子宫下段高位剖宫产术用于肩先露35例疗效观察

1997年1月-2007年12月,我们对35例肩先露产妇行子宫下段高位剖宫产术,均顺利娩出胎儿,母婴并发症少。现报告如下。     

髋臼骨折的手术治疗体会

1984～1993年,我院经手术治疗髋臼骨折患者16例,体会如下。1 临床资料 男13例,女3例,年龄13～46岁。合并骨盆他处骨折12例,同时伴有股骨骨折者3例,同侧髋关节脱位4例,合并尿道损伤3例,膀胱破裂1例,伴有坐骨神经损伤1例,8例伴有失血性休克。手术均在6～15天内施行,有合并症者先处理合并症,有髋脱位者先试行复位及牵引,合并股骨骨折者术前均行骨牵引,股骨骨折均行加压钢板内     

臀位分娩并脐带脱垂8例处理体会

脐带脱垂是分娩期的严重并发症 ,如不及时处理可致胎儿死亡。近年来 ,我们共发现臀位分娩期间出现脐带脱垂者 8例 ,经及时处理 ,母婴均安全。报告如下。临床资料 :本组 8例年龄 2 4～ 33岁 ,初产妇 3例 ,经产妇 5例。 8例中足先露 6例 ,混合先露 2例。脐带脱垂发生于第一产程 7例 (其中发生于宫口开大 4 cm前 4例 ,宫口开大 5～ 7cm2例 ,宫口近开全 1例 ) ,第二产程 1例。宫口开大 7cm以前发生脐带脱垂的 6例均行剖宫产术 ,新生儿 1分钟 Apgar评分 >7分。宫口近开全的 1例为经产妇 ,静推 6 54- 2 10 mg后 ,行会阴侧切及臀位牵引术 ,新生儿 …     

76例剖宫产术中应用剖宫产产钳解决娩头困难

目的探讨剖宫产产钳在解决剖宫产娩头困难中的应用效果。方法将2011年8月~2013年8月在我院行剖宫产术中发生娩头困难,选用剖宫产产钳助产的76例产妇作为研究对象,回顾性分析本组产妇的分娩结局及临床资料。结果本组产妇在应用产钳后,均顺利娩出胎头,胎头娩出成功率100%。新生儿无1例发生颅内出血、颅骨骨折、头皮擦伤等并发症,无死亡病例。76例产妇中,有65.8%都是因胎头高浮而发生胎头娩出困难,胎头高浮是娩头困难的主要原因,其所占比例,显著高于其他原因(手术视野差、胎儿巨大、胎头嵌入盆腔较深、麻醉不佳),P<0.05,差异均具有统计学意义;76例新生儿有89.5%的Apgar评分都≥8分,明显高于4~7分(9.2%)及≤3分(1.3%)者,P<0.05,差异均具有统计学意义。结论在剖宫产术中发生娩头困难时,使用产钳助产能够加快胎头娩出,提高新生儿身体状况,减少新生儿并发症的发生,临床使用安全性较高,可在临床上加以推广。     

腹膜外剖宫产同时选择性切除子宫肌瘤32例临床分析

对于妊娠合并子宫肌瘤患者 ,在剖宫产术中是否同时行子宫肌瘤切除术意见尚不一致 ,采用何种术式才能减少术中出血、降低手术风险及减少术后并发症 ,也是临床探讨的问题。 1 987年 9月～ 2 0 0 0年 9月 ,我院共收治妊娠合并子宫肌瘤患者 82例 ,3 6例有剖宫产指征 ,其中 3 2例行腹膜外剖宫产同时切除子宫肌瘤 ,报告如下。1　资料与方法1 .1　一般资料　本组腹膜外剖宫产同时切除子宫肌瘤 3 2例 ,年龄 2 3～ 40岁 ,平均 2 8岁。初产妇 2 3例 ,经产妇 9例。剖宫产指征 :肌瘤阻碍胎先露下降 7例 ,胎儿窘迫 4例 ,高龄初产 4例 ,臀位 4例 ,巨大儿2…     

