经桡动脉穿刺冠脉介入治疗术后采取腕关节固定器的效果

探讨在经桡动脉穿刺实施冠脉介入治疗术后采取腕关节固定器对穿刺部位进行固定的价值。方法:选择2017.03-2022.03作为本次研究的研究时段,选取在我院进行经桡动脉穿刺冠脉介入治疗的患者300例作为本次研究的研究对象,根据随机数字表法分作两组即对照组与观察组,每组病患例数各150例,对照组在经桡动脉穿刺冠脉介入治疗术后采用常规约束带固定;观察组在经桡动脉穿刺冠脉介入治疗术后以腕关节固定器进行固定。对两种不同的固定方式进行固定后的固定合格率、穿刺处血肿、出血指标差异。结果:经对组间干预效果进行比较,观察组固定合格率、穿刺处血肿发生率及穿刺处出血率比对照组优,P<0.05。结论:在术后以腕关节固定器实施固定,可得到良好固定效果,不仅能够确保桡动脉压迫器妥善固定,还能降低患者穿刺部位发生出血、血肿等症状,具备安全性高、操作简单等特点。经桡动脉穿刺实施冠脉介入治疗术后采取腕关节固定器对穿刺部位进行固定适宜基层医院借鉴应用。

高能量创伤性桡骨远端粉碎性骨折的治疗

目的回顾分析闭合复位、单侧外固定器跨腕关节静力性固定治疗高能量创伤性桡骨远端粉碎性骨折的疗效。方法2000年6月～2003年6月,20例(24处)桡骨远端粉碎性骨折患者,男16例,女4例;年龄15～48岁,平均33.4岁;左侧12例,右侧4例,双侧4例。骨折分型均为FrykmanⅧ型或AOC3型。采用手法或外固定器协助复位,外固定器静力性固定。骨折愈合时间6～8周,平均7.4周。骨折愈合后拆除外固定器,行腕关节屈伸、桡偏、尺偏及前臂旋前、旋后等功能锻炼。结果20例患者均获得随访,随访时间6～42个月,平均16个月。末次随访时,桡骨远端位置的影像学评估(Stewart改良的Sarmiento评分)优17例(21处),良3例(3处);腕关节功能评分(Gartland-Werley功能评分)优13例(16处),良5例(6处),可2例(2处)。2例2处出现针道表浅感染,经口服抗生素及局部换药后好转;5例(7处)骨折复位后干骺端出现明显的骨缺损,未经任何处理,骨折愈合时骨缺损消失。无一例出现骨性针道感染、松动、医原性骨折及桡神经浅支损伤等并发症。结论闭合复位、单侧外固定器跨腕关节静力性固定是治疗高能量创伤性桡骨远端粉碎性骨折的有效方法,无须植骨,通过选择合适的外固定针置入部位,可以减少并发症的发生,有利于术后早期进行手部功能锻炼。

Ligamentotaxis for comminuted fracture of capitate： a case report

We present the technical report for treat- ment of comminuted fracture of the capitate with ligamentotaxis. The base of third metacarpal was found to be fractured with comminution of the capitate. The decrease in carpal height index and comminution of the third metacar- pal base lead to dilemma between conservative treatment and surgical management of this particular injury. The sur- gical management was chosen to maintain the carpal height index of the wrist to prevent the late degenerative changes.The patient was applied with external fixator in distraction mode expanning the wrist joint for six weeks, and the wrist was mobilised after removal of the fixator. It is shown that the external fixator in distraction mode expanning the wrist joint is a good alternative method for treatment of capitate fracture.