动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效比较

目的:比较动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折的临床疗效和安全性。方法:收集我院收治的老年股骨近端骨折患者64例,随机分为DHS组和PFN组,每组各32例。DHS组患者给予动力髋螺钉的固定方式,PFN组给予股骨近端髓内钉的固定方式。手术后对患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症以及患者临床疗效进行检测并比较。结果:与治疗前相比,两组患者治疗后的Harris评分均显著下降(P0.05);与DHS组相比,PFN组患者的手术切口长度、术中出血量、手术时间、骨折愈合时间、术后并发症的发生率以及Harris评分均较低(P0.05)。结论:股骨近端髓内钉的固定治疗老年股骨近端骨折的临床疗效较好,安全性更高。     

顺行髓内钉、逆行髓内钉及锁定加压钢板内固定治疗股骨远端骨折的对比研究

摘要目的：探讨顺行髓内钉、逆行髓内钉及锁定加压钢板内固定3种方法治疗股骨远端骨折患者的疗效。方法：对2011年1月至2012年12月间我院收治的101例股骨远端骨折进行临床随机分组手术,分别在手术中使用顺行髓内钉、逆行髓内钉以及锁定加压钢板内固定。对三组患者手术时间、术中出血量以及切口长度等一般情况进行比较分析,同时采用Harris评分系统对三组患者术后恢复情况进行分析比较。结果：经过手术治疗后,逆行髓内钉组Harris评分显著高于其他两组（P〈0．05）。另外,逆行髓内钉组手术过程短、出血量少、手术切口小,上述指标与其他两组比较均有统计学意义（P〈0．05）。结论：股骨远端骨折行逆行髓内钉治疗的疗效优于顺行髓内钉以及锁定加压钢板内固定,具有手术时间短、术中出血少、切口小等优点,能够有效提高术后膝关节功能的恢复,值得临床推广使用。     

锁定型gamma钉与普通型gamma钉、动力髋螺钉治疗不稳定性股骨粗隆间骨折的 临床疗效比较

目的:比较锁定型γ钉(Locking Gamma Nail,LGN)、普通型γ钉(Traditional Gamma Nail,TGN)和动力髋螺钉(Dynamic Hip Screw,DHS)治疗不稳定性股骨粗隆间骨折的临床疗效和安全性。方法:选择2009年1月至2011年1月在我院分别接受锁定型γ钉(A组)、普通型γ钉(B组)和动力髋(C组)内固定治疗的随访资料完整的患者共92例。记录和比较三组患者的手术时间、术中出血量、骨折愈合时间及末次髋关节功能评分等相关数据。结果:A组、B组和C组的手术时间、术中出血比较有统计学差异(均P<0.01),但A、B组之间无明显统计学差异;A组和B组、C组的骨折愈合时间、髋关节功能评分比较差异均有统计学意义(均P<0.01),B、C组之间无明显统计学意义。结论:LGN的固定效果和生物力学性能良好,操作简便,固定牢固,整体治疗效果优于TGN和DHS,可作为临床治疗不稳定性股骨粗隆间骨折的首选。     

MIPO技术结合锁定加压钢板、顺行交锁髓内钉及锁定加压钢板治疗肱骨干中段骨折疗效的对比研究

摘要 目的：探讨微创经皮钢板内固定（MIPO）技术结合锁定加压钢板、顺行交锁髓内钉、锁定加压钢板治疗肱骨干中段骨折的疗效。方法：选择2016年2月至2019年2月我院收治的126例肱骨干中段骨折患者，采用随机数字表法将其分为三组，MIPO组（42例）采用MIPO技术结合锁定加压钢板固定治疗，髓内钉组（42例）采用顺行交锁髓内钉固定治疗，钢板组（42例）采用锁定加压钢板固定治疗。所有患者术后随访12个月，比较三组手术时间、术中出血量、术后住院时间、骨折愈合时间、术前和术后第12个月美国加州大学肩关节评分系统（UCLA）评分、Mayo肘关节功能评分（MEPS）、欧洲五维健康量表(EQ-5D)评分以及并发症发生率。结果：MIPO组和髓内钉组的术中出血量与术后住院时间均少于钢板组（P＜0.05），MIPO组和髓内钉组之间无统计学差异（P＞0.05）。MIPO组、钢板组骨折愈合时间短于髓内钉组（P＜0.05），MIPO组、钢板组之间无统计学差异（P＞0.05）。MIPO组、钢板组术后第12个月UCLA评分均高于髓内钉组（P＜0.05），MIPO组、钢板组之间无统计学差异，第12个月MEPS无差异（P＞0.05）。术后第12个月MIPO组、钢板组EQ-5D评分高于髓内钉组（P＜0.05），MIPO组、钢板组之间无统计学差异（P＞0.05）。三组桡神经损伤、肩峰损伤发生率相比较，差异有统计学意义（P＜0.05），桡神经损伤以钢板组发生率最高，肩峰损伤以髓内钉组发生率最高。结论：MIPO技术结合锁定加压钢板具有微创、术后恢复快、对肩关节功能及生活质量的影响较小、术后并发症较少的优势，是肱骨干中段骨折较为理想的治疗方式。     

