胸锁关节的CT研究

目的 了解正常胸锁关节、锁骨胸骨端和胸骨柄在CT图像上的径线长度,确定由内固定物向胸骨柄钻孔的安全角度和长度.方法 对50名健康志愿者的胸锁关节进行CT扫描成像,成像角度包括矢状面、冠状面和横断面.测量锁骨近端的高度与前后径、锁切迹的长度与前后径、锁切迹与胸骨的成角、胸骨柄与身体长轴的成角、胸骨柄的厚度、胸锁关节间隙大小以及锁骨间距.并确定由内固定物向胸骨柄钻孔的安全角度和长度结果左、右侧的各项测量指标比较,差异均无统计学意义(P＞0.05).冠状面上胸骨柄锁切迹的长度和锁骨内侧端的长度接近,差异均无统计学意义(P＞0.05).横断面上锁切迹的前后径比锁骨内侧端的前后径短,差异有统计学意义(P＜0.05).胸骨后方重要组织中,头臂干、左右头臂静脉贴近胸骨柄的后缘,术中应以安全角度(α＞46°β＜-49°)进钻,或将进钻深度控制在安全深度(2.38±0.61)cm以内.结论 本研究明确了 CT图像上正常胸锁关节的特征,并定量描述了胸骨柄与其后方重要组织的伴行关系,对胸锁关节脱位的诊断与治疗提供了参考.

Abstract：

Objective To investigate anatomical features of the sternoclavicular joint on computed tomography (CT) scans to determine the safe angle and length of drilling into the manubrium sterni for implants. Methods CT scans were taken in 50 healthy human volunteers.Reconstructive images on coronal,sagittal and transverse planes of the sternoclavicular region,from the superior border of the clavicle to the sternal angle,were obtained.Measurements were conducted on the images to determine the height and the anteroposterior dimension of the proximal end of the clavicle,the length and the anteroposterior dimension of the clavicular notch,the angle between the clavicular notch and the sternum,the angle between the manubrium sterni and the trunk,thickness of the manubrium sterni and the distance between the bilateral clavicles.The safe angle and length of drilling into the manubrium sterni for implants were determined.Results There were no significant differences between the above left and right measurements (P＞ 0.05).There were no significant differences in length between the clavicular notch and the internal extremity of clavicle on the coronal image (P＞0.05).The anternposterior dimension of the clavicular notch was significantly shorter than that of the internal extremity of clavicle on the cross section ( P ＜ 0.05 ).Of the tissues behind the sternum,the anonyma and the bilateral innominate veins were the nearest to the manubrium sterni.The safe angle and length of drilling into the manubrium sterni for implants were α ＞ 46° or β ＜-49° and 2.38 ± 0.61 cm respectively. Conclusion This investigation provides specific and quantitative CT data of the sternoclavicular joint which may help clitical diagnosis and treatment of the sternoclavicular dislocation.     

经皮空心螺钉微创逆向进针治疗肩锁关节脱位

2009年4月笔者应用自肩峰向锁骨远端逆向进针的方法固定肩锁关节脱位5例,效果良好,现报告如下.     

The Imageological Measurement of Sternoclavicular Joint and Its Clinical Application

Objective: The paper aims to investigate its imageological anatomical features, and design a new style plate for facilitating therapy of SCJ dislocation according to these data. Methods: Fifty-three healthy Chinese volunteers examined with chest computed tomography (CT) in our hospital were included into the study. Volunteers with SCJ deformity or injury were excluded from the study. The coronal, sagittal and axial images of the sternoclavicular region from the superior border of the clavicle to sternal angle were reconstructed. The diameter of the sternal head in inferolateral to superomedial direction(DOSH), the length of clavicular notch and the angle between clavicular notch and sternum were measured on the coronal images. The angle between presternum and trunk were measured on the sagittal images. The following issues were measured in the axial images, including ⑴ the anteroposterior dimensions of sternal head, clavicular notch and presternum; ⑵ the SCJ wide; ⑶ the distance between bilateral clavicles; and ⑷ the minimal distance from presternum to the underlying structures in the thoracic cavity. New plate was designed according to the data measured in the study to treat SCJ dislocation or subluxation. Six dislocated joints were repaired by the new designed plate . All these cases were available for a mean duration of follow-up of 10 months (range, 9-12months). Result: The proximal clavicle is higher than the presternum in a horizontal position. On the axial images, the anteroposterior dimension of the sternal head was longer than the presternum, and the center region of the presternum was thinner than the edges. The left SCJ space was 0.82±0.21cm, and the right was 0.87±0.22cm. Among the structures going behind the sternum in the thoracic cavity, the left bilateral innominate vein ran nearest to the presternum. The distance from the anterior cortex of sterna to left bilateral innominate vein was 2.38±0.61cm. A new-style plate was designed according to our measurement. Anatomical reduction of the dislocated joint and safe insertion of screws into the presternum was achieved in the management of SCJ dislocation with the use of the new plate. All cases have got satisfactory clinical effect by follow-up office visit. Conclusions: Normal parameters of the SCJ were measured on the CT images. The measurement can facilitate the treatment of SCJ dislocation or subluxation. The new designed plate can be used to treat SCJ dislocation effectively and safely.     

