可吸收螺钉治疗34例老年胫骨平台骨折并发骨质疏松的效果及其对疼痛和并发症的影响

王金华+徐世华+冷干生+姚新贵

摘 要 目的：探讨可吸收螺钉治疗老年胫骨平台骨折并发骨质疏松的效果及其对疼痛和并发症的影响。方法：选取2011年1月—2013年6月我院收治的老年胫骨平台骨折并发骨质疏松患者68例，按数字随机法分为观察组和对照组，每组34例。观察组采用可吸收螺钉内固定+外固定治疗，对照组采用金属松质骨螺丝钉内固定+外固定治疗。术后两组均接受为期12～15个月的随访。比较两组HSS膝关节功能评价表得分、骨折愈合情况、VAS评分和并发症发生情况。结果：治疗前观察组和对照组HSS膝关节功能评价表得分为优、良的患者比例均为0%，治疗后分别为的17.65%和76.47%与8.82%和61.76，且治疗后观察组HSS膝关节功能评价表得分为优、良的患者比例均高于对照组（P<0.01）。观察组治疗前的VAS得分为（7.68±2.44）分，显著高于治疗后的（2.45±1.22）分，对照组治疗后的VAS评分低于治疗前，且观察组治疗后的VAS评分得分亦低于对照组，差异有统计学意义（P <0.05）。与对照组比较，观察组骨折愈合时间和放射学骨折线消失时间均缩短，膝关节屈曲角度则增大（P <0.05）。两组术后总并发症发生率无明显差异（P >0.05），但观察组感染的发生率高于对照组，差异有统计学意义（P <0. 05）。结论： 可吸收螺钉治疗老年胫骨平台骨折并发骨质疏松疗效好，且可促进骨折愈合和缓解疼痛，但患者术后感染的发生率较高，因此治疗期间需注意预防感染的发生。

关键词 可吸收螺钉 胫骨平台骨折 骨质疏松 疼痛 并发症

中图分类号：R683.42 文献标识码：B 文章编号：1006-1533（2016）17-0034-04

Effect of absorbable screw in the treatment of 34 cases of elderly patients with tibial plateau fracture complicated with osteoporosis and its effect on pain and complications*

WANG Jinhua， XV Shihua， LENG Gansheng， YAO Xingui

（Xiushui County Hospital of Traditional Chinese Medicine， Jiujiang 332400， China）

ABSTRACT Objective： To investigate the effect of absorbable screw in the treatment of elderly patients with tibial plateau fracture complicated with osteoporosis and its effect on pain and complications. Methods： Sixty-eight cases of elderly patients with tibial plateau fracture complicated with osteoporosis were selected and randomly divided into an observation group and a control group with 34 cases each. The observation group underwent absorbable screw fixation and external fixation while the control group underwent internal fixation and external fixation. All the patients were followed up for 12-15 months after the operation. The knee HSS scores， fracture healing， VAS scores and complications were compared between the two groups. Results： The ratio of knee HSS scores evaluated as excellent or good in both groups was zero before treatment and was 17.65% and 76.47% in the observation group and 8.82% and 61.76% in the control group after treatment， respectively （P<0.01）. The VAS score in the observation group was （7.68±2.44） before treatment and （2.45±1.22） after treatment. The VAS score in the control group was lower after treatment than before but much lower in the observation group than in the control group （P<0.05）. Compared with the control group， the time for the fracture healing and the disappearance of the radiographic fracture line was shortened while the knee flexion angle was increased in the observation group （P<0.05）. There were no significant differences in the incidence of postoperative complications （P>0.05） between the two groups， but the incidence of infection was higher in the observation group than in the control group （P<0.05）. Conclusion： Absorbable screw in the treatment of senile tibial plateau fracture complicated with osteoporosis has good efficacy and can promote fracture healing and relieve the pain， however， the incidence of postoperative infection in patients is higher， so great attention should be paid to the prevention of infection during the treatment.

摘 要 心力衰竭患者常合并室性心律失常，二者可以互为因果形成恶性循环，病情进展迅猛、病死率较高，严重影响患者的生活质量，是心力衰竭患者常见的死亡原因之一。临床治疗包括缓解症状、基础疾病治疗和诱因治疗、抗心律失常治疗、阻止或延缓心室重塑、防止心肌损害进一步加重等多个方面，最终达到改善症状和降低死亡率的目的。

关键词 心力衰竭 室性心律失常 进展

中图分类号：R541.7； R972.2 文献标识码：A 文章编号：1006-1533（2016）17-0019-06

Progress in the diagnosis and treatment of patients with heart failure complicated with ventricular arrhythmia

QIN Fei11， JI Wenhui2，WANG Zhancheng1， FANG Ningyuan3（ 1. Department of Electrocardiogram， the Eighth Peoples Hospital of Shanghai， Shanghai 200235， China； 2. Department of Internal Medicine， Huajing Community Health Service Center of Xuhui District， Shanghai 200231， China； 3. Department of Geriatrics， Renji Hospital affiliated to Shanghai Jiao Tong University， Shanghai 200001， China）

ABSTRACT Patients with heart failure are often complicated with ventricular arrhythmias and both can reinforce each other in a vicious cycle. The rapid progression and high mortality of this disease can seriously affect the quality of life of patients and it is also one of the common causes of death in patients with heart failure. The remission of symptoms， the treatment of the underlying disease and its incentives， the anti-arrhythmic therapy， the prevention or delay of ventricular remodeling and the prevention of the further aggravation of myocardial damage and so on are usually included in its clinical treatment so as to eventually achieve the goal of improving symptoms and reducing mortality.

KEY WORDS heart failure； ventricular arrhythmias； progress

心力衰竭的发病率逐年增加。在欧美等发达国家，心力衰竭的患病率为l%～2%，每年有40～58万例的新诊断心力衰竭患者，目前有心力衰竭患者500～650万人，5年存活率不到30%[1]。……