腕头月关节脱位的影像学表现

目的：分析头月关节脱位的X线平片和CT表现,提高对本病的认识和诊断水平。方法：回顾性分析24例头月关节脱位患者的X线平片及CT薄层扫描、多平面重组（MPR）和容积再现技术（VR）表现,总结不同影像学检查方法的应用价值。结果：24例患者中,月骨脱位2例,月骨周围后脱位22例,其中不伴有腕舟骨骨折的单纯月骨周围后脱位18例,经舟骨月骨周围后脱位4例;合并尺桡骨远端骨折4例7处,合并腕骨撕脱性骨折6例7处。X线平片准确诊断月骨脱位2例、单纯月骨周围后脱位16例、经舟骨月骨周围后脱位2例,漏诊单纯月骨周围后脱位2例、经舟骨月骨周围后脱位1例,误诊经舟骨月骨周围后脱位1例,漏诊腕骨撕脱性骨折4例5处。CT薄层扫描结合重建技术全部准确显示脱位及骨折（100%）。结论：X线平片是腕关节损伤的首诊方法,对头月关节脱位具有一定诊断价值。CT薄层扫描及重建技术能够直观清晰地显示头月关节脱位及脱位类型,可全面观察骨折情况,对避免漏误诊、指导临床治疗具有重要价值。     

经舟骨月骨周围脱位误诊37例分析

目的：分析经舟骨月骨周围脱位漏误诊的原因，提高对本病的认识及诊断水平。方法：37例X线检查漏诊患者，CT检查确诊为经舟骨月骨周围脱位并经手术中证实。结果；CT检查典型型16例，不典型型10例，复合型8例，掌侧脱位型3例。结论：CT是避免误漏诊的关键，熟悉腕关节正常解剖及常规X线学表现并重视本病的存在，可减少经舟骨月骨周围脱位的漏诊。     

腕骨及其韧带损伤性病变的影像学表现﹙附60例分析﹚

目的:探讨腕骨及其韧带损伤性病变的影像学表现和诊断。材料与方法:对60例经影像学检查及手朮证实的病例作回顾性分析,并依其x线表现分类诊断。结果:腕舟骨骨折30例﹙50%﹚,月骨骨折2例,舟骨损伤性缺血坏死3例,三角骨骨折7例,钩状骨骨折4例,头状骨折1例,腕月骨坏死5例;月骨周围脱位3例,月骨脱位2例,舟月骨分离3例。结论:舟骨骨折是腕骨骨折中最常见的骨折;腕脱位中最常见的是月骨周围脱位,月骨周围脱位常累及月骨周围的韧带。这些骨折,脱位及韧带损伤所具有的特征性影像学表现为正确诊断提供了依据。     

经舟骨月骨周围脱位漏误诊的分析

目的分析经舟骨月骨周围脱位漏诊误诊的原因以提高对本病的诊断水平。方法27例X线检查漏诊患者。CT检查确诊为经舟骨月骨周围脱位并在手术中证实。结果CT检查典型型13例，不典型型7例，复合型5例，掌侧脱位型2例。结论CT可减少经舟骨月骨周围脱位的误诊，熟悉腕关节正常解剖及常规X线学表现，是避免误漏诊的关键。     

经舟骨月骨周围腕骨脱位13例分析

目的 探讨经舟骨月骨周围骨脱位的诊断和治疗。方法 回顾性分析13例经舟骨月骨周围腕骨脱位病例，背侧型12例，掌侧型1例；其中7例系新鲜损伤，余6例为陈旧性；4例伴正中神经损伤，其中3例见于陈旧性组。新鲜损伤组6例手法闭合复位成功，仅1例因舟骨对位不良接受手术治疗；陈旧性组均接受手术，4例行开放复位内固定，1例行近排腕骨切除术，另1例行桡腕关节融合术。结果 随访12例中11例（91．67％）获得满意疗效，陈旧性组1例造成舟骨远端缺血性骨坏死，3例遗留正中神经损害症状。结论 经舟骨月骨周围腕骨脱位的早期治疗简单且疗效较好，而一旦误诊，则多数需手术治疗，且残留不同程度的功能障碍。提高对本病损伤机制，腕部体征和影像学特点的认识和了解，减少误诊，是提高本病预后的关键因素之一。     

带关节外固定支架治疗经舟骨月骨周围骨折脱位疗效观察

目的探讨单侧带关节外固定支架结合有限内固定治疗经舟骨月骨周围骨折脱位的疗效。方法应用单侧带关节外固定支架超腕关节外固定结合有限切开复位、克氏针等有限内固定，治疗经舟骨月骨周围骨折脱位共8例。结果随访8～42个月，骨折愈合时间12～16周，优良率l00％。8例均未发生钉道感染、外固定针及支架松动、皮肤坏死、神经血管损伤、骨折畸形愈合以及舟骨缺血性坏死等并发症，腕关节功能恢复较为满意。结论该方法具有手术创伤小、并发症少、骨折愈合快、关节功能恢复良好等优点。     

