[目的]比较龚氏四步复位法石膏外固定与常规手法复位石膏外固定治疗踝关节骨折的效果.[方法]回顾性分析本院2020年6月—2022年6月手法复位的90例踝关节骨折患者的临床资料.根据术前医患沟通结果,45例接受龚氏四步复位石膏外固定(龚氏组),45例接受常规手法复位石膏外固定(常规组).比较两组临床与影像资料.[结果]随治疗后时间推移,两组踝VAS评分均下降(P＜0.05),而AOFAS评分和踝ROM均显著增加(P＜0.05).治疗后6个月,龚氏组的VAS评分[(1.9±0.3)vs(2.4±0.3),P＜0.001],AOFAS 评分[(90.3±3.9)vs(86.4±4.4),P＜0.001]和踝 ROM[(51.4±4.9)° vs(49.0±5.2)°,P=0.027]均显著优于常规组.影像方面,两组关节面复位质量的差异无统计学意义(P＞0.05).治疗后龚氏组的胫踝角(tibiocrural angle,TCA)[(76.5±4.8)° vs(73.8±4.5)°,P=0.007]、踝内侧净间隙(medial clear space,MCS)[(3.5±0.3)mm vs(3.9±0.4)mm,P＜0.001]及胫腓净间隙(tibiofibular clear space,TFCS)[(6.0±1.5)mm vs(6.6±1.2)mm,P=0.039]均显著优于常规组.[结论]两种方式手法复位均可有效治疗踝关节骨折,其中龚氏四步复位法石膏固定的疗效优于常规手法复位石膏外固定.

目的 分析血清Flt3配体(Flt3L)和生长停滞特异性蛋白6(Gas6)对骨折患者感染的诊断效果.方法 以2019年1月-2021年6月河南省驻马店市中心医院收治的进行骨折内固定手术治疗的188例患者为研究对象,依据患者是否发生术后感染分为感染组45例和非感染组143例,分析感染患者感染病原菌分布,单因素及多因素Logistic回归分析骨折患者术后感染影响因素,受试者工作特征(ROC)曲线分析Flt3L和Gas6对骨折患者术后感染的诊断效果.结果 45例术后感染患者共检出69株病原菌,其中革兰阳性菌23株(33.33％),主要为金黄色葡萄球菌,革兰阴性菌43株(62.32％),主要为铜绿假单胞菌,真菌3株(4.35％).多因素Logistic分析结果显示,创口遗留死腔、合并糖尿病、手术时间≥3h是骨折患者术后感染的影响因素.ROC曲线分析结果显示,血清Flt3L、Gas6表达水平对骨折患者术后感染均有较佳的诊断效果,两者联合应用,特异度为0.902,敏感度为0.800.结论 创口遗留死腔、合并糖尿病、手术时间≥3h为骨折患者术后感染的影响因素,Flt3L、Gas6表达水平对骨折患者术后感染有较佳的诊断价值.

Objective:To analyze the effects of medial and lateral double-plating fixation of knee on patients with complex fracture of the tibial plateau.Methods:A total of 78 patients with complex fracture of the tibial plateau treated in Zhumadian Central Hospital from January 2019 to April 2020 were selected and divided into observation group and control group according to random number table method, with 39 cases in each group. The control group was treated by anteriorly medial incision double-plating fixation, while the observation group was treated by medial and lateral double-plating fixation. The excellent and good rate of knee function, perioperative conditions, Rasmussen score (articular surface collapse, angulation deformity, platform widening), tibial plateau Angle, including medial posterior slope angle (PA), tibial plateau angle (TPA), and Fugl-Meyer motor function assessment (FMA) score were compared between the two groups.Results:The excellent and good rate of knee joint function in observation group (89.74%, 35/39) was higher than that in control group (71.79%, 28/39), P<0.05. Compared with the control group, the observation group had longer operation time, less intraoperative blood loss, shorter loading time and shorter fracture healing time ( P<0.05). Six months and 1 year after surgery, the scores of articular surface collapse, angulation deformity and platform widening in observation group were higher than those in control group (all P<0.05). One year after operation, the PA and TPA of observation group were lower than those of control group ( P<0.05). Six months and 1 year after surgery, the FMA score of observation group was higher than that of control group ( P<0.05). Conclusions:Medial and lateral double-plating fixation in the treatment of complex fracture of the tibial plateau with can accelerate the postoperative recovery and fracture healing, promote the recovery of tibial plateau angle and knee joint function, and improve the function of lower limbs.

