闭合复位微创内固定治疗青壮年股骨颈骨折

目的 探讨青壮年股骨颈骨折的治疗方法与疗效.方法 对58例青壮年股骨颈骨折采用闭合复位空心钉内固定治疗,其中男37例,女21例;年龄19～ 56岁,平均37.5岁.Garden分型:Ⅰ型7例,Ⅱ型19例,Ⅲ型23例,Ⅳ型9例.结果 随访0.5～7.0年,平均3.8年,50例Ⅰ期愈合,平均愈合时间为5.8个月.另有3例骨不连,5例股骨头缺血坏死,其中6例Ⅱ期行缝匠肌髂骨瓣植入,3例愈合.按Harris评定:优29例,良22例,可2例,差5例,优良率为88％.结论 闭合复位、空心钉内同定是治疗青壮年股骨颈骨折有效方法,具有创伤小、并发症少、愈合率高、功能恢复满意等特点.切开复位内固定加肌骨瓣移植可作为青壮年股骨颈骨折不愈合、股骨头缺血坏死的补救治疗措施.     

空心钉内固定加缝匠肌髂骨瓣移植治疗青壮年股骨颈骨折

目的探讨应用空心钉内固定加缝匠肌髂骨瓣移植治疗青壮年股骨颈骨折的临床疗效。方法自2003年2月～2008年5月对应用空心钉内固定加缝匠肌髂骨瓣移植治疗38例青壮年股骨颈骨折。男性30例,女性8例;年龄16～54岁。致伤原因:道路交通伤16例,高处坠落伤11例,重物砸伤6例,摔伤5例。其中左侧21例,右侧17例。骨折部位:头下型12例,经颈型26例,按Garden分型:Ⅲ型22例,Ⅳ型16例。GardenⅡ型及基底型采用闭合复位,空心钉微创固定,无需切开骨瓣植骨。结果本组32例获得随访,参照张振兴等评定标准:优25例(78.1%),良5例(15.6%),差2例(6.2%);优良率93.7%。骨折愈合30例,愈合率为93.7%。结论空心钉内固定加缝匠肌髂骨瓣移植治疗青壮年股骨颈骨折有效的提高了骨折的愈合率,降低了股骨头缺血坏死的发生率。     

带血管蒂的髂骨瓣转移加空心钉内固定治疗股骨颈骨折

应用带旋髂深血管髂骨瓣转移加空心钉内固定治疗３０例股骨颈骨折。随访２～１１年,股骨颈骨折全部愈合,平均愈合时间３～６个月,无骨不连。研究表明：空心钉内固定使骨折更加稳定,带血管蒂髂骨瓣转移为股骨颈骨折愈合重建了血供,预防了骨不连和股骨头坏死的发生,效果明显。     

用带蒂骨瓣加骨髓移植治疗青壮年股骨颈头下型骨折

目的观察带蒂骨瓣加骨髓移植治疗青壮年股骨颈头下型骨折的效果。方法从1994年1月～2001年12月,对37例股骨颈头下型骨折采用带缝匠肌蒂髂骨瓣结合红骨髓移植治疗,同时应用2根空心加压螺纹钉内固定。结果术后随访2～5年,34例在术后6个月～1年全部骨折愈合,未发现股骨头坏死,优良率达91．9％。3例因过早弃拐负重,导致股骨头坏死。结论采用内固定及带血运皮质骨块植骨与植入红骨髓的方法,可以促进股骨颈头下型骨折早期愈合,防止股骨头坏死。     

三种不同方法治疗青壮年移位股骨颈骨折的临床疗效比较

目的比较3种不同方法治疗青壮年移位股骨颈骨折的疗效。方法湖北省十堰市太和医院2013年1月—2015年1月收治移位的股骨颈骨折105例,其中切开复位3枚空心钉固定联合带血管蒂大转子骨瓣移位治疗35例(A组),Garden分型:Ⅲ型19例,Ⅳ型16例;切开复位3枚空心钉固定联合股方肌骨瓣移位治疗35例(B组),Garden分型:Ⅲ型18例,Ⅳ型17例;单纯闭合复位3枚空心钉固定治疗股骨颈骨折35例(C组),Garden分型:Ⅲ型19例,Ⅳ型16例。观察3组患者骨折愈合时间、术后1年患髋关节Harris评分、骨折不愈合及股骨头坏死情况。结果 3组病例随访24~48个月,平均35个月。A、B、C组骨折愈合时间分别为(82.0±17.6)d、(97.0±15.3)d、(109.0±14.5)d;术后1年患髋关节Harris评分分别为(87.5±3.6)分、(86.3±4.8)分、(86.1±3.5)分;骨折不愈合例数分别为1例(2.9%)、3例(8.6%)、5例(14.3%);股骨头坏死例数分别为2例(5.7%)、5例(14.3%)、7例(20.0%)。在骨折愈合时间、骨折不愈合率和股骨头坏死率方面,A组与B、C组之间,差异均有统计学意义(P0.05)。在术后1年患髋关节Harris评分方面,A组与B、C组之间,差异均无统计学意义(P0.05)。结论应用切开复位3枚空心钉固定联合带血管蒂大转子骨瓣移位治疗青壮年移位股骨颈骨折能显著降低骨折不愈合以及股骨头坏死发生率。     

