ObjectiveThis study aims to assess the early clinical outcomes of bipolar hemiarthroplasty for treating femoral neck fractures in elderly patients aged 75 and above using the Orthopädische Chirurgie München (OCM) approach.MethodsA retrospective analysis was conducted on a cohort of 95 elderly patients who underwent bipolar hemiarthroplasty for Garden Type III and IV femoral neck fractures between January 2020 and December 2022. The participants were categorized into two groups according to the surgical approach used: the OCM approach and the posterior-lateral approach (PLA). The average follow-up duration was 11.20 ± 2.80 months for the OCM group and 11.12 ± 2.95 months for the PLA group, with both groups ranging from 6 to 18 months. Clinical outcomes assessed included surgical duration, incision length, postoperative hospital stay, time to ambulation, hemoglobin levels, serum creatine kinase (CK) levels, C-reactive protein (CRP) levels, pain (assessed using the Visual Analogue Scale, VAS), and functional recovery (evaluated through Harris hip scores). Additionally, complications such as intraoperative and postoperative fractures, deep vein thrombosis, wound infection, nerve injury, postoperative dislocation, leg length discrepancy, and Trendelenburg gait were monitored.ResultsThere was no significant difference in the surgical duration between the OCM and PLA groups. However, the OCM group exhibited shorter incision lengths, reduced postoperative hospital stays, and earlier ambulation times compared to the PLA group. Significantly lower intraoperative blood loss, smaller decreases in hemoglobin levels on postoperative days 1 and 3, lesser hidden blood loss, and decreased levels of CK and CRP were observed in the OCM group. Pain levels, measured by VAS scores, were lower, and Harris hip scores, indicating functional recovery, were higher at 2 and 6 weeks postoperatively in the OCM group than in the PLA group. The incidence of complications, such as periprosthetic fractures, intramuscular venous thrombosis, hip dislocations, Trendelenburg gait, and leg length discrepancies, showed no significant differences between the groups.ConclusionThe OCM approach for bipolar hemiarthroplasty in patients aged 75 and above with femoral neck fractures offers significant early clinical benefits over the traditional PLA, including faster recovery, reduced postoperative pain, and enhanced early functional recovery.

目的 探讨前外侧切口结合距骨定位治疗胫骨远端粉碎性骨折的疗效.方法 采用前外侧切口结合距骨定位治疗20例胫骨远端粉碎性骨折患者.观察骨折复位情况、骨折愈合时间、踝关节活动度、AOFAS踝-后足功能评分.结果 患者均获得随访,时间8～13个月.骨折解剖复位15例,功能复位4例,复位丢失1例.骨折愈合时间3～5个月.末次随访时,踝关节活动度:背伸5° ～20°,跖屈20° ～45°,均无跟腱挛缩表现;AOFAS踝-后足功能评分69～98分,其中优12例,良6例,可2例,优良率18/20.结论 采用前外侧切口结合距骨定位治疗胫骨远端粉碎性骨折具有显露充分、软组织损伤小、复位固定确切、并发症少等优点,有利于患者踝与后足功能恢复.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

腹部创伤是外科常见的问题,近年来,各种道路交通伤、高处坠落伤、自然灾害伤等日益增多,腹部创伤的就诊率显著提高,并且多为复合伤、多发伤,伤情复杂、病情危急.随着医疗水平的进步,许多新观念、新技术应用于腹部创伤的诊断和治疗.损害控制手术和损害控制复苏理念在腹部创伤的治疗中发挥了重要作用.对于失血性休克患者,优先使用创伤重点超声评估,尽早输注血液和血液制品,并尽快手术;对于血流动力学稳定患者,CT可以明确损伤部位、确定损伤严重程度并有助于决定治疗方案.腹腔镜探查及手术具有安全性高、创伤小、恢复快、并发症低的优点,避免了不必要的开腹手术.介入治疗可应用于腹部实质器官的血管损伤,可以作为确定性手术的临时辅助手段.

