黄长智医生的科普号

摘要：目的探讨青少年习惯性髌骨脱位的手术方式选择及临床疗效。方法笔者医院于2015-12收治1例青少年习惯性髌骨脱位，采用五联法手术（膝外侧软组织松解术+内侧软组织紧缩术+Roux-Goldthwait手术+内侧髌股韧带重建术+股内侧肌下移术）治疗，回顾性分析临床资料并复习文献。结果经18个月随访膝关节功能恢复良好，无神经、血管损伤，无切口感染，无髌骨脱位复发等不良事件发生。结论经五联法手术治疗青少年习惯性髌骨脱位疗效满意，但手术方式的选择应视具体情况而定。

【摘要】骺板损伤由于早期诊断困难，往往在肢体出现成角畸形和(或)短缩时才被发现。此时在骨骺与干骺端之间已经形成骨性连接即骨桥，若不去除骨桥将使正常的骺板全部或部分提前闭合，加重肢体短缩和(或)成角畸形。骺板早闭的治疗是一个既复杂又棘手的问题，包括骺板损伤早闭的早期手术及非手术治疗和骺板损伤早闭的晚期手术治疗(即各种后遗畸形的矫形术)，本文参考国内外相关研究文献对骺板损伤后遗畸形的诊疗现状进行回顾，并对其前景作一展望。【关键词】骺板损伤;畸形;矫形术Diagnosis and treatment of epiphyseal plate injury with deformityHUANG Chang-zhi1，YANG Xiao-ning2(1．Xuzhou Medical College，Xuzhou 221000，China;2．Department of Orthopaedics，First People’s Hospital of Xuzhou，Xuzhou Medical College，Xuzhou 221000，China)【Abstract】It is difficult to make early diagnosis for epiphyseal plate injury．Most of cases were diagnosed when limb reduction and(or)angulated deformity were observed，which resulted in the bony bridge between the epiphysis and metaphysis．Preserving bony bridge may cause severe partial or entire growth plate arrest and aggravate limb reduction and(or)angulated deformity．The treatment of epiphyseal plate injury included surgical and nonsurgicaltreatment in the early stage and surgical treatment in the late stage．This article discusses the current developmentand future for the diagnosis and treatment of epiphyseal plate injury with deformity．【Key words】epiphyseal plate injury;deformity;orthopedics

摘要：目的探讨Arch 钛板在颈后路单开门椎管扩大成形治疗颈椎管狭窄症的方法及临床疗效。方法对2010-11-2013-11 间20 例颈椎管狭窄症患者行颈后路单开门椎管扩大成形Arch 钛板内固定术。男12 例，女8 例；年龄40～80 岁，平均65 岁；病程3～28 个月，平均8.5 个月。结果术后6个月摄颈椎X 线及CT 检查所有患者门轴侧椎板均已骨性融合，无“再关门”现象，未发现内固定物松动、移位、断裂等现象，无脊髓损伤、血肿等并发症。所有患者神经功能恢复良好。结论颈后路单开门椎管扩大成形Arch 钛板内固定术治疗颈椎管狭窄症初期疗效满意，是一种切实可行的方法。关键词：颈椎管狭窄症；单开门椎管扩大成形术；Arch 钛板；内固定The use of cervical posterior single open-door laminoplasty with Arch titanium plate fixationfor cervical spinal stenosisHUANG Chang-zhi1，LIN Quan1，YUAN Yan-lin2，et al（1. First Department of Orthopaedics, Ningde Hospital Affiliated to Fujian Medical University,Ningde, Fujian 352100, China;2. Arthritis Institute,Peking University People's Hospital,Beijing 100044, China;3.First Department of Orthopaedics, The First People's Hospital of Xuzhou, Xuzhou,Jiangsu 221002,China.）Abstract：Objective To explore the way and therapeutic effect of cervical posterior single open-door laminoplasty with Arch titanium plate fixation in the treatment of cervical spinal stenosis.Methods From November 2010 to November 2013, cervical posterior single open-door laminoplasty with Arch titanium plate fixation was performed in 20 cases with cervical spinal stenosis, which included 12 males and 8 females with average of 65 years （40~80 years） and average disease course of 8.5 months（3~28 months）.Results 6 months after operation, all patients received X ray and CT examination, all door shaft side lamina had bony fusion, no“shutdown”phenomenon, without the phenomenons such as internal fixation loosening or displacement or fractures. There were no complications such as spinal cord injury or hematoma. All patients' nervous function recovered well. Conclusion The early curative effect of cervical posterior single open-door laminoplasty with Arch titanium plate fixation in the treatment of cervical spinal stenosis is satisfied, it is a feasible method.Key words：cervical spinal stenosis; single open-door laminoplasty; arch titanium plate; internal fixation

