老年股骨粗隆间骨折的手术治疗选择

目的 探讨老年股骨粗隆间骨折的治疗选择和疗效.方法 采用DHS、Smithneph短重建钉、亚洲钉、PFN、PFNA治疗老年股骨粗隆间骨折193例(内固定组),人工双极股骨头置换治疗老年股骨粗隆间骨折28例(人工股骨头置换组).结果 内固定组193例中175例获得随访(DHS 46例、PFN 9例、PFNA 35例、Smithneph短重建钉54例、亚洲钉31例),随访率90.1%,随访时间9～73个月,平均18.2个月.发生患肢深静脉血栓4例,旋转畸形6例,髋内翻5例,螺钉松动退钉8例,螺钉切割3例,内固定失效5例.优良率:DHS 87%、Smithneph短重建钉91%、PFN 88.9%、PFNA 94%、亚洲钉93.5%.人工股骨头置换组28例中26例得到随访,随访率93%,随访时间9～41个月,平均26个月.Harris评分为(87.9±2.7)分,3例出现假体松动下沉,2例出现髋臼磨损.结论 老年股骨粗隆间骨折应常规CT扫描,其能更清晰的了解骨折、骨质、髓腔情况,根据具体情况选择最佳的外科治疗方法.     

PFNA-Ⅱ微创治疗老年股骨粗隆间骨折临床效果

目的观察亚洲型股骨近端抗旋髓内钉（PFNA-Ⅱ）微创治疗老年人群股骨粗隆间骨折的临床效果。方法自2011年08月至2012年08月对68例老年股骨粗隆间骨折患者采用亚洲型股骨近端抗旋髓内钉（PFNA-Ⅱ）手术治疗,其中男19例,女49例;年龄66～91岁,平均71.6岁。根据AO/ASIF分型,A1型12例,A2型36例,A3型20例。结果本组患者手术时间30～80分钟,平均45分钟,术中出血50～210ml,平均115ml。68例均获得随访,随访时间12～24个月,平均18个月,所有患者均获得骨性愈合,功能恢复良好。按Harris疗效评定标准评价,平均93分。结论亚洲型股骨近端抗旋髓内钉（PFNA-Ⅱ）微创治疗老年股骨粗隆间骨折具有设计合理、操作简便、手术创伤小、固定安全可靠及便于早期下床活动等优点,值得在老年股骨粗隆间骨折的治疗中推广应用。     

老年股骨粗隆间骨折髓内钉内固定围手术期处理及并发症的防治

目的 讨论股骨近端髓内钉内固定在老年股骨粗隆间骨折治疗中围手术期处理、手术相关并发症的原因与防治.方法 对老年股骨粗隆间骨折116例,行闭合复位股骨近端髓内钉内固定治疗.结果 随访97例,平均随访6.5个月,骨折均愈合.功能恢复评估方法采用李强等报道的分项百分制髋关节评分方法(改良Harris法),优良率84.54%.结论 股骨近端髓内钉内固定具有损伤小、生物力学优点突出等特点,是治疗老年股骨粗隆间骨折的有效方法之一.     

国产重建钉治疗老年股骨粗隆间骨折

目的探讨国产重建钉治疗老年股骨粗隆间骨折的临床效果和并发症。方法自2001年3月~2005年5月,采用重建钉治疗46例老年股骨粗隆间骨折患者,平均随访12个月,观察疗效。结果2例术中复位不良,本组无术中股骨近段骨折发生,随访9~30个月后,无远端锁钉处骨折发生。6例发生髋内翻,其中4例近端拉力螺钉切割股骨头,1例近端拉力螺钉退出,1例为术中复位不良者;余40例骨折愈合良好,髋关节活动良好。近端拉力螺钉退出2例,1例不合并髋内翻。结论国产重建钉治疗老年股骨粗隆间骨折,术中并发症少见,更易完成手术,但远期髋内翻发生率高,不能令人满意。     

亚洲型股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折

目的探讨亚洲型股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折的临床疗效。方法纳入自2018-01—2020-06诊治的65例老年骨质疏松性股骨粗隆间骨折,采用闭合复位亚洲型股骨近端防旋髓内钉内固定治疗,末次随访时采用髋关节功能Harris评分标准评定疗效。结果 65例均获得随访,随访时间平均10(3～12)个月。4例出现肺部感染,2例出现泌尿系感染,1例下肢深静脉血栓形成,经抗感染、溶栓等对症治疗后痊愈。骨折均获得愈合,未出现股骨颈短缩及髋内翻畸形。末次随访时采用髋关节功能Harris评分标准评定疗效:优30例,良27例,可6例,差2例,优良率87.7%。髋关节功能Harris评分为差的1例系术后再次外伤导致股骨干骨折,1例因股骨头切割导致内固定失败。结论亚洲型股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨粗隆间骨折具有微创优势,其独特的设计更加符合亚洲人股骨近端的生理特点,术后患者恢复快,可避免应力性骨折发生。     

