目的 探讨身痛逐瘀汤加减方联合腰椎牵引疗法治疗急性期腰椎间盘突出症(LDH)的临床疗效.方法 将114例急性期LDH患者按随机数字表法分为观察组与对照组各57例,对照组给予腰椎牵引,观察组在对照组基础上给予身痛逐瘀汤加减方;7 d为1个疗程,共3个疗程.结果 与本组治疗前相比,两组中医证候评分、镇痛效果、运动功能评价均有所改善(P＜0.05或P＜0.01),且观察组改善更为显著(P＜0.05).在临床疗效中总好转与临床症状恢复时间的比较上,观察组的提升更为明显(P＜0.05).结论 采用身痛逐瘀汤加减方联合腰椎牵引疗法治疗急性期LDH的临床疗效显著,且能够有效改善患者急性期的疼痛状态.

Objective:To investigate the risk factors of lower extremity venous thrombosis in elderly patients with femoral neck fracture during perioperative period after artificial bipolar femoral head replacement and the effect of Mailuoshutong in clinical prevention and treatment of thrombosis.Methods:A retrospective case-control study was conducted on the clinical data of 92 elderly patients with femoral neck fracture who were admitted to the Affiliated Hospital of North China University of Technology from January 2015 to January 2020.According to the treatment method, the patients were divided into an observation group (44 cases) and a control group (48 cases). Patients in the observation group were treated with the combination of Mailuoshutong Pill and low molecular weight heparin calcium.The control group was treated with low molecular weight heparin calcium.The patients in both groups started anti-coagulation therapy immediately after admission, and they stopped the drug one day before operation and continued to take the drug on the second day after operation.Venous ultrasound of both lower limbs was recorded at the time of admission, on the 7th day after admission, and 14 days after surgery.The changes in hemoglobin, red blood cell count and drainage volume before and after operation were recorded.Results:The incidence of thrombosis was 2 cases (4.54%) on the 7th day after admission in the observation group and 9 cases (18.75%) in the control group.The difference was statistically significant (χ 2=4.400, P=0.036). The incidence of thrombosis was 3 cases (6.82%) in the observation group and 11 cases (22.92%) in the control group 14 days after operation.The difference was statistically significant(χ 2=4.611, P=0.032). The hemoglobin changes of observation group and control group were (23.73±6.89) g/L and (22.10±5.18) g/L respectively on the first day before operation and 48 hours after operation.The red blood cell count changes were (0.67±0.32) × 1012/L and (0.56±0.36) × 1012/L respectively, and the drainage volume of drainage tube after operation was (100.27±23.73) ml and (102.40±20.90) ml, respectively.There was no significant difference in the above indexes between the two groups (all P>0.05). Multivariate Logistic regression analysis showed that only low molecular weight heparin calcium was used to prevent and treat thrombosis ( OR=10.281, 95% CI: 1.609-65.689, P=0.014); the elderly patients ( OR=1.190, 95% CI: 1.061-1.336, P=0.003) and the thrombosis at the time of admission ( OR=8.346, 95% CI: 1.773-39.281, P=0.007) were the risk factors for lower extremity venous thrombosis on the 14th day after surgery. Conclusion:Mailuoshutong pill combined with low molecular weight heparin calcium can safely and effectively treat lower extremity venous thrombosis in perioperative period of artificial femoral head replacement for femoral neck fracture in elderly patients.Mailuoshutong pill combined with low molecular weight heparin calcium was a protective factor for lower extremity venous thrombosis 14 d after operation, while advanced age and thrombosis at the time of admission were risk factors.

