Objective To investigate the diagnosis and treatment of interphalangeal lateral collateral ligament injury. Methods Twenty-eight patients with interphalangeal lateral collateral ligament injury who were treated in our hospital from January 2010 to January 2015 were enrolled in the study.These patients were treated by different surgical methods,with using aluminium panels or gypsum to fix injuried finger straightly,to remove the external fixation during 4~6 weeks after operation and to carry out functional exercise gradually until returning to normal. The therapeutic effects were observed, moreover the pain degree of patients was assessed by VAS score and functional assessment was performed according to Dargan functional scoring.Results The primary wound healing rate was 100%.After 3 ~12 month follow up, the para position of avulsion fracture of phalanx base was good,with bone union rate being 100%,without finger deformity.The VAS scores before operation were(5.86 ± 1.21) points,which were (2.50 ± 1.07) points after operation,there were significant differences (P<0.05). The Dargan scores of interphalangeal joint range of motion before operation were(47.86 ± 7.20) points,however,which were (80.00 ± 7.11) points after operation, there were significant differences (P <0.05),with excellent and good rate being 89.29%.Conclusion It is an ideal therapeutic method to carry out surgery to restore joint capsule and reconstruct collateral ligaments in treatment of interphalangeal lateral collateral ligament injury,moreover, postoperative active rehabilitation treatment can effectively restore finger function and prevent disability.

目的 分析带线锚钉联合锁骨钩钢板治疗Ⅲ型肩锁关节脱位的临床效果.方法 对我院2012年1月—2016年1月收治的行带线锚钉联合锁骨钩钢板治疗Ⅲ型肩锁关节脱位23例的临床资料进行回顾性分析.结果 本组均顺利完成手术,术后伤口均Ⅰ期愈合.随访1～5年,平均12.6个月,肩锁关节脱位均得到纠正,X线检查结果显示术后无锚钉松动及脱出,无缝线断裂,无脱位复发,无血管、神经损伤等并发症.采用Constant-Murley评分系统对肩关节功能进行综合评价,评分82～100分,平均96.5分,其中优19例,良4例,优良率100％.结论 带线锚钉联合锁骨钩钢板治疗Ⅲ型肩锁关节脱位具有手术创伤小、术中操作简单、可早期行肩关节功能恢复锻炼、术后并发症少等优点.

Objective To explore clinical effects of first-stage bridge graft and Herbert nail compression fix-ation in the treatment of scaphoid fracture via palmar approach. Methods A total of 26 patients with from January 2008 to January 2017 were enrolled in this study. One-stage bridge inlay bone graft and Herbert nail compression fix-ation were performed via palmar approach. The fracture reunion was observed and the clinical effects were observed. Results All the patients were followed up for 9-24 (15.34 ± 5.37) months. All the incisions were primary healing. The time of fracture reunion was 8-18 (10.62 ± 3. 15) months. The alignment was good without malformation. Visu-al analogue scores before and after operation were (6.80 ± 1.21) and (2.04 ± 1.42) respectively, and wrist joint function scores were (53. 66 ± 11.70) and (87.59 ± 8.44) respectively, suggesting significant differences (P<0.01). The results were excellent in 13 cases (50.00％), good in 10 (38. 46％), general in 3 (11. 54％), with an excellence rate of 88 .46％, and there was significant difference in excellence rate postoperatively in different frac-ture time (χ2 =11.662 , P=0 .025 ) . Conclusion The treatment of scaphoid fracture with compression fixation and bridge graft via palmar approach is simple and easy, which shortens the period of treatment, achieving a satisfactory clinical effect.

目的 探讨松质骨螺钉等重建肌腱韧带止点的临床应用效果.方法 2013年1月—2016年7月我科应用松质骨螺钉结合抗菌素缝线重建肌腱韧带止点15例,男性10例,女性5例;年龄18~60岁,平均(32.0±12.0)岁;训练运动伤10例,交通伤3例,摔伤1例,砸伤1例;受伤至手术时间为10~60 d,平均(15.6±2.6)d;陈旧性膝关节内侧副韧带损伤8例,跟腱止点撕脱性损伤5例,足内翻畸形矫形肌腱移位者2例.术后定期随访观察,采用Lysholm评分标准评估疗效.结果 15例患者伤口一期愈合率为100.0%.所有患者均获得随访,平均随访12.6个月,内固定钉固定在位无松动,无新发撕脱性骨折,无再次肌腱断裂.术后及末次复诊MRI示肌腱及其止点连续无断裂及水肿.3例肌腱韧带止点重建1年后手术取出内固定钉.随访按Lysholm疗效评分标准:优4例,良9例,可2例,差0例,优良率86.7%.结论 应用松质骨螺钉及超高分子聚乙烯纤维编织缝线(抗菌素缝线)重建肌腱韧带止点可达到良好的治疗效果,选材方便,经济实惠,手术操作简单,患者易于接受,具有较好的临床应用价值.

