Objective:The aim of this study was to describe the surgical technique of endoscopy-assisted anterior cervical discectomy and fusion (ACDF), to evaluate the advantages, efficacy, and safety of this procedure for the treatment of cervical spondylotic myelopathy (CSM). Methods:The clinical data of patients with CSM treated with endoscopy-assisted ACDF from January 2023 to December 2023 were retrospectively reviewed. And 35 patients, including 13 females and 22 males, were included in this study. Endoscopic assisted ACDF surgery was described step by step in detail, and clinical and imageological assessment were performed before and after operation and follow-up. Results:All 35 patients underwent endoscopy-assisted ACDF surgery successfully, and were followed up for 12.9 ± 2.1 months (range 9∼18 months). The operation time was 74.4 ± 10.7 min (range 60∼100 min). Postoperative drainage volume was 14.1 ± 5.8 mL (range 5∼25 mL). No complications were observed. There were no complications, aggravation of neurological symptoms after operation, and the JOA score at the last follow-up was significantly improved compared with that before operation (15.7 ± 0.8 vs. 10.3 ± 1.9, P < 0.001). At the last follow-up, the C2-C7 Cobb angle was significantly higher than that before operation (P < 0.001), and Δ Cobb angle was 7.4 ± 2.5˚, and all patients achieved bony fusion. Conclusions:Endoscopy-assisted ACDF, which combined the uniaxial spinal endoscopy with traditional ACDF, achieved satisfactory short-term clinical efficacy and safety in the treatment of CSM.

Cervical spondylotic myelopathy (CSM) is a common cause of cervical spinal cord disease. Spinal endoscopy offers surgical advantages such as a magnified view and a water-mediated clear surgical field. This study describes an endoscope-assisted anterior cervical discectomy and fusion (ACDF) procedure. The addition of spinal endoscopy to traditional ACDF surgery magnifies the surgical field and allows for more precise operations, thereby improving surgical safety. Postoperatively, patients experienced significant improvements in neurological function, with no complications such as dysphagia, hematoma, or spinal cord injury. Postoperative imaging revealed that spinal cord compression was completely relieved, with sufficient decompression of the spinal cord and optimal placement of the fusion cage. The clear visual field provided by spinal endoscopy improves the identification of cervical anatomical structures during surgery, effectively reducing the risk of injury to the spinal cord and nerves. Endoscope-assisted ACDF has demonstrated excellent clinical and radiological outcomes in the treatment of CSM.

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.

Context:With the rapidly aging population globally, osteoporosis (OP) has become a major public health problem, and fracture is a common complication of OP. Older adults, especially postmenopausal women, have a higher incidence of OP.Objective:The study intended to analyze the clinical information, epidemiological characteristics, treatments, and follow-up results of patients with osteoporotic fractures (OPFs) in adults over 65 years old, to provide data support for the prevention, treatment, and use of OPF focus groups in clinical practice.Design:The research team performed a retrospective analysis using electronic medical records and related imaging data of patients.Setting:The study took place at Hebei General Hospital in Hebei, China.Participants:Participants were 387 patients over 65 years old with osteoporotic fractures who had been admitted to the hospital between July 2012 and July 2018.Outcome Measures:The research team recorded participants' ages, genders, fracture causes, and fracture sites. The team performed a follow-up analysis on refractures, treatment with anti-osteoporotic drugs, exercise, and survival status within the 3 years after surgery.Results:The study's male-to-female ratio was 1:3.1, and the rate of osteoporotic fracture for females was significantly higher than that of males. The mean age of participants with fractures was 75.6 ± 8.5 years, and most fractures occurred in participants 78 to 85 years old. Of the 387 participants, 169 participants had hip fractures (43.67%); 98 had vertebral compression fractures (25.32%); 51 had distal radius and ulna fractures (13.18%); 42 had proximal humerus fractures (10.85%); and 27 had other fractures (6.98%). The number of women with fractures at each site was greater than the number of men, but the differences weren't statistically significant (P > .05). The main causes of injury were falls (71.58%), and the main place of the occurrence of injury was at home (65.6%). Of the 387 participants, 346 had surgical treatment (89.41%), and the effective rate of surgical treatment was 99.42%. Three years after surgery, the research team followed up with 235 participants, for a follow-up rate of 60.72%. Within the 3 years of the follow-up period, 61 participants had refractures (25.63%), 29 received treatment with regular anti-osteoporotic drugs (12.34%), 36 exercised twice or more a week (15.32%), and 32 had died for various reasons (13.62%).Conclusions:The study preliminarily described the epidemiological characteristics of 387 osteoporotic fractures in adults over 65 years old. More women had fractures than men; the hip was the most common fracture site, and falls were the main cause of injury. Most of the fractures occurred in the place of residence, and the refracture rate was 25.96% at three years after surgery.

