单边外固定架治疗胫骨骨不连的疗效

目的 探讨单边外固定架治疗胫骨骨不连的疗效.方法 回顾性分析2010年1月至2013年12月我院收治的28例胫骨骨不连患者的临床资料,均行外固定架植入、胫骨截骨、骨延长.截骨术后l0d开始延长,每天延长1mm.结果 随访时间1～4年,平均2.5年.所有患者均获得骨和软组织缺损修复.根据改良Paley骨延长评分,18例为优,8例为良,2例为可.结论 单边外固定架操作简便、创伤小、预后良好,是胫骨骨不连患者的有效治疗方法.     

通络生骨胶囊加微创内固定术治疗非创伤性股骨头缺血性坏死患者的护理

对185例口服中药通络生骨胶囊加微创植骨支撑内固定术治疗围塌陷期非创伤性股骨头缺血性坏死患者进行护理,认为术前做好各项检查及心理护理,术后注意观察病情变化,保持术肢体位正确,加强基础护理,预防并发症,正确指导患者服用中药及功能锻炼,并做好出院指导工作,对患者恢复髋关节功能起重要作用。     

Humoral immunity induced by a live Francisella tularensis vaccine. Complement fixing antibodies determined by an enzyme-linked immunosorbent assay (CF-ELISA)

A complement-fixing enzyme-linked immunosorbent assay (CF-ELISA) with bacterial sonicate as the antigen, human AB serum as the source of complement and alkaline-phosphatase-labelled anti-(human C3e) as the conjugate was developed for detecting antibodies to Francisella tularensis. Humoral responses after inoculation with a live attenuated tularemia vaccine were studied in 13 subjects by this method. Twelve responded with CF antibodies, which in most cases appeared 4 weeks after vaccination, the response time varying from 1 week to 2 months. The highest individual CF titres, of 140–9990, were reached 1–4 months after vaccination (average 2.4 months). The CF titres tended to decrease with time, and at 10 months two of the 12 subjects with an earlier CF positive response were negative again. CF antibodies were nevertheless still detectable in all three subjects studied 1.5 years after vaccination.     

带蒂颊肌瓣鼻底转移术与硅胶鼻底植入术治疗萎缩性鼻炎的疗效比较

目的：比较带蒂颊肌瓣鼻底转移术与硅胶鼻底植入术治疗萎缩性鼻炎的疗效。方法：将80例萎缩性鼻炎患者分为2组,43例行带蒂颊肌瓣鼻底转移术（A组）,37例行硅胶鼻底植入术（B组）。结果：手术治疗后总有效率A组高于B组（P＜0.05）,术后并发症A组少于B组（P＜0.05）。结论：带蒂颊肌瓣鼻底转移术治疗萎缩性鼻炎具有更好的疗效。     

Comparison of the Effectiveness of Simple Plate Fixation and Plate Combined with Local Fixation of Broken Ends in the Treatment of Oblique Fracture of Midshaft Clavicle

ObjectiveTo compare the clinical efficacy of performing simple plate fixation with that using a plate combined with fracture end fixation to investigate the necessity of fracture end fixation outside the plate in cases of oblique fracture of the middle clavicle.MethodsThis was a retrospective follow‐up study of patients with middle clavicle oblique fractures (Robinson types 2A1 and 2A2) between 2015 and 2020. Patients were divided into two groups according to their treatment options: the simple plate fixation (SPF) group (n = 79; 43 men and 36 women; average age, 46.37 ± 14.54 years) and the plate combined with fracture local fixation (PLFP) group (n = 81; 36 men and 45 women; average age, 48.42 ± 12.55 years). Intraoperative blood loss, operation time, postoperative fracture healing time, postoperative shoulder function score (Constant–Murley and disabilities of the arm, shoulder, and hand [DASH] scores), clinical complications, and postoperative subjective satisfaction were compared between the two groups.ResultsOne hundred sixty patients with a sufficient follow‐up period were included in the final analysis: 79 in the SPF group (follow‐up time: 16.24 ± 3.94 months) and 81 in the PLFP group (follow‐up time: 16.15 ± 3.43 months). Age, sex, body mass index, follow‐up duration, fracture classification, and cause of injury were not significantly different between the two groups. There was no significant difference in blood loss, Constant–Murley and DASH scores, follow‐up period, and postoperative subjective satisfaction between the two groups (P > 0.05). The fracture healing time was shorter in the PLFP group than in the SPF group (4.41 ± 0.99 vs. 4.87 ± 1.60 months, P < 0.05), but the operation duration was longer in the PLFP group than in the SPF group (65.48 ± 16.48 min, P < 0.05). There were seven (complication rate, 8.86%) and five (complication rate, 6.17%) cases that had complications in the SPF and PLFP groups, respectively. There was no significant difference in the complication rates between the two groups (P > 0.05).ConclusionAlthough the healing time was shorter in the PLFP group than in the SPF group, the clinical efficiency of the two methods in the treatment of oblique fracture of the middle clavicle was similar.     

