微创经皮插入接骨板内固定治疗胫骨远端骨折

目的 介绍经皮插入接骨板内固定治疗胫骨远端骨折，并观察其效果。方法 采用闭合复位经皮插入接骨板内固定治疗胫骨远端骨折25例。AO分型：43A型15例(A2型6例，A3型9例)，43B型6例，43C型4例。术后不辅以其他外固定，第2天即开始不负重关节功能锻炼。结果 随访25例，所有病例伤口一期愈合。骨折无延迟愈合，无畸形愈合，平均临床愈合时间15周。根据Mazur的踝关节功能评分．优良率95％。结论 微创经皮插入接骨板内固定术是治疗胫骨远端骨折的有效方法。     

股骨远端骨折治疗方案的探讨

股骨远端骨折是创伤骨科治疗领域内的一个难点。主要原因是治疗方案的混乱和远期膝关节的病损。自1998-2005年采用经皮股骨远端髓内钉(DFN)内固定、切开复位接骨板内固定的方法治疗股骨远端骨折共59例,分析如下。1临床资料经皮DFN共27例,男19例,女8例;年龄19~75岁,平均35岁。交通伤19例,老年跌伤6例,砸伤2例。按AO分型:A1型10例,A2型8例,A3型6例,C1型3例。伴有开放性损伤4例,多发骨折3例,前交叉韧带损伤1例。切开复位接骨板内固定共32例,男21例,女11例。年龄18~79岁,平均36岁。交通伤21例,老年跌伤6例,砸伤4例,炸伤1例。按AO分型:B1型…     

AO万向掌侧双柱锁定加压接骨板治疗不稳定桡骨远端骨折的疗效分析

目的探讨经腕关节掌侧切口AO万向掌侧双柱锁定加压接骨板治疗不稳定桡骨远端骨折的临床疗效。方法回顾性分析2012年3月至2013年6月采用AO万向掌侧双柱锁定加压接骨板治疗不稳定桡骨远端骨折57例,其中AO/ASIF分型：A3型6例,B2型4例,B3型7例,C1型18例,C2型12例,C3型10例,均为闭合性骨折。结果对所有患者随访12-27个月,平均18个月。均未发生感染、内固定松动断裂、腕管综合征、肌腱激惹、正中神经损伤等情况,未见骨延迟愈合和骨不连。术后1年平均掌倾角为（7.5°±1.8°）,尺偏角为（19.8°±2.7°）。按照改良McBride评价标准评定：优38例,良14例,可5例;优良率为91.2%。结论经掌侧切口应用AO万向掌侧双柱锁定加压接骨板治疗AO/ASIF不稳定型桡骨远端骨折,置钉方便、灵活、固定确切、术后并发症少,有利于早期功能锻炼,是治疗不稳定型桡骨远端骨折的良好方法。     

上臂前侧入路微创钢板接骨术治疗肱骨干骨折

目的：探讨上臂前侧入路微创钢板接骨术（MIPO）治疗肱骨干骨折的方法及疗效。方法：2006年1月至2007年10月,采用上臂前侧入路行微创钢板接骨术治疗肱骨干骨折15例,其中男11例,女4例;年龄16-59岁,平均35岁;病程5～10d,平均7．5d。骨折按AO分型：A型6例,B型8例,C型1例。手术均选用AO4．5mm限制接触窄动力加压接骨板固定。对本组患者手术前后进行查体,观察肩、肘关节运动,检查其功能情况,将数据进行比较。结果：随访5～18个月,平均10个月。根据Gill临床上肢评分评定,优12例,良3例。Gill评分由术前的平均（59．33±8．21）分升至术后的平均（84．67±5．81）分。术后2—3个月骨折均临床愈合,患者恢复日常生活。无神经损伤、切口感染、内固定失败、骨折不愈合等并发症。结论：上臂前侧入路微创钢板接骨术治疗肱骨干骨折是可行的,能有效避免损伤桡神经,有利于骨折早期愈合。     

