尺骨鹰嘴截骨入路手术治疗成人C型肱骨髁间骨折的疗效观察

目的探讨C型肱骨髁问骨折经尺骨鹰嘴截骨入路手术治疗的临床疗效。方法对16例肱骨髁间C型骨折,采用经尺骨鹰嘴截骨入路双钢板内固定。男9例,女6例;年龄18～72岁,平均36．9岁。结果对本组患者随访3—36个月,骨折及尺骨鹰嘴截骨均未发现不愈合。按照Mayo评分为0～100分,平均81．25分,优8例,良5例,可2例,差1例。结论经尺骨鹰嘴截骨入路切开复位内固定治疗肱骨髁间粉碎性骨折的疗效满意,截骨方法对术后功能无明显影响。坚强固定和早期功能锻炼有利于肢体功能恢复,是治疗肱骨髁间骨折的首选方法之一。     

鹰嘴截骨入路双钢板固定治疗肱骨髁间骨折

目的：探讨尺骨鹰嘴截骨入路应用肱骨内、外髁双钢板治疗肱骨髁间骨折的方法和临床疗效。方法：2001年6月至2007年3月采用尺骨鹰嘴截骨入路结合肱骨内、外髁双钢板治疗肱骨髁间骨折38例,男24例,女14例;年龄19～48岁,平均37岁;全部病例均为闭合性骨折。根据A0肱骨髁间骨折分型：C1型12例,C2型20例,C3型6例。受伤至手术时间6h～14d,平均7d。结果：38例患者均获得随访,时间5个月～2年,平均12个月。1例切口愈合欠佳,经换药治疗后愈合。骨折均已愈合,无骨不连发生,无内固定松动及断裂。愈合时间12-22周,平均15周。根据改良的Cassebaum评价标准评价肘关节功能：优15例,良17例,可5例,差1例。结论：经尺骨鹰嘴截骨入路显露骨折充分,肱骨内、外髁双钢板固定肱骨髁间骨折牢固可靠,早期功能锻炼是提高疗效的关键因素。     

改良尺骨鹰嘴截骨治疗肱骨髁间骨折

目的:探讨改良尺骨鹰嘴截骨治疗肱骨髁间骨折的手术方法和疗效。方法:2007年5月至2012年12月采取改良尺骨鹰嘴截骨入路治疗肱骨髁间骨折32例,男21例,女11例;年龄18~65岁,平均46.3岁;右侧19例,左侧13例。AO分型,C1型7例,C2型11例,C3型14例;开放性骨折5例(GustiloⅠ型3例,GustiloⅡ型2例)。6例合并其他处骨折,4例合并尺神经损伤,2例合并桡神经损伤。术后定期复查及X线检查,按Cassebaum评分系统评定肘关节功能。结果:32例均获随访,时间9个月~5年,平均1.9年;截骨块愈合时间6~10周,平均7.4周。未发生尺骨鹰嘴关节内骨折,无截骨块不愈合。2例肘后内固定隆起处屈肘轻度疼痛不适,1例骨折块松动,2例出现异位骨化。肘关节功能评定:优19例,良8例,可4例,差1例。结论:改良尺骨鹰嘴截骨治疗肱骨髁间骨折具有不侵袭关节、术中截骨简便、固定简单、截骨块力学稳定性好、截骨并发症发生率低等优点。     

两种手术入路治疗肱骨髁间骨折疗效分析

目的评价尺骨鹰嘴截骨入路与肱三头肌舌形瓣入路治疗肱骨髁间骨折手术疗效。方法手术治疗56例肱骨髁间骨折,行尺骨鹰嘴截骨入路32例,肱三头肌舌形瓣入路24例。结果对于AO/ASIF分型C1C2型肱骨髁间骨折,尺骨鹰嘴截骨入路比肱三头肌舌形瓣入路手术时间长,但骨折暴露充分。对于C3型骨折,两种入路手术时间相近,前者肘关节功能评分比后者显著较高。结论尺骨鹰嘴截骨入路治疗肱骨髁间骨折暴露充分,术后肘关节功能优于肱三头肌舌形瓣入路。     