目的 探讨119例中老年人小转子处股骨与髓腔直径比值与骨密度的相关性,预测骨密度值及判断骨质疏松症的准确性.方法 华北理工大学附属医院2014年1月—2020年1月同时行骨盆正位片和骨密度检查的55岁以上中老年人119例.通过骨盆正位X线片,测量得到股骨小转子上缘、中点、下缘股骨直径与髓腔直径的比值.经双能X线骨密度测量仪测量腰椎及股骨颈骨密度.按T值≤-2.5标准差将其分为骨质疏松组40例与非骨.质疏松组79例.比较二组性别、年龄、体重指数.通过Pearson偏相关分析,揭示股骨髓腔直径比值与腰椎和股骨颈骨密度之间的相关性.通过一元线性方程分析股骨髓腔直径比值预测骨密度的准确性.通过接受者工作特征曲线(ROC)确定股骨髓腔直径比值诊断骨质疏松症的最佳值及准确率,预测的灵敏度和特异性.结果 骨质疏松组平均年龄(68.98±6.68)岁,男11例,占27.5％,女29例,占72.5％、小转子处股骨髓腔直径上缘、中点、下缘比值分别为(1.124±0.063)、(1.199±0.058)、(1.263±0.073);非骨质疏松组平均年龄(65.76±6.27)岁,男40例,占50.6％,女39例,49.4％,小转子处股骨髓腔直径上缘、中点、下缘比值分别为(1.187±0.073)、(1.324±0.086)、(1.385±0.074),二组比较,差异均有统计学意义(均P＜0.05).Pearson偏相关分析小转子处上缘、中点、下缘股骨髓腔直径比值与股骨颈骨密度的相关性结果分别为(r=0.173,PP=0.061)、(r=0.310,P=0.001)、(r=0.508,P=0.000),与腰椎骨密度相关性结果分别为(r=0.282,P=0.002)、(r=0.399,P=0.000)、(r=0.507,P=0.000).股骨颈骨密度和腰椎骨密度与小转子下缘股骨髓腔直径比拟合一元线性回归方程结果分别为(调整后R2=0.267,F=43.967,P=0.000),(调整后R2=0.264,F=43.260,P=0.000),方程均有统计学意义;小转子下缘股骨髓腔直径比值每增加0.01,股骨颈骨密度值增加0.00806 g/cm2,腰椎骨密度值增加0.00747 g/cm2.利用ROC曲线进行骨.质疏松症的诊断性分析得知曲线下面积AUC=0.884,预测准确率为63.6％,小转子下缘股骨髓腔比值为1.328,敏感度为0.886、特异度为0.750,以上差异均有统计学意义.结论 小转子下缘股骨髓腔直径比与骨密度呈正相关,通过小转子处股骨髓腔直径比值进行骨质疏松症的筛查具有一定准确性且方便快速,具有普及应用价值.

患者,男,66岁,因车祸致全身多发伤,右上肢疼痛、出血并完全性皮肤脱套4. 5 h于2020年5月30日入我院治疗.既往有高血压病史6年,冠心病史3年,未规律服药控制,吸烟饮酒史20 余年.查体:右上肢皮肤脱套伤,皮瓣呈桥状,范围由手腕至腋下,约占全身面积的6. 5％(见图1A).脱套皮瓣边缘存在碾挫伤,内部含有大量泥沙等异物,其血管、淋巴管及皮下组织同深筋膜肌肉层完全离断.肘关节周围肌肉组织挫伤较重,肘部及前臂肌腱、神经、血管组织外露并中度挫伤.肘关节囊开裂,可见关节软骨外露.右腕部尺桡动脉搏动可触及,右手感觉减退明显.X线检查未见明显骨折线.

目的 探讨封闭负压引流(VSD)后应用自制生肌玉红膏纱条换药治疗骶尾部Ⅳ期压疮伴感染的临床疗效.方法 收集我院2015年1月～2020年8月收治的骶尾部Ⅳ期压疮伴感染患者86例,按随机数字表法分三组:A组26例,单纯应用生肌玉红膏换药;B组27例,对创面清创后行VSD再采用西医换药治疗;C组33例,对骶尾部压疮清创后VSD,再采用生肌玉红膏换药.比较三组患者在入院时、治疗第10d、治疗第30d压力性溃疡治疗评估表(PUSH)分值变化及入院时和治疗第10d白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(HBG)、血清白蛋白(ALB)、血清前白蛋白(PAB)、超敏C反应蛋白(CRP-C)、红细胞沉降率(ESR)变化.结果 入院时三组患者PUSH得分差异无统计学意义(P>0.05);治疗第30d时三组患者PUSH得分分别为(11.62±1.79)分、(14.07±1.27)分、(10.45±2.02)分,差异有统计学意义(F=32.669,P=0.000);其中C组恢复最好.入院时三组WBC、RBC、HGB、ALB、PAB、CRP-C、ESR差异无统计学意义(P>0.05),治疗第10d时上述指标组间比较差异有统计学意义(F=3.356、P=0.040,F=7.799、P=0.001,F=6.390、P=0.003,F=3.356、P=0.040,F=7.799、P=0.001,F=11.769、P=0.000,F=4.117、P=0.020),说明应用VSD治疗的B、C组指标优于A组.结论 VSD配合生肌玉红膏换药治疗骶尾部Ⅳ期压疮恢复快、患者一般状况好,值得临床推广.

