腕关节骨折脱位并发腕管综合征的手术治疗体会

<正>腕关节骨折脱位并发腕管综合征,如果处理不当,可导致腕关节活动及拇对掌功能障碍。2004年6月至2009年3月,收治腕关节骨折脱位并发腕管综合征25例,取得了满意的临床疗效。1临床资料本组25例,男19例,女6例;年龄16～48岁,平均29岁;右侧16例,左侧8例,双侧1例。致伤原因:车祸伤15例,行     

髋关节前脱位伴同侧股骨粗隆下骨折救治1例

患者,男,22岁,因重物砸伤致右髋、右大腿肿胀、腹股沟区疼痛1.5 h,于2009年5月17日收住入院.患者为建筑工,在搬运重物时,重物倒塌,砸伤右髋、右大腿,当即致右髋和右大腿肿胀、疼痛、活动障碍,当时患者无昏迷、胸闷气促、恶心、呕吐、腹痛、腹胀等不适.     

全麻下手法复位严重颈椎骨折脱位联合前后路手术1例报道并文献回顾

患者,男,34岁,以“高空坠落致四肢瘫痪6 h余”为主诉于2020年7月23日晚入院。6 h前从高6 m处高压线触电后坠落致四肢感觉活动障碍,无意识障碍。至当地医院予以对症处理后,由救护车转运至我院就诊。体格检查:神志模糊,精神差,双侧瞳孔等大等圆,直径2.5 mm,对光反射迟钝,颈部颈托外固定。     

微型外固定支架联合克氏针治疗开放性粉碎性掌指关节骨折的临床观察

目的 :探讨采用微型外固定支架联合克氏针固定开放性粉碎性掌指关节骨折的方法和疗效。方法 :自2013年1月至2014年12月,采用微型外固定支架配合克氏针固定治疗13例开放性粉碎性掌指关节骨折患者,其中男9例,女4例;年龄18~56岁,平均35岁。根据开放性骨折Gustilo分型:Ⅱ型8例,ⅢA型4例,ⅢB型1例。受伤至手术时间2~7 h,平均5 h。均累及掌指骨关节面。观察术后骨折愈合时间及术后并发症情况,采用2000年中华医学会手外科学会上肢断肢再植功能评定试用标准(TAM系统)进行功能评价。结果:13例患者均获得随访,时间3~12个月,平均7个月。骨折均达到骨性愈合,愈合时间4~6周,平均(4.6±1.0)周。术后未出现断钉及松动现象,无钉道感染、畸形愈合、支架松动,未见反射性交感神经性营养不良。根据TAM系统,优7例,良4例,可1例,差1例。结论:微型外固定支架联合克氏针固定开放性粉碎性掌指关节骨折,操作简便、稳定性好、可后期调整、对软组织骨膜破坏小、感染率低、可早期行功能锻炼,值得临床推广应用。     

Bilateral traumatic patellar fracture: a case report and review of literature

Simultaneous isolated bilateral patellar fractures are very rare injuries and most often associated with systemic disorders such as hyperparathyroidism,osteoporosis,stress fracture and kidney failure.I...     

锁骨内侧骨折合并同侧肩锁关节脱位漏诊1例

患者,男,50岁,2h前从高约5m屋顶坠落,右侧肩部着地,起立后无法上举、外展右侧上肢,感右肩部、胸部及足部疼痛,就诊我院急诊科,行胸腰部CT检查(仅扫描到一部分锁骨,且患者非严格仰卧位,身体左侧倾斜)示右侧锁骨内侧端骨折,第3-5肋骨骨折(图1a).仰卧位右肩部X线示右锁骨内侧端骨折(图1b).由于患者足部受伤,未予...     

足舟状骨体骨折脱位合并骰骨骨折的治疗

目的 探讨足舟状骨体骨折脱位合并骰骨骨折的治疗方法与临床疗效.方法 对2005年3月至2010年3月收治的17例闭合性足舟状骨体骨折脱位合并骰骨骨折患者的临床资料进行回顾性研究;男12例,女5例;年龄17～63岁,平均40岁.舟骨骨折按照Sangeorzan分型:Ⅱ型5例,Ⅲ型12例,骰骨骨折按照AO分型:C1型3例,C2型14例.17例均在2～7 d(平均4.5 d)内择期行切开复位内固定.根据骨折类型分别选择不同的内固定材料.结果 17例患者术后获2个月至5年(平均1.5年)随访.采用Maryland评分标准评定疗效:优4例,良6例,可5例,差2例,优良率为58.8%.差的2例患者中1例发生创伤性关节炎,导致日常活动明显受限,二期行关节融合术;1例术后发生骨不连,行走时有疼痛感,二期行游离骨片摘除术.结论 尽早选用恰当的手术方案、早期功能锻炼、较晚负重,是提高此类骨折疗效的关键.