目的 总结全内镜下胸椎管减压术治疗胸椎管狭窄症的技术要点,分析全内镜下胸椎管减压术的临床疗效.方法 回顾性分析本院2017年6月至2020年12月收治的27例应用全内镜下椎管减压术治疗的单节段胸椎管狭窄症患者,致压因素为胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)14例,胸椎间盘突出伴纤维环骨化2例,后纵韧带骨化或椎体后缘骨赘9例,胸椎OLF合并后纵韧带骨化2例.根据致压因素位于脊髓腹侧或背侧压迫的严重程度,采取经椎板间入路或者经椎间孔入路.通过评价术前、术后和随访过程中的影像学表现评估手术减压情况.记录手术时间、手术并发症.应用改良日本骨科协会评分(modified Japanese Orthopedic Association,mJOA,11分法)评估术前和术后的神经功能并计算其改善率.结果 所有手术顺利完成,采用经椎板间入路脊髓背侧减压术14例,经椎间孔入路脊髓腹侧减压术11例,经椎间孔入路脊髓腹侧背侧同时减压2例.手术时间为159.1 min,其中经椎板间入路脊髓背侧减压手术时间为160 min,经椎间孔入路脊髓腹侧减压手术时间为136 min.所有患者术后及随访过程中的CT及MRI影像显示脊髓减压充分.术前mJOA评分1～10分,平均(6.0±2.3)分.末次随访时mJOA评分5～11分,平均(8.7±2.0)分,术前与术后差异有统计学意义(P<0.001),mJOA评分改善率25％～100％,平均64.5％.术中并发颈项疼痛2例,术中一过性神经功能恶化1例.术中硬膜缺损5例,其中4例为胸椎OLF合并硬膜骨化,未行硬膜修补,术后未出现影像学或有临床表现的假性硬膜囊肿或切口不愈合.术后48 h出现迟发性硬膜外血肿1例,二次内镜下探查血肿清除术后症状改善.结论 全内镜下胸椎管减压术治疗胸椎管狭窄症是一项安全有效的技术,做到脊髓充分减压的同时可以更好地减小手术创伤,规避并发症.

目的 比较改良俯卧位下椎间孔入路与椎板间入路脊柱内镜手术治疗合并高髂嵴的L5-S1椎间盘突出症的疗效.方法 选取2016年8月～2018年12月本院收治的35例合并高髂嵴的L5-S1腰椎间盘突出症患者为研究对象,根据手术方式分为研究组15例和对照组20例.研究组接受改良俯卧位下椎间孔入路脊柱内镜手术,对照组接受椎板间入路脊柱内镜手术.比较两组患者手术时间、及术后住院时间等指标,观察术前及术后随访各时间点的疗效指标和并发症发生情况.结果 研究组手术时间、及术后住院时间与对照组差异均无统计学意义(P>0.05),但术中透视次数明显多于对照组(P<0.05).手术后1 d、1个月、3个月和12个月,两组患者VAS评分、ODI指数均较术前显著降低(P<0.05);但组间差异均无统计学意义(P>0.05).术后随访12个月,研究组术后优良率86.67％与对照组85.00％比较,差异无统计学意义(P>0.05).研究组术后并发症发生率低于对照组,但差异无统计学意义(0％vs15.00％,P>0.05).结论 改良俯卧位下椎间孔入路与椎板间入路脊柱内镜手术均可用于治疗合并高髂嵴的L5-S1椎间盘突出症,术后疗效相当,但前者术后并发症发生率相对较低.

