目的 比較克氏針張力帶與鎖骨鉤鋼板治療RockwoodⅢ型肩鎖關節脫位的臨床療效。 方法 1999年1月－2007年3月，收治肩鎖關節脫位患者29例，分別采用克氏針張力帶聯合喙鎖韌帶重建（克氏針組10例）和鎖骨鉤鋼板（鋼板組19例）治療。其中男18例，女11例；年齡19～50歲，平均38.2歲。患者均為新鮮RockwoodⅢ型肩鎖關節脫位，受傷至手術時間1～16 d，平均3 d。兩組患者性別、年齡、受傷至手術時間等一般資料比較差異無統計學意義（P＞0.05）。進行兩組患者術后臨床及影像學評估比較。 結果 25例患者（克氏針組10例，鋼板組15例）獲隨訪，隨訪時間2～12年，平均6年。術后克氏針組發生克氏針彎曲5例、斷裂1例；鋼板組切口淺表感染2例，經換藥后治愈，其余患者切口Ⅰ期愈合。兩組患者肩鎖關節均獲得良好功能，組間比較差異無統計學意義（P＞0.05）。影像學方面：與克氏針組相比，在患肢負重位時鋼板組喙鎖間隙間距增加了23%（P＜0.05），非負重位兩組間距差異無統計學意義（P＞0.05）。術后8～12周出現喙鎖韌帶鈣化，鋼板組12例、克氏針組2例（P＜0.05）。術后6個月出現肩鎖關節骨性關節炎，鋼板組2例、克氏針組1例（P＞0.05）。肩關節功能與影像學結果無相關性（r=0.096，P＞0.05）。 結論 克氏針張力帶聯合喙鎖韌帶重建和鎖骨鉤鋼板固定治療RockwoodⅢ型肩鎖關節脫位均可獲得良好的臨床功能。與克氏針張力帶相比，鎖骨鉤鋼板固定具有手術操作簡便、療效確切、并發癥少、能夠早期康復鍛煉等優點。
【摘要】 目的 總結應用經皮微創鋼板固定（minimally invasive percutaneous plate osteosynthesis，MIPPO）技術治療2型糖尿病患者脛骨遠端骨折的臨床經驗及治療效果。 方法 2007年5月-2010年11月，采用MIPPO技術治療2型糖尿病合并脛骨遠端骨折15例。其中男9例，女6例；年齡38~70歲，平均60歲。左側脛骨遠端骨折 4例，右側 11例。單發骨折10例，多發骨折5例。根據 AO分型:A1型2例，A2型1例，A3型5例，B1型3例，B3型3例，C1型1例。傷后至手術時間為2~14 d。 結果 15例患者隨訪時間8~12個月，平均10個月。手術時間平均89 min，術中失血量平均285 mL。術后1年采用Johner-Wruhs方法評估療效:優4例，良5例，中3例，差3例；總體滿意率80%。X線片示13例患者骨折均獲骨性愈合，愈合時間4~8個月，平均6個月，無再發骨折。3例發生泌尿系統感染，1例發生呼吸系統感染，感染率26.7%。 結論 MIPPO技術治療2型糖尿病脛骨近端骨折具有對骨折周圍軟組織剝離少、符合生物學固定概念、內固定牢靠、切口較小等優點，降低了切開復位內固定術后并發癥的發生率。【Abstract】 Objective To summarize the clinical experiences and effects of minimally invasive percutaneous plate osteosynthesis (MIPPO) technique for type 2 diabetic patients with fractures of distal tibia. Methods From May 2007 to November 2010, 15 type 2 diabetic patients with distal tibia fractures including 9 males and 6 females were treated with minimally invasive percutaneous plate osteosynthesis. Their age ranged from 38 to 70 years old averaging at 60. Left distal tibia fracture occurred to 4 cases, and right distal tibia fracture occurred to 11 cases. Ten patients had single fracture, and 5 had multiple fractures. According to AO fracture classification, there were two cases of A1, one cases of A2, five cases of A3, three cases of B1 and B3 respectively, and two cases of C1. The time from the occurrence of fracture to operation was ranged from 2 to 14 days. Results The patients were followed up for 8 to 12 months with an average period of ten months. The average operation time was 89 minutes and perioperative blood loss was (285±38) mL. Johner-Wruhs method was used to evaluate the efficacy. Four cases were excellent, 5 were good, 3 were fair, and 3 were poor, with an overall satisfaction rate of 80%. X-ray showed that 13 patients were healed. The healing time was 4 to 8 months, averaging 6 months, and no further fractures occurred. There were 3 cases of urinary tract infection and 1 case of respiratory infection with an infection rate of 26.7%. Conclusion Minimally invasive percutaneous plate osteosynthesis technique for fractures of distal tibia in diabetic patients is a safe method with better mechanical stability, less intervention of blood supply, less soft tissue complications and smaller incisions.
Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan-Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.