目的 探讨胸腰椎爆裂性骨折(TLBF)应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗的临床效果。方法 选取我院2013年7月—2016年7月收治的28例TLBF患者,均行经伤椎椎弓根钉固定结合经椎弓根植骨治疗。详细记录所有患者术中出血量、手术时间及住院时间等围术期情况;比较28例患者手术前后影像学指标、腰背部疼痛视觉模拟评分法(VAS)评分及Frankel分级;随访期间并发症情况。结果 与术前相比,28例患者术后1个月、3个月时的椎体前后缘高度、Cobb角及VAS评分,均更优(P<0.01);经Ridit分析知,28例患者术后6个月时Frankel分级显著优于术前(P<0.01);术后随访6个月期间内,未见内固定松动、断裂等情况,且并未发生因椎弓根植骨而引起的神经症状。结论 TLBF应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗能有效复原与保持脊柱生物力学稳定性,矫正后凸畸形,减少患者术后痛苦与并发症,改善神经功能,安全可靠,具有较高临床推广价值。

Objective To investigate the effects of the pedicle screw fixation combined with pedicle bone graft in treatment of thoracolumbar burst fracture(TLBF). Methods Selected 28 patients with TLBF treated in our hospital from July, 2013 to July, 2016, all of whom were treated with the pedicle screw fixation combined with pedicle screw fixation in the treatment of vertebral pedicle screw fixation. Recorded all patients' detailed situations on preoperative period of bleeding volume, operation time and length of stays. Compared 28 patients' imaging parameters, back pain visual analogue scale (VAS) score and Frankel classification before and after operation. And to observe the complications during follow-up as well. Results Compared with the pre-operation, 28 patients' anterior and posterior margin height, Cobb angle and VAS score were significantly better (P<0.01) than that of one month and three months after the operation. According to the Ridit analysis, six months after the operation, 28 patients' Frankel classification was better than that of pre-operation (P<0.01). No internal fixation loosening or breakage was found during the follow-up period of 6 months, and there was no nerve symptoms caused by pedicle screw fixation. Conclusion The pedicle screw fixation combined with pedicle screw fixation in treatment of thoracolumbar burst fracture(TLBF) can effectively restore and maintain the biomechanical stability of the spine, correct kyphosis, reduce postoperative pain and complications, improve nerve function and be safe and reliable,have higher clinical value.

目的 回顾分析椎体成形术(PVP)对于治疗骨质疏松性新鲜椎体压缩骨折(OVCF)患者的疗效。方法 收集2011年1月—2012年6月新鲜OVCF患者伤后两周内行PVP术治疗共34例(51个椎体)。于术前1天、术后3天、1个月、3个月、6个月、12个月予VAS、ODI评分,并行X线检查以测量病椎前、中、后缘的高度和病椎cobb角。结果 纳入研究的34个病例中,患者术后各时间点随访中VAS和ODI评分均较术前1天明显改善(P<0.05)。术后各时间点随访中行X线检查时,术后各次随访中椎体前缘、中段、病椎cobb角均较术前有较为明显的矫正(P<0.05)。结论 应用PVP治疗新鲜OVCF疗效满意,可快速缓解疼痛、改善生活质量和矫正病椎后凸畸形。

Objective To study the efficiency and safety of percutaneous Vertebroplasty(PVP) for the fresh osteoporotic vertebral compression fractures(OVCF). Methods 34 patients (30 females and 4 males), mean age 75.8 years old(75.79±9.32, range 60 to 93 years old) hospitalized between January 2011 to June 2012 were reviewed retrospectively in this study. Evaluation at follow-up time point(1 day before PVP, 3rd day, 1st, 3rd, 6th, 12th month after PVP) included the pain score with VAS, mobility improvement with ODI and the measurement of anterior, middle and posterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra with X-ray image. Results For the 34 patients by followed up 1 year, the mean VAS score and ODI decreased significantly after PVP at any follow-up time compared with the 1 day before operation. Anterior and middle body height and the focal kyphotic angle at any follow-up time after PVP was improved statistically significant compared with the preoperative value(P<0.05). Conclusion Percutaneous vertebroplasty results in prompt pain relief, rapid rehabilitation and kyposis reduction, it is a safe and effective procedure for treating fresh osteoporotic vertebral compression fractures.

