早期肱桡关节闭合穿针内固定治疗成人孟氏骨折

目的 探讨早期经肱桡关节闭合穿针内固定治疗成人孟氏骨折的手术效果.方法 1998年7月～2006年7月我院骨科收治的41例孟氏骨折病人,我们采用尺骨早期切开复位内固定,桡骨小头脱位行手法复位后经肱桡关节闭合穿针固定.结果 41例随访时间12～30个月,平均15.1个月.采用改良Cassebaum评分系统,本组优28例,良10例,可3例,无一例出现感染、尺骨不愈合或畸形愈合,前臂的旋转及肘关节屈伸功能均较满意,3例发生克氏针松动并针尾穿出皮肤.结论 对于成人孟氏骨折采用早期肱桡关节闭合穿针内固定处理桡骨小头脱位,操作简单,效果可靠,为此类骨折的治疗提供了一种新的选择.     

儿童陈旧性孟氏骨折的手术治疗

我院自1996～2000年收治儿童陈旧性孟氏骨折16例,给予尺骨截骨矫形、桡骨头复位固定及环状韧带重建手术,疗效满意,现报告如下.     

儿童陈旧性孟氏骨折手术治疗体会(附26例)

儿童陈旧性孟氏骨折多因漏诊延误治疗造成 ,作者于 1 982～ 1 998年间 ,通过对儿童陈旧性孟氏骨折采用上尺桡关节切开复位环状韧带单纯修补及尺骨斜形截骨延长内固定这一手术方式的治疗 ,取得了较为满意疗效 ,现报告如下。1　临床资料儿童陈旧性孟氏骨折共 2 6例 :男 1 6例 ,女1 0例。左侧 1 2例 ,右侧 1 4例。年龄 3.5～ 1 1岁 ;病程 4周～ 8月。伤因 :摔伤 8例 ,车祸伤 5例 ,机器绞伤 3例 ;合并桡神经损伤 8例。分型 :伸直型 1 8例 ;屈曲型 8例。手术方式 :①上尺桡关节成形术 :上尺桡关节切开复位 ,将脱位的桡骨头复位。取肘后外侧切口 ,…     

外固定架治疗儿童陈旧性孟氏骨折20例分析

目的 探讨外固定架在儿童陈旧性孟氏骨折的治疗中的应用.方法 20例患者均经X线片证实有尺骨近端骨折畸形愈合,桡骨头脱位.均予桡骨头切开复位,尺骨近端截骨、外固架固定.结果 优14例,良4例,差2例,优良率90％.结论 外固定架治疗儿童陈旧性孟氏骨折矫正尺骨畸形更为有效,手术更为容易,骨折愈合后无需二次手术取出内置物.     

儿童陈旧性孟氏骨折：需要重建环状韧带吗？

背景：桡骨头的再次脱位一直是陈旧性孟氏骨折令人担忧的并发症之一,许多治疗方法已描述治疗中骨折和环状韧带重建的需要,但并不明确。
　　目的：通过两组儿童治疗上的对比,从而强调探讨环状韧带重建的实用性。
　　方法：纳入12例陈旧性孟氏骨折儿童并进行前瞻性研究,所有儿童均接受桡骨头切开复位内固定。其中5例儿童接受尺骨延长矫形截骨和环状韧带重建治疗;7例患儿仅行尺骨延长矫形截骨而没有韧带重建治疗;病程从损伤至临床表现为3-18个月(平均9个月)。10例患儿为Bado用Ⅰ型,另外2例分别是Bado Ⅱ、Ⅲ型。治疗前后采用Kim标准评价韧带重建对于治疗的可靠性。
　　结果与结论：12例均获得随访,平均随访22个月(8-26个月)。愈后按照 Kim标准进行评估：优10例,无畸形,无疼痛,关节活动度>250°,无肘关节受限,日常生活活动能力25分）;良2例,轻度畸形,轻度或间歇性疼痛,关节活动度200°-250°,肘关节受限,日常生活活动能力15分;差0例,严重畸形,疼痛,关节活动度<200°,肘关节严重受限,日常生活活动能力0分。随访22个月,所有患儿尺骨截骨平均愈合时间为8周(6-14周)。伤口均一期愈合,无感染及骨不连发生。说明尺骨延长截骨矫形在桡骨头稳定性中具有重要意义,是否行环状韧带重建基于受伤时间、手术方式及术中桡骨头稳定性而定。     

