锁骨钩钢板治疗肩锁关节脱位及锁骨远端骨折36例分析

肩锁关节脱位及锁骨远端骨折多为直接损伤引起.其中Allman Ⅲ度肩锁关节脱位为肩锁关节完全脱位,关节稳定装置遭到破坏,需要手术治疗;Neer Ⅱ型锁骨远端骨折,保守治疗一般难以奏效,也常需要手术治疗.手术治疗的方法较多,我们自2004年4月至2008年4月对36例Allman Ⅲ度肩锁关节脱位和Neer Ⅱ型锁骨远端骨折患者采用锁骨钩钢板行内固定治疗,疗效满意,现报道如下.     

管状骨骨骺骨折的X线诊断(附8例误诊分析)

目的:回顾性分析儿童管状骨骨骺骨折的发生机制、特点和分型,提高诊断率,指导临床治疗,避免畸形.方法:收集自2008年以来接诊的120例儿童闭合性损伤致骨骺骨折患儿,用S-H分型方法分型和归类.结果:Ⅰ型为10%,Ⅱ型为48%,Ⅲ型为6%,Ⅳ型为30%,Ⅴ型为1%.误诊8例(6%).结论:管状骨骨骺骨折为儿童外伤所特有的损伤,发生率高,若诊治不当,易导致患儿畸形及生长障碍,尤其是严重的关节功能障碍.     

儿童伸直型髁上骨折发生肘内翻的原因分析

目的 探讨儿童伸直型髁上骨折发生肘内翻的可能原因.方法 回顾性分析临床明确诊断为伸直型髁上骨折的244例患儿的临床资料.Ⅰ型骨折60例,其中尺偏型28例,桡偏型32例,采用闭合复位石膏固定治疗.Ⅱ型骨折56例,其中尺侧损伤偏重25例,桡侧损伤偏重31例,采用闭合复位石膏固定治疗.Ⅲ型骨折128例,均手术治疗,其中63例行肘内侧入路手术,32例行肘外侧入路手术,33例行内外侧小切口双侧入路手术.合并神经血管损伤23例,无血管神经损伤221例.治疗6个月后观察肘内翻发生率.结果 Ⅰ型骨折尺偏型肘内翻发生率明显高于桡偏型（P＜0.05）;Ⅱ型骨折尺侧损伤重者肘内翻发生率明显高于桡侧损伤重者（P＜0.05）;Ⅲ型骨折外侧入路肘内翻发生率明显高于内侧入路及双侧入路（P＜0.01）.伴有血管神经损伤者术后肘内翻发生率明显高于无血管神经损伤者（P＜0.01）.GartlandⅡ型骨折术后肘内翻率高于Gartland Ⅰ、Ⅲ型（P＜0.05）.结论 儿童伸直型髁上骨折发生肘内翻的原因复杂,合理有效的治疗可降低肘内翻发生率,但无法避免.     

15例股骨远端骨骺损伤治疗体会

目的 观察不同方法 治疗股骨远端骨骺损伤临床应用效果. 方法 以手法复位石膏外固定,闭合或切开复位内固定治疗股骨远端骨骺损伤15例.结果 本组15例出现2例骨折再移位和内、外翻成角畸形,1例出现关节僵硬,4例出现骺板早闭.结论 股骨远端骨骺损伤较其它部位损伤并发症多且严重,Salter-HarrisⅡ型骨折最为常见,建议行髋人字石膏固定,或复位后常规经皮空心钉或交叉克氏针固定.     

外伤性无颈椎骨折脱位型颈髓完全性损伤的治疗(附8例报告)

目的探讨颈髓完全性损伤的治疗问题.方法报告了8例外伤性无颈椎骨折脱位型颈髓完全性损伤非手术治疗结果.结果按Frankel分级,8例中仅有3例进步至B级.文中分析了颈髓完全性损伤早期手术与非手术治疗结果无明显差异.并探讨了颈髓在无颈椎骨折脱位情况下出现颈髓损伤的临床机制.结论通过对患者的CT、MRI检查结果分析,认为一过性损伤是造成无骨折脱位型完全性颈髓损伤的主要因素.     

