肘关节"恐怖三联征"并桡骨轴向脱位一例

肘关节"恐怖三联征"是肘关节的一种严重损伤,桡骨轴向脱位又称Essex-Lopresti损伤.极易漏诊,两者合并出现临床罕见.笔者2008年4月收治1例肘关节"恐怖三联征"并桡骨轴向脱位.现报告如下.     

肘关节恐怖三联征的治疗策略

目的探讨肘关节"恐怖三联征"的治疗方法。方法对11例肘关节"恐怖三联征"患者均采用手术内固定治疗,并修补肘内外侧副韧带,术后屈肘90°前臂旋转中立位石膏外固定3周,开始功能锻炼。结果随访5～36个月,按Broberg-Morrey肘关节功能评分标准:优5例,良3例,可2例,差1例。结论肘关节"恐怖三联征"应采取手术治疗,尽可能恢复骨性解剖结构、修复关节囊及侧副韧带,术后早期功能锻炼,恢复关节功能。     

肘关节恐怖三联征10例手术治疗体会

[目的]介绍肘关节"恐怖三联征"的治疗体会。[方法]回顾了10例肘关节脱位合并桡骨小头和冠状突骨折("恐怖三联征")病人的治疗,手术方法包括:尽可能的固定冠状突骨折,固定桡骨小头,修复相关的关节囊和外侧韧带损伤,必要时修复内侧副韧带和辅助外固定。采用Mayo肘关节功能评分标准进行疗效评估。[结果]肘关节Mayo评分平均得分75%,优3例,良5例,可2例,优良率80%。[结论]对肘关节"恐怖三联征"的损伤机制的充分认识,并重建其稳定性可以获得更好的术后功能。     

肘关节恐怖三联征术后肘关节僵硬的危险因素分析

目的探究肘关节恐怖三联征切开复位内固定术后肘关节僵硬的危险因素。方法回顾性分析自2015-01—2018-12采用切开复位内固定治疗的100例肘关节恐怖三联征,30例术后肘关节活动范围屈伸/旋转<100°(僵硬组),70例术后肘关节活动范围屈伸/旋转≥100°(非僵硬组)。分析年龄、性别、骨折分型、损伤是否优势侧、损伤能量、受伤至手术时间、术后制动时间、桡骨头内固定构型、是否服用抗异位骨化药物与肘关节恐怖三联征术后肘关节僵硬的相关性。结果单因素分析结果显示2组在损伤能量、受伤至手术时间、术后制动时间、术后使用抗异位骨化药物比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示高能量损伤、受伤至手术时间>1周、术后制动时间>2周是肘关节恐怖三联征术后肘关节僵硬的危险因素。结论高能量损伤、受伤至手术时间>1周与术后关节制动时间>2周是导致肘关节恐怖三联征骨折术后肘关节出现肘关节僵硬的独立危险因素,在临床治疗中应引起重视并谨慎处置。     

铰链式外固定支架治疗肘关节恐怖三联征的临床体会

目的探讨铰链式外固定支架治疗肘关节恐怖三联征的手术方法及疗效。方法选取2008年10月至2012年10月本院利用铰链式外固定支架治疗肘关节恐怖三联征28例,均行肘关节恐怖三联征切开复位内固定结合铰链式外固定支架外固定肘关节。结果全部病例术后随访1～3年,平均2年,采用Mayo肘关节功能评分标准,平均86.5分（78～93分）。优16例,良12例。结论应用铰链式外固定支架辅助治疗肘关节恐怖三联征,可增强肘关节的稳定性,使肘关节早期、安全的功能煅练,利于防止肘关节僵硬,促进骨折愈合及损伤韧带的修复,是一种较好的辅助手术方法。     

肘关节“恐怖三联征”并桡骨轴向脱位一例

肘关节“恐怖三联征”是肘关节的一种严重损伤,桡骨轴向脱位又称Essex—Lopresti损伤,极易漏诊,两者合并出现临床罕见。笔者2008年4月收治1例肘关节“恐怖三联征”并桡骨轴向脱位。现报告如下。     