PFNA在老年股骨粗隆间骨折治疗中的应用

目的 探讨股骨近端抗旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的临床疗效.方法 应用PFNA治疗老年股骨粗隆间骨折40例.结果 31例获得随访,时间6～18个月,平均9个月,骨折全部愈合.术后Harris髋关节功能评分:优24例,良6例,差1例,优良率96.8%.结论 PFNA治疗老年股骨粗隆间骨折具有微创、操作简...     

股骨近端抗旋髓内钉(PFNA)治疗老年不稳定股骨粗隆间骨折

目的 探讨股骨近端抗旋髓内钉(PFNA)治疗老年不稳定性股骨粗隆间骨折的临床疗效.方法 采用PFNA治疗老年不稳定性股骨粗隆间骨折24例.23例闭合复位PFNA内固定,1例因骨折复位不佳行有限切开PFNA内固定.结果 本组随访6～12个月,平均8个月,骨折均愈合,关节功能恢复良好.结论 PFNA治疗股骨粗隆间骨折具有手术创伤小、固定牢固,可早期活动等优点.     

PFNA治疗老年不稳定型股骨粗隆间骨折疗效分析

目的 评价采用股骨近端抗螺旋髓内钉(PFNA)手术治疗老年不稳定型股骨粗隆间骨折的疗效.方法 自2008年8月至2009年7月,共治疗老年不稳定型股骨粗隆间骨折64例,均采用PFNA微创内固定.Hairs评分系统评价骨折复位质量.结果 所有病例术后随访6～18个月(平均12个月).术后X线片示骨折全部愈合.术后颈干角123.2°～132.8°,平均128°.Hairs评分:优34例,良24例,可3例,差3例.结论 采用PFNA治疗老年不稳定型股骨粗隆间骨折疗效肯定,值得临床推广应用.     

组合式外固定架辅助闭合复位髓内钉内固定治疗老年股骨粗隆间骨折的临床体会

目的探讨亚洲型股骨近端防旋髓内钉内固定治疗老年股骨粗隆间骨折术中采用组合式外固定架辅助复位的手术技巧。方法回顾性分析自2016-01—2019-08采用亚洲型股骨近端防旋髓内钉内固定治疗的80例老年股骨粗隆间骨折,术中采用组合式外固定架辅助复位并维持复位。结果术后摄X线片显示骨折复位良好,未出现骨折复位丢失与再移位情况,所有患者均早期开始进行功能康复锻炼。80例均获得随访,随访时间平均14(13~18)个月。骨折均一期愈合,骨折愈合时间平均8(6~12)周。末次随访时髋关节功能Harris评分为80~95分,平均86分。结论对于采用髓内钉内固定治疗的老年股骨粗隆间骨折患者,术前需进行CT三维重建检查准确判断骨折块的移位情况,术中采用组合式外固定架牵引能够对骨折进行满意复位,同时有效维持骨折复位效果,有利于防止髓内钉置入后骨折复位丢失。     

PFNA治疗老年股骨粗隆间骨折短期疗效分析

目的 探讨防旋股骨近端髓内钉(PFNA)治疗老年股骨粗隆间骨折的短期临床疗效.方法 自2007年9月～2008年9月.采用PFNA治疗股骨粗隆间骨折15例.结果 15例均获7～15个月随访,骨折全部愈合.按Harris髋关节功能评分标准:优10例,良4例,中1例.结论 PFNA具有操作简单、手术时间短、创伤小、出血...     

杭州健康女性定量骨超声测定原发性骨质疏松

目的 评价杭州健康女性骨超声速度(SOS)值随增龄减少和骨质疏松患病率，建立杭州地区女性骨超声速度值参考数据库。方法 定量超声法测定1208例杭州地区健康女性桡骨远端(RAD)，第3指骨近节(PLX)，第V跖骨(MTR)和胫骨中段(TIB)的超声速度值。结果 RAD、PLX、MTR和TIBSOS峰值(Peak of SOS)均出现在40-45岁，TJB的SOS峰值出现在35—40岁，此后随年龄增长而下降。绝经后妇女在绝经后早期和晚期各有1个SOS快速减少期，前见于桡骨近端，平均年减少率为2．4％，后见于胫骨中段，平均年减少率为1．8％。各部位骨SOS累积减少率随年龄增长而增加，到85岁4部位累积减少为13％-18％。60岁以后骨质疏松性症(OP)检出率为45％-70％，OP检出率以桡骨远端最高，60-70岁平均为67％，第3指骨近端次之约50％，胫骨中段最低为36％；75岁以后分别为70％，65％和45％。结论 全身各部位骨超声速度值到达峰值的年龄不同，峰值也各有差异。绝经后妇女骨超声速度值随年龄增加减少较快，应予激素和补钙治疗，桡骨远端为本地区SOS检测和OP检出的敏感部位。     