目的 观察超声术前辅助定位在多发伤伴肋骨骨折患者治疗中的应用效果.方法 选择多发伤伴肋骨骨折患者62例,均行肋骨骨折切开复位内固定手术治疗,其中30例(A组)采用肋骨正斜位X线片+胸部肋骨CT三维重建进行术前定位、32例(B组)在A组基础上术前行彩色多普勒超声辅助定位.结果 A组共手术固定骨折肋骨103根,准确定位69根,定位准确率67％,单根肋骨手术切口长度(3.7±1.0)cm、手术暴露时间(6.8±1.4)min.B组手术固定骨折肋骨141根,准确定位129根,定位准确率91％,单根肋骨手术切口长度(2.4±0.5)cm、暴露时间(4.2±0.9)min.两组定位准确率及单根肋骨手术切口长度、暴露时间比较,差异均有统计学意义(P均<0.05).结论 多发伤伴肋骨骨折患者术前超声辅助骨折断端定位,可提高骨折断端定位准确率,从而缩短手术切口的长度及手术时间,减轻患者手术创伤.

目的 探讨人工股骨头置换术和全髋关节置换术治疗老年股骨颈骨折患者的临床效果与预后情况.方法 纳入该院2015年1月—2018年12月收治的210例股骨颈骨折老年患者为对象,用随机数字表法把210例患者分成对照组和观察组各105例.采用人工股骨头置换术治疗对照组患者,采用全髋关节置换术治疗观察组患者,比较两组患者的临床治疗优良率,调查两组患者治疗前和随访3个月的生活质量.结果 观察组患者的临床治疗优良率97.14％比对照组88.57％高,差异有统计学意义(P<0.05);出院时-随访3个月观察组患者的生活质量评分均比对照组高,差异有统计学意义(P<0.05).结论 老年股骨颈骨折患者采用全髋关节置换术治疗的优良率比人工股骨头置换术高,术后患者生活质量改善显著.

目的 构建成人钝性脾损伤患者手术干预的列线图(nomogram)模型.方法 回顾分析2014年1月—2018年12月南通大学附属医院急诊外科收治的257例成人钝性脾损伤患者,其中男性180例,女性77例;年龄17～103岁,平均49.96岁.根据最终是否剖腹手术分为手术治疗组和非手术治疗组,采用单因素分析和多因素Logistic回归法分析影响手术干预的独立危险因素,根据独立危险因素建立预测成人钝性脾损伤患者手术干预的列线图模型,计算可决系数R2、一致性指数、ROC曲线下面积,检测列线图模型的拟合优度和预测准确度.计算约登指数(Youden index),确定最佳界值.结果 多因素Logistic回归分析发现,脾损伤分级AAST(OR:224.92)、腹腔积血≥1000mL(OR:93.59)、输RBC≥4U(OR:5.52)是成人钝性脾损伤患者手术干预的独立危险因素,应用R软件绘制获得预测模型列线图,用Bootstrap法进行模型内部验证,显示其R2为0.668(调整R20.667),一致性指数为0.843(95％CI 0.814～0.872),AUC为0.963(95％CI 0.937～0.989).最大约登指数为0.883,其对应的最佳界值为0.631.结论 脾损伤分级AAST(OR:224.92)、腹腔积血≥1000mL(OR:93.59)、输RBC≥4U(OR:5.52)是成人钝性脾损伤患者手术干预的独立危险因素,该模型对成人钝性脾损伤患者的临床诊疗决策具有一定指导意义.

目的 分析股骨颈隐匿性骨折临床特点和诊疗经验.方法 回顾性分析30例股骨颈隐匿性骨折患者的临床资料.结果 30例患者中,24例伤后当日确诊,4例伤后3周内确诊,2例伤后6个月内确诊.非手术治疗8例中,6例骨折愈合,2例复查发现有骨折移位.1例行中空螺钉固定,1例行全髋关节置换术.22例行闭合复位中空螺钉固定患者的股骨颈均骨折愈合;其中,4例出现骨折断端部分短缩,中空螺钉部分退钉,无螺钉穿出股骨头进入关节腔;术后随访2年,2例发生股骨头坏死伴有部分塌陷,行全髋关节置换术后功能恢复.结论 建议股骨颈可疑骨折患者早期行CT、MRI检查,明确诊断后予以中空螺钉固定治疗;对因不配合检查而未能明确诊断的患者,建议采取制动措施,避免负重活动,并定期复查,注意避免骨折移位.

