浮肩损伤的手术治疗

目的探讨手术治疗浮肩损伤的临床疗效。方法对10例锁骨和肩胛骨骨折患者采用一期手术切开复位内固定术。结果 10例患者均获随访,时间6～24个月。采用ASES评分标准评定肩关节功能:优7例,良2例,中等1例。结论浮肩损伤早期手术和术后功能锻炼,可获得满意疗效。     

浮肩损伤的手术治疗

目的 探讨手术治疗浮肩损伤的方法和疗效.方法 2001年1月-2007年12月收治24例浮肩损伤患者.按黄长明等的分类:A型(同侧肩胛颈骨折+锁骨干骨折)14例;B型(同侧肩胛颈骨折+锁骨外侧端骨折)6例;C型(同侧肩胛颈骨折+肩锁关节脱位)4例.均行手术治疗,其中锁骨或肩锁关节固定7例,锁骨或肩锁关节和肩胛颈部固定17例.并对手术前后孟极角(GPA)进行测量.结果 术前GPA≥30°5例,GPA 20°～29°8例,GPA＜20°11例.术后GPA≥30°19例;GPA20°～29°5例,均为单纯固定锁骨者;术后GPA较术前有明显改善.随访时间为3个月至4年,平均16个月;骨折愈合时间为11～27周,平均15周.肩关节功能采用Hardegger功能评定标准评定:优13例,良9例,可2例.结论 浮肩损伤为肩关节悬吊复合体结构的严重损伤,积极切开复位内固定为早期功能锻炼提供基础,有利于肩关节功能的恢复.     

Current aspects in the arthroscopic treatment of shoulder instability

With regard to postoperative stability of the shoulder joint, the results yielded by the various arthroscopic refixation techniques are not as good as those obtained after open operation. The aim of this paper is to analyze the reasons for this and to present a new procedure which it is hoped will improve the arthroscopic results. The main reason for the high postoperative recurrence rate after arthroscopic joint stabilization seems to be that refixation of the capsule is not performed at the level of the lesion, but above it, because of the position of the subscapularis tendon. Another reason for the poor results of arthroscopy is that the enlarged capsule cannot be shortened as desired, because the glenoid labrum is used for refixation of the capsule. To improve the arthroscopic results we suggest basic changes of the procedure in cases with severe damage to the soft tissue at the antero-inferior aspect of the glenoid and/or in cases with an enlarged capsule: refixation of the capsule should not be carried out from inside the joint but from outside the capsule. To this end, we applied the so-called extraarticular screwing technique. Refixation is achieved by inserting small cannulated titanium screws by means of a special screwdriver. No metal is placed inside the joint. This technique requires a new portal, namely the so-called antero-inferior portal, which is placed 1.5 cm inferior to the coracoid process. If the precautionary measures described are duly observed, the musculocutaneous nerve cannot be damaged. The technique allows stable refixation of the capsule in the desired length by placement of one or two small screws in the center of the Bankart lesion. Our preference is based on experience with 83 patients with recurrent shoulder instability who were operated on by arthroscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)     

浮肩损伤临床评估与治疗

浮肩损伤(FSI)是一种少见的高能量所致肩部复合伤,强大暴力也造成严重软组织损伤及其他伴发伤.新近研究发现FSI发生机制并不单纯局限于同侧锁骨干和肩胛颈骨折,肩部韧带组织损伤也是发生机制之一,因而传统FSI概念并不能囊括所有类型,这也使得临床上无法制定统一的诊断标准.有关FSI是采用保守治疗还是手术治疗,以及手术治疗是行单纯锁骨固定还是锁骨与肩胛骨双固定,各家说法不一.保守治疗的优点在于无再创伤、无手术并发症风险;手术固定治疗允许早期功能锻炼,利于伴发伤的诊断与护理.文献报道这两种治疗方式都有良好的疗效.     

肩关节上方悬吊复合体损伤的手术治疗

目的探讨手术治疗肩关节上方悬吊复合体(SSSC)损伤的方法和疗效。方法收治SSSC损伤患者18例,其中肩胛颈骨折伴锁骨中远段粉碎性骨折6例,肩胛颈骨折伴肩峰骨折5例,锁骨远端粉碎性骨折伴肩峰及关节盂骨折2例,均行切开复位内固定术;肩锁关节完全脱位伴喙锁韧带完全断裂3例,行钩钢板固定及韧带修复;肩胛颈粉碎性骨折伴肩锁关节脱位1例,锁骨远端粉碎性骨折伴喙锁韧带断裂1例,均行切开复位内固定术及韧带修复。结果所有患者均获得随访,平均9个月(3~14个月),均解剖复位并愈合,骨折愈合时间平均8.6周(7~12周)。Constant-Murley评分为72~100分,平均91分,其中优11例,良4例,中3例,优良率为83.3%。结论 SSSC损伤解剖结构复杂,手术以内固定治疗为主,可恢复其稳定性,治疗效果良好。     

