目的 探讨骨水泥球泥复合植入联合椎体成形术治疗骨质疏松性椎体骨折的临床疗效.方法 回顾性分析自2018-01-2018-12采用骨水泥球泥复合植入联合椎体成形术治疗的68例骨质疏松性椎体骨折,比较术前、术后3d、术后1年的疼痛VAS评分、ODI指数.结果 68例均顺利完成手术并获得至少1年的随访.2例出现椎旁骨水泥渗漏,1例骨水泥突破终板,出现椎间隙骨水泥渗漏.未发生骨水泥椎管渗漏及肺栓塞等严重并发症.术后3d与术后1年疼痛VAS评分、ODI指数较术前明显降低,差异有统计学意义(P＜0.05).术后3 d椎体前柱高度恢复率10％～82％,平均29％;术后1年椎体前柱高度恢复率6％～80％,平均26％.结论 骨水泥球泥复合植入联合椎体成形术治疗骨质疏松性椎体骨折对降低骨水泥渗漏率,改善患者临床症状,恢复椎体高度具有显著的效果.

目的 构建一种富氧温控型骨组织工程材料并对其性能进行评价.方法 本实验制备出含5％和10％1-溴十七氟辛烷的温控型骨组织工程材料,检测2种材料的凝固时间、pH值、释氧曲线,并通过筛选较优1-溴十七氟辛烷浓度的材料,检测该材料的微观结构、毒性及生物相容性.结果 2种1-溴十七氟辛烷浓度的材料均可在37℃条件下凝固成胶,时间为4.5 min.2种材料的凝固时间和pH值比较差异无统计学意义(P＞0.05).2种材料浸提液中的氧分压均呈上升趋势,并在7 d时达到峰值,10 d内均可持续释放氧气,但1-溴十七氟辛烷浓度为10％的材料的释氧效能更高(P＜0.01).1-溴十七氟辛烷浓度为10％的温控型骨组织工程材料呈三维立体网状结构,孔隙率较高,且无细胞毒性,生物相容性良好,在体内可被完全降解.结论 1-溴十七氟辛烷浓度为10％的温控型骨组织工程材料具有良好的释氧性能、良好的生物相容性和可降解性,可作为改善移植后早期低氧环境的缓释骨移植替代物.

2019年12月,新型冠状病毒肺炎(C0VID-19)疫情在武汉市暴发,主要通过呼吸道和密切接触传播,具有传染性强、人群普遍易感染的特点,给医疗机构的诊疗工作带来巨大的挑战.军队医院不仅要完成卫勤保障任务,还要积极参与所在地区的抗击疫情工作.如何做好军地患者的救治工作,防止医务人员感染,严防C0VID-19通过交叉感染输入部队,同时在疫情特殊时期加强为兵服务,是每一所军队医院面临的重要课题.

目的 探讨埋入式负压封闭引流(vacuum sealing drainage,VSD)技术治疗肢体巨大脓肿的应用效果及注意事项.方法 对采用埋入式VSD技术(研究组)与传统切开引流技术(对照组)治疗肢体深部巨大脓肿进行对比分析,观察术后愈合时间、疼痛程度及复发率以评估治疗效果.结果 研究组愈合时间短于对照组.研究组术后3~8 d疼痛评分明显小于对照组,差异有统计学意义(P<0.05).结论 埋入式VSD技术比传统切开引流技术具备操作简单、皮肤及皮下软组织切开损伤小、脓腔创面愈合快、疗程短、术后治疗护理方便等优点.

Objective To investigate clinical effect of Kirschner wire fixation with tension band wiring in treatment of mallet finger with avulsion fracture.Methods Clinical data of 32 patients with mallet finger of avulsion fracture during underwent modified Kirschner wire fixation with tension band wiring July 2010 and July 2015 was retrospectively analyzed.Surgical effects and postoperative complications were observed.Results All wounds were primary healing.With follow-up for 3-12 months, (7.5 months of average time), avulsion fractures of distal phalanx base were good contraposition and synostosis.No finger deformity or postoperative infection was found.The fineness rate of hand function reached to 91%.Conclusion Kirschner wire fixation with tension band wiring in treatment of mallet finger with avulsion fracture can achieve satisfactory effect, effectively recover the integrity of muscle-tendon-bone system and extension and inflexion function of distal interphalangeal joint with simple operation and less spending.

骨质疏松性椎体压缩骨折( osteoporosis vertebral compression fracture, OVCF)是一种易发生于老年患者的临床疾病. 随着社会老龄化程度的逐步加快,其发病率逐渐升高. 相关研究报道, OVCF 在女性和男性的整体发病率分别为10. 7‰和5. 7‰,而在75~79岁女性和男性发病率分别上升至29 . 3‰和13. 6‰[1]. 传统的保守治疗方法包括卧床休息、理疗及镇痛治疗,但长期卧床易导致骨量进一步流失及肌肉废用性萎缩,还可能导致肺部感染、静脉血栓等一系列并发症. 因此,如无明显手术禁忌证,手术干预是治疗OVCF,减轻患者痛苦,加快临床康复的必要手段. 经皮椎体成形术( percutaneous vertebro-plasty, PVP)和经皮椎体后凸成形术( percutaneous kyphoplasty, PKP)是治疗 OVCF 较理想的治疗手段,均已在临床广泛应用. 但由于PVP和PKP均存在各自的优点和缺点,因此近些年来,有些学者在PVP手术操作的基础上,参照PKP球囊的原理,通过注入骨水泥颗粒使压缩的椎体复位,既可以避免PVP单纯依靠注入骨水泥产生椎体内高压的缺点,也可以达到恢复椎体高度的目的. 然而,无论椎体成形术的术式如何改进,由于骨质疏松性椎体骨折生物力学的研究起步较晚,对影响椎体成形术中椎体生物力学的相关因素尚缺乏全面深入的认识.

Objective To investigate clinical significance of procalcitonin( PCT) in diagnosis of infectious fever after implant surgery in the Department of Orthopedics. Methods From January 2013 to January 2014,a total of 56 patients in Department of Orthopedics had a fever after the implant operation,according to the diagnostic criteria,they were divided into non-infective fever group( n = 32) and infective fever group( n = 24) and were checked for C-reactive protein( CRP) and PCT on the fever day and the third day. All the results were analyzed,and then the authenticity of diagnosis of postoperative infective fever by CRP and PCT was evaluated. Results There were no significant differences of CRP levels on the fever day and on the third day between the two groups( P 0. 05),but PCT levels showed significant differences( P 0. 05). The sensitivity and specificity of serum PCT at the level of 0. 25 ng /L as critical value in the diagnosis of postoperative infective fever were higher than those of CRP on the fever day and the third day. Conclusion PCT has more clinical value than CRP in the differential diagnosis of fever after implant surgery in the Department of Orthopedics.