目的 探讨早期康复训练对高龄股骨骨折内固定患者术后康复的影响研究。方法 抽选我院2015年3月—2017年7月收治的98例高龄股骨骨折患者,均以防旋股骨近端髓内钉（PFMA）内固定治疗,根据患者自愿及实际自身状态原则分为对照组（n=45例,仅开展常规术后康复护理）和观察组（n=53例,在内固定治疗期给予早期康复训练）,比较术前及术后3、6个月髋关节运动功能（Harisr评分）及日常生活活动能力（Barthel指数）,观察6个月内并发症发生情况。结果 观察组干预3、6个月后Harisr髋关节活动评分、Barthel指数均高于对照组（P<0.05）。观察组锻炼6月后,髋关节运动功能恢复优良率高于对照组（P<0.05）。观察组发生骨延迟愈合、压疮、切口感染、肺炎、泌尿系感染等并发症的概率低于对照组（P<0.05）。结论 高龄股骨骨折患者PFMA内固定术后开展早期康复训练,可促进患者骨关节功能恢复,改善运动功能,降低并发症发生率,值得临床推广。

目的 分析比较经皮微创椎弓根钉内固定和传统开放式手术治疗脊椎骨折的优劣差异。方法 本研究选择我院2015年2月—2016年6月收治的脊椎骨折患者72例,按照治疗方法的不同将全部患者分成对照组(36例)和实验组(36例),两组患者分别给予传统开放式手术治疗和经皮微创椎弓根钉内固定治疗,对两组患者的临床疗效进行观察分析。结果 在手术时间、手术出血量、切口长度以及住院时间方面,实验组患者均优于对照组(P＜0.05);实验组患者术后的血清肌酸激酶活性低于对照组患者(P＜0.05);治疗后两组患者椎体前缘高度、Cobb's角均优于治疗前(P＜0.05),但是组间比较差异无统计学意义(P＞0.05)。术后两组患者均没有发生椎间隙感染、神经损伤、切口感染等并发症。结论 在对脊椎骨折患者进行治疗时,经皮微创椎弓根钉内固定治疗和传统开放式手术治疗的临床疗效比较类似,但是和传统开放式手术相比较,经皮微创椎弓根钉内固定治疗对患者的损伤更加轻微,术后恢复时间更短。

目的 探讨重症胸外伤患者在行胸腔镜手术探查同期行肋骨骨折内固定术的有效性和临床意义。方法 选取我院2008年—2017年收治的68例具有胸腔镜手术探查指征的重症胸外伤患者,其中36例同期行肋骨骨折内固定术,32例单纯行胸腔镜探查术。比较2组患者的VAS评分、镇痛药物用量、卧床时间、住院天数等。结果 2组患者术后VAS评分、镇痛药物用量、卧床时间、住院天数等有统计学差异。结论 胸腔镜手术探查同期行肋骨骨折内固术治疗重症胸外伤可降低术后并发症的发生,加速患者的康复,值得推广。

Objective To investigate the clinical significance and effectiveness of thoracic endoscopic surgery for patients with severe thoracic trauma. Methods 68 cases of severe thoracic trauma with thoracoscopic operation, of which 36 cases underwent internal fixation of rib fracture and 32 cases were performed by thoracoscope. The VAS score, analgesic dosage, bed time and hospitalization days were compared between the two groups. Results There were significant differences in VAS score, analgesic dosage, bed time and hospitalization days after operation in the two groups. Conclusion The treatment of severe thoracic trauma by thoracoscopic surgery and internal fixation of rib fracture may reduce postoperative complications and accelerate the recovery of patients, which is worth popularizing.

