目的:探讨BARTON骨折切开复位内固定的临床疗效.方法:收治Barton骨折患者40例.所有患者均予以切开复位内固定治疗.结果:治疗后,功能评估优良率95%,患者对治疗效果满意度(90.22±3.11)分;治疗后没有患者发生并发症的情况.结论:对不稳定性桡骨远端骨折患者予以切开复位内固定治疗,其临床效果显著,不会产生并发症,且患者较易接受.

Objective To explore the association among bone iron content,serum ferritin(SF) and bone mineral density in patients with thoracolumbar fractures.Methods A retrospective analysis was conducted in 243 patients with thoracotumbar fracture who were undergone percutaneous kyphoplasty from January 2008 to December 2014.Mean age of the patients(91 males and 152 females)was 62.5 years(range:50-81 years).The patients were assigned to osteopenia group and osteoporosis group based on the preoperative bone mineral density(BMD).Blood samples were collected to determine iron metabolism and bone turnover biomarkers after overnight fasting.Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after percutaneous kyphoplasty.Results There was no significant statistical significance between osteopenia group and osteoporosis group in gender,age,height, and weight(P>0.05).Pearson correlation analysis showed that the age,bone iron content,SF,serum procollagen type 1 N-terminal propeptide, and β-carboxy terminal telopeptide of collagen type 1 were negatively correlated with BMD at femoral neck (r=-0.712,-0.348、-0.323,-0.236,-0.227;all P<0.05) and lumbar spine (r=-0.541,-0.206,-0.213,-0.184,-0.191;all P<0.05);the weight,body mass index,transferrin, and total iron binding capacity were positively correlated with BMD at femoral neck and lumbar spine (P<0.05).Bone iron content combined with SF could be put into the regression models of BMD at femoral neck and lumbar spine(femoral neck R2=0.388,L1-4 R2=0.374).Both bone iron content and SF were negatively correlated with BMD at lumbar spine (P<0.05).Conclusion The higher the values of bone iron and serum iron protein content in osteoporotic vertebral fracture patients,the higher the degree in osteoporosisis.Iron accumulation and osteoporosis is significantly correlated.

Objective To explore the surgical management and clinical efficacy for terrible triad of the elbow.Methods The clinical data of 28 patients with terrible triad of the elbow were retrospectively analyzed.Lateral approach or lateral combined with anteromedial approach was adopted during surgery.Fixation in coronoid process of ulna was conducted using suture anchor or Herbert hollow screw.Fixation in caput radii using Herbert hollow screw or artificial prosthetic replacement for caput radii was performed.Intraoperative exploration and sew-up were conducted in the patients with internal and external accessory ligament injury.Fixation using hinged external fixator was performed in the patients with elbow joint instability.Results Fracture healing was observed in all cases.The excellence-good rate of elbow joint function was 92.9%(26/28).The total incidence rate of complications was 10.7%(3/28).The range of flexion-extension of elbow joint was(120.1 ±5.7)°.The range of pronation/supination of forearm was(84.4 ±4.6)°/(65.2 ±3.5)°.Conclusion Open reduction and fixation combined with internal and external repair through lateral incision or lateral combined with anteromedial approach might achieve a satisfied clinical efficacy for terrible triad of the elbow.

目的 探讨不同剂量罗哌卡因联合利多卡因腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响.方法 选取老年骨科患者86例,采用随机数字表法分为两组,43例患者实施0.50%罗哌卡因(剂量10 mg)+1%利多卡因(2 ml)腰硬联合麻醉为对照组,43例患者实施0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉为观察组,比较两组不同时点细胞免疫功能及血流动力学指标的改变情况、感觉阻滞效果、运动阻滞效果和不良反应情况.结果 两组CD3+、CD4+、CD4+/CD8+、自然杀伤(NK)细胞数量在T1时显著降低,在 T3时降至最低点,在T4时明显升高.观察组CD3+、CD4+、CD4+/CD8+、NK细胞数量在T1、T2、T3、T4时均明显高于对照组.两组心率、平均动脉压在Ta时显著降低,在Tc时降至最低点,在Td时恢复正常.两组中心静脉压在Ta时显著升高,在Tc时升至最高点,在Td时恢复正常.观察组心率、平均动脉压在Ta、Tb、Tc时均明显高于对照组,中心静脉压在Ta、Tb、Tc时均明显低于对照组.观察组感觉阻滞起效时间、最高平面出现时间、运动阻滞起效时间均明显早于对照组,观察组最高平面维持时间、运动阻滞维持时间均明显长于对照组,观察组改良Bromage评分明显高于对照组,观察组不良反应发生率明显低于对照组(P<0.05).结论 0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响较小,麻醉起效快且维持时间长,不良反应少且安全性高.

