经尺骨鹰嘴截骨治疗肱骨髁问C型骨折

目的 探讨经尺骨鹰嘴关节内垂直截骨及关节外斜形截骨治疗肱骨髁间C型骨折的手术方法及疗效.方法 采用2种经尺骨鹰嘴截骨人路内固定治疗肱骨髁间骨折28例,对手术入路、时间、术后肘关节功能,及并发症等进行分析.结果 术后随访6～38个月,平均13个月.按Cassebaum法对肘关节功能进行评定,经尺骨鹰嘴关节内垂直截骨组优良率75%,经尺骨鹰嘴关节外斜形截骨组优良率83%.结论 经尺骨鹰嘴截骨是治疗肱骨髁间C型骨折较好的入路,尤其是经尺骨鹰嘴关节外斜形截骨更具有易操作,有利于截骨部骨折的愈合,以及术后肘关节功能恢复并发症低等优点.     

尺骨鹰嘴截骨入路双钢板内固定治疗成人C型肱骨髁间骨折的效果

目的探讨尺骨鹰嘴截骨入路双钢板内固定治疗成人C型肱骨髁间骨折的效果。方法随机将76例成人C型肱骨髁间骨折患者分为2组,各38例。观察组采取尺骨鹰嘴截骨入路双钢板内固定,对照组采取肘后肱三头肌舌形瓣入路。比较2组疗效。结果观察组手术时间、X线暴露时间、骨折愈合时间均短于对照组,肘关节功能优良率高于对照组,差异均有统计学意义(P0.05)。结论在治疗成人C型肱骨髁间骨折证实施尺骨鹰嘴截骨入路双钢板内固定术,可缩短手术和骨折愈合时间,且肘关节功能恢复较好。     

经尺骨鹰嘴截骨治疗肱骨髁问C型骨折

目的探讨经尺骨鹰嘴关节内垂直截骨及关节外斜形截骨治疗肱骨髁间C型骨折的手术方法及疗效。方法采用2种经尺骨鹰嘴截骨入路内固定治疗肱骨髁间骨折28例，对手术入路、时间、术后肘关节功能，及并发症等进行分析。结果术后随访6～38个月，平均13个月。按Cassebaum法对肘关节功能进行评定，经尺骨鹰嘴关节内垂直截骨组优良率75％，经尺骨鹰嘴关节外斜形截骨组优良率83％。结论经尺骨鹰嘴截骨是治疗肱骨髁间C型骨折较好的入路，尤其是经尺骨鹰嘴关节外斜形截骨更具有易操作，有利于截骨部骨折的愈合，以及术后肘关节功能恢复并发症低等优点。     

经尺骨鹰嘴V形截骨双钢板内固定治疗肱骨髁间粉碎性骨折

目的探讨经尺骨鹰嘴截骨入路并应用肱骨内外侧柱双钢板固定治疗肱骨髁间粉碎性骨折的方法和疗效。方法 2004年4月至2009年1月采用经尺骨鹰嘴V形截骨双钢板内固定治疗粉碎性肱骨髁间骨折33例,其中C1型7例,C2型15例,C3型11例。全部获得随访,随访时间5～30个月（平均19个月）,用改良Cassebaum评分系统对其疗效评定。结果 33例骨折全部愈合,平均愈合时间18.7周。术后疗效优17例,良11例,可4例,差2例,优良率84.8%。结论解剖复位骨折,重建肘关节的稳定性以及早期的功能锻炼是肘关节功能恢复的关键因素。经尺骨鹰嘴截骨入路显露骨折充分,肱骨内、外侧柱双钢板固定肱骨髁间骨折牢固可靠,并可满足患者早期进行关节功能锻炼。     

经尺骨鹰嘴Ⅴ型截骨入路内固定治疗肱骨髁间骨折

[目的]探讨经尺骨鹰嘴V型截骨入路内固定治疗肱骨髁间骨折治疗特点及临床疗效。[方法]采用经尺骨鹰嘴截骨入路内固定治疗肱骨髁间骨折。其中C1型4例,C2型8例,C3型9例。全部病例采用Y型钢板、螺钉固定;C2及C3型有长于2.5 cm的骨折块时应用钢丝捆扎。肱骨髁间骨折的固定应达完整三角形的稳定效果。[结果]21例病人随访1~4年,平均18个月,所有骨折均愈合。随访结果按Aitken-Rorabeck肘关节功能评定标准评价,优10例,良8例,可3例,优良率84.7%。[结论]尺骨鹰嘴V型截骨入路三角形稳定内固定治疗肱骨髁间骨折可获得满意的临床疗效。     