尺骨斜行截骨成角延长术治疗儿童陈旧性孟氏骨折14例临床分析

目的探讨尺骨斜行截骨后成角延长联合金属截骨板内固定术治疗儿童陈旧性孟氏骨折的临床效果。方法 14例陈旧性孟氏骨折患儿,采用尺骨斜行截骨成角延长术将尺骨畸形明显部位斜行截断,矫正尺骨成角及短缩畸形;并应用金属截骨板固定,将桡骨头切开复位后探查修复或重建环状韧带;术后根据Mackay标准进行疗效评定。结果术后随访12~16个月,桡骨头均无再脱位,肘关节活动度较术前明显改善;疗效优10例,良4例。结论尺骨斜行截骨成角延长术联合金属截骨板内固定术治疗儿童陈旧性孟氏骨折疗效确切,可有效恢复肘关节功能、改善前臂旋转及屈曲活动受限。     

手术治疗小儿陈旧性孟氏骨折恢复肘关节及前臂功能

对9例小儿陈旧性孟氏骨折进行切开,复位,环状韧带重建,尺骨截骨钢板内固定术。平均随访14个月,骨折均愈合,无桡骨头再脱位,肘关节及前臂活动均正常。     

手术治疗小儿陈旧性孟氏骨折恢复肘关节及前臂功能

对9例小儿陈旧性孟氏骨折进行切开，复位，环状韧带重建，尺骨截骨钢板内固定术。平均随访14个月，骨折均愈合，无桡骨头再脱位，肘关节及前臂活动均正常。     

尺骨截骨联合Orthofix外固定治疗儿童陈旧性孟氏骨折与护理

<正>孟氏骨折指尺骨上1/3骨折合并桡骨头脱位,儿童常见,易漏诊[1],2个月至14岁均可发病,以6~10岁为发病高峰,占儿童骨折的0.4%~5%。儿童孟氏骨折一旦及时诊断多可采用保守治疗,即手法复位联合石膏托外固定,一般可获得满意的疗效。该种治疗的目的是获得并维持桡骨头解剖复位,若保守治疗不能获得或维持桡骨头的同心圆复位,则需手术治疗[1]。陈旧性孟氏骨折指伤后6周     

陈旧性儿童孟氏骨折19例手术治疗的临床观察

目的探讨陈旧性儿童孟氏骨折的手术治疗方法。方法19例陈旧性孟氏骨折患儿采用Boyd切口显露桡骨近端，行桡骨头复位后用克氏针固定，如尺骨明显成角则截骨延长，并切取长约10cm宽约0．8cm的大腿阔筋膜重建环状韧带，石膏外固定4～6周。结果全部病例得到随访，随访5—36个月，平均18个月。疗效评价：优14例，良4例，差1例，优良率达94．7％。结论陈旧性儿童孟氏骨折手术中用大腿阔筋膜重建环状韧带，固定牢固，不易复位丢失，有利于早期功能煅炼．疗效满意。     

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUNDPulmonary thromboembolism (PTE) is a serious postoperative complication that can occur after a fracture. Generally, PTE is caused by the falling off of lower extremity deep vein thrombosis (LEDVT) after lower limb fracture surgery. LEDVT and PTE after upper extremity fracture surgery are very rare. PTE is one of the most common clinical causes of sudden death. Venous thromboembolism includes PTE and DVT. We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery. The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery, and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARYWe report a 51-year-old Chinese male who had severe fractures of the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third post-operative day, computed tomographic pulmonary angiography showed PTE. Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins. After a period of anticoagulation therapy, on the 25^th d after the PTE, computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared. Furthermore, about 4 mo after the PTE, thrombosis in the deep veins of the lower limbs disappeared. About 1 year after the surgery, X-rays showed good fracture healing, and the function of the wrist joint recovered well.CONCLUSIONThough rare, PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.     

