抗撬法整复肩关节前脱位

<正>肩关节前脱位传统复位方法有拔伸托入法、牵引推拿法、手牵足蹬法等。自2006年1月至2009年12月运用广东骨伤名家何竹林"抗撬法"[1]整复肩关节前脱位33例,此法单人操作,技巧性高,复位成功率高,现将治疗结果报告如下。     

俯位改良Hippocrates法整复肩关节脱位

目的:探讨肩关节前脱位复位方法,评价俯位改良Hippocrates法治疗效果。方法:1998年2月至2011年4月,应用俯位改良Hippocrates法整复肩关节前脱位1028例,男689例,女339例;年龄11～86岁,平均38.3岁;其中32例曾因Hippocrates法复位失败;86例合并肱骨大结节撕脱性骨折。复位方法:患者取俯卧位,术者立于患侧,双手握患侧腕部,足蹬于患侧腋下(左侧脱位用右足,右侧脱位用左足),另一足立地支撑;复位时,双手持缓用力牵引腕部约半分钟,足蹬腋下加以对抗,并且逐渐由畸形位置变为外展、外旋及后伸位;牵引同时发挥足跟的杠杆支点作用进行收展时轻轻摇晃患肢并内旋外旋进行复位。结果:1027例患者1次复位成功,平均复位时间50s;1例因合并肱骨外科颈骨折后行手术治愈。86例合并肱骨大结节撕脱性骨折中84例达到解剖复位或近解剖复位,2例较大骨片者复位后不稳定,行经皮克氏针内固定痊愈。按Neer评分:优1012例,良15例。结论:俯位改良Hippocrates法整复肩关节脱位成功率高,复位时不需麻醉,患者痛苦少,费用低,复位时间短,易掌握值得广泛应用。     

推顶回旋法治疗难治性肩关节前脱位

肩关节前脱位是临床上最为常见的关节脱位之一,目前常用的复位手法如拔伸足蹬法、拔伸托入法等,均为外展、外旋位牵引复位,对于一般的肩关节脱位疗效尚佳,但对肌肉发达,体格健壮者,实难奏效。我院自1990年至1996年,运用前屈上举位拔伸牵引、推顶回旋法治疗难治性肩关节前?..     

手法复位治疗难复性肩关节后脱位一例

肩关节后脱位在临床上较少见,常易被误诊、漏诊[1-6].3周以内的肩关节后脱位大多被认为手法复位容易成功[3,5].我们近期为一例急诊肩关节后脱位患者进行手法整复却相当困难,将常规的手牵足蹬法予以改良后才复位成功,报告如下.     

难复性肩头节前脱位28例整复体会

肩关节前脱位的治疗一般并不困难,但如伤后局部软组织肿胀严重,或伴有皮肤破损,则对治疗增加困难.1986年以来我们收治此类患者脱位后时间2小时至24天.平均2—3天.已于院外闭合整复失败2—3次19例,3次以上9例,最多达6次.入院后经牵引足蹬复位法成功4例,坐立牵引复位法成功7例;三点牵引复位法成功9例.失败8例.     

牵挎手法治疗肩关节前脱位

肩关节脱位临床常用足蹬法、转腰膝顶法、牵引回旋法、托人法等复位法,方法不一,效果各异。笔者自2001年6月至2012年6月采用牵挎手法整复肩关节前脱位126例,取得良好的效果,现报告如下。     

牵引过顶推按法整复肩关节前脱位的体会

肩关节前脱位是临床常见的创伤疾患，治疗时常采用拔伸足蹬法、拔伸托入法或牵引回旋法等，是传统有效且规范的整复方法，不论中医还是西医的骨伤科医生都能熟练掌握其技巧而灵活运用。对于未能复位成功的病例，笔者近10年来试用牵引过顶推按法整复治疗8例，均获得成功复位，现将整复治疗方法和体会报告如下。     

