OBJECTIVE:To investigate the differences in clinical efficacy between percutaneous curved kyphoplasty(PCKP) and unilateral percutaneous kyphoplasty(UPKP) in the treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF),with a focus on evaluating cement distribution,leakage risk,and vertebral biomechanical restoration. METHODS:A total of 78 patients with acute thoracolumbar OVCF admitted between January 2022 and April 2024 were included. They were divided into a PCKP group and a UPKP group based on the surgical technique. The PCKP group comprised 37 cases,including 12 males and 25 females,with an age of (78.84±11.24) years and a bone mineral density T value of -4.05±0.81. The UPKP group included 41 cases,comprising 17 males and 24 females,with an age of (77.68±10.73) years and a bone mineral density T value of -4.15±0.82. Comparisons were made between the two groups regarding preoperative and postoperative visual analogue scale (VAS) pain scores,Oswestry disability index (ODI) scores,anterior vertebral body height,rate of good/excellent cement distribution,cement leakage rate,and surgery-related parameters. RESULTS:All patients were followed up for 12 months. In the PCKP group,the mean VAS preoperatively,and at 2 days,3 months,and 12 months postoperatively were (6.35±2.34),(2.95±0.70),(1.76±1.19),and (0.97±0.80) points,respectively. Corresponding scores in the UPKP group were (6.83±2.23),(3.15±0.82),(1.73±1.12),and (1.17±0.74) points. The mean ODI scores in the PCKP group at the same time points were (75.73±3.42),(34.57±3.18),(24.03±5.24),and (22.84±1.68) points,respectively,compared to (74.41±2.85),(35.54±3.49),(24.95±2.85),and (22.66±1.70) points in the UPKP group. Both groups showed significant improvement in VAS and ODI scores postoperatively (P<0.05),but no statistically significant differences were observed between the groups (P>0.05). The rate of good/excellent cement distribution in the PCKP group was 91.89% (34/37),significantly higher than the 65.85% (27/41) in the UPKP group (P=0.001). The cement leakage rate was 13.51% (5/37) in the PCKP group,which was significantly lower than the 34.15% (14/41) in the UPKP group (P=0.030). No significant difference was found in the degree of vertebral compression between patients with poor cement distribution/leakage and those without in either group (P>0.05). The mean anterior vertebral body height in the PCKP group increased from (13.22±2.47) mm preoperatively to (16.68±1.42) mm at 2 days postoperatively. In the UPKP group,it increased from (13.80±2.50) mm to (17.02±1.35) mm at 2 days postoperatively. Both groups showed significant restoration of anterior vertebral height postoperatively (P<0.05),with no significant intergroup difference (P>0.05). Re-fractures occurred in 4 cases in the PCKP group and 6 cases in the UPKP group,showing no significant intergroup difference (P>0.05). No significant differences were found in operative time or fluoroscopy frequency between the two groups (P>0.05). CONCLUSION:PCKP,utilizing a curved drill technique,optimizes bilateral cement dispersion,significantly improving distribution uniformity and reducing leakage risk,making it particularly suitable for moderate-to-severe compression fractures. Its technical characteristics such as unilateral puncture and low-pressure cement infusion-provide a safer and more effective minimally invasive solution for thoracolumbar OVCF without increasing operative time or radiation exposure. Future studies with larger sample sizes and longer follow-up are needed to verify its long-term biomechanical advantages.
