腕部X线正位片形态学测量及临床应用

Objective To obtain normal values of parameters of the wrist joint by measuring posteroanterior X-rays of normal wrist joints and provide basis of using these parameters for judgment of pathological conditions of the wrist. Methods Standard postereanterior X-rays of 40 normal wrists were taken.The "Pacs System" software was used to measure 9 parameters in these radiographs, including 7 new parameters:the ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width ( PDRW), sigmoid notch width (SNW) and sigmoid notch length (SNL). The respective indices were defined by the ratio of these parameters to the length of the third metacarpus. Results The values and indices of USL, UHL, UHD, MDRW and PDRW are (3.01±1.65) mm,(0.05±0.03), (9.11±1.54) mm, (0.15±0.02), (18.56±1.96) mm, (0.30±0.03),(29.60±2.70) mm, (0.48±0.04), (27.60±2.00) mm and (0.45±0.03), respectively. Four types (Ⅰ toⅣ) of sigmoid notch were identified, with types Ⅰ, Ⅱ and Ⅳ present dominantly. The SNW of types Ⅰ, Ⅱ, and Ⅳ are (3.32±1.61) mm, (3.53±1.15) mm and (1.55±1.01) mm, respectively. The SNL of types Ⅰ, Ⅱ,and Ⅳ are ( 10.15±1.61 ) mm, ( 10.96 ± 2.33) mm and ( 10.32 ± 1.57) mm, respectively. Correspondingly,the SNW indexes were (0.05±0.02), (0.06±0.02), and (0.03±0.02); the SNL indexes were (0.16±0.02), (0.18±0.03) and(0.17±0.02). Conclusion The study presents a number of new indices which may be useful in quantifying the changes of wrists in radiograph. The measured normal values provide a basis for evaluation of changes in wrist disorders.     

腕部X线正位片形态学测量及临床应用

Objective To obtain normal values of parameters of the wrist joint by measuring posteroanterior X-rays of normal wrist joints and provide basis of using these parameters for judgment of pathological conditions of the wrist. Methods Standard postereanterior X-rays of 40 normal wrists were taken.The "Pacs System" software was used to measure 9 parameters in these radiographs, including 7 new parameters:the ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width ( PDRW), sigmoid notch width (SNW) and sigmoid notch length (SNL). The respective indices were defined by the ratio of these parameters to the length of the third metacarpus. Results The values and indices of USL, UHL, UHD, MDRW and PDRW are (3.01±1.65) mm,(0.05±0.03), (9.11±1.54) mm, (0.15±0.02), (18.56±1.96) mm, (0.30±0.03),(29.60±2.70) mm, (0.48±0.04), (27.60±2.00) mm and (0.45±0.03), respectively. Four types (Ⅰ toⅣ) of sigmoid notch were identified, with types Ⅰ, Ⅱ and Ⅳ present dominantly. The SNW of types Ⅰ, Ⅱ, and Ⅳ are (3.32±1.61) mm, (3.53±1.15) mm and (1.55±1.01) mm, respectively. The SNL of types Ⅰ, Ⅱ,and Ⅳ are ( 10.15±1.61 ) mm, ( 10.96 ± 2.33) mm and ( 10.32 ± 1.57) mm, respectively. Correspondingly,the SNW indexes were (0.05±0.02), (0.06±0.02), and (0.03±0.02); the SNL indexes were (0.16±0.02), (0.18±0.03) and(0.17±0.02). Conclusion The study presents a number of new indices which may be useful in quantifying the changes of wrists in radiograph. The measured normal values provide a basis for evaluation of changes in wrist disorders.     

行特殊血管检查致胸廓出口综合征诊断的假阳性率

目的 研究健康人群中用于诊断胸廓出口综合征的特殊血管检查的阳性率的出现情况.方法 采用6种常用的特殊血管检查方法,对由健康人群中随机抽取的86名志愿者进行检查,并分性别和检查项目计算诊断为胸廓出口综合征的阳性率.结果 86名中51名出现检查阳性,阳性率为59.3％;其中32名出现一项阳性,阳性率为37.2％;11名出现二项阳性,阳性率为12.8％;6名出现三项阳性,阳性率为7.0％;2名出现四项阳性,阳性率为2.3％.结论 目前的特殊血管检查方法可能会导致错误诊断一些健康人群患有胸廓出口综合征.     

