目的 分析活血止痛方外用配合针刺治疗老年全髋关节置换术(THA)后气虚血瘀型患者患肢肿胀疼痛的效果.方法 选取2020年7月—2021年5月在四川省骨科医院就诊的182例老年THA术气虚血瘀型患者为研究对象,采用数字表法随机分为观察组和对照组,每组91例.对照组给予针刺治疗,观察组在对照组的基础上采用活血止痛方联合治疗.比较2组干预前、干预3 d、7 d及14 d时的疼痛程度(VAS评分)、患肢肿胀程度和凝血指标[纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D?二聚体(D?D)];比较2组治疗不良反应发生情况及下肢深静脉血栓(DVT)发生率.结果 在干预前、干预3 d、7 d及14 d时,2组的组内VAS评分比较差异有统计学意义(P<0.05);观察组干预3 d、7 d及14 d时的VAS评分低于对照组(P<0.05);2组干预前、干预3 d时的患肢肿胀阳性率比较差异无统计学意义(P>0.05),而观察组干预7 d及14 d时的患肢肿胀阳性率低于对照组(P<0.05);在干预前、干预3 d、7 d及14 d时,2组的组内血清FIB、D?D水平比较差异有统计学意义(P<0.05),与干预前及干预14 d时比较,2组干预3 d时的血清D?D、FIB水平升高,APTT、PT值缩短,组间比较差异有统计学意义(P<0.05).在干预14 d时,观察组的血清D?D及FIB水平低于对照组(P<0.05),而2组APTT、PT值比较差异无统计学意义(P>0.05);2组治疗期间药物不良反应及DVT发生率比较差异无统计学意义(P>0.05).结论 给予老年THA术气虚血瘀型患者活血止痛方外用配合针刺治疗,可有效缓解术后疼痛及患肢肿胀情况,但其对DVT发生率的影响,还需进一步探究.

目的:探究平行置钉与倒三角置钉治疗中青年股骨颈骨折的疗效.方法:按照术式不同将167例股骨颈骨折患者分为A组(n=102)及B组(n=65),A组实施常规平行置入三枚空心钉治疗,B组实施倒三角置入空心钉治疗,均随访两年.对比两组患者的围术期指标(手术时间、术中透视次数、术中出血量等)、股骨头坏死率、骨折骨性愈合情况、关节功能Harris评分及退钉率.结果:A组手术时间短于B组,且术中透视次数少于B组(P<0.05);但两组术中出血量比较差异无统计学意义(P>0.05).A组股骨头坏死率低于B组,而骨折骨性愈合率高于B组(P<0.05).两组患者术后两年的Harris评分及退钉率比较,差异无统计学意义(P>0.05).结论:相较于倒三角置钉,平行置钉治疗中青年股骨颈骨折可降低手术时间、术中透视次数及术后股骨头坏死情况,值得临床推广使用.

目的 基于Wnt/β-catenin通路探讨巨噬细胞对全髋关节置换术(THA)后骨溶解的影响.方法 2018年12月～2020年12月间股骨颈骨折后期继发股骨头坏死行二期THA手术病人115例,根据术后是否出现骨溶解分为两组,对照组60例,未出现骨溶解,研究组55例,出现骨溶解.检测两组白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、骨代谢因子β胶联降解产物(β-CTX)的浓度,以及CD206、CD68和β-catenin蛋白表达量.通过Pearson对连续变量进行相关性分析.结果 研究组的IL-6为(79.16±14.35)pg/ml,TNF-α为(101.86±15.34)ng/ml,β-CTX为(0.38±0.07)pg/L,对照组分别为(22.84±3.57)pg/ml,(49.62±7.11)ng/ml,(0.17±0.04)pg/L,两组比较差异有统计学意义(P<0.05).研究组的CD206蛋白和CD206/CD68比值高于对照组,而CD68和β-catenin蛋白低于对照组,差异有统计学意义(P<0.05).β-catenin蛋白表达量与CD206的表达量负相关,与CD68的表达量正相关,差异有统计学意义(P<0.05).β-catenin蛋白表达量与CD206/CD68比值负相关,差异有统计学意义(P<0.05).CD206蛋白表达量与IL-6、TNF-α、β-CTX正相关;CD68蛋白表达量与上述指标负相关;CD206/CD68比值与IL-6、TNF-α、β-CTX正相关,差异均有统计学意义(P<0.05).结论 在THA病人中,β-catenin通路的抑制会促进巨噬细胞向M1型极化引起炎性反应,从而导致骨溶解.

