髓内钉与锁定钢板内固定治疗肱骨干骨折22例疗效分析

目的探讨并比较髓内钉与锁定钢板两种内固定方式治疗肱骨干骨折的临床疗效。方法回顾性分析2008年1月—2011年1月我院手术治疗的肱骨干骨折病例22例,其中采用髓内钉治疗11例,采用锁定钢板治疗11例,比较两组手术时间、术中出血量、并发症发生率、骨折愈合时间、对关节功能影响等。结果经随访12～36月,两组骨折愈合时间差异无统计学意义(P>0.05),手术时间、平均术中出血量差异有统计学意义(P<0.05)。结论治疗肱骨干骨折选用髓内钉及锁定钢板内固定均取得很好疗效,髓内钉对患者创伤较小,更有利于患者康复。     

髋动力锁定钢板与交锁型股骨近端髓内钉治疗中老年股骨转子间骨折体会

背景:老年股骨转子间骨折进行积极的内固定治疗已被大家认同,但选择何种固定方式,尚无权威标准.目的:比较应用髋动力锁定钢板与交锁型股骨近端髓内钉两种不同内固定方式修复股骨转子间骨折的疗效,探讨内固定选择的临床依据.方法:选择2005年8月至2014年4月在吐鲁番地区中心医院骨科收治的中老年股骨转子间骨折患者66例,分别接受髋动力锁定钢板(锁定钢板组)与交锁型股骨近端髓内钉(交锁髓内钉组)内固定治疗,分析比较两组患者下地活动时间及负重时间、骨折愈合时间、功能恢复程度及并发症发生情况.结果与结论:所有患者治疗后随访18-24个月,平均20个月.锁定钢板组和交锁髓内钉组患者骨折愈合时间均为12周左右,修复后2周Harris髋关节功能评分比较差异无统计学意义(P＞0.05),但交锁髓内钉组患者下地活动时间及负重时间短于锁定钢板组(P＜0.01).随访过程中,锁定钢板组1例发生髋内翻,交锁髓内钉组1例因摔倒坠落再次发生骨折.结果提示两种内固定系统治疗股骨转子部骨折均可获得良好的疗效,应根据患者具体情况选择适合的修复方式和植入物.     

锁定钢板与交锁髓内钉对股骨干粉碎性骨折治疗的效果比较分析

目的 分析锁定钢板与交锁髓内钉对股骨干粉碎性骨折治疗的效果.方法 选择收治的30例股骨干粉碎性骨折患者作为研究对象,随机将30例骨折患者分成对照组与观察组,各15例患者.其中对照组应用带锁髓内钉固定治疗,观察组应用锁定钢板固定组治疗,对比两组术后骨折愈合率、两组手术中和手术后一般指标(手术时间、术中出血量、骨折愈合时间、48 h血红蛋白值、术后48 h引流量、住院时间),两组延迟愈合例数,术后并发症情况(膝关节疼痛、感染、固定针脱落).结果 根据kolmert功能评价,观察组骨折愈合优良率93.33％,对照组骨折愈合优良率60％,与对照组相比,观察组骨折愈合优良率更为理想,两组对比差异显著(P＜0.05).结论 锁定钢板治疗股骨干粉碎性骨折疗效更为理想,可以缩短患者骨折愈合时间,提高骨折愈合优良率,降低延迟愈合率,减少术后48 h引流量,缩短患者住院时间,降低术后并发症,值得推广应用.     

