【摘要】 目的 探讨强直性脊柱炎合并脊柱骨折脱位的临床特点及手术治疗效果。 方法 2009年10月-2010年6月，共收治6例强直性脊柱炎合并脊柱骨折脱位患者，其中男5例，女1例；年龄38～76岁，平均48.6岁。下颈椎骨折脱位3例，2例为颈5-6、1例颈6-7；胸腰段骨折脱位3例，为胸10-11、胸11-12、胸12-腰1各1例。6例患者中除1例术前神经功能为Frankel分级 E级，其余5例均有不同程度的神经损伤。6例患者均行手术治疗，下颈椎骨折脱位采用前后联合入路复位及固定，胸腰段骨折脱位采用后路切开复位及椎弓根螺钉固定。术后观察手术节段内固定位置及骨融合情况，评估神经功能恢复情况，记录手术并发症。患者随访10~18个月，平均14.2个月。 结果 所有患者术后均未出现切口感染；脑脊液漏1例，换药对症处理3周后愈合。1例颈5-6骨折脱位患者行前路手术后第2天出现内固定移位，骨折椎再次脱位立即二次行前后联合入路复位固定术；3例术后神经功能由术前Frankel C级恢复至D级，2例无明显改善（术前均为A级），1例较术前加重（术前E级，术后为A级，经再次手术减压并康复治疗6个月后恢复至D级）。随访期间均达骨性融合，未出现内固定松动断裂移位现象。 结论 强直性脊柱炎脊柱骨折好发于下颈椎及胸腰段；对于下颈椎骨折脱位宜行前后联合入路复位固定，而胸腰段骨折宜行后路长节段椎弓根螺钉固定，术中应先充分减压后再精细复位，避免加重神经损伤。【Abstract】 Objective To explore the clinical characteristics of spinal fracture and dislocation in ankylosing spondylitis (AS) and its surgical treatment effect. Methods From October 2009 to June 2010, six cases with spinal fractures in AS underwent surgical treatment. There were 5 males and 1 female with an average age of 48.6 years (38-76 years old). The preoperative neural function of one case was grade E according to the Frankel classification and different degrees of neural damage could be found in other 5 cases. Three cases of lower cervical fractures underwent the operation with a combined posterior-anterior approach. Three cases of thoracolumbar fracture underwent the operation with posterior approach (posterior reduction, fixation with pedicle screws and bone graft). The situation of internal fixation and bone fusion was observed after operation, the neural function had been evaluated and the postoperative complications was recorded. Results All of the six patients were followed up for 10-18 months (mean 14.2 months). There was no incision infection. One patient with cerebrospinal fluid leakage was cured with conservative treatment for three weeks. One patient with C5-6 fracture and dislocation got anterior implant loosening and fracture-dislocation recurrence in the second day after the operation and underwent a combined posterior-anterior operation immediately. Three cases got remarkable neuronal function improvement after the operation. Two cases were remain primary situation. One case was aggravated from preoperative grade E grade to postoperative grade A and recovered to grade D after recovery treatment for 6 months. Bone fusion was achieved in all cases. There were no loosening and breakage of internal fixation in the later followed up. Conclusions Lower cervical and thoracolumbar spine are the usual locations of fracture in AS. A combined posterior-anterior surgical approach is effective for lower cervical fractures and posterior long-segmental reduction and the fixation is a desired select for thoracolumbar fractures.
Based on the anatomical studies, the authors had designed an operation for treating old dorsal subluxation of the inferior radio-ulnar joint.The periosteum was longitudinally incised at the dorsal side of the lower ulna. forming musculo-periosteal flap, and a periosteal flap, and a periosteal valves of pronator quadratus. They were subluxation, passing the flap from palmar to the dorsal side through thc subperiosteal tunnel at the lateral margin of the radius corresponding to the ulna. Then it was circled round the lower end on the ulna and sutured to the muscular flap and the tough interosseous membranes at the palmar side, being used to stabilize the recuperated dorsal subluxation of the inferior radio-ulnar joint. The result of its clinical use was satifying.