PFN与DHS治疗老年不稳定型股骨粗隆下骨折的疗效分析

目的：比较PFN与DHS内固定治疗老年不稳定型股骨粗隆下骨折的预后及评其疗效。方法：2002年1月至2008年1月我科共收治老年不稳定型股骨粗隆下骨折患者129例,男59例,女70例,年龄51～86岁,平均61．7岁。随机选择PFN或DHS内固定,PFN组62例,DHS组67例。比较两组的手术时间、术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折愈合时间、Harris评分等6项指标。结果：116例获得13-48个月的随访,平均18．7月,除手术时间及Harris评分无差异外,PFN组在术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折平均愈合时间等方面与DHS组比较有显著优势（P〈0．05）。结论：PFN内固定创伤小、术后并发症率较低,可以成为治疗老年不稳定型股骨粗隆下骨折的主要方法。     

PFN与DHS治疗老年不稳定型股骨粗隆下骨折的疗效分析

目的:比较PFN与DHS内固定治疗老年不稳定型股骨粗隆下骨折的预后及评其疗效方法:2002年1月至2008年1月我科共收治老年不稳定型股骨粗隆下骨折患者129例,男59例,女70例,年龄51～86岁,平均61.7岁随机选择PFN或DHS内固定,PFN组62例,DHS组67例。比较两组的手术时间、术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折愈合时间、Harris评分等6项指标。结果:116例获得13～48个月的随访,平均18.7月,除手术时间及Harris评分无差异外,PFN组在术中出血量、术后第二天CRP值、张力侧出现骨痂时间、骨折平均愈合时间等方面与DHS组比较有显著优势(P<0.05)结论:PFN内固定创伤小、术后并发症率较低,可以成为治疗老年不稳定型股骨粗隆下骨折的主要方法     

Intramedullary Nail versus Dynamic Compression Plate Fixation in Treating Humeral Shaft Fractures: Grading the Evidence through a Meta-Analysis

There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN) and dynamic compression plate (DCP). This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation)-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs) and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.     

前路锁定钢板联合加压螺钉与锁定钢板行踝关节融合的疗效比较

目的:比较运用前路锁定钢板联合加压螺钉与单用锁定钢板行踝关节融合的临床疗效。方法:选择2012年4月至2015年7月收治并符合纳入标准的52例终末期踝关节炎患者,按照不同的手术固定方式分为锁定钢板联合加压螺钉组(A:n=27)和锁定钢板组(B:n=25),记录并比较两组手术时间、关节融合时间、AOFAS评分、术中及术后并发症。结果:两组手术时间比较无明显差异;所有关节最终都获得骨性融合,A组平均骨愈合时间为(13.0±2.1)周,B组为(16.0±4.6)周,较A组明显缩短(P0.01);A组末次随访时平均AOFAS评分为(81.8±5.19)分,B组为(78.3±6.94)分,较A组明显升高(P0.05)。结论:与单用锁定钢板相比,锁定钢板联合加压螺钉用于踝关节融合术可获得更加坚强的固定,有利于患肢早期功能锻炼、负重,缩短骨愈合时间。     

锁定加压钢板与三叶草钢板内固定治疗老年肱骨近端骨折比较分析

目的:探讨锁定加压钢板与三叶草钢板内固定治疗老年肱骨近端骨折的临床效果.方法:老年肱骨近端骨折分别采用锁定加压钢板治疗44例,三叶草钢板治疗48例,随访观察并比较二者手术时间、术中出血量、术后引流量、住院时间、肩关节Neer评分、术后并发症等指标.结果:二种治疗方法在Neer评分优良率和住院时间方面无明显差异(P>0.05).但在手术时间、术中出血量、术后引流量和术后并发症,锁定加压钢板优于三叶草钢板(P<0.05).结论:锁定加压钢板内固定方法可靠,骨折愈合率高,创伤小,并发症少.     

微创PCCP与传统动力髋螺钉治疗老年股骨转子间骨折疗效比较

目的:比较微创PCCP与传统动力髋螺钉治疗老年股骨转子间骨折的疗效.方法:回顾性分析我院2010年1-2011年6月收治的老年股骨转子间骨折患者36例,根据治疗方法不同分为微创PCCP和传统动力髋螺钉组,比较两组的治疗效果.结果:两组切口长度(t=12.824,P＜0.05)、出血量(t=9.342,P＜0.05)、手术时间(t=6.209,P＜0.05)和住院时间(t=7.923,P＜0.05)比较,差异有统计学意义.两组髋关节Harris评分(t=1.038,P＞0.05)与并发症发生率(X2=0.929,P＞0.05)比较,差异无统计学意义.两组疗效进行比较,X2=4.213,P＜0.05,两组手术效果差异有统计学意义.结论:微创PCCP较传统动力髋螺钉治疗老年股骨转子间骨折的疗效更优,适合临床应用.     

