选取2016年6月～2017年12月86例糖尿病胸腰椎骨折术后患者,随机平分为对照组予以常规护理,观察组在常规护理的基础上运用集束化技术护理.结果 胸腰椎术后第一次排气,排便时间及排便状况比较,2组差异(P ＜0.01或P ＜0.05).结论 对糖尿病胸腰椎骨折患者术后实施中集束化护理腹胀便秘可促进其胃肠功能恢复,排气、排便时间提前,术后腹胀和便秘的发生率明显下降.

The clinical efficacy was compared between 3D navigation-assisted percutaneous iliosacral screw (3DPS) and minimally invasive reconstruction plate (MIRP) in treating sacroiliac complex injury and the surgical procedures of 3DPS were introduced. A retrospective analysis was performed on 49 patients with sacroiliac complex injury from March 2013 to May 2017. Twenty-one cases were treated by 3DPS, and 28 cases by MIRP. Intraoperative indexes as operative time, blood loss, incision length, length of hospital stay and postoperative complications were respectively documented. Quality of reduction was postoperatively evaluated by Matta radiological criteria, and clinical effect was assessed by Majeed scoring criteria at the last follow-up. Operative time and hospital stay were significantly shortened, and blood loss, and incision length were significantly reduced in 3DPS group as compared with those in MIRP group (P<0.05). No statistically significant difference was found between 3DPS group and MIRP group in the assessment of reduction and function (P>0.05). It was concluded that both 3DPS and MIRP can effectively treat the sacroiliac complex injury, and 3DPS can provide an accurate, safe and minimally invasive fixation with shorter operative time and hospital stay.

OBJECTIVE:To explore the application value and clinical effect of three-dimensional printing combined with composite plate internal fixation in the treatment of old acetabular posterior wall fracture. METHODS:From May 2010 to October 2016, Mimics 19.0 software was used to plan preoperatively according to a 1:1 print pelvic 3D model. At the same time, 23 patients with old acetabular posterior wall fractures were treated with combined plate internal fixation, including 15 males and 8 females, aged 20 to 63 (43.0±5.1) years old, and the time from injury to operation was 23 to 101(47.0±10.5) days. According to Letournel-Judet classification, 11 cases were posterior wall fracture, 7 cases were transverse with posterior wall fracture, and 5 cases were posterior column with posterior wall fracture. All patients were treated with single Kocher-Langenbeck approach combined plate internal fixation, and the evaluation indexes were recorded during operation, after operation and during follow-up. RESULTS:The operation time of 23 patients was (113.5±11.5) min, bleeding was (550.0±104.7) ml and fluoroscopy was (12.7±0.8) s. Matta radiographic reduction criteria were used: excellent in 14 cases, good in 7 cases and poor in 2 cases; 23 patients were followed up for 10 to 24 (16.0±5.6) months. The hip function was evaluated according to the modified Merle d'Aubingne and Postal scoring system at the last follow-up: excellent in 11 cases, good in 8 cases, fair in 3 cases and poor in 1 case. There were 3 cases of traumatic arthritis, 1 case of femoral head necrosis, 2 cases of heterotopic ossification and 5 cases of sciatic nerve irritation. CONCLUSIONS:3D printing technique is an effective and fast method for the treatment of old acetabular posterior wall fractures. In addition, the printing model can provide three-dimensional morphological structure for the operator, combined with preoperative simulation, facilitate intraoperative reduction, and effectively improve the efficiency of surgery.

滑膜骨软骨瘤病是一种良性关节滑膜疾病,病理特征为滑膜下纤维组织增生,关节滑膜内软骨基质钙化或骨化[1].该病的病因尚不明确,好发于30～50岁人群,且男女比例为2∶1[2].病变部位多累及大关节,膝关节发病率最高,髋关节次之[3],肩关节发病较为罕见[3-6].目前手术治疗方式主要包括切开或关节镜下游离体摘除、滑膜切除,但术后复发率尚不明确[5-7].笔者于2017-05诊治1例肩关节滑膜骨软骨瘤病,对其手术治疗方法、随访结果及经验进行总结并复习相关文献,加深对滑膜骨软骨瘤病的认识,报道如下.

目的 探讨微创接骨板内固定(MIPO)治疗不稳定型骨盆骨折的临床疗效.方法 回顾性分析2014年3月至2016年12月河南省南阳市中心医院骨科收治的27例不稳定型骨盆骨折患者资料,所有患者骨盆前环、后环骨折均采用MIPO内固定技术,统计手术时间、术中出血量、透视时间,术后复位质量、术后5～12个月随访骨折愈合及功能恢复情况.结果 27例骨盆骨折患者平均手术时间及术中平均出血量前环分别为:(55.65±10.50)min、(110.50±50.41)mL,后环分别为:(45.83±6.62)min、(135.50±45.10)mL,术中透视时间平均为(1.25±0.81)min,术后第3天复查骨盆X线片及CT三维重建,优良率为88.94％;术后有1例患者手术切口出现感染,经过2次清洗、负压封闭引流(VSD)覆盖,1个月后痊愈;其余患者手术切口均I期愈合,且无内固定松动、断裂,神经损伤等并发症;术后经5～12个月随访,27例患者骨折均获得骨性愈合,双下肢及骨盆功能恢复良好,末次随访时采用Majeed评分标准评定骨盆功能,优良率为100.00％.结论 MIPO内固定技术治疗不稳定型骨盆骨折,具有创伤小、并发症少及固定牢靠等优势,临床可推广使用.

目的观察中西医不同治疗方法对糖尿病肾病尿微量白蛋白的影响。方法将80例随机分为3组。对照组(A组)29例,单纯降糖治疗;缬沙坦组(B组)26例在降糖治疗同时,每晨服缬沙坦胶囊80mg;肾炎康复片组(C组)25例在降糖治疗的同时,给予肾炎康复片口服治疗。3组均连续治疗12W,比较治疗前及治疗后1、2、4、8和12W时组间及组内尿白蛋白排泄率(UAER)等的变化。结果 A组UAER在治疗前后差异无统计学意义(P>0.05);B组和C组治疗前后差异有统计学意义(P<0.01-0.05);治疗后,B组、C两组UAER与A组比较差异有统计学意义(P<0.01-0.05),但B、C两组间第12W治疗后UAER下降差异有统计学意义(P<0.05)。结论 B、C组均能减少早期糖尿病肾病患者的UAER,B组较C起效快,但后者作用持久。二者分别具有低血压和胃肠道不耐受;交换治疗后可消除其副反应。