Objective:This study aims to compare and analyze the clinical efficacy of early versus late partial weight-bearing in patients undergoing Taylor Spatial Frame (TSF) external fixation for open tibial shaft fracture.Methods:63 patients with open tibial shaft fractures treated with TSF between January 2018 and June 2020 in the Department of Orthopaedics Ward One of Tianjin Hospital were retrospectively studied. Based on the timing of initiating postoperative partial weight-bearing (PWB) , the patients were classified as the early weight-bearing group initiating PWB at 6 weeks postoperative and the late weight-bearing group initiating at 10 weeks postoperative. The limb function was evaluated using Johner and Wruh’s Criteria during the final follow-up. The duration of TSF application, time to full weight-bearing, and occurrence of complications were recorded and compared between the two groups.Results:Both groups achieved fracture union. At the final follow-up, the early weight-bearing group exhibited a good-to-excellent rate of 83.33%, while the late weight-bearing group showed a good-to-excellent rate of 69.7%, suggesting a statistically significant difference between the two groups ( Z=-2.072, P=0.038) . The early weight-bearing group had a shorter duration of TSF application and time to full weight-bearing compared with the late weight-bearing group, indicating statistically significant differences between the two groups (all P<0.05) . Conclusion:Compared with late PWB, early, regular, continuous, and moderate PWB after TSF external fixation in patients with open tibial shaft fracture can promote fracture healing, reduce the duration of external fixation device usage, facilitate rapid functional recovery of the affected limb, thereby exhibiting clinical application value and guiding significance.

Objective:To investigate the feasibility of combined treatment of bone grafting and Ilizarov bone removal for bone defects of lower limb. Methods:62 cases of lower limb bone defect treated in our hospital were randomly divided into two groups, 31 cases in each group. Ilizarov bone removal treatment was used as control group, and the control group was added with bone grafting at the opposite end as observation group, to compare the effect.Results:The external fixation time and bone healing time of the observation group were shorter, and the bone healing index was lower, which were significantly different from the control group（P＜0.05）.Before surgery, there was no significant difference between the two groups in serum inflammatory factors and quality of life（P＞0.05）.One week after surgery, the level of inflammatory factors in the observation group was lower and the score of quality of life was higher,the difference was significant（P＜0.05）. The complication rate of observation group was lower than control group, and the difference was significant（P＜0.05）.Conclusion:The combination of bone graft and Ilizarov bone transfer in the treatment of lower limb bone defects can not only shorten the rehabilitation time and better improve inflammation, but also have high safety and better postoperative life quality, which is worthy of application.

伴随着我国现代化科学技术的不断发展提升,在临床治疗中也充分应用了现代化科学技术,更多的先进技术融入到了治疗中,为广大患者带来了福音.3D打印技术是一种以实物模型制作来进行手术治疗的一种新技术,充分利用了数字模型数据,然后通过粘合材料打印方法再把实物打印出来,在骨科中应用极广,且受到了广大好评.

基于Ilizarov张力应力法则和牵张成骨理论的骨搬移技术是治疗大段骨缺损的金标准,对合端延迟愈合是Ilizarov骨搬移治疗过程中最常见的并发症,在很大程度上影响患者的治疗周期,是临床亟待解决的关键问题.对合端延迟愈合的原因包括:应力刺激不足、骨端接触不良、软组织阻挡等.其治疗以保守治疗和手术方法为主:保守治疗以持续加压和"手风琴"技术为主,手术治疗以"断端切新联合植骨"的手术方法为主,此外还包括联合髓内针等内固定、辅助体外震波治疗、电磁场刺激、高压氧疗法和基因治疗等治疗手段.本文针对Ilizarov骨搬移术对合端延迟愈合的发生机制及治疗进展进行综述,为后续研究提供理论参考.