手术治疗胸腰椎Chance骨折

目的 探讨胸腰椎Chance骨折的发生机制和诊治方法.方法 2006年7月～2008年1月治疗胸腰椎chance骨折18例,平均年龄29.6岁.损伤部位:T111例,T125例,L17例,L2 4例,L31例;按Denis分型:Ⅰ型11例,Ⅱ型5例,Ⅲ型2例,Ⅳ型0例.全部患者采用经后路手术治疗,行椎弓根螺钉钉棒固定.结果 随防时间平均9.5个月.骨折复位满意,椎体前份高度恢复,分离的后部结构闭合.术前有神经损伤的患者术后不同程度恢复,植骨全部骨性愈合.结论 Chance骨折属屈曲牵张型损伤,不只发生于车祸伤,CT矢状位重建对诊断有重要意义.其损伤涉及了脊柱的三柱,属于不稳定骨折,需要手术内固定治疗.后路经椎弓根螺钉钉棒固定可以达到满意复位、脊柱的三柱即刻稳定等,是治疗Chance骨折的有效方法.     

颈前路中空螺钉内固定治疗齿状突骨折的护理体会

枢椎齿状突骨折是一种严重的颈椎损伤,单纯枢椎齿状突骨折相对少见,约占颈椎骨折总数的8%左右,其中AndersonⅡ型(通过齿状突基底部)的骨折占齿状突骨折的70%[1].此型骨折常出现明显的寰枢椎不稳,易引起神经症状,且愈合率约为本型的1/4左右,因此需要手术的比例较高.     

股骨远端骨折手术入路的现状

股骨远端骨折多由高能量创伤引发,其占股骨骨折的4％～6％[1].按照AO分类法股骨远端骨折可分为3种类型:股骨远端A型骨折(即关节外骨折)、股骨远端B型骨折(即累及部分关节面的骨折)和股骨远端C型骨折(即累及整个关节面的骨折).由于股骨远端松质骨和密质骨移行处髓腔宽、松质骨多,并且周围有重要的神经、血管通过,使得其治疗较为棘手[2-3],并发症较多,致残率也较高.早期多采用保守治疗,骨折难以达到理想的复位和固定,为修复膝关节结构的损伤和早期功能锻炼,常需要手术治疗[4-5].目前,临床上手术治疗股骨远端骨折方法很多,手术入路也不尽相同.每种手术入路各具解剖上的优缺点及其适应证.笔者将股骨远端骨折手术入路的现状作一综述.     

踝关节旋后外旋型Ⅳ度损伤的手术治疗

目的 探讨踝关节旋后外旋型Ⅳ度损伤的手术治疗方法和疗效.方法 手术治疗踝关节旋后外旋型Ⅳ度损伤患者56例.所有病例均有内外踝骨折.49例内踝骨折行金属螺钉固定,7例可吸收螺钉固定.36例出现后踝骨折,其中10例行拉力螺钉固定.外踝行可吸收螺钉固定7例,金属螺钉固定6例,1/3管型钢板固定43例.12例行下胫腓联合固定.术后石膏固定4～6周.结果 56例中48例获得随访,随访时间6～18个月,骨折均愈合,愈合时间8～12周.根据Baird-Jackson系统进行疗效评定,优38例,良13例,可4例,优良率为87.7%.结论 切开复位内固定治疗踝关节旋后外旋型Ⅳ度损伤具有良好的疗效,可最大限度地恢复踝关节的功能.     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

锁骨远端骨折和肩锁关节脱位是临床上常见的一种损伤,而NeerⅡ型锁骨远端骨折和TossyⅢ型肩锁关节脱位者常需要手术治疗。我院自2003年1月至2007年12月,对40例该类损伤分别采用克氏针钢丝张力带和锁骨钩钢板治疗,比较疗效,报告如下。     

