【摘要】 目的 评价切开复位Herbert螺钉内固定加外支架治疗对亚急性和陈旧性舟状骨骨折的治疗效果。方法 2008年2月—2009年5月,对15例受伤后4周以上(平均7.6周)入院诊断为亚急性和陈旧性舟状骨骨折的患者均采用Herbert螺钉内固定加外支架治疗,术后随访5～16个月,平均12.5个月,按Gartland amp; Werley和改良Green amp; O’Brein评分系统进行评价治疗效果。结果 15例患者均进行有效随访,末次随访Gartland amp; Werley评分优8例,良5例,中2例,优良率为86.7％,改良Green amp; O’Brein评分优7例,良5例,中3例，优良率为80％。结论 此方法是治疗亚急性和陈旧性舟状骨骨折的有效措施,值得推广。
A total of 12 cases of old facet dislocations of cervical spine treated between december 1988 and 1993 were analyzed in order to evaluate the efficacy of various surgical modalities. In this series, there were 8 males and 4 females, with ages ranged from 16 to 50 years old (averaged 37.8 years old). The duration from injury to admission to our hospital was ranged from 1 to 8 months (averaged 3.7 months). Dislocation levels were as follows: C3,4 in 1 case, C4,5 in 4 cases, C5,6 in 4 cases and C6,7 in 3 cases. Unilateral facet dislocation was in 7 cases and bilateral facet dislocation in 5 cases. Neurological status on admission was as follows: spinal cord and nerve root lesion in 5 cases, nerve root lesion alone in 5 cases and neurologically intact in 2 cases. Besides all facets receiving facetectomy and iliac bone graft, other four kinds of adjuvant treatments were used, including internal fixation by stainless wires laminae or spinous processes in 4 cases, Luque rod in 1 cases, anterior fibrolysis combined with posterior laminoplasty in 1 cases and sustained skull traction without internal fixation in 6 cases. The reduction efficacy from postoperative stustained skull traction was better and the stainless wires fixation ranked the next. The patients only suffering from the nerve root lesion recovered better, but those who had spinal cord combined with nerve root lesion recovered badly. In conclusion, for the treatment of old facet dislocation, it is necessary to resect the facet and graft with iliac bone.
Objective To analyze and compare the clinical efficacy and advantage between two treatments methods for chronic anal fissure. Methods Divided 96 patients with chronic anal fissure into two groups based on the odd and even numbers of treatment order: 48 patients in study group received sequential anal dilation and microwave treatment, and 48 patients in control group received posterior internal sphincterotomy. The blood loss in operation, wound healing time, wound infection rate, anal infection rate, anal control, postoperative defecation function, anal stenosis rate, and the recurrence rate between the two groups were compared and analyzed. Results Blood loss and wound healing time were less in study group than those in control group (Plt;0.01). Anal control was better in study group than that in control group (Plt;0.05). There were no occurrences of wound infection or anal infection, and the defecation function was improved in both of the two groups. There was no recurrence after one year follow-up in both of the two groups. Anal stenosis rate in study group is lower than that in control group (Plt;0.01). Conclusion The technique of sequential anal dilation and microwave treatment can reduce pain, and is simple, effective, and worthy of promotion.
Objective To observe the therapeutic effect of scleral buckling procedure on old retinal detachment. Methods The clinical data of 42 patients (46 eyes), including 24 males (27 eyes) and 18 females (19 eyes), with old retinal detachment treated by scleral buckling procedure in our department were retrospectively reviewed. The duration of the disease ranged from 1 month to 2 years. All the patients were with rhegmatogenous retinal detachment and combined with mainly predominantly-subretinal proliferative vitreoretinopathy (PVR) (stage C), including stage C1 of PVR in 16 eyes (34.8%), stage C2 in 19 eyes (41.3%), and stage C3 in 11 eyes (23.9%). Scleral buckling was performed on 13 eyes (28.3%) and cerclage combined buckling on 33 eyes (71.7%). Sterile air was injected into 36 eyes (78.3%) during the operation, and C 3F 8 was introvitreal injected into 7 eyes (15.2%) after the operation. Results The follow-up duration was from 6 months to 1 year (mean 7.3 months). Retina was completely reattached in 31 eyes (67.4%), and was alleviated obviously in 12 eyes (26.1%). The subretinal fluid increased after the operation with un-reattached retina and vitrectomy was performed in 2 eyes. One eye underwent vitrectomy due to the development of PVR. After the first operation, the curative ratio of retinal detachment was 67.4%, and effective ratio (cure and alleviation) was 93.5%. The visual acuity improved in 28 eyes (60.9%), kept no change in 11 eyes (23.9%), and decreased in 7 eyes (15.2%). Conclusion Reattachment of retina and improvement of visual acuity can be achieved in some degree in some patients with old retinal detachment who undergo simple scleral buckling procedure without vitrectomy. (Chin J Ocul Fundus Dis, 2006, 22: 35-38)
