目的 分析基于叙事护理理论的心理干预在突发创伤下肢骨折患者中的应用价值。方法 选择南方医科大学深圳医院2023年4月—2023年10月收治的100例突发创伤下肢骨折患者,根据随机数字表法将患者分为研究组和对照组,各50例。对照组提供常规心理护理和健康教育,研究组在对照组的基础上增加基于叙事护理理论的心理干预。对比两情绪压力量表和创伤后成长情况、康复依从性。结果 研究组的情绪压力评分维度中抑郁和焦虑及压力评分明显低于对照组（P<0.05）;研究组的创伤相关评分维度中与他人的关系、新的可能性和个人力量、生活的欣赏和精神变化评分高于对照组,康复依从性高于对照组（P<0.05）。结论 基于叙事护理理论的心理干预,可缓解突发创伤下肢骨折患者的心理压力,提高康复依从性,促进早日康复。

Objective To analyze the application value of psychological intervention based on narrative nursing theory in patients with sudden traumatic lower extremity fracture．Methods A total of 100 patients with sudden traumatic lower extremity fracture admitted to Shenzhen Hospital of Southern Medical University from April 2023 to October 2023 were selected and divided into study group and control group with 50 cases in each group by random number table method．The control group received routine psychological nursing and health education,and the study group was added psychological intervention based on narrative nursing theory．The two emotional stress scales were compared with post-traumatic growth and rehabilitation compliance．Results The scores of depression,anxiety and stress in the study group were significantly lower than those in the control group（P<0.05）．The trauma-related scores of the study group were significantly higher than those of the control group in relation to others,new possibilities and personal strength,appreciation of life and spiritual changes,and the rehabilitation compliance was significantly higher than that of the control group（P<0.05）．Conclusions Psychological intervention based on narrative nursing theory can relieve psychological pressure of patients with sudden traumatic lower extremity fracture,improve rehabilitation compliance,and promote early recovery．

目的 分析血红蛋白水平对上肢骨折患者深静脉血栓形成(DVT)的影响。方法 采用回顾性分析法,对2018年1月—2021年6月期间来我院进行治疗的386例上肢骨折患者展开研究,依据患者是否发生DVT分为DVT组(n=114)和对照组(n=272)。对2组患者的各项一般资料和临床资料进行比较,对有统计学意义的因素进一步行Logistic多因素回归分析,探究上肢骨折患者发生DVT的危险因素,并Pearson分析血红蛋白水平与各危险因素的相关性。结果 与对照组相比,DVT组患者为女性、年龄＞60岁、体质量指数(BMI)＞25 kg/m²、冠状动脉粥样硬化性心脏病、糖尿病、合并其他骨折、受伤至超声检查时间≥3 d、受伤至手术时间＞5 d、纤维蛋白降解产物(FDP)≥35 mg/L、凝血酶时间(TT)≥17 s、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L、全身麻醉、术后住院时间＜7 d的发生率升高,差异有统计学意义(P＜0.05)。Logistic多因素回归分析显示,年龄＞60岁、BMI＞25 kg/m²、受伤至手术时间＞5 d、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L是上肢骨折患者发生DVT的危险因素(P＜0.05)。上肢骨折患者的血红蛋白水平与年龄、BMI、受伤至手术时间、血小板计数/血红蛋白比值、血糖水平呈现负相关(P＜0.05)。结论 血红蛋白≤120 g/L是上肢骨折患者发生DVT的危险因素,与DVT的发生存在相关性。