硬膜内型腰椎间盘突出症(ILDH)是一种罕见的疾病,其误诊率、漏诊率很高.由于突出椎间盘进入硬膜内,一旦误诊或漏诊,可能导致治疗效果不理想,甚至加重,给患者造成巨大的心理与经济负担.为提高临床对该疾病的诊疗水平,正确制订诊疗方案.本文分析探讨1例就诊于河北省人民医院骨科的硬膜内腰椎间盘突出症患者,该患者出现神经根受累症状和马尾综合征表现,通过术前查体、阅读影像学资料,考虑为ILDH,行腰椎后路开放手术治疗,取出疝入硬膜内的髓核组织,术后病理检查证实为ILDH,积极给予对症治疗,术后恢复良好.通过回顾性分析国内外文献,多数认为一旦确诊ILDH,应积极手术治疗;同时通过对疾病的症状、临床表现、影像特征、手术方式等进行文献复习,提高对该疾病的认识,进而以少误诊或漏诊.

目的 探讨老年骨质疏松性骨折术后再骨折的发病特点.方法 回顾性分析自2005-07-2018-07诊治的345例骨质疏松性骨折手术后再骨折.利用电子病案查询系统及医学影像计算机存档与传输系统记录、分析患者的基本信息,比较男性与女性老年骨质疏松性骨折手术后各个骨折部位出现再骨折的概率.结果 结果345例均完成调查,女性(81.7％)患者的数量较男性(18.3％)多,69.9％的患者骨密度T值≤-2.5 SD,脊柱(64.1％)是发病率最高的骨折部位.女性髋部、肱骨近端骨折发病率高于男性,差异有统计学意义(P＜0.05).摔伤(64.6％)是最主要的致伤原因.64.35％的患者出现再骨折的时间为首次手术后1～5年,仅有11.0％的患者首次手术后规律服用抗骨质疏松药物.15.1％的患者每周运动次数≥2次.结论 老年骨质疏松性骨折术后再骨折多发生于女性群体,骨折部位以椎体骨折最常见,首次骨折术后5年内再骨折发生率为77.9％,首次骨折后患者进行抗骨质疏松治疗的依从性较差.

[目的]比较不同入路及体位行椎间孔镜手术治疗椎间盘突出症的治疗效果.[方法]回顾分析2016年2月～2018年2月行椎间孔镜手术的L5S1椎间盘突出症患者96例.其中,32例采用常规俯卧体位椎间孔入路,32例采用改良俯卧体位椎间孔入路,32例采用常规俯卧体位椎板间入路.比较3组围手术期、随访和影像资料.[结果]96例患者均顺利完成手术,术中无严重并发症发生.改良组及椎板间组患者手术时间显著短于常规组(P＜0.05).早期并发症和不良反应发生率由高至低依次为常规组(3/32)、椎板间组(2/32)、改良组(0/32),但差异无统计学意义(P＞0.05).所有患者随访12个月以上,随时间推移,3组患者腰痛和腿痛VAS评分均显著减少(P＜0.05).相应时间点,3组间腰痛和下肢痛VAS评分的差异均无统计学意义(P＞0.05).影像方面,术后12个月三组患者LCI和椎间隙高度均较术前无显著改变(P＞0.05).相应时间点,3组间腰椎曲度指数和椎间隙高度的差异均无统计学意义(P＞0.05).[结论]改良俯卧位联合椎间孔入路可缩短手术时间,降低并发症风险.

患者, 男,27 岁, 体重指数为23kg/ m2 .因左小腿疼痛1 个月于2019 年9 月10 日至河北省人民医院就诊.患者入院前1 个月食用小龙虾(约1 kg)后,出现左侧小腿后方及足背肿胀疼痛,皮温稍高,左足因疼痛而背伸受限,行走时左下肢疼痛加重.就诊于当地县医院,查下肢深静脉及肌间静脉彩超未见异常病变,查血尿酸值稍高于正常值.

