目的:比較人工股骨頭置換與骨折內固定治療高齡股骨轉子間骨折的臨床療效。方法:篩選1997年6月至2008年6月間收治的60例高齡新鮮不穩定性股骨轉子間骨折患者分為A、B兩組。A組為行人工股骨頭置換者,B組為行骨折內固定者。A組30例,平均年齡83.6歲;B組30例,平均年齡81.7歲。隨訪時間8個月～9年(平均2.3年)。結果:兩種術式在住院時間和術后引流量的差異無統計學意義(Pgt;0.05);而在手術時間、術中出血量、下地開始行走時間、術后早期并發癥、術后內科合并癥和髖關節功能恢復、術后1年內死亡率等方面,兩組比較差異均有統計學意義(Plt;0.05)。結論:人工股骨頭置換術可以作為治療高齡股骨轉子間骨折的一種選擇,術后能早期離床負重活動、較快恢復傷前活動能力、降低術后短期并發癥和內科合并癥的發生率、減低術后一年內死亡率。
目的 探討空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折的臨床療效。 方法 2005年6月－2010年9月采用空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折38例，男29例，女9例；年齡32～69歲，平均42.2歲。其中髕骨中份橫行骨折18例，斜行骨折15例，髕骨縱行骨折3例，髕骨下極骨折2例。骨折塊移位0.6～3.2 cm，平均1.7 cm。受傷至手術時間1～7 d，平均2.1 d。末次隨訪時評估雙側膝關節主觀感受、視覺模擬評分（VAS）、患側膝關節活動度（ROM）、Lysholm評分及影像學變化。 結果 患者隨訪13～54個月，平均19.5個月。康復期內未出現皮膚刺痛、滑囊炎、切口延期愈合或不愈合等臨床并發癥。末次隨訪時疼痛VAS評分（1.5 ± 0.9）分，患側膝ROM為健側的85.2%。術后2.1～3.2個月，平均2.8個月達到臨床骨性愈合。 患側Lysholm評分優27例、良8例、可1例、差2例，優良率92.1%；健側膝關節Lysholm評分優35例、良1例、可0例、差2例，兩側比較差異無統計學意義（P＞0.05）。 結論 空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折可獲得較好臨床療效，且術后循序漸進的康復鍛煉是膝關節功能得到最大恢復的關鍵。
目的 探討游離股外側肌瓣聯合封閉式負壓吸引技術（VSD）修復四肢軟組織缺損的臨床效果。 方法 2009年6月－2011年6月，對25例四肢軟組織缺損患者采用游離股外側肌瓣聯合VSD治療對創面經徹底清創后，先行VSD覆蓋，5～9 d后去除VSD負壓膜。再次清創受區，切取股外側肌瓣修復創面，處理血管危象，二期植皮。 結果 25例均獲得隨訪，時間6～12個月。經負壓封閉引流后，局部創面無明顯感染，肌腱及骨外露區周圍肉芽組織生長良好。出現血管危象3例，經及時處理后3例肌瓣均恢復血液循環。感染控制良好，無竇道形成，患肢功能恢復滿意。 結論 對于嚴重創傷后的肢體軟組織缺損，經徹底清創后，應用封閉式負壓引流及游離股外側肌瓣修復，可明顯縮短治療周期，提高手術成功率，最大限度恢復患肢的功能。
Objective To explore the clinical efficacy of external fixation combined with autogenous periosteal iliac bone for repairing cartilage injury of the talus. Methods The data of 18 patients with talus cartilage injury treated in Mianyang Central Hospital between January 2018 and January 2022 were retrospectively analyzed. All patients received autogenous periosteal iliac bone transplantation and external fixation brackets. The Visual Analogue Scale (VAS), joint range of motion, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle posterior foot score were assessed before surgery and 6 months after surgery. The changes of cartilage damage of the talus on MRI before and after surgery were compared. The complications related to the operation were recorded. Results The patients included 5 males and 13 females, with an average age of (50.7±5.4) years. There were 6 cases injured on the left side and 12 cases injured on the right side. The Hepple’s classification was type Ⅲ in 8 cases and type Ⅳ in 10 cases. The average follow-up time was (17.6±8.2) months. The preoperative VAS score, ankle range of motion, and AOFAS score were 5.5±1.5, (48.0±10.5)°, and 54.9±11.1, respectively. Six months after surgery, the VAS score, ankle range of motion, and AOFAS score were 2.1±0.9, (64.8±7.8)°, and 82.6±8.7, respectively, and the differences from preoperative scores were all statistically significant (P<0.05). The preoperative MRI showed that the area of talus cartilage injury was (2.6±0.6) cm2, and the depth was (10.0±0.4) mm; the 1-year follow-up MRI showed that the area of talus cartilage injury was (0.6±0.2) cm2, and the depth was (5.5±0.3) mm, which statistically differed from those before surgery (P<0.05). By the last follow-up, no postoperative complications such as incision infection, bone graft fracture, and nonunion of the inner ankle were found. Conclusions Autogenous periosteal iliac bone graft can repair cartilage injury of the talus. External fixation stent provides early joint stability, avoiding uneven joint compression or joint impact.
ObjectiveTo evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius.MethodsBetween December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases.ResultsAll incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications.ConclusionFor Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.
ObjectiveTo summarize the injury characteristics and therapeutic strategy of patients injured in " 8·8” Jiuzhaigou earthquake.MethodsThe clinical data of 48 patients injured in " 8·8” Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency.ResultsExcept 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported.ConclusionIntensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue.