Objective:To explore the efficacy of balloon dilation percutaneous kyphoplasty (PKP) combined with prying reduction bone grafting in the treatment of thoracolumbar fractures, and its impact on patients′neurological function.Methods:The clinical data of 184 patients with thoracolumbar fractures from March 2017 to May 2020 in Cangzhou Integrated Traditional Chinese and Western Medicine Hospital of Hebei Province were retrospectively analyzed. Among them, 86 patients were treated with balloon dilation PKP combined with prying reduction and bone grafting (combined group), and 98 patients were treated with open reduction decompression and internal fixation (internal fixation group). The intraoperative bleeding volume, surgical time, intraoperative fluoroscopy frequency, efficacy and complications were recorded. One year after surgery, X-ray films were taken to measure the height of the anterior border and posterior border of vertebral body and the Cobb angle, and the pain visual analogue score (VAS), Barthel index and neurological Frankel grade were evaluated.Results:The intraoperative bleeding volume and surgical time in combined group were significantly higher than those in internal fixation group: (205.64 ± 45.63) ml vs. (180.37 ± 30.08) ml and (110.22 ± 28.91) min vs. (81.66 ± 20.77) min, and there were statistical differences ( P<0.01); there was no statistical difference in intraoperative fluoroscopy frequency between the two groups ( P>0.05). The total effective rate in combined group was significantly higher than that in internal fixation group: 91.86% (79/86) vs. 79.59% (78/98), the total incidence of complications was significantly lower than that in internal fixation group: 13.95% (12/86) vs. 38.78% (38/98), and there were statistical differences ( P<0.05 or <0.01). The height of the anterior border and posterior border of vertebral body 1 year after surgery in combined group were significantly higher than those in internal fixation group: (95.78 ± 1.59) mm vs. (62.74 ± 1.80) mm and (98.53 ± 3.80) mm vs. (95.06 ± 3.28) mm, the Cobb angle was significantly smaller than that in internal fixation group: (6.53 ± 2.80)° vs. (18.06 ± 2.68)°, and there were statistical differences ( P<0.01). The VAS and Barthel index 1 year after surgery in both groups improved significantly, and there were statistical differences ( P<0.01), but there were no statistical differences between the two groups ( P>0.05). The rate of neurological Frankel grade E 1 year after surgery in combined group was significantly higher than that in internal fixation group: 56.98% (49/86) vs. 23.47% (23/98), and there was statistical difference ( P<0.01). Conclusions:Compared with open reduction decompression and internal fixation, the balloon dilation PKP combined with prying reduction and bone grafting patients with thoracolumbar fractures is better for vertebral reduction and deformity repair, with higher safety, more significant pain relief, and better recovery of daily life and neurological function.

Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.

患者,女,49岁,15年前因左股骨远端皮质骨旁骨肉瘤行病灶切除铰链膝置换术,术后肿瘤无复发,7年前左膝出现窦道,先后8次行开放清创术,感染未得到控制,患者保肢愿望迫切,于2015 年1月26日入我科住院治疗.

目的:临床对颈椎病人使用颈前路减压零切迹椎间植骨融合内固定系统(Zero-P)进行治疗,观察研究其治疗效果.方法:选取2015年7月-2016年7月来我院治疗经确诊为颈椎病的42名病人作为主要研究对象,其中男性23人,女性19人,年龄在39岁到78岁之间;患有脊髓型颈椎病33人,神经根型9人,全部使用颈前路减压Zero-P手术进行治疗.病变阶段:8例C3/4、4例C4/5、7例C5/6、13例C6/7.在手术之前对9名神经根型病人进行VAS评分,并在手术之后两个月及一年对病人再次进行评分;使用JOA对脊髓型病人术前,术后两个月及一年情况进行评分.测量病人颈椎Cobb角,然后观察病人在手术之后出现吞咽不适时长和概率.根据手术之后伸屈侧位X片观察手术间隙.结果:手术进展顺利,时间在56分钟到150分钟之间,平均用时90分钟;手术中出血量为30毫升到230毫升,平均为135毫升.15名病人在手术之后一种左右的时间内出现了吞咽不适的情况,13名病人吞咽不适感在两个月内消失,剩下的2名病人不适感在4个月后消失.随访时间为一年到一年半,平均15.2个月.脊椎型病人术后JOA评分均高于术前,而神经根型病人VAS评分均低于术前,术后各组病人Cobb角大于术前角度,以上各指标差异都比较明显(均为P<0.05).而手术后四个月与手术后一年的各指标相比较,无统计学差异(P>0.05).在随访期间手术间隙没有发生异常移位的现象.结论:对颈椎病人使用颈前路减压Zero-P固定手术进行治疗,得到了良好的治疗效果,重建颈椎的稳定性高且病人术后发生吞咽不适的概率较低.

