BACKGROUND:Enchondromas originating in the epiphyses of long bones are rare and epiphyseal osteoid osteomas are also uncommon. Diagnosis can become elusive when enchondromas or osteoid osteomas occur in atypical locations and present with nonspecific clinical and imaging characteristics.CASE PRESENTATION:We report a case of epiphyseal enchondroma of the left proximal femur in a 15-year-old girl with a 2-month history of left lower extremity pain. Preoperative CT displayed thickened cortex in the anterior surface of the left proximal femur with specks of calcification and inhomogeneity of the adjacent bone marrow cavity. She was diagnosed with osteoid osteoma. Postoperative pathological examination of surgically excised specimens revealed a diagnosis of enchondromas.CONCLUSIONS:Our case highlights that enchondroma should be considered in lesions of the epiphysis.

经皮椎间孔镜技术为治疗腰椎间盘突出症提供了一种全新的微创理念.文章报告1例采用经皮椎间孔镜技术治疗的L5～S1巨大型腰椎间盘突出症.

Objective To investigate the relationship between.serum 25-hydroxy vitamin D (25OHD) and parathyroid hormone (PTH) with the severity in elderly patients with osteoporosis.Methods A total of 160 patients with fractures treated in this hospital from January 2015 to January 2016 were selected and divided into the normal bone mass group(53 cases),osteopenia group (63 cases) and osteoporosis group(44 cases) according to the bone mineral density (BMD) in the lumbar vertebra 1-4,total hip and femoral neck any position.Then the serum levels of 25OHD,PTH,T value of BMD,serum osteocalcin (BGP) and bone alkaline phosphatase (ALP) were compared among 3 groups.Results The serum PTH detection value had no statistically significant difference among the normal group,osteopenia group and osteoporosis group (P＞0.05).The serum 25OHD level in the normal group was higher than that in the osteopenia group and osteoporosis group (P＜0.05);the serum BGP and.ALP levds in the normal group were significantly lower than those in the osteopenia group and osteoporosis group (P＜0.05).The level of serum 25OHD in the osteopenia group was higher than that in the osteoporosis group (P＜0.05).The level of serum BGP and ALP in the osteopenia group was significantly lower than that in the osteoporosis group (P＜0.05).The BMD value of the lumbar vertebra 1-4,total hip and femoral neck in the normal group was significantly higher than that in the steopenia group and osteoporosis group (P＜0.05).There was a significant positive correlation between serum 25OHD and the BMD value in lumbar vertebra 1-4,total hip joint and femoral neck (P＜0.05).Conclusion The level of serum 25OHD is significantly decreased in the patients with osteoporosis,and.is positively correlated with the BMD level.

目前在国内外医学界,对于巨大型腰椎间盘突出症无统一定义,根据相关影像学资料,无论突出的椎间盘组织位于椎管的左侧还是右侧,只要突出物的最远端超出椎管矢状位中线50％以上就可以称为巨大型腰椎间盘突出症[1].

目的 观察经皮穿刺椎体成形术治疗老年胸腰椎椎体压缩性骨折的快速康复指导.方法 选取2016年9月-2017年2月河北省人民医院收治的老年胸腰段椎体压缩性骨折患者20例,随机分为观察组和对照组,每组10例.对照组施行骨科护理常规,观察组在对照组护理的基础上实施心理指导、体位指导、并发症预防、康复锻炼及院外随访等快速康复指导.比较2组患者术后VAS疼痛缓解率、治疗满意度.结果 观察组疼痛缓解率为100.0％高于对照组的80.0％,差异有统计学意义(P<0.05).观察组治疗满意度为100.0％高于对照组的80.0％,差异有统计学意义(P<0.05).结论 快速康复指导用于老年经皮穿刺椎体成形术围术期护理可有效缓解患者的疼痛,提高患者满意度,提高患者生活质量,促进患者快速康复,值得临床推广应用.

