目的 对比分析经皮椎体成形术(PVP)与经皮椎体后凸成形术(PKP)治疗重度骨质疏松性椎体压缩骨折(OVCF)的临床疗效及安全性.方法 回顾性分析河北医科大学第三医院脊柱外科2012年9月至2015年9月行PVP或PKP治疗的重度OVCF 57例,根据手术方式不同分为PVP组(n=31)和PKP组(n=26).随访并比较两组患者术前、术后1 d及末次随访时伤椎前缘高度、局部Cobb角、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)的变化以及骨水泥渗漏、邻近椎体骨折等术后并发症发生情况.结果 所有手术均顺利完成,57例患者均获完整随访,随访时间12~20个月,平均(16.1±2.3)个月.PVP组患者的手术时间为(30±3)min,少于PKP组的(37±4)min,差异有统计学意义(t=7.413,P<0.05).两组患者术后1 d及末次随访时VAS、ODI评分及局部Cobb角较术前均有改善,差异有统计学意义(PVP组:F=260.639,F=276.357,F=20.783,P<0.01;PKP组:F=162.701,F=196.772,F=83.591,P<0.01).PKP组患者术后1 d及末次随访时伤椎前缘高度较术前均有改善,差异有统计学意义(F=22.084,P<0.01),PVP组术后伤椎前缘高度与术前相比无统计学差异.两组间术后1 d及末次随访时VAS、ODI评分比较,无统计学差异.PKP组术后伤椎前缘高度及局部Cobb角改善均优于PVP组,差异有统计学意义(P<0.05).术中发生骨水泥渗漏15例(26.3%),无肺栓塞、脊髓神经损伤发生.随访期间共5例(8.8%)患者继发邻近椎体骨折.两组骨水泥渗漏率及邻近椎体骨折发生率无统计学差异.结论 对于重度骨质疏松性椎体压缩骨折的治疗,PVP与PKP均可显著缓解患者疼痛症状;PKP具有较好的复位和矫正后凸畸形的效果,但手术时间较长;PKP在骨水泥渗漏率、邻近椎体骨折发生率上相对于PVP未表现出明显的优越性.

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from orthopedic wounds.Methods Data of bacterial strains isolated trom orthopedic wounds in the Third Hospital of Hebei Medical University from January 2008 to December 2012 were retrospectively analyzed.Strains were identified by using French bioMérieux Vitek32 identification system,and the drug susceptibility was tested by Kirby-Bauer method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains.Results A total of 2 456 bacterial strains were isolated,vith 1 652 (67.26％) gram-negative bacilli,777 (31.64％) gram-positive cocci,26 (1.06％) fungi,and 1 (0.04％) gram-positive bacillus.The top five pathogens were Staphylococcus aureus (666 strains,27.12％),Pseudomonas aeruginosa (606 strains,24.67％),Acinetobacter baumannii (355 strains,14.45％),Escherichia coli(188 strains,7.65％) and Enterobacter cloacae (187 strains,7.61％).The positive rate of Acinetobacter baumannii was on the rise during 2008 and 2012 (x2 =35.266,P ＜ 0.0l).The rates of pan-drug resistant strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 6.20％ (22/355) and 0.17％ (1/606),respectively.The rates of extended-spectrum β-lactamases positive strains in Escherichia coli and Klebsiella pneumoniae were 39.89％ (75/188) and 29.23％ (19/65),respectively.The rates of methicillin-resistant strains in Staphylococcus aureus and coagulasenegative Staphylococcus were 40.69％ (271/666) and 52.38％ (22/42),respectively.The rate of vancomycin-intermediate strains in Enterococci was 3.70％ (2/54).The positive rate of methicillin-resistant &aphylococcus aureus was on the rise during 2008 and 2012 (x2 =18.317,P ＜ 0.01).Staphylococcus aureus were sensitive to teicoplanin,vancomycin and linezolid; Resistance rates to rifampicin and amikacin were 11.29％-33.33％; Resistance rates to penicillins and erythromycin were 76.80％-100.00％; Resistance rates to cefazolin,cefuroxime,cefoxitin,amikacin and levofloxacin were on the rise (P ＜ 0.05) ; And resistance rates to sulfamethoxazole (28.11％-48.35％) were on the decline in the same period (P ＜ 0.01).Resistance rates of Pseudomonas aeruginosa to imipenem,meropenem and sulfamethoxazole were on the rise (P ＜ 0.05) ; Resistance rates to ciprofloxacin,levofloxacin,amikacin,gentamicin and piperacillin/ tazobactam were on the decline (P ＜ 0.05) ; Resistance rates to cefoperazone/sulbactam were the lowest (9.15％-20.51％).Resistance rates of Acinetobacter baumannii to imipenem,meropenem,levofloxacin,piperacillin/tazobactam,sulfamethoxazole were on the rise (P ＜ 0.01); Resistance rates to cefoperazone/ sulbactam were the lowest (11.86％-19.70％).Escherichia coli and Enterobacter cloacae were sensitive to imipenem and meropenem,and the resistance rates to cefoperazone/sulbactam and piperacillin/tazobactam were low (0-14.29％); Resistance rates of Escherichia coli to piperacillin,cefepime,amikacin,levofloxacin,cefoperazone/sulbactam were on the decline (P ＜ 0.05) ; Resistance rates of Enterobacter cloacae to cefoxitin were on the rise (P ＜ 0.01),while the resistance rates to piperacillin,ceftazidime,cefoperazone,ceftriaxone,levofloxacin were on the decline (P ＜ 0.05).Conclusion During 2008 and 2012,the predominant bacterial pathogens of orthopedic wound in patients of the Third Hospital of Hebei Medical University are Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae,and most strains are multiple drug resistant.

