Objective:To compare the occurrence of DVT and identify the risk factors in patients after arthroscopic surgery for upper and lower limbs, providing reliable clinical reference for the evaluation and prevention of DVT after arthroscopic surgery.Methods:Retrospective analysis was conducted to collect general information and relevant laboratory indicators of patients undergoing arthroscopic surgery in Jinjiang Hospital from October, 2021 to October, 2022. The patients with DVT displayed by color ultrasound before operation were excluded. According to different exposure factors, they were divided into DVT group and non-DVT group. To explore the risk factors that cause DVT after arthroscopic surgeries in upper and lower limbs, independent sample t test was used for measurement data of exposure factors, and chi square test was applied for counting data to identify potential risk factors. Modified Poisson regression analysis was performed on potential risk factors with statistically significant differences between the two groups.Results:A total of 232 patients were enrolled. Among them, 25 (10.8%) had postoperative DVT in lower limb, and all were distal DVT. Among these 25 patiens, 24 cases were intermuscular veins in the calf, one case was posterior tibial vein combined with anterior tibial vein, and no postoperative pulmonary embolism (PE) occurred. There was no statistically significant difference in the incidence of DVT between upper and lower limb arthroscopy surgerie. Compared with the non-DVT group, there were statistically significant differences in age(t=-2.140), BMI(t=-2.592), postoperative Caprini score(t=-6.410), the duration of operation(χ2=12.262), the duration of using tourniquet(χ2=6.812), and postoperative D-dimer(χ2=7.719)(all P<0.05 ). Modified Poisson regression analysis showed that increased BMI [relative risk(RR)=1.235, 95%confidence interval(CI) (1.084, 1.408), P<0.01), postoperative Caprini score (RR=1.080, 95%CI(1.062, 1.312), P<0.01) and postoperative D-dimer increase (RR=3.657, 95%CI(1.465, 9.130), P<0.01) were risk factors for postoperative DVT.Conclusions:The incidence of DVT after arthroscopy in upper limb is not lower than that after arthroscopy in lower limb, which should be taken seriously by clinical doctors. An increase in BMI, postoperative Caprini score, and postoperative D-dimer elevation are important risk factors for the occurrence of DVT.

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.

肩胛胸分离是一种罕见的损伤类型,常因上肢受到巨大的牵拉暴力导致肩胛胸关节损伤,伴随肩锁关节分离、锁骨移位骨折或胸锁关节脱位,约88％的患者伴有血管损伤,94％的患者发生严重神经损伤.肩胛胸分离的临床表现和治疗方法多样,与接诊医生对该疾病的认识程度有关.目前公认的分型是改良Zelle分型,其对肩胛胸分离损伤的预后具有重要参考意义.

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.

目的 对比研究悬吊钛板与锁骨钩钢板在治疗肩锁关节脱位中的应用.方法 2015年6月～2018年1月,选取符合纳入标准的肩锁关节脱位(Rockwood Ⅲ型)患者50例,随机分为悬吊钛板、钩钢板组两组,每组各25例.观察和比较两组患者的平均手术时间、术中出血量、医疗费用,根据Karlsson标准评定疗效,美国肩肘关节外科医师协会肩关节功能评分(ASES)评定肩关节功能情况.结果 ①两组患者在平均手术时间、术中出血量比较差异无统计学意义(P＞0.05);②悬吊钛板组医疗费用高于钩钢板组,比较差异有统计学意义(P＜0.05);③术后1年按Karlsson标准评定治疗优良率,与钩钢板组(68％)比较,悬吊钛板治疗优良率(92％)明显更高,差异有统计学意义(P＜0.05);④与钩钢板组比较,悬吊钛板组在术后6周、3个月、6个月、1年的ASES评分明显更高,差异均有统计学意义(P＜0.05).结论 钩钢板在肩锁关节脱位治疗中具有经济性,而悬吊钛板的疗效更优.

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。

我院自1999年7月～2001年3月收治股骨颈骨折32例,采用透视下闭合复位经皮7.3mm空心加压螺纹钉治疗,经随访疗效满意.现报告如下.