Objective:To study the clinical effect of Maizhiling tablets combined with salmon calcitonin in the treatment of elderly femoral neck fracture after artificial femoral head replacement and the influencing factors of hip joint function 6 months after operation.Methods:Prospective research methods were used in this article.A total of 84 elderly patients with femoral neck fracture who underwent artificial femoral head replacement in the Affiliated Hospital of North China University of Science and Technology from January 2017 to June 2019 were selected and randomly divided into the treatment group (41 cases) and the control group (43 cases) by the random number table method.The treatment group was treated with Maizhiling tablet and salmon calcitonin nasal spray plus basic calcium; the control group was treated with basic calcium.Independent sample t test was used to compare the visual analogue score (VAS) on the 5th day after operation, the time of complete disappearance of congestion in thigh, and the time of first ambulation after operation between the two groups.The bone mineral density (BMD) of contralateral femoral neck and Harris score of hip joint function were compared between the two groups at 14 days, 3 months and 6 months after operation by repeated measurement variance analysis.Multivariate Logistic regression was used to analyze the influencing factors of hip joint function at 6 months after operation.Results:VAS score on the 5th day after surgery: (6.34±1.54) points in the treatment group and (7.02±1.50) points in the control group.Complete regression time of thigh congestion: (12.12±2.27) d in the treatment group and (13.88±2.58) d in the control group.The first postoperative activity time was (5.93±1.52) d in the treatment group and (7.84±1.05) d in the control group, and the differences of the above indexes between the two groups were statistically significant ( t value was 2.051, 3.313, 6.673, respectively, all P<0.05). The BMD values of the contralateral femoral neck in the treatment group were (0.543±0.123), (0.561±0.119), (0.606±0.105) g/cm 2 at 14 days, 3 months and 6 months after operation, and (0.530±0.092), (0.517±0.089), (0.526±0.090) g/cm 2 in the control group.The results of variance analysis of repeated measurements showed that Fintra-group=55.726, P<0.01; Finter-group=4.206, P<0.05; Finteraction=57.654, P<0.01.There were significant differences between 3 months, 6 months and 14 days after operation in the treatment group (all P<0.01), and between 3 months and 6 months after operation ( P<0.01). In the control group, there was significant difference between 14 days and 3 months ( P<0.01), and between 3 months and 6 months ( P<0.01); 6 months after operation, the difference was statistically significant ( P<0.01). The Harris scores of hip joint in the treatment group were (82.12±8.18), (85.49±6.61), (87.10±6.57) points and (78.91±5.75), (81.44±6.42), (83.67±6.97) points in the control group.The results of repeated measurement ANOVA showed that Fintra-group=64.526, P<0.01; Finter-group=6.529, P<0.05; Finteraction=0.501, P>0.05.There were significant differences between 3 months, 6 months and 14 days after operation (all P<0.01). There were significant differences between 3 months and 6 months after operation ( P<0.05). There were significant differences between the groups 14 days, 3 months and 6 months after operation ( P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age( OR=1.318, 95% CI1.002-1.732, P=0.048) and treatment method ( OR=29.168, 95% CI 1.030-824.623, P=0.048) were risk factors for hip function on the replacement side, and Harris score of hip function 14 days after surgery ( OR=0.624, 95% CI 0.447-0.873, P=0.006) were protective factors for hip function 6 months after surgery. Conclusion:Maizhiling tablets and salmon calcitonin nasal spray have good effects on removing blood stasis, relieving pain, effectively improving bone mineral density and promoting the recovery of joint function after artificial femoral head replacement for senile femoral neck fracture.The younger age of patients, postoperative treatment with Maizhiling tablets combined with salmon calcitonin and good recovery of hip function in 14 days after operation are the protective factors of good hip function in 6 months after operation.

