动力髁螺钉微创治疗股骨远端骨折

目的探讨动力髁螺钉的手术微创方法及其治疗股骨髁上、髁间骨折的疗效和优缺点。方法全部采用不显露骨折处或附以微显露关节面骨折处,以非关节面骨折处为中心,经皮远近双小切口动力髁螺钉骨膜外插入桥接间接复位后的骨折的固定。结果通过对动力髁螺钉微创治疗远端股骨骨折13例术后获得的回顾性随访分析,平均随访11个月。结果以Schatzker评分标准进行股骨髁上骨折评价,优8例,良5例,可0例,差0例。结论动力颗微创治疗股骨远端骨折手术时间短、创伤小、固定可靠,是一种满意的治疗方法之一。     

MRI诊断肌萎缩侧索硬化1例

患者女,45岁,因"前臂萎缩无力并双下肢痉挛1月余"就诊,行走呈痉挛步态,需他人搀扶。无家族病史。专科检查:双下肢肌力4级,肌张力增高,膝腱反射活跃,巴宾斯基征阳性,双侧霍夫曼征阳性。肌电图:椎旁肌、骨间肌及胫前肌有束颤电位,运动单位电位时限延长,波幅增高。实验室检查未见异常。头颅MR检查:T2WI轴位双侧内囊后肢后部见对称性斑点状高信号,冠状位T2WI示双侧内囊     

松质骨螺钉张力带与鹰嘴钢板治疗尺骨鹰嘴骨折的疗效评价

目的评价松质骨螺钉张力带和鹰嘴钢板治疗尺骨鹰嘴骨折的疗效。方法采用两种方法治疗尺骨鹰嘴骨折40例,其中鹰嘴钢板18例,松质骨螺钉张力带组22例。根据术后x线片和关节功能恢复情况评定疗效。结果随访2至18月(平均10个月),平均骨折愈合时间7周。鹰嘴钢板组优15例,良2例,可1例。松质骨螺钉张力带组优20例,良2例;两种治疗方法临床效果差异无统计学意义。结论松质骨螺钉张力带一样是治疗尺骨鹰嘴骨折较理想的有效方法。     

Case report: sternal fracture from a seatbelt

We report a case of a sternal fracture in a patient restrained by a seatbelt on the passenger side of a car in a moderate-speed motor vehicle accident. This patient apparently did not have contact with any fixed part of the car. In reporting this case it is our intention to demonstrate that the increased use of seatbelts, although life-saving in many ways, may be associated with emergence of a new spectrum of less “life-threatening” injuries associated with their use. We, therefore, make a case for increased search for sternal injuries and potential complications (including cardiac) for restrained passengers without evidence of other direct chest trauma. We believe that although seatbelts are an essential part of passenger car safety, their use should not deter extensive investigation when evaluating the emergency patient for injuries usually associated with the unrestrained passenger.     

下颌骨髁状突骨折CT的应用价值

下颌骨髁状突骨折在颌面部外伤病人中较为常见,在下颌骨骨折中仅次于下颌体和下颌角骨折,且类型复杂多变,其中以矢状骨折多见１,普通Ｘ线检查较难明确诊断其骨折类型。本文收集了８例下颌骨外伤后疑有髁状突骨折的患者进行ＣＴ扫描,分析其ＣＴ表现,并与普通Ｘ线检查比较,结合临床需要,进一步探讨ＣＴ在髁状突骨折诊断中的价值。１资料与方法的下颌骨外伤史,主要症状及体征有耳前区肿胀或疼痛、张口受限、外耳道出血和牙齿松动等。８例均进行了普通Ｘ线检查和ＣＴ检查,普通Ｘ线检查采用薛氏位或下颌骨开口３０°后前位反汤氏…     

MRI误诊侧脑室转移瘤1例

患者男,59岁,1个月前无明显诱因出现头痛,呈持续性钝痛,无恶心、呕吐,无四肢抽搐及大小便失禁。当地医院头颅CT提示头颅占位性病变。入院后MRI:右侧侧脑室前角内见5.3cm×6.4cm×4.8cm肿块,呈稍长T1长T2信号,病灶内部见小片状短T1短T2信号,病灶边界清晰,充填右侧侧脑室     