Objective To explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group ( P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups ( χ 2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups ( χ 2=0.917, P=0.821). Conclusion Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

目的:观察Taylor空间支架外固定治疗闭合性胫腓骨骨折合并膝内翻畸形的临床疗效.方法:2015年8月至2016年7月收治37例闭合性胫腓骨骨折合并膝内翻畸形患者,男24例、女13例;年龄19～61岁,中位数44岁;胫腓骨骨折按照AO分型,A2型10例、A3型15例、B1型12例.均采用Taylor空间支架外固定治疗,术后通过调整外固定支架纠正下肢力线.术后随访观察骨折愈合、下肢力线调整及膝关节功能恢复情况.结果:所有患者均获得随访,随访时间10～16个月,中位数12个月.骨折均愈合,且患侧下肢力线均通过胫骨嵴.拆除外固支架后,患侧Lysholm膝关节功能评分高于健侧[(92.70±6.52)分,(53.38±11.43)分,t=-19.080,P=0.000].结论:采用Taylor空间支架外固定治疗闭合性胫腓骨骨折合并膝内翻畸形,术后通过调整外固定支架调整下肢力线,不仅骨折愈合率高,还可以纠正膝关节内翻畸形、促进膝关节功能的恢复.

[目的]介绍应用Taylor空间支架(TSF)调整胫腓骨骨折单臂外固定架术后对位不良的手术经验.[方法]回顾性分析2016年8月～2017年8月本科收治的胫腓骨骨折单臂外固定架术后对位不良患者11例.转换TSF前所有患者复查X线片,发现不同程度的移位、成角、旋转畸形,其中2例为向前成角,5例为向后成角,内翻畸形2例,外翻畸形1例,内旋畸形1例.转换后拍摄小腿正侧位X线片,获取安装和畸形参数.将数据输入计算机配套软件获取调整数据.调整后再次摄片,如合并软组织损伤则转换后二期处理.[结果]经TSF调整所有病例均获得解剖复位.11例患者均获得12～16个月随访,骨折均愈合,无骨外露及软组织问题,固定针无松动,针道无感染.术后参照Johner--Wruhs评分表评价:优9例,良1例,可1例,优良率90.91％.[结论]采取转换TSF治疗胫腓骨骨折单臂外固定架术后对位不良是一种微创、经济、有效的治疗方式.

目的:探讨骨痂力学测试在胫腓骨骨折支架外固定术后骨折愈合评价中的应用价值.方法:回顾性分析74例采用Taylor空间支架外固定治疗的胫腓骨骨折患者的病例资料,根据术后评价骨折愈合的方法不同将其分为骨痂力学测试组38例和传统方法组36例.骨痂力学测试组术后12周开始进行骨痂力学测试判断骨折愈合情况,每4周测试1次;传统方法组术后定期复查,根据骨折临床愈合标准、影像学检查结果及医师经验判断骨折愈合情况.比较2组患者带外固定支架时间及并发症发生情况.结果:2组患者均获得随访,随访时间7～12个月,中位数8个月.骨痂力学测试组患者带外固定支架时间短于传统方法组[(175.30±5.60)d,(346.90±21.64)d,t=-8.670,P=0.000].2组患者均无骨折不愈合、再骨折等并发症发生.结论:在胫腓骨骨折支架外固定术后,应用骨痂力学测试评价骨折愈合情况,可以缩短患者佩戴外固定支架的时间,安全性好.

The present study aimed to determine the anticancer effects of the combination of β-elemene and ligustrazine in vitro as well as in in vivo. Following evaluation using an MTT assay, β-elemene, ligustrazine and the β-elemene-ligustrazine combination treatments all exhibited the capacity to inhibit the growth of OS-732 cells, with inhibitory rates of 43.3, 54.4, and 75.0%, respectively. Using a flow cytometry assay, it was determined that the β-elemene-ligustrazine combination possessed the highest apoptotic rate (30.6%). Furthermore, β-elemene-ligustrazine combination treatment resulted in the highest downregulation of G protein-coupled receptor 124, vascular endothelial growth factor, matrix metallopeptidase (MMP)-2 and MMP-9 mRNA, and protein expression levels. In addition, the combined treatment led to an increase in the mRNA and protein expression of endostatin, TIMP metallopeptidase inhibitor (TIMP)-1 and TIMP-2 in OS-732 cells. Additionally, β-elemene-ligustrazine caused a decrease in nuclear factor-κB, interleukin-8, C-X-C motif chemokine receptor 4 and urokinase-type plasminogen activator mRNA expression, as well as an increase in caspase-3, caspase-8, and caspase-9 mRNA expression. In vivo, the β-elemene-ligustrazine combination was able to reduce the weight and the bulk of the tumor in BALB/c-nu/nu nude mice compared with any other group. All the results described above regarding changes to mRNA and protein expression were further confirmed in vivo in the tumor tissue of mice. The results of the present study have suggested that the combination of β-elemene-ligustrazine exhibits greater anticancer effects compared with β-elemene- or ligustrazine-alone treatment.

