External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.

Total knee arthroplasty and fractures of the tibial plateau

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Application of medial column classification in treatment of intraarticular calcaneal fractures

BACKGROUND There are many types of treatments for calcaneal fractures,including conservative treatment,conventional surgical treatment,and minimally invasive surgery.The choice of specific treatment options is still controversial.Open reduction and internal fixation are currently the most commonly used surgical procedures in the clinic.A good fracture reduction effect can be achieved by using the lateral extension incision of the calcaneus;however,many studies have reported a high incidence of postoperative incision complications.Although there are many methods for the classification of intra-articular calcaneal fractures,it is generally believed that the computed tomography(CT)classification proposed by Sanders has high application value in the selection of treatment methods and evaluation of prognosis of calcaneal fractures.However,this method has no clear guiding significance for the choice of surgical incision and surgical plan.AIM To explore the application and clinical efficacy of medial column classification in the treatment of intra-articular calcaneal fractures.METHODS From July 2017 to July 2018,91 patients,including 60 males and 31 females aged 27 to 60 years,were enrolled.All participants had closed intra-articular calcaneal fracture,and their surgical options were selected under the guidance of medial column classification.The patients'fractures were classified according to the Sanders classification:Type II,35 cases;Type III,33 cases;and Type IV,23 cases.Among them,53 patients had medial column displacement(shortened varus)and underwent open reduction and internal fixation with L-lateral incision of the calcaneus;38 patients had no displacement of the medial column and underwent open reduction and internal fixation with tarsal sinus incision.The calcaneus Bohler angle,Gissane angle,length,width,height,and step thickness of the articular surface were evaluated by X-ray and three-dimensional CT before and after surgery and at the last follow-up.Foot function recovery was assessed by the Maryland foot scoring criteria.RESULTS All patients were followed for 5 to 14 mo,with an average of 10.5±2.9 mo.The fractures of all patients healed,and the healing time was 10 to 19 wk,with an average of 10.8±1.5 wk.One patient developed wound infection 1 wk after surgery and was actively debrided and implanted with antibiotic calcium sulfate to control the infection.The patient's fracture healed 5 mo after surgery.One patient developed a sural nerve injury,and the symptoms disappeared 3 mo after surgery.The patients were assessed according to the Maryland foot scoring system:Excellent in 77 cases,good in 10,and fair in 4.The excellent and good rate was 95.6%.CONCLUSION Medial column classification can effectively guide the surgical selection for intraarticular fractures of the calcaneus.

Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long-Term Follow-Up

There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.

Stress analysis of three-dimensional finite element model of malunion calcaneus during gait

Objective: To analyze the stress distribution of calcaneus with posterior articular facet compressed after fracture and talus during gait. Methods: A wedge under the posterior articular was transected from a normal finite element model of calcaneus and talus to simulate malformation of compression of the posterior facet after fracture of calcaneus. The model was used to simulate for three subphases of the stance during the gait(heel strike, midstance, push off) and calculate the finite element. The results were compared with normal situation. Results: The stress distribution within the bone in situation of malformation was obtained and regions of elevated stresses for three subphases were located. The results were significantly different from that of normal situation. Conclusion: The simulation of calcaneus and talus in malformation has important clinic implication and can provide an insight into the factors contributing to many clinic pathogenic changes after fracture of calcaneus.

Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.

Stress fractures in uncommon location:Six case reports and review of the literature

BACKGROUND Individuals’interest in sports activities has been increasing,contributing to more stress fracture occurrences in uncommon locations on the skeleton.In this study,several cases of stress fractures in atypical locations are presented,and the possibility of combining diagnostic methods to make accurate and quick diagnoses is explored.Additionally,different causes of stress fractures,as well as various modalities of treatment,are highlighted.Other potential factors of stress fractures were identified by a literature review.CASE SUMMARY Six cases of stress fractures in the calcaneus,intermediate cuneiform bone,sacrum,tibia(bilateral),navicular bone and femoral neck are presented,with different types of diagnostic imaging and treatments.All of the cases were associated with an aspect of mobility because all of the patients were physically active in various sport disciplines.CONCLUSION The type of therapeutic procedure selected should depend on the specific clinical case,i.e.,the patient’s condition and level of physical activity.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

