屈指肌腱修复术后的综合康复医疗

目的手外伤行屈指肌腱断裂修复或肌腱移位术后,采取综合康复医疗措施有效地促进术后功能的恢复。方法用中级红斑量紫外线照射、脉冲磁疗和蜡疗、按摩等康复疗法。结果早期实施综合康复后,Ⅰ区7指优良率为10％,Ⅱ区32指优良率为48％,长时间制动Ⅱ区3指优良率为4％;合并骨折7例13指,其中进行Ⅱ期肌腱移植3例5指和黏连松解术后4例8指,优良率为7％和12％,其他区23指优良率为3％,合并骨折的13指优良率为6％。结论使肌腱与腱鞘的生长及促使肌腱愈合加快、减轻肌肉萎缩和肌腱的挛缩程度,同时对保持关节活动度也有明显的促进作用。     

多术式联合纤维胆道镜治疗肝内胆管结石

目的 总结近10年来治疗肝内胆管结石的效果。方法 回顾分析近5年来采用胆总管切开、肝实质切开、肝(叶段)切除等方法联合术中纤维胆道镜治疗肝内胆管结石的并发症、残石率及优良率,并同1996年前5年的资料进行比较。结果 近5年肝内胆管结石术后并发症为18例,残石率为9.7％(13/133),优良率为91.7％(122/133),死亡2例。1996年前5年术后并发症为29例,残石率为27.5％(39/142),优良率为60.1％(85/142),死亡4例。两组并发症P>0.05,残石率和优良率P<0.01,治疗效果有显著性差异。结论 纤维胆道镜在肝内胆管结石治疗中具有重要的作用,应争取术中结合病灶切除等方法减少残石率。     

切吸术，溶核术联合治疗腰椎间盘突出症的临床对比

目的 通过对比经皮椎间盘切吸术,注射胶原酶溶核术及二者联合应用（切溶术）治疗腰椎间盘突出症的临床效果,明确切溶术的临床价值。方法 将切吸术和溶核术的适应证患者150例,随机分组,每组50例分别行切吸术（A组）,溶核术（B组）,切溶术（C组）,随访观察临床效果。结果 随访6月－3年,切吸术有效率84％,优良率72％;溶核术有效率82％,优良率74％;切溶术有效率94％,优良率90％。结论 切溶术能提高疗效,减少术后疼痛反应的发生,并不增加操作的难度,值得推广应用。     

皮下前置术与带血运前置术治疗肘管综合征的疗效对比

目的比较两种治疗肘管综合征手术方法的疗效。方法回顾分析2008年1月-2012年1月收治的160例肘管综合征患者,其中97例接受传统皮下前置术,63例接受带血运前置术。根据手外科尺神经功能评定标准评价两组患者的尺神经功能,然后分别比较两组的评分、中重度患者的优良率及总优良率。结果术后两组的评分分别为（7．5±0．86）分、（7．4±0．96）分,无统计学差异（P〉0．05）。带血管蒂前置组总优良率为87．3％,略高于传统皮下前置组86．59％（P〉0．05）。两组间中度患者的术后优良率分别为88．09％,94．73％（P〉0．05）,但重度患者的优良率分别为85．71％和57．14％（P〈0．05）,有统计学差异（P〈0．05）。结论带血运前置术治疗重度肘管综合征疗效优于传统皮下前置术。     

消痔灵注射联合悬吊术治疗脱垂性痔60例疗效观察

目的探讨消痔灵注射联合悬吊术治疗脱垂性痔的疗效。方法研究组60例，采用消痔灵注射内痔段黏膜下层后用可吸收线将痔体上提悬吊；设对照组60例，其中24例采用消痔灵注射，36例注射后加用外剥内扎术。观察对比两组病例术后疗效及随访6—15个月的疗效。结果消痔灵注射联合悬吊术后疗效优良率98．3％，单纯消痔灵注射疗法术后优良率71．7％，消痔灵注射联合外剥内扎术后优良率97％；随访6～15个月的优良率分别为98％、67．2％、96．9％。消痔灵注射联合悬吊术疗法较单纯消痔灵注射疗法优良率分别高26．6％、20．8％，较消痔灵注射联合外剥内扎术疗法高1．3％、1，1％。结论消痔灵注射联合悬吊术治疗脱垂性痔的疗效确切，显著优于单纯消痔灵注射疗法，与消痔灵注射联合外剥内扎术疗效一致，但术后反应及恢复时间均显著优于后者，且能更有效地保护肛垫。     

