背景:有研究显示与传统的前开口注入器相比,侧开口注入器可改善椎体成形治疗中的骨水泥充盈模式,引导水泥流向内侧,降低渗漏风险,同时增加骨水泥注入量.目的:探讨采用侧开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体压缩性骨折及防止术中骨水泥渗漏的临床疗效.方法:选择2014年1月至2018年12月衡水市哈励逊国际和平医院收治的220例骨质疏松性椎体压缩性骨折患者,其中114例采用侧开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗,106例采用标准前开式注入器进行双侧椎弓根椎体成形骨水泥注射治疗,术后拍摄X射线和CT扫描评估骨水泥渗漏情况.术前和术后3d及6个月进行目测类比评分与椎体压缩率评估.研究获得衡水市哈励逊国际和平医院伦理委员会批准(20131214841X).结果 与结论:①220例患者均顺利完成手术,无任何早期并发症,疼痛均有所缓解,生活质量得到明显改善;②侧开式注入器组骨水泥注射量大于前开式注入器组(P＜0.05);③两组术后3d、6个月的目测类比评分均明显低于术前(P＜0.05),但两组组间比较差异无显著性意义(P＞0.05);④侧开式注入器组130个椎体中21个椎体发生骨水泥渗漏(渗漏率为16.15％),前开式注入器组120个椎体中36个椎体发生骨水泥渗漏(渗漏率为30％),侧开式注入器组骨水泥渗漏率低于前开式注入器组(P＜0.05);⑤两组术后3d、6个月的椎体压缩率较术前显著降低(P＜0.05),两组组间椎体压缩率比较差异无显著性意义(P＞0.05);⑥结果表明,采用侧开式或前开式注入器进行椎体成形骨水泥注射治疗骨质疏松性椎体骨折均可获得令人满意的临床疗效,但侧开式注入器可优化骨水泥注入模式,降低渗漏及渗入椎体周围血管的潜在风险,同时可通过调整骨水泥注入方向达到较为满意的骨水泥弥漫效果.

背景:已有一些研究分析了经皮球囊扩张椎体后凸成形后再骨折的高危因素,但对经皮球囊扩张椎体后凸成形后椎体再骨折的高危风险因素及干预措施尚存有争议.目的:分析经皮球囊扩张椎体后凸成形后椎体再骨折的风险因素,探讨针对性的风险因素干预在预防经皮球囊扩张椎体后凸成形后再骨折中的应用价值.方法:纳入骨质疏松性椎体压缩性骨折患者,2009年4月至2011年4月接受经皮球囊扩张椎体后凸成形治疗的60例作为A组,采用Logistic多因素分析经皮球囊扩张椎体后凸成形后再次椎体骨折的高危因素,并针对高危因素制定相应的干预措施;2013年5至2015年5月60例接受经皮球囊扩张椎体后凸成形治疗的患者,作为B组,接受针对性干预处理(对患椎邻近存在椎体真空裂隙征的椎体,予以预防性注入骨水泥;服用抗骨质疏松药物,并进行健康用药指导等),术后随访记录并比较两组椎体再骨折发生率等情况.结果与结论:①A组术后平均随访18个月,21例再次发生骨折,38例未发生骨折;B组10例患者再次出现椎体骨折,B组2年无事件生存时间显著长于A组(P=0.015);②Logistic多因素模型分析结果显示,术前骨密度T值、抗骨质疏松治疗依从性、糖皮质激素用药史、术中骨水泥渗漏及椎体裂隙征是影响经皮球囊扩张椎体后凸成形后再次骨折的独立因素(P<0.05);③经ROC分析显示,术前骨密度T值和抗骨质疏松依从性评分预测患者经皮球囊扩张椎体后凸成形后再次骨折的AUC分别为0.772和0.693(β=0.064,0.067,95％CI=0.646-0.898,0.562-0.823,P=0.001,0.014),最佳截断值分别为-3.74和4.53分,敏感度分别为0.795和0.81,特异度分别为0.762和0.59;④结果说明,经皮球囊扩张椎体后凸成形后重视术前骨密度、术后抗骨质疏松治疗依从性、糖皮质激素用药史等高危风险因素警示作用,给予针对性干预有助于降低术后再骨折发生率,改善预后.

