40例幼儿肱骨髁上骨折临床治疗观察

目的分析切开复位克氏针内固定方法和手法复位外固定方法治疗幼儿肱骨髁上骨折的临床疗效。方法收集2013年1月到2014年1月东莞市中堂镇医院收治40例幼儿肱骨髁上骨折患者临床资料,按照不同的治疗方法,分为治疗组与对照组,各20例。治疗组采取切开复位克氏针内固定方法,对照组采取手法复位外固定方法,最后分析两组患儿临床治疗效果。结果治疗组患儿治疗总有效率为95%,明显高于对照组的80%,差异显著P0.05;治疗组患儿UCLA评分和ASAES评分明显高于对照组,差异显著P0.05;治疗组并发症的发生率为5%,明显低于对照组的25%,差异显著P0.05。结论切开复位克氏针内固定治疗于幼儿肱骨髁上骨折患者,治疗有效率较高,促进术后康复,有利于改善患儿预后情况,值得临床推广。     

前方小切口入路治疗股骨颈骨折的围术期指标观察

目的研究前方小切口入路治疗股骨颈骨折的围术期指标观察。方法选取湖北省孝感市中心医院2011年2月—2013年7月收治的98例股骨颈骨折患者,抽签随机分为对照组和观察组各49例。对照组患者采用传统后外侧入路切开复位术,观察组采用前外侧小切口入路复位术,观察两组围术期相关指标。结果观察组手术切口(7.8±1.1)cm较对照组(15.3±1.7)cm明显较小,术中出血量(107.2±21.4)m L较对照组(187.4±32.1)m L明显较低,具有统计学意义(P0.05);观察组骨折愈合率100%较对照组89.80%明显较高,观察组并发症率4.08%较对照组16.33%显著较低,具有统计学意义(P0.05)。结论前方小切口入路术切口小,术中出血量低且术后并发症较少,有利于股骨颈骨折患者病情恢复。     

腕关节镜辅助复位经皮克氏针内固定的临床疗效

目的探讨桡骨远端经关节面骨折腕关节镜辅助复位经皮克氏针内固定的疗效。方法对普宁市人民医院2011年5月至2013年12月期间收治的50例桡骨远端经关节面骨折的骨折患者,关节镜辅助复位经皮克氏针内固定,对疗效进行分析。结果在50例患者中,术后随访3~36个月,平均为(16.1±3.2)个月。对患者的疗效进行分析,其中优25例,良16例,优良率达82%。所有患者经过治疗后,其中10例患者出现并发症,包括5例为穿克氏针处感染,经加强换药后好转;3例患者为克氏针退针,但不影响位置和骨折愈合,1例患者出现并发腕管综合征,行腕横韧带切断及正中神经松解术,术后随访后,1例患者出现创伤性骨关节炎。结论腕关节镜辅助复位经皮克氏针内固定治疗桡骨远端经过关节面骨折,能够更清晰的显示骨折块,对于患者来说,疗效高,并发症少,值得临床推广应用。     

经皮中空螺钉内固定与张力带内固定内踝骨折的临床疗效观察

研究探讨经皮置入中空螺钉内固定治疗闭合性内踝骨折(Ashurst和Bromer分类的内翻内收型骨折Ⅰ度)的临床实用性,收集60例闭合性内踝骨折的患者,随机分为两组各30例。A组予传统切开复位张力带内固定术治疗,B组予闭合复位经皮置入中空螺钉内固定治疗。术后采用Takakura踝关节评分系统来评价疗效,并对结果进行分析。     

腹腔镜下后入路胰十二指肠切除术和传统开腹胰十二指肠切除术的比较

目的比较腹腔镜下后入路胰十二指肠切除术和传统开腹胰十二指肠切除术的近期临床效果,探讨腹腔镜下后入路胰腺十二指肠切除术的手术方式、安全性、可行性。方法选取2012年4月—2014年3月行腹腔镜下后入路胰十二指肠切除术和开腹胰十二指肠切除术各15例,比较两组术中情况(手术时间、术中出血量、术中输血量)情况和术后情况(ICU住院时间、排气时间、经口进食时间、术后住院时间、术后并发症、再手术率、病理学)。结果与开腹组比较,腹腔镜组手术时间明显延长[(524±77)min vs(358±72)min,t=6.093,P=0.001],术中出血量、术中输血量明显减少[(313±101)m L vs(417±100)m L,t=-2.828,P=0.017;(1.2±1.0)U vs.(2.2±0.6)U,t=-3.697,P=0.001],腹腔镜组术中清扫淋巴结数目明显增多[(17.2±4.5)枚vs(12.8±4.9)枚,(t=2.547,P=0.017)]。两组在ICU住院时间、排气时间、经口进食时间、术后住院时间、术后并发症发生率、R0切除率无显著差异。结论与传统开腹胰十二指肠切除术对比,腹腔镜下后入路胰十二指肠切除术是一种安全可行的手术方式,手术近期效果良好。     

两种不同治疗股骨远端骨折方法的疗效比较

目的比较两种内固定方式治疗股骨远端骨折的疗效,为临床应用提供依据。方法对2010年8月至2013年9月本院收治的90例C型股骨远端骨折患者资料进行回顾性分析,根据内固定方式不同随机分为两组:微创内固定系统(LISS)组和动力髁螺钉(DCS)组各45例,比较两组患者手术切口大小、手术时间、术中出血量、住院天数、骨折愈合天数。按照Kolment疗效标准对患膝肢体功能进行评估。结果 90例患者术后获得12~36个月,平均18.3个月随访。观察组切口(12.8±3.6)cm,出血量(212.6±31.3)m L,骨折愈合时间(12.8±0.7)d,均明显优于对照组,两组间差异具有统计学意义(P0.05);在手术时间以及住院天数方面,两组差异不具有统计学意义(P0.05);骨折愈合后按照Kolment疗效标准对患膝进行功能评定。优良率:观察组88.89%,明显优于对照组73.33%,两组间差异具有统计学意义(P0.05)。结论 LISS系统可减少组织创伤,保护局部血运,降低不愈合和延迟愈合的风险,减少术后感染的发生率。是一种值得临床推广和使用治疗股骨远端骨折的方法。     

前、后路手术治疗颈脊髓损伤的效果比较

目的比较前、后路手术治疗颈脊髓损伤的临床效果。方法选取78例颈脊髓损伤患者,抽签随机分为两组,其中39例采用前路手术治疗患者记为前路术组,另外39例采用后路手术治疗记为后路术组,观察两组手术相关指标并结合术后有效随访比较治疗综合效果。结果前路术组手术时间(75.4±10.2)min、术中出血量(206.3±31.5)m L较后路术组明显较低,术后1年颈椎功能JOA评分(14.4±1.8)分较后路术组显著较高(P0.05);前路术组不良结果发生率5.13%较后路术组低(P0.05)。结论同后路手术相比,前路手术具有手术时间短、术中出血量少的特点,且能有效减少术后不良结果的发生,对病情康复和改善预后具有重要意义。     

3D腹腔镜与2D腹腔镜在肾部分切除术中的临床对比研究

目的探讨研究经3D腹腔镜对肾部分切除术的应用价值。方法收集曲靖市第一人民医院2013年10月—2015年3月泌尿外科实施肾部分切除术的患者82例作为研究对象,其中44例患者选择采用2D腹腔镜技术进行了肾部分切除,设为对照组;其余38例患者选择采用3D腹腔镜技术进行了肾部分切除,设为实验组。分析并比较两组手术时间、术中出血量、术后并发症发生率,术后住院时间。结果实验组的手术时间(90.12±11.32)min、术中出血量(70.32±15.67)m L、术后并发症发生率3.2%,术后住院时间(6.5±2.5)d;对照组手术时间(114.20±10.65)min、术中出血量(100.23±15.13)m L、术后并发症发生率20.5%,术后住院时间(7.0±2.0)d。实验组的手术时间、术中出血量、术后并发症发生率、术后住院时间均少于对照组。结论与2D腹腔镜相比,高清3D腹腔镜肾部分切除术,术野清晰,手术时间短,出血量少,术后并发症少,值得在临床推广。     