足蹬外旋复位法治疗肩关节前脱位的病例对照研究

目的：介绍足蹬复位法（Hennipen）外旋治疗肩关节前脱位的特点及其临床疗效。方法：2007年3月至2010年3月采用Hennipen外旋法治疗肩关节前脱位28例（Hennipen组）,男17例,女11例;年龄21-72岁,平均（39．2＋5．1）岁;其中喙突下脱位8例,盂下脱位16例,锁骨下脱位4例。同期采用足蹬法复位法治疗肩关节前脱位44例（Hippocratic组）,男32例,女12例;年龄15-68岁,平均（36．8＋3．4）岁;其中喙突下脱位12例,盂下脱位29例,锁骨下脱位3例。所有患者均根据临床表现和肩关节X线片确诊,手法复位后行搭肩位肘胸绷带固定3～4周。比较两组患者复位过程、并发症及功能恢复情况（采用UCLA肩关节功能评分标准）。结果：Hippocratic组复位操作在2-5min完成[平均（3．9＋1．2）rain],其中32例接受静脉麻醉;Hennipen组复位操作在0．5-2rain完成[平均（1．3±0．7）min],3例患者需在麻醉下复位;两组复位时间差异有统计学意义（P〈0．05）。Hippocratic组1例老年患者复位过程中发生肱骨大结节撕脱骨折,1例发生肋骨骨折;Hennipen组无明显并发症发生。复位3-4周后随访,Hippocratic、Hennipen组患者肩关节UCIA评分分别为（34．2±2．1）分和（33．8±1．6）分,差异无统计学意义（P〉0．05）。结论：足蹬法复位法和Hennipen外旋法治疗肩美节前脱位均能获得良好的疗效．但HenniDen外旋法操作简单．并发症少．尤其适干急诊寅位操作。     

对抗牵引整复肩关节前脱位的体会

1999年来采用椅背整复法(观察组)治疗的肩关节前脱位38例，与同期采用手牵足蹬法(对照组)治疗的肩关节前脱位40例比较，现报告如下。     

零度位牵引法治疗急性肩关节前脱位83例临床体会

目的总结11年来临床应用零度位牵引治疗急性肩关节前脱位的效果。方法体会83例急性肩关节前脱位用零度位牵引复位的疗效。结果复位均成功,无神经血管损伤、骨折等并发症,随访3～6个月,无复发脱位。结论零度位牵引法整复急性肩关节前脱位,其效果显著,该手法具有安全有效,痛苦小,并发症少等众多优点,值得在临床上运用。     

Methotrexate, Azathioprine, Cyclosporine, and Risk of Fracture

We studied the fracture risk associated with use of methotrexate, azathioprine, and cyclosporine. The study was designed as a case-control study. All patients with a fracture (n = 124,655) in the year 2000 in Denmark served as cases. Information on fractures and confounders was retrieved from the National Hospital Discharge Register and a number of other national registers. For each case, three age- and gender-matched controls were randomly drawn from the general population (n = 373,962). Exposure was use of the drugs and a number of covariates including other immunosuppressive drugs, corticosteroids, any cancer, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, liver and kidney disease, prior fracture, and alcoholism. Azathioprine was associated with an increase in overall fracture risk, but besides this, none of the drugs was significantly associated with overall fracture risk or risk of hip, spine, or forearm fracture. Liver [odds ratio (OR) = 1.55, 95% confidence interval (CI) 1.42–1.69] and kidney (OR = 1.26, 95% CI 1.16–1.37) diseases were significantly associated with increased risk of fractures. Azathioprine was associated with an increase in overall fracture risk but not in the risk of spine, hip, or forearm fractures. Methotrexate and cyclosporine were not associated with fracture risk. It thus seems that the underlying disease for which the treatment is administered may be responsible for much of the increase in fracture risk rather than the drugs used to treat the disorder in question.     

Overview: Epidemiology,indications, goals,extent, and nature of work-up

Each year in the United States, it is estimated that there will be 42,000 new cases of rectal cancer and 8,500 deaths^.1,2 Some patients present with an incurable rectal cancer but more often death follows development of recurrent rectal cancer after failed curative-intent therapy. Knowledge of the natural history of rectal cancer and limitations of treatment options coupled with sound clinical judgment and compassion are essential prerequisites for the clinician providing palliative care.     

