To evaluate the possibility of judging the degree of bone healing by wall thickness analysis provide reference for quantitative analysis of bone healing. Patients with lower limb fracture from April 2014 to October 2019 were recruited and divided into bone healing (group A), poor bone healing (group B), and nonunion (group C). Models were built in Mimics 20.0 with DICOM 3.0 data obtained from patient’s CT. Three-dimensional geometric models of unaffected limb and affected limb after simulated removal of internal fixation were established, corresponding to basic phase and simulated phase, respectively. Wall thickness analysis was performed to obtain median wall thickness after meshing. R2 (median wall thickness ratio), R4 (CT value ratio), and R5 (healing index ratio) were obtained by calculating the ratio of each value in simulated phase to that in basic phase. Receiver operating characteristic curve analysis was used to evaluate the ability of Wall Thickness Analysis to indicate fracture healing. 112 CT scans of 79 patients were included in the study. The frequency of categorization in groups A, B, and C was 49, 37 and 26, respectively. The median R2 in groups A, B, and C was 0.91, 0.80, and 0.67, respectively (group A > group B > group C, all P < 0.05). The best cutoff point for R2 in predicting bone healing was 0.84, and predicting bone nonunion was 0.74. The Wall Thickness Analysis can be used to quantitatively evaluate fracture healing state, with median wall thickness ratio as a more intuitive and reliable judgment index.

Osteofacial compartment syndrome (OCS) is one of the serious complications in traumatic orthopedics. If not treated in time, OCS may result in irreversible damage to nerve and muscle,even amputation or death in serious condition. 5P presents to be the classic clinical diagnosis of OCS, but it is highly subjective and cannot timely and accurately judge the progression of the disease. Intracompartment pressure manometry is the main auxiliary method for the diagnosis of OCS. Although there are many manometry methods, there is still no authoritative pressure threshold as the diagnosis standard. Clinicians often aggressively perform fasciotomy to avoid serious complications, leading to unnecessary fasciotomy. The authors retrospectively reviewed the data of patients with OCS treated at Air Force Hospital of Eastern Theater of PLA from March 2010 to March 2020 and found that some patients with OCS had gradual alleviation of clinical symptoms after appropriate conservative treatments such as brace releasing, limb stabilization and swelling subsidence, with no need of fasciotomy. However, the symptoms of some patients progressively aggravated after the above-mentioned traditional treatments and timely fasciotomy was required. The authors graded the severity of OCS and proposed for the first time the OCS grading criteria according to quantitative clinical results and quantitative indicators such as ratio of mean blood flow velocity of bilateral arteries and pulse wave changes, aiming to take corresponding intervention measures for patients with different OCS classifications, carry out more precise treatment and avoid unnecessary fasciotomy.

目的 比较人工真皮与游离植皮修复指腹皮肤软组织缺损的临床效果.方法 回顾性分析自2018年6月至2020年6月间收治的指腹皮肤软组织缺损病例115例.根据手术方式不同分为游离植皮组63例,人工真皮组52例.游离植皮组男56例,女7例,平均年龄(45.56±7.57)岁;人工植皮组男47例,女5例,平均年龄(48.85±6.26)岁.游离植皮组在清创后一期采用自体取中厚皮片植皮;人工真皮组在清创后一期采用人工真皮覆盖;两组术后均加压包扎,术后1周拆除加压包,隔日换药.比较两组移植物存活率、手术次数、手术时间、住院时间、住院费用和创面完全愈合时间;采用国际标准评价两组指腹感觉等级和两点辨别觉;采用总主动活动度(total active range of motion,TAM)系统评定两组手功能恢复情况.结果 两组移植物存活率、手术次数和住院时间比较,差异均无统计学意义(P＞0.05);游离植皮组手术时间长于人工真皮组,差异有统计学意义(P＜0.05);游离植皮组住院费用和创面完全愈合时间均少于人工真皮组,差异有统计学意义(P＜0.05);两组指腹感觉等级达到S3+比例、指腹两点辨别觉和TAM评分比较,差异均无统计学意义(P＞0.05).结论 人工真皮修复指腹皮肤软组织缺损的手术操作更加简单、创伤更小、临床效果良好,但增加了治疗时间和住院费用.