目的:探讨经腹直肌外侧入路治疗多发伤伴骨盆髋臼骨折的临床疗效.方法:回顾性分析2015年2月-2017年9月采用经腹直肌外侧入路治疗的19例多发伤伴骨盆髋臼骨折患者的临床资料.手术方式前路采用经腹直肌外侧入路,后路采用Kocher-Langenbeck入路.记录患者手术时间、术中出血量等;随访根据患者病情选择头胸腹部CT及骨盆平片.结果:本组19例患者均顺利完成手术,单纯前路13例,前后入路同时6例.手术平均时间152 min.术中出血量510～2 100 mL,平均820 mL.术后按照Matta影像学评估标准评定髋臼骨折复位情况:解剖复位9例,满意复位7例,不满意复位3例.19例患者术后进行了13～19个月随访(平均15个月).所有患者骨折均获得良好愈合,愈合时间13～29周,平均16周.术后6个月采用改良的Merled'Aubigne和Postel评分系统评定患侧髋关节功能,优7例,良8例,可3例,差1例.无发生内固定松动、断裂或者失效.所有患者随访未见术区继发疝气.结论:经腹直肌外侧入路手术切口及损伤相对较小,疗效好,并发症少,是用于治疗多发伤伴骨盆髋臼骨折的良好选择.

目的 对比OCM入路微创小切口全髋关节置换术与常规前外侧入路全髋关节置换术围手术期的显性失血量,并探讨原因.方法 选择2015年1月-2016年3月人工全髋关节置换术患者40例,年龄62～85岁.分为OCM入路组(20例)、常规前外侧入路组(20例),两组均为首次单侧关节置换.统计两组的术中、术后显性失血量并进行比较.结果 OCM入路与常规前外侧切口入路全髋关节置换术术中出血量分别为(545.0±67.9)mL和(625.0±82.3)mL,两组间差异有统计学意义(t=4.3,P<0.05);术后引流量分别为(296.0±93.9)mL和(399.0±162.7)mL,两组间差异有统计学意义(t=3.4,P<0.05),术中、 术后显性失血量比较均有统计学意义.结论 与常规前外侧入路全髋关节置换术相比较,采用OCM微创小切口手术入路THA可明显降低术中、术后显性失血量.

2015 年1 月~2016 年1 月,我科采用跗骨窦切口钢板螺钉治疗10 例SandersⅡ、Ⅲ型跟骨骨折患者,取得良好疗效,报道如下. 1 材料与方法 1.1 病例资料 本组10 例,男7 例,女3 例,年龄18~67 岁.左足4 例,右足6 例.SandersⅡ型6 例,Ⅲ型4 例.受伤至手术时间4~7 d.

目的：探讨胫腓骨骨折切开复位内固定术后所并发的拇趾及其他四趾屈曲畸形的病因及治疗方法。方法2001-2015年胫腓骨骨折术后并发拇趾及其他四趾屈曲畸形11例，5例单纯拇趾屈曲畸形患者，2例行拇长屈肌腱粘连松解术，2例行拇长屈肌腱切断术，1例行拇长屈肌腱延长术。其余6例多趾屈曲畸形患者，2例行拇长屈肌腱延长术，4例行拇长屈肌腱+趾长屈肌腱延长术。结果术后随访6~23个月，畸形均有不同程度的矫正，疼痛缓解，步态及着鞋有改善，但屈拇趾力弱影响奔跑，除此外患者未诉有其他失能表现。结论非典型的单个后深间室的骨筋膜室综合征，临床中很难早期诊断，小腿后方的进行性剧烈疼痛可能是较有价值的线索。出现骨筋膜室高压尽早行减压术，可以减少肌肉缺血性挛缩导致勒马缰畸形的发生。

目的 对比撬拨和切开复位后植入物内固定治疗SandersⅡ型跟骨骨折的疗效.方法 选取2014年2月-2016年2月收治的80例SandersⅡ型跟骨骨折患者为研究对象,采用随机数字表法分为两组,给予对照组患者切开复位后植入物内固定术治疗,给予观察组患者撬拨复位治疗,对比两组临床疗效.结果 观察组患者的优良率为87.5%,对照组为85%,差异无统计学意义(P>0.05);观察组手术出血量少于对照组,复位操作时间、住院时间短于对照组,差异有统计学意义(P<0.05).结论 撬拨和切开复位后植入物内固定均能够有效治疗SandersⅡ型跟骨骨折,但撬拨复位内固定术的手术效率更高,值得广泛推广.

Objective To investigate the clinical effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) and open reduction and internal fixation (ORIF) in the treatment of tibial fractures in middle and distal segment. Method From July 2012 to December 2014, 53 cases used MIPPO and ORIF technology for the treatment of distal tibia fracture in our hospital, 20 cases were treated with MIPPO (MIPPO group), 33 cases were treated with ORIF (ORIF group), operation time, length of incision, amount of bleeding, length of stay, healing time of fracture, Johner-Wruh score and postoperative complications between the two groups were observed. Result All patients were followed-up 11 ~ 30 months, amount of bleeding of MIPPO group was less than ORIF group (P < 0.01), length of incision of MIPPO group was smaller than ORIF group (P < 0.01), operation time, ength of stay and healing time of fracture of MIPPO group were shorter than ORIF group (P < 0.01). There were no significant differences in Johner-Wruh score and postoperative complications between the two groups (P > 0.05). Conclusion MIPPO and ORIF in the treatment of tibial fractures are satisfactory, but MIPPO is more simple, less trauma and conducive to fracture healing.

目的:探究骨科损伤控制在不稳定骨盆骨折合并四肢多发骨折治疗中的应用效果评价.方法:选取2013年6月至2015年6月间在我院进行诊治86例不稳定骨盆骨折合并四肢多发骨折的患者,按照随机数字表法将其分为实验组和对照组,对照组患者给予综合常规治疗,实验组患者在综合常规治疗的基础上加骨科损伤控制治疗,比较两组患者的治疗效果.结果:实验组患者的优良率、骨性愈合率、生活自理率及不良反应发生率分别为95.2%、95.2%、100.0%、0%,对照组患者的优良率、骨性愈合率、生活自理率及不良反应发生率分别为81.3%、81.3%、86.0%、14.0%,实验组患者的优良率、骨性愈合率、生活自理率均显著高于对照组患者,且不良反应发生率低于对照组患者,差异具有统计学意义(P<0.05).结论:不稳定骨盆骨折合并四肢多发骨折在治疗过程中应用骨科损伤控制,可以显著提高患者的临床治疗优良率、骨性愈合率及生活自理率,并降低不良反应发生率,值得临床进一步推广应用.

Objective To study the clinical effect of the application of intra medullary nail and plate in proximal tibia oblique fracture. Methods The application of intra medullary nail and plate in proximal tibia oblique fracture in 8 cases. Results All the patients were followed up for 12~18 months, all had the bone healing, postoperative deformity were less than 5 degrees, no incision infection and the failure of internal fixation. Conclusion The application of intra medullary nail and plate in proximal tibia oblique fracture has the advantages of simple operation, stable fixation, is applicable to the proximal tibial oblique fracture.

