肱骨外髁骨折不愈合伴发育不全的手术治疗

目的 评价手术切开复位内固定治疗肱骨外髁骨折不愈合伴发育不全的临床疗效.方法 通过对16例肱骨外髁骨折不愈合伴发育不全采用手术切开复位内固定治疗,并对肘关节功能进行手术前及术后评价.结果 16例获得随访,时问1～5年(平均3年),根据HSS美国特种外科医院临床评分标准:优11例,良3例,一般2例,优良率87.5%.结论 对于肱骨外髁骨折不愈合伴发育不全,手术治疗可获得满意的效果.     

儿童无移位肱骨外髁骨折的治疗探讨

儿童肱骨外髁骨折常继发肘外翻、骨折不愈合、尺神经炎等并发症 ,即使是无移位的骨折 ,在保守治疗的过程中也可能出现移位 ,最终需行手术治疗。我们 1995～ 2 0 0 1年收治 11例早期无移位而后期出现移位病例 ,报告如下。临床资料1.一般资料 :本组男 7例 ,女 4例 ,年龄 4～ 10岁 ,均为嬉闹、运动及半高位坠落摔伤所致。均及时就诊并摄片发现肱骨外髁骨折 ,由于无明显移位或轻度移位经手法复位后满意 ,以小夹板或石膏外固定 ,其中 6例于 1周后复查Ｘ片发现骨折移位 ,4例于 2周后发现移位 ,另 1例于近 4周时发现移位。2 .治疗 :对于本组出现骨…     

儿童陈旧性肱骨外髁骨折不愈合手术治疗的临床分析

目的 探讨陈旧性肱骨外髁骨折不愈合的原因、治疗及注意事项.方法 对11例陈旧性肱骨外髁骨折不愈合行手术治疗.结果 10例获随访,肘关节功能:优9例,良1例.结论 固定时间短、过早或不正确的活动、医患重视程度轻未及时复查是导致肱骨外髁骨折不愈合的主要原因.对其应选择手术治疗.     

肱骨外髁骨折手术治疗的体会

肱骨外髁骨折，在儿童亦称为肱骨外髁骨骺骨折，骨折块常包括肱骨小头和肱骨滑车之桡侧部。由于肱骨外髁骨折块很大部分由软骨构成，X线片软骨不显影，而且年龄越小，软骨越多，易发生漏诊，治疗不当常发生骨折不愈合。造成肘关节功能障碍。我院于2000年1月至2005年10月手术治疗肱骨外髁骨折18例，取得满意结果。     

手术治疗儿童肱骨外髁骨折86例

儿童肱骨外髁骨折亦称肱骨外髁骨骺骨折，在儿童肘部骨折中较常见，其发生率仅次于肱骨髁上骨折，属关节内骨折，如处理不当常发生各种畸形和并发症，造成肘关节功能障碍。作者近年来采用手术治疗86例，疗效满意。     

儿童肱骨外髁骨折骨不连的治疗

目的 探讨儿童肱骨外髁骨折骨不连的治疗方法.方法 对13例肱骨外髁骨折骨不连进行诊治.患几年龄平均10.5岁(6～14岁),受伤至就诊时间平均6.7年(0.9～10年).其中Milch Ⅰ型3例(X线片表现为肱骨外髁骨块较小、桡骨小头呈圆形、肱骨小头凹陷),Milch Ⅱ型10例(X线片表现为肱骨外髁骨块较大、肱桡关节结构近似正常).13例中行单纯骨折切开复位内固定术1例,游离髂骨植骨内固定术3例,游离髂骨植骨内固定+尺神经松解前置术1例,游离髂骨植骨内固定+肱骨髁上楔形截骨术5例,游离髂骨植骨内固定+肱骨髁上楔形截骨+尺神经松解前置术3例.结果 术后随访时间平均为5.6年(2.2～12年).除2例患者骨延迟愈合外,其余患者均达到骨愈合.术前疼痛症状及肘关节不稳消失.患手握力恢复至健侧的87%(84%～100%).3例肘关节屈伸活动度得到明显改善.平均改善47.7°(30°～58°);2例肘关节屈伸活动度无明显改善;8例肘关节屈伸活动度与术前相比有所下降,平均下降16°(8°～30°).13例中除2例肘外翻角度增加和2例继发肘内翻外,其余9例提携角平均下降14.2°.按Broberg肘关节功能评分系统评定:优7例,良6例;优良率为100%.结论 儿童肱骨外髁骨折骨不连可行外科手术治疗,骨折切开复位、植骨内固定术是确实且有效的治疗方法.     

