Objective: To observe the clinical efficacy of medicine suits of Epimedium Herb and Radix Paeoniae Alba in the treatment of senile lumbar disc herniation (LDH). Methods: From January 2013 to September 2015, a total of 81 LDH patients older than 65 years old in Xiyuan Hospital of Chinese Academy of Medical Sciences and Wangjing Hospital of China Academy of Traditional Chinese Medicine were divided into Chinese medicine treatment group (42 cases, only oral Chinese medicine) and western medicine control group (39 cases, only treated with Voltaren). The pain NRS score and total physical therapy were evaluated. Results: ①Pain NRS score: there was no significant difference in the NRS score between the two groups before treatment, and the score of the TCM treatment group was 2.81+1.43 after treatment, which was lower than the western medicine control group (4.01+1.41) (P<0.05). ②The total effective rate of the Chinese medicine treatment group was 95.24％, the total effective rate of the western medicine control group was 89.74％, and the curative effect of the Chinese medicine treatment group was effective. Compared with the western medicine control group, the difference was statistically significant (P<0.05). Conclusion: Medicine suits of Epimedium Herb and Radix Paeoniae Alba have advantages in improving symptoms and signs integral and alleviating pain in elderly patients with prolapse of lumbar intervertebral disc. It is worth further research and promotion.

目的:研究补肾活血汤治疗老年肾虚型腰椎间盘突出症的临床疗效.方法:收集符合入选标准的患者65例,分为中医治疗组33例(仅予补肾活血汤)和西医对照组32例(仅予扶他林片治疗),比较两组总体疗效、症状体征积分及满意度.结果:总体疗效:中医治疗组总有效率是93.94％,西医对照组总有效率是90.63％,各组均无不良反应,两组差异无统计学意义;症状体征积分:治疗前两组积分差异无统计学意义,治疗结束后,中医治疗组症状体征积分为(20.38±3.82),比西医对照组(17.13±3.16)高(P＜0.05);满意度比较:两组均获得良好的满意度,差异无统计学意义.结论:补肾活血汤在改善老年肾虚型腰椎间盘突出症症状体征积分方面具有一定优势,且患者满意度较高.

从损伤的部位来看,在上肢的肩、肘、腕中,以腕关节损伤为主,特别是中老年人以腕部骨折为多;在下肢的髋、膝、踝中,以髋、踝关节骨折和韧带损伤多发.之所以这些部位容易出现损伤,是因为人在滑倒的瞬间,常常采用自我保护的姿势,如手掌撑地或踝关节翻转造成的.

In the treatment of chronic osteomyelitis, the common methods in primary stage are debriding, draining and lavaging, but the clinical outcomes are not always satisfactory. Autogenous bone grafting in a second stage procedure has been the gold standard for this type of treatment, but its quantity is limited. In addition the autogenous bone graft will be absorbed or become sequestrum if the inflammation control is not sufficient [1][2]. Allogeneic bone, although solving the problem of limited supply, is likely to cause or increase the immune response and infection [3][4]. The availability of antibiotic loaded polymethylmethacrylate (PMMA) bone cement, particularly the antibiotic bead chain, provides a new direction for the treatment of osteomyelitis. However, antibiotic impregnated bone cements are non-absorbing, can support a biofilm and become a foreign body and nidus for infection at the implant site. They must be removed in a further surgical procedure if bone graft implantation is required.

IntroductionIn the treatment of distal radius fractures, bone grafting for subchondral bone defects is often used in order to avoid articular surface collapse and radial shortening.At present, the bone graft materials used regularly include autogenous bone, allogeneic bone or heterogenous bone and synthetic materials.Autogenous bone graft has been the gold standard for bone grafting and is the ideal implant bone substitute, but its source is limited [1] [2] .Moreover, opening reduction to expose the fracture segment and the donor site of bone will increase blood loss, surgery time and the possibility of infection.Allogeneic bone, although solving the problem of insufficient amount, has the disadvantage of the lack of sources and has the potential for immune response, infection and re-fracture [3][4] .Synthetic calcium sulphate graft has the advantage of good biocompatibility, it is biodegradable and injectable and will set in situ, which makes it an excellent choice for the clinical application of the treatment of distal radius fracture, particularly suitable to be implanted by injection.Its' relatively rapid resorption time and complete resorption will minimize the risks associated with any intra-articular migration, which could be a problem with the much slower resorbing calcium phosphate cements.The authors present a retrospective analysis of the clinical outcome on the treatment of distal radius fractures using calcium sulphate cement. Material and operating technique 2.1 Patient selectionOver a period of four years, from January 2006 to January 2010, data from 60 patients was reviewed; 42 males and 18 females, ages from 46-68 years old (mean age 56 years old).Fractures were classified to A3 (12 cases), C2 (28 cases) and C3 (20 cases) using AO classification and all had some degree of subchondral bone defects.There were 8 cases treated with closing reduction and 52 cases treated with external fixation.In all cases fractures were implanted with calcium sulfate cement (Stimulan Kit, Biocomposites Ltd., UK) without autogenous bone graft. www.intechopen.comBone Grafting 126 Calcium sulphate cement fillingAfter appropriate fixation, the size of the bone defect was preliminarily measured before cement injection.Puncture needles were inserted into the gaps of fracture defect under fluoroscopic control.Once the needle position was satisfactory the calcium sulphate powder and diluent were mixed.The paste was extruded into the defect cavity until full when viewed under fluoroscopy.The implantation was made in different directions to access all gaps.In all cases 3 -5cc of paste was used and the whole implantation procedure was completed within 6 minutes. Clinical resultFractures healed in all cases.All patients were followed up for 4 to 18 months (mean 8 months) and X-ray images were taken for review.The study found that callus appeared in all cases within 2 to 4 months.Most of the calcium sulphate had absorbed within 2 months and all was completely absorbed in 3 months post surgery.X-ray images for 57 patients demonstrated that the reduction of the fracture was stable and satisfactory, with no fracture side collapse and/or displacement found.3 cases showed slight collapse which may be a result of the adjustment of the external fixator too early after the surgery.No foreign body reactions or infection were found in all 60 patients.No complications such as pin loosening dislocation of fixators, injury of blood vessels and radial nerves, pin track infections occurred.According to Mcbride scoring, the results were excellent in 50 cases, good in 7 cases, fair in 1 case and poor in 2 cases, the excellent and good rate being 95%.Two cases had traumatic arthritis and 1 case had wrist joint stiffness. How to referenceIn order to correctly reference this scholarly work, feel free to copy and paste

