CT三维重建模型下模拟髋臼前柱2种经皮置钉方法的比较

目的对比CT三维重建模型下模拟髋臼前柱2种经皮置钉方法的效果。方法选取55例正常成人骨盆CT资料构建三维模型,共110侧髋臼前柱,调整模型透明度使其类似常规X线片,分别用2种置钉方法进行置钉,A组利用出口闭孔位和入口髂骨位引导置钉,B组利用髋臼前柱轴位引导置钉,置钉完成后恢复图像为不透明状态,记录螺钉是否进入髋关节及与耻骨支的位置关系。结果55例110侧髋臼,4侧未能找到髋臼前柱轴位影像予以剔除,106侧髋臼前柱纳入研究。2组模型均无螺钉进入髋臼。A组螺钉置入优秀、良好、尚可率分别为59.4%、17.0%、23.6%,B组分别为59.4%、22.6%、17.9%,2组总体置钉质量差异无统计学意义(Z=-0.829,P=0.407)。A组女性骨盆置钉优秀、良好、尚可率分别为7.1%、21.4%、71.4%,B组分别为28.6%、21.4%、50.0%,B组置钉质量显著高于A组(Z=-3.000,P=0.003)。A组男性骨盆置钉优秀率78.2%,良好率15.4%,尚可率6.4%,B组分别为70.5%、23.1%、6.4%,2组差异无显著性(Z=-0.969,P=0.333)。结论髋臼前柱轴位可以作为引导置钉的一种手段,尤其适用于女性患者,对于男性患者,2种方法均可实现较好的置钉。     

Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To introduce a novel technique for transscleral fixation of the PC-IOL that requires no sutures on the IOL haptics. METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 months. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method. RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group (-1.02±0.46 diopters vs -1.57±0.77 diopters; P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group. CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.     

Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

浮肩损伤的临床特征和治疗

目的 总结浮肩损伤（floating shoulder injury，FSI）的临床特征和治疗效果。方法1993年1月-2004年9月收治浮肩损伤患者8例，除2例行锁骨固定带固定外，其余6例均行手术治疗，其中单纯行锁骨切开复位重建钢板内固定1例，同时行肩胛骨内固定5例。受伤至手术时间为2h～7d，平均3．5d，术后6个月对患肩功能进行Constant评分判定疗效，并对浮肩损伤的临床特征和治疗进行总结。结果6例患者经过6个月～3年（平均11个月）的随访，锁骨和肩胛骨骨折均愈合，肩关节活动范围无明显受限，但有2例患者在举重物时肩关节有轻度的疼痛，1例患侧上肢肌力较对侧稍减弱。术后6个月患肩功能Constant评分平均为93分。结论浮肩损伤多为高能量暴力所致的不稳定性肩胛带损伤，在治疗方案上尚存争议。但对移位明显的浮肩损伤以及有伴发伤的浮肩损伤进行手术治疗是必要的。     

AO钢板内固定治疗跟骨骨折

目的 探讨复杂跟骨骨折治疗方法及AO钢板内固定价值.方法 应用AO钢板治疗累及距下关节的跟骨骨折24例,术中注意关节面复位和Bohler角的恢复.结果 24例病人经12～24个月随访,按照Fernandez评定标准:24例跟骨SandersⅡ-Ⅳ型骨折病人有18足评为优良.结论 距下关节面的复位和Bohler角的恢复,牢固的内固定和术后足够长时间的负重限制是成功的关键.     

空心螺钉治疗股骨颈骨折术后并发症的分析

目的探讨影响空心螺钉治疗股骨颈骨折术后早期并发症及中晚期股骨头缺血性坏死的因素。方法对1994年1月～2004年1月间应用空心螺钉治疗的116例股骨颈骨折患者进行回顾性总结,将患者性别、年龄、骨折类型、骨折复位情况、外伤至手术时间与骨折术后早期并发症及中晚期股骨头缺血性坏死间的关系进行统计学分析。结果116例患者获平均(3．2±2．5)年(1～11年)随访。术后早期并发症包括：骨折内固定失败6例,骨折周围再骨折2例,感染2例,下肢深静脉血栓6例。年龄是引起骨折术后早期并发症的主要因素之一；骨折术后早期并发症还与骨质情况及内固定技术有关。本组16例出现股骨头缺血性坏死,其坏死率为13．8%。造成股骨头缺血性坏死的因素主要是骨折类型,其次为骨折复位情况。结论①年龄大于60岁的患者股骨颈骨折术后早期并发症相对多。②对于骨折移位严重的高龄患者,建议行人工关节置换术。③内固定术应尽可能解剖复位、坚强牢靠,以减少术后股骨头缺血性坏死的发生。     

