Fracture-dislocations of all five carpometacarpal joints: a case report

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.     

带蒂包皮内板皮管法尿道下裂一期成形术

１９９３年以来，采用带蒂包皮内板皮管法行尿道下裂一期成形术１２例，其中冠状沟型５例，阴茎型７例。裁取包皮内板作成带蒂皮管尿道，长度１．５～４．０ｃｍ，平均２．５ｃｍ。全部病例一次手术成功，无尿瘘，３例有轻度尿道外口狭窄，需短期尿道扩张，术后平均住院７天。包皮内板制成带蒂皮管管腔宽、血供好、易成活，不易形成瘘管及瘢痕狭窄，该术式适用于冠状沟型和阴茎型的尿道下裂。     

Scapholunate dissociation from a fall on the elbow

We report an undescribed mechanism of injury that caused scapholunate dissociation. Scapholunate dissociation has been previously described as resulting from a fall on the outstretched hand. In this case injury was caused by a fall on the elbow. The mechanism is compared to that of an axe head that is repositioned by butting the handle of the axe on the ground. Recognition of this mechanism may help in the diagnosis of this injury.     

肱骨远端全骺分离

肱骨远端全骺分离在5岁以下儿童中是较常见的肘部损伤,且极易误诊为肱骨髁上骨折或肘关节脱位。本组25例肱骨远端全骺分离均为向内侧移位,年龄11个月至14岁,平均5.6岁,属Salter-HarrisⅠ型或Ⅱ型。对本症骨骺损伤的解剖学和组织学,诸骨(和骨化中心)之间的对应关系以及骨骺损伤的诊治进行了简短的讨论。     

小切口微创与开放前路矫形内固定术治疗特发性胸腰椎脊柱侧凸的临床疗效比较

目的比较传统开放与保护膈肌的小切口微创前路矫形内固定术治疗胸腰椎脊柱侧凸的临床疗效和并发症。方法系统性回顾分析72例特发性胸腰椎脊柱侧凸患者的临床资料。其中A组34例,行保护膈肌的小切口微创前路矫形内固定术,男3例,女31例,平均年龄16岁(12~25岁),术前Cobb角平均58°(42°~76°),内固定节段T11~L318例,T11~L410例,T11~L26例;B组38例,行传统开放胸腰段前路矫形内固定术,男4例,女34例,平均年龄17岁(13~26岁),术前冠状面Cobb角平均54°(40°~74°),内固定节段T10~L37例,T11~L320例,T11~L411例。结果A组随访12~24个月(平均18个月),术后Cobb角平均12°,纠正率为81%,4例胸腰段后凸畸形术后矢状面恢复形态良好。最终随访冠状面Cobb角平均14°,丢失率4%。出现手术侧下肢皮温升高3例,术后渗出性胸膜炎2例,胸腔积液2例(其中1例行穿刺引流)。B组随访6~22个月(平均13个月)。术后冠状面侧凸术后平均15°,矫正率73%,最终随访Cobb角平均18°,丢失率5%。5例出现手术侧下肢皮温升高,胸腔积液2例。结论保护膈肌的小切口微创胸腰椎脊柱侧凸前路矫形是可行的,在减少手术创伤的同时能够达到与传统入路相似的临床疗效,并发症的发生率无明显增加,具有较大的临床实用价值。     

