强化疼痛教育对跟骨骨折围手术期患者疼痛认知及疼痛控制效果的影响

目的 评价强化疼痛教育对跟骨骨折围手术期患者疼痛认知及疼痛控制效果的影响.方法 将174例跟骨骨折患者随机分为研究组和对照组,各87例,分别采用1＋1式强化疼痛教育和传统综合方式进行健康教育,采用疼痛及疼痛控制认知量表进行调查,并比较两组术后疼痛控制效果和满意度.结果 研究组对疼痛控制积极性、表达意识、参与性和重视程度显著高于对照组（P＜0.05）.研究组对止痛药物的认知和采取止痛治疗较对照组更为积极（P＜0.05）.研究组术后1～3天疼痛程度均显著低于对照组（P＜0.05）,使用止痛药和主动疼痛表达比例均显著高于对照组（P＜0.05）.研究组对疼痛教育、疼痛控制、家属及陪护协助的满意度均显著高于对照组（P＜0.05）.结论 强化疼痛教育能有效提高患者对疼痛和止痛药物应用的认知并改善患者进行疼痛控制的积极性和主动性,疼痛控制效果明显提高,有利于患者预后恢复.     

老年股骨转子间骨折髓内钉内固定术后功能恢复危险因素分析

目的:研究影响老年患者股骨转子间骨折髓内钉内固定术后髋关节功能恢复的相关因素,提出相应措施促进术后髋关节功能恢复。方法:选取2012年6月至2015年6月行股骨转子间骨折闭合复位髓内钉内固定术患者74例,男33例,女41例,平均年龄(75.07±7.89)岁。根据术后1年随访时Sanders功能评分将患者分为功能良好组(55例)和功能不良组(19例),统计患者年龄、性别、骨折分型、骨密度、术前基础疾病、营养状态、麻醉ASA分级、麻醉方式、术中复位情况、术后疼痛评分、术后并发症、尖顶距及是否康复师康复等相关因素。采用单因素和多因素Logistic分析对相关危险因素进行评估。结果 :单因素分析显示患者年龄、骨密度、营养状态、麻醉ASA分级、麻醉方式、复位情况、康复师康复,尖顶距对术后髋关节功能恢复差异有统计学意义(P0.05);多因素Logistic回归分析显示骨密度(P=0.006,OR=0.077),康复师康复(P=0.006,OR=0.070),麻醉ASA分级(P0.001,OR=0.049),营养状态(P=0.046,OR=0.188)是术后髋关节功能恢复的独立影响因素。结论 :骨密度、康复师康复、麻醉ASA分级和营养状态影响老年股骨转子间骨折髓内钉内固定术后功能恢复,通过整合骨科、麻醉科、康复科、营养科等学科,建立快速康复外科体系,可有效促进老年患者术后髋关节功能恢复。     

ICS classification system of infected osteosynthesis: Long-term results

The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals. Patients classified as ICS Type 1 (N = 83) feature callus progression and hardware stability, in spite of the presence of infection; these patients were treated with suppressive antibiotic therapy coupled with local debridement in 18.1% of the cases, and no hardware removal until bone healing. Type 2 patients (N = 75) are characterized by the presence of infection and hardware stability, but no callus progression; these patients were treated as Type 1 patients, but with additional callus stimulation therapies. Type 3 patients (N = 57), showing infection, no callus progression and loss of hardware stability, underwent removal and exchange of the fixation device. Considering only the initial treatment, performed according to the ICS classification, at a minimum 5 years follow up, 89.3% achieved bone healing and 93.5% did not show infection recurrence. The ICS classification appears as a useful and reliable tool to help standardizing the decision-making process in treating infected osteosynthesis with the most conservative approach.     

Epidemiology of distal radius fractures in polytrauma patients and the influence of high traumatic energy transfer

IntroductionFor several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF.MethodsThis was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system.ResultsA total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients.ConclusionHigher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.     

