目的:观察基于子午流注取穴的一指禅推法对腰椎间盘突出症(LDH)的临床疗效,为LDH寻找新的治疗手段.方法:选取2018年1月至2019年8月收治的LDH患者88例,所有病例随机分为子午流注组和常规推拿组(各44例).通过两组治疗前后比较疼痛视觉模拟(VAS)评分、日本骨科协会(JOA)评分及Barthel指数评分,评估基于子午流注取穴的一指禅推法对LDH的疗效.结果:基于子午流注取穴的一指禅推法在治疗LDH上能减轻疼痛,提高患者的腰椎功能.两组患者治疗1个疗程和2个疗程后VAS评分及JOA评分差异均有统计学意义(P＜0.05),治疗后子午流注组和常规推拿组患者总有效率分别为93.18％和81.82％,两组在总体疗效上差异有统计学意义(P＜0.05).结论:基于子午流注取穴的一指禅推法能够显著提高患者临床疗效,减轻疼痛,改善患者的腰椎功能,并降低腰痛对患者日常生活的影响,基于子午流注取穴的一指禅推法对LDH疗效更好.

目的 探讨上臂前外侧入路双锁定钢板治疗肱骨干术后骨不连的临床疗效.方法 回顾2015年2月至2018年6月在我科行上臂前外侧入路双钢板治疗肱骨干骨折术后骨不连患者并随访获得完整资料的患者13例.其中,男8例,女5例;左侧4例,右侧9例;年龄21～75岁,平均50.2岁;肱骨干上1/3段骨折3例,中1/3段骨折8例,下1/3段骨折2例;10例患者钢板断裂失效,3例钢板完好.增生性骨不连9例,缺血性骨不连3例,萎缩性骨不连1例.记录患者基本信息和随访结果,肩关节Constant-Murley评分、肘关节Mayo评分、患侧上肢DASH评分来评定临床疗效.结果 13例患者随访获得完整随访资料,平均随访10.7个月(9～14个月),所有患者均获得骨性愈合,平均愈合时间6.2个月(4～11个月),1例出现术后一过性桡神经麻痹,该患者术后2个月恢复正常,并发症发生率为7.69％.患者肩关节Constant-Murley评分(术前67.2±5.7、术后末次随访81.2±4.4),肘关节Mayo评分(术前74.2±5.4、术后末次随访80.2±3.2),患侧上肢DASH评分(术前8.9±2.7、术后末次随访7.97±2.3).该三项评分术后末次随访较术前改善,与术前比较差异有统计学意义(P＜0.05).结论 上臂前外侧双锁定钢板治疗肱骨干骨折骨不连效果满意.

目的 探讨应用微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗老年肱骨近端不稳定型骨折的临床疗效.方法 选取2015年7月至2017年8月本院采用微创接骨板内固定技术手术治疗并成功随访的34例肱骨近端不稳定型骨折老年患者,其中男12例,女22例;年龄69.2～81.5岁,平均年龄为73.5岁;右侧20例,左侧14例.骨折按Neer分型:二、三、四部分骨折分别为10例、17例、7例.受伤到手术时间3～7 d,本组患者均获得完整随访资料,分别记录手术时间、手术出血量、术中透视次数、骨折愈合时间、术后并发症发生率及术后12个月时肩关节功能Neer评分分析该手术方法的临床疗效.结果 所有患者均获随访,随访时间12～18个月,平均16个月.手术时间52.6～135.4 min,平均78.5 min;术中出血量45.6～135.4mL,平均75 mL;术中透视7～18次,平均9.7次;骨折愈合时间2.3～5个月,平均愈合时间3个月.2例出现内固定松动,经治疗后骨折均一期愈合.术后12个月时肩关节功能Neer评分:优22例,良8例,可3例,差1例,总体优良率88.2％.结论 微创接骨板内固定技术是治疗肱骨近端骨折的有效方法,创伤小、骨折愈合快,临床疗效满意.