T形锁定加压接骨板治疗桡骨远端骨折

目的探讨T形锁定加压接骨板治疗桡骨远端骨折的临床效果。方法对21例按AO分类为B型和C型的桡骨远端骨折患者,应用T形锁定加压接骨板进行内固定治疗。结果19例获得随访,时间4～10（6.5±1.9）个月。骨折全部愈合,愈合时间6～12（7.4±1.3）周。根据改良Mcbride腕关节功能评价标准：优12例,良5例,差2例。结论采用T形锁定加压接骨板治疗桡骨远端骨折具有固定可靠,尤其对不稳定的骨折患者具有良好的治疗效果,并有利于患肢早期的功能锻炼。     

T型锁定加压接骨板与远端万向锁定加压接骨板治疗桡骨远端骨折的疗效分析

目的 比较使用T型锁定加压接骨板和远端万向锁定加压接骨板在治疗桡骨远端骨折时的手术疗效.方法 回顾性分析2011年12月-2015年11月于首都医科大学附属北京友谊医院骨科分别采用T型锁定加压接骨板与远端万向锁定加压接骨板治疗桡骨远端骨折的118例患者病例资料.T型锁定加压接骨板组60例;按AO/OTA分型,其中A3型3例,B2型5例,B3型7例,C1型10例,C2型20例,C3型15例.远端万向锁定加压双柱接骨板组58例;按AO/OTA分型,其中A3型1例,B2型2例,B3型4例,C1型15例,C2型18例,C3型18例.分析对比两组术后影像学参数、功能恢复情况.随访以门诊随访进行.掌倾角、尺偏角、桡骨高度、腕关节背伸、掌屈、尺偏、桡偏、旋前、旋后角度以及Gartland-Werley功能评分用均数±标准差((x)±s)表示,组间比较行￡检验.结果 所有患者术后均得到随访,T型锁定加压接骨板组平均随访时间26.5个月,远端万向锁定加压双柱接骨板组平均随访时间25.6个月.结果显示,在尺偏角、桡骨高度、桡偏角度以及Gartland-Werley功能评分方面两组间差异无统计学意义,在掌倾角、腕关节背伸、掌屈、尺偏、旋前、旋后角度方面两组间差异有统计学意义,远端万向锁定加压接骨板具有优势.结论 采用两种内固定手术方式治疗桡骨远端骨折均获得满意的临床疗效,远端万向锁定加压接骨板更具有优势,临床手术应用可根据患者具体情况选择相应的内固定方式.     

微创锁定接骨板技术治疗股骨转子间骨折的临床研究

目的评价通过微创接骨板技术以锁定加压接骨板内固定治疗股骨转子间骨折的疗效。方法从2007年10月至2009年10月,通过微创接骨板技术以锁定加压接骨板内固定治疗35例股骨转子间骨折。男性22例,女性13例,年龄17～84岁,平均51岁。按AO/OTA分类,A1 9例,A2 19例,A3 7例。无开放性骨折。以临床功能和X线检查评定治疗效果。结果 35例均获随访,平均随访时间13个月（4～28个月）。35例骨折全部愈合,平均愈合时间为13周（9～16周）,没有发生内固定失败以及骨不愈合者。发生浅表感染1例。髋关节功能评价（Harris）优良31例,优良率88.5%。结论微创锁定接骨板技术操作简单,创伤小,效果好,是治疗股骨转子间骨折的一种有效方法。     

经前方入路微创锁定加压接骨板内固定治疗肱骨中下段骨折

目的 探讨肱骨中下段骨折应用锁定加压接骨板(LCP)经前方入路微创内固定技术(MIPO)的临床效果.方法 回顾性分析2018-04—2020-01驻马店魏道德骨科医院收治的46例肱骨中下段骨折患者的临床资料.男37例,女9例;年龄23.67岁(范围:20～39岁).骨折AO分型:A型25例,B型17例,C型4例.均采用...     