目的 探讨人工股骨头置换术(femoral head replacement,FHR)和股骨近端防旋髓内钉(proximal femoral nail anti-rotation,PFNA)治疗伤前日常生活能力较好的高龄股骨转子间骨折(intertrochanteric femoral fracture,IFF)患者的效果.方法 选取伤前日常生活能力较好的高龄IFF患者106例,根据治疗方法不同分为FHR组51例和PFNA组55例.比较2组手术时间、围术期失血量、术后下床活动时间、住院时间、髋关节Harris评分及并发症发生情况.结果 FHR组围术期失血量高于PFNA组,术后下床活动时间和住院时间均短于PFNA组,差异有统计学意义(P<0.05);2组手术时间差异无统计学意义(P>0.05).术后12个月,2组髋关节Harris评分高于术前,FHR组髋关节Harris评分高于PFNA组,差异有统计学意义(P<0.05).随访12个月,FHR组术后并发症总发生率低于PFNA组,差异有统计学意义(P<0.05).结论 相较于PFNA,FHR治疗伤前日常生活能力较好的高龄IFF患者可显著减少术后出血,缩短术后下床活动时间及住院时间,加快髋关节功能恢复,且并发症少.

Background Refractory intercostal neuralgia is a troublesome disease with long treatment cycle and short-term therapeutic effects. No treatment modality has given effective pain relief. The authors present here a safe and effective endoscopic surgical option for refractory intercostal neuralgia. Objectives To introduce the surgical techniques of percutaneous endoscopic intercostal neurectomy used for refractory intercostal neuralgia and to evaluate its safety and efficacy. Study design A retrospective study. Setting The Department of Orthopedics at the Hebei General Hospital in China. Methods Thirteen patients with refractory intercostal neuralgia were treated with percutaneous endoscopic intercostal neurectomy. Patients were followed up to 12 months postoperatively. The pain was measured by the Visual Analog Scale (VAS) score. Complications, such as aspiration, dysfunction, infection, and local hematoma were analyzed. Results Pain was relieved in all 13 patients, with only 1 patient reporting burning sensation along the intercostal nerve distribution area after operation. No other complications were found. All patients had significant improvement, with significantly lower VAS scores recorded postoperatively. No recurrence was reported during the follow-up period. Limitations The retrospective nature of this study is a limitation, as well as the small sample size and short observation time. Conclusions Endoscopic intercostal neurotomy is an effective and safe minimally invasive surgical treatment for refractory intercostal neuralgia.

患者,男, 32 岁,因摔倒致左手着地,当即出现左腕掌部肿胀、疼痛明显,就诊于当地医院,X线片显示左手各骨质未见明显异常.治疗2周待肿胀消退后,左手腕掌局部有一向背侧凸起肿物,触及较硬,左手示指功能受限,再次经当地医院诊断为左手肿物,未行特殊处理.患者为求进一步诊治,于2017年11月8日至河北省人民医院骨科就诊,手部CT检查提示左手第2 腕掌关节脱位.

目的 运用Meta分析研究椎间孔入路(transforaminal percutaneous endoscopic lumbar discectomy,TF-PELD)和椎板间入路(interlaminar percutaneous endoscopic lumbar discectomy,IL-PELD)治疗高髂嵴L5-S1椎间盘突出症的疗效.方法 检索Cochrane图书馆、MEDLINE、EMBASE、PUBMED、中国生物医学文献数据库、中国期刊全文数据库、维普数据库、万方数据资料系统.观察的结局指标包括:手术时间、术中透视次数、术中出血量;视觉模拟评分法(visual analogue scale,VAS)、Oswestry功能障碍指数评分标准(oswestry disability index,ODI)、改良Macnab疗效评定标准、日本骨科协会评估治疗评分(Japanese Orthopaedic Association Scores,JOA)、并发症、复发情况.采用RevMan 5.3软件对所需数据进行整合统计分析与异质性分析.结果 共纳入16篇文献,包括1054例患者,其中TF-PELD组525例患者,IL-PELD组529例患者.分析结果显示,手术时间、术中透视时间、术中出血量、术后48 h内VAS评分的差异有统计学意义(P<0.05),其余术后VAS评分、ODI评分、改良Macnab评分、JOA评分、并发症、复发情况等指标无统计学意义(P>0.05).结论 TF-PELD和IL-PELD治疗高髂嵴L5-S1腰椎间盘突出症术后疗效相当,并发症与复发程度无明显差异.但IL-PELD手术时间较短,术中透视次数及术中出血量较少.因此,对于高髂嵴L5-S1腰椎间盘突出症患者推荐使用IL-PELD手术.但IL-PELD对术者的技术操作要求较高,需要熟练掌握手术操作.