BACKGROUND Bone neoplasms are common in humans and have high lethality. Recently, great progress has been made in understanding the pathophysiological mechanisms, but little is known about the molecular and genetic networks involved. MATERIAL AND METHODS qRT-PCR assays were conducted to detect the expression levels of lncRNA HULC in various cell lines. MTT assay, Transwell assay, and wound-healing assay were performed to investigate the proliferation speed, invasion ability, and migration ability of each cell line, respectively. Western blot analysis was also done to assess the expression level of EMT-related factors. Statistical analysis was performed using the t test, Kaplan-Meier method, and log-rank test. RESULTS Compared to the human normal bone cell line, we found lncRNA HULC was over-expressed in all 6 bone neoplasm cell lines, and we finally chose HT1080 and Saos-2 cell lines, which possessed the highest lncRNA HULC expression level, for the subsequent studies. We then observed that the expression level of lncRNA HULC was negatively correlated with overall survival rate of bone neoplasm patients, which means that lncRNA HULC has prognostic value in patients with bone neoplasms. Thus, we assessed the influence of lncRNA HULC down-regulation on proliferation, invasion, and migration abilities of bone neoplasm cells, and found a significant decrease in these abilities. Finally, we found that down-regulating lncRNA HULC led to decreased expression of EMT-related factors in bone neoplasm cells. CONCLUSIONS LncRNA HULC can promote the tumorigenesis of bone neoplasms through increasing the proliferation, invasion, and migration abilities and the expression level of EMT-related factors.

目的:探讨骨搬移术结合贯通冲洗引流治疗创伤性骨髓炎的临床疗效和安全性.方法:2014年3月至2015年6月,采用骨搬移术结合贯通冲洗引流治疗创伤性骨髓炎患者14例,男11例女3例;年龄21~65岁,中位数32.5岁.股骨骨折3例,胫骨骨折11例;开放性骨折10例,闭合性骨折4例;均接受过骨折固定手术治疗,行骨折外固定术10例骨折内固定术4例.合并软组织缺损10例.病程3个月至2年,中位数5个月.治疗结束后随访观察感染控制骨折愈合及患肢外形恢复情况.结果:本组患者搬移延长骨段3~11 cm,中位数7 cm;贯通冲洗引流时间2~12周,中位数4周.14例患者均获随访,随访时间9~22个月,中位数12个月;外固定架固定时间8~20个月,中位数11个月;骨折均愈合,愈合时间6~14个月,中位数10个月.行皮瓣移植术3例,软组织修复良好.搬移骨段出现成角偏移1例,经截骨调整外固定架处理后成角偏移纠正;并发针道感染2例,经换药后感染控制;并发骨缺损处软组织塌陷3例,经克氏针牵拉处理后软组织恢复;并发踝关节功能障碍1例,行踝关节融合术后行走功能恢复.末次随访时,参照改良ASAMI评价标准评价疗效,本组优10例良2例可2例.结论:骨搬移术结合贯通冲洗引流治疗创伤性骨髓炎,有利于感染控制骨折愈合和患肢外形的恢复,安全可靠.