肘关节恐怖三联征的治疗策略

正肘关节恐怖三联征(terrible triad of the elbow)1996年由Hotchkiss~[1]提出,指的是在肘关节后脱位的同时伴有桡骨头和尺骨冠状突骨折。相较于单纯骨折,恐怖三联征治疗困难,术后并发症较多,一旦处理不当,将严重影响患者的肘关节功能。本文在探讨肘关节恐怖三联征的发病机制、诊断和分型的基础上,重点阐述该病的治疗策略,同时为年轻医师们介绍一些治疗经验和技巧。     

肘关节恐怖三联征研究进展

正Hotchkiss~[1]首先定义肘关节恐怖三联征,即冠状突骨折、桡骨头骨折及肘关节脱位。常见的损伤机制是摔伤时手臂掌心向上、旋后及肘部的外翻应力。恐怖三联征发病高峰是40岁左右的男性,可以并发同侧的桡骨远端、尺骨干和腕骨损伤。恐怖三联征治疗的目标是恢复骨性解剖、韧带重建,为肘部提供足够的稳定性,早期活动以防止肘关节僵硬。肘关节损伤后容易     

肘关节恐怖三联征的手术治疗体会

目的探讨恐怖三联征后肘关节的解剖功能重建对恢复肘关节功能的影响。方法回顾性分析自2003年1月至2008年10月收治的肘关节恐怖三联征13例临床资料,其中男9例,女4例;年龄18～45岁,平均26岁。采用手术切开复位内固定同时修复副韧带,术后早期功能锻炼。结果术后13例均获得3个月～2年随访,平均1．7年。随访发现手术能较好恢复肘关节稳定及功能,并采用Mayo肘关节功能评分,优2例,良7例,可3例,差1例。结论肘关节恐怖三联征骨折同时多伴有侧副韧带撕裂,肘关节严重不稳定,只有在重建了骨关节和软组织结构稳定的基础上进行早期康复锻炼,才能获得较好的功能恢复。手术治疗是治疗肘关节恐怖三联征较好的方法。     

手术治疗肘关节恐怖三联征10例临床观察

[目的]探讨肘关节恐怖三联征的手术方式和术后疗效.[方法]自2007年1月～2011年1月手术治疗肘关节恐怖三联征10例,术后随访9个月～4年,平均26个月.[结果]10例患者均骨折愈合,肘关节稳定,无疼痛.肘关节屈伸幅度平均120°,前臂旋转幅度平均110°.[结论]肘关节恐怖三联征虽然治疗困难,预后差,但是及早诊断,尽可能恢复骨性及软组织解剖结构,早期功能锻炼,仍可达到满意效果.     

Intra-Articular Fractures of the Distal Tibia

In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture.

When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis.

It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.     

Significance of Endogenic Factors in the Location of Fractures of the Proximal Femur

The significance of endogenic factors in the localization of the fractures of the proximal femur was studied in 373 patients, with 402 fractures. A statistically significant relation was found between muscular disturbances of the affected leg and trochanteric fractures, while the incidence of femoral neck fractures was high in osteoporotic but physically active individuals.     

带锁髓内钉治疗股骨干骨折合并同侧胫腓骨骨折

目的 探讨股骨干骨折合并同侧胫腓骨骨折的特点和治疗方法，减少并发症的发生。方法 使用带锁髓内钉早期同时固定胫骨和股骨，治疗11例。结果 随访1～3年，平均2年，根据Karlstroem和Olerud功能评定标准：优8例，良2例，中1例。Gustilo Ⅰ度和Ⅱ度创口均一期愈合，骨折愈合时间4～6个月，患者功能恢复满意。结论 该方法有防止骨折分离和旋转移位的作用，可调整为加压固定，可稳定关节、减少感染，防止骨折畸形愈合和不愈合以及膝关节僵直等并发症。     

A modified technique for the treatment of intra-articular calcaneal fractures with the use of the Ilizarov apparatus