经尺骨鹰嘴关节外斜行截骨治疗肱骨髁间骨折

目的介绍经尺骨鹰嘴关节外斜行截骨入路治疗肱骨髁间骨折的手术方法和临床疗效。方法1999年2月～2004年12月采用经尺骨鹰嘴关节外斜行截骨入路重建钢板内固定治疗12例肱骨髁间骨折患者,按AO分型：C1型2例,C2型6例,C3型4例。术后3～7d开始主、被动关节功能锻炼。结果12例患者术后获6～36个月(平均14个月)随访。按HSS评分标准评定疗效：优6例,良5例,一般1例。所有患者截骨块均愈合,未见截骨块移位及畸形愈合。2例诉鹰嘴处钢丝尾部隆起部轻度不适。1例关节活动角度欠佳。结论经尺骨鹰嘴关节外斜行截骨入路具有操作简便、固定牢固、力学性能优良、有利于术后早期功能锻炼及并发症发生率低等优点,该入路治疗肱骨髁间骨折疗效优良。     

改良空心钉联合张力带内固定在肱骨髁间骨折尺骨鹰嘴截骨入路手术中的应用

目的探讨尺骨鹰嘴截骨入路改良空心钉联合张力带内固定在肱骨髁间骨折手术治疗中的应用。方法回顾性分析自2013-07—2018-07采用尺骨鹰嘴截骨入路内固定术完成尺骨鹰嘴截骨修复重建的7例肱骨髁间骨折,术中使用6.5 mm空心钉与张力带修复截骨。结果 7例均顺利完成手术,5例获得随访,2例失访,随访时间平均46.4(20～92)周。未出现血管神经症状、切口感染、截骨处骨折再移位、骨折不愈合等并发症。骨折愈合时间平均14.4(11～20)周。末次随访时Mayo肘关节功能评分平均80(70～90)分。结论采用尺骨鹰嘴截骨入路内固定术在肱骨髁间骨折的手术治疗中可以取得满意疗效,术中使用6.5 mm空心钉与张力带修复截骨固定坚强、并发症少,值得临床推广。     

老年肱骨髁间骨折经尺骨鹰嘴截骨手术治疗的研究

目的探讨老年患者肱骨髁间骨折经尺骨鹰嘴截骨手术内固定的临床疗效。方法对2007年7月至2009年7月收治的22例老年肱骨髁间骨折行尺骨鹰嘴截骨切开复位双钢板内固定治疗的临床效果进行回顾性分析。男8例,女14例;年龄60～79岁,平均69．2岁。按Riseborough分型,Ⅰ型2例,Ⅱ型6例,Ⅲ型10例,Ⅳ型4例。术后采取影像学、Mayo肘关节功能评分、上肢肩手功能障碍评分进行评价。结果所有患者均获随访,随访时间12．6～35．8个月,平均25．7个月。X线片显示肱骨远端前倾角12°～28°,平均22°,关节面台阶均小于2mm。除了1例严重肘关节功能障碍外。其余肘关节平均屈曲角度为106°,平均伸直角度丢失25°。Mayo评分为50～94分,平均77．2分,优5例,良10例,可3例,差4例,优良率为68．2％。上肢肩手功能障碍评分为24．7分。并发症包括2例肱骨髁上延迟愈合伴内固定失效,1例鹰嘴骨不连,1例严重的肘关节僵硬,2例尺神经麻痹。结论经尺骨鹰嘴截骨双钢板内固定治疗老年肱骨髁间骨折可以获得较好的关节功能恢复,但手术治疗在老年患者严重骨质疏松且骨折粉碎严重时需要慎重。     

尺骨鹰嘴V型截骨AO重建钢板治疗复杂肱骨髁间骨折

目的：探讨尺骨鹰嘴V型截骨入路加AO重建钢板治疗复杂肱骨髁间骨折的疗效。方法：对54例肱骨髁间骨折患者1周内采用尺骨鹰嘴V型截骨入路加AO重建钢板治疗,术后3 d内行肘关节被动活动,1周后开始肘关节主动功能锻炼。结果：术后随访1～20个月（平均16个月）,关节功能采用Cassebaum方法评价,优32例,良19例,可2例,差1例。结论：尺骨鹰嘴V型截骨入路加AO重建钢板内固定治疗复杂肱骨髁间骨折,可获得满意疗效。     

