汶川地震现场超声诊断长骨骨折及指导手法复位的实际应用

目的探讨便携式超声在应急事件中诊断长骨骨折、指导手法复位的应用价值。方法应用便携式超声现场诊断汶川地震48例长骨骨折患者,在受伤现场指导手法复位。结果48例长骨骨干骨折超声诊断为横形骨折18例、斜形骨折25例、粉碎性骨折5例,均与X线片诊断一致,超声引导骨折手法复位优良29例（60．4％）,尚可17例（35．4％）,差2例（4．2％）。48例均未加重损伤或造成继发性损伤。结论便携式超声在应急事件现场诊断长骨骨折、指导手法复位,可避免再次损伤、减少并发症和病死率。     

高频超声在小儿胫腓骨骨折中的应用

目的探讨高频超声在胫骨、腓骨骨折筛查、诊断过程中动态观察与效果评估的应用价值。方法利用高频超声技术对临床怀疑胫腓骨骨折的小儿进行筛查,如超声显示骨皮质连续性中断,低回声区或无回声区等异常声像,则诊断为胫腓骨骨折。以X线为诊断标准,进行对比。结果胫腓骨近端骨折3例,中段骨折12例,远端骨折（外髁部）15例。针对X线检查,阳性27例,阳性率90.0%;阴性3例,阴性率10.0%。超声下局部组织表面不完整、光滑,骨折组织不同程度肿胀,无骨组织错位。结论高频超声技术对小儿胫腓骨骨折的诊断安全可靠,损害低于X线,值得在小儿骨折诊断中应用。     

高频超声与X线在肋骨骨折诊断中的对比分析

目的探讨高频超声与X线在轻微肋骨骨折诊断中的应用价值。方法回顾性分析54例肋骨骨折的高频超声及X线检查特点,对比超声及X线检查方法的表现及检出率。结果 54例患者经高频超声初次检查均已发现有肋骨骨折及软组织损伤情况,检出率为100%;其中骨折断端错位在3mm以上者有22例,经X线初诊时检出19例,诊断符合率86%;骨折断端错位在3mm以内的轻微骨折患者有32例,经X线初次检出15例,检出率为47%(P<0.01),有统计学意义。高频超声能检出X线检查不能显示的轻微肋骨骨折。结论高频超声检查对轻微肋骨骨折较X线检查优胜,可作为轻微肋骨骨折的常规检查方法。     

高频超声与X线对照在肋骨骨折诊断中的应用价值

目的探讨高频超声与X线对照在肋骨骨折诊断中的应用价值。方法分别采用高频线阵探头和X线胸片对30例肋骨骨折患者进行检查并分析其结果,总结其应用价值。结果 B超检查均显示有肋骨骨折改变,诊断确诊率100%;X线检查只有9例显示骨折,诊断确诊率30%,假设检验表明B超诊断确诊率远高于X线(χ2=32.31,P<0.01)。结论高频超声诊断肋骨骨折临床价值明显优于传统的X线胸片,可动态观察,是诊断轻微肋骨骨折的重要检查手段,有利于临床医师对疾病的及时诊治,应将其作为肋骨骨折尤其是X线不易查出的肋骨骨折的首选检查方法。     

单臂外固定支架在B超引导定位下治疗肢体骨骨折中的临床应用

目的：用超声取代X线引导单臂多功能外固定架治疗肢体骨骨折的临床应用。方法：根据骨折的部位和类型选择“一”型或“T”型外固定支架。术中用B超了解骨折断端情况并观察骨折复位时的对位、对线情况，为单臂外固定支架进行位置定位，然后进行常规的手术操作。结果：本组48例外固定支架的固定针位位置及深度适宜。28例为解剖复位，12例为近解剖复位，6例为功能复位、2例复位较差，后改为切开复位内固定复位，其复位率达95．38％。结论：单臂外固定支架在超声引导定位下对治疗肢体骨骨折，具有广泛的应用前景。     

超声引导下对四肢长、短骨骨折断端麻醉及手法复位的临床意义

目的探讨超声引导下对四肢长、短骨骨折断端麻醉以及手术复位的临床作用。方法本研究选取2012年6月至2014年6月我院接收治疗的39例闭合性四肢长、短骨折患者,通过超声引导下对四肢长、短骨骨折断端麻醉以及手法复位。结果所有患者中优良者25例、占总患者的64.10%,基本满意者有11例,占28.20%,基本未恢复者3例,占7.69%。结论超声能清晰显示骨折的部位以及骨折错位的距离及畸形的角度,并且在超声引导下可反复多次观察,提高了手法的针对性,克服了在X线监视下需经常改变肢体位置的诸多不便,并且无辐射性,值得临床推广。     

