踝关节骨折的治疗进展

尽管对旋转暴力型踝关节骨折的研究已经相当深入并且基本治疗策略已较为成熟,但向纵深和细微发展,还存在较多的争议,有进一步研究的必要。如某些骨折类型的手术指征并未获得广泛的认同,如何精准评估下胫腓联合的损伤还值得深入探讨,在下胫腓联合固定和后踝固定方面也还存在不同意见。随着技术的进步,可吸收内固定及微创技术的应用可望在骨折治疗中取得更好的结果,但对其手术经验和远期治疗效果还需更多的观察与总结。     

伊里扎诺夫技术修复兔胫骨骨缺损成骨机制的研究

目的探讨截骨推移区骨愈合的组织学特点和新骨形成规律。方法取青紫蓝兔24只,建立胫骨大段骨缺损模型,在近干骺端截骨。分别于截骨后第1、2、4、6、8、10周各处死4只兔,在近干骺端的分离区取材进行组织学观察。结果截骨后第1周出现血肿机化,第4周出现膜内成骨和软骨内成骨,第6周推移区大部分被骨性骨痂取代,第8周开始改建。结论推移区存在膜内成骨和软骨内成骨2种方式,以膜内成骨为主。     

股骨近端解剖型锁定钢板治疗老年股骨转子间骨折

2008年6月～2010年5月,我科采用大转子直切口股骨近端解剖型锁定钢板治疗23例老年股骨转子间骨折患者,取得满意疗效。1材料与方法1.1病例资料本组23例,男9例,女14例,年龄65～85岁。伤后至手术时间3～10 d。左侧10例,右侧13例,按     

股骨髁锁定钢板结合重建锁定钢板治疗股骨远端骨折

2007年1月～2010年6月,我科采用切开复位股骨髁锁定钢板结合重建锁定钢板内固定治疗股骨远端骨折28例,疗效满意,报道如下。1材料与方法1.1病例资料本组28例,男20例,     

Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer: retrospective analysis of risk factors

The purpose of this study is to determine the incidence, clinical characteristics and risk factors of postradiation pelvic insufficiency fracture (PIF) in women with uterine cervical cancer. We reviewed the medical records of 126 patients who received definitive radiotherapy (RT) for uterine cervical cancer between 2003 and 2009 at our institution. Among them, 99 patients who underwent at least one computed tomography (CT) or magnetic resonance imaging of the pelvis during their follow-up at more than 6 months were included in this analysis. The relationship between the incidence of PIF and several patient- and treatment-related factors was analyzed. The median follow-up period was 21 months. Of the 126 patients, 33 (with a total of 50 lesions) were diagnosed with PIF. The 2-year cumulative incidence was 32%. Univariate analysis showed that age ≥70 years (P= 0.0010), postmenopausal state (P = 0.0013), and lower CT density of bone and bone marrow (P= 0.020) significantly related to PIF. In a multivariate analysis, of the 59 patients whose CT densities were evaluable, lower CT density was the only significant factor associated with PIF (P = 0.0026). In conclusion, postradiation PIFs were detected in a considerable number of patients after definitive RT for cervical cancer. Predisposing factors were older age, postmenopausal state, and decreased density of bone and bone marrow on CT.     

Pro-inflammatory interleukins in patients operated on for proximal femur fracture

Abstract

Objectives. The aims of this study were to measure plasma IL 6 and IL 8 in patients with proximal femoral fracture (PFF) during the early phases of trauma and operation and to find out if there was any correlation between these ILs and the post-operative lower limb oedema. Material and methods. Thirty patients with a median age of 81 years were grouped into pertrochanteric fracture (PTF) (n = 16) and femoral cervical fracture (FCF) (n = 14). Plasma interleukin levels were determined on blood samples obtained from the common femoral vein, immediately after hospital admission, 1 h before operation, and post-operatively at 1, 6, 12, 24, 48 h and on the 7th day. Thigh oedema was calculated by the frustum method. Results. In the patients with PTF, maximum mean plasma IL-6 and IL-8 values were found, respectively at 24 h (45.12 pg/mL) and 6 hours (21.7 pg/mL) postoperatively. Whereas, in the patients with FCF, it was respectively, at 12 h (33.1 pg/mL) and 6 h (17.0 pg/mL), for IL-6 and IL-8 post operatively. The patients with PTF and FCF had respectively, 34.1% and 27.4% more thigh oedema in the operated limb on the 7th post-operative day as compared to the preoperative oedema volume (p<0.001). No significant correlation could be found between the plasma IL-6 and IL-8 levels and oedema in the operated limb. Conclusion: Increased levels of IL 6 and IL 8 suggest ongoing inflammation.     

关节镜下经髌腱入路空心拉力螺钉复位固定治疗胫骨髁间嵴撕脱骨折*

目的探讨在关节镜下经髌腱入路,利用空心拉力螺钉复位固定胫骨髁间嵴撕脱骨折(TEFx)的安全性和有效性。方法选取2014年1月-2015年12月23例TEFx的患者,均在关节镜下经髌腱入路,用空心拉力螺钉复位固定。术前Meyers-McKeever分型:Ⅱ型8例,Ⅲ型10例,Ⅳ型5例;男17例,女6例;年龄16～53岁,平均27.8岁。术前前抽屉试验、Lachman试验均阳性。比较术前术后的视觉模拟评分(VAS)、Lysholm、Tegner和国际膝关节文献委员会(IKDC)评分评价患侧膝关节功能。结果 23例患者均得到随访,随访时间30～40个月,平均36个月。术后即刻X线片示TEFx均复位良好,术后3个月骨折均愈合。无1例感染、关节僵硬、伸直受限、复位丢失及神经血管损伤等并发症。最终随访患侧膝关节活动度均恢复正常,前抽屉试验、Lachman试验均阴性。VAS评分术前(4.8±1.2)分,最终随访为(1.2±0.8)分,术前术后比较,差异有统计学意义(t=18.72,P=0.003);Lysholm评分术前为(50.8±6.2)分,最终随访为(90.8±5.4)分,术前术后比较,差异有统计学意义(t=-42.64,P=0.000);Tegner评分术前为(4.0±1.0)分,最终随访为(5.1±1.2)分,术前术后比较,差异有统计学意义(t=-16.82,P=0.005);IKDC主观评分术前为(52.5±7.4)分,最终随访为(91.5±5.7)分,术前术后比较,差异有统计学意义(t=-40.58,P=0.000)。结论膝关节镜下经髌腱入路空心拉力螺钉内固定治疗TEFx具有微创、操作简捷、固定可靠和恢复快的优点。     

渗透性缓泻药物早期干预对老年股骨 转子间骨折患者排便功能的影响

〔摘 要〕 目的：探讨渗透性缓泻药物早期干预大便管理对卧床的老年股骨转子间骨折患者排便功能的影响。 方法：选取南通市第四人民医院 2016 年 1 月至 2020 年 12 月收治的 86 例股骨转子间骨折老年患者,在入院时随机抽 签选入对照组及观察组,每组 43 例。对照组入院后按常规排便管理,观察组在常规排便管理的同时,入院后即口服 渗透性缓泻药物早期干预排便,比较两组患者排便情况。结果：观察组入院后首次排便时间早于对照组,首次排便消 耗时间短于对照组,入院后首周内排便次数多于对照组,差异具有统计学意义（P ＜ 0.05）;观察组首次大便的性状 更合理于对照组,差异具有统计学意义（Z = –6.126,P ＜ 0.05）。结论：渗透性缓泻药物的应用能够有效预防便秘 的发生,早期预防性口服渗透性缓泻药物能更好对排便功能进行管理。     

陈旧性与新鲜性压缩骨折行椎体成形术的临床对比研究

【摘要】 目的 回顾性对比研究陈旧性与新鲜性椎体压缩性骨折行经经皮椎体成形术(percutaneouss vertebra plasty,PVP)后的临床效果。 方法 对24例老年骨质疏松性胸腰椎压缩性骨折患者行PVP治疗,将研究对象按陈旧性骨折和新鲜性骨折分为2组,分别拍摄2组术前、术后标准正侧位X线片,从而对骨折椎体高度的恢复、后凸畸形的矫正及疼痛视觉模拟量表（visual analogue scale, VAS）评分进行研究对比。 结果 所有患者术后平均随访6个月,无严重并发症发生。2组患者术后疼痛缓解且恢复良好,均恢复日常活动能力。但陈旧性压缩性骨折患者术后椎体高度恢复和后凸畸形的矫正程度均不如新鲜性骨折患者。 结论 PVP术操作简单、创伤小,对于骨质疏松性椎体压缩性骨折的治疗效果明显,尤其对新鲜骨折效果显著,且对于缓解陈旧性骨折疼痛症状也有良好效果。