The management of intra-articular calcaneal fractures during the past years has been ranged from the nihilistic approach of no active treatment to open reduction and internal fixation (ORIF) or even to early subtalar arthrodesis. The management of such fractures with the use of circular external fixators in a closed fashion or in combination with minimal approach is demonstrated in our study. The midterm results of 36 intra-articular calcaneal fractures treated between 1996 and 2003 with the use of the Ilizarov apparatus according to our modified operative strategy are presented. In treating calcaneal fractures, the classic Essex-Lopresti classification into depression and tongue type has been proved very useful in our hands. While the depression-type fractures can be reduced through skeletal traction and the above-mentioned minimal approach, tongue-type fractures can cause difficulties in reducing and especially maintaining the reduction of the tongue fragment. Especially for these fractures, a combined technique was applied by reducing the fracture with Steinmann pins according to the Essex-Lopresti method and incorporating them into the Ilizarov apparatus. This technique appears to be a lot easier and more accurate than the alternative bent-wire technique for reducing and holding down a tongue fragment. The original Essex-Lopresti manipulation alone with plaster immobilization does not allow weight bearing and is associated with regional osteoporosis. Apart from the Essex-Lopresti classification, the material was also categorized by the widely accepted Sanders CT classification for comparison of our results to those of the literature. The SF-36 patient-oriented general health status questionnaire was utilized before, during, and after the treatment period to assess patients satisfaction levels. We propose this operative strategy as an option for the treatment of all calcaneal fractures.The authors have not received and will not receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.     

非扩髓交锁髓内钉治疗开放性胫骨干骨折

目的:评估非扩髓交锁髓内钉治疗开放性胫骨干骨折的疗效。方法:应用非扩髓交锁髓内钉治疗21例开放性胫骨干骨折。男18例,女3例,年龄23岁～59岁,平均36.3岁。AO/ASIF分类A型10例,B型9例,C型2例。Gustilo分类Ⅰ型9例,Ⅱ型11例,ⅢA型1例。结果:所有患者得到4～21个月随访(平均14.3个月)。所用髓内钉直径平均8.9mm。骨折平均愈合时间27周(13～34周)。采用Johner-Wruh评分,结果优14例,良6例,差1例,无感染,无断钉和骨不连。结论:非扩髓交锁髓内钉治疗开放性胫骨干骨折,只要严格掌握适应证和手术时机,彻底清创,熟练掌握操作技术,具有创伤小、能早期活动、骨折愈合率高和感染率低等优点。     

有限内固定结合外固定支架治疗胫腓骨不稳定性骨折

我院自 1993- 1998年采用小切口螺钉钢丝有限内固定并同时应用单侧多功能外固定支架治疗胫腓骨不稳定性骨折 5 5例 ,疗效满意 ,报告如下。1　临床资料　　本组 5 5例中男 38例 ,女 17例 ;年龄 17～ 65岁 ,平均 4 2 6岁。致伤原因 :摔伤 10例 ,坠落伤 8例 ,压砸伤 13例 ,车祸伤 15例 ,其它伤 9例。开放性骨折18例 ,按Ｇｕｓｔｉｌｏ分类[1] ,Ⅰ型 8例 ,Ⅱ型 7例 ,Ⅲａ型3例 ;其他 37例为闭合性骨折。骨折类型 :短斜型 13例 ,长斜型 16例 ,螺旋型 12例 ,粉碎型 14例 (其中多段骨折 3例 )。骨折平面 :位于胫骨中上段 18例 ,中下段 2 6例 ,下段…     

青少年髌骨骨软骨骨折

目的探讨青少年髌骨骨软骨骨折的临床特征、诊治要点和手术疗效。方法对14例青少年髌骨骨软骨骨折的临床资料进行分析。结果平均随访26.2个月(11个月~4.5年),13例骨折愈合。膝关节功能完全恢复正常12例,膝关节疼痛、活动受限2例。结论青少年髌骨骨软骨骨折易漏诊误诊,详细查体、髌骨轴位X线片及CT薄层扫描是防止漏诊最重要的手段。一经确诊应及早手术,切开复位、应用可吸收螺钉和缝线固定能满足固定要求且不需取内植物,是一种较理想的治疗方法。     