展筋活血散治疗足踝部急性软组织损伤临床分析

目的：探讨展筋活血散对足踝部急性损伤治疗作用。方法：选取2016年6月至2017年2月来我院足踝外科门诊及病房就诊的60例足踝部急性损伤患者，随机分为治疗组和对照组，每组30人。治疗组患者使用展筋活血散治疗，对照组患者使用布洛芬缓释胶囊治疗。2周后，观察两组患者的临床疗效，治疗前后的疼痛评分、肿胀评分、压痛评分和功能障碍评分，以及肿胀消退影像学指标T2。结果：治疗2周后，治疗组的临床总有效率达到90.0%，而对照组的总有效率仅为53.3%，两组差异有统计学意义（P<0.05）；治疗后，两组的疼痛评分、肿胀评分、压痛评分和功能障碍评分均显著降低（P<0.05），但两组间比较，除肿胀评分和压痛评分外，差异均无统计学意义（P>0.05）。两组治疗前后磁共振成像（Magnetic Resonance Imaging， MRI）检查T2值比较，差异均有统计学意义（P<0.05），且治疗组变化幅度更大，两组间比较差异有统计学意义（P<0.05）。结论：展筋活血散能显著改善足踝部急性软组织损伤的临床症状，且对肿胀消退影像学指标也有显著改善，可在临床推广。     

不同角度植骨和空心钉固定股骨颈骨折的生物力学研究

目的：探讨游离髂骨块不同角度植骨、空心钉固定股骨颈骨折的生物力学效果,为临床应用提供生物力学依据。方法选用9对成人防腐股骨标本,随机分入0°角植骨组和30°角植骨组。所有标本均制成股骨颈骨折模型,解剖复位后采用3枚空心钉及髂骨块固定,空心钉呈正等腰三角型分布,髂骨块越过骨折线约1 e．5 cm,其中0°角植骨组髂骨块位于三枚空心钉中间,并与其平行,30°角植骨组髂骨块与空心钉成30°角。2组标本均应用Electro-force 3520-AT生物力学实验机进行抗扭转、抗压、循环载荷及极限载荷实验。结果抗扭转实验中使股骨头扭转3°和5°时,30°角植骨组扭矩值均大于0°角植骨组（ P均＜0．05）;抗压实验中在700 N和1000 N的垂直载荷下,30°角植骨组位移值均小于0°角植骨组（ P均＜0．05）;所有标本均成功完成了循环实验,无疲劳骨折、内固定失败出现。30°角植骨组能够承受的极限载荷比0°角植骨组大11．7％（ P ＜0．05）。结论采用3枚空心钉固定股骨颈骨折时,30°角植骨的生物力学稳定性优于0°角植骨,本实验结果为临床上治疗股骨颈骨折采用最佳的植骨方式提供了生物力学依据。     