Objective:To explore the clinical effect of external wash of Chinese herbs combined with sodium hyaluronate injection for treating osteoarthritis of knee joint.Methods:All 128 cases with osteoarthritis of knee joint were randomly divided into treatment and control groups,64 cases in each.The patients of treatment group were treated with external wash of Chinese herbs combined with intra-articular injection of sodium hyaluronate,and the patients of control group were treated with intra-articular injection of sodium hyaluronate only,5 weeks for a course.The treatment effects were observed after one course.Results:There was no significant difference in gender,age,duration of disease,occupation,and the ratio of height and weight between the two groups(P0.05).In the treatment group,22 cases were cured,31 cases were markedly effective,5 cases were effective,and 6 cases were ineffective,the total effective rate was 92.19%.In the control group,12 cases were cured,29 cases were markedly effective,20 cases were effective,and 13 cases were ineffective,the total effective rate was 78.13%.Conclusion:External wash of Chinese herbs combined with intra-articular injection of sodium hyaluronate is an effective non-surgical method for treating osteoarthritis of the knee joint.

目的:观察鹿丹通督方配合中药离子导入治疗腰椎间盘突出症的临床疗效.方法:治疗组采用鹿丹通督方治疗.对照组采用腰痛宁胶囊治疗,两组患者均局部采用中药离子导入治疗,15天为1个疗程.结果:两组对比观察,治疗组总有效率91.38%,对照组总有效率67.24%,以及治疗前后积分对比观察,治疗组均明显优于对照组.结论:鹿丹通督方配合中药离子导入治疗腰椎间盘突出症的疗效显著.

OBJECTIVE To explore more effective measures for preventing and controlling surgical site infection (SSI)in open fractures.METHODS A retrospective survey was carried out and 1233 cases of open fractures from Sept 2007 to Sept 2009 in our hospital)were surveyed.The risk factors of SSI in open fractures were analyzed.RESULTS The incidence of SSI in open fractures was 11.27%.There was no correlation among age,gender,cause of injury and infection,but there was significant correlation among traumatic type,debridement time,the types and quantities of bacteria,rational use of antibiotics and infection.From 88 isolates detected,Pseudomonas aeruginosa accounted for 23.86%,followed by Staphylococcus aureus(19.32%).CONCLUSIONS SSI is often found in open fracture patients.The infection is significantly correlated to traumatic type,debridement time and virulence and quantities of bacteria.Appropriate measures should be taken to reduce the incidence of SSI.

Objective To study changes of bone loss with age and incidence of osteoporosis in normal women by quantitative ultrasonometry (QUS).Methods Ultrasound parameters were measured in right calcaneus of 272 subjects(age 20-84 years),including broadband ultrasound attenuation (BUA,dB/MHz)and speed of sound(SOS,m/s)and stiffness index(STI,%).Results Mean bone peak was observed in women of 30-39 years.The ultrasound parameters reduced markedly in the 50-59,60-69 and 70-84 age groups;the differences were significant between any two groups of them( P 0 01),and between any one group of them and the 30-39 age group( P 0 01).The rates of bone mass loss were 26% and 37%,and the incidences of osteoporosis were 42% and 69% for the 60-69 and 70-84 age groups,respectively.Bone loss by STI was the highest among the three parameters,and the incidences of OP were approximate in detection by BUA and STI,both higher than those by SOS.Conclusion BUA, SOS and STI have a similar ability to differentiate between premenopausal and postmenopausal women;STI is most sensitive in detecting bone loss and osteoporosis.\;

目的探讨甲亢引发的超声骨质量的变化特征及其临床意义.方法用定量超声法测量64例甲亢患者跟骨的超声振幅衰减和超声传导速度,以及骨硬度指数,并与性别、年龄相匹配的健康人作对照.同时测量了男、女各20名健康青年人,并据此统计分析甲亢组的骨质减少及骨质疏松发生率.结果未经治疗甲亢组的超声振幅衰减和骨硬度指数平均下降9.5%和12.6%,显著低于同龄对照组(P均＜0.01).甲亢组骨质丢失发生率达43.8%,对照组7.8%,有显著性差异(χ2=25.7,P＜0.01).结论超声振幅衰减和骨硬度指数可以敏感地检测甲亢引发的骨质量下降.定量超声法操作简单、便携,且无放射性污染,可能是诊断骨质疏松症的一种有益工具.

笔者对正常人手足关节显像进行了定量分析,现报道如下. 一、资料与方法 正常体检者17例,女13例,男4例,平均年龄42(21～65)岁.99Tcm发生器由中国原子能科学研究院提供.亚甲基二膦酸盐(MDP)由北京师范大学应用化学研究所制备,自行标记,放化纯度>95%.静脉注射99Tcm-MDP 740 MBq,3～4 h后行双手双足局部骨静态显像.应用Sopha DST双探头SPECT仪,配低能平行孔准直器,预置计数5×105, 矩阵256×256,放大倍数1.33.双手显像时包括腕关节和部分尺、桡骨,双足显像时双侧踝关节伸直略内旋,上方探头轻压足背.静脉注射部位应避开关节区.