儿童髋关节滑膜嵌顿症的治疗

儿童髋关节滑膜嵌顿症是一种临床较常见的小儿骨科疾病 ,由滑膜皱襞嵌压在关节间隙而引起。近年来有学者在病理基础、发病机制以及诊断方法等方面作了深入研究[1] ,而治疗方面仅有手法复位和手术开放切除的报道[2 ] 。笔者尝试了多种治疗方法 ,疗效满意。1　临床资料1 1　一般资料　 4 2例中男 2 9例 ,女 13例。年龄 3～ 13岁 ,平均 9岁。均为单髋病变 ,左 19例 ,右 2 3例。 18例有外伤史 ,但外伤后仍能行走 ,一般于伤后次日晨起发病 ;12例病前 1个月内有“上呼吸道感染”病史 ;12例无明显诱因。所有病例均起病急 ,出现持续的髋关节疼痛 ,跛…     

骨盆骨折腹膜后血肿并发骨盆筋膜间隔综合征一例

腹膜后血肿是骨盆骨折的常见并发症，出血多来源于骶前静脉丛或骨折的边缘小动静脉，这种压迫的另一个少见而严重的并发症是压迫输尿管引起肾功能衰竭。此问题在文献中很少提及，国内未见报道。1982年Antoci报告1例骨盆骨折并发输尿管阻塞。骨盆筋膜间隔综合征这个概念由Hessmann在1998年提出，笔者于2003年治疗1例骨盆筋膜间隔综合征患者。现报告如下。     

半肢骨骺发育异常的临床特征与治疗

目的: 探讨半肢骨骺发育异常的临床特征与治疗方法。方法: 随访自 1988~2002年本院诊治半肢骨骺发育异常 14例,平均随访 8 (2~13) 年, 所有病人均有连续X线片及功能检查记录。结果: 采用GAFS (GlobalAssesmentFunctionScale) 评分治疗优良率 90%。结论: 半肢骨骺发育异常及时诊断适当治疗预后良好。     

补肾强督方治疗强直性脊柱炎肾虚督寒血瘀证的临床研究

目的 评估补肾强督方治疗强直性脊柱炎肾虚督寒血瘀证的疗效和安全性.方法 采用对照研究方法,选择强直性脊柱炎肾虚督寒血瘀证患者,分为补肾强督方治疗组和嫩(旭)痹冲剂加白芍总苷对照组,观察两组患者临床症状、证候积分、体征、实验室检查的变化;计算两组显效率、有效率和总有效率,并观察药物的副作用;探讨补肾强督方的作用机理.结果 两组患者治疗前后全身疼痛、脊柱疼痛、夜间疼痛、晨僵时间、畏寒喜暖、乏力和血瘀证积分均有明显下降;两组患者指地距、胸廓活动度、schober试验、脊柱活动度和4字试验治疗前后均有明显改善;两组患者血沉(ESR)、C反应蛋白(CRP)、外周血单核细胞计数、血小板计数、IgA和IgG治疗前后均有明显改善;补肾强督方治疗AS显效率为30%,,有效率为56.67%,总有效率为86.67%.结论 补肾强督方治疗AS,具有明显的抗炎和活血化瘀作用以及一定的免疫调节作用,总有效率高,且安全无明显毒副作用.     

髂内动脉或腹主动脉阻断对山羊髂内动脉网压力的影响

目的 评估山羊髂内动脉或腹主动脉阻断后髂内动脉压力的变化,为治疗骨盆骨折合并动脉出血合理选择阻断动脉的方法提供理论依据. 方法 共选择5只山羊,分别按以下方法测量髂内动脉的压力:(1)测量正常髂内动脉动脉压,(2)测量阻断一侧髂内动脉后远端压力,(3)测量阻断双侧髂内动脉后远端压力,(4)测量阻断腹主动脉和双侧髂内动脉后远端压力,(5)测量单纯阻断腹主动脉后髂内动脉压力. 结果 正常髂内动脉血压为(57.84±13.46) mm Hg,阻断一侧髂内动脉后远端压力为(38.40± 17.39)mm Hg,阻断双侧髂内动脉后远端压力为(29.70±12.16)mm Hg,阻断腹主动脉和双侧髂内动脉后远端动脉压力为(32.80±17.02) mm Hg 单纯阻断腹主动脉后髂内动脉远端压力为(29.20±18.52) mm Hg.不同的阻断方法对髂内动脉的压力均有明显的影响(P＜0.05),但不同的阻断方法之间差异无统计学意义(P＞0.05).结论 上述4种阻断方法对降低髂内动脉压力的作用是相似的,临床工作中选择一种方法即可,不必重复应用.     