目的 探讨穿支血管筋膜蒂皮瓣的临床应用效果.方法 应用穿支血管筋膜蒂皮瓣修复手、足、小腿等部软组织缺损15例,根据病损的部位及大小需要设计并制备皮瓣:观察皮瓣色泽、张力、皮温及毛细血管充盈试验情况.结果 15例移植皮瓣术后全部成活,3例患者术后皮瓣显示苍白,毛细血管充盈试验缓慢,3 d后缓解.2例皮瓣远端缝合口边缘发黑,3周后脱痂,深层愈合良好.随访3~6个月,皮瓣愈合好,无骨髓炎及感染复发病例,臃肿逐渐消退,外形满意.皮瓣一期愈合13例,占86.66,延迟愈合2例,占13.33%.其中顺行皮瓣移植者6例,存在并发症1例,一期愈合率为83.33%,逆行皮瓣移植者9例,存在并发症1例,一期愈合率为88.89%,2组样本愈合率差异无统计学意义(P>0.05);下肢及足踝部皮瓣移植面积为(51.88±44.90)cm2,手部皮瓣移植面积为(9.71±5.06)cm2,2组样本皮瓣面积大小差异有统计学意义(P<0.05),2组样本愈合率差异无统计学意义(P>0.05).结论 应用穿支血管筋膜蒂皮瓣转移修复软组织缺损选材灵活,手术操作简便,不损伤主要血管,皮瓣成活率高,外形良好等特点,在皮瓣移植过程中,皮瓣面积的大小、无论是逆行或顺行移植对皮瓣的一期愈合率不构成影响,具有较高的临床应用价值.

目的 探讨埋入式负压封闭引流(vacuum sealing drainage,VSD)技术治疗肢体巨大脓肿的应用效果及注意事项.方法 对采用埋入式VSD技术(研究组)与传统切开引流技术(对照组)治疗肢体深部巨大脓肿进行对比分析,观察术后愈合时间、疼痛程度及复发率以评估治疗效果.结果 研究组愈合时间短于对照组.研究组术后3~8 d疼痛评分明显小于对照组,差异有统计学意义(P<0.05).结论 埋入式VSD技术比传统切开引流技术具备操作简单、皮肤及皮下软组织切开损伤小、脓腔创面愈合快、疗程短、术后治疗护理方便等优点.

Objective To investigate clinical effect of Kirschner wire fixation with tension band wiring in treatment of mallet finger with avulsion fracture.Methods Clinical data of 32 patients with mallet finger of avulsion fracture during underwent modified Kirschner wire fixation with tension band wiring July 2010 and July 2015 was retrospectively analyzed.Surgical effects and postoperative complications were observed.Results All wounds were primary healing.With follow-up for 3-12 months, (7.5 months of average time), avulsion fractures of distal phalanx base were good contraposition and synostosis.No finger deformity or postoperative infection was found.The fineness rate of hand function reached to 91%.Conclusion Kirschner wire fixation with tension band wiring in treatment of mallet finger with avulsion fracture can achieve satisfactory effect, effectively recover the integrity of muscle-tendon-bone system and extension and inflexion function of distal interphalangeal joint with simple operation and less spending.

目的 探讨Pilon骨折的最佳手术时机及治疗方案.方法 回顾性分析2006年1月-2016年2月我院收治的57例Pilon骨折临床资料.结果 本组开放性骨折38例,闭合性骨折19例;AO/OTA分型:43B型21例,43C型36例.合并腓骨骨折39例.2例行急诊手术,余人院后10 ～14 d行二期手术;行胫骨单纯内固定20例,单纯外固定14例,有限内固定结合外固定23例.术后平均随访12.7个月,术后功能恢复优38例,良11例,可3例,差5例,优良率86.0％.术后早期并发症:伤口感染及外固定支架针眼处皮肤感染各2例,局部皮肤坏死及内踝钢板外露各1例;术后晚期并发症:踝关节创伤性关节炎4例,踝内翻畸形及慢性根骨痛各1例.结论 根据Pilon骨折患者骨折分型、周围软组织情况及病情紧急程度等因素合理选择手术时机及手术方式,是取得较好疗效、减少术后并发症发生的关键.

