目的 系统分析单侧双通道内镜手术(UBE)与显微镜下椎管减压术(MED)治疗腰椎管狭窄症的安全性.方法 计算机检索Pubmed、Cochrane library、MEDLINE、Web of Science、Embase等英文数据库,以及中国知网和万方中文数据库.纳入UBE和MED治疗腰椎管狭窄症的临床随机对照试验(RCT)及队列研究.观察指标包括总并发症发生率,以及硬膜外血肿、神经根损伤、硬膜囊损伤、减压不彻底、因相关并发症再次手术发生率.采用Revman5.3软件进行Meta分析.结果 最终纳入7篇相关研究,包括2篇RCT、5篇队列研究;共纳入475例病人,其中UBE有248例,MED有227例.Meta分析显示两种手术方法的总并发症发生率以及硬膜外血肿、神经根损伤、硬膜囊损伤、减压不彻底、因相关并发症再次手术等并发症发生率均无统计学差异(P＞0.05).结论 UBE与MED治疗腰椎管狭窄症在安全性方面基本一致.

目的 对比高粘度骨水泥椎体后凸成形术与伤椎椎体成形术联合后路融合固定术两者治疗方案对无神经症状Ⅲ期Kümmell病预后的影响.方法 回顾性分析2018年3月至2020年1月的50例神经症状Ⅲ期Kümmell病患者的病历资料.按照手术方案不同,其中采用高粘度骨水泥椎体后凸成形术治疗28例,计为A组;采用伤椎椎体成形术联合后路融合固定术22例,计为B组.比较两组的手术时间、骨水泥注射量、并发症发生情况,以及术前、术后1 d、1年的腰背部疼痛视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI)、伤椎前缘、伤椎与邻椎前缘高度比值、伤椎后凸Cobb角.结果 B组手术时间及骨水泥注射量均高于A组,差异均有统计学意义(P<0.05).术前、术后1 d及术后1年,两组疼痛VAS评分及ODI评分比较,差异均无统计学意义(P>0.05).术后1 d、1年,B组伤椎椎体前缘高度均高于A组,差异均有统计学意义(P<0.05);与术后1 d比较,术后1年两组伤椎椎体前缘高度均有所丢失,但差异均无统计学意义(P>0.05);术前,两组伤椎后凸Cobb角比较,差异无统计学意义(P>0.05);术后1 d、1年,两组Cobb角均降低,且B组Cobb角均小于A组,差异均有统计学意义(P<0.05);术后1年,A组Cobb角均比术后1 d增大,差异有统计学意义(P<0.05),B组虽有增大但差异无统计学意义(P>0.05).A组出现1例骨水泥渗漏,B组出现2例骨水泥渗漏,两组均未出现再骨折和邻椎骨折等并发症,两组比较差异无统计学意义(P>0.05).结论 高粘度骨水泥椎体后凸成形术与伤椎椎体成形术联合后路融合固定术治疗无神经症状Ⅲ期Kümmell病均可有效缓解患者背部疼痛,恢复椎体高度及纠正后凸畸形,改善患者脊柱功能,且并发症均较少;但相对于前者,后者预后更佳.

目的 探讨改良虚弱指数(modified frailty index,mFI)在骨质疏松性椎体压缩骨折经非手术治疗失败中的预测价值.方法 选择2016年1月～2019年6月在本院接受非手术治疗的113例急性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)患者作为研究对象,根据患者3周治疗效果分为非手术治疗有效组和无效组,对两组患者的改良虚弱指数(modified frailty index,mFI)和其他相关指标进行比较;采用多因素Logistic回归分析影响非手术治疗无效的风险因素,以验证mFI是否为一项独立的预测因素.结果 113例中,非手术治疗失败47例,失败率41.59％.治疗有效和治疗无效患者的年龄、骨密度(bone mineral density,BMD)、体质量指数(body mass index,BMI)、mFI评分相比,差异存在统计学意义(P<0.05).多因素Logistic分析显示,年龄≥74.5岁、mFI>2分是非手术治疗无效的风险因素(P<0.05),而BMD>-3.21是非手术治疗无效的保护性因素(P<0.05).结论 急性OVCF患者具有较高的非手术治疗失败率,进行mFI评估对其非手术治疗的结局具有预测价值.对于年龄>74.5岁、BMD≤-3.21和mFI>2分的患者,应考虑其非手术治疗失败的可能.

