桡骨茎突切除后修凿成带筋膜蒂骨瓣治疗腕舟状骨骨不连

对196例腕舟状骨骨不连患者采用桡骨茎突部分切除后,修凿成带筋膜蒂骨瓣植骨加交叉克氏针固定治疗。采用Kaulesar Sukul腕舟状骨骨折临床疗效评价标准及放射科检查结果进行疗效评价,认为本方法是治疗腕舟状骨骨不连的有效方法。     

经皮穿刺胎儿骨泥注入法治疗舟状骨不连17例

经皮穿刺胎儿骨泥注入法治疗舟状骨不连１７例武警新疆总队医院骨科焦郭堂，高宏，陈勇（乌鲁木齐８３００００）舟状骨骨折骨不连接的治疗，Ｂｏｎｅｑｒａｆｔ从１９２８年采用各种植骨术将治疗率提高到９２％，１９６０年Ｒｕｓｓｅ采用带肌蒂桡骨瓣植骨法优于一般植骨...     

桡骨远端背侧带血管蒂骨瓣转位治疗陈旧性舟骨骨折

目的 评价桡骨远端背侧带血管蒂骨瓣转位治疗陈旧性舟骨骨折的中远期疗效.方法 回顾性分析1995-2006年行桡骨远端背侧带血管蒂骨瓣转位治疗的13例陈旧性舟骨骨折,其中9例伴近侧极缺血坏死.血管蒂为1,2区间间伸肌支持带上血管.固定方式包括螺钉内固定及外支架固定.评价内容包括Mayo腕关节临床功能评分以及影像学评价.结果 手术距受伤时间平均22.2个月,平均随访76.6个月.骨折愈合13例,平均愈合时间11.2周.功能评价:优3例,良8例,可2例.末次随访时,腕关节功能评分、关节活动度、握力均较术前有显著提高.舟骨角以及舟月角明显改善.结论 桡骨远端背侧带血管蒂骨瓣转位治疗陈旧性舟骨骨折手术过程相对简单,疗效满意.术中予腕关节松解,术后腕关节在外支架的保护下进行早期功能锻炼可促进关节功能的恢复.     

高海拔地区带血管蒂骨移植治疗陈旧性舟状骨骨折的护理体会

陈旧性舟状骨骨折不连接是临床常见的病损 ,由于舟状骨的特殊解剖形态及生物力学特性 ,使此类病损在治疗上难度很大。近年来 ,临床应用较多的是带血管蒂骨移植 ,但疗效不够理想。为了提高疗效 ,我院开展了带血管蒂桡骨茎突翻面骨膜骨条髓内移植治疗陈旧性舟状骨骨折 ,疗效满意。现将笔者的护理体会报告如下。1　临床资料本组骨折病人 1 0例 ,男 9例 ,女 1例 ,年龄 1 8～ 3 5岁 ,病程 8～ 2 6个月 ,平均 1 2个月。左侧 3例右侧 7例 ,术后随访 3～ 1 8个月。2　手术方法带血管蒂桡骨茎突翻面骨膜骨条髓内移植治疗陈旧性舟状骨骨折 ,以茎突返支…     

高原地区陈旧性腕舟状骨骨折治疗方法的选择

目的：在高原地区，选择更为有效的腕舟状骨陈旧性骨折的治疗方法。充分发挥骨膜移植的膜内化骨作用。方法：分别应用单纯植骨内固定，带血管蒂桡骨条移植内固定及带血管蒂骨膜面桡骨条髓内移植内固定方法（ｔｈｅｖａｓｃｕｌａｒｉｚｅｄｒａｄｉｕｓｅａｎｄｕｐｓｅｔｐｅｒｉｏｓｔｅａｌｆｌａｐｓｇｒａｆｔ，ＶＲＰＦＧ）治疗舟状骨陈旧性骨折８例，１２例及１６例，共３６例，并对上述方法的疗效进行了比较研究，结果：术后     

带血管蒂桡骨茎突翻面骨膜骨条髓内移植治疗陈旧性舟状骨骨折

带血管蒂桡骨茎突翻面骨膜骨条髓内移植治疗陈旧性舟状骨骨折武警总医院骨科邢更彦,姚建祥,姜川,李禾,王振宇,杜明奎,王明新（北京１０００３９）关键词翻面骨膜骨条移植,陈旧性舟状骨骨折,髓内移植陈旧性舟状骨骨折不连接是临床常见的病损,由于舟状骨的特殊解剖...     

