桡骨交锁钉固定防止桡神经深支损伤的应用解剖

目的:为桡骨交锁髓内钉固定术避免桡神经深支损伤提供解剖学依据。方法:前臂标本44侧解剖显露桡神经深支,将肱骨外上髁与Lister结节连线和桡骨头关节面,关节面下1.0、1.5、2.0cm,桡神经深支穿入旋后肌平面,桡神经深支跨越桡骨平面等6个面的交点,依次标记为A、B、C、D、E、F6个点。记录AE、AF的长度,测量B、C、D3个定点在屈肘前臂旋前、中立、旋后位与桡神经深支的水平距离。结果:B、C、D3个定点离桡神经深支的距离越来越近;而对于同一定点,其与桡神经深支的距离按旋前、中立、旋后位的顺序越来越远。结论:桡骨交锁髓内钉固定时,宜于屈肘前臂中立位,在肱骨外上髁与Lister结节连线上,距桡骨头关节面约1.5cm的位置,由前臂后外侧向前内侧插入远端交锁螺丝钉较为安全。     

带锁髓内针治疗股骨骨折74例

目的 探讨股骨带锁髓内针治疗股骨干骨折的临床应用价值。方法 回顾我院74例带锁钉治疗股骨干骨折的临床资料。结果 74例股骨干骨折术后能早期负重,早期功能锻炼,均骨性愈合,关节功能良好。结论 股骨带锁钉治疗股骨骨折特别是复杂的股骨干骨折疗效满意,且并发症发生率较低,带锁钉的临床应用扩大了普通髓内针的适应证。     

缝匠肌骨瓣移植空心拉力钉固定治疗青壮年股骨颈骨折

目的：通过采用缝匠骼骨瓣移植、空心拉力钉固定治疗青壮年股骨颈骨折,获得更好的疗效。方法：自１９９２年１月～１９９９年１２月,采用缝匠肌骨瓣移植桥接与空心拉力钉固定治疗青壮年股骨颈骨折,随访时间１～５年,平均４年。结果：７３例新鲜骨折中１例骨折不愈合,股骨头坏死,１例骨折愈合股骨头坏死;２７例移位型陈旧骨折中３例骨折不愈合,股骨头坏死,２例骨折愈合后股骨头坏死。骨折愈合率９６％,股骨头坏死率７％。结论：缝匠肌骨瓣移植可改善股骨头血供并使植骨以“活骨骨折愈合”的方式完成,陈旧性骨折股骨颈吸收的可重建股骨颈,井有一定的强度支撑防止股骨头坏死应力塌陷,与空心拉力钉有协同支撑固定作用。三根空心拉力钉固定创伤小而连接控制面积大是理想的内固定物。     

缓降解聚酰胺可吸收髓内针治疗成人四肢长骨骨折

目的研究缓降解聚酰胺可吸收髓内针治疗成人四肢长骨骨折的临床应用效果。方法将48例四肢长骨骨折患者设为观察组,采用国产缓降解聚酰胺可吸收髓内针治疗,将同期50例四肢长骨骨折患者设为对照组,采用金属交锁髓内针治疗。术后定期随访,比较两组的手术时间、术中出血量、住院时间、手术并发症、骨折愈合率及肢体功能评价结果。结果两组在手术时间、术中出血量、住院时间差异有统计学意义,观察组明显低于对照组(t=5.466,P=0.000;t=4.199,P=0.001;t=2.214,P=0.034);两组肢体功能评价结果差异无统计学意义(χ2=0.387,P>0.05);观察组未出现术中神经、血管副损伤、骨折不愈合及术后感染等并发症。结论国产缓降解聚酰胺可吸收髓内针治疗成人四肢长骨骨折疗效确切,手术创伤小,安全性高,免除二次手术,具有良好的临床推广和应用价值。     

四肢长骨病理性骨折的治疗

目的分析石膏托和交锁髓内钉治疗股骨、胫骨、肱骨、桡骨病理性骨折的疗效。方法30例病理骨折(26例骨折、4例临界骨折)采用交锁髓内钉治疗,9例采用石膏托外固定。6例良性病变行病灶刮除、自体和(或)异体骨移植;15例转移癌13例行病灶姑息切除、骨水泥填充加强,2例单纯闭合穿钉固定。结果6例良性病变患者获随访,骨折首次术后平均4.5个月愈合;因复发或内固定失败需再手术2例。15例转移癌获随访,疼痛缓解功能恢复满意。结论交锁髓内钉是治疗股骨、胫骨、肱骨病理性骨折理想的内固定物,外固定可缓解疼痛,但有关节僵硬等并发症。     