Objective: To evaluate the efficiency of modified Ottawa Ankle Rules (OAR) for the differential diagnosis of fractures in acute foot and ankle injuries. Methods: From October 2016 to December 2016, 272cases (135 males and 137 females) of foot and ankle injury in emergency department of Tianjin Hospital were prospective enrolled in the study.The median age was 27.5 years (7-87); left limb 155, right 117 cases; injury time ranged from 0.3 to 24 h (median 4 h). Conventional and modified OAR was applied on physical examination, subsequently radiography performed to determine the occurrence of fractures.The efficiency of the two methods were compared and analyzed. Results: Fractures were found in 100 cases (36.8%), 49 cases of ankle and 51 cases of foot fractures.With the imaging results as the standard, the sensitivity for conventional and modified OAR were 93.0% and 100%, specificity were 9.9% and 8.7%, the positive predictive value were 37.5% and 38.9%, the negative predictive value were 70.8% and 100%, the accuracy were 40.4% and 42.3%, missed diagnosis rate were 7% and 0% respectively.The sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and missed diagnosis ratio were better than in modified OAR compared with Conventional OAR, while the specificity was slightly lower compared to Conventional OAR.The Kappa value of modified OAR was 0.065 (P>0.05), which is better than conventional OAR.Conventional OAR can reduce 6.3% (17/272) X-ray and modified OAR decline 5.5% (15/272). Conclusion: Modified OAR significantly reduces the rate of missed diagnosis of foot fractures, but its specificity is poor. Ultrasound can be assisted to improve the specificity and reduce the number of unnecessary X-rays.

Objective To compare the clinical effect of the treatment for calcaneal fracture by percutaneous reduction combined with Ilizarov stent and open reduction and internal fixation.Methods Data of 35 patients with closed calcaneal fractures from June 2012 to January 2014 were respectively analyzed.13 cases were fixed with poking reduction and Ilizarov support.Among them,there were 9 males and 4 females,aging from 20 to 51 years old (average,34.46± 10.21 years);Sanders type Ⅱ fractures in 2,type Ⅲ in 8 and type ⅣV in 3;Tscheme-Gotzen 2 degree of soft tissue injury in 9 and 3 degree in 4.22 cases were treated with open reduction and internal fixation.Among them,there were 15 males and 7 females,aging from 18 to 60 years old (average,33.59±12.07 years);Sanders type Ⅱ fractures in 3,type Ⅲ in 15,type ⅣV in 4;Tscheme-Gotzen 0 degree of soft tissue injury in 13 and 1 degree in 9.Results There was no significant difference in the anatomic parameters between the two groups before operation.Postoperative calcaneal B(o)hler angle of stent group (27.77°±2.86°) was less than that of the plate group (30.45°±3.45°),and Gissane angle of stent group (131.23°±3.92°) was larger than that of the plate group (127.82°±4.65°);axis angle of stent group (19.23°±2.20°) was less than that of the plate group (22.64°±5.14°);calcaneal width of stent group (33.61±3.43 mm) was less than plate group (36.05±3.26 mm),and the difference have statistical significance.The calcaneal length of the stent group (63.23±5.67 mm) was smaller than that in the plate group (63.59±4.58 mm),but there was no significant difference.The time from the injury to surgery in stent group (4.77±0.83 d) was less than that in the plate group (6.68± 1.84 d),the blood loss of stent group (45.00±6.04 ml) was significantly less than that of the plate group (292.95±43.66 ml).The fracture healing time of stent group (9.31± 1.38 week)was less than that of the steel plate group (9.82± 1.40 week),but there was no significant difference.About limb function American Orthopaedic Foot and Ankle Society (AOFAS) score,7 cases in the stent group were excellent,3 cases good,1 cases fair,2 cases poor;and 9 cases of the plate group were excellent,7 cases good,3 cases fair,3 cases poor,there was no significant difference.Conclusion For the Sanders Ⅱ / Ⅲ type calcaneal fractures and Sanders type ⅣV patients associated with soft tissue damage which are not suitable for open reduction and internal fixation in short term,Ilizarov technique is a good option.