髌骨骨折合并膝关节韧带、半月板损伤的回顾性分析

目的 探讨髌骨骨折合并膝关节韧带、半月板损伤的发病规律和临床特点. 方法 回顾性分析2003年3月至2012年2月期间收治的1337例髌骨骨折患者资料,男974例,女363例;年龄8～98岁,平均45.2岁.以临床体征、X线、磁共振成像(MRI)检查及手术结果筛选出合并膝关节韧带、半月板损伤的患者进行分析,计算髌骨骨折合并膝关节韧带、半月板损伤的发病率,统计各种韧带、半月板损伤的发病率在不同髌骨骨折类型及致伤原因中的差异. 结果 髌骨骨折合并膝关节韧带、半月板损伤的发病率为2.1％ (28/1337).致伤原因:交通伤13例,摔伤10例,运动损伤3例,坠落伤2例.髌骨骨折按Regazzoni分型:A型2例,B型17例,C型9例.52处合并伤中,交叉韧带损伤15处,侧副韧带损伤14处,半月板损伤23处.髌骨骨折Regazzoni分型中,A型和C型骨折患者与B型骨折患者各种合并伤的发病率比较差异均无统计学意义(P＞0.05).各种致伤原因中,运动损伤和坠落伤患者的内侧副韧带损伤发病率(100％)与摔伤患者(10.0％)、交通伤患者(23.1％)比较,以及交通伤患者后交义韧带损伤发病率(70.0％)与摔伤患者(10.0％)比较,差异均有统计学意义(P＜0.05). 结论 各种类型髌骨骨折均可合并膝关节交叉韧带、侧副韧带或半月板损伤,应予高度警惕,并在麻醉前、后做膝关节的相应体格检查,必要时行MRI检查.     

Four Pins Assisted Reduction of Complex Segmental Femoral Fractures： a Technique for Closed Reduction

Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduc- tion and intramedullary nail fixation to determine the therapeutic effect of this closed reduction tech- nique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a. gentle traction was attempted on the limb. Usu- ally, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the me- dullary cavity, and the ＂T＂ sharp handles were fixed on the Schanz pins. The fragments were then re- duced by reversing the deforming forces for segmental fractures by two assistants~ And then, the re- duction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all pa- tients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen （86.7%） patients had anatomic reduction and two of them （13.3%） had minor varus alignment of 3° and 5°. Knee stiffness was Observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures With four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.     

肘前小切口治疗严重移位肱骨髁上骨折

目的：寻求治疗严重移位的肱骨髁上骨折复位快而准确的方法。方法：采用肘前小切口法，于肱二头肌腱外侧达骨折断端，复位后交叉克氏针固定，结果：48例，随访3年，优36例，良12例，无一例缺血性肌挛缩，无感染或神经损伤发生，8例（16．7％）发生无症状的肘内翻，结论：该方法简单，可靠，创伤小，住院时间短。     

Bryan颈人工椎间盘置换术失败原因分析

Objective To analyze the failed Bryan cervical disc arthroplasty and to improve its re-sults. Methods From October 2004 to October 2007, 48 patients underwent Bryan cervical disc arthro-plasty. All patients were followed up 2 to 38 months(mean 18 months). Among them, 4 failed cases were an-alyzed, which include 1 male and 3 females, with the age of 42, 51, 40, 49 years. Results Case 1 reported the brachial plexus injury as the result of the patient's shoulders being overstretched while fixing his position during operation, the muscular power of both upper extremities declining to degree Ⅱ and Ⅲ upon operation completion, which was restored to degree 4 when discharged from hospital (45 days after operation). Case 2 reported the compression on the spinal cord as the result of failure to remove the ossification of posterior lon-gitudinal ligament (OPLL) which had been identified by the preoperative CT; the patient complained of no release of symptoms after the operation and postoperative CT showed that compression still existed. Case 3 reported incomplete spinal cord injury caused by massive bleeding during decompression, a function of ex-tremely small vertebral canal anteroposterior diameter (5 mm shown in preoperative MRI); the muscular pow-er of left extremity dropped to degree 0 upon operation completion; the patient could walk with crutch 10 days after operation. Case 4 reported'heterotopic ossification (OP) which occurred 1 year after operation and became deteriorated 2 years later, but did not affect the motion of prosthesis. Conclusion Bryan disc arthroplasty is being extensively used as an effective procedure for decompression and reconstruction of the cervical disc. Excellent clinical results are related to strict selection of indications, perioperative manage-ment, and the experience and surgical technique of the surgeon are also important to the final outcome.     

Bryan颈人工椎间盘置换术失败原因分析

Objective To analyze the failed Bryan cervical disc arthroplasty and to improve its re-sults. Methods From October 2004 to October 2007, 48 patients underwent Bryan cervical disc arthro-plasty. All patients were followed up 2 to 38 months(mean 18 months). Among them, 4 failed cases were an-alyzed, which include 1 male and 3 females, with the age of 42, 51, 40, 49 years. Results Case 1 reported the brachial plexus injury as the result of the patient's shoulders being overstretched while fixing his position during operation, the muscular power of both upper extremities declining to degree Ⅱ and Ⅲ upon operation completion, which was restored to degree 4 when discharged from hospital (45 days after operation). Case 2 reported the compression on the spinal cord as the result of failure to remove the ossification of posterior lon-gitudinal ligament (OPLL) which had been identified by the preoperative CT; the patient complained of no release of symptoms after the operation and postoperative CT showed that compression still existed. Case 3 reported incomplete spinal cord injury caused by massive bleeding during decompression, a function of ex-tremely small vertebral canal anteroposterior diameter (5 mm shown in preoperative MRI); the muscular pow-er of left extremity dropped to degree 0 upon operation completion; the patient could walk with crutch 10 days after operation. Case 4 reported'heterotopic ossification (OP) which occurred 1 year after operation and became deteriorated 2 years later, but did not affect the motion of prosthesis. Conclusion Bryan disc arthroplasty is being extensively used as an effective procedure for decompression and reconstruction of the cervical disc. Excellent clinical results are related to strict selection of indications, perioperative manage-ment, and the experience and surgical technique of the surgeon are also important to the final outcome.