先天性多指畸形31例的整复

介绍采用四种术式治疗先天性多指畸形31例的体会。认为手术时机以1～5岁为宜;术前辨认主副指是最重要的步骤,与术式的选择、手术切口设计与术后主指外形直接相关。关节囊修补与成形应在副指寄生处作鱼口状皮肤切口紧贴骨面剔除副指,防止损伤主指及近端。文中还就先天性多指畸形发生率做了统计。     

Comparison of a semiquantitative and a quantitative method for assessing vertebral fractures in osteoporosis

There is no agreed definition for the assessment of vertebral fractures and deformities in patients with osteoporosis. Radiographs of 66 patients randomized for therapy with etidronate or placebo were analyzed at baseline and during follow-up (60/120/150 weeks) independently using two procedures. The first method of spinal deformity index (SDI_G) and vertebral deformity score (VDS_G) is based on a semiquantitative visual reading of each vertebra between T4 and L4. The second method of spine deformity index (SDI_M) and vertebral deformity index (VDI_M) is based on vertebral height measurements of T4 through L5 and each measurement from T5 to L5 (anterior, middle and posterior height) is related to T4 and compared with the respective T4-related normal range. There was good agreement between the mean vertebral deformation from T5 to L4 graded by VDS_G and VDI_M, with correlation coefficients betweenR=0.52 (p<0.0001) andR=0.9 (p<0.0001) respectively. Spinal deformation at baseline as measured by SDI_M and SDI_G was correlated withR=0.76 (p<0.0001). For diagnosing a vertebra as fractured or not, VDI_M reached a sensitivity of 82% and a specificity of 85% using VDS_G as a standard, and on the other hand VDS_G reached a sensitivity of 78% and a specificity of 88% in relation to VDI_M. The changes in spinal deformation from week 0 to 150 were correlated withR=0.58 (p<0.0002) between SDI_M and SDI_G. To detect vertebral fracture progression the sensitivity of VDI_M was 74% and the specificity 86%, when changes in VDS_G were used as a standard. On the other hand sensitivity for VDS_G was 56% and specificity 95% to detect vertebral fracture progression, when changes in VDI_M were used as a standard. The comparison of changes in spinal deformation in the etidronate and placebo group during the 3-year study demonstrated that changes in SDI_M during follow-up confirmed the results found by the changes in SDI_G. As an independent standard for vertebral deformity and fracture definition is not available, the present study does not allow a decision as to whether semiquantitative reading (SDI_G) or vertebral height measurements (SDI_M) are closer to the biological truth. We conclude that in clinical studies the assessment of vertebral fractures or deformations should be validated by the comparison between two different established techniques, performed independently.     

膝关节内翻屈曲畸形全膝关节置换的软组织平衡

目的探索对膝关节内翻屈曲畸形患者施行的全膝关节置换（total knee arthroplasty,TKA）软组织平衡技术。方法2001年1月～2005年12月,对实施的86例104膝骨性关节炎（osteoarthritis,OA）行TKA的膝内翻屈曲畸形患者进行回顾性研究,对术中的软组织平衡问题进行讨论。其中男19例23膝,女67例81膝;年龄57岁～78岁,平均66岁。行单侧TKA术68例,双侧18例。均为初次行TKA的OA患者。术前内翻角为6～34°,平均12.3°;其中软组织性内翻占总内翻角的56.7%,骨性内翻占43.3%。术前膝关节屈曲挛缩畸形10°以下21膝,10～19°45膝,20～29°22膝,30°以上16膝,平均18.9°。结果患者术前膝关节平均屈曲挛缩18.9°,术中除4例残留5°屈曲挛缩外,其余患者术中膝关节均能达到完全伸直。术后随访6～72个月,平均37个月,6例残留5～10°屈曲挛缩,余膝关节可达到完全伸直。术前内翻角6～34°,平均12.3°;术后测量股胫角170.3～175.6°,平均174.7°,其中2例残留内翻角〉3°。术中、术后发生并发症6例,其中内侧副韧带股骨起点损伤2例;髌骨弹响2例;脑栓塞及腔隙性脑梗塞各1例,经内科治疗后未遗留神经症状。均无皮肤坏死、切口感染及深部感染发生。结论软组织平衡是矫正膝关节内翻屈曲挛缩畸形的主要手段,良好合理的软组织平衡可使高度畸形的膝关节在TKA术后获得明显的功能恢复和畸形矫正。     

Brothers with genu recurvatum

Genu recurvatum deformity is rare, usually resulting from injury to the anterior part of the proximal tibial growth plate. However, a small group of cases have no known cause. We describe brothers with the same type of this deformity on the same side. The degree of deformity differed between them, but deformities began at the same age in both (17 years) and progressed over a short period. There was no history of trauma, or other orthopaedic or genetic disorders. These features strongly suggested involvement of heritable risk factors.     

超声引导介入治疗脐尿管畸形并感染结石1例

患者男,72岁,尿急、尿频2年余,近期加重入院.查体:老年男性,一般状况良好.因前列腺增生症(Ⅱ度)行超声检查以排除其他疾患.     

Dysphagia and micrognathia in a patient with juvenile rheumatoid arthritis

Summary This report describes the case of a 35-year-old man with juvenile rheumatoid arthritis. The patient experienced swallowing difficulties that were initially thought to be a result of the disease affecting the cervical spine. A maxillofacial examination, however, showed a total loss of the mandibular condyles, short rami and bodies, and a retrusion of the jaw. This was considered to be the main cause of the dysphagia, and not a glossopharyngeal nerve compression. The surgical-orthodontic management of these difficult cases is discussed.     

Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)

Introduction  

Pedicle screw instrumentation in AIS has advantages of rigid fixation, improved deformity correction and a shorter fusion, but needs an exacting technique.     

单侧唇裂继发畸形整复术的术式改良

目的 探讨改良术式修复单侧唇裂术后继发唇、鼻畸形的效果.方法 手术切几线与口鼻轮廓线相一致,片使鼻翼外侧脚整体旋转复位,重建鼻槛及鼻底,通过鼻腔的V-Y黏软骨瓣使鼻翼软骨上推,矫正鼻畸形.结果 自2000年以来,应用此方法对69例单侧唇裂继发唇、鼻畸形患者进行了修复,均取得较满意的效果,术后瘢痕线不明显.结论 轮廓线切口以及鼻翼软骨上推复位的方法符合唇、鼻的解剖特征,是一种较好的手术方法.     

鼻前庭推进瓣修复单侧唇裂术后鼻畸形

为探讨并改进单侧唇裂术后鼻畸形的修复方法,根据 Cronin 的鼻畸形修复原则,采用鼻前庭 V-Y 推进瓣,充分游离鼻翼软骨,重置悬吊,并通过鼻翼外脚沟弧形切口,松解梨状孔外侧和上唇的牵拉,使鼻尖偏移、鼻翼扁平塌陷、鼻孔横置、鼻翼外展下垂、鼻孔基底塌陷等得以充分矫正。6年间,共修复单侧唇裂术后鼻畸形106例,通过近远期随访观察,效果满意,证明此术式是修复唇裂术后鼻畸形的良好手术方法。