High incidence of screw penetration in the proximal and distal tibiofibular joints after intramedullary nailing of tibial fractures—A prospective cohort and mapping study

BackgroundIntramedullary-nails (IMN) are the treatment of choice for most tibial shaft fractures due to their minimally-invasive nature and non-demanding surgical technique. However, a potential iatrogenic pitfall is intra-articular interlocking screw positioning within the proximal (PTFJ) and distal (DTFJ) tibiofibular joints that may go unrecognized.ObjectiveTo evaluate the incidence of intra-articular screw penetration of the PTFJ and DTFJs after interlocking of IMN for tibial fractures.InterventionReamed IMN using modern techniques, including proximal interlocking via standard aiming jig and distal interlocking either freehand or using SureShot^®.MethodsProspective series of 165 consecutive patients with a tibial shaft fracture managed with an IMN. Diagnosis and incidence of penetration of the PTFJ and DTFJ was assessed on protocolled low-dose postoperative CT-scans (standardized clinical practice for assessing rotational alignment). The degree of penetration of the TFJ’s was graded as: Grade 1–slight breach of the tibial cortex; Grade 2–clear penetration of the tibial cortex with intra-articular screw tip; and Grade 3–penetration of both tibial- and fibular cortices with screw tip in fibula.ResultsOf the 165 tibial shaft fractures, using the AO/OTA classification, 69% were simple, 16% wedge and 15% complex fractures. Following IMN 42% of patients had intra-articular screw penetration of their PTFJ whilst 39% had penetration of their DTFJ. 66% of patients had penetration of either one- or both of their TFJs. The grading of PTFJ violation was distributed as follows: Grade 1 in 24 patients; Grade 2 in 26 patients and Grade 3 in 19 patients. DTFJ violation was graded as: Grade 1 in 21 patients; 40 patients had Grade 2 violation; and four patients had a Grade 3 penetration.ConclusionsThis diagnostic imaging study reports a high rate of intra-articular screw penetration of the PTFJ and DTFJ after interlocking of IMN for tibia shaft fractures. A prospective cohort study is underway to evaluate its clinical significance.Changes to enable alteration in forced angle of interlocking screw trajectory and avoidance of the anteromedial to posterolateral locking screw may reduce the incidence of TJF violation.Level of evidenceLevel II – Diagnostic Imaging Study     

Regeneration of nails with artificial dermis

Abstract

We treated fingertips injured through the proximal half of the nail bed using artificial dermis in 22 patients from 2004 to 2009. We classified the injuries to the nail bed into three types according to where the wounds were. Type ? was localised to the nail bed with or without minor injury to the surrounding structure; type II was an avulsion and amputation of the fingertip including the nail bed, the finger pulp, and the distal phalanx at the level of the proximal nail bed; and type III was post-traumatic shortening of the nail, in which the pulp and distal phalanx were intact. Regeneration and elongation of the nail was achieved in every patient by applying artificial dermis. All patients were satisfied with the results.     

WEILBY-BURTON ARTHROPLASTY OF THE TRAPEZIOMETACARPAL JOINT OF THE THUMB

Twenty-three patients (25 thumbs) were treated by tendon interposition arthroplasty for trapeziometacarpal arthrosis as described by Weilby and modified slightly as described by Burton and Pellegrini. There was good (4/25, 16%) or complete (19/25, 76%) pain relief in 23 (92%) of the cases. Activities of daily living were generally easier. Mobility and strength of the thumb were satisfactory. One patient had signs of instability during a stress test. We conclude that our technique produces a stable and pain-free thumb joint. However, careful selection of the patients for this procedure is essential, and the patient must be given comprehensive information about all stages.     

A Case of Acquired Idiopathic Pterygium Inversum Unguis

Pterygium inversum unguis (PIU) is a rare nail abnormality in which the distal nail bed adheres to the ventral surface of the nail plate, with obliteration of the distal groove. Because of the rarity of this condition, its exact origin is unknown. This disorder can be either congenital or acquired, with or without a family history. The acquired forms may be idiopathic or secondary to systemic connective tissue diseases or other causes such as stroke, neurofibromatosis, leprosy, or the use of nail fortifiers. We present an unusual case of acquired idiopathic PIU of the 10 fingernails in a 22-year-old man.