Modern aspects of the ankle fracture treatment

The ankle fractures continue to be a topical issue in orthopedic surgery. X-ray diagnostics, but primarily also other modem diagnostic procedures such as CT, MRI, and arthroscopy enable detection of not only fractures but also osteocartilaginous fractures and soft-tissue ligamentary lesions, which are frequent causes of pain and instability of the ankle. The key segment is the posterio-lateral segment and tibio-fibular syndesmosis whose integrity is sometimes only surgically establishable. In the ankle treatment, stable fixation - since recently by means of resorptive osteofixation materials - and early rehabilitation of the operated ankle are aimed at. The open and pylon fractures, as the most severe forms of ankle fractures, are treated by external fixation with minimum internal fixation (hybrid fixation) of the ankle with conversion of the rigid into a dynamic (articulated) external fixator enabling movement and nutrition of the damaged articular cartilage.     

肩关节悬吊复合体损伤的手术治疗策略

目的探讨肩关节悬吊复合体(SSSC)损伤的特点和手术治疗策略。方法回顾性分析自2008年3月～2010年9月收治的SSSC损伤21例的临床资料。结果本组获得10.2(6～18)个月随访,骨折全部愈合,平均愈合时间9.6(8～12)周。随访结果:ASES评分平均88.4(67～100)分;Hardegger疗效评价标准:优13例,良6例,可2例,优良率90.5%。结论手术治疗可以恢复SSSC的完整性和稳定性,有利于发挥其维持上肢和躯干之间稳定性的作用,最大限度的恢复肩关节的功能。     

内固定手术治疗浮肩损伤

目的探讨内固定手术治疗浮肩损伤的临床疗效。方法回顾性分析切开复位钢板内固定手术治疗的27例浮肩损伤患者资料。末次随访按Herscovici标准对患侧肩关节进行功能评价。结果患者均获得随访,时间12~23个月。骨折均愈合,无骨折移位、内固定断裂等并发症。末次随访按Herscovici肩关节功能评定标准评价疗效:优15例,良9例,可3例,优良率24/27。结论切开复位钢板内固定治疗浮肩损伤,可重建肩关节上部悬吊复合体的解剖结构并增加稳定性,有利于患肩早期功能锻炼,最大限度恢复肩关节功能,临床疗效肯定。     

Modern aspects of surgical treatment of diabetic foot]

Result of treatment of 225 patients with diabetic angiopathy of lower extremities (LE) was studied. Efficacy of conservative treatment, supplemented, according to indications, by opening of purulent foci, registrated during 5 days, than we established indications for the LE amputation. Application of improved tactics of surgical treatment had permitted to preserve supportive function of foot in 63.6% patients.     

浮肩损伤的治疗方法选择

目的探讨浮肩损伤治疗方法的选择。方法52例浮肩损伤患者行非手术治疗15例,手术治疗37例,并对其进行回顾性对比分析。采用Herscovic i功能评估方法;影像学检查主要在肩关节正位X线片上测量盂极角(GPA)。结果48例获8个月~16年随访。非手术组:随访13例,优2例,良3例,可2例,差6例;7例GPA>20°,6例GPA<20°。手术组:随访35例,其中单纯锁骨或肩锁关节固定26例:优16例,良3例,可5例,差2例;20例GPA>20°,6例GPA<20°。肩胛颈、锁骨联合手术9例:优4例,良2例,可2例,差1例;8例GPA>20°,1例GPA<20°。结论浮肩损伤手术治疗明显优于非手术治疗,且多数病例可采取单纯固定锁骨或肩锁关节的手术方案,但对于锁骨骨折合并同侧严重移位的肩胛颈骨折宜采用联合手术治疗,以重建肩关节稳定,促进关节功能的早期康复。     

