肱骨近端锁定加压钢板与解剖钢板治疗老年肱骨外科颈骨折的疗效比较

目的比较肱骨近端锁定加压钢板与解剖钢板治疗老年肱骨外科颈骨折的临床疗效。方法将50例老年肱骨外科颈骨折患者按治疗方法分为两组,使用肱骨近端锁定加压钢板治疗(锁定钢板组)25例,使用肱骨近端解剖钢板治疗(解剖钢板组)25例,比较两组手术时间、术中出血量、术后住院天数、术后骨折愈合时间、术后关节活动度、术后3个月Neer肩关节功能评分及术后并发症的情况。结果 50例均获得随访,时间12~18(13.5±4.1)个月。手术时间(min):锁定钢板组为55.3±23.7,解剖钢板组为73.7±30.3,P0.05。术中出血量(ml):锁定钢板组为189.5±34.5,解剖钢板组为273.2±39.8,P0.05。术后住院时间(d):锁定钢板组为8.3±3.1,解剖钢板组为10.5±4.2,P0.05。术后骨折骨性愈合时间(d):锁定钢板组为97.2±23.8,解剖钢板组为119.5±34.5,P0.05。肩关节活动度:锁定钢板组优于解剖钢板组(P0.05)。术后3个月采用Neer肩关节功能评分进行比较:锁定钢板组优良率为23/25,解剖钢板组优良率为21/25,两组比较差异无统计学意义(P0.05)。术后并发症:锁定钢板组无肱骨头缺血坏死,无内固定松动及断裂;解剖钢板组出现螺钉松动退钉1例,钢板断裂1例。结论肱骨近端锁定加压钢板设计合理,操作简便,同时具有固定和加压作用,固定牢固,可早期功能锻炼,肩关节功能恢复良好,术后骨折愈合快,治疗老年肱骨外科颈骨折疗效更好。     

Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails

ObjectiveThe aim of this study was to compare the biomechanical resistance to rotational and axial forces of a conventional locking nail with a newly designed intramedullary humeral nail developed for humeral shaft fractures with a secure locking mechanism through the distal part of the nail.MethodsInSafeLOCK humeral nail system (group 1, TST, Istanbul, Turkey) and Expert humeral nail system (group 2, DePuy Synthes, Bettlach, Switzerland) of the same size (9 × 300 mm) were examined. In total, 24 fourth-generation humerus sawbones were used in the experiment. Osteotomy was performed at the humerus shaft, and a defect was created by removing 1 cm of bone. After pre-loading 5000 cycles at a frequency of 2 Hz and a force of 50–250 N for axial loading and 5000 torsion torques between 0.5 Nm and 6.5 Nm at a 2 Hz frequency for torsional loading, the failure load values of each load were recorded. Distal interlocking was performed with an endopin in group 1, while a double cortex screw was used in group 2.ResultsAll samples successfully passed the cyclic loading. The initial and final stiffness values were similar between the groups after axial loading (p = 0.873 and p = 0.522, respectively). The mean axial failure load values in groups 1 and 2 were 2627 ± 164 N and 7141 ± 1491 N, respectively. A significant difference was found in the axial failure load values (p = 0.004). Significant differences were observed between the initial and final torsional stiffness between the two groups (p = 0.004 and p = 0.004, respectively). No significant difference was found in the failure load values after torsional loading (11791 ± 2055 N.mm and 16997 ± 5440 N.mm) (p = 0.055).ConclusionThese results provide a biomechanical demonstration of the adequate stability of both nails after axial and rotational loading. The reliability of the newly developed InSafeLOCK humeral nail system, which does not require fluoroscopic control and an additional incision for distal locking, supports its use in the clinic.     

成年血液透析患者不同封管液应用效果的网状Meta分析

目的评估不同封管液对成人血液透析患者的封管效果。方法通过计算机检索PubMed、Cochrane Library、Embase、中国知网、万方数据库、维普数据库,检索时间为建库至2018年9月。收集不同封管液对血液透析患者封管效果比较的随机对照试验。使用Cochrane 5.1.0系统评价手册进行质量评价,Stata12.0软件绘制网络图,WinBUGS进行数据分析。结果最终纳入文献15篇,包含7种封管液,共计样本量2 159例。网状Meta结果显示,对于导管相关性感染、导管接口处感染以及病死3个结局指标,各个研究结果比较,差异无统计学意义,但就概率排序,对降低导管相关性感染、导管接口处感染以及病死的发生,最优的封管液分别为抗生素、枸橼酸盐和乙醇。结论结合网状Meta分析结果和概率排序,考虑抗生素耐药特性,推荐乙醇或枸橼酸盐作为血液透析患者的封管液。     

交叉专科护理在颧骨复合体骨折患者中的应用分析

目的:分析交叉专科护理在颧骨复合体骨折患者治疗中的作用价值,为后续临床护理提供方法参考.方法:25例颧骨复合体骨折患者于2017年1月-2019年1月期间在我科室接受治疗,患者围术期均采取眼科及口科的交叉专科护理,分析护理效果.结果:25例患者术后颜面情况恢复良好,术后并发症较少;随访6个月后患者眼球内陷等状况改善,咬合状况良好.结论:颧骨复合体骨折临床治疗中采取交叉专科治疗可明显提高治疗效果,降低术后并发症发生率,具有临床推广价值.     

