目的探讨磁共振神经成像(magnetic resonance neurography,MRN)技术在骨盆骨折合并腰骶丛损伤中的应用价值。方法回顾性分析2014年1月至2020年6月,采用MRN辅助诊断并且手术治疗的9例骨盆骨折合并腰骶丛损伤患者资料,男8例,女1例;年龄(40...目的探讨磁共振神经成像(magnetic resonance neurography,MRN)技术在骨盆骨折合并腰骶丛损伤中的应用价值。方法回顾性分析2014年1月至2020年6月,采用MRN辅助诊断并且手术治疗的9例骨盆骨折合并腰骶丛损伤患者资料,男8例,女1例;年龄(40.6±11.0)岁(范围18~54岁);3周以内的新鲜骨折2例,陈旧性骨盆骨折7例。骨盆骨折AO分型:C1.3型6例,C3型3例;骶骨骨折Denis分型:Ⅱ型8例,Ⅲ型1例;术前神经损伤Gibbons分级:Ⅱ级2例,Ⅲ级4例,Ⅳ级3例;根据英国医学研究会神经损伤委员会(Nerve Injuries Committee of the British Medical Research Council,BM-RC)提出的肌力评价标准评定:M1级2例,M2级3例,M3级2例,M4级2例。术前通过MRN技术,准确定位腰骶神经损伤部位及程度,采用神经探查松解术或内固定物置入联合神经探查松解术进行治疗。结果9例患者均顺利完成手术,手术时间(217.8±63.8)min(范围150~360 min);术中出血(388.9±293.4)ml(范围200~1100 ml)。所有患者均获得随访,随访时间(21.6±19.3)个月;骨折均获骨性愈合,愈合时间(12.7±2.2)个月(范围10~18个月)。末次随访时,神经损伤Gibbons分级:Ⅰ级3例,Ⅱ级5例,Ⅲ级1例;根据BMRC标准评定术后肌力恢复情况:M5级6例,M4级2例,M3级1例。1例患者出院后2个月发生泌尿系统感染,经治疗后痊愈。结论MRN技术可辅助术者术前充分了解骨折对腰骶丛压迫、牵拉损伤情况,对神经损伤进行精确定性及诊断,使手术操作更加精准化、微创化,是对传统腰骶丛损伤诊断方法的一种补充。展开更多
目的回顾性分析经单一前方入路治疗肱骨近端骨折合并肱骨头后脱位的临床结果,总结手术治疗经验。方法对2013年1月至2023年12月期间应用单一前方入路切开复位内固定治疗的肱骨近端骨折合并肱骨头脱位的26例(29肩)患者进行回顾性分析。收...目的回顾性分析经单一前方入路治疗肱骨近端骨折合并肱骨头后脱位的临床结果,总结手术治疗经验。方法对2013年1月至2023年12月期间应用单一前方入路切开复位内固定治疗的肱骨近端骨折合并肱骨头脱位的26例(29肩)患者进行回顾性分析。收集患者的性别、年龄、受伤原因、受伤类型、受伤至手术时间、手术出血量、骨折形态等信息,术后随访内容包括肩关节X线片、美国加州大学肩关节功能评分(the university of California at Los Angeles shoulder rating scale,UCLA)、Constant评分、视觉模拟评分(visual analogue scale,VAS)以及并发症发生情况等。结果23例患者(26肩)获得随访,随访时间平均(43.1±11.0)个月。26肩的关节脱位及骨折均复位良好,无再脱位病例,所有骨折均获得临床愈合,骨折愈合时间平均(12.4±3.2)周。术后1个月及末次随访的Constant评分、UCLA评分、VAS评分以及肩关节前屈、外展、内旋范围均较术前明显改善。陈旧损伤组与新鲜损伤组比较,术后的前屈功能、外展功能较差,两组有统计学差异。不同性别、年龄以及骨折类型的术后评估结果没有统计学差异。发生肱骨头坏死2例,无术后感染、内固定物失效以及医源性神经及血管损伤等并发症。结论经单一前方入路切开复位内固定治疗肱骨近端骨折合并肱骨头后脱位可以获得较好临床效果,陈旧性病例肩关节前屈及外展功能较新鲜病例差。避免漏诊,尽早进行手术。术中应充分显露病变部位,确保在直视下完成关节和骨折的复位固定,同时注意保护肱骨头的血运,以提高治疗效果。展开更多
Background Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature.The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly p...Background Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature.The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.Methods We retrospectively reviewed the records of pelvic fractures in elderly patients （age ≥55 years） who were treated in our department from September 1997 to May 2010.Results A total of 40 elderly patients with pelvic fractures were identified.Their mean age was 65.8 years （range 55-87 years）.About 68% （n=27） were men.The average Injury Severity Score （ISS） was 17.8 （range 6-45）.Twelve （30%）patients required blood transfusion （mean 10 units） during the first 24 hours.The fractures were most frequently due to falling from a standing position （48%）.Almost half （48%） were grade I breaks.Associated injuries were present in 70%（n=28） of patients,and 65% （n=26） had medical co-morbidities.Altogether,29 patients （73%） underwent non-surgical management of their pelvic fracture.The average hospital stay was 25 days.There were five in-hospital deaths and one death 10 months after discharge.High ISSs （〉25） were associated with increased in-hospital mortality （P=0.018）.At the final assessment （mean follow-up 15 months）,52% of the surviving patients had experienced decreased self-sufficiency.Conclusions Pelvic fractures in elderly patients result in high morbidity and mortality rates.A high ISS （〉25） can be used to identify a patient at high risk.We recommend aggressive resuscitation and intensive care for that patient.For patients with an unstable pelvic or displaced acetabular fracture （≥2 mm） who can endure surgery,open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.展开更多
