关节镜和开放治疗复发性肩关节前方不稳的Meta分析

目的系统评价关节镜下和开放手术治疗青壮年复发性肩关节前方不稳定的疗效。方法计算机检索Cochrane图书馆(2011年第6期)、MEDLINE(1966年至2011年6月)、EMBase(1966年至2011年6月)、中国生物医学文献数据库(1979年1月至2011年6月)、PubMed(1966年6月至2011年6月)、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献。收集所有关节镜与开放手术比较治疗青壮年患者(18～55岁)复发性肩关节前方不稳的随机对照试验,筛选出符合纳入标准的文献,对其进行严格的质量评价后应用RevMan5.0软件进行Meta分析。结果共纳入5个随机对照试验,包含278例患者。Meta分析结果显示,术后肩关节Rowe评分(WMD=4.43,95%CI2.27～6.59),关节镜手术治疗组优于开放手术治疗组。但二者在术后肩关节不稳复发(RR=1.31,95%CI0.51～3.34)、术后神经损伤(RR=0.51,95%CI0.11～2.32)、术后再手术(RR=0.49,95%CI0.11～2.27)、术后恢复伤前功能(RR=0.96,95%CI0.80～1.15)等方面比较均无统计学意义。结论与传统开放手术相比,关节镜手术治疗青壮年复发性肩关节前向不稳,术后肩关节Rowe评分具有优势,但术后并发症等方面二者间无明显差异。     

撬拨复位外固定和切开复位内固定治疗跟骨骨折疗效分析

目的探讨经皮撬拨复位外固定和切开复位内固定治疗跟骨骨折的疗效。方法回顾分析我科自2006年5月至2011年7月治疗45例（50足）跟骨骨折的临床资料。结果所有患者均获得随访,时间为10～20个月,平均14.9个月。术后复查X线片显示跟距关节面基本恢复正常,撬拨复位外固定器固定组,Bo。hler角和Gissane角分别由术前的（9.56±6.23）°,（85.24±9.36）°恢复至术后的（32.43±7.61）°,（124.34±10.51）°;切开复位内固定组,Bo。hler角和Gissane角分别由术前的（8.29±7.47）°,（90.63±8.47）°恢复至术后的（30.49±8.06）°,（130.57±6.49）°,经统计两组之间差异无统计学意义（P〉0.05）。根据Maryland足部评分系统评价术后功能,撬拨复位外固定器固定组：优7足,良10足,中4足,差1足,优良率77.3%;切开复位内固定组：优10足,良13足,中3足,差2足,优良率82.1%,经统计两组优良率差异无统计学意义（P〉0.05）。结论这两种方法治疗跟骨骨折都是比较实用有效的选择,但应根据不同的骨折类型选择不同的治疗方法,实现治疗的个性化,才能取得良好的治疗效果,将骨折对患者术后的日常生活影响降到最低。     

Ⅱ、Ⅲ型Pilon骨折治疗手术时机的选择

目的探讨手术时机对切开复位内固定治疗Ⅱ、Ⅲ型Pilon骨折疗效的影响。方法对96例Ⅱ、Ⅲ型Pilon骨折患者按受伤至手术时间分为两组,早期手术组44例,于伤后12 h或3 d内行切开复位解剖钢板内固定术;延期手术组52例,于伤后7～14 d待肢体肿胀消退后手术。对两组术后进行随访分析。结果 96例均获随访,时间10～24(15.3±3.4)个月。踝关节功能优良率早期手术组为79.6%,延期手术组为84.6%,差异无统计学意义(P>0.05);延期手术组在骨折愈合时间、术后并发症发生率、术后下床活动时间及开始负重时间等指标上均优于早期手术组,差异有统计学意义(P<0.05)。结论手术时机选择是Ⅱ、Ⅲ型Pilon骨折治疗的关键,延期手术有利于提高远期临床疗效,减少并发症的发生。     

切开复位与闭合复位治疗老年桡骨远端不稳定骨折疗效比较

2008年1月～2010年12月,我院采用切开复位与闭合复位治疗老年桡骨远端不稳定骨折82例,笔者比较两种方法的临床疗效及患者满意度,报道如下。1材料与方法1.1病例资料本组82例,男18例,女64例,年龄60～80(71±5)岁。均为     