产伤性新生儿骨折12例分析

产伤性骨折是难产严重的并发症,对新生儿危害极大。现将我院20年中发生的12例骨折进行回顾性分析。 临床资料:1981～2001年活产分娩16878例,发生新生儿骨折12例,发生率为0.7％。骨折部位:锁骨骨折6例,肱骨骨折4例,股骨骨折2例。其中锁骨骨折并臂丛神经损伤1例;肱骨骨折并桡神经损伤2例。胎龄及胎方位:12例中38～48周8例,41～42周4例。头位10例,臀足位2例。新生儿体重:3000～3500g2例,3600～3800g2例,4000～4500g8例。分娩方式:头位难产助产10例,臂位助产1例,臂位足先露剖宫     

髋关节后脱位合并髋臼后壁骨折的手术治疗

目的观察髋关节后脱位合并髋臼后壁骨折的手术治疗效果。方法选择髋关节后脱位合并髋臼后壁骨折患者12例,先行髋关节脱位闭合复位、胫骨结节骨牵引,进一步行髋关节CT扫描及CT三维重建,确定手术指征;采用Kocher-Langenbeck入路行开放复位内固定治疗,术后行持续胫骨结节骨牵引6～12周,其间行股四头肌舒缩功能锻炼。结果术后随访1～6 a,参照美国矫形外科研究院的髋关节功能评估标准,本组疗效为优10例、良2例。结论髋关节后脱位合并髋臼后壁骨折应先行股骨头脱位闭合复位,确定手术指征后行髋臼骨折开放复位内固定,可取得较好效果。     

新式剖宫产术中胎头娩出困难因素及处理对策

目的分析新式剖宫产术中胎头娩出困难因素及相关处理对策。方法选择2009年5月—2011年5月我院收治的行新式剖宫产术中发生胎头娩出困难的临床病例86例,对其临床资料进行回顾性分析。结果 86例患者中由于胎头高浮者38例,胎头深定者30例,巨大儿11例,麻醉因素4例,切口小3例。结论导致胎头娩出困难的因素较多,在实施新式剖宫产术中,要引起高度注意,减少胎头娩出困难的发生率,提高分娩安全性。     

挤压胸廓法预防新生儿窒息及咽下综合征

新生儿窒息及咽下综合征是产科的棘手难题。笔者根据临床体会提出挤压胸廓法可有效地预防上述两种疾病的发生。现报告如下。１　资料与方法１１　一般资料　选取１９９７年１０月以来我院分娩的８７例新儿,其中单胎妊娠分娩８４例,三胎妊娠分娩３例。顺产２例,余８５例均为难产,包括有妊娠并发症、合并症及分娩期并发症并以产钳助产术、胎头吸引助产术及剖宫产结束分娩者。经阴道分娩２１例,剖宫产分娩６６例。另取同期分娩的８２例为对照组,其中单胎分娩８０例,双胎分娩２例;顺产３例,难产７９例;经阴分娩２０例,剖宫产分娩６…     

对产程活跃期胎头浮动孕妇实行体位干预的效果观察

目的探讨对产程活跃期胎头浮动孕妇实施体位干预的效果。方法选择产程活跃期宫口开大〉3cm、经阴道检查确诊胎头浮动的产妇200例,随机分为观察组和对照组各100例。观察组于宫缩期间取蹲式体位或坐于分娩球上,保持胸部前倾的舒适体位,宫口开大5～6cm时行人工破膜,确定胎方位,宫缩间歇时取坐位休息。对照组取平卧位或侧卧位直至宫口开全。观察两组产程、剖宫产率、产后出血及新生儿并发症发生情况等。结果观察组先露下降速度明显大于对照组,第一产程及总产程时间、产后出血量明显少于对照组,剖宫产率、胎儿及新生儿并发症发生率明显少于对照组（P〈0．05、0．01）。结论对产程活跃期胎头浮动孕妇实行体位干预,可促进自然分娩,降低剖宫产率及新生儿并发症发生率,提高产科质量,但应严格掌握适应证。     

