目的 比较膝关节镜联合MIPPO技术复位内固定与切开复位内固定治疗胫骨平台骨折的临床疗效及安全性.方法 回顾性分析2018年7月至2020年7月期间十堰市太和医院创伤骨科收治的76例SchatzkerⅠ-Ⅲ型胫骨平台骨折患者资料.依据手术方式不同分为膝关节镜联合MIPPO技术微创内固定组(A组)35例和传统切开复位内固定组(O组)41例.记录并比较两组患者的手术时间、切口长度、术中失血量、术后引流量、膝关节内软组织损伤情况、住院时间、术后下床活动时间、术后Rasmussen放射评分、骨折愈合时间、术后并发症发生情况、术后1、2、3、6个月时膝关节HSS功能评分及术后12个月时HSS评分优良率,评估两组手术方式的临床疗效.结果 A组手术时间较O组长,差异具有统计学意义(P<0.05);A组术中失血量、术后引流量少于O组,膝关节内软组织损伤者较O组多,差异具有统计学意义(P<0.05);A组切口长度、术后下床活动时间、骨折愈合时间均较O组短,差异具有统计学意义(P<0.05);两组住院时间比较差异无统计学意义(P>0.05).A组术后Rasmussen放射评分高于O组,差异具有统计学意义(P<0.05);A组术后1、2、3、6个月时膝关节功能HSS评分均较O组高,差异具有统计学意义(P<0.05);两组患者术后12个月时膝关节HSS功能评分优良率比较,差异无统计学意义(P>0.05).结论 两种方式治疗SchatzkerⅠ-Ⅲ型胫骨平台骨折均有良好的临床疗效,但在膝关节镜辅助下联合MIPPO技术治疗胫骨平台骨折可以精准诊断和治疗膝关节内损伤的软组织,具有手术创伤小、视野清晰、骨折复位质量高、骨折愈合快、术后膝关节功能恢复快等优点,有利于患者术后早期快速康复,是治疗SchatzkerⅠ-Ⅲ型胫骨平台骨折的较好方法.

目的 在新型冠状病毒疫情下,初步探讨创伤骨科病房人群中无症状新型冠状病毒肺炎(COVID-19)的防控措施.方法 回顾性分析2020年1月20日至2020年2月25日期间逗留本科的245人的资料.其中,患者103人,陪护108人,清洁工2人,医护共32人.其中男98人,女147人;年龄3～88岁,平均年龄48岁.统计医生、护士、科室清洁人员、患者及患者家属胸部CT、ESR、hsCRP及核酸检测结果,是否感染COVID-19.对院前、围手术期及院外采取的防控措施进行归纳总结.结果 共发现2例无症状感染者,1例为患者陪护家属,1例为医护人员;自从防控措施实施后未见医务人员感染.结论 在保障患者利益的前提下,正确认识无症状感染者的存在,当核酸检测受限时,联合流行病学、影像学及化验检查可进行有效的初步筛查,采取严格的防控措施可减低医务人员感染的发生率.

目的研究颈神经背根节卡压所致顽固性肘外侧疼痛的病理特点和诊治方法.方法采用YabuKi对颈神经背根节的研究方法,同时对7具成人防腐标本颈背根节的位置和毗邻关系进行了观察.结合临床对35例顽固性肘外侧疼痛,因神经在颈部或同时存在肘部的卡压,所表现的不同体征,分为单卡型和双卡型.分别采取背根内侧支阻滞配合手法以及肘部痛点封闭治疗.结果单卡型组平均治疗3次,双卡型组平均治疗5次.平均随访9个月,术后疗效优良率分别为87.5%和79.0%,总优良率为83.8%.结论颈神经背根节卡压可能是顽固性肘外侧疼痛又一重要发病因素.神经阻滞配合手法治疗,对该类型顽固性肘外侧疼痛,具有较好的治疗效果.

颈神经后支源性颈肩痛,因缺乏特征性体征,诊断较为困难,易被忽略.为了提高诊疗效果,根据Bogduk对颈神经后支的解剖学研究,通过对130例临床资料的分析,对其诊断标准以及中医手法的治疗作用进行探讨和评价.研究结果表明:其一,对颈神经后支源性颈肩痛临床症候群深入认识,有助于提高诊疗水平,是学科发展的重要课题;其二,中医手法治疗,具有有效性、持续性、可补性三大优势;其三,深化对颈椎小关节形态学的三维研究,为手法的针对性和安全性提供必要保证.

Objective:Probing into the method of straight leg raising treating prolapsed lumbar intervertebral disc adaptive symptom and impacting curative effect relevant factor.Methods:Adopting the classification of three-dimensional localization imaging study by Hu Yuogu,we retrospectively analyse curative effect of 120 cases of prolapsed lumbar intervertebral disc.Results:Prolapsed lumbar intervertebral disc locating at layer,section,field,the cure rates and efficiency rates were 91.7%,92.6%,80.8%,the failed rates were 8.3%,7.4%,19.2%.Coalescing side crypta stenosis and spinal stenosis patients were 76 cases(accounting for 63.3%).The cure rates and efficiency rates were 86%,84.2%;the failedrates were 14%,15.8%.Conclusion:The prolapse locating at c～d field,excess 1/2 of vertebral canal fore-and-aft diameter,was called largeness-type prolapsed lumber intervertebral disc.This case should be held cautions attitude and was inadvisable to choose the method of straight leg raising as premier choice.The cases of side crypta stenosis and spinal stenosis having clue to imaging study,should consider its actual pathologic diversity and complexity.This case had reciprocal clinical symptom,and judged by symptom as emphases.Coalescing side crpta stenosis and spinal stenosis are relevant factor of affecting curative effect.