肩锁关节脱位的手术治疗进展

肩锁关节损伤是肩部常见损伤,主要包括肩锁关节脱位和锁骨远端骨折,9％ ～ 10％的肩胛带损伤累及肩锁关节.肩锁关节脱位在肩部损伤中发病率较高,约占肩部损伤的12％ [1-2],其治疗方法仍存在争议,以非手术治疗为主.近年来,随着对肩关节损伤机制的研究深入,对于移位较大的肩锁关节损伤患者,大多学者更倾向于手术治疗.本文就目前国内外有关肩锁关节脱位的手术治疗进展作一综述. 一、肩锁关节的解剖特点 肩锁关节是由锁骨远端和肩峰构成的滑膜关节,可活动,中间有关节盘.由关节囊、肩锁韧带、喙锁韧带等维持关节的稳定性.肩锁韧带是限制锁骨和肩峰前、后移位的首要结构,喙锁韧带是限制锁骨垂直移位的重要结构[3].相关研究[4]表明,稳定肩锁关节的主要结构为喙锁韧带.肩锁关节在功能上属微动关节,参与肩关节的联合运动,主要有上下、前后、旋转3种基本运动形式.上肢上举时锁骨会出现40°～50°的旋转,但由于锁骨上旋和肩胛骨下旋同时发生,因此,正常的肩锁关节只有5 °～8°的活动度[5].     

不均匀沉降理论在踝关节骨性关节炎中的应用

Based on the non-uniform settlement theory of professor Yingze Zhang,the tibia,as a load-bearing bone,takes place apparent settlement due to osteoporosis in the human aging process,which does not occur...     

桡骨小头置换术与切开复位内固定术治疗改良MasonⅢ型与Ⅳ型桡骨头骨折效果比较的Meta分析

目的 比较桡骨小头置换术(PR)和切开复位内固定术(ORIF)治疗改良MasonⅢ型和Ⅳ型桡骨头骨折的效果与安全性.方法 检索2003年4月—2021年9月在PubMed、中国知网、万方数据库、Cochrane Library等中英文数据库中公开发表的PR和ORIF治疗改良MasonⅢ型和Ⅳ型桡骨头骨折研究的文献.通过RevMan 5.4软件对文献依据Cochrane系统评价方法学进行Meta分析.结果 最终9篇文献被纳入Meta分析,包括216例PR患者(PR组),179例ORIF患者(ORIF组).Meta分析结果显示,PR组患者的肘关节功能评分显著高于ORIF组(SMD=-13.27,95％CI=-17.60～-8.94,Z=6.01,P<0.05).两组患者术后肘关节功能优良率无明显差异(RR=0.84,95％CI=0.66～1.07,Z=1.42,P>0.05).PR组患者的术后并发症总体发生率显著低于ORIF组患者(RR=2.27,95％CI=0.26～0.74,Z=3.08,P<0.05),ORIF组患者骨折不愈合的发生率明显增高(RR=6.14,95％CI=2.23～16.92,P<0.05),内固定失败的发生率明显增高(RR=2.51,95％CI=1.24～5.06,P<0.05).结论 在改良MasonⅢ型和Ⅳ型桡骨头骨折的治疗中,PR比ORIF术后效果好,并发症发生率低,但仍需要中长期的随访研究进一步验证.     

侧方入针股骨头干三维互动技术治疗成人难复位性股骨颈骨折

目的 探讨侧方入针股骨头干三维互动闭合复位技术治疗成人难复位性股骨颈骨折的疗效. 方法 2009年1月至2010年12月共收治10例成年难复位性股骨颈骨折患者,男6例,女4例;年龄22 ～ 60岁,平均40.5岁;骨折Garden分型均为Ⅳ型.所有患者均采用侧方入针股骨头干三维互动闭合复位技术3枚空心加压螺钉内固定术治疗.记录患者的手术时间、术中出血量和复位质量,末次随访时根据髋关节Harris评分标准评定疗效. 结果 本组患者平均手术时间为51 min(30～65 min),平均术中出血量为37 mL(20～ 50 mL).10例患者术后获平均3.0年(1.5 ～4.2年)随访.9例患者骨折复位质量达Garden指数Ⅰ级,1例达Garden指数Ⅱ级.所有患者骨折均获骨性愈合,愈合时间为15 ～21周,平均18.1周.1例患者于术后2年发生股骨头坏死,采用全髋关节置换术治疗.末次随访时根据髋关节Harris评分标准评定疗效:优8例,良1例,可1例. 结论 侧方入针股骨头干三维互动闭合复位技术治疗成人难复位性股骨颈骨折具有创伤小、操作简单、容易掌握及复位效果理想等优点,尤其适用于较肥胖、不易触及股动脉搏动的患者.