颈椎后路椎管扩大成形加短节段固定手术疗效及影响因素分析

目的探讨颈椎后路椎管扩大成形加短节段固定手术治疗脊髓型颈椎病的疗效及影响因素。方法 2006-08-2008-06因脊髓型颈椎病行颈椎后路单开门椎管扩大成形加颈椎侧块钉棒系统固定融合术的患者21例,将患者的年龄、病程、术前椎管矢状径值、骨性椎管扩大率、脊髓后移距离、术前JOA评分诸影响因素与JOA改善率进行多元逐步回归分析,分析JOA改善率与上述诸因素的相关性。结果术前JOA评分、病程与JOA改善率明确相关,有显著性统计学意义。病程与JOA改善率呈明显负相关,术前JOA评分与JOA改善率呈明显正相关。结论颈椎后路单开门椎管扩大成形加颈椎侧块钉棒系统固定融合术是治疗脊髓型颈椎病的有效方法;术前JOA评分和病程是决定脊髓型颈椎病预后的重要因素,是判断预后的重要指标,两者相比,术前JOA评分更重要。     

Open access endoscopy in rural and remote Western Australia: Does it work?

Background: Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over‐servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines.The aim was to assess whether an out reach surgical service offering open access endoscopy to rural areas was being over utilized. Methods: Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures. Results: A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups. Conclusion: The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings andconvenience. There is an associated reduction in government‐assisted travel costs to larger centres as well as decreased waiting lists.     

Parathyroid autotransplantation during thyroidectomy

Permanent hypoparathyroidism is a debilitating morbidity following thyroidectomy, with a reported incidence of up to 43%. Apart from meticulous dissection to preserve parathyroid glands and their blood supply, parathyroid autotransplantation (PA) has been increasingly employed to preserve parathyroid function. The adoption of PA during thyroidectomy has been reported to be associated with a low incidence of permanent hypoparathyroidism. Biochemical function of parathyroid autografts can be demonstrated objectively by forearm reimplantation or during long-term follow up. The clearest indication for PA is for inadvertently removed or devascularized parathyroid glands during thyroid surgery. Other strategies, including routine autotransplantation of at least one parathyroid gland, can be considered, but is associated with a high incidence of transient hypocalcaemia. Apart from refinement in technique to facilitate graft success, a reliable way to assess overall parathyroid function or viability of individual parathyroid gland may assist in monitoring parathyroid function and selecting patients requiring this procedure to prevent permanent hypoparathyroidism.     

预防性肌瓣在小腿开放性骨折中的应用

目的探讨预防性肌瓣在治疗小腿Ⅱ、Ⅲ度开放性骨折中的应用效果。方法急诊一期彻底清创,选择髓内钉、外固定支架及钢板固定骨折,应用各种不同肌瓣覆盖骨折断端及缺损创面。结果临床应用15例,所有病例伤口均Ⅰ期愈合,无感染发生。随访1～3年,患者肢体功能恢复满意。结论预防性肌瓣一期应用对小腿Ⅱ、Ⅲ度开放性骨折及合并严重软组织缺损的治疗可取得良好疗效。     

Traumatic Complex Hawkins Type IV Talar Fracture: A Case Report

Fracture-dislocations of the talus are one of the most complex injuries involving the foot and ankle. These injuries are often accompanied by additional traumatic orthopedic injuries, avascular necrosis, and infection. When approaching limb reconstruction and salvage, the overall prognosis and functionality of the limb are key factors to consider. In the present report, we draw attention to the importance of a multidisciplinary team approach for formulating a treatment plan that incorporates the talar injury and associated injuries or pathologic features. We also reviewed the published data related to avascular necrosis of the talus, open talar fracture management, and treatment outcomes.     

Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms

Objective

To evaluate the impact of preoperative pulmonary function on outcomes after open repair of descending thoracic (DTA) and thoracoabdominal aortic (TAAA) aneurysms.