复位内固定术与关节融合术治疗Lisfranc关节急性损伤的疗效比较

目的:评价复位内固定术与关节融合术治疗Lisfranc关节急性损伤的疗效比较。方法:自2006年1月至2012年6月,按照纳入及排除标准选取35例患者纳入研究,复位内固定组(RIF组)17例,关节融合组(JF组)18例,随访均超过2年。采用VAS、AOFAS调查问卷方法进行疗效评估,采用X线片进行影像学评估足关节炎、复位、骨愈合等情况。结果:35例患者均获得门诊随访,平均随访27.5个月(25~35个月),与RIF组患者比较,JF组患者在术后3、6、12、24个月的VAS评分均有明显降低,在术后6、12、24个月的AOFAS评分均有明显增加(P<0.05)。两组患者在满意度比较,JR组满意度优良率高达94%,RIF组满意度仅达65%,5例(29%)患者行关节融合治疗。结论:Lisfranc关节急性损伤患者一期行关节融合术的疗效确切,尤其适用于Lisfranc关节内侧柱及中柱严重骨折脱位或单纯韧带损伤患者,具有并发症发生率低、满意度高等优势,是治疗Lisfranc关节损伤安全、有效的手术方式。     

可吸收螺钉治疗桡骨小头骨折

<正>桡骨小头对肘关节的稳定和旋转有较大影响,桡骨小头切除术存在诸多远期并发症,如疼痛、肘关节不稳下尺桡关节半脱位、患肢力量减弱等。2006年3月至2009年6月我院采用可吸收螺钉资料13     

32例地震所致挤压综合征患者的急救与护理

目的 探讨在地震灾害中对挤压综合征患者进行观察、急救与护理的方法.方法 对5·12汶川大地震中收住我院的32例挤压综合征患者进行观察、急救和护理,并对护理效果进行分析.结果 32例患者中有1例死亡;24例行血液透析治疗,实验室指标恢复;21例行筋膜切开减压保肢成功,5例行二期截肢术.结论 在地震灾害中对挤压伤患者及时、准确的观察并给予正确的救治和护理,可以有效地降低病死率和致残率.     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

四川汶川地震伤情统计与分析

目的研究四川汶川地震所致伤员的伤情特点和规律。方法对我院收治患者进行登记，采用国际疾病分类方法（ICD-10）统计、分析其损伤的外部因素、疾病分类及构成情况。结果本组患者主要损伤外部原因为被物体击中和被物体挤压。疾病构成前5位为：胫腓骨骨折158例（13．37％），骨盆骨折122例（10．32％），脊柱骨折120例（10．15％），股骨骨折109例（9．22％），前臂骨折／脱位106例（8．97％）。结论深入研究地震所致伤员的伤情特点，对合理使用、调配医疗资源，更好地为灾民提供医疗服务有重要的指导意义。     

急诊手术治疗高龄患者股骨粗隆间骨折

目的:评价急诊手术治疗高龄股骨粗隆间骨折的临床价值。方法:研究方法为回顾性分析。排除年龄小于70岁、陈旧性骨折、病理性骨折、多发创伤、入院时明显内科合并症患者。将2006年3月至2012年3月绵阳市中心医院收治的70岁以上高龄股骨粗隆间骨折患者127例(男38例,女89例)纳入研究。按是否采取急诊手术分为两组:急诊手术组56例,伤后24h内行手术治疗;非急诊手术组71例,入院24h后行手术治疗。回顾性调查内容:①住院期并发症,包括电解质紊乱、隐性失血、谵妄、深静脉血栓形成、上消化道出血、肺部感染、尿路感染、心脑血管意外、褥疮。②预后,包括住院期死亡例数、随访1年死亡例数、住院时间、骨折愈合时间及髋关节功能评分。结果:急诊手术组主要住院并发症依次为隐性失血、谵妄、肺部感染、电解质紊乱、尿路感染;非急诊手术组主要住院并发症依次为隐性失血、肺部感染、电解质紊乱、谵妄、褥疮。急诊手术组无住院期死亡病例,随访1年死亡1例;非急诊手术组住院期死亡4例,随访1年死亡7例。急诊手术组平均住院时间(9±3)d,低于非急诊手术组平均住院时间(17±8)d。骨折愈合时间平均为(12±2)周。电解质紊乱、谵妄、深静脉血栓形成、肺部感染、尿路感染、褥疮、住院期死亡人数、随访1年死亡人数、住院时间两组间差异均有统计学意义。隐性失血、上消化道出血、心脑血管意外、骨折愈合时间、髋关节功能方面两组间差异均无统计学意义。结论:高龄患者股骨粗隆间骨折伤后24h内的急诊手术可减少住院期间并发症,缩短住院时间,降低死亡风险。     

单侧椎板开窗髓核摘除术治疗中央型椎间盘突出症

[目的]探讨单侧椎板间开窗髓核摘除术治疗中央型腰椎间盘突出症适应证及疗效. [方法]对自2004年1月～2006年12月收治66例确诊中央型腰椎闻盘突出症患者行单侧椎板问开窗髓核摘除术. [结果]全部病例得到3～36个月随访(平均17个月).疗效按照NaKai评定标准,其中优48例,良13例,可4例,差1例.优良率92.4%.疗效差1例分析原因可能因为术中过度牵拉神经根所致,予以卧床休患2周,并加用激素、神经营养药物等,2周后缓解.本组病例无意外损伤及感染等病例发生. [结论]单侧椎板间开窗髓核摘除术是治疗中央型腰椎间盘突出症有效方法,临床效果满意.     

Gamma钉治疗老年人股骨粗隆间骨折的临床分析

资料与方法一、一般资料：40例中男性12例,女性28例。年龄54～80岁,平均年龄74岁。左侧30例,右侧10例。按Evan分类：一类Ⅱ°18例,Ⅲ°10例,Ⅳ°12例为不稳定型骨折。受伤原因：不慎平地跌倒28例,机动车撞到lO例,非机动车撞到2例。均有基础疾病,心肌劳损25例,高血压20例。     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

股骨近端防旋髓内钉急诊治疗高龄股骨转子间骨折

目的探讨股骨近端防旋髓内钉(PFNA)急诊治疗高龄股骨转子间骨折患者的临床疗效。方法对29例80岁以上股骨转子间骨折患者在伤后24 h内急诊行PFNA固定治疗。结果术中失血量45～120(82±39)ml,手术时间35～76(53±19)min。1例术中发生医源性股骨干近段骨折,改用加长型PFNA固定。输血治疗26例,输血量150～330(247±71)ml。术后发生谵妄7例,深静脉血栓1例,上消化道出血1例。患者均获随访,时间4～36个月。骨折愈合时间12.9～25(15.6±6.4)周。疗效采用Sanders评分:优23例,良4例,差2例。结论 PFNA急诊治疗高龄股骨转子间骨折患者安全有效。