肱骨小头冠状面骨折治疗进展

肱骨小头冠状面骨折是肱骨小头前半部分的冠状面劈裂骨折，可累及肱骨滑车的外侧髁凸，并不越过滑车中线。肱骨小头冠状面骨折在临床上比较少见，由于此骨折属于关节内骨折，如果处理不当，会严重影响肘关节的功能，故在临床上具有非常重要的治疗意义。近年来，随着对肱骨小头冠状面骨折认识的加深，新固定材料和新技术也不断涌现。现就肱骨小头冠状面骨折的治疗进展综述如下。

维生素K2与骨质疏松症的研究进展

骨质疏松症是一种骨量降低，骨组织微结构破坏，以骨脆性增加，骨强度下降，骨折风险增加为特征的全身骨骼系统疾病。近年来，随着老龄化人数的增加，骨质疏松症已经严重威胁了中老年人身体健康，成为人类社会共同关注的重要健康问题。据一项全国性流行病学调查显示，50岁以上男性骨质疏松症患病率为14.4%，女性升高到20.7%，60岁以上人群的患病率进一步升高[1]。目前治疗骨质疏松症的药物包括骨形成促进剂(甲状旁腺激素等)、骨吸收抑制剂(双膦酸盐类、降钙素、雌激素、雌激素受体调节剂等)和骨矿化促进剂(钙剂、活性维生素D3等)等三大类[2]。维生素K作为自然界中广泛存在的营养素，在骨质疏松症治疗过程中起到多方面的作用，引起了诸多学者的注意。

骨盆骨折临床与康复

骨盆骨折占全身骨折的2.3%～3.0%，大多数由高能量创伤导致，包括交通事故、挤压伤和高处坠落等[1]，表现为不稳定骨折，常伴发腹部或盆腔脏器、泌尿生殖系统、盆腔神经血管、腹膜后区损伤及下肢骨折等其它损伤。Wubben [2]报道骨盆骨折的病死率取决于骨盆骨折及盆腔外损伤的类型，范围在6.4%～30%，Heetveld等[3]认为骨盆骨折合并血流动力学不稳定时，病死率高达37%，急诊的快速评估和诊断以及病情稳定后的康复治疗对良好的预后至关重要。

胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64/100000[1]。随着交通、工业建筑事故的不断增加，胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段( T11～L2)处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域，应力相对集中而容易受到传导暴力的直接损伤[2]，该部位骨折约占脊柱创伤75%～95%，椎体发生爆裂骨折后，后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来，随着影像学、生物力学对胸腰椎骨折研究的不断深入，在治疗方面也出现了许多新理论、新技术，但手术与否、手术时机、手术入路、术式的选择方面，仍有争议；现将研究状况综述如下。

胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64/100000[1]。随着交通、工业建筑事故的不断增加，胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段( T11～L2)处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域，应力相对集中而容易受到传导暴力的直接损伤[2]，该部位骨折约占脊柱创伤75%～95%，椎体发生爆裂骨折后，后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来，随着影像学、生物力学对胸腰椎骨折研究的不断深入，在治疗方面也出现了许多新理论、新技术，但手术与否、手术时机、手术入路、术式的选择方面，仍有争议；现将研究状况综述如下。

髋臼骨折常见并发症的产生机制及治疗进展

伴随经济的飞速发展及交通运输业的日渐发达，由车祸、高空坠落及工业意外导致的高能量损伤越来越多，髋臼骨折的发生率也在逐年增加。由于髋臼解剖结构的特殊性及其生理功能的复杂性，骨折后手术难度大，并发症多，对患者的预后产生重要的影响。现对髋臼骨折常见并发症的产生机制及治疗进展作如下综述。