Abstract：

Objective To explore clinical management of the navicular fracture and dislocation combined with cuboid fracture. Methods A retrospective study was done to analyze the 17 cases of closed navicular fracture and dislocation combined with cuboid fracture who had been treated from March 2005 to March 2010 in our hospital.They were 12 men and 5 women,aged from 17 to 63 years (mean,40 years).By Sangeorzan classification for navicular fractures,there were 5 cases of type Ⅱ and 12 cases of type Ⅲ; by AO classification for cuboid fractures,there were 3 cases of type C1 and 14 cases of type C2.Open reduction and internal fixation was performed for the 17 cases in 2 to 7 days (average,4.5 days).Specific fixations were used according to the specific fracture type and early functional exercises were encouraged. Results All the patients in this group were followed up from 2 months to 5 years (average,1.5 years).By the Maryland scoring system,4 cases were rated as excellent,6 cases as good,5 cases as fair and 2 cases as poor.The excellent to good rate was 58.8％.Traumatic arthritis occurred in one poor case who had to sustain secondary arthrodesis because of limitation of motion in daily activities; nonunion occurred in the other poor case who had to sustain secondary removal of free bone flaps because of pain in walking. Conclusion In treatment of navicular fracture and dislocation combined with cuboid fracture,an appropriate surgical strategy as early as possible,early functional exercise and late weight-bearing may lead to a satisfactory outcome.     

Unusual presentation of hemochromatosis as isolated metacarpophalangeal joint osteoarthritis: a case report

Background  

Hemochromatosis, North America’s most prevalent genetic disorder, tends to present with an insidious onset and subtle, yet characteristic findings. Patients tend to present with both constitutional symptoms and end-organ effects.     

Late presentation of a complete complex thumb metacarpophalangeal joint dislocation: A case report

Metacarpophalangeal (MP) joint injuries and dislocations of the fingers and thumb are not uncommon. They can be classified directionally as either being volar or dorsal, and are further categorized as incomplete, simple complete or complex complete. Complex dislocations are described as dislocations that are irreducible and often require surgical intervention. This is often because tissue has become entrapped within the MP joint, precluding its anatomical reduction. For the thumb MP joint, anatomical structures that may become trapped include the volar plate, sesamoid bones, bony fracture fragments or the flexor pollicis longus tendon. Both dorsal and volar surgical approaches have been described, and their relative merits will be discussed. The unusual case of a late presentation (two months postinjury) of a complex complete dorsal dislocation of the thumb MP joint approached from a dorsal incision is presented.     

早期手术切开复位治疗新鲜嵌顿性掌指关节脱位

目的:探讨嵌顿性掌指关节脱位的致伤机制及治疗方法.方法:收治新鲜嵌顿性掌指关节脱位7例,其中男6例,女1例;年龄8～33岁,平均17岁.7例均为背侧脱位,食指3例,拇指2例,中指1例,小指1例,均为闭合复位失败予切开复位.术中均见致伤机制为"纽扣"式机制,掌骨头自关节囊掌侧薄弱部穿出,掌板嵌顿在掌骨头背侧.结果:7例随访3～42个月,均解剖复位,伸屈功能良好.结论:对嵌顿性掌指关节脱位若闭合复位失败,不应多作手法整复,应早期手术切开复住,以免导致功能障碍.     

腕舟状骨疲劳骨折3例

疲劳骨折亦称行军骨折，多发生在下肢骨骼，发生在第2、3跖骨、胫骨、股骨颈等部位的疲劳骨折已不少见，但是发生在上肢的疲劳骨折尚不多见。自2002年以来，发现3例腕舟骨疲劳骨折，现报告如下。     

舟骨、月骨骨折和（或）脱位的疗效分析

 目的 探讨舟骨、月骨骨折和（或）脱位的诊断和治疗效果。方法 收集2005年1月至2013年12月收治并获得随访的舟骨、月骨骨折和（或）脱位患者的病历资料,按照纳入及排除标准共77例患者纳入研究进行回顾性分析。男64例,女13例;年龄15~73岁,平均31.9岁。单纯骨折41例,骨折合并脱位32例,单纯脱位4例。按治疗方式分为保守治疗组（9例）和手术治疗组（68例）,手术治疗组再依术式（加压螺钉固定术、克氏针固定术、近排腕骨切除术和月骨切除+头状骨移位术）分为4个亚组。术后1、3、6、12个月及超过24个月进行的末次随访进行疗效评价,临床评估采用改良Mayo腕功能评分,影像学评估采用腕关节正、侧位X线片观察骨折愈合情况及腕关节稳定性。结果 77例患者均获得随访,随访时间6个月~8年,平均3年5个月。保守治疗的9例患者中4例骨折未愈合再次行手术治疗并纳入手术治疗组。手术治疗组中加压螺钉固定36例、克氏针固定34例、近排腕骨切除1例、月骨切除+头状骨移位1例。加压螺钉组骨折愈合时间平均为6.1周,克氏针固定组为7周。根据改良Mayo腕功能评价标准,优51例（66.2%）、良11例（14.3%）、可9例、差6例,优良率为80.5%。加压螺钉固定组治愈率为97%,克氏针固定组治愈率为85%,两组治愈率的差异有统计学意义。术后舟骨骨折畸形愈合4例,畸形程度不重且仅1例背曲畸形的患者为优势手,经对症处理后腕痛症状消失。1例舟骨陈旧性骨折合并经舟骨、月骨周围性脱位患者术后出现腕关节不稳定,18周后行桡、舟、头韧带紧缩术,再次术后Mayo评分为优。结论 腕关节正、侧位X线片是舟骨、月骨骨折和（或）脱位的常用检查方法,但易误诊、漏诊,须加摄特殊体位。治疗应以手术为主,宜根据骨折和（或）脱位的具体情况选择相应术式,加压螺钉固定术的治疗效果优势较明显。     