髌骨骨折分型及治疗策略改进的疗效分析

目的探讨髌骨骨折分型及治疗的临床效果,寻找治疗髌骨骨折的规范化术式。方法在对1998～2000年（A组）48例髌骨骨折疗效欠佳病例分析的基础上,对2000~2006年（B组）109例髌骨骨折的分型及治疗策略改进,做回顾性总结分析。将髌骨骨折分为七种类型,对109例髌骨骨折进行分型,对应选择合理的治疗方法并观察其疗效。结果术后AB两组均随访12～36个月,平均26个月,按陆裕朴等的疗效评定标准进行评定,A组：优良率89．6％,优比率75％。B组：优良率96．3％,优比率86．2％。结论在传统髌骨骨折分型的基础上重新对其归类、补充以及改进治疗方法,在保证原有髌骨骨折治疗优良率的同时,可明显提高优良率及优比率。     

组合式支架在胫骨近端截骨术中的应用

目的：探讨膝内外翻畸形,胫骨高位截骨术纠正下肢负重力线,方法：对胫骨近端施行胫骨高位载骨术,组合式支架固定36例,结果：全部获－14年随访,1年优良率97．5％,2年优良率95％,4年优良率87．5％,结论：组合式支架应用于胫骨近端截骨术中,截骨处愈合时间明显缩短,无关节僵 及肌肉萎缩,不需石膏及内固定物固定,术后X线片显示股胫关节内或外侧间隙较术前增宽,关节退变明显改变,关节疼痛消失。     

三种带血运髂骨移植术治疗成人股骨头坏死

目的 评价带血运髂骨移植术治疗成人股骨头缺血性坏死46例的疗效。方法 通过术前、术后患者按股骨头坏死疗效百分评价法打分的结果比较疗效。结果 Ⅰ期病例优良率为75.0%,Ⅱ期病例优良率为80.7％,Ⅲ期病例优良率为45.0％,优良率66.67％。结论 带血运髂骨和骨膜移植,可促进坏死股骨头的血运重建,使坏死骨的温长的爬行替代过程转变为活骨对活骨的骨折愈合过程,从而可明显缩短疗程。     

双极射频椎间盘髓核成形术治疗颈性眩晕的疗效观察

目的评价双极射频椎间盘髓核成形加臭氧融盘术治疗颈性眩晕的临床疗效。方法对192例颈性眩晕患者在C型臂x线引导下经皮穿刺到椎间隙靶点,用双极射频仪对靶点加热消融,治疗180s,再结合臭氧注射消融,应用改良Macnab评价标准对眩晕及伴随症状进行临床疗效综合评估。结果192例患者共368个椎问盘均穿刺成功。术后均有不同程度的症状改善,未发现有任何不良反应及并发症发生。192例患者术后1周及1、3、6、12、24个月,患者的改良Macnab评价标准优良率分别为91．67％、56．25％．、81．25％、81．25％、79．17％、87．50％。术后1周及3个月的优良率明显高于术后1个月;而术后3、6、12、24月的优良率基本相近。结论射频消融、臭氧溶核联合应用是治疗颈性眩晕的有效方法,创伤小,安全性高。     