Objective To analyze the influence of hemoglobin level on deep vein thrombosis (DVT) in patients with upper extremity fractures. Methods A retrospective study of 386 upper extremity fracture patients who came to our hospital for treatment from January 2018 to June 2021 was carried out.According to whether the patients had DVT or not, they were divided into DVT group (n=114) and control group (n=272).The general data and clinical data of the two groups were compared, and the statistically significant factors were further analyzed by Logistic multivariate regression analysis to explore the risk factors of DVT in patients with upper limb fractures, and analyzed the hemoglobin level and the risk factors correlation by Pearson. Results Compared with the control group, the DVT group had increased incidence in female, age >60 years old, body mass index (BMI) >25 kg/m², coronary heart disease, diabetes mellitus, other fractures, injury to ultrasonic time ≥3 days, injury to operation time >5 days, fibrin degradation products (FDP) ≥35 mg/L, thrombin time (TT) ≥ 17 s, hemoglobin ≤120 g / L, platelet count / hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L, general anesthesia and postoperative hospital stay <7 days, and the difference was significant (P<0.05).Logistic multivariate regression analysis showed that age>60, BMI>25 kg/m², time from injury to operation>5 days, hemoglobin≤120 g/L, platelet count/hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L were the risk factors of DVT in patients with upper extremity fractures (P<0.05).The hemoglobin level of those patients was negatively correlated with age, BMI, time from injury to operation, platelet count/hemoglobin ratio and blood glucose level (P<0.05). Conclusions Hemoglobin ≤120 g/L was a risk factor for DVT in patients with upper extremity fractures, and it was related to the occurrence of DVT.

目的 探讨柳州市老年骨质疏松性骨折（OPF）现状及其发生的危险因素。方法 回顾性分析2018年1月—2020年12月柳州市工人医院创伤中心收治的5 235例60周岁及以上老年OPF患者的临床资料,并从中随机抽取300例老年OPF患者临床资料作为研究组;选取同时期接诊的老年骨质疏松未骨折的300例患者临床资料作为对照组,通过医院病案管理系统,详细收集2组患者各项临床资料,分析柳州市老年OPF现状及危险因素。结果 5 235例老年OPF患者中,以胸腰椎压缩性骨折占比最高58.19%、其次为股骨颈骨折15.42%;60~74岁年龄段患者以胸腰椎压缩性骨折占比最高77.03%,75~89年龄段患者股骨颈骨折、粗隆间骨折占比均较高分别为43.36%、41.34%,≥90岁患者粗隆间骨折占比最高49.25%;男性、女性均以胸腰椎压缩性骨折占比较高,分别为46.34%、62.47%。经单因素/多因素分析显示,年龄、性别、体质量指数（BMI）、跌倒史、骨折史、骨密度（BMD）、糖尿病、不良生活习惯为老年OPF发生的独立危险因素（P<0.05）。结论 胸腰椎压缩性骨折是柳州市老年OP患者骨折的主要类型;老年OPF的发生与年龄、性别、BMI、跌倒史、骨折史、BMD 、糖尿病、不良生活习惯等因素有关,应采取积极预防措施,降低OPF的发生风险。

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．

目的 探讨磁共振成像（MRI）技术在膝关节隐匿性骨折临床诊断中的应用价值。方法 从我院2020年7月—2022年7月期间接诊的膝关节隐匿性骨折病例中随机抽取78例作为研究对象,所有病例均开展MRI、CT检查,分析并比较MRI和CT检查对该病变的检出率。结果 在78例膝关节隐匿性骨折病例中,MRI检查确诊76例,检出率97.44%,CT检查确诊61例,检出率78.21%,MRI检查对该疾病的检出率相比CT检查更高,差异有统计学意义（P<0.05）。MRI对半月板损伤、关节腔少量积液、韧带损伤、骨折塌陷及水平错位检出率相比CT更高,差异有统计学意义（P<0.05）,两种检查方式在严重骨折检出率差异较小,差异无统计学意义（P>0.05）。结论 在膝关节隐匿性骨折的临床诊断中应用MRI对疾病检出率较高,且操作简便,在临床中具有较高的推广价值。

Objective To investigate the application value of magnetic resonance imaging(MRI)in the clinical diagnosis of occult knee fractures. Methods A total of 78 cases of occult knee fracture received by our hospital from July 2020 to July 2022 were randomly selected as research subjects,and MRI and CT examinations were performed on all cases,and the detection rates of MRI and CT examination were analyzed and compared. Results Among the 78 cases of occult knee fracture,76 cases were confirmed by MRI examination,with a detection rate of 97. 44%,and 61 cases by CT examination,with a detection rate of 78. 21%,and the detection rate of MRI examination for this disease was higher than that of CT examination,and the difference was statistically significant(P<0. 05). MRI had higher detection rate of meniscal injury,small effusion in the joint cavity,ligament injury,fracture collapse and horizontal misalignment than CT(P<0. 05),and the difference in the detection rate of severe fractures was small and not statistically significant(P>0. 05). Conclusions The application of MRI in the clinical diagnosis of occult knee fracture has a high disease detection rate and simple operation,and has high promotion value in clinical practice.