Abstract Objective To systematically review the clinical efficacy (pain, function, quality of life) and safety of platelet-rich plasma (PRP) in the treatment of frozen shoulder through meta-analysis, and provide evidence-based medical evidence for the effectiveness of PRP in the treatment of frozen shoulder. Methods A search was conducted on international databases (Pubmed, Web of science, Embase) and Chinese databases (CNKI, Wanfang, VIP) to search the clinical studies on the efficacy of platelet-rich plasma in treating frozen shoulder (adhesive capsulitis/periarthritis/50 shoulder) and their corresponding references published from inception until January 2024. Thoroughly excluded literature not meeting the predetermined inclusion criteria, extracted relevant data from the literature, and input it into RevMan5.4 for meta-analysis. Results This study ultimately included 14 RCTs, with a total of 1024 patients. The results showed that PRP has significant advantages compared with control groups in VAS (mean difference (MD) =-0.38, 95% confidence interval(CI)(-0.73, -0.03), P = 0.03), UCLA (MD = 3.31, 95% CI (1.02,5.60),P = 0.005), DASH (MD = -4.94,95% CI (-9.34, -0.53),P = 0.03), SPADI (SPADI Total: MD =-16.87, 95% CI (-22.84, -10.91), P < 0.00001; SPADI Pain: MD =-5.38, 95% CI (-7.80, -2.97), P < 0.0001; SPADI Disability: MD =-11.00, 95% CI (-13.61,-8.39), P < 0.00001), and the active and passive Range of Motion (active flexion: MD = 12.70, 95% CI (7.44, 17.95), P < 0.00001; passive flexion: MD = 9.47, 95% CI(3.80, 15.14), P = 0.001; active extension: MD = 3.45, 95% CI(2.39, 4.50), P < 0.00001; active abduction: MD = 13.54, 95% CI(8.42, 18.67), P < 0.00001; passive abduction: MD = 14.26, 95% CI (5.97, 22.56), P = 0.0008; active internal rotation: MD = 5.16, 95% CI (1.84, 8.48), P = 0.002; passive internal rotation: MD = 3.65, 95% CI(1.15, 6.15), P = 0.004; active external rotation: MD = 10.50, 95% CI(5.47, 15.53), P < 0.0001; passive external rotation: MD = 6.00, 95% CI (1.82, 10.19), P = 0.005) except passive extension (MD = 2.25, 95% CI (-0.77, 5.28), P = 0.14). In terms of safety, most studies reported no adverse effects, and only one study reported common complications of joint puncture such as swelling and pain after treatment in both PRP and control groups. Previous studies have shown a risk of osteonecrosis caused by corticosteroids. Therefore, the safety of PRP treatment is more reliable. Conclusion The results showed that PRP was more durable and safer than corticosteroids and other control groups in the treatment of frozen shoulder. Study Design Systematic review. Trial registration PROSPERO CRD42022359444, date of registration: 22-09-2022.
BACKGROUND:This study examined whether pericapsular nerve group (PENG) block combined with local infiltration analgesia (LIA) could improve pain management and functional recovery after total hip arthroplasty. METHODS:All patients were randomly assigned to receive PENG block combined with LIA (PENG group) or sham PENG block and LIA (Sham group). The primary outcome was cumulative morphine consumption within 24 hours after surgery. Secondary outcomes were pain scores on a visual analog scale (VAS); time to first rescue analgesia; cumulative morphine consumption during hospitalization; intraoperative consumption of opioids; postoperative recovery; and postoperative complications. RESULTS:PENG patients consumed significantly less morphine within the first 24 hours and throughout hospitalization and smaller amounts of intraoperative opioids. There were significantly lower pain scores at rest and during motion within 24 hours in PENG patients. PENG patients took significantly longer until the first rescue analgesia and showed significantly better postoperative rehabilitation. However, the absolute change in morphine consumption and VAS scores did not exceed the reported minimal clinically important differences (morphine consumption: 10 mg; VAS scores: 1.5 at rest and 1.8 during movement). The two groups showed no difference in quadriceps muscle strength and postoperative complications. CONCLUSION:PENG block combined with LIA could improve postoperative pain relief, reduce opioid use, and enhance recovery in total hip arthroplasty patients, without weakening the quadriceps muscle strength. This work justifies further trials to examine the safety and efficacy of this block and to explore maximal effective volume of local anesthetic for motor-sparing PENG block.