ObjectiveTo investigate the effectiveness of a modified surgical treatment of old Monteggia fracture. MethodsBetween March 2006 and December 2013, 40 cases of old Monteggia fracture were treated with modified operation. Modified operation procedure included expanding excision of pedicled forearm fascia flap for reconstruction of the annular ligament and repair of elbow radial lateral collateral ligament complex and extending osteotomy of the ulna, callus replantation, and internal fixation with steel plate. There were 26 boys and 14 girls, aged 2-10 years with an average age of 4 years. Injury was caused by falling in 24 cases, by traffic accident in 8 cases, and by falling from height in 8 cases. The disease duration was 2-11 months (mean, 4 months). Four patients had combined radial nerve palsy. ResultsIncision healed by first intention after operation, without early complication of radial nerve palsy, fascial compartment syndrome, or decreased hand extensor muscle strength. All the children were followed up 1-5 years (mean, 2.5 years). X-ray films showed fracture healing, and the healing time was 10-20 weeks (mean, 15 weeks). During follow-up, 3 cases had re-dislocation. Neither hand dysfunction caused by hand muscle adhesion nor radial head bottleneck shape change was found. On the basis of the functional evaluation criteria by Mackay, the results were excellent in 32 cases, good in 5 cases, and poor in 3 cases; the excellent and good rate was 92.5% at last follow-up. ConclusionThe modified surgical treatment of old Monteggia fracture is an effective method, with good matching of humeroradial joint and without internal fixation of the humeroradial joint.
Objective To evaluate the clinical result of allogeneic tendon in treatment of chronic Achilles tendon rupture.Methods FromJuly 1996 to November 2000, 6 cases of chronic Achilles tendon rupture were treated by use of allogeneic flexor tendon to repair Achilles tendon with Bosworth way. Five cases were followed up 27-53 months with an average of 38.5 months.Results According to Arner-Lindholm criteria for curative result, the result was excellent in 1 case and good in 4 cases.Conclusion Allogeneic tendonin repair of chronic Achilles tendon is effective. It can avoid the injury and complication caused by autograft.
OBJECTIVE: To explore a new surgical treatment of old atlantoaxial dislocation. METHODS: 5 patients aged 12 to 45 years, who suffered from old atlantoaxial dislocation for 1 to 4.5 years, received the new surgical treatment by the transoccipitocervical posterolateral approach, and expansion of the foramen magnum, odontectomy and bony fusion of the occipitoatlantoid region were performed. Neurological examinations and CT scan were undertaken after operation. RESULTS: All 5 patients survived. Sensory function recovered almost completely and motor function was better more than 1 degree. CT scan showed the diameter of the spinal canal restored well. CONCLUSION: The transoccipitocervical posterolateral approach is an ideal and safe pathway to reach the site of old atlantoaxial dislocation and the operating field is exposed completely. Anterior-posterior decompression and occipitocervical spinal fusion can be performed simultaneously
ObjectiveTo observe and assess the therapeutic effect of posterior amputation of internal sphincter and partial external sphincter in the treatment of old anal fissure. MethodsEighty patients with old anal fissure treated between August 2012 and June 2014 were randomly divided into study group and control group with 40 in each. The study group received posterior amputation of internal sphincter and partial external sphincter, while the control group underwent single amputation of internal sphincter. Then we observed the cure rate, wound healing days, pain at defecation after operation, defecation control after operation, and long-term recurrence rate. ResultsAll the 40 patients in study group were healed with a recovery rate of 100%, while 38 in control group were healed with a recovery rate of 95%; the difference between the two groups were not significant (P>0.05). The wound healing time in study group[(17.0±3.5) days] was much longer than that in the control group[(10.5±3.8) days] (P<0.05). The pain extents of fundament during defecating on the first day and 3, 7, and 15 days later in study group were more alleviated than those in the control group (P<0.05). In the six-month follow-up period, one patient in study group had liquid stools out of control 3 months after the surgery, and the others had no similar symptoms (P>0.05). ConclusionPosterior amputation of internal sphincter and partial external sphincter is a reasonable method for the treatment of old anal fissure. It can not only cure old anal fissure but also alleviate pain at defecation after operation and facilitate defecation.