目的 对比观察经皮椎体后凸成形术(PKP)和经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎压缩性骨折缓解疼痛的临床疗效.方法 选择骨质疏松性胸腰椎压缩性骨折患者50例作为研究对象,随机分为两组各25例,对照组应用PVP治疗,观察组应用PKP治疗,对比两组治疗情况.结果 治疗后,观察组患者的疼痛评分、病椎恢复高度优于对照组,差异无统计学意义(P>0.05);观察组患者的椎体后缘高度恢复情况均优于对照组,数据比较;差异有统计学意义(P<0.05).结论 骨质疏松性胸腰椎压缩性骨折患者应用PVP与PKP均可有效缓解疼痛,但在椎体后缘高度恢复方面,PKP更具优势.

目的:探究案例教学法在本科生骨科临床带教中的应用效果.方法:本次研究遵循着公平公正的原则,选取了在我院进行实习的本科护生作为研究对象,目的就是为了体现出案例教学法在进行本科生骨科临床带教效果.本次研究所应用的研究对象一共有88例,所有参与带教的本科护生都为本科实习,选择时间为2015年9月,为了突出案例教学法的效果,本次研究一共分为两组,观察组和对照组,两组护生人数相同,均为44人,其中观察组主要应用案例分析法进行带教,对照组主要应用常规带教方式进行带教,主要对比分析的是两组护生的理论成绩、实践成绩以及对带教方式的满意程度.结果:本次研究中的观察组护生不论是在理论成绩还是实践成绩,均优于对照组,而且在带教满意程度方面也要高于对照组.结论:案例教学法在本科生骨科临床带教中的应用效果显著,可以进一步应用.

目的 通过回顾性分析采用外固定架联合克氏针撬拨闭合复位或有限切开复位固定治疗桡骨远端C3型骨折的临床疗效.方法 回顾性分析自2012年10月至2015年11月,共23例患者,23例复杂桡骨远端关节内骨折,AO C3型;通过外固定架联合克氏针闭合复位或者有限切开复位治疗,分别对患者的年龄、功能评分、相关病变、并发症、临床畸形和复位的质量进行了分析.进行独立和配对样本t检验.用线性回归分析确定连续参数变量之间的相关性.显著性差异设定在P<0.05.结果 所有患者平均随访20个月(14～26个月),末次随访,改良的Gartland和Werley评分系统:优5例,良12例,一般5例,差1例.总体结果满意.结论 通过外固定架联合克氏针固定闭合复位或有限切开复位治疗桡骨远端C3型骨折可以取得满意的临床效果,功能情况与关节面复位情况相关.

目的研究闭合复位微创钢板螺钉内固定治疗跟骨骨折效果。方法本次研究一共选择了已经确诊为跟骨骨折的68例患者作为本次研究对象,而且所有患者都是自愿参与调查研究的,在此基础上将所有患者进行平均分组,观察组和对照组,每组患者的人数都一致,均为34例,而且68例患者的病例选取时间均在2017年7月至2018年7月,其中对照组应用的是切开复位内固定方式治疗,观察组采用的是闭合复位微创钢板螺钉内固定治疗,对比分析两组患者的治疗效果、术后功能恢复情况以及术后并发症的发生情况。结果观察组的治疗效果、术后功能恢复情况以及术后并发症的发生情况均优于对照组,差异显著。结论闭合复位微创钢板螺钉内固定治疗跟骨骨折效果明显,值得进一步研究发展。

目的 探讨Meta钉治疗胫骨远端关节外骨折的适应症和临床疗效.方法 选取2012年5月-2014年10月采用Meta钉治疗的12例胫骨远端关节外骨折患者.其中,男性10例、女性2例;年龄23~58岁(平均38.2岁).按AO分型:A1型3例,A2型4例,A3型5例.所有患者均为闭合性骨折.骨折线距胫骨远端关节面3~5 cm.结果所有患者术后获得随访6~18个月(平均10.2个月),骨折愈合时间12~24周(平均18.6周),无畸形愈合、伤口感染、髓内钉断裂等并发症.患肢踝、膝关节功能采用Johner-Wruhs评分,优7例,良4例,可1例.结论 Meta钉治疗合并严重软组织损伤的胫骨远端关节外骨折疗效良好.

