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骨搬移、骨延长术治疗长骨慢性骨髓炎和感染性骨不连体会  [PDF]
班照楠,黄富国,王莹
华西医学 , 2014, DOI: 10.7507/1002-0179.20140273
Abstract: 目的 探索分析Ilizarov骨搬移、骨延长术治疗长骨感染和肢体短缩,以及感染所致骨折不愈合的临床疗效。方法 回顾性分析2011年6月-2013年10月,用骨感染病灶清除、Ilizarov外固定支架固定及骨干骺端截骨骨搬移和骨延长术治疗13例长骨感染、缺损的股骨、胫骨和腓骨慢性骨髓炎和感染性骨不连患者,其中股骨和胫骨慢性骨髓炎8例(伴股骨病理性骨折1例),感染性骨不连4例;腓骨慢性骨髓炎1例。结果 13例患者感染均得到一期治愈,窦道愈合,骨搬移结合处正常愈合。其中2例出院后自行搬移过程中出现钉道感染(1例经再次清创后治愈,1例经清创后感染复发截肢),1例在骨愈合后发生再骨折,经髓内钉固定后骨折愈合。13例患者骨搬移长度5~13cm,平均7.5cm;13例患者中有11例骨搬移后双下肢等长,2例患侧下肢较健侧下肢短缩。所有患者未出现神经损伤。结论 Ilizarov骨搬移和骨延长技术是治疗长骨感染及感染性骨不连的一种有效办法,手术可祛除感染,治愈窦道,恢复肢体长度,从而解决患者痛苦,提高其生活质量。
骨搬移技术治疗下肢感染性骨缺损  [PDF]
李维,王子明,杜全印,王雨,熊雁,王爱民
第三军医大学学报 , 2015,
Abstract: 目的探讨应用骨搬移技术治疗严重下肢感染性骨不连的临床疗效。方法按照牵拉组织再生原理,对26例四肢高能量损伤后下肢感染性骨不连患者采取病灶彻底切除+干骺端截骨搬移术。术后7d以0.25mm/6h速度延长,固定延长至骨缺损端会合,于骨缺损处两断端加压并继续维持外同定支架至骨愈合。结果26例全部获随访,平均随访56(20~92)个月。骨延长2~14cm,平均5.5cm,骨性感染全部治愈。带支架时间6~24个月,平均13个月。23例骨缺损处及延长部位骨生长良好,达到了骨性愈合;3例断端骨接触后6个月无明显骨愈合,其中2例行自体髂骨植骨,1例拆除支架后行自体髂骨植骨内固定,4~6个月达到骨性愈合。截骨延长部位及骨缺损对合处对位对线良好。结论骨搬移技术治疗下肢感染性骨不连,术后感染控制良好,骨愈合率高。
自体微小颗粒骨一期治疗感染性骨缺损及骨不连的临床研究  [PDF]
李志远,李刚,荆浩,周越,胡宁敏
宁夏医科大学学报 , 2012,
Abstract: 目的探讨一期自体微小颗粒骨移植治疗感染性骨缺损及骨不连的疗效。方法30例感染性骨缺损或骨不连患者,患处彻底清创,切除坏死组织至创面出血,创面放置VSD负压吸引材料,单边或多边外固定架固定,一期植入自体微小颗粒骨,敞开植骨创面,生理盐水或庆大霉素纱布换药至新鲜肉芽覆盖后,行植皮或皮瓣转移手术。结果骨折愈合30例,时间为3-8个月,平均6个月,术后平均7个月(4~12个月)去除外固定架,无感染等并发症发生。结论自体微小颗粒骨移植是治疗感染性骨缺损及骨折不愈合的更积极有效的方法,可以获得理想的效果。
骨骺板力学性质的实验研究
(华筑信,(刚芹果,(林振福,(李军
科学通报 , 1996,
Abstract: 骺板又名生长板,位于骨骺与干骺端之间,存在单向软骨增殖与成骨活动,是生长期骨骼的生长发育部位。当动物发育成熟,骺板的软骨增殖与成骨活动相继结束,骺板完全钙化,长骨纵向生长停止(图1)。
儿童骨骺及骺板损伤的诊断和治疗进展  [PDF]
杨健,刘少峰,刘敏
华西医学 , 2012,
Abstract: 儿童骨折中可能涉及骨骺及骺板损伤,骺板损伤可导致骨骺与干骺端之间形成骨桥,骺板提前闭合,造成肢体短缩和(或)成角畸形,影响儿童生长发育。骨骺及骺板损伤的早期诊断和治疗仍是小儿矫形外科的难题。现有的诊断方法和治疗方法众多,但都不甚满意,现就儿童骨骺及骺板损伤的诊断和治疗进展进行综述。
腓骨截骨结合自体髂骨植骨治疗胫骨术后骨不连  [PDF]
曹烈虎,魏强,陈晓,翁蔚宗,崔进,李海航,汪琳,张军,周启荣,纪方,苏佳灿
- , 2017, DOI: 10.16781/j.0258-879x.2017.02.0142
Abstract: 目的 探讨采用腓骨截骨结合自体髂骨植骨治疗胫骨术后骨不连的临床疗效。方法 对2008年7月至2013年6月第二军医大学长海医院收治的45例胫骨术后骨不连患者进行腓骨截骨结合自体髂骨植骨治疗。根据骨不连分型:肥大型29例,萎缩型14例,假关节2例。首次固定器械:钢板固定32例,髓内钉固定11例,外固定支架固定2例,对其中8例钢板内固定稳定患者行单纯腓骨截骨自体髂骨植骨术,对35例内固定和2例外固定失效患者行固定取出更换锁定加压钢板+腓骨截骨结合自体髂骨植骨术,通过定期正侧位X线观察骨折愈合情况和相关并发症,并根据Olerud-Molander评分标准对踝关节功能进行评分。结果 患者手术时间为1.3~2.5(1.7±0.5)h,术中出血量为200~500(250.0±59.6)mL,腓骨截骨长度为2~3(2.4±0.5)cm,髂骨植骨量为3~23(7.8±1.3)cm3。随访时间为12~48(16.5±3.3)个月,45例患者的骨折愈合时间为3~11(5.6±2.4)个月。26例(58%)患者在3~5个月愈合,13例(29%)患者6~8个月愈合,其余6例(13%)患者9~11个月愈合。肢体无短缩27例,短缩<1 cm者9例,短缩1~2 cm 6例,短缩>2 cm 3例。末次随访时评定下肢关节功能:优23例,良14例,可5例,差3例。结论 腓骨截骨结合自体髂骨植骨可以对骨折断端进行加压,增加断端接触面积,促进骨折愈合,减少并发症。
