目的 分析胫距跟关节融合术在老年终末期踝关节骨性关节炎治疗中的应用价值.方法 44 例老年终末期踝关节骨性关节炎患者随机分为对照组及观察组各22 例,对照组行踝关节融合术治疗,观察组行胫距跟关节融合术治疗;记录两组围术期指标、骨融合率及预后评分.结果 观察组术后引流量、住院天数显著低于对照组(P<0.05),两组手术时间、切口长度及术中失血量差异无统计学意义(P>0.05);两组术后并发症发生率,术后12 个月视觉模拟评分(VAS)、美国足与踝关节协会(AOFAS)评分、麦奎尔(Mcguire)评分、马祖尔(Mazur)评分均无统计学差异无统计学意义(P>0.05);术后10 w,观察组骨融合率显著高于对照组(P<0.05),术后12 个月两组融合率差异无统计学意义(P>0.05).结论 对终末期踝关节骨关节炎患者行胫距跟关节融合术,在术后可实现更快的骨性融合,减轻患者痛苦,不增加手术风险.

目前,多数学者对有脊髓压迫的无骨折脱位型颈脊髓损伤主张早期手术治疗,本研究旨在通过回顾性分析,探讨单开门椎管扩大成形术治疗无骨折脱位型颈脊髓损伤的疗效.

目的 研究胫骨结节下斜式双平面胫骨高位截骨术(distal tibial tuberosity in open wedge high tibial osteotomy,DTT-OWHTO)对髌股关节影像学和功能评分的影响.方法 自2015年1月至2019年12月于沧州市中心医院行胫骨结节下斜式双平面截骨手术治疗内翻膝骨关节炎合并髌股关节炎的患者共36例,男15例,女21例;年龄43～64岁,平均(52.96±4.59)岁.比较手术前后髌股关节Iwano分级、胫骨近端内侧角、髌骨高度、外侧髌骨角、胫骨后倾角和Lysholm评分、Kujala评分、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities,WOMAC)骨关节炎指数评分的变化.结果 所有患者随访15～33个月,平均随访(23.69±4.22)个月,手术前后髌股关节Iwano分级比较差异有统计学意义(P＜0.05);胫骨近端内侧角由术前(81.84±3.96).提高到术后(90.57±2.53)°,充分矫正膝内翻;手术前后髌骨高度、外侧髌骨角和胫骨后倾角比较差异无统计学意义.Lysholm评分由术前(58.50±5.87)分提高到术后(86.39±2.14)分(P＜0.05);Kujala评分由术前(56.69±9.43)分提高到术后(72.69±5.79)分(P＜0.05);WOMAC评分由术前(65.19±6.48)分降低为术后(43.81±8.48)分(P＜0.05).结论 胫骨结节下斜式双平面截骨可以避免髌骨低位,改善髌股关节功能.对于合并有髌股关节炎的内翻膝患者,该术式可作为其保膝治疗的有效方法.

[目的]探讨颈椎双开门椎板成形术治疗无骨折脱位型颈脊髓损伤的疗效.[方法]回顾性分析本科2016年1月～2019年6月颈椎双开门椎板成形术治疗的无骨折脱位型颈脊髓损伤52例患者的临床资料,受伤至入院的时间1～120 h,平均(25.62±6.43)h.[结果]手术时间1.52～2.53 h,平均(2.12±0.17)h,术中出血量200～800 ml,平均(265.51±41.27)ml,无1例颈脊髓损伤加重.52例患者均获得随访,随访时间6～36个月,平均(19.22±4.33)个月,末次随访时JOA评分(13.71±2.62)分,与术前(5.42±1.85)分相比差异有统计学意义(P＜0.05),平均恢复率63.56％,优良率78.80％.[结论]颈椎双开门椎板成形术治疗无骨折脱位型颈脊髓损伤,可取得满意的疗效,有较高的安全性.

