延迟切开复位内固定治疗Rudёi Ⅲ型Pilon骨折

目的　评估采用延迟切开复位内固定治疗RudёiⅢ型Pilon骨折的临床效果。　方法　 1 997年 5月～ 2 0 0 3年 6月 ,对 38例RudёiⅢ型Pilon骨折患者急诊行跟骨牵引 ,同时使用甲基强的松龙和甘露醇。 5～ 8d后予常规切开复位并用苜蓿叶钢板固定。术后 1周即行踝关节不负重活动。　结果　随访平均 1 8个月 ,所有患者均采用Teeny和Wiss系统进行主客观评估 ,优良率74 %,中 2 1 %,差 5 %。所有骨折的平均愈合时间为 5 .7个月。仅出现 2例伤口浅表感染和 1例浅层皮肤坏死。　结论　延迟切开复位内固定为治疗严重Pilon骨折提供了良好的途径。     

延迟切开复位内固定治疗RudeeiⅢ型Pilon骨折

目的 评估采用延迟切开复位内固定治疗RudeeiⅢ型Pilon骨折的临床效果。方法1997年5月～2003年6月，对38例RudeeiⅢ型Pilon骨折患者急诊行跟骨牵引，同时使用甲基强的松龙和甘露醇。5～8d后予常规切开复位并用苜蓿叶钢板固定。术后1周即行踝关节不负重活动。结果 随访平均18个月，所有患者均采用Teeny和Wiss系统进行主客观评估，优良率74％，中21％，差5％。所有骨折的平均愈合时间为5．7个月。仅出现2例伤口浅表感染和1例浅层皮肤坏死。结论 延迟切开复位内固定为治疗严重Pilon骨折提供了良好的途径。     

股骨近端防旋髓内钉在股骨转子间骨折内固定失效翻修中的应用

目的 评价股骨转子间骨折内固定失效后行股骨近端防旋髓内钉(PFNA)内固定加自体髂骨植骨术的疗效. 方法 选择2007年1月-2012年6月采用切开复位PFNA内固定加自体髂骨植骨术治疗初始内固定失效的股骨转子间骨折患者21例,其中男9例,女12例;年龄27 ～ 76岁,平均54岁.Ⅰ期失效的内固定包括动力髋螺钉(DHS)7例,股骨近端锁定钢板(LPFP)8例,Gamma钉2例,股骨近端髓内钉(PFN)2例,国产重建钉2例. 结果 手术时间平均150 min(100～240 min),出血量平均800 ml(400 ～2 000 ml),术中无严重并发症.随访6～ 66个月,平均26个月,所有患者均获得骨愈合,平均愈合时间4个月(3～8个月).Harris髋关节功能评分:术前为36 ～ 48分[(42.1±3.2)分],末次随访为62 ～ 94分[(87.2±3.8)分](P＜0.05).X线片测量颈干角平均130°时(110°～ 142°),未发现髋关节退行性改变及股骨头无菌性坏死表现.结论 对于活动能力强、股骨近端残留骨量多、髋关节无严重损害的股骨转子间骨折内固定失效患者,PFNA内固定加自体髂骨植骨术可获得满意疗效.     

高能量胫骨Pilon骨折术式选择及疗效相关因素

目的 通过3种术式疗效分析,探索不同情况高能量胫骨Pilon骨折的手术方法,并浅析影响胫骨Pilon骨折疗效的相关因素。方法 对38例单侧胫骨Pilon骨折分别行急诊切开复位内固定术（A组）、延期切开复位内固定术（B组）、Orthofix公司单侧带关节外固定架结合有限内固定（C组）手术。结果 术后随访12～48个月,平均30个月。手术疗效用经Mazur评分系统评定：优10例,良14例,町6例,差8例,优良率63．2％。结论 如果选择好手术适应证及时机,此3种手术方法治疗胫骨Pilon骨折均有较好疗效。影响手术疗效的因素除骨折类型、胫骨关节面的复位质量、腓骨骨折的复位和固定、移植骨填充及适宜固定物的选择等外,还与手术适应证的选择及手术时机的把握、骨折周围软组织损伤情况有关。     

吻合血管的髂骨瓣植骨联合锁定加压板固定治疗复杂胫骨平台骨折

目的探讨利用吻合血管的髂骨瓣植骨及锁定加压板固定治疗严重粉碎胫骨平台骨折的临床疗效。方法从2008年8月～2011年7月,对17例Ⅲ型(Schatzker分型)以上严重粉碎的胫骨平台骨折,采用吻合血管的髂骨瓣植骨及锁定加压板固定治疗。结果随访7～18个月(平均12.8个月),骨折均获愈合(平均7.5个月),无一例发生内固定松动、断裂或骨折复位丢失现象。术后6个月膝关节活动度平均为90°;根据膝关节HSS评分评定疗效:优7例,良6例,中4例,优良率为76.5%。结论吻合血管的髂骨瓣植骨不仅有效改善骨折端血运,还能提供有力的平台支撑,术后能早期进行功能锻炼,有利于促进骨质愈合;相比传统的单纯游离植骨治疗复杂胫骨平台,效果更加确实、可靠。     

