Lower limb stress fractures in sport:Optimising their management and outcome

Stress fractures in sport are becoming increasing more common,comprising up to 10%of all of sporting injuries.Around 90%of such injuries are located in the lower limb.This articles aims to define the optimal management of lower limb stress fractures in the athlete,with a view to maximise return rates and minimise return times to sport.Treatment planning of this condition is specific to the location of the injury.However,there remains a clear division of stress fractures by"high"and"low"risk."Low risk"stress fractures are those with a low probability of fracture propagation,delayed union,or non-union,and so can be managed reliably with rest and exercise limitation.These include stress fractures of the PosteroMedial Tibial Diaphysis,Metatarsal Shafts,Distal Fibula,Medial Femoral Neck,Femoral Shaft and Calcaneus."High risk"stress fractures,in contrast,have increased rates of fracture propagation,displacement,delayed and non-union,and so require immediate cessation of activity,with orthopaedic referral,to assess the need for surgical intervention.These include stress fractures of the Anterior Tibial Diaphysis,Fifth Metatarsal Base,Medial Malleolus,Lateral Femoral Neck,Tarsal Navicular and Great Toe Sesamoids.In order to establish the optimal methods for managing these injuries,we present and review the current evidence which guides the treatment of stress fractures in athletes.From this,we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport.Following this,key recommendations are provided for the management of the common stress fracture types seen in the athlete.Five case reports are also presented to illustrate the application of sportfocussed lower limb stress fracture treatment in the clinical setting.

Combined effect of Traditional Chinese Medicine decoction and low-molecular-weight heparin calcium on the postoperative deep venous thrombosis in patients with lower limb fracture

OBJECTIVE: To investigate the combined effect of Traditional Chinese Medicine(TCM) decoction and low-molecular-weight heparin calcium on deep vein thrombosis(DVT) induced by surgery in patients with lower limb fracture.METHODS: Totally 86 hospitalized patients with DVT after surgery of lower limb fracture between September 2012 and January 2015 were recruited and randomly divided into control group and observation group, 43 cases in each group. The patients in the control group were treated with subcutaneous injection of low-molecular-weight heparin calcium, and those in the observation group were additionally given Danshen Injection and TCM decoction. The differences between two groups in occurrence rate, medication time, therapeutic effects,recurrence rate of thrombosis, activated partial thromboplastin time(APTT), and prothrombin time(PT) were compared.RESULTS: The occurrence rate of DVT in observation group(4.65%, 2/43) was lower than that in control group(27.91%,12/43)(P<0.05). The medication time of observation group was(6.15±2.94) d, shorter than(9.76±3.12) d in the control group(P<0.05). In observation group, 2 cases of DVT were cured(2/2); in the control group, 9 cases presented therapeutic effects and the total effective rate was 75.00%(9/12). The improvement of APTT and PT in the observation group was better than that in the control group(P<0.05).CONCLUSION: Integrative TCM decoction plus low-molecularweight heparin calcium is superior to applicaton of low-molecularweight heparin calcium alone in reducing and treating DVT in the postoperative patients with lower limb fracture.

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.

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.

Observation on the Anesthesia Effect of Ultrasound-Guided Nerve Block for Elderly Patients with Lower Limb Fractures

Objective:To explore the anesthesia effect of ultrasound-guided nerve block in elderly patients with lower limb fractures.Methods:From November 2017 to November 2020,50 elderly patients with lower limb fractures in our hospital were divided into experimental group(25 cases,general anesthesia+femoral nerve and sciatic nerve block)and control group(25 cases,general body anesthesia).Compare the MAP,HR,anesthesia effect,and adverse reactions between the two groups at each time period.Results:Before induction,the difference in MAP and HR between the two groups of patients did not form,p>0.05;the MAP and HR of the experimental group were compared with the control group at the time of skin incision,1 hour during the operation,and removal of the laryngeal mask,P<0.05;the time of extubation in the experimental group(14.28±3.18)min,awake time(5.57±1.32)min,orientation recovery time(11.89±2.23)min,propofol dosage(191.36±22.48)mg,remifentanil dosage(0.23±0.04)mg,Compared with the control group,P<0.05;the adverse reaction rate of the experimental group(8%,2/25)was lower than that of the control group(32%,8/25),P<0.05.Conclusion:The use of ultrasound-guided femoral nerve and sciatic nerve block for elderly patients with lower limb fractures can enhance the effect of anesthesia,effectively reduce the use of anesthetics,and have fewer adverse reactions.It is worthy of promotion.