人工关节置换术治疗老年股骨颈骨折81例临床观察

目的探讨人工关节置换术治疗老年股骨颈骨折的临床效果。方法选取2005-08～2011-08老年股骨颈骨折患者81例(其中头下型28例,经颈型26例,头颈型17例,基底型10例),均采用人工关节置换术治疗。结果 1例术前合并有高血压和糖尿病患者,术后24 h脑卒中死亡。1例脱位属DorrⅠ类,经徒手复位成功,继用皮牵引治愈。其余79例术后1周左右可扶拐下地部分负重行走,1个月后可逐步弃拐行走,2个月后髋关节功能活动基本正常。80例患者伤口一期愈合。按sanders评分标准优46例(56.8%),良25例(30.9%),可9例(11.1%),差1例(1.2%),平均得分为50分。结论人工关节置换术治疗老年股骨颈骨折优良率高,且手术时间短,术中出血少,住院时间及卧床时间短,再手术率低,是临床上治疗老年股骨颈骨折的一种有效方法。     

Iliopsoas bursitis-associated femoral neuropathy exacerbated after internal fixation of an intertrochanteric hip fracture in rheumatoid arthritis: a case report

We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present.     

双动人工股骨头置换治疗老年股骨颈骨折

目的股骨颈骨折是老年人常见病，治疗效果不确实，并发症多，我们采用双动人工股骨头置换治疗老年股骨颈骨折，观察其疗效。方法我们在１９８９～１９９４年对６７例老年股骨颈骨折患者采用了６１２所生产的双动人工股骨头。对其中７０岁以上和陈旧性骨折患者３４例，因骨质疏松明显，使用骨水泥固定假体柄，其余患者使用珍珠面的假体柄，并进行了１～６年随访。结果根据Ｈａｒｒｉｓ评分，术后平均９２分，治疗效果优良率为９３％，６２例患者能早期活动，尽快恢复生活自理，无１例感染及下肢静脉栓塞。１例关节脱位，１例骨化性肌炎。另３例为疼痛，其中２例发生松动，假体下沉，１例为假体选择不当。结论双动人工股骨头置换术具有手术方法安全、简单、并发症少，术后关节功能恢复快等特点，是治疗老年股骨颈骨折的有效方法。     

Iliopsoas bursitis-associated femoral neuropathy exacerbated after internal fixation of an intertrochanteric hip fracture in rheumatoid arthritis: a case report

Abstract

We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present.     

Mid-clavicle fracture with dislocation of the ipsilateral acromioclavicular joint treated with Endobutton system: A case report and review of the literature

Rationale:Acromioclavicular joint (ACJ) dislocation combined with ipsilateral midclavicular fracture is extremely unusual and is a high-energy injury to the shoulder. A review of the literature divides the treatment of clavicular fractures is divided into nonsurgical treatment, plates, and intramedullary nailing, while the options for ACJ dislocation are elastic fixation and rigid fixation. However, there is still a lack of consensus about the most appropriate way to treat this shoulder injury. This case report involves a mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification.Patient concerns:A 65-year-old man came to the emergency department after a traffic accident in which he was driving a motorcycle that collided with another motorcycle and his right shoulder collided directly with the ground. Digital radiography (DR) and computed tomography (CT) scans of the right shoulder joint showed mid-clavicle fracture with dislocation of the ipsilateral ACJ, which was classified as type V according to Rockwood classification.Diagnoses:The diagnosis of mid-clavicle fracture with dislocation of the ipsilateral ACJ was confirmed by DR and CT.Interventions:The patient was treated with a clavicle plate combined with the double Endobutton technique.Outcomes:After a 6-month follow up, the patient had excellent results for shoulder range of motion and functional. The patient''s Constant-Murley score is 92.Lessons:Mid-clavicular fracture with a high-energy injury is highly suspicious and requires perfect shoulder CT or bilateral shoulder stress position DR to confirm whether there is a combined ACJ dislocation.     