Objective To observe the efficacy of paraspinal approach in combined with pedicle screw fixation in the treatment of thoracolumbar vertebral fracture with no nerve damage. Methods A total of 13 patients with single segmental thoracolumbar vertebral fracture were treated with paraspinal approach in combined with pedicle screw fixa-tion. The postoperative injured vertebral sagittal plane Cobb angle,the injured vertebral front edge height,pain,spinal function,and complications were observed. Results The operations were successful. One -year follow up visit was paid to all the patients. The wounds were healed at the first grade. The postoperative injured vertebral sagittal plane Cobb angle was significantly lessened when compared with before operation( P ﹤0 . 05 ). The postoperative injured vertebral front edge height was significantly increased when compared with before operation( P﹤0 . 05 ). The postoper-ative VAS score and ODI were significantly reduced when compared with before operation( P﹤0 . 05 ). No complica-tions of infection,and internal fixation loosening or breaking were occurred. Conclusion The paraspinal approach in combined with pedicle screw fixation can effectively correct the injured vertebral front edge height of single segmental&nbsp;thoracolumbar vertebral fracture,and rectify the kyphosis,with less adverse reactions.

目的：观察高龄骨折患者术后应用镇痛泵镇痛的临床疗效。方法随机选取来该院就诊的高龄骨折患者34例，术前向病人介绍自控镇痛泵（PCA）的使用方法、放置方法及注意事项，术后分为硬外泵注组和皮下泵注组（n＝17），采用视觉模拟评分（VSA）法记录镇痛、镇静评分；记录病人呼吸和血压变化；记录恶心、呕吐等副反应的发生率及术后PCA的满意度，观察镇痛泵的临床疗效。结果皮下泵注组患者在术后4、8、12、24、48、72 h VSA评分均低于硬外泵注组（ P＜0.05）；患者对术后镇静总体满意度评估，皮下泵注的优良和良好多于硬外泵注组（ P＜0.05）；两组患者各时间段内嗜睡、恶心、呕吐、血压、呼吸均无显著差异（ P＞0.05）。结论皮下泵注组患者PCA的效果好于硬外泵注组，皮下泵注可推广应用于术后镇痛及代替硬外泵注。

Objective To understand the significance of multiple fractures of early diagnosis and treatment of internal fixation.Methods 87 cases of patients with multiple fractures of lower limbs were selected to have comprehensive examinations besides routine examination in order to prevent misdiagnosis and improve early diagnosis.The internal fixation treatment was adopted to analyze the pros and cons of different internal fixation methods at different times.Results There are 71 cases of superior efficacy,1death case and 15 cases of poor efficacy(1 case of amputation,1 case of postoperative infection,2 cases of malunion,6 cases of delay or nonunion,3 cases of joint stiffness or rigidity,1 case of breakage of fixed things,1 case of fracture after removing internal fixation) in 87 cases.Conclusion The early diagnosis and internal fixation treatment of multiple fractures of the lower limb can reduce morbidity and mortality,and significantly reduce the incidence of systemic complications.

Objective To investigate therapy effect and its clinical complications of the clavicular hook plate internal fixation for the treatment of Type Neer Ⅱ distal clavicle fracture and tossy Ⅲ acromioclavicular joint dislocation.Methods Twenty-two patients of Neer Ⅱ distal clavicle fracture and 16 patients of Tossy Ⅲ acromioclavicular joint dislocation were selected as our subjects.All patients were hospitalized and treated by using clavicular hook plate fixation form August 2007 to Februay 2012.The clinical effect and complications were analyzed retrospectively.Results All patients were showed the primary healing in terms of incision.Of all patients,30 cases were being following up,and follow-up periods was 6.0 to 18.0 months (average of (10.45 ±3.78) months).All patients underwent implant removal surgery at postoperative 6-14 months.No refracture or acromioclavicular joint separation again occurred.Four patients were with complications,of which,2 patients were clavicular hook plate decoupling at 7 days or 3 weeks after operation; One patient occurred clavicle stress fracture at more than 3 months after operation.All mentioned 3 cases were treated with re-operation.1 patient was with shoulder abnormal sound after operation and abnormal sound disappear after internal fixation removed.The shoulder functions were evaluated according to University of California-Los Angeles (UCLA) score system at before and after clavicular hook plate was taken out.The scores of pain and function of the shoulder,forward lateral flexion range were significant difference between before and after clavicular hook plate removed ((7.90 ±1.20) vs.(9.20±1.03),t =-2.327,P=0.045;(8.00±0.94) vs.(9.40 ±0.97),t=-3.280,P=0.001 ; (4.00 ±0.47) vs.(4.70 ± 0.48),t =-4.583,P =0.001).After the hook plate was removed,all shoulder functions showed improvement.The overall efficacy was excellent in 15 cases,good in 13 cases,and poor in 2 cases,and the recovery of excellent and good rate were 93.33％.Conclusion The clinical efficacy is well in terms of using clavicular hook plate internal fixation to treat Type Neer Ⅱ distal clavicle fracture and Tossy Ⅲ acromioclavicular joint dislocation.Prevention and treatment of complications should paid more attention.

<正>2009年4月~2011年2月,我院应用伤椎置钉技术治疗10例胸腰椎骨折患者,报道如下。1材料与方法1.1病例资料本组10例,男8例,女