尺骨鹰嘴骨折不同程度骨量丢失对肘关节稳定性的影响

Objective To investigate effects of different bone defects on stability of the elbow in the olecranon fracture. Methods Ten fresh cadavers with 20 upper extremities were used in the present study. Different models of bone defects in the middle olecranon were created by cutting the bone from 10 mm below the olecranon process. The 20 specimens were randomly made into intact, 3 mm defect, 6 mm defect and 9 mm defect groups. After osteotomy fixations were applied with the tension band wire. Changes in the range of motion of the elbow joint were measured. When the elbow was flexed at 30°, 60°, 90°, and 120°, a and the varus angulations in the varus test position, and observe the changes in relationship to the humeroulnar joint. Results Extension of the elbow was limited when the defect was 3 mm. X-ray showed that the extension of the elbow was obviously limited when the defect was 6 mm, with the humeroulnar joint moving resistantly, the olecranon process completely touching the surface of the trochlear and the interspace between the humeroulnar joint increasing. When the defect was up to 9 mm, the humeroulnar joint was subluxated obviously,with the trochlear notch nearly disappearing. Given the same degree of elbow flexion, the valgus angulation increased with the defect, especially when the defect was beyond6 mm (P ＜0.05). Conclusions When the bone defect at the middle olecranon reaches 6 mm, the trochlear notch radian will change, leading to an unstable elbow joint. Consequently, comminuted fractures of the middle olecranon can be treated with fixation if the defect is less than 6 mm: Otherwise bone grafting may be necessary to recover the trochlear notch radian and reduce the risk of traumatic osteoarthritis.     

尺骨鹰嘴骨折不同程度骨量丢失对肘关节稳定性的影响

目的 探讨尺骨鹰嘴骨折时不同程度骨量丢失对肘关节稳定性的影响.方法 取10具20侧男性新鲜上技标本,在距尺骨鹰嘴尖部10 mm处向远端截骨,制备鹰嘴中部不同程度骨缺损,即骨量丢失模型,截骨分为4组,每组5侧上肢标本,即尺骨鹰嘴完整组、截除3mm组、截除6mm组、截除9 mm组,骨折断端予张力带内固定后,测量每组肘关节屈伸活动范围变化及肘关节在屈曲30°、60°、90°、120°时,前臂施加1.96 N·m扭距,肘关节内外翻角度的变化,同时观察肱尺关节关系.结果当尺骨鹰嘴截骨至3 mm时,肘关节的伸直活动开始受限;当尺骨鹰嘴截骨至6 mm时,CB片示肱尺关节出现不服贴,鹰嘴尖紧贴滑车关节面,滑车与鹰嘴之间间隙增大,肘关节的伸直活动明显受限;当尺骨鹰嘴截骨至9mm时,CR片示肘关节明显处于半脱位,滑车切迹的弧度基本消失.肘关节屈曲30°、60°、90°时,随截骨量增大肘外翻角度增大,当截骨量达到6 mm时外翻角度明显增大,差异有统计学意义(P＜0.05).而肘关节屈曲30°、60°、90°、120°时,内翻角度组间差异无统计学意义(P＞0.05).结论 尺骨鹰嘴中部截骨缩短达到6mm时,滑车切迹弧度发生改变,出现肘关节不稳定.临床对于尺骨鹰嘴中部粉碎性骨折如短缩不超过6 mm可单纯固定,否则应考虑原位植骨内固定.     

人工全髋关节置换对红细胞免疫功能影响的临床研究

目的:探讨人工全髋关节置换术对红细胞免疫功能的影响。方法:人工全髋关节置换患者32例以郭峰法测不同时间点红细胞Ⅰ型补体受体花环率(RC3bRR)、红细胞免疫复合物花环率(RICR)、自然肿瘤红细胞花环率(NTERR),同时测20例健康人红细胞免疫上述指标作为对照。结果:手术开始30、60min,术后l0min、1天RC3bRR、NTERR、RICR与对照组比较差异有统计学意义(P<0.05);手术开始30、60min,术后l0min时RC3bRR、NTERR低于术前及术后1天(P<0.05),RICR高于术前及术后1天(P<0.05)。结论:人工全髋关节置换术后红细胞免疫功能降低,清除循环免疫复合物能力下降,可能是术后深静脉血栓形成的原因之一。     

