克氏针内固定治疗末节指骨撕脱性骨折

2015 年3 月 ～2018 年10 月,我科采用改良切开复位克氏针内固定治疗25 例新鲜闭合末节指骨撕脱性骨折患者,疗效满意,报道如下. 1 材料与方法 1.1 病例资料 本组25 例,男17 例,女8例,年龄21 ～58 岁.损伤指别:环指10例,小指10 例,中指3 例,示指2例.均为新鲜闭合骨性锤状指,表现为...     

经股动脉介入术后国产动脉压迫止血器止血的应用

目的 探讨经股动脉介入诊疗术后应用国产动脉压迫止血器的安全性、有效性及临床应用价值.方法 102例经股动脉介入治疗术后,59例应用动脉压迫止血器体外压迫穿刺点止血,43例人工传统压迫止血.记录止血时间、下肢制动时间及并发症.结果 动脉压迫止血器组止血时间[(3.0±1.5)min比(20.0±2.5)min,P＜0.001]和下肢制动时间[(8.0±1.2)h比(17.0±4.2)h,P＜0.001]明显短于人工压迫组;局部并发症和迷走神经反射两组无差异.结论 经皮股动脉介入诊疗术后应用动脉压迫止血器止血安全、有效,缩短卧床时间,且不增加血管并发症,值得推广应用.     

Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury

Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation.Design: This study is a retrospective analysis.Setting: In-patient rehabilitation unit of a tertiary research hospital.Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males).Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups.Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05).Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.     

APOFIX系统治疗上颈椎骨折脱位的临床应用（附6例报告）

对6例上颈椎骨折脱位患者（齿状突骨折伴寰枢椎半脱位4例,Hangman骨折2例）,应用APOFIX系统行后路C1－2固定及植骨融合术,术后定期摄颈椎X线片。结果6例内固定均成功,并获6个月以上随访,椎板钩及植骨块无松动及移位。植骨融合。认为APOFIX应用于上颈椎后路内固定,安全、简便、有效;术前解剖复位是手术成功的关键。     

Vascularized Ribs in the Treatment of Posterior Instrumentation Infection after Thoracic Vertebrectomy. Case Report

Isolated vertebral mestastases can be successfully treated by surgical removal of the affected vertebral body and stabilization with alloplastic material. The bone union between the upper and lower vertebra is expected, yet a relatively high rate of a non-union has been reported. In case of infection, bone consolidation is altered, and removal of alloplastic material is recommended, which decreases spinal stability and is a devastating complication.This case report of delayed infection and exposure of posterior hardware after thoracic vertebrectomy without an interbody osseous union, authors present a successful treatment with vascularized rib flaps through an anterior approach followed by hardware removal.     

经椎体后上缘入路椎体后凸成形术治疗腰椎骨质疏松性椎体压缩骨折的临床疗效

目的:分析经椎体后上缘入路椎体后凸成形术(percutaneous kyphoplasty,PKP)的手术设计,并与经双侧椎弓根入路PKP治疗骨质疏松性腰椎椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)进行临床疗效对比.方法:回顾性分析符合纳入标准并行...     

经皮微创与传统开放椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的对比研究

目的对比经皮微创与传统开放椎弓根螺钉内固定技术治疗老年胸腰段脊柱压缩性骨折患者的疗效。方法入选2013年6月至2017年2月解放军总医院海南分院骨科收治的老年胸腰段脊柱压缩骨折患者245例。依据手术方式分为2组:微创手术组(n=126)和传统手术组(n=119)。比较2组患者的手术时间、住院时间、术中出血量、住院费用、切口长度等围术期参数。术后随访至少6个月并测量伤椎前缘高度、Cobb角和矢状位指数。采用SPSS 18. 0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。结果与传统手术组患者相比,微创手术组患者的手术时间[(95. 2±16. 3) vs(126. 5±39. 0) min]和住院时间[(10. 8±4. 0) vs (22. 5±13. 6) d]显著缩短,术中出血量[(82. 7±39. 9) vs (327. 2±143. 1) ml]、术后引流量[(33. 5±15. 8) vs (301. 5±110. 8) ml]、住院费用[(5. 1±0. 3)×104vs (5. 7±0. 2)×104RMB yuan]和切口长度[(9. 3±0. 6) vs (12. 8±1. 9) cm]也显著减小,差异均有统计学意义(均P 0. 05)。与手术前相比,2组患者手术后的伤椎椎体前缘高度[微创手术组:(11. 2±7. 3) vs (20. 1±3. 3) mm;传统手术组:(12. 2±7. 6) vs (21. 7±2. 4) mm]、Cobb角[微创手术组:(14. 0±6. 8)°vs (4. 3±1. 8)°;传统手术组:(14. 8±7. 0)°vs (4. 6±2. 8)°]和矢状位指数[微创手术组:(64. 5±12. 6)%vs (93. 8±13. 9)%;传统手术组:(63. 8±13. 8)%vs (95. 0±9. 6)%]均得到显著改善(均P 0. 05)。结论与传统开放椎弓根螺钉内固定技术相比,采用经皮微创椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的疗效确切,且手术时间短、住院时间短、手术切口小、术中出血量少和住院费用少,值得临床推广。     

骨盆骨折创伤分级及临床应用

目的 根据骨盆骨折患者病情严重程度,确定骨盆骨折创伤分级,指导骨盆骨折外科治疗.方法 将1998年1月-2005年12月我科收治的180例骨盆骨折患者,按骨盆损伤程度、外科合并伤及严重性、四肢骨关节损伤及患者自身素质,分为4级.结果 Ⅰ级无1例死亡;Ⅱ级死亡1例为82岁,骨盆骨折并存其它三处骨折;Ⅲ级死亡1例,死于胸部损伤;Ⅳ级死亡4例,其中2例接受手术治疗.结论 应建立骨盆骨折创伤分级系统,用骨盆骨折创伤分级指导骨盆外科治疗,能提高救治成功率,保全生命,恢复盆部功能.     

解剖型锁定钢板治疗老年性股骨远端骨折

目的探讨解剖型锁定钢板治疗老年性股骨远端骨折的临床疗效。方法自2005年12月至2007年11月老年性股骨远端骨折患者15例。Müller分型:A2型3例,A3型2例,B2型2例,C1型4例,C2型3例,C3型1例。均采用股骨远端锁定钢板固定,术后未用外固定,配合CPM早期膝关节的功能锻炼。结果所有病例经8～18月随访,平均13月,骨折均愈合,愈合时间4～6个月,平均约5.3个月,按照AO膝关节功能评分,优良达13例,优良率86.7%。结论解剖型锁定钢板外形设计合理,对骨折血供破坏少,不易松钉,适合于老年性股骨远端骨折特别是有骨质疏松的患者,值得临床应用。     

经皮球囊扩张椎体后凸成形术的临床应用

目的总结经皮球囊扩张椎体后凸成形术治疗胸腰椎疾病的临床特点和疗效。方法胸腰椎疾病28例,其中男性9例,女性19例;年龄56～84岁,平均年龄65岁;骨质疏松性椎体压缩骨折(OVCF)24例,椎体血管瘤(VH)4例。应用经皮球囊扩张椎体后凸成形术进行治疗,观察术后症状改善情况。结果 28例患者手术均顺利完成。患者术后疼痛症状均即刻消失,术后次日即下床活动。术后平均随访10个月,28例患者均恢复发病前生活方式,无疼痛;影像学检查,病椎高度无明显丢失,无并发症发生。结论经皮球囊扩张椎体后凸成形术是治疗胸腰椎疾病安全有效的一种方法。