肱骨近端骨折手术与非手术治疗方法疗效分析

目的分析肱骨近端骨折手术及非手术治疗方法的疗效。方法2002～2003年对43例肱骨近端骨折分别采用切开复位解剖钢板、拉力螺钉、克氏针固定及手法复位夹板固定治疗。采用Constant-murley评分方法评定疗效。结果所有患者随访10～19个月,平均11.5个月。24例手术患者中优11例,良8例,可4例,差1例,优良率为79.2%;19例非手术患者中优6例,良7例,可6例,优良率为68.4%;手术疗效明显优于非手术疗效,差异有显著性意义(P<0.05)。X线片示无骨折不愈合及肱骨头坏死发生。结论对Neer分型中Ⅰ型和Ⅱ型中部分患者应采用非手术手法复位夹板固定治疗。而Ⅲ、Ⅳ型应采用手术方法治疗,主要采用解剖钢板固定。拉力螺钉、克氏针作为一种辅助手段,在手术中不宜过多使用。     

A New Harvest Site for Bone Graft in Anterior Cruciate Ligament Revision Surgery

During revision anterior cruciate ligament (ACL) surgery, femoral interference screws frequently require removal. This may lead to significant tunnel widening and possible graft fixation failure as a result. Solutions include drilling the revision tunnel in a different location, using stacked interference screws, or using bone graft to fill the defect. Autogenous iliac crest graft and allograft are both used, but there are significant comorbidities associated with each. We developed a new technique for harvesting autogenous bone graft that avoids many of the complications associated with other graft sources. By use of the existing surgical incision from the initial harvest of the bone–patellar tendon–bone autograft, bone from the medial tibial metaphyseal safe zone is harvested via an OATS tube harvester (Arthrex, Naples, FL). A bone plug 1 mm larger in size than the femoral defect is harvested and arthroscopically inserted via a press-fit technique. At 3 months after bone grafting, patients undergo revision ACL reconstruction. The proximal tibial metaphysis is a safe bone graft harvest site in revision ACL surgery and offers an effective method for filling large bony defects, allowing anatomic reconstruction of the ACL after bone healing has occurred. Furthermore, it eliminates the problems associated with allograft or use of a remote graft donor site.     

应用微创内固定系统治疗胫骨近端骨折

目的总结应用微创内固定系统(LISS)治疗胫骨近端骨折的临床经验,讨论应用指征及手术技巧。方法分析2003年11月～2004年6月间应用LISS治疗的22例高能量胫骨近端骨折,其中男16例,女6例,平均年龄41.8岁(22～69岁)。按AO分型:41-A型7例,41-C型15例。其中9例合并其它骨折,5例为开放性骨折(GustiloⅢA3例,ⅢB2例)。结果平均随访15个月(12～17个月)。22例完全愈合;2例发生浅表感染,经保守治疗痊愈;患者完全负重时间15.2周(12～18周);X线愈合时间14.5周11～17周)。1例术后6个月随访出现关节面复位丢失,无固定失效及力线不正;关节活动度平(均为2°(0°～15°～98.6°(60°～120°;按照Johner-Wruhs胫骨骨折临床疗效评价法,术后6个月功能优))13例,良7例,中2例,差0例,优良率为90.9%。结论LISS治疗胫骨近端骨折,特别是干骺端粉碎的骨折具有较好的力学稳定性,骨折愈合率高,软组织损伤小,并发症发生率低,是一种有效的治疗手段。但作为新型的固定系统其有特殊的手术技巧及指征,临床应用时应充分理解。     

Synovial chondromatosis of four compartments of the knee: medial and lateral tibiofemoral spaces,patellofemoral joint and proximal tibiofibular joint

A case of synovial chondromatosis of the proximal tibiofibular joint in addition to lateral and medial tibiofemoral spaces and patellofemoral joint has been presented.     

老年股骨粗隆间骨折的分类与手术方法的选择

回顾性分析1990年1月-2001年12月手术治疗219例老年股骨粗隆间骨折患者的诊治情况,探讨其骨折分类与治疗方法的选择.……     

强直性脊柱炎股骨近段形态学改变对全髋关节置换术假体选择的意义

目的分析强直性脊柱炎股骨近段的形态学改变,及其改变对全髋关节置换术假体选择的意义。方法1999年1月~2004年6月,将13例(16髋)强直性脊柱炎患者设为选择组,患者均已出现关节强直,需行全髋关节置换术。另16例(19髋)为对照组,为非强直性脊柱炎患者而拟行全髋关节置换术。两组患者均摄髋关节正侧位X线片,测量Singh指数、髓腔张开指数、皮质形态指数及皮质骨指数,并进行统计学分析。结果选择组Singh指数、髓腔张开指数及皮质形态指数分别为3.81±0.54、2.63±0.41及2.02±0.38,对照组分别为4.63±0.62、3.03±0.27及2.76±0.28,两组比较差异均有统计学意义(P<0.05)。选择组皮质骨指数为1.69±0.69,对照组为2.12±0.24,两组比较差异无统计学意义(P>0.05)。选择组患者髓腔呈烟囱型10例13髋,普通型3例3髋;对照组烟囱型3例3髋,普通型13例16髋。结论强直性脊柱炎的全髋关节置换术应采用骨水泥型人工关节假体,并根据患者髓腔形态使用定制型骨水泥假体,以达到更好的近段固定效果。对于有严重骨质疏松者应按关节翻修术处理。     