目的 探讨人工股骨头置换术对超高龄不稳定型股骨转子间骨折伴骨质疏松症的临床效果.方法 回顾性分析2018年1月—2019年7月河北省人民医院骨科收治超高龄(≥90岁)不稳定型股骨转子间骨折伴骨质疏松症患者96例,男性42例,女性54例;年龄91～106岁,平均95.8岁,均为摔伤导致骨折.根据患者术式不同(患者自愿选择)分为髓内钉内固定组与股骨头置换组,各48例,髓内钉内固定组行防旋型股骨近端髓内钉治疗,股骨头置换组行人工股骨头置换治疗.髓内钉内固定组男性22例,女性26例;年龄91～106岁,平均96.2岁.股骨头置换组男性20例,女性28例;年龄92～105岁,平均95.6岁.观察两组患者手术时间、术中出血量、下地负重时间、术后3个月、1年Harris评分优良率以及并发症发生情况.结果 髓内钉内固定组手术时间(67.2±9.3)min短于股骨头置换组(90.6±10.4)min,差异有统计学意义;术中出血量(121.8±31.4)mL少于股骨头置换组(130.7±40.6)mL,但差异无统计学意义(P>0.05),髓内钉内固定组下地负重行走时间(12.5±2.0)d长于股骨头置换组(5.6±2.1)d,差异有统计学意义(P<0.05);术后3个月、1年随访,股骨头置换组Harris评分优良率分别为85％和92％,髓内钉固定组65％和71％,股骨头置换组优于髓内钉固定组,差异有统计学意义(P<0.05).髓内钉内固定组患者发生术后并发症4例,分别为泌尿系感染2例、患肢深静脉血栓形成2例;股骨头置换组2例,均为坠积性肺炎,差异无统计学意义(P>0.05).结论 应用人工股骨头置换治疗≥90岁的超高龄不稳定型股骨转子间骨折伴骨质疏松症患者,其近期临床效果优于防旋型股骨近端髓内钉治疗,值得临床推广应用.

BACKGROUND:Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery.METHODS:This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded.RESULTS:Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; p=0.03). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed.CONCLUSION:Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

Background: Many complications are associated with thoracic open decompression surgery, such as dural tears and neurological deficits. The clinical outcomes are also not satisfactory. Full-endoscopic decompression of the lumbar spinal canal has achieved satisfactory results for the treatment of lumbar spinal stenosis. This surgery may be used for the treatment of thoracic ossification of the ligamentum flavum (OLF) under local anesthesia. The aim of our study is to introduce the surgical techniques used for full-endoscopic decompression for thoracic OLF and to evaluate its safety and efficacy. Methods: Fourteen patients with thoracic OLF (4 combined with dural ossification) underwent full-endoscopic decompression surgery. An interlaminar approach was performed. The anchoring method was used to establish the working passage. Spinal cord exposure began at a space between the ossification and the spinal cord, and dorsal and contralateral decompression were performed with the "Over the Top" technique. The modified Japanese Orthopedic Association score (11 points) was used to evaluate the efficacy during follow-up. At the same time, the visual analogue scale score for assessing back pain before and after the operation was evaluated. Results: The average operation time was 159.73 +/- 62.09 minutes, and the hospitalization time was 7.43 +/- 1.79 days. The follow-up period ranged from 8 to 22 months. Neurological function was improved. There were no serious complications. Dural tears occurred in 5 patients, intraoperative neurological deterioration occurred in 1 patient, and intraoperative headache and neck pain occurred in 1 patient. Conclusion: Full-endoscopic decompression is an effective, safe surgical technique for thoracic OLF even the cases combined with dural ossification.

