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1.
微创锁定钢板治疗肱骨近端骨折19例临床观察   总被引:1,自引:0,他引:1  
目的:探讨肩峰下外侧横切口经三角肌入路行肱骨近端锁定钢板内固定治疗肱骨近端骨折的临床效果。方法:采用肩峰下外侧横切口经三角肌入路肱骨近端锁定钢板治疗肱骨近端骨折19例。根据Neer分型:二部分骨折6例,三部分骨折12例,四部分骨折1例。结果:19例均获得随访,随访时间6~18个月,平均10个月,切口均一期愈合。疗效评价采用Neer功能评分优良率为89.5%。结论:肩峰下外侧横切口经三角肌入路行肱骨近端锁定钢板内固定治疗肱骨近端骨折对骨与软组织损伤小,固定牢固可靠,骨折愈合率高,可使患肩早期功能锻炼,避免关节僵硬。对老年患者尤为适用。  相似文献   

2.
目的 评价应用锁定钢板经肩峰前外侧入路治疗肱骨近端骨折的临床效果.方法 对应用锁定钢板经肩峰前外侧入路治疗的22例肱骨近端骨折患者的临床资料进行回顾性分析.结果 本组病例手术时间50~100min,平均80min;术中出血60~130ml,平均85ml.随访时间6~18个月,平均9.2个月.所有骨折均骨性愈合,愈合时间11~28周,平均15.9周.末次随访时采用Neer评分:优8例,良11例,一般3例,优良率86.4%.结论 应用锁定钢板经肩峰前外侧入路治疗肱骨近端骨折,术中运用微创技术,具有创伤小、术中出血少、手术时间短、骨折愈合快、肩关节功能恢复好等优点.手术过程中须对腋神经加以保护.该术式可作为治疗肱骨近端Neer二、三部分骨折及大部分骨折的首选方法.  相似文献   

3.
目的探讨改良前外侧入路钢板内固定治疗肱骨中下段骨折的临床疗效。方法将2012年1月至2015年2月收治的肱骨中下段骨折患者69例随机分为两组:改良前外侧入路组(改良组)38例,传统前外侧入路组(传统组)31例。两组患者均采用钢板内固定治疗。结果随访半年以上。改良组手术时间[(55.0±5.2)min]少于传统组[(83.0±5.5)min],改良组医源性桡神经损伤0例,少于传统组3例(9.7%),差异有统计学意义(P<0.05);两组患者骨折愈合时间、肘关节功能比较,差异无统计学意义(P>0.05)。结论改良前外侧入路钢板内固定治疗肱骨中下段骨折手术可清晰显露视野,简化钢板放置操作,缩短手术时间;且无需常规游离显露桡神经,可降低医源性桡神经损伤的风险。  相似文献   

4.
目的探讨经皮微创锁定钢板内固定(MIPPO)对老年肱骨近端骨折患者疼痛程度及关节功能的影响。方法前瞻性选取2017年6月-2018年6月治疗的肱骨近端骨折患者105例,依据手术方法将其分为MIPPO组(n=55)和传统切开复位组(n=50),MIPPO组患者行微创锁定钢板改良内固定治疗,传统切开复位组患者行传统切开复位内固定治疗,比较两组患者围术期指标、治疗效果、治疗前后VAS评分及不良事件发生情况。结果MIPPO组患者手术时间[(69.1±16.4)min vs.(101.4±30.5)min]、术中出血量[(85.3±24.5)m L vs.(163.5±40.8)m L)]、术后引流量[(18.3±4.6)m L vs.(23.4±5.3)m L]、住院时间[(2.8±0.9)d vs.(4.5±1.0)d],骨折愈合时间[(11.6±2.3)周vs.(16.8±3.5)周],可负重时间[(8.1±2.1)周vs.(9.6±2.0)周]均短(少)于传统切开复位组,差异有统计学意义(P<0.05)。MIPPO组、传统切开复位组患者治疗有效率分别为94.55%、80.00%,MIPPO组优于传统切开复位组(P<0.05)。治疗前两组患者VAS评分比较差异无统计学意义(P>0.05);术后2、4周,MIPPO组患者VAS评分均低于传统切开复位组(P<0.05)。传统切开复位组患者术后3例发生骨折延迟愈合,2例发生外展受限;MIPPO组患者术后1例发生骨折延迟愈合,1例发生外展受限;两组患者不良事件发生率比较差异无统计学意义(10.00%vs.3.64%,χ^2=1.538,P=0.173)。结论微创锁定钢板改良内固定治疗老年肱骨近端骨折治疗效果显著,不增加不良事件发生风险,值得临床推广使用。  相似文献   

