目的 研究经皮椎弓根钉内固定术对脊柱骨折患者疼痛与椎体康复情况的影响.方法 选取中国人民解放军海军陆战队医院2018年1月至2020年1月收治的56例脊柱骨折患者为研究对象,采用随机数字表法分为对照组(28例,采用常规开放内固定手术治疗)和观察组(28例,采用经皮椎弓根钉内固定术治疗),两组患者术后均定期随访1年.比较两组患者围手术期情况,术前、术后1周、术后1个月疼痛评分,术前、术后1周、术后半年、术后1年椎体康复情况,以及术后并发症发生情况.结果 观察组患者术中出血量显著少于对照组;住院时间显著短于对照组;与术前比,术后1周、术后1个月两组患者视觉模拟疼痛量表(VAS)评分呈显著降低趋势,且术后各时间点观察组显著低于对照组;观察组患者术后并发症总发生率显著低于对照组(均P<0.05);与术前比,术后1周 ～1年两组患者椎体前缘高度百分比先升高后降低,后凸Cobb角先降低后升高,但两组比较,差异均无统计学意义(均P>0.05).结论 脊柱骨折患者给予经皮椎弓根钉内固定术治疗,可有效减少围手术期术中出血量,缩短出院时间,且可促进患者椎体康复,有效减轻疼痛感,并发症发生率较低,安全有效.

目的:对比分析经皮椎间孔镜腰椎间盘切除术(PTED)、椎板开窗腰椎间盘切除术(FD)对腰椎间盘突出症的治疗价值.方法:观察组行经皮椎间孔镜腰椎间盘切除术治疗,对照组行椎板开窗腰椎间盘切除术治疗.结果:2组手术时间对比P>0.05,观察组术中出血量、术后住院时间少于对照组,数据对比P<0.05;2组术前ODI指数对比P>0.05,术后3个月ODI指数观察组较术前降低幅度优于对照组(P<0.05);2组术前FH、ISH、DID、DFJA、ROM对比均P>0.05,术后1年观察组ROM低于对照组,观察组FH、ISH、DID、DFJA高于对照组(均P<0.05).结论:FD、PTED治疗LDH各有利弊,临床医生应根据患者实际情况综合判断后合理取舍治疗方案.

目的 评价人性化护理应用于骨科护理管理中的临床效果.方法 选取我院2018年6月～2019年6月收治的180例骨科患者作为研究对象,利用随机数字表法分为对照组(n=90)和观察组(n=90),对照组采用常规护理,观察组在常规护理的基础上应用人性化护理,对比两组患者的护理临床效果.结果 护理干预前,两组患者的SAS评分比较差异无统计学意义(>0.05);护理干预后,观察组患者的SAS评分和护患纠纷发生率小于对照组患者,护理满意度大于对照组患者,差异有统计学意义(<0.05).结论 人性化护理应用于骨科护理管理中,能够取得十分显著的效果,有助于提高护理质量和患者的护理满意度,改善焦虑情绪,降低护患纠纷的发生概率,值得临床临床应用应用.

目的 分析风险管理应用于骨科护理管理中的临床效果.方法 收集2016年6月~2019年6月中国人民解放军91811部队医院骨科收治的260例患者作为研究目标,按照随机数表法将其分为对照组(常规护理)130例与观察组(风险管理)130例,对比两组患者风险事故发生率及风险意识评分.结果 观察组风险事故发生率比对照组低,差异具有统计学意义(P<0.05);与对照组相比,观察组风险意识评分(风险因素了解、风险管理模式认识、风险意识态度、危险管理行为动向)更高,差异具有统计学意义(P<0.05).结论 骨科护理管理中开展风险管理,可提升患者风险意识,可有效避免风险事故发生,保障患者安全,减少护患纠纷,值得临床应用.

该文介绍了可用于四肢根部离断毁损伤的多用途充气加压包扎装置.该装置由长方形加压包扎区、术带区(4条束带)和其他附加装置组成,束带可根据需要利用末端的插扣快速连接和收紧;可用于四肢根部离断毁损伤创面加压包扎、皮肤软组织开放性损伤创面加压及下肢长骨临时外固定、多发肋骨骨折外固定、骨盆骨折外固定等场景;具有适形性好、创面加压均匀,充气快捷、压力可控,携行轻便、使用简单及节约敷料、可重复使用等优点,适用于战现场急救.