目的 探索心率变异性(heart rate variability,HRV)参数与胸腰椎骨折患者术后并发症风险关系.方法 选取我院 2019 年 11 月至 2023 年 1 月手术治疗的 212 例胸腰椎骨折患者.患者手术前 1 天佩戴 12 导联动态心电监护仪 24 h,收集 HRV 参数:极低频(very low frequency,VLF)、低频(low frequency,LF)、高频(high frequency,HF)和 LF/HF 比值.通过单因素和多因素 Logistic 回归模型和受试者操作特征(receiver operating characteristic,ROC)曲线分析评估 HRV 参数与术后 3 个月内并发症风险关系.结果 212 例患者术后总体并发症发生率为 46.7%(99/212),58 例有非手术并发症,26 例有手术并发症.多因素 Logistic回归分析结果显示 HRV 参数 VLF 和 LF/HF 比值降低与术后总体并发症(P<0.05)、术后非手术并发症(P<0.05)和术后手术并发症(P<0.05)风险相关.VLF 在诊断术后总体并发症、术后非手术并发症和术后手术并发症的 AUC 分别为 0.842(0.752～0.895)、0.889(0.847～0.932)和 0.801(0.746～0.856).LF/HF 比值在诊断术后总体并发症、术后非手术并发症和术后手术并发症的 AUC 分别为 0.874(0.840～0.908)、0.817(0.754～0.880)和 0.802(0.743～0.855).结论 胸腰椎骨折患者术后总体并发症发生率较高.评估和定位 HRV 参数VLF 和 LF/HF 能有效对患者术后并发症风险分层并用于确定需要加强围术期监测和预防性治疗的患者.
目的 系统评价比较单纯减压与减压融合术治疗退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的临床疗效.方法 计算机检索 PubMed、Web of Science、The Cochrane library、Embase、中国生物医学文献服务系统、中国知网、万方数据库,检索时间从建库至 2022 年 12 月.提取纳入研究的基本信息、Oswestry 功能障碍指数(oswestry disability index,ODI)、腰腿痛的疼痛数字评分(numeric rating scale,NRS)、欧洲五维健康量表(European quality of life-5 dimensions,EQ-5D)、临床优良率、并发症及再手术率等指标,采用 RevMan 5.4.1 软件进行 Meta 分析.结果 共纳入随机对照研究 5 篇,队列研究19 篇,共 82 787 例患者(其中单纯减压组 9678 例,减压融合组 73 109 例).术后第 1 年,在 ODI(P = 0.0006,MD = 2.40,95%CI:1.03～3.77),EQ-5D(P = 0.01,MD =-0.05,95%CI:-0.10～-0.01),腰背痛NRS 评分(P = 0.008,MD = 0.57,95%CI:0.15～1.00),腿痛 NRS 评分(P = 0.0008,MD = 0.53,95%CI:0.22～0.84)改善方面,两组差异有统计学意义,减压融合组优于单纯减压组.术后第 2 年,两组 ODI、EQ-5D、腰背痛、腿痛 NRS 评分差异无统计学意义(分别为 P = 0.12,P = 0.59,P = 0.55,P = 0.12).两组再手术率差异无统计学意义(P = 0.50,RR = 1.08,95%CI:0.86～1.37),而单纯减压组并发症发生率(P<0.0001,RR = 0.71,95%CI:0.59～0.84)低于减压融合组,且单纯减压组可缩短手术时间、住院时间,减少术中出血量.结论 减压融合较单纯减压治疗 DLS 短期内有优势,但术后 2 年随访,两者临床疗效相当,且单纯减压组与更少的术后并发症,更短的手术时间、住院时间,更少的出血量相关.
2012 年国际脊柱侧凸研究会 ( Scoliosis Research Society,SRS ) 发布早发型脊柱侧凸畸形 ( early-onset scoliosis,EOS ) 的最新定义:各种病因导致 10 岁之前出现且侧凸角度 > 10° 的脊柱畸形 [1-2].
