弹性髓内钉和钢板固定对儿童股骨干中段骨折的疗效比较

目的:观察并比较弹性髓内钉(ESIN)与钢板固定(PF)治疗儿童股骨干中段骨折的临床疗效。方法:选择2013年2月至2016年12月我院收治的股骨干中段骨折患儿90例,依据治疗方法不同分为ESIN组和PF组。ESIN组(n=45)采用弹性髓内钉固定,PF组(n=45)采用钢板固定,比较两组患者手术时间、手术切口、术中失血量、术后切口引流量等手术指标,随访评估患者住院时间、完全负重时间、骨折愈合时间;按Flynn评定标准比较两组患者的最终治疗结果。结果:两组患者术中失血量、术后引流量比较差异无统计学意义(P0.05),ESIN组患者手术切口显著小于PF组(P0.05),手术时间、透视时间、完全负重时间均显著短于PF组(P0.05),临床疗效明显优于PF组(P0.05)。结论:与钢板固定比较,弹性髓内钉在手术时间、透视时间显著短于钢板固定,临床疗效明显优于钢板固定,可作为儿童股骨干骨折内固定的首选材料。     

微创经皮钢板接骨术与Henry入路钢板内固定治疗桡骨远端骨折的疗效观察

目的:研究微创经皮钢板接骨术与Henry入路钢板内固定治疗桡骨远端骨折的疗效。方法:选取2013年2月到2014年2月我院收治的桡骨远端骨折患者86例,按照随机数字表法将患者分为Ⅰ组和Ⅱ组,每组43例,Ⅰ组患者给予微创经皮钢板接骨术治疗,Ⅱ组患者给予Henry入路钢板内固定治疗,术后随访患者1年,比较两组临床疗效。结果:Ⅰ组手术时间、术中出血量显著优于Ⅱ组,两组比较差异具有统计学意义(P0.05);Ⅰ组术后1年DASH评分显著优于Ⅱ组,两组比较差异具有统计学意义(P0.05);两组并发症比较无统计学意义(P0.05)。结论:微创经皮钢板接骨术治疗桡骨远端骨折具有较好的临床疗效,能缩短手术时间、降低术中出血量,改善患者上肢功能。     

微创经皮钢板接骨术治疗高能量胫骨干骨折的临床疗效

目的:探讨微创经皮钢板接骨术(Minimally invasive percutaneous plate osteosynthesis,MIPPO)技术治疗高能量胫骨干骨折的临床疗效。方法:选择2013年7月-2015年7月在我院接受手术治疗的高能量胫骨干骨折患者57例作为研究对象,根据手术方法不同将其分为MIPPO组(34例)和对照组(23例)。MIPPO组患者应用微创经皮钢板接骨术治疗,对照组患者采用传统内固定术治疗。观察并比较两组患者的手术效果及并发症的发生情况。结果:MIPPO组患者手术优良率为85.29%(29/34),对照组患者手术优良率为69.57%(16/23);MIPPO组手术效果明显优于对照组,差异具有统计学意义(P0.05)。与对照组比较,MIPPO组患者的手术时间短、术中出血量少、骨折愈合时间早,差异均具有统计学意义(P0.05)。两组患者均发生内固定松动、切口感染、骨恢复畸形等并发症,其中MIPPO组并发症的发生率为5.88%(2/34),对照组并发症的发生率为8.71%(4/23),MIPPO组并发症的发生率明显低于对照组,差异具有统计学意义(P0.05)。结论:MIPPO技术治疗高能量胫骨干骨折具有明显的临床效果,且并发症的发生率较低,安全性较高,值得临床推广应用。     

双切口双钢板内固定与单侧锁定钢板内固定治疗复杂胫骨平台骨折的疗效比较

目的:研究比较双切口双钢板内固定(DIDPIF)与单侧锁定钢板内固定(ULPIF)治疗复杂胫骨平台骨折(CTPF)的疗效。方法:从2010年2月至2015年11月选取在我院接受手术治疗的CTPF患者36例作为研究对象,按随访数字表法平均分为观察组和对照组,观察组接受DIDPIF术式治疗,对照组接受ULPIF术式治疗,比较两组术后固定疗效、手术指标以及术后并发症。结果:观察组术后固定的优良率是83.33%,与对照组的61.11%比较,差异不存在统计学意义(P0.05)。观察组骨折愈合的时间及下地负重的时间均显著短于对照组,差异存在统计学意义(P0.05)。观察组固定术后总并发症的发生率是27.78%,与对照组的38.89%比较,差异不存在统计学意义(P0.05)。结论:DIDPIF术式与ULPIF术式均可较好地治疗CTPF患者,但DIDPIF术式在骨折愈合的时间及下地负重的时间方面均优于ULPIF术式,且不会增加安全风险,值得推广应用。     