Objective To evaluate clinical outcomes of treating displaced intra-articular calcaneal fractures with Orthofix external fixation (EF) in comparison with open reduction and internal fixation (ORIF).Methods Between February 2013 and December 2014,39 patients with 41 calcaneal fractures were treated operatively and fully followed up at our department.They were 27 men and 12 women,aged from 27 to 56 years(average,42.5 years).The left foot was affected in 15 cases and the right in 26.By the Sanders classification,there were 11 cases of type Ⅱ,22 ones of type Ⅲ and 8 ones of type Ⅳ.The 5 open fractures were Gustilo type Ⅰ (2 cases) and Gustilo type Ⅱ (3 cases).Of the 11 fractures complicated with soft tissue injury,4 were Tscherne-Oestern type Ⅰ and 7 Tscherne-Oestern type Ⅱ.The patients were divided into group EF (25 cases) and group ORIF (16 cases) according to the operation they had received.The 2 groups were compared in intraoperative indexes and follow-up radiological data.The American Orthopaedic Foot and Ankle Society (AOFAS) scores for ankle and hindfoot were recorded at the final follow-up for every patient.Results The mean duration of surgery,intraoperative bleeding,time for hospitalization and bone healing in group EF were significantly less than in group ORIF (P ＜ 0.05).There were no significant differences between the 2 groups in follow-up duration,AOFAS score,Bthler angle,Gissane angle,calcaneal axis,calcaneal horizontal length,tuberosity height,hillock calcaneal height,calcaneal width,or talar inclination angle (P ＞ 0.05).According to the AOFAS scores at the final follow-ups,15 cases were rated as excellent,8 as good and 2 as fair in group EF while 10 were rated as excellent,5 as good and one as fair in group ORIF.Conclusions All types of calcaneal fracture can be treated using Orthofix external fixation which may lead to advantages of earlier surgery regardless of soft tissue condition,minimal invasiveness with less devascularization to the calcaneus and decreased risk of complications,and good clinical outcomes.

Objective: Hand and wrist research has recently shown obvious progress. The quantity and quality of publications from different nations, however, have not been analyzed. In our study, we aimed to assess the characteristics of worldwide productivity in hand and wrist literature using highly cited subspecialty journals.Methods: Literature search using the Web of Science database was conducted to identify hand and wrist articles in four highly cited subspecialty journals from 2005 to 2014. The number of articles, impact factors and citations were analyzed to evaluate the contributions of different countries. Publication activity was adjusted for the countries by population size.Results: A total of 4268 publications were identified. The number of articles showed a significant increase of 2.10-fold between 2005 and 2014 (p = 0.0001). North America, West Europe, and East Asia were the most prolific areas. The majority of publications (92.03%) were from high-income countries, 7.97% from middle-income countries, and no publications from lower-income countries. The United States published the most articles (53.89%), followed by United Kingdom (6.51%), Japan (6.14%), Canada (3.70%), and China (3.37%). Articles originating from the United States showed the greatest number of total 5-year impact factors (5y-IF) (4059.56) and total citations (17,998). When normalized to population size, United States ranked the first (7.16), followed by Sweden (6.53), and Netherlands (5.72). However, Netherlands (1.893) had the highest mean 5y-IF, followed by Germany (1.884) and Australia (1.883). Sweden had the highest average citations per article (11.38), followed by Germany (9.63), and Australia (9.08).Conclusions: The number of publications of hand and wrist research shows a significant increase during the past 10 years. The United States is the most productive country in hand and wrist literature. However, some European countries and Australia may have higher quality of articles according to mean 5y-IF and mean citations per article. (C) 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

OBJECTIVE:To compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament.METHODS:From January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically.RESULTS:The follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905).CONCLUSION:Treatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.

200 papers on nerve root type cervical spondylosis treated with Chinese medicine were retrieved and 38 papers with complete diagnostic criteria and medical statistics were included for study. The results showed acupuncture, massage, and herbal therapy were three common methods and have their own advantage, but systemic, standardized and normative treatment program was lack. In the meantime of treating nerve root type cervical spondylosis, prevention should also be paid attention. The treatment, prevention and exercise on the whole therapeutic idea should be established, which has far-reaching significance.