下颈椎可屈性与寰枢关节Magerl固定术的可行性分析

目的:探讨下颈椎的屈曲程度与后路经寰枢关节螺钉固定术的可能性。方法:回顾已施行经寰枢关节螺钉固定术病例的术前颈椎过屈位X线像,测量C2～C7间的角度,复习手术经过,分析可完成螺钉固定的颈椎曲度及其它相关因素。结果:在已完成后路经寰枢关节螺钉固定术的75例患者中有58例屈颈侧位X线像显示下颈椎呈后凸状态,后凸角平均为17.25°;另17例屈颈侧位片见下颈椎呈前凸状态,但这些病例都是体形瘦长者。结论:后路经寰枢关节螺钉固定术仅适合于下颈椎可以很好屈曲及体形瘦长的病例。     

外固定架治疗桡骨远端粉碎性骨折的疗效分析

目的:探讨闭合手法复位外固定架治疗桡骨远端粉碎性关节内骨折的临床疗效。方法:对29例桡骨远端粉碎性关节内骨折,通过外固定架的牵伸辅助复位,矫正桡骨的短缩、成角移位,恢复关节面的解剖关系,利用外固定架维持复位后的位置并进行功能练习。术后定期进行X线和腕关节功能的评价。结果:29例均获得随访,随访时间3~12个月,平均6.5个月。根据Aro功能评价:优9例,良17例,可2例,差1例,优良率89.66%。结论:外固定架能很好维持复位后的位置,恢复桡尺骨的相对长度和关节面的平整,使腕关节功能得到良好的恢复,因此是治疗桡骨远端粉碎性关节内骨折的有效方法。     

镍钛形状记忆合金环抱接骨板治疗桡骨近端1/3骨折

目的探讨治疗桡骨近端1/3骨折的理想内固定方法.方法 2001年8月～2004年4月,采用镍钛形状记忆合金环抱接骨板治疗24例桡骨近端1/3骨折.其中男19例,女5例.年龄16～48岁.摔伤9例,压砸伤5例,交通事故伤4例,直接暴力撞击伤3例,高处坠落伤3例.按照形状记忆合金环抱接骨板的安装方法进行骨折复位内固定.术后定期随访,观察骨折愈合及功能恢复情况.结果所有患者均获随访4～21个月,平均10个月.均无术中、术后并发症,切口Ⅰ期愈合;X 线片示骨折均于术后8～12周临床愈合,根据Anderson疗效标准,功能恢复优18例,良5例,可1例,优良率95.83%.结论应用镍钛形状记忆合金环抱接骨板治疗桡骨近端1/3骨折具有创伤小、操作简便安全、固定可靠、组织相容性好、并发症少等优点,有利于促进骨折愈合和肘、腕关节功能康复,是一种治疗桡骨近端1/3骨折的较好方法.     

关节镜辅助下钢板内固定治疗关节内跟骨骨折

[目的]探讨分析关节镜辅助下钢板内固定治疗关节内跟骨骨折的方法和疗效;[方法]对78位患者，86例累及关节面的跟骨骨折在关节镜辅助下行切开复位钢板内固定术，术后平均随访18个月（12～30个月），通过比较术前术后X线片和踝足功能的AOFAS评分对治疗效果作分析评价．[结果]86例关节内跟骨骨折术后X线示复位满意．与术前存在显著性差异（P〈0．01），AOFAS评分优良率91．86％．[结论]对于关节内跟骨骨折，采用关节镜辅助钢板内固定更加接近解剖复位，足部功能恢复满意且并发症少