目的 研究胫骨内侧高位截骨术对髌股关节软骨病变的影响.方法 回顾性分析自2014年1月至2018年12月诊断为膝骨关节炎合并髌股关节Iwano分级Ⅰ～Ⅲ级的86例患者,行关节镜及胫骨内侧高位截骨术,比较术后髌股关节的软骨改变.所有患者术前查体均为膝内侧疼痛,无髌股关节疼痛,膝正位X线片示内侧间室骨关节炎,髌骨轴位、侧位X线片可见髌股间隙变窄.术中使用关节镜探查髌股关节时,根据国际软骨修复协会软骨损伤分级(international cartilage repair society,ICRS)将患者分为 A组35例(ICRS 0～Ⅰ 级),其中男性9例,女性26例,平均年龄(55.66±4.66)岁;B组51例(ICRS Ⅱ～Ⅲ级),其中男性21例,女性30例,平均年龄(55.90±4.44)岁.所有患者均进行胫骨内侧高位截骨矫正力线,建议截骨处愈合后再次手术取出内固定钢板.比较两组患者在初次截骨手术和再次取出内固定手术时视觉模拟评分(visual analogue scale,VAS)、西大略湖麦克马斯特大学(Western Ontario and McMaster universities,WOMAC)骨关节炎指数评分和髌股关节Kujala评分差异;比较每组患者在截骨前后的Iwano分级和镜下ICRS分级差异.结果 两组患者在初次截骨术和再次取出内固定手术时VAS评分、WOMAC评分骨关节炎指数评分和Kujala评分比较,差异均有统计学意义(P＜0.05);每组患者截骨手术前后对比,术后髌股关节ICRS分级较术前有增长趋势,但Iwano分级和镜下ICRS分级比较差异无统计学意义(P＞0.05).非劣性检验Kujala评分结果表明B组术后评分并不比A组差.结论 对于内翻膝骨关节炎无髌股关节症状的患者,如果髌股关节软骨分级为ICRS 0～Ⅲ级,仍然可采取胫骨内侧高位截骨术,短期不会加重髌股关节炎的临床症状,且功能评分得到改善.

目的 探究人参皂苷Rb2在体内调控破骨细胞的作用及机制.方法 通过去势建立小鼠骨质疏松模型,分为4组(假手术组,去势组,低剂量组,高剂量组),腹腔注射不同浓度Rb2溶液[低剂量组5 mg/(kg·d),高剂量组20 mg/(kg·d),假手术组、去势组注射蒸馏水],常规饲养12周.使用Elisa试剂盒检测血清破骨细胞活性指标抗酒石酸酸性磷酸酶(tartrate-resistant factor acid phosphatase,TRAP)、Ⅰ型胶原C端肽(C-terminal telopeptide-Ⅰ,CTX-1)水平,股骨远端TRAP染色,从髓腔中提取和培养原代破骨细胞,TRAP染色并计数检测破骨细胞分化情况,Western-blot技术检测原代破骨细胞核因子κB (nuclear factor kappa-B,NF-κB)p65蛋白及自噬相关分子自噬标志轻链3(autophagy marker light chain 3,LC3)、哺乳动物雷帕霉素蛋白(mammalian target of rapamycin,mTOR)、5'-磷酸腺苷活化蛋白激酶(adenosine 5'-monophosphateactivated protein kinase,AMPK)、磷酸化腺苷酸活化蛋白激酶(phosphorylated adenosine monophosphate activated protein kinase,pAMPK)蛋白表达水平.结果 去势小鼠血清TRAP(64.10±1.18) pg/ml、CTX-1(70.43±1.71)ng/ml浓度最高,其余各组血清指标明显降低,高剂量组尤甚[分别为(44.62±2.02) pg/ml和(49.55±2.72)ng/ml](P＜0.01).去势组股骨远端TRAP染色阳性细胞密集,阳性区域最大,随着Rb2浓度增加,TRAP染色阳性区域面积减少(P＜0.05).去势组多核破骨细胞数量最多(152.00±18.55/孔),低剂量组(118.40±18.46/孔)和高剂量组(99.60±13.89/孔).TRAP染色阳性细胞数量均有不同程度减少,低剂量组最少(84.00±15.23/孔),各组P＜0.01.与去势组相比,各组NF-κB在细胞质增加(P＜0.05),在细胞核减少(P＜0.01);各组mTOR表达减少,AMPK、pAMPK表达增加,LC3 Ⅱ/LC3 Ⅰ比值增高(P＜0.05).结论 人参皂苷Rb2在体内通过抑制NF-κB信号通路以及调控mTOR介导的自噬信号通路抑制破骨细胞.