目的 观察五藤治尪汤辅助治疗急性加重期膝骨关节炎(KOA)的效果.方法 选取急性加重期KOA患者90例为研究对象,按照随机数字表法均分成对照组与研究组各45例.两组均给以玻璃酸钠关节腔内注射液和硫酸氨基葡萄糖胶囊进行治疗,研究组在此基础上给予五藤治旭汤治疗.治疗2周后,比较两组患者疗效差异,治疗前后中医证候积分、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分、骨关节炎的严重程度指数(Lequesne MG)评分、关节炎生活质量测量量表2-短卷(AIMS2-SF)评分、炎症因子[血沉(ESR)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)]及不良反应发生情况.结果 治疗后两组患者临床控制率差异有统计学意义(P＜0.05),但总有效率相当(P＞0.05);两组中医证候积分得分均明显低于治疗前(P＜0.05),且研究组明显低于对照组(P＜0.05);两组WOMAC、Lequesne MG评分均明显低于治疗前(P＜0.05),且研究组明显低于对照组(P＜0.05);两组AIMS2-SF评分均明显高于治疗前(P＜0.05),且研究组明显高于对照组(P＜0.05);两组炎症因子水平均明显低于治疗前(P＜0.05),且研究组明显低于对照组(P＜0.05);研究期间两组患者均无不良反应发生.结论 五藤治尪汤辅助治疗急性加重期膝骨关节炎疗效确切,可明显改善临床症状和膝关节功能,降低炎性反应.

目的:探讨第一跖骨远端截骨结合可吸收钉内固定术治疗(足母)外翻的方法及临床疗效.方法:回顾性分析自2015年1月至2019年3月行第一跖骨远端截骨结合可吸收钉内固定手术治疗的37例(62足)(足母)外翻病例资料.随访6～24个月,通过美国足踝外科学会Maryland评分系统(Maryland FootScore,MFS)评分,评价拇外翻术后畸形纠正情况、优良率及并发症发生率.结果:所有病例手术均顺利完成,术后(足母)外翻角(HVA) 10.6°～20.2°(15.1°±5.3°)较术前25.2°～40.5°(34.5°±5.4°)明显减小,(足母)外翻畸形明显矫正;第一、二跖骨间夹角(IMA)6.8°～10.1°(6.2°±2.7°)较术前11.3°～15.3°(12.8°±3.3°)恢复正常范围,差异有统计学意义(P＜0.05),临床疗效满意.未出现截骨端不愈合、畸形复发及感染等并发症.结论:第一跖骨远端截骨结合可吸收钉内固定术治疗(足母)外翻具有手术时间短、固定可靠、可有效维持术后矫正状态、恢复快、矫形满意等优点,值得临床推广应用.

目的 评价选择性跖骨远端截骨与可吸收螺钉固定治疗外翻的疗效.方法 选择2015年2月至2016年10月在中国中医科学院西苑医院选择性跖骨远端截骨治疗的外翻16例(25足),采用选择性跖骨远端截骨与可吸收螺钉固定治疗.结果 本组16例(25足),优24足,良1足;随访6～10个月,平均8个月,均未发生跖骨截骨处骨不愈合、局部感染及第1跖骨头缺血性坏死等情况.治疗后患足穿鞋痛、第一跖趾关节痛与前足走路痛等症状均有显著改善,差异有显著性(P<0.05);治疗后,25足外翻角及第1、2跖骨夹角均明显降低,差异有显著性(P<0.05).结论 选择性跖骨远端截骨与可吸收螺钉固定治疗外翻手术方法简单,创伤较小,跖骨头成形充分,由于使用了可吸收螺钉,术后无需外固定,且不需要二次取出螺钉.