长柄人工股骨头置换治疗高龄股骨转子间骨折的疗效分析

目的探讨长柄骨水泥型双极人工股骨头置换治疗高龄不稳定性股骨转子间骨折的临床疗效。方法对2005-01-2010-06采用长柄骨水泥型双极人工股骨头置换治疗75岁以上不稳定性股骨转子间骨折62例,平均随访15个月,观察术后并发症、骨折愈合时间、关节功能情况。结果术后53例患者获得随访,无一例死亡;有1例出现下肢深静脉栓塞,经治疗后痊愈出院;无褥疮、肺部感染、髋关节脱位等常见并发症发生。根据Harris评定标准评价：优43例（81．1％）,良7例（13．2％）,可3例（5．6％）,差0例,优良率达94．3％。结论长柄骨水泥型双极人工股骨头置换治疗高龄不稳定性股骨转子间骨折具有创伤小、手术时间短、下地活动早、并发症少、髋关节功能恢复好等优点,是一种较理想的治疗方法。     

The role of subchondral insufficiency fracture in rapid destruction of the hip joint: a preliminary report

OBJECTIVE: The pathophysiology of rapidly destructive arthrosis of the hip joint (RDA) is unknown. The purpose of this study was to document cases of subchondral insufficiency fracture of the femoral head, which has similar clinicoradiologic features to those of early-stage RDA. METHODS: This study was based on a retrospective review of 11 cases of subchondral insufficiency fracture of the femoral head that were confirmed histopathologically and for which radiographs both at the onset of hip pain and at the time of surgery were available. RESULTS: All patients were > 60 years of age (range 61-78 years, mean age 69), and 9 were women. On plain radiographs, the normal joint space had undergone rapid narrowing and/or disappeared within 9 months (mean 5.8 months). Magnetic resonance imaging, available in 2 cases, showed a pattern of bone marrow edema from the upper portion of the femoral head to the intertrochanteric region, with an associated focal low-intensity band on T1 paralleling the articular surface. In all cases, evidence of subchondral insufficiency fracture was confirmed histopathologically. In addition, in the marrow space, there were several round-to-oval granulomatous foci, which consisted of amorphous debris, fragmented bone, and articular cartilage surrounded by reactive histiocytes and giant cells. All 11 patients were osteopenic, as shown both radiologically and histopathologically. CONCLUSION: Subchondral insufficiency fracture resulting from osteopenia may lead to a rapid breakdown of the hip joint.     

空心钉内固定治疗1型糖尿病合并股骨颈骨折的临床观察

目的观察空心钉内固定治疗1型糖尿病合并股骨颈骨折的临床效果。方法通过2008年3月—2013年9月,该院对37例股骨颈骨折合并1型糖尿病患者行空心钉内固定术,统计其预后情况。结果 37例中有1例出现股骨头缺血坏死塌陷,1例出现骨折不愈合,其余35例全部骨性愈合,骨折愈合率94.6%,且髋关节功能恢复良好。结论空心钉内固定治疗1型糖尿病合并股骨颈骨折,具有手术操作简单、内固定可靠、愈合率高、创伤小、费用低等优点,是目前治疗1型糖尿病合股骨颈骨折较为理想的方法。     

Traumatic hip dislocation in a child

Traumatic dislocation of the hip joint is relatively uncommon in children. The trauma required to produce a dislocation can vary from minimal to severe, high-energy force. We report a case of posterior hip dislocation in a 9-year-old boy who received relatively minor trauma to his leg but who did not seek medical attention for more than 24 hours. The child's hip was reduced without significant sequelae. Delay in reduction greatly increases the likelihood of later complications, including avascular necrosis of the femoral head.     

Acute destruction of the hip joints and rapid resorption of femoral head in patients with rheumatoid arthritis

We report three rheumatoid arthritis (RA) cases with acute destruction of hip joint and rapid resorption of femoral head. The condition occurred in less than 6 months and closely resembled rapid destructive coxarthrosis. All three patients were postmenopausal women with active RA who had been taking steroids. Two of the patients were taking prednisolone (PSL) of over 20 mg as maximum dose per day, and all patients were resistant to disease-modifying anti-rheumatic drugs (DMARDs). Other than the problems of their hip joints, one had a giant bursitis around the pathological side of the hip joint, another had multiple rheumatoid nodules and skin infarction, and the other suffered from insufficiency fracture of the contralateral femoral subcapital lesion. As a result, all of them had total hip arthroplasty. We recommend taking repetitive radiographs for RA patients with continuing severe hip pain.