桡骨头骨折合并下尺桡关节脱位损伤误诊误治2例报告

目的：分析桡骨头骨折合并下尺桡关节脱位(Essex-Lopresti损伤)误诊误治的原因并探讨合理治疗方法。方法：2008年至2009年治疗2例桡骨头骨折合并下尺桡关节脱位患者,均为男性,年龄分别为56岁、66岁。摔倒致肘部肿胀压痛、前臂旋转受限明显。X线示桡骨小头粉碎性骨折,Mason Ⅲ型1例、Ⅳ型1例。均行桡骨小头切除术,术后常规石膏固定对症处理。结果：2例均出现前臂旋转功能受限明显伴肘关节、下尺桡关节疼痛。X线示下尺桡关节分离明显,桡骨近端移位。结论：Essex-Lopresti损伤早期诊断治疗很重要。在不能有效修复重建骨间膜时,重建桡骨长度的同时对下尺桡关节复位固定是治疗的有效方法。     

神经刺激器引导下多点臂丛神经阻滞在高龄患者前臂手术中的应用

目的比较神经刺激器引导下行多点腋路臂丛神经阻滞与传统腋路臂丛神经阻滞和全身麻醉在高龄患者前臂手术中的麻醉效果和安全性。方法60例择期行前臂及手部手术的高龄患者随机均分为A、B、C三组。A组在神经刺激器引导下行分别阻滞肌皮神经、正中神经、尺神经和桡神经,局麻药选用0.25%罗哌卡因各5～6ml;B组行单纯腋路臂丛神经阻滞,注射0.25%罗哌卡因20～25ml;C组行插管全身麻醉。记录患者平均动脉压、麻醉相关数据。结果B组VAS评分明显高于A组(P<0.01);C组T1、T2、T3时间点与T0MAP比较有明显降低(P<0.05、P<0.01、P<0.01);C组在T1、T3时间点的MAP、镇痛时间、在室时间、术后送ICU患者比例均与A、B组有显著差异。结论采用神经刺激器引导下行多点臂丛神经阻滞用于高龄患者前臂手术成功率高,安全、麻醉并发症少。     

旋前圆肌肌腱重建骨间膜中央束对Essex-Lopresti损伤后前臂纵向稳定的作用

目的 研究旋前圆肌肌腱转位重建骨间膜中央束在恢复Essex-Lopresti损伤中前臂纵向稳定中的效果.方法 10具新鲜成人前臂标本,各标本依次按桡骨头切除、桡骨头+三角纤维软骨复合体(TFCC)切除、桡骨头+TFCC+骨间膜中央束切除、旋前圆肌肌腱转位重建中央束、单纯桡骨头置换、旋前圆肌肌腱转位+桡骨头置换6个步骤进行试验.应用单因素重复测量数据的方差分析比较各步骤桡骨向近端移位5 mm时施加在标本两端的负荷差异,进而判断各步骤对前臂纵向稳定的恢复效果.结果 各个步骤中桡骨向近端移位5 mm时所需平均负荷差异均有统计学意义(P＜0.01).使桡骨向近端移位5 mm时,旋前圆肌重建中央束所需负荷是骨间膜完整时的55.66%;旋前圆肌肌腱转位+桡骨头置换时所需负荷是单纯旋前圆肌肌腱重建中央束时的599.31%,是桡骨头切除时的333.56%.结论 单纯旋前圆肌肌腱转位重建中央束不足以恢复Essex-Lopresti损伤后前臂纵向稳定性;旋前圆肌重建中央束结合金属桡骨头假体置换更有利于恢复前臂的纵向稳定性.     