Objective:To explore the efficacy of distracting external fixator for tibiofibular fractures combined with osteofascial compartment syndrome.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with tibiofibular fractures combined with osteofascial compartment syndrome admitted to Air Force Hospital from Eastern Theater of PLA from March 2009 to March 2019, including 47 males and 15 females, aged 20-78 years［（47.1±13.4）years］. There were 30 patients with tibia shaft fractures, 17 with tibia plateau fractures and 15 with tibia distal fractures. The fractures were classified as type 4A in 18 patients, type 4B in 24 and type 4C in 20 according to AO/OT classification. Distracting external fixation was performed for 30 patients（Group A）and calcaneal tuberosity traction for 32 patients（Group B）. Levels of alanine aminotransferase（ALT）, urea nitrogen（BUN）, creatine kinase（CK）and lactate dehydrogenase（LDH）of the injured limb were compared between the two groups during traction. Additionally, the fasciotomy rate, time of damage control treatment（observation interval from trauma to stage II definitive surgery）, time of stage II definitive surgery, internal fixation modalities of stage II definitive surgery, rate of needle tract infection and rate of non-planned secondary surgery were compared between the two groups. The limb function was assessed using Johner-Wruhs scoring system at the last follow-up.Results:All patients were followed up for 12-22 months［（15.1±2.7）months］. Level of CK in Group A was 315.6（140.0, 531.5）U/L, significantly lower than that in Group B［465.5（277.0, 1240.5）U/L］（ P<0.05）. The two groups revealed no statistical differences in levels of BUN, CK and LDH（ P>0.05）. The fasciotomy rate in Group A［40%（12/30）］was higher than that in Group B［34%（11/32）］, but the difference was statistically insignificant（ P>0.05）. The time of stage II definitive surgery in Group A was（68.5±17.1）minutes, significantly lower than that in Group B［（89.0±15.1）minutes］（ P<0.05）. The rate of non-planned secondary surgery in Group A［3%（1/30）］was lower than that in Group B［25%（8/32）］（ P<0.05）. There were no statistically significant differences in time of damage control treatment, internal fixation modalities of stage II definitive surgery and rate of needle infection between the two groups（ P>0.05）. According to Johner-Wruhs scoring system, the function in Group A were excellent in 17 patients, good in 5, fair in 2 and poor in 6 at the last follow-up, with the excellent rate of 73%. However, the difference was not statistically significant when compared to Group B: excellent in 13 patients, good in 3, fair in 7 and poor in 9, with the excellent rate of 50%（ P>0.05）. Conclusion:Compared with calcaneal tuberosity traction, the distracting external fixation of tibiofibular fractures combined with osteofascial compartment syndrome can attenuate soft tissue damage during the traction and shorten the time of stage II definitive surgery by maintaining intraoperative fracture reduction.

