前置钢板微创固定治疗肱骨干中下段骨折的可行性研究

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.     

重型颅脑损伤的救治体会

目的:总结重型颅脑损伤的救治体会。方法:对127例重型颅脑损伤患者从防治颅高压,及时手术治疗;避免继发性脑损害,并发症的防治等方面进行救治。结果:按GCS评分,良好41例,中残29例,重残16例,植物生存2例,死亡29例。结论:对重型颅脑损伤的早期诊、早期处理,避免继发性脑损害的,同时对病情的动态观察,并发症的防治,及时发现危及生命的各种因素。     

切开复位重建钢板内固定治疗移位Miller-AdaⅡ、Ⅲ型肩胛骨骨折

目的探讨切开复位重建钢板内固定治疗移位Miller-AdaⅡ、Ⅲ型肩胛骨骨折疗效。方法采用切开复位重建钢板内固定治疗23例移位Miller-AdaⅡ、Ⅲ型肩胛骨骨折,记录术后近期并发症、骨折愈合时间和肩关节外展功能。结果所有患者术后无切口感染。17例患者得到随访,时间4～24个月,骨折均愈合,愈合时间12～24周。肩关节外展90°～170°,平均150°。根据Neer肩关节功能评定标准：优13例,满意2例,不满意2例。结论采用切开复位重建钢板内固定治疗移位Miller-AdaⅡ、Ⅲ型肩胛骨骨折可获得良好的临床效果。     

锁定接骨板治疗肱骨近端三、四部分骨折

背景：锁定接骨板是一种新型的内固定钢板,可以改善肱骨近端骨折的临床治疗效果。 目的：探讨锁定接骨板置入内固定治疗肱骨近端三、四部分骨折疗效以及并发症的发生情况。 方法：回顾性分析复旦大学附属中山医院青浦分院骨科2008年1月至2009年12月行锁定接骨板内固定治疗31例肱骨近端骨折患者临床资料,其中男13例,女18例;年龄28-81岁,平均56.4岁。骨折类型采用Neer分类,三部分骨折19例,四部分骨折12例。内固定治疗采用胸大肌三角肌间沟入路,行肱骨近端锁定接骨板内固定术。另外,检索锁定接骨板治疗肱骨近端三、四部分骨折并发症的相关研究文献,对并发症的发生情况进行研究分析。综合分析临床病例疗效与检索文献中并发症的发生情况,获得锁定接骨板治疗肱骨近端三、四部分骨折的特点。 结果与结论：复旦大学附属中山医院青浦分院骨科应用锁定接骨板内固定治疗31例患者均得到13-49个月随访,平均随访19.8个月。骨折均愈合,无内固定失效,临床愈合时间为8-16周。根据Constant评分标准评定肩关节功能,其中优11例,良16例,可3例,差1例。锁定接骨板内固定是治疗肱骨近端三、四部分骨折可靠有效的方法。但也可发生螺钉松动、肱骨头坏死等相关并发症,因此,内固定治疗操作时应注意保护肱骨头血运,复位肱骨颈内侧骨折块并牢固固定,以减少并发症的发生,提高内固定治疗疗效。     