OBJECTIVE:To evaluate the overall diagnostic value related to magnetic resonance imaging (MRI) in patients with early osteonecrosis of the femoral head.METHODS:By searching multiple databases and sources, including PubMed, Cochrane, and Embase database, by the index words updated in December 2017, qualified studies were identified and relevant literature sources were also searched. The qualified studies included prospective cohort studies and cross-sectional studies. Heterogeneity of the included studies were reviewed to select proper effect model for pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were performed for meniscal tears.RESULTS:Forty-three studies related to diagnostic accuracy of MRI to detect early osteonecrosis of the femoral head were involved in the meta-analysis. The global sensitivity and specificity of MRI in early osteonecrosis of the femoral head were 93.0% (95% CI 92.0-94.0%) and 91.0% (95% CI 89.0%-93.0%), respectively. The global positive likelihood ratio and global negative likelihood ratio of MRI in early osteonecrosis of the femoral head were 2.74 (95% CI 1.98-3.79) and 0.18 (95% CI 0.14-0.23), respectively. The global DOR was 27.27 (95% CI 17.02-43.67), and the area under the SROC was 93.38% (95% CI 90.87%-95.89%).CONCLUSIONS:This review provides a systematic review and meta-analysis to evaluate the diagnostic accuracy of MRI in early osteonecrosis of the femoral head. Moderate to strong evidence indicated that MRI appears to be significantly associated with higher diagnostic accuracy for early osteonecrosis of the femoral head.

目的 探讨高龄股骨粗隆间骨折人工股骨头置换术与PFNA术后再次骨折的危险因素.方法 回顾分析人工股骨头置换术/PFNA治疗的高龄股骨粗隆间骨折患者181例.将患者年龄、治疗方式、骨密度(BMD)、体质量指数(BMI)纳入术后再次骨折危险因素,分为骨折组15例与PFNA组166例进行比较和多因素Logistic回归分析.结果 15例患者出现了术后再次骨折,占总人数的8.29％.其中13例为假体周围骨折,占术后再次骨折总人数的86.67％.术后出现再次骨折的平均天数为524 d.骨折组与无骨折组患者年龄、治疗方式、BMD和BMI比较差异有统计学意义(P<0.05).患者年龄大、BMD和BMI是影响术后再次骨折的因素.结论 患者年龄、BMD和BMI是影响术后再次骨折最重要的危险因素.

目的 探讨补阳还五汤治疗退行性脊柱侧凸后路椎弓根钉棒固定术后残留症状临床疗效.方法 将60例退行性脊柱侧凸术后患者随机分为2组,即治疗组和对照组各30例.对照组予常规治疗,治疗组在常规治疗基础上再给予补阳还五汤治疗.2组分别在术前、治疗后1个月及3个月收集JOA评分、ASIA感觉与运动评分及Oswestry功能评分并进行统计学分析.结果 2组治疗后3个月JOA评分、ASIA感觉与运动评分及Os-westry功能评分均优于治疗前(P均<0.05),且治疗组显著优于对照组(P均<0.05).结论 补阳还五汤配合术后常规西药治疗退行性脊柱侧凸后路椎弓根钉棒固定术后残留症状效果更好,可明显改善患者术后疼痛、麻木及功能等残留症状.

患者,男性, 67 岁,主因腰部、右臀部及右大腿疼痛1 个月,加重20 d入院. 入院前无发热、多汗、乏力等现象. 查体可见L3 椎体上下水平有明显压痛、叩击痛,腰椎活动度中度受限. 双下肢运动、感觉无明显异常. 入院查腰椎正侧位、过伸过屈位X线可见:L2～3椎体略后移,L1～5椎体边缘骨质变尖,附件骨质结构未见异常,各椎间隙未见明显狭窄. 腰椎CT 可见:L2 椎体后下缘弧形低密度影且局部骨皮质不连续,L3 椎体后上缘小片状低密度影. 腰椎MRI示:L2～3椎体见条片状异常强化影,以后部明显,边界欠清,L2～3椎体水平两侧腰大肌及椎体后方见条片状异常强化,边界欠清. 根据影像学资料可知L2～3椎体异常信号伴周围异常信号,考虑炎性病变可能性大.详细追问患者病史,患者自诉长期做皮草工作. 实验室检查:PPD试验(-);布氏杆菌凝集试验检阳性,1:200. 嘱患者于石家庄市疾控中心再次抽血化验明确诊断,布氏杆菌凝集试验结果回报:阳性. 根据患者职业、症状、实验室检查、影像学等资料诊断为:布氏杆菌性脊柱炎(腰椎). 疾控中心给予患者布鲁杆菌病相关药物治疗,同时我科给予患者消肿、止痛等对症治疗,症状逐渐减轻,腰椎活动较前改善,要求办理出院,回家自行口服药物治疗. 随访患者可知,患者症状目前已几乎消失,恢复正常生活,生活质量较前明显提高,布氏杆菌凝集试验阴性.

