目的:比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法:筛选1997年6月至2008年6月间收治的60例高龄新鲜不稳定性股骨转子间骨折患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组30例,平均年龄83.6岁;B组30例,平均年龄81.7岁。随访时间8个月～9年(平均2.3年)。结果:两种术式在住院时间和术后引流量的差异无统计学意义(Pgt;0.05);而在手术时间、术中出血量、下地开始行走时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面,两组比较差异均有统计学意义(Plt;0.05)。结论:人工股骨头置换术可以作为治疗高龄股骨转子间骨折的一种选择,术后能早期离床负重活动、较快恢复伤前活动能力、降低术后短期并发症和内科合并症的发生率、减低术后一年内死亡率。
目的 探讨游离股外侧肌瓣联合封闭式负压吸引技术（VSD）修复四肢软组织缺损的临床效果。 方法 2009年6月－2011年6月，对25例四肢软组织缺损患者采用游离股外侧肌瓣联合VSD治疗对创面经彻底清创后，先行VSD覆盖，5～9 d后去除VSD负压膜。再次清创受区，切取股外侧肌瓣修复创面，处理血管危象，二期植皮。 结果 25例均获得随访，时间6～12个月。经负压封闭引流后，局部创面无明显感染，肌腱及骨外露区周围肉芽组织生长良好。出现血管危象3例，经及时处理后3例肌瓣均恢复血液循环。感染控制良好，无窦道形成，患肢功能恢复满意。 结论 对于严重创伤后的肢体软组织缺损，经彻底清创后，应用封闭式负压引流及游离股外侧肌瓣修复，可明显缩短治疗周期，提高手术成功率，最大限度恢复患肢的功能。
目的 探讨空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效。 方法 2005年6月－2010年9月采用空心拉力螺钉联合钢丝张力带治疗髌骨骨折38例，男29例，女9例；年龄32～69岁，平均42.2岁。其中髌骨中份横行骨折18例，斜行骨折15例，髌骨纵行骨折3例，髌骨下极骨折2例。骨折块移位0.6～3.2 cm，平均1.7 cm。受伤至手术时间1～7 d，平均2.1 d。末次随访时评估双侧膝关节主观感受、视觉模拟评分（VAS）、患侧膝关节活动度（ROM）、Lysholm评分及影像学变化。 结果 患者随访13～54个月，平均19.5个月。康复期内未出现皮肤刺痛、滑囊炎、切口延期愈合或不愈合等临床并发症。末次随访时疼痛VAS评分（1.5 ± 0.9）分，患侧膝ROM为健侧的85.2%。术后2.1～3.2个月，平均2.8个月达到临床骨性愈合。 患侧Lysholm评分优27例、良8例、可1例、差2例，优良率92.1%；健侧膝关节Lysholm评分优35例、良1例、可0例、差2例，两侧比较差异无统计学意义（P＞0.05）。 结论 空心拉力螺钉联合钢丝张力带治疗髌骨骨折可获得较好临床疗效，且术后循序渐进的康复锻炼是膝关节功能得到最大恢复的关键。
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.