股骨近端防旋髓内钉、解剖型锁定钢板、人工股骨头置换治疗老年人股骨粗隆间骨折疗效比较

目的：比较股骨近端防旋髓内钉（proximal femoral nail anti?rotation,PFNA）、解剖型锁定钢板（PF?LCP）、人工股骨头置换治疗老年人股骨粗隆间骨折的临床疗效。方法：84例老年人粗隆间骨折,按手术方法分成PFNA组（27例）、PF?LCP组（30例）和人工股骨头置换组（27例）。对比各组患者手术时长、手术切口长度、术中失血量、总输血量、术后完全负重时间、术后髋关节Harris评分、住院天数,比较PFNA组和PF?LCP组术后骨折愈合时间。结果：PFNA组手术切口长度、术中失血量、术后完全负重时间、术后骨折愈合时间明显小于PF?LCP组,差异具有统计学意义（P < 0.05）。PFNA组手术切口长度、术中失血量明显小于人工股骨头置换组,差异具有统计学意义（P < 0.05）。PFNA组和人工股骨头置换组术后髋关节Harris评分及评分优良率明显高于PF?LCP组,差异具有统计学意义（P < 0.05）。PFNA组和PF?LCP组总输血量小于人工股骨头置换组,差异具有统计学意义（P < 0.05）。结论：PFNA和人工股骨头置换是治疗老年人股骨粗隆间骨折更好的手术方法,均可获得良好的髋关节功能,但需要谨慎注意手术适应证,选择适合的手术方案。     

股骨近端防旋髓内钉与股骨近端锁定钢板治疗老年股骨转子间骨折的疗效比较

目的比较股骨近端防旋髓内钉(PFNA)与股骨近端锁定钢板(LPFP)治疗老年股骨转子间骨折的疗效。方法将80例老年股骨转子间骨折患者随机分为2组,LPFP组给予LPFP,PFNA组给予PFNA,比较2组患者围术期临床指标、Harris评分、并发症与远期预后。结果 PFNA组患者围术期临床指标均显著优于LPFP组(P <0. 05);治疗后12个月,PFNA组Harris评分显著高于LPFP组(P <0. 05); PFNA组感染、下肢静脉血栓与髋内翻发生率均显著低于LPFP组(P <0. 05);PFNA组治疗后12个月生理功能、身体疼痛、活力与社会功能评分均显著高于LPFP组(P <0. 05)。结论相较于LPFP,PFNA对老年股骨转子间骨折患者的创伤更小,安全性更高。     

Results of titanium locking plate and stainless steel cerclage wire combination in femoral fractures

Background:

Some in vitro studies warn combining different metals in orthopedic surgery. The aim of this study is to determine the impact of combining titanium and stainless steel on bone healing and the clinical course of patients undergoing internal fixation of femoral fractures.

Materials and Methods:

69 patients with femoral fractures had polyaxial locking plate osteosynthesis. The locking plate was made of a titanium alloy. Two different cohorts were defined: (a) sole plating and (b) additional stainless steel cerclage wiring. Postoperative radiographs and clinical followup were performed at 6 weeks, 3 months and 12 months.

Results:

Cohorts A and B had 36 and 33 patients, respectively. Patient demographics and comorbidities were similar in both groups. In two cases in cohort A, surgical revision was necessary. No complication could be attributed to the combination of titanium and stainless steel.

Conclusion:

The combination of stainless steel cerclage wires and titanium plates does not compromise fracture healing or the postoperative clinical course.     

股骨重建钉治疗同侧股骨颈、干骨折

目的 探讨使用股骨重建钉内固定治疗同侧股骨颈、干骨折的临床疗效、手术要点和围手术期注意事项。方法 对12例使用股骨重建钉治疗的疗效进行回顾性分析。手术采用闭合穿钉、闭合或小切口切开复位，用三维瞄准器锁定远骨折端，股骨颈保持15。前倾角置人2枚拉力螺纹钉。结果 11例获得随访，随访平均时间12．3个月(6～58个月)。远期疗效按马元璋评定标准：优5例，良4例，可2例，优良率81．8％，平均股骨颈骨折临床愈合时间5．2个月、股骨干骨折临床愈合时间6．7个月，一期骨折愈合率达到72．7％，其中3例术后10，12，15个月远骨折段骨延迟愈合，改为动力固定，4～6个月后骨折愈合。无股骨头坏死征象。结论 股骨颈骨折强调不切开复位，并争取解剖复位；股骨干骨折则常规闭合穿钉、小切口复位、有限扩髓、静力固定。股骨重建钉是目前治疗股骨干粉碎性骨折伴同侧股骨颈骨折的有效方法。     

股骨近端锁定加压钢板治疗股骨转子间骨折

目的 探讨股骨近端锁定加压钢板（LCP）内固定治疗股骨转子间骨折的临床疗效.方法 采用股骨近端LCP治疗23例股骨转子间骨折的患者.随访观察骨折愈合时间,按Harris评分标准评价疗效.结果 23例均获随访,时间6~12（9±1.4）个月.骨折愈合时间14~20（17±1.7）周.髋关节Harris评分：优13例,良9例,一般1例.结论 股骨近端LCP内固定治疗股骨转子间骨折创伤小、出血少、对骨膜影响小,符合解剖形态,临床疗效满意.     

双侧锁定钢板治疗胫骨平台粉碎骨折

目的 探讨双侧锁定钢板治疗胫骨平台粉碎骨折的方法和疗效.方法对22例胫骨平台粉碎骨折患者行双侧锁定钢板内固定治疗.结果 22例均获随访,时间8～25个月.骨折均愈合,愈合时间6～16个月.膝关节功能按Iowa评分标准评定：优17例,良4例,可1例.结论 采用双侧锁定钢板治疗胫骨平台粉碎骨折固定牢靠,创伤小,并发症少,可早期功能锻炼,膝关节功能恢复良好,疗效满意.