目的 探究他莫西芬对骨肉瘤细胞增殖、凋亡、侵袭的影响及临床意义.方法 不同浓度他莫西芬干预骨肉瘤MG-63细胞(1、2、4、8、16μmol/L),MTT法检测细胞的增殖情况;流式细胞术和Transwell法检测他莫西芬(16μmol/L)处理的骨肉瘤MG-63细胞的凋亡率和侵袭能力;采用无血清培养基稀释MG-63细胞注射入SPF大鼠胫骨近端骨髓腔中,构建骨肉瘤大鼠模型,并予他莫西芬,观察肿瘤的体积;蛋白质印迹法(Western印迹)检测细胞中基质金属蛋白酶-9(MMP)-9、MMP-2蛋白的水平.结果 与对照组相比,他莫西芬可显著抑制细胞的增殖(P<0.05),且具有一定的浓度依赖性.他莫西芬处理的细胞凋亡率显著增加(P<0.05),侵袭能力显著下降(P<0.05).骨肉瘤大鼠模型经他莫西芬干预后,肿瘤体积显著低于模型组(P<0.05).他莫西芬可显著降低骨肉瘤细胞中MMP-9、MMP-2蛋白的水平(P<0.05).结论 他莫西芬可抑制骨肉瘤细胞的增殖,促进其凋亡,可能通过下调MMP-9、MMP-2蛋白的表达抑制细胞的侵袭能力.

目的 探讨生物型和骨水泥型人工全髋关节置换在高龄股骨转子间骨折的近期临床疗效.方法 将74例高龄股骨转子间骨折患者分为生物组和骨水泥组.生物组采用生物型假体人工关节置换,骨水泥组采用骨水泥型假体人工关节置换.比较两组手术时间、术中出血量、下床锻炼时间、住院时间、术后并发症,术前及术后1、6、12个月髋关节Harris评分.结果 生物组手术时间较骨水泥组短,差异有统计学意义(P＜0.05);两组术中出血量、下床锻炼时间、住院时间,以及切口感染、深静脉血栓、假体周围骨折发生率比较,差异均无统计学意义(P＞0.05);生物组心肺事件发生率低于骨水泥组,差异有统计学意义(P＜0.05).两组术前及术后1、6、12个月Harris评分比较,差异均无统计学意义(P＞0.05).结论 两种假体治疗高龄股骨转子间骨折的近期疗效相当,但生物型假体手术时间更短、出血量更少.

目的：探讨微创经皮钢板内固定（ MIPPO）技术联合锁定加压钢板（ LCP）治疗胫骨远端骨折的临床疗效。方法选取2011年7月至2013年7月该院收治的胫骨远端骨折患者93例，根据手术方式分为研究组（n＝45）和对照组（n＝48），研究组给予MIPPO技术联合 LCP治疗，对照组给予普通接骨板治疗，比较手术时间、术中出血量、临床愈合时间、骨折功能愈合情况以及并发症发生情况。结果两组手术时间比较无统计学意义（P＞0．05），研究组术中出血量显著少于对照组，临床愈合时间显著短于对照组（P＜0．05），骨折功能愈合优良率显著高于对照组（P＜0．05），并发症发生率显著低于对照组（P＜0．05）。结论 MIPPO技术联合LCP治疗胫骨远端骨折具有出血量少，临床愈合快，并发症少等优点。

[目的]提高对膝关节髌下脂肪垫内良性肿物早期诊断的认识,探讨关节镜下手术适应证的选择及疗效.[方法]回顾性收集2003 ～ 2013年经关节镜手术切除的髌下脂肪垫肿物患者23例.分析其发病特征、影像学表现及手术疗效.[结果]本组23例病例,平均就诊年龄34.48岁.男5例,女18例.均为单侧,左膝14例,右膝9例.4例患者有外伤史.术前病程平均持续时间27.13个月.膝前痛是最常见症状,最常见病理类型为局限性色素绒毛结节性滑膜炎.平均随访时间35.87个月,末次随访平均Lysholm评分由术前的73.17分提升至93.43分(P＜0.05).Lysholm评分分别与年龄、VAS评分、术前病程、Outerbridge分级呈负性线性相关(r=-0.670,P=0.000;r=-0.651,P=0.000;r=-0.723,P=0.000;r=-0.509,P=0.007).年龄分别与VAS评分、术前病程、Outerbridge分级呈显著正相关(r=-0.521,P=0.005;r =0.443,P=0.017;r=0.681,P=0.000).其中VAS与术前病程也呈正相关(r =0.353,P=0.049).[结论]膝关节髌下脂肪垫肿物比较少见,其症状与运动功能相关且缺乏特异性,容易被误诊漏诊.综合分析病变临床及影像学特点,对于提高诊断正确率具有重要意义.对于有症状的IFP良性肿物,经关节镜手术切除治疗可取得良好效果.此外,需要重视本病的临床早期诊断与早期治疗,防止病情进展.

