无名异冲剂促进去卵巢大鼠骨质疏松性骨折愈合的机制研究

为探讨无名异冲剂促进去卵巢 SD大鼠骨质疏松性骨折愈合的机制 ,用 48只 6月龄雄性 SD大鼠建立骨质疏松性骨折模型 ,随机分为模型组、跳骨片组、仙灵骨葆组、无名异冲剂组 ,于灌胃后 2周、4周取材 ,观察 X线片、骨密度、光镜 ,骨痂钙、磷、胶原含量 ,结果显示灌胃第 2周时 ,各组动物各项指标均无显著性差异 ;第4周时 ,无名异冲剂组的骨密度 ,骨痂钙、磷、胶原含量的检测结果与模型组有显著性差异 ( P<0 .0 5 ) ,X线及光镜观察骨痂的生长情况 ,无名异冲剂组也优于模型组 ,说明无名异冲剂能够通过提高骨密度 ,改善骨骼钙、磷、胶原的代谢 ,促进骨折端骨痂的生长 ,达到治疗骨质疏松性骨折的目的。     

胸椎骨折合并胸外伤的外科治疗

目的　总结 17例胸椎骨折患者的特点与诊疗情况 ,为提高此类合并胸外伤患者的疗效提供有效的治疗方案。方法　分析了 17例胸椎骨折患者的临床特点、诊疗经过、近远期随访结果。结果　 14例 (82 .4 % )合并肋骨骨折 ,11例 (6 4 .7% )合并血气胸 ,10例 (5 8.8% )合并严重脊髓伤 ,3例 (30 % )远期脊髓伤为有用恢复。结论　胸椎骨折常合并肋骨骨折、血气胸、严重脊髓损伤 ,预后较差 ,为此应重视合并胸外伤的胸椎骨折的围手术期处理     

外固定支架加自体骨髓多能干细胞治疗桡骨远端骨折

[目的]探讨外固定支架结合骨折端局部注射自体骨髓多能干细胞治疗桡骨远端粉碎性骨折的有效性。[方法]应用外固定支架结合骨折端局部注射自体骨髓多能干细胞治疗桡骨远端粉碎性骨折18例。[结果]随访6～15个月(平均8个月),优10例,良6例,可2例,差0例。优良率为88.9%。没有一例出现针道浅表感染等并发症。[结论]外固定支架结合骨折端局部注射自体骨髓多能干细胞是治疗桡骨远端粉碎性骨折的一种方便、有效的方法,不仅骨折愈合效果满意,而且固定确实可靠,并能早期功能调整和训练。     

中华长城系统治疗胸腰椎爆裂骨折

目的探讨中华长城椎弓根钉系统治疗胸腰椎爆裂骨折的优越性,并评价其临床效果。方法选择后正中入路椎管减压或单纯使用中华长城内固定系统治疗胸腰椎爆裂骨折40例。结果经3~18个月随访,椎体平均高度由术前的前34.5%和后74.5%恢复到术后的前95%和后98.5%,Cobb′s角由术前平均16.0°恢复为术后平均1.5°。对脊髓损伤的患者Frankel分级平均提高1.5级。未出现椎弓根钉松动和断裂。结论中华长城系统治疗胸腰椎爆裂骨折操作安全、固定确实、椎弓根大小设计合理,具有较明显的优越性,有待进一步临床应用观察。     

Osteochondral Fracture of the Fourth Metatarsal Head Treated by Open Reduction and Internal Fixation

Fracture of the metatarsal head is uncommon, and reports of isolated osteochondral fracture of the metatarsal head are rare. Because of the distal location of the fracture, it is difficult to achieve and maintain reduction, and potential complications include avascular necrosis and subchondral fatigue fracture. The authors present a case of an osteochondral fracture in a 40-year-old man, which was treated by open reduction and internal fixation with a single twist-off screw, with good results 12 months postoperatively.     

人工股骨头置换术治疗高龄非稳定性股骨转子间骨折

目的探讨高龄患者非稳定性股骨转子间骨折行人工股骨头置换术的临床疗效。方法本组74例，年龄75～89岁，平均80．3岁；骨折类型按Evans分类：ⅢA型31例，ⅢB型24例，Ⅳ型19例。其中3例为经内固定治疗失败病例，合并内科疾病者69例，在相关内科协同治疗后行双极骨水泥型人工股骨头置换术，术后早期进行康复锻炼。结果74例都顺利通过手术，住院期间无死亡病例；72例获得随访，随访时间3～16个月，平均9．2个月；无一例出现畸形，髋关节功能接近或恢复到受伤前水平，生活可自理；2例于出院后5个月、11个月死于其他疾病。结论人工股骨头置换术治疗高龄非稳定性股骨转子间骨折是一种效果确切的治疗方法，操作简单、创伤小、卧床时间短、并发症低、死亡率低，提高了高龄患者的生活质量。     

Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up

BACKGROUND CONTEXT: Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. PURPOSE: To evaluate the long-term clinical and radiological outcome after nonoperatively treated thoracic or lumbar burst fractures in adults, with special attention to posttraumatic radiological disc height reduction. STUDY DESIGN: Case series. PATIENT SAMPLE: Sixteen men with a mean age of 31 years (range, 19-44) and 11 women with a mean age of 40 years (range, 23-61) had sustained a thoracic or lumbar burst fracture during the years 1965 to 1973. Four had sustained a burst fracture Denis type A, 18 a Denis type B, 1 a Denis type C, and 4 a Denis type E. Seven of these patients had neurological deficits at injury, all retrospectively classified as Frankel D. OUTCOME MEASURES: The clinical outcome was evaluated subjectively with Oswestry score and questions regarding work capacity and objectively with the Frankel scale. The radiological outcome was evaluated with measurements of local kyphosis over the fractured segment, ratios of anterior and posterior vertebral body heights, adjacent disc heights, pedicle widths, sagittal width of the spinal canal, and lateral and anteroposterior displacement. METHODS: From the radiographical archives of an emergency hospital, all patients with a nonoperatively treated thoracic or lumbar burst fracture during the years 1965 to 1973 were registered. The fracture type, localization, primary treatment, and outcome were evaluated from the old radiographs, referrals, and reports. Twenty-seven individuals were clinically and radiologically evaluated a mean of 27 years (range, 23-41) after the injury. RESULTS: At follow-up, 21 former patients reported no or minimal back pain or disability (Oswestry Score mean 4; range, 0-16), whereas 6 former patients (of whom 3 were classified as Frankel D at baseline) reported moderate or severe disability (Oswestry Score mean 39; range, 26-54). Six former patients were classified as Frankel D, and the rest as Frankel E. Local kyphosis had increased by a mean of 3 degrees (p<.05), whereas the discs adjacent to the fractured vertebrae remained unchanged in height during the follow-up. CONCLUSIONS: Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.     

上胸椎骨折手术治疗方法的探讨

目的 探讨上胸椎骨折的特点及治疗。方法 15例病人按AO分型，A型2例、B型10例、C型3例。均经后路切开复位、脊髓减压、长节段内固定、取髂骨植骨融合术治疗。结果 随访18-24个月，后路长节段固定随访时无一例失败，完全瘫的患者9例中有1例神经功能改善I级．不完全瘫的5例均有Ⅲ级改善，1例无神经损伤。结论 上胸椎骨折损伤严重，后路长节段固定技术是一种合理的有效治疗方法。     

绝经后骨质疏松症中药治疗研究文献的质量评价

目的 了解目前国内中药治疗绝经后骨质疏松症的临床治疗研究的现状。方法 对检索到的50篇有关中药治疗绝经后骨质疏松症的临床研究论文，按照牛津循证医学中心证据水平标准和临床试验的没计原则，从诊断标准、纳入和排除标准、组间基线可比性、随机、对照、双盲、统计学方法、疗效判断、疗程及药物的不良反应、随访等多个方面进行分析评价。结果 50篇相关文献中，按照牛津循证医学中心证据水平标准评价，推荐级别为B级的占44.0％，C级的占56.0％；证据水平为2b级的占40.0％，3b级的占4.0％，4级的占56.0％；随机对照试验文献占44.0％；临床对照试验文献占4.0％；采用随机双盲者占9.1％，随机单盲者占18.2％，说明组间基线可比的占31.8％，有诊断标准的占90.9％，有纳入和排除标准的占86.4％，说明统计方法的占52.4％，有客观疗效评价指标的占90.9％，说明药物不良反应的占9.1％。结论 有关中医药治疗绝经后骨质疏松症的临床研究论文日益增多，但随机对照试验比例偏低，研究设计及论文撰写水平有待进一步提高。     

扩髓交锁髓内钉治疗股骨、胫骨干骨折

目的探讨交锁髓内钉治疗股骨、胫骨干骨折的临床效果.方法应用交锁髓内钉治疗不同类型的股骨干骨折18例,胫骨干骨折15例.结果33例患者随访8～24个月,平均15.2个月,33例均骨性愈合.未出观畸性愈合、再骨折、断钉及膝、踝关节僵硬等并发症.结论交锁髓内钉治疗股骨、胫骨干骨折治愈率高,并发症少,效果满意.