OBJECTIVE:To compare therapeutic effects between antegrade intramedullary nailing and retrograde intramedullary nailing for the treatment of humeral shaft fractures.METHODS:From March 1999 to October 2006, 105 patients with humeral shaft fractures were treated with locked intramedullary nail and were adequately followed up. There were 82 antegrade nailing and 23 retrograde nailing. The follow-up parameters included operation time, blood loss,fracture healing rate, healing time, complications, Constant-Murley shoulder score and Mayo elbow performance score.RESULTS:The mean follow-up period was 31.2 months. Antegrade intramedullary nailing had significantly less blood loss than that in retrograde intramedullary nailing (P=0.002). The differences in operation time, complications, healing time and bone healing rate between he two groups had no statistical significance. Complications in the antegrade intramedullary nail group included 4 patients with nonunions, 1 patient with radial nerve palsy, and 8 patients with shoulder pains and decrement in shoulder range of motion. Complications in the retrograde intramedullary nail group included 1 patient with radial nerve palsy and 3 patients with iatrogenic fractures. For shoulder joints,the difference in the average Constant-Murley shoulder score between the two groups was statistically significant (P=0.04). For elbow joints, the average postoperative Mayo elbow performance score between these two approaches did not differ significantly.CONCLUSION:Both the antegrade intramedullary nailing and the retrograde intramedullary nailing are good alternatives for the treatment of humeral shaft fractures. Because of higher incidence of iatrogenic fractures, the insertion point of retrograde intramedullary nailing should be carefully prepared. With antegrade insertion, it important to bury the humeral nail below the rotator cuff to prevent the subacromial impingement, and the rotator cuff should be carefully repaired to avoid shoulder pain and improve shoulder function.

OBJECTIVE:To investigate the effects of antibiotic-PMMA (polymethyl-methacrylate) beads combined with external fixator in treatment of infected fracture nonunion.METHODS:Twenty-two cases of infected fracture-nonunions were reviewed involving 20 male and 2 female with an average age of 34.68 years (ranging 21 to 74 years). The data consisted of 9 cases of tibial fractures, 2 distal fractures of the femur, 6 femoral shaft fractures, 3 intertrochanteric fracture of the femur and 2 humeral shaft fractures. The procedure included thorough debridement to wipe out dead bone and granulation tissue, then antibiotic-PMMA bead chains imbedded into the dead space. One week later, secondary debridement was performed, antibiotic-PMMA bead chains were changed according to result of bacterial culture and susceptibility test, and fractures were stabilized with external fixator. Three months after debridement, antibiotic-PMMA bead chains were taken out and bone graft with autogenous iliac cancellous bone chips was performed.RESULTS:The mean follow-up period was 19.98 months (ranging 15 to 28 months). Infection was controlled in 20 cases. One tibial fracture and 1 intertrochanteric fracture of the femur needed repeated debridement 2 and 3 months after bone grafting respectively,because of infection recurrence and sinus formation. All 22 cases achieved bony union averaged 15.09 weeks after bone grafting with a range of 8 to 24 weeks.CONCLUSION:Thorough debridement, imbedding antibiotic-PMMA bead chains combined with external fixator and staged bone grafting has proven to be effective and simple for treatment of infected fracture nonunion. The antibiotic bead delivers high tissue levels,obliterates dead space, aids bone repair.

[Objective]To study the effect of arthroscopic reconstruction of anterior cruciate ligament with hamstring tendons and mini-plates.[Method]Thirteen cases of anterior cruciate ligament ruptures were reconstructed arthroscopically with over six strands of hamstring tendons in way of one-bundle and two-tunnel reconstruction.The grafts were fixed with suspension technique by mini-plates.The patients were followed up for one year.The clinical results were evaluated according to Lysholm rating scale.[Result]Twelve patients(92.31%) had negative Lachman test,and one patient showed positive Lachman test.Pivot shift test was negative in 12 cases,and was positive in one case.The Lysholm score increases from 47.77±1.96 to 95.38±4.74(P<0.01).[Conclusion]Arthroscopic reconstruction of anterior cruciate ligament with hamstring tendons and mini-plates is reliable to restore the stability of the knee.