Percutaneous osteosynthesis versus cast immobilisation for the treatment of minimally and non-displaced scaphoid fractures. Functional outcomes after a follow-up of at least 12 month

The authors compare the functional outcome of 26 patients successfully treated by percutaneous osteosynthesis and 24 patients successfully treated by a short-arm thumb cast for the acute scaphoid fracture after a follow-up of at least 12 months. The patients treated by percutaneous osteosynthesis showed a significantly better range of wrist motion at the time of re-examination. Differences in persistent complaints and in grip strength compared to the uninjured wrist between both groups were statistically insignificant yet slightly in favour of the surgically treated patients. The higher suitability of percutaneous osteosynthesis is further supported by the significantly lower failure rate compared to conservative treatment. Based on these results, percutaneous osteosynthesis seemed to be the more favourable method of treatment of minimally and non-displaced scaphoid fractures than conservative treatment.     

祛瘀散烫疗对髋部骨折术后下肢深静脉血栓预防效果观察

目的观察中药制剂祛瘀散烫熨术对髋部骨折术后下肢深静脉血栓(DVT)的预防价值。方法选取髋部骨折术后患者100例,随机分为对照组和观察组各50例。对照组患者术后按常规方法护理,观察组患者术后在常规护理基础上于术后24h拔除引流管后加用中药祛瘀散对术肢进行烫熨,观察比较两组患者术前、术后组内及组间血浆D-二聚体指标变化情况。结果两组患者术前血浆D-二聚体比较,差异无统计学意义(P0.05);术后两组患者血浆D-二聚体比较,观察组明显低于对照组(P0.05)。结论中药制剂祛瘀散烫熨术对髋部骨折术后下肢DVT形成有预防作用,可降低术后下肢深静脉血栓形成的风险,减少髋部骨折术后并发症的发生。     

经皮椎弓根内固定术治疗胸腰椎骨折患者的疗效观察

目的：探讨经皮椎弓根内固定术(MIPPSO)治疗胸腰椎骨折患者的效果。方法：选择2013 年1 月~2014 年12 月在我院就诊 胸腰椎骨折患者28 例,随机分成开放组和微创组,每组各14 例。开放组行传统切开椎弓根螺钉内固定术,微创组行MIPPSO进 行治疗。比较两组患者手术时间、术中出血量、术后引流量、创口长度、住院天数、椎体前缘高度百分比和后凸Cobb 角指标,并进 行统计分析。结果：两组手术时间无统计学差异（P>0.05）,而术中出血量、术后引流量、创口长度和住院天数的差异均有统计学意 义,且开放组均大于微创组（P<0.01）;两组椎体前缘高度百分比和后凸Cobb 角术后较术前比均有所改善,差异均有统计学意义 （P<0.01）,两组间术前和术后比较,差异均无统计学意义（P>0.05）。结论：MIPPSO 对胸腰椎骨折的治疗效果优于传统切开椎弓根 螺钉内固定术,具有出血少、创伤小,且住院时间短等优点。     

逆行可膨胀髓内钉与锁定钢板治疗股骨远端骨折的疗效比较

目的:探讨比较运用逆行可膨胀髓内钉与股骨远端锁定钢板治疗股骨远端33A、33C1型骨折的疗效。方法:对2013年3月至2015年6月收治并符合纳入标准的43例股骨远端33A、33C1型骨折患者进行回顾性研究。按照不同的手术固定方式分为逆行可膨胀髓内钉组(n=18)和锁定钢板组(n=25),记录并比较两组手术时间、失血量、愈合时间及功能结果、术中及术后并发症。结果:所有骨折最终都获得愈合;逆行可膨胀髓内钉组在手术时间及失血量上都显著低于锁定钢板组,两组在愈合时间及功能评定方面无明显差异;5例开放性骨折的患者中1例出现浅表伤口感染,1例患者延迟愈合。结论:股骨远端逆行可膨胀髓内钉在获得与锁定钢板相当的骨折愈合时间及患肢功能的情况下,具有操作简单、手术时间短、失血量少等特点,对于股骨远端33A、33C1型骨折来说是一个较好的选择。     

Trabecular bone fracture healing simulation with finite element analysis and fuzzy logic

