动力髋螺钉治疗股骨转子间粉碎性骨折内固定取出术后再骨折的分析

目的总结动力髋螺钉(DHS)治疗股骨转子间粉碎性骨折的疗效并探讨内固定取出术后再骨折的原因及防治措施。方法对93例DHS治疗的股骨转子间粉碎性骨折患者进行回顾性分析,A组37例,存在转子下螺钉交叉固定,B组56例避免转子下螺钉交叉固定。对于A组中5例内固定取出术后再骨折,3例采用外固定架固定,2例采用改良Gamma髓内钉内固定。所有病例均在取出内固定后随访8~18个月,平均随访12.3个月。结果 5例内固定取出术后再骨折均发生在A组,B组无1例发生,明显优于A组(P<0.01)。5例再骨折病例术后6~12个月(平均8个月)均达骨性愈合。结论不适当的转子下螺钉固定可导致DHS内固定取出后再骨折的发生。外固定架或改良Gamm a髓内钉治疗此部再骨折疗效满意。     

动力髋螺钉治疗股骨转子间骨折疗效分析

目的：探讨股骨转子间骨折手术内固定术临床疗效。方法：在C形臂X线机透视下闭合复住,设计手术入路,经皮动力髋螺钉（DHS）内固定术治疗股骨转子间骨折46例,其中男32例,女14例;年龄41—74岁,平均57、5岁。结果：46例患者随访11-26个月,平均18、5个月．所有病例骨折均愈合,无一例发生感染、内固定失败和骨不连等并发症。结论：应用经皮DHS内固定术治疗股骨转子间骨钎,手术简便快速,创伤少,固定可靠,愈合快,术后并发症少,是股骨转予间骨折较为有效的治疗方法。     

桃红补骨汤在骨质疏松性股骨转子间骨折术后的应用效果分析

【摘要】 目的 探讨桃红补骨汤在骨质疏松性股骨转子间骨折 (FIF) 防旋型股骨近端髓内钉内固定术后的应用效果。方法 选取 2020 年 3 月至 2022 年 3 月许昌北海医院收治的 80 例骨质疏松性 FIF 患者作为研究对象, 按照随机数表法将其随机分为研究组 (40 例) 与对照组 (40 例), 研究组患者于防旋型股骨近端髓内钉内固定术后口服碳酸钙 D 3 片和桃红补骨汤, 对照组患者于防旋型股骨近端髓内钉内固定术后单纯口服碳酸钙 D 3片, 对比观察两组患者术后下床活动时间、骨折愈合时间以及骨代谢水平、疼痛程度、髋关节功能恢复情况与并发症发生情况。结果 研究组患者术后下床活动时间与骨折愈合时间均明显短于对照组 (t = 7.390、4.564, P均 <0.001)。治疗 4 周后, 研究组患者血清骨钙蛋白 (BGP)、骨碱性磷酸酶 (BALP) 水平以及 Harris 评分均明显高于对照组 (t =7.467、14.401、7.504, P 均 <0.001); 血清 I 型胶原羧基端肽 β 特殊序列 (β-CTX) 水平以及视觉模拟评分法 (VAS) 评分均明显低于对照组 (t =5.005、6.437, P 均 <0.001)。 治疗期间, 研究组患者并发症发生率为5.00%, 明显低于对照组患者的并发症发生率 22.50% (χ 2 =5.165, P =0.023)。结论 桃红补骨汤可明显促进骨质疏松性 FIF 防旋型股骨近端髓内钉内固定术后骨折愈合, 减轻患者疼痛程度, 改善患者髋关节功能。     

髋部螺钉加骨水泥治疗老年人骨质疏松性股骨转子间骨折

目的 探讨老年人骨质疏松性股骨转子间骨折的治疗方法。方法 对股骨转子问骨折采用切开复位,于股骨头颈骨隧道内灌注骨水泥,与髋螺钉组成“强力螺钉”接骨板作骨折内固定。用上述方法治疗老年人骨质疏松性股骨转子间骨折38例。结果本组骨折全部愈合,未发现切口感染、髋内翻畸形、螺钉在股骨头颈内移动或切出等情况。结论 强力螺钉能有效地解决因骨质疏松致螺钉在股骨头颈内移动或切出致内固定失效、发生髋内翻畸形的问题。其手术操作简便易行,治疗周期短,具有良好的社会效益和经济效益。     