股骨近端防旋髓内钉与联合加压交锁髓内钉治疗老年股骨转子间骨折的疗效比较研究

目的:研究对比股骨近端防旋髓内钉(PENA-Ⅱ)与联合加压交锁髓内钉(Inter Tan)治疗老年股骨转子间骨折的疗效。方法:选择2014年6月至2016年6月我院收治的老年股骨转子间骨折患者92例,按照随机数字表法分为PENA-Ⅱ组与Inter Tan组,每组各46例。两组患者分别接受PENA-Ⅱ治疗和Inter Tan治疗,术后进行为期12个月的随访。比较两组临床疗效、手术相关指标(手术时间、术中出血量、骨折愈合时间)、手术前后骨密度水平变化情况以及并发症发生情况。结果:PENA-Ⅱ组优良率为89.13%,略高于Inter Tan组的86.96%,但两组比较差异无统计学意义(P0.05)。PENA-Ⅱ组患者手术时间、术中出血量分别为(65.2±15.3)min、(57.2±29.3)m L,明显低于Inter Tan组患者的(84.3±13.8)min、(104.7±36.5)m L(P0.05),两组患者骨折愈合时间比较差异无统计学意义(P0.05)。术前、术后12周以及术后24周PENA-Ⅱ组患者的腰椎骨密度水平与Inter Tan组比较差异无统计学意义(P0.05)。两组切口感染、肺部感染、下肢深静脉血拴、近端股骨外侧皮质劈裂以及髋内翻发生率对比差异无统计学意义(P0.05)。结论:PENA-Ⅱ与Inter Tan治疗老年股骨转子间骨折的临床疗效相当,且两种手术方法对骨密度水平的影响及术后并发症发生率相似。但PENA-Ⅱ治疗具有手术时间短以及术中出血量少等优势,值得临床推广应用。     

股骨近端抗旋髓内钉与第三代Gamma钉治疗股骨转子间骨折的效果对比

目的:探讨股骨近端抗旋转髓内钉与第三代Gamma钉治疗股骨转子间骨折的临床疗效,为骨科手术提供可借鉴的资料。方法:2009年4月-2013年3月期间在我院接受治疗的40例股骨转子间骨折患者,随机分为两组。其中,PFNA组20例患者采用股骨近端抗旋转髓内钉质量,而Gamma 3组20例患者采用第三代Gamma钉治疗。观察并比较两组患者的手术时间、影像增强剂时间和失血量,术后评价复位质量和内置物位置,在随访中,记录术后并发症,包括股骨干骨折、切出、再次手术、肺炎、尿路感染、脑梗塞、心肌梗塞和褥疮性溃疡等。另外,用Parker-Palmer活动评分系统评价行走能力。结果:PFNA和Gamma 3组在手术时间、影响增强剂时间和失血量上没有差异(P0.05);Gamma 3组病例复位质量要好于PFNA组,差异显著且具有统计学意义(P0.05);两组在内置物位置、行走能力和术后并发症上没有显著差异(P0.05)。结论:PFNA与Gamma 3治疗股骨转子间骨折具有很好的安全性和有效性,但Gamma3可获得更好的复位质量,应进一步在临床推广。     

Dynamic changes in acid mucopolysaccharides during mineralization of the mandibular condylar cartilage

Summary Sequential histochemical changes related to acid mucopolysaccharides (AMPS) were studied in the calcifying cartilage of the mandibular condyle. Non-decalcified, 1 Eponembedded sections were subjected to a variety of histochemical procedures. The results indicate that AMPS are synthesized and secreted mainly by hypertrophic chondrocytes in the premineralizing zone. Within the matrix at the mineralization front the AMPS complexes are apparently degraded by lysosomal enzymes to yield a highly anionic fraction which is maintained in the matrix. This fraction could function as the site for mineralization and cationic dye reaction which allows for histochemical visualization.Supported in part by Grant DE 00163 from the National Institute of Dental Research, U.S.P.H.S.     