Runx2重组慢病毒感染骨髓间充质干细胞并促进其成骨分化的研究

目的　利用重组Runx2基因的慢病毒感染大鼠骨髓间充质干细胞（BMSCs）,使其Runx2基因的表达水平提高,观察BMSCs成骨相关基因的表达情况,研究Runx2基因促进BMSCs的成骨分化情况。 方法　PCR扩增Runx2基因,并连接到慢病毒表达载体质粒Pez-lv201,与包装质粒共转染293T细胞进行包装,测得慢病毒液滴度。取4周龄SD大鼠胫骨,分离、培养BMSCs,流式细胞仪鉴定。将Runx2重组慢病毒感染BMSCs。显微镜下观察细胞形态变化;RT-PCR分析BMSCs成骨基因的表达情况。 结果　Runx2基因重组慢病毒表达载体质粒酶切和测序鉴定正确。测得慢病毒液滴度为1.6×109 TU/ml。流式细胞仪检测表面抗原CD90和CD105,表达率为99.8%、99.3%。重组慢病毒感染后实验组细胞形态呈成骨样细胞改变;对照组未见明显变化。实验组Runx2、OCN、osteonectin、ALP、BMP-2、OPN基因的表达水平随时间推移而增高;对照组上述基因均无明显表达。 结论　利用Runx2重组慢病毒感染BMSCs,使其高表达Runx2基因,可以使OCN、osteonectin、ALP、BMP-2、OPN基因表达增强,说明Runx2基因可以促进BMSCs向成骨方向分化。     

The effectiveness of a standard drill connected to a core biopsy needle: How to obtain specimens in very strong bone tumors

IntroductionCore biopsy is today recognized as the gold standard for the diagnosis of bone lesions; unfortunately, when the bone is too solid it can be very difficult to penetrate it; in case of failure, open biopsy is indicated but it is associated with greater contamination and complications. A possible solution is to connect a common orthopedic drill to the core biopsy needle.The aim of the presenting study was to present a technique useful for performing biopsies in case of very strong bone lesions and to evaluate the adequacy and quality of the obtained specimen.Materials and methodsA standard bone biopsy set was connected to a commercial drill to perform bone biopsies. Data was collected over a 2-year period (2015–2016). Information regarding technical success, diagnostic data and complication rates was all collated to assess the technical feasibility of this technique.ResultsOut of 357 bone biopsies, 34 patients underwent the procedure using a common orthopedic drill connected to a core biopsy needle. Diagnostic material was obtained in each patient and the artifacts were considered irrelevant. No major complications occurred in any patient.DiscussionThe use of a core biopsy needle connected to a common orthopedic drill facilitates the penetration of thick cortical bone by simply applying continuous speed and pressure; nevertheless, the biopsy needle we use is not designed for a drilling procedure and for this reason it can be damaged, but if the biopsy is performed with particular attention, the mechanical failure can be avoidedConclusionsBone biopsy using a commercial hand drill has a technically high success rate with minimal complications. Further studies with more cases are necessary to verify our results.     

退变性脊柱侧弯分型的研究进展

随着社会老龄化的加剧,退变性脊柱侧弯发病率逐年升高。目前对于退变性脊柱侧弯的分型仍无统一的、固定的标准,现存的分型方法各有利弊。为达到脊柱畸形分型的目的 ,对该疾病系统化、预测疾病的自然进程及治疗结果、与健康状态或畸形程度相关联并能理想地指导治疗,探究一种更加可靠、有效的分型方法非常必要。     

胸腰段脊柱骨折手术治疗的选择策略

近年来,随着高处坠落伤及交通伤的不断增加,胸腰段脊柱骨折呈明显上升的趋势,常因伴有脊髓损伤,早期治疗延误、不当或效果不理想等引起畸形、慢性疼痛及神经功能障碍等。本文就2000年1月-2004年12月手术治疗的54例胸腰段脊柱骨折患者进行了总结,对前后路手术及重建胸腰段脊柱稳