OBJECTIVE To explore the risk factors for postoperative incision infections in fracture trauma patients and put forward prevention countermeasures so as to provide guidance for early prevention and control of postoperative incision infections.METHODS The clinical data of 3200fracture trauma patients who were treated in the hospital from Sep 2010to Sep 2013 were retrospectively analyzed,then the 75 patients with postoperative incision infections were assigned as the study group,while 75patients without postoperative incision infections were chosen as the control group,the related data were compared between the two groups,the risk factors for the postoperative incision infections were summarized,the corresponding prevention countermeasures were put forward,and the statistical analysis of all the data was performed with the use of SPSS11.0software.RESULTS The postoperative incision infections occurred in 75of 3200patients with the infection rate of 2.34%.A total of 103strains of pathogens have been isolated,among which the Staphylococcus aureus(39strains)accounted for 37.86%, Staphylococcus epidermidis(26strains)25.24%,Pseudomonas aeruginosa(17strains)16.51%,Escherichia coli(9strains)8.74%,Enterococcus(7strains)6.80%,Klebsiella pneumoniae(5strains)4.85%.There was statistically significant difference in the age,body mass index,underlying disease,incision type,use of steel plates,average debridement time,surgical site,operation duration,or postoperative length of hospital stay between the two groups(P0.05).CONCLUSION The incidence of postoperative incision infections in the fracture trauma patients is related to the patient's own situation,type of incision,average time of debridement,use of steel plates,surgical site,operation duration,or postoperative length of hospital stay;it is of great significance to the reduction of incidence of the postoperative incision infections to take the corresponding prevention countermeasures aiming at the risk factors.

Objective To explore the clinical effects of artificial cervical disc replacement( ACDR) combined with anterior cervical discectomy fusion ( ACDF ) for the treatment of multi-segmental cervical spondylotic myelopathy ( CSM) . Methods 18 cases with multi-segmental CSM which were treated by ACDR combined with ACDF were re-viewed. The stability of artificial disc, internal fixation and bone fusion were evaluated by X-ray films before opera-tive, immediate postoperative and follow-up. The JOA scores was evaluated also at the same time. Results 18 pa-tients were followed up from 24 to 60 months ( averaged 36 ± 9. 6 months) . The range of motion of the replacement segment were 13. 8° ± 6. 5° at preoperative and 12. 5° ± 5. 3° at the final follow-up, and there was no significant difference between them(P>0. 05). The preoperative JOA scores was 9. 5 ± 1. 5, which was improved to 14. 2 ± 2. 2 in 4 months after operation; Preoperative neurological symptoms were obviously alleviated in most patients, and the improvement ratio of JOA was 62. 7% ± 11. 2%. The results were excellent in 9 patients, good in 5, fair in 2 and poor in 2. There were no patient with false of internal fixation, and the position of artificial disc was good. Conclu-sions ACDR combined with ACDF is a good procedure for multi-segmental cervical spondylotic myelopathy, it not only maintain the cervical spine alignment with saving more movement segments,but also reduce the incidence of ad-jacent segment degeneration.

目的 探讨颈前路间隙减压人工颈椎间盘假体置换术治疗颈椎病的疗效.方法 对15例颈椎病患者行颈前路间隙减压,Discover人工颈椎间盘假体置换术,观察其疗效.结果 本组术后稳定性良好,置换节段存在活动度(ROM),神经受压症状均明显缓解,脊髓功能改善.本组均获得随访,随访时间12～50个月,平均25个月.JOA评分术前为(8.7±1.5)分,术后12个月为(15.6±1.2)分;术后12个月Odom评级为优14例,良1例.术后12个月置换节段前屈后伸ROM平均为4.9°,左右侧屈ROM分别为平均3.4°和3.5°.结论 人工颈椎间盘置换术可以获得前路减压一样的近期疗效,同时维持了颈椎的正常ROM.

目的探讨闭合复位防旋股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折的效果。方法采用闭合复位PFNA治疗老年股骨转子间骨折19例,观察其疗效。结果本组均成功手术,手术时间40～90 min,术中出血量50～350ml。本组14例获得随访,随访时间4～30个月;术后6个月按Harris髋关节功能评分标准,优9例,良3例,中2例,优良率为85.7%。结论闭合复位PFNA治疗老年股骨转子间骨折具有操作简单、手术损伤小、出血少、固定牢固、最大限度地保存局部骨量等优势,值得推广。