机器人辅助下经皮空心螺钉内固定治疗跟骨骨折术后并发症影响因素及模型预测分析

目的:分析机器人辅助下经皮空心螺钉内固定治疗跟骨骨折术后并发症的影响因素并探讨其预测效能。方法:选取2018年3月—2023年12月于绵阳市骨科医院行机器人辅助下经皮空心螺钉内固定术的70例跟骨骨折患者作为研究对象。统计患者术后并发症发生情况,根据其是否出现并发症分为并发症发生组(发生组,26例)、无并发症组(未发生组,44例)。比较两组患者基本资料,采用单因素、多因素Logistic回归分析影响机器人辅助下经皮空心螺钉内固定治疗跟骨骨折术后并发症发生的因素,建立受试者工作特征曲线(ROC)分析相关影响因素预测术后并发症的效能。结果:与未发生组比较,发生组年龄≥50岁和有糖尿病占比更高,术后引流占比更低,受伤至就诊时间更长(P<0.05)。单因素、多因素结果显示,年龄、糖尿病、受伤至就诊时间、术后引流均为机器人辅助下经皮空心螺钉内固定治疗跟骨骨折术后并发症发生的相关影响因素(P<0.05)。影响因素联合预测模型Y=-1.849×年龄+1.882×糖尿病+0.482×受伤至就诊时间-1.809×术后引流-3.075,其预测术后并发症发生曲线下面积为0.865,标准误为0.046,置信区间为0.776~0.955,特异度为0.977,敏感度为0.692(P<0.05)。结论:年龄增加、存在糖尿病、受伤至就诊时间增加、术后不引流是机器人辅助下经皮空心螺钉内固定治疗跟骨骨折术后并发症发生的危险因素,基于此构建的预测模型预测效能较好,具备一定临床参考价值。

关节镜小切口与跗骨窦切口治疗跟骨骨折的疗效比较

目的分析距下关节镜联合后侧小切口与跗骨窦切口在跟骨骨折患者中的应用效果。方法筛选2018年12月至2022年12月聊城市第二人民医院收治的100例跟骨骨折患者,根据随机数表法分为关节镜组和跗骨窦组各50例。关节镜组男32例,女18例,平均年龄(43.58±7.13)岁;给予距下关节镜联合后侧小切口治疗。跗骨窦组男34例,女16例,平均年龄(43.12±7.46)岁;给予跗骨窦切口治疗。对比两组手术相关指标及手术前后疼痛视觉模拟评分(visual analog score,VAS)、B hler角及Gissane角变化,术后12个月踝-后足功能优良率和并发症发生率。结果术后关节镜组随访(11.16±1.02)个月,跗骨窦组随访(11.24±1.06)个月。关节镜组住院时间和骨折愈合时间明显少于跗骨窦组(P<0.05);关节镜组术后12个月VAS评分明显低于跗骨窦组,关节镜组B hler角及Gissane角均明显高于跗骨窦组(P<0.05);相较跗骨窦组,关节镜组优良率更高(P<0.05),并发症发生率更低(P<0.05)。结论相较跗骨窦切口,距下关节镜联合后侧小切口可以明显改善跟骨骨折患者手术指标及疼痛情况,值得临床广泛推广。