儿童孟氏骨折的治疗探讨

目的探讨儿童孟氏骨折的临床特点及治疗效果.方法报道58例儿童孟氏骨折.患儿平均年龄7.1岁(2岁～14岁).新鲜骨折47例,陈旧骨折11例;开放性损伤3例,闭合性损伤9例;合并桡神经损伤55例.作者对上述骨折进行临床分型,采用闭合复位加外固定治疗22例,切开复位内固定治疗37例,桡神经修复1例.结果49例经随访半年～3年(平均14个月),优良率为93.9%.结论儿童孟氏骨折与成人不同,宜将此类损伤分为五型并使用不同的治疗方案.开放性骨折、闭合性骨折复位不理想、影响功能的陈旧骨折、合并桡神经损伤者均应行手术治疗.     

Salter髂骨截骨联合股骨粗隆下截骨术治疗学龄前儿童先天性髋关节脱位疗效分析

目的探讨Salter髂骨截骨联合股骨粗隆下截骨术治疗学龄前儿童先天性髋关节脱位的疗效。方法采用Salter髂骨截骨联合股骨粗隆下截骨术,治疗47例55髋年龄在3～7周岁的先天性髋关节脱位患儿。结果所有患儿均取得12～38个月的随访,平均26个月,优良率达89%。结论 Salter髂骨截骨联合股骨粗隆下截骨术治疗学龄前儿童先天性髋关节脱位效果良好。     

青少年胫骨远端骨骺骨折的手术治疗

目的：探讨青少年胫骨远端骨骺骨折的手术治疗。方法：对2000年5月～2009年12月期间手术治疗35例青少年胫骨远端骨骺骨折病例进行分析。平均年龄13岁（8～15岁）,男性25例,女性10例。按骨骺损伤Salter-Harris分型：Ⅲ型25例,Ⅳ型10例。结果：术后平均随访3.8年（2～5年）。按Helfet踝关节功能评价：优28例,良7,差0例,优良率100%。术后创伤性关节炎3例,骨骺早闭3例,无骨折延期愈合、不愈合。结论：青少年胫骨远端Salter-HarrisⅡ、Ⅲ、Ⅳ型手术治疗效果良好,手术治疗并发症少。     

学龄前儿童先天性髋关节脱位最佳术式的选择

目的通过分析两种常用术式治疗学龄前儿童先天性髋关节脱位的疗效,为临床提供最佳选择。方法随访采用手术治疗62例学龄前儿童先天性髋关节脱位,按照术式分为Salter手术32例41髋与Pember-ton30例40髋。结果平均随访时间3年,从手术情况,临床疗效和X线形态3方面进行评价,两种术式均获得良好的效果,但Salter手术纠正髋臼指数在15°以内并且需要手术再次取内固定,而Pemberton手术可纠正髋臼指数在15°以上。结论Pemberton手术应作为学龄前儿童先天性髋关节脱位的首选术式。     

The child and the snowmobile.

From November 1970 through March 1975, 41 children in Manitoba required hospitalization for treatment of injuries sustained in snowmobile accidents. The commonest injuries were fractures of a leg. In general, the injuries were severe, and in many instances the fractures were unusualy and uncommonly seen in children. Most often the child had been driving the snowmobile and all injuries were a result of driver error or misadventure; none was due to malfunction of the snowmobile. Recommendations to minimize the number and severity of snowmobiling injuries in children include an education program for both adults and their children, use of lightweight cowling to protect the legs, incorporation of a governor on the throttle to prevent excessive speeds, and use of a restraint for children travelling as passengers on the snowmobile. Children should always wear tight clothing when around snowmobiles.     

