目的 探讨股骨近端防旋髓内钉治疗股骨转子间骨折的疗效.方法 采用股骨近端防旋髓内钉治疗36 例股骨转子间骨折患者,比较不同类型的外侧壁破裂患者的手术情况及疗效.结果 患者均获得12 个月随访.术中出血量10～300(101.67±76.29)ml,术后住院天数1～11(5.6±2.7)d,住院总天数2～26(9.9±4.4)d.术后1 年髋关节Harris评分78～96(88.3±5.3)分.术中出血量、术后住院天数、住院总天数、术后1年髋关节Harris评分:不同类型的外侧壁破裂患者比较差异均无统计学意义(P>0.05).结论 PFNA治疗伴有外侧壁破裂的股骨转子间骨折,疗效良好,并不需要常规重建外侧壁.

目的 比较股骨内生软骨瘤与低度恶性软骨肉瘤的CT与MRI影像特征,为临床诊断与治疗提供参考.方法 回顾性分析自2008-01-2018-04诊治6例股骨内生软骨瘤与6例股骨Ⅰ级软骨肉瘤,行病灶刮除植骨术.术前测量CT图像上病灶的最大直径,观察CT图像上是否出现钙化斑、有无股皮质破坏,观察MRI图像上是否有髓腔内扇贝样改变.结果 12例均获得随访,股骨内生软骨瘤组随访时间平均59.5(18～90)个月,股骨Ⅰ级软骨肉瘤组随访时间平均32.3(13～68)个月.所有患者随访期间均未复发,患肢髋、膝关节功能恢复良好.股骨内生软骨瘤组CT图像上病灶最大直径为(4.08±3.31)cm,股骨Ⅰ级软骨肉瘤组最大直径为(6.07±2.97)cm.股骨内生软骨瘤组6例CT图像上均存在钙化斑,3例CT图像上存在骨皮质破坏,MRI图像上均无髓腔内扇贝样改变.股骨Ⅰ级软骨肉瘤组4例CT图像上均存在钙化斑,1例CT图像上存在骨皮质破坏,5例MRI图像上有髓腔内扇贝样改变.结论 股骨内生软骨瘤与Ⅰ级软骨肉瘤的术前影像学鉴别诊断较为困难,病灶刮除植骨术是安全有效的治疗方法.

Objective In this study,a new operating procedure to improve the probability of femoral stem prosthesis tips in femoral stem central zones was developed,the clinical outcome was then comapared with that of control group during cemetless total hip arthroplasty(THA).Methods 156 patients underwent cementless THA from January 2011 to February 2014 were divided into two groups(the reame fluting and the control groups). Radiology and thigh pain assessments were performed postoperation.ResultsAfter felow-up for(2~5 years),more middle rates of femoral stem prosthesis and less thigh pain incidences were recorded in the reame fluting group,when compared with the results from control group.ConclusionThe new operating procedure of reaming was able to make prosthesis tips in femoral centeral zones and to reduce the incidences of thigh pain. It is a reliable and easy method for extensive application without additionaly economic costs.

目的 探讨人工全膝关节置换(TKA)术后切口愈合不良的原因,并提出预防和治疗措施.方法 自2008-09-2012-04行TKA186例,共有5例伤口愈合不良,从患者自身及手术技术方面探讨其发生原因.结果 5例切口愈合不良中2例为类风湿性关节炎,长期服用激素;1例为强直性脊柱炎,长期服用英太青;1例合并心脏瓣膜置换术后,长期服用抗凝药物;1例肥胖患者,脂肪液化.结论 预防TKA术后切口愈合不良应以做好术前准备、提高手术技巧为主.

目的 探讨改良经后路腰椎间融合术治疗腰椎管狭窄症伴腰椎不稳的临床疗效.方法 45例腰椎管狭窄症伴腰椎不稳患者,采用后路椎板开窗减压、下关节突切除、椎间融合器植入、椎弓根钉内固定的改良术式进行治疗.采用日本骨科协会评分(JOA)、视觉模拟疼痛评分(VAS)及影像学检查评价治疗效果.结果 JOA评分,术前与术后3个月、6个月之间差异有统计学意义(P＜0.05),术后3个月与6个月之间差异无统计学意义(P＞0.05).VAS评分,术前与术后3个月、6个月之间差异有统计学意义(P＜0.05),术后3个月与6个月之间差异有统计学意义(P＜0.05).影像学检查显示椎间融合良好.结论 该术式能对椎管充分减压,椎间融合满意,是治疗腰椎管狭窄症伴腰椎不稳的一种有效方法.