Poly-l-aspartic acid protects cultured human proximal tubule cells against aminoglycoside-induced electrophysiological alterations

Cultured human proximal tubule cell monolayers maintained on permeable supports were treated simultaneously with the aminoglycoside antibiotic, gentamicin, and poly- -aspartic acid (PAA), an inhibitor of aminoglycoside nephrotoxicity. Following 4 days of exposure, cell monolayers were placed into Ussing chambers to allow monitoring of transepithelial electrical properties. For each of the three cell isolatation examined, aminoglycoside-induced alterations in electrogenic transport, reflected by changes in short-circuit current (Isc), as well as alterations in paracellular properties, indicated by changes in transepithelial electrical resistance (R_T), were diminished in the presence of PAA. Alterations resulting from selective basolateral exposure to gentamicin were unchanged in the case of apically applied PAA and attenuated only when PAA acid was added basolaterally. This is the first demonstration of PAA inhibition of aminoglycoside-induced cellular alterations involving human cells.     

Renal regulation of salt balance: a primer for non-purists

The greater than 40-fold range of voluntary salt intake in humans requires corresponding adjustments in renal excretion to maintain balance. Although many mechanisms have been implicated in the regulation of salt output by the kidney, surprisingly little consideration has been given to their quantitative significance and possible interaction. This survey summarizes the effects of changes in glomerular filtration rate, proximal peritubular physical factors, and plasma concentrations of aldosterone and atrial natriuretic factor (ANF), singly and in combination, on the level of salt excretion. Contrary to expectation, even large increases in filtration or decreases in proximal reabsorption have only minor natriuretic effects, due to constancy of fractional reabsorption in downstream nephron segments. Lack of aldosterone release increases salt excretion as much or more than the upstream mechanisms, whereas ANF-induced inhibition of reabsorption in the medullary collccting duct has the largest effect. It may be concluded, therefore, that the potency of these natriuretic factors increases with distance along the nephron, even though each is operating on a progressively small tubular load. However, none of the mechanisms, in isolation, is sufficient to explain salt balance over the range of voluntary intake. Combination of factors demonstrates synergism rather than simple additivity, resulting in more than enough reserve capacity for salt excretion.     

Hip fracture incidence in the canton of Vaud,Switzerland, 1986–1991

The objective of this study was to estimate the incidence of hip fracture in the canton of Vaud, Switzerland (total population 584 000), for the period 1986–1991 using routine hospital discharge data collected by the Cantonal Service of Statistical Research and Information (SCRIS). For the survey period, the estimated average annual crude incidence rate of hip fractures was 167 per 100 000 persons aged 20 or older (241 for women and 84 for men). For the population aged 50 years or older, the crude incidence rate was 388 per 100 000 persons (546 for women and 185 for men). The average annual age-specific rates rose exponentially by successive 5-year age groups. The median age of patients at the time of the fracture was 82 years in women and 74 years in men. There was no significant difference between the total number of cervical and trochanteric fractures. Between the ages of 20 and 84 years, the cumulative risk for a woman to be admitted to hospital with a hip fracture was twice that of a man (15.8% vs 7.8%). From 1986 to 1991, the age- and sex-adjusted incidence, like the ratio of cervical to trochanteric fractures, did not show any significant trend, although it was consistent with an increase in men (p=0.09). However, the annual number of fractures rose from 644 to 776, particularly among very aged men. The mean length of stay in the acute care hospital fell from 38 days in 1986 to 25 days in 1991. Finally, the comparison of these results with those obtained in 1986 for the same population from more exhaustive sources has confirmed the provision of a consistent, although overestimated, assessment of hip fracture incidence by means of these routine hospital statistics in the canton of Vaud, Switzerland.     

股骨近端骨折的分类与功能评价

股骨近端骨折主要包括股骨颈骨折、股骨转子间骨折和股骨头骨折：Garden股骨颈分类(1961)、Jensen改良的Evarts股骨转子间骨折分类(Evans-Jensen分类，1975)、Pipkin股骨头骨折分类(1957)、AO综合分类(1990)等是应用较广的主要股骨近端骨折分类方法。AO股骨近端骨折分类共分为3型9组27个亚组，其中关节囊外转子部骨折为A型，关节囊内股骨颈骨折为B型，关节内股骨头骨折则归为C型。由于股骨近端骨折的复杂性，骨折分类时应重点区分稳定性骨折与不稳定性骨折。股骨近端骨折治疗后的功能评价，多选用选用Harris髋关节功能评分(1969)、Sanders髋关节创伤临床功能评分(1988)。