小凸阵与高频线阵双探头联合超声扫查在小儿颅内出血诊断中的应用

目的:评价在颅脑超声检查中,联合应用小凸阵与高频线阵双探头诊断小儿颅内出血(ICH)的临床价值。方法:选择某院2015年11月~2017年2月73例疑似ICH患儿,利用低频凸阵探头和高频线阵探头对73例疑似患儿进行颅脑超声检查,并以CT检查为金标准,对比分析超声检查的结果。结果:73例疑似患儿中,CT检查确诊47例为小儿ICH,而高频线阵探头检查的诊断符合率为81.40%,凸阵探头诊断符合率72.09%,两种探头联合应用诊断符合率93.02%,组间差异显著(P0.05)。结论:在小儿ICH超声诊断中,联合应用小凸阵与高频线阵探头能够清晰探查到颅内组织结构变化,显著提高临床诊断的准确性,具有良好的临床应用价值。     

彩色多普勒超声检查在小儿肠套叠诊断和治疗中的作用

目的 探讨高频彩色多普勒超声检查对小儿肠套叠的诊断价值,并根据套叠肠管及其肠系膜血管的血流动力学情况选择复位治疗方式,进行疗效观察.方法 对377例可疑肠套叠患儿进行高频彩色多普勒超声检查,确诊肠套叠后,重点观察套叠肠管及其肠系膜血管的血流动力学情况,并依此选择进行水压灌肠复位治疗.结果高频彩色多普勒超声确诊肠套叠263例,诊断符合率100%,其中选择水压灌肠复位成功253例,复位成功率96.2%;10例复位失败后改手术治疗,失败组套叠肠管肠壁严重水肿,无血流显示.结论 高频彩色多普勒超声诊断小儿肠套叠准确率高.根据套叠肠管及其肠系膜血管的血流动力学情况可将肠套叠分三种类型:Ⅰ型即肠管肠壁血流信号增加或正常,应用水压灌肠复位;Ⅱ型即肠管肠壁血流较少且阻力指数偏高,尽量试用水压灌肠复位;Ⅲ型即肠壁严重水肿,阻力指数显著升高,无血流显示,禁忌水压灌肠复位,应尽快手术治疗.     

钼靶X线及高频超声诊断触诊阴性乳腺病灶的比较分析

目的观察比较数字钼靶X线摄影和高频超声检查对触诊阴性乳腺癌病灶的诊断价值。方法回顾性分析82例触诊阴性乳腺病灶患者的钼靶X线及高频超声诊断资料,以病理诊断结果作为金标准,对两种影像学检查方法的诊断价值进行分析比较。结果本组82例患者82个触诊阴性乳腺病灶,术后病理诊断结果显示,28例患者阴性乳腺病灶为癌性病灶,均为单发。钼靶X线检查25例阳性,57例阴性,高频超声检查显示22例阳性,60例阴性。钼靶X线检查的敏感性高于超声检查,经比较差异有统计学意义(P0.05)。钼靶X线检查的准确性、特异性虽高于超声检查,但经比较差异无统计学意义(P0.05)。钼靶X线与高频超声诊断28个触诊阴性乳腺癌病灶的阳性率分别为82.14%(23/28)和64.29%(18/28),两组经比较差异有统计学意义(P0.05)。两组均阳性的病灶占35.71%(10/28),仅钼靶X线显示阳性的病灶占46.43%(13/28),仅高频超声诊断显示阳性的病灶占28.57%(8/28)。钼靶X线检查乳腺癌病灶主要表现为恶性钙化,占诊断阳性病灶的69.57%(16/23)。高频超声检查乳腺癌病灶的超声特点主要为边界不清的低回声占位,占55.56%(10/18)。结论数字钼靶X线摄影和高频超声检查诊断触诊阴性乳腺病灶均有较高的临床应用价值,但钼靶X线具有更高的准确性、特异性及敏感性,具有更好的临床应用前景。     

高频彩色多普勒超声在儿童肠套叠的诊断及复位方式选择中应用

目的探讨高频彩色多普勒超声在儿童肠套叠的诊断及复位方式选择中的应用价值。方法回顾性分析213例肠套叠患儿的超声图像及复位方式。结果 213例肠套叠患儿均经彩色高频超声明确诊断。129例选择透视下空气灌肠复位,成功107例,成功率达82.9%,106例手术复位成功。结论高频超声结合彩色多普勒不但可以作为小儿肠套叠的首选检查方法,还能为临床选择复位方式提供参考依据。     