桡骨远端楔形截骨术治疗腕舟状骨骨折不愈合123例

1983年3月-2006年12月,我们采用桡骨远端楔形截骨术治疗腕舟状骨骨折不愈合123例,疗效满意。现分析报告如下。1临床资料1.1一般情况123例中,男91例,女32例;年龄18～62岁,平均34岁。骨折左手45例,右手78例。均有外伤史,伤后6个月仍无骨折愈合表现。外伤至手术时间：6～12个月98例,13～18个月20例,19～30个月5例。X线片示骨折端硬化98例,腕舟状骨囊性变15例,骨折近端密度增高、     

骨瓣植入加内固定治疗腕舟骨骨折不连16例

2001年1月～2005年12月,我们采用旋前方肌带桡骨瓣植入加可吸收螺丝钉内固定,治疗腕舟状骨骨折不连16例,疗效满意。现分析报告如下。     

带蒂第二掌骨瓣治疗陈旧性腕舟状骨骨折26例

腕舟状骨骨折多发生在其腰部。腕舟骨主要尺、桡动脉分支经附着舟骨结节、腰部韧带内细小的血管分支供血 ,近1 3为关节软骨覆盖 ,无血管分支进入。因此 ,腕舟骨骨折时舟骨近骨折段血供阻断 ,易发生骨吸收坏死 ,造成骨折延迟愈合或不愈合[1 ] 。在治疗上虽有桡骨茎突切除术、带血管蒂桡骨膜瓣或骨瓣、带旋前方肌桡骨瓣移植等多种方法 ,其效果均不满意。我院自 1992年 11月以来 ,应用带蒂第二掌骨瓣移植方法 ,治疗腕舟状骨腰部陈旧性骨折不连接 2 6例 ,效果满意。临　床　资　料1.应用解剖 :桡动脉深支在发出第1掌背动脉后 ,进入手掌之前发出…     

双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连

目的探讨双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连的临床疗效。方法分析总结15例肱骨中下段骨折术后骨不连患者的临床资料,骨不连的治疗均采用更换内固定+双钢板固定+植骨的方法。结果 14例获得随访,时间12~20个月,平均(16±2.7)个月,14例Ⅰ期愈合,平均愈合时间(5.0±1.2)个月,Ⅰ期愈合率为93.3%。按Jupiter肘关节功能评分:优8例,良5例,中1例,差0例,优良率92.9%。结论采用双重钢板固定加植骨治疗肱骨中下段骨折术后骨不连是一种较理想的方法。     

应用筋膜瓣移植或移位包绕植骨块治疗难治性骨缺损

我们自1983年1月开始设计了一种吻合血管移植或带蒂移位的筋膜瓣包绕植骨块的方法,重点治疗桡骨及胫骨下段难冶性骨缺损或骨不连接。临床应用16例,均获得满意疗效。同时进行模拟动物实验研究,经常规或血管造影等X线片检查和墨汁灌注切片检查,以及电镜观察证实:该方法可促进移植骨修复过程的完成,其筋膜瓣可演变为骨膜组织。     

