神效散联合交变脉冲磁疗仪治疗急性踝关节扭伤的临床研究

目的：观察神效散联合交变脉冲磁疗仪治疗急性踝关节扭伤的临床疗效。方法：将125例Ⅰ、Ⅱ度急性踝关节损伤患者依就诊顺序分为两组,对照组单纯外敷神效散治疗,观察组应用神效散联合交变脉冲磁疗仪治疗。结果：118例获得随访,对照组治愈率51.7%、总有效率79.3%,观察组治愈率75.0%、总有效率95.0%;对照组恢复工作平均时间（20.66±7.59）d,观察组平均（14.10±4.96）d;对照组满意度53.45%,观察组满意度86.67%（均P＜0.05）。结论：神效散联合交变脉冲磁疗仪联合治疗急性踝关节扭伤,具有见效快、疗程短、疗效好的特点。     

中空螺钉固定加带线铆钉修复治疗第5跖骨基底部骨折合并踝关节外侧副韧带Ⅲ度损伤

目的:观察第5跖骨基底部骨折合并踝关节外侧副韧带Ⅲ度损伤手术治疗的临床疗效。方法:自2008年1月至2011年12月,对32例第5跖骨基底部骨折合并踝关节外侧副韧带Ⅲ度损伤的患者进行手术治疗,其中第5跖骨基底部骨折采用切开复位中空螺钉固定,外侧副韧带损伤采用带线铆钉在韧带附着点予以固定修补治疗,术后均予石膏托固定踝关节于90°背伸轻度外翻位,2周拆线并扶双拐带石膏托下地不负重行走,6周后去除石膏,支具保护下部分负重行走2周,8周后完全负重。术后参照美国足与踝关节协会(AOFAS)踝与后足的功能评分标准进行疗效评定。结果:32例均获随访,时间8～18个月,平均12个月,全部病例跖骨骨折获得骨性愈合,平均愈合时间12.5周(8～24周)。参照AOFAS踝与后足的功能评分标准进行评定,优18例,良14例。结论:利用中空螺钉固定加带线铆钉修复能获得较好的功能恢复,是一种较为理想的治疗第5跖骨基底部骨折合并踝关节外侧副韧带Ⅲ度损伤的方法。     

树脂行走支具治疗踝关节损伤

树脂在高温下容易塑形，制成支具不必太厚，同时具有良好的韧性，在踝关节损伤的固定上可充分发挥其材料学上的特性。我科自2001年8月至2004年1月对接诊的236例踝关节侧副韧带损伤和稳定型踝关节骨折的患者，采用蝶形树脂U形外固定，临床效果满意。     

12例第五跖骨基底部骨折合并踝关节外侧副韧带损伤的诊疗体会

目的总结第五跖骨基底部骨折合并踝关节外侧副韧带损伤的诊疗体会。方法 2015年1月至2018年1月,我们对12例第五跖骨基底部骨折伴踝关节外侧副韧带损伤的病人进行手术治疗,第五跖骨基底部骨折采用闭合复位无头加压螺钉,踝关节外侧副韧带以锚钉在韧带附着点固定修补,术后行石膏外固定踝关节背伸轻度外翻位固定。2周后拆线并扶双拐带石膏托下地不负重行走,3~4周后去除石膏,支具保护下部分负重行走2周,8周后完全负重。术后6个月采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝与后足评分系统评定疗效。结果 12例均获随访,随访时间为8~12个月,平均10.5个月,伤口均达到Ⅰ期愈合,未出现伤口感染、神经血管损伤等。随访期间1例出现退钉情况。全部病人第五跖骨基底部骨折达到骨性愈合,愈合时间为6~8周,平均7.4周。术后6个月根据AOFAS系统评定,优10例,良2例。结论采用闭合复位无头加压螺钉联合带线锚钉固定治疗第五跖骨基底部骨折合并踝关节外侧副韧带损伤是一种可靠有效的方法,值得在临床工作中推荐。     

