三种不同X线表现的踝关节旋后外旋骨折分析

运踝关节旋后外旋骨折由Lauge-Hausen首先提出,并统计225例,此型占踝关节骨折71%,最为多见。1995年8月至2002年10月,本院共收治120例踝关节旋后外旋型骨折,发现此型骨折有3种不同的X线表现,依次归类为a型(骨折伴距骨向外脱位)、b型(骨折伴距骨向后脱位)及c型(骨折伴距骨向后外脱位)[1]。分析各自的暴力机制,按型区别治疗,疗效满意。1临床资料1.1一般资料:本组12例,男78例,女42例;年龄22～80岁,平均45岁;受伤原因:扭伤92例,车祸21例,重物压伤3例,坠落伤3例,钢丝绳绞伤1例。开放性损伤4例,无合并血管神经损伤。受伤至手术时间:4小时～40天,…     

经内外踝低位截骨入路治疗复杂距骨骨折脱位

自2003年3月～2008年2月,笔者采用通过内外踝截骨入路治疗35例复杂距骨骨折脱位,疗效满意,现报告如下. 1 临床资料 1.1一般资料本组35例,男19例,女16例;年龄26～58岁,平均(32±3.6)岁.受伤原因:车祸伤22例,高处坠落伤8例,其他5例.左侧19例,右侧16例.以距骨颈骨折为主的21例,按照Hawkins分型:Ⅱ型11例,Ⅲ型7例,Ⅳ型3例.以距骨体骨折为主的14例,按照Sneppen分型:Ⅲ型10例,Ⅳ型4例.伴踝关节骨折5例,均为新鲜骨折病例.纳入标准:经临床和影像学确诊的距骨体骨折;内外踝低位截骨入路手术治疗是首选方法.入选对象均在伤后1周左右及患侧踝关节肿胀消退后进行手术.     

血管束植入防止距骨坏死九例临床观察

强大暴力造成距骨颈骨折时常合并距骨体脱位 ,致使距骨体血供丧失贻尽 ,常发生距骨体坏死 ,预后不良。我们自1991年 4月至 1998年 10月 ,采用血管束植入距骨体治疗距骨颈骨折脱位 9例 ,随访效果满意。现报告如下 :1　临床资料1 1　一般资料　本组 9例 ,男 7例 ,女 2例 ;年龄 18～ 46岁。致伤原因 :摔伤 5例 ,车祸伤 2例 ,砸伤 2例。分型 :按Ｇｉｌｌｇｕｓｔ等[1] 分型 :Ⅲ型 6例 ,Ⅱ型 3例。合并伤 :内踝骨折 6例 ,外踝骨折 3例 ,其中 6例同时合并内外踝及后唇骨折 ,跟骨骨折 5例。脱位方向 :距下关节内侧脱位 2例 ,后侧脱位 1例 ,距骨体内…     

T型钢板加植骨治疗尾骨骨折脱位

2005年1月～2011年3月,我院采用T型钢板加植骨治疗8例尾骨骨折脱位患者,疗效满意,报道如下。1材料与方法1.1病例资料本组8例,男6例,女2例,年龄21～50岁。均为臀部着地所致尾骨骨折脱位。伤后至手术时间1～3个月。1.2治疗方法术前3 d给予患者泻     

外伤性髋关节骨折脱位18例治疗体会

髋关节骨折脱位是指股骨头后脱位合并髋臼骨折或 /和股骨头骨折。我院自 1989年 7月～ 1998年 7月治疗 18例髋关节骨折脱位 ,治疗效果满意 ,报告如下。1　临床资料本组 18例 ,男 16例 ,女 2例 ;年龄 2 1～ 5 6岁 ,平均 3 8 5岁。本组 18例均为受伤后 3周内手术 ,均为新鲜脱位合并骨折。 17例因车祸致伤 ,1例为高处坠落伤。2　治疗方法18例患者在无禁忌症情况下 ,全部在腰麻下进行手法复位。对复位成功不需手术者 ,进行皮牵引或骨牵引 4～ 6周 ,本组 6例。手法复位失败 2例和 10例股骨头虽然复位 ,但合并髋臼或股骨头骨折均手术治疗 ,行髋关…     

重度踝关节骨折脱位手术治疗体会

1990年1月至1995年6月我们手术治疗重度踝关节骨折脱位36例,取得较好的疗效。报告如下。 1 临床资料 1.1 一般资料 本组男23例,女13例,年龄18～68岁。车祸伤21例,重物砸伤9例,高处坠落伤6例。就诊时间伤后2h至2月,平均11d。分型:旋后一内收型3例,旋前一外展型13例,旋后一外旋型14例,旋前一外旋型6例,伴距骨骨折4例,跟骨骨     