Importance of echocardiography in prognosis of surgical outcomes in cholecystitis in elderly patients

The authors propose to use more often echocardiography (EchoCG) in examination of elderly (over 60 years) of age patients with cholecystitis that permits to increase surgical activity to 92.4%. Left ventricular ejection fraction is the most informative. When this fraction is lower than 45% surgery must be recommended on vital indications only. EchoCG was used in 155 patients with cholecystitis, 131 of them were operated. 2 (1.52%) patients died due to acute cardio-vascular insufficiency and pulmonary artery thromboembolism.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

目的 评价脊髓胶质细胞在小鼠骨癌痛形成中的作用.方法 健康雄性C3H/He小鼠40只,周龄8～10周,体重18～22 g,随机分为4组(n=10):假手术组(S组)、骨癌痛组(B组)、PBS组(P组)和米诺环素组(M组).S组跟骨骨髓腔内注射PBS 10 μl;余3组跟骨骨髓腔内注射含2×105个骨纤维肉瘤细胞的PBS 10 μl制备骨癌痛模型,于造模前即刻开始PBS组鞘内注射PBS 5μl,M组鞘内注射米诺环素(用PBS溶解为0.2 mmol/L)5μl,1次/d,连续11 d.于造模前1 d、造模后即刻、3、5、7、9、11 d时测定机械痛阈;于造模后3、7、9、11 d机械痛阈测定结束后测定冷痛阈.痛阈测定结束后处死小鼠,取脊髓组织,测定神经胶质纤维酸性蛋白(GFAP)和CD11b的表达水平.结果 与S组比较,B组和P组造模后3-11 d时、M组造模后3、5 d时机械痛阈升高,B组、P组和M组造模后7～11 d时冷痛阈升高,脊髓CD11b和GFAP表达上调(P<0.05).与B组比较,M组造模后3-11 d时机械痛阈降低,造模后7-11 d时冷痛阈降低,脊髓CD11b和GFAP表达下调(P<0.05).结论 脊髓胶质细胞(星形胶质细胞和小胶质细胞)的激活参与了小鼠骨癌痛的形成.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.     

脊髓胶质细胞在小鼠骨癌痛形成中的作用

Objective To evaluate the role of gliocyte in the spinal cord in the development of bone cancer pain (BCP) in mice. Methods Forty male C3H/He mice aged 8-10 weeks weighing 18-22 g were randomly divided into 4 groups ( n = 10 each) : group I sham operation (group S) , group II BCP, group Ⅲ PBS and group IV minocyline (group M) . In group BCP, PBS and M, bone cancer pain was produced by injection of NCTC2472 fibrosarcoma cell suspension (2 x 105 cells) 10 μl into medullary cavity of calcaneus bone, while in group S, PBS solution 10 μl was injected instead of cancer cell suspension. In group PBS and M, PBS 5 μl and minocyline 5 μl (dissolved to 0.2 mmol/L in PBS)_were given IT immediately before cancer cell inoculation once a day for 11 consecutive days respectively. Mechanical pain threshold was measured at 1 d before cancer cell inoculation, and at 0, 3, 5, 7, 9 and 11d after cancer cell inoculation. Cold pain threshold was measured at 3, 7, 9 and 11d after cancer cell inoculation. The animals were killed after measurement of pain threshold and L4-6, segment of spinal cord was removed for determination of GFAP and CD11b expression by Western blot. Results Compared with group S, mechanical pain threshold was significantly increased at 3-11 d after cancer cell inoculation in group BCP and PBS, and at 3 and S d after cancer cell inoculation in group M, and cold pain threshold was significantly increased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was up-regulated in group BCP, PBS and M ( P < 0.05) . Compared with group BCP, mechanical pain threshold was significantly decreased at 3-11 d after cancer cell inoculation, cold pain threshold was significantly decreased at 7-11 d after cancer cell inoculation, and expression of CD11b and GFAP was down-regulated in group M ( P <0.05) . ConclusionThe activiton of gliocyte in the spinal cord is involved in the development of bone cancer pian in mice.