OBJECTIVE:To compare the effects of anchor reconstruction of posterior tibial tendon with the traditional Kidner's procedure for accessory navicular bone syndrome. METHODS:A retrospective analysis was conducted on 40 young athletes diagnosed with accessory navicular bone syndrome who were admitted to our hospital from 2018 to 2021. Among them, 20 patients underwent the modified Kidner procedure for the anchor reconstruction of the posterior tibial tendon (Experimental group), while the remaining 20 patients were treated with the traditional Kidner's procedure (Control group). Regular follow-ups were conducted to evaluate the degree of relief of foot symptoms and functional recovery. RESULTS:All patients were followed up for 12 to 24 months (mean duration: 18.6±3.7) after the operation. At the last follow-up, significant differences were observed in the function and symptom relief of the affected foot compared to the preoperative state. The experimental group had a mean operation time of 52.10 ± 3.41 minutes, significantly shorter than the control group's 61.25 ± 2.75 minutes. The mean time to return to normal activity was 12.65 ± 1.23 weeks for the experimental group, compared to 15.25 ± 1.16 weeks for the control group. CONCLUSION:The modified Kidner procedure demonstrates a higher patient satisfaction rate compared to the traditional Kidner procedure. This is attributed to its shorter duration, reduced trauma, and quicker recovery of normal activity.

OBJECTIVE:The objective of this study was to provide practical guidance for the prevention of painful accessory navicular among recruits by comparing and analyzing the plantar pressure parameters of individuals with normal foot, flat foot, and accessory navicular.METHODS:After training, a total of 90 military recruits were included in this study, comprising 30 with normal foot, 30 with flat foot, and 30 with painful accessory navicular. The plantar pressure distribution was measured for all participants.RESULTS:In individuals with flat feet, there was an increase in plantar pressure on the medial side of the forefoot, as well as a significant increase in pressure on the medial side of the heel and arch (P<0.05). Conversely, there was a significant decrease in pressure on the lateral side of the heel and arch (P<0.05). In patients with painful accessory navicular, the medial pressure on the foot arch showed a further increase (P<0.001), while the lateral pressure on the foot arch exhibited a further decrease (P<0.001), indicating highly significant differences.CONCLUSION:Compared to participants with flat feet, participants with accessory navicular demonstrated faster and more impulsive impact on the ground within the same stress area, resulting in more noticeable pain caused by the injury to the accessory navicular.

2019年12月,新型冠状病毒肺炎(C0VID-19)疫情在武汉市暴发,主要通过呼吸道和密切接触传播,具有传染性强、人群普遍易感染的特点,给医疗机构的诊疗工作带来巨大的挑战.军队医院不仅要完成卫勤保障任务,还要积极参与所在地区的抗击疫情工作.如何做好军地患者的救治工作,防止医务人员感染,严防C0VID-19通过交叉感染输入部队,同时在疫情特殊时期加强为兵服务,是每一所军队医院面临的重要课题.

椎弓根螺钉内固定系统因其具有良好的生物力学性能已成为最常用的脊椎内固定方法,同时也是脊柱外科医师必须熟练掌握的一项技能,但是由于椎弓根毗邻椎管内静脉丛、硬膜囊和神经根等复杂而重要的结构,且个体上解剖学的差异[1],加大了手术置钉的难度和风险.目前,大多数脊柱外科医生是根据解剖标志、术前X线、CT影像学资料及术中C型臂X线透视观察定位进行椎弓根螺钉植入及验证其置入的准确性,这种方法不可避免地造成一定的误置率,由于不同医生操作方式的区别,不同文献报道的置钉误置率差别很大[2-3].

目的 比较虎力散片与痹祺胶囊在膝骨关节炎中(OA)治疗的有效性和安全性.方法 选取2010年1月-2016年12月医院收治的OA患者164例,随机将患者分为2组:虎力散组82例,采用虎力散片口服治疗,痹祺胶囊组82例,采用痹祺胶囊,同时将两组分别按年龄再次分为年轻组(<55岁)及中老年组(≥55岁),虎力散组包括年轻组28例,中老年组54例,痹祺胶囊年轻组26例,中老年组56例,观察2组患者治疗前后视觉模拟疼痛(VAS)评分情况.结果 治疗14 d后虎力散组和痹祺胶囊组治疗后VAS疼痛评分均低于治疗前,差异均有统计学意义(P<0.05),但2组患者治疗后VAS疼痛评分比较差异均无统计学意义(P>0.05).虎力散组中老年组VAS评分高于年轻组,差异有统计学意义(P<0.05).痹祺胶囊组治疗后中老年组较年轻组评分低,差异有统计学意义(P<0.05).2组各出现1例皮肤过敏,表现为轻度瘙痒和发红,予停药后皮疹消退,未发生与药物相关的全身性严重不良反应事件.结论 虎力散片和痹祺胶囊治疗OA具有明显效果,能有效减轻患者关节疼痛,虎力散片在治疗年轻组中有优势,而痹祺胶囊在中老年组中有优势.同时两者均有不良反应少,安全性较好的特点.