儿童肱骨外髁骨折的手术治疗体会

自2001年1月～2006年2月,笔者共手术治疗儿童肱骨外髁骨折198例,现报告如下.     

手法整复治疗儿童肱骨外髁翻转骨折

笔者总结了1980年6月～1989年6月间用闭合手法整复治疗的儿童肱骨外髁翻转骨折26例,取得较好效果,现分析报告如下。     

单侧多功能外固定器治疗肱骨干骨折不愈合

1993年1月～1996年1月,我们使用单侧多功能外固定器(ＤＡＦ)治疗肱骨干骨折不愈合20例,经1年以上随访发现骨折全部愈合,关节功能恢复良好,现报告如下。1　临床资料本组骨折不愈合的标准是骨折后8个月以上,临床仍有假关节活动,Ｘ线检查无骨折愈合征象。本组20例中,男13例,女7例;年龄14～56岁;左侧12例,右侧8例。肱骨上1/3骨折3例,肱骨中1/3骨折10例。肱骨下1/3骨折7例。开放性骨折8例,闭合性骨折12例。粉碎型10例,横型5例,斜型4例,螺旋型1例。初期处理:切开复位普通钢板固定10例,“Ｖ”形髓内钉固定2例,单纯螺钉固定3例,钢丝环扎1例,闭合复位…     

儿童肱骨外髁骨折834例治疗分析

目的探讨儿童肱骨外髁骨折诊治及并发症的预防。方法701例Ⅰ型骨折进行非手术治疗，673例非手术治疗成功，28例5～15d发现骨片移位接受手术治疗；59例Ⅱ型骨折，2例非手术治疗，49例手术治疗；62例Ⅲ型和Ⅳ型骨折，8例陈旧性骨折病例手术治疗，总共147例手术；12例放弃治疗。结果非手术治疗的骨折病例中，1例Ⅱ型骨折病例出现肘内翻；139例急性、亚急性手术病例，22例轻度肱骨外髁隆凸，5例轻度肘关节功能受限，1例肱骨小头及滑车坏死，1例内固定感染骨髓炎；8例手术治疗的陈旧性病例，5例效果满意，2例肘关节功能受限，1例骨不连。结论儿童肱骨外髁骨折治疗的关键是争取早期解剖复位，防止陈旧性骨折的发生。     

非移位型股骨颈骨折股骨头后倾角测量及对预后影响的研究进展

非移位型股骨颈骨折的治疗及预后等多方面仍存在有许多未解决的问题,如骨折不愈合、股骨头缺血坏死等。为了降低非移位型股骨颈骨折术后各类并发症发生的风险,股骨颈骨折后倾角及其对预后的影响引起了越来越多的关注。大量学者研究发现,当后倾角>20°后,内固定治疗失败的风险显著增加。基于这一理念,根据患者后倾角的不同,可选择使用初次人工关节置换来替代3枚螺钉内固定,以减少患者术后并发症的发生率。同时分析发现,股骨颈后段粉碎会导致后倾角增大。本文是探究股骨颈骨折后倾角与手术预后之间的关系,并介绍一种测量股骨颈后倾角大小的新方法。     

