肱骨髁间骨折的手术治疗

肱骨髁间骨折系关节内骨折，多发于青壮年，具有发生率低、肘关节缺少骨性阻挡、血管神经系统易因外伤而受损，以及骨折难以整复、固定等特点而被认为是上肢骨折治疗中难度最大之一。本院自１９８８年７月至２０００年１２月，对２１例骨折采用手术治疗，收到了满意效果。临床资料１．一般资料：２１例患者中，男性１４例，女性７例；年龄１３～６５岁，平均年龄３５．５岁；车祸伤６例，自行车伤９例，坠落伤２例，跌伤４例。按RiseboroughandRadin犤１犦骨折分类法，I型：肱骨小头与滑车之间的骨折无移位；Ⅱ型：肱骨小头与滑车骨折有分…     

手法复位夹板固定治疗肱骨髁间骨折21例

手法复位夹板固定治疗肱骨髁间骨折２１例山西省介休市正骨专科医院（０３１２０２）冀尔年我们采用手法复位、夹板固定法治疗肱骨髁间骨折２１例，报告如下。临床资料本组２１例中男１５例，女６例；年龄１５～６３岁；左９例，右１２例；伸直型１８例，屈曲型３例；伸直...     

成人肱骨小头冠状面骨折的手术治疗

[目的]探讨采用手术治疗成人肱骨小头冠状面骨折的固定方法和疗效。[方法]自2001年1月-2005年7月，采用手术切开直视下复位骨折，分别于肱骨小头、滑车置人螺钉固定治疗肱骨小头骨折6例。男2例，女4例，年龄27—48岁，平均38岁，左侧4例，右侧2例。所有患者均为新鲜闭合性骨折，无神经、血管损伤。手术时间为伤后3—9d。[结果]6例手术中均无血管、神经损伤，术后伤口Ⅰ期愈合，X线片显示骨折解剖复位。全部病例均获得随访，随访时间为术后12—52个月，平均32个月。骨折临床愈合时间为6—9周，平均7周。未见肘关节骨化性肌炎、肱骨小头缺血性坏死等并发症。疗效评估在使用Broberg—Morrey评分系统标准进行评价，结果极好5例，好1例。[结论]肱骨小头冠状面骨折应行切开复位内固定术，达到解剖复位和牢固固定并早期行肘关节主动伸屈功能锻炼，疗效满意。     

无头加压空心螺钉内固定治疗肱骨小头冠状面骨折

目的探讨应川无头加压空心螺钉内固定治疗肱骨小头冠状面骨折的疗效。方法选择2009年1月至2010年12川膻川无头JJnJ-t（空心短螺纹螺钉内固定治疗Bryan—MorreyIV型骨折12例，男9例，女3例；年龄18～39岁，平均27岁、3例患者合并部分桡神经损伤，均表现为虎口区感觉减退，无运动功能损伤症状，合并桡骨小头软骨轻度损伤2例，合并桡骨颈部位环状韧带部分损伤1例。所有患者均在伤后48～72h内手术治疗，术后24～48h开始件肘关节活动支具保护下进行肘关节功能练习。结果伞部患者获得24～30个月随访，术后6～10周CT检查证实骨折获得满意的临床愈合，随访24个月未发现肱骨小头坏死。按照Broberg—Morrey肘关节功能评分标准评价，术后3个月时优11例，良1例；术后24个月时优12例。3例合并部分桡神经损伤患者均在手术后2～3周完全恢复神经功能结论九头加压窄心短螺纹螺钉川于治疗肱骨小头冠状面骨折，可以提供牢固、稳定的固定并允许早期肘关节功能练习。     

肱骨小头骨折的诊治（附28例报告）

肱骨小头骨折少见，易发生误诊误治，本文报告收治２８例肱骨小头骨折，入院前误诊１２例，误诊率４２．８％。ｘ线侧位片能明确诊断，需与肱骨外髁骨折相鉴别。治疗方法有手法复位，开放复位内固定，肱骨小头切除术等，根据具体情况选择应用。     