5.
目的 探讨肩峰下外侧入路经皮微创钢板内固定术(MIPO)结合锁定加压钢板及三角肌-胸大肌手术入路对于治疗肱骨近端骨折的影响.方法 前瞻性研究2018年1月—2018年12月四川省攀枝花市中心医院骨科收治的肱骨近端骨折患者60例,其中男性34例,女性26例;年龄62~75岁,平均66.2岁;右侧41例,左侧19例;道路交...  相似文献   

6.
探讨经皮接骨板固定(MIPPO)技术,采用肩峰下前外侧经三角肌入路,关节囊外间接整复骨折,肱骨近端Philos接骨板固定的方法治疗肱骨近端骨折,疗效良好.  相似文献   

7.
目的探讨微创加压螺钉固定术不同入路治疗腕舟骨骨折的疗效及安全性。方法前瞻性选取2011年1月—2016年1月上海中冶医院确诊并微创加压螺钉固定术治疗的腕舟骨骨折患者50例,依据入路方法分为背侧入路组和掌侧入路组,每组25例。采用改良Mayo腕关节功能评分法(Mayo)得分评估腕功能,电话和复诊随访12个月,统计分析所有患者术中出血量、手术时间、骨性愈合时间、并发症和术后6、12个月腕功能情况。结果掌侧入路组与背侧入路组术中出血量(16.47±3.01)m L vs.(22.87±3.11)m L、并发症发生率(6.00%vs.32.00%)、骨性愈合时间(8.97±0.95)个月vs.(9.74±1.04)个月,掌侧入路组明显低于背侧入路组;掌侧入路组与背侧入路组手术时间(35.87±6.54)min vs.(30.48±5.98)min、术后6个月Mayo得分(85.76±8.24)分vs.(76.24±7.94)分、腕功能优良率(84.00%vs.56.00%),掌侧入路组明显高于背侧入路组,差异有统计学意义(P0.05);但背侧入路组和掌侧入路组术后12个月Mayo得分(96.65±6.21)分vs.(95.94±6.17)分、腕功能优良率(96.00%vs.92.00%)基本相同,差异无统计学意义(P0.05)。结论与背侧入路比较,掌侧入路可有效提高微创加压螺钉固定术治疗腕舟骨骨折的安全性,有利于改善患者骨性愈合和近期疗效,值得临床进一步推广。  相似文献   

8.
目的比较经皮微创钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)与传统切开复位内固定术(open reduction and internal fixation,ORIF)治疗NeerⅠ型及Ⅱ型肱骨外科颈骨折的临床疗效。方法 2016年3月—2017年12月郑州大学第一附属医院应用锁定加压钢板(locking compressior plate,LCP)治疗肱骨外科颈骨折患者21例,男性13例,女性8例;年龄46~72岁,平均56.4岁。21例患者随机分为采用经肩峰下三角肌入路MIPPO治疗10例(MIPPO组),采用传统经胸大肌三角肌入路(即传统切开复位内固定术,ORIF组)11例。比较两组患者手术切口长度、术中出血量、术后引流量、术后2周内VAS评分、术后3个月Constant-Murley肩关节功能评分及术后感染发生情况。结果 MIPPO组手术切口长度较ORIF组短[(7.23±0.54)cm vs.(14.45±1.56)cm],术中出血量、术后引流量以及术后2周VAS评分均较ORIF组低[(30.14±10.24)mL vs.(100.51±12.45)mL、(80.20±14.38)mL vs.(100.68±20.47)mL、(2.40±0.76)分vs.(4.17±1.21)分],术后3个月,MIPPO组肩关节功能评分较ORIF组高[(79.34±6.17)分vs.(60.63±5.01)分],两组患者比较差异均有统计学意义(P<0.05)。两组均无感染。结论 MIPPO治疗NeerⅠ型及Ⅱ型肱骨外科颈骨折具有伤口小、失血量少、疼痛轻,早期肩关节功能恢复好等优点,但有其应用指征,其风险主要是腋神经损伤。  相似文献   