目的 探讨急性闭合性跟腱断裂患者III型胶原比例的高低与其临床预后之间的关系.方法2015年1月至2016年10月我科共收治急性闭合性跟腱断裂患者41例,其中男39例,女2例,年龄20～55岁,平均36.2岁;左侧23例,右侧18例.损伤部位:距离跟骨结节4.5～6.0 cm.采用自行研制的微创跟腱缝合技术和器材进行手术治疗,伤后至手术时间为1～6天,平均2.2天,术中取断端局部横断面病理标本(距断裂位置<0.3 cm)做天狼猩红染色,计算每个患者跟腱胶原中III型胶原的比例,并按照其比例高低分为四组:A组0％～25％,B组26％～50％,C组51％～75％,D组76％～100％).术后随访12～18个月,平均16.8个月,根据Arner-Lindholm评定法进行预后评分.结果四组终末随访预后评定均达到优良水平,但术后6个月却有明显差异,A组共10例,优5例,良2例,差3例,总体优良率70％;B组共14例,优11例,良3例,总体优良率100％;C组共12例,优10例,良2例,总体优良率100％;D组共5例,优1例,良2例,差2例,总体优良率60％;术后6个月随访功能评定,A组与D组间优良率差异无统计学意义(P>0.05),A组优良率明显低于B组、C组,差异有统计学意义(P=0.018);B组与C组间优良率差异无统计学意义(P>0.05);D组优良率明显低于B组、C组,差异有统计学意义(P=0.009).结论对急性闭合性跟腱断裂患者,由同一组医师进行相同的手术及术后康复指导,四组患者自身跟腱III型胶原的比例不同,可能会导致功能恢复速度和程度有明显差异,III型胶原比例过高或者过低的患者恢复较慢.

目的 探讨步行训练联合骨髓间充质干细胞(BMSCs)移植对脊髓损伤(SCI)大鼠模型功能修复的影响.方法 取4周龄SD雌性大鼠5只,取骨髓,分离培养BMSCs,按1:2传代扩增,用3～4代细胞进行移植.采用随机数字表法将SD雄性大鼠80只分为模型组(伤后不干预)、BMSCs移植组(SCI大鼠模型制备成功后1周进行BMSCs移植)、步行训练组(模型制备成功后的第2天开始步行训练)、联合组(模型制备成功后进行步行训练联合BMSCs移植),各20只.采用医用动脉瘤夹钳夹脊髓的方法制备SCI模型,伤后按分组进行BMSCs移植和步行训练,分别于伤后1周、2周、3周、4周采用BBB评分评估四组大鼠后肢神经运动功能,评估结束后用免疫组化染色的方法检测脑源性神经生长因子(BDNF)、神经元特异性烯醇化酶(NSE)阳性表达,并观察四组损伤区脊髓组织神经纤维恢复情况.结果 SCI后1周,步行训练组、联合组BBB评分均明显高于BMSCs移植组、模型组,干预三组SCI后2周、3周、4周BBB评分均明显升高;SCI后2周、3周、4周,干预三组BBB评分均高于模型组,联合组BBB评分均高于步行训练组、BMSCs移植组;BMSCs移植组SCI后3周、4周BBB评分高于步行训练组,差异均有统计学意义(P<0.05);步行训练组、BMSCs移植组、联合组SCI后4周BDNF、NSE阳性表达均明显高于模型组,联合组明显高于步行训练组、BMSCs移植组,BMSCs移植组高于步行训练组,差异均有统计学意义(P<0.05).结论 步行训练联合BMSCs移植能促进SCI大鼠神经功能和运动功能的恢复,可能与调控神经细胞因子的表达有关.