目的 利用壁厚分析法定量判断胫骨骨折愈合程度,为临床判断胫骨骨不连和骨延迟愈合提供直观的诊断依据.方法 对48例患者下肢患侧与健侧进行三维建模后,计算最大壁厚(maximum wall thickness,MWT),并进行比值计算,将其对比值(B值)作为骨愈合程度的量化指标全程动态观察.当BMWT2＞0.9且BMWT1＞0.9时判定骨愈合;当BMWT2 = 0.9-0.7时判定骨愈合不良,定期复查该数值无明显增长,连续两次,可以判定骨不连,需要第二次手术干预治疗;当BMWT3＞0.9,且BMWT1＜0.7和BMWT2＜0.7时,可判定为内固定失效,二次手术中需更换内固定.对于临床诊断进行二次修正,并观察最终临床愈合结果.结果 对48例患者各复查时间段影像学进行临床诊断分析及有限元壁厚分析比较,临床判断骨延迟愈合21例,骨不连27例,再利用壁厚分析修正判断,骨延迟愈合34例,骨不连14例.其中2例判断内置物失效,采用更换内固定植骨干预,12例判断内固定仍然有效,单纯植骨手术干预,所有病例最终都取得骨愈合.进行Bowker检验法得到P= 0.094,判断壁厚分析方法与临床诊断相符合.结论 采用壁厚分析法可以定量分析骨折端的骨愈合程度,实现骨愈合程度的快速计算.病例结果证实有限元壁厚分析法优于单纯临床诊断法,对早期判断骨愈合不良有更好的鉴别诊断意义.

目的 建立下肢长骨干有限元分析模型,比较有限元骨承载力分析法与壁厚分析法预测下肢长骨干骨愈合程度的效果.方法 收集4例临床诊断为下肢长骨干骨折不愈合患者的CT扫描数据,建立有限元分析模型,分别采用有限元骨承载力分析法和壁厚分析法进行二次模拟仿真计算,共进行8次分析.骨承载力分析法通过有限元分析得出健侧与患侧应力-应变曲线,利用GraphPad计算曲线下总面积进行比值分析.壁厚分析法通过判读骨皮质壁厚薄弱区的情况,通过材料密度与刚度转化关系对最大壁厚分值进行比值分析.结果 4例临床诊断均为骨折不愈合,骨承载力法修正诊断结果为2例骨折愈合,2例骨折延迟愈合,内固定均有效;壁厚分析法修正诊断结果为3例骨折愈合,1例骨折延迟愈合,内固定均有效.ROC曲线分析结果显示,有限元骨承载力分析更加接近骨真实情况并且敏感性更好,有限元壁厚分析对判定骨愈合的特异性更高.结论 骨承载力分析法能更好地模拟目标骨段的真实载力环境,但是计算过程中软件切换次数较多,结果飘移度较大.壁厚分析法省略了赋值和载力环境的调试过程,在同一个软件下分析骨愈合过程中骨痂变化情况,能够更有效预测骨愈合程度.

背景:既往研究表明,骨骼肌缺血再灌注损伤在四肢再植术中是一个常见而且严重的临床问题,严重影响再植肢体术后存活率及功能.表没食子儿茶素没食子酸酯(epigallocatechin gallate,EGCG)具有较强抗氧化性、抗炎及抑制细胞凋亡的作用.目的:探讨EGCG在大鼠下肢骨骼肌缺血再灌注损伤中的作用.方法:将雄性SD大鼠30只随机分为5组:假手术组、缺血再灌注组、EGCG组(10,100,200 mg/kg),除假手术组外,其他4组建立下肢缺血再灌注损伤模型,EGCG组在再灌注前30 min按照体质量腹腔注射EGCG.缺血4 h再灌注2 h后,取下腔静脉血和右腓肠肌组织,ELISA法检测血清中肿瘤坏死因子α和白细胞介素1β水平,腓肠肌组织中超氧化物歧化酶和髓过氧化物酶水平;苏木精-伊红染色法观察腓肠肌组织病理形态;TUNEL实验观察腓肠肌组织中细胞凋亡情况.结果与结论:①与缺血再灌注组比较,EGCG组(100,200 mg/kg)血清中肿瘤坏死因子α和白细胞介素1β水平及腓肠肌组织中髓过氧化物酶水平降低,超氧化物歧化酶水平升高,且与EGCG剂量呈正相关性;②苏木精-伊红染色结果显示EGCG组(100,200 mg/kg)肌纤维连续性及完整性、间质水肿程度等病理表现得到明显改善;③TUNEL实验结果显示EGCG组(100,200 mg/kg)凋亡细胞明显减少;④结果表明,EGCG通过减轻炎症反应、抗氧化应激及抑制组织细胞凋亡保护大鼠骨骼肌缺血再灌注损伤.