目的 探讨老年髋部骨折（GHF）患者围术期隐性失血的影响因素及护理措施。方法 回顾性分析2020年3月—2023年3月我院收治的86例老年GHF患者,所有患者均采取手术治疗,计算所有患者围术期失血量,并收集所有患者的一般资料及围术期相关治疗情况,分析不同一般资料患者围术期隐性失血情况,不同手术方式及麻醉方式围术期隐性失血情况,不同术后处理方式围术期隐性失血情况,随后采取Logistic回归分析老年GHF患者围术期隐性失血的影响因素,最后针对结果制定老年GHF隐性失血的护理措施。结果 不同性别和是否合并冠状动脉粥样硬化、高血压患者围术期隐性失血量比较差异无统计学意义（P>0.05）,不同年龄、合并糖尿病、骨折类型患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同手术方式、麻醉方式患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同术后引流、使用肝素情况患者围术期隐性失血量比较差异有统计学意义（P<0.05）;Logistic回归分析结果表明：年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素都是造成GHF老年患者围术期隐性失血的影响因素（P<0.05）。患者经相关护理后,恢复较佳。结论 老年GHF患者围术期会存在大量隐性失血情况,同时年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素与围术期隐性失血量密切相关,临床上可采取针对性措施减少GHF患者隐性失血。

Objective To explore the influencing factors and nursing measures of perioperative hidden blood loss in elderly patients with geriatric hip fractures（GHF）．Methods From March 2020 to March 2023,86 elderly patients with GHF admitted to our hospital were selected as the study objects for retrospective analysis．All patients were treated with surgery．The perioperative blood loss of all patients was calculated,general information and perioperative treatment status of all patients were collected,the hidden blood loss of patients with different general information,different surgical and anesthesia methods and different postoperative treatment methods were analyzed．Logistic regression analysis was used to analyze the influencing factors of hidden blood loss of elderly GHF patients during the perioperative period．Nursing measures for hidden blood loss in elderly hip fractures were developed based on the results．Results There was no statistical difference in the amount of perioperative hidden blood loss among patients with different gender,complicated with coronary heart disease and hypertension or not（P>0.05）,but there was statistical difference in the amount of perioperative hidden blood loss among patients with different ages,complicated with diabetes and fracture types（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different surgical and anesthesia methods（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different postoperative drainage and use of heparin（P<0.05）．The results of Logistic regression analysis showed that age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use were independent risk factors for perioperative hidden blood loss in elderly patients with GHF（P<0.05）．Conclusions There will be a lot of hidden blood loss in the perioperative period of elderly patients with GHF．At the same time,age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use are closely related to the amount of hidden blood loss in the perioperative period．Targeted measures can be taken clinically to reduce the hidden blood loss in patients with GHF．

目的 探讨补肾活血汤在骨质疏松性股骨颈骨折(FNF)术后愈合的应用效果,旨在为临床治疗提供参考依据。方法 选取濮阳市中医医院2019年1月—2020年1月收治的骨质疏松性FNF患者76例,依据双盲法分为观察组(38例)与对照组(38例),2组均行手术治疗,对照组术后予以常规治疗与康复训练,观察组加用补肾活血汤治疗,以30 d作为1个疗程,持续治疗3个疗程。对比2组临床疗效与术前、术后6个月骨密度值及Harris评分以及术后6个月期间并发症发生情况。结果 相较对照组,观察组临床总有效率较高,差异有统计学意义(P＜0.05);比较2组术前骨密度值无差异(P＞0.05);较术前,术后6个月2组骨密度值均上升,且观察组骨密度值较高,差异有统计学意义(P＜0.05);2组术前Harris评分对比无差异(P＞0.05);较术前,术后6个月2组Harris评分均上升,且观察组Harris评分较高,差异有统计学意义(P＜0.05);2组并发症发生率对比无差异(P＞0.05)。结论 骨质疏松性FNF患者采用补肾活血汤治疗可提升临床疗效,增加骨折处骨密度值并改善髋关节功能,促进术后愈合,值得临床推广。