Objective:To investigate the effect and molecular mechanism on fracture healing of tibial plateau in rats.Methods:Totally 75 rabbits were randomly divided into control group, fracture model group and transforming growth factor-β (TGF-β) group by random number table. The tibial plateau joint collapse fracture was constructed in the fracture model group and TGF-β group. Rabbits in the control group only exposed skin, and was not subjected to tibial plateau fracture. The rabbits in TGF-β group were injected with Adeno associated virus harboring TGF-α (1×10 11 vg). The rabbits in the control group and fracture model group were injected with empty adeno-associated virus (1×10 11 vg). After 4 weeks of treatment, the fracture healing was measured by X-ray. The activity and swelling degree of knee joint in three groups were measured. The bone mineral density (BMD) of tibia was measured by X-ray scanning. The degree of knee ligament fibrosis was measured by Masson trichrome method. The biomechanical changes of tibial plateau were measured by three-point bending method. Analysis of variance was used to compare the measurement data, and LSD method was used to compare the two groups. Results:The X-ray score of fracture site in TGF-β group (17.09±4.18) was significantly higher than that in the fracture model group (13.69±3.71, t=4.109, P<0.05). BMD in the TGF-β group (0.48±0.03) was significantly higher than that in fracture model group (0.27±0.02, t=3.710, P<0.05). The range of motion of knee joint in TGF-β group [(118.38±12.43) degrees] was significantly higher than that in the fracture model group [(109.22±12.54) degrees, t=4.011, P<0.05]. The swelling degree of knee joint in TGF-β group [(0.20±0.03) cm] was significantly higher than that in the fracture model group [(0.25±0.03) cm, t=4.381, P<0.05]. Collagen fibers of medial ligament in TGF-β group (blue) [(37.14 1±79)%] was significantly lower than that in fracture model group [(20.154±81)%, t=4.193, P<0.05]. The maximum load, elastic load and stiffness of tibial plateau in the TGF-β group [(129.75±7.62) N, (85.33±8.01) N, (168.39±9.38) N/mm] was significantly higher than that in fracture model group [(71.59±6.09) N, (60.43±6.19) N, (125.41±11.26) N/mm, t=2.761, 3.018, 2.995, P<0.05]. Conclusion:TGF-β can significantly promote the fracture healing of tibial plateau, improve the function of knee joint, and improve the biomechanical properties of tibial plateau.

[目的]探讨多吻接血管断指再植手术治疗手指末节完全离断伤的效果.[方法] 2015年10月～2019年10月收治的68例手指末节完全离断伤患者随机分为两组,每组34例,多吻接组展开多吻接血管断指再植手术治疗,常规组行常规断指再植手术治疗,对比两组疗效.[结果]多吻接组断指成活率94.29％,而常规组为56.47％高,差异有统计学意义(P＜0.05).术后6个月,多吻接组远端指间活动度、两点辨别觉、断指指甲长度均显著优于常规组(P＜0.05).术后6个月,多吻接组手指功能总评分显著高于常规组(P＜0.05).[结论]多吻接血管再植手指末节完全离断伤可提升断指成活率,并促进患者手指功能有效康复.

目的 探讨微创内固定系统(LISS)术对胫骨骨折患者术后关节功能及生活质量的影响.方法 76例胫骨骨折患者随机分为两组,各38例.对照组行解剖钢板内固定术治疗,观察组行LISS钢板内固定治疗.比较两组疗效、关节功能及生活质量.结果 两组患者术后优良率无明显差异(P>0.05);对照组患者关节功能评分显著低于观察组(P<0.01);观察组患者在躯体活动功能、躯体功能对角色功能的影响、疼痛、活力及社会功能评分方面均显著高于对照组(P<0.01).结论 LISS钢板内固定与解剖钢板内固定术疗效相当,但LISS术对患者关节功能的早期恢复和生活质量的改善具有显著优势,值得临床推广.