骨质疏松性椎体压缩骨折( osteoporosis vertebral compression fracture, OVCF)是一种易发生于老年患者的临床疾病. 随着社会老龄化程度的逐步加快,其发病率逐渐升高. 相关研究报道, OVCF 在女性和男性的整体发病率分别为10. 7‰和5. 7‰,而在75~79岁女性和男性发病率分别上升至29 . 3‰和13. 6‰[1]. 传统的保守治疗方法包括卧床休息、理疗及镇痛治疗,但长期卧床易导致骨量进一步流失及肌肉废用性萎缩,还可能导致肺部感染、静脉血栓等一系列并发症. 因此,如无明显手术禁忌证,手术干预是治疗OVCF,减轻患者痛苦,加快临床康复的必要手段. 经皮椎体成形术( percutaneous vertebro-plasty, PVP)和经皮椎体后凸成形术( percutaneous kyphoplasty, PKP)是治疗 OVCF 较理想的治疗手段,均已在临床广泛应用. 但由于PVP和PKP均存在各自的优点和缺点,因此近些年来,有些学者在PVP手术操作的基础上,参照PKP球囊的原理,通过注入骨水泥颗粒使压缩的椎体复位,既可以避免PVP单纯依靠注入骨水泥产生椎体内高压的缺点,也可以达到恢复椎体高度的目的. 然而,无论椎体成形术的术式如何改进,由于骨质疏松性椎体骨折生物力学的研究起步较晚,对影响椎体成形术中椎体生物力学的相关因素尚缺乏全面深入的认识.

目的 探讨外固定架治疗桡骨远端骨折术后并发症发生原因及其防治策略.方法 回顾性分析在我院行外固定架治疗且出现术后并发症的桡骨远端骨折36例临床资料.结果 36例中发生骨折再移位10例(27.8％),未达解剖学复位;发生关节面不平整、关节僵硬及创伤性关节炎9例(25.0％),经理疗或二次手术后关节疼痛症状好转;针道感染8例(22.2％),经应用抗生素及定时换药后感染得以控制;神经损伤及伸拇肌腱损伤各3例(8.3％),行消肿及神经、肌腱缝合修补术后好转;第二掌骨医源性骨折3例(8.3％),给予石膏外固定痊愈.结论 熟练掌握桡骨远端及腕关节解剖结构,术中仔细操作、正确安装外固定架并避免可能导致的并发症,是提高手术安全性的重要措施.并发症发生后及时有效处理,避免造成严重后果.

目的 探讨球状骨水泥颗粒植入治疗老年骨质疏松性椎体骨折的临床疗效.方法 对接受球状骨水泥颗粒植入治疗的132例老年骨质疏松性椎体骨折术后疗效、常见并发症进行统计学分析.结果 球状骨水泥颗粒植入可产生良好的膨胀复位效果,由于减少了液态骨水泥的用量,除1例术中出现一过性低血压外,无其他并发症发生.结论 球状骨水泥颗粒植入治疗老年骨质疏松性椎体骨折疗效明显,可明显降低术中术后并发症发生率.

目的:探讨股骨头内甲基丙烯酸甲酯(骨水泥)注入对正常股骨头微循环影响.方法:选用纯种中国大白兔30只,左侧股骨头内注入骨水泥为实验组,右侧为穿刺对照组.分别于术后4周、8周、12周各取10只动物进行墨汁灌注及股骨头标本采集.显微镜下观察骨水泥注射后股骨头内骨水泥-骨组织学形态；每个标本切片取10个低倍视野,对微血管数计数.采用SPSS12.0软件做统计分析.结果:大体观察两组股骨头外形圆而光滑,关节软骨无剥脱及变性；实验组股骨颈断面可见骨水泥嵌入骨小梁之间.骨水泥注入后沿骨小梁间隙浸润,挤占骨小梁间隙内空间,骨水泥与正常骨小梁组织成为一种嵌合状态.实验组术后4周时位于骨小梁间隙内的微血管由于与骨水泥接触密切,数目明显减少,术后8周时开始逐渐恢复,术后12周时明显增多；对照组术后骨小梁间隙内微血管数目无明显变化.结论:骨水泥注入股骨头后由于化学及热烧伤作用,初期对股骨头内骨小梁表面造成了一定程度的损伤,导致微血管数减少,随着时间的延续,微血管数目恢复,股骨头的血液供应也得到了恢复.

