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.

Clinical Analysis of Minimally Invasive Single-segment Reduction and Internal Fixation in Patients with Thoracolumbar Fractures

Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.

Effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures

Objective:To investigate the effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures.Methods:Totally 80 cases of patients with Robinson 2A and 2B middle clavicular fractures admitted to our hospital between March 2017 and January 2019 were divided into the control group(n=41)receiving conventional kirschner wire internal fixation and the observation group(n=39)receiving locking compression plate internal fixation according to the operation plans.The differences in serum contents of inflammatory factors,oxidative stress indexes and bone metabolism indexes were compared between the two groups of patients before patients entered operating room,24 h after surgery and 48 h after surgery.Results:Before patients entered operating room,there were no statistically significant differences in the serum contents of inflammatory factors,oxidative stress indexes or bone metabolism indexes between the two groups(P>0.05).At 24 h and 48 h after surgery,serum inflammatory factors interleukin-1(IL-1),interleukin-17(IL-17),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α)contents in the observation group were lower than those in the control group;serum reactive oxygen species(ROS)and lipid hydroperoxide(LHP)contents were lower than those in the control group,while catalase(CAT)and glutathione peroxidase(GSH-Px)contents were higher than those in the control group;serum N-terminal propeptide of procollagen type I(PINP),bone gla protein(BGP)and alkaline phosphatase(ALP)contents were higher than those in the control group,while N-telopeptide of typeⅠcollagen(NTX),C-telopeptide of typeⅠcollagen(CTX)and tartrate-resistant acid phosphatase 5b(TRACP5b)contents were lower than those in the control group(P<0.05).Conclusion:Locking compression plate internal fixation can reduce the postoperative trauma extent and help promote the fracture healing in patients with Robinson 2A and 2B middle clavicular fracture.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Assessment of stress degree and bone metabolism activity in patients with middle humeral shaft fractures after minimally invasive surgery MIPO and open surgery ORIF

Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical treatment in Mianyang Orthopedic Hospital between June 2010 and October 2015 were enrolled and randomly divided into MIPO group and ORIF group who were treated with minimally invasive plate oateosynthesis and open reduction internal fixation respectively. Before surgery as well as 1 d and 3 d after surgery, serum was collected to determine the contents of stress response molecules and bone metabolism markers.Results:1 d and 3 d after surgery, serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of both groups were higher than those before surgery while bone formation markers BGP, BALP, PINP and OPG contents were lower than those before surgery;serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of MIPO group were lower than those of ORFI group while bone formation markers BGP, BALP, PINP and OPG contents were higher than those of ORFI group.Conclusion: Compared with ORIF, MIPO for middle humeral shaft fractures can reduce stress response degree and improve bone metabolism.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

纤维带与无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤

背景:Lisfranc韧带是维持足部横弓与纵弓的重要结构,Lisfranc损伤为一种严重的中足损伤。Lisfranc韧带损伤是复杂的,其治疗以及首选的固定方法有争议。目的:比较钢板联合Suturetape与钢板联合无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤的短期疗效。方法:回顾性分析东莞市中医院骨七科2019年1月至2022年6月因第1,2跖骨近端粉碎性骨折Lisfranc损伤患者48例,其中25例采用钢板联合Suture tape固定(观察组),23例采用钢板联合无头加压螺钉固定(对照组)。术前参照影像学资料,根据Myerson分类系统进行分型;术后随访根据骨折愈合时间、目测类比评分、美国足踝外科学会标准评估足功能恢复情况,并对两组术后并发症进行比较分析。结果与结论:①两组患者均顺利完成手术并获得随访,随访时间12-36个月,平均(18.0±5.42)个月;②两组患者手术时间、术中出血量比较差异均无显著性意义(P>0.05);③观察组较对照组骨折愈合时间稍长,差异有显著性意义(P<0.05);④术后3,6,12个月随访,观察组较对照组目测类比评分明显降低(P<0.05);⑤术后6,12个月,观察组术后各时间点随访足功能AOFAS评分较螺钉组明显改善(P<0.05),且均较术前显著提高(P<0.05);⑥术后观察组出现1例创伤性关节炎,对照组出现1例切口感染、1例螺钉断裂及2例创伤性关节炎,两组比较差异无显著性意义(P>0.05),考虑与样本量偏少有关;⑦提示对于第1,2跖骨近端粉碎性骨折Lisfranc损伤,实施钢板联合Suture tape内固定治疗Lisfranc关节损伤效果可靠,可改善患者足关节功能,且具有手术创伤小、术后并发症少、远期医源性创伤性关节炎风险低的优势,较无头加压钉更有利于足功能的恢复。

