No local recurrence of enchondroma after curettage and plaster filling

Introduction The most common treatment of enchondromas is curettage (with or without adjuvant therapy) followed by cancellous bone grafting. To avoid donor-site morbidity of the iliac crest, we applied plaster of Paris as a bone defect filler after curettage of enchondromas.Materials and methods We treated 19 enchondromas of the hand and foot in 19 patients (mean age 40 years, range 21–79 years) with curettage and filling of the cavity with sterile plaster of Paris (calcium sulphate/phosphate) tablets.Results The diagnosis was histologically confirmed in all cases. After a mean follow-up of 53 months (range 15–139 months), the mean functional Muskuloskeletal Tumor Society Score was 29.1 points (97%; range 28–30). There were no local recurrences although adjuvant therapy was not utilized.Conclusion Plaster of Paris appears safe and effective as a bone-filling substance after curettage of enchondroma.     

The use of particulate hydroxyapatite and plaster of Paris in aesthetic and reconstructive surgery

The authors describe their early investigative results of using a mixture of hydroxyapatite (HA) and plaster of Paris (PP) in skull and frontal sinus defects in a large series of cats. Histologically, bone was found to form and infiltrate the HA-PP implant over a period of months, with gradual resorption of the plaster in 6–8 weeks. Clinically, the HA-PP combination has been used in 24 patients over the past seven years for various skull, zygomatic, and mandibular defects.     

Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains

Background

Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures.

Materials and methods

126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p < 0.05 was taken to indicate significance.

Results

60 Patients completed the trial in each group. The mean ages were 28.77 ± 6.72 in the TG group and 29.83 ± 6.30 in the POP group (p = 0.034). There was a slight female predominance. Right and left ankles were equally involved in the TG group, while left ankles were mainly involved in the POP group. Mean differences in VAS and KS between the two groups were statistically significant at the end of the study. The mean number of painkillers used by the patients in the TG group was higher than the number used in the POP group (p < 0.001). The mean number of days taken off work was 4.18 ± 1.73 days in the TG group, and 6.25 ± 2.73 days in the POP group (p < 0.001). The mean number of sleepless nights was higher in the POP group.

Conclusion

The results of our study indicate that functional treatment provides better functional support and pain reduction than a below-knee POP cast.

Level of evidence

Level I.     

手法整复O形石膏外固定治疗陈旧性肩关节脱位21例

自1999-2004年共收治陈旧性肩关节脱位21例,现介绍如下。1临床资料本组21例,男15例,女6例;年龄42~75岁,平均60岁。脱位时间15~52 d。盂下脱位9例,喙突下脱位7例,锁骨下脱位5例。合并臂丛神经损伤5例,合并其他严重损伤4例。2治疗方法2·1麻醉根据患者体质和耐受力选用麻醉[1],单     

超关节夹板固定加悬垂石膏治疗肱骨中下段骨折

应用超关节夹板固定加悬垂石膏治疗肱骨中下段骨折２７例。经治疗后随访，Ｘ片复查骨折均在６～８周内愈合。无一例延迟愈合或不愈合。作者认为：夹板固定及石膏塑造同时并用，达到固定和牵引，维持骨折的稳定，消除局部剪力，促进骨愈合的目的。     

An experimental study of pressure-volume dynamics of casting materials

Casting materials are commonly used in a trauma and post-operative setting in orthopaedic practice. Swelling after trauma or surgery is universal, hence, the importance of understanding the pressure-volume dynamics of various materials commonly used for casting. This study attempts to define the pressure response of casts made from three commonly used materials to increasing volume, using a cylindrical model cast. Plaster of Paris (PoP), rigid fibreglass and semi-rigid non-fibreglass (Softcast) were chosen for comparison. Softcast had the best compliance and rate dependency characteristics, accommodating significantly more volume of fluid compared to plaster of Paris or Rigid fibreglass material. The latter two had similar compliance. All three materials demonstrated stress-relaxation which is of advantage in reducing peak pressures for a given volume change. This study shows that the casting materials behave in a viscoelastic manner, which allows them to accommodate more volume change than would otherwise be possible. The use of semi-rigid material may be safer than other materials as far as response to swelling (volume expansion) is concerned.     

掌侧锁定钢板与石膏固定制动治疗骨质疏松性桡骨远端关节内骨折的疗效比较

【摘要】目的分析掌侧锁定钢板与石膏制动治疗骨质疏松性桡骨远端关节内骨折的临床疗效。方法选择濮阳市人民医院2013年6月~2014年6月期间103例骨质疏松性桡骨远端关节内骨折患者进行分组,对照组51例给予手法复位后石膏制动治疗,观察组52例给予掌侧锁定钢板治疗,观察两组患者1年后改善腕关节功能及骨折愈合情况的对比。结果观察组术后总有效率96.15%高于对照组80.39%（P<0.05）;观察组1年后回访关节指标背伸活动度、掌屈活动度、桡偏角度、前臂旋前角度、前臂旋后角度改善情况均优于对照组（P<0.05）。结论掌侧锁定钢板能够通过减小对软组织的刺激、增强关节的稳定性以减轻骨质疏松性桡骨远端关节内骨折患者的疼痛,改善腕关节功能,效果确切。     

Evolution of casting techniques in early-onset and congenital scoliosis

Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 50⁰ to 60⁰) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation- Derotation- Flexion) casting.     