Trabecular bone fractures heal through intramembraneous ossification. This process differs from diaphyseal fracture healing in that the trabecular marrow provides a rich vascular supply to the healing bone, there is very little callus formation, woven bone forms directly without a cartilage intermediary, and the woven bone is remodelled to form trabecular bone. Previous studies have used numerical methods to simulate diaphyseal fracture healing or bone remodelling, however not trabecular fracture healing, which involves both tissue differentiation and trabecular formation. The objective of this study was to determine if intramembraneous bone formation and remodelling during trabecular bone fracture healing could be simulated using the same mechanobiological principles as those proposed for diaphyseal fracture healing. Using finite element analysis and the fuzzy logic for diaphyseal healing, the model simulated formation of woven bone in the fracture gap and subsequent remodelling of the bone to form trabecular bone. We also demonstrated that the trabecular structure is dependent on the applied loading conditions. A single model that can simulate bone healing and remodelling may prove to be a useful tool in predicting musculoskeletal tissue differentiation in different vascular and mechanical environments.     

Laparoscopic radical prostatectomy--analysis of our first 100 consecutive cases

The aim of this study was retrospective study of our first 100 consecutive cases of prostatic cancer, operated by laparoscopic approach and comparison with 100 cases of open retropubic radical prostatectomy (RRP) at our department, focusing on operative data and morbidity. From June 1999 to August 2003 we have performed first consecutive 100 laparoscopic radical prostatectomies (LRP), all according to Montsouris technique. In this study we have compared the results with 100 patients who underwent from May 1997 to August 2003 open RRP. Mean operative time was shorter after RRP (155 vs. 234 min, p = 0.018). Mean blood loss was significantly lower in LRP group (446 vs. 710 ml, p < 0.001). Mean catheter duration time (6.4 vs. 10 days, p < 0.001) and hospital stay (8.6 vs. 11 days, p < 0.001) were significantly shorter in LRP group. There was no statistically significant difference in complication rate in both groups (p = 0.139). Laparoscopic radical prostatectomy is a safe procedure for the patient and complications do not appear more often than in the open operation. In LRP we detected shorter mean catheter duration time, shorter hospital stay and less blood loss. This procedure demands perfect knowledge of the laparoscopic operative technique and due to long-term learning curve, the procedure could be done only in particular centers, where exist suitable equipment and also experienced operators in laparoscopic technique.     

骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后关节疼痛的影响

目的:探讨骨水泥型与生物型髋关节置换术治疗股骨颈骨折对术后患者关节疼痛的影响。方法:回顾性分析2012年2月-2013年8月我院收治的股骨颈骨折患者的临床病历资料,按照假体类型将其分为骨水泥型髋关节置换术(A组)和生物型髋关节置换术(B组),通过Harris与分项百分制髋关节疼痛评分比较两组患者术后髋关节的疼痛情况。结果:两组患者的手术时间、术中出血量以及术后引流量比较,差异无统计学意义(P0.05),A组的住院时间短于B组,差异有统计学意义(P0.05)。A组术后3、6个月的髋关节疼痛率均低于B组,术后12、24个月则高于B组,差异有统计学意义(P0.05);经x2趋势分析,A组患者术后髋关节疼痛率随时间增加呈逐渐上升趋势,差异有统计学意义(x2=10.837,P=0.001),B组患者术后髋关节疼痛率随时间增加呈逐渐下降趋势,差异有统计学意义(x2=9.842,P=0.002)。A组患者术后3、6个月的髋关节疼痛评分高于B组,术后12、24个月则低于B组,差异有统计学意义(P0.05);A组术后3、6个月的髋关节疼痛评分高于术后12、24个月,B组3、6个月的髋关节疼痛评分低于术后12、24个月,差异有统计学意义(P0.05)。结论:骨水泥型假体缓解髋关节疼痛近期效果优于生物型假体,而生物型假体远期效果优于骨水泥型假体。     

微创经皮钢板内固定术与切开复位钢板内固定术治疗胫骨PILON骨折疗效比较研究

目的:对比微创经皮钢板内固定术与切开复位钢板内固定术治疗胫骨PILON骨折的临床疗效。方法:选取2014年11月-2016年1月在我院接受治疗的胫骨PILON骨折患者76例,根据乱数表法将患者分为观察组和对照组各38例。观察组给予微创经皮钢板内固定术,对照组给予切开复位钢板内固定术,对比两组患者手术时间、术后引流量、术后发热时间、术中出血量、骨折愈合时间、住院时间及并发症发生率,对比两组患者术后4、8、12个月膝关节功能评分(HSS)、踝关节功能评分(Baird)。结果:观察组手术时间、术后引流量、术后发热时间、术中出血量、骨折愈合时间、住院时间较对照组均显著更少(P0.05);观察组术后4、8、12个月HSS评分和Baird评分较对照组显著更高(P0.05);观察组总并发症发生率较对照组显著更低(P0.05)。结论:与切开复位钢板内固定术比较,微创经皮钢板内固定术能有效减少手术时间、术中出血量、术后引流量、术后发热时间以及住院时间,降低并发症发生率,改善患者术后膝、踝关节功能,加快骨折愈合,促进患者康复,值得临床应用。     

Ground reaction force patterns in plyometric push-ups

Compared with lower extremity plyometrics, data concerning the loads and intensity associated with upper extremity plyometrics are limited. The purpose of this study was to compare vertical ground reaction force (vGRF) characteristics between the clap push-up and box drop push-ups from 3.8 cm (BD1), 7.6 cm (BD2), and 11.4 cm (BD3) heights and limbs (dominant, nondominant). Twenty-two healthy active male subjects (age 25.9 ± 1.3 years, height 1.8 ± 0.08 m, mass 87.6 ± 12 kg) performed 4 repetitions of each push-up variation in a random order. Four dependent variables, peak vGRF, time-to-peak vGRF, loading rate (LR), and propulsion rate (PR) were calculated for each extremity. Statistical analysis consisted of separate limb by variation repeated measures analysis of variance. In addition, ground contact time (GCT) was statistically compared between variations. The GCT for the clap push-up (p = 0.033) was significantly less than that for BD1 and BD2. No significant differences were revealed for time-to-peak vGRF (p = 0.717). Peak vGRF was significant between dominant and nondominant limbs (p = 0.045). Post hoc analysis of a significant limb by variation interaction in LR (p < 0.001) revealed the dominant limb to be significantly greater than the nondominant one in all 4 push-up variations. Furthermore, for both limbs, the clap LR was significantly greater than BD1, BD2, and BD3. The clap PR was significantly greater than BD1, BD2, and BD3. These data add rationale for determining upper extremity plyometric progression. The peak vGRFs are similar, and altering the box height did not affect peak vGRF. In contrast, the clap demonstrated the highest LR and PR suggesting that it may be a more powerful exercise than BD1, BD2, and BD3. The higher LR (Clap and BD3) for the dominant extremity illustrates bilateral disparity in the rate of eccentric loading.     

Callus Formation and Mineralization after Fracture with Different Fixation Techniques: Minimally Invasive Plate Osteosynthesis versus Open Reduction Internal Fixation

Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation.     

微创经皮钢板联合锁定加压钢板固定术治疗胫骨干骺端骨折的临床疗效

目的:探讨微创经皮钢板固定技术(MIPPO)与锁定加压钢板(LCP)治疗胫骨干骺端骨折的临床疗效。方法:选择2013年6月-2015年6月在我院接受手术治疗的胫骨干骺端骨折患者103例作为研究对象,根据手术方法不同将所选患者分为三组。其中,联合手术组(35例)患者采用MIPPO联合LCP内固定术治疗,外固定组(33例)患者采用超关节外固定支架术治疗,内固定术组(35例)患者采用切开复位钢板内固定术治疗。观察并比较三种手术方法的临床效果及对患者骨关节功能的影响。结果:与外固定术组及内固定术组比较,联合手术组患者的手术时间短,术中出血量少,骨折愈合时间早,差异具有统计学意义(P0.05);联合手术组患者的手术优良率高于外固定组和内固定组,差异有统计学意义(P0.05);内固定组手术优良率高于外固定组,差异具有统计学意义(P0.05);联合手术组患者术后并发症的发生率低于外固定组及内固定组,差异具有统计学意义(P0.05);外固定组与内固定组术后并发症的发生率比较,差异无统计学意义(P0.05)。结论:MIPPO联合LCP内固定治疗胫骨干骺端骨折具有手术切口小、术中出血量少、术后并发症发生率低、骨折愈合快、关节功能恢复较好等优点,是治疗胫骨干骺端骨折的理想方法,值得临床推广应用。     

Outcome following implantation of a peripheral nerve stimulator in patients with chronic nerve pain

