月骨周围性腕骨掌侧脱位(附3例报告)

月骨周围性腕骨掌侧脱位是一种罕见的腕部损伤,我们1982年至1994年收治3例,现报告如下:1 临床资料1.1 一般资料 本组3例均为男性,年龄18～33岁,左侧1例,右侧2例;均为新鲜损伤;闭合性损伤2例,开放性损伤1例.致伤原因:汽车手摇柄打击伤1例,高处坠落伤1例,机器压砸伤1例.脱位类型:月骨周围性腕骨掌侧脱位2例,经舟骨月骨周围性腕骨掌侧脱位1例.合并伤:1例合并同侧挠骨下端背侧缘骨折、骨盆骨折及腰2椎压缩性骨折,1例合并大多角骨骨折.3例均伴有正中神经损伤.     

近排腕骨切除治疗的探讨

1992年以来,作者共对11例腕部损伤、创伤性关节炎行近排腕切除术治疗,取得了较为满意的疗效,现报告如下。1　临床资料11例中男9例,女2例;新鲜创伤2例,陈旧性损伤9例。月骨、舟骨近端骨折、脱位2例,其中1例术后舟骨骨折不愈合;经舟骨月骨周围脱位2例,其中1例术后舟骨骨折不愈合;桡骨远端骨折损伤关节面、复位不良致后期桡腕关节炎3例;陈旧舟骨骨折不愈合致后期桡腕关节炎4例,其中2例外固定时间超过4个月。2　治疗方法在腕关节背部,由尺骨茎突至桡骨茎突作一长横形切口。切开后保护桡神经浅支,尺神经背侧支。切开腕背部韧带,保护拇长伸肌。切…     

带血管蒂桡骨茎突骨瓣移植治疗腕舟骨不稳定骨折15例

腕舟骨不稳定骨折系指舟骨骨折伴有舟月两骨不稳定 ,由舟骨骨折移位或经舟骨月骨周围脱位造成 ,容易发生骨折不愈合 ,近端缺血性坏死。笔者采用切开复位 ,克氏针内固定和带血管蒂桡骨茎突骨瓣移植治疗此类损伤 15例 ,效果良好。1　临床资料本组 15例 ,男 10例 ,女 5例 ;年龄 2 0～ 4 9岁 ,平均 30岁。左侧 6例 ,右侧 9例。伤因 :高处坠落伤 6例 ,跌伤 4例 ,车祸伤 3例 ,机器绞轧伤 2例。类型 :舟骨移位骨折 9例 ;经舟骨月骨周围脱位 :背侧脱位5例 ,掌侧脱位 1例。外伤距手术时间 :5～ 14d ,平均 7d ,15例均为经手法复位失败者。2　治疗方法…     

近排腕骨切除及腕关节成形术疗效观察

从1981～1992年对因陈旧性腕关节损伤骨折脱位以及月骨缺血性坏死,陈旧性粉碎性科力氏骨折畸形愈合等引起的腕关节功能障碍,经长时间理疗、锻炼而不能改善者应用近排腕骨切除腕关节成形术进行了治疗,临床效果满意。1　临床资料11　一般资料　本组11例,男9例,女2例,年龄22～48岁,平均31岁,左侧5例,右侧6例,优势手8例,非优势手3例,舟骨骨折3例,月骨脱位3例,腕关节挤压伤1例,陈旧性粉碎性科力氏骨折基层治疗畸形愈合而引起功能障碍者3例。11例术前均有腕部畸形,背伸掌屈严重障碍,僵直以及腕关节疼痛,活动后加重,均经较长时间理疗、封闭、锻炼而…     

小夹板治疗腕舟状骨骨折

我们自 1997年以来用小夹板治疗腕舟状骨骨折 2 3例 ,报道如下。1　临床资料本组 2 3例男 19例 ,女 4例 ;年龄 2 2～ 46岁 ,平均 2 8岁 ;其中新鲜骨折 2 0例 ,陈旧骨折 3例 ;腰部骨折 11例 ,近 1/3骨折 2例 ,远 1/3骨折 8例 ,结节部骨折 2例 ;桡斜型 (即骨折线由桡侧近端斜向尺侧远端 )骨折 10例 ,尺斜型 (即骨折线由尺侧近端斜向桡侧远端 )骨折 9例 ,横断型 (即骨折线几乎呈横向 )骨折 2例 ;就诊时间最早是伤后 2小时 ,最迟 90天。2　治疗方法2 1　手法复位　无移位的舟骨骨折不需复位。有移位的舟骨骨折 ,可将患腕保持中立位 ,拇指向上 ,…     