Scaphoid nonunions treated with vascularised bone grafts: MRI assessment

Purpose: To assess the value of MR imaging (MRI) with regard to union, graft viability and proximal pole bone marrow status, after use of vascularized bone grafts for treating scaphoid nonunions. Materials and methods: Vascularized bone grafts from the distal radius were used to treat 47 scaphoid nonunions resulting from fractures or enchondromas. Clinical and imaging evaluation was used for the pre- and postoperative assessment of all patients. Apart of conventional radiographs obtained in all cases, 15 patients were also assessed postoperatively with MRI at 3 months. From these 15 patients, eight were assessed preoperatively with MRI whereas nine had serial MRI evaluations at 6 and 12 months. The clinical follow-up time of this subgroup of 15 patients ranged from 6 to 27 months. Results: All patients showed clinical signs of union within 12 weeks form the procedure and at the latest follow-up they experienced complete (10 cases) or almost complete (five cases) relief from pain. Both plain and contrast-enhanced MRI obtained at 3 months showed viability of the bone graft in all cases. At 3 months union was established with plain radiographs in 12 patients at both sides of the graft and in three patients between the graft and proximal pole. At 3 months plain MRI showed nonunion in four patients (two between graft and proximal pole, two between graft and distal pole and one at both sides of the graft) whereas contrast-enhanced MRI revealed only one case of nonunion between graft and proximal pole. Four patients were considered to have osteonecrosis of the proximal pole intraoperatively. Two of them showed necrosis of the proximal pole with preoperative and postoperative plain radiographs and three of them with plain postoperative MRI. Contrast-enhanced MRI at 3 months showed postoperative reversal of necrotic changes in all four scaphoids. MRI also revealed bone marrow oedema of the carpal bones surrounding the scaphoid in 14 cases. Serial MRI at 6 and 12 months, obtained in nine patients, revealed resolution of the bone marrow oedema of the surrounding bones and full graft incorporation in all cases. Conclusion: Contrast-enhanced MRI is able to demonstrate the early union after treatment of scaphoid nonunions with vascularised bone grafts allowing thus earlier mobilisation. In addition, MRI can assess the viability of the proximal pole and the graft as well as the postoperative bone marrow oedema-like lesions of the surrounding bones.     

MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

Objective To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard.Design and patients A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20–38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients.Results Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%).Conclusions MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion.Paper presented at ESSR, European Society of Skeletal Radiology, Aarhus, Denmark, 14 June 2003. Awarded first prize for the ESSR award for Scientific PresentationsPaper presented at ISS, Closed Scientific Session, Malta, 3 October 2004 as part of the above prize     

Idiopathic osteonecrosis of the scaphoid (Preiser's disease)--MRI gives new insights into etiology and pathology

Objective

To describe the imaging signs of idiopathic osteonecrosis of the scaphoid (Preiser's disease) and to differentiate the findings from scaphoid nonunion.

Material and methods

10 patients (4 men, 6 women, mean age 36.9 years) with radial-sided wrist pain were identified to suffer from primary osteonecrosis of the scaphoid. Imaging methods included radiograms in all cases, CT imaging in 9 cases, and contrast-enhanced MRI in 7 cases. In CT and MRI, images were also acquired in the sagittal-oblique plane for depicting the scaphoids in the entire longitudinal extension. Follow-up examinations were performed in 5 patients, two of them underwent surgery with pedicled bone grafts.

Results

In all patients, both osteosclerosis and lesions of the bone marrow were most intensive at the proximal scaphoid pole. A three-layered architecture was found. The zone of osteonecrosis was located most proximally, followed by a zone of repair in the middle, and the zone of viable bone marrow in the distal part of the scaphoid. In contrast to scaphoid nonunion, pathological fractures were exclusively located within the zone of osteonecrosis in 8 cases. Applying morphologic criteria, three stages of Preiser's disease were discernible. The initial stage (proximal osteosclerosis, but unaltered shape of the scaphoid), the advanced stage (pathologic fractures, volume loss of the proximal pole), and the final stage (osteonecrosis of the entire scaphoid).

Conclusion

Pathoanatomy of Preiser's disease and the differentiation into three zones of bone marrow viability can be explained with the retrograde blood supply of the scaphoid. In its natural course, three different stages can be depicted with the initial stage seen only in MRI.     