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

股骨转子间骨折术后内固定失效的再次内固定治疗

目的 评价股骨转子问骨折术后内固定失效行再次内固定加自体髂骨植骨术的疗效. 方法回顺性研究2000年1月至2008年3月间收治的股骨转子问骨折术后内固定失效、骨折不愈合病例31例,其中25例接受切开复位重新内固定加自体髂骨植骨术.一期失效的内固定种类包括动力髋螺钉12例,髁钢板3例,角钢板1例,带锁髓内针3例和空心钉6例.根据遗留骨质状况以及骨折类型选择更换的内固定物,包括股骨近端髓内钉12例,动力髁螺钉7例,动力髋螺钉4例和角钢板2例.所有患者均行自体髂骨植骨. 结果随访时间6-84个月,平均24个月.平均手术时间200 min(120～240 rain),平均出血量1500 mL(800～3000 mL).术中和术后无严重并发症发生.骨折愈合24例,愈合率为96.0%(24/25).25例患者术后髋关节Harris评分平均87分(35～100分),优良率为76.0%.随访患者X线片测量颈十角平均120.(110°～140°),无股骨头缺血坏死表现及髋关节退行性改变. 结论对于股骨转子间骨折术后内固定失效的患者,股骨近端只要存在可固定的骨质,患者的髋关节无严重损害,再次内固定加植骨治疗能够获得满意的临床结果.

Objective: To explore the clinical ef-fects of external fixation associated with limited internal fixa-tion on treatment of Gustilo grade Ⅲ leg fractures.Methods: From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fiactures were emergently treated in our unit with external fixation frames.Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases.All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment.Limited internal fixation with plates and screws were per-formed on all the Gustilo Ilia cases and 10 Gustilo ⅢB cases at the first operation.But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD).Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation.Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.Results: The first operations were completed within 90-210 minutes (170 minutes on average).The blood trans-fusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included).All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average.The lower limb function was evaluated accord-ing to the comprehensive evaluation standards of leg func-tion one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.Conclusion: External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

Objective:　To investigate the characteristics of bone fractures from road traffic accidents and analyze their injury mechanisms so as to provide reference for the research and medical care of traffic trauma.　　Methods:　Three hundred and six patients with fractures from road traffic accidents were included into this study. A total of 507 fractures were identified and the injury mechanism, location distribution and frequency were analyzed. 　　Results:　The most common location of fractures was the lower extremities, followed by the upper extremities, skull and maxillofacial region, and the rarest was the spine. A total of 56% of the patients suffered from multiple fractures. The fractures of the patella, femur and pelvis and the fractures of the olecranon, humerus and shoulder often happened simultaneously.　　Conclusions:　The injury mechanisms can be classified into four types: impact, incoordinate movement, stretch injury and crush and extrusion. The fractures from traffic accidents have the following characteristics: centrifugal distribution of the injuries, multiple fractures, force transmission and ipsilateral occurrence.

Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period.Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months.Results: The size of the flap ranged from 6.6 cm2 to 28.18 cm2 and the rate of flap failure was 13.6％. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series.Conclusions: For soft tissuedefect of delayed open tibial fracture Type HIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for anysecondary manipulation; and ③ to use serial debridementto diminish flap failure.

Objective: To investigate the effect of allogeneic bone nail on articular fractures.Methods: Ninety-one patients with cancellous bone fracture involved in various joints were fixed with the bone nail or the bone screw. No immunosuppressive agent was used in this series. The average period of follow-up was 18months.Results: All patients except one healed without displacement and the healing time was within 1-3 months.Joint function was partially limited in 6 patients and others were functioning well. Conclusions: Allogeneic bone nail possesses a good biological compatibility and intensity, thus provides a rigid fixation. Being completely absorbed and ossificated, thus obviating the need for secondary operation, is a suitable internal fixation material for the treatment of articular fractures.

Objective: To analyze the expression of procollagen gene in fracture callus, and to search for the technique of in situ hybridization for undecalcified skeletal tissue.Methods: In situ hybridization of procollagen gene expression was performed on the undecalcified cryosections of rat fracture callus at 7, 14, and 28 d.Results: The hybridization signals achieved were clear and easy to be localized with high specificity. On the 7th day, the expressions of pro α1 ( Ⅲ ) in fibroblasts and some chondrocyte-like cells were dominant; and at the end of second week high expression of type-Ⅱ procollagen mRNA was observed in chondrocytes. At the end of fourth week, the cartilaginous callus was almost all replaced by woven bone tissue, and some type-Ⅰ procollagen mRNA positive osteoblasts and hypertrophic chondrocytes were found scattering in the woven bone and remnants of cartiiaginous callus.Conclusions: The modified method employed in this study is easier, quicker, and more sensitive with high specificity than the conventional technique for in situ hybridization of procollagen gene expression of decalcified rat fracture callus. The phenomenon of shared phenotype expression, which was demonstrated among cells engaged in fracture healing, indicates an important approach to reveal the meehantsm of the origin, differentiation, and orientation of cells.