同种异体肌腱在上肢损伤重建中的应用进展

严重的上肢肌腱损伤会对患者的生活产生重大影响。对于多条肌腱缺损的患者来说, 同种异体肌腱移植修复因具有创伤小、临床效果显著等优点, 是重建患者肢体功能的较好方法之一。临床医生在使用同种异体肌腱移植前应充分了解其优、缺点及适应证, 选择最适合患者的诊疗方案。自首次应用同种异体肌腱重建修复以来, 国内外学者对同种异体肌腱移植做了较多的研究及报道。本文就同种异体肌腱移植的保存、处理、免疫排斥反应及在上肢损伤重建中的效果作一综述。     

续记换药费回访模式在桡骨远端骨折术后出院患者中的应用

目的:续记换药费回访模式在桡骨远端骨折术后出院患者中的应用效果。方法:将2015年1~12月53例桡骨远端骨折切开复位掌侧钢板螺钉内固定术出院患者作为对照组,按出院要求常规复诊,电话回访;将2016年1~12月53例桡骨远端骨折切开复位掌侧钢板螺钉内固定术出院患者作为干预组,采用续记换药费回访模式进行回访。比较两组回访效果。结果:干预组复诊率、康复率、二次手术住院率、满意度均高于对照组(P0.05)。结论:采用续记换药费回访模式能有效提高桡骨远端骨折手术患者出院后复诊回访率,增强患者复诊依从性,提高满意度,值得推广。     

三种修复手部创面皮瓣的临床疗效评价

目的 比较骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣的临床疗效,为临床的皮瓣选用提供参考.方法 对应用骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣修复手部创面的23例患者进行随访,比较分析DASH(disability of the arm,shoulder and hand)分数、损伤的部位、触觉压觉(Senunes-Weinstein单丝法)、两点分辨觉(动、静态,m2PD、s2PD)、温度觉、臃肿程度和供区瘢痕挛缩程度.结果 三种皮瓣的DASH评分、瘢痕挛缩程度、皮瓣的臃肿程度、触觉压觉、两点分辨觉和温度觉的结果 ,差异均没有统计学意义;股前外侧皮瓣的臃肿程度高于其他两种皮瓣,差异具有统计学意义.结论 三种皮瓣各有特点,临床选择应该根据各种客观要求,不要主观臆测.     

腕部X线正位片形态学测量及临床应用

Objective To obtain normal values of parameters of the wrist joint by measuring posteroanterior X-rays of normal wrist joints and provide basis of using these parameters for judgment of pathological conditions of the wrist. Methods Standard postereanterior X-rays of 40 normal wrists were taken.The "Pacs System" software was used to measure 9 parameters in these radiographs, including 7 new parameters:the ulnar styloid length (USL), ulnar head length (UHL), ulnar head diameter (UHD), maximal distal radius width (MDRW), proximal distal radius width ( PDRW), sigmoid notch width (SNW) and sigmoid notch length (SNL). The respective indices were defined by the ratio of these parameters to the length of the third metacarpus. Results The values and indices of USL, UHL, UHD, MDRW and PDRW are (3.01±1.65) mm,(0.05±0.03), (9.11±1.54) mm, (0.15±0.02), (18.56±1.96) mm, (0.30±0.03),(29.60±2.70) mm, (0.48±0.04), (27.60±2.00) mm and (0.45±0.03), respectively. Four types (Ⅰ toⅣ) of sigmoid notch were identified, with types Ⅰ, Ⅱ and Ⅳ present dominantly. The SNW of types Ⅰ, Ⅱ, and Ⅳ are (3.32±1.61) mm, (3.53±1.15) mm and (1.55±1.01) mm, respectively. The SNL of types Ⅰ, Ⅱ,and Ⅳ are ( 10.15±1.61 ) mm, ( 10.96 ± 2.33) mm and ( 10.32 ± 1.57) mm, respectively. Correspondingly,the SNW indexes were (0.05±0.02), (0.06±0.02), and (0.03±0.02); the SNL indexes were (0.16±0.02), (0.18±0.03) and(0.17±0.02). Conclusion The study presents a number of new indices which may be useful in quantifying the changes of wrists in radiograph. The measured normal values provide a basis for evaluation of changes in wrist disorders.     

同种异体肌腱重建喙锁和肩锁韧带治疗肩锁关节脱位

目的 介绍应用同种异体肌腱重建喙锁和肩锁韧带治疗肩锁关节脱位的临床疗效.方法 2010年2月至2012年2月,对6例肩锁关节脱位患者,应用同种异体肌腱“V”形重建喙锁和肩锁韧带,并跟踪随访其疗效.随访包括调查患者总体满意度,观察患肩外形,测量肩关节活动度,摄片评价肩锁关节复位维持情况,使用Constant-Murley肩关节评分和美国加州大学洛杉矶分校(UCLA)评分系统评价患肩功能,视觉模拟评分法(VAS)了解患者疼痛情况.结果 术后平均随访时间为18个月,患者总体满意度为83.3％,所有患者肩关节外形正常,平均前屈上举163.5°、外展上举147.2°,Constant-Murley评分平均95.3分、UCLA评分平均32.8分、VAS评分平均0.3分.结论 应用同种异体肌腱修复重建喙锁和肩锁韧带治疗肩锁关节脱位,符合生物力学要求,术后随访疗效满意,是一种有效的治疗方法.     

