跗骨窦入路联合锁定钢板治疗移位跟骨关节内骨折

目的分析移位跟骨关节内骨折经跗骨窦入路联合锁定钢板内固定治疗的疗效。方法回顾性分析采用跗骨窦入路切开复位联合跟骨锁定钢板内固定治疗的移位跟骨关节内骨折11例(12足),其中男性8例,女性3例;年龄16~61岁,平均42.3岁。骨折根据Sanders分型:Ⅱ型7足,Ⅲ型4足,IV型1足。比较手术前后跟骨B9hler角、Gissane角,并按照Maryland足部评分系统进行疗效评价。结果伤后3~6d手术,平均4.5d,均获得随访,时间5~16个月,平均11.4个月。术后无内固定失败、感染坏死等软组织并发症;骨折愈合时间8~16周,平均12.6周。B9hler角由术前平均7.2°提高至术后平均32.3°;Gissane角由术前平均104.3°提高至术后平均131.6°。按照Maryland足部评分系统:优11足,可1足。结论跗骨窦入路联合锁定钢板内固定是治疗SandersⅡ、Ⅲ型跟骨关节内骨折的理想方法,微创,并发症少,疗效满意。     

跟骨骨折术后切口并发症的临床分析与防治

采用切开复位钢板内固定治疗40例46足跟骨骨折,随访8～26个月,根据Maryland足部评分标准,优良率为84．7％。发生切口并发症5足,发生率为10．8％。合适的手术时机、细致的切口处理及必要时植骨,可减少手术并发症。     

SandersII—IV型跟骨骨折的手术治疗

目的探讨跟骨关节内骨折的手术治疗。方法对2003年3月--2010年3月共收治143例166侧跟骨关节内骨折,按Samder分型标准：II型78足,III型70足,IV18型足,均经X光及CT检查确诊。术中采用切开复位解剖钢板内固定,羟基磷灰石人工骨植骨术后随访1-2年进行疗效评价。结果按Maryland足部评分系统评价术后功能,随访1-2年,优96足,良66足,可4足,优良率97．6％,除2例切口裂开,无伤口感染、皮肤坏死、慢性骨髓炎、后跟坏死。结论对跟骨骨折采用切开复位解剖钢板内固定粒基磷灰石人工骨植骨有较好治疗效果。     

外侧小切口结合经皮撬拨复位有限内固定微创治疗跟骨关节内移位骨折的体会

外侧小切口结合经皮撬拨复位有限内固定手术治疗跟骨骨折18例,术前、术后及健侧跟骨X线片对比,Maryland评分法评价术后功能。术口均愈合,跟骨恢复满意。骨折平均于术后8周愈合,患者平均于术后4.3个月恢复正常生活,Maryland评分优良率77.8%。外侧小切口结合撬拨复位有限内固定可有效治疗移位的跟骨关节内骨折,手术微创,并发症少。     

AO钢板螺钉治疗跟骨关节内骨折

目的探讨切开复位内固定治疗跟骨关节内骨折的手术时机及疗效。方法采用跟骨外侧延长"L"型切口,AO支持钢板内固定跟骨关节内骨折。结果所有病例经随访6～24个月,均骨性愈合。术后采用Maryland足部功能评分标准评定优良率83.4%。结论应用AO支持钢板治疗跟骨关节内骨折疗效满意。术前严格掌握手术时机,术中微创操作等措施可有效预防伤口裂开、感染等并发症。     

钢板内固定治疗跟骨关节内骨折的疗效和并发症分析

目的 探讨切开复位、钢板内固定治疗跟骨关节内骨折的疗效和并发症.方法 采用美国足踝骨科协会(AOFAS)的后足评分系统,对28足跟骨关节内骨折术后1～2年行功能评定,同时测定跟骨手术前后的Bohler角.评估切口感染、腓肠神经损伤、腓骨肌腱炎、畸型愈合、跟腓撞击征、创伤性关节炎的发生率.结果 根据AOFAS评分标准,平均分为86.2分(65～99分),优14足,良8足,可4足,差2足;优良率78.6%.影像学检查,术前Bohler角-23°～24°,平均4°;术后Bohler角16°～43°,平均24.8°,二者有显著差异(P＜0.01).术后并发症:切口表浅感染2足,深部感染1足;腓肠神经损伤1足;腓骨肌腱炎1足;创伤性关节炎3足.结论 跟骨关节内骨折,通过良好的切开复位、钢板内固定和早期功能锻炼,能获得满意疗效.     

