Bartonicek Ⅱ型Bosworth骨折脱位一例报道并文献复习

踝关节骨折是四肢骨折中常见损伤，但Bosworth骨折脱位在踝关节骨折中较为罕见，其由Bosworth在1947年首先描述报道并以此命名，特点是腓骨骨折近端嵌入胫骨腓切迹后方，导致脱位难以闭合复位，常需要切开复位。因其损伤机制及特点，容易出现漏诊，如未及时诊治，或按照一般踝关节骨折处理，可能导致围手术期相关严重并发症，如骨筋膜室综合征、距骨缺血性坏死及创伤性关节炎等。Bartonicek将此类损伤分为三型，其中报道较多的为Ⅲ型，合并腓骨远端骨折。我院近期收治了一例踝关节Bosworth骨折脱位患者，腓骨全长无骨折，为较罕见的Ⅱ型。该患者经过及时闭合复位、二期内固定手术，未出现不良事件，预后良好，本文通过该病例结合文献复习Bosworth骨折脱位的临床表现、损伤机制、诊断及治疗，分析BartonicekⅡ型Bosworth骨折脱位的特点。     

Posterior Dislocation and Fracture—Dislocation of the Shoulder

Two cases of posterior dislocation (PD) and four cases of posterior fracture—dislocation (PFD) of the shoulder are reported. There was one bilateral PD and two bilateral PFD. One PD was treated with closed reduction but in three cases of PFD operative reduction was necessary. All measures were applied in the late phase within 1 to 10 months after the injury with good primary results. However, because of posttraumatic arthrosis, the final result was poor. the average follow—up period was 4 years. the diagnosis of posterior dislocation is often missed. An axillary X-ray is essential.     

Operative treatment of complex lombosacral fracture dislocation: L5 chance fracture with trans S1-S2 dislocation

Sacral fractures are uncommon injuries that are often diagnosed late, the transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance fracture has never been reported. The purpose of this report is to describe operative treatment of transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance fracture. A 17-year-old woman sustained multiple injuries in a road accident and presented with hypovolumic shock. Radiological assessment demonstrated transverse fracture dislocation of the sacrum at the S1-S2 level associated with a L5 Chance-fracture. Neurologic examination demonstrated L5 root deficit and perineal hypoesthesia. Operative treatment was undertaken. The procedure consisted of laminectomy of L5, S1, and S2 and osteosynthesis of L3-L4 - S3-S4 (in sacral alae). Attempts to reduce dislocation failed. Postoperative recovery was uneventful. One year after operative treatment the patient presented no neurologic deficit and had resumed normal activity. Follow-up radiological imaging demonstrated consolidation of fracture zones. Management for uncommon lumbrosacral junction injuries must take into account various parameters including hemodynamic condition, neurologic status, and stability of the spinal lesions. Decompression of neural impingement and stabilization of fractures by osteosynthesis appear to be a useful alternative that allows patients to stand again and begin rehabilitation quickly.     

通用脊柱椎弓根钉棒矫形固定系统治疗胸腰椎骨折脱位的疗效分析

目的评价通用脊柱椎弓根钉棒矫形固定系统治疗胸腰椎骨折脱位的临床效果。方法对应用通用脊柱椎弓根钉棒矫形固定系统治疗的110例胸腰椎骨折脱位的患者进行随访,平均时间为14月。结果术后X线片显示脱位椎体全部复位,随诊时的X线片显示椎弓根钉固定牢固,无松动。并发症6例,术中并发症3例,发生率为2.7%;术后并发症3例,发生率为2.7%。术后神经症状明显改善。结论通用脊柱椎弓根钉棒矫形固定技术治疗胸腰椎骨折脱位疗效确切,是一种简捷,可靠的治疗方法。     

髋关节后脱位伴同侧转子间骨折的治疗

我院自1987年8月-2000年3月采用Gibson切口治疗髋关节后脱位伴同侧转子间骨折16例,经0.5～5年随访,取得较好疗效,现总结如下.……     

Ankle injury manipulation before or after X-ray – Does it influence success?

Many acute, deformed ankle injuries are manipulated in the Emergency Department (ED) before X-rays are taken to confirm the nature of the injury. This often occurs in the absence of neurovascular or skin compromise without consideration of other possible injuries such as talar, subtalar or calcaneal injuries. We believe that an inappropriate manipulation of an unknown injury pattern may place the patient at increased risk. A balance needs to be struck between making the correct diagnosis and preventing any further neurovascular or skin compromise.     

Radial styloid fractures

Radial styloid fractures can occur in isolation or in association with other injuries, including complex intra-articular distal radius fractures, carpal fractures, carpal dislocations, and radiocarpal dislocations. The anatomy surrounding the radial styloid is complex, and complications related to surgical approach, treatments, and symptomatic hardware can occur. Operative treatments vary according to the injury pattern present, and pattern recognition is the key to optimizing treatment of these injuries. Outcomes are related to the precision of the reconstruction as well as the magnitude of the injury; better results are associated with lower-energy patterns.     

Isolated radial shaft fracture with unreducable posterior dislocation of the radial head and rupture of the lateral collateral ligament: A case report

Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. We describe an uncommon case of an isolated radial shaft fracture with an unreducable posterior dislocation of the radial head and associated rupture of the lateral collateral ligament of the elbow.     