累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位

背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙状切迹背侧骨块螺钉固定的数量比较差异有显著性意义(P<0.05)。③Logistic多因素回归分析显示,乙状切迹骨块螺钉固定的数量是影响尺背侧乙状切迹骨块移位唯一的危险因素(P<0.05)。④提示在累及桡骨背侧的桡骨远端关节内骨折中,Ⅱ型最常见,Ⅲ型和Ⅰ型次之,大部分患者均存在乙状切迹背侧骨块。而乙状切迹背侧骨块其受下尺桡关节韧带影响易发生术后移位,术中至少1枚有效螺钉固定能降低其移位风险并有助于提高治疗效果。

Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial frac- tures

Objective： To investigate the efficacy of the locking internal fixator （LIF）, which includes the locking compression plate （LCP） and the less invasive stable system （LISS）, in the proximal and distal tibial fractures. Methods： We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthe- sis （MIPO） technique. The data consisted of 43 proximal tibial fractures （type AO41 C3） and 55 distal tibial fractures （type AO43C3）. Results： No complications were observed in all patients after operation. The mean healing time was 8.4 months （range 5-14 months）. Only two cases of delayed union oc- curred at postoperative 10 months. No infections were re- ported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at post- operative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion： Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

Multi-slice spiral computed tomography in diagnosing unstable pelvic fractures in elderly and effect of less invasive stabilization

BACKGROUND Older people are more likely to experience pelvic fractures than younger people.Multi-slice spiral computed tomography(CT)uses three-dimensional(3D)reconstruction technology to generate 3D images that can clearly demonstrate the 3D space of fractures and detect fractures at a higher rate.AIM To investigate the clinical value of multi-slice spiral CT 3D reconstruction in the diagnosis of unstable pelvic fractures in the elderly as well as the effect of less invasive stabilization.METHODS A total of 86 patients with unstable pelvic fractures treated between March 2016 and March 2019 underwent femoral supracondylar bone traction before surgery.Pelvic radiography and multi-row spiral CT were performed successively once the patient’s vital signs and hemodynamic indices were stable.Secondary processing of the original data was performed to obtain 3D reconstruction images and determine the vertical displacement of the pelvis.After basic or complete reduction,minimally invasive internal fixation using hollow lag screws was performed.The detection rates of fracture location and classification by X-ray and CT reconstruction were compared.Patients were divided into two groups according to the presence or absence of preoperative 3D reconstruction to compare postoperative reduction,wound healing time,fracture healing time,hospitalization time,visual analog scale(VAS)score,poor internal fixation,and functional recovery.RESULTS The diagnostic coincidence rates of X-rays for pubic symphysis,ilium wing,sacroiliac periarticular,and sacral fractures were lower than those of CT reconstruction.The coincidence rate of CT reconstruction in the clinical classification of pelvic fractures was 100%,whereas 11 cases were misdiagnosed by X-ray;the total coincidence rate was 87.21%.The total excellent and good rates of postoperative reduction were significantly higher in the study group than in the control group(P<0.05).The wound healing,fracture healing,and hospitalization times were significantly shorter in the study group than in the control group(P<0.05).The VAS scores decreased in both groups postoperatively and were lower in the study group than in the control group(P<0.05).The total incidence of poor postoperative internal fixation was significantly lower in the study group than in the control group(P<0.05).The overall rate of postoperative functional recovery was significantly higher in the study group than in the control group(P<0.05).CONCLUSION Multi-slice spiral CT has high guiding significance for the diagnosis,classification,and treatment of unstable pelvic fractures in the elderly.Preoperative 3D reconstruction can effectively shorten the operation time and promote fracture healing,while minimally invasive internal fixation can effectively reduce pain and promote functional recovery of fracture sites,making it worthy of clinical application.

