单节段内固定术治疗胸腰椎骨折的手术方法与临床疗效分析

目的 研究单节段内固定术治疗胸腰椎骨折的手术方法与临床疗效.方法 将90例胸腰椎骨折患者按随机数字表法分为观察组（单节段内固定术）和对照组（双节段内固定术）,每组45例,比较两组手术情况、术后疼痛程度、矫正情况、伤椎相邻椎关节病变情况等.结果 观察组手术时间、出血量、切口长度、术后疼痛发生率、上节段和下节段间盘退变发生率明显少于对照组[（107.93±2.75） min比（132.68±2.81） min、（198.44±9.17）ml比（314.18±8.73）ml、（8.36±1.15）cm比（12.33±1.08） cm、8.89％（4/45）比26.67％（12/45）、6.67％（3/45）比22.22％（10/45）和4.44％（2/45）比20.00％（9/45）],差异有统计学意义（P＜0.01）.两组矫正情况比较差异无统计学意义（P＞0.05）.结论 在症状适宜的情况下,单节段内固定术治疗胸腰椎骨折效果突出,术后患者恢复状况好,术后并发症少,远期不良影响轻微,建议在临床中推广应用.     

Good radiological and functional results after intramedullary nailing of distal radius fractures

Abstract

To evaluate the results after fixation of distal radius fractures using Micronail® internal fixation, a prospective cohort study was performed, including displaced fractures of the distal radius (AO type A 2.2, A3.1, and A3.2). In total, 60 patients were included and 44 patients were available for 1-year follow-up (radiological and clinical examination) and 39 for 5-year follow-up (telephone interview). It was found that all fractures healed, with an average radial volar tilt of 2°, radial length of 11 mm, and a radial inclination of 22°. The functional result was excellent-to-good in 93% of the patients. Thirteen patients (30%) reported paraesthesia of the superficial branch of the radial nerve at the 1-year follow-up. In four patients the paraesthesia of the radial nerve was persistent. No other complications or reoperations were reported by the patients at the 5-year follow-up and only one implant had been removed. The study confirms that the Micronail® is a minimal invasive method that can provide a stable fixation of selected distal radius fractures and provide a good functional outcome with a very low need of implant removal after fracture healing with few complications related to the operation, the main complication being permanent damage to the radial nerve.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

加长柄人工股骨头置换治疗68例老年性股骨粗隆间骨折的临床疗效

目的探讨加长柄人工关节置换治疗老年性股骨粗隆间骨折的手术方法及疗效。方法选择2007年1月-2012年1月间采用加长柄人工股骨头置换术治疗的68例高龄股骨粗隆间骨折患者进行随访。观察手术时间、出血量、Harris关节功能评分及并发症情况。结果随访9-32个月,平均14个月,所有患者术后7 d离床活动。平均手术时间为88 min、平均出血量为380 mL、关节功能优良率83.7%,未发生重大并发症。结论对于老年性股骨粗隆间骨折,加长柄人工股骨头置换术是一种安全有效的治疗手段。     

护理老年骨质疏松性骨折 ——护士压力源相关因素调查分析及对策

目的 随着生物-心理-社会医学模式的转变，全新护理老年骨质疏松性骨折对骨科护士身心健康所造成的压力及危害的压力源，为骨科护士减轻压力、提高护士生活质量提供依据。方法 自行设计骨科临床一线护士压力源调查表进行调查。调查表包括5个方面共13种压力源，在相对范围内对80%以上护士造成压力的压力源作为共同压力源。结果 骨科临床一线护士共同压力源来自 超负荷及紧张的工作状态，工作量大，护理人员紧缺，医院优质护理服务要求严格，注重专科内涵，社会支持保障不足，年轻护士专科知识不过硬，心理，自我提升（考试、晋升、考核），家庭社会，以及工作环境压力等。结论 医院护理管理者在注重提高优质护理服务质量的同时，必须关注护士的身心健康，制定有效的减压措施，以维护骨科护理队伍的稳定。     

综合护理干预对老年股骨颈骨折患者术后首次排便的影响

目的探讨综合护理干预对老年股骨颈骨折患者术后首次排便的影响。方法便利抽样法选择2010年11月至2011年11月在镇江市第二人民医院住院治疗的84例老年股骨颈骨折需手术的患者为研究对象,按随机数字表法将其分为观察组和对照组,每组42例。观察组患者采用综合护理干预措施,对照组采用骨科常规护理措施,观察比较两组患者术后自觉肠鸣音时间、肛门排气时间、首次排便时间以及首次大便通畅度情况。结果观察组患者术后自觉肠鸣音时间、肛门排气时间、首次排便时间均早于对照组,且首次大便通畅度优于对照组,差异均有统计学意义(均P<0.01)。对照组有24例术后96h仍未排便,给予通便药物或灌肠干预,而观察组仅有1例患者需灌肠干预。结论综合干预措施能明显缩短老年股骨颈骨折患者术后肠功能恢复时间。