目的 观察克氏针钢丝张力带及镍钛聚髌器治疗不同类型髌骨骨折的疗效, 探讨两种手术方式的临床适应证及治疗优点。方法 选取2011年3月—2013年12月,成都中医药大学附属医院骨科住院部45例髌骨骨折患者,术后通过Lyshoml膝关节评分等标准,对患者康复情况进行评估,并对数据加以分析, 比较两种治疗方法的临床效果。结果 两种治疗方法在治疗效果上无差异, 观察后分析:髌骨横形骨折可选克氏针钢丝张力带治疗; 粉碎性骨折采用镍钛聚髌器疗效满意。结论 两种髌骨骨折内固定方法临床疗效相似,但镍钛聚髌器兼有复位良好,固定稳定,操作简便等优点,对于粉碎性髌骨骨折更为适用。

Objective To observe the curative effect of Kirschner wire tension band and Ni Ti patellar concentrator in the treatment of different types of patellar fracture,study the clinical indications on and therapeutic advantages of this two kinds of operation methods. Methods By selecting 45 cases of patellar fracture patients hospitalized in the department of orthopedics,the affiliated hospital of Chengdu university of TCM from 2011-03 to 2013-12.To assess the patients rehabilitation by Lyshoml knee score (standard) after operation and analysis the data,compare the clinical effects of this two methods. Results There is no significant differences between this two methods. After observation and analysis:transverse fracture of patella can be treated with kirschner wire and tension band and Comminuted fracture treated with Ni Ti patellar concentrator will be better. Conclusion This two kinds of operation methods have a similar curative effect in the Clinical reatment of patella fracture, but the Ni Ti patellar concentrator has a good function of reduction, stable fixed and easy to operation,Particularly suitable for Comminuted fracture of patellar.

目的 对比微创稳定系统(LISS)与解剖板治疗股骨远端复杂骨折的疗效比较。方法 45例股骨远端复杂骨折分别应用LISS及解剖板治疗。其中LISS组25例,解剖板组20例。结果 术后LISS组随访12～18个月,平均14.1个月;解剖板组随访12～18个月,平均13.9个月。所有患者手术切口均一期愈合。骨折愈合时间及术后并发症发生总数两组比较差异无统计学意义。LISS组的植骨例数少于解剖板组。切口大小、手术时间、术中失血及Merohan疗效比较,LISS组优于解剖板组。结论 LISS及解剖板治疗股骨远端复杂骨折均可取得满意疗效,但LISS系统创伤小,骨折固定牢固,体现微创原则,是治疗股骨远端复杂骨折的新趋势。

目的 观察肌内效贴技术对桡骨远端骨折内固定术后手功能的影响,并与对照组进行比较。方法 随机选取36例桡骨远端不稳定骨折内固定术后患者,随机分为治疗组与对照组,治疗组18例患者采用肌内效贴扎及腕关节主动活动康复训练,对照组18例采用腕关节主动活动康复训练。所有患者在治疗前及治疗后1周、2周均采用Gartland-Werley进行腕关节功能评价;容积法测量腕关节远端肿胀程度、视觉模拟疼痛评分(visual analog scale,VAS)进行疼痛评价。结果 治疗后1周,后2周治疗组的腕关节功能Gartland-Werley评定,腕关节远端肿胀程度和VAS优于对照组,差异有统计学意义(P＜0.05)。结论 肌内效贴技术对改善桡骨远端骨折术后肿胀,促进患者手功能恢复,改善患肢疼痛方面疗效显著,值得推广。

Objective To observe the effect of Kinesio taping on hand function after internal fixation of distal radius fracture, comparing to the control group. Methods Using randomized controlled methods, 36 cases of unstable distal radius fracture after internal fixation were randomly divided into two groups, 18 cases in the treatment group were treated by Kinesio taping and wrist active rehabilitation training. The control group (18 cases) only got wrist active rehabilitation training. All patients were evaluated before and after treatment in 1 week and 2 weeks, including the function assessment of wrist joint by Gartland-Werley, swelling measurement of distal wrist joint by volumetric method, pain evaluation by visual analogue scale (visual analog scale, VAS). Results In the twice evaluation after treatment, Gartland-Werley assessment of wrist joint, distal swelling degree and VAS of the treatment group were superior to that of the control group, the difference had statistical significance(P<0.05). Conclusion Kinesio taping can improve the distal radius fracture postoperative swelling, promote the recovery of hand function in patients, and improve the curative effect of limb pain significantly. It's worthy of promotion.

目的 探讨经皮微创技术应用股骨近端解剖锁定钢板治疗高龄骨质疏松粗隆间骨折的治疗。方法 我院自2009年12月—2013年6月共收治高龄骨质疏松粗隆间骨折56例,男35例,女21例;年龄76～94岁,平均81岁。所有患者应用股骨近端解剖锁定钢板通过经皮微创置入技术治疗。根据Harris髋关节功能评分对治疗效果进行评定。结果 56例手术时间30～90 min,平均45 min;术中失血量70～250 mL,平均110 mL。全部患者获随访,时间6～13.5个月,平均9.5个月。X线骨折愈合时间3～6个月,平均3.5个月。其中优41例,良12例。结论 对于高龄骨质疏松患者粗隆间骨折,采用经皮微创置入股骨近端解剖锁定钢板内固定治疗,具有手术创伤小、出血少、安全可靠等优点,有良好的临床应用价值。