目的探讨严重开放性粉碎性胫腓骨骨折分分期修复重建骨及软组织创面治疗效果。方法从2005年3月～2009年5月对收治的17例严重开放性粉碎性胫腓骨骨折进行分期修复重建骨及软组织创面治疗情况。结果本组17例创面均顺利愈合,骨折愈合满意,17例术后均获随访。平均8周部分骨痂生长,12周植骨,创面缺损者腓肠神经营养血管皮瓣覆盖,连续随访12～24个月,无一例发生骨不连接、畸形或短缩。结论早期稳定,中期清创植骨加皮瓣,后期间断再植骨分期治疗,可使胫腓骨及周围软组织毁损严重病例,骨折愈合满意,软组织创面覆盖理想,肢体功能恢复佳,值得临床推广。

Objective To study the significance of internal fixations of intertrochanteric hip fractures in elder patients by comparing the effects of various kinds of internal fixations.Methods One hundred and thirty nine elder patients with intertrochanteric hip fractures were followed up.They were treated with the four kinds of operations respectively: dynamic hip screw(DHS),locking proximal femur plate(LPFP),proximal femoral nail(PFN) and proximal femoral nail antirotation(PFNA).The data of each group were collected for statistical analysis on the following aspects: operative time,blood loss,clinical healing time of fractures,posteroperative complications and functional outcome.Results The differences of the operative time and blood loss between group PFNA and other groups were statistically significant.There were significant differences in the rate of loosening of internal fixation and the total rate of complications.No differences of functional outcome and clinical healing time of fractures in four groups were found.Conclusion Group PFNA has shorter operative time and less blood loss than other groups.Group DHS has higher rate of loosening of internal fixation and the complications.

Objective To evaluate the clinical effectiveness of total hip arthroplasty with threaded mortars in patients with osteoarthritis secondary to acetabular dysplasia.Methods Threaded mortars were used to reconstruct 61 hips in 40 patients with osteoarthritis secondary to acetabular dysplasia.Results The pain was completely relieved and the dysfunction was obvious relieved.The differences of the Harris score between preoperation and postoperation were significant.Clinical and radiographic analysis demonstrated the stable fixation and better location of the mortars.Conclusion Total hip arthroplasty with threaded mortars provides stable fixation for the patients suffering from osteoarthritis secondary to acetabular dysplasia,and get good clinical results.

Objective To analyse the reasons caused locking compression plate (LCP) brekage in fracture treatment.Methods A retrospective analysis was done to study the causes of the 8 cases with locking compression plate breakage.Results Of the 8 cases with LCP breakages,1 was caused by short length of LCP,5 by oversized screw density,1 by noncompression to the bone fracture or the selectional mistake of LCP,5 by no bone plant,1 by postoperative infection,2 by operative mistakes,4 were open fractures with severe primary injury.Conclusion It is necessary for application of LCP in fracture treatment to correctly understand the principles of both locked internal fixators and AO internal fixation,which is the key to successful surgery for the traumatic fractures.

胸腰段骨折如初期处理不当可致该段脊柱迟发性后凸畸形[1],从而致患者腰背痛甚至产生神经脊髓受压症状:双下肢麻木、行走不稳、大小便障碍.脊柱后凸畸形较大、症状较重者需行截骨矫形术[2].经椎弓根椎体或椎间隙截骨可有效地矫正患者脊柱后凸畸形.本研究2004年5月~2009年4月根据后凸顶点、畸形角度的不同及椎间盘有无破损采用2种不同的经椎弓根截骨方式治疗胸腰段陈旧性骨折伴后凸畸形14例,取得较好临床效果.