椎体成形术对胸腰椎椎体转移癌疼痛的治疗

目的：探讨经皮穿刺椎弓根途径椎体成形术治疗椎体转移性肿瘤疼痛的效果。方法：对20例多发性椎体转移癌患者的53个椎体施行了经皮椎弓根途径椎体成形术，采用视觉模拟评分法（visual-analogue scale，VAS）对治疗前后患者疼痛状况进行评估、分级，术后疼痛缓解程度采用6级评定法评定。术后1周、3、6、12个月常规随访，进行疼痛缓解程度评价。结果：20例患者中11例局麻药药效消失后疼痛缓解，6例48h后疼痛缓解，1例1周后疼痛缓解，2例出现下肢疼痛加重。随访时间12～21个月，平均随访13．4个月。术后1周优良率为75％。有效率为85％。术后3个月优良率为70％，有效率为80％。术后6个月优良率为60％，有效率为65％。术后1年优良率为50％，有效率为55％。结论：经皮穿刺椎弓根途径椎体成形术对椎体转移性肿瘤疼痛具有良好的止痛效果．能够有效改善患者的生存质量。     

Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy

BACKGROUND: Spastic hip subluxation and dislocation are common problems in children with cerebral palsy. Soft-tissue releases have proved to be beneficial in the prevention of spastic hip dislocation. A protocol for treatment based on patient age, hip abduction, and hip migration percentage was established in 1988. The purpose of this study was to assess the outcome in sixty-five children treated according to this protocol and followed for a minimum of eight years. METHODS: The medical records and radiographs of sixty-five children, from an original series of seventy-four patients, who met the inclusion criteria were available for review. Forty-seven children had spastic quadriplegia and were unable to walk; eighteen children had spastic diplegia and were able to walk independently or with assistive devices. The mean age at the time of the surgery was 4.4 years. Open adductor tenotomy and psoas muscle recession or iliopsoas tenotomy were performed on 129 hips, which were followed for a mean of 10.8 years. The mean age at the time of follow-up was fifteen years. Hips were grouped according to the hip migration percentage preoperatively, at one year postoperatively, and at the time of final follow-up. The final outcome for the patient was defined according to the worse hip. An analysis was performed to identify potential factors influencing outcome. RESULTS: Thirty-two patients (49%) had a good result, eleven (17%) had a fair result, three (4%) had a poor result, and nineteen (30%) had a failure. The mean hip migration percentage was 34% preoperatively and 18% at the time of final follow-up. Nineteen patients required subsequent osseous reconstructive procedures, and eleven required repeat soft-tissue releases. The migration percentage at one year postoperatively was the most predictive of the final outcome (p = 0.001). Patients who had been able to walk preoperatively had a better long-term outcome (p = 0.01). Neither the preoperative hip migration percentage nor the age at surgery significantly affected the outcome. CONCLUSIONS: Soft-tissue release was effective for long-term prevention of hip dislocation in 67% (forty-three) of sixty-five children with spastic hip subluxation. Two preoperative factors that were related to a favorable outcome were a spastic diplegic pattern of involvement and the ability to walk. The hip migration percentage at one year postoperatively was a good predictor of final outcome.     

Tuberculosis of hip in children: A retrospective analysis

Background:

Tuberculosis (TB) of hip constitutes nearly 15% of all cases of osteoarticular tuberculosis. We report a retrospective study carried out on 43 children with hip TB.

Materials and Methods:

Forty-three children of TB hip treated between 1971 and 2000 were analysed. Twenty-four children of the early series were treated with streptomycin (S), isoniazid (H) and PAS (Pa) for 18 months (3HPaS, 15 HPa), while 19 children in the later series were treated with isoniazid (H), rifampicin (R) and ethambutol (E) or pyrazinamide (Z) for 12 months [(12 RHE(Z)]. Five out of 18 children with radiologically normal appearing type hip TB were treated with chemotherapy alone and 38 children were subjected to surgery; simple synovectomy alone in 31 hips, joint debridement in six hips, and proximal femoral varisation osteotomy in one. After surgery hips were immobilized in cast for one to three months according to the severity of the disease and patients pain tolerance, and then were mobilized under leg traction in bed gradually till pain subsided completely.

Results:

TB of hip healed with minimum sequelae in all children. In 18 Type one hip TB, normal hip (synovial form) anatomy was maintained, and in 25 patients with advanced lesions some defect in the femoral head and acetabulum was noticed, though painless good hip motion was maintained. Excellent to good results were obtained in 31 children (73.1%), fair in eight (18.6%), and poor in four (9.3%). In four patients with poor results, there was some residual morphological defect in the hip. None developed ankylosis of hip.