目的探讨微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)结合锁定接骨板治疗肱骨近端Neer Ⅱ、Ⅲ型骨折的疗效。方法回顾性分析2013年6月~2015年6月在我科运用MIPPO技术结合锁定接骨板治疗的肱骨近端骨折44例患者,根据NEER分型,属于二部分骨折30例,属于三部分骨折14例。围手术期预防使用抗生素,术后肩关节功能采用NEER评分评估。结果全部病例获得随访,平均16个月。骨折均愈合,末次随访时肩关节功能NEER评分:优24例,良14例,可6例,总优良率86.4%。结论微创经皮锁定接骨板内固定是治疗肱骨近端骨折的有效方法,尤其Neer Ⅱ、Ⅲ型骨折能提供足够坚强固定,并发症少、疗效满意。

Objective To investigate the correlation between the production of NO, iNOS and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in the articular cartilage of rabbits with traumatic osteoarthritis(OA), and to explore the influence of Sodium hyaluronate(SH) on cartilage degeneration in traumatic OA. Methods 48 New Zealand rabbits underwent anterior cruciateligament transaction(ACLT) of the right knee and then were divided into three groups. The animals in the SH-treatment group were injected with SH(0.3 mg) in the knees 4 week after operation, once a week for 4 weeks.Rabbits in the model group were treated with normal saline under the same condition and the control group does nothing.All rabbits were sacrificed after the last treatment. Cartilagineus changes of the medial femoral condyles were grossly checked and OA severity was evaluated under light-microscope. The concentration of NO and iNOS in joint fluid, serum and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in joint fluid were assessed ELISA kit. Results The results of HE staining and pathological score show that cartilage degeneration in the SH-treatment group was significantly slighter than that in the model group. The concentration of NO and iNOS in joint fluid, serum and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in joint fluid were significantly lower than those in the model group( <0.01) after SH treatment. Conclusion The expression of NO was positively correlated with inflammatory Cytokines in the early stages of OA. And SH may protect articular cartilage by inhibiting synthesis of NO.

Objective To evaluate the surgical technique and clinical results of free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. Methods From March 2009 to November 2011, we have treated 15 patients(19 cases hip), useing free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. The Harris hip score, results of the X-ray and the postoperative complications were used to evaluate the clinical curative effectofthe surgical method. Results The patients were followed up after operation, the follow-up time 15 to 24 months, an average of 18 months. 1 patien had strands of anterolateral nerve innervation region skin numb and hypesthesia, and has recoveried after 4 months; 1 case of dorsalis pedis hsd hypoesthesia; 2 patiens in the lateral crus muscle strength was abate. All cases did not appear femoral neck fracture, ankle instability, infection and other side effects. The last follow-up Harris hip score : Ⅱ stage(4 hips 92.3 points), Ⅲ stage(12 hips 85.8 points), IV stage(3 hips 73.8 points). X ray shows that15 hips have different degree improvement; 3 hips have not been obviously changed; 1 hip has been worsened in performance(preoperative for stage IV). Period rate is 78.94%. Conclusion The treatment of femoral head necrosis with free vascularized fibula grafting is safe and effective, especially in early to mid patients. And the early proper treatment of this surgical technique can make many patients exempt or delay artificial joint replacement.

Objective To explore the intra-articular injections of safflower injection effect on knee joint of postoperative adhesion prevention, provide reference for clinicaltreatment of knee joint of postoperative adhesion. Methods Adult healthy male Japanese big ear rabbit 24,3.5 to 4.0 kg weight, randomly divided into 3 groups: group A(sodium hyaluronate group) and B(safflower injection group) group and C group(saline blank control group), each group of eight, all animals are on the right side of the knee joint synovial resection, postoperative 4 weeks right leg tube type gypsum was fixed, the group to the physiological saline, sodium hyaluronate, safflower injection intra-articular repeated injection once A week, each group A total of 4 times each knee visual score on each group of animals, biomechanics analysis,histologic observation and knee joint synovial average collagen content analysis. Results Biomechanical experiments showed A and group B than in group C( <0.01), there was no significant difference between A and B group( >0.05);Knee visual points A and B were in small C group( <0.01), there were no significant difference between A and B group( >0.05); Histological observation of A and B group were less than group C( <0.01), there was no significant difference between A and B group( >0.05); Knee joint synovial average collagen content determination of A and B is less than C group( <0.01), group B is less than group A( <0.01). Conclusion Intra-articular injections of safflower injection can well prevent knee postoperative adhesion, there was no significant difference effect with sodium hyaluronate.