锁定加压钢板治疗胫骨远端骨折

目的探讨锁定加压钢板内固定治疗胫骨远端骨折的临床疗效。方法自2005年5月至2007年12月应用切开复位锁定加压接骨板内固定治疗胫骨远端骨折24例,男18例,女6例;年龄20-62岁,平均41岁。骨折按AO分类,43A型13例,B型7例,C型4例。其中开放性骨折9例（按照Gustilo标准分类,I型6例,Ⅱ型3例）。结果24例均获随访,随访时间6-12个月,平均9个月。骨折无延迟愈合及不愈合,无钢板螺钉松动及断钉。根据Johner-Wrushs评定标准。优18例,良4例,中2例,优良率91.7％。结论锁定加压钢板内固定治疗胫骨骨折具有保护骨膜、固定可靠、骨折愈合时间短等优点,而且可以单皮质固定,是治疗胫骨骨折安全有效的方法。     

锁定钛板联合重建钛板固定治疗肱骨干下1/4骨折

2007年12月～2010年12月,我科采用肱骨远端锁定加压钛板联合重建钛板内固定治疗22例肱骨干下1/4骨折患者,效果优良,报道如下。1材料与方法1.1病例资料本组22例,男16例,女6例,年龄19～61岁。均为闭合骨折;无桡神经损伤。骨折按AO分型:A3型4例,B1型6例,B2型6例,B3型3     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

Vasoconstrictor effect of cyclosporin on the mesenteric artery in the dog

To evaluate the effect of cyclosporin (CyA) on the mesenteric arterial bed, studies were performed on the isolated mesenteric artery perfused at a constant flow in 20 dogs. Changes in mesenteric perfusion pressure reflected variations in vascular resistance. Pure powder CyA was dissolved in autologous blood and injected at doses of 5, 10, 20 and 40 mg. Infusions of 5 and 10 mg CyA caused nonsignificant mean increases of 3±2 mm Hg [95% confidence interval (CI)-2 to +7; P>0.05] and 3±3 mm Hg (95% CI-3 to +9; P>0.05) in mesenteric perfusion pressure, with CyA blood levels in the mesenteric vein averaging 466±153 and 692±130 nmol/l, respectively, at the end of the injections. Infusions of 20 and 40 mg CyA caused significant increases in mesenteric perfusion pressure averaging 11±3 mm Hg (95% CI 3–18; P<0.05) and 26±4 mm Hg (95 % CI 16–34; P<0.05), respectively. CyA blood levels at the end of infusion averaged 806±85 and 1118±89 nmol/l, respectively, in the mesenteric vein. Blockade of alpha-adrenergic receptors with phentolamine abolished the CyA vasoconstriction of the mesenteric artery, with the increase in perfusion pressure averaging 16±4 mm Hg before and 3±3 mm Hg after phentolamine (P<0.05). Thus, in the dog, CyA causes an acute vasoconstriction of the mesenteric artery through stimulation of alpha-adrenergic receptors.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

The Classic: Hospital for the Cure of Deformities: Course of Lectures on the Deformities of the Human Frame

This Classic Article is a reprint of the original work by W.J. Little, Hospital for the Cure of Deformities: Course of Lectures on the Deformities of the Human Frame. An accompanying biographical sketch of W.J. Little is available at DOI  10.1007/s11999-012-2301-z. The Classic Article is ©1843 and is reprinted courtesy of Elsevier from Little WJ. Hospital for the Cure of Deformities: course of lectures on the deformities of the human frame. Lancet. 1843;41:350–354.     