带血管胸大肌蒂锁骨膜联合锁定钛板固定BMP植入治疗锁骨术后骨不愈合及骨缺损

目的 探讨锁骨骨折术后骨缺损、骨折不愈合的临床特点,评价锁定钛板固定骨形态发生蛋白(bone morphogenetic protein,BMP)植入联合带血管胸大肌蒂锁骨膜转位的治疗效果.方法 2004年1月-2008年4月,锁骨骨折不愈合12例,平均年龄42.8岁,均行内固定物取出,清除骨折端纤维瘢痕及硬化骨,锁定钛板同定BMP植入,带血管胸大肌蒂锁骨膜转位覆盖,术后进行功能康复锻炼. 结果 12例患者术后均获得随访,时间8～24个月,平均1.2年,应用Constant-Murley肩关节评分系统进行评价,所有患者均在4～7个月达到临床愈合,部分患者已将内固定物取出. 结论 锁定钛板固定BMP植入联合带血管胸大肌蒂锁骨膜转位治疗锁骨骨缺损、骨不连,可取得良好的临床效果.     

股骨骨折骨不连的生物力学因素及其对策

目的：探讨股骨骨折骨不连的生物力学因素，并提出相应的对策。方法：68例股骨干骨折骨不连经带锁髓内钉治疗，13例股骨远端骨折骨不连实施动力髁螺钉(DCS)内固定术，治疗同时行自体髂骨髓腔内外植骨术。结果：81例股骨骨折骨不连患者随访8～24个月，平均14个月。68例股骨干骨不连治疗后，有5例出现主钉或锁钉折断，经再次行带锁髓内钉内固定加植骨术治愈，其余患者不连端全部愈合；13例股骨远端骨不连经DCS内固定术后全部愈合。81例平均愈合时间为6．5个月。根据骨折愈合及功能恢复综合指标评定疗效，本组优54例，良21例，差6例，优良率92．6％。结论：股骨骨折骨不连的主要原因为内收肌群的生物力学因素导致内固定失败造成；股骨干骨折及骨不连手术内固定应以髓内固定为主，股骨髁部骨折及不连接应选用坚强的DCS系统。     

桡骨骨钉治疗腕舟骨骨折不愈合

目的探讨桡骨骨钉治疗腕舟骨骨折不愈合的疗效及可行性。方法对我院自1999年4月—2005年9月收治的52例腕舟骨骨折不愈合患者采用桡骨骨钉治疗的情况进行回顾性分析。本组患者均于开放复位后,凿取1.5 cm×0.4 cm×0.4 cm桡骨骨钉进行内固定,术后石膏固定2~3个月。结果全部病例术后随访6个月~1年,52例骨折全部愈合,优27例,良22例,可3例。结论采用桡骨骨钉治疗腕舟骨骨折不愈合,能够牢靠固定骨折,并明显促进骨折愈合,是治疗腕舟骨骨折不愈合的有效方法。     

Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures

AIM: To determine the clinical value of scaphoid and pronator fat stripes in identifying occult underlying scaphoid and distal radius fractures, respectively. MATERIALS AND METHODS: In our department, all patients with clinically suspected scaphoid fractures and normal scaphoid series of radiographs undergo magnetic resonance imaging (MRI) of the wrist. We selected 50 cases with unequivocal MRI evidence of scaphoid fracture, 50 cases with distal radius fracture and 50 cases with no MRI evidence of bony injury. All 150 initial plain radiographs were examined retrospectively in random order without knowledge of the MRI findings and the scaphoid and pronator fat stripes scrutinized. RESULTS: The scaphoid fat stripe was abnormal in only 25 cases (50%) with confirmed scaphoid fracture on MRI. The pronator fat stripe was abnormal in 13 cases (26%) with confirmed distal radius fracture. In the 50 cases with no MRI evidence of bony injury, the scaphoid fat stripe and pronator fat stripe were abnormal in 25 (50%) and 15 (30%) cases, respectively. The sensitivity and specificity for an abnormal scaphoid fat stripe was 50%. The sensitivity and specificity for an abnormal pronator fat stripe was 26 and 70%, respectively. CONCLUSION: Scaphoid and pronator fat stripes are poor predictors of the presence or absence of underlying occult fractures.