手外科循证实践与临床互动教学平台建设

目的：探讨提高医学生学习兴趣、培养医学生临床和循证医学思维的教学平台建设。方法：根据教学过程中是否结合平台教学将医学生分为传统教学组和传统教学结合平台教学组。教学结束后,教师调查学生学习感受和测试学生知识掌握情况,观察教学效果。结果：结合手外科循证实践与临床互动教学平台教学组的学生满意度和测试成绩均优于传统教学组(P <0.05),大多数学生认为传统教学结合平台教学可激发学习兴趣,有助于掌握知识和提高自学能力,有助于培养循证医学思维和临床问题解决能力,增强临床工作自信心。结论：手外科循证实践与临床互动平台建设可以实现建构主义和循证医学相结合的学习模式,为医学生提供了一条有效的学习途径。     

锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的疗效比较

目的 比较锁定加压接骨板与外固定支架治疗桡骨远端粉碎性骨折的临床疗效.方法 对40例桡骨远端粉碎性骨折患者,采用掌侧锁定加压接骨板和外固定支架治疗;其中21例行掌侧锁定加压接骨板,19例行外固定支架.按AO/ASIF分型:C1型10例,C2型15例,C3型15例.随访内容包括测量腕关节活动度,前臂旋转活动度,握力、捏力及相关影像学资料(掌倾角、尺偏角、桡骨高度).按上肢功能评定标准(Disabilities of the Arm,Shoulder and Hand,DASH)和Gartland-Werley腕关节评分标准进行综合评估.对随访数据进行统计学分析,比较两组的治疗效果.结果 术后随访时间为6～48个月,平均18.8个月.根据Gartland-Werley腕关节评分标准评定,锁定加压接骨板治疗组优良率为81.0%,外固定支架治疗组优良率为78.9%.两组在掌曲、背伸、桡偏、旋前、旋后、握力、捏力、掌倾角、尺偏角、桡骨高度等方面,Gartland-Werley腕关节评分和DASH值差异均无统计学意义(P＞0.05);锁定接骨板组的腕尺偏活动度小于外固定支架组,差异有统计学意义(P＜0.05).锁定接骨板治疗组中无并发症出现.外固定支架治疗组中1例反射性交感神经营养不良症,药物治疗和理疗后好转;1例钉道感染,局部换药后治愈.结论 采用掌侧锁定加压接骨板和外固定支架治疗桡骨远端粉碎性骨折具有相同效果,具体可根据骨折类型、患者的功能要求及经济情况选择手术方案.

Abstract：

Objective To compare the treatment outcomes between locking compression plate and external fixator for treating severely comminuted distal radius fracture. Methods Forty patients of severely comminuted distal radius fractures were treated with either locking compression plate fixation via a volar approach or external fixator. Twenty-one patients were treated with locking compression plate fixation, while the other 19 patients were treated with external fixator. According to AO/ASIF classification, there were 10 type C1 fractures,15 type C2 fractures and 15 type C3 fractures.Wrist range of motion, forearm range of motion, grip and pinch strength, radiographic data (palmar tilt, radial inclination, radial height), scores by the Disabilities of the Arm,Shoulder and Hand (DASH) and by Gartland-Werley were collected at follow-up. The data were statistically analyzed to compare the clinical effects. Results Postoperative follow-up ranged from 6 to 48 months with an average of 18.8 months. According to Gartland-Werley wrist score, the excellent and good rate was 81.0% in the locking compression plate group, and 78.9% in the external fixator group. No significantly difference was detected in the ROM of flexion, extension, radial deviation, pronation, supination, grip and pinch strength, the parameter of palmar inclination, ulnar inclination and radial height and in Gartland-Werley score and DASH score between the two groups (P＞0.05). The ROM of unlar deviation in the locking compression plate group was significantly smaller than that in the external fixation group ( P＜0.05). No complication occurred in the locking compression plate group. One patient developed sympathetic reflex dystrophy postoperatively in the external fixation group. After medication and physical therapy the symptoms had resolved. Infection of the external fixator pin tract was note in another patient which was effectively treated by wound care. Conclusion Locking compression plate and external fixator lead to siunilar treatment outcomes for severely cormminuted distal radius fractures. Patient's functional requirement, age and financial status should be taken into consideration while choosing one of these procedures.