目的 本文旨在研究辩证行为疗法(Dialectical Behavior Therapy,缩写为DBT)在治疗有自杀/自伤倾向的抑郁症患者的应用,并评估其疗效.方法 以2017年12月～2018年6月间在解放军第102医院心理咨询中心接受治疗的58例有自杀/自伤倾向的抑郁症患者作为研究对象;将这些患者随机均分为两组,即研究组与对照组,对他们进行药物治疗.其中,研究组在接受药物治疗后继续接受DBT.最后,采用Beck自杀意念量表对两组患者的自杀意念及抑郁症状进行评估和比较分析.结果 在接受6个和9个星期的治疗后,研究组的Beck自杀意念量表评分均低于治疗组(P＜0.05).结论 辩证行为疗法可有效减轻有自杀倾向抑郁症患者的抑郁程度,降低他们的自杀意念.

OBJECTIVE To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. METHODS Between January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0 +/- 1.1 and 75.3 +/- 11.2, respectively. RESULTS The operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0 +/- 0.5 and 17.6 +/- 3.4, respectively, showing significant differences when compared with preoperative ones (t = 30.523, P = 0.000; t = 45.312, P = 0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. CONCLUSION The U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.

Objective To evaluate the effectiveness and safety of percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture.Methods A retrospective study was done on percutaneous kyphoplasty applied to 30 patients(8 males,22 females;aging 55-86 years) with osteoporotic vertebral compression fracture involving 40 vertebrae totally(single in 23 cases,double in 4 cases,three in 3 cases).Results Operation was successful in all the 30 cases with a dramatic relief in pain and no surgical complication occurred.The operation time was from 35 to 138 minutes.The balloon’s expansion pressures was from 200 to 300 psi(1 psi = 6.89 kPa),and the volume of cement injection was from 2.5 to 5.0 ml.During the procedure,balloon rupture occurred in 1 case,paraspinal leakage in 1 case,disc leakage in 2 cases and intraspinal leakage in 1 case,which led to no obvious clinical symptoms at all.One case suffered from decreased blood pressure and weak pulse during the operation,which were improved after treatment.Conclusion Percutaneous kyphoplasty can quickly release the back pain,effectively restore the height of the compressed vertebrae and significantly decrease the cement leakage.It is a simple,safe and micro-invasive therapeutic approach to osteoporotic vertebral compression fracture.

<正>马尾神经综合征(CES)系指各种原因导致马尾神经损害,临床出现鞍区感觉、括约肌功能、性功能三大障碍为主的综合征。我院自2006年5月—2010年10月,采用全椎板切除减压、椎弓根钉内固定并椎间融合术治疗腰椎间盘

Objective To explore the clinical outcomes of a single-segment tension compression reduction and fixation system for pure lumbar spondylolysis. Methods From December 2009 to January 2012, 14 cases with pure lumbar spondylolysis were treated in the 188th Hospital of PLA using single-segment tension compression reduction and fixation system with autogenous bone grafting in isthmic position. CT, MRI and X-rays were performed for all patients. Results All cases were followed up from 3 to 12 months, with the average of 10.9 months. According to Henderson standard, there were excellent in 9 cases, good in 4 cases, fair in 1 case, with the excellent and good rate was 13/14. No fixation failure or nerve syndrome aggravation occurred. Conclusion Single-segment tension compression reduction and fixation with autogenous bone grafting for pure lumbar spondylolysis has the advantages of simple procedure, less injury, high safety, and good clinical outcomes. Proper cases chosen, good understanding of indications, and precious experience of surgeon are the key points for the treatment of pure lumbar spondylolysis.

目的探讨射频消融髓核成形术治疗颈椎间盘突出症的安全性和疗效。方法应用射频消融髓核成形术治疗颈椎间盘突出症22例,男19例、女3例;年龄18～35岁,平均（25.5±4.5）岁。共23个椎间隙:单间隙21例,双间隙1例。术后随访近期效果。结果本组22例患者均获随访,随访时间1～12个月,平均7.6个月。显效17例,有效4例,无效1例,总有效率95.45%。结论射频消融髓核成形术是治疗颈椎间盘突出症行之有效的方法,这种技术简单、微创、安全、疗效肯定。关键是选择合适的适应证。