关节镜微创治疗与传统手术治疗跟骨骨折的临床疗效比较

目的探讨关节镜微创治疗与传统手术治疗跟骨骨折的临床疗效。方法选择2018年3月—2023年3月在四川省什邡市人民医院就诊治疗的41例跟骨SandersⅡ、Ⅲ型骨折患者,按术式不同分为传统组(n=21)与关节镜组(n=20)。比较2组患者手术时间、术中出血量、切口长度、骨折愈合时间和Maryland足功能评分、美国足踝矫形外科协会(American orthopedic foot and ankle society,AOFAS)足功能评分及临床治疗有效率和并发症发生率。结果关节镜组手术时间、术中出血量、切口长度、骨折愈合时间均小于传统组(P<0.05)。2组患者术后AOFAS、Maryland足功能评分均较术前升高,与术前比较差异有统计学意义(P<0.05)。术后3个月,关节镜组AOFAS、Maryland足功能评分高于传统组,差异有统计学意义(P<0.05)。关节镜组治疗总有效率和并发症发生率分别为95.00%、5.00%,与对照组的61.90%、38.10%比较,差异有统计学意义(P<0.05)。结论关节镜辅助治疗跟骨SandersⅡ、Ⅲ型骨折较传统手术治疗创伤小,促进足部功能的恢复好,并发症发生率低,临床治疗效果好,对提高跟骨骨折的治疗效率有非常积极的影响。

强化护理干预应用于跟骨骨折患者术后护理的效果分析

目的:分析强化护理干预应用于跟骨骨折患者术后护理的效果。方法:选取2019年6月—2022年10月滕州市中心人民医院收治的跟骨骨折患者126例作为研究对象,采用随机数字表法分为参照组与试验组,各63例。参照组患者实施常规护理干预,试验组实施强化护理干预。比较两组足部功能恢复情况、并发症发生情况及满意度。结果:试验组足部功能总恢复率高于参照组,差异有统计学意义(P<0.001)。试验组并发症总发生率低于参照组,差异有统计学意义(P=0.001)。试验组护理能力、心理护理、护理态度、健康护理、并发症护理、病房护理满意度评分高于参照组,差异有统计学意义(P<0.001)。结论:强化护理干预应用于跟骨骨折患者术后护理的效果显著,能够促进患者足部功能恢复,减少并发症,提高满意度,值得临床应用并予以推广。

超前镇痛方案对跟骨关节内骨折患者OPG/RANKL信号通路因子表达的影响

目的 探讨跟骨关节内骨折患者采用超前镇痛方案对骨保护素(OPG)/核因子-κB受体活化因子配体(RANKL)信号通路因子表达的影响。方法 回顾性选取2017年2月至2022年2月大庆油田总医院收治的跟骨关节内骨折患者100例,依据镇痛方案不同分为对照组和观察组,每组各50例。对照组患者接受常规性静脉自控镇痛方案,观察组患者接受地佐辛超前镇痛联合常规性静脉自控镇痛方案。统计分析两组围手术期指标(术中出血量、手术时间、术后引流量、术后引流时间、住院时间),麻醉前、手术前、手术后即刻的血流动力学(平均动脉压、心率),手术前、手术后1 d的应激反应[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)],手术后即刻,手术后6 h、12 h、1 d的镇静[Ramsay镇静评分(RSS)、视觉模拟评分法(VAS)评分]和镇痛效果,以及手术后1 d、手术后1周的血清OPG、RANKL含量和术后并发症发生情况。结果 两组患者的术中出血量、手术时间比较,差异均无统计学意义(P>0.05);观察组患者的术后引流量为(59.86±2.54) mL,少于对照组[(110.97±9.41) mL],术后引流时间、住院时间分别为(123.23±9.82) h、(5.61±0.45) d,均短于对照组[(178.22±9.32) h、(8.01±0.31) d],差异均有统计学意义(P<0.05)。麻醉前、手术前、手术后即刻,两组患者的平均动脉压、心率比较差异均无统计学意义(P>0.05)。手术后1 d,两组患者的血清CRP、TNF-α、IL-6、PGE2水平均明显高于手术前,观察组患者的血清CRP、TNF-α、IL-6、PGE2水平分别为(5.11±1.47) mg/L、(43.15±7.51)μg/L、(32.52±5.31) ng/L、(138.11±12.68) pg/mL,均明显低于对照组[(21.42±3.44) mg/L、(87.60±13.56)μg/L、(75.77±21.35) ng/L、(144.60±15.20) pg/mL],差异均有统计学意义(P<0.05)。与手术后即刻比较,两组患者手术后6、12、24 h的RSS评分、VAS评分均逐渐降低,差异均有统计学意义(P<0.05);手术后6、12、24 h,两组患者的RSS评分、VAS评分比较差异均无统计学意义(P>0.05)。手术后1周,两组患者的血清OPG、RANKL含量均高于手术后1 d,且观察组患者的血清OPG、RANKL含量分别为(188.86±21.47)、(108.37±10.43) pg/mL,均高于对照组[(177.75±19.23)、(98.76±8.26) pg/mL],差异均有统计学意义(P<0.05)。观察组患者的术后并发症发生率为8.00%,明显低于对照组(32.00%),差异有统计学意义(P<0.05)。结论 超前镇痛方案能够促进跟骨关节内骨折患者OPG/RANKL信号通路因子表达及患者术后康复,提高镇痛效果,减少术后并发症的发生。