目的 探究在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗的临床疗效,并对其进行探讨与分析。方法 随机选取2019年1月—2021年1月于我院骨科治疗的胸腰段椎体成形术椎再骨折患者58例作为研究对象。给予患者后路椎体次全切治疗,记录患者的手术时间及术中出血量,对比手术前以及手术后6个月患者的VAS疼痛评分、后凸Cobb角、椎体高度、椎管容积率以及美国脊柱损伤协会(ASIA)损伤分级。结果 患者的手术时间为1.4～3.8 h,手术平均时间为(2.45±0.61)h,患者术中出血量为580～1 470 mL,术中平均出血量为(835.48±134.75)mL。手术后6个月患者的VAS疼痛评分低于手术前(P＜0.05);手术后6个月患者的后凸Cobb角小于手术前(P＜0.05);手术后6个月患者的椎体高度和椎管容积率均大于手术前(P＜0.05);患者手术前ASIA损伤分级: A级12例、B级14例、C级16例、D级12例、E级4例;患者手术后6个月ASIA损伤分级:A级5例、B级8例、C级13例、D级15例、E级17例。结论 在胸腰段椎体成形术椎再骨折患者中采用后路椎体次全切治疗可缓解患者的疼痛感,减小后凸Cobb角,增大椎体高度和椎管容积率以及改善患者的ASIA损伤分级。

Objective To investigate the clinical efficacy of posterior subtotal vertebral dissection in patients with vertebral re-fractures of thoracolumbar segmental vertebroplasty. Methods Fifty-eight patients with thoracolumbar segmental vertebroplasty vertebral re-fractures treated in the orthopedic department of our hospital from January 2019 to January 2021 were randomly selected as study subjects.The patients were treated with posterior subtotal vertebral dissection, and the operating time and intraoperative bleeding of the patients were recorded, and the VAS pain score, posterior convex Cobb angle, vertebral body height, spinal canal volume ratio, and American Spinal Injury Association (ASIA) injury classification were compared in patients before and 6 months after surgery. Results The operating time was 1.4-3.8 hours, with a mean of (2.45±0.61) hours, and the intraoperative bleeding was 580-1470 mL, with a mean of (835.48±134.75) mL.The VAS pain scores at 6 months after surgery were lower than those before surgery (P<0.05); the posterior convex Cobb angle at 6 months after surgery was smaller than that before surgery (P<0.05); the vertebral body height and spinal canal volume ratio at 6 months after surgery were greater than those before surgery (P<0.05). Preoperative ASIA injury grading: 12 cases with grade A, 14 cases with grade B, 16 cases with grade C, 12 cases with grade D and 4 cases with grade E; six months after surgery, 5 cases with grade A, 8 cases with grade B, 13 cases with grade C, 15 cases with grade D, and 17 cases with grade E. Conclusion Posterior subtotal vertebral body resection could relieve pain of thoracolumbar vertebroplasty fractures, reduce the posterior convex Cobb angle, increase vertebral body height and spinal canal volume, and improve ASIA injury classification.