目的 探讨双针撬拨法联合弹性钉治疗儿童桡骨头 Judet Ⅳ 型骨折临床疗效.方法 回顾分析2017 年 3 月至 2021 年 6 月,我院收治的 45 例桡骨头 Judet Ⅳ 型骨折患儿的资料.其中男 23 例,女 22 例;年龄 6～11 岁,平均 7.6 岁.试验组 24 例,行双针撬拨法联合弹性钉固定术;对照组 21 例,行单针撬拨法联合弹性钉固定术,术后两组均行长臂石膏托固定 4 周.术后比较两组的手术时间、骨折复位和神经损伤情况以及肘关节功能.结果 45 例均获随访,随访时间 10～20 个月,平均 13 个月.手术时间:试验组(25.21±4.82)min,对照组(36.71±6.83)min,差异有统计学意义(P<0.05).骨折复位情况以 Metaizeau 标准行放射学评定,试验组 24 例均解剖复位;对照组优 14 例(解剖复位),良 6 例(成角≤20°),中 0 例(成角 30°～35°),差 1 例(水平移位约 2 mm),差异有统计学意义(P<0.05).肘关节功能评定参照中华医学会手外科学会上肢功能评定标准,试验组优 23 例,良 1 例;对照组优 14 例,良 6 例,差 1 例,差异有统计学意义(P<0.05).结论 双针撬拨法联合弹性钉固定具有耗时少、骨折复位佳及肘关节功能恢复好的优势,是治疗儿童桡骨头 Judet Ⅳ 型骨折的有效方法.
目的 观察采用带线锚钉缝合固定老年后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床效果.方法 回顾分析 2019 年 1 月至 2021 年 10 月,我科收治的 22 例老年患者膝关节PCL 胫骨止点撕脱骨折的临床资料.手术均采用后内侧小切口切开复位锚钉缝合固定.评价患者术前后影像学情况,记录术前及末次随访时双膝关节活动度、Lysholm 评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分.结果 22 例均获得随访,随访 9～18 个月,平均 11.3 个月,X 线及CT 检查提示骨折均获得骨性愈合.末次随访时,所有患者均无伸屈膝关节受限,2 例患者膝关节后抽屉试验弱阳性,余患者膝关节稳定性良好.末次随访时,膝关节 Lysholm 评分、IKDC 评分及患侧膝关节活动度较术前比较差异均有统计学意义(P<0.05);患侧膝关节伸直活动及屈曲活动度同健侧差异无统计学意义(P>0.05).术前患侧膝关节伸直活动度及屈曲活动度与健侧差异有统计学意义(P<0.05).结论 采用带线锚钉缝合固定老年 PCL 胫骨止点撕脱骨折的效果显著,具有手术操作简单、手术时间短、固定牢靠,术后患者可早期功能锻炼等特点.
目的 探讨应用弹性髓内钉治疗学龄前儿童股骨干骨折的疗效,分析影响预后的相关因素.方法 回顾分析 2016 年 1 月至 2022 年 1 月,北京儿童医院应用弹性髓内钉治疗的 3～6 岁股骨干骨折患儿,共计 32 例,其中男 22 例,女 10 例;年龄 3.1～5.9 岁,平均(4.5±1.1)岁.收集基本信息和影像学资料,记录最终随访时冠状面、矢状面成角和相关并发症情况,分析影响预后的相关因素.结果 本组随访时间12～36 个月,平均 24 个月,所有患儿均实现闭合复位,按照 Flynn 标准优 24 例,满意 8 例,差 0 例.最终随访时所有患儿均获得骨折愈合,愈合时间(5.6±1.7)周,无术后再移位、骨折不愈合发生,术后针道激惹反应 2 例,无深部感染发生,残留矢状面成角 7 例,平均 5.9°(5°～8°),残留冠状面成角 7 例,平均 4.3°(3°～6°),双下肢不等长 2 例(差异分别为 0.7 cm、1.0 cm),按照 Flynn 标准无不可接受的畸形发生.单因素分析受伤机制(χ2 = 4.885,P = 0.053)、骨折位置(χ2 = 6.788,P = 0.023)和术后即刻存在成角(χ2 = 5.788,P = 0.035)是影响患儿最终残留成角的因素,多因素分析显示骨折位置(P =0.030,OR = 9.991)是影响最终残留成角的独立危险因素.结论 应用弹性髓内钉治疗学龄前儿童股骨干骨折疗效满意,术后并发症少,是该年龄段患儿的有效治疗方式,骨折位于远近端 1/3 时会增加成角畸形的风险.
