负压封闭引流技术在骨科的临床应用进展

负压封闭引流(VSD)技术是临床上用来加速组织愈合、恢复外形及功能的重要治疗方法,最初应用于治疗软组织损伤和开放性骨折,在不断地优化后,现运用于各种类型疾病中,并取得了良好效果。随着对VSD技术在软组织损伤、创面感染和术后切口感染、骨筋膜室综合征、皮肤移植修复、骨髓炎的疗效及作用机制的深入研究,VSD技术已然变成近几年研究的热门之一。目前该技术已日臻完善,覆盖骨科疾病治疗的范围也逐年扩大,在临床疗效上获得了广泛认可,当然,这其中也存在美中不足的部分,需要各方人员不断推陈出新,共克难关。本文就负压封闭引流技术在骨科的临床应用进展作一综述,以利于VSD技术在临床中推广和进一步发展应用。     

Quadrilateral plate fractures of the acetabulum: Proposition for a novel classification system

BackgroundCurrently, there is no definition or classification system for quadrilateral plate (QLP) fractures; the aim was to anatomically and radiologically characterise the QLP, propose a definition and classify QLP fractures.MethodsThis study included an anatomical component and a radiological component. The anatomical study aimed at defining the characteristics of the QLP; the QLP was identified using four articulating bony pelvis specimens. A titanium mesh was placed on the specimens’ quadrilateral surface; standard anteroposterior and oblique views were obtained, and axial CT images, to determine the radiological landmarks. The radiological study included the review of images of patients with QLP fractures; fractures involving the QLP were identified in a series of 609 consecutive patients with acetabular fractures.ResultsWe considered QLP fractures where the QLP is separated from both columns of the acetabulum; this was found in 16% (98 cases). They were mostly encountered with associated both columns fractures (60 cases; 61%), Separation of the QLP could be complete or incomplete, or simple or comminuted, so QLP fractures were divided into three types: QLP1, simple with incomplete separation; QLP2, comminuted with incomplete separation; QLP3, comminuted with complete separation (QLP4), simple with complete separation.ConclusionThe QLP was characterised, and a definition and classification system; Cairo University Hospitals (CUH) Classification was proposed for these fractures. We believe that this classification may prove useful in the future for the identification and management of these fractures.     

Factors influencing short-term outcomes for older patients accessing emergency departments after a fall: The role of fall dynamics

BackgroundWhile the relevance of falls in raising the risk of fractures, hospitalization and disability in older age is well recognized, the factors influencing the onset of fractures and the need for ward admission after a fall have yet to be fully elucidated. We investigated which factors and fall dynamics were mainly associated with fall-related injuries and hospitalization among elderly persons accessing the Emergency Department (ED) following a fall.MethodsThe study involved 2144 older subjects who accessed the ED after a fall. Data on the fall´s nature and related injuries, ward admissions, history of falls, dementia, and medical therapies were examined for all patients. Considering dynamics, we distinguished accidental falls (due to interaction with environmental hazards while in motion) and falls from standing (secondary to syncope, lipothymia, drop attack, or vertigo).ResultsThe overall prevalence of fractures in our population did not differ significantly with advancing age, though hip fractures were more common in the oldest, and upper limb fractures in the youngest patients. Falls from standing were associated with polypharmacy and with higher ward admission rate despite a lower fractures´ prevalence than accidental falls. The chances of fall-related fractures were more than fourfold as high for accidental dynamics (OR = 4.05, 95%CI:3.10–5.29, p < 0.0001). Ward admission was associated with polypharmacy, dementia, anticoagulants´ use and fall-related fractures (OR = 6.84, 95%CI:5.45–8.58, p < 0.0001), while it correlated inversely with accidental fall dynamics.ConclusionsOutcomes of falls in older age depend not only on any fall-related injuries, but also on factors such as polypharmacy, cognitive status and fall dynamics.     