关节镜治疗肩关节脱位合并肱骨大结节骨折的近期效果分析

目的探讨分析关节镜在治疗肩关节脱位合并肱骨大结节骨折时的近期临床效果。方法回顾性分析广东省清远市人民医院骨科自2013年11月到2014年11月之间收治的肩关节脱位合并肱骨大结节骨折的患者16例,其中男性有10例,女性6例,年龄从36~68岁,平均年龄为(46±2)岁。所有患者均有明确的受伤史;其中有14例患者为摔伤,有2例患者为坠落伤;有12例为左侧肩部受伤,有4例为右侧肩部受伤;然后对所有患者采取关节镜下进行修复,其中有6例患者为完全关节镜下修复,有10例为采取关节镜下辅助小切口进行修复。结果经治疗后,所有患者切口均达到Ⅰ期愈合标准,未出现伤口感染、出血等并发症。术后2~6个月内对患者行X线片检查,发现肱骨大结节骨折的愈合从3~6月,平均为4.1个月。对所有患者均进行了定期(每半年1次,共3次)随访观察。术后第6个月随访时,有3例患者出现肩关节外展,外旋活动轻度受限,有1例患者出现前屈活动受限;有1例患者出现前屈时疼痛。后经积极的康复训练,均恢复良好。所有患者肩关节未出现再次脱位。采用Constant-Murley肩关节评分系统为(32.88±4.12)分;本组优11例,良4例,可1例,优良率93.75%。结论临床上,在治疗肩关节脱位合并肱骨大结节骨折时采用关节镜技术不仅手术创伤小,术后恢复快,而且治疗效果满意,与保守治疗相比并发症少,值得临床医生学习推广。     

可吸收螺钉内固定治疗骨折的疗效及临床优势分析

目的分析可吸收螺钉内固定治疗内踝关节骨折的疗效及临床优势。方法研究对象选取2012年6月至2014年5月86例内踝关节骨折患者,根据随机原则分成对照组和实验组。其中对照组患者采用金属螺钉内固定治疗,实验组患者采用可吸收螺钉内固定治疗。术后随访1年,对比两组患者踝关节功能恢复情况的差异。结果经过数据统计发现,对照组患者术后1年时踝关节功能为优22例、良15例、可4例、差2例,优良率为86.05%;实验组患者术后1年时踝关节功能为优26例、良16例、可1例,优良率为97.67%。实验组患者术后踝关节功能优良率明显高于对照组,组间有显著的统计学差异(P0.05)。结论可吸收螺钉内固定治疗骨折的疗效确切,且避免了二次手术的创伤,可将其作为内踝关节骨折治疗的有效方案推广应用。     

Novel calorimetric investigation of different degenerative disorders of the human hyaline cartilage

The purpose of this investigation was to further elucidate calorimetric properties of cartilage samples from femoral head necrosis and osteoarthritis from live surgeries. The natural course of this disease is one of steady progression with eventual collapse of the femoral head, followed by secondary osteoarthritis in the hip joint. All samples showed a clear denaturation peak on the calorimetric curve. Cartilage obtained from necrotic femoral head required the lowest amount of energy for decomposition. The use differential scanning calorimetry as part of thermal analysis was a reliable method for differentiating.     

518例先天性髋关节脱位筛查结果分析

报道了518例先天性髋关节脱位筛查结果，并对造成该病的原因进行了讨论。     

DSC analysis of human fat tissue in alcohol-induced avascular necrosis of the femoral head

Avascular necrosis of human femoral head (ANFH) causes incongruity in the joint that leads to disability in patients requires total hip arthroplasty (THA). Several etiological factors of ANFH have been proposed in the literature but there are cases of idiopathic origin. We observed macroscopic variation in quality of the subcutaneous fat tissue in patients with ANFH compared to patients with osteoarthritis or hip fracture during THA procedures. The samples were analysed by histology, gas chromatography (GC) and differential scanning calorimetry (DSC). Conclusion: the alteration in the fatty acid profile did not cause histological changes, however we could detect biochemical changes using DSC and GC.     