目的探讨病灶清除后椎间植骨加内固定术治疗胸腰椎结核的疗效。方法36例患者,采用经胸或经腹膜外入路,行病灶清除、髂骨椎间植骨、内固定术。术后卧床2~3个月,抗结核治疗1.0~1.5年。结果平均随访29个月,疗效满意,1年内结核病无复发,所有患者内固定无松动或断裂。植骨后3~6个月骨性愈合。结论彻底病灶清除、椎间植骨加内固定,可重建脊柱的稳定性,有利于结核病灶的稳定与修复,在病灶内植入内固定器械是安全可行的。

患者,女,38岁,主因右膝下渐肿胀3年入院,不伴有关节交锁,打软腿,无外伤病史.查体:右膝髌下膨隆肿大,象眼消失,触诊约有5 cm×5 cm大小肿物,表面欠光滑,质柔韧,无压痛,活动差,右膝关节活动度良好.辅助检查:CR拍片可见右膝髌下散在多个圆形高密度影.MRI扫描见,右膝髌骨下方,关节囊前方有团状异常信号影,T1W1上以低信号为主,内见斑点状高信号影(图1),T2W1上呈高低混杂信号,内见多发结节状影(图2),GR序列上以高信号为主,内间低信号影.

1临床资料 患者,男性,18岁,在校大学生,主因颈部被打伤疼痛10h入院.

近年来研究证实,在退变和突出的椎间盘组织中有细胞因子和炎症介质的存在,这些生物化学物质在椎间盘退变的复杂病理过程中具有重要的调控作用.现将近几年国内外有关细胞因子和炎症介质与腰椎间盘退变的关系的研究做一概述.

目的探讨单开门颈椎椎板成形术的手术适应证、手术方法及近期随访结果.方法回顾性分析了应用单开门颈椎椎板成形术治疗脊髓型颈椎病、颈椎间盘突出症及无骨折脱位型颈脊髓损伤共24例.结果经近期随访,术后20例病人的JOA评分提高2～6分,脊髓功能平均改善率为42%,椎管矢状径平均增加4 mm.结论单开门颈椎椎板成形术对于治疗脊髓型颈椎病、颈椎间盘突出症及无骨折脱位型颈脊髓损伤等是一种安全、有效的手术方法.

儿童寰枢椎旋转性半脱位是引起儿童斜颈的常见原因,2000年我院共收治此病患儿6例,现报告如下.

目的探讨臀肌筋膜挛缩症的手术治疗效果.方法手术治疗34例臀肌筋膜挛缩症患者.术中探查臀肌挛缩情况,切断、松解挛缩带,或作臀中肌肌腱延长.结果 34例患者经6个月随访,优32例,良2例;经2年以上随访,优30例,良4例,近期、远期疗效满意.结论该手术创伤小,术后功能较好,是治疗臀筋膜挛缩症的较满意手术方案.

腰椎的稳定性是指腰椎在载荷作用下维持自身结构正常形变的能力,即腰椎刚度的大小.手术后腰椎不稳定是指各种腰椎手术破坏了腰椎赖以维持平衡的解剖结构,从而引起手术后腰椎刚度丢失,也称为医源性不稳.腰椎不稳定是手术失败综合征的常见原因[1].

自1987年至1996年间,我科共收治55岁以上骨科疾病患者532例,手术治疗457例,占收治总数的85.90%,老年患者往往伴有各种其它老年病,在治疗上比较复杂,但只要做好围手术期的各项工作,全面了解患者的健康状况,手术仍不失为一种很有价值的治疗方法.本组病例经随访,大部分老年人术后生活自理.