EFFECT OF INTERNAL FIXATION PLATES ON MICROCIRCULATION IN UNDER-PLATE CORTICAL BONES MICROANGIOGRAPHY AND SCANNING ELECTRONMICROSCOPY

To elucidate the effect of the internal fixation plates on the local bone blood sapply, we used microangiography and scanning electron microscopy to observe the morphological changes of microcirculation in the cortical bones obtained from intact rabbit tibiae on which plates of two different stiffness had been fixed for comparison. The results indicated that both rigid stainless steel plate and less rigid methyl methacrylate plate could induce the bone microcirculation under the plate to undergo a process from early depression to late reactive recruitment. The features of the microcircuiation recruitment such as vascular number, arrangement and dilatation varied with plates of different stiffness and were more obvious in the cortex fixed by rigid stainless steel plate.

Quantitative Histological Study on Changes of the Cortical Bones after Internal Fixation with Plates of Different Rigidity

In an effect to explore the potemtial role of bone microcirculation causing plate-induced reginal osteoporosis

两种切口钢板内固定治疗胫骨平台骨折的疗效比较

目的比较两种切口钢板内固定治疗胫骨平台骨折的疗效。方法将108例胫骨平台骨折患者按照切口不同分为观察组(采用微创切口钢板内固定治疗,54例)和对照组(采用传统切开复位钢板内固定治疗,54例)。记录两组切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间、并发症发生情况、膝关节活动度、膝关节功能优良率。结果患者均获得随访,时间12~18个月。切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间观察组均短(早)于对照组(P<0.05)。术后6个月,膝关节功能优良率观察组高于对照组(P<0.01),膝关节屈曲、伸直活动度观察组均优于对照组(P<0.05)。术后并发症发生率观察组低于对照组(P<0.05)。结论与传统切开复位钢板内固定相比,微创切口钢板内固定治疗胫骨平台骨折具有创伤小、住院时间短、并发症发生率低的优点,更利于骨折愈合、患者早期功能锻炼及膝关节功能的恢复。

Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate

Objective To discuss the clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion.Neurological signs and symptoms were evaluated before and after surgery, and mean follow up time was 11.3 months.Result In all cases,radiography demonstrated a solid bony fusion.Additional general complications include a large wound hematoma in one and hoarseness in one.All patients’ neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression, bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.

机器人导航技术在股骨颈骨折微创内固定治疗中的应用效果分析

目的 探究机器人导航技术在股骨颈骨折微创内固定治疗中的应用效果。方法 选取2020年4月—2023年4月保定市第一中心医院接收的102例股骨颈骨折患者为研究对象。采用随机数字表法分为徒手组(51例,采用传统徒手空心钉内固定)和机器组(51例,采取机器人辅助下空心钉内固定)。比较两组患者手术指标、影像学资料、髋关节功能、股骨颈短缩分级情况以及术后并发症发生率。结果 机器组患者手术时间短于徒手组,术中出血量低于徒手组,导针钻孔次数少于徒手组,住院时间、骨折愈合时间均短于徒手组(P <0.05);机器组患者前倾角、颈干角偏离度均低于徒手组(P <0.05);两组患者的髋关节退变情况构成比比较,差异无统计学意义(P>0.05);机器组患者Harris评分、髋伸屈活动度、髋内旋外旋活动度均高于徒手组(P <0.05),Fernandez-Esteve骨痂评分低于徒手组(P <0.05)。机器组患者的股骨颈短缩分级情况优于徒手组(P <0.05)。机器组的术后感染、退钉、神经损伤、骨折愈合不佳等并发症发生率低于徒手组(P <0.05)。结论 机器人导航技术在股骨颈骨折微创内固定治疗中能够提高手术精准度,缩短手术和恢复时间,改善术后股骨颈功能恢复,降低并发症风险,提高患者满意度,具有良好的应用前景。