腰椎滑脱症外科治疗策略选择

目的探讨不同类型腰椎滑脱症及合并症的手术治疗方式、疗效及优缺点。方法2000年2月～2004年4月应用后路椎弓根螺钉复位内固定后，分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体问植骨融合术治疗不同类型腰椎滑脱症及合并症的患者78例，比较术后及随访时疗效、滑脱椎体复位率、椎间隙高度恢复率、植骨融合率以及复位丢失率。结果术后28例Ⅰ度滑脱及37例Ⅱ度腰椎滑脱患者获得解剖复位．9例Ⅱ度滑脱及4例Ⅲ度腰椎滑脱患者矫正至Ⅰ度滑脱。随访时总体优良率为89．72％，42例椎体间植骨患者植骨融合良好，滑脱椎体复位无丢失，椎间隙高度维持良好；36例后外侧植骨者有12例复位丢失，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂：结论对小于Ⅱ度退变性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉复位固定加后外侧植骨融合术；对峡部裂性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉固定加椎体间植骨融合术；对Ⅱ度以上峡部裂性单纯腰椎滑脱者以及腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术。     

中老年股骨颈骨折全髋关节置换术和中空加压螺钉内固定术临床比较

目的比较全髋关节置换术和中空加压螺钉固定术治疗中老年股骨颈骨折的疗效。方法对55～65岁有移位新鲜股骨颈骨折患者85例的治疗情况进行回顾分析，其中51例行中空加压螺钉内固定术，34例行全髋关节置换术，进行了住院情况，术后1年，术后3年功能评估。结果全髋关节置换组在手术时间，术后早期下床活动等方面具有一定的优越性，但全髋关节置换假体费用较贵，3年后有2例出现假体松动。中空加压螺钉固定组有45例3年后无任何并发症发生，髋关节功能活动良好，且能够从事正常体力劳动。结论中老所股内颈骨折患者手术治疗应首选中空加压螺钉内固定术治疗。     

胸椎旁路法植入椎弓根螺钉的力学实验研究

目的：研究在胸椎节段应用椎弓根旁路法植入椎弓根螺钉的力学可行性。方法：5副成人新鲜尸体胸椎（T1-8）, 分解为40个单一椎体标本,每一标本左右两侧分别使用经椎弓根入路法（n=40）和旁路法（n=40）植入螺钉,并进行螺钉沿椎体矢状轴拔出强度的力学测量,比较两种方法的拔出强度。结果：旁路法植入螺钉后出现两种情况A和B,A：19个椎体（47.5%）,为螺钉经横突后沿椎弓根外壁固定至椎体;B：21个椎体（52.5%）,为螺钉经椎弓根外侧皮质至椎体。旁路法中A植入螺钉的拔出强度为（827.01±260.00）N,旁路法中B植入螺钉的拔出强度为（954.25±254.00）N。结合A、B两种情况,旁路法中植入螺钉的平均拔出强度为（890.63±342.00）N,胸椎经椎弓根入路螺钉的拔出强度为（1 001.23±220.00）N,二者比较,旁路法螺钉的平均拔出强度较经椎弓根入路法螺钉的拔出强度降低11.04%,但差异无显著性（P>0.05）。结论：胸椎椎弓根旁路法植入椎弓根螺钉在力学上是可行的。     

股骨干骨折内固定治疗问题——附135例临床分析

本文总结了我院从1963年11月到1985年10月对135例(143个股骨)股骨干骨折手术治疗的经验,并对四种内固定方法进行了比较,随访结果:130个股骨干手术切开复位内固定疗效满意,优良率占91％。在施行股骨干骨折内固定术时,必须具备有关内固定的基本理论知识和技术条件,方能获得满意效果。     

应用可吸收螺钉-可吸收缝线治疗关节内骨折

目的探讨可吸收材料治疗关节内骨折的临床效果。方法用芬兰产B iofix可吸收拉力螺钉治疗关节内骨折56例。根据不同的骨折部位和类型采取合适的手术入路,根据骨折情况选择可吸收材料进行固定,术后给以石膏托固定4~6周,髋臼及股骨头骨折术后牵引4~6周。结果全组56例,有54例得到6~18个月随访,平均(14.1±3.6)个月,骨折全部愈合,关节功能良好,效果满意,无延迟愈合及不愈合发生。综合评价:优43例,良11例,关节功能均达到正常肢体90%以上,无切口感染,无非特异性炎症反映。结论可吸收材料是关节内骨折的较为理想的内固定物,可以避免二次手术,减轻患者负担,对关节内骨折的治疗具有特殊的优越性。