人工全髋关节置换术治疗强直性脊柱炎髋关节病变的临床疗效

目的 观察人工全髋关节置换治疗强直性脊柱炎髋关节病变的手术方法和临床效果.方法 对2001年3月至2009年6月26例(31髋)强直性脊柱炎髋关节病变患者行人工全髋关节置换并随访,置换前患者日常活动均明显受限或者严重疼痛,Harris评分平均(43.2±5.8)分,髋关节活动度平均51.8°±9.7°.记录术后末次随访的Harris评分,X线检查结果,观察假体有无松动、脱位及异位骨化. 结果 所有病例得到随访,平均随访24.9(8 ～125)个月.末次随访患者均疼痛消失,步态正常.Harris评分平均(82.4±4.7)分;髋关节活动度平均148.6°±7.4°;髋关节Harris评分及关节活动度均显著高于置换前(P＜0.05).2髋出现异位骨化,为Brooker分级Ⅰ、Ⅲ级.无脱位、骨折及假体松动下沉,无患者进行翻修. 结论 人工全髋关节置换是治疗强直性脊柱炎晚期髋关节病变的有效方法,可以恢复关节功能,缓解关节疼痛并改善患者生活质量.     

髋臼重建治疗Crowe Ⅲ型髋臼发育不良

目的 探讨髋臼重建治疗Crowe Ⅲ型髋臼发育不良的手术方法及疗效.方法 2001年1月至2007年6月43例(54髋)Crowe Ⅲ型髋臼发育不良继发骨关节炎患者接受全髋关节置换术治疗.术前Harris评分平均39分.髋臼重建方法包括单纯加深或穿透髋臼(A组)27例(34髋)、髋臼内壁截骨(B组)12例(15髋)、髋臼自体股骨头植骨(C组)4例(5髋).分别记录每种重建方法的手术时间、出血量、并发症.术后随访进行放射学及临床疗效评估.结果 40例(50髋)患者获得完整随访,随访时间平均29个月.在术后3～5个月随访时截骨和植骨已愈合.摄x线片测量A、B、C组重建方式的髋臼外倾角分别为(41.0±7.5)°,(46.0 ±7.7)°,(39.0±11.0)°;前倾角分别为(10.0±2.8)°,(9.0±2.5)°,(4.0±1.9)°;旋转中心上移分别为(8.4±3.6)mm,(7.3 ±2.6)mm,(1.2±0.5)mm;旋转中心内移分别为(7.0±1.5)mm,(9.9 ±1.7)mm,(-2.7 ±1.2)mm.A、B、C组末次随访平均Harris评分分别为B9、91、86分.随访患者中2例发生下肢深静脉血栓,2例可疑肺栓塞,4例坐骨神经麻痹.结论 单纯加深或穿透髋臼、髋臼内壁截骨、自体股骨头植骨是Crowe Ⅲ 型髋臼发育不良髋臼重建的有效方法.应根据术前评估、术中具体情况采用相应的重建方法.     

Genetic requirements for the development of the GVH reaction following small-bowel transplantation

The genetic requirements for the development of graft-versus-host (GVH) disease have been investigated in a model of semiallogenic, heterotopic small-bowel transplantation in the rat. Following semiallogenic MHC-incompatible small-bowel transplantation, all graft recipients showed characteristic signs of GVH disease and died within 14 days. On autopsy the transplanted bowel was normal, while the recipient's bowel was dilated and distended with gas. Histology showed a generalized cell infiltration of the connective tissue with macrophages and lymphocytes. After semiallogenic, RT1.A-incompatible, small-bowel transplantation, the graft recipients developed mild and temporary symptoms of GVH disease between days 25 and 40. Only two of the six animals died, while the remaining animals survived the observation period. Small-bowel transplantation across an isolated RT1.C barrier was unable to induce GVH reaction. These results indicate that the development of GVH disease after small-bowel transplantation is controlled genetically by the MHC. Class II MHC incompatibility is necessary for the induction of an acute and lethal GVH reaction.     

