浮肩损伤

1浮肩损伤的概念 1992年,Herscovici等首先将同侧肩胛颈骨折和锁骨中部骨折称为浮肩损伤。而Edwards等怛。认为锁骨、肩胛骨和肱骨的同时骨折称为浮肩损伤。Ganz和Noesberger认为由于肩胛颈和锁骨中部骨折导致锁骨稳定性丧失,应进行手术治疗。     

后侧入路内固定治疗胫骨平台后侧骨折

目的 探讨后侧入路内固定治疗胫骨平台后侧骨折的近期疗效.方法 对2008年6月至2010年6月采用后侧入路内固定治疗且随访资料完整的11例胫骨平台后侧骨折患者进行回顾性分析.男7例,女4例;年龄33～60岁,平均47.8岁.AO/OTA分型:41-B2.2.4型2例,41-B3.1.2型3例,41-B3.3.2型3例,41-B3.1.2型+41-B3.3.2型2例,41-C3.3型1例.5例后外侧骨折采用膝关节Carlson后外侧入路;3例后内侧骨折采用Carlson后内侧入路;3例累及胫骨平台前、后侧及胫骨髁间嵴骨折者采用Carlson后内和(或)后外入路,辅以前侧入路行钢板螺钉内固定.关节面塌陷者采用自体髂骨植骨.结果 随访3个月至2年,平均1.6年.全部病例均获得影像学上的骨性愈合,愈合时间12～16周.Rasmussen放射学评分15～18分,平均16.7分.骨折愈合后美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分75～96分,平均86.2分.后外侧入路5例膝关节活动范围平均0°-135°,后内侧入路3例0°-130°,混合入路3例-10°-125°.结论 胫骨平台骨折表现为以后侧为主时,应选择后外或后内侧手术入路,于直视下进行复位及固定,便于操作,术后近期疗效满意.

Abstract：

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.     

髓内钉固定股骨干骨折继发感染的治疗

长骨骨折髓内钉固定术后感染是较难处理的一个并发症。在存在活动性感染的情况下,是否取出髓内钉尚有争议。我院2000年1月一2008年7月共收治12例,现报告如下。     

锁骨中段骨折术后再折原因分析

目的通过对重建钢板内固定治疗锁骨中段骨折术后再折病例的原因分析,找出其术后再折主要原因,指导临床工作。方法对锁骨中段骨折采用切开复位、重建钢板内固定治疗325例,其中5例术后再折进行分析总结。结果5例术后再折病例,经再次手术,植骨,内固定后愈合。结论切开复位、重建钢板内固定虽然可有效地治疗锁骨中段移位骨折,但术后钢板断裂再骨折仍然是重要的术后并发症,骨折类型、手术剥离广泛、钢板反复塑形、练功不当是锁骨中段骨折术后再折主要原因。     

经皮微创空心钉内固定治疗老年患者股骨颈骨折

股骨颈骨折为老年人常见的髋部骨折,治疗关键是尽早手术治疗,以减少骨折后的并发症.我院自2005年2月-2008年1月,应用经皮微创空心钉内固定治疗老年股骨颈骨折62例,经随访疗效满意,报告如下.     

股骨粗隆间骨折的治疗进展（综述）

股骨粗隆间骨折是老年人常见的骨折,随着社会的老龄化,人均寿命的延长,骨质疏松人数的增加,老年人发生股骨粗隆间骨折的机率呈上升趋势.国内外关于股骨粗隆间骨折的治     

外固定支架和生肌膏治疗胫腓骨开放性骨折

近年来开放性骨折的发病率明显提高，多伴有大面积的软组织缺损，切开复位内固定已很难满足创伤本身治疗的需要，而单侧多功能外固定支架对该类损伤治疗具有明显的优势。我院于１９９２年开始利用单侧多功能外固定支架和外用生肌膏治疗胫排骨骨折伴有大面积软组织缺损的患...     

股四头肌重建髌韧带紧缩术治疗小儿麻痹后遗症

股四头肌瘫在小儿麻痹后遗症中发生率约７２６％。造成膝关节不稳，屈膝畸型，行走障碍。自１８９７年Ｇｏｌｄｔｈｖｏａｉｔ首先用股二头肌转移替代瘫痪的股四头肌以后，国内外广泛应用月国绳肌、腹外斜肌、髂腰肌替代股四头肌，所有替代肌的止点均固定于髌骨上。我院...