快速康复外科护理在跟骨骨折患者围术期护理中的应用效果分析

目的:分析快速康复外科护理在跟骨骨折患者围术期护理中的应用效果。方法:选取2021年5月—2022年5月滕州市中心人民医院收治的跟骨骨折患者100例作为研究对象,按照双色球随机原则分为对照组和试验组,各50例。对照组实施围术期常规护理,试验组在对照组基础上实施快速康复护理。比较两组护理效果。结果:试验组伤口肿胀消退时间、首次下床活动时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.001)。术后,两组跟骨交叉角度、跟骨结节关节角度、跟骨高度、跟骨宽度小于术前,且试验组小于对照组,差异有统计学意义(P<0.05)。试验组足跟恢复优良率高于对照组,差异有统计学意义(P=0.002)。试验组并发症发生率低于对照组,差异有统计学意义(P=0.037)。结论:快速康复外科护理在跟骨骨折患者围术期护理中的应用效果显著,可促进患者康复,改善临床指标,降低并发症发生率。

Micro-CT分析跟骨内骨小梁分布及结构特征

背景:跟骨位于足的后下部,受力较大。跟骨外形复杂且不规则,外周有较薄的皮质骨包绕,内部充满大量的骨小梁,探讨骨小梁的微观结构、走行及分布特征有助于提高对跟骨骨折的认识。目的:采用微计算机断层扫描仪(Micro-CT)扫描跟骨标本获得其影像资料,对其内部骨小梁结构进行分析,探讨跟骨内骨小梁的形态、分布及结构特征。方法:采用Micro-CT连续扫描干燥成人跟骨标本,扫描后获得影像图像,将其以DICOM格式存储。导入影像资料到Hiscan Analyzer软件,显示清晰完整的成人跟骨矢状面、冠状面、水平面的图像,逐层观察骨小梁的走行,依据骨小梁走行特点将跟骨矢状面分为6个部分,在以7 mm为标准的相同厚度下,每个部分选择1个49 mm2等面积的兴趣区,三维重建后获得跟骨及骨小梁的立体微观结构,二值化后运用软件计算感兴趣区域内骨小梁的体积分数、表面密度、骨小梁厚度、骨小梁间隙和骨小梁数量参数。结果与结论:①跟骨表面皮质层很薄,内部充满大量骨松质,在Gissane角的骨皮质明显增厚;②跟骨上部的骨小梁体积分数大于跟骨下部前端、中和三角区、跟骨下后部、跟骨结节部、跟骨底部,跟骨结节部的骨小梁体积分数大于跟骨下部前端、中和三角区、跟骨下后部、跟骨底部;跟骨结节部的骨小梁表面密度大于跟骨下部前端、中和三角区、跟骨底部,跟骨上部、跟骨下后部的骨小梁表面密度大于中和三角区;跟骨上部的骨小梁厚度大于跟骨结节部;中和三角区的骨小梁间隙大于跟骨上部、跟骨结节部;跟骨结节部的骨小梁数量大于中和三角区;③中和三角区主要分布杆状骨小梁,骨小梁表面密度最小、体积分数较小、骨小梁间隙最大;该部位骨质较疏松,受到高冲击力时抗压缩能力差,骨小梁最先发生断裂,是易发生骨折的部位。