Objective To explore the causes and risk factors of non-operative management ( NOM) fail-ure in adults with blunt splenic injury.Methods A total of 110 adults cases admitted from Nov.2011 to Mar.2014 with blunt splenic injury ( BSI) were reviewed retrospectively,among whom 58 patients received NOM initially.A-mong these patients,36 were male and 22 were female.The average age was (43.4 ±15.1) years(17-89 years). The patients were then divided into success group and failure group based on whether they were performed laparoto-my.Univariate and multivariate logistic analyses were performed to investigate correlative factors affecting the out-come of NOM in adults with BSI and to identify independent risk factors of NOM failure.Results The rate of NOM was 52.7%(58/110).The rate of NOM failure was 24.14%(14/58) and no death occurred.The main causes of failure were active bleeding,early rebleeding and incorrect classification of splenic injuries in the early stage and de-layed subcapsular hematoma in the late stage.Univariate analysis revealed that factors associated with NOM failure in patients with BSI were shock index, degree of hemoperitoneum, grade of splenic injury, injury severity score ( ISS) ,new injury severity score( NISS) ,amount of transfused RBCs as well as hospitalization period( length of hos-pital stay),(P<0.05).Multivariate logistic regression analysis showed that the presence of moderate or large hae-moperitoneum,higher-grade splenic injury(AAST grade 3-5)and transfusion of more than 4U of RBCs were inde-pendent predictors of NOM failure.Conclusion Moderate or large haemoperitoneum,higher-grade splenic injury and transfusion of more than 4U of RBCs are high risk factors for NOM failure in adults with blunt splenic injury.

目的 探讨股骨干骨折术后钢板断裂及骨折内固定失败的原因.方法 收集我院2007年1月-2012年6月收治的8例股骨干骨折术后钢板断裂患者的资料,对其断裂原因进行回顾性分析.结果 钢板折断距手术时间3-9个月.造成钢板断裂的原因主要是术后锻炼不得当、内植物放置及应用不当、骨折复位不良及碎骨块血运破坏等因素.再次手术后骨折愈合良好.结论 术中良好的解剖复位、正确规范的AO操作、术后科学合理的功能锻炼及定期随访能有效防止术后钢板断裂.

Objective To investigate the effect of octreotide associated with ulinastatin in treatment of early postoperative inflammatory small bowel obstruction after enterorrhexis surgery and provide basis for clinical therapy. Method Collected 100 cases of intestinal obstruction patients with early postoperative inflammatory rupture from December 2007 to December 2013 in our hospital treated for the study, randomly divided into control group and observation group, 30 cases in each group. Beside some traditional therapy, control group were treated with octreotide and observation group were treated with octreotide and ulinastatin. Compared the effect, inflammatory mediators, abdominal symptom disappearance time, recovery of bowel movement and borborygmi, and hospitalization time of two groups. Result Control group were cured 24 cases(48.0%), 10 cases(20.0%) were markedly effctive, the effective rate was 68.0%; observation group were cured 28 cases(56.0%), 18 cases(36.0%) were markedly effective, the effective rate was 92.0%; the effective rate of treatment group was significantly higher than control group, the difference was significant(P 0.05). Two groups of patients before treatment, the difference between LPS, IL-8, TNF-α and hs-CRP and other inflammatory cytokines had no significant difference(P 0.05). After 7 days of treatment, the inflammatory factors in two groups were significantly lower than before treatment, and observation group were significantly lower than control group, the differences were statistically significant(P 0.05). The abdominal symptom disappearance time, recovery of bowel movement and borborygmi, and hospitalization time were all much shorter in observation group than control group, the difference was significant(P 0.05). Conclusion Compared to the octreotide therapy, octreotide combined with ulinastatin therapy for EPISBO after enterorrhexis surgery can improve the efficacy, decrease the levels of inflammation factors, and decrease the length of symptom disappearance and hospitalization time, worthy of application in clinic.

老年股骨粗隆间骨折患者多伴有骨质疏松、糖尿病、高血压等全身基础性疾病，骨折得不到合理的治疗会引起严重并发症，缩短患者寿命〔1〕。外固定支架和股骨近端防旋髓内钉系统（ PFNA）－Ⅱ是临床上常用的手术方法，均能达到良好的治疗效果，PFNA－Ⅱ属于髓内固定系统，近年来广泛应用于股骨粗隆间骨折，具有防止髋内翻、增加防旋抗压能力、早期可下床减少卧床时间等优点〔2〕，本研究观察老年股骨粗隆间骨折并脾破裂的患者行PFNA－Ⅱ联合脾切除术的效果。