目的分析腰椎转移瘤的误诊原因,并提出防范对策。方法对我院收治的1例子宫内膜癌腰椎骨转移误诊为腰椎结核伴脓肿形成的临床资料进行回顾性分析。结果本例因腰部疼痛半年,进行性加重、不能平卧1个月就诊于当地医院,以腰椎间盘突出症、腰椎结核伴脓肿形成给予理疗、止痛、抗结核治疗,症状无改善转来我院,结合相关检查初步诊断为腰椎转移瘤伴结核脓肿、腰椎结核伴椎旁脓肿、腰椎转移瘤伴化脓性感染。经手术病理证实为子宫内膜癌腰椎骨转移,术后抗肿瘤治疗,随访1年,症状好转,腰部病灶无复发。结论部分妇科恶性肿瘤的癌细胞可经淋巴途径转移至腰椎腹主动脉旁淋巴结,形成癌肿,破坏骨质,且周围组织坏死液化后形成囊肿,与腰椎结核脓肿较难鉴别,临床工作中要引起重视,防止误漏诊。

Objective To observe the therapeutic effect of micro-invasive surgery under small arthroscope for patients with functional handicap and pain of metacarpophalangeal joint and proximal interphalangeal joint after hand injury.Methods 8 patients(10 metacarpophalangeal and interphalangeal joint malfunction) were analyzed retrospectively in the study.The lesion was located at interphalangeal joints in 6 cases and at the metacarpophalangeal joints in 4 cases.Based on the small arthroscopic findings,the diseases of the metacarpophalangeal joint and the proximal interphalangeal joint were studied,the hyperplastic bone was cleared and scathing gristle,synovium in the joint,releasing joint capsule,collateral ligaments,volar plate and tendon,passive motion on the metacarpophalangeal joint and the proximal interphalangeal joint were attended to.Results The patients were followed up for 6-12 months with an average of 8 months postoperatively.Joint malfunction,pain and discomfort in all the patients were alleviated to some extent and in accordance with the scoring system of total active movement(TAM),2 cases achieved excellent results,4 good,2 fair and 1 poor results of active range,and 4 cases achieved excellent and good results respectively,2 fair results of passive activity range.Conclusion Treatment of metacarpophalangeal and interphalangeal joint malfunction under small arthroscope has many advantages,such as being less invasive,more accurate and quick recovery.

<正>1病例资料【例1】男,45岁。因电击伤后左肩、左手、右足疼痛4 h入院。患者4 h前工作时不慎左手接触交流电,当即出现短暂意识不清,摔倒于地,具体着地部位不详。1 min后意识恢复,醒后感左肩、左手和右足疼痛不适。我院门诊X线检查提示左肩胛骨骨折,收入骨科。查体:生

Objective To discuss the femoral head plastic operation for prevention and treatment of aseptic necrosis of the femoral head(ANFH).Methods 60 Chinese white rabbits were randomly divided into normal group,natural recovery group,bone cement group and the contrast agents of bone cement group,with 15 in each group.The four groups,except the normal Group,were made of ANFH modle.The bone cement group was filled with bone cement after being made defect,and the contrast agents of bone cement group was filled with bone cement added with barium sulfate agent after being rendered defect.Hind limb movement after operation was observed.In the 12th week,all rabbits were killed,and femoral head shape of the femoral head,and articular cartilage properties were observed through specimen,and also pathological examination and biomechanical testing were taken and analyzed respectively.Results 1 week after surgery,the other 3 groups,except the normal group,had right hind limbs of mild claudication.But the activities in the bone cement group and contrast bone cement group returned to normal,and activities in the natural recovery group was still limited physically.Bone cement group and the contrast agent of bone cement group had a complete shape without deformation,articular cartilage transparency,and smooth surface.Natural recovery group had collapse of right femoral head,muddy articular cartilage surface,rough surfaces and the emergence of crack.Cartilage thickness in the normal group,bone cement group and contrast angents of bone cement group was thicker than that in the natural recovery group,

<正>肩锁关节脱位是肩部常见损伤之一,多由直接暴力所致,肩锁关节脱位约占肩部损伤的12%[1]。男性发病是女性的5～10倍。随着肩锁关节生物力学研究深入,笔者2007年3月至2009年9月采用异体肌腱重建肩锁关节韧带,及锁骨钩板

