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成人單純頸椎朗格漢斯組織細胞增生癥的臨床診療

肘關節分裂脫位一例

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.

鎖骨鉤鋼板固定結合喙鎖韌帶重建治療陳舊性肩鎖關節脫位

目的 總結鎖骨鉤鋼板固定結合喙鎖韌帶重建治療陳舊性肩鎖關節脫位的臨床療效。 方法 2003 年6 月－ 2008 年12 月，采用鎖骨鉤鋼板固定結合喙鎖韌帶重建治療17 例陳舊性肩鎖關節脫位。男11 例，女6 例；年齡16 ～ 53 歲，平均39 歲。均為直接暴力致傷。左側7 例，右側10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受傷至手術時間為14 ～ 55 d，平均23 d。 結果 術后切口均Ⅰ期愈合。肩鎖關節脫位均糾正，無神經、血管損傷等并發癥發生。術后患者均獲隨訪，隨訪時間6 ～ 15 個月，平均12 個月。術后3 ～ 6 個月取出鎖骨鉤鋼板，無再脫位發生。術后6 個月按Karlsson 療效評價標準：優12 例，良4 例，差1 例，優良率94.1%。 結論 鎖骨鉤鋼板固定結合喙鎖韌帶重建具有操作簡便、創傷小、固定可靠、可早期功能鍛煉等優點，是治療陳舊性肩鎖關節脫位的一種有效方法。

下頸椎骨折合并齒狀突骨折的手術治療

目的 總結手術治療下頸椎骨折合并齒狀突骨折的臨床療效和方法。 方法 2001 年3 月－ 2008年6 月，在顱骨牽引基礎上，采用頸前路減壓病椎次全切除、自體髂骨植入、前路鈦板內固定、齒狀突骨折閉合復位空心加壓螺釘內固定，治療6 例下頸椎骨折合并齒狀突骨折男性患者。年齡20 ～ 52 歲，平均34 歲。受傷至就診時間6 h ～ 5 d。損傷節段：C4 1 例，C5 3 例，C6 2 例。下頸椎骨折根據ALLEN 分類，屈曲壓縮型4 級2 例，縱向壓縮型3 級4 例。齒狀突骨折Anderson Ⅱ型2 例，淺Ⅲ型4 例。入院時脊髓損傷采用Frankel 分級：A 級2 例，B 級2 例，C 級2 例。 結果 術后患者切口均Ⅰ期愈合。6 例均獲隨訪，隨訪時間6 ～ 72 個月，平均44 個月。齒狀突骨折3 ～ 6 個月愈合，平均4.3 個月。1 例Frankel A 級患者術后6 個月死于肺感染，1 例Frankel A 級患者術后神經癥狀無改善，余4 例均有不同程度恢復。 結論 下頸椎骨折合并齒狀突骨折臨床少見，采用同一切口手術治療不增加創傷，利于神經功能恢復，便于護理。