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。

OBJECTIVE:To study the effect of minimally invasive treatment with the locking compression plate (LCP) in the treatment of intertrochanteric fractures in the elderly age.METHODS:Twenty-eight cases of intertrochanteric fracture were retrospective studied from August 2007 to January 2009, included 13 males and 15 females with an average age of 78.6 years ranging from 70 to 102 years. All the 28 patients were treated with minimally invasive operations with locking compression plates. The time from injury to operation was ranged from 3 to 8 days (with an average of 4.5 days).RESULTS:The operation time was from 40 to 90 minutes (with an average of 55 minutes). The average bleeding volume during the operation was 70 ml (from 50 to 150 ml). One patient died during hospital stay. Twenty-five patients were followed up from 6 months to 2 years with an average of 15 months after operation. The fracture healing time was from 10 to 12 weeks (10.4 weeks in average). According to an evaluation standard of HUANG Gong-yi, the results were excellent in 20 cases,good in 4 cases, poor in 1 case.CONCLUSION:Minimally invasive approaches with LCP could treat the elder intertrochanteric fractures with the advantages such as minimal invasive, stable fixation and less blood loss.

入冬以来,连续几场大雪,让人有了天寒地冻的感觉.每年的这个季节,出现外伤的几率都要大于以往,主要是因为寒冷的天气影响到人们活动的灵活性,也无暇顾及周遭,加上雪地湿滑,导致骨关节损伤和软组织挫伤陡增.

韩斌:骨关节炎(osteoarthritis,OA)是最常见的慢性退行性关节病损,以缓慢发展的关节疼痛、僵硬、关节肥大畸形伴活动受限等为主要特点,又称退行性骨关节病、肥大性关节炎或老年性骨关节病.病因尚不明确,它的发生与年龄、肥胖、炎症、创伤及遗传因素等有关.非甾体类抗炎药(NSAIDS)是目前治疗骨关节炎的主要手段,很多人需要长期服用.

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.

Objective To observe the curative effect and difference between calcium sulfate and calcium phosphate as bone substitutions in traumatic fractures. Methods Fifty cases (26 with Colle's fractures and 24 with calcaneus's frac-tures) were treated with internal and external fixation, and filled bone defect with bone substitutions. Calcium sulfate was used for 24 cases and calcium phosphate for 26. Results All fractures that filled with bone substitutions were healed well. Average healing time was 11 weeks. Two cases used the calcium phosphate were effusion in local soft tissue and change dressing. The mean period of follow-up was 24 (16 ～ 50) weeks. The bone substitutions were absorbed comple-tely. The absorptive of calcium sulfate was faster then calcium phosphate cement. Conclusion The advantages of calcium sulfate and phosphate as the bone substitutions are safety, convenience, and less side effect, fill certainly better and frac-tures healed well. The calcium sulfate powder of the total had better supporting for bone defect area after solidification, and it operated easily. Both of the calcium sulfate and phosphate can be the suitable bone substitutions for bone defect in traumatic fractures under the effective fixation.

目的 通过对比分析方法,判断三种不同的方法治疗老年桡骨远端粉碎性骨折的疗效.方法 150例65岁以上老年桡骨远端粉碎性骨折,88例行手法复位石膏外固定,26例行闭合复位外固定架加硫酸钙骨粉注射植骨固定,36例行切开复位背侧斜T型钢板内固定,随访比较不同治疗方法的疗效.结果 所有病例均得到8～26个月随访,平均15个月,骨折全部愈合.按Anderson功能评价标准进行评定,石膏外固定组功能优良率为76.1%,外固定架固定组为92.3%,斜T型钢板内固定组为80.6%.外固定架固定组疗效明显优于其他两组病例,差异有显著性意义(P＜0.01).结论 闭合复位外固定架加硫酸钙骨粉注射植骨固定能提供有效的固定,操作简单,创伤小,是值得推荐的治疗老年桡骨远端粉碎性骨折的有效方法.