[目的]探讨牵引外固定技术在胫腓骨开放性骨折初期治疗中的意义.[方法]回顾性分析本院2012年2月～2017年8月处理的96例胫腓骨开放骨折患者,其中,40例在初期治疗采用外支架牵引固定(牵引外固定组),56例采用常规外支架技术(常规外固定组),两组均二期改行内固定术.比较两组临床与影像资料.[结果]牵引外固定组初次外固定手术时间和改行内固定术的间隔时间均显著短于常规组(P＜0.05).针道感染率牵引外固定组为2.50％ (1/40),而常规外固定组为16.07％ (9/56),差异有统计学意义(P＜0.05).牵引外固定组二期内固定手术时间显著少于常规外固定组(P＜0.05).随访14～25个月,平均(18.26±5.56)个月.两组开始负重时间和完全负重时间,以及末次随访时膝关节ROM、踝关节ROM和VAS评分的差异均无统计学意义(P＞0.05).影像方面,两组在内固定术后残余畸形和骨折愈合时间的差异均无统计学意义(P＞0.05).[结论]对开放性胫骨骨折采用初期处理采用牵引外固定,有利于二期内固定术.

目的 利用四维有限元骨承载力分析的方法,对于长管骨骨折术后患者采用双腿平行CT扫描、双腿几何建模、有限元分析的方法,通过与健侧肢体相同部位的对比分析,根据时间轴上的变化趋势,判断目标骨段骨愈合的程度,辅助诊断长管骨的骨愈合、骨延迟愈合和骨不连.方法 选择2014年到2017年间,临床诊断骨延迟愈合的26例病例进行了系统随访.在骨愈合不同阶段的CT数据进行三维建模,材料赋值,建立下肢长管骨的三维有限元模型,模拟仿真计算目标骨段承载受力状况,通过有限元分析软件,进行单轴压缩实验的仿真,分析双腿目标骨段的受载荷情况.结合米塞斯应力最大值及载力-位移曲线下总面积进行比值分析,作为观察骨愈合程度的指标,对于临床诊断进行二次修正,并观察最终临床愈合结果.结果 所有病例均获得2～4年的随访,平均随访时间3.4年.临床诊断骨延迟愈合完整病例26例,对26例病例采用有限元骨承载力分析法共分析54次,修正诊断为:6例(23.1％)病例判定骨愈合;16例(61.5％)病例判定骨愈合不良;4例(15.4％)病例判定骨不连.利用米塞斯应力最大值及载力-位移曲线下总面积进行比值分析,并进行卡方检验,差异无统计学意义.通过Fisher精确概率检验法得到P=0.170,具有统计学意义,两种方法存在非随机相关性.结论 采用有限元骨承载力分析的技术,可以三维定量分析骨折端的骨愈合程度,结合时间轴上变化规律的描述,可以给骨不连和骨延迟愈合的临床诊断提供一个相对客观的诊断依据.该方法也较好的观察到,高能量损伤的骨愈合过程难以按照经典骨愈合理论的进程演变,通常其骨愈合所需的时间更长,但能显示出其缓慢的愈合趋势,应用前景广阔.