PHILOS钢板与髓内钉治疗肱骨近端骨折的疗效比较

目的比较PHILOS钢板和髓内钉治疗NeerⅡ、Ⅲ型肱骨近端骨折的疗效。方法回顾性分析PHILOS钢板和髓内钉治疗NeerⅡ、Ⅲ型肱骨近端骨折的临床效果。2012年9月—2016年10月余姚市中医医院共手术治疗NeerⅡ、Ⅲ型肱骨近端骨折70例。其中37例采用PHILOS钢板内固定手术治疗,平均随访时间为14.5个月(6~30个月),33例采用髓内钉内固定手术治疗,平均随访时间为13.1个月(7~21个月),比较两组手术时间及出血量、并发症例数及术后Constant-Murley肩关节功能评分。结果髓内钉组在手术时间及出血量[(50.2±9.8)min、(150.0±20.4)m L]方面均较PHILOS钢板组[(70.9±10.5)min、(300.0±30.6)m L]有优势,两组比较差异有统计学意义(P0.05),而Constant-Murley肩关节功能评分和并发症例数方面,两组差异无统计学意义(P0.05)。结论 PHILOS钢板和髓内钉组在术后功能恢复及并发症例数方面无差异,均能取得良好的疗效,后者在术中出血量及手术时间方面具有优势。     

弹性髓内钉与锁定钢板内固定在四肢骨干骨折中临床应用研究

目的探讨弹性髓内钉与锁定钢板内固定对四肢骨干骨折中的影响,为临床治疗四肢骨干骨折提供有效依据。方法前瞻性研究2016年4月—2017年6月四川省雅安市人民医院治疗的四肢骨干骨折患者98例,男性55例,女性43例;年龄20~59岁,平均36.6岁。按照随机数表法分为弹性髓内钉组(50例)和锁定钢板组(48例),弹性髓内钉组行弹性髓内钉内固定处理;锁定钢板组行锁定钢板内固定。比较两组患者围术期指标(手术时间、住院时间、骨折愈合时间、骨折线消失时间、术中出血量)、治疗前后VAS评分、愈合情况及并发症发生情况。结果弹性髓内钉组手术时间、住院时间、骨折愈合时间、骨折线消失时间均显著短于锁定钢板组(77.04±12.67)min vs.(117.76±17.64)min、(6.56±1.12)d vs.(7.93±1.27)d、(14.19±1.67)周vs.(17.42±1.98)周、(16.89±2.24)周vs.(19.45±2.64)周,P<0.05;弹性髓内钉组术中出血量显著少于锁定钢板组(98.67±12.74)mL vs.(211.84±23.48)mL,差异有统计学意义(P<0.001)。术前两组患者VAS评分比较差异无统计学意义(P=0.862),术后2、4周弹性髓内钉组VAS评分(4.34±0.36)分、(3.65±0.34)分显著低于锁定钢板组(5.17±0.49)分、(4.68±0.55)分,差异有统计学意义(P<0.01)。弹性髓内钉组愈合率96.00%显著高于锁定钢板组81.25%(P=0.006);弹性髓内钉组优良率90.00%显著高于锁定钢板组64.58%(P=0.003)。两组患者并发症发生率分别为10.00%与18.75%,差异无统计学意义(P=0.117)。结论弹性髓内钉内固定治疗四肢骨干骨折效果显著,且其能显著加速患者康复,改善预后,值得临床推广使用。     

高原地区两种手术治疗肱骨中远端骨折疗效分析

目的探讨高原地区肱骨中远端骨折治疗方法,提高临床治疗水平。方法回顾性分析本院2008年1月~2013年6月收治的68例肱骨中远端骨折患者的临床资料,根据固定方式分为锁定加压钢板组(A组)32例和重建钢板内固定组(B组)36例,分析比较两组的手术时间、术中出血量、上臂肿胀程度、住院时间、骨折愈合时间和术后恢复率。结果手术时间两组无显著差异(P>0.05),术中出血量B组明显多于A组(P<0.01),术后1 d上臂水肿程度B组更重(P<0.01),住院时间A组短于B组(P<0.01),骨折愈合时间A组更短(P<0.01);两组手术并发症情况:A组断钉1例(3.13%);B组断钉2例,钢板断裂3例,合计发生率为13.89%。A组总优良恢复率高于B组(P<0.05)。结论高原地区肱骨中远端骨折用锁定钢板固定更利于骨折的恢复。     

交锁髓内钉在肱骨干骨折中的应用

采用交锁髓内钉治疗肱骨干骨折38例,闭合性骨折35例,开放性骨折3例.术中尽可能在C型臂机下闭合复位,注意纵向加压固定,术后悬吊制动,早期功能锻炼.认为交锁髓内钉能有效治疗肱骨干骨折,固定牢,愈合快,并发症少,优于传统疗法.     