目的：探讨 Taylor 空间支架外固定治疗胫腓骨开放性骨折的临床疗效和安全性。方法：2012年8月至2014年7月，采用Taylor 空间支架外固定治疗胫腓骨开放性骨折患者21例，男15例、女6例；年龄19～55岁，中位数29岁；左侧9例，右侧12例。骨折位于上段1例、中下段20例。Gustilo 骨折分型，Ⅱ型7例、ⅢA 型12例、ⅢB 型2例。受伤至手术时间0．5～5 h，中位数3．5 h。术后随访观察骨折愈合、患肢功能恢复及并发症发生情况。结果：本组21例患者均获随访，随访时间12～21个月，中位数14个月；骨折均愈合，愈合时间10～24周，中位数14周。术后10个月，参照罗从风等制定的标准评定下肢力线恢复情况，本组优20例、可1例。术后1年，参照 Johner －Wruhs 胫骨干骨折治疗最终效果评价标准评定患肢功能，本组优14例、良4例、可3例。术后并发钉道感染3例，经换药及口服抗生素治疗后感染控制。结论：采用 Taylor 空间支架外固定治疗胫腓骨开放性骨折，可维持骨折复位，有利于骨折愈合和患肢功能恢复，安全可靠。

目的：探讨锁定钢板内固定结合肱骨头植骨重建治疗肱骨近端 Neer 三、四部分骨折的临床疗效和安全性。方法：2012年12月至2014年1月收治30例肱骨近端骨折患者，男13例、女17例；年龄35～76岁，中位数54岁；Neer 三部分骨折15例、四部分骨折15例。均为单侧闭合性损伤，未合并严重神经损伤。采用锁定钢板内固定结合肱骨头植骨重建治疗，术后随访观察临床疗效和安全性。结果：所有患者均顺利完成手术，未发生重要血管神经损伤。4例发生切口延迟愈合，未发生切口感染。所有患者均获随访，随访时间12～24个月，中位数18个月。所有患者骨折均愈合。1例发生螺钉切割肱骨头现象，未发生钢板及螺钉断裂、肱骨头坏死及骨折畸形愈合等并发症。术后多数患者出现肌肉废用性萎缩，以三角肌及肱二头肌萎缩为主，大部分患者在3个月后基本恢复肌肉功能。术后患肩功能逐渐恢复，按照 Constant －Murley 肩关节评分量表评定疗效，术后3个月、6个月及12个月时的评分分别为（55．97±10．06）分、（81．37±10．06）分、（86．87±6．90）分。结论：采用锁定钢板内固定结合肱骨头植骨重建治疗肱骨近端 Neer 三、四部分骨折，骨折端稳定性好、骨折愈合率高、短期内并发症少、肩关节功能恢复满意。

[目的]探讨Maisonneuve骨折的诊断特点和手术治疗。[方法]自2006年6月～2010年10月本科收治Maisonneuve骨折20例,男性12例,女性8例;年龄23～55岁,平均33.2岁;致伤原因:交通事故10例,跌倒扭伤6例,运动损伤4例,均为闭合性损伤,X线显示均存在高位腓骨骨折及下胫腓联合分离,13例伴有内踝骨折。手术均采用切开复位,逆骨折发生顺序进行复位,按照下胫腓联合-后踝-内踝的复位顺序复位。[结果]20例患者中,7例在本次入院前出现漏诊,漏诊率35%。本组20例均获得随访,随访时间15～24个月,平均17.5个月,20例均获得骨性愈合,平均愈合时间12.5周。按美国足踝外科协会(AOFAS)评分系统对踝关节的疼痛、步态、功能、活动度、影像学表现进行评定;85～100分15例,75～85分4例,60～75分1例,低于60分0例。[结论]在临床中遇到旋前外旋损伤机制的踝部骨折患者,要考虑Maisonneuve的可能,重视临床查体和小腿全长X线检查,手术治疗骨折的同时,要重视内侧结构、下胫腓关节及踝穴的重建。