扩髓型交锁髓内钉治疗股骨、胫骨干骨折

目的分析交锁髓内钉治疗股骨、胫骨骨折并发症的原因,并提出具体防治措施。方法回顾143例股骨、胫骨骨折,闭合性骨折87例,开放性骨折56例,股骨59例,胫骨84例,均采用交锁髓内钉内固定。结果143例随防半年以上,共发生各种并发症13例(9.0%),在56例开放性骨折中,其中感染1例,适应证选择不当造成内固定失败2例,远端锁钉放置失败2例,术中再骨折1例,远端锁钉断裂2例,退钉1例,轻度膝外翻1例,髓钉进入关节1例,有2例骨不连,时间超过1年,其余均在半年内愈合。143例手术均无继发骨筋膜室综合征、神经损伤、主钉断裂情况。结论交锁髓内钉治疗股骨、胫骨骨折是较好的一种固定方法,但需要严格掌握适应征,按步骤、规程,熟练掌握,同时使用交锁钉专门的操作技术,提倡闭合穿钉;术中在C形臂X线机监视下操作;对粉碎性骨折病人应延迟负重时间。     

ALCOHOL ABUSE AND HEALING COMPLICATIONS AFTER CERVICAL HIP FRACTURES

Osteonecrosis of the femoral head following femoral neck fracturesis a common condition. Spontaneous osteonecrosis, is, however,a rare disorder, which is observed with increased frequencyin alcohol abusers. In this retrospective study, we followed512 consecutive male patients who had sustained femoral neckfractures between 1984 and 1992; 82 of these 512 patients (16%)had earlier been registered at the Department of Alcohol Diseasesas high consumers of alcohol. The aim of the study was to determinethe relationship between the rate of healing complications andalcohol consumption. No differences were observed in the degreeof fracture dislocation, frequency of femoral head necrosis,and pseudoarthrosis among the abusers. Furthermore, no differenceswere found in causative events, primary operative treatment,post-operative complications, and the number of secondary operations.The abusers were significantly younger, had a higher rate ofearly retirement, and had an increased death rate. Our studysuggests that alcohol complicates the healing process to a lesserextent than earlier thought, and that osteonecrosis of the femoralhead after femoral neck fractures is equally conimon in non-abusersas in abusers.     

多层螺旋CT在胫骨平台骨折诊疗中的价值

目的探讨多层螺旋CT在胫骨平台骨折诊断和治疗中的临床使用价值。方法48例胫骨平台骨折患者,均接受X线检查、16层螺旋CT扫描和扫描后图像后处理,比较两者的检查结果,并与术中所见对照。结果多层螺旋CT三维重建可以清晰显示胫骨平台骨折部位及细节,平台塌陷范围、程度,以及隐匿骨折,依据16层螺旋CT及重建图像的资料,平片漏诊6例,更正骨折分型4例。结论多层螺旋CT检查能直观、立体地显示胫骨平台骨折的形态,有助于骨折的分型及治疗。     

DETERMINATION OF PLASMA {alpha}-GLUTATHIONE-S-TRANSFERASES IN CHRONIC ALCOHOL ABUSERS: RELATIONSHIP WITH ALCOHOL INTAKE AND LIVER INVOLVEMENT

-Gluthathione-S-transferascs (-GSTs) are enzymes involved inthe cellular detoxifying processes; elevated circulating -GSTsactivity is considered to be an early index of liver damage.Glutathione (GSH) is the substrate for -GST action. The aimsof our study were: (1) to evaluate plasma GSH levels and -GSTactivity in chronic alcohol abusers with or without liver cirrhosis;(2) to define the relationship between these two biochemicalparameters; (3) to establish their clinical relevance in patientswith alcohol abuse and/or liver damage. We studied 69 subjects(18 healthy subjects and 51 chronic alcohol abusers: 29 withoutliver cirrhosis and 22 with). Plasma -GST activity was determinedon baseline samples and every following day for a total of 10days in five alcoholics by HEPKIT (Alpha-Biotech, Biotrin International,Dublin, Ireland). GSH was determined on all subjects' baselinesamples by fluorescent high-performance liquid chromatography.Alcohol intake was evaluated in all patients by determiningblood-alcohol concentrations. Significant increases in plasma-GSTs were observed in 9/29 (31%) alcoholics and 3/22 (13.6%)cirrhotics irrespective of their alcohol intake. GSH was significantlylower than normal values (P < 0.001) in all alcoholics withor without cirrhosis (controls 10.4 ± 4.8; alcoholicswithout cirrhosis 3.9 ± 1.4; alcoholics with cirrhosis3.3 ± 1.6). No correlation was observed between plasma-GST and GSH levels. Our data indicate that: (1) -GST activitydoes not correlate with GSH levels in the plasma; (2) -GSTsdo not have clinical relevance as markers of recent alcoholintake; (3) in cirrhotics, -GST does not provide more informationthan other liver function tests. However, plasma -GST determinationmay be useful in selecting a subgroup of alcoholics in whomroutine biochemical markers of liver damage are within referenceranges.     

