尺骨鹰嘴骨折几种内固定的实验研究

尺骨鹰嘴骨折几种内固定的实验研究张朝春梅芳瑞自１８８３年Ｌｉｓｔｅｒ首先对尺骨鹰嘴骨折采用金属丝内固定以来，其内固定的方法较多，如矩形或“８”字形钢丝、克氏针张力带钢丝、髓内针、钩钢板，以及髓内加压螺丝钉等．为了寻找一种既方便、可靠、创伤又小的内固定...     

新型微创髓内系统与解剖钢板固定尺骨鹰嘴骨折的生物力学比较研究

目的 利用自主研制新型微创髓内系统固定尺骨鹰嘴骨折，与传统解剖钢板进行生物力学比较，为临床应用奠定实验基础。方法 取10具共20侧尺骨尸体标本，其中男性7人，女性3人；死亡年龄45～72岁，平均62.0岁。制备尺骨鹰嘴横型骨折模型，分A、B两组，A组使用新型微创髓内固定系统进行固定；B组选用尺骨鹰嘴解剖钢板进行固定。对两组标本进行四点弯曲实验及扭转实验，传感器记录弯曲实验中的位移值及扭转实验中的扭矩值。结果 四点弯曲试验中，A组位移值(1.114±0.040)mm, B组位移值(1.140±0.031)mm,两组比较差异无统计学意义(P=0.057)。扭转实验中，A组扭矩值(0.851±0.035)N,B组扭矩值(0.894±0.040)N,两组比较差异有统计学意义(P<0.05)。结论 新型微创髓内系统在固定尺骨鹰嘴横型骨折中，具有优良的抗弯曲及抗扭转能力，固定牢靠，生物力学性能可以满足尺骨鹰嘴骨折微创固定需求。     

尺骨鹰嘴截骨入路治疗肱骨远端C3型骨折的临床观察

目的 观察分析尺骨鹰嘴入路双柱钢板固定治疗肱骨远端C3型骨折的临床效果.方法 肱骨远端C3型骨折35例,选择尺骨鹰嘴截骨双柱钢板内固定术,早期功能锻炼,12月后采用HSS肘关节评分系统评价疗效.结果 35例肱骨远端C3型骨折全部愈合;无局部感染、出血.无螺钉松动及钢板断裂等现象.经HSS肘关节评分系统评价:优57.14%(20/35),良31.43%(11/35),可11.43%(4/35).总优良率88.57%(31/35).结论 尺骨鹰嘴截骨双柱钢板固定治疗肱骨远端C3型骨折,复位精确,固定牢靠,可早期进行功能锻炼,提高优良率,减少并发症.     

张力带钢丝内固定治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折大多累及关节面，为防止关节功能障碍，内固定术后应尽早行肘关节的伸屈锻炼，由于尺骨鹰嘴部系防三头肌肌胜的附着处，单纯的克氏针、探丝钉等内固定不易获得坚强的固定效果，难以施行早期锻炼。1988年以来，我们采用张力带钢丝内固定术治疗尺骨鹰嘴骨折，效果满意。l临床资料本组共17例，其中男性13例，女性4例。右侧11例，左侧6例。横断骨折12例，斜形骨折5例。年龄10～72岁，平均32．5岁。术后功能锻炼开始时间1～10d，平均3d。术后随访8个月至6年，平均2年5个月。X线复查所见：“关节骨折面复位好”。骨折线消失时间为28…     

新型动力化前路方形区钛板螺钉系统在不同置钉方法下固定髋臼骨折的有限元比较

目的 采用三维有限元分析法研究新型动力化前路方形区钛板螺钉系统(DAPSQ)固定髋臼高位双柱骨折的生物力学特点,并比较其在不同方形区螺钉置钉方法 下的生物力学稳定性.方法 应用1例成年男性志愿者骨盆CT图像构建左侧髋臼高位双柱骨折的全骨盆有限元模型,并采用新型动力化前路方形区钛板螺钉系统固定.分别构建DAPSQ联合单方形区螺钉(A组)、双方形区螺钉(B组)、三方形区螺钉(C组)和四方形区螺钉(D组)固定模型,施加600 N垂直载荷或8N/m扭矩,模拟骨盆站位、坐位、站位+健侧旋转和站位+患侧旋转,比较各组内固定方法 下骨折线平均位移和内固定应力分布情况.结果 在站位、坐位、健侧旋转和患侧旋转4种工况下,方形区骨折线路径上各节点平均位移表现为A组>B组>C组>D组,组间比较显示D组位移显著低于A组和B组(P<0.05),C组和D组比较差异无统计学意义(P>0.05).应力分析结果 显示,站位和坐位下D组应力主要集中在钛板螺钉结合处,以近端第1枚方形区螺钉承担应力最大.结论 新型动力化前路方形区钛板螺钉系统固定髋臼高位双柱骨折的生物力学性能可靠,推荐在方形区应至少置入3或4枚螺钉进行固定,且靠近坐骨大切迹的方形区螺钉为关键钉.     