三维(3D)打印技术辅助微创手术治疗骨盆不稳定骨折的临床观察

目的分析三维(3D)打印技术结合微创手术治疗骨盆不稳定骨折的临床疗效。方法选取2019年1月-2022年9月江苏省人民医院和江苏省溧阳市人民医院收治的40例不稳定骨盆骨折患者作为研究对象。所有患者在3D打印技术辅助下,通过微创经皮骨盆前环内固定术(Infix)治疗,部分患者后环不稳定,联合钢板内固定治疗。收集手术相关数据,包括手术时间、失血量、重要组织损伤情况、骨折愈合情况以及术后功能的恢复情况;并在随访过程中,对骨折复位情况和肢体功能进行评估。结果40例患者的伤口在第一阶段就已愈合,未发生伤口感染。患者受伤至手术时间平均为(6.0±1.5)d;骨盆骨折固定术的手术时间为30~95 min,平均(60.8±5.9)min;术中平均失血量为(30.6±11.5)mL;骨折愈合时间为(12.8±2.6)周。根据Matta标准评估骨折复位质量:优33例(82.5%),良7例(17.5%);基于Majeed标准的肢体功能评估结果:30例为优秀(75.0%),10例为良好(25.0%)。结论3D打印技术辅助微创手术内固定可以在术前较好地评估患者骨盆骨折情况,有利于建模,可以缩短手术时间,减少术中失血,提高定位精度,最终达到更好的手术效果。

拔除下颌近中水平完全埋伏阻生牙保留颊侧骨板的效果探讨

目的:探讨微创手术拔除下颌近中水平完全埋伏阻生牙时保留颊侧骨板的效果。方法 :选取近中低位水平埋伏阻生牙86颗,随机分为2组,试验组以球钻开窗,暴露牙冠远中面,保留颊侧骨板,使用仰角手机配合加长车针行多次T形截冠,去除牙冠,微创拔除。对照组采用球钻去除远中及颊侧骨板,暴露远中及颊部牙冠,T形截冠,其余操作均一致。观察2组患者术后肿胀程度、开口受限程度以及疼痛视觉模拟量表(VAS)评分,检测C反应蛋白水平以及抗溶血链球水平;1个月后检查邻近第二磨牙牙周探诊深度(probing depth,PD)、出血指数(bleeding index,BI)及临床附着丧失(clinical attachment loss,CAL)水平。采用SPSS 25.0软件包对数据进行统计学分析。结果:试验组术后肿胀程度显著轻于对照组(P<0.05),开口受限与疼痛程度无显著差异(P>0.05)。试验组C反应蛋白水平显著高于对照组(P<0.05),抗溶血链球菌水平2组之间比较无显著差异(P>0.05)。术后1个月,对照组PD和CAL均显著高于试验组(P<0.05),2组BI比较无显著差异(P>0.05)。结论:保留颊侧骨板微创拔除下颌近中水平完全埋伏阻生牙患者术后反应更轻,创口愈合更好。

