目的:比较空心螺钉与动力髋螺钉(DHS)在PauwelsⅢ型股骨颈骨折治疗中的疗效.方法:选取符合纳入标准的PauwelsⅢ型股骨颈骨折患者58例,随机分为空心螺钉、DHS两组,每组各29例.观察和比较两组患者平均手术时间、术中出血量、术中透视次数、退钉率、股骨头坏死率,评估术后6个月、12个月Harris评分评定髋关节功能情况.结果:①与空心螺钉组比较,DHS组的平均手术时间更长,术中出血量更多,差异均有统计学意义(P<0.05);②DHS组术中透视次数较空心螺钉组少,差异有统计学意义(P<0.05);③与空心螺钉组比较,DHS组退钉率低于空心螺钉组,差异有统计学意义(P<0.05);股骨头坏死率低于空心螺钉组,但差异无统计学意义(P>0.05);④与空心螺钉组比较,DHS组在术后6个月、12个月的Harris评分明显更高,差异均有统计学意义(P<0.05).结论:空心螺钉在PauwelsⅢ型股骨颈骨折治疗中创伤更小;DHS在PauwelsⅢ型股骨颈骨折治疗中术中透视少,退钉率低,术后关节功能恢复更佳.

目的 研究空心钉结合内侧支撑钢板在Pauwels Ⅲ型股骨颈骨折治疗中的应用效果.方法 2015年11月至2018年10月,选取符合纳入标准的Pauwels Ⅲ型股骨颈骨折患者58例,随机分为空心钉、空心钉结合内侧支撑钢板两组,每组各29例.观察和比较两组患者平均手术时间、术中出血量、术中透视次数、骨折复位质量、术后并发症(如退钉、骨不连、股骨头坏死率、髋内翻、股骨颈短缩等),术后6、12、24个月Harris评分评定髋关节功能情况.结果 患者均获随访,随访时间24～56个月,平均(30.6±6.1)个月.(1)与空心钉组比较,空心钉结合钢板组的平均手术时间更长、术中出血量更多,但术中透视次数少,两组比较差异均有统计学意义(P＜0.05).(2)空心钉结合钢板组骨折复位优良率高,两组比较差异有统计学意义(P＜0.05).(3)空心钉结合钢板组术后退钉、股骨头坏死、髋内翻、股骨颈短缩等并发症的发生率均低于空心钉组,两组比较差异有统计学意义(P＜0.05),术后骨不连发生率两组相当,差异无统计学意义(P＞0.05).(4)与空心钉组比较,空心钉结合钢板组在术后6、12、24个月的Harris评分明显更高,差异有统计学意义(P＜0.05).结论 空心钉结合内侧支撑钢板在PauwelsⅢ型股骨颈骨折治疗中的疗效较好,术后并发症发生率低,可为临床治疗该类型骨折提供参考.

Objective To compare the advantages and disadvantages of interlocking intramedullary nail and minimally invasive percutaneous plate osteosynthesis in the treatment of tibia fracture.Methods 59 cases of tibia fracture,treated from 2013.01 to 2015.01,were randomly divided into two groups,one group were treated with interlocking intramedullary nail,and the other were treated with minimally invasive percutaneous plate osteosynthesis.The operation time,blood loss cases,the number of perspective,postoperative complications,and fracture healing time were observered to comparer the efficacy of interlocking intramedullary nail and minimally invasive percutaneous plate osteosynthesis in the treatment of tibia fracture. Results Except 1 person in each group was lost follow-up, The other patients were followed up for 19~27 weeks (average 22.4 weeks), and their fracture have healed.we found obvious difference between two groups according to the date of the operation time,blood loss cases,the number of perspective,and fracture healing time ( <0.05). In the aspects of postoperative complications,the two groups had no significant difference ( >0.05). Conclusion The group treated with interlocking intramedullary nail has longer operation time,more blood loss cases,more number of perspective, but shorter fracture healing time. And in the aspects of postoperative complications,the two groups had no significant difference.

Objective To evaluate the risk factors of postoperation tibial nonunion and to investigate experience in treatment.Methods Form 2005 to 2014,36 patients with postoperation tibial nonunion were included in this study,they were treated by doing another operation and divided into two groups:LCP (Limited contact locking compression plate)fixation or ENT (Tibial intramedul ary nail)fixation.We Compared the date of Duration of operation,bleeding volume,Duration of union Between two groups.Results Except 1 patient who was in the LCP group loss to fol ow-up 1 month after the operation,The other patients were fol owed up for 3~13 months (average 9 month),and their fracture have healed.we don’t found obvious dif erence between two groups according to the date of Duration of operation and Bleeding volume.but the Duration of union who in ENT group were statistics shorter than in LCP group.Conclusion Both LCP fixation or ENT fixation to treat postoperation tibial nonunion can achieve a satisfactory ef ect.There aren’t obvious dif erence in Surgical trauma between two ways of fixation.Compared with LCP group,ENT group took shorter time to knit ing,It might suggest that ENT fixation may be bet er than LCP fixation in treatment of postoperation tibial nonunion.

目的：在行跟骨骨折切开复位内固定术中，分别采取侧卧位和俯卧位，对两种体位下行内固定进行对比研究。方法自2011年1月到2014年10月行跟骨骨折切开复位内固定患者80例，将入选病例分为单侧跟骨骨折及双侧跟骨骨折，再进一步分为侧卧位组和俯卧位组，比较其手术时间、术中出血量及术中 C 型臂透视次数的区别。结果在行单侧跟骨骨折切开复位内固定术中，侧卧位 C1组的术中 C 型臂透视次数较俯卧位 F1组多，差异具有统计学意义（P ﹤0.01）；在行双侧跟骨骨折切开复位内固定术中，侧卧位 C2组的手术时间、术中出血量及术中 C 型臂透视次数均较俯卧位 F2组多，差异具有统计学意义（P ﹤0.01）。结论在行跟骨骨折切开复位内固定术中，采用俯卧位较侧卧位具有更多优势，特别是在行双侧跟骨骨折切开复位内固定术中。

目的探讨股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)在股骨近端(粗隆间、下)骨折治疗中的应用,评价其临床疗效。方法 C型臂透视下牵引闭合复位,应用PFNA微创治疗股骨近端(粗隆间、下)骨折76例。股骨粗隆间骨折55例,男26例,女29例;年龄37～86岁,平均67岁。股骨粗隆下骨折21例,男15例,女6例;年龄30～66岁,平均41岁。结果本组76例随访6～36个月,手术时间为45～90min,骨折全部愈合,骨折临床愈合时间为8～20周,无髋内翻及内固定物切出,无螺钉退出或穿出。髋关节功能采用Harris评分,优52例,良22例,可2例,优良率达97%。结论 PFNA微创治疗股骨近端(粗隆间、下)骨折疗效确切、操作简单、损伤小、并发症少、固定牢靠,是治疗股骨近端(粗隆间、下)骨折较理想的内固定材料。