目的:探讨四神煎加减联合青鹏软膏对骨质疏松性胸腰椎压缩性骨折患者术后疼痛及骨折愈合的影响.方法:将96例骨质疏松性胸腰椎压缩性骨折经皮球囊扩张椎体后凸成形术后患者按随机数字表法分两组,各48例.对照组予青鹏软膏治疗,观察组在对照组基础上予四神煎加减治疗.比较两组患者术前、术后1个月的视觉模拟评分法评分、受伤椎体Cobb角和前缘高度及骨钙素指标,观察药物不良反应发生情况.结果:观察组患者术后1周、术后1个月时的VAS评分分别为(3.11±0.95)分、(2.38±0.67)分,均低于对照组的(3.84±1.24)分、(3.23±1.12)分,比较差异有统计学意义(P<0.05).术后1个月时,观察组患者的Cobb角为(11.72±1.58)°,低于对照组的(13.54±1.63)°;而伤椎前缘高度、骨钙素分别为(21.69±2.58)mm、(4.69±1.12)μg/ml,均高于对照组的(19.06±2.14)mm、(2.46±0.66)μg/ml,差异有统计学意义(P<0.05).两组患者在局部皮痒、头晕及恶心方面的不良反应发生率比较,差异无统计学意义(P>0.05).结论:四神煎加减联合青鹏软膏能减轻骨质疏松性胸腰椎压缩性骨折患者术后疼痛程度,促进骨折愈合,且安全性较好.

目的:观察口服中药补阳还五汤配合切开复位内固定术治疗旋后外旋型踝关节骨折的疗效.方法:将所有入选的旋后外旋型踝关节骨折患者共70例,随机分为对照组与治疗组两组,每组各35例.所有患者均对症处理后行手术切开复位,然后采用钢板及空心钉内固定.治疗组于术后采用补阳还五汤加减口服,对照组术后口服伤科接骨片.两组疗程均为8周,并随访3个月.结果:疗程结束后,治疗组的总有效率为97.1％,对照组的总有效率为73.3％,两组相比,有统计学差异(P＜0.05).治疗组的平均肿痛消失时间及平均骨折愈合时间均明显短于对照组,两组相比,有统计学差异(P＜0.05).治疗组骨折愈合程度评分在第4周、6周和8周时均少于对照组,两组相比,有统计学差异(P＜0.05).结论:口服补阳还五汤配合切开复位内固定术治疗旋后外旋型踝关节骨折,可以明显提高临床疗效,缩短肿痛消失时间及骨折愈合时间,且无明显不良反应,值得临床推广使用.

Objective To investigate the relationship between the leteral facet orientation,the degree of facet arthritis and the lateral recess stenosis. Method The MSCT axial images of 60 patients aged 38~81years with lateral recess stenosis. The facet orientation was evaluated, grades of FJOA were evaluated by 4-grade scale on CT images at L4 ~L5 and L5 ~S1 . The sagetal and transverse diameters of lateral recess also were evaluated. Result The orientation at L4 ~L5 is (50±8. 5)°,L5 ~S1(37±10. 6)°,45 of 60 cases are asymmetric. There are 1 case in grade 0,9 cases in grade 1,35 cases in grade 2,15 cases in grade 3,82. 3% of 60 cases have severe facet arthritis. The transverse di-ameter is (2. 5±0. 7)mm at intervertebral level. The sagital diameter is (5. 25±0. 8)mm. Conclusion The orienta-tion and asymmetry of the lateral facet may be the reason of facet arthritis. The arthritis take place with lateral recess stenosis.