腰椎融合术结合椎弓根钉棒系统内固定术是临床上治疗退行性病变、感染、创伤和肿瘤等各种腰椎疾病的基本术式 [1].前路腰椎椎间融合术 ( anterior lumbar interbody fusion,ALIF ) 和斜外侧入路腰椎椎间融合术 ( oblique lateral interbody fusion,OLIF ) 都是通过腰椎横突前方进入椎间盘的,前方入路较后方入路可提供简单且完整的椎间盘准备并获得很高的融合率,可显著纠正冠状面和矢状面的失衡,可植入较大面积和体积的融合器有效恢复椎间隙和椎间孔高度从而实现间接减压效果.
黄韧带主要由弹性纤维和结缔组织构成,覆盖于椎管的后壁,从上椎板的一半呈叠瓦状覆盖下椎板的上半部分,它被认为是维持脊柱内在稳定性、控制椎间运动、并维持硬脊膜后部表面光滑的重要结构 [1],韧带的异位骨化便是黄韧带骨化 ( ossification of ligament flavum,OLF ).
目的 运用 Meta 分析方法系统评价双通道内镜下腰椎间融合术(unilateral biportal endoscopic lumbar interbody fusion,ULIF)并发症发生率.方法 在 CNKI、WANFANG DATA、SinoMed、EMbase、Web of Science、PubMed,全面检索 2023 年 4 月 30 日以前关于 ULIF 并发症的临床观察性研究,评价指标包括总并发症发生率、硬膜外血肿发生率、硬膜撕裂发生率、神经根损伤或短暂性麻痹发生率、其它并发症发生率.采用 RevMan 5.4 软件行 Meta 分析.结果 15 篇文献入选 Meta 分析,总样本量 987 例.Meta 结果表明:ULIF并发症的总发生率为 9%(MD = 0.09,95%CI:0.06～0.11,P<0.000 01);硬膜撕裂损伤并发症发生率为 3%(MD = 0.03,95%CI:0.02～0.04,P<0.000 01);术后硬膜外血肿发生率为 5%(MD = 0.05,95%CI:0.01～0.08,P = 0.004);神经根损伤或短暂性麻痹发生率为 2%(MD = 0.02,95%CI:0.01～0.04,P = 0.001);其它并发症发生率为 3%(MD = 0.03,95%CI:0.01～0.04,P = 0.0001).结论 单侧 ULIF 并发症发生率较低,安全性较高且创伤小,适合临床广泛应用.
低磷酸酶血症 ( hypophosphatasia,HPP ) 是一种罕见的遗传性疾病,其特征是以骨及牙齿矿化缺陷,血清及骨碱性磷酸酶减低为主.该病的遗传方式为常染色体隐性或显性遗传,多数为常染色体隐性遗传,少数为显性遗传,发病率为 1 / 10 000,重型少见,轻型较常见 [1].由于家族内的可变表达和显性遗传方式的不完全外显,导致 HPP临床表现差异较大,即从严重无骨骼矿化的死产到没有骨骼症状的早期牙齿脱落,根据年龄可分为 6 种形式:围生期型 ( 致死性、良性 ),婴儿型,儿童型,成人型和牙型 [2].国外报道以围生期型和婴儿型为主 [3],国内以儿童型和牙型为主,儿童型 HPP 的发病年龄在 6 月龄到 18 岁之间,症状严重程度不一 [4].笔者通过对 1 例儿童型 HPP患儿的临床、生化、影像以及基因检测结果的分析来探讨HPP 的诊断和发病机制.