目的 探讨改良俯卧位下经皮椎间孔镜手术治疗合并高髂嵴的L5S1椎间盘突出症临床疗效.方法 回顾性分析自2014-01-2016-07采用改良俯卧位下经皮椎间孔镜手术治疗11例L5S1椎间盘突出症合并高髂嵴,比较术前采用常规俯卧位时与改良俯卧位时α值,比较术前、术后1d、3个月时疼痛VAS评分,术前、术后1、3个月ODI指数.结果 11例均顺利完成手术并获得随访,随访时间平均13.5(12～18)个月,未出现马尾神经、硬脊膜损伤、感染、切口愈合不良等并发症.术前采用改良俯卧位,髂嵴相对下移,α值较常规俯卧位明显减小,差异有统计学意义(P＜0.05);采用改良俯卧位时,d所落区域3区2例,2区9例.术后1d、3个月疼痛VAS评分及术后1、3个月ODI指数均较术前明显降低,术后3个月疼痛VAS评分较术后1d降低,术后3个月ODI指数较术后1个月降低,差异有统计学意义(P＜0.05).术后1年采用改良MacNab标准评价疗效:优9例,良1例,可1例.结论 改良俯卧位下经皮椎间孔镜手术治疗合并高髂嵴L5S1椎间盘突出症疗效满意,安全性高.

Negative pressure wound therapy (NPWT) is an important therapy for the management of refractory wounds. The aim of this retrospective preliminary study was to introduce a modified NPWT (m-NPWT) and compared the efficacy of it with conventional NPWT (c-NPWT) in the management of refractory wounds. A total of 127 patients with refractory wounds receiving the NPWT from January 2010 to October 2017 in our hospital were retrospectively reviewed. The demographics and clinical data were collected from medical records and compared between m-NPWT group and c-NPWT group. There were 65 patients in c-NPWT group and 62 patients in m-NPWT group. No significant difference was observed between 2 groups in antimicrobial use (P = .51), hospitalization time (P = .24), wound-healing rate (P = .44) or complication rate (P = .59). However, patients in m-NPWT group had shorter wound-healing time (24.82 vs 27.66 days,P < .01), less debridement times (1.23 vs 2.08,P < .01), less total cost (3743.93 vs 6344.33 yuan,P < .01) and higher satisfaction rate (56/62 vs 44/65,P = .02) compared to those in c-NPWT group. The m-NPWT technique was an efficient and safe alternative therapy for refractory wounds.

目的 比较股骨近端防旋髓内钉(PFNA)与动力髋螺钉(DHS)内固定治疗合并糖尿病的老年股骨转子间骨折的疗效.方法 将86例合并糖尿病的老年股骨转子间骨折患者根据治疗方法不同分为PFNA组(采用PFNA治疗,45例)和DHS组(采用DHS治疗,41例).比较两组切口长度、手术时间、术中出血量、术后引流量、完全负重时间、临床疗效及并发症发生情况.结果 患者均获得随访,时间12～16个月.切口长度、手术时间、术中出血量、术后引流量、完全负重时间PFNA组均明显短(少)于DHS组(P<0.05).并发症发生率PFNA组低于DHS组(P<0.05).术后3个月Harris评分PFNA组明显高于DHS组(P<0.05);术后6个月、末次随访时Harris评分两组比较差异均无统计学意义(P>0.05);末次随访时Harris评分优良率PFNA组高于DHS组(P<0.05).结论 相比DHS,PFNA治疗合并糖尿病的老年股骨转子间骨折临床疗效更好,更利于关节功能恢复,术后并发症发生率更低.