前置钢板微创固定治疗肱骨干中下段骨折的可行性研究

Objective To evaluate effects of minimal invasive plating for treatment of mid-distal humeral shaft fractures.Methods From May 2004 to December 2007, 20 patients with isolated unilat-eral mid-distal third humeral shaft fractures were surgically treated with close reduction and internal fixation using a 4.5 mm dynamic compression plate which was anteriorly inserted through 2 small incisions on the anterior aspects of proximal and distal parts of the arm, away from the fracture site.The postoperative function of the radial nerve and the musculocutaneous nerve, the postoperative alignment of the main fragments on the anteroposterior radiographs, the bone healing time and muscle strength of biceps muscles were measured and recorded, Results Four patients complained of numbness at the area innervated by the lateral ante-braehial cutaneous nerve in the affected forearm after the surgery.No signs of iatrogenic radial nerve palsies occurred after the surgery.A completely normal alignment was achieved in 7 patients, but varus of 11° was found in 2 cases and varus of 2°, 3°, 4°, 5°, 6°, 7° and 10° in one each.Valgus deformity was noticed in 4 cases, and valgus of 3°, 4°, 6° and 7° in one each.The mean follow-up of 10.4 months for 19 patients re-vealed bony union of all the fractures.The average bone healing time was 13.4 weeks.At the latest follow-up, the biceps muscle strength of all the patients was 5 degrees.Hardwires were removed in 5 patients without any complications.Conclusions Minimally invasive anterior plating is a safe alternative osteosynthesis for mid-distal third humeral shaft fractures.However, this technique may interfere with the function of the lateral antebrachial cutaneous nerve.     

麻醉下推拿治疗腰椎间盘突出症的临床进展

腰椎间盘突出症是临床常见疾病，其治疗以非手术治疗为主（仅有19％的病人需要手术治疗）。非手术治疗中，以麻醉下推拿治疗最具有代表性，且效果最好。自Chrisman 1950年采用全麻下重力牵引大推拿治疗腰椎间盘突出症取得效果后，20世纪五十年代以后此法在我国逐渐推广应用开来，有效率达90％以上。七十年代以后，麻醉下推拿治疗腰椎间盘突出症的方法在我国有了较系统的发展，     

牵引下旋转复位法治疗颈椎关节病影像学观察

[目的]应用牵引下旋转复位治疗颈椎关节病,观察颈椎影像学(CR片)改变.[方法]应用随机数字表法将病人分配到治疗组和对照组,每组30例.[结果]牵引下旋转复位法可以有效纠正颈椎病患者颈椎生理曲度的改变,与普通牵引治疗相比能更好改善病人的疼痛等症状.[结论]牵引下旋转复位法是治疗颈椎关节病的有效手法,值得推广.     

皮下钉棒系统改良置钉法治疗Tile B型骨盆骨折的临床观察

目的 :探讨皮下钉棒系统改良置钉法治疗Tile B型骨盆骨折的可行性及临床疗效。方法 :自2014年6月至2015年8月选择性应用钉棒系统改良经髂前下棘和耻骨结节置钉治疗14例Tile B型骨盆骨折,男8例,女6例;年龄23~65岁,平均42岁。观察患者的手术时间、术中出血量、骨折愈合情况及术后并发症,并采用Matta复位标准及Majeed功能评分进行疗效评价。结果:所有患者获得随访,时间8~15个月,平均10.5个月。手术时间25~45 min,平均32 min;术中出血量10~35 ml,平均18 ml。术后骨折均Ⅰ期愈合,愈合时间9~14周,平均12.5周。术后无切口感染、内固定失败及异位骨化等并发症发生。4例出现单侧股外侧皮神经损伤,1例出现单侧股神经麻痹,最终均恢复正常。Matta复位标准结果 ,优7例,良5例,中2例。末次随访时Majeed功能评分为(81.50±8.05)分,其中优5例,良7例,中2例。结论 :应用皮下钉棒系统改良经髂前下棘和耻骨结节置钉固定前环创伤小、复位牢靠、并发症少,是治疗Tile B型骨盆骨折一种有前景的手术方式。     

持续温热效应对推拿治疗慢性腰肌劳损的作用

目的：观察持续温热效应对推拿治疗慢性腰肌劳损的作用。方法：将门诊符合要求的慢性腰肌劳损患者随机分为推拿治疗组（对照组）60例,推拿加持续温热治疗（观察组）60例,两组进行对照。结果：对照组和观察组的有效率分别为：78.3%,93.3%,比较有差异（P〈0.05）;2组治疗前后疼痛指数（P〈0.01）和血栓烷B2（TXB2）均有显著差异（P〈0.05）;结论：持续温热效应对推拿治疗慢性腰肌劳损有较好的促进作用。