目的 探索单侧双通道内镜椎间盘切除术(unilateral biportal endoscopic discectomy,UBED)治疗的腰椎间盘突出症(lumbar disc herniation,LDH)隐性失血(hidden blood loss,HBL)的危险因素.方法 回顾分析 2018 年 6 月至 2022 年 12 月接受 UBED 治疗的 200 例 LDH 患者.收集患者临床资料并根据计算公式计算 HBL 量.通过多元线性回归分析识别影响患者 HBL 量的独立危险因素.结果 200 例 LDH 患者血容量(blood volume,BV)、总失血量(total blood loss,TBL)、可见失血量(visible blood loss,VBL)和 HBL 分别为(4.84±0.68)L、(469.98±35.41)ml、(174.42±33.47)ml 和(295.56±42.41)ml.HBL 占 TBL 的 62.9%.男性,ASA 评分 3 分,高血压和糖尿病患者 HBL 量分别高于女性,ASA 评分 1～2 分,无高血压和糖尿病患者(P<0.05).年龄(r = 0.352)、体质量指数(body mass index,BMI)(r = 0.254)、手术时间(r = 0.385)和椎旁肌厚度(r = 0.311)与 LDH 患者 HBL 量呈正相关(P<0.05),血红蛋白(hemoglobin,Hb)(r =-0.534)、白蛋白(albumin,ALB)(r =-0.425)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)(r =-0.301)和纤维蛋白原(fibrinogen,FIB)(r =-0.421)与 LDH 患者 HBL 量呈负相关(P<0.05).多元线性回归结果显示男性、BMI 越高、高血压、FIB 越低、手术时间越长和椎旁肌厚度增加是 HBL 量增加的独立危险因素(P<0.05).结论 UBED 治疗的 LDH 患者 HBL 量超出预期值.男性、BMI、高血压、手术时间、FIB和椎旁肌厚度是影响 HBL 量的因素.通过评估和定位这些因素可以重点关注高危患者,确保围术期安全及提高预后.
目的 探讨跟腱断裂微创术后康复,早期负重对患者功能及功能满意度的影响.方法 回顾分析解放军总医院骨科跟腱损伤患者数据库中 2020 年 3 月至 2021 年 3 月行跟腱断裂微创手术修复的 101 例患者,术后 7～14 周和术后 15～19 周分别作为患足负重和站立位单足提踵锻炼的标准时间,按照早于、遵循和晚于标准时间将患者分为三组:提前组、按时组和延后组,采用跟腱完全断裂功能评分(achilles tendon rupture score,ATRS)、患者功能满意度量表、术后恢复到伤前运动水平时间(recovery time to pre-injury exercise level,RTTPEL)等指标进行随访评价.结果 术后 6 个月评价,患足负重提前组 ATRS 评分(86.22±7.04)相比按时组(81.21±14.47)显著增高,站立位单足提踵提前组 ATRS 评分(84.95±11.18)相比延后组(78.61±15.12)也显著增高,差异均有统计学意义(P<0.05).术后 12 个月评价,患足负重和站立位单足提踵各组间患者 ATRS 评分差异无统计学意义(P>0.05).患者满意度分析显示,负重项目提前组(64.7%)高于按时组(29.8%),差异有统计学意义(P<0.05).术后 RTTPEL 分析显示,患足负重项目提前组仅为伤后(19.06±5.90)周,相比按时组(27.13±12.81)周和延后组(32.00±17.58)周显著提前,差异均有统计学意义(P<0.05);站立位单足提踵提前组术后 RTTPEL 为(19.97±8.74)周,相比延后组(29.67±11.05)周显著提前,差异有统计学意义(P<0.05),与按时组之间差异无统计学意义(P>0.05).结论 跟腱断裂微创术后早期负重与锻炼是安全可靠的,适度提前患足负重和单足提踵锻炼时间有益于加速跟腱断裂微创术后患者的康复.
