关节镜下治疗胫骨髁间嵴撕脱骨折疗效分析

正前交叉韧带(anterior crucial ligament,ACL)胫骨止点撕脱骨折即胫骨髁间嵴撕脱骨折是常见的膝关节损伤,多伴明显移位,常需要手术治疗。我院自2009年1月-2011年11月采用不同固定方法治疗此类损伤,取得了较好的疗效。1资料与方法1.1一般资料本组27例,其中男19例,女8例;年龄17-43岁,平均29.2岁。按照Meyers-MC-Keever[1]分型,Ⅰ型2例,II型6例,III型19例,其中新鲜骨折24例,单纯ACL胫骨止点撕脱骨折21例,合并有半月板损伤6例,胫骨平台骨折4例,侧     

Segond骨折的临床特点及其合并伤的诊治

探讨12例Segond骨折及其合并伤的诊断及治疗。8例合并前交叉韧带完全断裂者行自体腱重建术,2例胫骨髁间嵴撕脱性骨折行关节镜下空心螺钉固定术,半月板损伤行成形术(修补术),胫骨平台外侧撕脱性骨折行非手术治疗。10例手术患者末次随访时Lysholm术后评分为86。     

关节镜下治疗胫骨髁间嵴撕脱性骨折

探讨关节镜下治疗胫骨髁间嵴撕脱性骨折手术要点和围手术期注意事项。     

关节镜下双带线锚钉前交叉韧带止点足印重建治疗胫骨髁间嵴撕脱骨折

目的:探讨关节镜下复位、双带线锚钉前交叉韧带(ACL)止点足印解剖重建治疗胫骨髁间嵴撕脱骨折的手术方法及临床疗效。方法:2009年4月～2011年4月,对15例胫骨髁间嵴撕脱骨折患者在关节镜下行骨折解剖复位、双带线锚钉ACL止点足印解剖固定术。胫骨髁间嵴撕脱骨折的Meyers-McKeever分型:Ⅱ型8例,Ⅲ型5例,Ⅳ型2例;男12例,女3例;年龄21～57岁,平均30.6岁。术前前抽屉试验及Lachman试验均呈阳性,Lysholm评分为(49.9±3.7)分,IKDC 2000主观膝关节评分为(53.3±5.3)分。结果:患者均获随访,随访时间9～15个月,平均12个月。术后6个月X线片复查示髁间嵴骨折均愈合,骨折复位良好。末次随访时,患肢膝关节活动范围达0～120°;Lysholm评分为(89.6±3.2)分,IKDC2000主观膝关节评分为(90.8±5.7)分,两项评分与术前比较差异均有统计学意义(t1=22.100,t2=20.700,P=0.000)。结论:关节镜下复位、双带线锚钉ACL止点足印解剖重建治疗胫骨髁间嵴撕脱骨折,有利于实现ACL胫骨止点解剖原点重建,对于恢复ACL正常生理功能有重要意义。     

关节镜下治疗胫骨平台骨折合并前交叉韧带胫骨止点撕脱骨折和半月板根部撕脱骨折的经验分享

目的：描述一例胫骨平台骨折合并前交叉韧带胫骨止点撕脱骨折和半月板根部撕脱骨折和内侧副韧带损伤的病例成功治疗,对此类患者手术方式和康复方案提供了一种参考。病例描述：患者男性,35岁,以“跌倒致右膝肿痛、活动受限1天”为主诉来我院就诊。骑电动车摔倒后右膝关节疼痛,活动受限。完善检查诊断：1、右膝胫骨髁间棘骨折;2、右膝前交叉韧带损伤3、右外侧胫骨平台骨折;4、右膝外侧半月板损伤;5、右膝内侧副韧带损伤。行联合关节镜手术治疗。结果：患者3个月骨折愈合,逐渐恢复到正常生活中。结论：我们的联合关节镜技术能够很好的治疗胫骨平台骨折合并前交叉韧带胫骨止点撕脱骨折和半月板根部撕脱骨折和内侧副韧带损伤的病人。     

关节镜下治疗髁间嵴撕脱性骨折

关节镜下治疗髁间嵴撕脱性骨折夏春张祥生代刚孙正义闵坤山前十字韧带起于髁间嵴的前外部，外侧半月板前角与髁间嵴相连．髁间嵴撕脱性骨折错位时，会使前十字韧带功能丧失及外侧半月板前角损伤，因此，多主张手术治疗［１～４］．关节镜下治疗髁间嵴撕脱性骨折，只有极少...     