目的 探讨全髋关节置换术结合自体股骨头骨泥植骨治疗髋臼内陷的临床疗效.方法 2015年1月至2018年1月我院收治21例(25髋)髋臼内陷患者,根据Sotello-Garza和Charnley分型,Ⅰ型(内陷1～5 mm)2例(2髋),Ⅱ型(内陷6 ～15 mm)14例(15髋),Ⅲ型(内陷＞15 mm)5例(8髋),原发性8例,继发性13例.采用全髋关节置换结合自体股骨头骨泥植骨治疗,Ⅰ型按常规方式脱位并截除股骨头,Ⅱ型、Ⅲ型采取适量截除髋臼后上方骨赘或者股骨颈二次截骨后,取头器取出股骨头.利用自体股骨头,制备骨泥.将骨泥填充、压实于磨锉成形的髋臼,恢复偏心距,增加臼底骨量,利用边缘固定原理放置生物型髋臼杯.采用Harris髋关节评分评估髋关节功能,随访双髋正位片观察假体是否有松动和偏心距恢复程度以及植骨愈合情况.结果 本组手术未发生血管、神经损伤以及髋臼和股骨劈裂骨折,术后4个月自体移植骨均与髋臼融合.末次随访的Harris髋关节评分由术前(53±7)分提高至(93±11)分,差异有统计学意义(t=22.79,P＜0.01).股骨头中心点到坐骨结节连线的距离由置换前的(73±13)mm减少到(69±12)mm,差异有统计学意义(t=4.219,P＜0.01);股骨头中心到Kohler线的距离由置换前的(10±4)mm增加到置换后的(24±5) mm,差异有统计学意义(t =2.289,P＜0.01).随访期间均无髋臼假体松动发生.结论 对髋臼内陷患者采用自体股骨头骨植骨,可增加髋臼底部骨量,同时恢复髋关节旋转中心及偏心距,边缘固定技术可使生物型髋臼杯假体获得可靠的初始稳定性,两者结合,可保证假体的初始、远期稳定性,近中期临床效果满意.

目的 观察抗骨质疏松胶囊治疗老年骨质疏松性髋部骨折的近期临床疗效.方法 将我院接受治疗的130例老年骨质疏松性髋部骨折患者随机分为中医组与西医组各65例,在骨专科治疗基础上,西医组应用西药进行抗骨质疏松治疗,中医组应用抗骨质疏松胶囊治疗,对比两组患者骨折治疗效果、髋关节功能以及各项临床指标.结果 治疗前,两组患者髋关节功能评分(Harris)、治疗优良率差异不明显(P＞0.05);治疗结束后两组血清骨钙素(BGP)、I型胶原交联羧基末端肽(CTX)、脱氧吡啶啉(DPD)指标水平相比,中医组优于西医组(P＜0.05);两组不良反应发生率相比,中医组低于西医组(P＜0.05).结论 抗骨质疏松胶囊治疗老年骨质疏松性髋部骨折能够获得满意的近期临床疗效,有标本兼顾的作用,能帮助患者促进骨折愈合,改善相关指标,调节机体整体状况,且有较高的用药安全性.