目的 探究骨质疏松患者骨代谢标志物与骨密度之间的关系及临床意义.方法 选择2016年2月~2017年2月期间我院收治的70例骨质疏松患者作为骨质疏松组,另选同期为诊断为骨质疏松的50例健康者作为健康对照组,测定两组患者的骨钙素(OC)、甲状旁腺激素(PTH)、25-羟基维生素D[25(OH)D]、总Ⅰ型胶原氨基端前肽(P1NP)等生化指标及骨密度.结果 骨质疏松组患者的骨密度低于健康对照组,差异显著(P<0.05);骨质疏松组患者的P1NP为(40.86±9.02),显著低于健康对照组的(44.88±9.67),组间差异显著(P<0.05);骨质疏松组患者的OC为(26.03±8.03),显著高于对照组的(21.05±7.82),组间差异显著(P<0.05);两组的PTH、25(OH)D等指标比较无显著差异(P>0.05).结论 骨代谢标志物OC、P1NP与骨密度具有一定的相关性,能反应出骨质疏松患者的骨代谢变化,是综合评价骨质疏松症的重要指标.

目的 比较不同方式治疗股骨粗隆间骨折的临床疗效.方法 选取2013年2月～2015年2月我院收治的150例股骨粗隆间骨折患者作为研究对象,根据治疗方式分为内固定组(30例)、外固定组(20例)以及人工置换组(100例),内固定组实施传统的内固定手术,外固定组利用外固定架进行治疗,人工置换组实施人工股骨头置换术,对比三种治疗方式的临床效果.结果 人工置换组在住院时间以及下地活动的时间明显短于另外两组,并发症的发生率都明显低于另外两组;随访12个月,人工置换组骨折复位的优良率明显高于另外两组(P＜0.05),有统计学意义.结论 对于股骨粗隆间骨折患者采用人工股骨头置换术可以取得显著的治疗效果.

Objective To explore the clinical efficacy and the mechanism on lumbar intervertebral disc herniation(LIDH)treated with integrated Chinese and western medicine.Methods 70 cases of LIDH in accordance with diagnostic criteria were randomized into a treatment group and a control group.In control group(35 cases),the western medicine was taken orally for anti-inflammation,analgesia and nourishing nerves.Additionally,the intravenous drop was administered with sodium aescinate for injection 20mg and lumbar vertebral contraction(western medicine therapy)was applied.In treatment group(35 cases),on the basis of the treatment as control group,the modified duhuo jisheng decoction was combined(integrated Chinese and western therapy).7 day treatment made 1 session in two groups.The efficacy was observed after 2 sessions of treatment.Results The total effective rate was 97.0 % in treatment group and was 85.7% in control group,presenting significant difference in statistics(P0.05).The efficacy in treatment group was remarkably superior to that in control group.Conclusion The integrated Chinese and western medicine can improve the overall efficacy on LIDH and shorten the time of treatment.This therapy deserves to be promoted in clinical practice.

Objective:To study the clinical curative effects of radiofrequency target thermocoagulation combined with ozone injection in treating intervertebral disk hernia.Methods:62 cases of intervertebral disc herniation were randomly divided into radiofrequency target thermocoagulation group as the control group(group A,n=31) and radiofrequency target thermocoagulation combined with ozone injection group as the treatment group(group B,n=31).Therapeutic effects were respectively evaluated in the first week,second months and sixth months after the operation.Results:Compare with the control group,the treatment group showed a higher effective rate in the first week,second months and sixth months after the operation(P<0.05).Both groups had no significant postoperative complications.Conclusion:Radiofrequency target thermocoagulation combined with ozone injection shows better curative effects in treating intervertebral disk hernia than the single use of radiofrequency target thermocoagulation for treatment.

目的:观察针刀结合手法治疗神经根型颈椎病的临床疗效.方法:36例患者给予针刀结合手法治疗,治疗3月后判定疗效.结果:痊愈26倒,显效26例,有效3例,无效1例,有效率为97.22%.结论:针刀结合手法治疗神经根型颈椎病疗效显著.