目的:探讨BARTON骨折切开复位内固定的临床疗效.方法:收治Barton骨折患者40例.所有患者均予以切开复位内固定治疗.结果:治疗后,功能评估优良率95%,患者对治疗效果满意度(90.22±3.11)分;治疗后没有患者发生并发症的情况.结论:对不稳定性桡骨远端骨折患者予以切开复位内固定治疗,其临床效果显著,不会产生并发症,且患者较易接受.

Objective To explore the association among bone iron content,serum ferritin(SF) and bone mineral density in patients with thoracolumbar fractures.Methods A retrospective analysis was conducted in 243 patients with thoracotumbar fracture who were undergone percutaneous kyphoplasty from January 2008 to December 2014.Mean age of the patients(91 males and 152 females)was 62.5 years(range:50-81 years).The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density(BMD).Blood samples were collected to determine iron metabolism and bone turnover biomarkers after overnight fasting.Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after percutaneous kyphoplasty.Results There was no significant statistical significance between osteopenia group and osteoporosis group in gender,age,height, and weight(P>0.05).Pearson correlation analysis showed that the age,bone iron content,SF,serum procollagen type 1 N-terminal propeptide, and β-carboxy terminal telopeptide of collagen type 1 were negatively correlated with BMD at femoral neck (r=-0.712,-0.348、-0.323,-0.236,-0.227;all P<0.05) and lumbar spine (r=-0.541,-0.206,-0.213,-0.184,-0.191;all P<0.05);the weight,body mass index,transferrin, and total iron binding capacity were positively correlated with BMD at femoral neck and lumbar spine (P<0.05).Bone iron content combined with SF could be put into the regression models of BMD at femoral neck and lumbar spine(femoral neck R2=0.388,L1-4 R2=0.374).Both bone iron content and SF were negatively correlated with BMD at lumbar spine (P<0.05).Conclusion The higher the values of bone iron and serum iron protein content in osteoporotic vertebral fracture patients,the higher the degree in osteoporosisis.Iron accumulation and osteoporosis is significantly correlated.

目的 探讨不同剂量罗哌卡因联合利多卡因腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响.方法 选取老年骨科患者86例,采用随机数字表法分为两组,43例患者实施0.50%罗哌卡因(剂量10 mg)+1%利多卡因(2 ml)腰硬联合麻醉为对照组,43例患者实施0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉为观察组,比较两组不同时点细胞免疫功能及血流动力学指标的改变情况、感觉阻滞效果、运动阻滞效果和不良反应情况.结果 两组CD3+、CD4+、CD4+/CD8+、自然杀伤(NK)细胞数量在T1时显著降低,在 T3时降至最低点,在T4时明显升高.观察组CD3+、CD4+、CD4+/CD8+、NK细胞数量在T1、T2、T3、T4时均明显高于对照组.两组心率、平均动脉压在Ta时显著降低,在Tc时降至最低点,在Td时恢复正常.两组中心静脉压在Ta时显著升高,在Tc时升至最高点,在Td时恢复正常.观察组心率、平均动脉压在Ta、Tb、Tc时均明显高于对照组,中心静脉压在Ta、Tb、Tc时均明显低于对照组.观察组感觉阻滞起效时间、最高平面出现时间、运动阻滞起效时间均明显早于对照组,观察组最高平面维持时间、运动阻滞维持时间均明显长于对照组,观察组改良Bromage评分明显高于对照组,观察组不良反应发生率明显低于对照组(P<0.05).结论 0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响较小,麻醉起效快且维持时间长,不良反应少且安全性高.

目的 比较股骨近端髓内钉(PFNA)和动力髋螺钉(DHS)治疗老年股骨粗隆间骨折的疗效差别.方法 回顾性分析2012年9月-2014年7月在苏州市第七人民医院手术并获得随访的85例老年股骨粗隆间骨折患者,根据手术方式不同,将患者分为PFNA组45例,DHS组40例.比较两种术式的手术时间、手术中出血量、手术后引流量、手术后下地时间、骨折愈合时间、手术后并发症及髋关节Harris评分等指标.结果 所有患者均获得随访,随访7～14个月,平均8个月.PFNA组在手术时间、术中出血量、术后伤口引流、术后下地负重时间上优于DHS组(P＜0.05);术后患者均获随访,两组骨折愈合时间、早晚期并发症发生率、髋关节Harris评分比较差异无统计学意义(P＞0.05).结论 PFNA治疗老年股骨粗隆间骨折的疗效优于DHS,对高龄股骨粗隆间骨折应首选PFNA治疗.

