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锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位

目的 总结锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位的临床疗效。 方法 2003 年6 月－ 2008 年12 月，采用锁骨钩钢板固定结合喙锁韧带重建治疗17 例陈旧性肩锁关节脱位。男11 例，女6 例；年龄16 ～ 53 岁，平均39 岁。均为直接暴力致伤。左侧7 例，右侧10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受伤至手术时间为14 ～ 55 d，平均23 d。 结果 术后切口均Ⅰ期愈合。肩锁关节脱位均纠正，无神经、血管损伤等并发症发生。术后患者均获随访，随访时间6 ～ 15 个月，平均12 个月。术后3 ～ 6 个月取出锁骨钩钢板，无再脱位发生。术后6 个月按Karlsson 疗效评价标准：优12 例，良4 例，差1 例，优良率94.1%。 结论 锁骨钩钢板固定结合喙锁韧带重建具有操作简便、创伤小、固定可靠、可早期功能锻炼等优点，是治疗陈旧性肩锁关节脱位的一种有效方法。

成人单纯颈椎朗格汉斯组织细胞增生症的临床诊疗

CLINICAL OBSERVATION OF IMPROVING AXIAL OFFSET BY USING Ilizarov BONE TRANSPORT TECHNOLOGY

ObjectiveTo explore the effectiveness of Ilizarov technique in improving bone transport axial offset. MethodsBetween January 2010 and December 2014, 14 patients with tibial fracture were treated by using Ilizarov technique. Of 14 cases, 11 were male and 3 were female, aged 18-70 years (mean, 38.8 years); there were 10 cases of infective bone defect and 4 cases of non-infective bone defect. According to Paley typing, 7 cases were rated as type B1(bone defect without shortening) and 7 cases as type B3(bone defect with shortening). The injury to operation time was 1 to 72 months (mean, 11.9 months). Ilizarov fixation was used for type architecture and adjusting fixed bone removal of half the distance between the needle and the ring, changing the auadrilateral edges, adjusting the convolution relationship between the bone removal section and bone segment involution, and adjusting the two force lines of bone segment involution end so as to make the limb lines of force satisfactory. ResultsThe patients were followed up 9-31 months (mean, 19.1 months). Four cases achieved natural bone healing at last follow-up, bone healing was obtained in 10 cases after bone graft. At 1 week after operation, X-ray films showed angulation in the coronal plane in 10 cases (3-12°, 4.9° on average) and in the sagittal plane in 9 cases (2-12°, 3.8° on average); axial offset was observed in 6 cases (43%), which was corrected in 5 cases except 1 case. At last followup, angulation in the coronal plane was observed in 5 cases (2-4°, 2.6° on average), angulation in the sagittal plane in 6 cases (2-6°, 4.1° on average), and axial offset in 1 case (7%), which were significantly improved when compared with ones at 1 week. According to Paley evaluation criteria, the osseous results were excellent in 12 cases and good in 2 cases; the functional results were excellent in 12 cases and good in 2 cases at last follow-up. ConclusionAxial offset in the Ilizarov bone transport relatively common. By adjusting fixed bone removal of half the distance between the needle and the ring, the axial offset can be improved.

肘关节分裂脱位一例

下颈椎骨折合并齿状突骨折的手术治疗

目的 总结手术治疗下颈椎骨折合并齿状突骨折的临床疗效和方法。 方法 2001 年3 月－ 2008年6 月，在颅骨牵引基础上，采用颈前路减压病椎次全切除、自体髂骨植入、前路钛板内固定、齿状突骨折闭合复位空心加压螺钉内固定，治疗6 例下颈椎骨折合并齿状突骨折男性患者。年龄20 ～ 52 岁，平均34 岁。受伤至就诊时间6 h ～ 5 d。损伤节段：C4 1 例，C5 3 例，C6 2 例。下颈椎骨折根据ALLEN 分类，屈曲压缩型4 级2 例，纵向压缩型3 级4 例。齿状突骨折Anderson Ⅱ型2 例，浅Ⅲ型4 例。入院时脊髓损伤采用Frankel 分级：A 级2 例，B 级2 例，C 级2 例。 结果 术后患者切口均Ⅰ期愈合。6 例均获随访，随访时间6 ～ 72 个月，平均44 个月。齿状突骨折3 ～ 6 个月愈合，平均4.3 个月。1 例Frankel A 级患者术后6 个月死于肺感染，1 例Frankel A 级患者术后神经症状无改善，余4 例均有不同程度恢复。 结论 下颈椎骨折合并齿状突骨折临床少见，采用同一切口手术治疗不增加创伤，利于神经功能恢复，便于护理。