经跗骨窦切口治疗跟骨关节内骨折54例临床效果分析

目的探讨跟骨关节内骨折患者应用跗骨窦切口进行切开复位钢板固定的临床效果。方法回顾性分析2013-2015年收治的54例跟骨关节内骨折患者临床资料,其中男性40例,女性14例;年龄22~56岁,平均42.3岁。致伤原因:高处坠落伤32例、道路交通伤18例,其他4例。患者累及距下关节跟骨骨折,对其进行经跗骨窦切口入路跟骨解剖钢板方法进行内固定治疗,如有必要则进行植骨手术,评价经跗骨窦微创切口跟骨解剖钢板治疗的临床效果。结果 X线片显示患者解剖结构恢复良好。Bohlee角平均恢复到38°,Gissane角平均恢复到135°。术后对其进行平均12个月的随访,其中46例获得随访,对其临床治疗效果以Maryland足部评分系统进行评价,患者临床治疗总有效率为86.9%。结论对跟骨关节内骨折患者应用经跗骨窦切口入路外侧跟骨钢板内固定方法进行治疗,必要时联用植骨方法,能够获得良好的临床治疗效果,且患者接受治疗后不会出现严重的不良反应,具有安全高效的优点,值得临床推广。     

不同止血方法对跟骨骨折手术切口愈合的影响

目的观察和对比分析电凝止血、钳夹止血及压迫止血对跟骨骨折手术切口愈合的影响。方法收集2012年12月~2015年12月收治的60例66足跟骨骨折患者临床资料,其中男性48例,女性12例;年龄18~59岁,平均36.6岁。均经跟骨外侧L形切口行切开复位钛板内固定术,术中止血方法分别采用电凝止血、钳夹止血及压迫止血。记录三组患者年龄、骨折分型、伤后至手术时间、手术时间、切口干燥时间、切口愈合时间、切口并发症发生率及足部功能Maryland评分等,并进行统计学分析。结果在切口干燥时间、切口愈合时间及切口并发症等方面钳夹止血组显著优于电凝止血组和压迫止血组(P0.05),而电凝止血组和压迫止血组之间无显著性差异(P0.05),三组足部功能Maryland评分无显著性差异(P0.05)。结论跟骨骨折术中行钳夹止血可明显降低切口并发症的发生率。     

锁定钢板外置治疗跟骨骨折的体会

对28例(30足)跟骨骨折患者行切开复位锁定钢板外置治疗,术后Bohler角和Gissane角恢复良好。按Maryland足部评分标准评价术后功能恢复情况,评估锁定钢板外置治疗跟骨骨折的临床疗效,优16足、良10足、可3足、差1足,优良率为87%。锁定板外置治疗跟骨骨折兼顾了外固定和内固定的优势,是一种较为理想的手术方式。     

解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效

目的：探讨解剖型跟骨钛板并植骨治疗跟骨关节内骨折的临床疗效。方法选择2009年3月～2012年5月期间收治的25例（33足）SanderslⅡ～Ⅳ型跟骨关节内骨折患者,男性20例（26足）,女性5例（7足）;年龄15～65岁,平均（36.16±14.63）岁。单足17例,双足8例,采用切开复位解剖型跟骨钛板内固定并植骨进行治疗,术中恢复跟骨解剖形态,按Maryland足部评分系统进行术后功能评分,评价手术效果,进行系统的回顾性总结分析。结果本组25例（33足）术后均获12～36个月随访（平均19.3个月）,按Maryland足部评分标准：优17足、良12足、可4足,差0足;优良率为87.88％。结论解剖型跟骨钛板并植骨治疗跟骨关节内骨折能够恢复跟骨距下关节面平整,有利于患者早期功能锻炼,疗效可靠。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

磁共振DWI和动态增强鉴别颅底脊索瘤和侵袭性垂体瘤的应用

目的 探讨磁共振扩散加权成像(DWI)和动态增强在颅底脊索瘤和侵袭性垂体瘤(IPA)鉴别诊断中的应用价值.方法 搜集经手术病理证实且影像学有鞍区破坏的颅底脊索瘤患者15例、向鼻咽部侵犯的IPA患者20例.测量二者的表观扩散系数(ADC)值,绘制受试者工作特征曲线(ROC),分析动态增强曲线的类型,统计达峰时间(TTP)、增强峰值(EP)和最大对比增强率(MCER),分析各个参数在鉴别诊断中的价值.结果 颅底脊索瘤的ADC值为(1.274±0.07)×10-3mm2/s,高于IPA ADC值(0.672±0.03) ×10-3 mm2/s(P ＜0.001),ADC阈值为0.964×10-3mm2/s时,ROC曲线下面积为0.997,敏感度为93.3％,特异度为100％.颅底脊索瘤时间-信号强度曲线(TIC)Ⅰ型14例,TICⅢ型1例,此例TICⅢ型者TTP约40 s;IPA TIC Ⅰ型7例,TICⅢ型13例.颅底脊索瘤和IPA的EP、MCER差异均有统计学意义(P ＜0.001).结论 ADC值和TIC的类型及其相关参数(EP,MCER)有助于颅底脊索瘤和IPA之间的鉴别.     

Treatment of intrahepatic arteriovenous fistula in hepatocellular carcinoma with N-butyl-2-cyanoacrylate

Primary hepatocellular carcinoma (HCC) continues to be one of the most common malignancies with an incidence of approximately one million cases per year and a dismal prognosis; some authors have reported a median survival of 1 ～ 2 months after diagnosis. Although surgery remains the only hope for cure, few patients are candidates[1,2].