背景:利用CT扫描骨折端,而后进行微分建模分析,是判断骨愈合程度一种行之有效的方法.为获得微分建模仿真的高精度,如何选择最优的CT扫描参数则需要进一步研究分析.目的:在个性化微分建模分析法中,对比不同CT扫描参数对建模精度的影响,验证个性化微分建模法对仿真目标骨段还原的准确性和有效性,探索该方法在判断下肢长管骨骨愈合程度中的研究价值.方法:用猪股骨建立内固定模型,分别采用80 kV-300 mA(A组-低剂量组)、120 kV-335 mA(B组-自动管电流调控系统组)、140 kV-300 mA(C组-手动设置对比组)、140 kV-80 mA(D组-高千伏低毫安组)4组不同曝光条件,进行相同螺距、层厚及环境的扫描,采用相同CT值范围,应用微分建模分析法分别进行目标骨段建模.对CT扫描图像中金属伪影的平均面积、最大面积,微分建模分析后的平均CT值、体积和最大壁厚峰值,以及4组扫描条件下辐射量进行比较,判断减小金属伪影、建模准确度及辐射情况,从而选出最优CT扫描参数.结果与结论:①伪影测量方法结果:A组金属伪影较多,对骨组织遮挡明显,存在漏诊可能;D组金属伪影最少,骨组织周围遮挡少,但图像对比度欠佳,灰雾度较大;而B、C组区别在于图像清晰度,对诊断的准确性基本一致,所以伪影大小排序为:A组>B组>C组>D组;②微分建模分析法结果:B组由于伪影较小,CT值丢失较少,所以仿真出的模型更加接近真实,而且B组采用自动管电流调控系统后,可以明显看出辐射量较小,更加保护患者;③提示B组条件下的CT扫描,可以有效减少金属伪影带来的干扰,更好地保留CT灰度值的原始信息,最大程度地保留目标骨段的密度信息.所以在建立微分建模时,CT自动管电流调控系统为最优的CT扫描参数,不仅可提高个性化微分建模的仿真精度,也增加了计算的准确性.

血栓闭塞性脉管炎,又称 Buerger氏病,最早于 1879 年被报道,中医将其归于脱疽范畴.这是一种少见的慢性复发性四肢远端中、小动静脉的节段性炎症性疾病,常伴有腔内血栓形成,下肢多见,表现为患肢缺血、疼痛、间歇性跛行、足背动脉搏动减弱或消失和游走性表性静脉炎,严重者有肢端溃疡和坏死[1].作为血管外科的一种疾病,某些初发症状却会使患者初次就诊于骨科而引起误诊.下面就以一例被初诊为甲沟炎的下肢血栓闭塞性脉管炎的病例,通过文献回顾,分析其诊断原因.

[目的]探讨平衡牵引外支架辅助间接复位在胫骨远侧干骺端骨折前外侧入路微创接骨板接骨术(MIPO)中的应用效果.[方法]回顾性分析2012年8月～2017年8月治疗的32例胫骨远侧干骺端骨折临床资料,术中先用单针双边外支架平衡牵引、复位与临时固定,而后MIPO手术.记录手术时间,包括复位时间和透视时间.术后根据正侧位X线片分别测量胫骨内-外翻、前-后屈成角的角度,评估复位质量.记录手术并发症和骨折愈合时间.末次随访应用Johner-Wruhs评分评价功能.[结果]32例中简单骨折13例,粉碎性骨折19例,两者之间的复位时间、透视时间和手术时间差异无统计学意义(P＞0.05).两者术后内-外翻与前-后屈成角均不超过5°,两者之间差异无统计学意义(P＞0.05).所有患者均获得术后随访12～21个月.两者之间骨折愈合时间差异无统计学意义(P＞0.05).术后l例浅表感染,2例敏感性瘢痕,均发生在远侧微创切口.1例骨折不愈合,二期植骨后愈合,无畸形愈合及内固定失效,骨折愈合率96.88％.末次随访Johner-Wruhs评分优良率93.75％.[结论]平衡牵引外支架辅助MIPO手术,间接复位效果可靠,可重复性强,尤其适用于胫骨远侧干骺端粉碎性骨折前外侧入路微创手术.

