Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

目的 对比观察手法复位弯角经皮椎体成形术(percutaneous curved vertebroplasty,PCVP)与单侧经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床效果.方法 选取我院2019年1—12月收治的85例OVCF患者,根据治疗方法 的不同分为两组.复合组40例采用手法复位PCVP治疗,常规组45例采用单侧PKP治疗.记录两组手术时间、术中透视次数、骨水泥用量、骨水泥渗漏率、治疗费用、骨水泥分布等级,术前术后后凸Cobb角、伤椎前缘高度(AVH)、疼痛视觉模拟评分法(visual analogue scale,VAS)评分、Oswestry功能障碍指数(oswestry disability index,ODI)评分.结果 复合组手术时间短于常规组,术中透视次数、治疗费用少于常规组,差异均有统计学意义(P<0.05或P<0.01).复合组骨水泥用量大于常规组,骨水泥分布等级优于常规组,差异均有统计学意义(P<0.05或P<0.01).两组骨水泥渗漏率比较差异无统计学意义(P>0.05).两组术后后凸Cobb角、AVH、VAS评分、ODI评分均较术前改善(P<0.01),但两组组间比较差异均无统计学意义(P>0.05).结论 手法复位PCVP治疗OVCF不仅可达到常规PKP复位伤椎、改善后凸畸形的效果,而且可减少术中透视次数、缩短手术时间和降低治疗费用,但在缓解疼痛、改善脊柱功能方面无明显优势.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

目的 观察弯角椎体成形术(PCVP)治疗骨质疏松性椎体压缩骨折( OVCF)的临床疗效.方法 收集2018年12月—2019年6月延安大学附属医院骨科收治老年新鲜单节段脊柱胸腰段OVCF患者76例临床资料,依据术中是否采用PCVP分为弯角组36例和常规组40例.弯角组采用PCVP完成手术;常规组采用常规单侧经皮椎体成形术(PVP)完成手术.观察2组手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏率、骨水泥双侧分布率,术前术后疼痛视觉模拟(VAS)评分、Oswestry功能障碍指数( ODI)评分及手术预后情况.结果 2组手术时间、术中透视次数比较,差异均无统计学意义(P＞0. 05).弯角组骨水泥注入量、骨水泥双侧分布率大于常规组,而骨水泥渗漏率小于常规组,差异均有统计学意义(t/P=2. 308/0. 023, Z/P=3. 638/0. 000, χ2/P=4. 395/0. 036). 2组术后VAS评分、ODI评分较术前均降低,差异有统计学意义(t/P=28. 134/0. 000、29. 840/0. 000,11. 979/0. 000、11. 887/0. 000);2组间比较,差异无统计学意义(P＞0. 05). 76例手术均顺利完成,术中未出现血管神经损伤等并发症.结论 与常规PVP比较,采用PCVP治疗新鲜单节段OVCF,在降低骨水泥渗漏风险的同时,有效地增加骨水泥注入量、改善骨水泥双侧分布情况;但在术后疼痛缓解和功能改善方面无明显优势.

目的 探讨3D打印技术在复杂跟骨骨折医患沟通及手术的应用效果.方法 回顾性分析自2017-01-2018-12收治的45例复杂跟骨骨折,依采用常规影像学资料与3D打印技术辅助完成术前医患沟通及手术的不同分为常规组22例与3D组23例.结果 2组均顺利完成手术.常规组谈话时间、手术时间、术中出血量大于3D组,差异有统计学意义(P＜0.05).常规组沟通满意度小于3D组,差异有统计学意义(P＜0.05).2组理解程度、术后Bohler角及Gissane角比较,差异无统计学意义(P＞0.05).结论 在复杂跟骨骨折的术前医患沟通和术中应用3D打印技术,可提升术前医患沟通效果,缩短手术时间并减少术中出血量.

