骨巨细胞瘤治疗方法的选择

Eighty-two patients with giant-cell tumor of the bone were operated with 4 different methods depending on the site of tumor, extent of local invasion and degree of malignancy. Curettage plus filling operation was performed for Grade I tumors and localized lesions. Resection of the tumor segment and replacement of the joint with allograft or artificial joint were done for Grade II tumors involving the joint but with clear borders. The indications of amputation were Grade III tumors, frequent recurrence and malignant change. Local curettage plus radiotherapy was undertaken in tumors that could hardly be completely curetted, such as tumors in the sacrum and spine. The results showed that the first method gave a high recurrence rate; the second method was the best; the third was worse due to conservativeness of amputation; the fourth method had the poorest prognosis owing to incomplete removal of the tumor.     

Relationship of Hyperbaric Oxygen Therapy of Acute Compartment Syndrome with Changes of Plasma Fibronectin Concentration

This report describes for the first time the effects of hyperbaric oxygen therapy with 253kPa on patients(n=24) with post - trauma acute compartment syndrome, and the relationship be-tween the prognosis of the syndrome and the changes of plasma fibronectin. Plasma fibronectin wasmeasured using single radial immunodiffusion both before and after therapy with hyperbaric oxygen,with 30 healthy people as control for plasma fibronectin. The results showed that the clinical symp-toms and signs of all 16 patients with acute compartment syndromes in early stage were significantlyimproved after 3 times of hyperbaric oxygen therapy and disappeared after 5 times withoutfasciotomy. Six patients who were treated with hyperbaric oxygen after fasciotomy showed reductionin the infection, and, edema of the injured limb However, the effects were less favorable for 2 pa-tients with necrosis although their clinical symptoms and signs were partially improved. Besides,we found that these patients' plasma fibronectin concentrations were significantly afterhyperbaric oxygen therapy. The mean increase was 43 (18. 9％; P<0. 01), 61( 24. 7%, P<0. 01),49 (17. 2%, P<0. 01), 57 (17. 4%; P<0. 05) and 55 mg/L ( 16. 6%; P<0. 05) after 1, 2, 3, 4and 5 times of therapy, respectively. Plasma fibronectin concentrations returned to the level of thecontrols after 3 times of therapy (P>0. 05). After fourth and fifth therapy plasma fibronectin lev-els of the patients rose higher than those of the controls (P<0.05). The results suggest that hyperbaric oxygen therapy has a beneficial effect on patients withacute compartment syndrome in the early stage Hyperbaric oxygen therapy can reduce edema andskeletal muscle necrosis The method can be used to treat patients with acute compartmentsyndrome in early stage and as an effective adjunctive treatment after fasciotomy.     

非典型腰椎间盘突出症

腰椎间盘突出症比较常见,典型病例诊断并不困难,但对于非典型病例,如中央型、极外侧型及合并有腰椎管狭窄症者,由于突出物与神经根的关系不同,所产生的临床症状多种多样,不少病人不是以腰腿痛来     

骨盆截骨对先天性髋脱位的治疗

3岁以内的先天性髋脱位,手法复位不易成功,强力复位极易发生股骨头坏死、关节僵直等合并症。目前渐趋一致的意见是以手术治疗为主。我科自1979年1月～1984年3月,对3岁以上的患者,分别选用骨盆外旋截骨(Salter)及骨盆内移截骨(Chiari)手术治疗32例40个关节,现报告我院选用这两种截骨术的体会。     

AAA骨移植的实验研究

AAA骨是通过抗原浸出与自行消化、表面脱钙与冻干处理的一种新型库存异体骨。以在除去异体骨的抗原成份的同时,保持骨基质中骨形态发生蛋白(BMP)的骨诱导能力。能否达到这一目的,作者以AAA骨、新鲜自体与异体骨进行动物移植对照实验,结果如下:     

弓形记忆加压接骨器的研制与治疗上肢管状骨骨折和骨不连（附57例报告）

本文报告了弓形记忆加压接骨器的研制和５７例临床应用结果。该器具有２个纵轴加压枝，２～８个半环固定枝。其超弹、记忆效应作用于上肢管状骨时，可为骨断端提供一种轴向的、动态的和持续的加压力（２４～５６ｋｇ）直至骨愈合。临床应用骨折３１例，骨不连２６例，术后弃用外固定，早期活动。随访４～３２个月，平均１３．７个月。骨折组术后平均２．２个月，骨折处为板状替代；骨不连组术后平均３．６４个月，不连处为板状替代。两组均未发现术后感染、骨不连等并发症，其中４６例于术后半年左右取出本器，随访中未见板状替代部再骨折。     

先天性巨指(趾)症治疗六例

我们1966年～1989年,共治疗6例先天性巨指(趾)症患者。男4例,女2例,年龄1～6岁4例,15～22岁2例,单侧5例,双侧1例,4例为足趾,2例为手指,受累指(趾)外形粗大,皮肤发亮且柔软而富弹性,无感觉异常,活动不灵活,     

筋膜间隔综合征的高压氧治疗与血浆纤粘素变化的关系

本文首次报道采用253kPa的高压氧治疗24例创伤后筋膜间隔综合征(PACS)病人并采用免疫单扩散法检测了治疗前后血浆纤粘素(FN)的变化与预后的关系。30例健康人作为血浆FN的对照组。结果表明:16例早期PACS病人,经3～5次高压氧治疗,症状和体征逐渐好转,无1例作筋膜切开减压。6例筋膜切开减压后行高压氧治疗者,水肿、炎症消退,体温降低,临床症状好转。2例坏死期PACS虽然临床症状好转,但效果差。高压氧治疗后,病人血浆FN显著高于治疗前。分别较治疗前高43(18.9％;P<0.01)、61(24.7％;P<0.01)、49(17.2％;P<0.01)、57(17.4％;P<0.05)和55mg/L(16.6％;P<0.05)。根据本组研究的结果,提示高压氧是治疗早期PACS的有效非手术疗法和筋膜减压后有效辅助疗法。     

急性踝关节外侧副韧带断裂手术修补42例报告

踝关节外侧副韧带断裂是踝关节极度内翻使韧带受到的张力超过最大限度所造成的。韧带一旦断裂后,如不及时手术修复,则断端回缩,形成疤痕组织,关节因而松弛无力,容易反复扭伤。因此早期诊断和治疗颇为重要。本文简要地报道42例急性踝关节外伤副韧带断裂的损伤机理、诊断要点和治疗效果。一、损伤机理踝关节的外髁较内髁低,外侧副韧带较内侧三角韧带薄弱,足部内翻肌群较外翻肌群力量强。因此,当快速运动而足部来不及调正足的位置时,常易发生内翻蹠屈位着地,使外侧副韧带损伤。外侧副韧带由腓距前、腓跟和     

梅花型髓内钉固定治疗股骨骨折(附150例分析)

二十五年来,我院收治成人股骨骨折272例,需内固定者170例,其中150例采用梅花型髓内钉固定,占手术病例的88.2%。据临床体会,梅花型髓内钉固定的效果好,值得选用。