微型外固定支架治疗掌指关节囊内粉碎性骨折

目的 评价应用微型外固定支架治疗掌指关节囊内粉碎性骨折的疗效.方法 8例掌指关节囊内粉碎性骨折,其中开放性损伤6例,闭合性损伤2例.采用Orthofix微型外固定支架固定,其中2例同时加用克氏针内固定,2例采用皮瓣覆盖创面.结果 术后平均8周骨折均愈合,未出现关节面不平整或关节间隙狭窄,受伤关节无不稳定.掌指关节活动范围达65°～85°,手握力达健侧80%～90%.结论 应用Orthofix微型外固定支架治疗掌指关节囊内粉碎性骨折,不仅能有效固定关节内的骨折,且大大缩短了骨折端的愈合时间,早期功能锻炼有效地减少了手指的致残率.     

Subtalar anterolateral dislocations: case report and literature review

We present the case of a 19-year-old man who sustained an isolated subtalar anterolateral dislocation. The incidence of this dislocation is very low, and generally it is associated with fractures or open wounds. We examine and discuss the treatment and the long term follow-up at two years, and review literature about it. We completed the evaluation with computed tomography. We consider favourable the result of this case, with patient satisfaction. Received: 5 April 2002, Accepted in revised form: 10 June 2002 Correspondence to: R. Capelli     

Ligamentotaxis for comminuted fracture of capitate: a case report

We present the technical report for treatment of comminuted fracture of the capitate with ligamentotaxis.The base of third metacarpal was found to be fractured with comminution of the capitate.The decr...     

骶髂关节脱位及周围骨结构骨折的前后入路手术治疗特点

目的：探讨前后入路手术骶髂关节脱位及周围骨结构骨折的治疗特点。方法：自2006年1月至2012年9月,收治39例骶髂关节脱位及周围骨结构骨折患者,均进行手术治疗。其中男28例,女11例;年龄12-64岁,平均41．3岁。前入路手术处理17例,后入路手术治疗13例,前后联合入路9例。前入路取仰卧位,切开复位,用2块4孔重建钢板,横跨骶髂关节做固定。后入路取俯卧位,选择闭合或切开复位,在C形臂X线机透视下攻入1～2枚直径7．3nlFtl的60～75mm空心松质骨拉力螺丝钉。术后观察两组的并发症情况,参照Matta评分系统评价骨折复位情况,Majeed评分系统评价术后功能情况。结果：所有患者获随访,时间6～36个月。术后2~4周患者可在床上坐起,6周后可扶拐下地活动。术后随访期间未发现内固定松动及螺钉钢板断裂。x线片示除陈旧性骶髂骨骨折1例复位欠佳,其余骶髂关节脱位及周围骨折术后对位良好。根据Matta标准评定：优30例,良8例,可1例;根据Majeed功能评分标准,优14例,良20例,中4例,差1例。结论：经前后入路手术治疗骶髂关节脱位及周围骨结构骨折均有良好的治疗疗效,但需要根据脱位骨折的解剖部位及类型、移位的方向程度以及术前的复位程度,对术中复位的难易程度评估、固定强度等因素综合考虑来确定入路方式。     

Ⅰ期前后路手术治疗C7严重骨折脱位合并颈脊髓损伤1例

<正>患者,男,53岁,于2017年10月20日下午5时左右从1.8m高处坠下,头先着地,致颈部疼痛、四肢活动感觉障碍,诉当时不能站立,双下肢不能活动,双上肢活动轻度受限,全身多处软组织擦伤,行颈椎CT检查提示:C₇椎体重度滑脱,C₇双侧椎板骨折,C₆棘突骨折,T₁椎体前上缘骨折。当地医院予以颅骨牵引治疗,负重6 kg,未行手术治疗。患者及家     

Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base

Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- cal examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His ra- diographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with anextra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.