Objective:To investigate the effects of posterior internal fixation combined with transpedicular bone grafting in elderly patients with osteoporotic thoracolumbar fractures.Methods:Clinical data of 92 elderly patients with osteoporotic thoracolumbar fractures were retrospectively analyzed.According to the operation method, patients were divided into the control group(n=38)and the observation group(n=54). The control group received the conventional posterior approach and short-segment transpedicular fixation, and the observation group underwent transpedicular fusion in addition to the treatment the control group received.Surgery quality metrics, clinical effects and postoperative recovery were compared between the two groups.Results:The operation time and bleeding volume were higher in the observation group than in the control group( P<0.05). The bone fusion rate was higher and the failure rate of internal fixation was lower in the observation group than in the control group(96.3% vs.78.9%, 3.7% vs.15.8%, χ2=6.929 and 4.103, all P<0.05). The Japanese Orthopaedic Association score(JOA score)increased in both groups after operation( Ftime=47.628, P<0.05). The increase of the JOA score( Finteraction=4.477, P<0.05)and the overall JOA score( Fgroup=5.638, P<0.05)were greater in the observation group than in the control group.The Oswestry Disability Index(ODI)index in both groups decreased with time( Ftime=72.581, P<0.05). The decrease of the ODI index( Finteraction=7.421, P<0.05)and the overall ODI( Fgroup=9.276, P<0.05)were higher in the observation group than in the control group.The visual analogue scale(VAS)score in both groups decreased with time( Ftime=93.157, P<0.05). The decreases of the VAS score( Finteraction=9.473, P<0.05)and the overall VAS( Fgroup=13.272, P<0.05)score were greater in the observation group than in the control group.The Frankel nerve function grade was better in the observation group than in the control group 12 months after operation( z=2.123, P<0.05). Conclusions:Posterior internal fixation combined with transpedicular bone grafting can help improve nerve function, reduce postoperative pain, and has a high bone fusion rate and a low failure rate of internal fixation.
OBJECTIVE To explore the clinical effect of improved postural drainage of sputum on patients with pulmonary infections after cardiothoracic surgery.METHODS From Sep 2014 to Aug 2016,a total of 92 patients who had pulmonary infections after cardiothoracic surgery were enrolled in the study and randomly divided into the experimental group and the control group,with 46 cases in each group.The control group was treated with conventional therapy and conventional postural drainage,while the experimental group was given the conventional therapy and the improved postural drainage,and the curative effects were compared between the two groups of patients after the treatment for 2 weeks.RESULTS There was no significant difference in the partial pressure of arterial oxygen (PaO2),partial pressure of arterial carbon dioxide (PaCO2),positive rate of sputum culture,sputum volume or deoxidation time between the two groups of patients before the treatment.The PaO2,PaCO2,positive rate of sputum culture,sputum volume and deoxidation time were respectively (91.26±7.21)mmHg,(35.33±3.23)mmH g,8.7％,(212.3 ± 25.4)ml/d and (15.67 ±2.32)min/d in the experimental group after the treatment for 2 weeks(P ＜0.05).The time of use of antibiotics of the experimental group was (11.42 ± 1.21) days,significantly shorter than the control group (P＜0.05).The proportion of the patients with reduction of pulmonary infections focus was 95.65％ (44 cases) in the experimental group,significantly higher than that in the control group(P＜ 0.05).The cure rate of the experimental group was 58.7％,higher than 32.6％ of the control group;the effective rate of the experimental group was 87.0％,significantly higher than the control group(P＜0.05).CONCLUSION The improved postural drainage may facilitate the discharge of sputum of the patients with pulmonary infections after the cardiothoracic surgery,improve the pulmonary ventilation function and boost the curative effect,and it is worthy to be promoted in the hospital.