目的:观察癫狂梦醒汤加减方与喹硫平在治疗高龄髋部骨折术后活动过多型谵妄的同时,对比两组药物对凝血功能的影响.方法:采用严格的随机对照临床研究方法将100例高龄髋部骨折术后发生谵妄的患者随机分为癫狂梦醒汤加减方治疗组(中药组)和喹硫平治疗组(西药组),治疗术后谵妄的同时,观察术后肢肿胀程度、凝血功能变化、贫血程度、深静脉血栓发生率,评估癫狂梦醒汤加减方对高龄髋部骨折患者凝血功能的影响.结果:癫狂梦醒汤加减方在改善术后肢体肿胀程度、高凝状态、贫血程度方面与喹硫平组存在显著差异,P＜0.05,具有统计学意义,能有效降低深静脉血栓发生.结论:在治疗基础疾病的基础上,癫狂梦醒汤加减方不仅对高龄髋部骨折术后活动过多型谵妄有良好疗效,且能明显改善高龄髋部骨折患者术后高凝状态,降低深静脉血栓风险,值得临床推广应用.

目的:探讨SMF短柄全髋关节置换术的近期疗效.方法:2016年5月至2017年10月对25例患者26髋行SMF短柄假体全髋关节置换,均采用后外侧入路.结果:25例均选用SMF假体,所有患者均获随访,随访时间21～36个月,平均27个月.患者术前Harris评分平均(41.6±1.5)分,术后12个月Harris评分平均(93.1±2.3)分.患者均未见伤口感染、术后脱位、下肢肢体不等长、深静脉血栓等并发症.手术时间40～70 min,平均55 min;术中出血量268～430mL,平均312 mL.结论:应用SMF短柄髋关节系统进行髋关节置换是治疗髋关节疾病的良好选择,中短期疗效可靠.

目的 探讨氨甲环酸联合利伐沙班用于老年人工全髋关节置换术患者的有效性和安全性.方法 选取2016年7月至2019年7月于四川省骨科医院行人工全髋关节置换术的髋关节相关病变老年患者200例,应用随机数字表法分为对照组与观察组,各100例.对照组患者于人工全髋关节置换术后口服利伐沙班片治疗,连续服用35 d,观察组围术期给予氨甲环酸治疗,术后口服利伐沙班,用法用量与对照组一致.比较2组患者术中失血量、隐性失血量和显性失血量,治疗前后血常规和凝血酶原时间,以及术后不良反应和深静脉血栓发生率.结果 剔除未按研究方案治疗和未按规定检查的患者,观察组纳入93例、对照组纳入91例.观察组术中失血量、隐性失血量和显性失血量均少于对照组[(313±40)ml比(342±37)ml,(220±44)ml比(439±48)ml,(357±40)ml比(484±51)ml](t=7.841、54.665、18.554,均P<0.001).治疗后,2组患者凝血酶原时间均长于治疗前,且观察组长于对照组[(17.5±1.1)s比(14.8±1.1)s](均P<0.05),但2组血红蛋白和血小板计数比较差异均无统计学意义(均P>0.05).观察组术后不良反应发生率和深静脉血栓发生率均低于对照组[19.4％(18/93)比33.0％(30/91),7.5％(7/93)比23.1％(21/91)](χ2=5.661、9.327,P=0.017、0.002).结论 氨甲环酸联合利伐沙班用于老年人工全髋关节置换术患者,能够有效降低患者术中失血量、隐性失血量和显性失血量,改善凝血酶原时间,降低深静脉血栓发生率.

目的 对比老年移位型股骨颈骨折采用内固定术后失效二期全髋关节置换与初次全髋关节置换术后的早期临床效果,探究老年移位型股骨颈骨折的最佳治疗方案.方法 回顾性分析2011年1月-2015年1月300例老年移位型股骨颈骨折患者,其中150例采用初次全髋关节置换术,150例采用内固定失效后二期全髋关节置换术;评估两组患者手术时间、术中出血量、术后引流量、术后下床时间、术后住院时间、术后并发症发生率、术后髋关节功能评分.结果 与二期置换组相比,初次置换组手术时间更短[(54.7±15.3)vs.(70.1±23.4) min],出血量更少[(116.9±35.0) vs.(131.7±44.5) mL],术后下床时间更早[(1.0±0.3)vs.(1.8±0.6)d],住院时间更短[(12.0±2.9)vs.(15.2±3.1)d],差异均有统计学意义(P＜0.05),但术后并发症发生率及术后3、6、12、24个月Harris评分差异无统计学意义(P＞0.05).结论 股骨颈骨折二期全髋关节置换手术难度增大,住院时间延长,但早期临床疗效与股骨颈骨折初次全髋关节置换相当.