空心加压螺钉固定加缝匠肌骨瓣植骨治疗青壮年股骨颈骨折术后骨不连

目的探讨青壮年股骨颈骨折术后骨不连的有效治疗方案。方法对20例青壮年股骨颈骨折术后骨不连采用空心加压螺钉固定加缝匠肌骨瓣植骨治疗。结果 1例出现股骨头坏死,余均骨性愈合;髋关节功能按Harris评分方法,优良率达87.2%。结论应用空心加压螺钉固定加缝匠肌骨瓣植骨治疗青壮年股骨颈骨折术后骨不连,效果满意。     

空心钉固定加带旋髂深血管髂骨瓣治疗股骨颈骨折的疗效观察

目的探讨加压空心钉并带旋髂深血管蒂的髂骨块植骨治疗股骨颈骨折的疗效。方法采用三枚空心钉品字形固定股骨颈骨折处,采用带旋髂深血管蒂的髂骨瓣,骨块植骨治疗股骨颈骨折。结果50例全部获随访,随访时间平均24个月,骨折愈合46例,占92%,其中髋关节功能完全正常者30例,占65%;仍有疼痛者16例,占35%;不愈合发生股骨头坏死功能丧失行全髋关节置换4例,占8%。结论加压空心钉固定带旋髂深血管蒂的髂骨块植骨治疗股骨颈骨折愈合率高,局部有丰富的血液循环,坚强的加压空心钉内固定,使骨折端固定可靠,空心钉的孔道可减轻股骨头内的压力,使血液循环在股骨头内充分重新分布,降低了股骨头缺血坏死的发生,此手术操作简单,不需吻合血管,治疗效果可靠,适合于成年人各型的股骨颈骨折治疗。     

闭合复位经皮空心钉内固定治疗距骨颈Ⅰ、Ⅱ型骨折

目的探讨采用闭合复位经皮空心钉内固定治疗距骨颈Ⅰ、Ⅱ型骨折的疗效及实用性。方法选JR2006年1月～2012年6月收治的16例简单距骨颈骨折采用闭合复位经皮空心钉内固定治疗的患者,骨折采用Hawkins分型,其中I型7例,Ⅱ型9例,术后门诊复查随访,术后1、2、3、6、12月复查x片,根据复查结果于术后4～6周拆除石膏进行功能锻炼。结果随访1～3年,平均随访20个月,采用Hawkins评分：优6例（I型3例,Ⅱ型3例）,良8例（I型4例,Ⅱ型4例）,中2例（1I型2例）,优良率为87．5％。距骨缺血性坏死2例,距下关节创伤性关节炎2例,骨折畸形愈合1例,无骨折不愈合病例。结论闭合复位空心拉力螺钉内固定治疗距骨颈骨折是一种简单、有效的方法,既能达到骨折良好复位和坚强内固定,又避免了切开复位对距骨血供的进一步破坏,降低距骨缺血性坏死率及骨折不愈合率。     

闭合复位经皮空心钉固定治疗股骨颈骨折38例

采用闭合复位经皮空心钉固定治疗GardenⅠ~Ⅲ型股骨颈骨折38例,经临床观察,疗效满意。总结临床经验,探讨股骨颈骨折经皮复位空心钉固定的技巧及注意事项。     

三种内固定器治疗股骨颈骨折的临床观察及生物力学分析

目的：对三种内固定器治疗股骨颈骨折的疗效进行临床观察及生物力学分析。方法：1994－07－2001－02，我院收治股骨颈骨折病人72例，分别采用三刃钉、动力髋钢板（DHS）、多根空心螺纹钉进行内固定治疗，观察其并发症发生率及髋关节功能状况，其中67例获得随访（随访时间3－62个月，平均28个月）。结果：多根空心螺纹钉组并发症最少，髋关节功能最佳。结论：（1）早期良好的复位，使用合适的内固定器，大多数患者（约70％－80％）可获得满意的结果。（2）对股骨颈骨折，三根空心螺纹钉的固定较为确实，骨折不愈合率及股骨头无菌性坏死率均较低，髋关节功能较好。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.