目的 探讨后路手术中360°植骨融合术治疗腰椎滑脱症的近期疗效。 方法 2008年1月－2011年2月收治39例腰椎滑脱症患者，男21例，女18例；年龄35～75岁，平均51岁。病程12～50个月，平均31个月。滑脱部位：腰3 1例，腰4 11例，腰5 24例，腰4、5 3例。腰椎退变性滑脱27例，峡部裂性滑脱12例。按Meyerding分度：Ⅰ度21例，Ⅱ度13例，Ⅲ度5例。患者均有腰腿痛症状，保守治疗无效后行后路减压、复位及椎弓根钉棒系统内固定，术中以360°行椎间及后外侧三维立体植骨融合，在椎体前中柱采用植骨加椎间融合器的融合方式。术后定期随访，摄X线片检测融合情况，使用视觉模拟疼痛（VAS）评分评估症状缓解情况，Greenough-Fraser综合评分评价腰腿痛治疗结果。 结果 有36例患者获随访，随访时间12～36个月，平均24个月。植骨愈合率100%，愈合时间10～18个月，平均14个月。无内固定松动、断裂、外露及脱落等并发症发生。术前下肢神经根痛VAS评分为（7.52 ± 1.23）分，末次随访时为（1.67 ± 1.18）分；下腰痛术前（6.83 ± 1.51）分，末次随访时为（1.11 ±0.76）分；手术前后比较差异均有统计学意义（P＜0.05）。Greenough-Fraser综合评分术前为（24 ± 7）分，末次随访时为（55 ± 4）分，差异有统计学意义（P＜0.05）。 结论 360°植骨融合术治疗腰椎滑脱症是一种确实有效的融合方法，利于提高相应区域的植骨融合率及恢复椎间隙高度，使融合更稳定。
ObjectiveTo systematically review the safety and efficacy of operative versus non-operative treatment for displaced midshaft clavicle fractures.MethodsDatabases including PubMed, The Cochrane Library, EMbase, MEDLINE(Ovid), CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) and cohort studies about operation versus non-operation for displaced midshaft clavicle fractures from inception to June 3rd, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by RevMan 5.2 software.ResultsA total of 14 RCTs and 5 prospective cohort studies involving 1 543 patients were included. The results of meta-analysis showed that operation was superior to non-operation in the Constant score (SMD=0.76, 95%CI 0.40 to 1.13, P<0.000 1), DASH score (SMD=–0.49, 95%CI –0.91 to 0.06,P=0.02), nonunion rate (RR=0.17, 95%CI 0.10 to 0.30, P<0.000 01), malunion (RR=0.20, 95%CI 0.12 to 0.33,P<0.000 01) and patients’ satisfaction rate (RR=1.39, 95%CI 1.13to 1.71,P=0.002), respectively.ConclusionCurrent evidence shows that operation could improve the function of the upper limbs, reduce nonunion and malunion, and improve the satisfaction of the patients with midshaft clavicle fractures. Due to the limited quality of the included studies, more large-scale, high-quality studies are required to verify the above conclusion.
Objective To analyze retrospectively the overall situation of medical rescue in the First Affiliated Hospital of Guangxi Medical University after the Wenchuan earthquake, so as to provide references for the emergency preparation for the disaster of earthquake. Methods Analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the hospital. The software Microsoft EXCEL was used for data management, and SPSS 13.0 was used for statistical analysis. Results From May 22 to May 26, 91 cases from the disaster area had been treated in the hospital, of which 90 were from Mianyang and 1 from Chengdu. These patients included 44 males with a median age of 38 (27, 53) years old and 47 females with a median age of 51 (33, 62) years old. Most patients were sent to the hospital within the first 10 or 11 days after the earthquake, with 86.8% hospitalized after 10 days and 22.0% after 11 days. The number of outpatients reached its peak of 37.1% of all the outpatients (33 cases) within 34 days after the earthquake. The wounded were mainly admitted into the Department of Orthopaedics, with 34.81% of the patients having lower limb fracture, 18.26% having spine fracture, and 12.59% suffering pelvis fracture. Only 2 out of the 89 patients died. One death was due to 60% burning injury and 1 died of multiple catastrophic injuries. Conclusion Based on the data, it is important to develop an emergent plan for medical rescues after an earthquake disaster and to strengthen the reserve of medical supplies, personnel training, scientific field triage and the construction of information platforms.
Objective To review the progress of cell sheet technology and its application in bone and cartilage engineering. Methods The recent literature concerning the cell sheet technology used in treatment of bone and cartilage defects was extensively reviewed and summarized. Results Cell sheet built through many different ways can protect extracellular matrix from proteolytic enzymes. As a three-dimensional structure, cell sheet can repair bone and cartilige defects via folding, wrapping scaffold, or be created by the layering of individual cell sheets. Conclusion The cell sheet technology would have a very broad prospects in bone and cartilage tissue engineering in future.
Objective To review the progress of perioperative treatments for patients of Parkinson’s disease and hip fractures. Methods The related literature of treatments for patients of Parkinson’s disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson’s disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson’s disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson’s disease and hip fractures are associated with the severity of Parkinson’s disease. Conclusion There are few clinical studies about the patients of Parkinson’s disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson’s disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson’s disease and hip fractures need to be further explored.
Objective To review the application and research progress of in-situ tissue engineering technology in bone and cartilage repair. Methods The original articles about in-situ tissue engineering technology in bone and cartilage repair were extensively reviewed and analyzed. Results In-situ tissue engineering have been shown to be effective in repairing bone defects and cartilage defects, but biological mechanisms are inadequate. At present, most of researches are mainly focused on animal experiments, and the effect of clinical repair need to be further studied. Conclusion In-situ tissue engineering technology has wide application prospects in bone and cartilage tissue engineering. However, further study on the mechanism of related cytokines need to be conducted.
Objective To explore the effect of early weight-bearing exercise on the recovery of elderly patients with intertrochanteric fractures after internal fixation. Methods The clinical data of 50 patients with unstable intertrochanteric fractures (AO 31-A2 or A3) who underwent proximal femoral nail treatment between February and August 2015 were collected. Among them, 25 patients underwent early weight-bearing exercise after surgery (the observation group), and 25 patients underwent routine recovery after surgery (the control group). Demographic data of patients, modified Barthel Index, and EuroQOL Five Dimensions Questionnaire (EQ-5D) scores were collected, and mortality was assessed by telephone follow-up one year after surgery. Results In the observation group, the modified Barthel Index before injury, within 48 hours , 6 weeks , 12 weeks, and 1 year after surgery was 49.56±2.00, 26.40±3.11, 44.04±3.92, 47.92±3.13, and 48.76±3.07, respectively; in the control group, the modified Barthel Index at the above mentioned time points was 49.92±0.40, 26.52±3.34, 40.92±2.62, 45.44±2.36, and 49.16±1.75, respectively. The difference between the observation group and the control group at 6 and 12 weeks after surgery was a statistically significant (P<0.05), and the observation group was better than the control group; there was no statistical difference between the two groups in the modified Barthel Index before surgery, within 48 hours after surgery or one year after surgery (P>0.05). None of the patients died within the first one year after surgery. Conclusion The early weight-bearing exercise after hip fracture in the elderly has a positive effect on the recovery of the patients.