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。     

Mitek Anchor系统锚钉置入辅助加固修复急性闭合性跟腱断裂:2年同一机构12例资料回顾

12例急性闭合性跟腱断裂患者采用改良Kessler法修补跟腱,后用Mitek Anchor钉各1枚置于跟腱内外侧跟骨内,采用Bunnell方法将尾线由远向近穿经跟腱断端,加固缝合后的跟腱.随访伤口愈合情况、负重行走时间、足跟部疼痛和跟腱再断裂情况,采用Arner-Lindholm方法评价踝关节功能.修补后未见切口感染或者皮肤坏死病例.12例患者锚钉置入辅助加固修补跟腱后随访14～25个月,平均17个月.无足跟部疼痛和再断裂发生,根据Arner-Lindholm踝关节功能评定标准,优4例,良8例.结果提示,采用Mitek Anchor系统辅助加固治疗急性闭合性跟腱断裂,跟腱修补后可早期负重,降低了跟腱再断裂发生率,是一种理想的治疗方法.     

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。     

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.     

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     

髓内钉和微创钢板在肱骨干骨折内固定治疗中的应用

背景:随着微创技术的开展,髓内钉和微创钢板内固定广泛应用于肱骨干骨折并取得良好效果,但也并存一些并发症,如何改进内固定的设计及操作以减少或避免并发症成为研究热点.目的:总结近年来肱骨干骨折微创内固定的治疗进展.方法:由第一作者检索PubMed/MEDLINE(http://www.ncbi.nlm.nih.gov/PubMed)、Web of knowledge (http://apps. isiknowledge.com)、OVID(http://ovidsp.tx.ovid.com)、Elsevier(http://www.sciencedirect.com)、中国期刊网(http://epub. edu.cnki.net)及万方数据库(http://wanfang.lib.sjtu.edu.cn)2005/2010有关髓内钉和微创钢板内固定治疗肱骨干骨折的文献,英文检索词为“humeral shaft fractures,internal fixation,minimally Invasvie,中文检索词为“肱骨干骨折,微创,内固定.排除重复性研究及肱骨干病理性骨折相关文献,纳入32篇文献进行综述.结果与结论:只有准确掌握肱骨干骨折及不同内固定种类的特点,做到个体化治疗,才能达到最好的治疗效果并最大程度减少并发症.目前深化了对肩袖损伤的认识,初步寻找到减少肩袖损伤的方法,改进了髓内钉及钢板的设计,在方便操作、减少手术时间的同时一定程度上避免了神经血管损伤.     

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.     

经皮穿针导入股骨近端髓内钉内固定治疗股骨转子间骨折的前瞻性研究

目的比较采用经皮克氏针引导小切口与传统方法插入股骨近端髓内钉(PFN)内固定治疗股骨转子间骨折的临床疗效。方法采用前瞻性研究,将2004年1月～2005年3月收治的51例股骨转子间骨折患者随机分为微创组和传统组,均予以闭合复位,其中微创组在完成复位后经皮自大转子顶点打入1枚克氏针置于股骨近段髓腔中央,后做皮肤小切口,在克氏针引导下插入PFN；传统组患者按常规方法置入PFN固定。记录两组的手术时间、术中失血量、切口长度、影像增强仪曝光时间、术后住院时间和骨折愈合时间并进行比较。结果微创组平均手术时间、失血量、切口长度分别为77．20min、104．20mL和5．12cm,均明显低于传统组(分别为108．84min、240．38mL和11．79cm),差异有显著性意义(P＜0．01)；微创组影像增强仪曝光时间高于传统组(P＜0．01)；两组患者骨折临床愈合时间和平均住院时间无显著差异(P＞0．05)。两组所有骨折均愈合,无延迟愈合与不愈合。结论与传统手术方法相比,经皮克氏针引导小切口插入PFN治疗股骨转子间骨折是一种更加微创的内固定手段,早期临床疗效更令人满意。