The proximal femoral nail antirotation (PFNA) in the treatment of proximal femoral fractures

Proximal femoral fractures, especially in elderly persons with osteoporosis, present a challenge for the traumatologist. While the dynamic hip screw (DHS) became the implant of choice for the treatment of stable fractures, the ideal implant for the treatment of unstable fractures remains an issue. In our experience, Proximal Femoral Nail Antirotation (PFNA) is an excellent device for osteosynthesis as it can be easily inserted, it provides angular and rotational stability and allows early weight bearing on the affected limb. Between February 2007 and August 2009, 76 patients underwent the PFNA fixation for proximal femoral fractures (15 men and 61 women). Forty seven fractures were pertrochanteric, 14 subtrochanteric, 2 pathological and 5 ipsilateral trochanteric and diaphyseal fractures whereas in 8 cases the PFNA was used in reosteosynthesis. The mean age of patients was 73.4 years (range 22-91 years). The fractures were reduced on a traction table and the implant was inserted using minimally invasive technique. Four patients developed superficial postoperative wound infection. No cases of implant breakage have been recorded; there was one cut-out; delayed union was noted in three patients. The majority of patients regained their pre-injury mobility status. The PFNA is an excellent implant for stabilisation of both trochanteric and complex combination fractures as well as an exceptional device for reosteosynthesis. It is easily inserted with few intra- and postoperative complications and allows early weight bearing on the affected limb as well as quicker rehabilitation of patients.     

Compression fractures of the vertebrae in children with acute lymphoblastic leukemia]

Compression fractures of vertebrae were noted in 20 out of 1,700 children with the acute lymphoblastic leukemia. Usually prognosis in these cases has been favourable (70% of patients are alive from 5 months to 19 years). Percentage of recovery from compression fractures has been relatively high. Lymphoblastic leukemia with infiltrations localized in the spine is relatively non-aggressive, develops slowly, and despite extensive lesions to the bones its outcome results are favourable. Main symptom of spinal involvement include severe and persisting back aches which make walking impossible. Such symptoms should indicate the diagnosis of leukemia and advocate proper hematological examinations.     

Study of the fatigue curve in quadriceps and hamstrings of soccer players during isokinetic endurance testing

Many studies have presented regression models of quadriceps (Q) muscle strength loss with fatigue development. Paradoxically, the hamstrings (H), which are the principal site of muscle injury in soccer players, have received little attention, and no regression model has been established. This study investigated strength loss in the Q and H to establish a regression model using the lowest number of flexions-extensions during isokinetic endurance testing. Twenty-four semiprofessional soccer players performed 50 flexion-extension movements at 180 degrees x s(-1) on an isokinetic dynamometer. The theoretical equations were calculated from the first 10, first 15, first 20, and first 25 contractions for each muscle group by several regression models (linear, quadratic, cubic). The linear model was the best fit to this exercise protocol to describe the strength loss in both muscle groups. The quadratic model was the best fit to predict the changes in the H/Q ratio. This study showed that a regression model can be established for both muscle groups. A minimum of 20 extensions and 15 flexions was needed to establish a linear model that represented strength loss in, respectively, Q and H. A minimum of 25 flexions-extensions was needed with the quadratic model to accurately determine the decrease in the H/Q ratio. Isokinetic endurance testing can be carried out with only 25 flexions-extensions. This reduction should facilitate the implementation of this protocol. Regular evaluation would contribute to the efforts to prevent muscle injury during competitive sports activity.     

Effects of one-legged endurance training on femoral arterial and venous size in healthy humans.

The cross-sectional area (CSA) of large-conductance arteries increases in response to endurance training in humans. To determine whether training-induced changes in arterial structure are systemic in nature or, rather, are confined to the arteries supplying exercising muscles, we studied 10 young men who performed one-legged cycle training [80% of one-legged peak O2 uptake (VO2 peak)), 40 min/day, 4 days/wk] for 6 wk and detraining for another 6 wk. There were no significant differences in baseline one-legged VO2 peak) and CSA of the common femoral artery and vein (via B-mode ultrasound) between experimental and control legs. In the experimental leg, one-legged VO2 peak) increased 16% [from 3.0 +/- 0.1 to 3.4 +/- 0.1 (SE) l/min], arterial CSA increased 16% (from 84 +/- 3 to 97 +/- 5 mm2), and venous CSA increased 46% (from 56 +/- 5 to 82 +/- 5 mm2) after endurance training. These changes returned to baseline during detraining. There were no changes in one-legged VO2 peak) and arterial CSA in the control leg, whereas femoral venous CSA in the control leg significantly increased 24% (from 54 +/- 5 to 67 +/- 4 mm2) during training. Changes in femoral arterial and venous CSA in the experimental leg were positively and significantly related to corresponding changes in one-legged VO2 peak) (r = 0.86 and 0.76, respectively), whereas there were no such relations in the control leg (r = 0.10 and 0.17). When stepwise regression analysis was performed, a primary determinant of change in VO2 peak) was change in femoral arterial CSA, explaining approximately 70% of the variability. These results support the hypothesis that the regional increase in blood flow, rather than systemic factors, is associated with the training-induced arterial expansion. Femoral arterial expansion may contribute, at least in part, to improvement in efficiency of blood transport from the heart to exercising muscles and may facilitate achievement of aerobic work capacity.