距骨骨折及脱位的手法治疗

距骨骨折是踝关节中较严重的骨折，应及时满意复位，处理不当则后果较严重。本院自1980～1995年共手法复位治疗19例，报告如下。临床资料本组19例中，男16例，女3冽；年龄5～51岁。均为新鲜骨折，其中开放伤2例，距骨体粉碎骨折2冽。合并内、外踝骨折4例，内、外、后、前踝及下肢脏关节分离1例，合并跟骨骨折2例，聪骨骨折1例。按Gilbost’‘’分类：I”距骨颈骨折无移位或轻度移位1例，11”距骨颈骨折合并距下关节脱位或半脱位11例，Ill”距骨颈骨折合并距骨体完全脱位7例。治疗方法全部先以手法复位，石膏外固定治疗，对2例开放伤则先行…     

空心螺钉治疗距骨颈骨折脱位23例疗效分析

距骨颈骨折脱位作为足部最严重的损伤之一,几乎占距骨骨折的50%[1],随着交通及建筑业的发展,距骨颈骨折脱位有逐渐增多的趋势。我院自1995年3月至2005年2月收治此类患者23例,其中19例给予手术治疗,现报告如下。1临床资料本组23例,男14例,女9例;年龄21~47岁,平均35.6岁。受伤原因:车祸伤10例,高处坠落伤7例,压砸伤4例,行走时扭伤2例。开放性损伤7例,闭合性16例。按Hawkin[2]分型:Ⅰ型4例,Ⅱ型13例,Ⅲ型5例,Ⅳ1例。伤后至手术时间2h~6d,平均3.1d。2治疗方法非移位的4例距骨颈Ⅰ型骨折患者行石膏外固定6~8周,不负重关节功能锻炼,3个月扶拐下地…     

经踝后内侧入路空心螺钉治疗距骨后突骨折

<正>2013年2月~2015年8月,我科采用经踝关节后内侧入路空心螺钉内固定治疗9例距骨后突骨折患者,效果满意,报道如下。1 材料与方法1.1 病例资料本组9例,男8例,女1例,年龄22~55岁。单纯距骨后突骨折6例,合并距骨体、颈骨折2例,合并距下关节脱位1例。完全距骨后突骨折7例,外侧结节骨折1例,内侧结节骨折1例。伤后至手术时间4~12 d。1.2治疗方法硬膜外麻醉下手术。经踝后内侧纵向切口约10 cm,显露距     

跗外侧血管束植入治疗距骨颈骨折脱位(附7例报告)

我们于1985～1992午,应用跗外侧血管束植入及螺纹钉内固定治疗距骨颈骨折脱位7例,均随访1年以上,效果满意。 1 临床资料 1.1 一般资料 7例中,男性5例,女性2例。年龄最小14岁,最大56岁,平均年龄26.6岁。右侧6例,左侧1例。其中坠落伤4例、压砸伤2例,车祸伤1例。2例合并骨盆骨折,1例合并内踝骨折。按改良Hawkin分类:Ⅰ型距骨颈骨折无移位。Ⅱ型距骨颈骨折合并距下关节脱位。Ⅲ型距骨颈骨折合并距骨体脱位,即胫距关节和距下关节脱位。Ⅳ型距骨颈骨折合并距舟关节脱位和距骨体脱位。7例病人中,Ⅰ型1例,Ⅱ型2例,Ⅲ型4例。其中Ⅱ型1例为陈旧性距骨颈骨折脱位(伤后3周),其余均为新鲜骨折脱位。全部病例施行切开复位螺丝钉内固定、跗外侧血管束于跗骨窦部植入。合并内踝骨折者同时行内踝复位螺纹钉内固定。 1.2 手术方法 在硬膜外麻醉下,仰卧位,取足背正中切口,在其外侧找到跗外侧血管束,连同血管束周围部分组织一并游离,以防止血管束损伤及便于血管束固定,逐步游离到末端,将末端切下,温盐水纱布保护备用。足尽力跖屈将骨折脱位尽可能解剖复位,自距骨头向内后下方打入一枚松质骨累纹钉固定     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

三角韧带损伤的手术治疗

[目的]探讨踝关节三角韧带损伤的手术治疗及效果。[方法]2002年4月-2005年4月治疗伴有三角韧带损伤的踝关节骨折40例，均采用切开复位和坚强内固定，并修复重建三角韧带，恢复踝关节内外侧结构的稳定性。下胫腓联合分离仍不稳定者，给予皮质骨螺钉横向内固定。[结果]全部病例得到16个月-3a随访，平均1．5a。按齐氏疗效评定标准：优良30例，可8例，差2例，优良率75％。[结论]强调踝关节骨折切开解剖复位，坚强内固定的同时，应充分重视修复重建三角韧带。     

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.