分步延期切开复位内固定治疗Pilon骨折的疗效分析

目的 观察分步延期切开复位内固定治疗Pilo骨折的临床疗效.方法 回顾性分析2001年1月-2006年10月收治的36例单侧Pilon骨折患者的临床资料.36例患者中男26例,女10例;年龄18～57岁,平均38.5岁;开放性骨折9例,闭合性骨折27例,合并腓骨骨折25例;Ruedi-Allgower分型Ⅰ型6例,Ⅱ型21例,Ⅲ型9例.予跟骨牵引或石膏托行骨折临时固定7～14d,平均9.8d,待局部软组织损伤恢复后再行切开复位内固定治疗.对踝关节功能进行评定并记录术后并发症发生情况.结果 术后随访19～34个月,平均28个月.根据Mazur评分系统评定,踝关节功能优13例,良17例,可4例,差2例,优良率83.3%.术后并发症包括切口表浅感染2例,切口皮缘坏死2例,关节退行性变19例.结论 Pilon骨折行分步延期切开复位内固定治疗术后局部软组织并发症少,长期随访踝关节功能优良.     

高能量Pilon骨折手术治疗体会

目的 探讨高能量劈裂骨折（Pilon）的适宜手术方法、手术时机。方法 对1998～2004年接受手术治疗的56例高能量Pilon骨折治疗进行回顾性分析。Ⅱ型骨折35例,Ⅲ型21例;21例行国外骨折内固定技术（AO）切开复位内固定术,16例行有限内固定结合外固定支架,19例行分步和延期两阶段分步治疗（ORIF）治疗,术后平均随访34个月。结果 采用Mazur评分系统评估手术疗效,优24例,良20例,优良率78．6％。术后并发症包括创面不愈合4例,术后感染2例,延迟愈合1例,关节退行性变10例。结论 充分的术前准备和计划,根据骨折类型和软组织条件,灵活选择不同的手术治疗方法是取得良好治疗效果的关键。     

关节镜下经皮植骨螺钉内固定治疗胫骨平台SchatzkerⅠ～Ⅲ型骨折

目的：探讨胫骨平台SchatzkerⅠ～Ⅲ型骨折患者采用关节镜辅助下经皮植骨螺钉内固定治疗的临床效果观察。方法采用随机数字表法将我院2011年3月～2013年3月收治的45例胫骨外侧平台SchatzkerⅠ～Ⅲ型骨折患者分为研究组（23例）和对照组（22例）,研究组采用关节镜辅助下经皮植骨螺钉内固定治疗,对照组采用传统切开复位内固定治疗,比较两组患者的术中情况及术后疗效。结果随访6～12个月,所有患者伤口均一期愈合,无感染、愈合迟缓病例;研究组患者骨折愈合时间、Lysholm评分、雍氏评分均显著优于对照组（P＜0．05）;研究组的疗效分布、总优良率均显著优于对照组（P＜0．05）。结论关节镜辅助下经皮植骨螺钉内固定治疗胫骨平台骨折患者较传统切开复位手术具有更好的临床效果,同时缩短患者愈合时间。     

同种异体骨植骨加支撑钢板内固定治疗复杂胫骨平台骨折

目的探讨同种异体骨植骨加支撑钢板内固定治疗复杂胫骨平台骨折的方法及临床疗效。方法对16例复杂胫骨平台骨折患者全部采用同种异体骨植骨,并用支撑钢板稳定固定,术后根据韧带有无损伤早期结合CPM机行膝关节功能锻炼或石膏外固定。结果所有患者术后获10～62个月(平均38.2个月)随访,骨折均获骨性愈合,骨折愈合时间平均为4.5个月。膝关节功能参照Mechant评分标准,优9例,良5例,可2例,优良率为88%。结论对复杂胫骨平台骨折患者应严格评估软组织损伤程度及围手术期治疗,正确选择手术入路,解剖复位关节面的平整性,对骨折端予以坚强稳定的内固定,坚持生物学固定原则,骨缺损区行足量植骨并压实,有效修复交叉韧带、侧副韧带及半月板的损伤,避免术后胫骨平台发生Ⅱ期塌陷和膝关节机械轴的对线不良。     

复杂pilon骨折的手术治疗

目的探讨超脚踝关节外周架结合有限内固定加打压植骨治疗pilonⅢ型骨折的疗效。方法2007年2月～2010年12月我科收治pilon骨折65例,按Ruedi-Allgower分型均为Ⅲ型。全部采用手术治疗,开放性骨折采用急诊清创有限内固定加超踝关节外固定治疗;闭合性骨折均待肿胀消退后,行切开复位有限固定结合超踝关节外固定加打压植骨治疗。结果本组65例均获随访,随访时间9～30个月,平均19．2个月。临床疗效按美国足与踝关节协会（AOFAS）踝与后足功能评分：优48例,良10例,可5例,差2例,优良率89．23％。结论对复杂pilon骨折,根据骨折类型和软组织损伤程度,选择合适的手术方法和时机,干骺端缺损区充分植骨,关节面的整复以及术后早期行踝关节功能锻炼是手术成功的关键。     

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.     

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).     

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.     

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.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.