目的:研究关节镜下经后入路保留残留后交叉韧带纤维与板股韧带重建后交叉韧带的临床疗效.方法:对12例患者在关节镜下结合常规入路和后入路保留残留的交叉韧带纤维和板股韧带重建交叉韧带.在手术后12个月比较手术前后膝关节功能恢复情况.结果:经过治疗后,所有患者没有发生伸膝受限的情况,3例患者有轻度的屈膝受限.Lysholm膝关节功能评分和IKDC评分与术前比较均具有统计学价值(P<0.05).结论:膝关节后入路保留交叉韧带残留纤维和板股韧带重建交叉韧带,关节镜下视野比较清晰,操作比较安全,短期疗效比较显著.

目的 比较分析传统外侧"L"形切口钢板内固定与跗骨窦小切口空心钉内固定治疗跟骨骨折的临床疗效.方法 回顾性分析2016年3月—2018年3月该科收治的SandersⅡ型、Ⅲ型跟骨骨折患者80例,随机分为跗骨窦组与传统组.比较两组手术时间、术后引流量、术后并发症发生率及术后1年AOFAS评分情况.结果 跗骨窦组手术时间、术后引流量、术后并发症发生率均低于传统组,差异有统计学意义(P<0.05);术后1年AOFAS评分比较,差异无统计学意义(P>0.05).结论 采用跗骨窦小切口空心钉内固定及传统外侧"L"形切口钢板内固定治疗SandersⅡ型、Ⅲ型跟骨骨折均能达到良好的效果,但前者具有出血少、恢复快,并发症发生率低等优点,值得推广应用.

2008 年2 月 ～2014 年10 月,我科采用经皮撬拨复位结合空心螺钉内固定治疗30 例Garden Ⅲ、Ⅳ型股骨颈骨折患者,效果良好,报道如下. 1 材料与方法 1. 1 病例资料 本组30 例,男10 例,女20 例,年龄50 ～ 72 岁.

患者,男,51岁,因右外踝反复肿痛活动受限2 年加重3 个月于2018 年6月11 日入院. 患者2 年前扭伤右踝关节,1周后症状明显改善,遂下地行走及日常活动,肿痛症状反复出现,休息缓解,活动加重. 近3个月来,自觉右外踝处持续肿痛,行走不稳,为进一步诊治入院. 右外踝处肿胀,外踝尖部前缘、外侧踝穴、距骨头外侧及跗骨窦区均有压痛,提踵试验( -);踝关节背伸15°,跖屈40°;踝关节前抽屉试验( +),踝内翻应力试验( +). 应力X线片显示距骨倾斜角>10°;MRI检查显示距腓前韧带距骨侧断裂,距骨外侧穹窿软骨损伤. 在腰麻下取外踝前弧形切口.

Objective:To discuss the clinical efficacy of Zero-P on single segmental cervical spondylosis myelopathy in elderly patients.Methods:45 cases of elderly patients with single segmental cervical spondylosis myelopathy who received Zero-P treatment were selected.The changes of JOA score,VAS score,NDI index,cervical inter-vertebral height and the Cobb angle 1 month,2 months and 6 months after operation were analyzed.And the change of the level of inflammatory response factor in serum was also detected.Results:The JOA score and Cobb angle were increased(P<0.05),while VAS score,NDI index,cervical inter-vertebral height and inflammatory factors (IL1β,IL2 and IL6) were decreased after treatment.Compared with preoperative,the differences were statistically significant(P<0.05).Conclusion:The clinical efficacy of Zero-P on single segmental cervical spondylosis myelopathy in elderly patients is very good.

