微创经皮钢板与切开复位内固定治疗胫骨中下段骨折疗效比较

[目的]探讨微创经皮钢板与切开复位内固定治疗胫骨中下段骨折的疗效差异.[方法]回顾性分析本院近年来收治的40例胫骨中下段骨折患者的临床资料.[结果]两组患者的手术时间比较,无明显差异性,而术中出血量、骨折愈合时间比较,具有显著性差异,P＜0.05.两组患者预后Johner-Wruhs评分的优良率比较,P＜0.05,具有显著性差异.[结论]微创经皮钢板内固定治疗胫骨中下段骨折,与切开复位内固定比较,不仅符合生物力学的内固定原则,还最大程度的保护了骨折部位的局部血运功能,是治疗胫骨中下段骨折理想的内固定方法,值得临床推广使用.     

肱骨小头骨折的手术疗效分析

[目的]探讨肱骨小头骨折手术治疗的疗效及其影响因素.[方法]自2006年1月～2009年5月采用切开复位内固定治疗29例肱骨小头骨折,其中空心钉固定18例;可吸收钉固定4例;空心钉结合可吸收钉固定4例;克氏针固定1例;克氏针结合可吸收钉固定1例;克氏针结合星形钢板固定1例.[结果]本组28例病人,29肘随访时间平均26.2个月(11 ～37个月),骨折于随访期内全部愈合.Ⅰ型对比Ⅲ型和Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异有统计学意义(分别t=3.411,P=0.004;t=3.327,P=0.005).Ⅲ型对比Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异无统计学意义(分别t=-0.278,P=0.784).本组出现3例异位骨化,2例迟发性尺神经炎,无肱骨小头缺血性坏死病例.按照Broberg和Morrey的肘关节评分标准进行评分:优13例;良11例;可5例,优良率82.76％.[结论]Ⅰ型肱骨小头骨折手术解剖复位内固定,早期功能锻炼能达到满意疗效,Ⅲ、Ⅳ型肱骨小头骨折常合并肘关节其他骨折,肘关节韧带损伤或肘关节脱位预后较差.     

拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折

目的 探讨拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折的疗效. 方法 回顾性分析2007年12月至2011年11月手术治疗的12例(14髁)Hoffa骨折患者资料,男8例(10髁),女4例(4髁);年龄20～ 61岁,平均36.2岁.Hoffa骨折类型:内髁骨折6例,外髁骨折4例,双髁骨折2例.骨折按AO/OTA分型:33B32型10例,33B33型2例;按Letenneur分型:Ⅰ型7髁,Ⅱ型1髁,Ⅲ型6髁.开放性骨折2例,闭合性骨折10例.合并伤:股骨干骨折1例,胫骨近端骨折3例,踝部骨折1例,伸膝装置损伤2例,交叉韧带损伤4例,内侧副韧带损伤1例,半月板损伤3例.受伤至手术时间平均为3.2d(2 h至7d).所有患者均采用松质骨拉力螺钉结合抗滑钢板同定治疗. 结果 12例患者术后获6 ～ 54个月(平均20.3个月)随访.骨折均获骨性愈合,愈合时间为11 ～23周,平均16.6周.无内固定失效、骨折移位及骨坏死发生.1例患者出现伤口感染,1例患者出现伤口不愈合,经治疗后痊愈.根据Letenneur功能评估标准评定疗效:优良11例,可1例,优良率为91.7％. 结论 拉力螺钉辅加抗滑钢板治疗Hoffa骨折疗效优良、可靠.选择正确的手术入路、解剖复位及坚强固定是治疗成功的关键.     

综合护理在髋部骨折手术患者中的应用效果研究

目的：探讨综合护理在髋部骨折手术患者中的应用效果。方法将180例髋部骨折手术患者随机分为综合护理组和对照组,每组各90例。对照组给予常规护理,综合护理组给予综合护理。比较两组患者的术后并发症发生率、心理状态及临床总有效率。结果综合护理组临床总有效率为88．9％,高于对照组的67．8％,术后并发症发生率低于对照组,且综合护理组患者心理健康水平优于对照组（P＜0．05）。结论综合护理能明显提高髋部骨折手术患者临床总有效率,降低术后并发症发生率,值得临床推广应用。     

哮喘患儿外周血降钙素原、IL-17及CRP水平监测及应用

目的监测哮喘患儿外周血降钙素原（PCT）、白介素-17（IL-17）、C-反应蛋白（CRP）的水平变化,并探讨其诊断价值。方法选取单纯哮喘患儿组36例,哮喘合并细菌感染组患儿31例,正常对照组40例,检测各组患儿血清PCT、IL-17、CRP水平。结果哮喘合并细菌感染组患儿血清PCT、IL-17、CRP水平明显高于单纯哮喘患儿和对照组患儿（P〈0.05）。单纯哮喘患儿组PCT轻度增高,与正常对照组比较差异无统计学意义（P〉0.05）,诊断价值不明显。结论哮喘患儿合并细菌感染后血清PCT、IL-17、CRP水平增高显著,为临床疾病诊断提供了很好的理论依据。     

风水之道 趋吉避凶

无论如何，择址是第一。 首先要选好你的住宅及办公地点。天地为一大宇宙，人体为一小宇宙。我们每个人都是一个独特的人体场，而每套房屋亦是一个独立的气场。人与宅相匹配则得其吉气，顺利通达。谈到择址，就涉及到“形势”与“理气”。中国古代正宗的风水学一玄空学的精华正在于此。     

Prophylaxis against venous thromboembolism in orthopedic surgery

Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less Ukely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis ( with its associated fatigue fractures), as well as bowel or bladder complications.     

带锁髓内钉治疗526例长骨骨折疗效分析

目的评价带锁髓内钉治疗股骨、胫骨和肱骨骨折的疗效。方法回顾性分析自1994年4月至2003年9月应用带锁髓内钉治疗长骨骨折546处(526例)。男430处(412例)，女116处(114例)；平均年龄36．4岁。新鲜闭合骨折432处，开放骨折38处；陈旧骨折76处。手术利用“C”型臂或“G”型臂行闭合复位或切开复位内固定。其中闭合复位194处，切开复位352处；扩髓485处，未扩髓61处；静力型固定539处，动力型固定7处；顺行髓内钉固定519处，逆行髓内钉固定27处。结果平均随访时间31．6个月(9～123个月)，543处骨折获得愈合，愈合率为99．5％，骨折平均愈合时间为4．4个月。其中531处(97．2％)一期愈合，12处(2．2％)二期愈合。延迟愈合11处(2．0％)，10处经动力化，1处维持外固定和制动，均获得骨性愈合；骨折不愈合4处(0．7％)，1处经更换带锁髓内钉后骨折愈合；畸形愈合3处(0、5％)；感染5处(0．9％)；外伤性骨折2处(0.4％)；内固定失败7处(1、3％)，其中主钉断裂3处，远侧锁钉弯曲或退出4处。髋周异位骨化9处；桡神经轻瘫1例；肺栓塞1例。股骨或胫骨骨折患者，术后肩、膝、髋关节功能活动优良，术后膝前痛15例，肩部疼痛6例。结论带锁髓内钉是治疗股骨、胫骨和肱骨骨折的一种较好的方法。新鲜长骨骨折尽可能闭合复位、陈旧骨折切开复位，均采用静力固定，根据骨折部位和伤情选择是否扩髓。术后正确指导功能锻炼等是治疗成功的关键。