目的:探讨球囊扩张椎体后凸成形注入骨水泥治疗老年骨质疏松性椎体骨折的疗效。方法:对52例老年骨质疏松性单椎体骨折患者采用球囊扩张椎体后凸成形术治疗。在DSA透视引导下行单侧或双侧椎弓根穿刺,注入骨水泥。结果:发生骨水泥渗漏6例,术后1周腰背疼痛、后凸角度、伤椎高度、活动能力较术前明显改善(P<0.05),术后6个月、末次随访与术后1周,上述指标比较差异均无显著性(P>0.05)。结论:球囊扩张椎体后凸成形注入骨水泥,不仅能够明显缓解骨质疏松性脊柱骨折导致的疼痛,而且可以部分恢复椎体高度和改善脊柱后凸畸形,有利于脊柱功能的恢复。

OBJECTIVE:To explore the clinical efficacy of delayed open reduction and internal fixation with minimally invasive percutaneous locking compression plate for the treatment of type II and III Pilon fractures.METHODS:From January 2007 to September 2009, 32 patients with type II and III Pilon fractures were treated with open reduction and anatomic plate fixation (AP group) and minimally invasive percutaneous locking compression plate osteosynthesis (LCP group). There were 11 males and 6 females in AP group, with an average age of (37.4 +/- 13.3) years (ranged, 19 to 55 years). And there were 10 males and 5 females in LCP group, with an average age of (34.6 +/- 11.3) years(ranged, 21 to 56 years). The operating time, fracture healing time, aligned angulation and ankle function were compared between the two groups.RESULTS:All the patients were followed up, and the during ranged from 12 to 25 months, with a mean of (15.0 +/- 1.7) months. The average operation time was (76.5 +/- 8.3) min for AP group and (58.3 +/- 3.4) min for LCP group; the average time of fracture healing was (20.5 +/- 0.4) weeks for AP group and (15.7 +/- 0.2) weeks for LCP group; the total angulation between anterior posterior film and lateral film was averaged (6.6 +/- 0.5) degrees for AP group and (3.6 +/- 0.2) degrees for LCP group. As to above index, the results of LCP group were better than those of AP group (P < 0.05). According to Kofoed criteria for ankle joint, the results of LCP group were better than those of AP group in ankle joint pain, wakling and ankle joint function (P < 0.05).CONCLUSION:The method of minimally invasive percutaneous locking compression plate internal fixation is effective in the treatment of Pilon fracture with less invasion, faster bone union, more stabilized fixation, quicker recovery of ankle function and fewer complications, which is more advantaged for type II and III Pilon fractures.

目的 探讨异种骨经椎弓根椎体强化及短节段椎弓根螺钉内固定治疗胸腰椎不稳定骨折的疗效.方法异种骨经椎弓根椎体强化及短节段椎弓根螺钉内固定治疗胸腰椎不稳定骨折20例,对患者术前后椎体高度、Cobb's角、椎管矢状径占位率进行比较. 结果 30例患者术后l周伤椎前后缘高度比值、Cobb's角、椎管矢状径占位率较术前明显改善,差异均有显著性(P<0.05),末次随访与术后l周上述指标比较差异均无显著性(P>0.05).术后神经ASIA分级A级中1例恢复为B级,余均为E级. 结论 异种骨椎体强化内固定术植骨融合率高,能有效防止术后矫正丢失及内固定失效.

Objective To explore the clinical efficacy of combining short-segment pedicle screw fixation and transpedicular grafting vertebroplasty with reconstituted bone xenograft(RBX) on thoracolumbar fracture.Methods 52 cases with thoracolumbar single-vertebra fractures were recruited,of which 24 cases treated with transpedicular grafting vertebroplasty(TPG group)were compared to 28 cases treated with posterolateral fusion(PLF group) according to clinical outcome,X-ray and CT examination data before and after operation.Results One week after operation,anterior(posterior) height of the injured vertebra,Cobb's angle and occupation of sagittal diameter of vertebral canal were averagely restored to 95.7%(98.3%),5°and 9.7% in TPG group,the relevant indexes in PLF group were 96.3%(96.9%),6°and 11.3%,respectively.Above-mentioned radiological measurements had no significant difference(P0.05) between two groups.With a follow-up period of 5 to 36 months,all cases were improved for ASIA grades respectively in two groups.At the last follow-up days,it showed a significant loss of correction,higher rates of internal fixation failure in PLF group.TPG group was obviously better than PLF group(P0.05).Conclusions Transpedicular RBX grafting vertebroplasty and internal fixation can not only recuperate the normal bone construction,improve the biomechanics intensity of injured vertebrae and restore the spinal alignment with saving more movement segments but also reduce the incidence of missing of rectification degrees,internal fixation failure and adjacent segment degeneration.