Background Subacromial impingement syndrome (SAIS) is characterized by pain experienced through an arc of elevation as the shoulder abducts and diagnosed commonly by Neer test (NT). However, the diagnostic accuracy of NT for SAIS is still limited. Here, a modified Neer test (MNT) was introduced to improve the accuracy of the clinical examination in diagnosing SAIS and differentiating it from frozen shoulder. The aim of this study was to investigate the diagnostic values of MNT in diagnosing SAIS and differentiating it from frozen shoulder. Methods Between January 2015 and June 2015, a prospective study assessed 85 shoulders among 82 patients with shoulder joint disease; 42 patients underwent arthroscopic surgery, and all 82 patients received X-rays, magnetic resonance imaging (MRI) or MRI contrast examinations. The diagnostic criteria are based on arthroscopy and MRI scanning. Results Using clinical epidemiology and diagnostic tests, we calculated the sensitivity, specificity, positive predictive value, negative predictive value and degree of accuracy of MNT in diagnosing SAIS. The diagnostic accuracy rate of MNT in identifying shoulder SAIS was 90.59%, and the specificity was 95.56%. Conclusions In the diagnosis of SAIS, MNT is a reliable and highly accurate maneuver and seems useful to distinguish this syndrome from frozen shoulder.

INTRODUCTION:We analyze the outcome of circumcisions performed with 8-figure non-absorbable suture (8FNS) and assess the feasibility of using the technique in male circumcision.METHODS:We randomly divided 317 patients who would undergo circumcision between February 2009 and January 2012 into 2 groups. Each group was subdivided into children (age range: 7 to 15 years) and adult (range: 16 to 85 years). In the experiment group (n =166), we used 8FNS and in control group (n = 151), commonly absorbable suture (CAS) were used for the circumcised wound closure. The results of 2 groups were compared. We also performed a cost analysis and a mean 6-month follow-up (range: 1-12). Chi-square and Student's t-test were used in statistical analysis. Differences were considered significant (p < 0.05).RESULTS:No patients were required to remove their sutures postoperatively. Among them, the sutures of the 8FNS for circumcision fell off spontaneously within 9 days (6.2 ± 1.57). There was no statistically significant difference between the 2 groups in surgical duration (16.2 ± 1.73 vs. 15.8 ± 2.01) and follow-up time (6.4 ± 3.82 vs. 6.2 ± 2.39). The overall complication rate of the 2 groups was 6.63% and 10.53% (p = 0.15), respectively. In addition, the complication rate among the adults was significantly lower in the 8FNS group compared to children (2.53% vs. 10.34%, p = 0.04). Also, the average cost (in US dollars) of 8FNS for circumcision was $20.7 ± $3.83 less than $35.8 ± $5.02 of CAS, which is a very significant difference (p < 0.0001).CONCLUSIONS:8FNS for circumcision is feasible, easy, safe and cost-effective, especially for adult males.

<正>1病例资料患者,女,56岁。35年前发现右手小指肿物,在当地医院行截小指术。之后右手中、环指开始出现局部隆起,逐年增长,近半年来增长迅速,无疼痛,表面皮肤无破溃,屈伸活动受限,影响日常生活,2012年3月来我院就诊。

目的:通过对比中药外敷个性化支具与传统石膏外固定治疗老年患者桡骨远端骨折肿胀消退及骨折临床愈合时间,探讨两种方法治疗的优缺点。方法:2006年2月-2010年11月收治84例单侧桡骨远端闭合骨折患者,其中中药外敷个性化支具外固定治疗40例,传统石膏外固定治疗44例,通过对两组患者性别、年龄、骨折类型等一般资料比较,差异无统计学意义(P>0.05),对两组患者骨折愈合时间、解剖评价标准及腕关节功能进行临床评定。结果:患者外固定后均获得随访,随访时间3～28个月,骨折临床愈合时间比较差异有统计学意义(P<0.05),水肿开始消退时间比较差异无统计学意义(P>0.05),水肿完全消退时间比较差异有统计学意义(P<0.05)。结论:中药外敷个性化支具较传统石膏外固定治疗桡骨远端骨折对水肿消退及骨折愈合均有明显促进作用。

