OBJECTIVE:To investigate clinical effect of sternoclavicular hook plate in treating acute proximal clavicle fracture.METHODS:The clinical of 12 patients with acute unstable proximal clavicle fracture from June 2016 to June 2019 were retrospectively analyzed. There were 8 males and 4 females, aged from 46 to 63 years old. Ten patients caused by car accident and 2 patients caused by high falling. All patients had multiple injuries;the time from injury to surgery ranged from 2 to 14 d. All patients were treated with domestic sternoclavicular joint hook plate. The operative time ranged from 40 to 115 min. The intraoperative bleeding volume ranged from 30 to 110 ml, follow-up time ranged from 10 to 36 months, the fracture healing time ranged from 8 to 18 weeks. At the latest follow-up, the efficacy was evaluated by using shoulder joint function score (Rockwood score).RESULTS:All 12 patients were followed up, with no obvious pain at the latest follow-up. The rockwood scores of the affected shoulder ranged from 13 to 14, and the healthy shoulder ranged from 14 to 15.CONCLUSION:The sternocleidoclavicular joint plate is fixed with preformed plate. The cantilever is designed to retain the motion of the sternoclavicular joint. It's safe and simple, avoid, the injury of important organs during operation, and has a good prognosis. It is an ideal fixation method for the treatment of proximal clavicle fracture.

PURPOSE:To investigate the surgical effects of modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS:From April 2013 to October 2017, a total of 53 patients with thoracolumbar OVCF were treated with controllable balloon percutaneous kyphoplasty (C-PKP). Peri-operative parameters including days from injury to operation, operation time, injected cement volume, cement leakage and complications were collected. Visual analogue scale (VAS) and Cobb angle before and after operation were applied to evaluate surgical effects. Moreover, a total of 53 cases treated with traditional balloon of percutaneous kyphoplasty were retrospectively analyzed and compared with C-PKP in above parameters. RESULTS:C-PKP achieved significant fewer events of cement leakage (type C) than that of traditional PKP (5/53 vs 13/53, p < 0.01). The patients were followed up for 10.8 ± 4.2 months; VAS and Cobb angle of the injured vertebra in both two groups at three days and final follow-up were significantly improved compared with that before surgery (p < 0.05), while there were no significant differences between the two groups regarding the VAS and Cobb angle at corresponding time points (p > 0.05). CONCLUSIONS:C-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCF, and it can reduce cement leakage.

Transient osteoporosis of the hip(TOH) is classified as a type of bone marrow edema syndrome. TOH is lack of previous study and there is still controversy about his pathogenesis. In recent years, with the development of multi-discipline, such as imaging, pathology, molecular biology, the study has found that the pathological mechanism is complex, while its mechanism is still not clear, which need further research. This paper summarizes the research progress on the pathogenesis of TOH from neurogenic, osteonecrosis, abnormal vascular function, subchondral fracture, heredity and regional acceleration and son on.

We present the case of a 91-year-old woman who presented with a 2‑day history of progressive pain and immobility of the right shoulder joint after fever of unknown etiology. Aeromonas sobria was isolated from a culture of purulent synovial fluid. The clinical condition gradually improved with the application of appropriate antibiotics and no surgical intervention was necessary. This report indicates that acute septic arthritis may result from Aeromonas veronii biotype sobria infections in healthy people. This case is contrary to the previous reports due to the absence of obvious risk factors.

OBJECTIVE:To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur.METHODS:From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction.RESULTS:The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation(P<0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation(P<0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing.CONCLUSIONS:Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.

二分髌骨临床相对少见，常因查体发现，有时伴有外伤，甚至会被误认为髌骨骨折，导致误诊误治。笔者现就二分髌骨的再认识作一综述。

目的 探讨后正中入路微创治疗后交叉韧带(PCL)止点撕脱骨折的方法和临床疗效.方法 收集自2007年10月～2013年9月后交叉韧带止点撕脱骨折患者44例的病例资料,采用膝关节后内侧倒”L”形入路方法治疗25例,后正中入路治疗19例,记录两组患者的手术时间、切口长度、骨折复位情况及Lysholm评分,评价并比较手术疗效.结果 所有病例随访时间为(7.5±2.1)个月.膝后内侧入路组手术时间为(53.2±12.3)min,切口长度为(13.6±3.3)em,后正中入路组手术时间为(32.6±9.2)min,切口长度为(2.3±0.8)cm,组间比较差异均有统计学意义(P＜0.05);两组病例术前Lysholm评分为(47.65±5.02)和(48.73±4.28),术后6个月分别提高到(91.36±4.87)和(90.52±3.72),与术前相比,差异有统计学意义(P＜0.05),但术前、术后Lysholm评分的组间比较,差异均无统计学意义(P＞0.05).结论 后正中入路微创治疗后交叉韧带止点撕脱骨折创伤小、手术时间短,能达到常规入路同样的手术效果,是一种安全有效的方法,值得临床推广.