弹性髓内针在儿童长骨骨折中的应用

目的：探讨弹性髓内针治疗儿童长骨骨折的临床效果及意义。方法：观察本院2008年4月～2010年10月收治的32例小儿长骨骨折临床资料,分析其治疗方法及临床效果。结果：32例患儿均在术后3～5个月内骨折达到愈合,并拔除髓内针,按照Flynn评分标准评定：优31例,良1例,总优良率为100%。经随访证实,患者无断针、骨感染、骨不连、术后再移位及拔针后再骨折现象。结论：弹性髓内针微创技术治疗儿童长骨骨折具有创伤小、操作简单、并发症少等优点,且疗效确切,是目前治疗儿童长骨骨折的一种最佳方法。     

小切口内固定加植骨治疗跟骨关节内骨折39例临床研究

目的探讨小切口切开复位内固定植骨治疗跟骨关节内骨折的临床疗效。方法回顾性分析2008年3月至2012年3月我院应用小切口内固定加植骨治疗跟骨关节内骨折患者39例的临床资料。结果治疗后,总优良率为89.7%,术前与术后的Bohler角及踝关节活动范围相比差异有统计学意义(P<0.05)。结论小切口内固定加植骨治疗跟骨关节内骨折切口小,关节面复位准确,愈合快,并发症少。     

股骨远端骨折手术治疗临床研究

目的对锁定加压接骨板内固定治疗股骨远端骨折进行探讨。方法回顾性分析2006～2008年本院收住的股骨远端骨折患者的临床资料。手术方法：采取股骨下段前外侧入路,整复骨折,遇严重粉碎,骨端有缺损或开放骨折有缺损的病例,行I期股骨髓内植骨,放置加压接骨板锁定加压接骨板固定;髁上长阶段粉碎骨折在放射线证实复位良好后,锁定加压接骨板两端用锁定螺钉固定。结果所有病例随访9～27个月,平均10个月,骨折均达临床愈合,优8例,良2例,可1例,优良率91%。结论经锁定加压接骨板内固定治疗股骨远端骨折,与其他内固定方法相比,具有更大的优势,值得临床推广应用。     

髓内钉与钢板固定长骨骨折134例的比较分析

目的：比较下肢长骨骨折不同固定方法后的骨愈合情况,为临床手术方式的选择提供参考。方法：勃利县人民医院2003年9月～2008年9月,使用带锁髓内钉治疗下肢长骨骨折66例与同期钢板固定68例的骨折愈合时间进行比较。结果：带锁髓内钉治疗组骨折愈合时间缩短。结论：只要适应证选择得当,使用带锁髓内钉治疗下肢长骨骨折,值得推荐。     

跟骨关节内骨折的手术治疗和并发症防治

目的探讨跟骨关节内骨折切开复位钢板内固定及术后并发症防治的方法和疗效。方法本组28例30足。术前均行X线摄片及CT检查按Sanders分型:Ⅱ型6足、Ⅲ型17足、Ⅳ型7足。闭合性骨折28足,开放性骨折2足。均采用跟骨外侧"L"型切口跟骨钢板内固定,必要时植骨。术后按Maryland足部评分系统进行功能评定。结果本组28例患者均获随访。所有患者无深部感染、骨髓炎、骨不连。Maryland足部评分优良率93.3%。结论跟骨关节内骨折切开复位钢板内固定是值得肯定的治疗方法。只要我们能准确把握手术时机,充分术前准备,术中有良好的复位和可靠的固定,并进行必要的植骨。对术后并发症有正确的认识,尽早干预就可以获得理想的疗效。     

闭合复位交锁髓内钉固定结合阻挡钉治疗下肢长骨干骺端骨折

目的探讨闭合复位应用阻挡钉纠正交锁髓内钉治疗下肢长骨干骺端骨折的疗效。方法回顾性分析手术治疗下肢长骨骨折36例资料。其中,股骨远端骨折15例,胫骨中上1/3骨折5例,胫骨中下1/3骨折16例。均采用闭合复位。术中透视发现骨折端成角畸形,根据骨折端成角的方向以及髓内钉在髓腔内的偏移方向,用阻挡钉辅助纠正骨折端成角畸形和维持骨折端的稳定。结果 36例获随访6-20个月,Karlstrom-Olerud临床评分:优,24例;良,10例;可,2例。结论闭合复位交锁髓内钉结合阻挡钉技术治疗下肢长骨干骺端骨折,可以有效矫正成角畸形,增加骨钉复合体的稳定性。     

