Objective： To explore the clinical efficacy of percutaneous minimally invasive spinal internal fixation system in the treatment of thoracolumbar fracture. Methods： 100 patients with thoracolumbar fracture in our hospital were selected and randomly divided into control group and observation group. The control group was treated with traditional open reduction and internal fixation， and the observation group was treated with percutaneous minimally invasive spinal internal fixation system， and the treatment effect of the two groups was statistically analyzed. Results： The therapeutic effect of observation group was better than control group（ P<0.05）. Conclusion： the percutaneous minimally invasive spinal internal fixation treatment thoracolumbar fractures system compared with the traditional treatment， with shorter operation time， intraoperative blood loss and shorter hospitalization time， less postoperative recovery fast， can effectively improve the treatment effect of patients， to avoid severe pain after surgery to the patients， has high clinical significance， recommended in clinical promotion.

目的:应用指动脉终末背侧穿支螺旋桨皮瓣修复指端软组织缺损的方法及临床效果。方法:自2018年10月至2019年7月我们采用指动脉终末背侧穿支螺旋桨皮瓣修复35例第2～5指末节软组织缺损的患者，供区取前臂全厚皮片植皮。结果:术后35例皮瓣全部存活，2例皮瓣远端部分坏死，经换药愈合，供区植皮全部成活。随访2～12个月，伤指外形好，无明显臃肿，皮瓣色泽、质地较好，皮瓣感觉平均达S 3＋，指间关节活动基本正常。按中华医学会手外科学会上肢部分功能评定试用标准评定：优28例，良6例，可1例；优良率为97.1%。 结论:指动脉终末背侧穿支螺旋桨皮瓣血供可靠，不牺牲指固有动脉，操作相对简单、安全，术后疗效满意，是修复指端软组织缺损的理想术式。

目的 探究经皮椎弓根内固定术对脊柱椎体骨折患者血清CRP和伤椎恢复的影响.方法 选取2016年4月至2019年6月桂林医学院第二附属医院收治的脊柱椎体骨折患者90例,按随机数字表法分为研究组与对照组,各45例.对照组患者行开放式内固定术,研究组患者行经皮椎弓根内固定术.观察两组患者手术相关指标;比较术前和术后30 d两组患者伤椎椎体前缘高度、椎间隙高度及Cobb角;对比术前和术后24、48 h两组患者血清CRP水平变化.结果 与术前比,术后30 d两组患者伤椎椎体前缘高度、椎间隙高度均增大,研究组大于对照组;Cobb角均减小,研究组小于对照组;与术前比,术后24～48 h研究组患者血清CRP水平呈先升高后降低趋势,对照组呈逐渐升高趋势,且术后24、48 h研究组均低于对照组;与对照组比,研究组患者手术出血量减少,术后住院时间缩短(均P<0.05).结论 经皮椎弓根内固定术作用于脊柱椎体骨折可有效调节血清CRP水平,缓解机体应激反应,恢复患者伤椎椎体前缘和椎间隙高度,减小Cobb角,加速术后恢复.

Objective This study was performed to compare the clinical effects of locking plates (LPs) with those of hook plates (HPs) in the treatment of Neer type II distal clavicle fractures. Methods From August 2014 to April 2018, 64 patients with Neer type II distal clavicle fractures were treated in our department. The clinical effects were assessed with respect to the operation time, intraoperative blood loss, incision length, fracture healing, postoperative pain, postoperative complications, and postoperative shoulder joint function. Results There were no significant differences in the healing time, operation time, or intraoperative blood loss between the LP and HP groups. The incision length was significantly shorter in the LP than HP group, and the postoperative complication rate was significantly lower in the LP than HP group. The visual analog scale score, Constant–Murley score, and University of California Los Angeles score were significantly better in the LP than HP group. Conclusions Compared with HPs, the use of LPs involves a smaller incision in the treatment of Neer type II distal clavicle fractures and significantly reduces postoperative pain and complications. Therefore, priority can be given to the use of LPs in the treatment of Neer type II distal clavicle fractures.

膝关节前交叉韧带在人体膝关节稳定中具有较高的作用价值,在前交叉韧带损伤后均无法自愈,对患者的生活质量造成了严重影响.近年来,伴随着前膝关节交叉韧带损伤后对患者身体带来的影响得到社会越来越多的关注,分析影响前膝关节交叉韧带重建术后腱骨愈合因素,并对其采取有效的治疗措施帮助改善患者术后的临床症状及康复是临床关注的重点.因此,对膝关节前交叉韧带重建术后腱骨愈合的最新进展进行分析有着重要意义.