肘内外侧联合入路和肘后尺骨鹰嘴截骨入路治疗肱骨髁间骨折

目的:探讨肘内外侧联合入路和肘后尺骨鹰嘴截骨入路治疗肱骨髁间骨折的疗效及优缺点。方法:2012年10月至2016年5月,对18例肱骨髁间骨折患者进行手术治疗,男12例,女6例;年龄4~56岁,平均33.5岁。按AO分型:C1型3例,C2型8例,C3型7例。8例行肘关节内外侧联合入路,10例行尺骨鹰嘴截骨入路;所有患者术前排除神经、血管损伤。结果:18例患者获随访,时间12~26个月,平均15个月。患者伤口愈合良好,未发现异位骨化。按改良的Cassebaum肘关节功能评分:优14例,良3例,可1例。结论:根据骨折类型,选择合适的手术入路及固定方式,力求解剖复位、坚强固定,配合早期功能锻炼是肱骨髁间骨折手术取得成功、最终获得良好功能恢复的重要条件。     

经尺骨鹰嘴关节外斜行截骨治疗肱骨髁间骨折

目的探讨经尺骨鹰嘴关节外斜行截骨治疗肱骨髁间骨折的手术方法及疗效。方法自1995年3月至2003年10月间采用经尺骨鹰嘴关节外斜行截骨、单纯“8”字钢丝固定的方法治疗肱骨髁间骨折26例,男15例,女11例;年龄19～68岁,平均43.2岁。左侧14例,右侧12例;车祸及摔伤23例,其他3例。按照AO分型,C1型3例,C2型5例,C3型18例;开放骨折5例(CustiloⅠ型3例,Ⅱ型2例),皮肤挫伤3例,多发伤5例,合并原发性尺神经损伤4例。术后2～7d开始功能锻炼,以定期物理检查结果及X线片的表现作为判断截骨处骨愈合的指标,同时以Cassebaum的方法对肘关节功能进行评价。结果21例获得随访,术后随访9个月至8年,平均1年6个月。所有患者截骨处全部愈合,平均愈合时间为6.2周,无截骨块分离移位。4例发生异位骨化,其中2例肘关节活动明显受限。4例原发性尺神经损伤者术中探查尺神经连续性存在,均行尺神经前移术,3例完全恢复,1例遗留轻度感觉、运动障碍。肘关节功能评价:优12例,良6例,可1例,差2例。关节平均活动范围为110°。结论经鹰嘴关节外斜行截骨具有不侵袭关节、操作简便、固定方式简单、力学性能优良、有利于术后功能锻炼及并发症发生率低的优点,采用该方法治疗肱骨髁间骨折疗效优良。     

经尺骨鹰嘴关节外斜行截骨治疗肱骨髁间骨折

目的介绍经尺骨鹰嘴关节外斜行截骨入路治疗肱骨髁间骨折的手术方法和临床疗效。方法1999年2月～2004年12月采用经尺骨鹰嘴关节外斜行截骨入路重建钢板内固定治疗12例肱骨髁间骨折患者,按AO分型：C1型2例,C2型6例,C3型4例。术后3～7d开始主、被动关节功能锻炼。结果12例患者术后获6～36个月(平均14个月)随访。按HSS评分标准评定疗效：优6例,良5例,一般1例。所有患者截骨块均愈合,未见截骨块移位及畸形愈合。2例诉鹰嘴处钢丝尾部隆起部轻度不适。1例关节活动角度欠佳。结论经尺骨鹰嘴关节外斜行截骨入路具有操作简便、固定牢固、力学性能优良、有利于术后早期功能锻炼及并发症发生率低等优点,该入路治疗肱骨髁间骨折疗效优良。     

经尺骨鹰嘴截骨入路双侧锁定加压钢板治疗肱骨远端C型骨折

目的探讨经尺骨鹰嘴截骨入路双侧锁定加压钢板治疗肱骨远端C型骨折的方法及疗效。方法采用经尺骨鹰嘴截骨入路双侧锁定加压钢板治疗31例肱骨远端C型骨折患者。采用改良Cassebaum评分系统评价肘关节功能。结果 31例均获得随访,时间12~24个月。末次随访时X线片示骨折处及鹰嘴截骨处全部愈合。关节功能:优11例,良15例,可3例,差2例(并发骨化性肌炎),优良率83.9%。结论经尺骨鹰嘴截骨入路可以充分显露肱骨远端,有利于解剖复位粉碎的关节面;双侧锁定加压钢板固定骨折块,牢固可靠,可满足肘关节早期功能锻炼。     

两种手术入路治疗肱骨髁间骨折疗效分析

目的评价尺骨鹰嘴截骨入路与肱三头肌舌形瓣入路治疗肱骨髁间骨折手术疗效。方法手术治疗56例肱骨髁间骨折,行尺骨鹰嘴截骨入路32例,肱三头肌舌形瓣入路24例。结果对于AO/ASIF分型C1C2型肱骨髁间骨折,尺骨鹰嘴截骨入路比肱三头肌舌形瓣入路手术时间长,但骨折暴露充分。对于C3型骨折,两种入路手术时间相近,前者肘关节功能评分比后者显著较高。结论尺骨鹰嘴截骨入路治疗肱骨髁间骨折暴露充分,术后肘关节功能优于肱三头肌舌形瓣入路。     

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。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

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.