Thrombelastography and color Doppler flow imaging in the perioperative period after closed lower limb fracture

Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from 11 healthy adults were used

Lower limb intracast pressures generated by different types of immobilisation casts

AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmH g. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mm Hg and lower. CONCLUSION Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

筋骨疗伤膏联合补肾接骨汤对老年下肢骨折术后肿胀及Wnt/β-catenin信号通路的影响

目的探讨筋骨疗伤膏联合补肾接骨汤对老年下肢骨折患者术后肿胀及典型Wnt/β-链蛋白(Canonical Wnt/β-catenin pathway,Wnt/β-catenin)信号通路的影响。方法收集2021年1月—2022年7月在医院骨外科进行诊治的下肢骨折患者92例,随机数字法分为试验组(46例)及对照组(46例)。所有受试者予以切开复位内固定术,对照组术后接受常规康复手段和热水泡脚,试验组在对照组的基础上予以筋骨疗伤膏联合补肾接骨汤。对比两组临床恢复情况、肿胀程度、疼痛评分、血液流变学指标、Wnt/β-catenin信号通路血清蛋白水平、骨痂生长情况及不良反应。数据结果应用统计学软件SPSS 19.0加以处理。结果与对照组相比,试验组完全负重锻炼、骨折愈合时间缩短,骨折延迟愈合率较低(P<0.05)。与治疗前相比,两组治疗后肿胀程度、疼痛评分均明显降低(P<0.05),与对照组相比,试验组患者肿胀程度、疼痛评分较低(P<0.05)。与治疗前相比,两组治疗后β-catenin升高,β-Ⅰ型胶原羧基端肽(βisomer of C-terminal telopeptide of type Ⅰ collagen,β-CTX)及总Ⅰ型胶原氨基端延长肽(total type Ⅰ collagen amino terminal extender peptide,T-PINP)水平均明显降低(P<0.05),与对照组相比,试验组β-catenin水平较高,β-CTX及T-PINP水平较低(P<0.05)。与治疗前相比,两组骨痂量评分、骨痂密度评分均明显升高(P<0.05),与对照组相比,试验组治疗后骨痂量评分、骨痂密度评分较高(P<0.05)。与对照组相比,试验组并发症发生率较低(P<0.05)。结论通过筋骨疗伤膏联合补肾接骨汤可减轻老年下肢骨折患者的肿胀及疼痛程度,改善血液微循环,其治疗机制可能与调节Wnt/β-catenin信号通路具有密切相关性。

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.

基于Caprini风险评估的护理措施对下肢骨折患者DVT的预防效果研究

目的 探讨基于Caprini风险评估的护理措施对下肢骨折患者深静脉血栓形成(DVT)的预防效果。方法 选择2019年2月至2022年2月空军军医大学第二附属医院骨外科收治的150例下肢骨折患者进行研究,按随机数表法分为观察组和对照组各75例,对照组患者采用常规护理,观察组患者采用基于Caprini风险评估的护理措施,两组患者均护理至出院。比较两组患者的DVT发生率、血栓最大宽度,护理前及患者出院时(护理后)的髋关节评分量表(Harris)和膝关节评分量表(HSS)评分,并比较两组患者的髋关节、膝关节优良率及患者对护理工作的满意度。结果 观察组患者的DVT发生率为4.00%,明显低于对照组的13.33%,血栓最大宽度为(5.50±1.33) mm,明显小于对照组的(6.73±1.45) mm,差异均有统计学意义(P<0.05);观察组患者护理后的Harris评分、HSS评分、关节功能优良率、对护理工作的满意度分别为(85.37±4.13)分、(87.79±2.24)分、89.33%、97.33%,明显高于对照组的(80.12±3.94)分、(82.18±3.09)分、73.33%、88.00%,差异均具有统计学意义(P<0.05)。结论 下肢骨折患者采用基于Caprini风险评估的护理,可以降低患者的DVT发生率,并有助于髋关节、膝关节功能的恢复,提高关节功能优良率及护理工作的满意度。