目的 探讨损伤控制性外固定架(DCEF)的使用原则,在开放性胫骨中下段骨折治疗中的应用.方法 回顾性分析自2012-08-2017-03收治的63例开放性胫骨中下段骨折,31例一期使用DCEF原则外固定(DCEF组),32例采用传统外固定架(TEF)原则固定(TEF组),DCEF组全部转二期内固定,TEF组30例均转二期内固定.记录并比较2组外固定架操作时间、刨面皮肤坏死、针道感染、确定性手术时间间隔、手术切口感染和末次随访Johner-Wruhs评分.结果 63例均获得随访,随访时间平均15.7(12～24)个月.2组创面皮肤坏死率比较,差异无统计学意义(P＞0.05).与TEF组相比,DCEF组外固定架操作时间更短,二期外固定架转确定性手术时间间隔更长,差异有统计学意义(P＜0.05).与TEF组相比,DCEF组针道感染率、切口感染率更低,Johner-Wruhs评分优良率更高,差异有统计学意义(P＜0.05).结论 DCEF构型便于安装,骨针跨过损伤和二期手术区域,降低感染风险,不影响确定性手术时机.

Calcium homeostasis in osteoblasts plays fundamental roles in the physiology and pathology of bone tissue. Various types of mechanical stimuli promote osteogenesis and increase bone formation elicit increases in intracellular-free calcium concentration in osteoblasts. However, whether microgravity, a condition of mechanical unloading, exerts an influence on intracellular-free calcium concentration in osteoblasts or what mechanisms may underlie such an effect are unclear. Herein, we show that simulated microgravity reduces intracellular-free calcium concentration in primary mouse osteoblasts. In addition, simulated microgravity substantially suppresses the activities of L-type voltage-sensitive calcium channels, which selectively allow calcium to cross the plasma membrane from the extracellular space. Moreover, the functional expression of ryanodine receptors and inositol 1,4,5-trisphosphate receptors, which mediate the release of calcium from intracellular storage, decreased under simulated microgravity conditions. These results suggest that simulated microgravity substantially reduces intracellular-free calcium concentration through inhibition of calcium channels in primary mouse osteoblasts. Our study may provide a novel mechanism for microgravity-induced detrimental effects in osteoblasts, offering a new avenue to further investigate bone loss induced by mechanical unloading.

目的:探讨海桐皮汤在踝关节骨折术后康复中的临床效果.方法:选择2014年3月-2017年3月我院收治的64例踝关节骨折术后完成康复的患者,随机分成两组,每组32例,对照组采用关节主被动活动度训练理疗方法,实验组在采用对照组方法基础上加用海桐皮汤熏洗治疗,每日2次,1周为一个疗程,其中6天治疗,1天休息;总共4个疗程,随访6个月.结果:根据Olerud-Molander踝关节骨折功能评分,实验组的优良率在治疗4周、8周、12周后均明显高于对照组,两组比较差异具有统计学意义(P<0.05).结论:海桐皮汤在踝关节骨折术后康复中疗效确切,可以有效减少创伤性关节炎等并发症的发生.

Objective To analysis the evaluation value of blood coagulation and fibrinolytic indexes of lower limb venous thrombosis in patients with orthopaedic trauma. Methods We evaluated 230 patients with traumatic surgery in our hospital from January 2014 to June 2016. Color Doppler ultrasonography was used to detect DVT before and after operation. Plasma prothrombin time(PT),fibrinogen enzymes(Fbg),fibrinogen degradation products(FDP),activated partial prothrombin time(aPTT) and D-dimmer(DD) were tested.At the same time, we analyzed the relationship among blood glucose,blood pressure,gender,age and thrombosis. Results There were 37 patients with deep vein thrombosis of lower extremity in 230 cases and the incidence of DVT was 16.0%. The incidence of lower extremity venous thrombosis in patients with diabetes and high blood pressure were significantly higher than the control group(27.6% vs 12.2%;30.3% vs10.3 %). Preoperative and postoperative DD,FDP and Fbg in the thrombus group were significantly higher than that non-thrombosis group. The differences of PT and aPTT between the thrombosis group and the control group were not statistically. Conclusion Coagulation and fibrinolysis indicators help to screen and diagnose DVT.

目的:探讨海桐伸筋汤在膝关节周围骨折术后康复中的临床效果.方法:72例膝关节周围骨折术后康复患者,随机分成对照组和实验组,每组36例.对照组采用主被动关节功能训练、超声波方法,实验组在对照组方法基础上加用海桐伸筋汤熏洗治疗,比较两组的临床效果.结果:实验组在治疗4周、8周、3个月后的优良率均高于对照组,差异具有统计学意义(P＜0.05).结论:海桐伸筋汤在膝关节周围骨折术后康复中疗效确切,能够有效减少膝关节炎的发生,帮助膝关节功能的恢复,值得推广.

[Objective] To compare minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) for treatment of AO Type 41-C2 fracture.[Methods] A retrospective analysis was conducted on 69 patients with AO Type 41-C2 fracture surgically managed between August 2012 and March 2016.Of the 69 patients,37 patients were treated with MIPO (the MIPO group),while the remaining 32 patients treated with ORIF (the ORIF group).There were no significant differences in gender,age,cause of injury,injury severity of enveloping soft tissue,and time interval from injury to operation between the two groups (P＞0.05).The operative time,intra-operative blood loss,fracture healing time,and complications were compared between the two groups.[Results] The operative time in MIPO group was significantly shorter than that in the ORIF group (t=2.287,P=0.027),associated with significantly lesser intra-operative blood loss than the ORIF group (t=2.820,P=0.007).Skin necrosis at incision edge occurred in 4 patients,includingl in the MIPO group (2.70％) and 3 in the ORIF group (9.38％),all the 4 patient had Tscheme Grade 3 soft tissue injury,with significant difference between the two groups (P＜0.05).All the patients were followed up for 12 to 25 months with a mean of 18months.No significant difference was found in the average bone healing time between the 2 groups (t=1.608,P=0.115).Malunion happened in 2 patients of the MIPO group (5.41％),whereas 1 patient of the ORIF group (3.13％),without significant difference between them (x2=1.665,P=0.579).In addition,no significant difference was noted in HSS score between the two groups (t=1.296,P=0.201).[Conclusion] Both MIPO and ORIF have good results for treating AO Type 41-C2 fractures.By comparison,MIPO is superior to ORIF for treating the high-energy fractures especially with concomitant severe soft tissue lesions.

目的：比较微型铆钉和抽出钢丝法治疗锤状指的临床疗效。方法选取单纯伸肌腱止点撕脱导致的锤状指患者23例，11例采用微型铆钉修复，12例采用抽出钢丝法修复。23例患者术后均固定于近节指间关节屈曲、远节指间关节过伸位6周，6周后行手指功能锻炼。观察患者远节指间关节活动度。结果23例患者获7.2～12.3个月随访，微型铆钉修复患者远节指间关节活动度优6例，良4例，可1例；抽出钢丝法修复患者远节指间关节活动度优5例，良6例，差1例（由于功能锻炼过程中肌腱再撕脱）；两组比较差异无统计学意义（P＞0．05）。结论微型铆钉和抽出钢丝法治疗锤状指临床疗效均较好，但微型铆钉可有效防止肌腱再撕脱。

目的：探讨常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折时的效果差异。方法：2013年1月-2015年5月本科收治的GUSTILO-III型胫骨开放性骨折的患者49例，23例采用常规冲洗，26例采用脉冲冲洗，对于受伤至冲洗的时间差、冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况、感染率数据进行统计分析，并对冲洗前后的创面组织进行细菌培养。结果：两种冲洗方法在冲洗时间、冲洗量、伤口愈合时间、伤口愈合情况及感染率方面无明显统计学差异，与受伤至冲洗的时间差无统计学相关性。结论：常规冲洗与脉冲冲洗在治疗GUSTILO-III型胫骨开放性骨折均效果良好，而且两种方法效果无差异。