Conclusion:

We achieved good outcome with minimum sequelae in this series. The management goal should be aimed not only to heal the disease but also to maintain a painless mobile hip and anatomical cephalocotyloid relationship until maturity, and retard the development of secondary osteoarthritis.     

Windswept hip deformity in children with cerebral palsy

Windswept hip deformity describes an abduction and external rotation position of one hip with the opposite hip in adduction and internal rotation. Windswept hip deformity may occur in association with hip dislocation and scoliosis. We analysed the prevalence of this deformity in a total population of children with cerebral palsy, and the impact of hip prevention and early treatment of contractures on the prevalence and severity of windswept hip deformity. The frequency of windswept hip deformity was 12% in the control group and 7% in the study group, comprising children in the hip prevention programme. The children with this deformity in the study group had a lower frequency of scoliosis and none had hip dislocation. It thus seems that the hip prevention programme results in a decrease in the number of children with windswept hip deformity, and a decrease in the severity of the deformity.     

Relationship of an increased internal rotation of the hip with pelvic tilt,spinal alignment and posture - does the so-called antetorsion syndrome exist?

AIM: A cross-sectional study of pupils should show a possible relation between hip movement, posture and spinal alignment. METHODS: 143 children aged 6 to 17 years were clinically examined with particular respect to internal rotation and extension of the hip, spinal alignment and posture to determine if the so-called antetorsion syndrome exists in children as a remnant of the uprising of man. RESULTS: Internal hip rotation decreased with age without any difference regarding the age between children with and without hip contracture. Children with hip flexion deformity had a significantly higher ability for internal hip rotation (p = 0.0471), but both hip extension and internal rotation were not related to spinal alignment (p = 0.5585/0.5612). On the other hand a normal posture is related with a "normal" back and age (p = 0.0004). The spinal alignment itself did not differ in the age groups. 30 % of the children with sufficient posture and 38 % of the ones with insufficient posture had a hip contracture. The latter showed an increased internal hip rotation by 12 degrees (p = 0.0079). CONCLUSION: On the basis of these results, a relationship between muscular performance, neuromuscular maturity, decreased hip extension and increased internal hip rotation can be assumed. This so-called antetorsion syndrome exists in 20 % of the examined children. A relation to the spinal alignment especially the hollow-round back, cannot be found.     

Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位

目的　应用Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位 ,从而降低术后髋关节脱位、僵硬和股骨头坏死发生率。方法　自 1989年 8月 - 1999年 8月 ,用Pemberton手术为主多种辅助手段治疗大龄儿童 (7～ 14岁 )先天性髋脱位 4 6例 (5 8髋 ) ,随访 2～ 9年 ,平均 5年 3个月。辅助手段包括 :①髂腰肌及内收肌切断 ,股骨髁上骨牵引 ;②股骨粗隆下旋转加短缩截骨 ;③单髋人字石膏制动 ;④髋关节早活动 ,晚负重 ;⑤术后被动活动髋关节加主动功能锻炼。结果　髋关节完全复位率10 0 % ,髋关节屈曲小于 90°者 4髋 ,占 6 9% ,按Salter提出的股骨头坏死诊断标准 4 6例 (5 8髋 )中 ,股骨头坏死 6髋 ,占 10 3% ,明显降低了大龄儿童先天性髋脱位术后髋关节僵硬、股骨头坏死率。结论　Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位疗效确切 ,优良率高。     

Adductor release in nonambulant children with cerebral palsy

Historically, nonambulatory children with cerebral palsy represent a "group at risk" for spastic hip dislocation. We reviewed the effectiveness of adductor release and anterior obturator neurectomy in treating 86 hips at risk in 50 nonambulatory children. Results were judged by comparing the migration percentages measured on the preoperative, early postoperative, and final postoperative radiographs. Adductor release succeeded in preventing hip dislocation and obviating the need for further surgery in 80% of cases. Patients with preoperative uncoverage exceeding 50% were found to be at greater risk for deterioration of femoral head coverage despite adductor release. Unilateral adductor release had a negative effect on the nonoperated hip.     