TiNi形状记忆合金鹰嘴接骨板与张力带治疗尺骨鹰嘴骨折的疗效评价

目的评价TiNi形状记忆合金鹰嘴接骨板与张力带治疗尺骨鹰嘴骨折的的临床疗效。方法采用两种方法治疗尺骨鹰嘴骨折50例,其中TiNi形状记忆合金鹰嘴接骨板组（A组）15例,克氏针张力带组（B组）35例。结果全部病例均获随访,时间6～24个月,所有病例均骨性愈合,按照Broberg＆Morrey评分标准进行评定：A组优12例,良2例,优良率93．3％;B组优24例,良3例,优良率77．1％;两种治疗方法存在统计学差异。结论TiNi形状记忆合金鹰嘴接骨板治疗尺骨鹰嘴骨折疗效优于张力带内固定,其方法有利于骨折复位固定,便于肘关节早期功能锻炼。     

骨片钉治疗尺骨鹰嘴骨折

骨片钉治疗17例尺骨鹰嘴骨折，随访9个月，肘关节功能优14例，良3例。手术操作简单，创伤小，骨折端有明显的加压作用，固定牢固。     

骨外固定加压治疗尺骨鹰嘴骨折(附94例报告)

目的　采用骨外固定器治疗尺骨鹰嘴骨折。方法　对 94例尺骨鹰嘴骨折行外固定治疗。复位时先矫正侧方移位 ,然后将近端骨块向尺骨体中心推挤 ,使之完全对位。对少数难以整复的骨折可在X线透视下用克氏针“撬拨法”将骨折完全复位。粉碎性骨折整复时 ,以双手掌环抱 ,使分离的骨折端靠拢 ,骨外固定器通过钢针对骨端纵向加压 ,使骨折端紧密对合。结果　 94例骨折愈合时间为 5～6周 ,平均 35天 ,关节功能恢复正常。结论　本治疗方法简便 ,骨折固定牢固稳定 ,多数病人可在门诊治疗 ,不需住院 ,经济方便。     

LCP结合克氏针治疗MayoⅡB型尺骨鹰嘴粉碎性骨折

目的探讨解剖锁定接骨板(LCP)结合克氏针治疗MayoⅡB型尺骨鹰嘴粉碎骨折的临床疗效。方法回顾性分析2014年3月—2017年3月唐山市第二医院收治并成功随访的19例MayoⅡB尺骨鹰嘴粉碎骨折患者资料,男性12例,女性7例;年龄20~65岁,平均40.5岁。左侧10例,右侧9例。所有患者均为新鲜闭合骨折,均无神经及血管损伤,不合并尺骨冠状突骨折、肘关节脱位等损伤。均采用切开复位LCP结合克氏针内固定治疗。观察术后并发症,并采用Broberg-Morrey肘部骨折疗效评分标准进行评价。结果 19例患者术后均获得随访,随访时间12~30个月,平均18.5个月。术后随访骨折全部骨性愈合,未发生克氏针针尾退出,无螺钉松脱、内固定失效、感染、骨髓炎等并发症。术后发现尺骨鹰嘴关节面复位部分丢失1例,但未引起明显功能障碍。术后1年按照Broberg-Morrey肘部骨折疗效评分标准评定,优8例,良9例,可2例;优良率89.5%。结论 LCP结合克氏针治疗MayoⅡB型尺骨鹰嘴粉碎性骨折,关节面复位良好,固定牢固可靠;术后可早期行肘关节功能锻炼,减少术后并发症的发生,疗效满意。     

三种固定方式治疗胫骨平台后外侧1/2骨折的生物力学分析

目的通过尸体标本及有限元模型对前侧拉力螺钉固定、外侧L型钢板固定和后侧T型钢板固定治疗胫骨平台后外侧1/2骨折行生物力学分析,为临床工作提供基础数据。方法选取上海交通大学医学院解剖教研室提供的新鲜成人尸体胫骨标本24个,用电动摆锯制备胫骨平台后外侧1/2骨折模型,将模型随机等分为前侧拉力螺钉固定组、外侧L型钢板固定组及后侧T型钢板固定组各8具。另选取1名健康男性志愿者,对其膝关节行螺旋CT后将数据导入Mimics14.0等软件后得到三维胫骨平台实体,经分割等操作后获得胫骨平台后外侧1/2骨折模型,而后结合三维解剖数据,通过Solidworks2013软件制作相应的拉力螺钉及钢板,模拟前侧拉力螺钉固定、外侧L型钢板固定及后侧T型钢板固定三种胫骨平台后外侧1/2骨折内固定有限元模型。对各骨折内固定实体标本和有限元模型分别施加250、500、1000、1500N的轴向载荷,比较各组骨折块移位及受力情况。结果实验生物力学结果表明,250N、500N和1000N载荷下前侧拉力螺钉固定组、外侧L型钢板固定组及后侧T型钢板固定组内固定实体标本骨折块移位值[250N:(0.14±0.02)mm vs.(0.13±0.02)mm vs.(0.14±0.13)mm;500N:(0.27±0.05)mm vs.(0.29±0.06)mm vs.(0.28±0.07)mm;1000N:(0.49±0.12)mm vs.(0.53±0.10)mm vs(0.50±0.09)mm],差异均无统计学意义(P0.05),1500N载荷下前侧拉力螺钉固定组骨折块位移值(0.57±0.14mm)小于外侧L型钢板固定组(0.72±0.10mm)和后侧T型钢板固定组(0.76±0.13mm),差异均有统计学意义(P0.05),外侧L型钢板固定组和后侧T型钢板固定组骨折块位移值差异无统计学意义(P0.05)。有限元分析结果表明,在各载荷下前侧拉力螺钉固定模型的骨折块位移值及内固定最大应力均小于外侧L型钢板固定模型和后侧T型钢板固定模型。两种实验方法所得最大位移值分布区域均为近侧胫腓关节交界区。结论对于胫骨平台后外侧1/2骨折,前侧拉力螺钉固定、外侧L型钢板固定和后侧T型钢板固定均可提供早期稳定性,其中前侧拉力螺钉固定在稳定性方面最具优势,应作为临床首选方案。     

Fracture of the hook of the hamate.

Three patients with hamate hook fractures were evaluated. These fractures were difficult to diagnose clinically and radiographically. Mechanisms of injury reported in the literature include blunt trauma to the hamulus or pisiform, forceful swinging of a grasped object, or a forceful muscular contraction. Delayed diagnosis may result in late complications including carpal tunnel syndrome, flexor tendon rupture, ulnar nerve palsy, or ulnar artery compromise. Pain when grasping or swinging an object is often a clue to the correct diagnosis. Normal standard and carpal tunnel views do not exclude this injury. Tomography may be necessary for radiographic detection and permits detailed evaluation of fracture margins. Pertinent carpal anatomy is reviewed.     

Stress fracture of the hook of the hamate

Fractures of the hook of the hamate have rarely been reported. They have usually resulted from blunt trauma or a sharp strike against the hamate hook while swinging a golf club, baseball bat, or tennis racquet. Patients present with acute onset of pain localised over the ulnar aspect of the wrist and reduction in grip strength. In the case reported here, the patient complained of gradual onset of pain on the ulnar aspect of the wrist after altering his grip for serving in tennis. Once the diagnosis was made, the fracture was treated conservatively and the patient made a complete recovery.     

Fractures of the hook of hamate: radiographic signs

Isolated fractures of the hamulus, formerly considered rare, are being seen more frequently. Many of these injuries are sports related, particularly in golf, tennis, racquetball and baseball players. Failure to make an early diagnosis can result in severe pain and sometimes incapacitating disability. We studied the clinical and radiological findings in 12 patients who had fracture of the hook of the hamate. We propose three radiographic signs of fracture that are readily seen on routine PA projections: "absence" of the hook of the hamate; "sclerosis" of the hook; and lack of cortical density, i.e., a barely visible outline, of the hamulus.     

Ultrasound treatment of nonunion of the hook of the hamate in sports activities

Two cases of nonunion of the hook of the hamate were treated with low-intensity pulsed ultrasound. The patients were baseball players and had been injured as a result of hitting repeatedly. Nonunion was detected on computed tomography (CT) and was exposed to ultrasound for 20 min a day for 4 months. In both cases pain at the hypothenar eminence disappeared, and bone union was confirmed on CT at the end of the ultrasound treatment.     

乳腺钩丝定位在临床中的应用

目的:探讨乳腺二维钩丝定位的方法及其对外科手术的指导作用。方法:通过常规乳腺钼靶头尾位(CC)和侧斜位(MLO),发现59例临床不能扪及的乳腺微小病变。手术前,对病变进行X线二维钩丝定位;手术后,切取标本(连定位钩丝)再行钼靶检查,核实病灶是否已被完整切除,然后行病理学检查。结果:59例中57例定位满意,2例定位偏离,定位满意率96.6%。其中恶性病变16例,良性病变43例。结论:乳腺术前钩丝定位是一种简单而有效的方法,并可指导外科医生准确切取病变。     

Symptomatic,partial union of the hook of the hamate fracture in athletes

BACKGROUND: Many clinicians believe that after fracture of the hook of the hamate, nonunions are the rule rather than the exception. PURPOSE: To describe a previously unreported condition in which the fractured hook of the hamate unites only along its ulnar column and causes pain similar to that in cases of nonunion. STUDY DESIGN: Retrospective review. METHODS: Eight patients who had sustained a hook of the hamate fracture were identified, on the basis of their persistent pain, as having achieved only partial union. This diagnosis was made despite evidence on computed tomography of healed bone across a significant portion of the fracture. All eight patients underwent subperiosteal excision of the hamulus because of persistent pain. At an average of 4 years after excision, each patient was evaluated by dynamometer grip strength testing and a subjective outcome assessment. RESULTS: All patients were able to return to their preinjury level of sports participation at an average 8 weeks after excision of the hook of the hamate. Grip strength was not adversely affected in any patient. Subjective evaluation of each patient revealed no residual pain. CONCLUSIONS: Chronic or unresolved pain on the ulnar side of the wrist after hook of the hamate fracture can be due to partial union. This condition should be managed no differently from a symptomatic nonunion, with excision of the hook of the hamate and repair of the ligament attachments.     

插入式与指突式锁骨钩钢板临床应用比较

目的对插入式与指突式锁骨钩钢板的临床应用进行分析、比较。方法自2000年9月至2003年10月采用锁骨钩钢板治疗肩锁关节脱位（TossyⅢ型）及锁骨外侧端骨折（NeerⅡ型）共计33例。其中使用插入式锁骨钩钢板（AO／ASIF）18例，使用指突式锁骨钩钢板（德国WALDEMAR LINK公司）15例。结果插入式组平均切口长度7．6cm，平均手术时间28min；所有患者均获良好复位固定；术后无脱钩发生，但有1例发生肩峰下撞击。指突式组平均切口长度9．8cm，平均手术时间40min；术后发生脱钩1例，发生肩峰下撞击1例，肩峰部皮肤受钩端顶突痛2例。除1例脱钩者外，两组术后X线片复查均达满意复位，取出内固定后无再脱位，肩关节功能恢复良好。结论插入式锁骨钩钢板操作更简便，有利于手术时间和切口的最小化，理论的潜在并发症少，在肩锁关节脱位（TossyⅢ型）及锁骨外侧端骨折（NeerⅡ型）的治疗中更具优势。     

Optimization of conventional X-ray images for the detection of hook of hamate fractures

Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection. After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45 degrees supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30 degrees. An axial spiral CT was used as a reference for detection of the fracture. The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image. If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.     

WOLTER钢板治疗陈旧性肩锁关节脱位

目的 探讨治疗陈旧性肩锁关节脱位的新方法。方法 应用Wolter肩锁钩钢板治疗陈旧性肩锁关节脱位5例,术后随访5～22个月,平均13个月。结果 所有病例均解剖复位,术后4周～3个月肩关节外观及功能恢复满意,随访未见钢板断裂和松动的表现,2例去除内固定后未见脱位复发。疗效优4例,良1例。结论 Wolter肩锁钩钢板治疗陈旧性肩锁关节脱位是一种较好的手术方法。