交通伤后胫骨髁间棘撕脱性骨折关节镜下治疗

目的 探讨交通伤后胫骨髁间棘撕脱骨折在关节镜下复位、PDS-Ⅱ线固定的治疗方法.方法 在2005年2月～2009年12月间,我科共治疗36例交通伤后急性胫骨髁间棘撕脱骨折.男性25例,女性7例;平均年龄27.5岁(11～55岁).其中Ⅱ型9例(25%),Ⅲ型20例(56%),Ⅳ型7例(19%).手术采用关节镜下骨折复位...     

关节镜下Ethibond缝线联合Endobutton钢板治疗膝前交叉韧带下止点撕脱骨折

目的探讨关节镜下Ethibond缝线联合Endobutton钢板固定治疗前交叉韧带下止点撕脱性骨折的可行性及近期疗效。方法2010年7月～2012年8月对23例膝前交叉韧带下止点撕脱骨折患者行关节镜下Ethibond韧带缝线联合Endobutton带袢钢板止点重建术,男性16例,女性7例;年龄25～66岁,平均38．5岁。术中使用Ethibond缝线,横穿撕脱骨折腱骨联合区,经韧带两侧胫骨骨隧道拉到胫骨内下方,固定在胫骨前方Endobutton钢板上。结果手术时间45—70min,平均55min。23例均随访11—24个月,平均17．5个月。术后6个月,所有骨折均获愈合,未出现骨折移位及膝关节不稳;Lysholm膝关节功能评分86～97分。结论关节镜下韧带缝线联合Endobutton带袢钢板治疗膝前交叉韧带下止点撕脱骨折,操作简便,效果可靠。     

关节镜下缝线固定治疗后交叉韧带胫骨止点撕脱骨折

后交叉韧带 (PCL)胫骨止点撕脱骨折治疗较为棘手。对于骨块较大的撕脱骨折 ,一般经膝关节后路行切开复位内固定 ,该方法创伤较大 ,难以同时处理关节内的合并损伤 ;对于骨块较小的撕脱骨折 ,由于内固定难以实施 ,多主张采用保守治疗 ,骨块复位不佳往往导致PCL松弛或者功能不全 ,最终影响膝关节功能。近年由于关节镜技术的进展 ,在关节镜下进行骨折的复位固定已经实现。关节镜下治疗PCL胫骨止点撕脱骨折虽然有一定的难度 ,但因其创伤小、监控直接 ,加之采用缝线技术 ,复位和固定可靠 ,适用于不同大小骨块的撕脱骨折 ,故有利于膝关节功能的…     

关节镜下带线锚钉与空心拉力螺钉内固定治疗胫骨髁间嵴撕脱骨折的疗效评价

目的对比分析关节镜下不同内固定方法治疗胫骨髁间嵴撕脱骨折的疗效,为临床治疗提供参考。方法选取钦州市中医医院骨科2014年5月—2015年7月收治的胫骨髁间嵴撕脱骨折患者42例为研究对象,随机抽签法分为锚钉组和螺钉组各21例,锚钉组患者行关节镜下带线锚钉治疗,螺钉组患者行关节镜下空心拉力螺钉内固定治疗,观察两组患者术后切口愈合、膝关节功能变化以及膝关节活动范围。结果两组患者术后切口均I期愈合,无感染情况出现。术后均成功获得随访,随访时间1年以上,术后即刻X线检查示骨折复位良好。术后3个月复查骨折均骨性愈合,无患肢功能障碍。术前两组患者膝关节功能评分差异无统计学意义(P0.05),术后膝关节功能评分均显著提高(P0.05),但锚钉组膝关节功能评分(92.97±3.15)与螺钉组(89.94±3.28)差异无统计学意义(P0.05)。术前两组患者膝关节活动范围差异无统计学意义(P0.05),术后膝关节活动范围显著增加(P0.05),但锚钉组膝关节活动范围(120.6±11.0)与螺钉组(118.5±10.7)差异无统计学意义(P0.05)。结论胫骨髁间嵴撕脱骨折关节镜下带线锚钉和空心拉力螺钉内固定治疗均有很好效果,带线锚钉固定无需二次手术取出,操作简单。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.