自制夹板外固定治疗掌骨骨折的临床疗效观察

目的： 探讨手法复位结合自制夹板外固定治疗掌骨骨折的临床效果。方法： 回顾性分析急诊科自2018年1月至2018年12月采用手法复位自制夹板外固定治疗的掌骨骨折患者126例,其中男102例,女24例;年龄9~73（33.2±14.3）岁。治疗期间定期复查X线,根据X线情况选择继续或调整外固定,X线示骨痂生长,骨折端稳定后拆除外固定继续功能锻炼,采用TAM评分标准对手的功能进行评价,并对患者骨折愈合情况及并发症情况进行总结。结果： 126例中6例在治疗过程中出现骨折再移位而选择手术治疗,其余120例经该方法治疗掌骨骨折均获得骨性愈合,骨折愈合时间（6.3±1.8）周。随访时间2~12（4.4±2.2）个月。随访结束时采用TAM评分标准对患者的手功能进行评价：优105例,良13例,可2例,差0例。7例骨折出现短缩畸形,3例出现成角畸形。结论： 手法复位结合自制夹板外固定治疗掌骨骨折可以取得良好的临床效果,自制夹板取材方便且费用低廉,是值得临床推广的一种有效方法。     

Effects of neuromuscular deprogramming on the head position

Objectives:

The aim of this study was to evaluate the effects of the neuromuscular deprogramming of the mandible on the craniocervical position.

Methods:

Participants (n?=?65) were separated into two groups: 25 untreated controls (10 men and 15 women) and 40 patients (17 men and 23 women) and underwent neuromuscular deprogramming with upper occlusal splints for an average of 6 months and 7 days, before orthodontic treatment. Lateral cephalograms were obtained from each subject in the natural head position (NHP), before and after neuromuscular deprogramming. Craniocervical cephalometric analysis was performed to evaluate craniovertical (NSL/VER), craniocervical (OPT/NSL and CVT/NSL), and cervicohorizontal (OPT/HOR and CVT/HOR) angulation, and the angle of the cervical curvature (OPT/CVT).

Results:

After neuromuscular deprogramming, significant changes in three angles — NSL/VER (P<0·001), OPT/NSL (P<0·001) and CVT/NSL (P<0·001) — were found between the two groups. For the cervical spine position, no significant changes were observed.

Conclusion:

The results indicate that neuromuscular deprogramming using occlusal splint causes significant extension of the head.     

An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol

Background

Birth-related brachial plexus injury (BRBPI) occurs in 1.2/1,000 births in British Columbia. Even in children with “good” recovery, external rotation (ER) and supination (Sup) are often weaker, and permanent skeletal imbalance ensues. A preventive early infant shoulder passive repositioning program was created using primarily a novel custom splint holding the affected arm in full ER and Sup: the Sup-ER splint. The details of the splint and the shoulder repositioning program evolved with experience over several years. This study reviews the first 4 years.

Methods

A retrospective review of BCCH patients managed with the Sup-ER protocol from 2008 to 2011 compared their recovery scores to matched historical controls selected from our database by two independent reviewers.

Results

The protocol was initiated in 18 children during the study period. Six were excluded due to the following: insufficient data points, non-compliance, late splint initiation, and loss to follow-up. Of the 12 matches, the Sup-ER group final score at 2 years was better than controls by 1.18 active movement scale (AMS) points (p = 0.036) in Sup and 0.96 AMS points in ER (but not statistically significant (p = 0.13)). Unexpectedly, but importantly, during the study period, zero subjects were assessed to have the active functional criteria to indicate brachial plexus reconstruction, where previously we operated on 13 %.

Conclusions

Early application of passive shoulder repositioning into Sup and ER may improve outcomes in function of the arm in infants with BRBPI. A North American multi-site randomized control trial has been approved and has started recruitment.     

手法复位、小夹板固定治疗桡骨远端骨折的临床疗效分析

目的探讨手法复位、小夹板固定治疗桡骨远端骨折的临床效果。方法选取本院2011年1月至2013年1月桡骨远端骨折患者40例,根据术式分为两组,切开复位内固定患者20例为对照组,手法复位后小夹板固定患者20例为观察组,比较两组患者的临床指标、临床疗效、并发症情况。结果观察组患者疼痛缓解时间、手背肿胀消退时间、骨折愈合时间均明显少于对照组,优良率明显高于对照组,并发症发生率明显低于对照组,差异均有统计学意义（P＜0．05）。结论手法复位后小夹板固定是治疗桡骨远端骨折的有效方法,可明显缓解患者疼痛,消除肿胀,缩短恢复时间,效果显著,并发症少,安全性高。     

三维超声下颌定位技术在(牙合)垫治疗颞颌关节绞锁中的应用

目的应用三维超声下颌定位技术,观察颞颌关节绞锁应用于（牙合）垫治疗前后髁突运动轨迹的变化。方法对21例单侧颞颌关节绞锁患者使用下颌稳定性（牙合）垫治疗。运用三维超声下颌定位技术观察绞锁性颞颌关节在（牙合）垫治疗前后健患侧髁突运动轨迹在最大开口运动、最大前伸运动和侧方运动中运动范围的变化。结果通过三维超声下颌定位技术可观察到患者髁突运动轨迹表现为双侧的不对称性。患侧关节在（牙合）垫治疗前后运动范围的比较发现,在最大开口运动的矢状位、冠状位、轴位的髁突运动范围增大（P〈0．05）;前伸和侧方运动的矢状位、冠状位的髁突运动范围增大（P〈0．05）。结论（牙合）垫治疗后绞锁性颞颌关节健患侧髁突的运动轨迹更加对称,患侧关节运动轨迹的范围增大。三维超声下颌定位技术可作为（牙合）垫治疗颞颌关节绞锁髁突运动轨迹改变有效的观测与评价手段。     

Evaluation of two dental registration-splint techniques for surgical navigation in cranio-maxillofacial surgery

BackgroundSurgical navigation requires precise registration of the pre-operative image dataset to the patient in the operation theatre. Different marker-based and marker-free registration techniques are available, each of them with advantages and disadvantages regarding precision and clinical handling. In this model study, the precision of two dental splint techniques for marker-based registration is analyzed.Materials and methodsA synthetic full-size human skull was registered with its cone beam computed tomography dataset using (a) a dentally-mounted “rapid” occlusal splint with five titanium screws directly attached to the splint, (b) an “extender”, a dentally-mounted occlusal splint with similar fiducials fixed to an extension of the splint. The target registration error was measured for 170 landmarks distributed over the viscero- and neurocranium in 10 repeats per splint type using the Vector Vision² (BrainLAB AG, Heimstetten, Germany) navigation system. Statistical and graphical evaluations were performed per anatomical region.ResultsIn the periorbital region, the rapid splint, with an average deviation of 1.50 mm (SD = 0.439) showed greater accuracy than the extender with 1.76 mm (SD = 0.525). The viscerocranial results for both splints were similar (extender 1.84 mm, SD = 0.559, rapid occlusal splint 1.86 mm, SD = 0.686). In the cranial vault region, registration with the extender (2.33 mm, SD = 0.685) proved to be more precise than with the rapid splint (2.86 mm, SD = 0.929).ConclusionsDue to the more compact dimension of the rapid occlusal splint, errors close to the splint were smaller compared to the extender technique. The advantage of greater distances between the registration fiducials on the extender is particularly important in areas such as the orbital roof, the cranial vault, and the lateral skull base.     

The Effectiveness of Radial Extracorporeal Shock Waves for Treatment of Carpal Tunnel Syndrome: A Randomized Clinical Trial

This study examined the effectiveness of radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome (CTS). Forty patients with mild to moderate CTS were allocated to two groups: (i) shock wave + wrist splint and (ii) wrist splint. Patients used wrist splints followed by three sessions of low-energy shock wave therapy in the intervention group and wrist splints alone in the other group. The QuickDASH Questionnaire, visual analogue scale and nerve conduction studies were used to evaluate the patients before the study and at 3, 8 and 12 wk after the start of the treatment. At the end of the study, both groups saw the same clinical benefits. However, a significantly greater improvement in the median nerve distal sensory latency was noted in the shock wave group compared with the control group. We suggest that application of shock wave with alternative protocols may be effective in the treatment of CTS in future studies.     

跨肩带小夹板治疗肱骨外科颈骨折的临床应用

目的探讨跨肩带小夹板治疗肱骨外科颈骨折的疗效。方法对我院骨伤科的肱骨外科颈骨折患者手法复位后外固定随机分成跨肩带小夹板治疗组和常规治疗组，跨肩带小夹板治疗组59例患者，运用跨肩带小夹板进行外固定处理，常规治疗组59例患者采用教科书的四块小夹板外固定方法，对比分析两组患者的临床疗效。结果治疗组与常规治疗组在小夹板松脱、骨折移位、畸形、治疗前后疼痛、肿胀症状减轻和骨折临床愈合的疗效、后期肩关节功能恢复随访三个月的疗效，前面各项比较差异有极显著性（P〈0．01）。骨折愈合临床疗效，治疗组总有效率94．9％，对照组总有效率79．6％。治疗组显著优于对照组（P〈0．01）。结论运用跨肩带小夹板治疗肱骨外科颈骨折，能对骨折舒适又牢固外固定，避免和减少骨折的移位，早期症状疗效和临床疗效显著，提高患者满意度，值得临床推广。     

A simple jaw splint for minimally displaced mandible fractures with undisplaced occlusion

A 35-year-old patient presented with a minimally displaced jaw fracture with normal occlusion. She was treated conservatively with a soft diet and told to avoid doing things that hurt to prevent movement at the fracture site. She had the most difficulty with pain generated by walking, driving on bumpy roads and waking up with an unfavourable jaw position during her sleep. She created a simple Velcro (Velcro Industries BV, USA) splint, that removed all of her pain with walking, driving and sleeping and went on to heal her fracture uneventfully. The occupational therapist easily fabricated this splint for a second patient, who also found it very helpful.     

板治疗对骨性Ⅰ类错畸形患者髁突功能位置和诊断的影响

目的：研究板治疗对骨性Ⅰ类错畸形患者双侧髁突功能位置和诊断的影响。方法板治疗34例骨性Ⅰ类错畸形患者。使用髁突位置测量仪( measures of condyle displacement, MCD)测量患者治疗前、中、后的正中关系( centric relation,CR)位与正中( centric occlusion, CO)位的差异,板治疗结束时重新评估错畸形诊断,比较板治疗前后功能位置差异和左右双侧对称性的改变。使用配对检验对数据统计分析。结果板治疗后患者CR与CO位的双侧髁突功能位置变化的对称性比治疗前有改善。板治疗后,患者中有2人(7．1%)骨性诊断改变,有6人(21．4%)的安氏诊断改变。结论板治疗可以使骨性Ⅰ类错畸形患者髁突CO-CR位置差异趋于协调,对称性得到改善。必要的板治疗可以改善错畸形患者诊断的正确率。