双钢板内固定治疗胫骨平台复杂性骨折疗效分析

目的：探讨双钢板内固定治疗胫骨平台复杂性骨折的临床效果。方法回顾性分析39例采用双钢板内固定治疗的Schatzker吁型、遇型胫骨平台骨折,术后随访12~30个月,采用Rasmussen评分标准评定膝关节功能。结果术后塌陷(后髁)1例,余无内固定失败病例,术后膝关节功能优良率89.74%。结论双钢板内固定是目前治疗胫骨平台复杂性骨折比较理想的方法,愈合率高,并发症少。     

The evaluation of the sensitivity and specificity of wrist examination findings for predicting fractures

Background

The aim of this study was to evaluate the sensitivity and specificity of physical examination findings and functional tests in adult acute wrist trauma patients who presented to the emergency department (ED) and to create a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma.

骨科患者漂浮血栓危险因素分析

目的:探讨骨科患者漂浮血栓(FFT)的发生率及危险因素。方法:以2009年1月至2013年11月因骨科疾病致深静脉血栓(DVT)患者855例为研究对象,对年龄、就诊原因、发现时间、骨折部位、发生血栓部位等方面的资料进行统计分析。结果:855例患者发生漂浮血栓70例,发生率8.2%,平均年龄51.34岁,因摔伤及车祸、工伤而入院的患者最多,伤后发现血栓时间平均4.77d,以股骨远端及髁间,胫骨近端及胫骨平台骨折发生漂浮血栓最多,达31例,占44.3%,70例漂浮血栓中,腘静脉漂浮血栓最常见,占82.9%。FFT较普通血栓(OT)风险度更高,其发生与患者年龄、病史、骨折部位及血栓发生部位均具有相关性,对于高危患者,临床医生要引起高度重视,积极采取预防措施降低FTT及肺栓塞的发生。     

Radiological vignette. Insufficiency fracture of the acetabulum

Summary An insufficiency fracture (IF) involving the acetabulum is presented. This fracture occurred in a 67-year-old woman who had been hysterectomized and oophorectomized 27 years earlier for a carcinoma of the uterine cervix, and who had received external pelvic irradiation. This IF location has been rarely described earlier, and its awareness should preclude unnecessary aggressive diagnostic procedures especially in patients with osteoporosis and previous pelvic radiotherapy.     

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County,Minnesota

Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject’s medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0–3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1–5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9–6.5) and 3.2 times more likely (CI: 1.0–10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.     

新鲜下肢骨折术前深静脉血栓形成危险程度评分量表初探

目的 初步尝试建立新鲜下肢骨折术前深静脉血栓形成危险程度评分量表,用于院内下肢骨折患者术前深静脉血栓形成危险程度的客观判断.方法 回顾性分析2011年1月至2012年12月北京积水潭医院创伤骨科治疗的新鲜下肢骨折患者资料,依据排除标准剔除病例后共纳入分析1 705例.这些患者被随机分为两组,研究组(879组)通过logistic回归分析筛选出危险因素,以多因素logistic回归OR值赋分的方法产生新鲜下肢骨折术前深静脉血栓形成危险程度评分量表,检验组(826例)对评分表进行验证.结果 纳入患者中男性1 106例,女性599例;平均年龄(50±18)岁,logistic回归分析显示可以预测深静脉血栓形成的因素包括年龄、待术时间、受伤原因、受伤部位、心脑血管疾病史以及D-二聚体(D-Dimer)检测值.根据回归OR值得出的分值分别是:年龄≤35岁为1分,＞35 ～ ＜65岁为4分,≥65岁为6分;待术时间＜8d为1分,≥8d为2分;受伤原因低能量为1分,高能量为3分;受伤部位中,足踝损伤为1分,小腿骨折为3分,膝关节周围骨折为5分,股骨中上段为7分,骨盆髋臼为4分,多发骨折为6分;无心脑血管疾病史为1分,有心脑血管疾病史为2分;D-Dimer＜ 600 μg/L为1分,≥600μg/L为3分.受试者工作特征曲线下面积为0.79,临界点15.5分,总体数据临界点灵敏度为77.00％,特异度为68.17％.结论 新鲜下肢骨折术前血栓危险程度评分量表对深静脉血栓形成具有一定的预测效能,但是存在局限性.