甘草附子汤源于《伤寒论》,现代应用于类风湿关节炎、骨关节炎等疾病的治疗.本文对甘草附子汤近20年来临床应用及药理作用研究进展进行综述,期望为进一步提高该方临床应用价值和拓展药理基础研究提供参考.

目的 基于核因子-κB(NF-κB)信号通路探讨甘草附子汤(GCFZ)对膝关节骨关节炎(knee osteoarthritis,KOA)大鼠的作用及其机制.方法 将40只SD大鼠随机分为5组,每组8只,采用膝关节腔注射木瓜蛋白酶混合液的方法建立大鼠KOA模型,观察各组大鼠膝关节宽度、机械性痛阈和右下肢负重能力的变化;酶联免疫吸附测定法(Elisa)检测大鼠膝关节腔关节液肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和白介素-1β(IL-1β)的水平;实时荧光定量聚合酶链反应(RT-PCR)方法检测膝关节滑膜组织TNF-α、IL-6、IL-1βmRNA表达水平;蛋白免疫印迹(Western blot)法检测膝关节滑膜组织NF-κB信号通路关键蛋白p65、抑制蛋白κBα(IκBα)、磷酸化抑制蛋白κBα(p-IκBα)、抑制蛋白激酶α/β(IKKα/β)、磷酸化抑制蛋白激酶α/β(p-IKKα/β)的表达情况.结果 第14、28天,与空白组比较,模型组膝关节宽度增加、机械性痛阈和右下肢负重百分比显著降低(P<0.01),关节液TNF-α、IL-6和IL-1β水平显著上升(P<0.01),膝关节滑膜组织TNF-α、IL-6和IL-1βmRNA表达提高(P<0.01),p65、p-IκBα和p-IKKα/β蛋白表达明显上调、IκBα蛋白降解明显.与模型组比较,第14、28天,3个给药组均能降低膝关节宽度(P<0.01)、提高大鼠机械性痛阈和右下肢负重能力(P<0.05);阳性药物组和GCFZ高剂量组能降低关节液TNF-α水平(P<0.05);3个给药组均能显著降低IL-6和IL-1β水平(P<0.05)、抑制滑膜组织TNF-α、IL-6和IL-1βmRNA表达(P<0.01);阳性药物和GCFZ能明显抑制KOA大鼠滑膜组织p65、IκBα蛋白的表达,抑制IκBα和IKKα/β蛋白的磷酸化.结论 甘草附子汤对KOA有一定的防治作用,作用机制可能与调控NF-κB信号通路有关.

目的:探究应用智能预控外科平台对骨科住院医师规范化培训医生进行临床教学的效果.方法:选取2017年9月至2019年9月在广州医科大学附属第一医院骨科接受规培的16名规培医生的各项考核评分.根据是否使用智能预控外科平台进行临床教学(大于半年)分为试验组及对照组.其中试验组有4名,研究生学历比例75.00％,入科成绩87.25±2.22分,对照组有12名,研究生学历比例83.33％,入科成绩86.17±3.56分.对所有规培医生的入科教育考核评分、全国水平测试分数、全国与省排名及规培医生对临床教学的满意度调查评分进行统计并比较分析.结果:16名规培医生均按照要求进行医院规培基地培训并完成国家水平测试.两组规培医生学历比例、入科教育成绩分数差异均无统计学意义(P>0.05),经过医院基地培训后,与未使用智能预控外科平台进行临床教学的对照组规培医生相比,使用智能预控外科平台进行临床教学的试验组规培医生在国家水平测试分数、国家水平测试省内排名占比、国内排名占比及对临床教学满意度调查评分均较高,且差异具有统计学意义(P<0.05).结论:应用智能预控外科平台对骨科规培医生进行临床教学具有良好效果,可提升骨科规培医生的临床知识水平,提高规培医生对临床教学的满意度.

OBJECTIVE:To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). METHODS:The clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m 2, with an average of 40.04 kg/m 2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. RESULTS:All 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference ( t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups ( P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups ( P>0.05). CONCLUSION:The patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.

Objective:To investigate the incluence of abnormal anterior cruciate ligament (ACL) MRI on the efficacy of unicompartmental knee arthroplasty (UKA).Methods:This study used statistical methods such as t test, rank sum test, and analysis of variance to retrospectively analyse the patients with anterior medial knee osteoarthritis treated by UKA admitted from May 2014 to May 2019 in the department of joint surgery of The First Affiliated Hospital of Guangzhou Medical University.Inclusion criteria: diagnosed anteromedial knee osteoarthritis, knee MRI showed only medial compartment cartilage wear and ACL abnormality, intra-operative findings showed only anterior medial cartilage wear while ACL function was normal. Exclusion criteria: multi-compartment osteoarthritis, rheumatoid arthritis, infectious arthritis. The MRI results showed ACL conditions, which were divided into ACL-MRI normal group and ACL-MRI abnormal group. A total of 55 patients (61 knees), of which 26 cases (30 knees) had complete ACLs, and 29 cases (31 knees) had abnormal ACLs. For the two groups, the Hospital for Special Surgery knee score (HSS), visual analogue scale (VAS) and range of motion (ROM) were used to evaluate the knee joint functions before operation and the last follow-up situation after operation respectively.Whether the prosthesis was loosening or infected after the operation, and whether the gasket had abrasion, dislocation or other complications, were also observed.Results:All the patients were followed up for the longest time of five years, with an average follow-up time of (21±17) months. At the last follow-up of normal ACL-MRI group after surgery, the average HSS score was(75.9 ± 7.6). The average VAS score was 1.0(0.7, 1.3), and the average ROM was (109.9±9.9)°. Postoperative ACL-MRI was abnormal at the last follow-up of the group. The average HSS score was(77.7 ± 6.6). The average VAS score was 0.8(0.6, 1.1), and the average ROM was(108.0±10.6)°. All the data were significantly improved compared with the preoperative scores. There was no statistically significant difference between the two groups in knee range of motion, knee HSS score and pain score (P>0.05). No complication such as prosthesis infection, loosening, fat embolism, gasket wear, or dislocation occurred in the two groups.Conclusion:The patients with preoperative abnormal ACL MRI but the ACL is confirmed unbroken and good function during operation may have good short-term and mid-term effects after UKA, which still needs follow-up for the long-term results.

OBJECTIVE:To investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint. METHODS:The clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m 2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m 2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m 2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups ( P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement. RESULTS:There was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups ( P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones ( P<0.05); but there was no significant difference among 3 groups ( P>0.05). CONCLUSION:For obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.

Objective:To evaluate the effectiveness of cemented polyethylene liner technique in hip revision. Methods:Based on inclusion criteria, the clinical data of 26 patients who were undergone hip revision between January 2011 and December 2013, were retrospectively reviewed. Among them, 14 cases were treated with isolated liner exchange (group A) and 12 cases were treated with cemented polyethylene liner technique (group B). There was no significant difference in gender, age, the time from primary total hip arthroplasty to revision, and the preoperative Harris score between 2 groups ( P>0.05). The post-operative Harris score and complications were compared between 2 groups, and X-ray findings of the hip joint were recorded to review the position of hip components. Results:All patients were followed up 4.4-6.4 years (mean, 5.4 years). Except for two femoral fractures during the revision (1 in each group), there was no other complication in 2 groups. The hip pain relieved and the lame gait corrected in 2 groups. The hip's function of 2 groups improved gradually after operation, with a better Harris score at 3 months and the best at the last follow-up, compared with preoperative scores ( P<0.05). There was no significant difference in Harris score at difference time points after operation between 2 group ( P>0.05). X-ray films showed no dislocation, aseptic loosening, and other interface related complication. Conclusion:For the cases without the chance to do change liner, cemented polyethylene liner technique has a good effectiveness. But restrict patient selection should be considered before hip revision.

Objective To evaluate the efficacy and safety of radial extracorporeal shockwave therapy for treatment of supraspinatus tendinopathy in juvenile swimmers.Methods The study was designed as a prospective randomized controlled trial.After supraspinatus tear was excluded, 16 juvenile swimmers who were diagnosed supraspinatus tendinopathy by clinical examination and magnetic resonance imaging were enrolled in the study and were divided into control group and radial extracorporeal shockwave therapy (rESWT)group randomly.Ice compress, massage,modulated medium frequency electrotherapy were prescribed in the control group and meanwhile ice compress and rESWT were applied in the rESWT group. Visual analogue scale(VAS), simple shoulder test score, Constant score were used to evaluate before the treatment and at six weeks and 12 weeks after the last treatment.Independent t test was applied for comparing the results of both groups.P <0.05 was considered as significant difference.Results Compared to the control group,the VAS score of rESWT group was significantly lower at six weeks(t=3.757,P<0.01)and 12 weeks(t=3.982,P<0.01)after the last rESWT.Compared to baseline,MRI scan after rESWT showed no significant change of supraspinatus.None of the complications related to rESWT was observed.Conclusion It shows a better short-term result of rESWT in releasing shoulder pain in juvenile swimmers with supraspinatus tendinopathy;the long term results are not clear.

Objective To find out whether three-dimensional reconstruction of CT images in preoperative plan before total hip replacement(THA)in developmental dysplasia of the hip(DDH),compared to X-ray could improve the precision of prosthesis matching with the anatomical morphology of proximal femur medullary canal.Methods From Jan 2013 to Dec 2015,38 cases(46 hips)of DDH undergone THA in the orthopedics department of the first affiliated hospital of Guangzhou Medical University were selected in the study,except for the cases which were suffering osteoarthritis of hip,avascular necrosis of femoral head,DDH of Crowe Ⅳ,or accepted osteotomy of hip.All the cases were randomly divided into two groups: standard X-ray images were used in the X-ray group(23 hips)and 3D reconstructions of CT images were used in the CT group(23 hips)respectively in the preoperative plans.All the femur prostheses were cementless fitted.The size of femur prosthesis both anticipated in the preoperative plan and used in THA was recorded and the coincidence rates of the two groups were compared.CT scan was performed at two weeks after the surgery.Parameters of femur medullary and prosthesis,including anteroposterior and trans-diameters at the sites of femoral neck osteotomy,25mm and 75mm distal to the sites of femoral neck osteotomy,and femoral isthmus were measured with CT software.D-value of diameter between femur medullary and prosthesis was calculated and the indices of compatibility were compared between the two groups by paired t test.Results The coincidence rate of anticipated and actual size of femur prosthesis in the X-ray group were lower than the CT group(χ2=5.03,P<0.05).The indices of compatibility of femur medullary and prosthesis in X-ray group were lower than the CT group,including anteroposterior and trans-diameters at the sites of femoral neck osteotomy,25mm and 75mm distal to the sites of femoral neck osteotomy,and femoral isthmus(D-value of anteroposterior diameter,t=2.234,2.081,2.449,2.245,P<0.05;D-value of trans diameter,t=2.435,2.033,2.145,2.296,P<0.05).Conclusion With the benefit of higher coincidence of anticipated and actual sizes of femur prosthesis and the compatibility index of femur medullary and prosthesis,it is worthy to choose 3D reconstruction of CT scan for preoperative plan before THA in DDH patients.

Objective To compare the influence of total knee arthroplasty(TKA)and unicompartmental knee arthroplasty(UKA)on post-operative extensional strength of knee.MethodsThirty-nine knees undergone TKA and thirty knees undergone UKA in the orthopedics department of the First Affiliated Hospital of Guangzhou Medical University were recorded and analyzed in this study from January 2015 to December 2016.All the cases were diagnosed as osteoarthritis.Sex,age,BMI index,pre-and post-operative visual analogue scale(VAS score),American knee society knee score(KSS score)were compared between the two groups.Knee extension strength of the flexion positions at 20°and 90°were measured and compared.The calculations for continuous variables were performed with the independent samples t-test and Chi-square tests were used in case of dichotomous data by SPSS19.0 software.A P value <0.05 was considered to be significant.Results VAS score of the UKA group at two weeks after the surgery was significantly lower than that of the TKA group(t=7.098,P<0.01),and the extensional strength of knees at the flexion positions of 90°and 20°were significantly higher than those of the TKA group(t=5.290,9.165;P<0.01).Compared to the value before the surgery,in the TKA group,the strength of extension at the flexion positions of 90°and 20°declined significantly(t=9.792,10.01;P<0.01).Conclusion Compared to TKA,UKA presents less pain and less influence on extensional strength of knees.

Objective To review the early result of total hip arthroplasty via mini-invasive anterolateral approach ( OCM ) and demonstrate the technique of the OCM approach at a 45°lateral position.Methods Eighteen cases of total hip arthroplasty via OCM approach in 45 °lateral position were retrospectively analyzed and compared with 32 cases of total hip arthroplasty via conventional posterior approach .Clinical results including VAS score ,Harris score at the time of peri-operation and one year follow-up were recorded and radiologic data such as abduction and antevesion of acetabular component ,varus/valgus position and subsidence of femur component were evaluated .Loss of hemoglobin ,rate of blood transfusion,hospital stays were also compared .Data were calculated with software Spss 19.0,independent t test and chi-square test were used .A P value <0.05 was considered to be significant .Results VAS score at 48 hour postoperative ,Harris score at one week postoperative ,hemoglobin loss ,blood transfusion rate,hospital stays of OCM group were significantly better than the posterior approach group .At the time of one year follow-up,Harris scores of OCM group and the posterior approach group were ( 93.74 ±1.80 ) and (92.24 ±2.76) respectively (t=2.068,P<0.05).Complication was not observed in the two series of cases and the difference of radiologic data was not found neither .Conclusion With the superiority in quick rehabilitation ,less pain and less blood loss ,OCM approach in total hip arthroplasty could be more acceptable in the future ,and more long term results and prospective clinical studies are expected .

Background:It is very difficult to diagnose surgical site infection (SSI) as soon as it happened after major sur-gery in orthopedics department. Serum procalcitonin (PCT) has been proved a good biomarker in detecting infection. How-ever, its effect is still unknown in the field of orthopedics. Objective:To evaluate the effect of PCT on the diagnosis of SSI after major surgery in orthopedics department. Methods:Fifty-three patients undergoing major surgery in orthopedics depart-ment between January 2011 and June 2016 were included in this prospective clinical study. Drainage, a clinical sign of SSI, was found in these patients after surgery. According to the results of bacterial cultures of specimens from the wound and the findings in the process of debridement, the patients were divided into non-infection group and SSI group. Serum PCT and C-reactive protein (CRP) were detected and compared between the two groups. Sensitivity and specificity of PCT in diagnosis of SSI were evaluated. Results:Eventually, 31 patients were diagnosed as SSI, and the infection rate of Gram-positive bacte-ria was 54.8%(17/31). Serum PCT level was (0.498±0.753) ng/ml in SSI group, which was significantly higher than that in non-infection group ([0.133 ± 0.164] ng/ml, P<0.05). When 0.5ng/ml PCT was applied as threshold in diagnosing SSI, the sensitivity and specificity of diagnosis were 26.7% and 95.5%, respectively. Conclusions: With a poor sensitivity, serum PCT is not proper for a marker in diagnosing SSI after major surgery in orthopedics department.

目的 探讨人工髋关节置换术后股骨假体周围Vancouver B型骨折患者,进行假体翻修、内固定治疗的效果.方法 2005年1月至2009年12月间,广州医科大学大学附属第一医院关节外科收治人工髋关节置换术后股骨假体周围B型骨折患者16例,其中11例为全髋,5例为半髋;男4例,女12例;年龄平均69岁(59 ～81岁);Vancouver分类B1型3例,B2型5例,B3型8例.B1型骨折采用内固定、或加异体皮质骨板移植治疗;B2型骨折选择加长股骨柄翻修、捆扎带环扎;B3型骨折选择加长股骨柄翻修、加同种异体皮质骨板移植和捆扎带环扎固定.所有患者均进行随访,随访时间平均90个月(5～9年).采用Harris髋关节功能评分、X线片对治疗结果进行评价.结果 12例患者获得随访,骨折全部愈合,患者能自由行走,末次随访髋关节功能评分(Harris评分)平均90分(76 ～ 93分).结论 针对人工髋关节置换术后股骨假体周围骨折的不同类型,分别采取切开复位内固定、加长股骨柄假体翻修、异体皮质骨板移植治疗,能取得较好疗效.