目的 探究纽扣钢板内固定方法治疗新鲜Rockwood Ⅲ型以上肩锁关节脱位的效果。方法 选取2013年1月—2017年12月在我院诊断并治疗的肩锁关节脱位(Rockwood Ⅲ型以上)60例,随机分为观察组(30例)与对照组(30例),观察组采用纽扣钢板内固定方法,对照组采用锁骨钩钢板方法。对比两组治疗前后肩功能指标(Constant-Murley)、手术的治疗疗效指标(Karlsson)的优良率,以及手术时间和术中出血量。结果 治疗前两组的Constant-Murley评分无差异(P＞0.05),治疗后两组评分均提高(P＜0.05),其中观察组高于对照组(P＜0.05);观察组的Karlsson评分优良率、术中出血量均优于对照组(P＜0.05),观察组的手术时间高于对照组(P＜0.05)。结论 纽扣钢板内固定能够有效恢复患者正常肩部功能,具有良好的治疗效果,同时对患者造成的创伤较小。

Objective To observe the effect of button plates in treatment of Rockwood Ⅲ and greater acromioclavicular dislocation. Methods From January 2013 to December 2017, 60 Rockwood Ⅲ and greater acromioclavicular dislocation patients in our hospital were randomly divided into observe group(30 cases)and control group (30 cases), the observe group received button plates treatment, the control group received clavicula hook plate treatment. The shoulder function(Constant-Murley)of two groups before and after treatment were compared, and the effect of operation(the good rate of Karlsson), surgical time and intraoperative bleeding of two groups were also compared. Results There were no difference in shoulder function between two groups before treatment(P＞0.05). The indices were increased after treatment(P<0.05), and the indices in the observe group were higher than that of control group(P＜0.05), The good rate of Karlsson index, intraoperative bleeding of observe group were better than that of control group(P＜0.05).The surgical time of observe group were better than that of control group(P＜0.05). Conclusion Button plate's internal fixation nay better improve the shoulder function; it has better therapeutic effect, and smaller trauma to patient.

目的 探讨康复护理路径早期功能训练对桡骨远端骨折LCP(锁定加压接骨板locking compression plate, LCP)内固定术后患者腕关节功能康复的影响。方法 对2014年5月—2016年6月住院80例桡骨远端骨折LCP 内固定术后患者分为对照组和观察组,每组各40例,对照组按桡骨远端LCP内固定术后护理措施进行护理,观察组患者在此护理基础上,制定术后功能康复护理路径,按功能康复护理路径对术后患者实施早期功能康复训练,随访评价两组患者患肢的组织肿胀、疼痛、骨折复位和腕关节功能康复效果。结果 疼痛评分:对照组在术后第3天~14天疼痛评分均高于观察组(P＜0.005);肿胀程度评分:对照组在术后第3天~7天肿胀程度评分均高于观察组,消肿速度比观察组慢(P＜0.001);腕关节的屈伸活动范围、握力和捏力比较观察组优于对照组(P＜0.001);腕关节复位优良率观察组95%高于对照组87.5%(P＜0.001)。结论 应用康复护理路径对桡骨远端骨折的LCP内固定术后患者进行早期腕关节功能康复训练,能减轻患者疼痛和局部软组织肿胀,减少并发症,提高术后患者康复质量。

Objective To investigate the early functional training of rehabilitation nursing path to the effects of distal radius fracture LCP (locking compression plate LCP) in patients after internal fixation of wrist joint function rehabilitation. Methods From May 2014 to June 2016, 80 patients with distal radius fractures were divided into control group and observation group(n=LCP), each with 40 cases. The control group was treated with nursing care of patients with distal radius LCP internal fixation. On the basis of nursing, the patients in the observation group were given rehabilitation nursing pathway, and the patients were followed up according to the rehabilitation path including evaluation of two groups of patients with fracture limb swelling, pain, fracture reduction and wrist joint function rehabilitation. Results Pain score: in the third days to fourteenth days pain score of the control group was higher than the observation group (P<0.005); Swelling degree score: swelling scores of the control group for the third days to seventh days after were higher than those in the observation group, the swelling reduced slowly (P<0.001); The wrist flexion range, grip and pinch strength compared to the observation group was better than the control group (P<0.001); The good rate of wrist joint reduction in the observation group (95%) was higher than that in the control group[(87.5%) (P<0.001)]. Conclusion The application of rehabilitation nursing path for patients with distal radius fracture after LCP internal fixation for early rehabilitation of wrist function may reduce the pain and local soft tissue swelling, reduce complications and improve the quality of postoperative rehabilitation.