微创经皮钢板内固定技术在锁骨中段粉碎性骨折锁定钢板固定术中应用

目的 探讨微创经皮钢板内固定(MIPPO)技术在锁骨中段粉碎性骨折锁定钢板固定术中的应用价值。方法 回顾性选取2020年6月—2022年6月130例锁骨中段粉碎性骨折的临床资料,根据手术方法分为观察组和对照组,每组65例。对照组行传统切开复位内固定,观察组行MIPPO技术联合锁定钢板治疗。比较2组围术期指标、并发症、手术优良率及手术前后疼痛应激介质、肩关节功能指标。结果 观察组切口长度、骨折愈合时间短于对照组,术中出血量少于对照组,术后1 d疼痛视觉模拟评分法评分低于对照组(P<0.01)。术后1 d,观察组血清P物质、前列腺素E_(2)低于对照组,β内啡肽高于对照组(P<0.05);术后3、6个月,观察组Constant-Murley肩关节功能评分及肩关节前屈、后伸、外旋活动度高于对照组(P<0.05)。观察组并发症总发生率低于对照组,术后6个月手术优良率高于对照组(P<0.05)。结论 MIPPO技术联合锁定钢板治疗锁骨中段粉碎性骨折能显著提高手术优良率,减少术中出血量,促进肩关节功能恢复,抑制疼痛因子释放,缓解术后早期疼痛,还能降低并发症风险。

胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡的疗效分析

目的 观察胫骨横向骨搬移微创导板技术联合桃红四物汤治疗糖尿病足溃疡(diabetic foot ulcer,DFU)的疗效。方法 选取自2021年1月至2022年12月在湖南中医药大学第一附属医院四肢关节科拟进行胫骨横向骨搬移手术的50例DFU患者为研究对象,随机分为观察组与对照组,各25例。对照组采用胫骨横向骨搬移微创导板技术结合常规基础治疗;观察组在对照组基础上,术后第1天开始服用桃红四物汤,均连续治疗4周。比较治疗前和治疗后3个月两组患者的疼痛视觉模拟量表(visual analogue scale,VAS)评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数以及溃疡创面面积、愈合时间,评估临床疗效。结果 治疗3个月后,观察组临床有效率为92%,高于对照组的76%(P<0.05);观察组溃疡创面愈合时间较对照组明显缩短(P<0.05);两组患者的VAS评分、患肢皮肤温度、10 g尼龙丝检查评分、踝肱指数均较治疗前明显改善(P<0.05),且观察组上述各项指标较对照组改善更明显(P<0.05)。结论 胫骨横向骨搬移微创导板技术联合桃红四物汤治疗DFU的临床疗效显著,创伤小,创面愈合快,可明显缓解患肢疼痛,加速溃疡创面修复。

不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效研究

目的:分析不同入路法联合小针刀术在胸腰椎创伤性骨折微创椎弓根钉内固定术中的临床疗效,以及对血清骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原羧基肽β特殊序列(β-CTX)水平的影响。方法:选取我院2020年1月-2022年6月收治的120例行微创椎弓根钉内固定术联合小针刀术干预治疗的胸腰椎创伤性骨折患者,随机分为三组。A组(40例)选择经皮入路,B组(40例)选择经Wiltse入路,C组(40例)选择经后正中入路。记录并比较三组伤椎有效性指标:Oswestry功能障碍指数(ODI)、后凸Cobb角和前缘高度比;视觉模拟疼痛(VAS)评分、血清BALP、β-CTX水平和围手术期指标(手术时间、术中出血量和术后引流量)。结果:三组患者术后7 d、30 d的伤椎ODI、后凸Cobb角和前缘高度比均优于术前,差异有统计学意义(P <0.05),但三组间伤椎ODI、后凸Cobb角和前缘高度比差异无统计意义(P>0.05);三组患者术后VAS评分均显著下降,差异有统计学意义(P <0.05),且三组术后1 d、7 d的VAS评分比较差异有统计意义(P <0.05);三组患者术后血清BALP水平均明显上升,血清β-CTX水平均明显下降,差异均有统计学意义(P <0.05),且三组术后7 d的血清BALP及β-CTX水平比较差异有统计意义(P <0.05);三组手术时间、术中出血量和术后引流量关系为A组<B组<C组,差异有统计学意义(P <0.05)。结论:经皮入路和经Wiltse入路微创椎弓根钉内固定术联合小针刀术干预治疗能有效改善胸腰椎创伤性骨折患者伤椎有效性及骨代谢水平,而传统后正中入路的有效性及对骨代谢水平的改善作用相对较差,临床可结合患者情况在经皮入路和经Wiltse入路二者之间酌情选择入路方式,并结合小针刀术进行干预治疗。