BACKGROUND:Scholars have studied the three-dimensional finite element models of tibial plateau fractures with different fixation methods, but the research on three-dimensional finite element model of tibial plateau fracture fixation was not much. OBJECTIVE:To analyze the biomechanical characteristics of external fixator for tibial plateau fracture by using the three-dimensional finite element method. METHODS:The tibial plateau fracture models treated with locking plate fixation and external fixator were established. Three-dimensional finite element analysis was used to analyze the stress distribution and displacement of two kinds of models. RESULTS AND CONCLUSION:(1) The average displacement value and the maximum displacement value of tibial plateau fracture external fixator model group were smal er than that of tibial plateau fracture locking plate fixation model group, but no significant difference was found (P>0.05). (2) X axial displacement value and Y axial displacement value were smal er in the tibial plateau fracture external fixator model group than in the tibial plateau fracture locking plate fixation model group, but no significant difference was found (P>0.05). (3) The stress of tibial plateau fracture locking plate fixation model focused on the junction of the screw and bone tissue as wel as the junction of plates and screws. The maximum stress value of tibial plateau fracture locking plate fixation model (173 MPa) was greater than that of tibial plateau fracture external fixator model (86 MPa). The stress of tibial plateau fracture external fixator model was scattered. Obvious stress concentration did not occur. The stress at the junction of the clamp and the nail and the junction of the connecting rod and screw was higher than that at other regions, and was a weak link in the clinical mechanics. (4) Results showed that external fixation for tibial plateau fractures had better stability and fixing strength as compared with the internal fixation.

目的 评价采用微创经皮钢板置入(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术联合锁定加压接骨板(locking compression plate,LCP)、外固定架、切开复位普通钢板内固定3种手术方法对胫骨远端骨折的治疗效果.方法 将采用MIPPO技术联合LCP内固定的45例患者作为A组,采用外固定架固定的23例患者作为B组,切开复位普通钢板内固定的23例患者作为C组,比较3组关节功能、手术时间、术中出血量、骨折愈合时间及术后并发症情况.结果 A组关节功能、骨折愈合时间、并发症与B组比较,差异均有统计学意义(P＜0.05);A组疗效、手术时间、术中出血量、骨折愈合时间、并发症与C组比较,差异均有统计学意义(P＜0.05).结论 采用MIPPO技术联合LCP比外固定架以及切开复位普通钢板内固定在治疗胫骨远端骨折时更具有优势,是治疗胫骨远端骨折的理想方法.

目的 评价采用微创经皮钢板固定技术(MIPPO)结合锁定加压钢板(LCP)、超关节外固定架、切开复位普通钢板固定3种手术方法治疗胫骨干骺端骨折的疗效.方法 采用MIPPO技术结合LCP内固定的61例为A组,采用超关节外固定架外固定的23例为B组,切开复位普通钢板内固定的25例为C组,比较3组手术时间、术中出血量、骨折愈合时间、关节功能及术后并发症情况.结果 A组在骨折愈合时间、并发症发生率及踝关节功能方面优于B组,差异有统计学意义(P＜0.05)；A组在手术时间、术中出血量、骨折愈合时间、并发症发生率及踝关节功能方面优于C组,差异有统计学意义(P＜0.05).结论 LCP结合MIPPO技术内固定比超关节外固定架固定及切开复位普通钢板内固定治疗胫骨干骺端骨折更具有优势,是治疗胫骨干骺端骨折的理想方法.

