目的 探讨膝关节镜手术保留或清理髌下脂肪垫与术后膝前痛之间的关系.方法 选取2020年1月-2021年12月在南京市一民医院行膝关节镜手术的患者60人(60膝),采用随机数字表法分为IPFP清理组和IPFP保留组,各30膝.记录并比较两组患者术前及术后1个月Insall-Salvati指数、VAS评分以及滑车角度等指标,探讨髌下脂肪垫清理与膝前痛之间的关系以及可能的作用机制.结果 术前两组患者在上述指标方面比较,差异无统计学意义.术后1个月,两组患者的Insall-Salvati指数相比,差异无统计学意义(P>0.05),IPFP清理组VAS评分较保留组明显降低,差异有统计学意义(P<0.05),IPFP清理组滑车角度与保留组相比,差异有统计学意义(P<0.05).结论 膝关节镜手术时行IPFP清理,可以显著降低关节术后膝前痛发生率.

目的 研究经皮球囊成形术(PKP)对骨质疏松胸腰椎骨折患者的疗效、疼痛程度及安全性的影响.方法 方便选取解放军第149医院2017年1月—2019年8月及南京一民医院2019年9月—2021年1月收治的60例骨质疏松胸腰椎骨折患者为探究对象,所有患者按抓阄的形式分为经皮组(实施PKP术,30例)与固定组(实施椎弓根螺钉固定术,30例).观察两组患者的手术效果情况,对比手术前后两组患者疼痛程度评分及Cobb角变化,采用Oswestry功能障碍指数问卷表(ODI问卷)评估两组患者术前、术后1 d时及术后6个月时的腰部功能情况.结果 与固定组相比,经皮组的术中出血量、植骨量、手术时间、住院时间更短,差异有统计学意义(P<0.05).术前两组患者的视觉模拟评分法(VAS)评分、Cobb角指标对比,差异无统计学意义(P>0.05);术后3个月时经皮组患者VAS评分(1.16±0.58)分、Cobb角(7.42±1.33)°均低于固定组的(3.49±1.43)分、(12.64±2.40)°,差异有统计学意义(t=4.240、5.967,P<0.05);术前两组患者ODI评分对比,差异无统计学意义(P>0.05),术后6个月时经皮ODI评分(10.61±3.58)分,显著低于固定组的(12.64±2.74)分,差异有统计学意义(t=2.641,P<0.05);经皮组术后并发症发生率3.33％,显著低于固定组的26.67％,差异有统计学意义(χ2=5.034,P<0.05).结论 PKP能有效治疗骨质疏松性胸腰椎骨折,可显著缓解患者的疼痛程度,促进伤椎生理结构恢复,改善腰部生理功能,安全性较高.

目的 研究锁定钢板内固定术在复杂跟骨关节内骨折患者中的治疗效果及对术者出血量的影响.方法 在本院2018年8月～2019年5月诊治的复杂跟骨关节内骨折患者中选出30例为对象,将其随机分入两组,对照组患者给予常规解剖钢板内固定术,观察组患者给予锁定钢板内固定术,对比两组的术中出血量、踝后足评分等.结果 观察组患者的术后并发症发生率0低于对照组的26.67％,P<0.05;两组的手术时间、术中出血量差异不明显,P>0.05;观察组术后6个月的AOFAS评分高于对照组,P<0.001.结论 锁定钢板内固定术在复杂跟骨关节内骨折治疗中疗效显著,对术中出血量影响不大,但有利于促进患者踝功能恢复.

Objective So far, little is known about the mechanisms of molecular biology of primary frozen shoulder (PFS). This study was to investigate the effects of the single nucleotide polymorphisms ( SNP ) of matrix metalloproteinase-3 ( MMP-3) and col-lagen type Ⅰ alpha 1 ( COL1A1 ) on the susceptibility of PFS . Methods We recruited 42 PFS patients from the Department of Or-thopedics , Nanjing Jinling Hospital between January and July 2016 and 50 healthy controls.We genotyped the SNPs rs679620 and rs522616 of MMP-3 and rs1107946 of COL1A1 in the two groups of subjects. Results The genotype distribution of the MMP-3 SNP rs679620 showed no significant correlation with the susceptibility of PFS (P>0.05), and no statistically significant difference was found between allelic A and G (OR=0.54, 95%CI:0.30-0.99, P=0.044).The COL1A1 SNP rs1107946 and allelic frequencies were not correlated with the susceptibility of PFS , either ( P=0.994 and 0.920) .The recessive heredity model GG exhibited no statistically sig-nificant difference from GT, TT, and GT+TT, and nor allelic T from G (P>0.05). Conclusion Allelic A of the MMP-3 SNP rs679620 is a protective factor against the risk of PFS .Neither the MMP-3 SNP rs522616 nor COL1A1 rs1107946 is associated with the susceptibility of the disease .