目的 探讨改良外固定架胫骨横向骨搬移联合负压封闭引流(vacuum sealing drainage,VSD)技术对糖尿病足的临床疗效及并发症情况.方法 2019 年 9 月至 2021 年 12 月,我科采用传统外支架和改良外支架胫骨横向骨搬移联合 VSD 技术治疗 29 例糖尿病足患者,其中改良组(n = 14)采用改良外固定架胫骨横向骨搬移术治疗,传统组(n = 15)采用传统外固定架胫骨横向骨搬移术治疗,比较两组患者术后溃疡面愈合时间、下床行走时间和完全负重时间,并且进行术前、术后 1 个月及 3 个月患足皮肤温度、疼痛视觉模拟评分(visual analogue scale,VAS)、踝肱指数(ankle brachial index,ABI)对比.结果 两组患者术前与术后1 个月、3 个月的足温、溃疡面愈合时间、ABI 和 VAS 评分比较差异无统计学意义.改良组的下床行走时间[(43.79±2.12)天 vs.(74.36±2.02)天]和完全负重时间[(89.86±1.51)天 vs.(121.64±12.70)天]优于传统组,差异有统计学意义(P<0.05).结论 改良外固定架胫骨横向骨搬移术治疗糖尿病足,症状缓解快,功能恢复好,并发症少,具有良好的临床应用价值.
Gorham-Stout 综合征 ( Gorham-Stout syndrome,GSS )又称骨溶解病、特发性大块骨溶解骨病等,特征是骨基质中血管结构的增殖与进行性骨破坏和骨吸收 [1],且无新的骨形成 [2-3].到目前为止,所见报道约 300 例 [1].
目的 探讨肱桡肌腱入路保留旋前方肌改良 Henry 入路治疗不稳定桡骨远端骨折临床效果.方法 回顾性分析 2019 年 12 月至 2020 年 11 月收治的 31 例桡骨远端骨折患者,男 12 例,女 19 例;年龄22～65 岁,平均 48.16 岁;道路交通伤 6 例,摔伤 22 例,高处坠落伤 3 例;均采用肱桡肌腱入路、保留旋前方肌.记录术中出血量、手术时间,观察骨折愈合、内置物及术后并发症情况.分别采用 Dienst 评分评价末次腕关节功能、前臂旋转角度观察术后腕关节活动度.结果 手术时间 35～55 min,平均 47.42 min;术中出血量 20～35 ml,平均 23 ml;随访时间 1 年以上.骨折块均获得良好愈合,愈合时间 11～14 周,平均11.75 周.术区皮肤愈合良好,无严重神经、血管损伤,术后不同时间段患者腕关节正侧位显示,桡骨高度、掌倾角、尺偏角相比差异均无统计学意义(F = 2.86、0.224、5.56,P = 0.73、0.80、0.09),未见其角度丢失及骨折再次移位.术后不同时间段疼痛视觉模拟评分(visual analogue scale,VAS)与术前相比较,差异有统计学意义(F = 813.86,P<0.01).术后不同时间段前臂旋前角度和旋后角度差异有统计学意义(F = 465.66、288.42,P 均<0.01).末次随访根据 Dienst 评分评价腕关节功能,其中优 13 例,良 15 例,可 3 例,优良率为90%(28/31).6 例患者在取出内固定装置时发现旋前方肌未出现萎缩.结论 行改良 Henry 入路切开肱桡肌腱后保留旋前方肌治疗桡骨远端骨折,骨折复位满意、出血量少、手术时间短,术后可获得良好腕关节功能且内固定位置未见丢失,是临床上可优先选择的手术方法.
正常肌腱止点是一系列高度特异排序的组织,包括骨、钙化的纤维软骨层、非钙化的纤维软骨层和肌腱 [1]. 这一结构在力学传导中能避免应力集中,提供足够的强度 [2].手术修复是腱骨界面损伤的主要治疗手段,术中为了促进腱骨愈合需要对骨及肌腱组织进行新鲜化,清除残留的纤维软骨层,但在愈合过程中腱骨界面的纤维软骨层再生很困难.
遗传性多发性骨软骨瘤 ( hereditary multiple exostoses,HME ),又叫骨干续连症、遗传性多发性外生骨疣等,是一种以长骨干骺端出现多个良性软骨帽肿瘤为特征的常染色体显性遗传病 [1].目前认为 HME 主要是由于 ETX1 和EXT2 基因发生突变引起 [2].