Objective To investigate the interleukin-17 (IL-17) levels changes in both synovial fluid and venous plasma of patients with primary knee osteoarthritis (OA) after intra-articular injection of platelet-rich plasma (PRP). Methods Between January 2015 and January 2016, 30 patients with primary knee OA were treated by intra-articular injection of PRP once a week for 3 weeks (trial group). Thirty healthy individuals were recruited into the study as control. There was no significant difference in gender, age, and body mass index between 2 groups ( P>0.05). Visual analogue scale (VAS) score and Knee Society Score (KSS) were used to evaluate pain level and function of the knee for patients with OA. The IL-17 levels in both venous plasma and synovial fluid were measured before injection and at 1, 3, 6, and 12 months after injection in trial group and the IL-17 levels in venous plasma were measured in control group. The levels were determined using ELISA method. Results There was no knee joint swelling, fever, local infection, or other uncomfortable symptoms for all patients in process of PRP injection. All patients were followed up 13.5 months on average (range, 12-15 months). In trial group, the VAS scores at different time points after injection were significantly lower than that before injection ( P<0.05). And the KSS scores at different time points after injection were significantly higher than that before injection ( P<0.05). There was no significant difference in VAS and KSS scores between different time points after injection ( P>0.05). The IL-17 levels in venous plasma before and after injection in trial group were significantly higher than that in control group ( P<0.05). The IL-17 levels in venous plasma at each time point after injection were significantly lower than that before injection ( P<0.05). There was no significant difference in IL-17 levels in both venous plasma and synovial fluid between different time points after injection ( P>0.05). Conclusion Intra-articular injection of PRP can significantly release the pain symptoms, improve joint function, and reduce IL-17 levels in both synovial fluid and venous plasma of the patients with knee OA, but IL-17 levels can not reduce to normal level.

Objective To investigate effects and mechanism of ginsenoside Rb2 on osteoclasts in vitro. Methods The mouse osteoclast precursor cells RAW 264.7 were cultivated to induce osteoclasts. Rb2 ( 0.1 μM, 1 μM, 10 μM ) was respectively added in the culture solution. CCK-8 was used for the detection of drug toxicity. The morphology and count of osteoclasts were observed by TRAP staining. The expression of osteoclast specific gene mRNA, such as TRAP and NFATc1, was detected by RT-PCR. Western blot technique was used to detect the expression levels of LC3 I, LC3 II and mTOR proteins. Results Compared with the control group ( 168.2 ± 22.6 ), the number of osteoclasts decreased significantly: group 0.1 μM ( 131.0 ± 16.3 ), P = 0.018; group 1 μM ( 98.8 ± 17.9 ), P<0.01;group 10 μM(85.8 ± 17.3),P<0.01.The expression of TRAP and NFATc1 osteoclast specific gene mRNA decreased significantly, the ratio of LC3, II / LC3 and I increased significantly, and the amount of mTOR decreased, P< 0.01. Conclusions Rb2 may affects the expression of osteoclast genes by autophagy pathway to reduce the osteoclast formation. mTOR pathway plays an important role in this process.