发育性髋关节脱位闭合复位时关节腔压力改变与股骨头缺血性坏死的关系

[目的]通过对发育性髋关节脱位闭合复位前后髋关节腔压力测定的比较,探讨有效降低关节腔压力与减少股骨头缺血性坏死之间的关系。[方法]随机抽出2001年6月～2005年7月43例（56髋）髋关节脱位的患儿,将牵引侧和正常侧关节腔压力的测量结果比较,以及内收肌切断、闭合复位前后关节腔压力比较的临床资料进行统计学处理。平均随访时间为26.4个月（12～42个月）。[结果]牵引之后脱位侧的关节腔压力仍高于正常侧,在三种体位中,屈曲外展位的压力为（-0.37±0.32）kPa明显高于正常侧（P〈0.01）。内收肌切断闭合复位后关节压力明显下降,以屈曲90°外展45°位压力下降最少为（-0.09±0.71）kPa（P〈0.01）。[结论]本组经复位前牵引、内收肌切断、闭合复位的成功率为90.2%,没有发生股骨头缺血性坏死。髋关节腔测压方法简单、实用,可以根据测得的关节压力,调整内收肌切断的范围和选择石膏固定的角度,有利于减少或者避免闭合复位后股骨头缺血性坏死。     

The caput medusae of hypercoagulability

Thrombosis may be the most common cause of death in the United States. Virchow postulated, approximately 150 years ago, that intravascular thrombosis was caused by changes of the vessel wall, by reduction in blood flow, and by alteration of the chemical composition of the blood. The hypercoagulability component of the Virchow triad has, until recently, been poorly defined. During the past 40 years, a number of acquired and congenital hypercoagulable disorders have been described so that currently the cause for thrombotic events can be determined in many patients. The hypercoagulable-related thromboses are usually venous but may, less often, be arterial, and the thromboses often are the cause of significant morbidity and mortality. The vascular surgeon often participates in the management of hypercoagulable disorders. This review of hypercoagulable disorders is presented with the hope that the early recognition of these disorders will lead to the appropriate diagnosis and proper management of hypercoagulable-related thromboses.     

Luxatio centralis femoris

Ohne Zusammenfassung Mit 1 Abbildung im Text.     

Epiphyseolysis capitis femoris

Background

Slipped capital femoral epiphysis (SCFE) is the most common hip disease in adolescents and is always surgically treated with the aim to avoid further slippage and to reduce the risk of degenerative arthritis at young age.

Objectives

A summary of the etiology, pathogenesis, clinical features, radiographic imaging and current therapy concepts is given.

Material and methods

A selective review of the literature was performed.

Results

With an increasing body mass index in adolescents the incidence of SCFE also increases. The diagnostic routine is comprised of a clinical examination with the evaluation of Drehmann’s sign and a radiographic evaluation including anterior-posterior aspect and frog’s legs view. In situ stabilization with a single screw is the standard treatment for the most prevalent mild or moderate stable slippages. In cases of acute slippage a gentle reduction maneuver may be attempted. Hardware removal must not be performed before epiphyseal closure. Common bilateral but not simultaneous occurrence of the disease requires prophylactic pinning of the unaffected side by default, at least in central Europe. Various surgical treatment options exist to reduce the femoroacetabular impingement caused by the slippage.

Conclusions

Current treatment algorithms result in satisfactory long-term outcomes. If the risk of developing degenerative arthritis after SCFE may be reduced even more with modern arthroscopic or open surgical procedures to restore the anatomic pre-slip conditions has to be confirmed through further long-term studies. The implementation of programs to prevent obesity in adolescents may also reduce the incidence of SCFE.     

Luxatio femoris infracotyloidea

Ohne Zusammenfassung     

Regulation of rat caput epididymidis contractility by prostaglandins

Mechanical activity of the rat caput epididymidis in vitro was recorded using a videomicrography system. The effects of prostaglandin (PG)F2 alpha, PGE2, and aspirin on caput epididymidis contractility were determined by measuring the frequency of contraction, luminal diameter, and amplitude of contraction at various concentrations of each test compound in vitro. PGF2 alpha stimulated contractility of the tubules at physiological concentrations, while PGE2 reduced contractility. Aspirin strongly inhibited contractility at concentrations of 10(-3) and 10(-2)M. Endogenous levels of PGF2 alpha and PGE were determined for rat testes, caput, corpus, and cauda epididymidis and vas deferens. While the concentrations of PGE were consistently higher than those of PGF2 alpha, both compounds were relatively low in the testes, high in the vas deferens, and intermediate throughout the epididymis. Results from these experiments strongly suggest that PGs are important regulators of proximal epididymidis contractions and thus may regulate sperm transport through that organ.