Objective To study the application of proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques in the treatment of senile osteoporosis curative effect of intertrochanteric fractures in elderly patients. Methods We have treated 56 elderly patients of senile osteoporosis intertrochanteric fractures in December 2009 to June 2013, including 35 male and 21 female cases, aged 76~94, the average of 81. All patients were applied in the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology according to Harris hip joint function scale curative effect. Results 56 cases of operation time 30~90 min, an average of 45 min. Intraoperative blood loss was 70~250 ml, an average of 110 ml. All patients received follow-up from 6 to 13.5 months, an average of 9.5 months. The X-ray fracture healing time was from 3~6 months, 3.5 months on average. According to the Harris hip joint function scale: 41 cases was excellent, 12 cases was good. Conclusion For the senile osteoporosis intertrochanteric fracture, using the proximal femur anatomic locking plate with minimally invasive percutaneous plate osteosynthesis technology can make minimal trauma, less bleeding reliable fixation,and has good clinical application value.

目的 探讨光棒引导与传统喉镜气管插管在不稳定型颈椎骨折患者中的应用效果。方法 不稳定型颈椎骨折患者80例,按照随机数字表法随机分成光棒引导组和传统喉镜组各40例,记录两组患者的插管时间、插管总成功率,入室安静后(T0)、诱导后插管前(T1)、气管插管后即刻(T2)、气管插管后3 min(T3)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、血浆去甲肾上腺素(NE)、肾上腺素(E) 和血管紧张素Ⅱ(ATⅡ)的变化和插管时气道并发症。结果 两组间插管时间(光棒组29.63±11.04s vs.喉镜组62.41±19.49 s)有统计学意义(P<0.001)。两组插管总成功率无统计学意义(P=0.305)。光棒组T2、T3时刻SBP、DBP、HR 、NE、E和ATⅡ均低于喉镜组(P<0.001)。光棒组气道并发症低于喉镜组无统计学意义(P>0.05)。结论 光棒引导气管插管较传统喉镜气管内插管插管时间短,对血流动力学和应激激素水平影响较轻。

目的 观察动静平衡康复训练对胫骨平台骨折术后患者平衡和行走功能的影响。方法 将2012年7月—2014年12月100例胫骨平台骨折患者,随机分为两组,每组50例。对照组术后展开常规康复训练,观察组实施动静平衡康复训练,观察两组膝关节功能、康复效果以及肌力恢复情况。结果 观察组患者的膝关节功能优良率为98.0%,高于对照组的60.0%,差异有统计学意义(P＜0.05)。观察组患者的Lysholm评分,高于对照组(P＜0.05)。观察组患者的肌力恢复情况,优于对照组(P＜0.05)。结论 基于“动静平衡”理念针对胫骨平台骨折患者实施术后康复指导与训练,有利于促进患者关节功能以及肌力恢复,巩固康复疗效,在训练过程中实现动态平衡,具有积极的临床意义。

Objective To investigate the static and dynamic balance rehabilitation training on the tibial plateau fracture patients balance and walking functions. Methods 100 cases of patients with tibial plateau fractures from July 2012 to December 2014, were randomly divided into two groups, 50 cases of each group. The control group was launched conventional rehabilitation, observation group received static and dynamic balance rehabilitation training. The knee function, rehabilitation and muscle recovery of the two groups were observed and statistically analyzed. Results The knee function excellent rate of observation group was 98.0%, significantly higher than control group 60.0%, there was statistical significance(P＜0.05). Lysholm score of observation group was higher than control group(P＜0.05). Muscle recovery of observation group was better than control group(P＜0.05). Conclusion Based on the “static and dynamic balance” concept for tibial plateau fractures postoperative rehabilitation for patients with guidance and training, and it will be promoting joint function in patients with muscle recovery and consolidate the recovery effect, to achieve dynamic equilibrium in the training process, with positive clinical significance.

股骨转子间骨折是最常见的髋部骨折,内固定手术为其目前治疗的首选方式。头颈钉位置是评估手术效果和判断治疗预后的重要因素,合适的置钉位置有利于稳定骨折、加速康复以及改善预后。目前头颈钉位置最经典的评估方式为尖顶距（TAD）,但TAD至今仍存在较多争议。近年来提出的轴刀角、尖颈距离比、偏心距（ED）以及标准化TAD（STAD）为临床实践拓展了新视野。文章通过对上述头颈钉位置的评估方法及局限性进行文献综述,旨在为临床手术置钉时提供相应的参考。ED和STAD的提出,为未来人工智能评估头颈钉位置提供了可能。

