髋臼骨折的手术治疗

目的：探讨提高髋臼骨折手术预后的方法。方法：自1999年8月至2004年10月，共手术治疗各类髋臼骨折38例。按Letournel分类，后壁骨折20例，前柱骨折3例，横断加后壁骨折3例，后柱加后壁骨折4例，双柱骨折6例，T型骨折2例。手术采用髂腹股沟入路及kocher-langenbeck入路。结果：Matta复位标准，复位优良率为86．5％。结论：髋臼骨折的复位质量是决定手术疗效的关键。把握手术时机、及时处理股骨头脱位、钢板的正确放置、并发症的预防，是提高手术预后的关键。     

髋臼骨折的手术治疗

目的　探讨手术治疗髋臼骨折的临床疗效。　方法　 1995年 6月～ 2 0 0 0年 12月手术治疗髋臼骨折 6 2例 ,其中后壁骨折 13例 ,后柱骨折 2例 ,前柱骨折 3例 ,横形骨折 5例 ,横形伴后壁骨折 15例 ,后柱伴后壁骨折 3例 ,“T”形骨折 5例 ,前方伴后半横形骨折 4例 ,双柱骨折 12例。手术采用Kocher-Langenbeck(K -L)入路 37例 ,髂腹股沟入路 12例 ,扩展髂股入路 4例 ,髂股入路 2例 ,联合入路 (髂腹股沟 K -L入路 ) 7例。　结果　解剖复位 37例 ,良好复位 17例 ,差 4例 ,关节轮廓复位 4例。随访 1～ 5年 ,平均 2 .7年。临床疗效优良率 71% (4 4 /6 2 ) ,解剖复位和非解剖复位的临床优良率分别为 89% (33/37)和 4 4 % (11/2 5 ) (χ2 =2 2 .89,P <0 .0 1)。并发症 :坐骨神经损伤 4例 ,深部感染 2例 ,下肢深静脉栓塞 5例 ,异位骨化 2 4例 ,骨性关节炎 15例 ,股骨头缺血性坏死 5例。　结论　髋臼骨折最佳手术时机为伤后 4～ 7d ;手术治疗髋臼骨折可获得满意的骨折复位和临床疗效 ;手术疗效与骨折复位质量密切相关。     

髋臼骨折的手术治疗

目的：回顾性分析髋臼骨折的手术方法和治疗效果。方法：自2004-06~2009-03,共手术治疗髋臼骨折28例,其中新鲜骨折26例,陈旧性骨折2例。按Letournel-Judet骨折分型：后壁骨折10例,后柱骨折2例,后壁伴后柱骨折4例,前壁骨折2例,前壁伴前柱骨折3例,后壁伴横形骨折4例,＂T＂型骨折3例,手术采用Kocher-Langenbeck入路和髂腹股沟入路。结果：解剖复位22例,复位满意4例,复位不满意2例。全部病例获随访6~27月,平均10.2月,临床效果优良率为92.8%（26/28）。结论：手术是治疗髋臼骨折的有效方法,正确的手术入路选择、骨折解剖复位、稳定的内固定及早期功能锻炼是治疗的关键。     

髋臼骨折的手术治疗

目的：回顾性分析髋臼骨折的手术方法和治疗效果。方法：自2004-06~2009-03,共手术治疗髋臼骨折28例,其中新鲜骨折26例,陈旧性骨折2例。按Letournel-Judet骨折分型：后壁骨折10例,后柱骨折2例,后壁伴后柱骨折4例,前壁骨折2例,前壁伴前柱骨折3例,后壁伴横形骨折4例,＂T＂型骨折3例,手术采用Kocher-Langenbeck入路和髂腹股沟入路。结果：解剖复位22例,复位满意4例,复位不满意2例。全部病例获随访6~27月,平均10.2月,临床效果优良率为92.8%（26/28）。结论：手术是治疗髋臼骨折的有效方法,正确的手术入路选择、骨折解剖复位、稳定的内固定及早期功能锻炼是治疗的关键。     

手术复位治疗髋臼骨折移位259例

目的探讨髋臼骨折手术复位技巧，提高手术复位率。方法总结1995年9月-2005年10月259例手术治疗髋臼骨折的经验，并分析其临床疗效。结果解剖复位（移位≤1mm）203例，占78．4％。简单型髋臼骨折解剖复位率为96．0％（120／125）；复杂型髋臼骨折解剖复位率为61．9％（83／134），其中双人路解剖复位率为77．8％（42／54），单人路为51．3％（41／80）。满意复位（移位2～3mm）42例，占16．2％，其中简单型髋臼骨折5例，复杂型髋臼骨折37例；不满意复位（移位≥3mm）14例，占5．4％，均为复杂型髋臼骨折。187例获远期随访，随访时间8个月～6年6个月，平均2年5个月。按改良的Postel—D’Aubignel临床结果评分标准：优98例（占52．4％），良40例（21．4％），一般34例（18．2％），差15例（8．0％），优良率为73．8％。非解剖复位组优良率为38．9％（14／36）；解剖复位组优良率为82．1％（124／151），差异有统计学意义（x^2=28．1，P〈0．01）。结论提高复位技术、正确处理各个治疗环节，才能在有限的切口内提高位置深在、周围解剖关系复杂的髋臼骨折手术复位率。     