Objective:To investigate interleukin-1β (IL-1β), IL-6, and IL-17 levels in both synovial fluid and serum of patients with primary knee medial osteoarthritis (OA) after high tbial osteotomy (HTO). Methods:Twenty-six patients with primary knee medial OA undergoing HTO between January 2011 and June 2014 (experimental group) and 30 healthy individuals (control group) were recruited into the study. There was no significant difference in gender, age, and body mass index between 2 groups ( P>0.05). The X-ray film was taken to record healing time at osteotomy site, to measure the tibiofemoral angle, and to assess limb alignment after HTO. Visual analogue scale (VAS) pain score and knee society score (KSS) were used to evaluate pain level and function of the knee. The IL-1β, IL-6, and IL-17 concentrations in both plasma and synovial fluid were measured before operation and at 6, 12, and 18 months after operation in the experimental group using ELISA method; the levels in plasma were measured in control group. Results:Primary healing of incisions was achieved in patients. All patients were followed up 18-24 months (mean, 21 months). The X-ray film showed osseous healing at osteotomy site at 9-14 weeks (mean, 11.5 weeks). The average tibiofemoral angle was 167.5° (range, 165-170°) after bone healing. Satisfactory limb alignment was obtained in all patients. The postoperative VAS pain score was significantly decreased and KSS score was significantly improved when compared with preoperative scores ( P<0.05), but no significant difference was found between different time points after operation ( P>0.05). The preoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly higher in patients than controls ( P<0.05). The postoperative IL-1β, IL-6, and IL-17 concentrations in plasma and synovial fluid were significantly lower than preoperative ones in patients ( P<0.05), but the concentrations were significantly higher than those in controls ( P<0.05). The postoperative plasma and synovial fluid IL-1β, IL-6, and IL-17 concentrations were significantly declined in patients, but there was no significant difference between different time points after operation ( P>0.05). Conclusion:HTO can significantly improve the pain symptom and joint function and reduce IL-1β, IL-6, and IL-17 levels in both plasma and synovial fluid of patients with medial compartment knee OA, but these cytokines can not return to normal level.

Objective To compare the therapeutic effects of intra-articular injection combining intra-cancellous bone injection of platelet rich plasma ( PRP) and simple intra-articular PRP injection for the treatment of knee osteoarthritis .Methods From June 2014 to August 2015, 40 patients with knee osteoarthritis in grade Ⅱ~Ⅲ according to Kellgren-Lawrence staging ( K-L) were randomly divided into two groups.Group A contained 20 cases [six males, 14 females, average age (54 ±3) years], which received intra-articular injection of PRP 2 ml combined with medial tibial plateau and medial femoral condyle injection of PRP 1.5 ml.Group B also included 20 cases [ four males, 16 females, average age (49 ±5) years], which were given intra-articular injection of PRP 5 ml.Two weeks later, both the groups followed the same operation above .All the patients were followed up at month 1, 3, 6, 12 with visual analogue scale (VAS) score and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index.The data were analyzed by repeated measurement design chi-square test.Results No significantly difference was found in the two groups before receiving the treatment ( P >0.05 ) .VAS and WOMAC scores were all declined especially at the end of the first month .Comparing the VAS scores , there was no significant difference in the 1st month (P >0.05), but at the 3rd (F =203.15, P <0.05), 6th (F =556.82, P<0.05) and 12th (F =1310.56, P <0.05) month, the significant differences were found between the two groups.At the 1st and 3rd month, the improvement in WOMAC scores was similar in group A and B(P>0.05), while at the end of 6th(F=185.49, P<0.05) and 12th(F=76.09, P<0.05) month, the scores in group A were determined to be both statistically and clinically superior than those in group B.Conclusion Intra-articular injection combined with intra-cancellous bone infiltration of PRP can reduce pain and improve function of knee , the long-term efficacy may be better than intra-articular injection .

目的 探讨关节腔内联合软骨下骨的松质骨内注射富血小板血浆(PRP)治疗膝骨关节炎(KOA)的临床疗效.方法 Kellgren-Lawrence (K-L)分级Ⅱ~Ⅲ级的KOA患者60例,按照随机数字表分为两组:A组28例、B组32例,A组关节腔内注射PRP 2 mL,内侧股骨髁和胫骨平台软骨下骨的松质骨内分别注射PRP 1.5 mL,间隔2周后再进行1次穿刺注射;B组关节腔内注射透明质酸钠2 mL,每周注射1次,连续5次.患者在治疗前和完成全部注射后的1、3、6、12个月使用视觉模拟评分(VAS)、The Western Ontario和McMaster大学骨关节炎指数(WOMAC评分)进行疗效评价.结果 治疗前两组各指标比较,P均>0.05.A组治疗后VAS、WOMAC评分较治疗前改善明显,且在第3个月后趋于稳定(P均＜0.05);B组治疗后第1、3个月有所好转,但第6个月后开始失效,VAS和WOMAC评分逐渐增高(P均＜0.05).治疗后两组各评分比较,P均＜0.05.结论 关节腔内联合软骨下骨的松质骨内注射PRP治疗K-L Ⅱ~Ⅲ级的KOA,能有效缓解患者膝关节疼痛,改善关节功能.

