目的 评价铆钉结合克氏针辅助固定治疗RockwoodⅢ型急性肩锁关节脱位的治疗效果.方法 回顾性分析2018年3月—2020年3月厦门大学附属第一医院收治的21例RockwoodⅢ型急性肩锁关节脱位手术患者的临床资料,均采取切开复位、铆钉固定于喙突、2条尾线分别贯穿固定于锁骨远端内侧(即斜方韧带和锥状韧带附着点)、克氏针辅助固定维持复位的手术方式.结果 术程顺利,手术时间(49.1±7.6)min,术中出血量(81.2±11.8)mL.随访时间6～9个月,平均随访时间7个月,随访期间未出现铆钉拔钉、克氏针松动、骨折或肩锁关节再脱位.术后3、6个月肩关节功能Constant-Murley评分分别为(97.4±0.9)、(97.6±0.7)分,优于术前的(41.4±7.3)分,手术前后比较,差异有统计学意义(P<0.05);Karlsson评分优良率均达100％.结论 采用铆钉结合克氏针辅助固定治疗RockwoodⅢ型急性肩锁关节脱位具有手术微创、操作简单、术后肩关节功能恢复快、无需二次手术的优点,短期疗效满意.

Objective To investigate the medium-term efficacy of total hip replacement with CFP handle prosthesis.Methods Thirty-two patients (34 hips) undergoing total hip replacement with CFP handle prosthesis were selected.The preoperative diagnosis was:femoral neck fracture in 6 cases,femoral head necrosis in 12 cases,osteoarthritis in 10 cases,ankylosing spondylitis in 3 cases,and pigmentation villi nodular synovitis in 1 case.Ten days,1 month,6 months,and 1 year (a year later) after surgery,the hip joint function and X ray film performance were followed up.Results There was no complication such as infect and injury of blood vessel and nerve.Postoperative X ray film showed the femoral handle prosthesis position was good.The average Harris hip score was 32.6 (20-53) scores before surgery,and back to 95.3(90-100) scores after surgery,no patients needed revision surgery.Postoperative Engh score was above 10 scores after half a year.Conclusion The medium-term efficacy of total hip replacement with CFP handle prosthesis is good,and can be used as one of the choice of primary total hip replacement.

Objective To compare the outcome of proximal femoral nail anti-rotation (PFNA)versus anatomical locking plate (ALP) in treatment of unstable intertrochanteric fracture.Methods The study included 89 patients who had received PFNA fixation (PFNA group,n =45) or ALP fixation (ALP group,n =44) for unstable intertrochanteric fracture between February 2008 and September 2009.Operation time,amount of bleeding,drainage volume,postoperative complications,fracture healing time and hip joint score after fracture healing were compared between two groups.Results Mean operation time in PFNA group was obviously shorter than that in ALP group (61.4 minutes vs 114.8 minutes,P ＜0.01).Mean amount of bleeding and drainage volume were significantly lower in PFNA group than in ALPgroup (119.3 mlvs 136.8ml,P＜0.01; 74.9mlvs80.3 ml,P＜0.01).While,PFNA group was not significantly different from ALP group with regard to average fracture healing time and Harris hip joint score after fracture healing (4 months vs 4.1 months,P ＞ 0.05; 91.2 points vs 89.8 points,P ＞0.05).Two patients had poor fracture reduction in PFNA group,but all patients had good fracture reduction in ALP group.No obvious adverse postoperative complications occurred in PFNA group,but one patient had fracture nonunion in ALP group.Conclusions PFNA and ALP fixation of unstable intertrochanteric fracture present insignificant differences in fracture healing time,postoperative complications and hip joint function after fracture healing.Whereas,PFNA is more suitable for the elder patients on account of shorter operation time and less intraoperative bleeding.

Objective To discuss the choice of acetabular prothesis and operation method for development dysplasia hip,DDP.Methods Twenty four patients (26 hips ) were performed total hip replacement for DDH.The mean age was 52 (41～68) years old.According to the classification of Perner,10 hips belong to typeⅠwere performed total hip replacement with common cup;9 type Ⅱwith threaded acetabular components;5 type Ⅲ and 2 type Ⅳ with small cup.All the cups were in the real acetabulum and cementless components without structural bone grafts.Results The follow-up time was from 0.5 to 3.5 years.The components had no loosening.The pain had been completely relieved.The hip motion range had increased.The hip function was good.The mean Harris hip score was 86.Conclusion The total hip replacement is effective for adults with DDH.To choice the appropriate cup according to the different type and good performance can make the operation ease with less complication and better results.

陈旧性的指深屈肌腱损伤,特别是Ⅱ区的损伤,以往的肌腱修补,肌腱移植后,常出现肌腱的粘连,经常要二次手术松解,基本病程须6个月完成.手外科医生很久以来一直在寻找避免屈肌腱修复后粘连的途径.我们报告肌腱外科一种新的观念--使用完整的腱系膜血供的屈肌腱和由腱周组织及共同腕鞘组成的固有滑动装置,使肌腱愈合过程减少到最小粘连,在手术中,重建肌腱采用环中指浅层肌腱,它的血供是由居永氏(Guyon's)管近端得尺动脉发出经腱系膜血管供应,以保证完全的肌腱血供和缝合后一个适合的间隙,以维持肌腱本身的内环境,取得满意的效果.

松质骨是人骨的两种主要的组成形式之一.松质骨的代谢率是密度骨的八倍,与年龄和代谢有关的骨的生物力学性质的变化主要发生在松质骨[1].同时,松质骨是老年性骨质疏松性骨折易发部位,如腰椎骨,股骨近端和桡骨远端骨组织的主要组成部分,松质骨分别承担了该部位的50～75%载荷.据报道,我国在1994年有8300万人患有骨质疏松症,预计到2050年我国的骨质疏松患者将达到2.1亿[2].由于骨质疏松症带来的松质骨的生物力学性质显著恶化,患者极易发生骨折,这已成为一个世界性的社会问题.因此,发展灵敏度高,能够快速,精确表征松质骨的成分、微观构造、性质和微损伤及其变化的在体估值(in vivo assessment)方法,从而及早诊断和防止发生各类骨质疏松性骨折的研究在欧美等国近年来得到越来越多的重视,有关研究报导以指数率增长[3].