背景:在因骨溶解和内衬失败进行翻修手术时,用骨水泥将新聚乙烯内衬固定于稳定金属髋臼内是可选择的手术方式.如果金属髋臼外翻或前倾角度不良,单纯更换内衬可有脱位的风险.目的:了解聚乙烯内衬在一定范围内改变接触面积以骨水泥固定于金属髋臼内的早期力学强度.方法:选用40个60 mm外径的金属髋臼、40个28 mm内径的聚乙烯内衬,其中8个聚乙烯内衬外径51 mm为标准锁定组即对照组,32个聚乙烯内衬外径47 mm按内衬与髋臼赤道面交角不同平均分为0°、10°、20°、30°四个实验组.内衬外表面纹理化后以骨水泥固定于金属髋臼内,各组分别进行杠杆及扭转力学实验,观察内衬或内衬-骨水泥界面失败的情况,测量标准锁定装置及骨水泥固定内衬的最大抗杠杆力及抗扭力扭矩.结果:对照组所有内衬均出现分离或移位,实验组各组均未出现内衬-骨水泥界面的失败.4个实验组的最大抗杠杆力及抗扭力扭矩均优于对照组(P<0.05).实验组各组间最大抗杠杆力及最大抗扭力扭矩的差异无统计学意义(P>0.05).结论:聚乙烯内衬以骨水泥固定于金属髋臼内可以获得足够的初始固定力学强度.聚乙烯内衬外表面纹理化后,内衬与骨水泥、金属髋臼接触面积减少在一定范围内不会影响内衬-骨水泥界面的初始固定力学强度.

Objective To compare the clinical outcomes of different drains in total knee arthroplasty .Methods Thirty-two patients , who had undergone TKA from October 2011 to September 2012, were included in the comparative study .The same operative procedure and postoperative care were&nbsp;provided to all the patients .The patients were randomized to have either a subcutaneous indwelling or an intra-articular indwelling catheter and two months after surgery , the two groups were compared for blood loss ( hemoglobin decrease , transfusion requirements , hypotension episode ) , incidence of wound problems (requirements for dressing reinforcement , oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes ( value score , American Knee Society ) .Results The mean vacuum drainage volume was less in the subcutaneous indwelling group [(142.5 ±140.3) ml] than in the intra-articular indwelling group [(421.2 ±231.7) ml] (t=4.116, P<0.05).There were differences between the two groups in allogenic transfusion requirements ( 6.25% versus 43.75%, χ2 =4.167, P <0.05 ) .There was no difference between the two groups in HB decrease , incidence of wound problems and functional scores . Conclusion Subcutaneous indwelling closed suction drainage in total knee arthroplasty could reduce blood loss and chances of allogenic blood transfusion .It is a reasonable alternative to intra-articular indwelling closed-suction drainage .

Objective To investigate the bacterial contamination rates of suction tip in total knee arthroplasty ( TKA).Methods Fifty-two knees undergone TKA in the operating room of the First Affiliated Hospital of Guangzhou Medical University from Feb 2015 to May 2015 were enrolled in this controlled study.Two sets of suction tubes were used in every TKA procedure, of which one was used in the control group without contacting the surgical field and the other was used routinely in the experimental&nbsp;group.Specimens were taken by swabs and sent for culture from inner wall of the suction tips one hour after the incision and at the end of the surgery.The bacterial contamination rates of the suction tip were compared between the two groups.Results In the control group, no flora was found in the laboratory.In the experimental group, the samples from the two suction tips presented positive culture results with identical staphylococcus epidermidis both one hour after the incision and at the end of TKA. The contamination rate of the experimental group was 3.8%, not significantly higher than the control group ( x2=2.039, P >0.05).Conclusion As the low contamination rate of suction tip in TKA, it is not suggested suction tip changing in every 60 minutes as a compulsory sterile protocol in TKA.

静脉血栓栓塞症（ venous thromboembolism ， VTE）是骨科大手术后常见并发症，严重危害患者生命健康，致死致残。随着华法林、低分子肝素等药物在骨科大手术后应用经验的增加和对药物作用理解的深入，以及国内骨科同道对美国胸科医师协会（ ACCP）、美国骨科医师协会（ AAOS）、中国骨科大手术静脉血栓栓塞症预防指南（2009）等抗凝系列指南的解读，预防抗凝这一观念开始推广并深入人心。在这一过程中，新型口服抗凝药物（ NOAC）--Ⅹa因子抑制剂，以独有的优势获得骨科医师的关注和接受。口服方便，生物利用度高，抗凝效果好，无需监测凝血功能，是这类药物的特点。随着预防抗凝用药经验的增加，以及专家讨论和形成共识，国内外指南对骨科术后VTE的预防亦作了大幅更新，主要侧重点为对NOAC的推荐、术后预防时长及强度的建议、转换治疗及阿司匹林推荐地位的改变等，以便与时俱进地、更切实地为临床实践做出最佳指导，提高临床治疗质量。在按照指南进行抗凝的同时注意个体化预防，获益风险平衡这一概念逐渐被骨科同道所接受。本文对在国内上市的两种新型口服Ⅹa因子抑制剂--阿哌沙班、利伐沙班的药理学特性、研究进展及在各国指南中的定位予以综述和解读。

