岩浅大神经管及其周围结构的CT径线测量

目的探讨岩浅大神经管(greater superficial petrosal nerve canal,GSPNC)及其周围解剖结构在CT上的显示及其应用于颅中窝入路手术的重要意义。方法搜集我所行颞骨CT扫描的64例患者(内耳畸形、颞骨外伤史或颞骨手术史患者除外),在工作站上采用MPR后处理技术调整并显示GSPNC及其周围解剖结构的相对位置关系,测量主要结构间的径线值并进行统计学分析。结果测得GSPNC的平均长度为(2.9±2.5)mm(0～15.7)mm,膝状神经窝表面骨质平均厚度为(2.0±1.7)mm(0～7.4)mm,棘孔到岩浅大神经裂孔的平均距离为(10.3±2.2)mm(5.5～15.1)mm等;膝状神经节表面骨质厚度左右两侧存在统计学差异(P=0.033),余各结构间距离左右两侧无明显统计学差异。结论颞骨高分辨率CT图像上能够清楚显示颞骨内部各骨性解剖结构及其位置关系,对于欲行颅中窝入路颞骨岩部手术的患者行术前CT检查有利于实现手术方案的个性化选择。     

Anterior locking plate reduces trochanteric fracture migrations during hip extension

Background

Greater trochanter fractures or osteotomies fixed with lateral plates still present high rates of complications. Unblocked greater trochanter anterior movement during hip extension might be a possible cause of failure. This study aimed to determine, under stair climbing conditions, the biomechanical behaviour of a greater trochanter fragment and the impact of an anterior locking plate on its migration.

Methods

Eighteen femurs paired from nine fresh frozen cadaveric specimens were tested on a quasi-dynamic stair climbing cycling test bench. Left and right sides with greater trochanter fractures were randomly fixed either with an antero-lateral locking plate or with a lateral locking plate. Migrations, defined as the remaining movements of the unloaded greater trochanter fragment, were measured for all 18 femurs.

Findings

During hip extension, multi-directional greater trochanter fragment movements occurred and showed a back-and-forth anterior rotation. The lateral locking plate failed due to greater trochanter fragment rotation around the superior axis and anterior translation. The antero-lateral locking plate significantly reduced greater trochanter anterior migration (− 0.9 mm ± 1.6) compared to the lateral locking plate (9.6 mm ± 9.5).

Interpretation

Hip extension provides a plausible explanation for the high rate of post-operative failures of greater trochanter fixations. An antero-lateral locking plate represents an efficient surgical alternative counteracting the multi-directional greater trochanter movements occurring during hip extension.     

聚焦式体外冲击波联合离心锻炼治疗大转子疼痛综合征

目的:探讨聚焦式体外冲击波联合离心锻炼治疗股骨大转子疼痛综合征的临床疗效.方法:2017年9月至2019年6月,将符合研究标准的53例股骨大转子疼痛综合征(greater trochanteric pain syndrome,GTPS)的患者分为观察组(29例)和对照组(24例).观察组,男8例,女21例,年龄38～6...     

A new classification for combined greater tuberosity fracture and anterior shoulder dislocation: A study of fracture configurations and displacement after reduction

Objective: The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.Methods: A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.Results: There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).Conclusion: This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.Level of Evidence: Level IV, Diagnostic Study     

The Role of Intramedullary Nailing for Proximal Humerus Fractures: What Works and What Does Not

Purpose of ReviewThe evaluation of proximal humerus fractures (PHFs) should be aimed to answer the following four questions: (1) does the fracture need surgery in each particular patient? (2) if surgery is recommended, is it better to proceed with internal fixation or shoulder arthroplasty, (3) if internal fixation is recommended, what is the ideal fixation device strategy, and (4) how can outcomes be optimized? This review article tries to answer these questions and provides some clarity regarding what works and what does not in PHFs treated with intramedullary nailing.Recent FindingsAccording to published articles on the treatment of PHFs with intramedullary nails, it is difficult to draw conclusions about outcomes and complications due to great variation in age, type of fracture, and nail designs included in the studies. However, the literature seems to support the use of modern nail designs for PHFs, especially in fractures of the surgical neck as well as varus posteromedial and valgus fractures with no tuberosity involvement.SummaryAlthough the results of IMN in PHF seem to be better in two-part fractures, in more complex fractures, the quality of the reduction achieved seems to influence functional outcomes. Tuberosity malreduction leads to poor clinical outcomes, high rate of complications, and an increased risk of avascular necrosis. Malreduction of the humeral head increases the risk of postoperative loss of reduction, especially for varus posteromedial impacted fractures. A medial nail entry point decreases the risk of postoperative varus malunion, preserves the rotator cuff tendon, and avoids iatrogenic fractures of the GT. To decrease the risk of postoperative stiffness, fracture fixation should be stable enough to allow early mobilization.     

大网膜吸收功能的动物实验研究

为了进一步研究大网膜的吸收功能,我们采用显微外科技术创制了一种新的动物模型。利用这种动物模型,分别进行了大网膜对生理盐水、美蓝、Conray、I~(131-)人血清白蛋白、I~(131-)胆固醇的吸收功能试验。结果表明:大网膜对上述物质均有明显的吸收作用。这为临床上应用大网膜的吸收功能来治疗某些疾病提供了理论依据。     

不同频率电刺激内脏大神经传入纤维的血压效应

内脏大神经含有丰富的传入纤维,它在传导腹腔内脏器官活动信息方面起着重要的作用。用固定的刺激强度或频率电刺激不同动物的内脏大神经中枢端,可引起血压降低或升高。另外,动脉压力感受器传入可抑制刺激躯体神经传入纤维所致的交感神经传出冲动。切断狗双侧窦神经和主动脉神经(或颈     

Management of chronic osteomyelitis of the skull using vascularized omental transfer

A case of chronic osteomyelitis of the skull with a large scalp and bony defect is presented. Following radical debridement, a vascularized flap of omentum was used for coverage, in conjunction with antibiotics administered intravenously. Some basic considerations in the management of osteomyelitis are discussed, as are the advantages of omentum as a material for scalp replacement.     

大网膜游离移植修复慢性骨髓炎合并皮肤缺损

为了总结大网膜游离移植修复慢性骨髓炎合并皮肤缺损的临床效果，对１９８３年～１９９２年所作的１２例进行了随访观察。其中颅骨５例，胫腓骨４例，足跗骨３例，经彻底清除病灶后，均遗留有部分骨缺损或皮肤软组织缺损。采用吻合血管的自体大网膜移植充填缺损，其表面用中厚皮片移植覆盖。经３～９年随访，１１例无骨髓炎复发，无腹部并发症；１例术后４个月复发，并出现颅内高压症状，术后１年死于鳞状上皮癌