关节镜辅助下Schatzker胫骨平台骨折合并OCD的手术治疗

目的探讨关节镜辅助下治疗胫骨平台骨折应用微创手术治疗的方法和临床疗效。方法自2011年1月～2013年2月在关节镜监视下应用微创技术治疗SchatzkerⅠ～Ⅲ45例胫骨平台骨折（其中包括20例Ⅰ型、19例Ⅱ型、6例Ⅲ型胫骨平台骨折）。结果本研究平均随访12～13个月,骨折完全愈合,用Lysholm评分标准评定膝关节功能,统计得到91.5%的患者活动优良水平的治疗效果。结论针对SchatzkerⅠ～Ⅲ型胫骨平台骨折,在关节镜辅助治疗以后可以使关节内复位更加精准,术中对复位判断更为准确,降低术后畸形愈合率,能明显提高该类患者的治愈率。     

G-K带锁髓内钉治疗中下段胫骨骨折

目的探讨G—K带锁髓内钉治疗中下段胫骨骨折的优点、扩髓问题、适应症及手术技巧。方法对112例胫骨中下段骨折，均采用带锁髓内钉治疗，并对效果进行观察分析。结果在具备随访奈件的87例中，结果评分采用Johner—wruh评分标准。在65例闭合性骨折中，最后评定为优58例，良7例；在22例开放性骨折中，优12例，良6例，中2例，差2例。骨折平均愈合时间12．8周，闭合性骨折8．8周，开放性骨折18．5周。在112例中，无继发性骨筋膜室综合征、神经血管损伤。在随访87例中，无钉体或锁钉折断等情况。结论带锁髓内钉非常适用于中下段（不包括踝上区）骨折的治疗。     

股骨重建钉治疗髋部骨折合并同侧股骨干骨折临床疗效

目的评价股骨重建钉治疗髋部骨折合并同侧股骨干骨折的临床疗效。方法对2007年2月～2012年1月共23例髋部骨折(包括股骨颈骨折17例,转子间骨折6例)合并同侧股骨干骨折的病人,均用股骨重建钉内固定。随访8～36个月,平均26.0个月。结果全部股骨干骨折均在术后4～8个月内获得愈合,股骨颈骨折1例出现不愈合,余股骨颈及转子间骨折均在4～7个月内愈合;参照Friedman-Wyman评价标准,髋膝关节功能恢良好。结论对于髋部骨折合并同侧股骨干骨折,股骨重建钉是一种比较理想的内固定方法。     

OSTEOPENIA IN ALCOHOLICS AFTER TIBIA SHAFT FRACTURES

A marked reduction of 40–70% in regional bone mineraldensity (BMD) has been reported after fractures of long bones,and this post-traumatic osteopenia may to some extent persistfor several years, perhaps lifelong. In this cross-sectionalstudy, we investigated whether prolonged alcohol abuse had anyeffect on the degree of post-traumatic osteopenia after isolatedtibia shaft fractures, the rationale for such a suspicion beingthe deranged bone metabolism found in alcoholics. We also wantedto investigate whether dual energy X-ray absorptiometry (DEXA)or quantitative ultrasound technique could detect differencesbetween abusers and non-abusers in post-traumatic bone loss.We measured the BMD in 61 male patients with isolated tibiashaft fractures (1984–94) with the Lunar DPX-L^® andthe Lunar Achilles^®. Twenty-four of the patients were verifiedto be high consumers of alcohol. After correction for differencesin age and the time elapsed since the fracture event, we foundsignificantly lower (11%; P=0.017) BMD in the femoral neck ofthe fractured leg in abusers when utilizing the DEXA technique.No differences between abusers and non-abusers in BMD were detectablewhen using the ultrasound technique. We found a fair correlation(r=0.63–0.81) between the DEXA and the ultrasound techniquesin regions with spongious bone. Our findings suggest that alcoholabuse has some, albeit a limited, effect on the degree of post-traumaticosteopenia and that ultrasound measurements in the calcaneusare of little use in detecting an increased post-traumatic osteopeniain this patient group.     