髋臼骨折髋脱位的治疗

目的分析髋臼骨折合并脱位的非手术及手术治疗的随访结果。方法从１９７８年１月～１９９４年１月，治疗髋臼骨折髋脱位４５例。其分型是：前壁骨折６例，前柱骨折４例，后壁骨折９例，后柱骨折９例，前、后柱骨折１７例。结果牵引治疗２０例，平均随访３６．５个月，髋关节面复位优良率３５％（７／２０），髋关节功能优良率５０％（１０／２０），髋关节炎发生率５０％（１０／２０），异位骨化发生率１０％（２／２０）。手术治疗２５例，平均随访３０个月，髋关节面复位优良率８８％（２２／２５），髋关节功能优良率８４％（２１／２５），髋关节炎发生率４４％（１１／２５），异位骨化发生率４８％（１２／２５）。结论髋臼骨折髋脱位的治疗方法选择，应依据骨折类型及关节面移位程度决定，移位１ｍｍ者，牵引治疗，移位大于３ｍｍ者，应手术治疗     

影响移位髋臼骨折手术复位质量的若干因素

目的：探讨影响移位髋臼骨手术复位质量的相关因素。方法：1990年3月－1999年7月共手术治疗移位髋臼骨折189例，年龄8－53岁，平均32岁，根据可能影响骨折复位质量的常见原因进行分组，并分析其临床疗效。结果：解剖复位率在最近和最初的4．5年手术组分别是89．7（105／117）和63．9％（46／72）；在简单和复杂型骨折组分别是97．8％（89／91）和63．3％（62／98）；在伤后手术时间＜3间和≥3周组分别是88．6％（101／114）和66．7％（50／75）；在复杂型骨折组，由双入路和前后方单一入路手术获得的解剖复位率分别是84．8％（28／75），在复杂型骨折组，由双入路和前后方单一入路手术获得的解剖复位率分别是84．4％（28／33）和51．0％（25／49）；获2－10年远期随访的136例中，解剖和非解部复位组的功能优良率分别是83．6％（92／110）和38．5％（10／26）。以上各因素分组间比较，差异具有非常显著性意义（P＜0．01）。结论；医师经验，骨折类型，伤后手术时间以及入路选择均有骨折复位质量和临床疗效产生显著影响，克服这些因素的负面影响将有利提高复位质量和临床疗效。     

Ⅰ期前后联合入路手术治疗复杂髋臼骨折

目的探讨经骼腹股沟入路联合Kocher—Langenbeck（K—L）入路治疗复杂髋臼骨折的疗效及复位固定技巧。方法回顾性总结2001年6月-2006年6月间经联合手术入路治疗63例复杂髋臼骨折。按Letournel分类：完全双柱骨折26例，“T”形骨折18例，横断伴后壁骨折11例，前柱骨折伴横形后柱骨折8例。术后X线表现按Matta标准评估，远期髋关节功能和异位骨化率按d’Aubigne和Brooker标准评估。术中采用专用骨盆器械及骨盆重建钢板螺钉进行骨折复位内固定。结果全部患者均获得随访，平均时间18个月。骨折均愈合。解剖复位45例（71％），满意复位14例（22％），不满意复位4例（6％）。髋关节功能：优48例（76％），良9例（14％），可6例（10％），优良率91％。并发症：坐骨神经不全性牵拉损伤1例（2％）；静脉血栓形成2例（3％）；中、重度骨关节炎2例（3％）；股骨头缺血性坏死1例（2％）。伤口发生浅表感染2例（3％）；膀胱破裂1例（2％）；骼腹股沟入路无一例异位骨化；K—L入路Ⅰ～Ⅱ度异位骨化1例（2％），Ⅲ～Ⅳ度异位骨化1例（2％）。结论经骼腹股沟联合K—L入路治疗复杂髋臼骨折显露充分，方便复位，固定稳定，临床效果好，并发症少。     

前后联合手术入路治疗复杂髋臼骨折

目的 探讨联合入路治疗复杂髋臼骨折及复位固定技巧。方法 对1999-2004年应用联合手术入路收治的36例复杂髋臼骨折的治疗进行回顾性研究。术后随访6个月-5年,平均3．6年。结果骨折复位情况按Mana评定标准,解剖复位2l例,满意复位11例,不满意复位4例。关节功能按照改良的Mefled’Aubigne and Postal评分系统进行评估,关节功能优26例,良6例,可4例,优良率88．9％。结论手术治疗复杂髋臼骨折时,联合入路能够很好地显露骨折部位,方便固定,临床效果满意。     

桥接组合式内固定系统治疗髋臼骨折疗效分析

目的：探讨桥接组合式内固定系统治疗髋臼骨折的手术方法及优势。方法总结27例髋臼骨折的围手术期处理及髋臼骨折切开复位内固定手术治疗要点和治疗效果。通过术后定期复查X线片观察术后骨折复位及愈合情况，定期随访了解关节功能恢复情况。术中根据不同的骨折类型，分别采用不同的入路。其中Kocher-Langenbeck 入路13例，髂腹股沟入路8例，前后联合入路（髂腹股沟加K-L入路）6例。充分暴露骨折，准确复位，牢固内固定。结果随访时间12～18个月，平均15个月。根据Matta影像学评分，优14例，良11例，差2例；优良率92.6％。发生创伤性关节炎1例。结论桥接组合式内固定系统适合于大部分髋臼骨折的手术治疗，可提供坚强内固定。     

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.