后路半椎体切除矫治半椎体所致脊柱侧后凸畸形

[目的]评价后路半椎体切除术治疗半椎体所致脊柱侧后凸畸形的临床效果。[方法]2000年5月~2005年11月,采用后路半椎体切除及矫形固定融合术治疗14例完全分节半椎体所致脊柱侧后凸畸形患者。年龄2.5~14.4岁,平均7.4岁,半椎体均为侧后方半椎体,其中胸椎7例,腰椎7例。[结果]手术时间2~7 h,平均4.7h,术中出血量150~2 500 m l,平均560 m。l固定节段2~8个椎体,平均3.5。术后随访6~36个月。平均15.6个月。术后站立位脊柱正侧位X线片示冠状面Cobb's角由术前46.2°矫正到17.3°,平均矫正率62.6%,矢状面Cobb's角由术前48.3°矫正至术后16.2°,平均矫正率68.7%。终末随访时冠状面Cobb's角平均21.7°,丢失4.4°,矢状面Cobb's角平均18.7°,丢失2.5°。围手术期并发症包括:伤口愈合不良2例,术中术后椎弓根螺钉切割椎体2例。[结论]后路半椎体切除可直接去除致畸因素,在冠状面及矢状面均获得良好的矫形效果,与前后路手术相比可缩短手术时间,减少创伤,适用于从胸段到腰段的半椎体畸形。     

高龄老年股骨转子间骨折的手术治疗

2000年1月~2005年1月,我科在C臂X线机下行闭合复位、有限小切口切开、短臂螺钉内固定治疗高龄老年股骨转子间骨折94例,取得了较好疗效。1材料与方法1.1病例资料本组94例,男42例,女52例,年龄80~97岁(80~89岁84例,90岁以上10例)。骨折按Evans分型:Ⅰ型26例,Ⅱ型31例,Ⅲ型29例,Ⅳ型8例。所有患者均存在不同程度骨质疏松和退行性骨关节病,其中79例有并存症,2种以上并存症者47例,个别病例最多并存症达5种。各种并存症中高血压41例,呼吸系统疾病21例,脑血管疾病15例,冠心病21例,糖尿病14例,泌尿系疾病11例,消化系统疾病9例,五官科疾病12例,肿瘤2…     

单钉-棒固定在胸腰椎结核前路手术中的应用

目的探讨脊柱结核手术内固定的有效方式。方法2002年6月~2004年6月,在手术前有效抗结核化疗的基础上,采用前路病灶清除、植骨融合及单钉-棒内固定的手术方式治疗胸、腰椎结核患者54例。术中在保证彻底清创的基础上注意保留病椎有血供的部分和无明显破坏的椎间盘,以减少切除范围和融合的节段,有神经症状者注意行椎管前侧减压。骨缺损采用自体髂骨、异体髂骨 自体碎骨、或钛网 自体碎骨的方法修复,安置单钉-棒时注意对移植骨块适当加压。患者术后卧床10d左右,然后在支具的保护下下床活动。本组共有41例患者获得随访,手术后随访的时间7~31个月,平均18个月。结果患者所有的结核病灶均顺利愈合,植骨稳定,无明显移位和塌陷,内固定器无松脱和折断,其中37例达到骨性愈合标准;脊柱后凸角平均矫正达23°,患者术前伴有的神经症状也大部分消失,绝大部分患者恢复日常生活、工作。结论前路单钉-棒内固定不仅能够维持胸、腰椎结核手术后脊柱的稳定,防止移植骨块的脱位、塌陷和骨不愈合的发生,而且可以最大范围地减少融合节段,减少术中创伤,故是手术治疗胸、腰椎结核的可靠固定方式。     

小儿内伤头痛辨治

74例小儿慢性头痛经辨证治疗,显效80.95%,好转16.67%,无效2.38%。痰浊头痛二陈汤或半夏白术天麻汤加减;肾虚头痛,杞菊地黄汤加减;淤血头痛,补阳还五汤;气血虚头痛八珍汤加减。指出了小儿内伤头痛的病因病机,并指出脑电图,脑阻抗血流图、CT、甲皱微循环可做为此病的诊断及疗效指标。     