肩关节悬吊复合体损伤的手术治疗策略

目的：探讨肩关节悬吊复合体（superior shoulder suspensory complex SSSC）损伤的特点和手术治疗策略。方法：回顾性分析2008年3月至2010年9月收治的SSSC损伤患者21例,男14例,女7例。年龄22—53岁,平均37．8岁。21例患者均接受手术治疗。根据AO肩胛骨骨折分型分为5型：A型肩胛骨体部骨折,6例,行重建接骨板固定;B型肩胛骨突起部骨折,3例,喙突骨折行空心拉力螺钉固定,肩峰骨折行张力带克氏针固定;C型肩胛颈骨折,2例,行重建接骨板固定：D型累及关节面的骨折（盂肱关节）,3例,行重建接骨板和空心螺钉或皮质骨螺钉固定;E型肩胛骨和同侧锁骨骨折,7例,锁骨干行重建接骨板固定,锁骨外1／3骨折行锁骨钩钢板固定,肩胛骨行重建接骨板和空心螺钉固定。结果：21例患者均获得10．2（6—18）个月随访,骨折全部愈合,平均愈合时间9．6（8～12）周。随访结果：ASES评分平均88．4（67～100）分;Hardegger疗效评价标准：优,13例;良,6例;可,2例;优良率达90．5％。结论：手术治疗可以恢复SSSC的完整性和稳定性,有利于发挥其维持上肢和躯干之间稳定性的作用,最大限度的恢复肩关节的功能。     

Microbiological aspects and antibiotic treatment of abdominal gunshot injury

Abdominal gunshot injury is a life-threatening condition that requires urgent and complex measures: control of hemorrhage and source of infection through a surgical intervention; prophylaxis and antibiotic therapy of the infectious complications; intensive care for cardiology and pulmonary support. First phase in infection process (diffuse peritonitis and bacteremia), is governed by Escherichia coli, Enterococcus spp, Bacteroides fragilis group, while the second (development of abscess)--by anaerobes. Application of antibiotic prophylaxis or therapy depends on the time since the incidence together with the score evaluating severity of patient'status. Empiric antibiotic therapy should be broad-spectrum and rapidly bactericidal.     

Modern aspects of diagnosis and treatment of acute pancreatitis]

Problems of pathophysiology, diagnosis and main principles of treatment of an acute pancreatitis were considered. An early accurate diagnosis, taking into account form of the disease, prognostication of his course, application of modern intensive therapy, obligatory prophylaxis and treatment of systemic inflammatory reaction and the early (noninfectional) and late (infectional) syndrome of polyorganic dysfunction, conduction of endoscopic intervention in systemic-toxic phase of the disease, adequate choice of operative method in presence of pancreatic infection are promoting the reduction of the disease course severity and the mortality lowering.     

肩关节盂唇损伤的关节镜诊断和治疗

目的 探讨肩关节镜诊断和治疗盂唇损伤的应用意义和临床疗效。方法 对明确诊断盂唇损伤的36例病例,进行X线检查、单纯造影、MR加造影和关节镜技术的比较总结回顾。28例单纯盂唇损伤,采用肩关节镜下损伤盂唇的部分切除术;5例合并肱二头肌长头腱复合体（SLAP）病损,采用肩关节镜下盂唇损伤处清创术,术后患肩零度位牵引;3例合并Bankart病损,行肩关节镜下盂唇损伤处清创术后,通过有限切口进行改良的Bristow手术。结果 术后随访10个月～3年,平均2年。参照美国Michasel Reese医疗中心的评分标准,疼痛评分总分75分:术前平均35分,术后平均65分。关节功能评分总分25分:术前平均10分,术后平均20分。全部病例术后临床症状均有明显改善,恢复日常生活与工作,8例合并SLAP或Bankart病损者,术后未出现肩关节不稳定症状。结论 盂唇是肩关节内损伤的好发部位之一。肩关节镜是明确诊断和治疗盂唇损伤的有效的先进技术。肩关节镜下手术有一定难度,需特备的手术器械,因此要求术者熟练掌握肩关节镜技术。     

改良McLaughlin术式治疗肩关节后脱位合并反Hill-Sachs损伤的疗效评估

[目的]评价改良Mc Laughlin术式治疗肩关节后脱位合并反Hill-Sachs损伤的疗效及结果。[方法]共6例患者接受改良Mc Laughlin术式并接受随访而入选本研究,年龄35~65岁(平均42.8岁),受伤至诊断时间1~86 d(平均47.5 d),所有患者均有肩关节后脱位伴有肱骨头前内侧骨缺损,缺损面积为25%~45%。6例患者中有5例延迟诊断,延迟诊断时间平均56.8 d(33~86 d)。所有患者均采用改良Mc Laughlin术式治疗。术后根据Constant评分及患者肩关节改善情况,进行功能评估。[结果]所有患者术后均获12~36个月的随访,平均22.8个月,优秀4例,良好2例。术后Constant评分75~90分(平均84分),随访无再发肩关节脱位及肩关节不稳定表现,且肩关节外旋角度平均恢复至30°左右。[结论]采用改良Mc Laughlin术式治疗肩关节后脱位合并反Hill-Sachs损伤,术后肩关节功能恢复可,如何处理反Hill-Sachs损伤是治疗本病的关键。