[Objective]To investigate the feasibility and merits of the Smith-Peterson osteotomy for the treatment of degenerative lumbar scoliosis. [Methods]Twenty-five patients(11 males,14 females)with degenerative lumbar scoliosis malformations underwent operations from May 2004 to October 2007.The mean average age were 67 years (range,56~77 years).All the patients underwent more than three segments Smith-Peterson osteotomy and lumbar pedicle screw fixation to have the reconstruction of spinal coronal and sagittal plane balance.[Results]The mean duration of surgery were 200 mins(range,150~320 mins),and the average intraoperative blood loss were 1000 ml (range,600~2 000 ml).There were two cases of postoperative cerebrospinal fluid leakage,which were alleviated by pulling drainage tube and oppressing the wound.Postoperative pain and numbness in both lower extremities were aggravated in 2 cases,one of which was recovered completely 3 weeks later,and another 12 weeks later.The mean clinical follow-up were 36 months(range,24~60 months).JOA 29 score was recorded to evaluate the relief of the symptoms.The good-to-excellent rate was 88.2% and the poor rate was 0%.The coronal Cobb's angle was improved from the preoperative average of 23° (range,15°~ 40°) to the postoperative average of 12° (range,8°~ 20°).The sagittal Cobb's angle was improved from the preoperative average of 0 °(range,-15°~ 15°) to the postoperative average of 33°(range,25°~ 40°).[Conclusion]Smith-Peterson osteotomy is an effective method for the decompression of lumbar spinal stenosis,and is helpful to correct the sagittal deformity of the degenerative lumbar scoliosis.It also has relatively small interference to nerve in the operation.

目的探讨灌洗引流法治疗慢性骨髓炎时灌洗量及灌洗速度的调控。方法对22例慢性骨髓炎,采用病灶清除灌洗引流术进行治疗,统计其术后的灌洗量及灌洗速度。结果灌洗量及灌洗速度与其病灶所在部位、病变大小及术后的时间段均有关系。结论灌洗量及灌洗速度应能保证引流出的液体呈淡红色并且澄清。

Objective To investigate the clinical effects of forward flow sural nerve island flaps in reconstruction of soft tissue defect in front knee.Methods From January 2006 to April 2009,12 cases of soft tissue defect in front knee were being repaired by using forward flow sural nerve island flaps.Among the patients there were ten males and two females,all wounds with deeply exposed tissue.The area of the selected flaps varied from 8 cm×5 cm to 15 cm×10 cm,with the length of fascia ranging from 8 cm to 15 cm and the rotation degree more than 80°.The flaps were twisted through subcutaneously tunnel.Results The 12 cases in this group received follow-ups from three to eight months,averaging 12 months.All the 12 flaps survived.The sense of haphalgesia could be felt in the flaps.And there was an abnormal sensation in the lateral part of the heel and the lateral part of the foot,but it did not affect life and work.Conclusion The application of this kind of flap is a practical and satisfactory method to reconstruct soft tissue defect in front knee,with high survival rate of flaps,simple operation procedures,small tissue injury,and good flap texture and appearance.

腕舟骨骨折临床上较常见,尤以年轻人多见,治疗方法及内固定方式多种多样.2006年8月-2009年3月,我院采用加压螺钉及取自体桡骨远端松质骨植骨方法治疗腕舟骨陈旧性骨折14例,术后疗效满意。

随着骨质疏松的高龄患者逐渐增加,特别是髋部,轻微的外伤就可造成髋部粉碎性骨折.我科自2001～2003年采用人工股骨头置换术治疗高龄老年股骨粗隆间不稳定型粉碎性骨折10例,取得满意的效果,报告如下.

2000年9月～2003年3月对部分腰椎间盘突出症伴腰椎不稳选择性应用单枚腰椎间融合器加关节突螺钉固定行腰椎间融合术,就其中资料完整的23例报告如下.

股骨粗隆间骨折是比较常见的下肢骨折,目前提倡闭合或切开复位髁钢板、DHS或PFN等内固定治疗,治疗效果令人满意.有关骨折愈合取出内固定物后股骨颈螺钉孔的愈合情况及是否并发股骨颈骨折的报告甚少.我院自1996～2001年收治股骨粗隆间骨折169例,年龄22～97岁.无论骨折类型(Ⅰ-Ⅳ型)都行DHS内固定[1].已取出DHS111例,其中2例取DHS后因轻微外伤导致股骨颈头下型骨折[1].现介绍如下.

目的报道腰椎间盘突出症伴腰椎不稳疾病中应用椎间后路融合器植入融合椎体的临床结果,并对该手术的优点、并发症防治进行讨论.方法回顾分析26例应用椎间融合器植入融合椎体的临床资料.结果术后经24～36月随访,疗效优良率为89.5%,椎间融合率为89.5%,融合器术后脱落1例.结论腰椎间盘突出症伴腰椎不稳以椎间融合器后路植入,椎体融合率高,可防止术后腰椎不稳,从而保证临床效果.但要严格掌握手术适应症,对其并发症要有足够认识,并提出预防方法.

我院自1990年1月～1998年1月共收治股骨干骨折489例,行手术治疗后出现骨不连、骨延迟愈合25例(占5.1%),现分析如下: