Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Epidemiological and Clinical Pattern of Open Fractures of Long Bones of the Lower Limbs in the South-West Region of Cameroon: A 5-Year Review

Background: An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and leads to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. Methodology: This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1st of January 2015 to the 31st of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. Results: A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20 - 40 years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%), the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include: 20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P = 0.02). Conclusion: Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.

The Effects of Absorbable Materials in the Treatment for Non-Weight-Bearing Bone Fractures of Extremities

Objective:To study the effects of absorbable materials in non-weight-bearing bone fractures of extremities.Methods:After 66 patients with nonweight-bearing bone fractures of extremities were selected,absorbable materials were used in the observation group and metal materials were used in the control group.Results:After treatment,the bone healing in the observation group was significantly improved(P<0.05).Conclusion:the application of absorbable materials in non-weight-bearing bone fractures of extremities is effective.

Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction

BACKGROUND Lower extremity fractures are mainly treated by surgical reduction,but this operation is often affected by the patient’s level of agitation and the type of anesthesia used.The main treatment for lower-extremity fractures is operative reduction.However,operations can often be affected by both agitation and the degree of anesthesia.Therefore,it is of great importance to develop an effective anesthesia program to effectively ensure the progress of surgery.AIM To discuss the effect of ultrasound-guided nerve block combined with dexmedetomidine anesthesia in lower extremity fracture surgery.METHODS A total of 120 hospital patients with lower extremity fractures were selected for this retrospective study and divided into an observation group(n=60)and a control group(n=60)according to the anesthesia scheme;the control group received ultrasound-guided nerve block;the observation group was treated with dextromethomidine on the basis of the control group,and the mean arterial pressure,heart rate(HR),and blood oxygen saturation were observed in the two groups.RESULTS The mean arterial pressure of T1,T2 and T3 in the observation group were 94.40±7.10,90.84±7.21 and 91.03±6.84 mmHg,significantly higher than that of the control group(P<0.05).The observation group’s HR at T1 was 76.60±7.52 times/min,significantly lower than that of the control group(P<0.05);The observation group’s HR at T2 and T3 was 75.40±8.03 times/min and 76.64±7.11 times/min,significantly higher than that of the control group(P<0.05).The observation group’s visual analog score at 2 h,6 h and 12 h after operation was 3.55±0.87,2.84±0.65 and 2.05±0.40.the recovery time was 15.51±4.21 min,significantly lower than that of the control group(P<0.05).Six hours post-anesthesia,epinephrine and norepinephrine in the observation group were 81.10±21.19 pg/mL and 510.20±98.27 pg/mL,significantly lower than that of the control group(P<0.05),and the mini-mental state exam score of the observation group was 25.51±1.15,significantly higher than that in the control group(P<0.05).CONCLUSION Ultrasound-guided nerve block combined with dexmedetomidine has a good anesthetic effect in the operation of lower limb fractures and has little effect on the hemodynamics of patients.

Tackling bone loss of the lower extremity:vascularized bone grafting

Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Surgical treatment of metastatic bone disease of the distal extremities

Metastatic bone disease of the distal extremities,also known as acrometastasis,is very rare.Thus,there is very limited information regarding the clinical manifestations and methods of surgical treatment.The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival.As metastatic bone disease is generally uncurable,the goal of surgical treatment is to provide the patient with good function with as few complications as possible.In this article,we discuss the clinical manifestation of acrometastases,the methods of surgical intervention,and the expected clinical outcome.Non-surgically managed pathological fractures generally remain ununited;therefore,conservative treatment is reserved for patients with poor general condition or dismal prognosis.The current evidence suggests that in lesions of the lower arm and leg,osteosynthesis(plate and screw fixation or intramedullary nail)is the most common method of reconstruction,whereas local excision or amputation are more commonly used in cases of more distal lesions(such as ankle,foot and hand).Following surgery most patients receive adjuvant radiotherapy,even though its role is poorly documented.Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome.Further studies are needed in order to provide stronger clinical evidence and improve decision-making,in an effort to optimize the patients’quality of life and avoid the need for revision surgery.

Virtual Reconstruction of Long Bone Fracture in Car-to-pedestrian Collisions Using Multi-body System and Finite Element Method

Lower limb injures are frequently observed in passenger car traffic accidents.Previous studies of the injuries focus on long bone fractures by using either cadaver component tests or simulations of the long bone kinematics,which lack in-depth study on the fractures in stress analysis.This paper aims to investigate lower limb impact biomechanics in real-world car to pedestrian accidents and to predict fractures of long bones in term of stress parameter for femur,tibia,and fibula.For the above purposes,a 3D finite element(FE) model of human body lower limb(HBM-LL) is developed based on human anatomy.The model consists of the pelvis,femur,tibia,fibula,patella,foot bones,primary tendons,knee joint capsule,meniscus,and ligaments.The FE model is validated by comparing the results from a lateral impact between simulations and tests with cadaver lower limb specimens.Two real-world accidents are selected from an in-depth accident database with detailed information about the accident scene,car impact speed,damage to the car,and pedestrian injuries.Multi-body system(MBS) models are used to reconstruct the kinematics of the pedestrians in the two accidents and the impact conditions are calculated for initial impact velocity and orientations of the car and pedestrian during the collision.The FE model is used to perform injury reconstructions and predict the fractures by using physical parameters,such as von Mises stress of long bones.The calculated failure level of the long bones is correlated with the injury outcomes observed from the two accident cases.The reconstruction result shows that the HBM-LL FE model has acceptable biofidelity and can be applied to predict the risk of long bone fractures.This study provides an efficient methodology to investigate the long bone fracture suffered from vehicle traffic collisions.

The evolution of lower extremity reconstruction

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century.Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection.The introduction of antibiotics improved surgical debridement and local reconstructive options,enhancing the viability of lower extremities with simple and proximal defects.With the advent of microvascular surgery,free tissue transfer techniques provided a means to reconstruct more distal and complex problems.As these surgical techniques have continued to evolve,so too have indications for reconstruction,patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function.The purpose of this article is to outline the evolution of lower extremity reconstruction,and how the standard of practice has changed over time.

Ankle fusion with a retrograde locked intramedullary nai for sequela of lower extremity compartment syndrome

Objective： To assess the value of ankle fusion with a retrograde locked intramedullary nail in the treatment of sequela of lower extremity compartment syndrome. Methods： Thirty-five cases ofequinus deformity follow- ing tibiofibular compartment syndrome treated by means of ankle fusion with a retrograde locked intramedullary nail from January 2001 to December 2010 were retrospectively reviewed. The complications, the time needed for bony fu- sion of the ankle joint assessed by anteroposterior and lateral X-ray photographs as well as patients＇ subjective evalua- tion were recorded and analysed. Results： Among the 35 patients, 15 had previously undergone surgical treatment twice on the same limb, 13 had thrice and 7 had to be operated on four times before ankle fusion. An anterior midpoint approach to the ankle joint was adopted in 29 cases, while anterior midpoint ap- proach plus a small incision on the posterior ankle joint was made in 17 cases, whereas lateral approach in 6 cases. Tar- sus joint fusion was performed on 4 cases. The follow-up period ranged 6-124 months, averaged 40.6 months. Bone grafting was not performed in this series. Preoperative tibial shaft fracture occurred in one patient and was healed after conservative treatment. Incision dehiscence located at pre- vious Achilles tendon incision was found in two patients. As a result, one received an intramedullary nail emplace- ment at calcaneoplantar part while the wound at anterosuperior part of the other one was healed by dressing change. Two patients failed to bony union 5 months postoperatively, in which one healed 10 weeks after retrieval of proximal tibial nail and another by iliac grafting. Terminal necrosis of the toe due to blood supply dysfunction was not found in this series. All the patients were satisfied with the ankle joint function postoperatively. The time for bony union on X-rays was 9.8 weeks on average. Except for one patient who demanded removal of intramedullary nail, all the intramedullary nails were not retrieved at the end of follow-up. Nail breakage happened in one patient and no other breakage or backing out of the nail was found. Conclusions： Lower extremity compartment syndrome and residual ankle deformity often extremely impact ambulation and are hard to deal with because several patho- logic phenomena might exist in these patients, for instance, poor skin conditions due to repeated preexisting surgery; poor perfusion in distal limbs following blood vascular injury; reflux limitation and long-term limb swelling due to muscle strength disturbance; osteoporosis as a result of long-term immobilization or limb disuse. Ankle fusion with a retro- grade locked intramedullary nail is an optimal protocol to solve these clinical symptoms and rather ensures a definite fusion and firm fixation to these patients with simple ma- nipulation and few complications.

Extremity fractures in children： a hospital based study in Tehran

Objective： Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children. Methods： During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children （≤16 years old） hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively. Results： During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/ 1, with the mean age of （10.3±4.2） years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3 % and 37.1%, respectively. Simple fall （falling on the ground） consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site （34.1%）. Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children. Conclusions： Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools＇ injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

Influence of the intelligent standing mobile robot on lower extremity physiology of complete spinal cord injury patients

Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applicability and the effect of robots in patients with complete injury.Objective:The current study aims to assess the efficacy of robots training on the lower extremity physiology in complete SCI patients.Methods:24 patients were recruited and randomly divided into experimental and control group.The two groups spent the same amount of time on regular training.Besides,a 1-h standing training twice daily was offered to both groups five days per week,for four weeks.The experimental group used robot for standing training,while the control group used standing frame.Before and after the experiment,muscle girth and bone mineral density(BMD)were measured as lower extremity physiology.Results:The experimental group showed increased muscle girth differences(left=0.08±0.40 cm,right=0.75±0.72 cm),while the control group showed decreased girth differences(left=-0.78±0.54 cm,right=-0.56±0.54 cm).The increases in the experimental group showed significant differences compared with the control group(left,P=0.0002;right,P=0.023).Both groups showed decreased BMD.The decreases in the experimental group were significantly smaller than those in the control group.Conclusions:Training with aid of robots combined with the regular rehabilitation treatment can benefit complete SCI patients,in aspect of postponing amyotrophy of lower extremities and reducing bone loss and osteoporosis.

Clinicopathological features and treatment of extremity bone metastasis in patients with endometrial carcinoma： a case report and review

Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.

基于诺莫图构建髋部骨折患者发生下肢深静脉血栓的预测模型

目的探讨髋部骨折患者发生下肢深静脉血栓(DVT)的独立危险因素,并构建和验证列线图模型。方法选择2020年1月至2023年6月佛山市中医院骨科收治的髋部骨折患者227例为研究对象,按照7∶3比例将患者分为建模组(n=159)和验证组(n=68)。收集患者的临床资料,采用LASSO回归和Logistic回归筛选髋部骨折患者发生DVT的独立危险因素,建立风险预测模型和列线图。采用一致性指数(C-index)、校准曲线、受试者工作特征(ROC)曲线进行评价。结果建模组159例髋部骨折中发生DVT 33例,发生率为20.89%。LASSO回归结合多因素Logistic回归分析结果显示,年龄≥70岁、糖尿病、受伤至手术时间≥5 d、低蛋白血症、D-二聚体>0.5是髋部骨折患者发生DVT的独立危险因素。基于上述危险因素绘制列线图模型,将上述5个危险因素构建列线图模型,模型区分度良好(C-index=0.932);Hosmer-Lemeshow检验显示,列线图的拟合优度良好(χ^(2)=57.625,P=0.732)。建模组和验证组发生DVT的ROC曲线下面积分别为0.932、0.821,模型准确度高。结论年龄≥70岁、糖尿病、受伤至手术时间≥5 d、低蛋白血症、D-二聚体>0.5是髋部骨折患者发生DVT的独立危险因素,基于上述因子构建的列线图模型可有效预测髋部骨折患者发生DVT的风险。