踝关节外侧韧带损伤治疗方法探讨

目的 :探讨踝关节外侧韧带损伤的治疗原则。方法 :依据踝关节内翻应力 X线片 ,对 15 3例不同程度踝外侧韧带损伤分度及不同方法治疗 ,观察其后期出现踝关节不稳、疼痛等后遗证。结果 :四黄散外敷组治愈率 : °损伤10 0 % : °损伤 60 .6% ; °损伤 0 %。单纯石膏固定组治愈率 : °损伤 94 .1% , °损伤 2 5 %。手术治疗组治愈率 : °损伤 10 0 % ; °损伤 90 .9%。结论 :踝关节外侧韧带 °损伤采用四黄散外敷即可 : °损伤采用踝关节石膏固定 3 w: °损伤行手术修补为佳。按照上述原则治疗会大大减少后遗症的发生 ,提高治愈率。     

双套圈交叉缝合治疗急性拇指Stener损伤

[目的]介绍双套圈交叉缝合治疗急性拇指Stener损伤的手术技术和初步临床效果.[方法]2012年5月-2019年7月,采用双套圈交叉缝合治疗急性拇指Stener损伤共12例,重建拇指掌指关节尺侧副韧带止点,术后拇人字石膏下托固定4周,不固定指间关节,期间行指间关节屈伸练习,4周后去除石膏下托,改用支具固定2周,不固定...     

微创锚钉治疗陈旧踝关节外侧副韧带损伤

目的探讨微创锚钉治疗陈旧踝关节外侧副韧带损伤的临床效果。方法采用微创锚钉治疗30例陈旧踝关节外侧副韧带损伤患者。术后给予支具固定踝关节并进行相关功能锻炼。观察伤口愈合情况,采用AOFAS评分、距骨倾斜角度及距骨移动距离评价疗效。结果伤口均一期愈合。患者均获得随访,时间6~12个月。术后6个月踝关节功能恢复良好,AOFAS评分、距骨倾斜角度及距骨移动距离与术前比较差异均有统计学意义(P<0.001)。结论微创锚钉治疗陈旧踝关节外侧副韧带损伤具有创伤小、高效恢复踝关节稳定及正常功能的效果。     

手术修补旋前外旋型Ⅲ度踝关节骨折三角韧带损伤的临床对照研究

目的:评价手术修补旋前外旋型Ⅲ度踝关节骨折三角韧带损伤的疗效。方法:将52例旋前外旋型Ⅲ度踝关节骨折其中内踝骨质完整的患者按就诊顺序分为三角韧带手术治疗组(治疗组)和术后内翻位石膏固定组(对照组)各23例,均行外踝骨折切开复位钢板螺丝钉内固定,下胫腓关节以螺钉固定8周;治疗组同时行三角韧带修补,对照组术后行内翻位石膏固定治疗;随访11~34个月,按美国足踝外科协会踝与后足功能评分标准评估疗效。结果:52例患者均获随访,治疗组和对照组优良率分别为84.6%和65.4%,治疗组优于对照组。结论:旋前外旋型Ⅲ度踝关节骨折中三角韧带损伤,有必要同时进行修补。     

踝关节韧带损伤的早期诊治

目的:探讨踝关节韧带损伤早期诊治的重要性。方法:48例踝关节韧带损伤患者,男28例,女20例;年龄13~52岁,平均29岁。其中踝关节外侧扭伤46例,内侧2例。受伤至治疗时间3 h~2周,平均3.5 d。根据坎贝尔手术学分类标准:Ⅰ度损伤21例,Ⅱ度损伤18例,Ⅲ度损伤9例。48例患者均采用踝关节的固定制动治疗,支具固定27例,石膏固定12例,绷带绑缚9例。6周后拆除外固定。随访观察,对结果进行疗效分析。结果:48例患者均获得随访,随访时间10个月~4年,平均2.9年。踝关节功能活动良好,未出现踝关节不稳及功能活动异常。按照美国足踝外科学会制定踝后足评分标准进行疗效评定:优42例,良5例,中等1例。结论:踝关节韧带损伤应该引起重视,力争做到早期诊断,并早期行踝关节固定制动,以免引起踝关节不稳。     

