两种入路方法治疗肱骨髁间骨折疗效观察

目的观察两种手术入路治疗肱骨髁间骨折的临床疗效。方法对我院自2002年6月—2006年6月期间收治的47例肱骨髁间骨折的患者随机分别采用肱三头肌舌状瓣切口入路(22例)、尺骨鹰嘴截骨入路(25例)术式进行治疗,比较两组术后患者功能恢复情况。结果术后依据标准评定,尺骨鹰嘴截骨手术入路组治疗优良率高于肱三头肌舌状瓣切口入路组,两组比较具有统计学差异(P<0.05)。结论与肱三头肌舌状瓣切口入路相比尺骨鹰嘴入路是最佳手术入路,能获得良好的疗效。     

尺骨冠突骨折24例临床分析

目的探讨尺骨冠突骨折的治疗方法。方法对我院2005年以来收治的24例随访资料完整的尺骨冠突骨折病人的临床治疗情况进行总结。结果对24例患者进行7—32个月随访,平均随访15个月,其中非手术治疗10例全部骨性愈合。内固定14例中12例骨f生愈合,2例因克氏针松动骨块移位导致延迟愈合。骨折愈合时间1．0—1．5个月,平均1-3个月。全部患者的肘关节功能情况：0° 125°14例,0° 110°6例,10° 130°4例。结论Ⅰ型骨折及无移位或轻度移位的稳定性Ⅱ、Ⅳ型骨折宜采用保守治疗,对Ⅲ型骨折及明显移位的不稳定性Ⅱ、Ⅳ型骨折宜采用切开复位内固定进行治疗。     

河北省骨科医院尺桡骨骨折的流行病学调查

目的 调查河北省骨科医院尺桡骨骨折病例的流行病学状况.方法 由8人组成的调查组入医院影像资料室和病案窜调集2005年1月1日至2007年6月30日全部尺桡骨骨折病例,设计调查表进行相关因素的登记,对尺桡骨骨折的流行特征及2年半来发生情况进行动态分析.结果 河北省骨科医院2005年1月1日至2007年6月30日共收治尺桡骨骨折病例6430例,其中男3885例,女2545例;左侧3327例,右侧3147例,其中包括双侧同时骨折者44例.少年儿童多见,骨折以跌倒扭伤为主;尺桡骨骨折患病率随年龄增长呈下降趋势,0～10岁儿童为发生尺桡骨骨折的高峰年龄;时间上来看,2年半间本院尺桡骨骨折患病率总体上保持平稳趋势(P>0.05),男性尺桡骨骨折患病率呈上升趋势,女性年均下降,但性别差异无统计学意义(P>0.05).尺桡骨骨折发生季节分布结果表明,冬季是尺桡骨骨折的高发季节.结论 河北省骨科医院尺桡骨骨折病例2年半来呈平稳趋势,预防的重点人群为青少年、儿童和老年人.     

手术治疗尺骨鹰嘴骨折的预后及影响因素分析

目的 探讨尺骨鹰嘴骨折手术治疗的预后并分析影响其临床疗效的因素. 方法 2004年1月至2008年1月共手术治疗尺骨鹰嘴骨折30例,其中应用克氏针加张力带固定19例,板钉系统固定11例,术中4例患者植骨;分析影响临床疗效的因素. 结果所有患者随访10～58个月,平均26.4个月.骨折均愈合,根据Broberg & Morrey功能评分评定:优19例,良10例,可1例,优良率96.7%(29/30).骨折分型、手术方式均对预后有明显影响,但无一是决定性因素.患者肘关节屈伸活动度和VAS疼痛评分分别与患者满意度及肘关节DASH评分有明显相关性. 结论手术治疗尺骨鹰嘴骨折的疗效与损伤程度、手术方式、术后康复等多方面相关,关键在于为每个患者选择适合的固定方法,有效的功能康复锻炼对预后至关重要.     

Pseudarthrosis presenting as a late complication of meningococcal septicaemia and disseminated intravascular coagulation

Late skeletal complications of meningococcal septicaemia and disseminated intravascular coagulation are well recognised in children and are largely centred on the growing epimetaphyseal region of long bones. In this article we describe a case of pseudarthrosis of the mid-ulna presenting 18 months following a devastating episode of meningococcal septicaemia in a 3-year-old boy. Radiographs and MRI demonstrated the ulna abnormality. We briefly review the late skeletal complications of the disease and other causes of pseudarthrosis.     