目的:研究胫骨远端解剖锁定钢板治疗复杂Pilon骨折的疗效及并发症情况.方法:回顾性分析80例复杂Pilon骨折患者,按照治疗方法的不同分为研究组(40例)和对照组(40例),研究组行胫骨远端解剖锁定钢板治疗,对照组行三叶草型固定板治疗,观察记录两组患者的治疗效果及并发症.结果:两组患者均成功完成手术,术后解剖复位率观察组为85%,对照组为45%;Mazur评分总优良率观察组为85%,对照组为65%;随访时发生延迟愈合、创伤性关节炎、关节僵硬等并发症的发生率,观察组为30%,对照组为60%;差异具有统计学意义(P＜0.05).结论:胫骨远端解剖锁定钢板治疗复杂Pilon骨折,疗效显著,关节复位率高,内固定稳固,术后并发症少.

Objective:To investigate the development of the prognosis of patients with deep venous thrombosis after closed fracture of lower limb and the change of the blood clot elastic diagram.Methods:Lower limb closed fractures 68 cases during January 2014 to December 2015 in our hospital were selected randomly.And they were treated by open reduction and internal fixation and con-firmed to be in hypercoagulable state,including 21 cases of female,47 male,aged 20 ~70,mean age (51.42 ±6.06).They were randomly divided into treatment group and control group,34 cases in each group,two groups were given conventional open reduction and internal fixation and orthopaedic basic treatment,while the control group was treated with 1 000u low molecular hep-arin and antiplatelet activity drug treatment,the treatment group were given oral Tongmai Decoction.Plasma prothrombin time (PT),activated partial prothrombin time (APTT),platelet count and thrombelastograph (TEG)were measured before the treat-ment and after 7th days and 14th days′treatment respectively.Results:After the intervention,the 7 d and 14 d PT,APTT and TEG were improved significantly in both two groups(P <0.05),no significant differences were found between the two groups (P>0.05).Conclusion:Tongmai Decoction can effectively improve the blood coagulation state,which is an effective treatment of deep venous thrombosis.

目的：探讨椎弓根钉固定疗法对胸腰椎骨折经椎弓根植骨椎体成形的治疗效果。方法选取60例胸腰椎骨折患者为研究对象，通过影像学检查、病例分析回顾，比较治疗前后的椎体高度变化、活动度、临床治疗结果以及Cobb角恢复程度，并对患者进行随访。结果胸腰椎骨折患者采用椎弓根钉固定疗法，提高了Cobb角的恢复程度，椎体高度改善，临床症状缓解。本组60例胸腰椎骨折患者采用椎弓根钉固定疗法后，疗效评价优良率达86．7％。结论采用椎弓根钉固定治疗胸腰椎骨折，治疗效果好，能缓解患者痛苦，有推广应用价值。

目的：对老年股骨粗隆间骨折患者应用股骨近端髓内钉固定的临床效果进行分析。方法选取2011年3月至2013年3月我院收治的60例股骨粗隆间骨折患者，随机的将所有患者分成观察组与对照组，两组均有30例患者，观察组患者采取股骨近端髓内钉固定进行治疗，对照组患者采取动力髋螺钉进行治疗，将两组患者的并发症、出血量、功能恢复情况等进行对比。结果在住院时间、手术时间、出血量、并发症以及患者的功能恢复方面，将两组进行对比，P＜0.05，其差异具有统计学意义。结论对于老年股骨粗隆间骨折患者来说，采取股骨近端髓内钉固定的方式，临床治疗效果比较理想，具有较高的安全性。

Objective:To explore the clinical effect of different operation methods in the treatment of ankle fracture.Methods:57 cases with ankle fracture were selected.All the patients were treated with kirschner wire or screw(including hollow screw) or steel screw internal fixation treatment.According to the fracture types,they were given different operation methods.The postoperative foot function scores and clinical effects of patients with different operation methods were compared.Results:The postoperative foot function scores of patients in three groups were compared,and the difference was not statistically significant(P<0.05).The clinical effects of patients in three groups were compared,and the difference was not statistically significant(P<0.05).Conclusion:The different types of ankle fractures are treated with open reduction and internal fixation in different methods,combined with early postoperative physical exercise.The functional recovery of patients is good.The clinical effect is significant.It is worthy to be popularized.

膝关节骨性关节炎是一种临床常见病,主要为退行性变,代表着关节的衰老,给广大患者的生活和工作带来了很多不便。笔者根据多年的临床治疗经验,总结了一些简便易操作、疗效肯定的防治方法介绍给大家。