目的：观察天舒胶囊治疗椎动脉型颈椎病疗效和对脑血管供血影响。方法选取2012年10月至20013年6月椎动脉型颈椎病患者60例，随机分为观察组和对照组，对照组采用盐酸氟桂利嗪胶囊（钙离子拮抗剂）治疗，每晚10mg，观察组在此基础上加服天舒胶囊（主要由天麻、川芎组成，每粒含生药0.34g），4粒/次，3次/d。疗程1个月后监测两组患者治疗前后临床症状改善情况。结果治疗结束后，观察组临床控制4例、显效16例、有效8例、无效2例，有效率为93.3%。对照组临床控制1例、显效10例、有效7例、无效12例，有效率为60.0%。两组比较差异有统计学意义（P<0.05），且均无严重不良反应。结论天舒胶囊联合氟桂利嗪治疗椎动脉型颈椎病安全、有效，值得临床推广。

Objective Tibial plateau fracture(TPF) with knee dislocation is an uncommon injury and unclassifiable according to the existing classification system of TPF,and relevant reports are rare.This article introduces our experience in the management of TPF with knee dislocation by external fixation combined with limited internal fixation.Methods We treated 15 cases of TPF with knee dislocation using the external fixator supplemented with limited internal fixation.Results The postoperative X-ray images revealed 11 cases of anatomic reduction and 4 cases of nearly anatomic reduction of the articular surface.The patients were followed up for 6 to 12(mean 10) months.There were no major complications such as postoperative infection and deep venous thrombosis,nor occurrence of re-dislocation after the lifting of the external fixator.Pain in the fracture site disappeared in about 10 days.Tenderness and pain at percussion of the vertical axis vanished after 3 weeks.X-ray examinations showed that the fractures were healed in all the cases after 3 months.Based on the joint activity Rasmussen assessment criteria,10 cases achieved excellent and the other 5 cases good results.Conclusion External fixation supplemented by limited internal fixation may acheive satisfactory results in the treatment of tibial plateau fracture with knee dislocation,which contributes to anatomic reduction of the articular surface,early motion of the knee joint,and decrease of complications associated with bones and soft tissues.

OBJECTIVE:To investigate the effects of the ventralateral approach in treating severe Pilon fracture.METHODS:From February 2002 to March 2008, 63 patients with Ruedi II-III Pilon fractures were treated with the ventralateral approach, including 36 males and 27 females with an average age of 37 years ranging from 19 to 71 years. The mean time from injury to operation was 8 days (ranged for 2 h-19 d). According to the Ruedi classification system, type II was 32 cases (6 cases of them combined with soft tissue lesion, 4 with open fracture) and type III was 31 cases (9 cases of them combined with soft tissue lesion, 8 with open fracture). The clinical effects were evaluated according to Helfet criteria and the complications were observed including condition of wound healing, infection, bone union, deformity union, motion of the ankle, the degree of the pain and so on.RESULTS:The first intention achieved in 59 cases, the delayed healing in 4 cases. Stiffness of the ankle was found in 5 cases because of bone disunion. All patients were followed up from 8 to 31 months with an average of 15.3 months. The ranging in bone healing time was from 8 to14 weeks with an average of 10 weeks. According to the Helfet criteria, 28 cases obtained excellent results, 30 good, 5 poor.CONCLUSION:The operative treatment of Ruedi I-III Pilon fractures with the ventralateral approach can obtain satisfactory results and avoid complications effectively.

OBJECTIVETo investigate the treatment method for collapse separation fractures of lateral tibial condyle.METHODSFrom January 2003 to October 2008, 45 patients with collapse separation fractures of lateral tibial condyle were treated by surgical method, including 27 males and 18 females,ranging in age from 15 to 76 years,with an average of 37 years. The duration from injury to operation ranged from 1 to 14 days. All of the patients preoperatively underwent X-ray examinations in order to accurately understand the extent of fracture and fracture collapse. All of the 45 fractures with collapse more than 2 mm and widen more than 5 mm were selected for surgical treatment. The lateral surgical approach was used to expose the lateral margin of the lateral meniscus first, and then the reduction of the lateral meniscus and lateral condyle were achieved. The results after operation were evaluated by the Rasmussen criteria, as well as the complications of the knee joint pain, the joint activity, the infection, deep venous thrombosis and recurrent fracture collapse.RESULTSPostoperative X-ray showed anatomical reduction was achieved in 31 patients, 14 patients got nearly anatomical reduction. The plate and screw position were satisfactory. Forty-two patients were followed up,and the duration ranged from 6 to 12 months, with an average of 10 months. Fracture re-displacement,postoperative infection and deep venous thrombosis did not occur after the lifting of external fixation. All the patients had pain disappeared about 10 days after operation,and had no vertical axis percussion tenderness at 3 weeks after operation. The X-ray showed fractures was healed in all patients at 3 months after operation. Joint activity Rasmussen assessment criteria results: 37 patients got an excellent result, 7 good, 1 poor.CONCLUSIONThe incarceration of lateral meniscus and the collapsed bone fragments are two factors which make the reduction of the lateral tibial condyle difficult.