两种内固定手术治疗老年股骨转子间骨折的隐性失血量及预后比较

目的比较动力髋螺钉(dynamic hip screw,DHS)、股骨近端抗旋髓内钉(proximal femoral nail antirotation,PF NA)内固定治疗老年股骨转子间骨折的效果。方法收集我院骨科收治的68例老年股骨转子间骨折患者,其中DHS内固定治疗32例(DHS组),PFNA内固定36例(PFNA组),患者术后均完成1年随访,统计2组患者手术时间、住院时间、术后完全负重时间、骨折愈合时间、隐性失血量,监测髋关节功能变化,比较2组预后。结果 1DHS组总有效率为93.75%,与PFNA组的94.44%对比,差异无统计学意义(P>0.05);2PFNA组手术时间、住院时间、术后完全负重时间、骨折愈合时间均短于DHS组(P<0.05);3PFNA组术后1、2~3、4~5 d隐性失血量均少于DHS组(P<0.05);4术后,2组Harris评分均上升,与术前对比差异有统计学意义(P<0.05),PFNA组术后3、6、12个月后评分上升幅度均高于DHS组(P<0.05);5术后3、6、12个月PFNA组日常生活活动力表(activies of daihy living,ADL)评分均高于DHS组(P<0.05)。结论 PFNA内固定术治疗老年股骨转子间骨折,整体效果好,患者隐性失血量少,术后髋关节功能恢复快,预后好。     

不同方法治疗老年股骨转子间不稳定骨折疗效对比

【摘要】 目的 对比分析生物型加长柄关节置换与股骨近端防旋髓内钉内固定治疗老年股骨转子间不稳定骨折的临床效果。方法 选取 2019 年 6 月至 2021 年 6 月安阳市第三人民医院收治的 104 例老年股骨转子间不稳定骨折患者作为研究对象, 根据不同手术治疗方式将其分为置换组 (52 例) 和固定组 (52 例), 置换组患者采用生物型加长柄关节置换术治疗, 固定组患者采用股骨近端防旋髓内钉内固定术治疗, 对比观察两组患者围术期相关指标、髋关节恢复情况、生活质量及术后不良事件发生情况。结果 置换组患者术中出血量明显多于固定组、手术时间明显长于固定组 (t = 5.545、5.150, P 均<0.001), 而首次下床活动时间及住院时间与固定组无明显差异 (t = 1.933、1.619, P= 0.056、0.109)。术后 12 个月, 置换组患者髋关节恢复优良率为 80.77%, 明显高于固定组患者的髋关节恢复优良率 61.54% (χ2 = 4.685, P= 0.030); 置换组患者健康调查量表 36 ( SF-36) 中的躯体功能、躯体疼痛、总体健康、生理功能评分均明显高于固定组 ( t = 3.062、2.868、3.028、3.440, P =0.003、0.005、0.003、0.001)。置换组患者术后不良事件发生率为 5.77%, 明显低于固定组患者的术后不良事件发生率 21.15% (χ2 = 5.283, P= 0.022)。结论 与股骨近端防旋髓内钉内固定相比, 生物型加长柄关节置换虽会增加老年股骨转子间不稳定骨折患者术中出血量, 延长手术时间, 但能够提高患者髋关节功能及生活质量,降低不良事件发生风险, 临床效果更佳。     

动力髋螺钉治疗股骨转子间骨折

目的探讨动力髋螺钉（dynamic hip screw DHS）手术治疗股骨转子间骨折的疗效。方法采用DHS治疗股骨转子间骨折26例，Ⅳ型骨折术中加用防旋拉加力螺钉。结果25例获得随访，骨折愈合时间5—10月，无切口感染，无髋膝关节功能障碍，2例发生轻度髋内翻。结论DHS手术治疗股骨转子间骨折具有固定牢固，断端加压，骨折愈合快等特点，加用防旋拉加力螺钉后可有效防止骨折端的旋转，畸形发生率低。     

股骨转子下骨折术后骨髓炎新发股骨颈骨折1例报告

老年女性,右股骨转子下骨折术后出现迟发性感染、大转子骨髓炎,骨折愈合后取出内固定物。在无明显创伤暴力情况下,新发右股骨颈骨折,予制动、抗感染、营养支持、负压闭式引流治疗后,感染得到控制,创口愈合,二期行股骨头置换术。创伤性骨髓炎患者骨折愈合、内固定物取出后,存在无诱因邻近部位骨折的可能,应避免过早负重。     

中老年股骨转子间骨折48例的治疗

目的：探讨应用股骨近端锁定接骨板内固定治疗高龄股骨转子间骨折的方法及临床效果。方法：回顾性分析2006-08～2009-01应用股骨近端锁定接骨板固定治疗48例高龄股骨转子间骨折患者完整临床资料。结果：骨折处均顺利愈合,无切口感染、退钉、髋内翻畸形发生。疗效评定标准：优良率91.7%。结论：股骨近端锁定接骨板内固定通过3枚近端锁定松质骨拉力螺钉,将股骨头颈与股骨上端采用多点固定,可有效控制近端旋转,建立股骨上端支架结构,术中无需预弯钢板,直视下复位较容易,安放方便。尤其对于高龄老年骨质疏松患者,锁定螺钉固定有效降低了术后退钉、髋关节内翻、颈干角丢失等的发生率。     