目的 探讨早期康复护理干预对胸腰椎骨折内固定术后患者的临床护理效果。方法 2014年6月—2016年12月,将94例胸腰椎骨折内固定术后患者按数字随机法,分为实验组51例和对照组43例,分别实进行早期康复护理和常规性护理。比较两组患者胸腰背部功能状况、胸腰背部疼痛情况、术后抑郁水平,以及护理满意度等相关指标,以评价早期康复护理的效果。结果 94例患者均获得3个月随访。与对照组比较,实验组患者平均住院天数减少4.1 d,差异有统计学意义(P<0.05);平均住院费用也有所下降;实验组和对照组总并发症发生率分别为7.84%和20.9%,两组间比较差异有统计学意义;实验组的护理工作满意度高达90.20%,高于对照组的67.44%,差异具有统计学意义(P<0.05)。术后3个月随访时,Oswestry功能障碍评分实验组为(14.74±3.25),低于对照组的(20.04±5.32)(P<0.05); SDS评分实验组的为42.35±3.68,低于对照组的(47.28±3.49)(P<0.05);胸腰背痛VAS评分实验组的为(1.07±0.67),低于对照组的(2.62±1.86)(P<0.05)。结论 早期康复护理干预是促进胸腰椎骨折内固定术后患者快速康复的有效方法,提高患者对护理工作的满意度,值得推广应用。

Objective To evaluate and compare the outcomes of early rehabilitation nursing and routine nursing care for patients with thoracolumbar bursting fracture after internal fixation. Methods From June 2014 to December 2016, this study enrolled ninety-four subjects who were randomly divided into observe group with fifty-one cases and control group with forty-three cases according to the digital random method. Patients in the control group were treated with routine nursing care, and early rehabilitation nursing care were used in the observe group. The physical function of thoracolumbar spine, psychological condition, pain of thoracolumbar spine, nursing satisfaction and soon. were compared between the two groups. Results The average days of hospital stay in the observation group was 4.10 days, it was less than that of control group, and the difference was statistically significant(P<0.05). Average hospital costs were also declined. The total complication rate were 7.84% in observe group and 20.9% in control group, there was significant difference between the two groups (P<0.05). The nursing satisfaction was 90.20% in observe group, which was higher than 67.44% in that in control group (P<0.05). When follow-up three months after operation, the ODI score in experiment group was(14.74±3.25), which was lower than that (20.04±5.32)in control group (P<0.05). The SDS score in experiment group was (42.35±3.68), which was lower than that (47.28±3.49)in control group(P<0.05). And the VAS score in experiment group was (1.07±0.67), which was lower than that(2.62 ±1.86)in control group (P<0.05). Conclusion Early rehabilitation nursing care is effective to the rapid functional recovery for patients with thoracolumbar bursting fracture after internal fixation, and improves the nursing satisfaction.

目的 探讨动力髋螺钉(dynamic hip screws,DHS)内固定与股骨近端解剖钢板在不同类型股骨粗隆间骨折中的应用价值。方法 研究对象取自于我院2013年11月—2014年11月收治的76例不同类型股骨粗隆间骨折患者,按随机数字表法分为对照组与观察组。对照组采用DHS内固定治疗;观察组用股骨近端解剖钢板治疗。统计两组患者手术时间等手术指标,记录并发症发生情况,随访6个月调查患者骨折愈合优良率。结果 观察组手术时间、术中出血量及术中输血量[(83.6±13.8)min、(236.5±27.3)mL和(208.3±86.6)mL]均优于对照组(P<0.05);较对照组,观察组术后并发症发生率13.2%低,骨折愈合优良率81.5%高,两组比较差异有统计学意义(P<0.05)。结论 为确保获得理想治疗效果,临床应结合股骨粗隆间骨折患者的骨折类型选择合适方法。股骨近端解剖钢板手术时间短、术中出血量少,术后并发症发生率低,优势更明显。

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 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.

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.