骨软骨瘤是临床上常见的良性骨肿瘤,多发于儿童或青少年,发生于成人指骨很少见。肿瘤发生常见有两种学说:1.骺板细胞分离学说,由Virchow提出:骺板软骨细胞由骺板分离后旋转90度,沿骨长轴垂直的方向生长。2. 骺板发育缺陷学说,起源于骨膜的软骨细胞巢不断增殖、骨化所形的肿瘤,由D.Ambrosia和Ferguson通过试验证实.本例患者属于成年后指骨外生发病,临床少见。骨肿瘤生长处有明显外伤史,且手指内异物长期存留,骨肿瘤是否为外伤损伤骨膜及异物长期刺激而导致,有待进一步探讨研究。骨软骨瘤依据放射学与大体观见可分为带蒂型与和广基底型两类,其中带蒂型常见.单发孤立型骨软骨瘤恶变率低,约为1%,多数恶变为软骨肉瘤,极少数恶变为骨肉瘤。一般基底部较宽的更易恶变,成年后肿瘤如继续生长,需高度重视恶变可能。骨软骨瘤具有典型影像学特征,X线检查基本可明确诊断。对病灶位于长骨干骺端的骨软骨瘤,如无功能影响,一般不手术治疗。当瘤体较大对周围组织产生压迫,影响功能或疑有恶变倾向时应手术治疗.《指骨巨大孤立型骨软骨瘤并异物》详见:中华显微外科杂志,2015.38(2)206
肘后肌属于肌肉的变异,由Chalmers在在尺神经探查中发现,其起于肱三头肌腱膜移行处及尺骨鹰嘴内侧缘止于肱骨内髁。屈肘时肌肉紧张。肘后肌参与肘管组成,对尺神经有潜在卡压风险。作者单位:1胜利油田中心医院 滨州医学院附属医院 手足外科(山东东营,257000)通讯作者:焦伟,骨外科硕士研究生,研究方向:手足外科、显微外科,E-mail:jiaowei850429@163.com 《双侧肘后肌肥大卡压致肘管综合症》详见:中华显微外科杂志,2014.37(6)620
焦伟[1]【摘要】 目的:探讨缓慢牵伸延长修复再植手指短缩畸形的临床疗效。方法: 2009年10月~2013年6月,采用指骨缓慢牵伸延长术治疗再植手指短缩畸形30例。男19例,女11例,年龄14~41岁,平均23.4岁;其中拇指2例,示指9例,中指8例,环指5例,小指6例。结果:30例病人术后均获得随访,随访时间12~22月,平均15.9月,术后延长骨愈合优23例、良4例、可2例、差1例,优良率90%;末次随访时指骨平均延长17.5±3.4mm;两点辨别觉平均增加0.6mm;指端血氧饱和度平均减少0.8%;延长指骨近端关节功能损伤评定值平均增加0.5%、远端关节功能损伤评定值平均增加0.2%;手指复合损伤的复合评定值减少23.4%。与术前比较指骨显著延长、手指复合损伤的复合评定值下降,差异有统计学意义(P<< span="">0.05);两点辨别觉、指端血氧饱和度、关节活动度无明显改变,差异无统计学意义(P>0.05)。结论:应用指骨延长器缓慢牵伸延长修复重建再植短缩的手指是一种较好方法。在修复再植手指短缩畸形中具有一定优势,且近期临床效果满意。【关键词】掌指骨延长 伊利扎诺夫原理 肢体延长 外固定延长器 骨缺损REPAIR OF REPLANTED FINGERS OF SHORTENED BONES WITH PHALANX-LENGTHENING METHOD /JIAO Wei, Department of hand and foot surgery,Shengli Oilfield Central Hospital,Hospital Affiliated to Bin Zhou Medical University ,DongyingShandong,257000.【Abstract】 Objective: To investigate the clinical efficacy of repairing replanted fingers with phalanx-lengthening method.Methods : Between Otober 2009 and June 2013,30 patients with replanted fingers were treated with phalanx-lengthening. There were 19 males and 11 females, age 14~41 years.(mean,23.4 years). There were 2 cases in which the thumb, index finger in 9 cases, 8 cases of the middle finger, ring finger in 5 cases, 6 cases of little finger. Results: All the patients were followed up 12 to 22 months with an average of 15.9 months. At last follow-up ,fracture union was achieved in most of patients . The case function were excellent in 23 cases, good in 4 cases, fair in 2 cases, poor in 1 cases, and the excellent and good rate was 90.0%. Last follow-up to extend the total length of the average phalanx extended 17.5 ± 3.4mm; Average the two-point discrimination increases by 0.6mm;Finger oxygen saturation decreased by 0.8% on average; Extension of the proximal phalanx joint dysfunction assessed value increased by an average of 0.5%、Distal joint dysfunction assessed value of an average increase of 0.2%;Damage assessment of composite finger composite value decreased 23.4%.Extend the length of the phalanx and Damage assessment of composite finger composite value were obviously improved when compared with preoperative ones, showing significant difference (P<0.05). other’s was not significant(P>0.05).Conclusions:phalanx-lengthening can be a method in the treatment of replanted fingers. The method has certain advantages than other methend and short-term clinical results were satisfactory.【Key words】 Metacarpal and Phalange lengthening Ilizarov technique Limb lengthening Synchronous lengthening device Bone defect作者单位:1胜利油田中心医院 滨州医学院附属医院 手足外科(山东东营,257000)通讯作者:焦伟,骨外科硕士研究生,研究方向:手足外科、显微外科,E-mail:jiaowei850429@163.com 《再植手指短缩的骨延长治疗》详见:中国骨与关节损伤杂志,2014.29(5)63-64