黄连解毒汤加减治疗跟骨骨折术前肿胀的临床研究

目的:观察黄连解毒汤加减治疗跟骨骨折术前肿胀的临床疗效和安全性,并探讨其可能的作用机制。方法:将符合要求的70例SandersⅡ~Ⅳ型跟骨骨折患者随机分为2组,每组35例。2组患者入院后均给予石膏托外固定制动、抬高患肢、静脉滴注甘露醇注射液、皮下注射那屈肝素钙等常规治疗。常规治疗组在此基础上口服地奥司明片,每次0.9 g,每日1次,晚餐后服用,共服用7 d;黄连解毒汤组在常规治疗基础上口服黄连解毒汤加减,早晚各1次,共服用7 d。比较2组患者的患肢肿胀率、疼痛视觉模拟量表(visual analogue scale,VAS)评分、血清C反应蛋白(C-reactive protein,CRP)水平、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平、血清白细胞介素-6(interleukin 6,IL-6)水平、中医证候积分及并发症发生情况。结果:①患肢肿胀率。2组患者的患肢肿胀率随时间变化均呈先升高后降低的趋势(F=246.771,P=0.000;F=282.982,P=0.000);治疗前2组患者患肢肿胀率的差异无统计学意义(t=0.596,P=0.553);治疗第3天和治疗第7天,黄连解毒汤组患者的患肢肿胀率均低于常规治疗组(t=2.147,P=0.035;t=2.799,P=0.007)。②疼痛VAS评分。2组患者的疼痛VAS评分随时间变化均呈逐渐降低的趋势(F=262.877,P=0.000;F=462.471,P=0.000);治疗前2组患者疼痛VAS评分的差异无统计学意义(t=0.432,P=0.667);治疗第3天和治疗第7天,黄连解毒汤组患者的疼痛VAS评分均低于常规治疗组(t=3.200,P=0.002;t=8.735,P=0.000)。③血清CRP水平。2组患者的血清CRP水平随时间变化均呈先升高后降低的趋势(F=1355.001,P=0.000;F=2271.167,P=0.000);治疗前2组患者血清CRP水平的差异无统计学意义(t=-0.470,P=0.570);治疗第3天和治疗第7天,黄连解毒汤组患者的血清CRP水平均低于常规治疗组(t=4.575,P=0.000;t=25.065,P=0.000)。④血清TNF-α水平。2组患者的血清TNF-α水平随时间变化均呈先升高后降低的趋势(F=366.536,P=0.000;F=811.863,P=0.000);治疗前2组患者血清TNF-α水平的差异无统计学意义(t=-1.019,P=0.312);治疗第3天和治疗第7天,黄连解毒汤组患者的血清TNF-α水平均低于常规治疗组(t=3.222,P=0.002;t=17.223,P=0.000)。⑤血清IL-6水平。2组患者的血清IL-6水平随时间变化均呈先升高后降低的趋势(F=895.505,P=0.000;F=1184.801,P=0.000);治疗前2组患者血清IL-6水平的差异无统计学意义(t=1.606,P=0.113);治疗第3天和治疗第7天,黄连解毒汤组患者的血清IL-6水平均低于常规治疗组(t=4.432,P=0.000;t=9.249,P=0.000)。⑥中医证候积分。治疗前2组患者的中医证候积分比较,差异无统计学意义(t=-0.595,P=0.554);治疗第7天,2组患者的中医证候积分均较治疗前减小(t=24.128,P=0.000;t=40.200,P=0.000);治疗第7天黄连解毒汤组的中医证候积分低于常规治疗组(t=9.272,P=0.000)。⑦并发症。2组各有2例患者发生下肢深静脉血栓,应用那屈肝素钙联合华法林治疗1周后血栓变小或吸收;黄连解毒汤组2例发生胃肠道不适、常规治疗组2例出现皮疹,均未予药物治疗,症状自行消失。2组患者并发症发生率的差异无统计学意义(χ^(2)=0.000,P=1.000)。结论:黄连解毒汤加减可有效减轻跟骨骨折患者的术前肿胀和疼痛,而且具有较高的安全性,其作用机制可能与其降低患者血清炎症因子水平有关。