月骨周围掌侧骨折脱位

目的探讨月骨周围掌侧骨折脱位的临床表现及治疗结果。方法对5例腕部复合损伤造成月骨周围掌侧骨折脱位的患者,其中2例(急性开放损伤)采用清创术,腕骨骨折脱位复位后予克氏针内固定或前臂外固定支架固定;3例为陈旧性损伤,行近排腕骨切除,其中2例同时行骨间背侧神经切除。结果5例随访时间平均为14．4个月。术后腕关节主动运动功能为掌屈15°～40°,平均20°;背伸20°～50°,平均35°;桡偏5°～10°,平均8°;尺偏10°～20°,平均12°。3例日常活动时腕关节疼痛,4例握物时力弱,1例X线片发现有舟月骨间分离;1例术后6个月重返原工作岗位,余4例仍残留其他部分功能障碍需进一步治疗。结论月骨周围掌侧骨折脱位由直接暴力作用所引起,临床易引起漏诊。由于损伤暴力大,常造成开放性多组织复合损伤,延误诊断是导致疗效不满意的主要原因。     

月骨周围脱位8例报告

１　临床资料１－１　一般资料　８例中男６例,女２例;年龄１９～４１岁;左侧５例,右侧３例;新鲜脱位５例,陈旧性脱位３例;闭合性损伤６例,开放性损伤２例。致伤原因：高处坠落伤１例,砸伤３例,摔倒跌伤４例。月骨周围脱位６例,经舟骨月骨周围脱位２例,合并股骨骨折１例。其中误诊为ｃｏｌｌｅ○ｓ骨折等损伤３例,漏诊１例。１－２　治疗方法　本组５例新鲜脱位在臂丛麻醉下行手法复位＋石膏外固定术,均获成功。３例陈旧性脱位２例行腕关节融合术,１例行近排腕骨切除术。１－３　结果　手法复位５例,腕部功能恢复满意,手术…     

掌背联合切口治疗陈旧性经舟骨月骨周围脱位

目的报道掌背联合切口治疗经舟骨月骨周围腕骨脱位的临床疗效。方法总结陈旧性经舟骨月骨周围腕骨脱位15例,采取掌背联合切口切开复位内固定以及带血管的桡骨瓣植骨促进舟骨愈合。结果所有病例经12～24个月的随访,平均随访15．6个月,骨折均骨性愈合。腕关节功能按Dienst功能评价标准评价,优8例,良5例,差2例,优良率86．7％。结论掌背联合切口治疗陈旧性经舟骨月骨周围腕骨脱位复位容易、暴露充分,是治疗陈旧性经舟骨月骨周围腕骨脱位的较好方法。     

经舟骨月骨周围脱位手术治疗分析

目的 探讨分析经舟骨月骨周围脱位手术治疗方法和疗效。方法 术前通过拍摄标准的患侧腕关节正位、侧位X线片，观察月骨的旋转和倾斜移位来判断腕关节的稳定性。对不稳定的腕关节手术时可采用克氏针贯穿固定头月桡关节，同时修复损伤的腕部韧带，新鲜的腕舟骨骨折选用双克氏针内固定，陈旧性腕舟骨骨折应选用微型螺丝钉加压固定，舟骨断端有骨缺损者给松质骨植骨。结果 腕舟骨骨折均顺利愈合，陈旧性损伤者舟骨骨折的愈合时间明显延长。腕关节僵硬、屈伸受限、头月关节半脱位是常见并发症，与原始损伤重有关。结论 正确的早期诊断，准确的手术复位和坚强的内固定是获得良好疗效的关键。     

腕掌侧入路、Bold螺钉、植骨治疗无骨坏死的陈旧性腕舟骨骨折

目的 探讨腕掌侧入路、Bold螺钉、植骨治疗无骨坏死陈旧腕舟骨骨折的疗效.方法 我院自2004年对12例无骨坏死陈旧腕舟骨骨折病例采用腕掌侧入路、Bold螺钉、植骨治疗.结果 12例陈旧性舟骨骨折患者均获4个月～3年随访,术后4～11个月内骨性愈合,愈合率100%,腕部功能恢复良好.结论 对于无骨坏死陈旧腕舟骨骨折,采用腕掌侧入路、Bold螺钉、植骨治疗,效果良好.     

跖骨感染骨外露的显微外科治疗

[目的]回顾总结跖骨骨感染骨外露的显微外科治疗方法。[方法]自1995年～2005年采用显微外科技术治疗214例跖骨骨外露骨感染患者。[结果]全部病例获得随访1～10年，平均随访3年，14例游离植皮术后皮肤成活良好，199例术后皮瓣全部成活，1例腓肠神经营养血管皮瓣移位修复术出现远端部分皮肤坏死，后经换药处理后，伤口自然愈合。皮瓣移植术后质地良好，无溃疡复发。患足均可负重走路。[结论]应用显微外科技术治疗跖骨骨感染骨外露可获得较好的疗效。     

Assessment of bone density and bone loss

Osteoporosis International - Dual-energy X-ray absorptiometry has become the standard for the evaluation of osteoporosis. It is useful both for identifying those people who are going to be at risk...     