目的 评价新型G型臂X线机在单侧经皮椎体后凸成形术(PKP)治疗单节段骨质疏松性椎体压缩骨折中的应用效果.方法 回顾性分析自2016-05-2017-08诊治的122例单节段骨质疏松性椎体压缩骨折,59例术中在G型臂X线机引导下行PKP治疗(观察组),63例术中在C型臂X线机引导下行PKP治疗(对照组).结果 所有患者术中均未发生神经血管损伤、再骨折等并发症.观察组手术时间较对照组短,观察组术中透视次数少于对照组,差异有统计学意义(P＜0.05).但2组骨水泥渗漏发生率差异无统计学意义(P＞0.05).结论 新型G型臂X线机透视下行PKP治疗单节段骨质疏松椎体压缩骨折较普通C型臂X线机透视可明显缩短手术时间、减少术中透视次数、增加手术安全性.

随着近年来医学技术的发展,例如关节置换技术的成熟使得下肢骨关节炎和股骨颈头下型骨折患者生活质量得到了质的改善.以及一些骨科大手术技术的成熟使得越来越多的疾病通过手术治疗可以基本或者完全恢复原来的功能.但是,下肢深静脉血栓的高发生率一直以来都是困扰临床治疗的一大难题.对于如何更好的预防、尽早发现和尽早治疗骨科大手术患者下肢深静脉血栓这一问题成了近来研究的热点.接下来,本文就近年来国内外关于骨科大手术围术期下肢深静脉血栓诊疗进展做一综述,以便大家共同学习.

Objective To compare the clinical efficacy of open reduction and internal fixation with or without bone graft treatment for displaced intra-articular calcaneal fractures.Methods The following electronic database was searched:PubMed,Embase and Conchrane Libray database.The time limit was from the establishing of the database to April 2017.Main evaluation index included excellent rate of foot function,Bohler angle,Gissane angle,calcaneus height,SF-36.Secondary evaluation index included incision necrosis or dehiscence,wound infection and osteoarthritis.The Review Manager 5.3 software was used for Meta-analysis.Results There were seven articles in qualitative and quantitative synthesis,two groups of a total of 824 cases,399 cases of bone graft.The Meta analysis showed that bone graft group and non bone graft group were not statistically significantly different at the end of follow-up (excellent rate of foot function,Bohler angle,Gissane angle,calcaneus height,incision necrosis or dehiscence,wound infection and osteoarthritis).There was statistically significant difference in SF-36.Conclusion According to meta analysis results,considering bone grafts leading to higher hospital costs or pain in donor site after autologous bone graft,bone graft is not essential for displaced intra-articular calcaneus fractures.

外侧踝关节扭伤(lateral ankle sprains,LASs)是最常见的运动损伤[1],约80%都能通过保守治疗康复,20%经治疗后依然发展成为慢性踝关节不稳定(chronic ankle instability, CAI).其症状包括:顽固性的疼痛、打软腿、反复扭伤和肿胀等.CAI分为功能性不稳定(functional ankle instability, FAI)和机械性不稳定(mechanical ankle instability ,MAI).前者韧带没有明显的松弛,不稳定的原因主要是踝关节受伤后该部位神经末梢和本体感觉未恢复导致的本体感觉缺失和平衡能力降低.后者为踝关节器质性病变的CAI患者,抽屉试验及应力位X线为阳性.两者之间最大的差别就是关节运动幅度是否处于正常范围,但有时较难区分且存在一定程度的共存.FAI可能发展为MAI.CAI若诊断治疗不及时可形成扭伤-不稳定-再扭伤的恶性循环,继而发生创伤性关节炎、关节软骨变性甚至永久性的功能障碍.CAI的诊断与治疗仍然具有争议性.根据国内外最新研究报道,本文对相关诊断与治疗做一综述,为临床诊治提供参考.

通过铸体薄片、物性分析、产量数据及压力恢复测试等资料,对定边油田XAB油区延9油藏地质及开发特征进行了分析.研究表明,延9地层厚度为20-30米,发育3-4条煤线,细分为延91与延92+3两个小层;西倾单斜背景上发育局部鼻状隆起构造;岩性为岩屑石英砂岩,孔隙类型以粒问孔为主,孔隙度平均值为15.2％,渗透平均值为16.3×10-3μm2,属于中孔—低渗储层;延9属于岩性—构造油藏,正常温度低压系统;含水率比较高,产量递减快,地层压力保持程度非常低.研究结果为后期油田采取用相应的调整措施提供依据.