快速免疫组化法区分人周围神经束性质

目的：观察免疫组化法区别感觉和运动神经的临床应用可行性。方法：取人周围神经干，经冰冻切片后，切片与抗人脊神经感觉神经元特异蛋白单克隆抗体孵育１０ｍｉｎ，然后与生物素化马抗小鼠ＩｇＧ作用５ｍｉｎ，再滴加生物素－抗生物素－过氧化酶复合物，１０ｍｉｎ后将切片与二氨基联苯胺成色反应２ｍｉｎ。然后进行光镜下观察。结果：感觉神经纤维呈棕黄色深染的阳性反应，而运动神经纤维及其它神经组织以及对照组均为阴性反应。结论：快速免疫组化ＡＢＣ法可准确快速地显示神经干中的感觉神经纤维。     

肱骨近端锁定钢板治疗老年性肱骨近端三、四部分骨折的近期疗效

目的评价肱骨近端锁定加压钢板(lockingproximalhumeralplate,LPHP)治疗老年性肱骨近端三、四部分骨折的近期疗效。方法自2004年4月至2005年4月,采用LPHP治疗62例老年(平均68.5岁)肱骨近端三、四部分骨折患者。其中男性45例,年龄62~77岁,平均70岁。女性17例,年龄60~71岁,平均67岁。根据Neer分型,单纯三部分骨折23例,三部分骨折伴有肩关节脱位3例;单纯四部分骨折31例,四部分骨折伴有肩关节脱位5例。采用改良Thompson切口,牵引复位后用克氏针临时固定骨折块,无需剥离骨膜,将LPHP插入合适位置,骨折近远端分别用锁定及单皮质螺钉固定。若有肩袖损伤则同时给予修补。术后第1天始进行钟摆、前屈、外旋被动功能锻炼,术后3个月开始力量训练。疗效评判采用Neer评分系统。结果术后随访3~12个月,平均8个月,60例患者得到随访。53例无肩痛,7例偶有肩痛,所有患者均能完成日常生活动作。肩关节活动范围:前屈85°~180°,平均155°;后伸65°~80°,平均70.5°;外展90°~120°,平均100°;内收30°~45°,平均40.5°;外旋40°~60°,平均55°;内旋60°~100°;平均90°,内旋时拇指能触及的椎体棘突高度为T11-T6,平均于T9水平。根据Neer评分,优43例,良12例,中5例,差0例。术后优良率为91%,患者主观满意率为90%。结论LPHP对治疗老年性肱骨近端三、四部分骨折尤其是骨折疏松患者近期疗效满意。在保留肱骨头的内固定方法中,LPHP效果最为确切。     

尺骨鹰嘴骨折不同程度骨量丢失对肘关节稳定性的影响

Objective To investigate effects of different bone defects on stability of the elbow in the olecranon fracture. Methods Ten fresh cadavers with 20 upper extremities were used in the present study. Different models of bone defects in the middle olecranon were created by cutting the bone from 10 mm below the olecranon process. The 20 specimens were randomly made into intact, 3 mm defect, 6 mm defect and 9 mm defect groups. After osteotomy fixations were applied with the tension band wire. Changes in the range of motion of the elbow joint were measured. When the elbow was flexed at 30°, 60°, 90°, and 120°, a and the varus angulations in the varus test position, and observe the changes in relationship to the humeroulnar joint. Results Extension of the elbow was limited when the defect was 3 mm. X-ray showed that the extension of the elbow was obviously limited when the defect was 6 mm, with the humeroulnar joint moving resistantly, the olecranon process completely touching the surface of the trochlear and the interspace between the humeroulnar joint increasing. When the defect was up to 9 mm, the humeroulnar joint was subluxated obviously,with the trochlear notch nearly disappearing. Given the same degree of elbow flexion, the valgus angulation increased with the defect, especially when the defect was beyond6 mm (P ＜0.05). Conclusions When the bone defect at the middle olecranon reaches 6 mm, the trochlear notch radian will change, leading to an unstable elbow joint. Consequently, comminuted fractures of the middle olecranon can be treated with fixation if the defect is less than 6 mm: Otherwise bone grafting may be necessary to recover the trochlear notch radian and reduce the risk of traumatic osteoarthritis.     