LCP、锁钉及多针固定中老年肱骨外科颈骨折的对比研究

目的探讨锁定加压钢板(LCP)、带锁髓内钉和多枚克氏针应用在中老年肱骨外科颈复杂性骨折治疗中的临床疗效。方法对本院2002年10月—2007年3月手术治疗并获得1年随访的肱骨外科颈骨折58例,年龄39～65岁,NeerⅡ型骨折33例,Ⅲ～Ⅳ型骨折25例,按手术方式不同分为:LCP组36例,带锁髓内钉治疗组(A组)11例,多枚克氏针治疗组(B组)11例,各组均采用手法复位。术后就术中出血量、切口总长度、伤口延迟愈合率、8周骨折愈合率、术后肩关节外展活动度方面,将LCP组分别与A组、B组进行统计学分析,肩关节功能按Constant-Murley绝对值标准评分。结果LCP组和A组比较切口总长度、伤口延迟愈合率、8周骨折愈合率无统计学意义(P>0.05),两组术中出血量、肩关节最大外展度数有统计学意义(P<0.05)。LCP组和B组比较术中出血量、伤口延迟愈合率无统计学意义(P>0.05),两组切口总长度、8周骨折愈合率、肩关节最大外展度数有统计学意义(P<0.05)。肩关节功能Constant-Murley绝对值评分结果:治疗Ⅱ型骨折LCP组优良率90.9%,Ⅲ～Ⅳ型骨折LCP组优良率85.7%。A组优良率45.5%,B组优良率36.4%。结论治疗中老年肱骨外科颈复杂性骨折首选应用锁定加压钢板技术固定,其临床疗效优于带锁髓内钉和多枚克氏针固定技术。     

Ⅰ期与择期带锁髓内钉治疗胫骨干开放性骨折比较

目的比较开放性胫骨干骨折Ⅰ期与择期带锁髓内钉治疗效果和并发症。方法102例123侧开放性骨折，分别按急诊清创后直接行带锁髓内钉固定和择期行带锁髓内钉固定两种方法进行治疗。结果随访半年以上，骨折全部愈合，膝、踝关节功能恢复良好。12侧胫骨皮肤不同程度坏死、缺损，但无感染，均行肌皮瓣修复，愈合后未影响肢体功能。Ⅰ期髓内钉内固定组在手术总时间、住院日、住院费用、抗生素用量、部分负重时间等方面显著优于择期手术，而手术后的疗效、并发症等方面差异无统计学意义。结论感染发生的危险性不是开放性胫骨干骨折带锁髓内钉治疗的绝对禁忌证，彻底清创、条件允许时可以Ⅰ期手术行带锁髓内钉内固定治疗。     

胫骨干骨折手术疗效分析

目的 探讨适合胫骨干骨折的手术治疗方法及并发症的预防措施。方法 回顾性分析手术治疗胫骨干骨折病例67例，根据选择手术方式不同，将病例分为交锁髓内钉、加压钢板和外固定支架3组，临床观察结合X线片评价骨折愈合、延迟愈合、不愈合作为判断临床疗效标准。结果 髓内钉组的骨折愈合率明显高于加压钢板和外固定支架组，外固定组的骨折延迟愈合率高于其他两组；并发症包括骨不连、关节僵硬及畸形愈合，发生率为22．4％，其中骨不连发生率为13．4％。结论 髓内钉内固定治疗胫骨干骨折的临床疗效优于加压钢板和外固定支架；骨不连为胫骨骨折常见并发症，应严格掌握适应证、规范手术操作。     

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.     

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.     

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）