目的:观察益尔力口服液治疗人工膝关节置换术后失血性贫血的临床疗效.方法:采用前瞻性、随机、双盲、平行分组研究,分析人工膝关节置换术发生术后失血性贫血的100例患者的临床资料,按照治疗方法随机分为对照组(n=50)和观察组(n=50).两组患者均给予常规治疗,观察组在常规治疗的基础上给予益尔力口服液,每次10ml,每天3次,连续服用14天.两组患者分别于治疗前和治疗后3天,7天和14天测定静脉血中的红细胞计数(RBC),血红蛋白(Hb)以及红细胞压积(Hct);比较膝关节功能评分(HSS)和视觉模拟评分(VAS);分析两组患者治疗14天后基于中医疗效评分和西医疗效评分的临床疗效.结果:观察组患者基于中医疗效评分的总有效率(86.00％ vs.74.00％)和基于西医疗效评分的总有效率(88.00％ vs.70.00％)均显著高于对照组(P＜0.05);治疗后两组患者的RBC,Hb以及Hct水平与治疗前相比均显著升高(P＜0.05),且观察组同一时间点的上述指标均显著高于对照组(P＜0.05);治疗后7天和14天两组患者的膝关节功能评分(HSS)与治疗前相比显著升高(P＜0.05),且观察组同一时间点膝关节功能评分(HSS)显著高于对照组(P＜0.05);治疗后两组患者的VAS评分与治疗前相比均显著下降(P＜0.05),且观察组治疗后7天和14天的VAS评分显著低于同一时点对照组(P＜0.05).结论:益尔力口服液治疗人工膝关节置换术后失血性贫血的疗效显著,可以明显提高患者的RBC,Hb以及Hct,改善患者的膝关节功能评分(HSS)以及VAS评分,值得临床推广应用.

Objective:To establish a simple and feasible risk assessment system to meet the characteristics of elderly patients with hip fracture,provide risk forecast and warning for the treatment of senile hip fracture.Methods:215cases of old people over 60years of age of hip fracture in our hospital from July 2013 to July 2014 were included in the statistics.Evaluation and classification of patients according to the risk assessment system,at the same time,there were high risk factors for screening,follow up for all patients,the incidence of complications and the time and cause of death were recorded,analysis of data,evaluation of clinical effectiveness of risk assessment system.Conclusion:The evaluation system has a certain clinical significance,and can provide the risk prediction for the clinical treatment of hip fracture in elderly patients.

Objective To evaluate the short-term efficacy of total hip arthroplasty combined with subcutaneous osteotomy in the treatment of CroweⅣ hip dysplasia (DDH).Methods From March 2012 to March 2015,14 patients (16 hips) underwent total hip arthroplasty with femoral distraction osteotomy S-ROM femoral stem prosthesis.And we observed its recent efficacy.Results All patients underwent S-ROM prosthesis.The patients underwent transverse osteotomy of the femoral trochanter.The osteotomy length was 2.0-3.5 cm.The average follow-up time was 19 months.And no complications such as dislocation,vascular nerve injury,deep vein thrombosis and infection were observed during the follow-up.The average Harris scores improved from 42.3 preoperatively to 90.4 postoperatively at 9 months after the operation.The average lengths of preoperative limb shortening and postoperative limb shortening were 6.4 cm and 4.3 cm respectively.The X-ray films showed no dislocation of acetabulum and femoral prosthesis.Bone healing was achieved at 6 months after osteotomy.Conclusion This method could be a good choice for Crowe Ⅳ developmental dysplasia.The short-term efficacy is satisfactory.