目的探讨评价肱骨近端锁定钢板(LPHP)在治疗肱骨近端严重粉碎骨折中的临床价值。方法经切开复位应用LPHP内固定治疗肱骨近端严重粉碎性骨折56例,其中Neer分型三部分骨折34例,四部分骨折22例。结果56例随访9～15个月,平均12.6个月,采用Neer评分优良率为91.07%。结论LPHP具有手术操作简单,固定牢固可靠,骨折愈合率高,术后并发症少等优点,是一种治疗肱骨近端严重粉碎性骨折的理想方法。
目的探讨加压交锁髓内钉治疗下肢长骨骨折的临床疗效。方法加压交锁髓内钉内固定治疗下肢长骨骨折95例。结果95例随访9~18个月,平均13.6个月,全部获骨性愈合,平均愈合时间为8.9个月,术后膝髋关节活动优良,未发现骨折不愈合,锁钉及髓内钉断裂等并发症。结论加压交锁髓内钉治疗下肢长骨骨折具有固定可靠,手术创伤小,骨折愈合好,并发症少等优点,是一种较好的治疗方法。
目的:探讨应用股骨近端髓内钉治疗不稳定性股骨转子间骨折的疗效。方法:应用股骨近端髓内钉治疗不稳定性股骨转子间骨折48例。结果:48例全部随访6~15个月,平均12个月,45例骨性愈合。对髋关节功能恢复情况采用Harris评分标准,优良率为93.75%。结论:股骨近端髓内钉治疗股骨转子间骨折具有生物力学固定、手术创伤小、固定可靠、抗旋转确实、并发症少等特点,是治疗股骨转子间骨折较理想的内固定材料。
目的探讨后路椎弓根钉内固定加椎间及后外侧植骨融合治疗腰椎滑脱症的临床疗效。方法采用后路手术,行椎管彻底减压,利用椎弓根钉复位内固定,取三面带皮质骨的髂骨行椎间及后外侧植骨融合治疗腰椎滑脱36例。结果复位满意率为91.7%,椎体间高度恢复正常,术后平均改善率(JOA评分)为85.3%,临床疗效优良率(Asher疗效评定)为94.4%,所有患者获骨性愈合,未见假关节形成及断钉等。结论椎弓根钉内固定加椎间及后外侧植骨融合术是治疗腰椎滑脱症的一种有效方法。
目的探讨交锁髓内钉内固定对肱骨干骨折的治疗效果。方法对76例肱骨干骨折采用顺行或逆行交锁髓内钉内固定术,并进行随访,观察治疗效果。结果76例病例经6~18个月,平均12个月的随访,依据Joher-Wruhs标准评定,优良率为100%。结论交锁髓内钉是固定肱骨干骨折较为理想的内固定材料。
胸腰段是脊柱活动度最大,骨折最好发生的部位.椎弓根螺钉内固定系统具有稳定性高,固定节段少,影响脊柱活动度小等优点[1].我院于1998年2月-2004年2月应用经后路椎弓根螺钉内固定治疗胸腰爆裂型骨折96例,经1～5年随访,取得了良好的效果.现报告如下:
随着交通业的日益发展,胫腓骨骨折的发生率有上升趋势,而骨折的不稳定程度亦高.我院自1998年10月-2004年10月应用有限内固定结合外固定支架治疗胫腓骨不稳定性骨折108例,取得了良好的治疗效果,现报告如下:
目的比较研究锁骨钩钢板与传统方法治疗锁骨远端骨折及肩锁关节脱位,评估锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位的临床效果。方法适用锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折24例,并与传统方法(克氏针张力带钢丝、钢丝环扎、钢板螺钉固定等)治疗28例进行分析,比较治疗效果及并发症。结果52例病例均得到12～24个月随访,平均15个月,按照Karlsson疗效评价标准,两组治疗优良率分别为100%及78.56%,表明锁骨钩钢板治疗效果明显优于传统治疗组。结论锁骨钩钢板治疗TossyⅢ型肩锁关节脱位和NeerⅡ型锁骨远端骨折具有固定牢固,不损伤关节面,并能早期功能锻炼、并发症少等优点,值得推广。
目的:研究和评价三根空心加压螺钉内固定治疗股骨颈骨折的使用价值.方法:通过对88例应用三根空心加压螺钉内固定治疗股骨颈骨折的疗效观察,评价其应用价值.结果:本组与传统的三刃钉及单一螺钉内固定相比较,其骨不连及股骨头坏死率均明显下降.结论:三根空心加压螺钉内固定治疗股骨颈骨折既有对骨折断端嵌插加压作用和对股骨头充分减压作用,避免了对骨折断端的进一步损伤,又具有较强的抗旋转能力,是一个较好的治疗方法.
