复杂性胫骨平台骨折的手术疗效分析

目的：探讨手术治疗复杂性胫骨平台骨折，即SchatzkerⅣ、Ⅴ和Ⅵ型骨折的疗效。方法：收集1997年－2000年在我院行切开复位内固定治疗的复杂胫骨平台骨折36例进行回顾性分析，全部病例术前进行详细的手术设计，螺旋CT平扫及三维图像重建，制订手术方案，术中T或L型钢板固定。结果：随访10个月－5年，平均26个月，按Mer-chant评分标准，优良率83.3%。结论：（一）切开复位支撑钢板固定治疗复杂性胫骨平台骨折疗效满意；（二）术前结合螺旋CT检查制定详细手术计划，术中力争解剖复位，足量植骨，坚强固定，术后完备的康复计划是手术成功的关键。     

三柱理论指导下胫骨平台骨折的入路选择

目的探讨在三柱理论指导下选择手术入路治疗复杂性胫骨平台的临床疗效。方法 2010年10月至2012年11月,在三柱分型理论指导下进行手术入路设计,采用钢板固定植骨术治疗复杂胫骨平台骨折24例。结果 24例均获随访,随访时间6~24个月,平均14个月。患者术后伤口一期愈合,无骨折延迟、畸形愈合。X线片显示胫骨平台均未发生二期塌陷及关节不稳。膝关节功能按Merchant评分标准评定,优10例,良10例,可4例,优良率为83.3%。结论在三柱理论指导下选择合适手术入路治疗复杂胫骨平台骨折,能同时达到骨折良好复位及内固定、软组织损伤小和功能恢复良好的目标。     

锁定钢板内固定治疗胫骨平台骨折疗效分析

目的探讨锁定钢板内固定治疗胫骨平台骨折的手术疗效和优点。方法对32例胫骨平台骨折采用锁定钢板内固定治疗。SchatzkerⅠ~Ⅲ型骨折采用胫骨近端前外侧入路,Ⅳ型骨折采用前内侧入路,此4型均采用单钢板固定;SchatzkerⅤ、Ⅵ型骨折采用前正中入路双钢板固定。结果手术复位固定满意,术后X线显示关节面台阶均在2 mm以内。32例均获随访8~18个月,骨折骨性愈合时间3~6个月。术后8个月采用Rasmussen评分评定疗效:优12例,良17例,可3例,优良率90.6%。结论锁定钢板内固定治疗胫骨平台骨折手术效果满意,与传统支持钢板相比,其在治疗复杂胫骨平台骨折时有明显优势。     

关于胫骨平台骨折的手术治疗体会(附37例报告)

[目的]探讨胫骨平台骨折的手术治疗方法。[方法]对37例胫骨平台骨折患者行切开复位内固定，Schatzker分类Ⅱ型、Ⅲ型、Ⅳ型者同时予以植骨。[结果]37例随访12～36个月，平均17个月。按Merchant评分标准，优良率86．5％。[结论]对移位的胫骨平台骨折宜采用切开复位适当的内固定术，Ⅱ型和Ⅲ型、Ⅳ型患者应予植骨。     

支持钢板固定植骨结合CPM治疗胫骨平台骨折

目的探讨支持钢板加自体髂骨植骨结合CPM治疗胫骨平台骨折的疗效。方法对34例胫骨平台骨折，采用切开复位解剖型支持钢板内固定，加自体髂骨植骨，并结合CPM早期行关节功能锻炼。结果34例患者均获得随访，随访时间6～36个月，平均18个月。按照Rasmussen评分标准，优15例，良14例，可5例，优良率达85．3％。结论合理选择切口切开复位，加解剖型支持钢板内固定自体髂骨植骨，并早期结合CPM功能锻炼治疗胫骨平台骨折疗效满意。     

复杂性胫骨平台骨折的手术治疗

为探讨复杂性胫骨平台骨折的早期治疗方法。对23例Schatzker分类为Ⅲ-Ⅵ型的胫骨平台骨折,早期行AO胫骨髁钢板及松质骨钉内固定手术,同时进行膝关节探查,术后早期功能锻炼,经过6个月－2年随访,按Merchant标准评价,其优良率达87．0％。     

累及后髁复杂性胫骨平台骨折的手术治疗

目的 探讨切开复位内固定治疗累及后髁的复杂性胫骨平台骨折的手术疗效.方法 对18例累及后髁的复杂性胫骨平台骨折行切开复位内固定,术后采用HSS法行膝关节评分.结果 18例均获得随访,平均27.8个月(0.5～6年).骨性愈合时间平均15.9周(12～16周).术后12个月HSS评分平均82分(66～91分).1例术后切口感染.结论 根据骨折的不同类型,采取适当手术入路、内固定方式,能获得较满意疗效.     

切开复位内固定并植骨治疗复杂胫骨平台骨折110例

目的探讨切开复位内固定并植骨治疗复杂胫骨平台骨折（SchatzkerIV—VI型）的手术方法及临床疗效。方法对110例采取切开复位内固定并植骨治疗的复杂胫骨平台骨折进行回顾性分析。结果术后110例均获得平均33．6（6-48）个月随访．所有患者均获骨性愈合,疗效采用Rasmussen评分标准评定：优43例,良51例,可10例,差6例,优良率85．5％。结论术中应根据具体骨折类型采用相应手术人路和固定方式,充分植骨并解剖复位关节面,维持下肢正常力线．修复关节周围韧带可取得满意的临床疗效。     

有限双切口复位双钢板内固定治疗SchatzkerV、VI型胫骨平台骨折

目的探讨有限双切口复位、双钢板内固定治疗SchatzkerV、Ⅵ型胫骨平台骨折的手术方法及临床疗效。方法自2008—01—2012-08采用有限双切口复位双钢板内固定治疗15例SchatzkerV、VI型胫骨平台骨折,分析其手术方法及临床疗效。结果15例均获得随访,时间10-14个月,平均12个月,骨折均骨性愈合。术后膝关节功能采用Merchant评分标准评定：优8例,良3例,可2例,差2例,优良率73.3％。结论对SchatzkerV、VI型胫骨平台骨折采取有限双切15I复位、双钢板内固定,并且重视术后功能锻炼的治疗方案效果良好。     

内固定治疗胫骨平台骨折的临床分析

目的 探讨胫骨平台骨折内固定治疗的临床效果.方法 胫骨平台骨折11例(Schatzker分型:Ⅲ型1例,V型3例,Ⅵ型7例),均采用切开复位内固定治疗,骨缺损者同时予以植骨.结果 11例患者术后随访6个月至4年(平均1.7年).按Hohl评分标准,优3例、良5例、可2例、差1例,优良率达72.73％.术后并发创伤性关节炎2例,关节强直1例.结论 手术内固定是治疗胫骨平台骨折的有效方法,术后并发症的发生与骨折的严重程度密切相关.保护好骨折段的生物学环境、术中解剖复位并牢固内固定,以及术后早期适当功能锻炼能提高手术疗效.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.