Objective The establishment of collagen induced arthritis model, Discussion different concentrations of IL-17 A neutralizing antibody to CIA serum inflammatory cytokines in mice. Methods 48 male SPF C57BL/6 mice were randomly divided into 4 groups: A(Normal group) group; B(The CIA and Saline Group) group; C(The CIA and high concentration group) group; D(The CIA and low concentration group) group. Use of chicken type II collagen fluorine’s complete adjuvant emulsion preparation of antigen tail more subcutaneous injection; Two weeks later, Primary immune with the same method for the second immunization, intraperitoneal inject neutralizing anti-murine interleukin-17 antibody or physiological saline after CIA mice models were induced; persistent observation and data record of the change of the general situation, mice weight,arthritis index and thickness of fat in two weeks, testing the CIA mice serum TNF-a, IL-6,IL-17 expression level. Results C, D and B compared of TNF-a, IL-17 and IL-6 expression level decreased significantly;neutralizing anti-murine interleukin-17 antibody of the high concentration group were lower than low concentrations in serum inflammatory cytokine expression level, the difference was statistically significant( <0.05). Conclusion Neutralizes interleukin-17 antibody can significantly reduce Inflammatory cytokine of the CIA mice model in serum TNF-a,IL-17, IL-6 expression level, and the highest concentration group improved joint function more significant than the low concentration group, the mechanism may be involved in regulating Th17 mediated by cytokines-osteoclasts immune system, Inhibit the inflammatory cytokine expression, Further affect osteoclast factor to achieve.

Objective: To disscuss the clinical efficacy and operation techniques of anterior cervical vertebrectomy and fusion with titanium cage and locking titanium plate internal fixation in treatment of cervical spondylopathy.Methods:31 cases of cervical spondylopathy patients treated by anterior cervical vertebretomy and fusion with titanium cage and locking titanium plate internal fixation,Japanese Orthopedic Association(JOA) score system was adopted for therapeutic efficacy evaluation though radiograph to analyse the fusion rate,the intervertebral altitude loss,the situation of internal fixator.Results:All patients was followed after operation,patients followed from 6to 23 months.The fusion rate is 100%; The intervertebral altitude did not lossed;The situation of internal fixator was correct, 1 patient had subsidence.No patients had difficulty in breathing, hoarseness,water choke to cough, 2cases had swallowing discomfort,after 4 weeks,all healed.Preoperative and postoperative JOA scores of 1 week,3months, 12 months showed significant difference( <0.05).Results of patients are 87.09% total effective treatment.Conclusion:Anterior cervica l vertebrectomy and fusion with titanium cage and locking titanium plate internal fixation in treatment of cervical spondylopathy make full decompression,has strong stability of cervical cord,has high fusion rate.It has a good effect with few complication and it is worth spreading.

Objective: To evaluate the clinical efficacy of posterior pedicle screw joint combined with Cage fusion for treatment of isthmic spondylolisthesis. Methods: Tirty-seven cases of patients with lumbar spondylolisthesis were enrolled in this study,whowere treated by posterior laminectomy and pedicle screw joint combined with Cage fusion. Then postoperative healing was observed and X-ray film was reexamined. Lumbar JOA function scores in the last follow-up visit before and after surgery were compared. After average 38 months follow-up visits,Lumbar JOA function scores were compared again. Result: After surgery,there were 35 cases of wound healingⅠ,with one patient of wound fat liquefaction and one patient of cerebrospinal fluid exposure. X ray re-examination showed that bone to bone fusion occurred in 13 ~ 42 weeks,with one case of fusion Cage subsidence by 1mm. In the other36 cases,there appeared no pedicle screw loosening,fracture,displacement,and there was no loss of vertebral disc space height and slipped vertebral reset. Lumbar JOA function score after surgery was significantly higher than before surgery( t = 10. 34,P < 0. 05). The function improvement of all patients in follow-up visit was satisfying,and after treatment the improvement rate was 86. 5%. Conclusion: The posterior pedicle screw joint combined with Cage fusion for treatment of isthmic spondylolisthesis can relieve pressure on spinal cord and nerve root inflicted by diseased region,improve lumbar function with assured efficacy.

