孟氏骨折脱位(儿童)愈合后畸形的早期手术矫治探讨

Objective To stody the clinic effect of treating the Deformation after Monteggia fracture healing with the orthopedic operation in nonage. Methods All expose the fracture of the ulna and the disloca-tion of the radial head through the Boyd incision. 17 cases of thedeformation were treated with two method, the one is cut off and extend ulna with bone graft, reduce humeroradial joint, theother is cut off and deeurtate radius and reest humeroradial joint, then re-establish annular ligament and fixed humeroradial joint with Kirschner wire temporarily,forearm is external fixation with plaster slab on crooked elbow I00° neutral position. Results The follow-up period for 13 to 27 months, 17 cases were all obtained the head of radius resetting fundamentally. The elbow-joint is stabilization and painless obviously and the functional rehabilitation is well fairly. Conclusion The orthopedic operation is favourable for the acromegalic normal development in nonage, that the head of radius is resetted, the ulna malformation is corrected, the normal article combination is recovered. Even though bone and joint is deformation,it can obtained occasion to renew molding in growth period. It is more valuable for active re-shaping than wait-and-see expecting for this reason.     

中西医结合非手术治疗老年股骨粗隆间骨折的临床疗效

目的评价中西医结合非手术治疗老年股骨粗隆间骨折的临床效果。方法1996～2006年间,204例老年股骨粗隆间骨折,按Evans分类法,结合床边X线片资料,运用以中医骨伤传统之复位、固定、药物、练功等四大疗法为主的中西医结合非手术疗法治疗。结果经治疗204例中200例临床痊愈占98.04%,其中治愈59例,好转151例。死亡6例,占2.94%,并发症19例占9.31%。结论中西医结合非手术治疗老年股骨粗隆间骨折应列为首选疗法,其风险小,并发症少,死亡率低,患肢功能恢复满意,临床疗效满意。     

股骨近端髓内钉（PFN）治疗老年股骨粗隆部骨折的临床探讨

目的探讨应用PFN内固定治疗老年股骨粗隆部骨折的手术适应证和临床效果。方法应用股骨近端髓内钉（proximal femoral nails，PFN）治疗老年股骨粗隆部骨折33例，以术前的综合评估能耐受手术治疗作为主要的适应证。结果随访13～22个月，平均17个月。本组骨折全部愈合，无内固定物松动和断裂等并发症，未出现死亡病例，且均能生活自理和下地步行。结论在身体条件能耐受手术时，对于老年股骨粗隆部骨折，采取积极的内固定治疗，特别是股骨近端髓内钉治疗具有明显的优势。     

微创针刀折骨术治疗四肢骨干陈旧性骨折畸形愈合

目的:探讨微创针刀折骨术治疗四肢骨干陈旧性骨折畸形愈合的临床疗效。方法:本组49例,全部采用微创针刀钻撬折骨,并加恰当的闭合手法折骨即可完成。折断后上肢手法整复,夹板固定,而下肢则可配合持续骨牵引及手法复位,夹板固定。结果:所有病例均随访1～2年,平均1年,参照术后X线片及肢体功能恢复情况制定评定标准,其中优16例,良24例,可9例,差0例。结论:微创针刀折骨术能有效地使骨痂坚硬度降低而易于折断,只要合理选择陈旧性骨折畸形愈合的适应证,就不失为一种简单而有效的临床治疗方法之一,值得临床推广。     

小直切口单纯钢丝张力带内固定治疗移位髌骨骨折

目的 探讨应用小直切121及前"8"字单纯钢丝张力带内固定治疗移位髌骨骨折的临床效果.方法 采用膝前纵行直切口与髌骨纵径相若.向两侧分离皮瓣,仅显露髌腱膜和髌骨横径,单纯用1.2mm钢丝作横"8"字张力带内固定治疗移位髌骨骨折93例.结果 随访6～30个月,93例均获得骨性愈合.按张春才疗效标准评定:优67例,良23例,可3例,优良率达96.8%.结论 该内崮定法治疗髌骨骨折坚固可靠,允许早期功能锻炼,与克氏针张力带内固定的效果相似,而操作简易,创伤较小,并发症更少,尤其对横断形及骨折块较大的粉碎性髌骨骨折是值得推荐的治疗方法.     

孟氏骨折脱位(儿童)愈合后畸形的早期手术矫治探讨

Objective To stody the clinic effect of treating the Deformation after Monteggia fracture healing with the orthopedic operation in nonage. Methods All expose the fracture of the ulna and the disloca-tion of the radial head through the Boyd incision. 17 cases of thedeformation were treated with two method, the one is cut off and extend ulna with bone graft, reduce humeroradial joint, theother is cut off and deeurtate radius and reest humeroradial joint, then re-establish annular ligament and fixed humeroradial joint with Kirschner wire temporarily,forearm is external fixation with plaster slab on crooked elbow I00° neutral position. Results The follow-up period for 13 to 27 months, 17 cases were all obtained the head of radius resetting fundamentally. The elbow-joint is stabilization and painless obviously and the functional rehabilitation is well fairly. Conclusion The orthopedic operation is favourable for the acromegalic normal development in nonage, that the head of radius is resetted, the ulna malformation is corrected, the normal article combination is recovered. Even though bone and joint is deformation,it can obtained occasion to renew molding in growth period. It is more valuable for active re-shaping than wait-and-see expecting for this reason.     

单纯钢丝8字张力带加钢丝环治疗髌骨骨折

自1996年以来，我院应用单纯钢丝8字张力带加钢丝环固定治疗髌骨骨折138例，效果良好。现总结报告如下。     

孟氏骨折脱位（儿童）愈合后畸形的早期手术矫治探讨

目的探讨早期手术矫形治疗儿童孟氏骨折愈合后畸形的临床效果。方法本组17例,全部采用肘后外侧切口。方法一：切断尺骨并作相应延长及植骨,使肱桡关节复位;方法二：切断桡骨,复位肱桡关节后作相应短缩。重建环状韧带,并用克氏针暂时固定肱桡关节,石膏托外固定前臂于屈肘100。中立位。结果随访13—27个月,本组17例均基本获得桡骨头复位,肘关节稳定而无明显疼痛。功能恢复情况较为良好,大致接近于肢体的正常活动范围。结论对儿童孟氏骨折后畸形早期采取积极的矫形治疗措施,使桡骨头复位,矫正尺骨畸形,恢复正常的关节组合,对患儿的正常发育是有利的。即使骨与关节已有变形,在成长期也可获得重新塑型的机会。因此积极矫形较等待观望的态度更有价值。     

小切口骨水泥双极人工股骨头置换治疗老年移位股骨颈骨折临床分析

目的观察小切口骨水泥双极人工半髋关节置换治疗老年移位股骨颈骨折的临床疗效,为临床选择更为合理的假体构型。方法在2004年6月至2008年12月间,应用骨水泥双极人工股骨头置换治疗老年（年龄67～89岁）移位股骨颈骨折67例,Garden分型：Ⅲ型56例,IV型11例。取髋前外侧（改良Hardinge切口）手术人路,平均手术时间约45min,常规输血200ml。术后加强对患肢活动和负重情况的监察及指导。结果随访15～85个月,平均38个月。根据改良Harris评分系统,术后36个月平均为92分,60个月为89分,无髋关节脱位及明显髋股部疼痛病例。结论小切口骨水泥双极人工股骨头置换术符合老年的骨质特点,初始稳定性良好。手术时问短,创伤和风险小,术后中短期并发症发生率低,不失为一种治疗老年股骨颈骨折的良好疗法。