Femoral intertrochanteric fracture is one of the most common hip fractures, and the internal fixation is the preferred treatment. The position of cephalic fixator is an important factor to evaluate the effect of operation and the prognosis of treatment. Tip-apex-distance（TAD）is the most classical method to evaluate the position of cephalic fixator, but it is still controversial. In recent years, the axis-blade angle,tip-neck distance ratio, eccentric distance（ED）and standardized TAD（STAD）have been proposed,though with limitations, they also provide a new perspective for clinical practice. In this study, we reviewed the literature on the evaluation of the position of cephalic fixator in order to provide the corresponding references and guidance for the clinical operation of internal fixation. Both STAD and ED may be the theoretical possibility of artificial intelligence evaluation of the position of cephalic fixator in the future.

       目的   对比分析双极半髋关节置换术（BHA）与全髋关节置换术（THR）治疗股骨颈骨折（FNF）的效果。方法   回顾性收集北京中医药大学东直门医院洛阳医院2019年6月—2023年4月90例FNF患者临床资料，依照手术治疗方案差异分为两组，BHA组（45例）行BHA治疗，THR组（45例）行THR治疗，比较两组围术期指标、术前及术后3 d炎症因子水平、术后6个月髋关节活动度、术前及术后6个月生活质量［欧洲生活质量评分（EQ-5D评分）］。结果  THR组手术时间（108.76±15.33）min、下床活动时间（40.37±10.24）h、住院时间（19.02±5.11）d均较BHA组［（53.49±10.12）min、（25.92±7.15）h、（15.16±4.87）d］长（t分别为20.184、7.761、3.668，均P＜0.05），术中失血量（318.69±35.14）mL、术后引流量（129.74±21.03）mL均较BHA组［（224.07±29.35）mL、（90.35±17.48）mL］多（t分别为13.863、9.663，均P＜0.001）；组间并发症发生率比较差异无统计学意义（P＞0.05）；术后3 d，BHA组血清白细胞介素-1为（17.35±3.06）pg/L、白细胞介素-6为（24.82±4.31）pg/L、C-反应蛋白为（26.17±4.59）pg/L，低于THR组的（20.16±3.48）pg/L、（27.04±5.06）pg/L、（28.90±5.12）pg/L（t分别为4.068、2.241、2.663，均P＜0.05）；两组术后6个月髋关节内旋、屈曲、外旋、外展、内收活动度及EQ-5D评分对比差异均无统计学意义（均P＞0.05）。结论   与THR相比，BHA能减少FNF患者围术期失血量，降低术后炎症因子表达水平，缩短手术及下床活动时间，促进恢复。

      Objective  To compare and analyze the effects of bipolar hemihip replacement（BHA）and total  hip replacement（THR）in the treatment of femoral neck fracture（FNF）．Methods  The clinical data of 90 patients with FNF in the Luoyang Hospital，Dongzhimen Hospital，Beijing University of Chinese Medicine，from June 2019 to April 2023 were retrospectively collected．The patients were divided into two groups according to the difference in surgical treatment plan．The BHA group（45 cases）received BHA treatment，and the THR group（45 cases）received THR treatment．The perioperative indicators，preoperative and postoperative inflammatory factor levels，postoperative hip joint mobility at six months，preoperative and postoperative quality of life ［European Quality of Life Scale（EQ-5D score）］were compared between the two groups．Results  The operation time（108.76±15.33）min，ambulation time（40.37±10.24）h，and hospitalization time（19.02±5.11）d in the  THR  group were longer than those in the BHA group ［（53.49±10.12）min，（25.92±7.15）h，（15.16±4.87）d］（t=20.184，8.630，3.668，respectively，all P＜0.05）．The intraoperative blood loss（318.69±35.14）mL and  postoperative  drainage volume（129.74±21.03）mL were both higher than those in the BHA group ［（224.07±29.35）mL，（90.35±17.48）mL］（t=13.863，9.663，respectively，all P＜0.001）．There was no significant difference in the incidence of complications between the groups（P＞0.05）．Three days after surgery，the serum levels of interleukin-1，interleukin-6，and C-reactive protein in the BHA group were（17.35±3.06）pg/L，（24.82±4.31）pg/L，and（26.17±4.59）pg/L，respectively，which were lower than those in the THR group（20.16±3.48）pg/L，（27.04±5.06）pg/L，and（28.90±5.12）pg/L（t=4.068，2.241，2.663，respectively，all P＜0.05）．There was no significant difference in the range of motion of internal rotation，flexion，external rotation，abduction，and adduction of the hip joint and EQ-5D scores between the two groups at six months after surgery（all P＞0.05）．Conclusions  Compared with THR，BHA can reduce perioperative blood loss in FNF patients，reduce postoperative inflammatory factor expression level，shorten operation and ambulation time，and promote recovery．