多元化健康教育模式在预防下肢骨折患者深静脉血栓中的应用

目的探讨多元化健康教育模式在预防下肢骨折患者深静脉血栓中的应用效果。方法采用便利抽样法,选取2021年1~12月收治的下肢骨折患者300例,按照住院时间将2021年1~6月收治的患者作为对照组,将2021年7~12月收治的患者作为观察组,每组150例。对照组采用常规健康教育模式,观察组采用多元化健康教育模式。比较2组患者对深静脉血栓的认知水平、基本预防措施依从性、深静脉血栓的发生率,以及患者对护理工作满意度。结果观察组患者对深静脉血栓的认知水平、对基本预防措施的依从性、护理满意度显著高于对照组(P<0.05)。观察组患者深静脉血栓发生率为16.00%低于对照组的25.33%,差异有统计学意义(P<0.05)。结论将多元化健康教育模式应用于下肢骨折患者,可提高护理效果,降低深静脉血栓的发生率,值得推广应用。

丹参片联合那屈肝素钙注射液对髋部骨折术后下肢静脉血流参数的影响

目的探讨丹参片联合那屈肝素钙注射液对髋部骨折术后下肢静脉血流参数的影响。方法将2021年12月至2022年12月接受髋部骨折手术治疗的108例患者作为研究对象,按随机数字表法分为对照组和观察组,每组54例,2组均在术后开始用药,对照组采用那屈肝素钙注射液治疗,观察组采用丹参片联合那屈肝素钙注射液治疗,2组均治疗7 d后,对比术前及术后7 d患肢小腿直径差,对比术前及术后7 d疼痛分级(NRS)、下肢静脉血流参数(股总静脉、股浅静脉、股深静脉)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、骨碱性磷酸酶(BALP)、骨钙素(BGP)、Ⅰ型胶原羧基端交联肽(CTX-1),比较2组术后下肢静脉血栓发生率、药物不良发生率。结果观察组术前及术后7 d患肢小腿直径差明显低于对照组,NRS评分低于术前及对照组术后7 d,差异均有统计学意义(P<0.05);术后7 d观察组股总静脉、股浅静脉、股深静脉参数、TT、PT、APTT、BALP、BGP水平明显高于术前及对照组术后7天,CTX-1水平明显低于术前及对照组术后7天,差异均有统计学意义(P<0.05);2组不良反应总发生率比较,差异无统计学意义(P>0.05);观察组下肢脉血栓发生率明显低于对照组(P<0.05)。结论丹参片联合那屈肝素钙注射液用于髋部骨折术后,能缓解患者肿胀及疼痛,加快下肢静脉血流,降低患者血液高凝状态,改善骨代谢指标,进而降低血栓发生率。

红光治疗仪联合藻酸盐敷料对下肢骨折术后创面愈合的疗效

目的:探讨红光治疗仪联合藻酸盐敷料对下肢骨折术后创面愈合效果。方法:选取80例下肢骨折患者,分为观察组与对照组,比较两组治疗前后FN与EGF水平差异。结果:观察组在术后14d、21d、28d的骨痂密度评分均高于对照组(P<0.05)。观察组术后2d、4d、6d疼痛评分均低于对照组(P<0.05)。治疗后,两组血清FN和EGF水平均高于治疗前,且观察组血清FN和EGF水平高于对照组(P<0.05)。结论:红光治疗仪联合藻酸盐敷料用于下肢骨折术后创面愈合,安全有效,能够促进骨痂生长,减轻患者疼痛程度,改善血清FN与EGF水平。

探索骨盆与下肢骨折患者术前深静脉血栓的危险因素

目的探索引起骨盆与下肢骨折患者术前深静脉血栓(DVT)的危险因素。方法采用回顾性队列研究,分析2017年1月至2021年12月在上海交通大学医学院附属第六人民医院急诊重症监护病房住院治疗的774例骨盆与下肢骨折患者临床资料,采用修正泊松回归分析可疑暴露因素是否为骨盆与下肢骨折患者术前发生DVT的独立危险因素。根据独立危险因素构建列线图预测模型并进行内部验证,以评价其区分度、校准度和临床适用性。结果骨盆骨折患者509例,97例(19.057%)出现DVT;骨盆合并膝关节以下骨折患者79例,21例(26.582%)出现DVT;骨盆合并股骨骨折患者186例,61例(32.796%)出现DVT。分析结果显示骨盆合并股骨骨折[调整后的相对危险度(ARR)=1.619,95%CI 1.223~2.144,P=0.001]、急诊腹部手术(ARR=1.924,95%CI 1.098~3.372,P=0.022)、体重指数≥24 kg/m^(2)(ARR=1.382,95%CI 1.072~1.783,P=0.013)、创伤严重度评分(ISS)≥25分(ARR=1.439,95%CI 1.082~1.913,P=0.012)、年龄40~59岁(ARR=1.594,95%CI 1.104~2.300,P=0.013)以及年龄≥60岁(ARR=1.868,95%CI 1.279~2.730,P=0.001)为骨盆与下肢骨折患者术前发生DVT的独立危险因素;据此所构建的列线图模型对预测DVT风险以及判断是否应该采取干预措施有一定的实用价值。结论骨盆与下肢骨折患者有发生DVT的风险,骨盆合并股骨骨折、经历急诊腹部手术、BMI≥24 kg/m^(2)、ISS≥25分、年龄≥40岁是骨盆与下肢骨折患者术前发生DVT的危险因素,对具有上述特征的患者应高度重视并及时采取适当的DVT防治措施。