OBJECTIVE To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain. METHODS From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group) according to propotion of 1:1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70 +/- 4.15), treated with sliver needle; In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03 +/- 5.86), treated with TCM fumigation. Changes of force-displacement distance (FDD), specific absorption rate (S) of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability questionnaire (RMDQ) were used to access clinical effects. RESULTS (1) VAS score of silver needle group was 4.77 +/- 0.78, 1.99 +/- 1.08 and 2.55 +/- 0.94, respectively before treatment, at 1 week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43 +/- 0.61, 2.48 +/- 0.71 and 3.05 +/- 0.86, respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment (P < 0.05). There was no sigificant differences between two groups before treatment, but sliver needle group performed well in analgesia than TCM fumigation group, and had obvious differences (P < 0.05). RMDQ score of silver needle group was 13.63 +/- 1.96, 5.87 +/- 2.33 and 6.53 +/- 2.89, respectively before treatment, at 1 week and 3 months after treatment, while RMDQ score in TCM fumigation group were 13.40 +/- 2.01, 6.90 +/- 2.31, 9.23 +/- 2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment (P > 0.05), and had obvious differences between two groups at 3 months after treatment (P < 0.01). Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. (2) Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P < 0.05); In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P < 0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P > 0.05), FDD of multifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P < 0.05); but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. (3) There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517, 0.811, 0.746 and 0.625; There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.

Objective:To investigate the distinction of the soft tissue tension between the normal people and the chronic lower back pain(CLBP)patients,and to research the correlations between the soft tissue tension characters and CLBP symptoms.Methods:All 30health people and 30CLBP patients were selected.The tension of both sides of the erector spinae was tested by soft tissue tension tester,and the VAS and RMDQ points were tested too.The indexes of soft tissue tension were compared between the normal patients and CLBP patients,and between the affected side and contralateral healthy side of CLBP patients.Results:The indexes of soft tissue tension were not different between the healthy side of CLBP patients and health group.Compare with normal person,the soft tissue tension of LBP patients was higher.For the LBP patients,the soft tissue tension of the affected side was higher than the normal side.There was no correlation between the soft tissue tension and VAS and RMDQ points.Conclusion:It is possible to distinguish the LBP patients from normal people with soft tissue tension test,and it can also be used to identify which is the affected side.

目的探讨手法复位结合弹性牵引治疗中老年桡骨远端粉碎性骨折的方法及疗效。方法采用手法复位结合弹性牵引治疗中老年桡骨远端粉碎性骨折28例。结果本组获随访6～20个月,骨折愈合时间平均4.6周。根据Aro功能评价:优20例,良7例,可1例,优良率96.4%。结论手法复位结合弹性牵引治疗中老年桡骨远端粉碎性骨折是合理有效的治疗方法,能最大限度的保留关节功能。

[Objective]To retrospectively study and discuss the indications,surgical techniques and outcomes of selective distal osteotomy of the first metatarsal. [Methods]From March 2007 to January 2011,60 patients(101 feet) with hallux valgus received distal osteotomy of the first metatarsal in our hospital,including 57 females and 3 males,with the mean age of 62.6 years(range,23~81 years). [Results]The followed-up period varied from 6 months to 4 years,with an average of 22 months.All patients were evaluated with the American Orthopaedic Foot and Ankle Society(AOFAS) hallux metatarsophalangeal-interphalangeal scale for the clinical assessment.The excellent result was abtained in 40(66 feet),good in 16(30 feet),and fair in 4(5 feet).The hallux valgus angles decreased from 36°(30°~44°) to 15.3°(10.5°~21°).The intermetatarsal angles were 16°(13°~18°) before surgery,and decreased to 8.5°(6°~10°) after surgery.The hallux metatarsophalangeal joint range of motion increased from 16°(0°~30°) to 35°(25°~50°).The length of the first metatarsals decreasedby 4.2 mm(3~6 mm). [Conclusion]This technique is of a soft-tissue and bone surgery,which has the advantages of minimal invasion,stable fixation and sufficiently plastic metatarsal head.It should be widely used in the clinical practice.