SERUM BIOCHEMICAL AND HAEMATOLOGICAL MARKERS OF ALCOHOL ABUSE IN PATIENTS WITH FEMORAL NECK AND INTERTROCHANTERIC FRACTURES

Excessive alcohol intake causes bone loss. Alcohol abuse isa commonly associated disorder in femoral neck fractures inmen, but little attention is given to such an association inwomen. Using serum biochemical and haematological markers (meanred cell volume MCV, gamma-glutamyl transpeptidase GGT, aspartatetransaminase AST, uric acid UA and triglyceride TG) alcoholabuse was assessed in 14 men and 93 women with non-violent fracturesof the hip. Abnormal elevations in one or more of the five testpairs known to correlate with increasing alcohol consumption(GGT/MCV, GGT/AST, AST/MCV, MCV/UA) were found in 7.1% of men,and 11.8% of women. When abnormal results in other test pairswere included the prevalence rose to 14.3% in men and 20.4%in women. These figures are higher than those reported for thegeneral population of elderly people.     

带锁髓内钉治疗胫骨骨折术后护理

目的探讨带锁髓内钉治疗胫骨骨折的术后护理疗效。方法回顾性分析72例应用带锁髓内钉治疗胫骨骨折患者的术后护理资料。结果患者经临床治疗和良好的术后护理,全部治愈,未出现骨折移位、骨折不愈合、褥疮等并发症。结论做好患者术后的心理、疼痛、感染、骨筋膜氏综合症的护理干预及功能训练,能有效提高患者的治愈成功率,促进患肢的功能恢复。     

老年人复杂性胫骨平台骨折31例临床分析

目的总结老年人复杂性胫骨平台骨折手术治疗的临床经验。方法根据Schatzker分型对31例老年人复杂性胫骨平台骨折病人进行分型,并按照分型选择相应的手术入路和手术方法。围术期积极控制伴随疾病。术后早期功能锻炼。结果随访6~24个月,平均17·0个月。膝关节功能评定,优17例,良10例,可2例,差2例。优良率达87%。结论老年人复杂性胫骨平台骨折应在控制好伴随疾病的情况下尽量早期手术治疗,术前分期准确,手术入路适当,内固定尽量牢固,早期功能锻炼,是取得良好疗效的关键。     

关节镜治疗胫骨髁间前棘骨折

目的　探讨关节镜在胫骨髁间前棘骨折治疗中的应用。方法　 2 0 0 1年 9月～ 2 0 0 3年 3月共治疗 16例胫骨髁间前棘骨折的患者。在关节镜监视下行骨折两断端清创、复位 ,然后由胫骨粗隆两侧钻孔 ,细钢丝横穿前交叉韧带基底并经骨床上的钻孔及骨隧道引出关节外打结、固定。结果　共有 14例获得随访 ,随访时间 2～ 12个月 ,平均 7.5个月。膝关节活动度正常 12例 ,活动受限 2例 ,但均超过 10 0°。 X线片示均为解剖复位。结论　关节镜手术治疗胫骨髁间前棘骨折可最大程度地减少创伤 ,手术简单易行 ,并发症少 ,可作为治疗此类骨折的常规方法     

交锁髓内钉治疗股骨胫骨骨折骨不连原因探讨

目的探讨股骨、胫骨骨折交锁髓内钉内固定后发生骨不连的原因及防治方法。方法对235例使用交锁髓内钉的股骨胫骨骨折病例进行回顾性分析,手术采用闭合、小切口或有限切开复位,用三维瞄准器锁定骨折远近端。结果235例随访189例196肢,平均随访15.2个月,股骨87例发生骨不连5例;胫骨109例发生骨不连8例。骨不连与骨折部位、手术方式、解锁时间有明显关系。结论应力遮挡和局部血供障碍是静力型交锁髓内钉所致骨不连的主要原因,术中尽量闭合复位和有限切开复位内固定及适时解锁可降低骨不连的发生。     

EVIDENCE OF SCURVY IN THE MANDIBULAR CONDYLE AND IN THE TIBIAL EPIPHYSIS

Scurvy is evidenced in the mandibular condyle by increased thickness of the cartilage, decreased differentiation of cartilage cells, disappearance of osteoclasts but without the typical gerüstmark of the tibial epiphysis.     