结合目标导向的康复锻炼对下肢骨折术后患者的干预效果

目的探讨结合目标导向的康复锻炼对下肢骨折患者术后干预期间的应用效果。方法选择2020年3月至2022年9月江苏省南通市第三人民医院骨科的110例下肢骨折患者,根据随机数字表法将其分为对照组和研究组,各55例。对照组实施常规护理,研究组在对照组的基础上结合目标导向的健康锻炼。比较两组术后不同时间段内下肢肿胀、膝关节功能、不良心理状态相关指标。结果整体分析发现:两组小腿周径、大腿周径、肿胀程度评分的组间、时间点比较及交互作用,差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:两组各时间点小腿周径、大腿周径、肿胀程度评分,差异有统计学意义(P<0.05);组间比较:研究组术后1、3个月小腿周径、大腿周径、肿胀程度评分低于对照组(P<0.05)。术后3个月,两组Lysholm膝关节评分均高于干预前,且研究组高于对照组(P<0.05);两组抑郁-焦虑-压力量表中文精简版评分低于干预前,且研究组低于对照组(P<0.05)。结论实施结合目标导向的康复锻炼可提高下肢骨折患者术后患肢恢复速度,改善其术后心理状态。

骨盆髋臼骨折患者合并静脉血栓栓塞性疾病的研究进展

骨盆髋臼骨折(pelvic and acetabular fractures,PAFs)是最常见的骨盆骨折类型之一,多为高能量损伤,骨盆髋臼结构复杂,手术方法有限。髋臼骨折本身所带来的创伤和术后需要长期卧床等情况,导致其临床并发症尤为复杂。静脉血栓栓塞(venous thromboembolic,VTE)是其众多并发症中发生率较高且后果严重的一种。本综述主要以PAFs术后导致的VTE为主要内容,分别从VTE的流行病学、危险因素以及防治措施三个方面展开叙述,旨在帮助改善预后,避免严重并发症的发生。

SuperPATH入路柄颈一体股骨头置换治疗老年股骨颈骨折早期疗效及术后下肢长度分析

目的 观察SuperPATH入路柄颈一体股骨头置换治疗老年股骨颈骨折早期疗效及术后下肢长度变化。方法 选择2015年9月至2020年10月收治并符合选择标准的75例单侧股骨颈骨折老年患者纳入研究。记录切口长度、手术时间、术中出血量、术后下地时间及并发症发生情况。比较术前及术后1、4、12、24周及1、2年的Harris髋关节功能评分、疼痛视觉模拟评分(VAS)。摄骨盆正位X线片,测量两侧泪滴下缘连线至小转子最上缘的垂直距离,判断双下肢长度差异。末次随访时行骨盆CT平扫观察股骨假体位置及骨长入。结果 患者术后均获随访,随访时间24~85个月,平均56.7个月。所有患者切口长度(7.85±0.51)cm,手术时间(89.29±26.84)min,术中出血量(78.67±56.79)mL,术后下地时间(1.43±0.49)d。术前与术后1周Harris髋关节功能评分和VAS评分比较,差异均具有统计学意义(P<0.05)。术后2年与术后1年Harris髋关节功能评分和VAS评分无统计学意义(P>0.05),其余随访时间点Harris髋关节功能评分和VAS评分与前比较,差异均有统计学意义(P<0.05)。术后所有患者双下肢长度差为(3.57±4.44)mm,与术前[(-17.61±7.86)mm]比较,差异有统计学意义(P<0.05)。末次随访时所有患者骨盆CT平扫显示股骨假体位置及骨长入良好,随访期间均无假体松动、下沉。结论 SuperPATH入路柄颈一体股骨头置换治疗老年股骨颈骨折创伤小、疼痛轻、恢复快、早期疗效满意,在有限显露下可有效调整肢体长度,预防双下肢不等长。

