目的 回顾分析不同内固定方式对老年股骨粗隆间骨折的临床疗效。 方法 1999年3月-2009年5月采用内固定手术治疗121例股骨粗隆间骨折患者,根据内固定方式不同分为4组:动力髋螺钉(DHS;A组43例)、经皮加压钢板(PCCP;B组19例)、股骨近端髓内钉(PFN;C组27例)、Gamma钉(D组32例)。4组患者年龄、骨折类型(Tronzo-Evans分型)等一般资料比较差异无统计学意义(P>0.05),具有可比性。记录手术时间、术中出血量及术后引流量、术中术后并发症、骨折临床愈合时间、术后髋关节功能恢复程度,比较评价各组临床疗效。 结果 术后各组患者切口均Ⅰ期愈合,无伤口感染等早期并发症发生。患者均获随访,随访时间18~108个月,平均56.4个月。与A组比较,B、C、D组手术时间明显缩短,术中出血量及术后引流量减少,骨折愈合时间缩短,差异均有统计学意义(P<0.01),A组较差;B、C、D各组间两两比较差异无统计学意义(P>0.05)。术后并发症发生率A组较高,与其余各组比较差异有统计学意义(P<0.05)。末次随访时各组髋关节功能Harris评分比较差异无统计学意义(P>0.05)。 结论 B、D组及C组3种手术方法在治疗老年患者股骨粗隆间骨折具有创伤小、并发症少等优势,与A组法比较更有利于老年患者术后康复,但应注意骨折的良好复位及内固定物位置。
Objective To explore a method of treating Madelung deformity. Methods Seven cases of Madelung deformity had been treated with the excision of ulnar carpi ulnaris segment and distal osteotomyof radius and tight constrict of extensor carpi ulnaris from Mar. 2000 to Nov. 2003. The angle of ulnar tilting was 37-70° and the angle of volar tilting wasover 16°. A longitudinal incision on each side of the radius and ulnar was made, the ulna was excised about 2-3 cm segment. Then the fracture of ulna was fixed by double across vertical steel wire and the radius was fixed with medullarywire. Lastly the extensor carpi ulnaris was shortened and sutured after the wrist was located restposition. Results After surgery, the deformity of wrist was improved and pain-free in the seven cases. The angle of ulnar tilting was reduced to 22-24°. The angle of volar tilting was reduced to 15° below. Follow-ups were conducted inthe 7 patients for 2 years in average. The activity of wrist joint and the rotation of forearm recovered from those before operation. The wrist joint could stretch fully. Conclusion This method of treating Madelung proves to be effective inrecovering deformity, releasing pain, improving function, and reducing traumatic osteoarthritics of the distal radioulnar joint.
目的 探讨外伤闭合性脾破裂行脾保留手术的术式及疗效。方法 回顾性分析我院2001年6月至2012年5月期间对外伤闭合性脾破裂行脾保留手术的32例患者的临床资料。结果 32例外伤闭合性脾破裂患者中行单纯黏合剂止血6例(Ⅰ级),单纯缝合修补6例(Ⅰ级),缝合修补加黏合剂止血13例(Ⅰ/Ⅱ级),脾部分切除手术4例(Ⅱ/Ⅲ级),脾动脉结扎加脾修补术3例(Ⅱ/Ⅲ级)。32例行脾保留手术患者中除1例因手术后再出血行脾切除获治愈外,其余31例均获保脾成功,术后3~6个月行B超和CT检查示脾脏生长良好,IgM、C3、C4等免疫功能指标均在正常范围。结论 对Ⅰ~Ⅲ级外伤闭合性脾破裂行脾保留手术安全、可行,疗效好,对保留和恢复脾脏功能有重要意义。
目的 总结Lilly氏法切除先天性胆总管囊肿的经验。方法 对1980年以来我院收治的20例采用Lilly氏法保留胆总管囊肿后壁外层切除先天性胆总管囊肿的技术要点及手术疗效进行了回顾性分析。结果 该术式操作方便,术后随访表明,它可有效地解除胆管囊肿的主要症状,无严重手术并发症及不良后果。结论 该术式安全简便,疗效满意,在Ⅰ型先天性胆总管囊肿炎性粘连较重时可适当选用。