目的 探讨经皮微创非融合外固定治疗胸腰椎骨折的近期临床疗效.方法 收集2013年1月至2013年10月在我院住院治疗的25例胸腰椎骨折患者的临床资料,手术方法均采用脊柱外固定结合伤椎内植骨进行微创非融合治疗,25例中,男15例,女10例.比较术前、术后3d、3个月及末次随访时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、局部后凸角、椎体高度丢失率,评价该微创术式治疗胸腰椎骨折的近期临床疗效.结果 本组患者得到平均14个月的随访(12～22个月).平均手术时间100 min(60～130 min),平均术中出血量55mL(35～120mL).仅1例出现皮下感染,经过2周换药后治愈;螺钉弯曲4枚;无椎体感染等发生;平均术后120 d拆除外固定支架;无神经损伤并发症.术后3d、3个月及末次随访的VAS评分、局部后凸角、椎体前缘高度丢失率与术前比较,差异均有统计学意义(均P＜0.05).结论 经皮微创非融合外固定治疗胸腰椎爆裂性骨折可获得满意的近期疗效.

Objective To investigate the new method of treatment with Allman classification type Ⅲ acromioclavicular joint injury by operation.Methods Through a retrospective study,we compared the curative effects of three methods in the treatment of type Ⅲ Allman acromioclavicular joint injuries in patients with a total of 63 examples.They were divided into three groups according to different kinds of operations:anchor through coracoid-clavicle fixation group with 22 cases,Kirschner wire tension band group with 21 cases,and 20 cases in clavicular hook plate group; all the cases were new dislocation,in which 38 cases were male,25 cases were female.In addition to anchor through the coracoid clavicle fixation group,all other cases were removed the implants after 12-19 months,a follow-up study was carried out to record clinical symptoms,signs and imaging findings of patients,and the results were statistically analyzed.Results The average follow-up was 19(13-31) months,according to Karlsson criteria of efficacy evaluation,the excellent rates of three kinds of operation were 95.5％,71.4％ and 85.0％ respectively,the numbers of cases with complication were 3,6 and 8 respectively.Conclusion Anchor through coracoid-clavicular fixation is a method with good effect in the treatment of acromioclavicular joint injury,it is consistent with the principles of physiology,simple and can avoid removel of internal fixation.

目的 比较微创经皮钢板接骨术(MIPPO)结合锁定加压钢板(LCP)与传统切开复位解剖型钢板内固定治疗胫骨远端骨折的疗效. 方法 回顾性分析2005年1月至2010年12月收治的106例胫骨远端骨折患者资料,男87例,女19例;年龄20 ～55岁,平均37.5岁;骨折根据Rtedi-Allgtwer分型:Ⅱ型52例,Ⅲ型54例.根据方式不同分为2组:微创组53例(采用MIPPO技术结合LCP治疗),切开复位组53例(采用传统切开复位解剖型钢板内固定治疗).两组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性. 结果 101例患者术后获6～24个月(平均14.0个月)随访.微创组(52例)骨折愈合时间为3.5 ～6.0个月,平均5.2个月;无术后严重并发症发生.切开复位组(49例)骨折愈合时间为5.5～10.0个月,平均7.2个月;2例患者术后出现切口部分坏死,1例患者发生骨髓炎.采用Baird-Jackson踝关节评分系统评定疗效:微创组优20例,良27例,可5例,优良率为90.4％;切开复位组优12例,良23例,可11例,差3例,优良率为71.4％.两组患者骨折愈合时间与优良率比较差异有统计学意义(P＜0.05). 结论 与传统切开复位解剖型钢板内固定相比,MIPPO技术结合LCP固定治疗胫骨远端骨折可有效保持骨折端血供,缩短骨折愈合时间,提高疗效.

目的:观察和分析外侧切口进行全髋置换的手术效果。方法:108例采用外侧切口行全髋置换术。手术后随访半年~3年,并以Harris法进行功能评定:结果:所有患者手术均在外侧切口下顺利进行,术中显露满意,手术时间短,出血少。半年后患肢功能恢复良好,无髋外展无力和髋关节脱位显现;X线片显示假体位置良好,无假体松动;优良率达100%。结论:外侧切口进行全髋置换术具有入路快捷,创伤小,出血少,手术时间短。