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陈旧性跖跗关节脱位的足弓重建

目的 总结陈旧性跖跗关节脱位足弓重建的治疗方法及效果。 方法 2004 年9 月－ 2008 年1 月，收治陈旧性跖跗关节骨折脱位26 例。男19 例，女7 例；年龄18 ～ 56 岁，平均38.4 岁。交通伤8 例，重物砸伤10 例，高处坠落伤8 例。根据Myerson 分类法的X 线分型：A 型6 例，B 型5 例，C 型2 例，D 型6 例，E 型3 例，F 型4 例。受伤至手术时间4 周～ 9 个月，平均9 周。采取切开复位、内固定术9 例，足弓重建跖跗关节原位融合术 17 例。 结果 术后切口均Ⅰ期愈合。26 例均获随访，随访时间12 ～ 48 个月，平均22 个月。4 例术后5 个月发生足部转移性疼痛，应用足弓垫治疗，2 例1 年后疼痛缓解，2 例扩大关节融合后疼痛缓解。按Maryland 足部评分标准测定：优 5 例，良17 例，可4 例；优良率84.6%。关节融合全部愈合。 结论 伤后4 ～ 6 周的陈旧性跖跗关节脱位可行切开复位内固定术，疗效满意；6 周以上陈旧性跖跗关节脱位，宜行足弓重建跖跗关节原位融合术。

距骨骨折脱位32 例治疗

目的 探讨距骨骨折及距骨与周围关节脱位的处理方法。方法 1998年2月~2005年10月收治32例距骨骨折脱位。其中男23例，女9例；年龄19~56岁。车祸伤13例，坠落伤10例，压砸伤7例，扭伤2例。其中开放性损伤7例，伴同侧肢体或踝部骨折、韧带损伤10例，脾破裂1例。距骨颈骨折按Hawkins分类：Ⅰ型5例，Ⅱ型12例，Ⅲ型7例，Ⅳ型2例，距骨体骨折4例，距骨头骨折2例。伤后2~26 h进行治疗。手术切开复位者以2枚螺丝钉内固定，距骨体粉碎性骨折者行距下关节融合术。结果 32例均获随访6个月～7年，术后疗效按Kenwright 4级分类法评定，闭合性复位7例，优5例，良2例；切开复位内固定14例，优6例，良3例，可3例，差2例；开放性损伤7例，优1例，良2例，可2例，差2例；距下关节融合术4例，优1例，良2例，可1例。结论 距骨骨折或脱位后及时取得良好复位，恢复正确解剖关系对稳定足部非常重要，合理处理能最大限度恢复踝关节功能。

可吸收螺钉改良Dewar术治疗陈旧性Ⅲ度肩锁关节脱位

锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位

目的 总结锁骨钩钢板固定结合喙锁韧带重建治疗陈旧性肩锁关节脱位的临床疗效。 方法 2003 年6 月－ 2008 年12 月，采用锁骨钩钢板固定结合喙锁韧带重建治疗17 例陈旧性肩锁关节脱位。男11 例，女6 例；年龄16 ～ 53 岁，平均39 岁。均为直接暴力致伤。左侧7 例，右侧10 例。Rockwood 分型：Ⅲ型14 例，Ⅳ型2 例，Ⅴ型1 例。受伤至手术时间为14 ～ 55 d，平均23 d。 结果 术后切口均Ⅰ期愈合。肩锁关节脱位均纠正，无神经、血管损伤等并发症发生。术后患者均获随访，随访时间6 ～ 15 个月，平均12 个月。术后3 ～ 6 个月取出锁骨钩钢板，无再脱位发生。术后6 个月按Karlsson 疗效评价标准：优12 例，良4 例，差1 例，优良率94.1%。 结论 锁骨钩钢板固定结合喙锁韧带重建具有操作简便、创伤小、固定可靠、可早期功能锻炼等优点，是治疗陈旧性肩锁关节脱位的一种有效方法。

肩锁钩钢板治疗肩锁关节脱位的临床应用

带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位

目的 总结带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位的疗效。 方法 2015 年 10 月—2017 年 6 月，采用带线锚钉重建韧带治疗 8 例陈旧性拇指腕掌关节半脱位患者。男 7 例，女 1 例；年龄 19～63 岁，平均 44 岁。致伤原因：机器撞击损伤 4 例，运动损伤 3 例，交通事故伤 1 例。受伤至入院时间为 4～12 周，平均 8 周。拇、示指捏持无力，影像学检查示拇指腕掌关节对合不全。 结果 术后切口均Ⅰ期愈合。8 例均获随访，随访时间 9～24 个月，平均 18 个月。末次随访时，拇、示指捏持有力，X 线片复查示第 1 腕掌关节对合良好，无再脱位发生。根据中华医学会手外科学分会手指关节总活动度系统评定方法评价疗效，获优 5 例、良 3 例，优良率 100%。 结论 带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位，手术操作简便，疗效良好。

肘关节分裂脱位一例

RESEARCH PROGRESS IN TREATMENT OF STERNOCLAVICULAR JOINT DISLOCATION

ObjectiveTo summarize the research progress in the surgical treatment of sternoclavicular joint dislocation. MethodThe literature on the treatment of sternoclavicular joint dislocation was reviewed, summarized, and analyzed. ResultsAt present, the main therapy of sternoclavicular joint dislocation is operation, including the sternoclavicular joint reconstruction, the inner end of the clavicle resection, and internal fixation of the sternoclavicular joint. The internal fixation surgery is the preferred way, which is reliable fixation and in favor of early functional exercise. ConclusionsIt is the current focus of attention to select a reliable fixation that is accord with sternoclavicular joint anatomy and biomechanics.

CAUSATIVE ANANLYSIS FOR REDISLOCATION AFTER OPERATIVE REDUCTION OF CONGENITAL DISLOCATION OF HIP

Redislocation of the femoral head may be occured after its operative reduction in the congenital dislocation of the hip, therefore, it is greatly important to disclose the causes of the redislocation in order to avoid this every complication and improve the curative effect of this operation. Seven cases of redislocation from 106 cases (128 sides) of the congenital dislocation of the hip which had been reduced operatively were studied with relative measurements of the hip joints on roentgenogram, associated their pathologic conditions described in operation. The results showed that, in these cases, there were (0.843 +/- 0.692) cm upward displacement of the femoral head beyond the horizontal Y line, (68.86 +/- 0.692) degree of the femoral anteversion, the more lateral displacement of the femoral head compared to the opposite side and the acetabular index increasing up to (33.86 +/- 3.72) degree from (26.14 +/- 2.73) degree of the operative correction. These phenomena indicate that the redislocation after operative reduction of the femoral head in congenital dislocation of the hip is mainly related to four causes which include the existence of large pressure between acetabulum and femoral head, the uncorrected abnormal femoral anteversion, the residue of the pathologic tissues in the acetabulum and the reascending of the acetabular index having been corrected in operation.

ACETABULOPLASTY IN THE TREATMENT OF CONGENITAL DISLOCATION OF HIP IN OLDER CHILDREN

Acetabuloplasty was used to treat 62 cases (76 hips) of congenital dislocation of hip in older children, with a period of follow-up for 1 to 7 years. The good results from operation rated 81.7 percent. It was considered that this type of operation could fulfil the physiological requirements, as the femoral head replaced into the acetabulum would accomplish the following benefits from establishing a stable joint, reducing the lumbar lordosis and minimizing development of hip and low back pain. The technique ...