目的:探讨撬拨复位对提高外展嵌插型股骨颈骨折疗效的作用.方法:回顾性分析2007年1月至2012年1月治疗50例外展嵌插型股骨颈骨折的疗效,其中闭合复位25例,撬拨辅助闭合复位25例.结果:所有患者均获得3年以上的随访.A组(常规闭合复位组):术后Garden指数评价5例获得解剖复位,Harris评分优良率88％,3例股骨头坏死.7例患者髋关节撞击实验阳性,其中5例患者术后3年骨盆平片显示伤侧髋关节外侧间隙变窄.B组(撬拨辅助闭合复位组):术后Garden指数评价22例获得解剖复位,Harris评分优良率96％,无股骨头坏死.无髋关节撞击实验阳性患者,未出现髋关节外侧间隙变窄病例.结论:斯氏针微创闭合撬拨复位在减少对股骨颈血运再损伤的前提下,可明显降低髋关节撞击及骨关节炎的发生率,临床疗效满意.

目的:观察桃红四物汤加味配合中医理疗预防老年股骨粗隆间骨折内固定术后下肢深静脉血栓形成(DVT)的效果.方法:80例65岁以上粗隆间骨折内固定手术病例随机分为研究组和对照组.研究组内服桃红四物汤加味配合中医理疗伤肢,对照组使用皮下注射低分子量肝素钙,配合空气梯级加压治疗伤肢的预防措施.测量两组患者术前、术后3天、10天、14天血小板、凝血酶原时间和伤肢肿胀情况,并用彩色多普勒超声探查术前、术后14天伤肢深静脉血流情况.结果:两组患者血小板较术前有升高,但组间比较差异无统计学意义;两组患者术后凝血酶原及部分凝血活酶时间较术前有延长,差异有统计学意义,但研究组延长时间短于西医对照组;彩色多普勒超声检查,6例出现下肢深静脉血栓形成,每组各3例,占8.11％.结论:内服桃红四物汤加味配合中医理疗伤肢的方法能达到与标准的西医措施同样的预防DVT的效果,并且中医措施具有口服药物安全方便的优势.

Objective To investigate the effect of artificial joint replacement and impaction bone graft in the treatment of severe osteoporotic femoral neck fracture. Methods 315 cases of severe osteoporotic femoral neck fracture treated by artificial hip joint replacement combined with impaction bone graft during operation between September 2011 and October 2013 in our hospital were followed up and their curative effect was analyzed. Results 3 months after operation,243 patients recovered to walk inde-pendently,accounting for 77. 14% and 72 patients walked on crutches or walkers,accounting for 22. 86%. 22 cases occurred com-plications:pulmonary infection occurred in 12 cases,urinary tract infection occurred in 8 cases and 2 cases of both,which were all cured after treatment. All the patients were followed up for two years. Among 315 cases of patients,no one had dislocation and no case of prosthetic loosening,the excellent and good rate reaching 100%,with satisfied curative effect. Conclusion As forsevere osteoporotic femoral neck fractures,artificial hip joint replacement and intra-operative impaction of bone graft are active and reliable treatment measures.

OBJECTIVETo study clinical efficacy of autologous bone graft for acetabular defect of Crowe III and IV hip dysplasia.METHODSThe 22 patients with 25 hips of DDH (Crowe type III, IV) from March 2010 to May 2013 were retrospectively analyzed. Total hip arthroplasty (THA) combined autogenous bone grafting was performed for all these patients with osteoarthritis secondary to DDH. Among them, 19 patients were females (21 hips) and 3 patients were males (4 hips), ranging in age from 43 to 67 years old, averaged 55 years old. There were 6 hips with Crowe type III and 19 hips with Crowe type IV. Before surgery, all the patients had hip pain, limb shortening and hip limited function of hip joint. After 12 months, the degree of recovery about limb length, functional recovery, autogenous bone graft fusion were observed.RESULTSAll the patients were followed up and no dislocation were occurred. At 12 months after operation, the average Harris hip joint llzncation score were 83.30±6.13, and 18 cases got an excellent result and 4 good. The length of lower limbs decreased from preoperative (3.20±0.81) cm to 12 months after operation (0.92±0.23) cm (t=14.864, P<0.05).CONCLUSIONTHA combined with structural femoral head autograft for patients with osteoarthritis secondary to DDH can obtain favorable results, significantly improving the effect of operation treatment.