Review of risedronate in the treatment of osteoporosis

Risedronate (Actonel, Procter & Gamble and Aventis) is a novel, orally administered pyridinyl bisphosphonate. Preclinical studies have shown that risedronate is a potent inhibitor of osteoclasts. Risedronate inhibited bone resorption and increased bone density in the spine and hip. Prospective, randomised, placebo-controlled trials (RCTs) in patients with postmenopausal osteoporosis (PMO) have demonstrated that risedronate decreased the risk of vertebral fractures by up to 49% and of non-vertebral fractures by up to 39% over 3 years in postmenopausal women with one or more prevalent vertebral fractures. This reduction of the risk for vertebral fractures was significant from the first year of treatment (risk reduction up to 65%). Risedronate was the first bisphosphonate to be studied in a large RCT with prevention of hip fracture as the primary end point. In this study, risedronate reduced the risk of hip fracture by 40% in elderly women with low hip bone density and one clinical risk factor for hip fracture and by 60% in women with low bone density and a prevalent vertebral fracture at baseline. Risedronate was also effective in the prevention and treatment of bone loss in glucocorticoid-induced osteoporosis (GIO), with a positive effect on vertebral fractures within the first year. Risedronate was well-tolerated with a safety profile comparable to placebo in all clinical studies. Patients with a previous or current history of upper GI illness or who were taking NSAIDs or aspirin were not excluded from these studies. Importantly, the upper GI safety profile of risedronate was shown to be similar to that of placebo in endoscopic studies. There was no evidence of acute-phase reactions or primary mineralisation defects. The most appropriate dose of risedronate was 5 mg/day.     

Review of risedronate in the treatment of osteoporosis

Risedronate (Actonel^®, Procter & Gamble and Aventis) is a novel, orally administered pyridinyl bisphosphonate. Preclinical studies have shown that risedronate is a potent inhibitor of osteoclasts. Risedronate inhibited bone resorption and increased bone density in the spine and hip. Prospective, randomised, placebo-controlled trials (RCTs) in patients with postmenopausal osteoporosis (PMO) have demonstrated that risedronate decreased the risk of vertebral fractures by up to 49% and of non-vertebral fractures by up to 39% over 3 years in postmenopausal women with one or more prevalent vertebral fractures. This reduction of the risk for vertebral fractures was significant from the first year of treatment (risk reduction up to 65%). Risedronate was the first bisphosphonate to be studied in a large RCT with prevention of hip fracture as the primary end point. In this study, risedronate reduced the risk of hip fracture by 40% in elderly women with low hip bone density and one clinical risk factor for hip fracture and by 60% in women with low bone density and a prevalent vertebral fracture at baseline. Risedronate was also effective in the prevention and treatment of bone loss in glucocorticoid-induced osteoporosis (GIO), with a positive effect on vertebral fractures within the first year. Risedronate was well-tolerated with a safety profile comparable to placebo in all clinical studies. Patients with a previous or current history of upper GI illness or who were taking NSAIDs or aspirin were not excluded from these studies. Importantly, the upper GI safety profile of risedronate was shown to be similar to that of placebo in endoscopic studies. There was no evidence of acute-phase reactions or primary mineralisation defects. The most appropriate dose of risedronate was 5 mg/day.     

植骨钛板内固定治疗跟骨关节内骨折疗效观察

目的 观察切开复位取自体髂骨植骨钛板内固定治疗跟骨骨折的疗效.方法 对我科收治的累及距下关节的跟骨骨折手术患者28例31足进行随访分析.按Sanders分型,Ⅱ型11足,Ⅲ型15足,Ⅳ型5足.均采用切开复位,钛板螺钉内固定.结果 28例31足均获得12～20个月随访,平均随访14个月,骨折全部愈合.根据Maryland足部评分标准,优15足,良13足,可3足,优良率90.3％.结论 跟骨关节内骨折切开复位取自体髂骨植骨钛板内固定有优良的临床效果,值得推广.     

Risedronate for prevention and treatment of osteoporosis in postmenopausal women

Risedronate sodium is an N-containing bisphosphonate that has been approved for the prevention and treatment of osteoporosis in postmenopausal women. An increase in the rate of bone remodelling is a regular feature of oestrogen withdrawal during the menopausal transition, but excessive remodelling leads to bone fragility. Risedronate and similar compounds reduce the rate of bone remodelling by suppressing the action of osteoclasts. The antifracture efficacy of risedronate is impressive. In large clinical trials of postmenopausal women with osteoporosis-related fracture(s) at entry, the risk of incident vertebral and non-vertebral fractures was reduced by approximately 40%. In older women at risk for hip fracture, incident hip fractures were also reduced by approximately 40%. Antifracture efficacy develops within the first 6 months, and treatment has been followed for as long as 5 years without deleterious effects on bone. We await reports of experience with risedronate in 'real-world' cases of greater complexity (i.e., in patients with co-morbidities and medications that would have excluded them from published clinical trials).