经舟骨月骨周围脱位的早期诊断失误14例分析

经舟骨月骨周围脱位是临床上的难治性伤病 ,早期漏诊及误诊率极高 ,经治疗带来更大的困难 ,甚至发生骨不连、骨坏死、腕不稳及创伤性关节炎等严重并发症 ,直接影响腕及手的功能。自 1 987年以来作者共收治经舟骨月骨周围脱位 1 8例 ,来院前发生漏诊与误诊 1 4例 ,占 77.8% ,现就漏诊及误诊原因分析如下。1　临床资料本组共 1 8例 ,均为男性 ,年龄 2 1～ 49岁 ,平均 32 .4岁 ,其中双侧脱位 1 1例 ,左侧脱位 8例 ,右侧脱位 9例。来院前发生漏诊与误诊 1 4例 ,占 77.8% ,漏诊及误诊原因 :急诊未拍 X线片1例 ,其余 1 3例均由于临床医生不熟悉正…     

月骨周围损伤的机制、分类及X线改变

目的：探讨月骨周围损伤的机制、分类及X线表现.材料与方法：回顾性分析经临床、手术证实的16例月骨周围损伤病例的X线表现并探讨其损伤机制和分类.结果：16例月骨周围损伤病例中：舟月骨分离3例;月骨周围及月骨脱位4例;月骨周围骨折/脱位9例.结论：月骨周围损伤是腕骨损伤中最常见的损伤,常伤及月骨韧带附着.月骨周围损伤是由腕部过度伸展所致.其损伤范畴包括有舟月韧带撕裂、月骨周围脱位,及月骨周围骨折/脱位.这些损伤类型实际上是一连续损伤过程中的某一片断,且可发现这一中间片断.     

经舟状骨骨折背侧型月骨周围脱位漏诊1例分析

笔者近期收治1例经舟状骨骨折背侧型月骨周围脱位漏诊患者,分析如下. 1 病历摘要 男,27岁.因干活时不慎从约3 m高处坠落,左手掌着地,伤后即感左腕部及左胸部疼痛.入院查体:左腕部肿胀,腕周广泛压痛,腕关节不能背伸,掌腕横纹处有压痛,并可触到脱出的月骨.胸廓挤压实验(+).X线片示:左侧肋骨多发性骨折,左侧桡骨茎突骨折合并月骨脱位.胸部CT示:双肺下叶膨胀不全,左侧胸腔积液.     

经舟骨月骨周围脱位误诊误治1例分析

本文对我院经舟骨月骨周围脱位误诊误治1例分析如下。1病历摘要例1:男,45岁。因矿山塌方事故伤及右腕关节3 h入院。体检示:右腕关节肿胀、压痛,以背侧为重;屈伸、桡尺偏活动障碍;患肢末梢血运感觉良好;手指活动正常。拍右腕关节片报告示(非标准正侧位片):右腕舟骨骨折,给予右前臂石膏托外固定。2个月后来院复诊拆除石膏外固定,体检发现右腕背部一骨性突起     

Traumatic radial head subluxation in young children: a case report and literature review

Traumatic radial head subluxation in young children is reviewed. This minor condition commonly results from a sudden longitudinal traumatic pull on pronated and extended forearm and appears to be infrequently recognized or diagnosed. Differential diagnosis of traumatic radial head subluxation from traumatic radial head dislocation, congenital radial head dislocation, brachial plexus palsy and "invisible" elbow fractures are discussed. It is postulated here that there are two types of traumatic rotary radial head subluxation in pronation, the simple type and the lateral type. Careful analysis of anteroposterior view of elbow reveals the change of the shape and position of the radial tuberosity indicating the simple type, or concommitant with lateral displacement of the radial head on the ulna indicating the lateral type. The lateral type and its reposition are demonstrated when premanipulative roentgenograms are compared with postmanipulative roentgenograms in one of the eight illustrative cases. Details of the supination manipulative reduction are described and demonstrated.     

Surgical treatment of late carpal dislocations

Background. Perilunate carpal subluxation is quite rare. The aim of our study was to assess outcome in the delayed treatment of these injuries. Material and methods. We studied treatment outcome in 25 perilunate carpal dislocations. The follow-up averaged 11 years and 4 months. The age of the patients ranged from 18 to 52 (average 32). The period from injury to surgery ranged from 1 day to 360 days (average 60 days). The range of motion and grip strength of the wrist were evaluated. In radiological assessment the ulnar dislocation index, carpal height index, and capitolunate, radiolunate, and scapholunate angles were examined. Subjective evaluation was based on the DASH questionnaire. Results. Only slight changes were observed during the observation period in the radiological parameters. There was no significant correlation between the use of traction in preparation for open reduction and the radiological, functional or subjective outcome. Contrary to expectations none of the outcome measures correlated with the type of dislocation or patient age, or with the delay from injury to surgery. In DASH evaluations, the strongest correlation was found between the subjective outcome and the radiological parameters, global grip strength, the sum of all four measures of range of movement, and wrist flexion. In three cases there were late complications: one case of aseptic necrosis of the lunate bone, and two cases of scaphoid pseudarthrosis. Conclusions. The best method of late treatment for perilunate carpal dislocation proved to be open reduction using the dorsal approach with Kirschner wire fixation.     