改道性结肠炎治疗进展

改道性结肠炎(diversion colitis,DC)是在结肠或回肠造口术后无粪流通过的旷置结肠段粘膜的非特异性炎症。尽管绝大多数肠道造口患者无症状,但几乎所有粪便改道患者均可出现DC。DC的临床症状主要有腹痛、里急后重、便血以及排粘液分泌物等,且随着肠管旷置时间延长而炎症可日渐加重,进而不同程度影响了这类患者的生活质量。然而,国内对DC的研究甚少,对DC的认识有限,因而还未引起临床医生的足够重视。鉴于此,我们在本文中对DC的表现及治疗方面的研究进展作一综述,以期能够提高临床对改道性结肠炎的认识,同时帮助临床医生做出更好的治疗决策。     

髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响

目的 探讨髌骨软骨破坏程度对保留髌骨的全膝关节置换术疗效的影响.方法 2002年1月至2006年5月行全膝关节置换术163例244膝,根据术中观察到的髌骨软骨破坏程度将患者分为轻度、中度、重度软骨破坏三组.所有手术均不置换髌骨.术后随访88例133膝,轻度组42膝,中度组43膝,重度组48膝.采用美国膝关节学会评分(Knee Society Score,KSS)系统(包括膝评分和膝功能评分)和膝前痛评分系统对三组疗效进行评估.结果 随访48～102个月,平均72个月.KSS膝评分和膝功能评分从术前(35.1±5.4)分和(19.2±9.8)分分别提高到(91.7±5.6)分和(83.7±17.5)分.三组KSS膝评分从术前(34.7±6.2)分、(36.5±5.2)分、(35.3±6.2)分分别提高至(92.6±4.5)分、(90.5±6.7)分、(91.9±5.9)分;膝功能评分从术前(14.2±8.6)分、(16.5±7.4)分、(17.0±7.5)分分别提高至(86.6±12.6)分、(82.0±17.2)分、(82.8±21.1)分.三组术后膝评分和膝功能评分的差异均无统计学意义.术后膝前痛的发生率为11.3%(15/133),轻度、中度、重度软骨破坏组分别为11.9%(5/42)、11.6%(5/43)、10.4%(5/48),差异无统计学意义.结论 全膝关节置换术后疗效及膝前痛的发生率与术前髌骨软骨破坏程度无关,髌骨软骨破坏程度不是全膝关节置换术中置换髌骨的可靠依据.

Abstract：

Objective To determine whether there was any correlation between the degree of degenerative changes in the patellar cartilage and the clinical outcome after TKA without patellar resurfacing.Methods A clinical study was performed on 133 knees of 88 patients that underwent TKA without patellar resurfacing from January 2002 to May 2006. According to the degenerative condition of the patellar cartilage,patients was classified as mild group, moderate group, and severe group. Pre- and post-operative evaluations were performed using the knee and function scores of the Knee Society Clinical Rating System (KSS) and Anterior Knee Pain Rating. Results The duration of follow-up was 72 months (range 48-102). The overall knee score of KSS in all patients were improved from 35.1±5.4 preoperatively to 91.7±5.6 postoperatively,and function score of KSS from 19.2±9.8 preoperatively to 83.7±17.5 postoperatively. The mean knee scores of KSS were improved from 34.7±6.2, 36.5±5.2 and 35.3±6.2 preoperatively to 92.6±4.5, 90.5±6.7 and 91.9±5.9 in mild, moderate, and severe group postoperatively, respectively. The mean function scores of KSS were improved from 14.2±8.6, 16.5±7.4 and 17.0±7.5 postoperatively to 86.6±12.6, 82.0±17.2 and 82.8±21.1 in mild, moderate, and severe group postoperatively, respectively. There was no difference among all groups with regard to the postoperative knee scores and function scores of KSS. The prevalence of anterior knee pain was 11.3% in all, and 11.9% in mild group, 11.6% in moderate group and 10.4% in severe group. There was no difference among all groups with regard to the anterior knee pain. Conclusion The clinical outcome and anterior knee pain after TKA without patellar resurfacing was not correlated with the severity of degenerative changes in the patellar cartilage. The degree of degenerative condition of the patellar cartilage is not indication for patellar resurfacing.