目的评价闭合复位第1、2掌骨间平行克氏针内固定术治疗Bennett骨折的手术方法及临床疗效。方法采用闭合复位第1、2掌骨间平行克氏针内固定术治疗Bennett骨折20例。结果本组20例,全部得到随访,随访时间12~24个月,术后TAM系统评分:优14例,良5例,中1例。影像显示均达到骨性愈合,Cooney评分均为优。功能满意。结论采用闭合复位第1、2掌骨间平行克氏针内固定术治疗Bennett骨折疗效确切,是一种有效的内固定手术方法,值得推广应用。

骨质疏松症是一种以骨量降低、骨微结构破坏、骨脆性增加、骨强度下降、骨折风险性增大为特征的全身性、代谢性骨骼系统疾病.由于骨质疏松症是一种全身性的疾病,骨质疏松症的原始治疗、骨质疏松性骨折术后及术后再骨折过程中抗骨质疏松药物的治疗非常重要,临床应用的抗骨质疏松药物主要包括两大类:骨吸收抑制类及促进骨形成类.随着骨代谢途径认识的不断加深,不断升级目前已有药物、已有药物的合理配伍使用、研发新型的改变细胞功能和基因表达的药物、继承和发展祖国传统中医药等都是值得探索的方向.随着这些新进展、新方案逐步通过临床试验的检验,将会给骨质疏松症的治疗带来新的希望.

<正>跟腱断裂临床上较为常见,由于解剖原因临床上跟腱止点附近的损伤,传统的治疗方法固定时间长往往导致肌肉萎缩、跟腱再断裂及踝关节功能障碍。我院自2009年8月-2012年9月应用双股缝线骨锚修复的31例跟腱断裂患者,均为急性期跟腱断裂患者,均采用Bunnell手术方法缝合跟腱,取得了良好的临床疗效,现报告如下。1临床资料1.1一般资料本组共31例,男25例、女6例;年龄21~47岁,平均32.3

目的探讨采用胸小肌肌腱重建喙锁韧带结合锁骨钩钢板治疗肩锁关节脱位的临床疗效。方法对48例(50肩)肩锁关节脱位采用胸小肌肌腱重建喙锁韧带结合锁骨钩钢板治疗。结果本组获得10~18个月的随访,术后疗效评定:优42例,可8例。结论采用胸小肌重建喙锁韧带结合锁骨钩钢板治疗肩锁关节脱位临床疗效好,具有损伤小、操作简单的优点。

Objective To explore the clinical effectiveness and skills of using LCP to treat the middle and distal tibial fractures.Methods From August 2012 to January 2013,total of 9 patients,7 males and 2 females,with the middle and distal tibial fractures were treated by external fixation with LCP,the average age of the patients at surgery was 32.3 years,ranging from 25 to 51 years old.According to Anderson-Gustilo classification,all the cases were type Ⅰ,ahout two third of the pstients were close fractures and one third were open fractures,based on AO classification system,the fractures comprised of 5 cases of type A,4 cases of type B.The effects of the treatments were analyzed in terms function recovery which evaluated according to Johner-Wruhs standed system,and to the radiography findings.Results 8 cases’ incision healed by first intention,the edge of incision necrosis occured in 1 case,but healed after dressing change.Screw deformation observed in 1 patient,though reducing weight,it did not fractured.The average follow-up period was 16.5 months(14 to 22 months).The average time of healing fracture was 13.6 weeks(13 to 19 weeks).The last followup according to Johner-Wruhs score the results were evaluated as excellent in 5 cases,good in 4 cases.Conclusion Using LCP to treat the middle and distal tibial fractures has small trauma,less bleeding,the less complications and clicinal treatment effect is good.