目的 探讨鲑鱼降钙素和阿仑膦酸钠在股骨颈骨折内固定术后预防和治疗骨质疏松及股骨颈短缩中的作用.方法 2014年1月-2019年6月华北理工大学附属医院收治的采用股骨颈骨折空心钉内固定术治疗的118例老年患者,按简单随机分组法分为二组.第1组56例,给予鲑鱼降钙素治疗,第2组62例,给予阿仑膦酸钠治疗.比较二组患者术后9个月内骨密度值、骨折愈合时间、术后第9个月时股骨颈短缩程度及股骨头坏死率.结果 术后9个月二组骨密度值变化重复测量的方差分析所得分组、时间点、分组×时间点比较结果分别为(F=7.060,P=0.009)、(F=7.560,P=0.000)、(F=0.982,P=0.406);两种治疗方法提升骨密度效果存在差异,阿仑膦酸钠在术后提升骨密度效果较鲑鱼降钙素好,术后骨密度值随时间存在趋势性变化,这种变化与治疗方法不存在交互作用.术后9个月时,二组股骨颈短缩程度结果分别为(7.79±1.78)mm和(8.50±1.68)mm,鲑鱼降钙素组术后股骨颈短缩程度少于阿仑膦酸钠组,差异有统计学意义(P＜0.05).鲑鱼降钙素组与阿仑膦酸钠组术后骨折愈合时间分别为(4.82±1.15)个月和(5.35±1.24)个月,鲑鱼降钙素组愈合时间短于阿仑膦酸钠组,差异有统计学意义(P＜0.05).术后9个月二组髋关节Har-ris评分比较结果为(89.39±5.20)和(86.39±6.99),鲑鱼降钙素组术后髋关节功能较好,差异有统计学意义(P＜0.05).术后9个月时行MRI检查二组股骨头坏死率,鲑鱼降钙素和阿仑膦酸钠术后差异无统计学意义(P＞0.05).结论 股骨颈骨折内固定术后应用鲑鱼降钙素治疗可促进骨折愈合,减少股骨颈短缩,髋关节功能较好;而应用阿仑膦酸钠术后提升骨密度效果较好;术后9个月时,二组股骨头坏死率差异无统计学意义.

目的 观察骨康胶囊用于促进鼻骨骨折恢复的临床疗效及安全性.方法 将80例外伤性闭合性鼻骨骨折患者随机分为对照组40例和试验组40例.对照组予以双氯芬酸钠每次75 mg,qd,口服;试验组予以骨康胶囊每次1.2 g,tid,口服.2组患者均治疗8周.比较2组患者鼻周软组织和鼻骨骨折的愈合情况,以及药物不良反应的发生情况.结果 治疗后,试验组和对照组的皮肤光亮消退时间分别为(3.50±0.88)和(5.50±1.41)d,淤血消退时间分别为(9.63±3.43)和(18.25±8.10)d,皮纹出现时间分别为(13.48±6.98)和(18.20±8.50)d,骨痂初现时间分别为(17.15±3.53)和(28.25±9.18)d,骨折线模糊时间分别为(29.80±9.40)和(35.75±12.54)d,骨折线消失时间分别为(42.80±12.51)和(55.50±6.97)d,差异均有统计学意义(均P<0.05).试验组治疗期间未见药物不良反应,对照组的药物不良反应以胃部不适为主.试验组和对照组的总药物不良反应发生率分别为0和12.50％,差异有统计学意义(P<0.05).结论 骨康胶囊在促进鼻周软组织和鼻骨骨折愈合方面的临床疗效确切,且短期用药安全.

阑尾炎是外科常见症.也是最多见的急腹症.虽然,过多的误诊已使临床医生重视阑尾炎的症状及辅助检查在其早期诊断中的价值,然而,异位阑尾炎[1]仍不时地给我们以教训.尤其是左位阑尾炎没有引起我们的充分注意,因而,我们仍不可忽视每一个具体患者.鉴于此,现将我院1986--2007年收治的4例左位阑尾炎报告如下.