跳跃式颈前路椎间盘切除植骨融合术治疗多节段颈椎病的疗效分析

目的 :评估跳跃式颈前路椎间盘切除植骨融合手术治疗节段跳跃式的颈椎间盘突出所致颈椎病的近期临床疗效及影像学变化。方法:回顾性分析我院2010年3月~2015年12月因跳跃式椎间盘突出导致颈椎病行跳跃式颈前路椎间盘切除植骨融合(ACDF)手术患者(A组),男性14例,女性4例,年龄37~67岁,平均52.2±10.1岁。取同期行连续ACDF手术的20例患者作为对照(B组),男性16例,女性4例,年龄40~68岁,平均51.6±9.5岁。比较两组患者手术时间、出血量、并发症、术前、术后3个月及末次随访的JOA评分、C2-C7整体活动度(ROM)、C2-C7矢状位垂直轴距离(SVA)、T1倾斜角(T1 slope)、植骨融合率、邻近椎间盘退变情况等结果。结果:所有38例患者术后均获随访,随访中位数时间为12个月(6~36个月),两组间无统计学差异(P0.05)。A组患者手术时间(71.7±9.2min)、手术出血量(17.8±7.3ml)均显著小于B组(111.5±36.1min、47.0±19.1ml,P0.05)。两组患者术后1周、术后3个月及末次随访时JOA评分均较术前有显著改善(P0.05),各时间点两组间JOA评分比较均无显著差异。末次随访时两组患者JOA评分改善优良率分别为94.4%与97.2%。A组患者的C2-C7 ROM从术前的50.0°±7.1°显著下降到术后3个月的38.0°±6.1°和末次随访时的44.3°±5.7°(P0.05),B组患者的C2-C7 ROM从术前的51.8°±10.6°显著下降到术后3个月的38.0°±9.4°和末次随访时的43.9°±10.5°(P0.05),两组之间比较差异无统计学意义。A组患者术后3个月C2-C7 SVA(26.8±2.0mm)相比术前(24.2±2.0mm)有显著升高(P0.05),而末次随访时C2-C7 SVA(24.5±2.2mm)与术前相比差异无统计学意义。B组患者的C2-C7 SVA从术前的23.8±1.4mm明显升高到术后3个月的26.5±1.8mm和末次随访时的24.3±1.5mm (P0.05)。两组之间C2-C7 SVA比较差异无统计学意义。A组患者的T1 slope从术前的28.1°±3.2°明显升高到术后3个月的31.4°±3.0°和末次随访时的30.0°±3.1°(P0.05),B组患者的T1 slope从术前的28.3°±2.1°明显升高到术后3个月的31.6°±2.3°和末次随访时的30.3°±2.1°(P0.05)。两组之间T1 slope比较差异无统计学意义(P0.05)。末次随访时,A组邻近节段椎间盘退变加重率为16.7%(6/36),保留节段椎间盘退变加重率为14.3%(3/21),B组邻近节段椎间盘退变加重率为20.0%(8/40),均未出现相关临床症状。两组间无统计学差异。结论:跳跃式ACDF术式的近期临床疗效良好,与连续ACDF术式近期临床疗效及影像学变化基本一致。     

Absence of sperm meiotic segregation error of chromosomes 1, 9, 12, 13, 16, 18, 21, X and Y in a case of 100% necrozoospermia

Varying degrees of necrozoospermia are common findings in cases of male sub-fertility; however, it is rare to find persistent and 100 % necrozoospermia. A case of persistent 100 % necrozoospermia is presented in this paper, where aneuploidy analysis was carried out on sperm. No known associations like thyrotoxicosis, genital infection, spinal injury and diabetes were found. Sperm fluorescent in situ hybridization (FISH) was carded out to evaluate sperm aneuploidy for chromosome 1, 9, 12, 13, 16, 18, 21, X and Y and did not show any excess of aneuploidy over controls. To the best of our knowledge, this is the first attempt on meiotic segregation analysis on 100 % necrozoospermic patient. (Asian J Androl 2003 Jun; 5:163-166 )     

Distribution, elimination, and action of d-tubocurarine in neonates, infants, children, and adults

The relation of plasma concentration of d-tubocurarine (dTc) to neuromuscular blockade, and the distribution and urinary excretion of dTc was determined in neonates (n = 4), infants (n = 6), children (n = 8), and adults (n = 8). The plasma concentration-time course curves to 24 hr are best described for all groups by three-compartment models. Both neonates and infants exhibit decreased plasma clearance (CLP), 1.1 +/- 0.08 and 1.0 +/- 0.06 ml X kg-1 X min-1, and in addition a prolonged t1/2 terminal phase, 311 +/- 44 and 306 +/- 35 (mean +/- SEM, min). The neonates' 24-hr urinary excretion, 27 +/- 2 (mean +/- SEM, % total dose) is significantly less than the adult value, 45 +/- 4% total dose. There was no significant difference seen in the log plasma concentration-evoked compound electromyogram (ECEMG) response between 20-80% paralysis for adults, children, infants, and five of the seven neonates studied. Two of the neonates had a significant shift of their log concentration-response curve to the right. There was also no significant difference between any of the groups in the time for 50% return of ECEMG stimulus height or the time required for recovery of the ECEMG from 25 to 75% of control value. for recovery of the ECEMG from 25 to 75% of control value.