BOLD螺钉治疗肱骨小头合并肱骨滑车骨折

目的提高对肱骨小头合并肱骨滑车骨折的认识,掌握其诊断与治疗要点。方法回顾分析采用后路鹰嘴截骨入路,BOLD螺钉内固定治疗的肱骨小头合并肱骨滑车骨折5例的临床资料,分析其受伤机制、分型、诊断和治疗。结果本组获1~3年的随访,术后骨折对位对线良好,8～10周骨折愈合,随访末期,功能恢复满意。结论对肱骨小头合并肱骨滑车骨折要早期明确诊断和治疗,采用BOLD螺钉内固定,结合早期功能练习能得到满意疗效。     

肱骨小头冠状面骨折16例疗效分析

[目的]探讨肱骨小头骨折的临床诊断特点及手术治疗效果。[方法]1996～2005年间手术治疗的肱骨小头骨折16例,其中男6例,女10例;年龄18～54岁,平均36.6岁;按Bryan-Morrey分型Ⅰ型8例,Ⅱ型8例。手术经前方入路,骨折复位后拉力螺钉固定;骨折块过于细小则行骨块切除。[结果]随访时间8～24个月,平均16个月。骨折临床愈合时间2～3月。随访未发现肱骨小头缺血坏死,4例有创伤性关节炎表现,平均Mayo评分86分。[结论]肱骨小头骨折的治疗需综合分型计划手术;经肘前方入路牢固固定,早期锻炼可获较好功能。     

肘关节前侧入路治疗单纯肱骨小头冠状面骨折

目的探讨肘关节前侧入路治疗单纯肱骨小头冠状面骨折的疗效。方法自2000年1月～2004年12月采用肘关节前侧入路治疗单纯肱骨小头冠状面骨折患者6例,其中男4例,女2例,平均年龄36岁。结果术后6例患者随访6个月～3年,6例骨折均骨性愈合,无骨折缺血坏死,肘关节功能均为优良。结论肘关节前侧入路骨折端暴露满意,复位及实施内固定容易。     

肱骨小头骨折的手术疗效分析

[目的]探讨肱骨小头骨折手术治疗的疗效及其影响因素.[方法]自2006年1月～2009年5月采用切开复位内固定治疗29例肱骨小头骨折,其中空心钉固定18例;可吸收钉固定4例;空心钉结合可吸收钉固定4例;克氏针固定1例;克氏针结合可吸收钉固定1例;克氏针结合星形钢板固定1例.[结果]本组28例病人,29肘随访时间平均26.2个月(11 ～37个月),骨折于随访期内全部愈合.Ⅰ型对比Ⅲ型和Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异有统计学意义(分别t=3.411,P=0.004;t=3.327,P=0.005).Ⅲ型对比Ⅳ型肱骨小头骨折术后肘关节平均伸曲度的差异无统计学意义(分别t=-0.278,P=0.784).本组出现3例异位骨化,2例迟发性尺神经炎,无肱骨小头缺血性坏死病例.按照Broberg和Morrey的肘关节评分标准进行评分:优13例;良11例;可5例,优良率82.76％.[结论]Ⅰ型肱骨小头骨折手术解剖复位内固定,早期功能锻炼能达到满意疗效,Ⅲ、Ⅳ型肱骨小头骨折常合并肘关节其他骨折,肘关节韧带损伤或肘关节脱位预后较差.     

肱骨小头骨折的手术治疗

肱骨小头骨折是肱骨远端冠状面骨折，好发于青少年，复位和固定均较困难，若处理不当，易遗留肘关节疼痛、畸形和功能障碍。本院自1998年1月至2006年6月，采用肘前和肘外侧入路两种不同的手术方法治疗了肱骨小头骨折14例，收到了满意的效果。现报告如下。     

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.     

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。     

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 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.