Baidu
map

锁定钢板结合自体腓骨支撑植骨治疗肱骨外科颈骨不连

2015-03-02 佚名 骨科周讯

引言 由于肱骨近端碎片太小且难以复位固定,肱骨外科颈骨不连的治疗比较困难,特别是在长期不愈合的情况下。此外,外科颈骨不连患者往往因之前多次手术治疗导致骨质量较差和软组织损伤。这些因素使得治疗变得更加复杂,其治疗具有相当挑战性。 虽然已经报道过许多治疗方案,但仍然没有统一而明确的手术方案,且预后差异较大。这项回顾性研究旨在评估锁定钢板内固定结合不带血管蒂自体腓骨支撑植骨治疗肱骨外

引言

由于肱骨近端碎片太小且难以复位固定,肱骨外科颈骨不连的治疗比较困难,特别是在长期不愈合的情况下。此外,外科颈骨不连患者往往因之前多次手术治疗导致骨质量较差和软组织损伤。这些因素使得治疗变得更加复杂,其治疗具有相当挑战性。

虽然已经报道过许多治疗方案,但仍然没有统一而明确的手术方案,且预后差异较大。这项回顾性研究旨在评估锁定钢板内固定结合不带血管蒂自体腓骨支撑植骨治疗肱骨外科颈骨不连的疗效。

患者与方法

2006年1月到2010年3月间,7例(表1)无菌性肱骨外科颈骨不连患者在我们的创伤中心接受治疗,由同一个治疗团队给予不带血管蒂的腓骨支撑植骨并行内固定。根据Weber和Cech分型,所有病例均为萎缩性不愈合,患者表现出不同程度的肱骨头内翻错位。

7例患者中有5名女性和2名男性,平均年龄58.4岁(45-76岁)。3例患者惯用的右手受到影响,4例患者非惯用的左手受到影响。所有骨不连都是由外伤性骨折造成的。其中5例骨折最初由高处摔落引发,2例是由交通事故引发的。从初次骨折到采用内固定和腓骨支撑植骨修复不愈合的平均时间为20个月,范围为10 48个月(表1)。

表1 患者特征

手术技术

在全身麻醉下采用“沙滩椅”体位对患者进行手术。我们对肩关节和同侧腿同时进行皮肤消毒和铺单。通过一个标准的胸大肌三角肌间入路来显露肱骨外科颈骨不连的位置,取出5例内固定失效患者的内植物,对中间的疤痕和纤维组织进行了清创,并收集组织样本进行培养,以排除任何隐匿性感染。所有患者的肱骨头内翻畸形得到校正,骨缺损的位置也被记录在案。我们在每一例患者中通过截骨获取同侧腿5-150px的腓骨,并将其施加于内侧皮质肱骨。移植物的头侧紧紧装进松质骨的顶端(图1a)。我们采用肱骨近端锁定钢板(Synthes)对所有患者行内固定。在尾侧部分至少用两枚螺钉固定腓骨移植块,留出大约1-50px的头侧部分紧紧装在肱骨头上(图1b)。我们没有尝试近端螺钉固定腓骨移植块。

图1a 腓骨与复位后的肱骨头嵌插固定;b 结合固定角度锁定钢板行最终固定及远端螺钉穿过植骨块

术后处理

所有患者的肩关节在术后悬吊固定6周。治疗专家在手术第一天对患者进行一系列被动范围活动训练,术后3周开始渐进范围的活动训练。每月在门诊随访直到骨折愈合。我们定义放射性愈合为桥接骨小梁穿过骨折部位且腓骨移植物在肱骨轴处融合。每次随访中我们采用Constant-Murley评分和视觉模拟评分(VAS)来评估每位患者的疼痛、肩关节活动和强度。为了测试术前及术后的Constant-Murley评分和模拟疼痛量表之间的差异,我们采用SPSS11.0统计软件(芝加哥,伊利诺伊州,美国)进行Fisher检验。P值小于0.05为统计学显著性差异。

研究结果

随访的平均时长为22.7±6.5个月(15-36个月)。所有患者均达到临床和放射学愈合,且不需要任何额外的处理(图2a–f)。从翻修手术到愈合的平均时间为6.1±1.3个月(5-8个月)。