肱骨近端移位骨折的手术治疗

目的：总结肱骨近端移位骨折的手术治疗方法和疗效。方法：分析手术治疗肱骨近端骨折28例资料。患者平均年龄24．4岁，平均随访2年6个月；手术均采用三角肌胸大肌间隙入路，钢板固定15例，交叉克氏针固定11例，单纯螺丝钉固定15例；采用Neer分类及评分方法评价手术结果。结果：两部分外科颈骨折优良率为64．7％，无头坏死及不愈合，三部分骨折和四部分骨折切开复位的满意率较低。结论：两部分骨折和三部分骨折可采用切开复位内固定，但尽量避免使用钢板；对四部分骨折，内固定满意率较低且肱骨头坏死率较高。     

锁骨钩钢板内固定配合康复治疗锁骨远端骨折

目的探讨和分析应用锁骨钩钢板内固定配合康复治疗锁骨远端骨折的新方法。方法42例应用锁骨钩钢板配合术后早期康复治疗锁骨远端骨折的患者全部得到了随访,随访时间2～46个月(平均15.6个月),患者年龄36～57岁,平均45.6岁。术后2d患肩按照制定的康复训练方法进行功能训练,最终随访按Lazzcano评价标准〔1〕评价治疗结果。结果42例患者术后X线检查均达到满意复位与固定,局部Lazzcano功能评定关节功能恢复优良率97.6%。结论应用锁骨钩钢板治疗锁骨远端骨折手术操作简单,配合术后完善的康复治疗,可得到非常满意的结果。     

关节镜监视下治疗胫骨平台骨折

2004—2006年，我院采用关节镜监视和定位治疗胫骨平台骨折，获得了良好的效果。     

跟骨骨折治疗方法的疗效观察

目的比较跟骨骨折不同治疗方法的效果。方法88例96足跟骨骨折分成三组,分别应用撬拨复位石膏外固定、切开复位钢板内固定、可调节跟骨骨折外固定器治疗,术后从Bhler角的恢复、主观症状、并发症三个方面进行比较分析。结果可调节跟骨骨折外固定组在恢复Bhler角、术后主观症状改善、减少并发症方面优于撬拨复位石膏外固定组及切开复位内固定组。结论可调式跟骨骨折外固定器治疗跟骨骨折疗效优于撬拨组和内固定组。     

经肘外侧入路治疗Gartland Ⅲ型肱骨髁上骨折

1995年1月～2006年6月，我院采用肘外侧纵形切口、交叉克氏针内固定治疗Gartlandm型肱骨髁上骨折96例，取得较好效果。     

Early results of immediate repair of obstetric third-degree tears: 65% are completely asymptomatic despite persistent sphincter defects in 61%

OBJECTIVE: The outcome of immediate repair of obstetric third-degree tears is poorly documented. Immediate repair may give better functional results than delayed repair because scarring is reduced. This aim of this prospective study was to examine the early outcome of immediate repair of third-degree tears. METHOD: A total of 121 women who had immediate repair of obstetric third-degree tears underwent interview, anal ultrasonography and anorectal physiology. RESULTS: At review, 79 (65%) were completely asymptomatic (score = 0), 23 (19%), had minor flatus incontinence or mild urgency causing no compromise to their quality of life (score 1-4), and 19 (16%) had clinically embarrassing faecal incontinence (score 5-24). Thirty-nine (32%) had an intact internal anal sphincter (IAS) and external anal sphincter (EAS) (i.e. a successful repair), eight (7%) had a defect in the IAS alone but the EAS was intact (i.e. a successful repair but a residual IAS defect), 43 (35%) had a residual defect in the EAS alone (IAS intact) and 31 (26%) had a persistent defect in the IAS and EAS. Residual defects in either or both of the sphincters were associated with a significantly higher incidence of abnormal resting and squeeze anal pressures. Anal manometry had no correlation with symptoms. The highest proportion of severe incontinence was in those with an IAS defect alone (37%) and when there was a residual IAS and EAS defect (24%). Only 2 of 39 (5%) with an intact IAS and EAS had severe incontinence and only 8 of 43 (18%) with a residual EAS defect alone had severe faecal incontinence. CONCLUSION: These results indicate a good outcome following immediate repair of third-degree obstetric tears and emphasize the role of the IAS in providing continence.