Rehabilitation after the operation of fracture of femoral condyle

ＢａｃｋｇｒｏｕｎｄＦｒａｃｔｕｒｅｏｆｆｅｍｏｒａｌｃｏｎｄｙｌｅｉｓｃａｕｓｅｄｍａｉｎｌｙｂｙｄｉｒｅｃｔｖｉｏｌｅｎｔｓａｎｄｉｓａｋｉｎｄｏｆｉｎｔｒａ－ａｒｔｉｃｕｌａｒｆｒａｃｔｕｒｅｄｉｆｆｉｃｕｌｔｔｏｂｅｃｕｒｅｄ．Ａｓｉｍｐｌｅｆｒａｃｔｕｒｅｏｆｍｅｄｉａｌｏｒｅｘｔｅｒｎａｌｍａｌｅｏｌｕｓｈａｓｎｏｏｂ-ｖｉｏｕｓｄｉｓｐｌａｃｅｍｅｎｔａｎｄｉｔｓｔｒａｄｉｔｉｏｎａｌｔｈｅｒａｐｙｍｅｔｈｏｄｉｓｏｕｔｅｒｆｉｘａ-ｔｉｏｎｂｙｇｙｐｓｕｍｏｒｓｐｌｉｎｔｆｏｒ６～…     

腹腔假性黏液瘤合并巴德-吉亚利综合征1例

患者男,53岁,腹胀、乏力、纳差2年,发现右上腹包块1年.患者7年前无明显诱因出现腹部疼痛,考虑急性阑尾炎而行阑尾切除术,术中发现回盲部5 cm×5 cm包块而行右半结肠切除术,术后病理报告为回盲部炎性肉芽肿;3年前发现右下腹壁包块伴疼痛,接受右下腹壁包块切除术.2年前无明显原因出现腹胀、乏力、纳差,腹部B超、CT所见符合巴德-吉亚利综合征(Budd-Chiari syndrome,BCS)改变,遂行下腔静脉支架植入术,术后症状无明显好转.     

股骨髁部骨折术后康复治疗

Background: Fracture of femoral condyle is caused mainly by direct violents, and is a kind of intra- articular fracture difficult to be cured. A simple fracture of medial or external maleolus has no obvious displacement, and its traditional therapy method is: outer fixation by gypsum or splint for 6～ 8 weeks.Long- term immobilization caused the adhesion between the patella and the thigh,or between the condyle of femur and the tibial plateau , or of quadriceps muscle of thigh , or of tissues surrounding the knee joint , which makes dysfunction of the knee joint; at the same time,immobilization may cause disuse changs of the bone and its surrounding tissues, joint's contraction and dysfunction.     

生物可吸收张力带治疗尺骨鹰嘴骨折9例

背景:目前尺骨鹰嘴骨折治疗的方法最常采用的是钢板螺钉或克氏针张力带内固定,都需要二次手术取出内固定物.目的:回顾性分析采用可吸收螺钉+可吸收缝线形成生物可吸收张力带治疗尺骨鹰嘴骨折的效果.方法:2006-07/2009-04同济大学附属东方医院收治的尺骨鹰嘴骨折患者9例,均采用可吸收螺钉+可吸收缝线形成生物可吸收张力带治疗,术后辅以石膏外固定3周后行肘关节功能锻炼.随访12个月,根据X射线片和Mayo肘关节功能评分评定疗效.结果与结论:9例患者术后影像学检查均愈合良好,骨折线模糊;Mayo肘关节功能评分优8例,良1例,未发生尺神经卡压症状;均未发生骨折或骨折端再移位现象.生物可吸收张力带治疗尺骨鹰嘴骨折可为患者早期功能锻炼提供足够的强度,具有固定效果好、无需二期手术取出内固定物的优点,是治疗尺骨鹰嘴骨折较理想的方法之一.