Surgical correction of deformities of the distal radius due to fractures in pediatric patients

Introduction The indication and treatment of malunited fractures of the distal radius in the growing skeleton differ from those for adults. The literature results are scarce. In this study we examined the results of surgical correction following fractures of the distal radius in infants.Materials and methods Seven infant patients with malaligned fractures of the distal radius that demonstrated significant functional deficit and poor prognosis for spontanous recovery were treated with surgical correction. Two of them were treated because of growth disturbance from post-traumatic closure of the distal radial physis.Results All seven osteotomies healed with acceptable radiologic alignment. After an average follow-up period of 3 years and 1 month (range 10 months to 8 years and 4 months), patients had an average range of wrist motion (ROM) of 131 deg in extension and flexion (93% of the contralateral side, 130% of presurgical situation); 65 deg in ulnar and radial deviation (94% of the contralateral side, 122% of presurgical situation); and 177 deg in pronation and supination of the forearm (97% of the contralateral side, 115% of presurgical situation). The average grip strength of 71.4 kPa was nearly equal to the other side with 72.8 kPa. The average postoperative angulation of the distal radius was 12 (range 10–17) deg, the radial inclination 20 (range 12–30) deg, and the ulnar variance was –0.6 (range –3 to +2) mm. According to the Fernandez point score system as well as the scale of Fernandez, there were five excellent results and two good results. The patients described low disability on the DASH scores, with a median of 4 (range 0–41) points.Conclusions Surgical correction for malunited fractures of the distal radius provides good and excellent radiological and functional results in the growing skeleton. It should be considered immediately if there is poor remodeling capacity and disabling loss of function.     

桡尺骨滋养孔和滋养动脉的研究

对234侧挠骨、235侧尺骨滋养孔及56侧滋养动脉进行了观察,绝大多数为单孔,缺少滋养孔者仅占:挠骨为1. 71±0. 85%,尺骨为0. 43±0. 42%。较有规律性的是滋养动脉“向肘而来”极为恒定。由孔至骨髓腔毫无例外的都要斜穿一段变异较大的8～33mm 的骨管。滋养动脉在骨管中虽能得到较好的保护,但骨折时也易受到损伤,并可能是延缓骨折愈合的因素之一。     

人湿尺骨对冲击载荷的响应

本文采用分离式Ｈｏｐｋｉｎｓｏｎ压杆（ＳＨＰＢ）技术对人湿润尺骨密质骨进行了应变率在ε＝１．２×１０３Ｓ－１条件下的冲击压缩试验，得到了不同纵向位置尺骨的极限强度、极限应变和压缩模量。实验结果表明，尺骨密质骨的力学响应随其纵向位置变化，呈现中间强两端弱的分布规律，最强的位置约在距近端１／３处，且近端强于远端；与静态结果的比较表明，尺骨密质骨对应变率有较大的依赖性。     

新型外固定在鹰嘴骨折治疗中的应用

Objective　To introduce a new device of external fixator for olecranon fracture,and evaluate its clinical treatment outcome.Methods　After close reduction under the supervision of the image intensifier,15 cases of olecranon fracture have been treated by the external fixator of self-design.The patients were followed for 6 to 8 weeks postoperatively.Results　Clinical observation and follow-up revealed that all these fractures healed up well with full recovery of elbow joint function.The average period for bony union was 7 weeks,ranging from 6 to 8 weeks.Normal range of motion of the elbow joint was regained,without any complications.Conclusions　This kind of external fixator used for olecranon fractures showed the advantages of minimal invasiveness,simple manipulation, reliable fixation,early post-operative joint movement,and no need for implant removal procedures.The author believes it is worth introduction and using clinically.     

应用尺桡骨交锁髓内钉治疗前臂粉碎性骨折

目的 探讨应用交锁髓内钉治疗前臂尺桡骨粉碎性骨折的可行性与疗效.方法 应用Smith-Nephew公司生产的尺桡骨交锁髓内钉治疗前臂粉碎性骨折29例.结果 术后随访6～36个月,骨折愈合时间8～14周,平均11.2周.术后1例骨折延迟愈合,1例锁钉钉道感染,取钉后愈合,所有患者均未发生骨不连.按Anderson评分标准评定:优18例,良9例,可2例.术后肘关节伸屈活动功能丧失0°～20°,平均10.2°,前臂旋前功能丧失5°～15°,平均9.9°,前臂旋后功能丧失5°～15°,平均11.2°.结论 应用交锁髓内钉固定方法是治疗尺桡骨骨折的较好方法.