锚钉固定在指间关节侧副韧带损伤修复中的应用效果观察

目的观察锚钉固定在指间关节侧副韧带损伤修复中的应用效果。方法将自2013-08—2015-09采用微型锚钉内固定治疗的20例指间关节侧副韧带损伤纳入观察组,将自2011-09—2013-07采用常规缝线修复治疗的20例指间关节侧副韧带损伤纳入对照组。比较2组手术时间、住院时间、术后1 h氧化应激和炎症指标,以及术后12个月Saetta关节功能评分。结果 40例均获得6~20(9.2±2.4)个月随访。观察组手术时间和住院时间均明显短于对照组,术后氧化应激水平和炎症反应程度均明显低于对照组,差异有统计学意义(P0.05)。术后12个月Saetta关节功能评分:观察组优11例,良8例,差1例,优良率95.0%;对照组优8例,良9例,差3例,优良率85.0%;观察组指间关节功能优良率明显高于对照组,差异有统计学意义(P0.05)。结论采用锚钉内固定治疗指间关节侧副韧带损伤对机体的创伤较小,患者炎症反应程度和氧化应激水平均较低,有助于手指功能康复。     

煨脓长肉膏联合浅静脉腔内激光术治疗臁疮

目的：评价煨脓长肉膏联合浅静脉腔内激光术治疗臁疮的疗效。方法：将72例患者随机分为治疗组和对照组。治疗组用煨脓长肉膏联合浅静脉腔内激光术治疗,对照组采用康复新液换药联合浅静脉腔内激光术治疗。结果：治疗组治愈31例,好转4例,无效1例,总有效率为97.2%;对照组治愈20例,好转11例,无效5例,总有效率为86.1%（P〈0.05）。治疗组和对照组的疮面愈合时间均数分别为（16.39±7.42）d和（55.70±31.37）d（P〈0.01）。症候群改善只有瘙痒、疼痛症候有统计学意义（P〈0.05）。结论：煨脓长肉膏联合浅静脉腔内激光术治疗臁疮,可以提高治愈率,缩短疗程,改善症状。     

On immediate functional bracing of Colles' fracture

A prospective randomized trial was carried out in 60 consecutive patients with Colles' fractures requiring manipulation. They were treated by either a standard Colles' plaster (control group) or in a functional plaster brace applied immediately after reduction of the fracture. The brace extended from the proximal radius and ulna to the level of the radial styloid and allowed a full range of movement at the radiocarpal joint. Both groups comprised 30 patients and were matched for age, sex and dominance of hand. There was no significant difference in initial severity of fracture or the quality of reduction. Radiological results on cast removal (35-42 days) were significantly better in the brace group compared with those treated with a below-elbow cast (P less than 0.05). Wrist function was also significantly better in the brace treated group at 12 weeks after fracture (P less than 0.05). This brace has a number of advantages over standard plaster treatment, but requires a degree of skill and experience in its application. A prefabricated brace has now been developed with a similar 'built in' three-point loading which will be easier for inexperienced staff to apply.     

一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察

目的：探讨一期韧带修复联合拉力螺钉固定治疗踝关节不稳的临床疗效。方法回顾性分析2011年1月至2013年6月间我科收治的34例急性踝关节外侧扭伤患者,男18例,女16例,年龄28.0~69.0岁,平均(49.3±1.9)岁。随机分为螺钉固定组和外固定组,每组各17例,分别采用一期带线铆钉原位修补联合拉力螺钉固定(螺钉固定组)和石膏或支具外固定治疗(外固定组)。所有患者术后患肢不负重,随访3个月,观察两组住院费用及并发症发生情况,根据美国足踝外科协会( American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分及视觉模拟评分法( visual analogue score, VAS)评价两种方法的治疗效果。结果螺钉固定组住院费用为(1.72±0.30)万元,外固定组为(0.68±0.20)万元,差异有统计学意义(P<0.05)。术后1、2、3个月随访AOFAS踝与后足评分,螺钉固定组为(66.2±1.3)分、(88.5±2.1)分、(97.2±1.9)分,外固定组为(46.8±1.6)分、(53.5±2.7)分、(75.6±1.2)分,差异有统计学意义(P<0.05)。采用VAS评分：螺钉固定组为(3.2±0.8)分、(2.5±0.6)分、(1.2±0.2)分,外固定组为(4.0±0.7)分、(3.1±0.6)分、(2.6±0.4)分,差异有统计学意义(P<0.05)。螺钉固定组所有患者术后未发生螺钉切出、断钉、创伤性关节炎、下胫腓不稳等并发症,外固定组中2例出现踝关节僵硬,经功能锻炼和物理疗法后有所缓解,4例术后3个月因疼痛和踝关节不稳二期行韧带重建术,恢复可。结论一期韧带修复联合拉力螺钉固定治疗急性踝关节不稳虽然住院费用较高,但并发症少,术后踝关节功能佳,是临床治疗踝关节扭伤的一种可行术式。     

Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography

Background There have been no reports describing the results of conservative treatment of acute lateral ligament injury of the ankle in detail in terms of the severity of the injury, and the results of conservative treatment for injury with severe instability are still controversial. The purpose of this study was to assess the results of nonoperative treatment of acute lateral ligament injury according to its severity. Methods Fifty-five consecutive acute lateral ankle ligament injuries in 54 patients who were treated nonoperatively were followed up as a prospective study. Twenty-seven were male patients and 27 were female patients; the average age was 23.9 years (12–55 years). The patients were divided into two groups according to the extent of the ligament injury: patients with an isolated injury of the anterior talofibular ligament and those with combined injuries of the anterior talofibular ligament and the calcaneofibular ligament. In addition to the routine examinations for inversion ankle sprain, subtalar arthrography was mainly used to assess the condition of the calcaneofibular ligament. The arthrography was performed an average of 3.5 days after the injury (0–5 days). Results Fifty-five ankles of patients who were treated nonoperatively according to the same protocol were included in this study, and were followed up for an average of 5.0 years (37–86 months). At the time of the final follow-up, 22 of 25 (88%) ankles with an isolated injury to the anterior talofibular ligament were asymptomatic; in contrast, only 9 of 30 (30%) ankles with combined injuries of the anterior talofibular and calcaneofibular ligament were asymptomatic. The average American Orthopaedic Foot and Ankle Society score of the isolated injuries was 97.8 points, in contrast to 92.4 points for the combined injuries. Conclusions The results of nonoperative treatment with 1 week immobilization followed by a functional brace were excellent in patients with an isolated injury of the anterior talofibular ligament, but were unsatisfactory in those with combined injuries of the anterior talofibular and calcaneofibular ligaments.     

Functional versus plaster cast treatment of acute rupture of the fibular ligament of the upper ankle joint. A randomized clinical study

From November 1987 to December 1988, 60 patients with recent ruptures of the fibular ligament were enrolled in a randomized trial. After randomization patients were treated with a pneumatic leg brace (Aircast) or with cast immobilization for 6 weeks. Follow-up examination was carried out 15 months after cessation of therapy and was possible in 90% of the patients studied. Clinical criteria were evaluated according to a validated questionnaire including a 120-point scoring scale. In 42 patients stress tenography was carried out. The functionally treated group had significantly better score values than the immobilized group (functional treatment group 46.4 points; immobilization group 37.2 points). There was no significant difference between the treatment groups in radiological stability after the injury or at follow-up. On the basis of this study and the literature we recommend a primary functional treatment for recent ruptures of the fibular ligaments of the ankle in adults.     

可吸收防粘连膜在肌腱修复中的应用疗效观察

目的观察可吸收防粘连膜预防肌腱修复术后粘连的临床应用效果。方法将38例急性手部肌腱损伤患者随机分为两组,肌腱缝合后分别采用包绕成都迪康公司生产的聚-DL-乳酸可吸收防粘连膜和早期使用动力性支具两种方法治疗。试验组15例65腱,涉及屈肌腱10例51腱,7例伴血管神经损伤;伸肌腱5例14腱。对照组23例76腱,涉及屈肌腱11例32腱,6例伴血管神经损伤;伸肌腱12例44腱。对损伤肌腱均采用5-0肌腱缝线行改良Kessler法修复。试验组术后以石膏托固定伤手于屈腕、屈掌指关节位(屈肌腱损伤者)或伸腕、伸指位(伸肌腱损伤者),鼓励患者早期行手指活动,对照组术后第3天改用动力性支具。4周后拆除石膏托或动力性支具,行主动屈伸锻炼,辅以中药熏洗。结果试验组1例伤口延迟愈合,2例肌腱修复处皮肤出现局限性硬结,其余伤口均一期愈合。术后随访6～14个月,平均8.7个月。术后屈肌腱功能用TAM法评定,伸肌腱功能用Miller法评定。试验组综合优良率为93.85%(61/65),对照组综合优良率为90.79%(69/76)(P>0.05),两组间无显著性差异。结论可吸收防粘连膜能有效防止肌腱损伤修复术后粘连的形成,同时避免了动力性支具安装的繁琐操作,消除了医患双方在使用支具过程中对可能发生肌腱断裂的担忧,具有良好的应用前景。     