目的 探究空心加压螺钉(CCS)和股骨颈系统(FNS)两种不同的内固定方法治疗60岁以下患者股骨颈骨折的疗效。方法 回顾性研究2018年1月—2019年9月期间在我院接受内固定手术治疗的100例股骨颈骨折患者,根据内固定方式不同,分为FNS组(观察组)和CCS组(对照组),比较2组患者的术后并发症、围手术期特征;并在手术前和手术后1年使用Harris髋关节评分(HHS)评估关节功能。结果 2组患者中,观察组的手术时间和围手术期出血量均大于对照组(P<0.05);术后观察组的骨愈合时间低于对照组,且观察组股骨颈短缩程度也低于对照组(P<0.05);观察组螺钉切除发生率以及术后并发症总发生率均低于对照组(P<0.05)。结论 年龄小于60岁的股骨颈骨折患者通过CCS或FNS治疗可以获得满意的临床效果。 FNS 具有优异的生物力学性能,并显示出更高的整体结构稳定性。

Objective To explore the curative effect of two different internal fixation methods, cannulated compression screw (CCS) and femoral neck system (FNS), in the treatment of femoral neck fractures in patients under 60 years old. Methods Retrospectively studied 100 patients with femoral neck fractures who underwent internal fixation surgery in our hospital from January 2018 to September 2019. According to different internal fixation methods, they were divided into FNS group (observation group) and CCS group (control group). The postoperative complications and perioperative characteristics of the two groups of patients were compared, and the Harris Hip Score (HHS) was used to assess joint function before and 1 year after the operation. Results In the two groups of patients, the operation time and perioperative blood loss of the observation group were more than those of the control group (P<0.05); the bone healing time of the observation group was shorter than that of the control group, and the degree of femoral neck shortening in the observation group was also lower than the control group (P<0.05); the incidence of screw resection and the total incidence of postoperative complications in the observation group were lower than those in the control group (P<0.05). Conclusions Patients with femoral neck fractures under 60 years old could obtain satisfactory clinical results through CCS or FNS treatment. FNS had excellent biomechanical properties and showed significantly higher overall structural stability.

目的 探究合并下胫腓联合韧带损伤的踝关节骨折患者实施手术固定治疗的临床价值。方法 遴选2018年1月—2020年12月70例合并下胫腓作者联合韧带损伤的踝关节骨折患者,根据随机数字表法分2组,开展石膏外固定治疗35例(记对照组),开展手术内固定治疗35例(记观察组),评估2组治疗优良率、治疗康复情况、踝关节功能(Kofoed评分)以及日常生活能力(ADL评分)、术后并发症率。结果 观察组治疗优良率94.29%相较对照组77.14%更高(P＜0.05);观察组康复速率更快,二次手术率更低(P＜0.05);术前2组Kofoed评分、ADL评分比较,均无统计学差异(P＞0.05),术后观察组Kofoed评分、ADL评分较对照组更高(P＜0.05);观察组术后并发症率低于对照组(P＜0.05)。结论 对合并下胫腓联合韧带损伤的踝关节骨折患者开展实施手术内固定治疗,对骨折早期愈合及修复韧带损伤具有显著价值,降低二次手术率及控制术后并发风险,促进关节功能早日恢复,实现理想的临床疗效。

Objective To explore the clinical value of surgical fixation in patients with ankle fracture with lower tibiofibular syndesmosis injury.Methods A total of 70 patients with ankle fracture and lower tibiofibular syndesmosis injury from January 2018 to December 2020 were selected and divided into two groups according to the random number table method.Thirty-five cases were treated with external plaster fixation (control group) and 35 cases were treated with internal surgical fixation (observation group).The treatment and rehabilitation outcomes,ankle function (Kofoed score) and ability of daily living (ADL score),postoperative complication incidence rate of the two groups were evaluated.Results The effective rates of treatment were 94.29% and 77.14% in observation group and control group (P＜0.05).The observation group has a faster recovery rate and a lower rate of secondary operations (P＜0.05).There were no significant difference in Kofoed score and ADL score between the two groups before operation (P>0.05).After operation,the Kofoed score and ADL score in the observation group were significantly higher than those in the control group (P<0.05). The postoperative complication incidence in the observation group was significantly lower than that in the control group (P<0.05).Conclusions The implementation of internal surgical fixation in patients with ankle fracture and lower tibiofibular syndesmosis injury had significant value for early fracture healing and ligament injury repair,reduced the secondary operation rate and controlling the postoperative complication risk,promoted the early recovery of joint function and achieved ideal clinical effect.