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总结分析了165例肱骨外髁骨折。初诊时,漏诊12例,误诊91例,闭合复位失败55例。按骨折不同类型和软组织损伤情况分别从七个方面:1.无移位骨折,2.移位或翻转移位骨折,3.软组织嵌入闭合复位困难,4.局部严重肿胀,5.陈旧性骨折,6.骨折畸形愈合并发肘外(内)翻严重,7.并发肘关节僵硬,提示了不同的治疗方法。介绍了手术时如何辨认骨折面、清除疤痕组织和骨痂、松解粘连的力法,以及1枚克氏针加粗丝线内固定法的操作要点。 相似文献
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目的:探讨外固定架复位动力髁钢板固定治疗陈旧性短缩股骨髁间伴髁上骨折的治疗方法。方法:自2000年2月~2005年10月采用动力髁钢板治疗陈旧性短缩股骨髁间伴髁上粉碎骨折16例,其中男13例,女3例/年龄21~59岁,平均35.4岁;骨折断端短缩3~8cm,平均5cm。伤后3~8周间手术。术中使用外固定支架牵开恢复肢体长度,复位骨折,同时植骨,动力加压螺钉钢板固定。术后膝关节应屈曲30°放置,早期进行功能锻炼,以HSS评分评价膝关节功能,以优良率表示。结果:随访14例患者,骨折全部愈合,无膝关节内、外翻现象,无断钉、断板、钢板折弯并发症,患肢短缩在0~1.5cm之内。优良率65%。结论:对陈旧性短缩股骨髁间伴髁上粉碎骨折,术中使用外固定支架复位,方法简便,效果满意,动力髁钢板固定可靠,疗效肯定。 相似文献
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目的: 研究在安氏Ⅱ类高角畸形正畸治疗中,减小后牙平面倾斜度对髁突位置的影响。方法: 15例安氏Ⅱ类高角畸形患者,年龄15~30岁。治疗前ANB>5°,下颌平面角FH-MP>32°,磨牙关系为双侧远中关系。常规排齐整平及适当扩弓后,利用多曲唇弓导下颌向前,并使后牙平面平坦化。利用锥形束CT(cone-beam CT,CBCT)测量治疗前、后颞下颌关节前、上、后间隙及后牙平面的改变情况。采用SPSS19软件包对变化量进行t检验;并利用相关性分析,进一步探讨髁突位置改变量与后牙平面倾斜度减小量之间的相关性。结果: 所有患者磨牙尖牙关系均调整到中性,侧貌改善明显,髁突后间隙平均增加(0.88±0.17)mm,变化有统计学意义(P<0.001);髁突上间隙平均增加(0.45±0.20)mm,变化也具有统计学意义(P<0.05)。后牙平面变平坦,POP-SN及POP-FH平均减小3.59°±2.31°及2.31°±3.62°,变化具有统计学意义(P<0.001)。髁突前间隙变化量无统计学意义,髁突位置改变量与后牙平面倾角的变化量之间无显著相关性。结论: 在安氏Ⅱ类高角畸形患者的正畸治疗中,通过正畸减小后牙平面倾斜度,可使髁突的位置发生适当的前下改变,有利于关节症状的改善。 相似文献
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ObjectiveThe aim of this study is to elucidate the local effects of fibroblast growth factor 23 (FGF23) in on mandibular condylar growth in growing rats.DesignGrowing Sprague–Dawley rats received intra-temporomandibular joint injections of phosphate buffer solution (PBS), adenovirus-mediated green fluorescent protein (Ad-GFP) or adenovirus-mediated fibroblast growth factor 23 (Ad-FGF23), which were marked as groups A, B, and C, respectively. In vitro, we treated rat mandibular cartilage chondrocytes with PBS, Ad-GFP, and Ad-FGF23.ResultsThe mandibular condyles in group C grew smaller sizes than those in the other control groups due to significant differences among the experimental and control groups with the value of C–D, Q–R (P ≤ 0.05), accompanied by diminished bone mass of sub-cartilage condyles via micro CT analysis. Histologically, the length of the hypertrophic zone was diminished and was associated with decreasing chondrocyte proliferation in group C. Quantitative real-time PCR indicated significant decreases in the expression of chondrogenesis marker genes, including Type X collagen (Col X) and SRY-type box 9 (Sox 9). Moreover, elevated Ad-FGF23 suppressed chondrocyte proliferation and the expression of the chondrogenic differentiation markers Col X and Sox 9 of in vitro.ConclusionsLocal injection of FGF23 suppressed the development and decreased the bone mass of condyles through the decreasing the formation of condylar cartilage, specifically by regulating condylar cartilage cell viability and chondrogenesis expression. 相似文献
