肘关节恐怖三联征的治疗体会

目的 探讨肘关节恐怖三联征的手术方法及疗效.方法对11例肘关节恐怖三联征损伤患者行手术治疗,以φ3 mm钛空心拉力螺钉或φ1.5～2 mm克氏针分别固定尺骨冠突和桡骨头,并缝合修复肘内外侧副韧带.术后屈肘90°,前臂旋转中立位石膏外固定,3周后开始肘关节屈伸和前臂旋转康复训练.结果 11例均获得随访,时间6～18个月.骨折均愈合.肘关节功能按Mayo评分标准：优7例,良4例.结论 手术治疗肘关节恐怖三联征重建了骨关节和软组织结构稳定,可早期进行康复锻炼,功能恢复较好.     

肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术治疗

目的 介绍肘关节"恐怖三联征"合并尺骨鹰嘴骨折的手术方法和疗效.方法 肘关节"恐怖三联征"合并尺骨鹰嘴骨折患者12例,男8例,女4例;年龄21~75岁,平均40.4岁.桡骨头骨折按Mason分型:Ⅱ型7例,Ⅲ型5例;因合并肘关节脱位,按Johnston-Mason分型均为Ⅳ型.冠突骨折按Regan-Morrey分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型6例.尺骨鹰嘴骨折按Mayo分型Ⅱa型2例,Ⅱb型2例,Ⅲa型2例,Ⅲb型6例.9例肘关节后脱位,3例为前脱位.12例均行手术治疗,冠突、鹰嘴骨折行内固定;桡骨头骨折行内固定、桡骨头切除、金属桡骨头置换,修复内、外侧副韧带.术后石膏托维持肘关节屈曲90°,前臂中立位固定3周.结果 8例(66.7%)患者获得随访,随访时间3~36个月.平均16.4个月.骨折全部愈合,愈合时间10~16周,平均14.2周.Broberg-Morrey评分为55~95分,平均88分,优4例,良2例,可1例,差1例,优良率为75.0%.肘关节屈伸范围为70°~150°,平均127.5°;前臂旋转范围为65°~155°,平均122.5°.结论 肘关节"恐怖三联征"合并尺骨鹰嘴骨折为高能量损伤,关节严重不稳定,必须重建骨关节及软组织的解剖结构,恢复肘关节稳定性.     

老年性肘关节骨折脱位的手术治疗

目的:探讨手术联合外固定治疗老年性肘关节骨折脱位的方法及疗效。方法:回顾性分析2011年7月至2015年8月收治的老年性肘关节骨折脱位7例,其中三联征损伤5例。桡骨头骨折按Mason法分类:Ⅰ型1例,Ⅱ型3例,Ⅲ型1例。尺骨冠突骨折按Regan-Morrey法分类:Ⅰ型1例,Ⅱ型5例,Ⅲ型1例。7例均采取了手术内固定治疗,桡骨头骨折予钢板或Herbert钉固定,尺骨冠状突骨折根据骨折类型予缝线或克氏针或钢板螺钉内固定,并修复侧副韧带。术后屈肘90°前臂旋转中立位石膏外固定3周,3周后拆除石膏改用肘关节可活动铰链支具辅助锻炼。结果:7例均获随访,时间13~48个月,平均20个月,骨折愈合较满意,肘关节稳定,无疼痛。Mayo肘关节功能评分:优3例,良3例,可1例。结论:老年性肘关节骨折脱位骨质疏松,骨量低下,术中难以稳定内固定,经辅助外固定可获得较好的功能恢复。     