Objective To assess the clinical efficacy of fibular osteotomy with autogenous iliac bone graft for treatment of nonunion of the tibia. Methods A cohort of 45 patients with postoperative nonunion of tibia between Jul. 2008 and Jun. 2013 were treated by fibular osteotomy combined with autogenous iliac bone graft in Changhai Hospital of Second Military Medical University. According to anatomical classification, there were 29 cases of hypertrophic nonunion, 17 cases of atrophic nonunion and two cases of pseudoarthrosis. For primary fixation, 32 cases had plates internal fixation, 11 had intramedullary nail and two had external fixation. Eight patients with stable plate internal fixation were treated by fibular osteotomy with autogenous iliac bone graft, 35 patients with failed internal fixation and two patients with failed external fixation were treated by removing implant and exchanging compression plate with fibular osteotomy using autogenous iliac bone graft. The status of fracture healing and relative complications were assessed by lateral and frontal X-ray. Functional recovery of the ankle was evaluated by Olerud-Molander Ankle Score (OMAS). Results The operation time was 1.3-2.5 (1.7±0.5) h, the intra-operation blood loss volume was 200-500 (250.0±59.6) mL, the fibular osteotomy length was 2-3 (2.4±0.5) cm, and the volume of iliac grafting was 3-23 (7.8±1.3) cm3. The follow-up time was 12-48 (16.5±3.3) months and the fraction healing time was 3-11 (5.6±2.4) months. The healing of 26(58%) patients took 3-5 months, 13(29%) patients took 6-8 months and 6(13%) patients took 9-11 months. Twenty-seven patients had no limb shortening, nine patients had limb shortening of <1 cm, six patients had limb shortening of 1-2 cm and three patients had limb shortening of >2 cm. The function of lower limb joints was excellent in 23 cases, good in 14 cases, common in 5 cases and bad in 3 cases at last follow-up. Conclusion The fibular
带锁髓内钉治疗四肢长骨干骨折骨不连23例分析  [PDF]
王光辉,杨伟宇,王磊
宁夏医科大学学报 , 2007,
Abstract: 为探讨四肢骨干骨折骨不连,尤其合并慢性感染性骨折骨不连的手术方法,分析采用带锁髓内钉治疗的23例四肢长骨干骨折骨不连患者临床资料。结果,术后临床随访,22例骨折骨不连,均在3~12个月愈合,1例慢性感染12个月骨折骨不连愈合。带锁髓内钉治疗骨不连,是提高长骨干骨折骨不连或延迟愈合治疗效果的主要方法之一。更多还原
育发剂致突变性2种试验方法的比较  [PDF]
宋瑞霞,阮鸿洁,张丽霞
癌变·畸变·突变 , 2007,