腰椎间隙感染是指腰椎间盘及相邻软骨、椎体的感染性病变,临床上分继发性和原发性.多数脊柱手术后继发的椎间隙感染,称继发性椎间隙感染.少数无明确的原因发生椎间隙的感染,称原发性椎间隙感染,原发性腰椎间隙感染较为少见,但近年来发病率逐年出现升高,易感因素包括静脉吸毒、长期使用激素等.患者主要表现为短期内突发腰部持续痉挛性剧痛,髋部及双下肢扩散,腰背部肌肉紧张,常伴发热.但目前临床表现缺乏特异性,患者发病率较低,容易出现误诊.目前原发性腰椎椎间隙感染,主要为保守药物治疗、药物和手术联合治疗,其手术干预治疗能够快速缓解患者临床症状.

Objective To observe the anatomical position of hypohyoid muscle group in approach of anterior cervical surgery and accordingly to provide a safe and reliable muscular marker for anterior cervical surgery. Methods 40 adult cadaveric specimens fixed with formalin were selected, exposing hypohyoid muscle group, cervical viscera sheath, carotid artery sheath, superior laryngeal nerve, recurrent laryngeal nerve, superior thyroid artery, inferior thyroid artery and corresponding vertebral body. The anatomical relation between the hypohyoid muscle group and the above structures were observed. Results The hypohyoid muscle group was adjacent to the cervical viscera sheath and arterial sheath. The external branches of the superior laryngeal nerve mainly penetrated into the lateral margin of the thyrohyoid muscle at the level of C2/3 and C3 vertebral bodies. The recurrent laryngeal nerve penetrated into the lateral margin of the sternothyroid muscle and run in tracheoesophageal sulcus. All of the penetration points of the recurrent laryngeal nerve located below the turning point of the anterior and posterior bellies of the omohyoid muscle and mainly at the level of the upper half of the T1 vertebral body and the level of the C7/T1 intervertebral disc. The superior thyroid artery penetrated through the lateral sternothyroid muscle at the level of C5 vertebra. The inferior thyroid artery penetrated into the sternohyoid muscle at the level of the C7 vertebra. The turning points of anterior and posterior bellies of omohyoid muscle correspond to the level between C5 and C6 vertebral bodies and the intersection of the sternothyroid and thyrohyoid corresponded to the level between the C4 and C5 vertebral bodies. Conclusion The hypohyoid muscle group has close anatomical relation with important blood vessels, nerves and vertebral bodies in anterior cervical surgery and thus can be used as a safe and reliable muscular marker in anterior cervical surgery.

临床实习教学是医学本科教育的重要环节,是医学生运用理论知识解决临床问题的过渡时期,是建立医生临床思维的关键阶段,这一时期的学习方法和效果将对医生未来的学习和临床工作产生深远影响.骨科实习是医学生外科临床实习的重要组成部分,而骨科专业性强,信息量大,学科交叉广泛,内容较为繁杂.医学生在有限的实习期内,普遍反映掌握骨科实习的内容较为困难,学习压力大,实习结束时收获比较有限,实习效果不够理想.为了解决这一在骨科临床实习中普遍存的问题,笔者尝试对医学生的临床实习教学进行了多项改革,并取得了一定的成效.现介绍如下.

目的 观察经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床效果.方法 选取2013年4月-2015年3月收治的110例腰椎间盘突出症患者,按照入院时间顺序先后分为对照组和观察组各55例,对照组采用小切口开窗手术治疗,观察组采用经皮椎间孔镜下髓核摘除术治疗,比较两组治疗效果,所得数据采用SPSS19.0软件进行处理.结果 治疗后观察组JOA评分高于对照组(t=11.331,P＜0.05),观察组卧床时间、术中出血量、切口大小均优于对照组(t=14.245、5.688、33.101,均P＜0.05),对照组总有效率为74.55％,低于观察组的92.73％,比较差异有统计学意义(x2=6.643,P＜0.05).结论 对腰椎间盘突出症患者实施经皮椎孔镜下髓核摘除术治疗,不但能使临床治疗效果提高,而且还能降低患者手术创伤,促进术后恢复.

2012年1月~2013年4月，我科对19例四肢肌腱止点区断裂伤患者采用缝合锚钉修复，取得较好疗效，报道如下。