内固定后早期功能锻炼治疗胫骨远端骨折

目的：介绍胫骨远端粉碎骨折的固定方法及其康复。方法：34例胫骨远端粉碎骨折，螺旋形骨折、冠状面骨折为主者采用螺丝钉或重建钢板内固定并辅以石膏外固定21例，以矢状面骨折为主者采用AO三叶钢板内固定13例，术后随访17．3个月。结果：按Mazur等制定的踝关节症状与功能评分系统，手术疗效评定结果为：优25例，良7例，可1例，差1例。结论：根据骨折类型和条件灵活选择固定方式及早期功能锻炼是取得良好效果的关键。     

半环槽式外固定器结合有限内固定治疗复杂胫腓骨骨折

目的 探讨应用半环槽式外固定器结合有限内固定治疗复杂胫腓骨骨折的疗效。方法 应用拉力螺钉及钢丝对骨折区域内骨折块进行有限内固定，恢复骨折块正常解剖关系，经有限内固定后胫腓骨骨折区域用半环槽式外固定器固定，外固定范围不超出膝，踝关节，术后第2天行主动膝，踝关节活动锻炼，术后2－3周行走负重。结果 随访12－18个月，骨折骨性愈合时间20－24周（平均22周），无骨感染，骨外感，内固定物外感，肢体肿胀，关节僵硬。结论 半环槽式外固定器结合有限内固定术式是治疗复杂胫骨骨折的有效方法。     

有限内固定结合外固定架在胫骨骨折治疗中的应用进展

胫骨骨折临床常见，常合并腓骨骨折，其中高能量损伤所致胫骨平台骨折、胫骨中下1／3骨折、Pilon骨折等，治疗上仍有一定挑战性。以往多采用单纯内固定或外固定等方法，随着内固定技术及外固定支具的进步，有限内固定结合外固定架方法形成一定优势，该方法在相对坚强固定的基础上，减少了对局部血运的破坏，更接近BO（Biological Osteosynthesis，BO）原则，有利于骨折早期愈合和功能锻炼。     

T型接骨板治疗桡骨远端不稳定骨折45例早期疗效分析

目前治疗桡骨远端骨折的方法很多，包括手法复位外固定、闭合复位外固定架固定、切开复位克氏针内固定、切开复位板钉内固定等。大多数桡骨远端关节外的简单骨折手法复位石膏外固定可获得满意疗效，对不稳定的桡骨远端粉碎骨折，尤其关节内骨折，单纯关节固定很难做到关节面良好的对位和稳定的固定，从而造成桡腕及桡尺关节骨性关节炎、握力下降、顽固性腕关节疼痛等并发症。因此对桡骨远端不稳定骨折诊断及治疗的研究日益受到各国学者重视。     

单臂外固定架治疗胫骨远端骨折22例

目的探讨单臂外固定架治疗胫骨远端骨折的疗效。方法根据骨折分型确定外固定针的安放部位，A型骨折在骨折两端置外固定针；远端骨折块过小不能容纳外固定针者以及B和C型骨折在骨折近端和跟骨及距骨安放外固定针。撑开复位，复位困难者部分切开复位，植骨螺钉或克氏针固定，合并腓骨骨折同时行切开复位内固定。结果22例外固定架固定3．5-8个月，平均5个月，骨折均愈合，无严重深部感染、骨髓炎、骨折不愈合等严重并发症。随访10-32个月，平均20个月，拆除外固定架康复6个月以上，按Tornetta胫骨远端骨折治疗标准，优11例，良7例，可3例，差1例。结论单臂外固定架固定联合有限切开内固定是治疗胫骨远端骨折简单有效的微创治疗方法之一。     

半环槽式外固定器结合有限内固定治疗复杂胫腓骨骨折

目的：探讨应用半环槽式外固定器结合有限内固定治疗复杂胫腓骨骨折的疗效。方法：拉力螺钉及钢丝对骨折区域内骨折块进行有限内固定，恢复骨折块正常解剖几何关系，半环槽式外固定器固定经有限内固定后胫腓骨骨折区域，外固定范围不超出膝、踝关节。结果：早期功能锻炼，术后第2d行主动膝，踝关节活动锻炼，术后2－3周行走负重，随访12－18个月，骨折骨性愈合时间20－24周，平均22周，无骨感染，骨外露，内固定物外露，肢体肿胀，关节僵硬。结论：半环槽式外固定器结合有限内固定术是一种治疗复杂胫腓骨骨折的有效方法。     

《骨外固定学》简介

经皮穿针骨外固定治疗骨折是介于手术内固定和手法整复骨折后用石膏绷带、夹板等固定骨折之间的一种方法。三者各有其特有的应用指征，在临床应用上互为补充，是骨科医师必须掌握的治疗技术。骨外固定的历史远早于内固定，1840年Malgaigne就设计出第一个外固定器用于治疗小腿骨折。但骨外固定的发展在经历了曲折而漫长的演进过程之后，     

髋关节功能X线解剖学研究与临床应用

目的：为股骨颈骨折复位及内固定提供X线解剖学资料，提高复位、内固定的质量。方法：在7具(14侧)成人整尸上，研究髋关节各方向位置变化时(包括屈曲、内旋、外旋位上股骨头内部骨小梁)的X线变化规律。结果：髋关节在屈曲、内旋、外旋时。其内部骨小梁的排列方向在正侧位上有规律可循，并将之应用于临床，明显提高了复位及内固定的质量，并降低了股骨头的坏死率及骨不连率。结论：研究髋关节功能x线解剖，有助于临床上对股骨颈骨折的解剖复位及牢固固定，进而降低了股骨头的坏死率及骨不连率。     