手术治疗肘关节“恐怖三联征”的短期疗效分析

目的探讨手术治疗肘关节"恐怖三联征"的手术方法和临床疗效。方法 2005年6月~2009年2月,本组应用手术治疗闭合性肘关节"恐怖三联征"患者6例。桡骨头骨折按改良Mason分型,Ⅰ型2例,Ⅱ型4例;尺骨冠突骨折按Regan-Morrey分型,Ⅰ型3例,Ⅱ型3例。术中发现肘内、外侧副韧带均有撕裂。按照McKee手术方法,所有患者采用肘内、外侧联合入路进行手术治疗;术后在肘关节屈曲90°和前臂旋转中立位的姿势下,以长臂石膏后托外固定7~10 d,之后开始进行肘关节屈伸和前臂旋转的主动训练。结果术后随访6例,随访时间12~26个月,平均随访时间15个月。6例患者伤口均Ⅰ期愈合;骨折亦复位良好,未见畸形愈合,临床愈合时间平均为11周(8~19周);2例患者术后6个月X线片显示肘关节轻度异位骨化;2例患者术后15个月X线片显示肘关节轻度退行性改变;最后随访时肘关节屈伸活动度(109±12)°,前臂旋转活动度(97±15)°,未发现肘关节僵硬、复发性脱位以及桡神经损伤症状;采用Mayo肘关节功能评估指数对随访患者进行评价,其中优2例,良3例,一般1例。结论肘关节"恐怖三联征"由于伴发损伤多,导致肘关节的严重不稳;只有通过手术治疗,恢复和重建肘关节的稳定结构,同时配合早期的康复训练,才能较好地恢复肘关节的功能。     

手术治疗11例肘关节恐怖三联征合并尺骨鹰嘴骨折

目的 探讨肘关节恐怖三联征合并尺骨鹰嘴骨折的手术方法和治疗效果.方法 肘关节恐怖三联征合并尺骨鹰嘴骨折11例,尺骨冠突根据Regan-Morrey骨折分型:Ⅰ型5例,Ⅱ型4例,Ⅲ型2例.桡骨小头根据Hotchkiss改良的Mason骨折分型:均为Ⅳ型.尺骨鹰嘴骨折分类Colton(1973)Ⅰ型2例,Ⅱ型9例.外固定架于肘关节屈曲至90°固定,术后6～9 d开始行肘关节屈伸和前臂旋转的主动锻炼.结果 本组获随访8～24个月,未出现骨折不愈合;肘关节屈曲-伸直活动范围平均在107.8°;前臂旋前-旋后活动范围平均为137.6°;肘关节按照Mayo标准评分:优3例,良5例,可3例,优良率72.7％.结论 肘关节恐怖三联征合并尺骨鹰嘴骨折要求手术重建肘关节的稳定性,及时行功能康复锻炼,才能获得良好的关节功能.     

内外侧联合入路治疗肘关节恐怖三联征7例效果分析

目的探讨手术治疗肘关节恐怖三联征的方法和临床疗效。方法 2009年1月至2012年12月,收治肘关节恐怖三联征患者7例。男5例,女2例;年龄24~57岁,平均(39.57±9.95)岁。高处坠落伤5例,车祸伤2例。尺骨冠状突骨折按Regan-Morrey分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型1例。桡骨小头骨折按Mason分型:Ⅰ型1例,Ⅱ型5例,Ⅲ型1例。手术采用肘内外侧联合入路行骨折复位内固定同时修复副韧带,术后石膏托将肘关节屈曲90°,前臂中立位固定,3周取下石膏行伸屈肘及前臂旋转功能锻炼。结果术后7例均获得6~27个月随访,平均(14.00±7.05)个月。所有病例骨折愈合,骨折愈合时间9~20周,平均(13.29±3.82)周;末次随访时肘关节屈伸范围为85°~145°,平均118.57°±20.35°;前臂旋转范围为90°~150°,平均126.43°±21.35°。Mayo肘关节评分65~95分,平均(82.86±10.35)分;优3例,良3例,可1例,差0例,优良率为85.71%。结论肘关节恐怖三联征应采取手术治疗,尽可能重建骨性结构及软组织解剖结构,恢复肘关节稳定性,术后尽早功能锻炼,促进关节功能恢复。     

冠突骨折及合并桡骨小头粉碎骨折生物力学

[目的]分析尺骨冠突骨折及合并桡骨小头粉碎骨折时肘关节的稳定性。[方法]选取上肢尸体标本8对，测试各种冠突骨折及合并桡骨小头粉碎骨折时肘外翻位移及外旋角。[结果]肘关节稳定性在冠突无骨折、Ⅰ型骨折、Ⅱ型骨折各组间无显著差异，冠突Ⅲ型骨折时显著不稳定。[结论]冠突骨折及合并桡骨小头粉碎骨折在冠突Ⅰ型、Ⅱ型骨折时肘关节稳定，可行桡骨小头切除术，Ⅲ型骨折不稳定，应修复桡骨小头或假体置换，并修复桡侧副韧带。     