Abstract: ?背景与目的:探讨检测育发剂致突变性的适宜的方法。材料与方法:运用ames试验、小鼠淋巴瘤细胞试验(mla)对3种育发剂的致突变性进行研究。结果:28种育发剂中有85.72%的样品对组氨酸缺陷型鼠伤寒沙门氏菌均有程度不同的抑菌或杀菌作用,选取的3种育发剂对组氨酸缺陷型鼠伤寒沙门氏菌均有较强的抑菌杀菌作用,在试验浓度下均未呈现致突变性;mla试验结果显示,1号样品和3号样品育发剂在测试浓度下未呈现致突变性;2号样品育发剂随浓度增大,l5178y细胞tk位点的突变频率有升高的趋势,其中8μl/ml、40μl/ml和200μl/ml剂量组的突变率,与对照组相比差异有统计学意义(p<0.05)。结论:小鼠淋巴瘤细胞试验(mla)可做为毒性较大育发剂的遗传毒性筛检的补充试验。
多发性骨软骨瘤病例分析  [PDF]
刘东,叶永杰,银毅,陈刚
华西医学 , 2014, DOI: 10.7507/1002-0179.20140632
Abstract: 目的 对多发性骨软骨瘤进行病例分析,以提高对该病的认识。方法 回顾分析2008年1月-2013年4月收治的14例多发性骨软骨瘤患者的临床资料。结果 男9例,女5例;年龄6~45岁,中位年龄17岁;4例有家族史。5例全身多发,1例双上肢多发,1例累及双侧膝关节,7例累及单侧膝关节。合并畸形包括2例前臂尺桡关节脱位,1例下肢短缩。合并疾病包括1例肋骨软骨瘤伴胸腔积血,1例肝功能异常及1例额部毛细血管瘤。所有患者行局部肿瘤切除术,手术史1例7次,1例4次,2例2次,10例1次;每次手术切除部位2例3个,5例2个,7例1个。1例患者术后(在外院行局部病灶切除术)20年复发再次行局部肿瘤切除术。1例术后发生右腓深神经运动支损伤。术后1例失访,余随访时间6~68个月,中位时间38个月。随访期内无恶变患者。结论 多发性骨软骨瘤可能是累及全身组织的一组临床综合征,诊断容易,畸形比例小、程度轻,局部肿瘤切除术效果确切,恶变几率小。
辅助锁定钢板植骨治疗髓内钉术后股骨骨不连  [PDF]
吴作培,陈春华,龚冲丞,姚中凯,孙贵新
- , 2016, DOI: 10.16118/j.1008-0392.2016.02.021
Abstract: 目的 探讨辅助锁定钢板治疗髓内钉固定术后股骨骨不连疗效。方法 2008年1月至2013年9月,6例股骨干骨折髓内钉固定术后骨不连患者,男4例,女2例,年龄25~55岁,平均(35.2±7.8)岁,骨折至髓内钉手术时间为1~5d,平均2.5±1.3d,髓内钉术后出现骨折不愈合时间8~18个月,平均时间为(11.3±5.6)个月,所有患者在动力化治疗之后保留原有髓内钉的基础上,采取有限切开辅助锁定钢板加自体髂骨移植治疗。结果术后随访10~22个月(平均15.8±7.3个月),6例患者术后4~10个月均出现骨性愈合,X线示骨痂连续性生长过骨折线或骨折线消失。伤口均I期愈合,未出现感染等异常,末次随访,髋膝关节活动良好,优良率达100%。结论在动力化治疗之后保留原有髓内钉的基础上,采用辅助锁定钢板联合自体髂骨移植治疗股骨干骨折髓内钉固定术后骨不连,手术创伤小,疗效确定,稳定可靠,是治疗髓内钉固定后股骨骨不连的有效方法。
Objective To evaluate the efficacy of augmentative locking plate for treatment of nonunion of femoral shaft fracture after intramedullary nailing interfixation. MethodsSix patients with non-union of femoral shaft fracture after intramedullary nailing interfixation were treated by augmentative locking plate and autogenous iliac grafting from January 2008 to September 2013. There were 4 males and 2 females with an average age of (35.2±7.8) years and with an average non-union time of (11.3±5.6) months. Results All the 6 cases were followed up for 15.8±7.3 months(10-22 months) and X-ray imaging proved bone callus at the broken ends of the fracture at 4-10 months after surgery. No one case suffered from infection in the incision. For the function of joints, 6 patients(100%) were excellent or good during the last time of the follow-up with.ConclusionAugmentative locking plate and autogenous iliac grafting for treatment of non-union of femoral shaft fracture after intramedullary nailing interfixation has advantages of less invasiveness, definite efficacy and stable fixation
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