利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果分析

目的分析利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果。方法选取2020年6月至2021年10月于厦门大学附属中山医院就诊的老年粗隆间骨折围手术期患者130例为研究对象。按随机数字表法分为观察组和对照组,每组65例。对照组采用低分子肝素皮下注射预防血栓,观察组采用利伐沙班口服预防血栓。比较2组患者术前及术后2周的凝血指标,术后2周内下肢深静脉血栓形成(DVT)和肺栓塞的发生率,术中出血量、术后引流量及住院时间,术后1 d炎症相关指标。结果2组患者术前、术后2周组间和组内凝血相关指标差异均无统计学意义(均P>0.05)。术后观察组下肢DVT发生率显著低于对照组[4.6%(3/65)比15.4%(10/65)],差异有统计学意义(χ^(2)=4.188,P=0.041)。观察组与对照组术中出血量、术后引流量及住院时间差异均无统计学意义(均P>0.05)。术后1 d观察组降钙素原和C反应蛋白水平显著低于对照组[(0.17±0.02)μg/L比(0.22±0.01)μg/L、(20.2±2.3)mg/L比(23.9±3.6)mg/L],差异均有统计学意义(均P<0.001)。结论利伐沙班与低分子肝素在老年粗隆间骨折患者围手术期均有良好的抗凝效果及安全性,但利伐沙班预防术后下肢DVT发生的效果更显著且口服用药更方便。

Management of limb fractures in a teaching hospital： comparison between Wenchuan and Yushu earthquakes

Objective： To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods： We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital （WCH） of Sichuan University. Results： In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day （PED） 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out- side the Sichuan Province. In Yushu earthquake, the maxi- mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 （396/942, 42.0%） open limb fractures, includ- ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower （6/61, 9.8%）. The percent of patients with acute complications in Wenchuan earthquake （167/891,18.7%） was much higher than that in Yushu earthquake （5/53, 3.8%）. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur- vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion： Provision of suitable and sufficient medi- cal care in a catastrophe can only be achieved by construc- tion of sophisticated national disaster medical system, pre- diction of the injury types and number of injuries, and con- flrmation of participating hospitals＇ exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.

个体化3D打印技术联合心理干预在下肢创伤骨折手术患者中的应用效果

目的:探讨基于医工结合背景下个体化3D打印技术联合心理干预,在改善下肢创伤骨折手术患者情绪状态的影响效果。方法:选取在唐山市第二医院住院治疗的下肢创伤性骨折手术患者为研究对象。将2022年1-6月住院的患者45例作为对照组,采用传统常规方式进行健康宣教;选取2022年7-12月住院的患者47例为研究组,采用医工结合背景下3D打印技术联合心理干预进行干预,比较两组患者入院时和出院时的焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分差异,比较两组患者存在焦虑状态和抑郁状态差异,比较两组患者依从性(包括健康教育掌握情况、配合治疗护理)和对护理工作满意度的差异。结果:①两组患者入院时焦虑和抑郁情绪没有显著差异,但在出院时研究组的SAS评分和SDS评分与对照组有显著差异(F=111.216,54.172;P<0.01),且实验组的焦虑和抑郁显著低于对照组,差异具有统计学意义(P<0.05);②两组患者的依从性和满意度存在显著性差异,差异均具有统计学意义(χ^(2)=5.520,7.723;P<0.05)。结论:医工结合背景下之3D打印技术联合心理干预可有效减轻下肢创伤骨折患者的焦虑、抑郁情绪,提升患者的依从性和满意度。