Objective To compare the treatment of intertrochanteric fracture with Gamma long versus short intramedullary nails .Methods Fifty-six elderly patients with intertrochanteric fracture of femur ( AO/OTA31-A1;A2,37 males,19 females) were divided into short intramedullary nails group [including 21 males and 12 females with a mean age of (73.21 ±6.24) years] and long intramedullary nails group [ including 16 males and 7 females with a mean age of (68.88 ±7.61) years].Medical records were reviewed for age ,gender,estimated blood loss, operative time ,preoperative hemoglobin ,transfusion rate ,length of stay and Harris scores 1 year after the operation . Results The average estimated blood loss [(149.11 ±87.31)mL] and transfusion rate(65.2%) for long nails were found to be significantly greater (P<0.01) than the average estimated blood loss [(93.25 ±61.26 )mL] and transfusion rate(36.4%) for short nails.The average operative time was also found to be significantly greater (P<0.01) for long [(73.80 ±17.40) minutes] than for short [(53.30 ±15.70) minutes] intramedullary nail proce-dures.But there was no significant difference in preoperative hemoglobin ,length of stay and Harris scores 1 year af-ter the operation.Conclusion Short intramedullary nails were found to be better than long intramedullary nails for less operation wound .

目的 加强对双极人工股骨头治疗老年股骨转子间骨折围手术期隐性失血量的探讨,分析其原因并提高对隐性失血的重视.方法 选择2008-2012采取双极人工股骨头治疗的63例股骨转子间骨折患者,依据Gross方程,根据患者身高、体质量及手术前后血细胞比容(Hct)变化计算围手术期隐性失血量.结果 围手术期未输血的患者6例(占9.5％),术中出血及术后引流量共380 ～ 740 mL,平均596 mL.患者术前平均Hb为119.6 g/L,术后为92.4 g/L,平均下降了27.2 g/L;术前平均Hct为34.84％,术后为27.36％,平均下降了7.48％,患者手术前后Hb、Hct均有统计学差异(P＜0.05).隐性失血量为680.25～1 105.74mL,平均(814.43±4.95)mL;总失血量为620～1 190mL,平均(962.34±5.74)mL,隐性失血占总失血量的84.63％.采取输血支持的患者57例(占90.5％),术中出血及术后引流量共350 ～ 740mL,平均554.5mL.患者术前平均Hb为108.2 g/L,术后为103.3 g/L,平均下降了4.9 g/L;术前平均Hct为32.34％,术后为30.87％,平均下降了1.47％.由于采取输血治疗,补充围手术期失血,输血量为400～1 600mL,平均740mL,手术前后Hb、Hct均无统计学差异(P＞0.05).隐性失血量为792.48 ～1 384.62 mL,平均(891.15±5.23)mL;总失血量为620～1 710 mL,平均(1 078.35±5.74)mL,隐性失血占总失血量的82.64％.结论 双极人工股骨头治疗老年股骨转子间骨折,围手术期隐性失血量较多,临床上应予以足够的重视.

自发性脊髓硬膜外血肿(spontaneous spinal epidural hematoma,SSEH)是一种罕见疾病,Holtas等[1]统计每年发病率约为0.1/100,000.这种疾病无明确外伤史并出现脊髓压迫症状,多以急性背部疼痛起病,进展迅速,导致脊髓、神经根受压甚至截瘫[2、3].确诊该病以体格检查及MRI为标准,但我科收治的1例SSEH患者,因发病当日行心脏冠脉造影支架置入术(爱克塞尔支架),无法行胸椎MRI检查,我们通过CT薄层增强扫描定位病灶并手术治疗,术后患者截瘫恢复,现报告如下.