降钙素在老年不稳定型股骨转子间骨折应用

 目的 比较采用股骨近端防旋转髓内钉(proximal femoral nail antirotation, PFNA)联合鲑鱼降钙素与单纯行 PFNA治疗老年不稳定型股骨转子间骨折的临床疗效。方法 前瞻性研究2009年1月至2011年12月,采用PFNA治疗 120例老年不稳定型股骨转子间骨折患者资料。术前随机将患者分为降钙素组(PFNA治疗联合应用鲑鱼降钙素)和对照组(单纯PFNA治疗)。降钙素组60例,男28例,女32例;年龄71~82岁,平均75.1岁;Evans?Jensen分型：ⅡA型20例,ⅡB 型32例,Ⅲ型8例。对照组60例,男27例,女33例;年龄70~83 岁,平均74.9岁;Evans?Jensen分型：ⅡA型22例,ⅡB型32 例,Ⅲ型6例。两组患者均为低能量损伤。术后观察骨折愈合情况,测量健侧髋关节骨密度,记录患者Harris评分及SF?12 量表评分,记录手术相关并发症、药物不良反应与其他部位骨折等情况。结果 113例患者获得至少2年以上的完整随 访,降钙素组55例,对照组58例。除对照组4例骨折延迟愈合外,其余患者术后6个月X线片均示骨折愈合良好;术后1年,所有患者骨折均愈合。术前降钙素组健侧髋部平均骨密度T值为-2.54±0.35,对照组为-2.53±0.27;术后6个月、1年、2年降钙素组健侧髋部平均骨密度T值分别为-1.82±0.27、1.33±0.23、-1.17±0.16,对照组分别为-2.14±0.32、-1.91±0.23 、-2.01±0.27,降钙素组患者骨密度明显提高。术后两组患者Harris评分和术后1年SF?12量表评分比较,差异均无统计学意义 。术后2年两组患者SF?12量表评分比较,差异有统计学意义。降钙素组仅1例患者术后3个月发生桡骨远端骨折,对照组 术后13~23个月,4例发生腰椎压缩性骨折,1例发生桡骨远端骨折,1例发生健侧髋部骨折。结论 PFNA治疗老年不稳 定型股骨转子间骨折具有固定牢靠,骨折愈合率高等优点,而联合鲑鱼降钙素治疗,可有效改善患者骨密度,提高骨折愈 合质量,降低再骨折风险,提高患者生活质量。     

逆行髓内钉固定治疗股骨远端T形骨折

目的探讨逆行髓内钉固定治疗股骨远端T形骨折的手术方法及临床疗效。方法对13例闭合股骨远端T形骨折患者采用膝前正中纵行切口逆行髓内钉内固定术。结果患者均获随访,时间6~24个月,复位均满意,无感染、骨不连、深静脉血栓等并发症发生。骨折愈合时间16~32周。末次随访时按Merchan评分标准评价:优6例,良6例,可1例。VAS评分:静息状态0~3分,负重行走0~4分;膝关节功能HSS评分:78~94分。结论前正中纵行切口逆行髓内钉固定治疗股骨远端T形骨折术野显露清晰,有利于关节面解剖复位、手术操作简便,创伤小,临床疗效确切,是一种很好的手术方法。     

Incidence of Fractures of the Distal Radius and Proximal Femur: Comparison of Patients in a Mental Hospital and the General Population

A statistically significant increase in the incidence of fractures of the distal radius was found in the general population of southern Sweden during recent decades. As regards fractures of the proximal femur, an increase in the incidence of trochanteric fractures was observed only in women. In male patients at a mental hospital the fracture rate of the distal radius was the same as in the general population but the fracture rate of the proximal femur was about twelve times higher. In female patients at the same mental hospital the fracture rate of the distal radius was three times greater and that of proximal femur about seven times greater than that of the general population. This difference may not only be due to an increased skeletal fragility in patients in mental institutions but may also suggest poorer protective mechanisms against falls. Undiagnosed cardiovascular or neurological diseases, for example intermittent cardiac arrhythmia or transient cerebral ischaemic attacks, may cause falls. Early diagnosis and treatment of such diseases may reduce the number of fractures of the proximal femur.