图2 顽固性肱骨外科颈骨不连患者的典型病例a 肱骨外科颈骨不连术后18个月b 结合三叶钢板内固定行翻修手术和自体松质骨植骨c 在翻修手术18个月后,X线片显示钢板断裂和肱骨头内翻畸形d 结合锁定钢板内固定行二期翻修手术和自体松质骨植骨e 二期翻修手术后5个月X线显示持续性不愈合伴锁定钢板断裂f 在肱骨颈内侧植入自体腓骨结合锁定钢板内固定行三期翻修手术7个月后骨愈合。肱骨头已扭曲,而没有观察到股骨头坏死g 临床照片展示患者的活动范围,恢复日常正常活动

Constant-Murley评分(P<0.001)平均值从术前25.7分(15-35)上升到术后77.7分(60-90)。VAS评分(P<0.001)从术前7.57分(6-10)下降至术后0.57分(0-2)(表2)。所有患者的疼痛得到显著缓解。

患者没有任何术后感染,也没有钢板和螺钉断裂。一例患者的小腿有局部浅表性腓神经麻痹,4个月内完全恢复。另一例患者出现桡神经麻痹,3个月内得到解决。在最后的随访中没有发现肱骨头缺血性坏死或关节炎。

讨论

治疗肱骨头下骨不连的理想方案仍存在争议。在本文中,我们描述了治疗这种骨不连的替代技术。

目前治疗外科颈骨不连的选择包括髓内钉,钢板和关节置换术。插入髓内钉的操作可能会导致肩峰撞击,且通常需要第二次手术来取出内固定。肩关节置换术适应症有限,往往只用于特定的老年患者或者作为一项补救手术方式,因为保留年轻患者的相对较好的骨量的原生肱骨头非常重要。目前最可行的固定技术是使用角稳定内固定。外科医生用角钢板治疗外科颈骨不连取得了良好疗效,但该技术要求高,插入钢板不当时,钢板与肩峰之间会引发撞击。

在我们的研究中,使用的是预塑形锁定钢板。这种钢板允许我们在一个小的、质量差的松质骨段中插入大量的多角度螺钉,肱骨外科颈骨不连的病例中经常为此类骨段。此外,该钢板的低切迹设计也使得肩峰下撞击的发生几率最小化。

由于冈上肌的牵拉,肱骨外科颈骨不连的近段通常处于内翻位。另外,内侧铰链复位不佳通常与薄而易碎的关节内骨块的固定不充分有关,往往导致头部内翻。最近的数据表明,单独用锁定钢板无法由外向内支撑肱骨头,该内侧柱的完整性是用于预测固定失败的主要因素。在本研究中,我们使用了支撑植骨重建内侧肱骨矩。我们推测,腓骨支柱可以提供干骺端内侧的支撑,以防止肱骨头内翻塌陷。

我们采用自体移植物而不是异体移植物。自体移植骨是唯一具有成骨功能、骨诱导和骨传导特性的移植材料,这使它成为理想的移植材料。异体移植物具有传染疾病的风险,会降低移植的成骨功能和骨诱导潜力。尽管如此,外科医生应该知道,虽然腓骨移植可以提供理想的内侧结构支撑,但它不能恢复肱骨头受损血管。因此,应该在手术时尽可能保留头部残余的血供,特别是要重视肱骨结节处附着的肌肉及后关节囊。本研究描述的病例中,尽管肱骨头因之前多次手术已变形,但在最后的随访中并没有出现股骨头坏死(图2f)。

f 在肱骨颈内侧植入自体腓骨结合锁定钢板内固定行三期翻修手术7个月后骨愈合。肱骨头已扭曲,而没有观察到股骨头坏死。

由于病例数较少,属于回顾性分析,且未设置对照组,因此这项研究有一定不足。有些患者很有可能会随着时间推移引发创伤性肩关节炎。尽管有这些不足,该研究为治疗肱骨外科颈骨不连这种临床难题提供了重要的数据和指导。

结论

锁定钢板联合非血管化自体腓骨支撑植骨治疗肱骨外科颈骨不连是一个简单而可靠的方法。


版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-08-07 hlycom3356

    期待有更多研究

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-04-12 x35042875

    患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-03-27 58.46.99.**

    肱骨头写成了股骨头

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-03-04 shalley68
  5. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-03-03 MedSci客户端网友