腕关节损伤(附300例分析)

目的：通过分析，探讨腕关节损伤机理及X线表现，试图总结其规律性，提高腕关节损伤的诊断率。材料与方法：详细分析我院有探讨价值的资料300份。结果：常见的腕骨损伤148例，少见的44例。常见的腕骨脱位83例，少见的23例，罕见的2例。结论：损伤机理：对个体来说多有偶然性，从群体分析很有规律性。只要密切结合腕关节解剖，临床和病史，均能提高腕关节损伤诊断率。     

Traumatic thrombophlebitis of the superficial dorsal vein of the penis: An occupational hazard

Several cases of thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) have been reported in the literature. Etiologies may include any of the following: trauma associated with vigorous sexual intercourse; penile strangulation caused by a multitude of entities; penile injection; infection; neoplasm; or surgery. We report a rare case of traumatic TSDVP in a cab driver following repeated injury to the penis by a coin-filled pouch. We review the etiologies, mechanism, and treatment of traumatic TSDVP, and attempt to identify men who may be at similar occupational risk.     

肾移植术后胸部并发症的X线表现

目的 探讨肾移植术后胸部并发症的X线表现，提高对该病的诊断水平。方法 回顾性分析67例。肾移植术后患者胸部并发症的临床与X线表现，实验室和超声检查结果。结果 肾移植术后胸部并发症主要为肺部感染，X线表现可分为4型：大叶性肺炎型36例(53％)，支气管肺炎型26例(38％)，栗粒型3例(4％)。结节型2例(3％)。其致病菌多为肺炎球菌30例(44％)，其次为真菌22例(32％)，结核杆菌11例(16％)和金黄色葡萄球菌4例(6％)。另外67例患者中还发现伴有心脏改变23例(30％)，胸腔积液11例(16％)和胸膜增厚3例(4％)。结论 肺部感染是肾移植术后胸部主要的并发症，X线平片是诊断该病经济、有效的检查方法，对指导治疗和判定预后有重要的临床意义。     

髋臼骨折脱位手术治疗56例分析

目的 :探讨髋臼骨折脱位及手术治疗髋关节功能恢复的效果。方法 :对 5 6例髋臼骨折、脱位及部分合并坐骨神经损伤病人早期复位、手术、早期髋关节功能锻炼 ,髋关节功能恢复的结果进行分析。结果 :随访时间 10月～ 3年。优 36例 ,良 12例 ,可 7例 ,差 1例 ,优良率 85 .7%。结论     

Thoracic duct injury from blunt trauma

We have reported a case of traumatic chylothorax occurring as a rare complication of fracture dislocation of the dorsal spine. When conservative management by drainage, low-fat diet, and parenteral alimentation proved unsuccessful, thoracic duct ligation effected a cure.     

钩钢板治疗Rockwood Ⅲ型肩锁关节脱位后内固定物的去留

背景:肩锁关节脱位内固定后是否须将钩钢板适时取出,在临床实践中仍有一定的争议。目的:通过对RockwoodⅢ型肩锁关节脱位术后随访肩关节功能评分和影像学测量,探讨是否应当早期适时取出钩钢板。方法:随访急性创伤性肩锁关节脱位(RockwoodⅢ型)以钩钢板手术治疗的患者共74例,按内固定后是否早期取出钩钢板分为取出组和保留组。结果与结论:比较取出组内固定取出前和保留组半年,各项指标差异均无显著性意义。取出组内固定取出后Constant评分、日常活动评分、活动范围评分和OSS评分均高于内固定取出前(P均<0.05);疼痛和力量评分前后差异无显著性意义。两组内固定后1年比较,取出组在Constant评分、日常活动、活动范围和OSS评分均高于保留组(P均<0.05);疼痛、力量、喙锁间距和肩锁宽度比较,差异均无显著性意义。所有病例均未发生术后感染,再骨折和钢板断裂等并发症。亦未发现在患者体内引起明显的全身和局部反应。结果提示,肩锁关节脱位内固定术后早期适时取出钩钢板,辅以功能锻炼,可以提高Constant和OSS评分,在不影响肩锁关节结构重建的情况下,能更好地恢复肩关节的功能,此外还能减少各种并发症的发生。     

腕关节脱位形成机制及其X线表现

目的分析腕关节脱位形成机制及其X线表现,提高对本病的诊断水平。方法10例腕关节脱位病例,男8例,女2例,年龄12～65岁,对其形成机制及X线表现进行分析。结果下尺桡关节脱位2例,桡腕关节脱位5例,腕骨间关节脱位3例。结论详细了解病史,熟悉腕关节正常X线表现,掌握各型腕关节脱位的X线特点,可防止漏诊发生。