Background:The medial patellofemoral ligament (MPFL) is a very important structure to avoid lateral dislocation of patel-la. The reconstruction of MPFL had been the first choice of treatment for unstable patella. Intraoperative tourniquet has been widely applied, which can improve surgical field and reduce bleeding, but also will inevitably change the tension of quadri-ceps. It has been no definite conclusion whether tourniquet has obvious effect on patellar tracking. Objective:To observe the patella tracking before and after tourniquet inflation. Methods:A total of 53 patients (66 knees) underwent double-stranded anatomic reconstruction of MPFL between March 2008 and February 2011. There were 23 males (28 knees) and 30 females (38 knees) with a mean age of 26 years (range, 18-34 years). The duration from onset of disease to surgical treatment was one month to 13 years. Forty four patients had the history of patellar dislocation caused by trauma. Patella tracking was observed before tourniquet was inflated and after it was released. The lateral retinacular release was recorded. Results:The lateral retinaculum needed to be released in 5 knees before tourniquet inflation and in 6 knees after tourniquet inflation (P>0.05). Under the circumstances of tourniquet inflation, 66 knees had normal patellar tracking after reconstruc-tion of MPFL;under the circumstances of tourniquet release, patellar medial transfer happened in 2 knees (P>0.05). Conclusions:The application of tourniquet has no significant effect on the patella tracking. It is unnecessary to release the lateral retinaculum when patellar tracking is normal during MPFL reconstruction.

Objective To evaluate the effect of internal iliac artery or abdominal aorta blockade on the pressure of internal iliac artery net in order to provide theoretical basis for reasonable option of arterial blockade in management of arterial bleeding of pelvic fractures. Methods Five goats were included in the study.The measurement of the pressure of internal iliac artery net was made in the following steps:( 1 ) measurement of the pressure of normal internal iliac artery,(2) measurenent of the pressure following blockade of unilateral internal iliac artery,(3) measurement of the pressure following blockade of bilateral internal iliac arteries,(4) measurement of the pressure following blockade of abdominal aorta and bilateral internal iliac arteries simultaneously,(5) measurement of the pressure following blockade of abdominal aorta only. Results The normal internal iliac artery pressure was ( 57.84 ± 13.46 ) mm Hg.The pressures following the blockade of unilateral internal iliac artery,bilateral internal iliac arteries,abdominal aorta and bilateral internal iliac arteries sinultaneously,and abdominal aorta only were (38.40±17.39) mm Hg,(29.70 ± 12.16) mmHg,(32.80 ± 17.02) mm Hg and (29.20 ± 18.52) mm Hg,respectively.All the blocking designs had obvious effect on the pressure of normal internal iliac artery ( P ＜ 0.05 ),while the various blockade modes themselves showed no statistical differences (P ＞ 0.05). Conclusion The upper described four modes of blockade are similar in decreasing the pressure of the internal iliac artery net.Thereby,only one of them is enough in management of artery hemorrhage following pelvic fractures.

<正>动力髋螺钉(DHS)是治疗股骨转子间骨折常用的一种内固定材料,但随访发现应用DHS术后可能发生髋内翻、头颈切割、骨折不愈合等并发症。本研究对23例DHS治疗股骨转子间骨折失败的患者行人工全髋关节置换,随访效果满意。1对象与方法1.1对象对2005年3月至2010年6月沧州市中心医院骨

股骨粗隆间骨折系指股骨颈基底至小粗隆水平牵引能做到内外兼治、动静结合,费用低,患者容之间的骨折,主要发生在有骨质疏松的老年患者;易接受.但Davidson等[3] 认为保守治疗卧床后易发生在年轻患者,粗隆间骨折往往由高能量损伤造成,肺部感染、深静脉血栓形成、褥疮、尿路感染等多并伴其他损伤[1] .随着社会经济的发展,人口老龄化种并发症,而且髋内翻的发生率高达 40%～50%,速度的加快,股骨粗隆间骨折的发病率呈逐年上升病死率高达34.6%[4] .