前臂骨间膜的超声检查方法及声像图特征

目的:探讨前臂骨间膜的超声检查方法及声像图特征。方法:分别对28例检查者共56只前臂的骨间膜在改变体位时进行横切面、长轴切面的超声对比观察。结果:56例完整的骨间膜在改变体位时其横切面和长轴切面上均表现为尺桡骨之间的一连续的线性高回声结构,且其厚度随体位改变无显著性差异。结论:超声检查能清楚显示前臂骨间膜的解剖结构,是诊断前臂骨间膜损伤的有效方法。     

Endothelial Dysfunction and Oxidant Status in Pediatric Patients with Hemoglobin E-β Thalassemia

Thalassemia major is characterized by anemia, iron overload, and oxidant damage to major organs, especially the cardiovascular system. Oxidative stress is ultimately involved in endothelial dysfunction, a condition which is evident in adults suffering from various cardiovascular diseases including thalassemia. We investigated endothelial function in pediatric patients with hemoglobin E-β thalassemia (HbE-β thalassemia), who have been exposed to excessive iron and oxidative stress for much shorter period than adults with thalassemia. We recruited 22 blood transfusion-dependent HbE-β thalassemia patients aged 11.8 ± 2.9 years and 20 healthy controls aged 12.1 ± 1.7 years. Oxidant status was determined, and endothelial function was assessed by a forearm blood flow technique. Oxidative stress was increased in the thalassemic patients, as blood glutathione (GSH) and ratios of reduced GSH to GSH disulfide were markedly reduced, and superoxide anion released from blood cells was highly elevated. Oxidative stress response, assessed by γ-glutamylcysteine ligase activity, was increased approximately twofold in thalassemia patients. Basal forearm blood flow was significantly increased in patients compared with controls (7.3 ± 1.8 vs 6.0 ± 1.8 ml/100 ml tissue/min, respectively), whereas forearm vasodilatory response to reactive hyperemia was depressed by 50% in patients compared with controls. Endothelial function is impaired in young thalassemia patients, and impaired endothelial function is associated with oxidant stress.     

前臂游离皮瓣行颌面部组织缺损修复术11O例

目的 :总结前臂桡侧游离皮瓣修复口腔颌面软组织缺损的经验。方法 :对 110例前臂桡侧游离皮瓣修复口腔颌面软组织缺损的病例进行临床分析。结果 :前臂桡侧游离皮瓣修复口腔颌面部各类软组织缺损 110例 (硬软腭缺损修复再造 3例 ) ,其中 1例为双前臂桡侧游离皮瓣。 10 5例全部存活 (尿毒症伴舌癌患者 1例 ) ,1例大部份存活 ,成功率 96.4% ,失败 4例。结论 :前臂桡侧游离皮瓣解剖恒定、制备方便 ,厚薄适中、便于折叠、血管蒂长 ,是一种修复口腔颌面软组织缺损的优良皮瓣 ,也是口腔颌面部软组织缺损修复的首选皮瓣     

Gradual ulnar lengthening in children with multiple exostoses and radial head dislocation: results at skeletal maturity

Purpose

Deformities of the forearm and shortening of the ulna occur in 30 % of patients with hereditary multiple exostoses (HME), leading to radial head dislocation and loss of movement. Several surgical techniques have been described for treatment, and the aim of our study was to present clinical and radiographic results at skeletal maturity in 15 children that underwent the surgical procedure of ulnar lengthening with external fixators.

Methods

We evaluated 15 patients with ulnar shortening and radial head dislocation that underwent external fixation procedures. Radiographic assessment included measurement of radial articular angle, carpal slip, and ulnar shortening. Clinical evaluation included range of motion, MAYO Elbow Score, assessment function of the extremity as described by Stanton, the visual analog scale (VAS) for pain, and SF-12 to evaluate quality of life.

Results

The average follow-up period was 77 months and took place when each patient had reached skeletal maturity. MAYO Elbow Score improved from 34.7 to 93.3 points, while the average preoperative functional assessment criteria score was 1.6 points and improved to 4.4. The preoperative average VAS ranged from 8.2 to 2.3, while the SF-12 in its physical (PCS) and mental (MCS) components resulted, respectively, as 53.3 and 54.2. Pronation and supination improved from a preoperative average value of 35.6° and 51.3° to 70° and 80.6°, respectively, at the most recent follow-up visit. Flexion and extension ranged, respectively, from 143° and 2° to 146.7° and 3°. Ulnar shortening improved from 24 mm preoperative to 3 mm, and radial articular angle varied from 37.7° preoperative to 26° at the last follow-up. Only one complication occurred in our group, and one patient completely healed from a case of nonunion of the ulna.

