髌骨横行骨折两种内固定方法比较

目的比较髌骨横行骨折采用克氏针张力带法与镍钛记忆合金髌骨爪法之疗效。方法2006-2012年共采用克氏针张力带法或镍钛记忆合金髌骨爪手术法治疗髌骨横行骨折77例,A组42例采用克氏针张力带治疗,B组35例采用镍钛记忆合金髌骨爪治疗,比较两组术后恢复情况。结果两组骨折愈合率、优良率均无明显差异(P >0.05)。结论克氏针张力带和镍钛记忆合金髌骨爪都是治疗髌骨横行骨折的有效方法,克氏针张力带治疗髌骨骨折具有费用低、手术简便、创伤小、并发症少等优点。     

人工关节置换术治疗老年股骨颈骨折疗效观察

目的探讨单极股骨头置换术（SHA）、双极股骨头置换术（BHA）与全髋关节置换术（THA）治疗老年股骨颈骨折的临床效果。方法2006年3月至2012年6月共收治老年股骨颈骨折患者95例,其中A组（SHA）24例,B组（BHA）39例,c组（THA）32例。观察三组围术期情况、髋关节功能及并发症。结果A、B组手术时间、术中出血量及术后引流量均显著少于c组（P〈0．05）;A组髋关节疼痛等并发症发生率高于B组及c组（P〈0．05）,B、C组间差异无统计学意义（P〉0．05）;三组患者术后一年髋关节Harris评分差异无统计学意义（P〉0．05）。结论三组患者均能获得良好的髋关节功能,A、B组手术时间短、术中、术后出血量少,B、C组并发症较少。双极人工股骨头是治疗老年股骨颈骨折患者的理想选择之     

Promoting lumbar spinal fusion by adenovirus-mediated bone morphogenetic protein-4 gene therapy

Objective: To determine whether an adenoviral construct containing bone morphogenetic protein-4(BMP-4) gene can be used for lumbar spinal fusion. Methods: Twelve New Zealand white rabbits were randomly divided into two groups, 8 in the experimental group and 4 in the control group. Recombinant, replication-defective type 5 adenovirus with the cytomegalovirus (CMV) promoter and BMP-4 gene (Ad-BMP-4) was used. Another adenovirus constructed with the CMV promoter andβ-galactosidase gene (Ad-β-gal) was used as control. Using collagen sponge as a carrier, Ad-BMP-4 (2.9×108 pfu/ml) was directly implanted on the surface of L5-L6 lamina in the experimental group, while Ad-β-gal was implanted simultaneously in the control group. X-ray was obtained at 3, 6, and 12 weeks postoperatively to observe new bone formation. When new bone formation was identified, CT scans and three-dimensional reconstruction were obtained. After that, the animals were killed and underwent histological inspection. Results: In 12 weeks after operation, new bone formation and fusion were observed on CT scans in the experimental group, without the evidence of ectopic calcification in the canal. Negative results were found in the control group. Histological analysis demonstrated endochondral bone formation at the operative site and fusion at early stage was testified. Conclusions: In vivo gene therapy using Ad-BMP-4 for lumbar posterolateral spinal fusion is practicable and effective.     

股骨粗隆间骨折不同固定方法疗效比较

目的 比较动力髋螺钉(DHS)、股骨近端髓内钉(Proximal femoral nail,PFN)和Gamma钉治疗股骨粗隆间骨折的疗效差别.方法 将我院在2006～2012年间收治的粗隆间骨折99例分为3组.A组28例,采用DHS治疗;B组34例,采用PFN或新改进的PFN (PFNA)治疗;C组37例,采用加长型Gamma钉治疗,对3组患者术中及术后恢复情况进行比较.结果 采用髋关节功能Harris评分系统评定,B、C组的优良率高于A组,差异有统计学意义(P＜0.05),B、C组之间差异无统计学意义.B、C组手术时间及术中出血量均少于A组(P＜0.05).结论 3种方法治疗股骨粗隆间骨折,Gamma钉、PFN疗效优于DHS.Gamma钉、PFN治疗股骨粗隆间骨折具有手术时间短、损伤小、出血少、固定牢靠、并发症少等特点,加长型Gamma钉能有效避免假体周围骨折,是老年股骨粗隆间骨折的理想内固定物.