自1999～2000年3月,作者采用三步手法配合中药内服治疗腰椎间盘突出症103例,取得了满意的疗效.现总结报告如下.

第三腰椎(L3)横突综合征是常见的慢性腰腿痛疾患,多见于青壮年体力劳动者.1998年9月～2000年9月,笔者采用小针刀配合曲安奈德复合药液注射治疗本病56例,疗效理想,现报道如下.

Purpose:We had used the hand skill of loosening congealation and separating tendon to treat the osteoarthrosis in knee joint and obtained a satisfied clinical effect. To probe into the mechanism of this method, we had researched the experiment.Method:According to the method of Videman T, knee joints of the sample rabbits had been fixed in straight position by gypsum for 6 weeks as osteoarthrosis model. Divide the sample animals into 3 groups randomly. The hand skill group were treated by the hand skill of loosening congealation and separating tendon every other day; The pharmaceutical contrast group were fed by a half gram of bone joint tonic every day; The blank contrast group were fed only fodder for 6 weeks.Result:In the pharmaceutical contrast group and the blank contrast group, the ill knee activity range of sample rabbits was obviously limited, the joint liquid became abnormal, the synovial membrane was proliferated. And under the microscope, it showed the cartilage cell in joint withered down and the quantity reduced, the cell nucleus concentrated, the cartilage base calcification was hindered; In the hand skill group, the ill knee activity range clearly enlarged, function was well, and there was no obvious difference of the joint liquid property compared with that at healthy side, there was no clear proliferation of synovial membrane and under microscope,the cartilage membrane and the cartilage cell were clear, range was normal,cartilage ossified regularly, clinical effect was notably superior to that of the pharmaceutical contrast group and the blank contrast group.Conclusion:This hand skill has a good effect for accelerating joint cartilage restoration,alleviating synovitis and improving joint function.

臀肌挛缩症(gluteal muscle conracture,GMC)常见于14岁以下儿童.对因就诊时间晚,大龄GMC未见详尽报道.1996年6月～1999年7月,我们共收治18岁以上的大龄GMC患者21例.本文对大龄GMC的病理特点及手术方式进行探讨. 临床资料 一、一般资料:本组21例,男15例,女6例,年龄18～22岁,平均20.5岁.既往有反复多次臀部肌肉注射史,均为双侧病变.所有患者行走时呈“外八字”步态,臀部凹陷不丰满,并膝不能下蹲,下蹲时呈“蛙式征”,跑跳受限,双大腿交腿试验、屈髋试验阳性,Ober氏征阳性12例,弹响髋20例.

目的研究股外侧肌肌骨瓣移植在治疗股骨头缺血性坏死疾患中的临床应用.方法对我院在1994年3月～1999年11月间,应用股外侧肌肌骨瓣移植治疗股骨头缺血性坏死的32例39髋患者,进行了临床观察和随访.结果经随访2年以上者29例33髋,其中Ⅲ期25髋,Ⅳ期8髋.术后疗效的优良率为90.9%.结论该方法对改善股骨头血运,促进坏死区血循环的重建与修复,具有较好的疗效.

colles骨折是人体最多见的骨折之一，尤其在老年人群中常见。临床治疗多用小夹板或石膏外固定方法，外固定期间可出现合并症。笔者以杉树皮小夹板固定与石膏外固定colles骨折进行比较，观察两种固定疗法的合并症情况。现报道如下。 1　临床资料 本组100例中，男41例，女59例；年龄在20岁～70岁，平均56．8岁。左腕者64例，右腕者36例；受伤到就诊时间25分钟～10小时，平均3 小时。 上述病例随机分为：治疗组（小夹板固定）50例，对照组（石膏外固定）50例。两组根据Solgaard分类标准分为四型［1］，见表1。

To explore the diagnostic and therapeutic methods of compressionsyndrome of cervical posterior branch, according to Yabukis'research about anatomy of cervical nerve, analyze retrospectively the therapeutic effect of compression syndrome of cervical posterior branch(89 cases) with cervical nerve block outside vertebral canal and manipulation. The average follow-up time was half a year. 38 out of 47 patients were cured with cervical nerve block and the curative rate was 80％, but other 42 patients were all cured with cervical nerve block outside vertebral canal and manipulation, the curative rate was 100％. There was a significant difference(P<0.05) in two groups. For head-neck-shoulder pain patients without clear cause and obvious nervous signs, they should be diagnosed as compression syndrome of cervical posterior branch, which related to being compressed of cervical posterior branch at the articular process. It was suggested that cervical nerve block outside vertebral canal with manipulation was a pointed and effective therapeutic method.

儿童股骨干骨折是小儿生长期间最常见的一种骨折.在骨折愈合过程中,因儿童习性好动,难于配合,故较易发生骨折远端的旋转和成角畸形,后果不良.笔者自1994年以来,采用先牵引并使用小夹板和石膏分期、多层外固定的方法,治疗儿童股骨干骨折68例,取得了较为满意的效果.现报告如下. 1 临床资料 本组68例中,男性46例,女性22例;年龄4岁～13岁,平均8.3岁.左侧23例,右侧45例;骨折部位:上段21例,中段35例,中下段12例;骨折类型:横型11例,斜型29例,螺旋型28例,粉碎型9例.选择病例全部为新鲜闭合性骨折,无复合伤和多发性骨折.

对健脾化湿方治疗四肢创伤性肿胀的疗效观察,从临床上和理论上进行了初步探讨.