DSC analysis of human fat tissue in idiopathic avascular necrosis of the femoral head

Avascular necrosis of human femoral head (ANFH) causes incongruity in the joint that leads to disability in patients requires total hip arthroplasty (THA). Several etiological factors of ANFH have been proposed in the literature but there are cases of idiopathic origin. We observed macroscopic variation in quality of the subcutaneous fat tissue in patients with ANFH compared to patients with osteoarthritis or hip fracture during THA procedures.The samples were analysed by histology, gas chromatography (GC) and differential scanning calorimetry (DSC).Conclusion: the alteration in the fatty acid profile did not cause histological changes, however we could detect biochemical changes using DSC and GC.     

Accumulation velocity of 99mTc-HMDP in hip joint diseases

The accumulation rate and velocity of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) in hip joints were determined within four minutes after a bolus of injection of 99mTc-HMDP in the patients with hip joint disorders. There exist a significant relationship between accumulation velocity of 99mTc-HMDP in the affected joint and serum osteocalcin in the patients with eight cases of degenerative osteoarthropathy and six cases of femoral necrosis. This result indicates that the accumulation velocity of 99mTc-HMDP in the affected joint is likely to become a marker of bone turnover in hip joint disorder.     

后路椎管减压内固定术治疗胸腰椎骨折并截瘫

为探讨后路椎管减压内固定治疗胸腰椎骨折并载瘫的治疗效果,从2000年2月至2003年12月,共手术治疗胸腰椎骨折并截瘫病人63例:T112例,T1211例,L124例,L215例,L38例,L43例;压缩性骨折21例,爆裂性骨折9列,旋转骨折16例,剪力骨折(切片状骨折)7例,椎体后部骨折(Chace骨折)10例;完全性截瘫21例,不完全性截瘫42例;全部病人采用后路椎管减压手术,Luque棒19例,双Harrington 12例,椎弓根螺钉32例。结果表明,本组63例无一例加重症状,获得随访的有51例,随访时间半年至2年,不完全截瘫患者均有明显的好转。提示后路减压内固定治疗胸腰椎骨折并截瘫可取得满意的临床疗效,尽早手术及彻底减压与疗效密切相关。     

Differential scanning calorimetric examination of the human hyaline cartilage of the femoral head after femoral neck fracture

The femoral neck fracture continues to be unsolved fractures and the guidelines for management are still evolving. The primary complications arising from femoral neck fractures are non-union and avascular necrosis. The various methods currently available for predicting the vascularity of the head at the time of fracture are not sufficiently quantitative to be used on a routine clinical basis. The hypothesis was that after the femoral neck fracture there are clear pathological abnormalities in the cartilage of the femoral head, which could be monitored besides the classical methods by differential scanning calorimetry. The thermal denaturation of human samples was monitored by a SETARAM Micro DSC-II calorimeter. All the experiments were performed between 0 and 100 °C. The heating rate was 0.3 K/min. DSC scans clearly demonstrated significant differences between the control and different stages avascular samples (control, fresh fractures: T _m  = 68.2 °C, ΔH _cal = 2.87 J/g, avascular necrosis: T _m  = 70.7 °C, ΔH _cal = 3.61 J/g,). These observations could be explained with the structural alterations caused by the biochemical processes during the degeneration of the cartilage due to avascular femoral head necrosis. With the investigations the authors could demonstrate that DSC is a useful and well-applicable method for the investigation of hyaline cartilage of the fractured human femoral head. It was confirmed significances between the changes of calorimetric results and the elapsed time from the primary femoral neck fracture.