腓骨内固定加管型石膏外固定治疗复杂Pilon骨折

目的探讨腓骨内固定加外固定治疗Pilon骨折的疗效。方法采用钢板螺钉内固定治疗腓骨骨折，然后用松质骨拉力螺钉或可吸收螺钉固定下胫腓关节，对压缩的胫骨取髂骨植骨，修复骨缺损，不做胫骨内固定手术，术后小腿管型石膏外固定。结果46例Pilon骨折，优36例，良5例，中3例，差2例。其中2例感染，皮肤伤口半年愈合，总优良率89．1％。结论有限内固定结合术后管型石膏外固定治疗Pilon骨折具有损伤小、愈合快、并发症少的优点。     

石膏前后夹板外固定腕关节功能位治疗桡骨远端骨折

<正>桡骨远端骨折是临床上最常见的骨折之一,约占急诊骨折患者的1/6[1],目前治疗桡骨远端骨折的方法很多,有手法复位石膏外固定、闭合复位外固定架固定、切开复位克氏针内     

功能磁共振联合神经导航辅助切除功能区海绵状血管瘤

目的探讨功能磁共振联合神经导航辅助的显微手术在治疗功能区海绵状血管瘤中的应用价值。方法用功能磁共振联合神经导航技术,对功能区的5例海绵状血管瘤行显微外科手术切除。结果病灶全切除率为100％,无重要神经功能受损表现,无手术并发症及死亡。结论功能磁共振联合神经导航辅助的显微手术治疗功能区内海绵状血管瘤,定位精确,微侵袭,可提高海绵状血管瘤切除率,降低手术并发症。对手术切除脑功能区海绵状血管瘤并保留运动功能有重要的指导作用。     

Co-registration of the Schaltenbrand-Wahren microseries with the probabilistic functional atlas

OBJECTIVE: The Schaltenbrand-Wahren atlas (SWA) is anatomical, sparse and inconsistent in three dimensions. A high-resolution, electrophysiology-based atlas derived from numerous specimens overcomes these limitations. A combined anatomy-physiology atlas leverages the strengths and complementarity of both, which is studied here. METHOD: An electronic version of the SWA was constructed. A probabilistic functional atlas (PFA) was developed from electrophysiological and neuroimaging data with 0.25 mm3 resolution. A combined atlas is constructed by co-registering the PFA with the SWA by applying linear scaling along the intercommissural distance and the height of the thalamus. RESULTS: An anatomy-physiology atlas is superior to its component atlases. When in register, the anatomical and functional atlases are displayed together and used simultaneously. A structure of interest from the PFA can be displayed with high resolution, compensating for its sparseness in the SWA, while its surrounding structures are obtained from the SWA. The best anatomical and functional targets can be compared: for the subthalamic nucleus, the horizontal and lateral coordinates of the SWA-based and PFA- based targets are approximately the same, while the latter is located 1.3-1.5 mm more anteriorly. CONCLUSION: An anatomy-physiology atlas may enhance the accuracy of targeting and increase the neurosurgeon's confidence. It also opens new research avenues to serve as a reference for: (1) constructing an extendable atlas by adding new electrophysiological data, (2) comparing anatomical and functional targets, (3) studying and comparing various symptoms, and (4) comparing image-based targets obtained from various modalities.     

Image-directed functional neurosurgery with the Cosman-Roberts-Wells stereotactic instrument

Summary An isocentered system for functional stereotactic procedures with the Cosman-Roberts-Wells frame and a CT localizer that allows extrapolation of target data directly from the CT slice is presented. Based on anatomical landmarks and on the scaled corresponding transverse plates of the Schaltenbrand and Wahren atlas, we delineate the thalamic and cerebellar nuclei. Twenty three image-directed functional procedures were performed in one year on 18 patients (7 with Parkinson's disease, 4 with dystonia, 3 persons with essential tremor, 2 patients with choreo-athetosis and 2 with de-afferentiation pain). The 23 procedures included 19 thalamotomies, two dentatotomies and two stereotactic implantations of deep seated brain electrodes. Successful targeting was verified by intra-operative electrical stimulation and postoperative CT scan. Complete reduction of symptoms was observed in 4 persons with Parkinson's disease and in 2 patients with essential tremor with significant improvement observed in the rest of the patients with the exception of the individual with choreo-athetosis. There were no operation-related complications. The reported technique is safer and less distressing for patients than previous radiological procedures and it makes image-directed stereotactic functional neurosurgery available to many units with the CRW frame.     

Pain and functional problems with the temporomandibular joint

Pain and functional problems with the temporomandibular joint present a variety of clinical forms. Contrary to what has been described for many years, they do not correspond to a syndrome. Questioning the patient and clinical examination are most often sufficient to specify the type of dysfunction of the manducatory apparatus. Treatment, which will not be detailed in this article, is oriented toward reversible treatments such as occlusal appliances, rehabilitation, or maxillofacial physical therapy.     

Indications and technic of functional fracture treatment with the Sarmiento brace

Fracture bracing is a way of conservative fracture treatment on the extremities, which avoids fracture disease by long-term immobilization. Indication is given in humerus shaft-, ulna shaft- and tibia or lower leg fractures, if there is no contraindication like angulation, shortening, muscle distraction or nerve injury. If these and other contraindications are taken into account, functional fracture bracing can be expected to be successful.