Objective To discuss the effectiveness of arthroscopic minimally invasive in the treatment of the first carpal metacarpal arthritis.Methods 16 patients with the first carpal metacarpal arthritis were cleaned through 1R and 1U entrance by 1.9 mm arthroscope.At the same time,a 3 cm transverse incision was made on the first and the second dorsal metacarpal base and the mini suture anchors were fixed at the second metacarpal base via through the radial artery and the deep surface of extensor pollicis longus mucscle tenodon,with use of suspension and tightening suture of the dorsalis joint capsule of the first carpometacarpal joint,capsuloplasty was made to correct the first carpometacarpal joint subluxation.Results All patients were followed up for 18 to 24 months;excellent in 5 cases,good in 7 cases,general in 3 cases and poor in 1 case,and the fine rate was 75%;the mean score evaluated by modified MAYO was preoperative(26.88±13.08) and(82.50±12.25) after the surgery,there was significant difference(P<0.01);X-ray showed the first carpometacarpal joint of the relationships was good and not dislocated.Conclusion Minimally invasive arthroscopic debridement and suspension arthroplasty in the treatment of the first carpal metacarpal arthritis has such advantages as being minimally invasive,simple,and rapid recovery,but further accumulation of cases is needed.

Objective To investigate the therapeutic effect of bone marrow mesenchymal stem cells(BMSCs) with different cellular concentrations on the experimental avascular necrosis of femoral head(ANFH) in rabbits.Methods The 40 New Zealand rabbits were randomly divided into 5 groups:1×10 4/ ml BMSCs(A),1×10 5/ ml BMSCs(B),1×10 6/ml BMSCs(C),1×10 7/ ml BMSCs(D),1×10 8(E) /ml BMSCs.The specimens were observed with methods of radioscopy and histology,and results were analyzed with microimage analysis system at 2,4,6 and 8 weeks after operation respectively.Results Radioscopic observation showed that the bone density in drilled hole area(DHA) increased gradually in all groups as the time longer.At 8 weeks,normal bone trabeculae in the DHA were observed in B,C,D,E groups,but not observed in A group.Histological observation showed that a large amount of BMSCs were seen in the DHA at 2 weeks in all groups.A sandwich-like structure in DHA was found in A group,in which new-formed bone trabeculae were located in lateral layer and osteoblasts in intermedial layer and inflammatory cells in interior layer.At 8 weeks,the matured bone trabeculae were observed and bone marrow was found in the intertrabecular space in the B,C,D,E-groups.Image analysis indicated that the percentage of bone trabeculae area was much higher in B,C,D,E groups than in A group.Conclusion 1×10 5-10 8/ml of BMSCs is suitable for the treatment of ANFH in rabbits.

Background: There is lack of study about bone marrow mesenchymal stem cells (BMSCs) and ultrastructure characteristics of osteoblasts after differentiation. Objective: To isolate and culture BMSCs by the whole bone marrow culture and adherence method, to induce the differentiation of BMSCs into osteoblasts, and to investigate the tiny and ultrastructure characteristics of induced and non-induced cells with an optical microscope and electron microscope. Design, Time and Setting: This experiment was performed at the Department of Human Anatomy, Hebei Medical University and Department of Orthopaedics, Bethune International Peace Hospital from March 2007 to April 2008. Materials: Adult New Zealand rabbits were obtained from Animal Experiment Center of Bethune International Peace Hospital. Scanning electron microscope (SEM), Hitachi S-3500N and transmission electron microscope (TEM), Hitachi-7500 were used in this study. Methods: Bone marrow was collected from posterior superior iliac spine of New Zealand rabbits. After primary culture and passage, some the third passage of cells were incubated in 10-8mmol/L dexamethasone, 50 mg/L ascorbate and 10 mmol/L β -glycerol phosphate. BMSCs were identified by alkaline phosphatase (ALP), bone morphogenetic protein and calcified node staining. Main Outcome Measures: General morphological characteristics of BMSCs and differentiated osteoblasts were observed by the optical microscope and their ultrastructural characteristics by the electron microscope. Results: At the third passage, BMSCs were positive for ALP staining and negative for bone morphgenetic protein (BMP) by immunohistochemical staining and calcified node staining, but induced BMSCs were positive for ALP staining, BMP immunohistochemistry and calcified node stainings. The BMSCs showed long fusiform shape mostly and a few showed astero-form by the optical microscope and scanning electron microscope. After induced, cell volume increased, the abundant organellas in BMSCs were observed by transmission electron microscope. After induced, mitochondrion increased and a lot of matrix vesicles, myelinated-like body and polyvacuolus-like structure appeared in cytoplasm. Conclusion: Increased matrix vesicles, myelinated-like body and polyvacuolus-like structure in cytoplasm maybe the ultrastructural characteristics of BMSCs after induced differentiating into osteoblasts.