金属铰链式外固定支架在肘关节“恐怖三联征”中的应用

目的介绍肘关节＂恐怖三联征＂（肘关节后脱位合并桡骨头和冠状突骨折）治疗体会及金属铰链式外固定支架在治疗中的应用。方法自2006年7月至2011年7月,共收治肘关节＂恐怖三联征＂患者38例,桡骨头骨折按Mason法分类,Ⅰ型13例,Ⅱ型17例,Ⅲ型8例。尺骨冠状突骨折按Morrey法分类,Ⅰ型12例,Ⅱ型19例,Ⅲ型7例。38例均采取了手术内固定治疗,其中24例术后采用石膏固定,14例术后采用金属铰链式外固定支架。手术主要固定或置换桡骨头,其中固定35例,置换3例,尽可能地固定修复重建冠状突骨折,修复相关的关节囊及内外侧副韧带。结果术后平均随访30周,手术治疗石膏固定组：肘关节平均屈伸范围为85°~120°,平均（102.24±15.55）°;前臂平均旋转范围为100°~125°,平均（112.40±20.28）°;Mayo肘关节评分为72~94分,平均82分。手术治疗铰链式外架固定组：肘关节平均屈伸范围为115°~135°,平均（125.78±21.69）°;前臂平均旋转范围为135°~175°,平均（165.15±15.25）°;Mayo肘关节评分85~95分,平均93分。结论对于肘关节＂恐怖三联征＂,在重建骨关节和软组织机构的稳定性的基础上,金属铰链式外固定架可以帮助肘关节获得更好的功能恢复。     

肘关节三联征诊断和治疗

<正>肘关节"恐怖三联征"的命名启发于膝关节、肩关节恐怖三联征,1996年由Hotchkiss[1]首先描述,是指肘关节后脱位合并桡骨头和尺骨冠状突骨折的三联     

肘关节恐怖三联征的手术治疗

目的探讨手术治疗肘关节恐怖三联征的方法和临床疗效。方法 2006年10月-2010年6月,收治肘关节恐怖三联征患者11例。男8例,女3例;年龄21～53岁,平均32岁。摔伤4例,交通事故伤7例。伤后30 min～9 d入院。尺骨冠突骨折按Regan-Morrey分型标准:Ⅰ型5例,Ⅱ型5例,Ⅲ型1例。桡骨头骨折按Mason分型标准:Ⅰ型4例,Ⅱ型5例,Ⅲ型2例。肘关节屈伸活动度为(63±9)°,前臂旋转活动度为(71±8)°。手术采用肘内外侧联合入路行骨折复位内固定。术后石膏托固定肘关节于屈曲90°、前臂中立位,7～10 d后开始被动功能锻炼,4周拆除石膏托行主动功能锻炼。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间7～27个月,平均14.5个月。X线片检查示骨折复位良好,于8～19周达临床愈合,平均11周。3例术后6个月出现肘关节轻度异位骨化,未作特殊处理;1例术后18个月出现肘关节轻度退行性改变,经康复锻炼后无进展。末次随访时,肘关节屈伸活动度为(103±14)°,前臂旋转活动度(122±13)°,与术前比较差异均有统计学意义(P<0.05),与健侧比较差异均无统计学意义(P>0.05)。根据Mayo肘关节功能评分标准,获优5例,良5例,一般1例,优良率90.9%。结论肘关节恐怖三联征外科手术治疗能有效恢复肘关节稳定,可术后早期活动,促进关节功能恢复。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.     

Fractures of the thumb and finger metacarpals in athletes

Most metacarpal fractures are minimally displaced and are treated without surgery. Markedly displaced fractures, fractures causing finger rotation, and displaced intra-articular fractures require surgical intervention. The challenge with the elite athlete is achieving an early return to play without compromising fracture position. Casts, splints, and surgery each have a role in getting the athlete back into action as soon as possible.