Objective To investigate the effect of percutaneous vertebroplasty and kyphoplasty (PKP) on bone density and serum leptin in patients with osteoporotic thoracolumbar compression fractures. Methods One hundred and two patients with osteoporotic thoracolumbar vertebral compression fractures and 100 cases of healthy control were treated with PKP surgery. The serum leptin and adiponectin, and the bone mineral density of the lumbar spine were determined. Results patients Levels of the serum leptin and adiponectin in patients with osteoporotic thoracolumbar vertebral compression fracture were significantly higher than those with non osteoporotic fracture patients (P < 0.05). One month post-PVP, the levels of serum leptin and adiponectin in the two groups were significantly decreased (P < 0.05). postoperative group of The lumbar bone density at 1 month post-operation was is significantly higher than that before operation in each group (P < 0.05, respectively), with no significant difference between the two groups. The levels of serum leptin and adiponectin were negatively correlated with the bone mineral density (BMD) (P < 0.05). Conclusions tLevels of serum adiponectin and&nbsp;leptin were both increased in osteoporotic or non bone osteoporosis thoracolumbar vertebral compressor fractures. The percutaneous vertebroplasty forming operation could effectively reduce the serum level of leptin and adiponectin, and improve the bone mineral density of the lumbar vertebrae.

目的 探讨两种不同方法(椎弓根内固定和椎体成形术)在治疗老年胸腰椎压缩性骨折患者方面的临床疗效.方法 病例来源于2010-10-2014-7我院骨科收治确诊的146例老年胸腰椎压缩性骨折患者,依据随机数字表法将两组患者均分成观察组和对照组各73例,其中给予观察组椎体成形术治疗,对照组给予椎弓根内固定手术治疗,比较两组患者的手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分等指标.结果 观察组手术前后VAS评分、骨折椎体压缩率和ODI指数评分分别与对照组比较,差异无统计学意义(P＞0.05);两组病患术后1周VAS评分、骨折椎体压缩率和ODI指数评分分别与本组术前比较,差异有统计学意义(P＜0.01).观察组术中出血量、手术时间、住院时间均明显优于对照组,差异有统计学意义(P＜0.01).结论 椎体成形术治疗老年胸腰椎压缩性骨折可迅速缓解疼痛、减少病患手术损伤,促进病患健康恢复,安全可靠.

Objective:To investigate the development of the prognosis of patients with deep venous thrombosis after closed fracture of lower limb and the change of the blood clot elastic diagram.Methods:Lower limb closed fractures 68 cases during January 2014 to December 2015 in our hospital were selected randomly.And they were treated by open reduction and internal fixation and con-firmed to be in hypercoagulable state,including 21 cases of female,47 male,aged 20 ~70,mean age (51.42 ±6.06).They were randomly divided into treatment group and control group,34 cases in each group,two groups were given conventional open reduction and internal fixation and orthopaedic basic treatment,while the control group was treated with 1 000u low molecular hep-arin and antiplatelet activity drug treatment,the treatment group were given oral Tongmai Decoction.Plasma prothrombin time (PT),activated partial prothrombin time (APTT),platelet count and thrombelastograph (TEG)were measured before the treat-ment and after 7th days and 14th days′treatment respectively.Results:After the intervention,the 7 d and 14 d PT,APTT and TEG were improved significantly in both two groups(P <0.05),no significant differences were found between the two groups (P>0.05).Conclusion:Tongmai Decoction can effectively improve the blood coagulation state,which is an effective treatment of deep venous thrombosis.

目的:探究撬拔复位和切开复位内固定治疗SandersⅡ型跟骨骨折的疗效差异.方法:选取2012年1月～2013年2月骨科收治的68例SandersⅡ型跟骨骨折患者为研究对象,随机分为撬拔组和切开组,每组34例,分别采用撬拔复位内固定和切开复位内固定方法进行治疗,并成功随访1年.比较两组患者手术时间、住院时间、切口愈合时间及术中出血量,随访1年后采用Maryland足功能评分系统评价两组患者功能恢复情况并统计相关并发症发生情况.结果:撬拔组手术时间、住院时间、切开愈合时间及术中出血量明显少于切开组(P＜0.05);随访1年撬拔组和切开组足功能恢复优良率分别为79.41％和82.35％,两组比较差异无统计学意义(P＞0.05);撬拔组和切开组并发症发生率分别为2.94％和17.65％,两组比较差异有统计学意义(P＜0.05).结论:撬拔复位内固定术治疗SandersⅡ型跟骨骨折具有创伤小、术中出血量少等特点,利于切口愈合,能明显缩短手术和住院时间,减少并发症发生.