This study evaluated the usefulness of the implanted peripheral nerve stimulator in patients with pain following injury to a peripheral nerve. The patient sample (n = 17) consisted of 7 men and 10 women with a mean age of 48 years (SD = 18 years). The mean follow-up time since implantation of the stimulator was 21 months (SD = 15 months). Workers' compensation and/or litigation were involved in 11 cases. Peripheral nerve stimulators were placed in the upper extremity in 12 patients and in the lower extremity in 5 patients. Pain relief following implantation was rated as excellent by five patients, good by six patients, fair by four patients, and poor by two patients. A statistically significant decrease in reported pain level was found postoperatively (p < 0.0003). There was no statistically significant difference in postoperative pain level between men and women (p = 0.30), between cases involving workers' compensation or litigation and those not involving these issues (p = 1.0), or between patients who received an upper-extremity implant and those who received a lower-extremity implant (p = 0.56). Of the 12 patients who were unable to work before the operation, 6 returned to work after the operation. In conclusion, peripheral nerve stimulators can be useful in decreasing pain in carefully selected patients with severe neurogenic pain.     

Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study

Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed. The fracture model was an unstable three-part fracture (AO type B2). Eight pairs of human cadaveric humeri were submitted to axial load and torque. In the first part of the study, it was assessed to which degree the original stiffness of the humeri could be restored after the osteotomy by the osteosynthesis procedure. Subsequently, subsidence during 200 cycles of axial loading and torque was analysed. During axial loading, the Philos plate was significantly stiffer and showed less irreversible deformation. Two double-plate fixations, but none of the Philos plate osteosynthesis, failed. During torsion, there were no significant differences between the two implants. From the biomechanical point of view, the angle-fixed Philos plate represents the implant of choice for the surgical fixation of highly unstable three-part fractures of the proximal humerus, as the internal fixator system is characterised by superior biomechanical properties.     

近端膨胀髓内钉与抗旋髓内钉治疗老年股骨转子间骨折的临床疗效分析

目的:探究近端膨胀髓内钉与近端螺旋刀片抗旋髓内钉治疗老年股骨转子间骨折疗效及躁动发生率比较。方法:病例来源为2012年5月至2013年10月收入我院的老年股骨转子间骨折患者60例,采用随机数字表随机分为两组,膨胀钉组30例,采用近端膨胀髓内钉的手术方法,PFNA组30例,采用近端螺旋刀片抗旋髓内钉的手术方法。手术结束后,对两组患者进行X射线片、手术时间及出血量、髋关节功能的比较,同时对比躁动发生率。结果:X线检查结果显示两组患者经手术后骨折处均复位良好,无并发症及内固定物的脱落及松动,两组比较无显著差异(P0.05);与PFNA组相比,膨胀组患者的手术时间及出血量明显降低,差异具有统计学意义(P0.05);两组患者术后3个月、6个月的Harris评分显示,与PFNA组相比,膨胀钉组的优良率明显升高,髋关节优于PFNA组,差异具有统计学意义(P0.05);膨胀钉组患者躁动率为10.00%低于PFNA组患者躁动率为33.33%,具有统计学意义(P0.05)。结论:可膨胀髓内钉具有手术时间较短、出血量少,更利于骨折的愈合,且躁动发生率较低,对股骨转子间骨折的疗效优于较近端螺旋刀片抗旋髓内钉,对临床有指导意义,值得临床推广。     

Evaluation of bone healing in femurs lengthened via the gradual distraction method

BACKGROUND: Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. MATERIAL AND METHODS: In the years 1990 through 2006 a total of 57 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. RESULTS: In 11 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 46 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 9 cases after the removal of the distraction apparatus. CONCLUSIONS: The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach.     

持续静态牵伸技术在肘关节康复训练患者中的临床疗效观察

为了探讨肘关节骨折患者行骨折术后采用持续静态牵伸技术结合常规功能康复的应用效果,并揭示其对患者生活质量的影响,本研究选取我院手术治疗的84例肘关节骨折患者,收集时间为2015年1月至2016年12月,其中42例患者术后接受常规功能康复(常规组)、另外42例患者在常规功能康复基础上加用持续静态牵伸技术(研究组),观察两组患者术后3个月和6个月时的肘关节功能和生活质量的差异。研究显示,术后3个月和6个月,研究组的疼痛、功能、矢状面活动、肌肉力量、屈曲挛缩、旋前、旋后评分均显著高于常规组(p<0.05);术后6个月,研究组的FIynn肘关节功能评价(优78.57%,良16.67%,可4.76%)优于常规组(优57.14%,良30.95%,可11.90%),差异具有统计学意义(p<0.05);两组患者术前生活质量无差别。术后3个月,研究组患者躯体功能、肢体疼痛等生活质量得分高于常规组。本研究表明,肘关节骨折患者行骨折术后采用持续静态牵伸技术结合常规功能康复可显著改善患者术后的肘关节功能,值得临床推广应用。