改良Salter截骨术治疗发育性髋关节脱位的临床研究

目的探讨改良Salter手术治疗小儿发育性髋关节脱位的临床疗效。方法通过对平均年龄3.5岁的38例（52髋）发育性髋关节脱位患儿行改良Salter截骨术,术后髋人字石膏固定6周,功能训练1个月后下地行走。结果所有病例均得到随访,按照Mckay临床评价标准评价,其中优47髋,良4髋,中1髋,差0髋。结论改良Salter骨盆截骨术是治疗小儿发育性髋关节脱位的较好方法。     

Pattern of extremity injuries in polytrauma in Lagos, Nigeria

BACKGROUND: Extremity injuries are common in polytrauma, which remains a leading cause of death, long hospitalisation and disability for all ages. There are few research works on the pattern of these extremity injuries in Lagos, Nigeria. OBJECTIVE: To describe the pattern of extremity (limb) injuries in polytraumatised patients. PATIENTS AND METHODS: This was a prospective study carried out at the Lagos University Teaching Hospital, between 1st November 2004 and 31st October 2006. RESULTS: A total of 291 patients presented with multiple injuries between November 2004 and October 2006. All of them had extremity injuries. The studied patients were aged 2 to 76 years with a mean of 31.2 +/- 16.4. Two hundred and twenty two (76.3%) of the patients were aged 40 years or less. There were 219 males and 72 females showing a male to female ratio of 3:1 Road traffic accident was the most common aetiology (73.2%). The most frequently seen fractures were tibia 27.8%, femur and fibula 24.7% each. An overwhelming majority (88.8%) had multiple fractures. The commonest fracture combinations were tibia/ fibula 24.7% and radius/ulna 19.6%. The most frequently associated injury was head injury 26.8%. Others were spinal and abdominal injuries 13.4% each. Hip dislocation accounted for a majority (56%) of all dislocations seen in this study. CONCLUSION: Lower extremity injuries were commoner than upper extremity injuries in polytrauma. Majority of them had multiple fractures especially among bones that have close anatomical location. Head injury was the most commonly associated injury.     

Outcome of calcaneal fractures treated operatively and non-operatively. The effect of litigation on outcomes

Background  

The optimum management of calcaneal fractures is controversial. These injuries are frequently associated with compensation litigation, which effects the outcome.     

Children's skiing injuries in Australia

Skiing is one of the most popular winter sports for adults and children in Australia. While much is known about the epidemiology of skiing trauma in adults, little has been written about the patterns of skiing injury in children in Australia. During the 1984 ski season, the injuries and risk factors of 149 children were compared with those of 1093 adults who were injured over the same period. Although Australian children were found to be possibly less prone to injury than were adults, they did sustain more serious injuries, in particular, fractures of the tibia. The significantly different associated risk factors that are thought to be responsible were the greater number of children who were injured in collisions and ski-lift accidents, and inadequate bindings on their skis. Such shortcomings are correctable; children require better boot-bindings and greater supervision on the ski-slopes.     

Head injuries related to the use of baby walkers.

To determine what proportion of head injuries in children under 24 months of age who presented to an emergency department were related to the use of baby walkers, we reviewed the charts of 52 such children. Walkers were involved in 42% of the head injuries in the children under 12 months of age and in none of those in the children aged 12 to 24 months. All walker-related injuries, including skull fractures in three children, involved stairs (p less than 0.001). Questionnaires were also sent to all families with children aged 3 to 18 months attending a private pediatric practice to determine the prevalence of falls involving baby walkers among these children and the factors associated with such falls. Of the 152 responding families 82% reported using or having used a walker. Thirty-six percent of the families reported that their child had a fall while in a walker, with 8.8% of the falls resulting in contact with a doctor. Walker-related falls were directly associated with time spent in the walker (p less than 0.001) and with a previous fall from the walker by an older sibling (p less than 0.03). Since there is no demonstrated benefit of walkers, their use should not be encouraged, and parents should be advised of their potential danger.