9.
目的比较髌上入路和髌下入路胫骨髓内钉治疗胫骨干骨折的疗效,为胫骨髓内钉置入路径的选择提供依据。方法回顾性分析南京医科大学第二附属医院2015年9月—2017年12月收治的58例胫骨干骨折患者,男性42例,女性16例;年龄19~73岁,平均50.3岁。均采用髓内钉内固定手术,按手术入路分为髌上入路(SPN)组和髌下入路(IPN)组,各29例,统计并比较两组手术时间、出血量、骨折愈合、膝前疼痛、膝关节功能评分。结果定期电话及门诊随访13~20个月,平均15.6个月。SPN组手术时间(100.66±6.78)min短于IPN组(110.07±8.92)min;SPN组与IPN组相比,膝前疼痛程度较轻(VAS评分1.07±1.00 vs.1.66±1.40),膝关节功能评分较高(Lysholm评分96.28±4.08 vs.93.93±4.62,Oxford评分53.28±3.96 vs.51.17±3.55),P<0.05。SPN组与IPN组在出血量[(79.31±11.00)mL vs.(83.10±11.37)mL]、骨折愈合方面(RUST评分27.03±2.34 vs.26.72±2.20),差异无统计学意义,P>0.05。结论与髌下入路组相比,髌上入路髓内钉治疗胫骨干骨折,操作简便,手术时间短,术后膝关节功能评分高,值得临床推广。  相似文献   

10.
目的探讨跗骨窦入路与外侧"L"型扩大入路治疗SandersⅡ、Ⅲ型跟骨骨折的疗效。方法回顾性分析2012年3月-2017年2月南京梅山医院骨科收治的72例SandersⅡ、Ⅲ型跟骨骨折患者资料,按手术入路分为跗骨窦入路组和外侧扩大"L"形入路组。跗骨窦入路组34例,其中男性21例,女性13例,左足18例,右足16例;年龄26~74岁,平均43.4岁。外侧扩大"L"型入路组38例,其中男性30例,女性8例,左足17例,右足21例;年龄27~72岁,平均43.1岁。比较两组患者受伤到手术的时间、切口长度、手术时间、术后引流量、术后疼痛视觉模拟(VAS)评分、AOFAS评分及骨折愈合时间。结果 72例患者经全程门诊随访12~18个月,平均14.3个月。外侧扩大"L"型入路组2例患者切口有较多渗液,经换药后好转;跗骨窦入路组1例出现腓肠神经牵拉症状。外侧扩大"L"型入路组和跗骨窦入路组受伤到手术的时间[(10.21±1.29)d vs.(5.30±0.68)d,P<0.05]、切口长度[(13.03±0.82)cm vs.(6.84±0.39)cm,P<0.05]、手术时间[(96.80±11.30)min vs.(80.60±5.90)min,P<0.05]、术后引流量[(108.20±13.30)mL vs.(98.20±12.60)mL,P<0.05]、术后VAS评分[(5.40±0.90)分vs.(4.10±1.00)分,P<0.05],差异均有统计学意义(P<0.05);而在AOFAS评分方面差异无统计学意义(P>0.05)。结论跗骨窦入路在术前等待时间、切口长度、手术时间、术后引流量、VAS评分方面相对于外侧扩大"L"型入路有优势,对于SandersⅡ、Ⅲ型跟骨骨折,跗骨窦入路可替代外侧扩大"L"型入路。  相似文献   