Anterior fracture dislocation of the hip: an unusual presentation and a review of principles of management

Anterior dislocation of the hip occurs in 10–15% of cases (DeLee et al. in J Bone Joint Surg Am 62(6):960–964, 1). It is usually due to high velocity trauma and associated with multiple injuries. We present a case of this unusual injury associated with an acetabular fracture and a Brumback type IV B fracture of the femoral head caused by a low energy mechanism. We discuss the rationale for our management including issues involved in making the diagnosis, the reasons for our delay in diagnosing the injury and we propose strategies to avoid this in the future. The current literature evaluating the aetiology as well as the treatment of anterior fracture dislocation of the hip is also critically evaluated.     

Apofix椎板夹治疗寰枢椎骨折、脱位

目的探讨应用Apofix椎板夹治疗寰枢椎骨折、脱位的方法及疗效。方法对8例寰枢椎骨折、脱位患者采用Apofix椎板夹固定。结果随访5~24个月,脱位纠正,颈部活动基本恢复正常,颈部不稳感消失,按照JOA评分法,术前平均为8.3分,术后平均为14.6分。结论Apofix椎板夹治疗寰枢椎骨折、脱位,术后无需坚强的外固定,具有操作技术难度小、手术风险低、安全、实用的特点。     

前路带锁钢板联合钛笼植骨融合术治疗下颈椎骨折脱位

目的评价前路带锁钢板系统结合钛笼内植骨融合治疗颈椎骨折脱位合并脊髓损伤的临床疗效及应用价值。方法对25例颈椎骨折脱位并脊髓损伤患者行颈椎前路减压、钛笼内植骨,纯钛带锁钢板内固定术,神经功能按JOA评分,于术前、术后1年余对所有病例均进行评分。结果25例患者全部获得随访,平均随访时间15．5个月。骨折、脱位复位均满意,植骨于术后3个月融合,无钢板螺钉松动、断裂、钛笼陷入椎体内等并发症,术后1年JOA评分恢复率为（69．2±12．5）％。结论应用前路带锁钢板系统结合钛笼内植骨融合术治疗颈椎骨折脱位,能充分保证固定节段的稳定性,植骨融合率高,有效地维持了椎问高度和生理曲度,使脊髓在相对生理环境下达到最大程度的功能恢复,在颈髓损伤中有较大的应用价值,远期效果还有待于进一步观察。     

Barton骨折脱位发病机理研究及21例报告

通过腕关节解剖和电视Ｘ线动态测量桡腕、月头关节伸屈活动，证实掌侧或背侧Ｂａｒｔｏｎ骨的脱位发病机理分别为腕部处于过伸位或过屈位受作时，月骨对桡骨远端关节面掌侧缘或背侧缘撞击所致。掌侧型应归为Ｃｏｌｌｅｓ骨折之特殊类型。楔形骨折块大小、是否粉碎、脱位程度和是腕骨骨折决定其治疗方法。保守治疗复位及固定与受力与受伤方向相反。手术治疗掌侧型用支持钢板，背侧型用克氏针固定。作者报道一组患者２１例，保守治疗１     

股骨头毁损三联征:股骨头骨折-脱位合并股骨颈骨折

股骨头合并同侧股骨颈骨折是一种严重而复杂的创伤,保髋手术大多会失败。其治疗的难点及预后的关键在股骨颈骨折上。鉴于股骨颈骨折的发生与股骨头骨折-脱位之间存在明显的、前后关联的贯序特点,笔者认为以股骨头毁损三联征（disastrous triad of femoral head,DTFH）来概括这种类型的损伤,更能反映其损伤机制和预后特点。结合临床观察和文献资料,DTFH可分为3个类型：Ⅰ型,普通型DTFH,股骨颈骨折的发生紧随于股骨头骨折-脱位之后,是同一暴力造成的损伤;Ⅱ型,医源型DTFH,是在股骨头骨折-脱位的诊疗过程中发生了医源性股骨颈骨折;Ⅲ型,应力型DTFH,发生于股骨头骨折-脱位的治疗之后,在股骨头骨折面的远侧缘发生应力性股骨颈骨折。本文对各型DTFH的临床特点进行了初步的讨论。     

急性经舟骨月骨脱位手术治疗的探讨

目的 探讨急性经舟骨月骨脱位早期切开复位内固定治疗的方法及其临床效果.方法 对8例急性经舟骨月骨脱位的患者,早期采用切开复位以Herbert螺钉或微型钛螺钉加克氏针内固定的方法治疗.术后随访X线片了解骨折愈合情况及腕关节轴线恢复情况.Cooney腕关节功能评分法评价术后腕关节功能恢复程度.结果 术后随访6月至3年,平均15个月.根据Cooney腕关节功能评分:优3例,良4例,可1例;8例患者术后腕关节疼痛均减轻,X线片检查舟骨、三角骨骨折全部愈合,腕关节轴线恢复正常.结论 早期采用切开复位以Herbert螺钉或微型钛螺钉加克氏针内固定,均能达到骨折解剖复位,腕关节轴线恢复好,术后腕关节功能恢复良好,是治疗急性经舟骨月骨脱位的有效方法.