老年骨质疏松性股骨粗隆间骨折的综合治疗

目的: 观察手术联合抗骨质疏松药物治疗老年骨质疏松性股骨粗隆间骨折的临床疗效及并发症。方法: 手术治疗的老年骨质疏松性股骨粗隆间骨折126例。其中常规治疗组56例,鹅头钉固定30例,Richard钉固定24例,Proximal femoral nail (PFN)钉固定2例,手术后按一般外伤性骨折处理;综合治疗组70例,鹅头钉固定14例,Richard钉固定54例,PFN固定2例,术前及术后给予降钙素、α-VitD₃及钙剂等抗骨质疏松药物、个性化康复、选择性制动的联合治疗。结果: 术后随访6个月~4年。常规治疗组近期出现钉切割、骨折再移位6例,远期1例。综合治疗组近期及远期均无并发症发生。两组差异有统计学意义(P<0.01)。结论: 老年骨质疏松性股骨粗隆间骨折围手术期加强抗骨质疏松药物治疗、个性化康复、选择性制动能够有效的防治骨质疏松,提高骨折愈合率及减少并发症。

Comprehensive treatment for osteoporotic intertrochanteric fracture in aged

Objective: This study was designed to characterize the ultrastructure of the coccoid Helicobacter pylori(H. pylori) forms in the tissues of carcinoma.Methods: Transmission electron microscopy(TEM) technique was used to examine the structure of coccoid H. pylori in 4 cases of gastric carcinoma and 2 cases of esophageal carcinoma.Results: It was found that the coccoid H. pylori were scattered in cancer nest and cancer interspace,some of which enterded cancer cells,macrophages and other cells.The coccoid H. pylori appeared to be similar to the L-forms of other bacteria with varying cell shape and size,different cytoplasmic electron densities and defects in cell wall.Two types of coccoid H. pylori could be distinguished in the tissues of carcinoma by TEM.Type A was smaller with higher electron density in the cytoplasma,and flagellation on the cell membrane,suggesting that it could be viable.However,the type B was larger with lower electron density in the cytoplasma,and no flagellation on the cell membrane,suggesting that it could be a degenerative form.Conclusions: The coccoid forms of H.pulori still have certain degree of viability,thus they may play an important role in the transmission of H. pylori,the relapse of H. pylori related disease after treatment and the development of the related carcinoma.