改良Halo-骨盆架分期牵引治疗重度僵硬性脊柱侧凸的疗效分析

目的：探讨改良Halo-骨盆架分期牵引联合手术治疗重度僵硬性脊柱侧凸的临床疗效。方法：自2004年1月至2010年5月治疗50例重度僵硬性脊柱侧凸患者,男23例,女27例;年龄4～16岁,平均10.8岁;先天性脊柱侧凸24例（分节不良11例,形成障碍7例,混合型6例）,特发性脊柱侧凸26例。采用改良Halo-骨盆架分期牵引联合手术治疗：Ⅰ期术前牵引,Ⅱ期松解牵引,Ⅲ期牵引矫形内固定。对治疗前后患者身高、侧凸Cobb角、后凸Cobb角及矫正率进行观察。结果：患者身高由治疗前平均（152.1±11.1）cm矫正至（158.5±10.5）cm,侧凸Cobb角由平均（91.8±14.5）°矫正至（30.8±7.9）°,后凸Cobb角由平均（69.5±14.0）°矫正至（31.6±10.1）°。Ⅰ期术前牵引后侧凸、后凸Cobb角平均矫正率分别为（30.4±6.6）%、（22.3±5.2）%;Ⅱ期松解牵引后侧凸、后凸Cobb角平均矫正率分别为（26.7±5.1）%、（21.2±6.0）%;Ⅲ期牵引矫形内固定后侧凸、后凸Cobb角平均矫正率分别为（33.7±7.2）%、（27.1±5.3）%（矫正率参照的基准Cobb角是上一期治疗的Cobb角）;分期牵引联合手术治疗的侧凸、后凸Cobb角平均矫正率分别为（66.5±7.2）%、（55.1±6.4）%。各期治疗前后患者身高、侧凸Cobb角、后凸Cobb角及矫正率差异均有统计学意义（P〈0.05）。结论：采用改良Halo-骨盆架分期牵引联合手术治疗重度僵硬性脊柱侧凸,可获得良好的畸形矫正和躯干平衡,并能减少术中、术后并发症,具有临床可操作性。     

Characteristics and Trends of Orthopedic Publications between 2000 and 2009

Background

This study was undertaken to investigate the trends of orthopedic publications during the last decade, and to document the country of origin, journal, funding source, and language of contribution using PubMed.

Methods

Orthopedic articles published between 2000 and 2009 were retrieved from PubMed using the following search terms: "orthopaedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])" and "orthopedic[Affiliation] AND ("2000/1/1"[PDAT]: "2009/12/31"[PDAT])." The articles were downloaded in XML file format, which contained the following information: article title, author names, journal names, publication dates, article types, languages, authors'' affiliations and funding sources. These information was extracted, sorted, and rearranged using the database''s management software. We investigated the annual number of published orthopedic articles worldwide and the annual rate of increase. Furthermore, the country of publication origin, journal, funding source, and language of contribution were also investigated.

Results

A total of 46,322 orthopedic articles were published and registered in PubMed in the last 10 years. The worldwide number of published orthopedic articles increased from 2,889 in 2000 to 6,909 in 2009, showing an annual increase of 384.6 articles, or an annualized compound rate of 10.2%. The United States ranked highest in the number of published orthopedic articles, followed by Japan, the United Kingdom, Germany, and the Republic of Korea. Among the orthopedic articles published worldwide during the last 10 years, 37.9% pertained studies performed in the United States. Fifty-seven point three percent (57.3%) of articles were published in journals established in the United States. Among the published orthopaedic articles, 4,747 articles (10.2%) disclosed financial support by research funds, of which 4,688 (98.8%) articles utilized research funds from the United States. Most articles were published in English (97.2%, 45,030 articles).

Conclusions

The number of published orthopedic articles has been increasing over the last decade. The number of orthopedic articles, journals publication, and funding sources were dominated by research conducted in the United States, while share and growth of Asian countries including Japan, the Republic of Korea, and China were notable.     

骨科术后自控镇痛的应用及护理

目的:探讨骨科患者术后自控镇痛(PCA)的临床应用及护理。方法:选取2009年1月～2010年1月我科手术治疗的下肢骨科手术患者80例,术后分别采用自控静脉镇痛(PCIA组)40例、采用自控硬膜外镇痛(PCEA组)40例,对比两组患者术后镇痛效果、不良反应发生情况,总结护理措施。结果:PCIA组镇痛总有效率为95%,PCEA组总有效率为85%,组间比较差异有统计学意义(P<0.05),可能与个体差异有关。PCIA组尿潴留发生率仅有2例(5%),明显低于PCEA组20例(50%)。结论:PCIA用于骨科术后镇痛效果确切,管理方便,不良反应发生率较PCEA低,值得推广应用。     

气压式循环驱动器预防老年骨科术后下肢DVT效果观察及护理

目的:探讨气压式循环驱动器预防老年骨科患者术后下肢深静脉血栓形成(DVT)的效果及护理方法。方法:将98例老年骨科术后患者随机分为观察组和对照组各49例,对照组行常规抗凝治疗及护理,观察组在此基础上使用气压式循环驱动器进行辅助治疗。比较两组患者卧床72 h后下肢DVT情况。结果:观察组下肢DVT发生率明显低于对照组(P<0.05)。结论:老年骨科术后患者应用气压式循环驱动器辅助治疗可有效预防下肢DVT。