<正>慢性腰痛是最常见的临床症状之一,但约有85%无法得到明确的病理解剖学诊断[1],通常称为"非特异性腰痛",给临床医师的诊断和治疗带来了很大的困惑。近年来笔者采用银质针联合氨酚羟考酮片治疗此类疾病,取得满意疗效,现报道如下。资料与方法 1诊断标准参照2007年美国内科医师和疼痛协会关于慢性非特异性腰痛的临床实践指南[2]制定。慢性腰痛,病程3个月以上,伴有或不伴有下肢痛,无间歇性跛行,无神经根受累症状(神经根痛、感觉丧失、肌肉功能障碍和反射消失等)。

Objective: To assess the short and long-term efficacy of percutaneous laser disc decompression(PLDD) combine Mckenzie therapy for patients with lumbar disc herniation.Methods: 90 patients suffered from lumbar disc herniation were seperated in to two groups randomly,and treated with PLDD and PLDD combine Mckenzie therapy respectively.The clinical outcomes were measured before treatment,1 month,6 months and 1 year after treatment.The outcomes of 1 month and 1 year were used as short,and long-term efficacy.The clinical outcomes were measured by Modified Macnab Criteria and Oswestry disability index.Results: The short-term efficacy shows no significant difference in two groups.The long-term efficacy of PLDD Mckenzie was significantly better than PLDD alone.The short-term and long-term outcome of PLDD group was 65% and 60% respectively,compare with 73% and 86% of PLDD Mckenzie group.Conclusions: PLDD was identified as effective therapy for patients with Lumbar disc herniation.Mckenzie therapy postoperatively enhanced the therapeutic efficacy obviously than PLDD alone.It is important to treat the disability of lower back soft tissue among patients with lumbar disc herniation.

目的可吸收张力带固定和AO张力带内固定治疗老年髌骨骨折的疗效比较研究。方法对42例老年髌骨骨折,采用PDS-Ⅱ结合可吸收螺钉张力带固定(A组),50例采用AO张力带内固定(B组)。结果随访6~24个月,按陆裕朴关节功能评定法,术后A、B两组膝关节功能优良率和活动度优良率比较,组间无差异。结论两种内固定方式治疗老年髌骨骨折均为有效可靠的方法。可吸收张力带生物学固定遵循了生物学固定的原则。

<正>近年来关节腔内注射玻璃酸钠已得到广泛应用并取得较好疗效,但为了止痛长期口服消炎镇痛药物导致胃肠道不适甚至溃疡。我们采用玻璃酸钠和氯诺昔康联合关节内注射与单纯玻璃酸钠关节内注射对比治疗骨关节炎进行对比,取得满意疗效疗。

目的 探讨医用硫酸钙骨粉(CSC)结合万古霉素治疗骨髓炎的疗效.方法 自2004年1月起,对11例骨髓炎患者,一期行清创扩创、充分引流或灌洗、抗生素骨水泥填充,二期采用医用硫酸钙骨粉(思迪骨粉Stimulan pellets )结合万古霉素植入骨髓炎病灶.结果 所有填充自制备载药万古霉素骨粉的病例均获随访(10～20个月),平均13个月,8例得到一次性治愈,3例手术后有渗出,经换药后愈合,未出现任何全身异常反应和并发症.结论 载有万古霉素的硫酸钙骨粉(CSC)固化后较坚固,具有填充和释放抗生素作用,在解决骨缺损的同时,还可以维持局部抗生素浓度在较高水平,是治疗骨髓炎的较为理想的方法.

踝关节骨折无论是AO分型还是Lauge-Hensen分型,都十分关注下胫腓联合的稳定性.一旦关节失稳,易导致创伤性关节炎的发生,从而造成踝关节功能障碍.自2004年10月～2007年10月,笔者用可吸收螺钉固定治疗36例下胫腓联合不稳定型踝关节骨折,术后疗效满意.

自2003年10月～2006年2月,采用动力髁螺钉(DES)小切口经皮下钢板固定(MIPO)技术治疗37例高龄股骨转子间粉碎性骨折,取得满意疗效.现报告如下.