微型钢板置入固定治疗儿童尺、桡骨远端不稳定性骨折18例

目的:观察微型钢板置入固定治疗儿童尺桡骨远端不稳定性骨折的临床疗效.方法:回顾性分析2006-08/2007-09华中科技大学同济医学院附属武汉妇女儿童医院骨科收治的尺、桡骨远端不稳定性骨折患儿18例,男15例,女3例;年龄4岁1个月～13岁3个月,平均9岁8个月,右侧9例,左侧9例;均采用微型钢板代替克氏针置入内固定治疗.术前根据骨折类型和部位选择合适的成人指骨、掌骨、跖骨微型不锈钢或钛钢板,测量骨折线距骺板的距离准备T型、L型、三叶草型或直型钢板.术后及随访时观察关节功能、前臂旋转丢失的程度、骨愈合情况及并发症的发生.结果:全部病例均在门诊获得随访,随访时间平均26.4个月.18例患儿前臂旋前功能有平均10°的受限,功能锻炼后基本恢复,不影响日常活动.旋后功能及腕关节屈伸功能基本恢复正常,骨折全部愈合.无再移位和再骨折、无畸形愈合、延迟愈合以及骨桥形成等并发症,也未见血管和神经损伤.结论:对不能满意复位、复位后不能维持稳定再次移位或陈旧性尺桡骨远端不稳定性骨折,需要开放复位者,用微型钢板内固定避免对前臂远端骨骺的损伤,术后并发症少,只要选择好合适的微型钢板,则可以代替传统的克氏针内固定.     

对桡骨远端粉碎性骨折及关节内骨折患者手术结合中药治疗的疗效评价

目的：评价手术结合中药治疗桡骨远端粉碎性骨折及关节内骨折的方法及疗效。方法：综合分析2000年4月-2003年4月采用不同方法治疗桡骨远端粉碎性骨折及关节内骨折患者的治疗效果。32例患者根据AO原则进行分类，按不同类型骨析相应采用钛板螺钉内固定、简单内固定加外固定架固定及单纯外固定架固定手术治疗，其中7例患者术后加中药外敷。结果：随访了全部患者，功能满意者26例，占81．25％；功能尚可者5例，占15．62％；功能不满意者1例，占3．13％。加敷中药者x线片显示骨折愈合时间及住院时间均显著缩短。结论：经合理的手术方法治疗桡骨远端粉碎性骨折及关节内骨折，能最大限度地恢复桡(尺)骨的相对长度、关节面平整、掌倾角及尺偏角，术后配合合理的锻炼，可以使腕关节功能得到最大恢复，加敷中药有助于骨折的愈合。     

同种异体骨钉治疗髋关节骨折脱位

目的：探讨同种异体骨钉治疗髋关节骨折脱位的疗效。方法：筛选符合检验标准的损献个体，按美国组织库标准制备骨钉，治疗髋臼和（或）股骨头骨折36例（髋臼16例，股骨头12例，髋臼＋股骨头8例），将骨折复位后以骨钉或骨螺钉固定。结果：平均随访23．4个月，除1例股骨头骨折断钉骨折轻度移位外，其余病例在骨折愈合前无移位，按美国骨科学会标准疗效评价，优良率83．3％。结论：同种异体骨钉具有良好的生物相容性，能完全吸收骨化，不需二次手术取出，是髋关节骨折脱位理想的生理型固定材料。     

隐动脉骨膜瓣加髓内钉治疗胫骨骨不连疗效观察

目的：介绍一种应用髓内钉加隐动脉逆行岛状骨膜瓣治疗胫骨骨不连的理想方法。方法：小腿前外侧切口，显露骨折断端，断端清理，剔除硬化骨质，形成新鲜骨创面，打通骨髓腔，维持胫骨干长度，带锁髓内钉固定。解剖膝降动脉，于关节支与隐动脉分叉近侧切断、结扎，切取股骨内髁骨膜瓣，形成隐动脉远端为蒂的骨膜瓣，转移至胫骨断端，同时取股骨内侧髁松质骨移植修复胫骨骨缺损．骨膜瓣与松质骨紧密贴附固定。结果：1998-09～2005-09共治疗胫骨骨不连12例，本组病例均得到随访，骨折均达骨性愈合，效果满意。结论：本术式操作简便、安全，骨膜瓣血运可靠，是一种可供选择的治疗胫骨骨不连的理想方法。     

Minimally invasive treatment of forearm double fracture in adult using Acumed forearm intramedullary nail: A case report

BACKGROUNDCurrently, open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture. However, open reduction is associated with a high risk of complications. This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail. The patient experienced good follow-up outcomes. The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture. Few studies have reported on the use of this approach for the treatment of fractures.CASE SUMMARYA 23-year-old male patient was admitted to hospital after 5 h of pain, swelling, and limited activity of left forearm caused by a careless fall. Physical examination showed stable basic vital signs, swelling of the left forearm, and severe pain when pressing on the injured part of the forearm. Further, friction was felt at the broken end of the bone; the skin was not punctured. Movement of the left hand was normal, and the left radial artery pulse was normal. Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius. The fracture was located in the upper third of the radius, with significant displacement on the fracture side. Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture. After analyzing the fracture pattern, age, and other patient characteristics, we chose an Acumed nail for treatment and achieved good follow-up outcomes.CONCLUSIONAcumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes.     

Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation

Occult dislocations at the wrist and elbow frequently accompany forearm fractures. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both Galeazzi (distal radius fracture with radioulnar joint disruption), and Monteggia (proximal ulna fracture with radial head dislocation) fracture-dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.     

In vivo motion analysis of forearm rotation utilizing magnetic resonance imaging.

OBJECTIVE: To analyse in vivo normal forearm rotation utilizing the image processing method on axial magnetic resonance imaging. DESIGN: Rotatory motion and translation of the radius and rotation of the ulna were analysed in vivo, utilizing features of the bone image; axial centre of gravity and axis of the bone. METHODS: Axial magnetic resonance images at the proximal, middle and distal portion of the right forearms of 20 healthy volunteers were examined in five rotational positions, maximum pronation, 45 degrees pronation, neutral, 45 degrees supination and maximum supination. The axis of forearm rotation, the rotation angle of the radius, the rotation of the radius around its axial centre of gravity, and the rotation of the ulna around its axial centre of gravity were calculated on these axial MR images. RESULTS: The radius rotates in a near-circular ellipse around its rotational centre located on a line through the radial head and the ulnar head from maximum supination to 45 degrees pronation. There was discrepancy between the calculated maximum rotational angle of the radius and the pronation-supination angle showed on the goniometer. This discrepancy was due to motion at the radiocarpal, midcarpal and carpometacarpal joints. The rotation of the ulna ranges within 6 degrees. At maximum pronation, there was palmar translation of the radius. CONCLUSIONS: The forearm rotation is not a simple rotatory motion but a complex motion with rotation and translation. The palmar translation of the radius at maximum pronation may be caused by incongruity of the distal radioulnar joint and contraction of the pronator quadratus muscle. RELEVANCE: To date there exist few methods for the accurate and non-invasive assessment for motion analysis of the forearm rotation. Such a technique utilizing magnetic resonance image characteristics is, however, helpful to reveal accurate self- and relative-rotatory motion of both radius and ulna as well as the translation movement on forearm rotation in normal forearm.     

Persistierende Funktionsstörung des Ellenbogengelenkes nach einer permanenten Luxation des Radiusköpfchens

This article reports the case of a 10-year-old girl with permanent luxation of the capitulum radii after a Monteggia’s fracture. The patient presented with persisting pain and a functional deficiency of the elbow joint. After diagnosing the luxation, an open-wedge osteotomy of the ulna with temporary transfixation of the humeroradial joint was performed. However, after the repositioning of the luxation and the osteotomy of the ulna had healed, the girl suffered from increasing functional deficiency of the elbow joint. Removal of the plate, arthrotomy and arthrolysis of the joint were performed. After using a brachial plexus catheter for the application of local anesthetics for about 5 days, the function of the elbow joint was restored. At 6 months after surgery, a slight functional deficiency of the joint continues. Care should be taken when a posttraumatic functional deficiency in childhood persists, and additional diagnostic procedures should be performed.     

微型钛板内固定治疗MasonⅡ、Ⅲ型桡骨头骨折的疗效

目的探讨微型钛板内固定治疗MasonⅡ、Ⅲ型桡骨头骨折的疗效。 方法对自2006年1月~2014年1月收治30例MasonⅡ、Ⅲ型桡骨头骨折,采用切开复位微型钛板内固定术进行治疗,术中有3例行同种异体骨植骨,2例行侧副韧带修复。 结果25例获得随访,随访10~29个月,平均15个月,全部骨性愈合,无畸形,按照Broberg和Morrey的肘关节功能评分标准进行评分,评分为平均93分（70~100分）;肘关节屈曲平均120°（100~145°）,伸直平均3°（0~10°）,旋前平均50°（30~80°）,旋后平均60°（40~85°）;本组:优18例,良5例,中2例,优良率92%。所有患者肘关节功能恢复良好,其中1例肌力稍较弱,对功能无影响,仅1例遗留肘部轻度疼痛。 结论采用切开复位微型钛板内固定术治疗MasonⅡ、Ⅲ型桡骨头骨折临床疗效满意,内固定牢固,可早期功能锻炼,减少并发症及致残率发生。