腋后路内固定治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效分析

目的:探讨腋后路治疗IdebergⅠa及Ⅱ型肩胛盂骨折的疗效。方法:回顾性分析2018年12月至2021年9月采用腋后路治疗的9例肩胛盂下部分骨折患者的资料,男3例,女6例;年龄50～78岁。所有患者骨折为闭合性骨折,依据肩胛盂骨折Ideberg分型:Ⅰa型6例,Ⅱ型3例。分别于术后第6、12周及6、12个月摄肩关节正、侧位X线片,记录所有患者末次随访时的Constant-Murley肩关节评分,上肢功能障碍(disability of the arm,shoulder and hand,DASH)评分,骨折愈合情况以及其他并发症情况。结果:术后9例患者获得随访,时间6～15个月。末次随访时9例均获得骨性愈合,愈合时间3～6个月,末次随访时患者的Constant-Murley评分为55～96分;DASH评分为3.33～33.33分。结论:腋后路内固定治疗IdebergⅠa、Ⅱ型肩胛盂骨折有效解决了前方入路显露肩胛盂下部分骨折困难的问题,可避免肩胛下肌以及关节囊医源性损伤,临床效果满意,值得临床推广使用。     

肩胛盂移位及成角在肩胛颈骨折治疗中的意义

目的探讨肩胛盂移位及成角在肩胛颈骨折治疗中的意义。方法回顾分析自2000年1月～2005年1月收治的9例伴有肩胛盂移位及成角的肩胛颈骨折治疗的临床资料。采用前后位X线片检查,辅以CT检查测量肩胛盂移位及成角畸形。采用Goss等的分型方法:ⅡA型5例,ⅡB型4例。伴有合并损伤者7例。肩肘吊带保守治疗2例,通过Judet入路重建钢板内固定手术治疗7例。结果9例患者7例获得随访,随访5个月～4年,平均28.6个月。根据Constant疗效评价标准,优3例,良3例,差1例,优良率为85.7%。远期主要并发症包括,肩关节疼痛3例,肌力下降及外展活动受限4例,肩关节不稳定1例。结论①肩胛颈骨折多由高能暴力所致,合并损伤发生率很高,容易漏诊。②正确的X线摄片及CT检查有助于明确骨折类型和选择治疗方法。③肩胛颈骨折肩胛盂移位超过1cm或成角超过40°应行手术治疗。④手术治疗是一种安全有效的方法,术后正确的康复训练对肩关节功能恢复至关重要。     

改良后侧入路手术治疗肩胛颈盂骨折

目的探讨肩胛颈盂骨折的改良后侧入路的手术治疗方法及疗效。方法对2004年6月以来收治的经改良后侧入路切开复位内固定治疗26例肩胛颈盂骨折患者进行分析。均为男性,左侧17例,右侧9例。肩胛颈骨折21例,肩胛盂骨折5例。手术取后侧改良切口,上肢外展上举,沿肩峰略偏向内至肩胛下角作弧形切口,将三角肌下缘的肌筋膜切开,松解三角肌并将其向上拉开,在冈下肌与小圆肌间隙进入,显露肩胛骨腋缘直至颈盂部。根据情况用重建钢板或拉力螺钉固定。结果随访3个月～4年,平均2.6年。均获得骨性愈合,按Hardegger标准疗效评定:优15例,良5例,中1例,差5例。结论经改良后侧入路治疗肩胛颈盂部骨折是安全可靠疗效肯定的方法。     

肩胛盂骨折的手术治疗

目的探讨肩胛盂骨折的手术指征及疗效。方法回顾肩胛骨骨折患者32例,其中涉及肩胛盂骨折19例。根据Ideberg分类系统进行分类,Ⅰ型2例,Ⅱ型7例,Ⅲ型3例,Ⅳ型5例,Ⅴ型2例。其中4例为“浮肩”,1例合并完全性臂丛神经损伤。根据骨折的类型,3例选择前入路,其余均为后入路。利用重建钢板结合螺钉行切开复位内固定。结果患者平均随访26个月,对双肩均予以Constant评分,根据患肩占正常侧功能的百分比计算,患肩平均分数为92.6%,肩关节平均前屈度数达152°,外展度达87°,外旋度达35°。结论对于肩胛骨波及肩胛盂的骨折除了遵循关节内骨折的治疗原则外,同时应考虑是否影响肩关节稳定性。手术指征选择恰当,固定可靠,结合完善的术后康复,可取得良好的临床效果。     

