肱骨干骨折内固定的选择及应注意的问题

目的正确选择肱骨干骨折手术内固定.方法对107例肱骨干骨折分别进行交锁髓内钉(34例)、加压钢板(29例)、Y型钢板(38例)、螺钉(6例)等内固定,并随访比较分析. 结果所有病例均得到随访,平均随访6.3个月.交锁髓内钉、螺钉内固定组全部愈合;加压钢板内固定组愈合26例,伴桡神经损伤2例;Y型钢板内固定组全部愈合,伴肘关节僵硬2例. 结论根据肱骨干骨折的部位和类型选用适当的内固定方法,骨折愈合良好,可有效的减少并发症的发生.     

肩后入路内固定治疗不稳定性肩胛骨骨折

目的：探讨不稳定性肩胛骨系列骨折的手术适应证与开放复位内固定的治疗效果。方法：22例肩胛骨骨折，男18例，女4例，年龄25～65岁，平均35．5岁。根据术前X线片与CT扫描对骨折进行分型，确定手术指征，经肩后入路行切开复位，采用重建钢板、微型钢板、拉力螺钉内固定，术后早期功能锻炼。结果：22例均获9～28个月随访，平均17．5个月，疗效优14例，良5例，可2例，差1例，优良率86．4％。所有骨折平均在术后8．5周骨性愈合。结论：对不稳定性肩胛骨骨折行开放复位内固定、早期功能锻炼可恢复较好的肩关节功能。     

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Abstract – Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.     

不稳定型桡骨远端骨折的外固定器治疗

目的：探讨外固定器治疗不稳定型桡骨远端骨折的疗效。方法：对12例不稳定型桡骨远端骨折的患者采用改良AO外固定器治疗，术后随访5－8个月，根据骨折愈合情况和腕关节形态及功能情况，按Jakim评分结果评价治疗效果。结果：骨折愈合时间为6－8周，优良率为91％。结论：外固定器治疗不稳定型桡骨远端骨折具有良好的固定作用，能较好地防止骨折畸形愈合和保护腕关节功能。     

鼻眶筛骨折手术治疗的临床评价

目的　探讨鼻眶筛骨折的手术入路、骨折复位与坚固内固定及合并眼球内陷的处理方法。方法　对 17例鼻眶筛骨折患者进行回顾性研究 ,根据CT结果与Fedor骨折分型分为三型 ,其中Ⅰ型 1例 ,Ⅱ型 7例 ,Ⅲ型 9例 ;13例选用鼻根正中入路 ,3例鼻旁入路 ,7例需同时附加眶下切口。 8例合并眼球内陷者采用眼球赤道后方碘仿纱条填塞与植骨矫正法。结果　①本组病例平均内眦宽度和内眦宽度 /外眦宽度比例从 ( 35± 7)mm、( 37± 8) %恢复到 ( 32± 4 )mm、( 35± 7) %比较正常水平 ;②面部外形全部恢复到正常或接近正常 ;③ 8例眼球内陷患者术后 6例恢复到基本正常 ,2例术后仍有轻度凹陷 ,5例复视术后全部消失。结论　鼻根正中入路附加眶下切口可充分显露骨折片 ,结合坚固内固定技术可使骨折片解剖复位 ;内眦韧带复位固定是本手术关键所在 ,重建正常眶内容积和眶内容物准确复位 ,以解决眼球内陷和眼球运动受限问题     

An approach to fractures of the midface: An interactive tutorial

Purpose: To describe an educational computer aided instruction program dealing with diagnosis and classification of facial fractures. Methods: A program was created for use on Macintosh computers using a graphic presentation package. This program allows for the display of high resolution digitized radiographic images and illustrations, along with integrated voice and text information. Users can interact with the program to review complex concepts or study additional cases. Case material was obtained from selected high quality plain radiographs and computed tomography (CT) scans obtained in the trauma center of one institution, and was scanned on a high resolution digital scanner with image parameters optimized for viewing on the Macintosh high resolution color monitor. Results: The program has been installed in the computer aided instructional laboratories or trauma centers at The University of Texas Health Science Center, Houston; The University of Alabama, Birmingham; Emory University School of Medicine, Atlanta, Georgia; and The University of North Carolina, Chapel Hill. The program is available to radiology residents and medical students rotating on the trauma radiology services at these institutions. Completion of the program requires 30–45 minutes. Conclusion: Based on our initial experience, the program has been used by residents in the training programs of all institutions with favorable results.     