目前髓内钉固定在长骨骨折中已经得到广泛应用,但是其弊端也逐渐显现,这就促使人们去研究更优的内固定装置.可 膨胀髓内钉系统的出现,刚好可以弥补之前的应力遮挡、手术时间较长、医生和患者在透视下暴露时间长等弊端.现就可膨胀髓内钉治疗胫骨骨折的研究进展做一综述.

Objective: To investigate the stability of hip joint replacement operation in the treatment of elderly unstable intertrochanteric fracture and the quality of life after healing. Method: 110 patients with the unstable intertrochanteric fractures who were treated in our hospital were selected and randomly divided into two groups with 55 cases in each one. The patients in the observation group were treated by the artificial total hip joint replacement, while the patients in the control group were treated by the DHS internal fixation. Then the operation time, the blood loss, the average time in bed, the clinical efficacy, the incidence of complications and the quality of life of patients in the two groups were observed and compared. Results: The operative time and blood loss in observation group were greater than in the control group, but the average time in bed was significantly shorter than in the control group(P0.05). The total effective rate in observation group was 87.27% and 70.90% in the control group,surgical results in observation group was better than in the control group(P0.05). The postoperative complication rate in observation group was 7.27%, significantly lower than in the control group(25.45%)(P0.05). The satisfaction of life quality in observation group was 80.00%, significantly higher than in the control group(61.82%)(P0.05). Conclusion: Hip replacement can reduce the amount of bleeding, activities in the fields with early time for patients, local tissue repair speed. For elderly patients with poor physical fitness and older, the operation is the best way to prolong the expectancy life.

目的 探讨Maisonneuve骨折的特点,提高临床认识,减少漏诊,同时给予正确的修复内侧结构,恢复踝关节功能.方法 患者外踝均采用钢板固定,内侧结构均给予固定,6例采用松质骨螺钉固定,3例采用锚钉固定,2例采用克氏针固定；下胫腓联合均采用单枚螺钉经或不经钢板孔固定.结果 该组11例,按照美国足踝骨科协会(American Orthopedic Foot&Ankle SocietyAOFAS)推荐的足踝评分系统评分恢复优5例,良4例,可2例.结论 要认识Maisonneuve骨折是踝关节骨折Lauge-Hansen分型中旋前-外旋型Ⅲ度骨折,AO分型中C型骨折,是较少见的一种骨折类型,减少漏诊的发生,并予可靠的固定,尤其是内侧结构,才能降低该病的致残率。

自1995年开始,第一个关于机器人应用于外科手术的程序被FDA所通过以后,至2000年,开始有大规模的应用在临床的趋势.在提高手术效果和精度的同时,也不断开展创新的手术,并向其他领域扩展[1-7].如何保证机器人系统临床应用的安全性,在远程遥操作中如何保证数据安全,是研制与临床应用中的一个关键问题.目前,对外科机器人安全性的研究,还没有一个专用的标准,大多是基于传统工业机器人的安全理论和方法,采用操作人员避开机器人工作区域的安全策略来讨论机器人安全[8].而骨科机器人手术过程中,机器人和手术者的工作空间必然要发生重叠.对骨科机器人安全性的研究,不能将机器人系统独立于手术服务环境,只研究机器人本身的安全可靠性,而应该从手术环境、手术方案的角度来综合研究应用机器人手术的安全性.

A medical robot that is used for closed reduction and the internal fixation of intramedullary locking nailing in treatment of tibial fracture is designed.The system is primarily composed of stereotaxic frame and computer system.Using C-shaped arm-taken X-ray images containing various marked points and keyhole-two-end-center of intramedullary nail,the system calculates the actual position of keyhole in the coordinate system of stereotaxic frame according to space mapping relation and locates the pilot hole on the reference coordinate according to computation.Electric-traction system can realize the precise reduction and remote control operation by network transmission of operation data.In the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture in 17 patients,robot reducing fracture and computer-assisted localization of distal keyhole were used.Remote control operation was applied in 4 of them.All operations were performed according to the preset procedure and planning of robot and navigation system.All distal lock nails were successfully implanted at one time.Results demonstrated that both medical robot and computer-assisted localization and navigation system can satisfy fracture reduction and distal Iock nail implantation in the closed reduction and the internal fixation of intramedullary nail for treatment of tibial fracture and shorten intraoperative fluoroscopy time;in addition,remote control operation is reliable and easily mastered due to its simple systemic structure.

