and CBM, was undertaken. Simultaneously, Chinese Journal of Orthopaedics, Chinese Journal of Orthopaedic Trauma, and Chinese Journal of Trauma were checked by hand to identify controlled trials regarding minimally invasive percutaneous and conventional open pedicle screw fixation in the treatment of thoracolumbar fractures published from inception to 2015, and the references of the included studies were checked. According to inclusion and exclusion criteria, references were screened, data were extracted and quality was evaluated by four investigators independently. Meta-analysis was conducted using RevMan 5.2 software. The quality of references of the included controlled trials was assessed with CONSORT statement and some surgery clinical evaluation indexes. RESULTS AND CONCLUSION: We included 28 studies, including 25 randomized controlled trials/quasi-randomized controlled trials and 3 retrospective comparative studies, with 1 285 patients. Meta-analysis results demonstrated that compared with the conventional open pedicle screw, minimally invasive percutaneous pedicle screw fixation could significantly reduce operation time, blood loss, hospital stays, postoperative complication rate and height loss (P < 0.05). No significant difference in postoperative pain grade was detected between them (P > 0.05). These results indicate that minimally invasive percutaneous pedicle screw fixation for thoracolumbar fracture was safe and reliable, had small trauma, less blood loss, rapid recovery, short hospital stay, and less postoperative complications. Nevertheless, methods and results of most studies are not detailed enough. We suggested reporting randomized controlled trials according to related standards in order to improve the report quality and authenticity of randomized controlled trials.       

玻璃酸钠与臭氧注射辅助踝关节牵开成形术对踝关节创伤性关节炎疗效及骨代谢的影响

目的:探索玻璃酸钠与臭氧注射辅助踝关节牵开成形术对踝关节创伤性关节炎的疗效及骨代谢的影响。方法:选取2011年11月至2016年11月的踝关节创伤性关节炎患者作为研究对象,共选取60例,按照随机数字表法将入组者随机分配至A组、B组及C组,每组各20例。三组患者均给予踝关节牵开成形术治疗,在此基础上,A组给予玻璃酸钠腔内注射,B组给予医用臭氧腔内注射,C组给予玻璃酸钠与医用臭氧联合腔内注射,测定并比较三组患者治疗前及治疗后1个月骨代谢指标血清骨钙素（BGP）、Ⅰ型胶原氨基末端延长肽（PINP）、Ⅰ型胶原交联羧基末端肽（CTX-Ⅰ）及抗酒石酸盐酸性磷酸酶（TRAP）水平,踝-后足指数评分（AOFAS）,并随访患者治疗情况。结果:治疗后1个月,三个组血清BGP及PINP增高,血清CTX-Ⅰ及TRAP降低,且C组血清BGP及PINP高于A组与B组（P<0.05）,血清CTX-Ⅰ及TRAP低于A组与B组（P<0.05）;三个组AOFAS均增高（P<0.05）,且C组各时间点AOFAS高于A组与B组（P<0.05）。结论:玻璃酸钠与臭氧注射辅助踝关节牵开成形术对踝关节创伤性关节炎进行治疗,可下调炎性因子和氧化应激因子的表达,优化机体骨代谢,缓解疼痛症状,并改善踝关节功能,安全可靠,值得临床推广应用。     

胫骨远端前外侧切口L-解剖锁定板治疗B_3、C型Pilon骨折

目的探讨胫骨远端前外侧切口L-解剖锁定板固定治疗B3、C型Pilon骨折的疗效。方法应用胫骨远端前外侧切口L-解剖锁定板固定延期(伤后9~19 d)治疗36例B3、C型Pilon骨折患者。伤后早期石膏固定6例,骨牵引11例,腓骨克氏针联合石膏固定11例,跨关节外固定支架固定8例。结果患者均获得随访,时间8~43个月。术后2例出现医源性腓浅神经麻痹,1例闭合骨折出现伤口感染,2例骨折延迟愈合。Olerud-Molander踝关节骨折功能评分:优20例,良11例,可5例,优良率86.1%。SMFA问卷得分0~39(24.7±8.2)分。结论选择胫骨远端前外侧切口解剖复位、L-解剖锁定板坚强固定治疗B3、C型Pilon骨折可获得满意的临床疗效。