文摘目的探讨磁共振神经成像(magnetic resonance neurography,MRN)技术在骨盆骨折合并腰骶丛损伤中的应用价值。方法回顾性分析2014年1月至2020年6月,采用MRN辅助诊断并且手术治疗的9例骨盆骨折合并腰骶丛损伤患者资料,男8例,女1例;年龄(40.6±11.0)岁(范围18~54岁);3周以内的新鲜骨折2例,陈旧性骨盆骨折7例。骨盆骨折AO分型:C1.3型6例,C3型3例;骶骨骨折Denis分型:Ⅱ型8例,Ⅲ型1例;术前神经损伤Gibbons分级:Ⅱ级2例,Ⅲ级4例,Ⅳ级3例;根据英国医学研究会神经损伤委员会(Nerve Injuries Committee of the British Medical Research Council,BM-RC)提出的肌力评价标准评定:M1级2例,M2级3例,M3级2例,M4级2例。术前通过MRN技术,准确定位腰骶神经损伤部位及程度,采用神经探查松解术或内固定物置入联合神经探查松解术进行治疗。结果9例患者均顺利完成手术,手术时间(217.8±63.8)min(范围150~360 min);术中出血(388.9±293.4)ml(范围200~1100 ml)。所有患者均获得随访,随访时间(21.6±19.3)个月;骨折均获骨性愈合,愈合时间(12.7±2.2)个月(范围10~18个月)。末次随访时,神经损伤Gibbons分级:Ⅰ级3例,Ⅱ级5例,Ⅲ级1例;根据BMRC标准评定术后肌力恢复情况:M5级6例,M4级2例,M3级1例。1例患者出院后2个月发生泌尿系统感染,经治疗后痊愈。结论MRN技术可辅助术者术前充分了解骨折对腰骶丛压迫、牵拉损伤情况,对神经损伤进行精确定性及诊断,使手术操作更加精准化、微创化,是对传统腰骶丛损伤诊断方法的一种补充。
文摘目的回顾性分析经单一前方入路治疗肱骨近端骨折合并肱骨头后脱位的临床结果,总结手术治疗经验。方法对2013年1月至2023年12月期间应用单一前方入路切开复位内固定治疗的肱骨近端骨折合并肱骨头脱位的26例(29肩)患者进行回顾性分析。收集患者的性别、年龄、受伤原因、受伤类型、受伤至手术时间、手术出血量、骨折形态等信息,术后随访内容包括肩关节X线片、美国加州大学肩关节功能评分(the university of California at Los Angeles shoulder rating scale,UCLA)、Constant评分、视觉模拟评分(visual analogue scale,VAS)以及并发症发生情况等。结果23例患者(26肩)获得随访,随访时间平均(43.1±11.0)个月。26肩的关节脱位及骨折均复位良好,无再脱位病例,所有骨折均获得临床愈合,骨折愈合时间平均(12.4±3.2)周。术后1个月及末次随访的Constant评分、UCLA评分、VAS评分以及肩关节前屈、外展、内旋范围均较术前明显改善。陈旧损伤组与新鲜损伤组比较,术后的前屈功能、外展功能较差,两组有统计学差异。不同性别、年龄以及骨折类型的术后评估结果没有统计学差异。发生肱骨头坏死2例,无术后感染、内固定物失效以及医源性神经及血管损伤等并发症。结论经单一前方入路切开复位内固定治疗肱骨近端骨折合并肱骨头后脱位可以获得较好临床效果,陈旧性病例肩关节前屈及外展功能较新鲜病例差。避免漏诊,尽早进行手术。术中应充分显露病变部位,确保在直视下完成关节和骨折的复位固定,同时注意保护肱骨头的血运,以提高治疗效果。
基金Dong Jinlei and Hao Wei contributed equally to this work. This study was supported by a grant from the National Natural Science Foundation of China （No. 81301556）.
文摘Background Pelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature.The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.Methods We retrospectively reviewed the records of pelvic fractures in elderly patients （age ≥55 years） who were treated in our department from September 1997 to May 2010.Results A total of 40 elderly patients with pelvic fractures were identified.Their mean age was 65.8 years （range 55-87 years）.About 68% （n=27） were men.The average Injury Severity Score （ISS） was 17.8 （range 6-45）.Twelve （30%）patients required blood transfusion （mean 10 units） during the first 24 hours.The fractures were most frequently due to falling from a standing position （48%）.Almost half （48%） were grade I breaks.Associated injuries were present in 70%（n=28） of patients,and 65% （n=26） had medical co-morbidities.Altogether,29 patients （73%） underwent non-surgical management of their pelvic fracture.The average hospital stay was 25 days.There were five in-hospital deaths and one death 10 months after discharge.High ISSs （〉25） were associated with increased in-hospital mortality （P=0.018）.At the final assessment （mean follow-up 15 months）,52% of the surviving patients had experienced decreased self-sufficiency.Conclusions Pelvic fractures in elderly patients result in high morbidity and mortality rates.A high ISS （〉25） can be used to identify a patient at high risk.We recommend aggressive resuscitation and intensive care for that patient.For patients with an unstable pelvic or displaced acetabular fracture （≥2 mm） who can endure surgery,open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.