中医适宜技术镇痛法联合渐进性肌肉训练在跟骨骨折患者围术期中的促康复效果研究

目的观察中医适宜技术镇痛方案与渐进性肌肉训练(PMR)方案联合促进跟骨骨折患者围术期康复及改善预后的临床效果。方法本次共计纳入80例跟骨骨折手术治疗患者为研究对象,样本采集时间为2018年12月至2020年12月。所有患者以数字表法随机分2组,包括对照组(40例)与观察组(40例)。对照组患者给予常规管理,观察组增加中医适宜技术镇痛法联合PMR方案。对比不同方案下2组跟骨骨折术后患者疼痛及功能康复情况差异。结果2组跟骨骨折患者术后1 d时的疼痛评为未见明显组间差异(P>0.05),术后7、14 d时观察组患者的疼痛评分相比对照组患者明显更低(P<0.05);2组跟骨骨折患者术前时焦虑、抑郁与舒适度评分均未见明显组间差异(P>0.05),术后14 d时2组患者的焦虑及抑郁评分相比术前均明显降低(P<0.05),舒适度评分则明显增高(P<0.05),且观察组焦虑及抑郁评分相比对照组患者更低(P<0.05),舒适度评分相比对照组患者更高(P<0.05);观察组跟骨折患者术后康复锻炼的依从率相比对照组明显增高(P<0.05),足踝功能评分也明显高于对照组(P<0.05);2组跟骨骨折患者术前时降钙素原(PCT)、白细胞介素6(IL-6)、C反应蛋白(CRP)表达水平均未见明显组间差异(P<0.05),术后7 d时2组患者的PCT、IL-6、CRP表达水平均明显较术前降低(P<0.05),且观察组PCT、IL-6、CRP表达水平相比对照组患者更低(P<0.05)。结论中医适宜技术镇痛法联合PMR能够减轻跟骨骨折术后患者疼痛症状,负性情绪及炎症反应程度,并提高康复锻炼依从性与足踝部功能恢复状况。

Allgower-Donati缝合法与Donati缝合法在跟骨骨折手术中临床疗效的Meta分析

目的通过Meta分析评价Allgower-Donati缝合法与Donati缝合法在跟骨骨折手术中的应用效果。方法通过建立检索式,对中国知网、维普期刊网、万方数据库、FMRS、PubMed等中英文数据库进行检索,检索时间段从数据库建立到2023年6月,将与跟骨骨折缝合方法相关的文献纳入调查研究,并使用Cochrane工具对纳入分析的文献进行文献质量评估。使用Review Manager 5.4软件对数据进行分析,比较两种缝合方法在跟骨骨折手术中的临床疗效,包括手术时间、切口缝合时间、引流管留置时间、切口愈合时间、术后切口瘢痕大小和术后VAS评分。结果共纳入13篇文献,Meta分析结果:手术时间、术口愈合时间、术后VAS评分的差异无统计学意义;切口缝合时间[OR=-0.50,95%CI为(-0.92,-0.08),P=0.02]、引流管留置时间[OR=-0.07,95%CI为(-0.13,-0.01),P=0.03]、术后切口瘢痕大小[OR=-0.42,95%CI为(-0.83,0.01),P=0.04]差异具有统计学意义。结论在跟骨骨折术口缝合方式上Allgower-Donati缝合法的临床疗效中优于Donati缝合法。