11.
Although self-talk during competitive sports is common and predictive of athletes' motivation, experiences, and performance, it is difficult to accurately assess self-talk. An important, yet underexplored, next step in the assessment of self-talk is to rely on a multi-method approach. The present study sought to examine whether tennis players' self-talk assessed either via self-reports or via a live-recorded procedure would relate to each other. Competitive tennis players (N = 120; Mage = 25.22; SDage = 9.82) were asked to perform multiple tennis exercises while verbalizing their thoughts, which were audio-recorded and subsequently coded. Prior to exercise engagement, they indicated their fear of failure, while, after exercise engagement, they reported on their experienced pressure and self-talk using questionnaires. There was substantial correspondence between the coded and self-reported measure, allowing the estimation of a latent factor representing a multi-method assessment of self-talk. Moreover, in a theory-consistent way, both latent factors representing negative and positive self-talk were related to a hypothesized antecedent (ie, fear of failure), with negative self-talk also relating to a hypothesized consequence (ie, perceived pressure). Overall, the present study shows that athletes' self-talk can be measured reliably through different methods. Guidelines for the assessment of self-talk in future research are provided.  相似文献   

12.
《Radiography》2014,20(1):48-52
IntroductionPrevious studies on radiographers' professional work have shown that this practice covers both technology and patient care. How these two competence areas blend together in practice needs to be investigated. The professionals' experiences of their work have not been studied in depth, and there is a need to focus on their experiences of the main features of their practice.The aimTo explore, from the perspective of the radiographer, the general tasks and responsibilities of their work.MethodData were generated through a combination of open interviews with radiographers and observations of their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The interviews and observations were analysed using an interpretative phenomenological method.ResultRadiographers' professional work with diagnostic imaging, in a Swedish context, can be viewed as a problem-solving process involving judgments and responsibility for obtaining images that can be used for diagnosis. The examination process comprises three phases; planning, producing the images, and evaluation. In the first phase the radiographer makes judgments on adapting the method to the individual patient, and the second phase involves responsibilities and practical skills for image production. In the third phase, the quality of the images is judged in relation to the actual patient and the imaging process itself.ConclusionsRadiographers consider that the main features of their professional work are patient safety aspects and their knowledge and skills regarding how to produce images of optimal quality, in the actual circumstances of each examination.  相似文献   

13.
目的探讨经腹直肌外侧及改良Stoppa两种入路方式治疗髋臼骨折的临床疗效及其相关性因素分析。方法回顾性分析2012年5月—2017年7月惠州市第一人民医院骨科收治的44例髋臼骨折患者的病例资料,根据不同入路分为经腹直肌外侧切口入路组(22例)和改良Stoppa切口入路组(22例)。其中经腹直肌外侧入路组:男性12例,女性10例;年龄25~56岁,平均45. 2岁;骨折Judet-Letournel分型:简单型骨折12例,复杂型骨折10例;致伤原因:坠落伤6例,重物砸伤7例,道路交通伤9例。改良Stoppa入路组:男性11例,女性11例;年龄27~59岁,平均47. 5岁;骨折Judet-Letournel分型:简单型骨折13例,复杂型骨折9例;致伤原因:坠落伤6例,重物砸伤8例,道路交通伤8例。比较两组患者围术期相关指标(如术后髋关节功能评分、手术显露时间、术中出血量、术后并发症及骨折复位质量)等差异。结果经腹直肌外侧切口入路组和改良Stoppa切口入路组患者术后髋关节功能评分分别为(16. 7±2. 6)分和(17. 2±2. 4)分;手术显露时间为(18. 0±3. 5) min和(17. 2±4. 0) min,差异均无统计学意义(P> 0. 05);经腹直肌外侧切口入路组患者术中出血量为(628. 4±25. 9) m L,显著低于改良Stoppa切口入路组(736. 8±37. 1) m L(P <0. 05);经腹直肌外侧切口入路组和改良Stoppa切口入路组并发症发生率分别为9. 09%和36. 36%,差异有统计学意义(P <0. 05);两组患者骨折复位质量比较差异无统计学意义(P> 0. 05)。两组患者的性别及手术入路比较差异无统计学意义(P> 0. 05),而年龄、骨折类型、手术时机、复位质量及有无异位骨化比较差异有统计学意义(P <0. 05)。分析发现骨折类型、复位质量及手术时机是影响术后患者临床疗效的独立因素(P <0. 05)。结论两种前入路手术方式治疗髋臼骨折患者的临床疗效相近的情况下,经腹直肌外侧切口入路术中围术期指标更优,医师应尽力做到解剖复位,帮助髋臼骨折患者术后髋关节功能恢复。  相似文献   