OBJECTIVE:To study the pathogenesis and treatment of gluteal heterotopic ossification caused by injection.METHODS:From April 2006 to May 2011, 4 old female patients with gluteal heterotopic ossification caused by injection were treated by resection. The average age was 71 years old ranging from 67 to 76. The illness were bilateral,the clinical character was pain and hard nodules in the both hip. The X-ray, CT and pathology matched the diagnosis of heterotopic ossification. Two of them were treated by totally removing the ossified tissues, and loosing the spastic and adhesive soft tissues. The other two were treated with local resection and soft-tissue lysis.RESULTS:The wound of all patients healed well, and there were no complication. All patients were followed-up from 2 to 64 months(averaged 26 months). There were no lump and pain in the location of surgical resection.CONCLUSION:Gluteal heterotopic ossification caused by injection is the drug reaction produced by injecting benzyl alcohol or other drugs,and happens in adults. The key for the treatment is to remove part or all of the painful lump,and loose the local fascia and other soft tissues of the gluteal muscles.

膝关节骨性关节炎(knee osteoarthritts,KOA)是一种慢性、退行性关节疾病,又称肥大性、增生性、畸形性、骨性或老年性关节疾病,是一种以关节软骨损伤和骨质增生为特点的非炎症性疾病[1],软骨病变是其始动环节,病理改变为早期软骨纤维样变,中期软骨丢失、负重关节面糜烂,晚期出现软骨下骨质硬化、囊变和骨赘[2].KOA可分为原发性和继发性两大类.临床主要表现为疼痛、肿胀、畸形及功能障碍等,是骨科常见病,因其发病率高,并有逐年上升的趋势,而引起医学界注意.中医学认为,"肾主骨,生髓",髓居骨中,骨赖髓以充养,本病的发生以肾精亏虚为本,另外还与邪侵、损伤等有关[3].兹将KOA的中西医治疗进展综述如下.

长期以来由于对下尺桡关节损伤认识不足,常被忽视而漏诊及延误治疗,最终导致腕部疼痛、无力及前臂旋转功能受限等严重后果.我科于2007年9月至2011年3月对26例急性下尺桡关节脱位的患者采取了非手术和手术进行治疗,疗效满意,现报道如下.

Objective To explore the effects of the treatment temperature of electromagnetic thermal Chinese herbal medicine on closed limb's fracture.Methods Forty patients of closed limb's fracture were treated with electromagnetic thermal Chinese herbal medicine.The cases were selected at random.20 cases were treated with electromagnetic thermal Chinese herbal medicine for two times everyday at a high temperature of 42±2℃, while another 20 cases were treated with electromagnetic thermal Chinese herbal medicine for two times everyday at a low temperature of 34±2℃.Clinical and functional results were followed up at 2,4,6 and 8 week.Results The results showed that,after 8 weeks,the high temperature(42±2℃) group obtianed a much better repair effect than that of the low temperature(34±2)℃group(p<0.01,p<0.05).Conclusions The preference temperatures of electromagnetic thermal Chinese herbal medicine has an obvious effect for promoting blood cycling at the boen fracture,accelerating bone growth and shortening curing time,which indicates that electromagnetic thermal Chinese herbal medicine is a good method for treating bone fracture.

患者 女,56岁.35年前发现右手小指肿物,于当地医院行小指截指术.之后右手中、环指开始出现局部隆起,逐年增长,近半年来增长迅速,无疼痛,表面皮肤无破溃,屈伸活动受限,影响日常生活.2011年3月来我院就诊.临床检查:全身一般情况可,右小指缺如,多处隆起,右环指近节指骨隆起最大,约30 mm×35 mm×38 mm,肿物表面均光滑、质硬,无破溃.

OBJECTIVE:To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures.METHODS:Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union.RESULTS:All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%.CONCLUSION:Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.

Objective:Appraisal after the chest pleural membrane outside way Ⅰ In the time infection eliminates,the titanium net to plant the bone to add the fixed treatment chest lumbar vertebra tuberculosis curative effect.Methods: Uses to 15 example chest lumbar vertebra tuberculosis patient after the chest pleural membrane outside the way Ⅰ The time infection eliminates,the titanium net to plant in the bone the pexia,the observation treatment result.Results:Complete A-grade heals,clinical symptoms vanishing,after the technique,has not presented the infection and Dou said.Conclusion:Chest lumbar vertebra tuberculosis line Ⅰ The time infection eliminates,the spinal cord reduced pressure,the titanium network to plant in the bone the pexia treatment,the curative effect is satisfied.