Effect of running exercise on the bone loss induced by orchidectomy in the rat

The effect of exercise on castration-induced osteoporosis in 3-month-old male rats weighing 264±4 g at the beginning of the experiment was studied. A testosterone deficiency was induced by orchidectomy (ORC), and the exercise group ran 10 m/minute for 1 hour a day on a treadmill at 0% grade. There were seven groups of eight rats (n=56) randomized into a control group killed at time 0, and sham, ORC and ORC and exercise groups killed at 4 and 8 weeks. ORC reduced body weight gain (with analysis of variance (ANOVA) P<0.001), and at 4 weeks the body weight was 343±14 g in ORC group and 301±4 g in the ORC and exercise group (P<0.01). The increase in femoral length was slower in the ORC+exercise groups. The ash weight of the tibia did not decrease significantly after ORC or ORC+ exercise. ORC did not affect ⁴⁵Ca incorporation, but exercise slightly increased it in the whole tibia 8 weeks after ORC (with ANOVA P=0.057). ORC had significantly lowered the trabecular bone volume in the secondary spongiosa of the distal femur at 4 and 8 weeks, and exercise did not prevent this. This is an opposite finding to our previous study with ovariectomized female rats [12]. ORC also significantly had reduced the osteoblast-lined trabecular bone surface and the number of osteoclasts by 8 weeks after the operation. Exercise increased the osteoblast-lined surface and the number of osteoclasts. The mechanical strength of the femoral neck also was reduced after ORC and this was not prevented by exercise either. In conclusion, ORC reduces bone growth and turnover which leads to osteopenia in growing rats. Moderate treadmill exercise does not reverse the ORC-induced loss of trabecular bone and the reduced mechanical strength of the femoral neck, although it has a positive effect on the osteoblast and osteoclast indices and on calcium incorporation into bone.     

上睑下垂的术前评估及改良提上睑肌缩短术矫治的疗效评价

目的评价改良提上睑肌缩短术矫治上睑下垂的效果。方法采用改良提上睑肌缩短术[此改良术式与常规术式不同之处在于增加分离提上睑肌腱膜的长度(22mm)和宽度(16mm),腱膜在睑板上固4对缝线,以增加其牢固度],共治疗上睑下垂57例68眼,其中轻度13例13眼,中度38例47眼,重度6例8眼。结果术后4～36个月随访,治愈48例59眼,欠矫9例9眼,无过矫病例。结论该提上睑肌缩短术与常规手术比较有改进,术后的睑缘高度易保持在上方角膜缘,弧度与健侧对称,不易形成眼角畸形,能较好提高矫治效果。     

Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial

Summary Randomized controlled study in 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based, simple, low-intensity exercise. Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength. Introduction and hypothesis Back-strengthening exercise is effective in increasing back extensor strength and decreasing risk of vertebral fractures. We hypothesized that a home-based, simple, low-intensity exercise could enhance back extensor strength and improve the quality of life and/or spinal range of motion in postmenopausal women in a short-term follow-up. Methods Eighty postmenopausal women with osteoporosis were randomly assigned to a control group (n = 38) or an exercise group (n = 42). Subjects were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position. Isometric back extensor strength, spinal range of motion, and scores for quality of life were evaluated at baseline and 4 months. Results Back extensor strength significantly increased both in the exercise group (26%) and in the control group (11%). Scores for quality of life increased in the exercise group (7%), whereas it remained unchanged in the control group (0%). There was a significant difference in quality of life score between the groups (p = 0.012). Conclusions Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis.     

椎体成形术中骨水泥量对椎体机械性能的实验研究

目的探讨聚甲基丙烯酸甲酯(PMMA)和自固化磷酸钙骨水泥(CPC)的不同用量对骨质疏松性椎体强度和硬度的影响,明确恢复椎体强度及硬度所需的最小骨水泥用量。方法取5具老年女性(65～73岁)48个脊椎标本(T6～L3),分解后压缩并测量其强度和硬度,将3、5、7ml PMMA和CPC注入压缩后的椎体,再测其强度和硬度,并与原来的强度和硬度进行比较。结果所有椎体注入骨水泥后强度都得到恢复,注入5ml、7ml骨水泥后强度明显增加;注入PMMA后硬度都得到恢复,而注入CPC 5ml、7ml才能恢复椎体硬度。结论骨质疏松性椎体骨折后,注入骨水泥可有效恢复椎体的强度和硬度,此结果可有利于指导椎体成形术的临床应用。     

纳米级羟基磷灰石梯度涂层植入体骨结合的研究

目的评价纳米级羟基磷灰石梯度涂层(HAP)植入体-骨界面骨结合情况。方法在Beagle犬股骨内植入纳米级HAP梯度涂层栓、普通级HAP涂层栓和钛合金(Ti-6AL-4V)栓,在4、8、12周比较X线结果和植入体-骨界面剪切强度。结果各时间点纳米级HAP涂层组和普通HAP梯度涂层组的X线结果相当,植入体-骨界面剪切强度均优于钛合金组和钛合金组。结论纳米级HAP梯度涂层植入体与骨有很好的结合力,能够加速骨质的愈合。     