The role of pelvic magnetic resonance in evaluating nonhip sources of infection in children with acute nontraumatic hip pain

We retrospectively identified all children with acute hip pain who underwent pelvic magnetic resonance (MR). Children with septic hip or history of trauma were excluded; the remaining children with signs of infection (fever, >38 degrees C; leukocytosis, >12 x 10(9)/L; or elevated erythrocyte sedimentation rate [ESR], >30 mm/h) comprised the study group. Thirty-three children (9 girls; age, 0.8-15.8 years) were identified. On MR examination, 18 (55%) of 33 children had hip joint effusion, whereas 19 (58%) of 33 children had other abnormalities, including pyomyositis (n=15), osteomyelitis (n=12), and sacroiliitis (n=3). Staphylococcus aureus was cultured from 13 (68%) of these 19 children. Compared with MR, sensitivity for bone and soft tissue abnormalities was 30% for pelvic radiography (n=26) and 71% for bone scintigraphy (n=8). Elevated ESR (>30 mm/h) was the clinical finding that best predicted pelvic osteomyelitis or pyomyositis. Pelvic MR should be performed to rule out pelvic osteomyelitis or pyomyositis in children with acute hip pain, ESR of more than 30 mm/h, and no evidence of septic hip.     

Clinicaly silent developmental hip dysplasia--significancy of the hip ultrasonographic examination]

We present the significancy of the hip USG examination in the diagnosis of the clinically silent developmental hip dysplasia (DDH). The clinical and ultrasonographic hip assessment were performed in 972 children and sonographic abnormalities silent in clinical examination were stated in 155 of them (15.9%). Physiological immaturity was stated in 87% of this group. An orthopedic treatment was nessesery in 34 children (3.5% of cohort). Children with pathological hip dysplasia (type II D or above according to the Graf classification) with no pathological signs in clinical assessment constituted 0.25% of the cohort. We claim the USG examination of the infant hip is a method of choice in the early diagnosis of the DDH and the only method to detect clinically silent DDH.     

A systematic review of the evidence for hip surveillance in children with cerebral palsy

We reviewed the evidence for hip surveillance in children with cerebral palsy from the published literature. Publications were identified using the Cochrane controlled trials register, the MEDLINE, EMBASE and CINAHL databases and by hand searching key journals and their references. Studies were included if they reported the frequency, associated risk factors or surveillance measures undertaken to identify subluxation or dislocation of the hip in children with cerebral palsy. Assessment of the quality of the methodology was undertaken independently by two researchers. Four studies described the natural history, incidence and risk factors for dislocation of the hip. Two reported their surveillance results. Approximately 60% of children who were not walking by five years of age were likely to develop subluxation of the hip, with the greatest risk in those with severe neurological involvement. The introduction of surveillance programmes allowed earlier identification of subluxation and reduced the need for surgery on dislocated hips. Surveillance can identify children most at risk of subluxation using radiological methods which are widely available.     

Pemberton手术加辅助手段治疗大龄儿童先天性髋脱位

目的应用Pemberton手术加辅助手段治疗大龄儿童先天性髋脱位,从而进一步降低术后关节僵硬和股骨头坏死发生率。方法自1987年2月～1998年2月,用Pemberton手术加辅助手段治疗大龄儿童(7～14岁)先天性髋脱位58例76髋,随访2～11年,平均5年2个月。辅助手段包括1术前充分牵引;2术后应用中立位外展木板鞋加尼龙套皮牵引制动;3髋关节早活动,晚负重;4术后被动活动髋关节加主动功能锻炼。结果髋关节屈曲小于90°者6髋,占7.9%。按照Salter提出的股骨头坏死诊断标准,58例76髋中股骨头坏死29髋,占38.2%,明显降低了大龄儿童先天性髋脱位术后髋关节僵硬及股骨头坏死的发生率。结论Pemberton手术是治疗大龄儿童先天性髋脱位的首选术式,辅助手段较好地克服了髋脱位术后出现的股骨头坏死与髋关节僵硬两大难题,并降低了发生率。