目的 从Cooney腕关节评分和腕关节活动范围的变化观察掌侧Henry入路锁定钢板内固定治疗对桡骨远端骨折的治疗效果.方法 采用回顾性研究方法,选取2015年2月至2018年8月中国解放军海军特色医学中心收治的桡骨远端骨折患者86例,按手术入路不同将患者分为两组:研究组(n=46)和对照组(n=40).研究组患者采用Henry入路的锁定钢板内固定,对照组患者采用背侧入路的锁定钢板内固定.观察并比较两组患者的骨折愈合优良率(采用Cooney腕关节评分来评价)和术后2周、6个月的腕关节活动范围.结果 研究组患者的Cooney腕关节评分结果的优良率(95.65％)显著高于对照组(80.00％),差异具有统计学意义(χ2=5.101,P=0.024);其中评价为优的比率(73.9％)也明显高于对照组(55.0％),差异具有统计学意义(χ2=5.753,P=0.017).术后2周,两组患者腕关节各活动度无显著差异(P>0.05);术后6个月,研究组患者的腕关节背伸(55.2±7.4°vs.69.5±5.4°)、掌屈(71.3±11.5°vs.54.5±10.2°)、桡偏(20.1±3.2°vs.15.1±3.5°)、尺偏(38.9±7.1°vs.32.3±7.5°)和前臂旋前(84.3±13.5°vs.75.3±12.7°)和前臂旋后(74.6±10.5°vs.69.4±12.2°)度数均显著高于对照组,差异有统计学意义(t=3.874、7.873、5.872、4.962、3.572,P<0.05).结论 从Cooney腕关节评分和腕关节活动范围的变化来看,掌侧Henry入路锁定钢板内固定治疗复杂桡骨远端骨折能获得更好的腕关节功能恢复.

Objective:To investigate the clinical applications of small incision fenestration minimally in-vasive surgery combined with lumbar laminectomy and fusion fixation in treatment of lumbar disc herniation with lumbar instability .Method:A total of 80 patients of lumbar disc herniation with lumbar instability were divided into two groups according to different operation .The group A had the small incision fenestration mini-mally invasive surgery combined with lumbar fixation and fusion , and the group B had the lumbar laminecto-my surgery combined with internal fixation and fusion .Result:The incision length , operative time , blood loss and bed time of the patients in group A were less than those in group B , the difference was statistically signif-icant (P <0.05);after surgery, the efficiency of the surgery and the number of patients whose ODI scores improved 35 points in group A were significantly higher than that in the group B after six months , the inci-dence of nerve root injury was lower than in group B , the difference was statistically significant ( P <0.05) . Conclusion:Small incision fenestration minimally invasive surgery combined with lumbar laminectomy and fusion fixation treatment has shorter operation time , milder trauma , higher fusion rate , quicker recovery , etc, it is worthy of clinical application .

Objective To compare clinical efficacy of traditional transforaminal lumbar interbody fusion ( TLIF) with modified TLIF treatment in elderly lateral lumbar disc herniation. Methods 50 cases of lateral lumbar disc hernia-tion in elderly patients were randomly divided into observation group and control group. 25 patients were in the control group using traditional TLIF surgery, observation group were treated with improved TLIF surgery, the two groups were compared surgery pain improved, intraoperative and postoperative recovery. Results The observation group was compared with the control group, which showed shorter operative time, blood loss decreased, ambulation after a short time, reduced costs ( P<0. 01 ) . 3 months after surgery, the two groups of patients′ VAS scores and preoperative JOA scores were significantly improved ( P<0. 01 ) , but there was no significant difference between the two groups (P>0. 05). Patients were followed up for 12 months, the rate of fusion patients were not significantly different (P>0. 05), but the observation group were better than the control group in JOA improved classification (P <0. 05). Conclusions Modified TLIF reduces the paraspinal soft tissue surgery destruction, trauma and has shorter operative time, and postoperative higher stability.

目的探讨非金属单侧外固定架治疗四肢骨不连的方法及临床疗效。方法采用非金属单侧外固定架治疗四肢骨不连21例。结果本组31例获随访3～18个月,拆除外固定架后随访3～8个月,骨折愈合良好,达到骨性愈合标准。结论非金属外固定架治疗四肢骨不连固定牢靠,符合骨折后骨不连早期的刚性固定和中后期的弹性固定,是一种简单有效的方法。

目的探讨应用撬拨复位克氏针交叉结合非金属单侧外固定架治疗老年肱骨近端粉碎性骨折的疗效。方法对老年肱骨近端粉碎性骨折52例应用经皮撬拨复位克氏针交叉结合非金属单侧外固定架治疗。结果本组获随访6～72个月,关节功能恢复满意,按Neer评分优良率达到96.2%。结论应用经皮撬拨复位克氏针结合外固定架治疗老年肱骨近端粉碎性骨折固定可靠,避免手术切开复位内固定创伤及二次手术取内固定,术后早期肩关节活动锻炼,治愈率高,并发症少,具有较好的临床应用价值。