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可吸收螺釘改良Dewar術治療陳舊性Ⅲ度肩鎖關節脫位

鉤鋼板治療鎖骨外側端骨折伴肩鎖關節脫位

REPAIR OF COLLATERAL LIGAMENT RUPTURE IN THE INTERPHALANGEAL JOINT USING SUPERFICIAL FLEXOR TENDON OF FINGER

OBJECTIVE To introduce the surgical procedure and clinical result of microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger. METHODS From 1987, 23 cases with collateral ligament rupture in the interphalangeal joint were repaired by part of superficial flexor tendon of finger. The initial point of collateral ligament was drilled two holes, 2 to 3 mm in distance, and crossed by steel wire. Then the superficial flexor tendon of finger was crossed under the steel wire and sutured to the terminal point of superficial flexor tendon of finger by 5/0 to 7/0 nontraumatic suture thread to maintain suitable tension, and sutured to collateral ligament by 8/0 nontraumatic suture thread. Extension splint fixation was performed 4 to 6 weeks postoperatively. RESULTS Followed up 3 to 6 months, 15 cases were excellent, 6 cases were better, 2 cases were moderate, and the excellent rate was 91.34% according to Saetta standard. CONCLUSION Microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger is a convenient and effective surgical method.

低位進釘法動力髖螺釘治療高齡股骨粗隆間骨折

【摘 要】 目的 總結利用低位進釘法動力髖螺釘（dynamic hip screw，DHS）治療高齡股骨粗隆間骨折的臨床經驗。 方法 2000 年1 月－ 2006 年12 月，利用低位進釘法DHS 治療高齡骨質疏松股骨粗隆間骨折25 例。男11 例，女14 例；年齡70 ～ 92 歲，平均81 歲。致傷原因：撞摔傷6 例，跌倒傷19 例。病程1 ～ 7 d。骨折類型按Evan’s 分型，Ⅰ型3 例，Ⅱ型10 例，Ⅲ型8 例，Ⅳ型4 例。伴其他部位骨折4 例，顱腦損傷1 例。合并高血壓病12 例，冠心病3 例，糖尿病1 例，腦血管病1 例，慢性支氣管炎和肺氣腫1 例。 結果 術中出現低血壓4 例，靜脈輸血和應用升壓藥物后好轉。術后1 個月內發生并發癥13 例，其中肺部感染4 例，精神障礙3 例，深靜脈血栓、腸道感染、心律失常、心肌梗死各1 例，經抗感染、抗精神藥物、溶栓等內科治療后無死亡患者。全部患者均獲隨訪，隨訪時間6 個月～ 3 年，平均21 個月。骨折平均愈合時間為14 周。參照Harris 評分標準，優9 例，良12 例，可3 例，差1 例，優良率84%。無螺釘松動、移位、滑出等內固定失敗發生。 結論 低位進釘法DHS 是治療高齡股骨粗隆間骨折較好的方法，選擇恰當的手術時機、采用正確的手術方法、術后適當的功能鍛煉是取得滿意療效的關 鍵。