[摘要]先天性髌骨脱位（Congenital dislocation of the patella,CDP）是一种罕见的疾病，病因不明，多认为是膝关节生长发育异常造成的一种持续性、不可复性的脱位，以双侧多见，具有一定的家族遗传倾向。由于其早期诊断困难，随着患儿的生长发育，导致一系列膝关节畸形，增加手术治疗难度。本文参考国内外相关研究文献对先天性髌骨脱位的诊断及治疗现状进行综述，为临床治疗提供帮助，并对其前景作一展望。[关键词]髌骨；脱位；治疗；诊断Present situation and the research progress in diagnosis and treatment of congenital dislocation of the patellaHuang Chang-zhi1,Lin Quan1,Yang Xiao-ning2.1First Department of Orthopaedics,Ningde Hospital Affiliated to Fujian Medical University,NingdeFujian,352100;2First Department of Orthopaedics,the FirstPeople’s Hospital of Xuzhou,Xuzhou Medical University,XuzhouJiangsu,221002,China[Abstract]Congenital dislocation of the patella is a rare disease,and its etiology is not completely clear.It is considered to be a persistent and non-complex dislocation caused by the abnormal growth and development of the knee joint,which common on both sides with a genetic predisposition.Due to the difficulties in early diagnosis,with the growth and development of children,resulting in a series of knee deformities,therefore increasing the difficulty of surgical treatment.This article discusses the current development and future for the diagnosis and treatment of congenital dislocation of the patella in order to provide help for clinical treatment.[Keywords]Patella;Dislocations;Treatment;Diagnosis

摘要： 目的 探讨人工全髋关节置换术（THR）治疗股骨粗隆间骨折伴股骨头坏死的方法及疗效。方法对15 例股骨粗隆间骨折伴股骨头坏死行THR。均采用生物型髋臼假体及骨水泥或生物型股骨柄，骨折均采用钢缆固定。结果假体均正确放置，无术中再骨折及神经损伤。术后4~6 周可扶拐下床进行早期功能锻炼。均获随访8~36 个月，Harris 评分：优11例，良4 例。结论对此类患者行一次性THR，虽然增加了难度及一定的危险性，但可减少并发症及二次手术的痛苦。

专家点评：病例资料较详实，治疗方案合理，分析到位，创新性有待进一步提高。该病例代表了临床的一类患者膝关节内翻的患者，属于常规手术，但是术中进行的术前计划及评估值得学习。膝关节骨关节炎合并膝内翻和屈曲挛缩畸形的患者，内翻畸形的矫正包括对下肢正常力线的重建和膝关节稳定性的重建。手术者应对内翻畸形的病理基础及形成机制深刻理解。膝内翻的发生导致内侧副韧带、后内侧关节囊、鹅足、半膜肌以及后交叉韧带的挛缩。内翻及屈曲挛缩畸形是全膝关节置换术中常见的畸形类型，通过手术中严格的软组织平衡技术有效纠正上述畸形。

[摘要] 目的 探讨复杂骨盆髋臼骨折切口入路选择及治疗方法和临床疗效。方法回顾性分析我院2016年9月收治复杂骨盆髋臼骨折老年男性患者1例，采用经腹直肌外侧入路联合双侧髂骨后入路复位内固定治疗，并总结其治疗过程及效果，同时回顾既往文献，加深对复杂骨盆髋臼骨折的认识。结果 患者术后功能恢复良好，无神经血管损伤，无切口感染，内固定在位牢固，骨折愈合良好。结论经腹直肌外侧入路联合切口治疗复杂骨盆髋臼骨折是可行的，初期疗效满意，值得临床推广应用。[Abstract] ObjectiveTo explore theincision selection and treatment methodsand therapeutic effect ofcomplex pelvic and acetabular fractures.MethodsOneelderlymalepatiens with complex pelvic andacetabular fractures were retrospectively studied. Uses rectus lateral incision combined with ilium posteriorincisionreduction and internal fixation treatment, and summarized the treatment process and effect, at thesame time reviewing previous literature, deepen the understanding of complicated pelvic and acetabularfractures.ResultsAfter operation the patient functional recovery well without nerve vascular injury and infection of incision, stableinternal fixation and fractured recovered completely.ConclusionRectus lateralincision combined with ilium posterior incision in the treatment of complex pelvic and acetabular fracturesearly curative effect is satisfied, is a feasible method andworth clinical application.