腋后路联合三角肌胸大肌入路内固定治疗肱骨近端骨折合并肩胛盂下部分骨折的疗效分析

目的探讨腋后路联合三角肌胸大肌入路治疗肱骨近端骨折合并肩胛盂下部分骨折的疗效。方法回顾性分析2019年7月至2021年9月宁波市第六医院创伤骨科采用腋后路联合三角肌胸大肌入路治疗的7例肱骨近端骨折合并肩胛盂下部分骨折患者资料。男2例, 女5例;年龄51～78岁, 平均62.9岁。所有患者骨折均为闭合性骨折, 肱骨近端骨折依据Neer分型:Ⅱ型1例, Ⅲ型1例, Ⅳ型3例, Ⅵ型2例。肩胛盂骨折Ideberg分型:Ⅰ型5例, Ⅱ型2例。术后第6周、12周、6个月、12个月摄患肩正、侧、腋位X线片了解骨折愈合及并发症发生情况。末次随访时记录所有患者的Constant-Murley肩关节评分、上肢功能障碍评分(DASH)。结果 7例患者术后获8～15个月(平均11.9个月)随访。7例患者均获骨性愈合, 愈合时间平均4.3个月(3～6个月)。术后无一例患者出现肩关节不稳、切口感染及腋窝瘢痕增生影响功能活动。末次随访时患者的Constant-Murley评分平均为83.4分(55～92分), DASH评分平均为13.5分(4.2～33.3分)。结论腋后路联合三角肌胸大肌入路治疗肱骨近端骨折合并肩...     

Judet入路切开复位内固定治疗复杂肩胛盂骨折

目的探讨IdebergⅣ型和Ⅴ型肩胛盂骨折的手术治疗方法。方法2004年8月至2012年1月间收治11例复杂肩胛盂骨折患者,均为男性,平均年龄38．8±10．7岁;IdebergⅣ型5例,Ⅴa型2例,Ⅴb型4例,关节面主要骨块间间隙或台阶平均为6．3mm±6．2mm。手术采用Judet入路重建钢板或重建带固定肩胛骨内、外侧缘,其中5例关节面骨块辅以空心螺钉固定。术后随访患者骨折愈合情况、肩关节前屈及内旋活动度,采用Constant肩关节功能评分、美国加州大学肩关节功能评分（UCLA）和上肢臂、肩、手功能障碍（DASH）调查量表评分标准评价肩关节功能。结果本组11例患者随访时间为12-50个月,平均28．2±12．6个月,骨折均获骨性愈合。无切口感染、内固定失败病例。末次随访时肩关节前屈活动度为150°～170°,平均163．5°±7．37°;内旋伸拇达T8水平以上5例,T12水平以上3例,L4水平以上3例。Constant评分为82-96分,平均87．8±4．9分;UCLA评分为30-35分,平均32．7±1．7分,其中优4例,良7例;DASH评分为3．4～13分,平均7．4±3．3分。结论Judet入路切开复位内固定治疗IdebergⅣ型和Ⅴ型肩胛盂骨折,可获得比较满意的疗效。     

不稳定肩胛颈骨折的手术治疗

目的 探讨不稳定肩胛颈骨折的手术治疗方法及疗效. 方法对2001年6月至2007年11月手术治疗且获得随访的13例不稳定肩胛颈骨折患者资料进行回顾性分析,其中男10例,女3例;左侧8例,右侧5例.单纯肩胛颈解剖颈骨折8例,肩胛颈骨折同时合并肩关节悬吊复合体损伤5例.手术采用肩关节后方入路,于因下肌与小测肌间隙进入,沿肩胛骨外缘到肩胛颈后方,复位固定肩胛颈骨折,同时固定合并的锁骨骨折、肩锁关节脱位及肩峰骨折.本组12例周定肩胛颈骨折的患者术前关节孟均向上倾斜,平均22.7°.采用Constant-Murley绝对值评分方法评价疗效. 结果 13例患者术后获平均45.1个月(10～90个月)随访.Constant-Mudey绝对值评分平均为81.2分(40～98分),平均前屈上举147.7°;优6例,良3例,可2例,差2例.术后12例固定肩胛颈骨折患者关节面向上倾斜平均为5.0°. 结论肩胛颈骨折的移位程度是影响预后的主要因素,采用肩关节后方入路复位固定移位的肩胛颈骨折可获得良好的临床效果.     

