目的 探讨胸外伤开胸探查的手术指征及救治策略。 方法 回顾性分析我院自 2006 年 1 月至 2014 年 12 月经开胸探查救治 51 例胸外伤患者的临床资料，其中男 43 例、女 8 例，年龄 24（17～75）岁。 结果 全组损伤严重度评分（ISS）平均 19.4 分。闭合性损伤 16 例，开放性损伤 35 例，治愈 45 例（88.24%），死亡 6 例（11.76%）。死亡原因为心脏破裂、失血性休克、感染性休克、多器官功能障碍综合征（MODS）、弥散性血管内凝血（DIC）。 结论 及时就医、快速诊断、准确把握手术指征、多科室联合诊治是救治胸外伤的关键。
目的探讨可吸收肋骨钉与记忆合金接骨板内固定两种方法治疗多发性肋骨骨折的效果。 方法回顾性分析2009年1月至2014年1月在上海市第六人民医院胸外科行手术内固定的胸部外伤致多根多处肋骨骨折患者321例的临床资料，其中可吸收肋骨钉组70例，其中男62例、女8例，年龄（48.54±9.74）岁；记忆合金接骨板组251例，其中男187例、女64例，年龄（51.44±10.22）岁。分析两组患者疗效差异。 结果两组患者术前疼痛评分（7.74±0.89 vs.7.66±0.92）、术后疼痛评分（3.80±0.79 vs.3.82±0.85），术后胸腔引流时间[（6.00±2.84）d vs.（5.68±2.98）d]差异均无统计学意义（P>0.05）。记忆合金接骨板组住院时间[（20.06±7.39）d vs.（17.77±7.68）d]，及手术时间（101.29±30.67）min vs.（71.95±29.50）min]均短于可吸收肋骨钉组，且差异有统计学意义（P＜0.05)。术后3个月随访复查胸部X线，两组患者骨折再移位差异无统计学意义。 结论可吸收肋骨钉与记忆合金接骨板均是治疗多发性肋骨骨折较理想的术式，记忆合金接骨板手术操作更为简单，可吸收肋骨钉手术无需在体内留置金属内固定装置，但固定强度较接骨板略差，应根据情况选择合适的内固定方法。
Objective To review the research progress of rapid surgery for hip fracture in elderly patients. Methods The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice. Results Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients. Conclusion In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.
Trabecular microstructure is an important factor in determining bone strength and physiological function. Normal X-ray and computed tomography (CT) cannot accurately reflect the microstructure of trabecular bone. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new imaging technique in recent years. It can qualitatively and quantitatively measure the three-dimensional microstructure and volume bone mineral density of trabecular bone in vivo. It has high precision and relative low dose of radiation. This new imaging tool is helpful for us to understand the trabecular microstructure more deeply. The finite element analysis of HR-pQCT data can be used to predict the bone strength accurately. We can assess the risk of osteoporosis and fracture with three-dimensional reconstructed images and trabecular microstructure parameters. In this review, we summarize the technical flow, data parameters and clinical application of HR-pQCT in order to provide some reference for the popularization and extensive application of HR-pQCT.