新型防旋支具在中西医结合保守治疗胫腓骨骨折中的应用

[目的]探讨新型防旋支具在中西医结合保守治疗胫腓骨骨折中的临床应用效果。[方法]2015年9月—2017年1月行保守治疗的胫腓骨骨折患者64例,随机分为试验组(32例)和对照组(32例)。两组患者入院后均行跟骨牵引术,中医正骨手法复位联合小夹板固定,辅以中药外敷内服。试验组术后采用新型防旋支具固定患肢,防止足部外旋;对照组术后采用传统的方法防止足部外旋。定期进行疼痛视觉模拟评分法(VAS法)评分,应用Kolcaba舒适状况量表(GCQ)检测舒适度改善状况,计算机断层扫描(CT)检查测量骨折旋转移位角度,随访记录骨折愈合时间及并发症情况,采用Johener-Wruhs评分系统对患肢功能进行评价。[结果]试验组骨折旋转移位角度小于对照组,牵引术后第1、3、7天的VAS疼痛评分均低于对照组,舒适度GCQ总分和其中的生理、心理精神维度单项得分均高于对照组,骨折愈合时间短于对照组,肢体功能Johner-Wruhs评分优良率高于对照组。两组间差异具有统计学意义(P0.05)。[结论]中西医结合保守治疗胫腓骨骨折过程中应用新型防旋支具,可以有效维持足部中立位,纠正成角及旋转畸形,辅助复位,减轻疼痛,提高患者舒适感受,缩短骨折愈合时间,有利于患肢功能恢复,且不增加并发症的发生,便于护理,安全可靠。     

Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures

ObjectiveThe objective of the study was to evaluate the effectiveness of the posterolateral minimally invasive plate osteosynthesis (MIPO) method for managing distal tibial or tibial shaft fractures with severe anterior and medial soft tissue injuries.Materials and methodsFive consecutive patients with three distal tibial and two tibial shaft fractures (three open fractures) at a level-1 trauma and tertiary referral center were retrospectively reviewed. All patients were definitively treated and followed to bone union. Main outcome was measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, complications, and bone union on radiographs.ResultsThe average follow-up period was 15.8 months (range, 12–24 months). The average AOFAS score was 88.2 (range, 81–90). There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. Bone union was achieved in all cases.ConclusionsPosterolateral MIPO is a feasible option when treating these fractures, especially in cases with severe anterior and medial soft tissue injuries.     

Management of Chronic Paronychia

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.     

Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis

BackgroundLocking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included “locking and dynamic holes separated” and “locking hole only” configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate.MethodsFinite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A “virtual” subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison.ResultsThe mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6 N/mm) compared with the combi design (115.0 N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5 N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design.ConclusionsThe computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture.     

手法复位加中药熏洗治疗旋前外展型踝关节骨折效果探讨

目的：分析研究手法复位加中药熏洗治疗旋前外展型踝关节骨折的临床应用价值。方法：选取2008年8月至2012年8月在该院接收的旋前外展型踝关节骨折患者一共有56例，对56例患者采取手法复位加中药熏洗治疗，对其临床治疗效果给予分析。结果：56例患者，其中优43例（76.79％）；良10例（17.86％）；差3例（5.36％），优良率为94.64％，临床手术以后跟踪随访6个月～3年，病人全部治愈。结论：旋前外展型踝关节骨折采取手法复位加中药熏洗治疗，可以使相关症状得到明显改善，使临床治疗效果进一步提高，具有临床推广价值。     

cN0甲状腺乳头状癌颈淋巴结选择性清除术的意义及方式探讨

目的探讨甲状腺乳头状癌颈淋巴结转移规律,为选择最佳手术方式提供参考。方法回顾性分析2012年1月~2016年1月宁德市闽东医院618例诊断为c N0甲状腺乳头状癌患者的临床和病理资料,术前、术中腺体内注射美蓝,切除甲状腺同时常规清扫中央区,根据淋巴结染色情况选择性清扫颈侧区。结果 618例有完整统计资料的c N0甲状腺乳头状癌患者中,病理诊断颈部蓝染淋巴结总转移率为88.19%(3347/3795),中央区(Ⅵ区)淋巴结转移率为89.49%(3006/3359),颈侧区(Ⅱ、Ⅲ、Ⅳ)蓝染淋巴结转移率为78.21%(341/436),其中Ⅱ区72.81%(83/114)、Ⅲ区80.46%(140/174)、Ⅳ区79.73%(118/148)。结论甲状腺乳头状癌最常见的转移部位是Ⅵ区,术中应常规清除,其次依次为Ⅲ、Ⅳ、Ⅱ、Ⅴ区,对于c N0患者也应选择性行颈部淋巴结清扫术,美蓝进行术前标记转移淋巴结方法可行,对于临床术式选择有一定的指导意义,值得推广应用。     

Pelvic discontinuity: Where are we today?

Pelvic discontinuities in revision total hip arthroplasty remain a challenging problem with an evolving set of treatment options. Discontinuities occur when bone loss of the acetabulum and subsequent unstable movement of the acetabular component result in a fracture between the anterior and posterior columns. These resemble chronic nonunions by the time of revision arthroplasty and are managed differently from the acute fracture type occurring during primary or revision acetabular reconstruction in a previously stable pelvis. We review the treatment options and describe our preferred method of treatment using surgical distraction.     

闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素分析

目的回顾性分析闭合复位空心螺钉治疗股骨颈骨折后股骨头坏死的影响因素。 方法对2009年1月至2017年3月293例采用加压空心螺钉治疗股骨颈骨折的患者进行回顾性分析，其中获得随访的患者247例。应用SPSS20.0软件进行统计学分析，并对影响股骨头坏死的各项因素进行Logistic回归分析。 结果247例患者获得平均58个月（24~80个月）随访，32例出现股骨头坏死，发生率12.9%，随访时髋关节Harris评分平均81.4±3.9分（54~98分）。影响股骨颈骨折术后股骨头坏死的因素和顺序依次为复位质量（OR=9.854，P=0.012），空心钉排列方式（OR=7.965，P=0.017），骨折分型（OR=6.453，P=0.021），空心钉取出与否（OR=5.364，P=0.027），术前是否牵引（OR=2.561，P=0.042）。 结论复位质量是影响股骨颈骨折预后最为关键的因素。空心螺钉正三角形排列、空心螺钉取出以及未及时术前牵引均可能加重股骨头坏死。