累及肩胛盂的肩胛骨骨折的手术治疗

[目的]探讨累及肩胛盂的肩胛骨骨折的手术治疗效果。[方法]回顾性分析2008年6月～2016年6月累及肩胛盂的肩胛骨骨折患者24例。其中男17例,女7例,年龄23～65岁,平均(40.38±12.17)岁。根据国际通用的Ideberg[1-2]进行分型,ⅠB型2例,Ⅱ型4例,Ⅲ型8例,Ⅳ型6例,Ⅴ型4例。分别经前三角肌-胸大肌间隙入路、Judet入路或改良Judet和肩胛骨外侧缘入路,行切开复位重建钢板加螺钉固定。采用美国肩肘外科医师协会评分(ASES)和上肢残障评分(DASH)评价临床效果。[结果]术后患侧肩胛骨周围软组织感染1例,经换药愈合,其余患者手术切口均甲级愈合。所有患者均接受12～70个月[平均(36.38±13.47)个月]随访。末次随访时,ASES评分43～100分,平均(90.89±7.83)分;DASH评分0.93～30.24分,平均(12.21±6.95)分。患者自我满意度:非常满意14例,满意6例,基本满意2例,不满意2例。末次随访时,4例存在肩关节的慢性疼痛或外展受限,1例轻度异位骨化。[结论]根据骨折类型选择合适的手术入路,给予切开复位坚强内固定,术后早期行功能锻炼,肩关节功能可获得良好的恢复。     

肩胛盂骨折的手术治疗

目的探讨肩胛盂骨折的分型、手术治疗指征和方法。方法对8例肩胛盂骨折手术治疗患者临床资料进行分析,根据改良Idebery肩胛盂骨折分型:Ⅰ型3例,Ⅱ型1例,Ⅲ型2例,Ⅴ型2例。分别采用切开复位重建钢板和拉力螺钉固定。结果患者均获随访,时间6~41个月,平均14.2个月。根据美国肩肘协会评分标准进行肩关节功能评分,为55~100分,平均85.6分,优5例,良1例,可1例,差1例。结论肩胛骨盂缘骨折块移位≥1 cm、前缘骨折块≥25%、后缘骨折块≥33%,或盂窝骨折肩关节面不平整≥5 mm及盂肱关节不稳定均需手术治疗。对肩胛盂骨折采用改良Idebery分型,有利于指导临床手术治疗,且手术疗效满意。     

经腋窝入路治疗肩胛盂骨折的疗效分析

目的探讨经腋窝入路治疗肩胛盂骨折的疗效。方法回顾性分析2019年11月至2021年4月郑州市骨科医院上肢骨科收治的12例肩胛盂骨折患者资料, 男4例, 女8例;年龄30～75岁, 平均53.5岁。肩胛盂骨折按照Ideberg分型:Ⅰa型2例, Ⅱ型9例, Ⅴa型1例。所有患者均采用腋窝入路治疗, 2例合并肩关节前脱位患者均于麻醉下先行手法复位, 2例IdebergⅠa型患者使用锚钉固定, 余10例患者使用腋窝入路专用接骨板固定, 3例合并大结节骨折患者均经肩外侧劈三角肌入路使用大结节专用接骨板固定。末次随访时分别采用肩关节Constant-Murley评分、视觉模拟评分(VAS)、Hawkins分级分别对患者治疗后肩关节功能、疼痛及稳定性进行评价。结果术后所有患者获9～20个月(平均14.4个月)随访;手术时间为55～110 min, 平均76.3 min;术中出血量为60～160 mL, 平均103.8 mL;住院时间为8～14 d, 平均11.1 d。所有患者手术切口均为甲级愈合。术后6个月肩胛盂均获骨性愈合。末次随访时所有患者均无肩关节不稳、血管神经损伤、内固定物松动或断裂。末次...     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.