兔踝关节外侧韧带Brostr(o)m重对韧带本体感觉的影响

目的探讨兔踝关节外侧韧带Brostr(o)m重建术对韧带本体感觉的影响。方法取63只成年新西兰大白兔,随机选取9只处死后切取踝关节外侧韧带(空白对照组);余54只全部切断踝关节外侧韧带,随机选取其中27只行Brostr(o)m重建术(实验组),27只旷置韧带(实验对照组)。术后第2、6和12周,两个实验组分别随机选取9只动物,处死后切取踝关节外侧韧带,行改良O'Connor and Gonzales氯化金染色后于光镜下观察、计数本体感受器小体。结果在踝关节外侧韧带内找到并识别了四种机械感受器：Ruffini小体、Pacini小体、Golgi腱器官及游离神经末梢。对前三种进行计数,空白对照组机械感受器小体总数为(21.0±3.5)个;实验组术后2、6、12周分别为(12.7±2.1)、(13.0±3.0)、(16.0±2.0)个;实验对照组术后2、6、12周分别为(7.7±1.5)、(4.7±1.5)、(6.3±0.6)个。实验组术后2,6,12周之间的差异有统计学意义(F=7.53,P=0.00),随时间推移小体数逐渐增多。实验对照组类似(F=16.27,P=0.00)。术后2、6、12周三组间的差异有统计学意义(F=88.75,102.91,122.53,P=0.00),实验组较实验对照组多,较空白对照组少。结论兔踝关节外侧韧带断裂后,不论手术与否,均会出现机械感受器小体数量下降;Brostr(o)m解剖重建术较韧带旷置能保留更多的机械感受器小体。     

复方蛇草汤治疗寻常性痤疮86例临床观察

目的:探讨复方蛇草汤治疗寻常性痤疮的临床疗效。方法:选择寻常性痤疮患者86例,将其随机分为两组,即观察组与对照组。对照组:以常规西医方法进行治疗;观察组:以复方蛇草汤进行治疗。观察两组治疗效果。结果:完成治疗后,观察两组患者临床效果,观察组总有效率为97.7%,对照组为76.7%,两组疗效比较有显著性差异。两组患者在治疗过程中均未出现严重不良反应,顺利完成治疗。结论:复方蛇草汤对痤疮的治疗有较好疗效,治疗有效率较高,且无不良反应,尤其是对于治疗瘀血阻滞型痤疮,治疗效果更佳,可临床推广应用。     

中医特色护理在重症脊髓型颈椎病康复中应用效果综合分析的研究

目的:探讨中医特色护理在重症脊髓型颈椎病康复中的应用效果。方法:选取2014年5月—2018年5月在我院行康复治疗的74例重症脊髓型颈椎病患者,随机分为对照组37例与观察组37例,对照组给予常规基础护理,观察组在对照组护理的基础上给予中医特色护理,主要包括颈部牵引与推拿、理疗,护理观察时间为14 d;比较两组的疗效、日本骨科协会(JOA)评分、并发症及炎症因子水平。结果:观察组的总有效率显著高于对照组(97.3%vs.81.1%)。护理后,观察组和对照组的JOA评分分别为(21.42±3.19)分和(18.20±4.09)分,均显著高于护理前的(8.99±2.19)分和(8.72±1.89)分,且观察组也显著高于对照组(P<0.05)。观察组护理期间的尿路感染、伤口积液、应激性溃疡、肺部感染、脑脊液漏等并发症总发生率为10.8%,显著低于对照组的40.5%(P<0.05)。两组护理后的血清的细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均显著低于护理前,且观察组显著低于对照组(P<0.05)。结论:中医特色护理在重症脊髓型颈椎病中应用能减轻继发性损伤和相关并发症,促进颈椎功能的改善,提高综合疗效,其作用机制可能与抑制炎症因子的表达有关。