老年桡骨远端AO-C型骨折手法复位小夹板固定与切开复位内固定临床疗效的对照研究

目的：对比手法复位小夹板固定与切开复位内固定治疗老年桡骨远端AO-C型骨折的临床疗效。方法：选取59例老年桡骨远端AO-C型骨折患者,随机分为手术组（29例）和夹板组（30例）,分析比较2组影像学参数,以及腕关节功能患者自评量表（PRWE）评分。结果：手术组术后1个月与术后3 d、术后6个月各影像学参数（掌倾角、尺偏角、桡骨高度）比较,差异均无统计学意义（均P> 0.05）。夹板组术后1个月与术后3 d、术后6个月尺偏角比较,差异无统计学意义（P> 0.05）;夹板组术后1个月与术后3 d掌倾角、桡骨高度比较,差异均有统计学意义（均P<0.05）;术后1个月与术后6个月掌倾角、桡骨高度比较,差异均无统计学意义（均P> 0.05）。2组间术后各时间节点影像学参数比较,差异均有统计学意义（均P<0.05）。术后6个月2组PRWE评分比较差异无统计学意义（P> 0.05）。结论：切开复位内固定治疗后桡骨远端形态恢复较手法复位小夹板固定更优;手术组术后桡骨远端形态得以稳定保持;骨折愈后腕关节功能评分对比,2种处理方式无明显差别。     

不完全性脊髓损伤等速肌力训练的疗效

目的探讨等速肌力训练系统对不完全性脊髓损伤患者下肢肌力恢复的作用。方法将60例胸腰段不完全性脊髓损伤患者随机分为治疗组和对照组各30例。所有患者均接受综合康复治疗,治疗纽同时接受等速肌力训练。治疗结束后两组患者均接受一次IsoMed2000型等速装置下肢肌力测试,主要观察指标为膝关节屈伸肌峰力矩、总做功量、力矩加速能。结果两组患者均有下肢肌力的改善,等速肌力训练结合综合康复治疗能更加明显的改善患者下肢肌力。结论等速肌力训练对不完全性脊髓损伤患者下肢肌力恢复有重要的作用。     

腕关节镜掌侧入路安全区的临床解剖学研究

目的 解剖观察与腕关节镜掌侧入路建立相关的腕部结构,探索建立入路的安全区域.方法采用8例防腐标本和2例新鲜标本,模拟手术“由内向外”操作,标识掌侧入路,测量与掌侧入路建立有关的1/2、6R、6U入路和VR、VR’、VU入路与周围重要结构的最近距离.结果 1/2入路与桡神经浅支的最近距离是( 2.4± 1.5 )mm.6U、6R入路与尺神经腕背支的最近距离是(16.2±1.3 )mm和(9.0±2.4)mm.VR、VR’入路与正中神经掌皮支的最近距离是(6.7±1.1)mm和(2.8±0.9 )mm,与桡动脉的最近距离是( 6.3±4.0 )mm和(10.0±3.4 )mm,并且均穿过桡侧腕屈肌腱的基底部.VU入路与尺动脉和指深屈肌腱的最近距离是(3.3±1.4)mm和( 0.3±0.5 )mm.结论 腕关节镜掌侧入路的建立有一定的安全区域.     

吻合血管游离腓骨移植治疗股骨头坏死研究进展

近年,股骨头坏死患者逐年递增,其好发于中青年男性,严重影响患者身体健康。吻合血管游离腓骨移植（FVFG）是治疗股骨头坏死保髋手术方法之一,适用于各种原因导致的中青年股骨头坏死患者,尤其对早期的非激素性股骨头坏死患者具有较好的保髋疗效。FVFG能提高患者的髋关节功能评分,对改善患者生活质量具有较好效果。FVFG较其他保髋术式有其自身优点,但需做好手术适应证筛选。此外,缺少有效的植骨区血供测定方法,难以了解术后植骨区骨细胞血运情况,仍是需要解决的问题。     