14.
The high-grade malignant gliomas (anaplastic astrocytomas and glioblastoma) have a very bad prognosis since the available methods of treatment (surgery, radiotherapy and chemotherapy) are unable to control the progression of the disease for long. The use of specific monoclonal antibodies labelled with a suitable isotope (iodine-131 or yttrium-90) represents an effective approach to hamper tumour regrowth. Some authors have injected the antibodies intravenously, or have tried to increase the tumour/background ratio with the avidin/ biotin system. In many cases the labelled monoclonal antibodies were injected directly into the tumoral bed after the operation. The authors’ experiences concern a quite large locoregional radioimmunotherapy study which was performed by using antitenascin antibodies labelled initially with 131I and more recently with 90Y. The clinical results demonstrate the ability of this technique to control, for a long time, the growth of these tumours. The glioblastoma median survival was prolonged to 25 months (131I group) or 31 months (90Y group). The response rate (which comprises PR, CR and NED) was 47.1% (glioblastoma 131I group) or 40% ( glioblastoma 90Y group). In many cases a significant tumour shrinking effect was radiologically demonstrated. The use of 90Y proved more favourable in bulky lesions, and reduced the radioprotection problems.  相似文献   

15.
Trans-venous approach has been described for endovascular treatment of many vascular lesions namely the intracranial dural, cavernous and intra-orbital malformations. A patient with a ruptured left deep parietal arteriovenous malformation (AVM) treated with primary transvenous Onyx 18 embolization is reported. Trans-arterial approaches were unsuccessful because of the tiny tortuous feeding arteries and hence a transvenous approach was used for embolization. Follow-up angiography at 3 month revealed persistent angiographic cure of the AVM. Our case illustrates that in patients with ruptured small AVM having a single draining vein, transvenous treatment can be utilized to achieve occlusion resulting in AVM cure.  相似文献   

16.
目的比较掌侧MIPPO入路与Henry入路在治疗桡骨远端骨折中的疗效。方法回顾性分析2016年5月—2017年5月青岛大学附属医院创伤外科行桡骨远端骨折手术患者30例,男性8例,女性22例;年龄40~75岁,平均61.8岁。其中采用掌侧MIPPO入路患者为MIPPO组(16例),采用Henry入路患者为Henry组(14例)。比较两组患者一般资料、手术时间、术中出血量、骨折愈合时间、并发症、腕关节活动范围以及上肢功能评定标准(DASH)评分。结果MIPPO组手术时间(40.4±1.5)min短于Henry组(60.8±1.9)min(P<0.05),术中出血量MIPPO组(20.3±14.5)mL少于Henry组(65.5±12.2)mL,差异有统计学意义(P<0.05)。两组患者的一般资料、骨折愈合时间、并发症、腕关节活动范围及DASH评分相比较差异无统计学意义(P>0.05)。结论MIPPO入路相比较Henry入路治疗桡骨远端骨折具有创伤小、手术时间短、出血量少等优点。  相似文献   

17.
The aim of this study was to evaluate an “all-in-one” MR procedure to examine the kidneys, the renal vascular supply and renal perfusion, and the urinary tract. In 64 patients (58 with urologic disease and 6 healthy volunteers), MR was performed including: (a) T1- and T2-weighted imaging; (b) 3D contrast-enhanced MR angiography (MRA), including the renal arteries, renal veins, as well as renal perfusion; and (c) 3D contrast-enhanced MR urography (MRU) in the coronal and sagittal plane. For the latter, low- and high-resolution images were compared. Prior to gadolinium injection, 0.1 mg/kg body weight of furosemide was administered intravenously. The results were compared with correlative imaging modalities (ultrasonography, intravenous urography, CT), ureterorenoscopy and/or surgical–pathologic findings. Visualization of the renal parenchyma, the vascular supply, and the collecting system was adequate in all cases, both in nondilated and in dilated systems and irrespective of the renal function. One infiltrating urothelial cancer was missed; there was one false-positive urothelial malignancy. Different MR techniques can be combined to establish an all-in-one imaging modality in the assessment of diseases which affect the kidneys and urinary tracts. Continuous refinement of the applied MR techniques and further improvements in spatial resolution is needed to expand the actual imaging possibilities and to create new tracts and challenges in the MR evaluation of urologic disease. Received: 27 September 1999; Revised: 20 January 2000; Accepted: 22 May 2000  相似文献   

