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 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 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.

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．