目的 对比观察扩髓与非扩髓髓内钉治疗成人胫骨干骨折的临床疗效.方法 选取河北省人民医院骨二科2015年9月-2016年9月收治的42例应用髓内钉治疗的胫骨干骨折患者作为研究对象,随机分为扩髓组(22例)和非扩髓组(20例),比较2组患者手术用时、术中出血量及骨折彻底愈合时间、内固定失效情况.结果 扩髓组患者的手术用时长于非扩髓组,术中出血量大于非扩髓组,但骨折愈合时间短于非扩髓组,差异均有统计学意义(P<0.05);扩髓组中髓内钉杆及锁定钉失效发生率为0,非扩髓组患者中发现1例髓内钉主杆失效,二次手术行扩髓髓内钉治疗后骨折顺利愈合,发现4例锁钉松动、退钉等现象,骨折愈合后取出失效内固定物,2组差异有统计学意义(P<0.05).结论 对于髓内钉治疗成人胫骨骨折,非扩髓由于其优势,可用于手术耐受性差的老年患者,扩髓组可用于活动需求量大的青年患者.

退行性脊柱侧凸(Degenerative Scoliosis,DS)是指骨骼发育成熟之后的成人,主要由于椎间盘不对称性楔形变,相对应的小关节突关节退变及脊柱其他附件退行性变等原因,引起的脊柱失衡并侧凸.常伴有冠状位移位Cobb角＞10°、旋转性半脱位和椎体矢状位滑脱即脊柱的三维旋转畸形.不仅影响形体美观,还带来了以腰背疼痛、神经根性症状及间歇性跛行等为主的诸多临床症状,严重影响患者的生活质量[1].近些年随着社会老龄化的加重,老年人作为DS的高发人群,DS的发病率随年龄增加也明显增加[2].由于人们的生活水平逐渐提高,同时人们对生活质量的要求也在提高,使解决DS的问题成为社会问题[3].

腘窝囊肿是一种临床常见疾病,患者常有疼痛不适,对患者的健康和生活产生严重影响.腘窝囊肿内合并游离体病例很少见.本文简要介绍腘窝囊肿内合并大量游离体1例及相关思考,为临床提供参考.

(母)外翻又称为"大脚病",发病原因复杂,是一种常见的(母)趾向足的外侧倾斜、第一跖骨内收的前足畸形,主要临床表现为足部畸形,跖趾关节骨性凸起处常形成痛性母囊炎,严重时跖趾关节半脱位,并发锤状趾,常影响行走及穿鞋.此病多见于中老年女性,常对称性发病,畸形程度进行性加重,畸形形成后保守治疗效果差,需手术治疗.传统治疗母外翻的手术方式创伤大,并发症多,恢复缓慢,随着微创技术的发展,目前微创小切口(母)外翻截骨矫形术已成为治疗该病较好的手术选择.现就我科2016年7月来行母外翻截骨矫形术+软组织松解术15例,其中2例术后切口处渗液、不愈合,我科讨论分析原因后并提出改进措施,现报道如下.

统计学方法是医学科研的重要工具,目前骨科文献中越来越多涉及到统计学方法的应用,其中误用情况很常见,本文将对骨科文献中统计学方法误用的思考进行总结,指导临床正确选择和使用合适的统计学方法.