带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

目的 为带血管蒂腓骨头骨骺截骨整形重建内踝提供解剖学依据,并探讨其临床应用效果.方法 20侧2～12岁新鲜儿童下肢标本,对腓骨头及内踝进行形态学测量,根据测量数据推导截骨公式.临床急诊或延期手术,移植截骨改良的腓骨头骨骺复合组织瓣一期修复内踝缺损,随访观察临床效果.结果 腓骨头倾斜角(M)为(170±8)°,关节面内倾角(N)为(145±6)°,纵长为(1.5±0.2)cm,横宽为(1.4±0.2)cm;内踝内翻角(L)为(152±8)°,关节面纵长为(1.25±0.2)cm,横宽为(1.25±0.2)cm.设内踝缺损面与胫骨纵轴的夹角为(Q),截骨角度X=L-N-Q,顶点位于腓骨头倒置后的关节面上1/6处.临床应用6例,全部一期愈合,随访1～3年,内踝发育良好,未发生骺早闭,无内翻畸形,踝关节负重、行走功能正常.结论 儿童腓骨头骨骺与内踝形态有一定的差异,通过截骨可获得满意的供体,同时携带皮瓣可一期修复内踝骨骺及周围软组织缺损并同步发育,是重建儿童内踝创伤性缺损的理想方法.     

A radiographic study of the distal femoral epiphysis

PurposePrevious studies have described the complex undulation pattern in the distal femoral physis. We investigated whether standard radiographs can visualize these landmarks, in order to guide hardware placement in the distal immature femur.MethodsWe studied 36 cadaveric immature femora in specimens 3 to 18 years of age. Anteroposterior (AP) and lateral radiographs were obtained with and without flexible radiodense markers placed on the major undulations and were analyzed to determine the relative height or depth of each topographical landmark. Intraclass correlation coefficients (ICCs) were calculated between measurements taken with and without markers for each undulation on each view.ResultsExamination of the specimens confirmed a central peak and anteromedial and posterolateral valleys as the major physeal structures. AP radiographs without markers correlated well with marked AP radiographs for all three landmarks (ICC = 0.92, 0.92, 0.91), but the lateral radiographs had lower correlations for the posterolateral valley (ICC = 0.36). The correlation between AP and lateral radiographs without markers on the posterolateral valley was also decreased compared to the other two landmarks (ICC = 0.28 versus 0.57 for the central ridge and 0.62 for the anteromedial valley).ConclusionsThis is the first study to rigorously evaluate radiographic visibility of the distal femur physeal undulations. The position of the central ridge, anteromedial valley, and posterolateral valley are reliably seen on AP radiographs, while the lateral view is less consistent, especially for the posterolateral valley. We recommend that caution should be taken when placing screws near the posterolateral aspect of the epiphysis, as lateral views do not visualize those undulations well.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

继发性骨骺发育障碍23例X线诊断探讨

目的：加深对本病的认识，探讨其X钱表现与发病机理。材料与方法：本组23例，男16例，女7例。发病年龄5—45岁。外伤所致19例，骨结核所致4例。作者回顾性总结分析了23例继发性骨骺发育障碍的X残片表现。结果：因发病部位不同其X线片表现各异，但基本X线表现为骨骺早期畸形愈合。结论：根据X线片表现结合病史诊断不难，但应与某些骨发有障碍性疾病鉴别。     

大骨节病儿童手部X线征分布特点的研究

为了提高大骨节病的早期诊断水平,我们分析了2800例大骨节病儿童手部掌指骨X线征的分布特点,现将结果报告如下。 一、材料与方法 2800例4～13岁大骨节病儿童来自陕西省彬县、永寿县等地区的大骨节病的中、重病区,其患病率在10％～55％之间,其中男性1524例,女性1276例。     

儿童股骨头骺板的解剖定位及其临床意义

为了解股骨头骺板的位置及其形状，为临床应用提供解剖依据，通过观测２３根儿童防腐湿性股骨上端标本，结果发现：股骨头后方软骨缘中点与骺板的距离为４．７７±１．２１ｍｍ；股骨头前方软骨缘中点与骺板的距离为４．４６±１．１８ｍｍ。股骨头头颈线与骺板中点的距离为７．０４±２．１７ｍｍ，在骨截面上观察到骺板的形状主要呈孤线型，少数呈直线型和波浪型。结果说明：所得数据有助于手术中对股骨头骺板的定位，确定在股骨颈开槽时向头部挖入的深度和在骺板上方开窗的部位，以达到对儿童股骨头缺血坏死的有效治疗和避免误伤骺板。     

Proximal fibular growth deformities

Several congenital and acquired conditions may cause relative disparity between the length of the tibia and fibula, with alteration of the proximal tibiofibular joint and concomitant (or consequent) alteration of the distal tibiofibular relationships at both the malleoli and syndesmosis. Hypoplasia of the fibula may occur in association with neuromuscular disorders (e.g., poliomyelitis, arthrogryposis) or osteomyelitis, and is frequently accompanied by valgus deformity of the ankle because of proximal displacement of the lateral malleolus. The physes of the distal fibula and tibia may be level, rather than the fibular physis being adjacent to the tibial articular surface. Hyperplasia of the fibula may be associated with congenital subluxation or dislocation of the knee, various short stature syndromes (e.g., achondroplasia, spondyloepiphyseal dysplasia), and hypoplasia, or aplasia of the tibia. The increased mobility of the proximal tibiofibular joint during the first eight to ten years of growth appears to be a major factor tendering the proximal end of the fibula susceptible to displacement secondary to relative longitudinal growth variations between the fibula and tibia. Recognition of such disparities at the proximal tibiofibular joint, especially during roentgenography, should aleri the clinician to further evaluate possible accompanying deformity at the distal tibiofibular syndesmosis.     

Perspectives: A vital biomechanical model of the endochondral ossification mechanism

Background: Mechanical usage effects could explain many features of endochondral ossification and related processes. Mineralization of growth plate cartilage could reduce its mechanical strains enough to make its resorption begin and to guide it in space. By removing most of its mineralized vertical septae, resorption could overload the remainder enough to increase woven bone formation on them and construct the primary spongiosa. After it finishes mineralizing, the primary spongiosa could become stiff enough to begin partial disuse in strain terms, so BMU-based remodeling would begin replacing it with lamellar bone. This would construct the secondary spongiosa. In transferring loads from the growth plate to the cortex, the central metaphyseal spongiosa becomes deloaded. This disuse would make remodeling remove it in the diaphyseal marrow space. Methods: The slow growth of epiphyses and apophyses gives their spongiosas more time to adapt to their loads than the metaphyseal spongiosa beneath faster growing growth plates. Compared to metaphyseal trabeculae, this leads to fewer and thicker epiphyseal trabeculae that turn over more slowly and should persist for life because they carry loads for life. Results: Rapid turnover of metaphyseal cortex in very young subjects could let it strain enough to form woven bone. Increased thickness and slower turnover of this cortex in older subjects could reduce its strains enough to make lamellar bone form there instead. This would compose this cortex mostly of woven bone in the very young and of lamellar bone in adults. Conclusions: This model assigns particular importance to the stiffness and strains of tissues (as distinguished from their strength and stresses), to the relative rates of some processes, and to responses of the skeleton's biologic mechanisms to a tissue's typical largest mechanical strains (as distinguished from their stresses). © 1994 Wiley-Liss, Inc.     

手法整复幼儿肱骨远端全骨骺分离性骨折

幼儿肱骨远端全骨骺分离性骨折是肱骨髁上骨折的一种特殊类型,自2002年到2007年共收治幼儿肱骨远端全骨骺分离性骨折10例,取得满意的临床效果,现报告如下.     

青少年胫骨远端骨骺骨折的手术治疗

目的：探讨青少年胫骨远端骨骺骨折的手术治疗。方法：对2000年5月～2009年12月期间手术治疗35例青少年胫骨远端骨骺骨折病例进行分析。平均年龄13岁（8～15岁）,男性25例,女性10例。按骨骺损伤Salter-Harris分型：Ⅲ型25例,Ⅳ型10例。结果：术后平均随访3.8年（2～5年）。按Helfet踝关节功能评价：优28例,良7,差0例,优良率100%。术后创伤性关节炎3例,骨骺早闭3例,无骨折延期愈合、不愈合。结论：青少年胫骨远端Salter-HarrisⅡ、Ⅲ、Ⅳ型手术治疗效果良好,手术治疗并发症少。