Aneurysmal bone cyst of the occipital bone

A 13 years boy presented with a painless hard and fixed swelling in occipital region for the last three months. Plain X-ray, CT scan and MRI showed an expansile multi loculated cystic lesion in occipital bone. Histopathological examination revealed it to be an aneurysmal bone cyst. Treatment of choice is surgery. However, radiotherapy may be helpful in incompletely excised lesions.     

Genetic regulation of bone mass: from bone density to bone strength

Osteoporosis is a common disease characterized in adults by diminished bone density. Bone is an organ that evolves and grows throughout life, and establishing optimal bone density in childhood and adolescence serves to buffer bone loss later in life. Bone density, a measurable entity, is the clinical substitute for bone strength, or the ability to defend against fracture. Chronic diseases may adversely affect optimal peak bone density. Bone density is under genetic control, as revealed by three lines of investigations. These include (1) the finding of quantitative trait loci for bone density, (2) the finding that specific mutations in genes that are important in the development of osteoblast or osteoclast lineages alter bone density, and (3) the linkeage of known polymorphisms for genes involved in mineral homeostasis to bone density and/or fracture. Future therapeutics for improving peak bone density or delaying bone loss later in life may take advantage of the genetic nature of bone density development.This work was presented in part at the IPNA Seventh Symposium on Growth and Development in Children with Chronic Kidney Disease: The Molecular Basis of Skeletal Growth, 1–3 April 2004, Heidelberg, Germany     

Development of bone canaliculi during bone repair

We recently found that silver impregnation staining with protargol (silver protein), that is, a modified Bodian method, is useful for histologically identifying the details of bone canaliculi structure, using thin sections of decalcified bone tissues. With this staining method, we conducted the present study to assess the development of bone canaliculi during the process of intramembranous ossification using a fracture-like stimulation model of the rat femur. After making a drill-hole in the cortex of the rat femur, decalcified thin sections were obtained after 3, 5, 7, and 14 days by the standard paraffin-embedding procedure. Silver staining for bone canaliculi was performed using our previously reported technique. The results showed that woven bone covered the fracture surface of the cortex after 5 days, then immature lamellar bone attached to the woven bone after 7 days, and finally the lamellar bone matured and became thick with appositional growth after 14 days. The osteocytes in the woven bone appeared at an early stage of bone repair and developed a few canaliculi that were short and irregularly distributed in the osteoid matrix, while the osteocytes in the lamellar bone at a late stage formed many bone canaliculi that were long and regularly distributed in mature bone matrix. Therefore, we concluded that woven bone osteocytes may be necessary for induction of the lamellar bone osteocytes followed by active appositional growth of the lamellar bone at the early stage of bone repair, and also that both bone tissues could be clearly distinguished from one another based on the pattern of development of bone canaliculi by the osteocytes, as seen with the use of our sensitive staining method.     

重组合异种骨植骨修复骨囊肿所致骨缺损

2001年10月～2003年9月,笔者共收治28例骨囊肿患者,均采用病灶刮除,瘤腔灭活和重组合异种骨植骨治疗,获得满意疗效,体会如下。     

Transmembrane bone matrix gelatin-induced differentiation of bone

In response to chemically-defined bone matrix gelatin (BMG) inside a diffusion chamber implanted in a muscle pouch, mesenchymal cells migrate directionally, aggregate and differentiate into new bone, on theoutside of the chamber. BMG diffuses through double membranes 275 to 300 μm in thickness. The inner membrane of pore size is 0.025 μm and the outer membrane of pore size is 0.45 μm. The inner membrane is 1/20 the pore size and the combination is twice the thickness of membranes previously reported to transfer osteoinductive activity of living cells. Autoradiographs show³⁵S-cysteine-labelled BMG produces very high transmembrane grain counts while³H-proline labelled BMG produces very low transmembrane grain counts. Electron micrographs demonstrate that gelatin-derived, uranyl-acetate-stained fine granules interspersed with ruthenium red-staining coarse granules, diffuse through the membrane of 0.025 μm pore size from the inside out. Solitary pale-staining collagen fibrils, possibly formed in interstitial fluid by renaturation of BMG are found in the interior of the chamber and in the interior of the outer 0.45 μm but not the inner 0.025 μm pore size membrane. Densely-stained new bone collagen fiber bundles cover the outer membrane, fill the 0.45 μm subsurface pores for a depth of 0.20 to 30 μm, and thereby attach the new cartilage and bone deposits to the outer surface of the chamber. BMG powders solubilize rapidly in diffusion chambers and produce high yields of new bone. The relationship between denatured collagen and renatured gelatin fibrils in the process of transfer of the bone morphogen from BMG to mesenchymal cell receptors is an intriguing subject for further investigation.     

Aneurysmal bone cyst of the frontal bone

Aneurysmal bone cyst rarely affects the skull. We report two cases of aneurysmal bone cyst of the frontal bone. One of the cases is associated with pregnancy. The association of pregnancy with aneurysmal bone cyst and enlargement of the aneurysmal bone cyst during the pregnancy have been discussed.