桡骨远端骨折合并腕关节韧带损伤的关节镜观察

Objective To report te incidence and extent of injuries of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL) and triangular fibrocartilage complex (TFCC)observed under wrist srthroscope during treatment of distal radius fractures.Methods Twenty-seven cases of distal radius fractures were treated with wrist arthroscopic assistance.Distal radius fractures were categorized using AO classification.Injuries of SLIL and LTIL were viewed and graded by Geissler's arthroscopic classification of carpal instability/intercarpal ligament injuries.TFCC lesions were recorded by Palmer's classification.Chi square statistical analysis was used to analyze the relationship between the extent of these ligament injuries and the types of distal radius fractures.Results All 27 cases had SLIL and LTIL injuries of grade Ⅰ to grade Ⅱ.25 cases had type Ⅰa TFCC lesions.There was no significant correlation between ligament injuries and the types of fractures.Conclusion There is a high incidence of ligament injury accompanying distal radius fractures.Wrist arthroscope assisted treatment of distal radius fractures can enhance the accurate detection of these carpal ligament injuries.     

桡骨远端骨折合并腕关节韧带损伤的关节镜观察

Objective To report te incidence and extent of injuries of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL) and triangular fibrocartilage complex (TFCC)observed under wrist srthroscope during treatment of distal radius fractures.Methods Twenty-seven cases of distal radius fractures were treated with wrist arthroscopic assistance.Distal radius fractures were categorized using AO classification.Injuries of SLIL and LTIL were viewed and graded by Geissler's arthroscopic classification of carpal instability/intercarpal ligament injuries.TFCC lesions were recorded by Palmer's classification.Chi square statistical analysis was used to analyze the relationship between the extent of these ligament injuries and the types of distal radius fractures.Results All 27 cases had SLIL and LTIL injuries of grade Ⅰ to grade Ⅱ.25 cases had type Ⅰa TFCC lesions.There was no significant correlation between ligament injuries and the types of fractures.Conclusion There is a high incidence of ligament injury accompanying distal radius fractures.Wrist arthroscope assisted treatment of distal radius fractures can enhance the accurate detection of these carpal ligament injuries.     

桡骨远端骨折合并腕关节韧带损伤的关节镜观察

目的 介绍桡骨远端骨折时,腕关节韧带(舟月骨间韧带、月三角韧带和三角纤维软骨复合体)损伤的关节镜观察.方法 对27例桡骨远端骨折,采用腕关节镜辅助治疗,观察舟月骨间韧带、月三角韧带和三角纤维软骨复合体的损伤情况,通过Gsssler腕部韧带损伤等级分型方法和Palmer方法记录损伤级别.采用卡方检验,分析腕关节韧带损伤程度与骨折类型之间的关系.结果 27例腕关节镜下观察均出现舟月骨间韧带、月三角韧带损伤,损伤为Ⅰ～Ⅱ级;25例有三角纤维软骨复合体损伤,损伤大多为Ⅰa型;腕部韧带损伤的程度与骨折的分型无显著关系.结论 桡骨远端骨折时,腕部韧带损伤率较高,采用腕关节镜辅助治疗有利于准确发现腕部韧带的损伤.

Abstract：

Objective To report te incidence and extent of injuries of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL) and triangular fibrocartilage complex (TFCC)observed under wrist srthroscope during treatment of distal radius fractures.Methods Twenty-seven cases of distal radius fractures were treated with wrist arthroscopic assistance.Distal radius fractures were categorized using AO classification.Injuries of SLIL and LTIL were viewed and graded by Geissler's arthroscopic classification of carpal instability/intercarpal ligament injuries.TFCC lesions were recorded by Palmer's classification.Chi square statistical analysis was used to analyze the relationship between the extent of these ligament injuries and the types of distal radius fractures.Results All 27 cases had SLIL and LTIL injuries of grade Ⅰ to grade Ⅱ.25 cases had type Ⅰa TFCC lesions.There was no significant correlation between ligament injuries and the types of fractures.Conclusion There is a high incidence of ligament injury accompanying distal radius fractures.Wrist arthroscope assisted treatment of distal radius fractures can enhance the accurate detection of these carpal ligament injuries.