Objective To investigate the clinical efficacy of three-point puncture combined with controllable balloon percutaneous kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fracture (OVCF).Methods From December 2010 to November 2013,37 OVCF patients with 43 fractured vertebrae were treated with three-point puncture combined with controllable balloon PKP.They were 11 males and 26 females,aged from 56 to 95 years (average 67 years).Clinical efficacy was evaluated and compared by visual analogue scale (VAS) scores and cobb angles in their X-ray films at preoperation,3 days postoperation and final follow-up visit.Results All the PKP operations were successful.The operation time ranged from 25 to 80 minutes (average,40 minutes).The cement injected into each vertebra was from 3 to 4.5 mL (average,3.8 mL).The cement was well distributed in the vertebrae without such complications as nerve injury or cement leakage into the spinal canal.Thirty-six patients with 42 fractured vertebrae were followed up for 3 to 35 months (average,11 months).At 3 days postoperation and final follow-up,the VAS scores were respectively 2.3 ± 0.3 and 1.9 ± 0.2 and the cobb angles were respectively 7.8° ± 0.7° and 8.7° ± 0.8°,significantly improved than those at preoperation (6.9 ± 0.8 and 18.5° ± 6.0°) (P ＜ 0.05).There were no significant differences in VAS score or cobb angle between 3 days postoperation and the final follow-up (P ＞ 0.05).Conclusion Three-point puncture combined with controllable balloon PKP is an efficient treatment for thoracolumbar OVCF.

目的:自行改良经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的工作通道控制球囊扩张方向,并应用其行PKP手术(controllable percutaneous kyphoplasty,C-PKP)治疗胸腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF),总结其治疗OVCF的优势.方法:将传统经皮椎体后凸成形术的工作通道末端2cm改为边缘圆钝的圆弧状和斜坡状缺口结构,通过调整工作通道方向控制球囊扩张方向.从2010年12月～2013年12月应用其治疗43例胸腰椎OVCF患者,并与同期收治的48例采用PKP治疗的OVCF患者比较.两组患者年龄、性别比、骨折部位、术前疼痛视觉模拟评分(visual analogue scale,VAS)、骨密度和骨折程度比较无统计学差异(P＞0.05),具有可比性.比较两组患者术后3d及术后6个月时的VAS评分、楔形角和后凸角的恢复情况及术后骨水泥渗漏情况.结果:所有患者均顺利完成手术,术中8例发生骨水泥漏,其中C型骨水泥漏6例,B、S型各1例,均发生在传统PKP组,均未出现神经症状及血管栓塞等并发症;C-PKP组骨水泥渗漏发生率低于PKP组,差异有统计学意义(P＜0.05).随访11.3±5.2个月(6～35个月),两组患者术后3d及术后6个月的VAS评分、楔形角及后凸角与术前比较差异均有统计学意义(P＜0.05),两组患者同一时间点的VAS评分、楔形角及后凸角比较差异均无统计学意义(P＞0.05).结论:应用C-PKP治疗胸腰椎OVCF是一种有效方法,可降低骨水泥渗漏的发生率.

目的：观察用编织法手术治疗髌骨下极粉碎性骨折的疗效。方法使用克氏针、钢丝利用编织法手术治疗髌骨下极粉碎性骨折21例。采用 Bostman 髌骨骨折功能评分优良率，X 线检查及膝关节功能检查评定临床效果。结果21例手术时间55～85min，过程顺利，术后2周内出院，切口愈合良好,术后6个月随访X 线摄片示髌骨均骨性愈合，Bostman髌骨骨折功能优16例（76.2%），良5例（23.8%）；膝关节伸（-3±2）°，屈(125±5)°。随访中未见切口感染、膝前疼痛、异物反应及内固定松动断裂等情况。结论编织法治疗髌骨下极粉碎性骨折，固定可靠，术后患者能够进行早期功能锻炼，早期负重，膝关节功能恢复好。

目的探讨跟骨骨折的手术技术及内固定方法。方法取外踝尖下方1.5~2.0,跟距关节水平横形小切口,短重建钢板固定跟骨骨折36例44足。结果本组获得随访3~36个月,采用Fernandez评分标准分为4级:本组优26足,良9足,可7足,差2足,优良率为79.54%,优良可率达到95.45%。结论本组所设切口位于跟骨前中部,易于暴露后关节面,因后关节面的凸面与距骨的凹面相吻合,及结节关节角的较好恢复,符合生物力学稳定性要求,减少了创伤性距下关节炎的发生率。术中手术技巧的运用,显著减少了创口感染、延迟愈合的发生。