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The merits of surgical treatment of fractures of the mandibular condyle versus non-surgical management remains highly controversial, despite a large volume of literature dedicated to this topic. One reason the controversy remains, is because most of the outcomes in the literature are not directly comparable. The disparate range of condylar fracture classifications used is one of the reasons that studies are not comparable. We sought to review classification systems for condylar fractures used in the recent scientific literature.Review of the literature from 2016 to 2019, looking for papers relating to fractures of the mandibular condyle. Papers identified were assessed for type of study, focus of study, classification system used.88 studies were identified, including prospective and retrospective cohort studies, randomised and non-randomised prospective studies, randomised controlled trials and case series. More studies focussed on epidemiological factors than surgical access, fixation or outcomes. 31 used no classification system, whilst 17 used unique classification systems and 40 used previously referenced classification systems.Classification systems are used to help separate clinical problems into distinguishable groups, where there is a difference in management or outcome depending on the distinguishing features.There is currently a wide diversity of classification systems used for condyle fractures, and as a result, comparisons of surgical access, fixation and outcomes are difficult to make. Having a single classification system across the published literature would allow easier comparison and the classification proposed by the AO group is recommended for future use. 相似文献
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Karthik Ramakrishnan Cynthia Scott Pavithra Sarda. K Narayanan Vivek Chandran Saravanan 《Journal of cranio-maxillo-facial surgery》2021,49(6):488-493
This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography.Medical records of patients diagnosed with unilateral condylar fractures from the year 2012–2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines.201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture.In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures. 相似文献
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目的研究甲状旁腺激素相关蛋白(parathyroid hormone-related protein,PTHrP)mRNA在髁突软骨与生长板软骨发育早期的表达变化,初步探讨PTHrP在软骨内成骨中的作用。方法选用胚胎SD大鼠的髁突软骨与生长板软骨作为研究对象,采用原位杂交染色法检测发育早期两种软骨内PTHrP mRNA表达,以图像分析仪进行图像分析。结果胎龄14~19 d,随着软骨发育的成熟,PTHrP mRNA在生长板软骨和髁突软骨中的表达越来越广泛并呈现一定的时空变化,但PTHrP mRNA在两种软骨中的表达部位存在一定的差异。在髁突软骨中,PTHrP mRNA在增殖层和前肥大层强表达;在生长板软骨中,其主要表达在软骨膜细胞和关节周围的软骨细胞,前肥大层中也有较强的表达,增殖层弱表达或不表达。结论 PTHrP mRNA在生长板软骨和髁突软骨中表达部位不同,但均呈现一定的时空变化,提示PTHrP对不同分化阶段的软骨细胞具有一定的调节作用。 相似文献
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目的:通过对面部不对称畸形患者的放射性核素检查,研究其年龄、性别、髁突生长活性等分布规律,为面部不对称畸形患者治疗时机的选择提供帮助。方法:采用SPECT系统,对589例发育性不对称畸形患者进行核素显像,采用SAS8.02软件包进行χ2检验与Wilcoxon秩和检验,分析双侧髁突生长活性差异在发生部位、性别、年龄上的分布规律。结果:下颌左偏的几率大于右偏;男性与女性髁突生长活性无显著差异;未成年患者有更大的几率表现出双侧髁突生长活性的差异。结论:下颌骨畸形发育的发展总趋势与全身的生长发育趋势基本一致,但髁突生长活性过高的患者在各年龄段都可能存在。临床上应对所有年龄的面部不对称畸形患者进行放射性核素显像,明确偏斜继续发展的可能性,以辅助选择正颌正畸治疗开始的时机。 相似文献
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