目的探讨采用闭合复位弹性髓内钉固定治疗O'BrienⅢ型儿童桡骨颈骨折的临床疗效。方法采用闭合复位弹性髓内钉固定治疗23例O'BrienⅢ型桡骨颈骨折。结果 23例获随访平均1.5年。末次随访时肘关节活动范围与健侧比较,差异无统计学意义(P>0.05)。肘关节功能根据Metaizau标准评定:优21例,良2例。结论采用闭合复位弹性髓内钉固定治疗O'BrienⅢ型儿童桡骨颈骨折,具有微创、手术操作简便、固定牢固、可早期活动、并发症少等优点。

<正>肩锁关节脱位是一种常见疾患,在肩关节损伤中约占12%。而TossyⅢ型[1]损伤,由于喙锁韧带及肩锁韧带均完全撕裂,肩锁关节极不稳定,维持复位困难。我院2007年7月至2012年8月,采用肩锁钩板联合改良Dewer手术治疗90例TossyⅢ型肩锁关节脱位患者,并随访进行回顾性研究,探讨肩锁钩板联合动力修复肩锁关节脱位的临床疗效、术后并发症及预防措施。报告如下。

目的探讨采用微创经皮钢板固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)联合锁定加压钢板(locking compression plate,LCP)治疗胫骨干骺端骨折的效果。方法对82例胫骨干骺端骨折在跟骨牵引闭合复位后采用MIPPO技术联合LCP治疗,男55例,女27例;年龄19～78岁,平均35岁。AO分型胫骨远端骨折A1型13例,A2型9例,A3型14例;胫骨近端骨折A2型12例,A3型34例。结果 82例患者全部获得随访,随访时间6个月～4年,伤口均一期愈合,骨折全部愈合,愈合时间6～13个月。按胫骨干骨折治疗效果评价标准(Johner-Wruhs)评定,优43例,良29例,中10例。结论 MIPPO技术联合LCP是治疗胫骨干骺端骨折的理想方法。

Objective To evaluate the curative effect of application of closed reduction titanium elastic nails in the treatment of children's long bone shaft fracture.Methods A total of 134 cases of children with long bone shaft closed fracture treated with closed reduction titanium elastic nails in our hospital from July 2007 to June 2011 were selected.All the cases were recorded the surgical incision lengths,mean surgery time,fracture X-ray cure time,post-operation complication and the joint function.Results Postoperative incisions were all stage Ⅰ healing,with no incision infection.The average surgical incision length was 2.15 cm and the mean surgery time was 50 min.All 134 patients were followed up for 1-3 years,with an average of 1.5 years.There was no fracture redisplacement,nonunion or delayed union occurred.The average healing time was 7 weeks,then the internal fixation was removed after 6 months.Nail tail irritation and synovial sac formation happened in 2 patients,which disappeared after removal of implants.In the last follow-up,the injury limbs had overgrown 0.75 cm.Compared with contralateral,the function of two joints up and down the fracture sites had no significant difference.Compared with contralateral,5 cases forearm rotation was mild limited,with no angular deformity.Conclusion For completely displaced children's long bone shaft closed fracture,closed reduction titanium elastic nails has advantages of simple operation,minimal invasion,faster healing and better prognosis.It should be used as a preferred method for treatment.

目的探讨采用肩锁钩板联合动力修复肩锁关节脱位的临床疗效。方法对63例TossyⅢ型肩锁关节脱位行肩锁钩板内固定联合动力修复治疗。结果 63例获随访4~34个月,取出内固定后2例发生半脱位,无全脱位及肩锁关节炎发生。内固定取出前肩关节评分为(84.82±2.28)分,内固定取出后肩关节评分为(95.17±1.73)分,差异有统计学意义(P<0.05)。结论肩锁钩板联合动力修复肩锁关节脱位,固定牢固、远期效果确切,但肩锁钩板长期存留影响肩关节功能,取出后功能明显改善。

<正>2007年5月～2011年4月,笔者应用跟骨牵引闭合复位后,经皮锁定加压钢板(LCP)治疗36例A型胫骨远端骨折患者,取得良好效果。1材料与方法1.1病例资料本组36例,男25例,女11例,年龄19～68岁。均为闭合骨折。其中合并腓骨骨折17例。AO分型:A1型13例,A2型9例,A3型14例。伤后至手术时间4～13 d。