INVOLVEMENT OF GENETIC POLYMORPHISM OF ALCOHOL AND ALDEHYDE DEHYDROGENASES IN INDIVIDUAL VARIATION OF ALCOHOL METABOLISM

The involvement of genetic polymorphism at the alcohol dehydrogenase2 (ADH2) and aldehyde dehydrogenase 2 (ALDH2) loci in determiningblood acetaldehyde levels and the rate of ethanol eliminationafter ethanol intake was investigated. Sixty-eight healthy subjectsingested 0.4 g of ethanol per kg of body weight over 10 min.Blood acetaldehyde levels scarcely increased in the subjectshomozygous for ALDH2^*I, regardless of their ADH2 genotypes (ADH2^*1/^*1,ADH2^*1/^*2 and ADH2^*2/^*2). The acetaldehyde levels in the subjectswith the ALDH2^*1/^*2 heterozygote increased to 23.4 µMon average, and no significant differences were observed betweenthe three ADH2 genotype groups. Subjects homozygous for ALDH2^*2showed very high levels of blood acetaldehyde, and the averagevalue was 79.3 µM. The values of Widmark's ß₆₀(mg/ml/hr)and ethanol elimination rate (mg/kg/br) showed significant differencesamong the three ALDH2 genotypes, and in decreasing order thevalues were ALDH2^*1/^*1, ALDH2^*1/^*2, ALDH2^*2 However, no significantdifferences were seen among the ADH2 genotypes.     

独活寄生汤加减治疗骨折延迟愈合36例临床观察

目的观察独活寄生汤加减治疗骨折延迟愈合的疗效。方法对符合骨折延迟愈合诊断标准的36例患者施用独活寄生汤加减治疗。结果经过4～12w治疗后,骨性愈合28例,好转4例,无效3例,中途脱落1例,有效率达88.9%。结论中药方剂独活寄生汤加减治疗骨折延迟愈合,避免病人手术痛苦,疗效显著,价格低廉,值得临床推广使用。     

外固定架联合带蒂皮瓣用于胫骨骨折术后感染并骨外露治疗的疗效分析

[目的]分析并总结利用外固定架联合带蒂皮瓣治疗胫骨骨折术后感染并骨外露的临床效果。[方法]总结我院2008~2009年收治的小腿胫骨骨折术后感染、骨及钢板外露者13例,治疗用外固定支架联合克氏针重建骨稳定性,采用同侧小腿内、外侧血管蒂皮瓣。[结果]治疗患者所有转移皮瓣全部成活良好,经6～36个月随访,平均24个月,所有骨折患者均愈合良好,下肢功能恢复良好,未见明显感染。[结论]外固定架联合带蒂皮瓣是治疗胫骨骨折术后感染并骨外露切实有效的临床手段。     

ALCOHOL AND THE EXCRETION OF GALACTOSE IN MAN

The ingestion of ethyl alcohol inhibits the conversion of administered galactose to glucose in man.     

有限切开锁定钢板内固定治疗胫骨Pilon骨折临床效果

目的对胫骨Pilon骨折采用有限切开锁定钢板内固定治疗的临床效果进行研究分析。方法从我院胫骨Pilon骨折患者中选取58例,并将其分为治疗组和对照组,均为29例,对比两组患者临床治疗效果。结果治疗组患者临床治疗优良率为89.66%、骨折愈合时间为(11.57±3.04)w、并发症发生率为6.90%,同对照组患者的65.52%、(19.79±3.71)w和24.14%相比,p<0.05。结论在治疗胫骨Pilon骨折疾病临床上有限切开锁定钢板内固定方法临床效果明显。