目的：探讨椎弓根钉固定疗法对胸腰椎骨折经椎弓根植骨椎体成形的治疗效果。方法选取60例胸腰椎骨折患者为研究对象，通过影像学检查、病例分析回顾，比较治疗前后的椎体高度变化、活动度、临床治疗结果以及Cobb角恢复程度，并对患者进行随访。结果胸腰椎骨折患者采用椎弓根钉固定疗法，提高了Cobb角的恢复程度，椎体高度改善，临床症状缓解。本组60例胸腰椎骨折患者采用椎弓根钉固定疗法后，疗效评价优良率达86．7％。结论采用椎弓根钉固定治疗胸腰椎骨折，治疗效果好，能缓解患者痛苦，有推广应用价值。

目的：对老年股骨粗隆间骨折患者应用股骨近端髓内钉固定的临床效果进行分析。方法选取2011年3月至2013年3月我院收治的60例股骨粗隆间骨折患者，随机的将所有患者分成观察组与对照组，两组均有30例患者，观察组患者采取股骨近端髓内钉固定进行治疗，对照组患者采取动力髋螺钉进行治疗，将两组患者的并发症、出血量、功能恢复情况等进行对比。结果在住院时间、手术时间、出血量、并发症以及患者的功能恢复方面，将两组进行对比，P＜0.05，其差异具有统计学意义。结论对于老年股骨粗隆间骨折患者来说，采取股骨近端髓内钉固定的方式，临床治疗效果比较理想，具有较高的安全性。

Objective To compare clinical results between locking compression plate (LCP) and anatomical plate (ACP) internal fixation in the treatment of proximal humeral fracture, and to explore the appropriate internal fixation methods for the fracture. Methods From January 2007 to January 2013, 63 patients with proximal humeral fracture were treated by LCP or ACP fixation in the Seventh People's Hospital of Suzhou, among them 26 patients underwent LCP fixation (LCP group), while 37 patients underwent ACP fixation (ACP group). Postoperative complications were observed, and clinical effects were evaluated by Neer scoring standard. Results In LCP group, 25 patients were followed up for an averge of 16 months (6-36 months); In ACP group, 29 patients were followed up for an averge of 26 months (7-48 months). According to Neer scoring criteria,&nbsp;good-excellent rate in LCP group was better than that in ACP group, but there had no statistical differences between two groups (96% vs 90%, P >0.05). During the follow-up, there were humeral head necrosis and absorption in 1 case and screw loosening and partly pull-out in 2 cases in ACP group. No poseoperative complications such as screw breakage, refracture, displacement, bone nonunion, radial or axillary nerve injury had been obseved in 2 groups. Conclusion Both LCP and ACP fixation are effective for patients with proximal humeral fracture, but LCP treatment in this study shows less postoperative complications and obtain more safe and reliable effects.

目的 观察可注射性硫酸钙在兔椎体松质骨中的成骨降解性能.方法 18只成年新西兰兔随机分为A、B两组,每组9只.其中A组向兔椎体松质骨注入硫酸钙骨水泥(calcium sulfate cement,CSC);B组作为空白对照组不植入材料.在不同时间点(2,6和12周)采用大体观察、X片影像学、组织学等方法观察和评估CSC植入后在椎体松质骨内的成骨和降解情况.结果 术后兔进食,活动正常,标本周围软组织无炎症反应.CSC在植入2周见少量新生骨,6周植入物部分吸收,见大量新生骨,12周植入物全部吸收,并有编织骨形成,成骨量明显高于对照组(P＜0.05).结论 可注射性硫酸钙有良好的生物相容性,植入椎体后成骨作用明显,新生骨与植入材料的吸收降解同步,是一种良好的骨移植材料.

目的探讨四肢骨折脱位合并周围血管损伤的早期诊治。方法应用显微技术,及时修复血管,重建血运,保存肢体。结果本组37例患者无死亡,疗效较佳。患肢功能评定采用Johner-Wruhs评分法:优8例,良24例,可4例,差1例,优良率为86.49%。结论四肢骨折脱位合并血管损伤早期正确诊断及治疗意义重大。