闭合性Pilon骨折术后下肢深静脉血栓形成的影响因素及其风险预测列线图模型构建

目的 分析影响闭合性Pilon骨折术后下肢深静脉血栓形成(DVT)的危险因素,并构建列线图预测模型。方法 2019年6月~2022年6月接受外科手术治疗的闭合性Pilon骨折病人182例,根据术后是否发生DVT分为两组,DVT组43例,非DVT组139例,采用单因素和多因素Logistic回归分析筛选影响闭合性Pilon骨折术后下肢DVT的危险因素;采用R软件构建预测闭合性Pilon骨折术后下肢DVT的列线图模型,使用受试者工作特征曲线(ROC)、校准曲线进行列线图模型验证。结果 Logistic回归分析结果显示,糖尿病史、血栓风险评估结果为中高危、手术部位发生术后感染是闭合性Pilon骨折术后下肢DVT的独立危险因素(P<0.05)。ROC曲线下面积0.716(95%CI:0.629~0.804)。校准曲线斜率接近1,且H-L拟合优度检验χ^(2)=2.556,P=0.635。结论 有糖尿病史、血栓风险评估结果为中高危、手术部位有发生术后感染是闭合性Pilon骨折术后下肢DVT的独立危险因素,整合以上3项独立危险因素构建的列线图预测模型能有效预测闭合性Pilon骨折术后下肢DVT,区分度、一致性较高。

艾司氯胺酮对急诊下肢骨折手术患者麻醉前摆放体位时的镇痛效果

目的观察艾司氯胺酮对急诊下肢骨折手术患者麻醉前摆放体位时的镇痛效果。方法选取2021年11月至2022年12月滨州医学院烟台附属医院收治的70例急诊下肢骨折手术患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分为观察组(麻醉前摆放体位时给予0.25 mg/kg艾司氯胺酮镇痛)和对照组(麻醉前摆放体位时不进行镇痛,给予0.25 mg/kg生理盐水),每组35例。比较分析两组患者进入手术室时(T_(1))、艾司氯胺酮静脉推注10 min后(T_(2))、摆放体位时(T_(3))的疼痛程度以及T_(1)、T_(2)、T_(3)、麻醉平面稳定后5 min(T_(4))的镇静情况。比较分析两组患者的麻醉操作时间、麻醉满意度评分、镇痛泵按压次数以及术后48 h的不良反应发生率。结果T_(1)时刻,两组患者的视觉模拟评分法评分、Ramsay镇静评分比较差异均无统计学意义(P>0.05);T_(2)、T_(3)时刻,观察组患者的视觉模拟评分法评分低于对照组,差异均有统计学意义(P<0.05);T_(2)、T_(3)、T_(4)时刻,观察组患者的Ramsay镇静评分高于对照组,差异均有统计学意义(P<0.05)。观察组患者的麻醉操作时间、镇痛泵按压次数均短于或少于对照组,麻醉满意度评分高于对照组,差异均有统计学意义(P<0.05)。两组患者术后48 h的不良反应发生率比较差异无统计学意义(χ^(2)=0.159,P=0.690)。结论术前应用艾司氯胺酮蛛网膜下腔阻滞可显著减轻急诊下肢骨折手术患者麻醉前摆放体位时的疼痛程度,缩短麻醉操作时间,明显提高患者的麻醉满意度,且安全性较好。

手术室人性化护理在老年下肢骨折患者中的应用分析

目的探究老年下肢骨折实施手术室人性化护理的作用。方法前瞻性随机选取2023年1—12月南京市第一医院收治的140例老年下肢骨折患者为研究对象。根据不同护理干预分为研究组和参照组,各70例。参照组行常规护理,研究组加用手术室人性化护理。比较两组患者心理状态、并发症发生情况及生活质量。结果护理后,研究组焦虑和抑郁评分分别为(48.51±3.54)分、(50.12±4.02)分,低于参照组的(52.33±4.36)分和(56.92±4.36)分,差异有统计学意义(t=5.691、9.593,P均<0.05)。研究组并发症发生情况优于参照组,差异有统计学意义(P<0.05)。研究组生活质量评分高于参照组,差异有统计学意义(P<0.05)。结论老年下肢骨折患者经手术室人性化护理后心理状态显著改善,并发症发生率较低,生活质量较理想。