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=35249, encodeId=35e73524960, content=期待有更多研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=184, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=332823945, createdName=hlycom3356, createdTime=Fri Aug 07 18:07:00 CST 2015, time=2015-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20883, encodeId=ce432088314, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:39:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=18957, encodeId=e5f61895ed8, content=肱骨头写成了股骨头, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=58.46.99.**, createdTime=Fri Mar 27 00:42:00 CST 2015, time=2015-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1460634, encodeId=dc1b1460634e5, content=<a href='/topic/show?id=b08e81986a8' target=_blank style='color:#2F92EE;'>#肱骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81986, encryptionId=b08e81986a8, topicName=肱骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=70e46352899, createdName=shalley68, createdTime=Wed Mar 04 00:32:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17517, encodeId=ad051e51730, content=丶, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=MedSci客户端网友, createdTime=Tue Mar 03 20:10:00 CST 2015, time=2015-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17399, encodeId=fbac1e399df, content=好文章,超赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=217, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Mon Mar 02 21:19:00 CST 2015, time=2015-03-02, status=1, ipAttribution=)]
    2015-03-02 xiaoai5777

    好文章,超赞

    0

相关资讯

基础:常见的骨结构翻译

骨的琐碎结构必然是要记下来的,今天我们就来小小的总结一下。这个看英文图谱的必备技能怎么能忘,就从这里开始吧 接下来就对结节,突,凹做个归纳吧,例子其实远远不全,就希望大家记住这些关键词,自己慢慢发掘喽! 1. Process ★Transverseprocess 横突(脊椎) ★Spinous process 棘突(脊椎) ★Styloid process

Injury:老年开放性肱骨远端骨折一期使用肘关节置换效果良好

肘关节置换在早期是被用于肘关节晚期关节炎的患者,取得了良好疗效,因此也用于老年复杂粉碎肱骨远端骨折,其治疗效果可以等同于或超过切开复位内固定的治疗效果。但是由于肘部软组织覆盖较差、而且大多为高分级的开放性骨折,对于老年肱骨远端骨折患者肘关节置换手术比较复杂,从理论上讲,对于开放性骨折,关节置换增加了切口和深部感染的风险。 美国的学者Michael S. Linn在老年开放性肱骨远端中采用

Injury:新型肱骨顺行髓内钉治疗肱骨近端骨折易损伤腋神经

肱骨近端骨折是第三常见的骨折,其中大部分经保守治疗后可获得良好的临床预后,特别是老年人的肱骨近端骨折。而切开复位后各种内固定方法也可用于治疗肱骨近端骨折。 有研究证明钢板内固定术和髓内钉固定术治疗肱骨近端骨折均可获得稳固的内固定。而Zhu等的研究结果显示钢板内固定术的术后并发症发生率明显高于髓内针固定(31%比4%),但是术后第三年两种手术方法的临床预后并无明显差异。 还有研究指出

手术技巧:肩关节置换治疗肱骨近端骨折

肱骨近端骨折(PHFs)约占老年人骨折的4%-10%,发病率仅次于髋关节和桡骨远端骨折。其中约有15%的患者需要手术治疗,包括骨折固定术和肩关节置换术。而术后的临床预后要取决于骨折移位部位和程度、肱盂关节的损伤情况和骨质疏松症等危险因素。 实际上,大部分患者可恢复到肩关节原来的活动能力,但术后并发症率高达40%-60%。肱骨头缺血性坏死(AVN)是最应关注的并发症,因为它可引起慢性疼痛、

COP:肱骨远端粉碎性骨折的治疗方案选择

最近几十年,随着低切迹预塑形钢板的不断改进和对内固定的使用原则和理解的不断深入,使得切开内固定术的手术难度在降低和患者预后获得改善。然而,肱骨远端骨折的治疗对手术医生仍然具有一定挑战性,尤其是合并有粉碎性骨折、骨质疏松或骨质减少的患者。 切开复位内固定术(ORIF)治疗肱骨远端粉碎性骨折的手术耗时长、难度高,而且术后恢复时间长。此外,骨质疏松的老年患者术后可发生患肢负重受限、内固定失败、骨折不愈

“宅男宅女”老了更容易骨折

新加坡国大医学研究生院近日对外公布的最新研究指出,中国老人普遍缺少维生素D,带来诸多健康隐患。人体约90%的维生素D来自晒太阳时自身皮肤合成,因此可以说中国老人很缺阳光,我们应该抓住时机,好好享用阳光这剂“天然补药”。 越来越多的年轻人患上骨质疏松 令人忧虑的是,越来越多的年轻人患上骨质疏松。全国各大体检中心发现,大量二三十岁的年轻人由于不爱晒太阳,也不运动,早早地被骨质疏松这种“老年病”

Baidu
map
Baidu
map
Baidu
map