切开复位内固定治疗严重嵌插外展型肱骨近端骨折

目的 评价切开复位内固定治疗严重嵌插外展型肱骨近端骨折的临床效果.方法 004年4月-2008年2月,手术治疗严重嵌插外展型肱骨近端骨折23例,采用改良的Thompson切口切开复位,用肱骨近端锁定钢板固定,其中20例行一期自体骨移植,8例术中发现有明显的肩袖撕裂而行修补术.术后进行系统的肩关节功能锻炼.结果 23例获得1年以上的随访,平均随访时间为17个月(12～33个月).所有骨折均于术后2个月内愈合,最近一次X线片检查未出现内固定失效和肱骨头坏死.采用肩关节Neer评分系统评分:优9例,良10例,可3例,差1例;优良率为82.6%.患者主观满意率为91.3%.5例出现供骨区髂部疼痛.结论 采用切开复位LPHP内固定治疗严重嵌插外展型肱骨近端骨折有利于早期功能锻炼,疗效满意.     

股骨头表面置换对正常股骨头组织学的影响

背景:拟通过建立动物模型探讨目前的髋关节表面置换的假体设计是否达到成熟、是否能引起股骨头坏死。目的:观察健康新西兰大白兔股骨头表面置换后的组织形态变化。方法:60只健康大白兔行左股骨头表面置换,右侧为正常对照侧。分3,6,9,12周共4次分批处死取股骨头标本行大体、光镜、扫描电镜观察。结果与结论:股骨头表面置换后,股骨头骨质仅在与骨水泥接触界面(骨-水泥界面)有小范围的骨细胞坏死和肉芽组织增生纤维化、以及骨吸收;与金属假体接触的界面(骨-假体界面)亦有轻度小范围骨细胞坏死和肉芽组织增生纤维化,但无骨吸收表现;在远离骨水泥和假体的股骨头中心部位既无骨坏死表现,亦无骨吸收表现,组织表现与正常未手术骨质相同。结果可见股骨头表面置换不会引起正常股骨头的坏死,股骨头坏死与术式及假体本身无因果关系,在一定程度上肯定了表面置换治疗髋关节疾患的安全性和优越性。     

三种内固定方法治疗肱骨髁间粉碎性骨折的疗效比较

目的比较二种内固定方法治疗肱骨髁间粉碎性骨折的疗效。方法2002年2月～2005年1月,采用单钢板螺钉(A组,21例)、“Y”形钢板(B组,33例)和双钢板(C组,19例)固定治疗73例肱骨髁间粉碎性骨折患者,根据Müller的AO分型标准均为C3型骨折。所有患者均取肘后正中切口,采用肱三头肌舌形瓣入路。对本组患者的内固定方式、肘关节功能及并发症等资料进行回顾性研究。结果所有患者获得12～36个月(平均22．3个月)随访。术后12个月,肘关节功能按Jupiter评定标准进行评定,A组优良率为57．1%,B组为81．8%,C组为89．5%。B、C组术后肘关节功能恢复明显较A组好,差异有显著性意义(P＜0．05)；根据Sodergard关于肱骨髁间骨折内固定失败的判断标准,A组失败率为33．3%,B组为15．2%,C组为5．3%,C组内固定失败率明显较A、B组低,B组明显较A组低,差异均有显著性意义(P＜0．05)。无一例出现切口皮肤坏死和深部感染。结论单钢板螺钉治疗肱骨髁间粉碎性骨折,术后肘关节功能恢复较差,内固定松动、断裂及肘内翻畸形发生率亦较高,临床应慎用此方法；“Y”形钢板和双钢板治疗肱骨髁间粉碎性骨折,符合肱骨远端生物力学特点,术后肘关节功能恢复良好者；但“Y”形钢板由于其自身的形态、结构特点,术后内固定松动发生率较高,因此对于肱骨内、外髁骨块较小者,不宜选用“Y”形钢板固定。     

Bold螺钉结合聚髌器治疗髌骨严重粉碎性骨折21例

目的：观察Bold螺钉结合镍钛记忆合金聚髌器治疗髌骨严重粉碎性骨折的效果。方法：采用Bold螺钉结合镍钛记忆合金聚髌器治疗闭合性髌骨严重粉碎性骨折21例,根据AO／OTA分型,21例均为34-C3型,术后功能评定采用改良膝关节活动度（ROM）评价标准。结果：21例患者术后获随访12-24个月,所有患者均获骨性愈合．未发生内固定相关的并发症,采用改良膝关节活动度（ROM）评价标准：优12例,良8例,可1例,优良牢95．2％。结论：Bold螺钉结合聚髌器治疗髌骨严重粉碎性骨折,关节面恢复满意,同定稳同可靠,并发症少,术后无需借助外固定,呵早期进行膝关节屈伸功能锻炼,从而获得良好的膝关节功能恢复。