Objective Retrospective analysis was conducted to evaluate the effect of bone grafting with injectable calcium sulfate powder in 30 cases of the fractures of distal radius. Methods Thirty cases (Colles fractures ) were treated with closed reduction and external fixation ( cast in 8 and fixator in 22 ),and meanwhile filled bone defect with bone substitutions ( Stimulan pellets ) by injection. Results All fractures that filled with bone substitutions were healed well. No complications were observed. The mean period of follow-up was 8 (4～18) months. The bone substitutions were absorbed completely in 3 months. Conclusions The advantages of calcium sulfate as the bone substitutions are safety,convenience,and fewer side effects,fill certainly better and fractures healed well. The calcium sulfate powder (Stimulan pellets) had better supporting for bone defect area after solidification,and it operated easily with injectable method and can induct ossification. Artificial injectable calcium sulfate can be the suitable bone substitutions for bone defect in fracture of distal radius and easily inject with minimal invasion.

Objective To compare the clinical results of the operations,the manual reduction and the plaster immobilization in management of unstable comminuted fractures of distal radia.Methods Retrospective analysis of the clinical data was done for the 150 patients with unstable comminuted fracture of distal radia who were treated from January 2003 to February 2006 in our department.Eighty-eight patients were treated with manual reduction and plaster immobilization,26 with external fixator combined with minimall invasive injectable graft,and 36 with T-plate internal fixation.Results Averaged follow-up was 15 months(8 to 26 months).According to the Anderson criteria,the excellent rate of functional outcome was 92.3% for external fixator,76.1% for plaster immohilization and 80.6% for T-plate fixation.The differences were statistically significant(P<0.01).Conclusion In treatment of unstable comminuted fractures of distal radius,the external fixator combined with minimally invasive injectable graft can produce more satisfactory effects than the others.

Objective:To evaluate the accuracy and safety of screw insertion with the guidance of orientation apparatus of vertebral pedicle axes through anatomic studies and clinical application.Methods:①Anatomic study:6 spinal specimens(ranged from T1 to S1)in which the distance between two entry points of screws,the angles(TSA/PSA)of pedicle axis as well as the length of the pedicle axes were measured by spiral CT scan.Basing on the collected data,inserted the K-wires(2.5 mm of diameter)into vertebrae along the pedicle axes guided by the orientation apparatus.Pull out the K-wires after the operation.The specimens took another CT scans and the data including KTSA,KPSA,KDSP were collected.These data were analyzed with the SPSS 10.0.②Clinical application:112 screws were inserted into vertebral pedicle in 26 patients with the guidance of orientation opparatus.There patients included 16 male and 10 female,with the mean age of 49.5 years(ranging from 21 to 71).The accuracy of screw insertion was evaluation through CT scans or MRI.Results: ①Anatomic study:the angles of the track of K-wire in horizontal plane and sagittal plane were close to those of vertebral pedicle axes (P>0.05);the actual entry point of vertebral pedicle axis and scheduled entry point were superimposed(P>0.05).②Clinical application:compared with the standard insertion position,the outcome was excellent in 107 screws(95.5%),good in 3(2.7%),poor in 2(1.8%).Conclusion:The orientation apparatus can exactly guide operator to drill along the vertebral pedicle axes,thus,it can increase the accuracy and safety of the pedicle screw insertion.

Objective:To compare clinical effects of intertrochanteric fracture of femur in senile treated with dynamic hip screw (DHS) using two approaches.Methods:From January 2000 to December 2004, 78 patients with intertrochanteric fracture of femur were retrospectively analyzed.Among them,male 33 cases,female 45 cases,the mean age was 76.8 years old (range from 60 to 98).They were treated with DHS using two approaches.Approach 1(22 cases) was minimal invasive approach,which depends on the technique of the biological fixation,and the mean age was 78.3 years old.Approach 2(56 cases) was common approach(AO technique),and the mean age was 76.2 years old.Results:All the data were analyzed with SSPS 10.0.The average bleeding volume in the operation was 92.5 ml by approach 1 and 283.3 ml by approach 2 (P<0.01).60 cases were followed up from 6 months to 4 years after operation.Mean healing time of the fractures was 3 months by appoach 1 and 3.6 months by approach 2(P<0.05).There was no statistical significance in functional evaluation in two approaches(P>0.05).Conclusion:Minimal invasive approach with DHS in treatment of intertrochanteric fracture of femur in senile has the advantages of trauma minimally,bleeding less,healing rapidly,and small scar.

硬化性骨髓炎(Garre's osteomylitis),属特发性骨皮质硬化和干性骨髓炎,此病少见且病因不明,国内外报道鲜见.国外报道多发源于下颌骨病变,而多部位骨骼受累未见报道.