经尺骨鹰嘴截骨入路双钢板内固定治疗肱骨髁间粉碎骨折

目的探讨肱骨髁间粉碎骨折经尺骨鹰嘴截骨入路双钢板内固定的疗效。方法采用尺骨鹰嘴截骨、骨折复位解剖型双钢板内固定治疗肱骨髁间粉碎骨折15例。结果15例随访6—24个月,骨折均愈合。按改良Cassebaum评分系统评分：优6例,良6例,可2例,差1例。结论采用尺骨鹰嘴截骨、关节面解剖复位、双钢板固定治疗肱骨髁间粉碎骨折临床疗效良好。     

AO双接骨板系统治疗肱骨髁间骨折

目的探讨尺骨鹰嘴截骨入路AO双接骨板系统治疗肱骨髁间骨折的方法和临床效果。方法采用尺骨鹰嘴截骨入路AO双接骨板系统治疗27例肱骨髁间骨折患者。观察术后骨折愈合情况、临床疗效、并发症情况。结果患者均获随访,时间6～24个月,骨折全部愈合,愈合时间4～6个月。术后1周切口感染1例,骨化性肌炎(BrookⅠ度)2例。无尺神经损伤、接骨板螺钉断裂等情况。肘关节功能根据Cassebaum评分系统:优8例,良14例,可3例,差2例。结论尺骨鹰嘴截骨能为肱骨髁间骨折手术提供满意的术野暴露,而双接骨板系统能提供足够坚强的稳定性,是治疗肱骨髁间骨折安全有效的方法,临床疗效满意。     

Hazards and complications of endoscopic transurethral ureterolithotripsy and lithoextraction and means of prevention

Complications related to ureterolithotomy and ultrasonic ureterolithotripsy performed under the control of visual endoscope were analyzed in 86 ureterolithiasis patients, methods of their prevention discussed. All the aforementioned complications were distributed into three groups: inapplicability of surgery due to anatomic and functional defects of lower and upper urinary tracts, intraoperative, and postoperative complications. The commonest ones were ureteral abruption and perforation, acute pyelonephritis, temporary vesicoureteral reflux. Their control measures were considered as relative methods of treatment: immediate surgical intervention in case of ureteral abruption, renal catheterization in patients with insignificant ureteral perforation or acute pyelonephritis. Adequate ureteroscopy, careful consideration of pro- and contraindications, catheterization of renal pelvis and urinary bladder performed within 2-3 days after the surgery and adequate antibacterial therapy are the most decisive steps in the control of aforementioned complications.     

牙体牙弓颌骨阻力中心及其临床意义

牙体、牙弓及颌骨的阻力中心在正畸矫治力系统中具有重要的意义,也是正畸学领域争论较多的一个问题。Dermaut等研究表明,当力作用于物体阻力中心时,物体将发生平动,否则将发生平动和转动的复合运动。目前,国内外多数学者认为牙体、牙弓及颌骨存在阻力中心,但其位置存在争议。本文就牙体、牙弓及颌骨的阻力中心及其临床意义作一综述。     

Characterisation and differentiation of chondroblastomas and chondromyxoidfibromas - presence and expression of collagen types I and II

AIM: Chondroblastomas and chondromyxoidfiibromas are rare benign skeletal neoplasms with reported overlapping histology. Aim of this study was to analyse the biochemical composition of the matrix of these tumour entities in order to further characterise the cellular phenotypes of these neoplasms using typical cell biological marker genes. METHODS: The matrix compositions of chondroblastomas and chondromyxoidfibromas were analyzed by HE-histology, histochemistry, and immunolocalization techniques. Cellular gene expression patterns were detected by mRNA in situ hybridization. RESULTS: Chondroblastomas are rich in collagen type I and show foci of an osteoid-like matrix, whereas collagen type II as a typical marker of chondrocytic differentiation was not detected in any of the specimens. Chondromyxoidfiibromas had foci of chondroid appearance with chondroblastic cellular differentiation characterised by collagen type II expression. CONCLUSION: These results characterise chondroblastomas and chondromyxoidfiibromas as skeletal neoplasms that have a different biology and which can be distinguished by matrix protein expression products: collagen type II, the typical marker of chondroblast differentiation, could only be detected in chondromyxoidfibromas, but not in chondroblastomas. Thus, both neoplasms are clearly different on the cell biological level.     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.