目的:比较癫狂梦醒汤加减方与喹硫平治疗高龄髋部骨折术后活动过多型谵妄的疗效.方法:采用严格的随机对照临床研究方法将100例高龄髋部骨折术后发生谵妄的病人随机分为癫狂梦醒汤加减方治疗组(中药组)和喹硫平治疗组(西药组),选用谵妄分级量表(DRS)、简明精神病量表(BPRS)、临床总体印象量表(CGI)进行评估,观察疗效1周,用副反应量表(TESS)评定不良反应.结果:①癫狂梦醒汤加减方与喹硫平治疗组均取得良好疗效,两组疗效差异无统计学意义(P＞0.05);②两组临床总体印象量表严重度CGI-SI分值在治疗后均明显降低,与治疗前比较差异有统计学意义(P＜0.01),两组间比较差异无统计学意义(P＞0.05);③两组在安全性比较中,癫狂梦醒汤加减方治疗组未见不良反应,而喹硫平治疗组出现嗜睡及头晕的不良反应.结论:在治疗基础疾病的基础上,癫狂梦醒汤加减方对高龄髋部骨折术后活动过多型谵妄具有与喹硫平相似的良好疗效,且未观察到确切的不良反应,值得临床推广应用.

OBJECTIVE:To observe clinical efficacy of renovation stem revision femoral head arthroplasty for the treatment of unstable intertrochanteric fracture in the elderly.METHODS:Totally 32 elderly patients with unstable intertrochanteric fracture were treated with renovation stem revision femoral head arthroplasty from September 2007 to January 2011. There were 11 males and 21 females with an average age of 83.8 (ranged, 80 to 98) years old,the time from injury to hospital ranged from 4 h to 14 days. According to Evans-Jensen classification, 6 cases were type II a, 20 cases were type II b, and 6 cases were type III. Postoperative mortality, complication rates and Harris hip function score were compared and analyzed to evaluate curative effect.RESULTS:All patients were followed up and no dislocation occurred. Six patients were died during 15 months and 4.5 years; 24 cases recoved to independent wakling at 6 months after operation, and 8 cases walked with stick and walker. The average Harris hip joint function score were (91.56 +/- 2.96), 28 cases got excellent results and 4 cases good. Nine cases occurred complications and healed after treatment.CONCLUSION:Renovation stem revision femoral head arthroplasty is a active and reliable method in treating unstable intertrochanteric fracture in the elderly.

目的:评价人工髋关节置换术治疗高龄骨质疏松不稳定型股骨粗隆间骨折的疗效.方法:回顾分析我科2009～2011年应用人工关节置换治疗22例高龄骨质疏松不稳定型股骨粗隆间骨折患者的临床资料.结果:对22例采用人工髋关节置换治疗的高龄骨质疏松不稳定型股骨粗隆间骨折患者进行6～12个月(平均7.5个月)的随访,年龄最小70岁,最大91岁,平均82.73岁.术后开始负重行走时间为3天～7天,平均5.2天.未出现髋内翻、深静脉血栓、感染、松动、脱位等并发症.根据Harris评分,优,18例,81.82%,良,3例,13.64%,可,1例,4.54%,差0例.结论:该手术能缩短手术时间,降低手术风险,迅速恢复患肢功能,降低并发症发生率,但仍应严格掌握适应证.

随着我国进入老年社会,脑血管意外后肢体偏瘫临床较为多见.偏瘫侧下肢的肌张力、肌力、感觉、运动改变,身体平衡能力下降,动作不协调,易摔倒跌伤;髋部肌肉力量薄弱,摔倒时保护性动作不灵敏;偏瘫下肢活动量少以及神经营养障碍等因素导致骨质疏松.这些原因使得偏瘫侧股骨颈骨折在临床上并不少见.这类患者并发症多,治疗上选择较难.自2003年3月至2006年3月采用人工全髋关节治疗脑血管意外偏瘫侧股骨颈骨折(GardenⅢ、Ⅳ型)16例,取得较满意的效果,现将治疗结果进行总结分析.