糖尿病是当前威胁全球人类健康最重要的非传染性疾病之一,根据国际糖尿病联盟统计,2011年全球糖尿病患者人数已达3.7亿,其中80%在发展中国家. 1型糖尿病患者骨折的愈合非常缓慢,一般来说正常成年人骨折整复固定术后7~10 d就会在断端处生成新骨(骨痂),而糖尿病患者可能术后1个月甚至半年骨折断端都无骨痂长入. 糖尿病患者发生骨折后机体处于应激状态,除可引起血糖升高,酮症酸中毒等糖尿病现存的表现外,还可引起骨折延迟愈合、骨不连、神经麻痹、肢端坏疽、压疮、泌尿感染、肌肉萎缩等后果[1]. 手术还可能引起切口延期愈合、切口过大、骨髓炎等严重后果. 2015 年10月我科收治1例1型糖尿病合并股骨粗隆间及股骨干骨折的患者,经过有效的治疗和精心的护理,治愈出院. 并通过1年的随访,患者骨折基本已愈合. 现报道如下.

骨性关节炎是临床上常见病、多发病,在累及关节的各种疾病中最为多见,多发生于全身负重的大关节上.病理生理方面以不断加重的关节软骨破坏,软骨下骨的硬化、囊性变以及骨赘形成等病理变化为特征.

Objective To analyze the accuracy of auxiliary positioner of proximal femoral nail anti-rotation (PFNA )in the clinical application. Methods Selected 40 patients with intertrochanteric fracture of the femur,according to the double-blind method,were divided into control group and observation group.The first 20 patients in the control group were received conventional surgery by PFNA.The rest 20 patients in the observation group were received PFNA surgery with screw-blade implanted auxiliary positioner.The number of implantation,the duration of operation and the number of C-arm X-ray exposure were recorded.The accuracy of the placement was evaluated by measuring the angle between the axis of the screw blade and the central axis of the femoral head(deflection angle).Results The operation time,X-ray exposure time,the number of screw inserts and the deflection angle of the observation group were less than those of the control group.The difference was statistically significant(P<0.05).Conclusion The proximal femoral screw counter screw blade assisted positioner allows for faster and more accurate placement of the screw blade at once.It can obviously reduce the exposure times of C-arm and effectively reduce the radiation damage of related personnel.

统计学方法是医学科研的重要工具,目前骨科文献中越来越多涉及到统计学方法的应用,其中误用情况很常见,本文将对骨科文献中统计学方法误用的思考进行总结,指导临床正确选择和使用合适的统计学方法.

BACKGROUND:Surgical accuracy is a key to surgical success.The traditional positioning method mainly depends on surgeons' experience,which is too subjective to cause screw misplacement.Three-dimensional (3D) printing technology-assisted pedicle screw placement can make individualized surgical scheme,most importantly,it is accurate and simple showing promising application prospect.OBJECTIVE:To design an individualized pedicle guide plate with 3D printing and to simulate screw placement in vitro,and to explore its feasibility in vertebral pedicle screw placement.METHODS:Lumbar spine CT data of 11 patients with degenerative lumbar spine were selected from April 2016 to July 2016 at Hebei General Hospital,and 3D reconstruction of L1,L3 and L5 vertebrae of each case was performed.Pre-experiment was conducted based on one patient's lumbar CT data:according to the principle of screw placement,the screw position and orientation were designed to prepare the best pedicle guide plate model.Afterwards,the screw placement in vitro was simulated,and was then cut by chainsaw to verify the accuracy of screw placement.RESULTS AND CONCLUSION:(1) A total of 30 pedicle guide plates were used,and 60 screws were inserted in the patients,and the placement process was successful.The guide plates adhered well,none appeared with screw perforating the pedicle cortex,and the screw position was accurate and reliable.(2) There were no significant changes in the transverse section and sagtial section angles of the left and right pedicle screws before and after placement (P ＞ 0.05).(3) These results suggest that the 3D-printed individualized pedicle guide plate holds a good accuracy of placement,which can be applied in the vertebral pedicle screw placement,but further clinical trials are needed.