早期康复干预对下肢骨折患者发生下肢深静脉血栓的预防价值

目的探讨早期康复干预对下肢骨折患者发生下肢深静脉血栓(DVT)的预防价值。方法收集2021年2月至2023年5月安徽医科大学附属宿州医院收治的180例下肢骨折患者的临床资料,按照住院期间是否接受了早期康复干预将患者分为观察组(于术后当天启动早期康复干预)和对照组(于术后3 d后启动康复干预),每组90例。比较两组患者的骨折情况、手术相关指标和住院结局。结果两组患者骨折部位、骨折下肢、骨折性质和手术相关指标比较,差异均无统计学意义(P﹥0.05)。术后住院期间,共9例(5.0%)患者发生下肢DVT,其中,观察组患者的下肢DVT发生率低于对照组患者,术后卧床时间短于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者轻微出血事件的发生率、院内感染的发生率以及术后72 h伤口或切口视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P﹥0.05)。结论早期康复干预可以降低下肢骨折患者发生下肢DVT的风险,缩短卧床时间,并且不会增加术后疼痛感和轻微出血的发生风险,具有降低术后感染风险的趋势。

小剂量罗哌卡因复合羟考酮用于老年下肢骨折手术麻醉中的效果探讨

目的探讨小剂量罗哌卡因复合羟考酮应用于老年下肢骨折手术麻醉中的效果。方法回顾性分析接受下肢骨折手术治疗的80例老年患者的临床资料,按麻醉方式不同分为对照组及观察组,每组40例。对照组采用常规剂量罗哌卡因麻醉,观察组采用小剂量罗哌卡因复合羟考酮麻醉。比较两组患者的血流动力学指标(收缩压、舒张压、心率)变化情况,麻醉质量,术后疼痛情况,不良反应发生情况。结果麻醉后5、30 min,两组收缩压、舒张压、心率水平均下降,但观察组的收缩压、舒张压、心率水平高于对照组,变化幅度小于对照组(P<0.05)。观察组麻醉优良率为95.00%(38/40),对照组为97.50%(39/40),对比差异不显著(P>0.05)。观察组术后2、6 h疼痛数字评分法(NRS)评分分别为(2.82±0.52)、(3.37±0.44)分,低于对照组的(3.58±0.54)、(4.10±0.51)分(P<0.05);两组术后12 h NRS评分对比,差异不显著(P>0.05)。观察组不良反应发生率为10.00%(4/40),低于对照组的25.00%(10/40),但组间对比差异不显著(P>0.05)。结论小剂量罗哌卡因复合羟考酮应用于老年下肢骨折手术中取得了良好的麻醉效果,能维持血流动力学的稳定,提升术后镇痛效果,并且有良好的安全性。

动态四点跪位训练对脊髓损伤患者髋关节骨密度及下肢运动功能的影响

目的:探讨脊髓损伤患者进行动态四点跪位训练对髋关节骨密度及下肢运动功能的影响。方法:采用前瞻性随机对照研究方法,选取2019年1月至2022年1月收治的80例脊髓损伤患者,采用随机数字表法分为对照组与观察组各40例,对照组采用常规康复训练+直立床训练,观察组采用常规康复训练+动态四点跪位训练,两组均连续干预12周。干预前及干预4周、8周、12周时,分别记录髋关节骨密度、下肢臀大肌及腘绳肌肌电信号、感觉评分、下肢运动功能评分(LEMS),股四头肌、臀大肌及腘绳肌的肌张力(改良Ashworth分级)和肌力,并统计两组不良事件(体位性低血压、膝关节疼痛、摩擦伤、跌倒)发生情况。结果:干预4周、8周、12周时,两组髋关节骨密度T-值均低于干预前,观察组高于对照组(P<0.05);干预4周、8周、12周时,两组表面肌电信号积分肌电值及LEMS均高于干预前,且观察组高于对照组(P<0.05);干预前及干预4周、8周、12周时,两组感觉评分差异无统计学意义(P>0.05);干预4周、8周、12周时,观察组肌张力低于对照组(P<0.05),肌力高于对照组(P<0.05);两组不良事件发生率比较差异无统计学意义(P>0.05)。结论:动态四点跪位训练可以在部分负重下通过动态训练刺激髋关节周围肌肉收缩以延缓脊髓损伤患者髋关节骨量流失,改善损伤平面以下下肢运动功能,且安全性较好。