目的 比较克氏针张力带与锁骨钩钢板治疗RockwoodⅢ型肩锁关节脱位的临床疗效。 方法 1999年1月－2007年3月，收治肩锁关节脱位患者29例，分别采用克氏针张力带联合喙锁韧带重建（克氏针组10例）和锁骨钩钢板（钢板组19例）治疗。其中男18例，女11例；年龄19～50岁，平均38.2岁。患者均为新鲜RockwoodⅢ型肩锁关节脱位，受伤至手术时间1～16 d，平均3 d。两组患者性别、年龄、受伤至手术时间等一般资料比较差异无统计学意义（P＞0.05）。进行两组患者术后临床及影像学评估比较。 结果 25例患者（克氏针组10例，钢板组15例）获随访，随访时间2～12年，平均6年。术后克氏针组发生克氏针弯曲5例、断裂1例；钢板组切口浅表感染2例，经换药后治愈，其余患者切口Ⅰ期愈合。两组患者肩锁关节均获得良好功能，组间比较差异无统计学意义（P＞0.05）。影像学方面：与克氏针组相比，在患肢负重位时钢板组喙锁间隙间距增加了23%（P＜0.05），非负重位两组间距差异无统计学意义（P＞0.05）。术后8～12周出现喙锁韧带钙化，钢板组12例、克氏针组2例（P＜0.05）。术后6个月出现肩锁关节骨性关节炎，钢板组2例、克氏针组1例（P＞0.05）。肩关节功能与影像学结果无相关性（r=0.096，P＞0.05）。 结论 克氏针张力带联合喙锁韧带重建和锁骨钩钢板固定治疗RockwoodⅢ型肩锁关节脱位均可获得良好的临床功能。与克氏针张力带相比，锁骨钩钢板固定具有手术操作简便、疗效确切、并发症少、能够早期康复锻炼等优点。
The dorsal dislocation inferior radio-ulnar joint was treated by the shortening operation of the pronator quadratus muscle by moving the muscle origin to its dorsum, so that the pronator quadratus muscle was always under tension whether the muscle was contracted or relaxed. Thus the anatomic position and stress distribution were improved. We had treated 11 patients in the past four years.The patients were followed from four months to four and half years and the results were 9 patients excellent and 2 good.
Objective To investigate the morphological anatomical abnormal ities of high congenital dislocation of hip in adults and provide anatomical basis for the total hip arthroplasty (THA). Methods From May 1997 to July 2008, 49 patients (57 hi ps) with high congenital dislocation of hip (Hartofilakidis type III) were treated. There were 6 males and 43 females with an average age of 29.4 years old (18-56 years old). The locations were left in 24 hi ps and right in 33 hi ps. The morphological parameters (including femoral length, isthmus, height of femoral head center, neck-shaft angle, medialhead offset, anteversion angle, canal flare index, anteroposterior diameter of the true acetabulum, posterior thickness of the true acetabulum, depth of the true acetabulum) of suffering hips (dislocation group, n=57) were measured by preoperative X-ray, CT and intraoperative cl inical observation and were compared with those of contralateral hips (control group, n=41). The intraoperative situations of hip were observed. Results The height of dislocation was (45.41 ± 2.15) mm. The length difference of both lower extremities was (40.41 ± 2.02) mm. In dislocation group, isthmus was shortened; height of femoral head center, neck-shaft angle and medial head offset were decreased; and anteversion angle was increased. CT showed that the canal flare index was larger than 4.7, femoral shape was funnel-shaped according to Noble classification. Anteroposterior diameter of the true acetabulum became smaller, posterior thickness of the true acetabulum became thicker, and depth of the true acetabulum was shallower. There were statistically significant differences in the morphological parameters of femur and acetabulum between two groups (P lt; 0.05). The intraoperative measurements showed that the anteroposterior diameter of acetabulum was (32.98 ± 1.02) mm and the depth of acetabulum was (14.21 ± 0.56) mm. There was no statistically significant difference between intraoperative measurements and preoperative measurements (P gt; 0.05). The acetabulum was full of fat and fibrous tissues. Running of the sciatic nerve in 40 cases were changed and it ran upward and laterally. Conclusion When high congenital dislocation of the hip in adults is treated with THA, anatomical variation must be fully taken into account. The acetabulum is expanded toward posterosuperior, excessive reamed should be avoided to prevent femoral fractures, and appropriate or tailor-made prosthesis was selected.
目的:探讨带线锚钉治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的疗效。方法:自2003年9月至2008年7月共收治28例急性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤患者。对28例患者均采用开放手术下带线锚钉固定髌骨骨折及修复内侧髌股韧带损伤。术后1年进行术后的髌骨骨折Levack功能评分。结果:所有患者术后随访时间12~30个月,平均(16±3.50)个月。术后1年的髌骨骨折Levack功能评分标准优23例,可3例,差2例,优秀率达82.14%。无再次髌骨脱位或伴脱位患者。结论:开放手术下带线锚钉治疗对髌骨骨折固定及内侧髌股韧带修复可靠,是治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的有效方法。