目的 探讨小切口椎弓根螺钉技术治疗胸腰椎骨折的方法和疗效. 方法 自2010年1月至2012年8月收治32例单节段胸腰椎骨折患者,分别采用小切口椎弓根螺钉技术(小切口组,16例)和开放椎弓根螺钉技术(开放组,16例)治疗.记录并比较两组患者的手术时间、术中出血量、术中X线曝光次数、术后住院时间、椎体前缘高度比值、腰背痛的疼痛视觉模拟评分量表(VAS)及Oswestry功能障碍指数(ODI). 结果 32例患者术后随访8～20个月(平均12.8个月).小切口组的手术时间、术中X线曝光次数较开放组多,但术中出血量、术后住院时间少于开放组,差异均有统计学意义(P＜0.05).两组患者术后均可有效恢复椎体前缘高度,差异无统计学意义(P＞ 0.05).术后l周小切口组的VAS评分和ODI评分均优于开放组,差异均有统计学意义(P＜0.05).但术后6个月VAS评分和ODI评分两组间比较差异均无统计学意义(P＞0.05). 结论 治疗单节段胸腰椎骨折,小切口椎弓根螺钉技术可获得与开放手术相当的矫形效果,而且术后早期疗效更为显著,具有创伤小、恢复快、住院时间短等优势,值得推广和应用。

Objective To evaluate the clinical effect of minimal access fixation combined with transforaminal debridement and fusion on the treatment of primary infection of intervertebral space. Methods From January 2010 to June 2013,18 patients of primary infection of intervertebral space were treated by minimal access fixation combined with transforaminal debridement and fusion. The operation time,intra-operative blood loss,times of X-ray exposure and fusion rates were recorded. visual analog scale( VAS) scores and Oswestry disability index( ODI) were compared between preoperation and postoperation. Results The average operation time was 96. 5 min,the average blood loss was 160. 6 mL,the average times of X-ray exposure was 5. 6. All patients were followed up for 6-25 months( mean 13. 6 months. The VAS score and ODI of postoperation were better than those before operation,and the difference was statistically significant( P 0. 01). The intervertebral fusion rate was 100%. There was neither wound infection nor recurrence during the follow-up. Conclusion The application of the minimal access fixation combined with transforaminal debridement and fusion for the treatment of primary infection of intervertebral space can get satisfactory clinical outcomes. The technique has the advantages of less trauma,simple manipulation,and easy to master.

Objective:To investigate the clinical effects on the prevention of venous thromboembolism (DVT) in total hip arthroplasty (THA), which is based on"Chinese orthopedic major surgery venous thromboembolism prevention guidelines"(Guidelines, published in 2009). <br> Methods:Retrospective analysis was carried out in 914 patients of cementless THA in Guangdong Kaiping Central Hospi-tal, Guizhou Hospital of Shunde City and our hospital in the past three years. The patients were divided into two groups, the 631 cases in prevention group were treated with the Guidelines and 283 cases of control group did not receive any treat-ment. Occurrence of DVT, bleeding and early complications were observed. <br> Results:In the prevention group , the incidences of DVT, proximate DVT and pulmonary embolism were 6.49%, 5.86%, and 0.47%; while in the control group, the incidences of DVT, proximate DVT and pulmonary embolism were 26.85%, 24.02%, and 2.82%The two groups had statistically significant dofferemce(P<0.01). In the prevention group and control group, the hemorrhage incidence was 0.63%and 2.82%respectively, and there was statistical significance (P<0.05). The in-cidence of early systematic complications was 3.16%in prevention group and 7.77%in control group, which was also sig-nificantly different (P<0.01). <br> Conclusion:The Guidelines is safe and effective for venous thromboembolis prevention after THA.