OBJECTIVE:To compare clinical effects of clavicular hook plate fixation, coracoid transplantation, and clavicular hook plate fixation combined with modified dynamic muscle transfer for the treatment of the complete acromioclavicular dislocation.METHODS:From January 2006 to November 2009, 65 patients with sustained complete acrominoclavicular dislocation were treated with clavicular hook plate fixation, coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer. All the patients were divided into three groups: 22 patients in group A were treated with clavicular hook plate fixation, including 17 males and 5 females, with an average age of (31.0 +/- 10.0) years; 21 patient in group B were treated with coracoid transplantation, including 16 males and 5 females,with an average age of (33.0 +/- 6.4) years; 22 patients in group C were treated with clavicular hook plate fixation combined with modified dynamic muscle transfer,including 18 males and 4 females, with an average age of (30.0 +/- 5.3) years. Postoperative functional recovery was evaluated by Karlsson criteria.RESULTS:All the patients were followed up, and the duration ranged from half to three years (averaged 1.5 years). In group A, 8 patients got half re-dislocation, 2 patients got complete re-dislocation and arthritis of acromioclavicular joint after internal fixations removal, 1 patient had clavicular hook plate broken after operation. In group B, 7 patients got half re-dislocation, 1 patient got complete re-dislocation,and 5 patients had arthritis of acromioclavicular joint with acute pain and limited shoulder function after internal fixations removal. In group C,2 patients got half re-dislocation, no complete re-dislocation and arthritis of acromioclavicular joint occurred after internal fixations removal. According to Karlsson evaluation, in group A, 12 patients obtained an excellent result, 8 good and 2 poor; in group B, the data were 9, 7 and 5 respectively; in group C, they were 20, 2 and 0 respectively. There were remarkable differences of therapeutic effects between the clavicular hook plate fixation combined with modified dynamic muscle transfer and that with either of the former two treatment methods (P < 0.05).CONCLUSION:Clavicular hook plate combined with modified dynamic muscle transfer is a reliable and good treatment for the complete acrominoclavicular dislocation, with advantages such as easy to handle,stable fixation and early exercise.

<正>2001年4月~2008年12月,我们采用手术切开复位双侧重建钛板内固定治疗肱骨髁间骨折20例,取得满意疗效。1材料与方法1.1病例资料本组20例,男9例,女11例,年龄18~73岁。按Aodmuller分型:C1型5例,C2型7例,C3型8例。开放性骨折2例,闭合性骨折18例。1例

<正>肱骨髁间骨折是青壮年严重的肘部损伤之一,非手术治疗往往不能得到满意的复位,关节功能预后较差。2001-04—2008-12,我们采用手术切开复位双侧重建钛板内固定治疗肱骨髁间骨折20例,结果如下。1资料与方法1.1一般资料20例均为本院骨一科住院患者,男9

Objective To explore the effect of proximal femoral locking plate or proximal femoral nail(PFN) in the treatment for senile intertrochanteric fracture.Methods 80 cases of older patients with intertrochanteric fracture were treated with operation,in which 41 cases treated with proximal femoral locking plate fixation,the other 39 cases with PFN fixation.Four correlated indexes about operation time,bleeding measure,and were compared and analyzed between the two groups.Results 80 cases were all followed up for 1~2 years.All the fractures healed in 3~5 months after operation with no pain and well recovering function of hip joint.There was no significant difference in operation time,blood loss,Harris score before operation and Harris score after operation between the two groups(P0.05).Conclusions It is necessary to choose suitable fixation according to the type of fracture and anatomic structure.Both proximal femoral locking plate and PFN have similar good clinical effects on senile intertrochanteric fracture of type Ⅰ～ Ⅲ according to Evans typing,but proximal femoral locking plate is more suitable for patients of type Ⅳ of Evans typing.

目的探讨股骨近端锁定钢板治疗老年骨质疏松型粗隆间骨折的临床效果。方法采用股骨近端锁定钢板对33例老年股骨粗隆间骨折进行手术固定治疗。平均随访时间16个月(8~20个月)。结果本组骨折均在20周内愈合。2例出现髋内翻。参照刘尚礼疗效评定标准,31例疗效优良,优良率93.9%。结论股骨近端锁定钢板治疗老年股骨粗隆间骨折,具有创伤小、手术操作简便、固定可靠等优点,尤其适合骨质疏松患者,是目前较理想的固定方法。