目的:评价巨大腰椎间盘突出的不同手术方式的临床效果并对其进行分析.方法:巨大腰椎间盘突出17例,手术采用全椎板切除椎间盘摘除术9例,其中3例采用后路植骨融合内固定术;椎板间开窗椎间盘摘除术3例;采用后路双侧椎板开窗髓核摘除术3例;采用半椎板切除椎间盘摘除术2例.结果:全部病例获得8月至10年的随访,采用传统的全椎板切除椎间盘摘除术9例,手术后症状全部消失,1例患者手术后6年出现腰椎不稳迹象;采用椎板间开窗椎间盘摘除术3例,2例手术后症状全部消失,1例手术后出现双下肢瘫,经高压氧治疗2周,应用神经营养药物后5月恢复,但鞍区感觉仍有减退;采用后路双侧椎板开窗髓核摘除术3例患者手术后2例症状全部消失,1例症状部分消失,采用半椎板切除椎间盘摘除术2例手术后症状全部消失.结论:巨大腰椎间盘突出选择手术方式优选全椎板切除椎间盘摘除术,慎用椎板间开窗椎间盘摘除术.

交通运输业的迅速扩展,导致了越来越多复杂及高能量损伤病例的出现,而人民生活水准的提高,对医疗卫生技术提出越来越高的要求,即微创术[1],于是新的医疗器械推陈出新,髓内针的出现即从根本上解决了四肢长骨干骨折的微创,早期负重,中心性固定等世界主流原则,但最大缺陷是远端锁孔的锁定,而北京积水潭医院与北京航空航天大学正是为了解决此方面问题,合作研制了计算机辅助骨科手术(以下简称CAOS技术),其与手动髓内针相比,优势在于:(1)增加骨科手术的精确性,适用于要求精度较高的操作;(2)微创操作,减少手术创伤,减少失血,减少了感染发生率和伤口并发症;(3)使医生能更好的进行术前计划,模拟手术过程;(4)大大的减少对患者和手术人员的射线照射.

Objective To investigate the effects of tibiofibula crossing healing on ankle joint movement. Methods A retrospective study was done for seven patients who experienced tibiofibula crossing healing for an average of 30 months (10 to 54 months) from September 1999 to November 2003. There were four left sides and three right sides. Two patients received plate fixation for their open tibiofibula fractures, while the other five intramedullary nailing for their closed fractures. The plantar flexion and dorsiflexion of the ankle were measured at the follow-ups. Results According to the Kofoed' s evaluation system for the ankle joint, six were assessed as excellent and one as good in this series. Tibiofibula crossing healing had an average influence of 6.3 degrees on the dorsiflexion of ankle, but little influence on the normal gait. Five patients reported different extents of discomfortableness at the ankle. Conclusion Tibiofibula crossing healing has a significant influence on ankle cataplasia.

OBJECTIVE:To investigate the effects of medical robot-assisted surgical navigation system based on fluoroscopic images in distal locking of femoral intramedullary nails.METHODS:Using a robot-assisted computer-guided system designed based on modularization and minimization that permitted C-arm alignment assistance and real-time navigation control, provided constant feedback without the need for radiologic updates, thus avoiding constant X-ray exposure. The C-arm was used to collect the orthotopic and lateral X-ray images into the computer so as to calculate the locations of the target points. Nails were locked into 5 plastic femurs (Swiss Sybone, 35 holes), 2 dry human femoral specimens (12 holes), and one leg of fresh human cadaver (6 holes). Radiographs were taken to confirm that screws were positioned correctly, and fluoroscopic time associated with the locking procedure was recorded.RESULTS:All distal holes were locked successfully. In 6 (11.1%) of the 53 holes the drill bit touched the canal of the locking hole, albeit with no damage to the nail. The fluoroscopy time of per screw was 1.83 +/- 0.31 seconds.CONCLUSION:The medical robot-assisted surgical navigation system enables the physicians to precisely navigate surgical instruments throughout the procedure using just a few computer-calibrated radiographic images. The total radiation time per procedure can be significantly reduced because additional X-ray exposure is not required for tool navigation. The idea of a robot-assisted surgical navigation system is practicable.