Objective To investigate the treatment effect of locking compression plate(LCP) for proximal humeral fractures.Methods 21 cases of proximal humeral fractures were treated with LCP.There were 16 males and 5 females,aged from 21 to 68 years.According to Neer types,4 cases were classified as Ⅱ,14 as Ⅲ and 3 as Ⅳ.Results Twenty-one cases were followed up for 6 to 18 months,average 13.5 months,and all fractures were union.According to Neer shoulder score,the result was excellent in 10 cases,good in 8 and fair in 3,the excellent and good rate was 85.7%.Conclusion Locking compression plate for proximal humeral fractures has such advantages as stable fixation of the fracture and less disturbance of the blood supply.It is an effective method to treat proximal humeral fractures.

<正>与常规开放手术比较,后路显微内窥镜椎间盘切除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症,具有损伤少、出血少、患者住院时间短、术后恢复快等优点,因而得到越来越多的应用。MED手术与常规开放手术一样存在并发症。我院自2006年1月至2010年1月用MED治疗腰椎间盘突出症360例,发生并发症9例。现报道如下。

[目的]探讨脊柱结核一期手术治疗的围手术期处理方法.[方法]对2005年1月至2009年6月一期手术治疗的19例脊柱结核患者,采用规范的围手术期处理.[结果]19例患者,切口均一期愈合,植骨均愈合,无结核感染复发,内固定无松动、断裂.[结论]对于脊柱结核的手术患者,外科临床治疗中,注意手术治疗的同时,应重视规范的围手术期处理.

可膨胀髓内钉(FixionTM)包括可膨胀自锁髓内钉(Fixion IM)、可膨胀交锁髓内钉(Fixion IL)和股骨近端髓内钉(Fixion PF)3种类型.国外学者[1]认为可膨胀髓内钉与交锁髓内钉相比更具优越性.2005年1月-2007年1月,我院采用FixionTM系统膨胀髓内钉内固定治疗下肢多发性骨折30例,疗效满意.

<正>1病例资料患者,女性,41岁。因发现右膝部包块3年余,疼痛半个月步行入院。2005年无明显诱因发现右膝部下外侧有一蚕豆大小无痛肿块,质硬。未做治疗。三年来肿块逐渐增大,2008年5月份以来感肿块持续隐痛。查体:生命体征平稳,未触及肿大浅表淋巴结。心、肺、腹检查未见异常。

1996年9月～2005年12月,我们采用牵引下即时管型石膏外固定治疗桡骨远端骨折42例,疗效满意.现分析报告如下. 1 临床资料 1.1 一般情况 42例中,男26例,女16例;年龄26～64岁.致伤原因:高处坠落10例(均合并脊柱损伤),跌倒21例,交通事故11例.按照 AO/ASIF 分型:A3 型15例,C3 型27例.其中伴桡骨茎突骨折29例,下尺桡关节脱位16例.桡骨短缩3.5～7.6 cm,平均5.6 mm;掌倾角-15°～-31°,平均-20°;尺偏角-12°～10°,平均:-3°.

腰椎间静脉压迫症以中老年患者多见,常规 X 线摄片及 CT、MRI 等检查阳性率极低,因其合并有腰椎间盘突出症、椎管狭窄、椎间小关节等疾病,临床症状相似,易引起漏诊、误诊.

目的 探讨腰麻在85岁以上超高龄髋部骨折患者中的应用效果.方法 85岁以上超高龄股骨颈骨折的患者行人工股骨头置换术,采用0.75%布比卡因2 ml行腰麻治疗76例,效果满意.结果 所有患者均顺利完成手术,与连续硬膜外麻、全麻相比,腰麻具有操作相对简单安全、诱导期短、剂量少、易控制麻醉平面、对心血管系统影响小、术后易管理的优点.结论 骨盆平面以下的超高龄骨折患者的手术,时间不超过3h的,腰麻是最佳选择.

目的:调查分析军事训练致脊柱损伤的影响因素。方法:通过追问病史、力学分析及现场调查,对军事训练导致脊柱损伤的训练项目、受伤原因、受伤例数等进行系统统计分析。结果:军事训练致脊柱损伤均与脊柱的解剖与力学特点有关;因技术动作错误及组织管理不科学致伤856例(60.4%),因预防意识不强、疲劳训练及心理素质差等致伤562例(39.6%)。结论:应针对各种致伤因素积极采取相应防范措施。