闭合复位经皮螺钉内固定治疗跖跗关节损伤

目的探讨应用闭合复位经皮螺钉内固定治疗跖跗关节损伤的临床疗效。方法自2003年1月～2005年6月应用闭合复位经皮螺钉内固定治疗跖跗关节损伤26例。按照Myerson分类:中间柱损伤13例,内侧、中间柱合并损伤7例,内侧、中间、外侧柱三柱损伤6例。结果本组切口均一期愈合,平均手术时间为40min(30～70min),切口长度平均为5mm;所有患者获平均11.4个月(6～17个月)随访,根据美国足踝骨科协会(AOFAS)评分平均为87分,患者术后平均5.3个月(3～11个月)恢复正常生活。结论闭合复位经皮螺钉内固定手术创伤小,软组织并发症低,能有效治疗跖跗关节复合体损伤;中间柱复位并沿Lisfranc韧带方向插入螺钉内固定是重建跖跗关节复合体稳定性的关键。     

MIPO与切开复位钢板内固定治疗肱骨中下段骨折的比较研究

目的 比较用微创内固定技术(MIPO)与传统切开复位钢板内固定治疗肱骨中下段骨折的临床效果.方法 55例肱骨中下段骨折,其中行MIPO技术治疗25例,传统切开复位钢板内固定30例,对术中和术后的各项指标进行分析.采用SAS 6.12软件对统计数据进行处理.结果 MIPO组在术中出血、术后平均住院时间、骨折平均愈合时间、骨不连和桡神经损伤发生率以及肘关节术后功能等方面优于传统切开复位内固定技术.结论 肱骨中下段骨折采用MIPO技术治疗不仅创伤小、术中出血少、术后恢复快,可更快地骨性愈合、获得良好的肩肘功能,而且同时具有不显露桡神经和减少医源性桡神经损伤发生风险的优点.     

山莨菪碱对大鼠颈总动脉吻合术后血流动力学的影响

目的研究山莨菪碱对血管吻合后血流动力学的影响。方法取ＳＤ大鼠９６只，切断左侧颈总动脉作端端吻合后，随机分成术后６、１２、２４、４８、７２和１２０小时共６个时间组。各时间组再分成实验组和对照组，每组８只大鼠。实验组用２％氢溴酸山莨菪碱（３０ｍｇ／ｋｇ）作腹腔注射，对照组则注射等体积生理盐水，给药１０分钟后用彩色多普勒血流仪检测颈总动脉吻合口前、吻合口、吻合口后动脉收缩期平均最高血流速度，并计算吻合口横截面积。结果术后１２、２４、４８、７２和１２０小时组，颈总动脉吻合口前的血流速度比对照组明显增加（Ｐ＜０．０５），平均增加３１．５％。术后６和２４小时组，实验组吻合口狭窄程度比对照组明显减轻（Ｐ＜０．０１，０．０５）。术后１２０小时组，山莨菪碱能够明显增加吻合口后的血流速度，实验组和对照组相比有显著性差异（Ｐ＜０．０５）。结论山莨菪碱能够提高大鼠颈总动脉吻合后，血管吻合口前及吻合口的血流速度，术后２４小时内用药能够减少吻合口的狭窄程度。     

髋臼骨折治疗的选择和对策

<正>髋臼骨折是髋部常见的损伤类型,分为简单和复杂两个大的类别,简单的髋臼骨折类型如后壁骨折、前柱骨折,其治疗措施相对单一,容易;复杂的髋臼骨折如完全双柱骨折,“T”形骨折的手术治疗非常具有挑战性,不仅手术难度高,而且在与骨折治疗有关的诸如分类、手术入路和内固定选择等方面存在较多的争议^[1]。此外,近年来逐渐增多的老年髋臼骨折的治疗也是研究的热点之一^[2]。     

前置钢板微创固定治疗肱骨干中下段骨折的可行性研究

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.     

手术治疗漂浮膝45例临床分析

目的:探讨不同手术方法治疗漂浮漆的疗效.方法:回顾分析2005年3月~2010年12月收治的45例下肢漂浮漆损伤患者的临床资料.结果:45例经12~56月(平均30个月)随访,疗效评定采用Karlstrm及Olerud标准,骨折愈合率100%,45例膝关节的平均活动度108°,优良率80%.结论:漂浮漆损伤应积极实行手术固定,术后康复治疗也非常重要.     

硝苯地平对大鼠颈总动脉端端吻合术后血流速度的影响

目的 研究硝苯地平（ｎｅｆｅｄｉｐｉｎｅ））对小动脉端端吻合后血流速度的影响。为血管吻合后临床应用硝苯地平的时间提供依据。方法 取ＳＤ大鼠４８只,切断左侧颈总动脉后作端端吻合。按术后所给药物的不同随机分成两组。实验组：术后用硝苯地平灌胃（１．０ｍｇ／ｋｇ）;对照组用同等体积生理盐水灌胃。按给药时间又分成术后２４、４８和７２ｈ３个给药时间组。每组均在给药后１、３、５和７ｈ,用彩色多普勒超声仪检测左侧     

前置钢板微创固定治疗肱骨干中下段骨折的可行性研究

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.     

肩关节后脱位的诊治进展

肩关节后脱位是临床上少见的损伤,容易造成漏诊。本文就肩关节后脱位的诊断、治疗和预后的最新进展做一综述。     

后内侧联合前外侧入路复位固定治疗后外侧关节面塌陷的复杂胫骨平台骨折

目的 探讨后内侧联合前外侧入路复位固定治疗后外侧关节面塌陷的复杂胫骨平台骨折的疗效。 方法 回顾性分析2010年7月至2012年9月收治并成功随访的19例复杂胫骨平台骨折患者资料,男11例,女8例;平均年龄49.5岁（30~65岁）。骨折根据Schatzker分型：Ⅴ型14例,Ⅵ型5例。所有患者的后外侧胫骨平台关节面骨折块通过前外侧入路复位,后外侧移位的皮质骨经后内侧入路复位,并用1块塑形的重建钢板固定于胫骨近端的后外侧,钢板近端不放置螺钉。胫骨平台外侧解剖钢板固定后外和外侧胫骨平台的骨折前外侧放置。随访指标包括手术时间、骨折愈合时间、术后即刻和术后1年X线片所示胫骨平台内翻角和后倾角以及术后1年患者的膝关节活动度。末次随访时采用美国特种外科医院评分系统（HSS）评定膝关节功能。 结果 平均手术时间为164.7 min（120~280 min）。19例患者术后平均随访17.8个月（12~30个月）。所有患者的骨折均一期愈合,愈合时间平均为15.2周（12~18周）。术后即刻和术后1年的X线片示胫骨平台内翻角平均为87.2°±1.0°、87.1°±1.1°;后倾角平均为7.0°±1.1°、7.0°±1.0°,术后即刻与术后1年比较差异均无统计学意义（ P>0.05）。术后1年患者膝关节活动度平均为128.7°（0~135°）。其中2例患者出现后外侧关节面高度丢失（关节面塌线≥2 mm）。末次随访时HSS评分平均为92.6分（88~97分）。 结论 复杂胫骨平台后外侧关节面骨折可通过后内侧联合前外侧入路复位,同时通过后内侧入路置入后外侧支撑钢板及前外侧钢板联合固定,手术效果安全、可靠。