Conclusions

Ulnar lengthening is a safe and reliable procedure for the treatment of HME that provides good to excellent results and reduces radial head dislocation.

     

严重前臂及手部外伤的急诊修复

目的探讨急诊修复严重前臂及手部外伤的治疗方法和疗效。方法对36例严重前臂及手部外伤患者采用下述方法一期修复：重建血循环18例,带蒂组织转移覆盖创面5例,游离移植软组织覆盖创面23例,组合移植覆盖创面6例。结果 36例均获得随访,随访时间为6个月-8年,平均20个月。末次功能评定：优14例,良16例,可4例,差2例,优良率为83.3%。结论对一些严重前臂及手部外伤,可以采用合理显微外科方法急诊修复来保留肢体的功能。     

四种蹄蝠ABR听力图特点与耳蜗形态及体型的相关性

目的研究我国现存蝙蝠的耳蜗形态和客观听力图与体型参数的相关性,为现存蝙蝠的听觉器官形态和功能进化状态提供数据资料,给蝙蝠听觉器官与发声频率的匹配关系提供依据,建立和完善客观评估蝙蝠听力图的理论和方法,通过本研究拟为蝙蝠的进化理论、生态适应对策和回声定位生理机制提供依据。方法应用美国TDT系统Ⅲ（Tucker-Davis Technologies TDT SystemⅢ）对大蹄蝠、黄大蹄蝠、中蹄蝠和小蹄蝠四种蹄蝠的听性脑干反应（auditory brainstem response,ABR）听力图进行测量和对比分析,测量四种蹄蝠的体型参数和耳蜗形态参数,采用统计学方法分析体型参数前臂长与耳蜗基底宽、耳蜗高和基部头盖骨宽,以及体型与蹄蝠叫声主频率的相关关系。结果本研究结果证明,蝙蝠体型与其叫声主频率呈负相关关系,体型与蝙蝠的社会交流叫声频率亦呈负相关关系。ABR听力图与行为听力图基本相似,蹄蝠听力图具有两到三个听阈敏感区,与蝙蝠的社会交流叫声频率和回声定位声纳频率相对应,而蝙蝠的社会交流叫声频率的ABR听力图在不同种蝙蝠间具有间断跳跃的趋势。从耳蜗基底宽与基部头盖骨宽的关系看,小翼手亚目较大翼手亚目的耳蜗形态要大得多,基本呈现负相关趋势。发现在同科蝙蝠间耳蜗形态与体型呈正向相关关系,比较四种蝙蝠的听力图形状,大蹄蝠均较体型小的蹄蝠听阈值要低及听觉频率范围要宽广。结论本研究结果说明目前体型大的蝙蝠拥有较大的耳蜗形态,与其发声器官相匹配的是耳蜗既要接收高频叫声的回声定位声纳信号,又要进行较低频率叫声的社会信息交流,支持蝙蝠叫声频率与听觉器官及听觉功能协同进化的结论。     

含脐旁皮动脉真皮下血管网皮瓣修复前臂及手部外伤的应用

 目的 总结含脐旁皮动脉真皮下血管网皮瓣修复前臂及手部软组织缺损的临床疗效.方法 回顾分析1999年7月～2007年3月应用含脐旁皮动脉真皮下血管网皮瓣修复前臂及手部软组织缺损创面87例,41例为手部、前臂热压伤,22例为手及前臂电接触损伤,12例手及前臂烧伤,12例为其他原因致伤.手术依创面情况选择皮瓣大小,最大切取面积25 cm×8 cm,长宽比1.5～4∶1,修薄皮下脂肪保留1～3 mm.结果 72例皮瓣完全成活,11例皮瓣远端小部分坏死,经换药后愈合,4例大部分坏死;或皮瓣与受区撕脱,再次手术.术后随访4个月～2年,受区皮肤平整,色泽好,质地软,外形美观,功能恢复满意.术后3个月～1年有触觉及痛温觉恢复.结论 应用脐旁皮动脉真皮下血管网皮瓣修复前臂及手部软组织缺损具有疗程短,术后手及前臂外形及功能恢复良好,是较理想的一种修复方法.