股骨近端防旋髓内钉与解剖型锁定钢板治疗股骨转子间骨折疗效对比

目的 对比分析股骨近端防旋髓内钉(PFNA)内固定与股骨近端解剖型锁定钢板(PFLP)内固定治疗股骨转子间骨折的临床疗效。方法 选取2018年6月至2021年6月驻马店段庄孙全贵骨科医院收治的130例股骨转子间骨折患者作为研究对象,按照随机数表法将其随机分为观察组(65例)和对照组(65例),观察组患者采用PFNA内固定治疗,对照组患者采用PFLP内固定治疗,对比观察两组患者手术相关指标、疼痛评分、髋关节功能恢复情况以及并发症发生情况。结果 观察组患者术中出血量、术后引流量均明显少于对照组(t=29.631、22.162,P均<0.001),手术时间、住院时间、术后助行器辅助负重时间、骨折愈合时间均明显短于对照组(t=17.842、12.135、43.875、18.229,P均<0.001);术后3个月,观察组患者视觉模拟评分法(VAS)评分明显低于对照组(t=9.246,P<0.001),Harris评分明显高于对照组(t=12.538,P<0.001);术后随访3个月,观察组患者术后并发症发生率为4.62%,与对照组患者的术后并发症发生率9.23%无明显差异...     

The need for individualized dosimetry for tangential breast treatment

We have examined the isodose distributions of 119 intact breast patients treated on a 6 MV linae to determine if a library of treatment plans could be used instead of individualized computer plans for patient treatments without compromising the quality of those treatments. The parameters studied were: field width, baseline separation, central axis separation, wedge angle, and isodose coverage. At least two wedges were used in the computer plans for each patient and the best plan was then chosen. In order to construct a library of plans, the choice of wedge, treatment isodose, and dose uniformity should be predictable. Our results show that for 90 out of 119 plans (76%), the 30° wedge was best. In the other 29 cases, either the 15° or the 45° wedge yielded better plans. On average, the improvement in dose homogeneity due to choice of wedge was about 2% (range 0–7%) for these cases. Although grouping like-patient parameters generally restricted the isodose variation to ± 2.5%, there were five patients for which up to a 7% underdosage would not have been predicted. For the set of plans using a 30° wedge, a significant correlation was found for the ratio of the baseline to central axis separation vs. treatment isodose. The average isodose which covered the target area was 97% (range 90–100%) and 102 out of 107 patient plans using the 30° wedge fell between 94 and 100%. We conclude from these results that the variation in dose distribution found with seemingly similar sized breasts is due to the variation in breast shape and symmetry. The use of a library plan with a single wedge and a standardized isodose line for tangential field treatment of intact breast could cause up to a 7% dose difference compared to the actual dosimetry for that patient.     

New Oily Agents for Targeting Chemoembolization for Hepatocellular Carcinoma

Purpose: The evaluation of new oily agents for targeting chemoembolization for hepatocellular carcinoma. Methods: Five types of oily preparation were injected into the hepatic artery of 54 rabbits inoculated with VX2 carcinoma cells in order to evaluate (1) the safety of these preparations, (2) their histologic distribution and the amount of agents remaining at tumor sites, and (3) computed tomographic (CT) images obtained. Of these preparations, three were made by mixing non-iodinated poppy seed oil and a thickener and then adjusted to have a viscosity lower than, equal to, or higher than that of lipiodol. A fourth preparation was a mixture of lipiodol and a thickener with a higher viscosity than lipiodol alone, and the fifth preparation was lipiodol alone. Results: (1) No injury to the hepatic parenchyma was observed hematologically or histologically. (2) With increase in the viscosity, a significantly larger amount of agent remained at the tumor site. No agent was present at normal sites 14 days after intraarterial injection, regardless of which preparation was given. (3) On CT scans following intraarterial injection, tumor cells were visibly deeply stained in the non-iodinated preparation groups, while the lipiodol groups were not evaluable because of excessively high attenuation. Conclusion: The non-iodinated oily preparations and highly viscous oily preparations developed in the present study were more useful than lipiodol for treatment of hepatic tumors.     

Strategy for finding new materials for ESR dosimeters

The right strategy for finding a new ESR dosimetric material sensitive to radiation is to follow the orthodox procedures used in the development of thermoluminescence dosimeters (TLD) and phosphorescence studies. Modern procedures used in materials sciences, such as computer calculation of molecular orbitals (MO), should be employed to estimate the ESR and optical properties of prospective materials. Radiation effects in lithium and magnesium sulfates and metal salts of organic acids, such as lithium and magnesium lactates, have been investigated in search for tissue-equivalent dosimeter with a large G value.