TRAM皮瓣乳房再造术后腹壁张力的研究

目的　研究TRAM皮瓣术后腹壁张力的情况。方法　采用调查表 ,运动测试和腹直肌形态CT扫描作手术前后对照。结果　手术初期 (1～ 6周 )腹壁张力下降 ,尤其以双蒂皮瓣者为甚 ,3个月后已无明显差异 ;运动测试显示术后运动不如术前 ;而CT扫描示腹直肌形态保持良好。结论　TRAM皮瓣乳房再造术后腹直肌肌力有下降 ,而腹壁张力无明显改变     

手法复位背侧石膏托外固定治疗桡骨远端粉碎性骨折

2006年3月~2011年9月,我院采用手法复位背侧石膏托外固定治疗120例桡骨远端粉碎性骨折患者,疗效满意. 1 材料与方法 1.1 病例资料本组120例,男48例,女72例,年龄在18~70岁.左侧38例,右侧82例.就诊时间为伤后2~10h.按Melon分类[1]:Ⅳ型48例,Ⅴ型72例.均为闭合骨折.手法复位前X线片示:掌倾角-40°~0°,尺偏角5°~23°,移位范围4~10mm,伴尺骨茎突骨折78例.     

依据气道峰压设置喉罩套囊内压的临床效果

目的观察全麻喉罩通气过程中能封闭气道的最小套囊内压(intracuff pressure,ICP)设置的效果。方法全麻下择期行妇科腹腔镜手术患者60例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为压力调控组(P组)和对照组(C组),每组30例。全麻诱导后插入4号Supreme喉罩,向套囊内注入空气,使ICP达60 cm H2O。行容量控制通气,记录气道峰压(peak pressure,Ppeak)。P组将喉罩套囊内气体抽净后,向套囊内充气至ICP达Ppeak水平,如漏气,每次增加5 cm H2O,直至无气体从口咽部漏出。气腹建立后,P组套囊充气恢复至60 cm H2O,再次记录Ppeak后重复以上操作,并以此作为封闭气道的最小ICP直至手术结束。C组ICP保持为60 cm H2O。记录气腹前和气腹后Ppeak、ICP和套囊充气容量;测定呼气相和吸气相ICP;记录吸气VT(VTi)和呼气VT(VTe),计算漏气率=[(VTi-VTe)/VTi×100%];记录术后24 h咽喉部并发症情况。结果与C组比较,P组在气腹前和气腹后呼气相和吸气相ICP均明显降低(P0.05)。气腹前和气腹后P组套囊充气容量明显低于C组(P0.05)。与气腹前比较,气腹后两组漏气率均明显升高(P0.05)。与C组比较,P组术后咽喉痛及吞咽不适的发生率明显降低(P0.05)。结论全麻喉罩通气过程中将ICP设置在Ppeak+0~5 cm H2O,可产生良好的密封效果,且可减少咽喉部并发症的发生。     

T型钢板内固定与石膏外固定治疗桡骨远端骨折的疗效比较

目的比较T型钢板内固定与石膏外固定治疗桡骨远端骨折的临床疗效。方法按随机数字表法将36例桡骨远端骨折患者分为两组,观察组(18例)采取T型钢板内固定治疗,对照组(18例)采取石膏外固定治疗。比较两组治疗效果。结果患者均获得随访,时间2~16(11.1±5.3)个月。复位后桡骨短缩程度、术后1周腕掌关节改善评分、术后2个月肘关节功能评分观察组均明显优于对照组(P<0.05)。结论T型钢板内固定治疗桡骨远端骨折维持桡骨长度效果好,疼痛度低,关节活动度大,可促进术后关节功能恢复。     

微型种植体支抗对口腔正畸患者正畸效果及不良反应的影响分析

目的:探讨和分析微型种植体支抗对口腔正畸患者正畸效果及不良反应的影响。方法:选取2015年1月-2016年12月于笔者医院口腔科接受治疗的100例口腔正畸患者,随机分成对照组和观察组,每组50例。对照组给予非种植体支抗治疗(口外弓支抗治疗);观察组给予微型种植体支抗治疗,比较两组患者接受治疗10个月后对正畸治疗的临床疗效、正畸效果、不良反应发生情况及患者治疗后满意程度。结果:经过10个月治疗后,观察组的总有效率显著高于对照组,两组比较差异显著,有统计学意义(P<0.05);观察组的上中切牙突距差和上中切牙倾角差均显著大于对照组,磨牙移位显著小于对照组,两组差异有统计学意义(P<0.05);观察组的不良反应发生率显著小于对照组,两组比较差异有统计学意义(P<0.05);观察组满意度为95.56%,对照组满意度为68.29%,两组比较差异有统计学意义(P<0.05)。结论:通过微型种植体支抗对口腔正畸患者进行治疗,可明显改善临床疗效,且患者不良反应发生率大大降低,不适感更少,可在临床上大范围推广使用。