患者女,78岁.因“贫血、淋巴细胞增高2年,乏力、气促1月”于2012年10月11日入住我院血液科.患者2010年2月发现右足近2～4趾骨处皮肤包块伴疼痛,无发热、皮疹等.切除肿块,病理组织学报告“右足滑膜肉瘤”,后行包括截趾在内的手术治疗共3次,均未行放疗及化疗.2010年10月行第3次手术后发现贫血,无其它不适,全身检查未发现滑膜肉瘤转移.此后,多次查Hb 70～90 g/L.淋巴细胞计数(5 ～ 7)×109/L,未诊治.既往体健无特殊病史.入院查体:神志清楚,消瘦,重度贫血貌,浅表淋巴结未触及明显肿大,皮肤黏膜无出血.

Objective To evaluate ESIN fixation for treatment of children’s fracture of tibia Shaft Fractures. Methods From January 2009 to June 2011,26 cases of unstable pediatric tibial shaft fractures have been treated by ESIN fixation; All patients were followed up for 4 to 11months(mean 4.5 months). Results All patients have received the first grade fracture healing; Postoperative fracture healing time has an average of 10 weeks. Neighboring joints and limb function, completely returned to normal, evaluated according to the criteria of Johner and Wruh. 23 cases were assessed as excellent 3 as good,The excellent and good rate was 100%. 2 patients had irritation of the soft tissue(ache, cyst, et al), After pulling nail, they all healed. Conclusion ESIN fixation for treatment of children’s fracture of tibia Shaft Fractures has clicinal treatment effects, minimal tissue trauma and the less complications.

Objective:To comparison the curative effect between the conservative method and surgery method with micro titanium screw for the treatment of radial head fractures of Mason type Ⅱ,and provide data for the clinical treatment.Methods:All 33 patients with radial head fractures of Mason type Ⅱwere retrospective analyzed.There were 17 cases treated by internal fixation,and 16 cases by conservative method.The function score of elbow was assessed according to the assessment criteria of Broberg and Monrrey.Results:All patients were followed-up for 16-47 months(25 months averagely).There were 9 excellent cases,7 good cases,and 1 poor case in the operation group,and there were 7 excellent cases,5 good cases,and 4 poor cases in the conservative group.The overall excellent and good rate was 94.1% and 75% respectively in the two groups(P<0.01).Conclusion:There are some obvious advantages of surgery method for treating radial head fractures of Mason type Ⅱ,such as functional recovery of joint mobility and muscle strength,compared with conservative method.

Objective To evaluate the method of treatment for terrible triad of the elbow associated with olecranon fracture.Methods From November 2005 to September 2009 eleven cases were diagnosed as terrible triad of the elbow associated with olecranon fracture.According to Regan-Morrey classification of olecranon fracture,type Ⅰ 5 cases;type Ⅱ 4cases;type Ⅲ 2 cases;The radial head fractures according to Johnston-Mason classification,type Ⅳ 11 cases;According to Colton(1973) classification of olecranon fracture,type Ⅰ 2 cases;type Ⅱ 9 cases.External fixators were fixed in position with elbow flexion at 90° and forearm rotation in neutral.After 6～9 days physical exercise started.Results All patients were followed-up from 8 to 24 months with hea led fractures The total range of elbow flexion-extension was 107.8° and forearm rotation was 137.6°.The clinical results were evaluated according to Mayo elbow performance score,excellent 3 patients,good 5 patients,2 fair and 1 poor;the excellent and good rate was 72.7%.Conclusion Terrible triad of the elbow associated with olecranon fracture can have chance of better functional outcome with reconstruction of joint and soft tissue structural stability and early rehabilitation exercises.

目的观察锁定钢板治疗高龄股骨转子间骨折的临床疗效。方法对56例高龄股骨转子间骨折的患者采用锁定钢板固定。结果所有患者术后随访10～24个月,平均18个月,其中无骨折不愈合、延迟愈合发生,患者功能基本恢复,生活能自理。结论锁定钢板固定手术简单、创伤小、时间短、固定牢靠、术后可早期锻炼,是治疗高龄患者股骨转子间骨折的较好选择。但需注意患者的选择、围手术期处理及抗骨质疏松治疗。