18.
The hyoid bone is characterized by sexually dimorphic features, enabling it to occasionally be used in the sex determination aspect of establishing the biological profile in skeletal remains. Based on a sample of 298 fused and non-fused hyoid bones, the present paper compares several methodological approaches to sexing human hyoid bones in order to test the legitimacy of osteometrics-based linear discriminant equations and to explore the potentials of symbolic regression and methods of geometric morphometrics. In addition, two sets of published predictive models, one of which originated in an indigenous population, were validated on the studied sample. The results showed that the hyoid shape itself is a moderate sex predictor and a combination of linear measurements is a better representation of sex-related differences. The symbolic regression was shown to exceed the predictive powers of linear discriminant function analysis when two models based on a logistic and step regression reached 96% of correctly classified cases. There was a positive correlation between discriminant scores and an individual's age as the sex assessment was highly skewed in favour of males. This suggests that the human hyoid undergoes age-related modifications which facilitates determination of male bones and complicates determination of females in older individuals. The validation of discriminant equations by Komenda and ?erný (1990) and Kindschud et al. (2010) revealed that there are marked inter-population and inter-sample differences which lessened the power to correctly determine female hyoid bones.  相似文献   

19.
The aim of this study was to evaluate the technical aspects and efficacy of placing tunneled central venous access catheters (CVA) in the inferior vena cava (IVC) via a direct translumbar approach. Between August 1994 and July 1998, 50 CVA (Hickman 13.5 F) were placed in the IVC via a direct translumbar approach in 46 patients (10 males, 36 females) with a mean age of 39.9 years (age range 10–87 years). The indications were chemotherapy administration plus leukoaphoresis (n = 39), bone marrow transplantation (n = 2) and hemodialysis (n = 5). The reasons for placing the CVA in the IVC were cosmetic (n = 34), supradiaphragmatic venous thrombosis (n = 8), previous catheter infection (n = 2), and non-functioning arteriovenous fistula (n = 2). There were no immediate complications. The mean period of time the CVA was in place was 3 months (15 days to 15 months), during which the function was excellent. The commonest late complication was infection (4 local, 6 bacteremia). Others included: pain (n = 2), ureteric fistula (n = 1), pericatheter fibrin sheath formation (n = 6) and catheter-tip impaction (n = 2). Two catheters were damaged due to postprocedural inappropriate manipulations and two others fell off due to incorrect fixation. Due to these complications, it was necessary to remove ten catheters, replace an additional four and reposition two. Direct translumbar catheterization of the IVC is a safe and effective way of placing a long-term CVA with a moderate complication rate. Received: 20 November 1998; Revision received: 5 March 1999; Accepted: 17 May 1999  相似文献   

20.
Objective To describe the technique of obturator nerve block under CT guidance via the posterior approach, and to evaluate the efficacy of the procedure in the short-term and mid-term relief of chronic hip pain. Design and Patients Consecutive patients referred for obturator nerve block were prospectively enrolled in this study. Under CT-guidance, via a posterior approach through the pelvis, local anaesthetic and steroid were infiltrated around the obturator nerve using a 22G spinal needle. Fifty-one patients (19 male, 32 female), mean age 54 years, with hip pain refractory to conventional therapy underwent the procedure. Visual Analogue Scale pain scores were recorded before the procedure and at 30 minutes, 24 hours, 1 week and 3 months thereafter. Results Pain scores within 30 minutes showed a decrease from a mean ± SD score of 8.41±1.22 pre-procedure to 2.86±2.1, p<0.001. At 24 hours, the mean pain score was 2.06±1.76, a decrease of 76% from pre-procedural score, p<0.001. Sustained pain relief at 1 week and 3 months was attained in 92% (mean pain score 2.41±2.2, p<0.001) and 82% (mean pain score 3.80±2.94, p<0.001) of cases respectively. Follow-up data was complete for all 51 patients. No serious side-effects were reported. Conclusions In patients with hip pain refractory to conventional pain control measures, CT-guided obturator nerve block can provide relief from pain in the short to medium term. The posterior approach offers safe, reliable and effective access to the nerve, in a procedure which is well-tolerated by the patient.  相似文献   

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