髂骨植骨尺骨延长治疗多发性骨软骨瘤前臂畸形的疗效评价

目的：探讨髂骨植骨尺骨延长治疗遗传性多发性骨软骨瘤所致前臂畸形的疗效。方法：保留尺骨远端骨骺部分，使尺骨一次性延长1．5～4cm，根据临床分型辅加环状韧带重建术和桡骨截骨术以矫正前臂弯曲畸形。结果：除1臂外，全部随访病例前臂畸形均获明显改善，肘腕关节活动与正常侧比较无明显差异。X线片示尺骨发育与桡骨近于匹配。结论：保留尺骨远端骨骺，行尺骨远端骨软骨瘤切除，同时髂骨植骨，一次性延长尺骨治疗遗传性多发性骨软骨瘤所致的前臂弯曲短缩畸形、下尺桡关节脱位及尺偏手效果良好，可使患儿获得近于正常的发育，提高生活质量。     

电生理检查在肘段尺神经前置术中的作用

１９９１年３用～１９９１年１２月，对１５侧肘管综合证术中尺神经松解前直接刺激神经所测得的肘上５ｃｍ→肘下５ｃｍ段的神经传导速度、潜伏期和波幅与术前在皮肤外用表面电极所测得结果相似，无显著差异（Ｐ＞０．５），因此结果同样可靠。当尺神经从肘管松解出来后，传导速度提高５０％，潜伏期缩短４０％，其中尤以传导速度的改善有显著意义（Ｐ＜０．０２）．说明传导速度是较敏感的检测参数。肘管综合征松解术中应用电生理检查有一定的监测作用。     

尺骨鹰嘴横形开放骨折合并尺神经断伤的手术疗效分析

目的 探讨尺骨鹰嘴横形开放骨折合并尺神经断伤手术治疗的临床疗效.方法 回顾性分析2003年8月-2007年6月收治的21例尺骨鹰嘴横形开放骨折合并尺神经断伤的患者,采用AO空心钉和钢丝张力带固定尺骨鹰嘴骨折,修复和皮下前置尺神经,支具保护下早期功能锻炼.结果 术后18例获得12～19个月的随访,平均13个月;3例失访.肘关节功能按Broherg-Morrey评分标准评估:优14例,良3例,可0例.差1例;优良率为94.0%.尺神经疗效评定根据英国医学研究会颁布的感觉(S)、运动(M)分级标准评定疗效:优M4S3,6例,良M3S310例,可M2S21例,差M1S1以下1例;优良率为88.9%.结论 尺骨鹰嘴横形开放骨折合并尺神经断伤,采用可靠的内固定和尺神经前置修复方法,结合早期功能锻炼,可明显提高术后的疗效.     

Abnormal geometry of the distal radioulnar joint: MR findings

Previously developed criteria of normal distal radioulnar joint (DRUJ) axial geometry were applied to routine magnetic resonance (MR) images of 50 wrists. All wrists lacked clinically evident DRUJ instability. An attempt to apply the three geometric criteria to seven of the cases was not possible, since the prescribed landmarks were not visible. The remaining 43 cases were retrospectively divided into a symptomatic group (25 wrists), with clinical abnormalities referable to the ulnar side of the wrist, and an asymptomatic group (18 wrists), with no such abnormalities. Abnormal DRUJ geometry was found in 12 symptomatic and 2 asymptomatic wrists. This difference between the groups is significant (p=0.02), suggesting that many symptomatic wrists exhibit different DRUJ geometry than is found in most asymptomatic wrists.     

尺动脉逆行岛状皮瓣及其在手部软组织缺损修复中的应用

作者应用自己设计的尺动脉逆行岛状皮瓣治疗手部裸露深部结构的软组织缺损22例,21例皮瓣全部成活,治疗结果满意。此种皮瓣能一次完成手部大面积组织缺损的修复与手指再造。前臂尺侧皮下脂肪少,部位较隐蔽,皮肤移动性好,供皮面积大,皮瓣不雍肿,对外观和功能影响小。本组皮瓣最大者130平方厘米,平均65平方厘米。血管蒂最大旋转角度为180°,平均为166°。用尺动脉逆行岛状皮瓣修复手部须作皮瓣移植的组织缺损,手术操作简单,病人痛苦小,不需特殊设备,既实用也易于推广。     

Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel

PURPOSE: Ulnar neuropathy at the cubital tunnel (UCT) is diagnosed on the basis of history, physical examination, and nerve conduction studies (NCSs); however, the wide spectrum of findings often makes the diagnosis difficult. The purpose of this study was to document the ultrasonographic differences in ulnar nerve size between patients with UCT and control subjects, and to correlate those differences with clinical examination findings and NCS abnormalities, thereby testing the validity of ultrasound (US) as an additional adjunct diagnostic modality for UCT. METHODS: Fifteen elbows in 14 patients with symptoms, clinical examination, and NCS findings consistent with UCT had US of the ulnar nerve. Patients were excluded if they had a history of polyneuropathy, acute trauma involving the upper extremity, previous trauma in the region of the elbow (including previous surgery), or brachial plexus injury. The control group consisted of 60 elbows from 30 normal volunteers that also had US. Maximal cross-sectional areas (CSAs) were measured and compared for the 2 groups and a correlation analysis was performed between nerve size and NCS findings. RESULTS: The average CSA of the ulnar nerve was 0.065 cm(2) in the control group, whereas in the UCT group it was 0.19 cm(2), indicating a significant statistical difference in ulnar nerve size between the 2 groups. The Pearson correlation coefficient between motor nerve conduction velocity of the ulnar nerve and the CSA was 0.80. CONCLUSIONS: High-resolution US is a noninvasive, safe, and reliable modality for imaging the ulnar nerve at the elbow and it may provide a valuable adjunct to NCS in the diagnosis of UCT.     

Ulnar growth patterns in radial longitudinal deficiency

PURPOSE: To determine the association between centralization surgical procedures and the longitudinal growth of the ulna in radial longitudinal deficiency (RLD). METHODS: The charts of 90 patients with 124 affected limbs were reviewed. Thirty-four patients were affected bilaterally and 56 were affected unilaterally. Based on the Bayne and Klug classification there were 5 type I, 3 type II, 9 type III, and 107 type IV deformities. Seventy-two limbs had available radiographs, which were measured for ulnar length. We plotted 384 ulnar length measurements in 72 limbs and compared these with both normative ulnar length data and ulnar length data in RLD. The average ulnar length was compared for the group (n = 46) treated with surgical centralization versus the nonsurgically treated group (n = 22). RESULTS: The nonsurgically treated group attained 64% of normal ulnar length whereas the nonnotched centralization group attained 58% of normal ulnar length. The notched centralization group attained 48% of normal ulnar length. Ulnar growth for the surgically treated group averaged 0.54 cm/y and the for the nonsurgically treated group averaged 0.71 cm/y, which showed no statistical significance. CONCLUSIONS: Wrist centralization procedures effectively increase the overall length of the limb by centralizing the hand and carpus over the shortened ulna; this must be weighed against the high rate of recurrent radial deviation deformity and some loss of ulnar growth.     

Coronoid fracture height in terrible-triad injuries

PURPOSE: The coronoid fractures that occur in the terrible-triad pattern of traumatic elbow instability (posterior dislocation with fractures of the radial head and coronoid) usually are small transverse fragments. Attempts to classify these fragments according to height as suggested by Regan and Morrey have been inconsistent and contentious. The purpose of this study was to quantify coronoid fracture height in terrible-triad injuries. METHODS: The height of the coronoid process of the ulna and the coronoid fracture fragment were measured on computed tomography scans of 13 patients with terrible-triad-pattern elbow injuries. Two observers performed the measurements with excellent intraobserver and interobserver reliability. RESULTS: The total height of the coronoid process of the ulna averaged 19 mm. The average height of the coronoid fracture fragment was 7 mm. This corresponds to an average of 35% of the total height of the coronoid process. CONCLUSIONS: The transverse coronoid fractures associated with terrible-triad elbow injuries have a variable height that may not be easy to classify according to the system of Regan and Morrey. Classification of coronoid fractures according to fracture morphology and injury pattern may be preferable.     

Radiology of postnatal skeletal development

Thirty-one pairs of distal radioulnar units were obtained from human cadavers ranging in age from full-term neonates to fourteen years. These were studied morphologically and radiographically. Specimen roentgenography using air/cartilage interfacing demonstrated the osseous and cartilaginous portions of the epiphyses. These roentgenographic aspects of development are discussed and illustrated to provide a reference index.The radial and ulnar physeal/metaphyseal contours initially are transverse. Progressively the distal radius develops a proximally directed curve adjacent to the radioulnar joint. Both physes subsequently develop a convex contour with mild undulations, and a central concavity associated with the secondary ossification center. Longitudinal ossification striations were observed crossing the distal ulnar physis. These appear to be normal.At no time during postnatal development did the distal ulna ever articulate directly with the carpus. It was always separated by a segment of triangular fibrocartilage connecting the ulnar styloid to the distal radial epiphysis. This was never perforated. this discoid cartilaginous structure is the anatomic cause of the concomitancy of ulnar styloid fractures with distal radial epiphyseal injuries, an injury pattern which may occur prior to ossification in the ulnar styloid, and which may lead to non-union of the styloid when ossification eventually occurs. In none of the specimens was an accessory ossification center present in either the radial or ulnar styloid process.