OUTCOME AFTER FRACTURES OF THE FEMUR IN PAGET'S DISEASE

We reviewed ninety-three patients who had one hundred and seven complete fractures of the femur between them and were treated over a twenty-five year period in Western Australia and South Australia. Operative surgical management of complete fractures in the middle and distal thirds was usually successful. In contrast, fractures proximal to the middle third were regularly associated with non-union, implant failure and requirement for revision surgery. In view of this significant difference in outcome after fracture of the pagetic femur in different sites, a comprehensive surgical management strategy is recommended in order to avoid complications.     

Quality of life as outcome in the treatment of osteoporosis: The development of a questionnaire for quality of life by the European foundation for osteoporosis

The morbidity of osteoporosis is caused by fractures. Vertebral fractures lead to pain and disability and a decrease in quality of life. A Working Party of the European Foundation for Osteoporosis has developed a specific questionnaire for patients with established vertebral osteoporosis. This questionnaire is intended for use in clinical trials. The questionnaire consists of questions and visual analogue scales in the following domains: pain, activities of daily living, jobs around the house, mobility, leisure and social activities, general health perception and mood. The questionnaire has been translated from English into French, German, Italian, Hebrew, Swedish and Dutch. The questionnaire is currently being validated in a multicentre study involving patients with stable osteoporosis and control subjects. Preliminary results indicate that the reproducibility is sufficient and that the questionnaire is able to discriminate between patients with vertebral osteoporosis and control subjects.     

股骨多段闭合骨折病人术前凝血功能的变化

目的 探讨股骨多段闭合骨折病人术前凝血功能的变化。方法 选择创伤股骨多段闭合骨折后当天入院的病人20例,年龄19-45岁,ASA Ⅰ级,为试验组(Ⅰ组);选择健康成年人15人,年龄21-39岁,作为对照组(Ⅱ组);Ⅱ组于清晨空腹采上肢静脉血标本,Ⅰ组病人入院后于骨折的第2天、第6天(手术当天清晨)空腹采上肢静脉血样本,检测血栓弹力图(TEG)指标[R时间、K时间、α角、血栓最大幅度(MA)、血栓硬度(G)]、D-二聚体浓度(D-Di)、血小板计数(PLC)及血小板聚集率(PAgR)的变化。结果 Ⅱ组TEG指标、D-Di、PLC及PAgR均在正常范围。与Ⅱ组比较,Ⅰ组骨折后第2天,K时间缩短(P<0.05),α角、MA、G及D-Di增高(P<0.01);骨折后第6天,R时间缩短(P<0.05),α角、MA、G、D-Di、PLC及PagR增高(P<0.01)。与骨折后第2天比较,Ⅰ组骨折后第6天MA、G、PLT及PAgR增高(P<0.05或0.01)。结论 病人创伤骨折后凝血功能24 h内增强,随时间的延长至术日呈高凝状态,应加强术中管理,并采取相应措施预防术中静脉血栓的发生。     

胫骨pilon骨折手术疗效的相关因素分析

目的探讨影响胫骨pilon骨折手术疗效的相关因素．方法1997年1月～1999年12月．手术治疗32例单侧胫骨pilon骨折．术后16例出现伤口并发症．关节退行性变及关节强直．男13例．女3例；年龄25～55岁，平均36．5岁；坠落伤7例，交通伤5例．砸伤3例．其它损伤1例，开放性骨折6例．均行急诊手术；闭合性骨折10例．伤后至手术时间为2～25d．平均8.1d、根据Ruedi-A1lgower分型．Ⅱ型7例，Ⅲ型9例。7例行切开复位钢板内固定．9例行有限切开固定并辅以石膏托外固定，结果术后随访12～36个月，平均24个月．采用Mazur评分系统评估手术疗效．可6例．其中Ⅱ型4例，Ⅲ型2例：差10例，其中Ⅱ型3例．Ⅲ型7倒术后发生创面不能闭合1例；切口感染4例，2例开放性骨折出现表浅感染．2例闭合性骨折出现深部感染；关节退行性变9例．其中2例出现较严重的踝关节内翻；关节强直11例，结论影响胫骨pilon骨折手术疗效的相关因素有骨折类型、胫骨关节面的复位质量和手术时机的选择、腓目骨折的复位和固定移植骨的填充及钢板支撑固定等因素。