指骨延长与关节成形修复再植手指短缩焦伟[1] 摘要目的:探讨指骨延长与关节成形修复再植术后手指短缩畸形的临床效果。方法:2009年2月~2013年1月15例患者行指骨延长与关节成形术。男8例,女7例;年龄14岁~41岁,平均23岁。拇指1例,示指8例,中指6例,均为再植术后手指短缩1.5cm以上者。再植术后去除内固定3个月后行指骨延长术。达到预期长度去除外固定延长器1月后行指间关节成形术。结果:术后患者均获得随访,随访时间12月~35月(平均21.3),手指平均延长1.8cm。采用国际手外科学会的复合损伤的复合评定公式A%+B%复合值=A%+B%×(100%-A%)评价,术后手指复合损伤较术前平均下降30.6%。结论:对于手指再植术后短缩畸形患者行指骨延长与关节成形术,可降低手指复合损伤值,较好的改善手功能,获得比较满意的临床效果。关键词:掌指骨延长 伊利扎诺夫原理 关节成形 肢体延长 外固定延长器 骨缺损REPAIR REPLANTED FINGERS OF SHORTENED BONES WITH PHALANX-LENGTHENING AND ARTHROPLASTY METHODS .JIAO Wei*, WANG Bin, MA Tiepeng. *Department of hand and foot surgery,Shengli Oilfield Central Hospital,Hospital Affiliated to Bin Zhou Medical University ,DongyingShandong,257000,P.R.Chian. Abstract Objective To investigate the clinical efficacy of repairing replanted fingers with phalanx-lengthening method and Arthroplasty method.Methods Between February 2009 and January 2013,15 patients with replanted fingers were treated with phalanx-lengthening and Arthroplasty methods. There were 8 males and 7 females, age 14~41 years.(mean,23 years). All the cases suffered from complete amputation and the finger were shortenign than they were more than 1.5cm. There were 1 case in which the thumb, index finger in 8 cases, 6 cases of the middle finger. Phalanx-lengthening can be carry out for 3 months after the Replantation operation.One months later, in the second stage of the Arthroplasty methods can be operate when the bone lengthing achieve the desired results.Results: All the patients were followed up 12 months to 35 months with an average of 21.3 months. At last follow-up ,fracture union was achieved in most of patients . The mean length increase was 1.8cm. The assessment method was used A%+B%value=A%+B%×(100%-A%).The Composite damage assessment of the value were reduced by 30.6%.Conclusions:Phalanx-lengthening and Arthroplasty methods can be methods in the treatment of amputated fingers. The method has certain advantages than other methend and short-term clinical results were satisfactory.Keywords:Metacarpal and Phalange lengthening;Ilizarov technique;Arthroplasty;Limb lengthening;Synchronous lengthening device ;Bone defec作者单位:1胜利油田中心医院 滨州医学院附属医院 手足外科(山东东营,257000)通讯作者:焦伟,骨外科硕士研究生,研究方向:手足外科、显微外科,E-mail:jiaowei850429@163.com 《指骨延长与关节成形修复再植手指短缩》详见:中华手外科杂志,2013.29.(6):379-381
【摘 要】 目的 总结掌指骨延长的研究进展,探讨存在的问题及进一步研究方向。 方法 查阅近年国内外关于掌指骨延长的文献,进行总结分析。结果 目前有许多方法治疗手指短缩畸形,但掌指骨延长的方法相对占优势。它包括一次性骨延长、骨痂延长、缓慢牵伸延长三种,每种方法均有优势和局限。然而截骨部位,延长长度及速度,术后并发症等尚存争议。 结论 缓慢牵伸掌指骨延长术创伤小、并发症少,相对优于一次性骨延长和骨痂延长术,但长期疗效尚不能明确,需要长期临床随访报道。【关键词】掌指骨延长 Ilizarov 肢体延长 外固定延长器 骨缺损PROGRESS OF THE METACARPAL AND PHALANGE EXTENDED【Abstract】 Objective To review the methods of metacarpal and phalange lengthening and to point out the problems at present as well as to predict the trend of development in his field. Methods: Domestic and abroad literature concerning the methods of the methods of metacarpal and phalange lengthening in recent years was extensively and thoroughly analyzed .Results: At present ,there were many methods to treat the short finger but the method of metacarpal and phalange lengthening had an advantage .The method included Callus-lengthening, Closed osteotomy lengthening, Modified Ilizarov Method. Every surgical way had its advantages and limitations. However the part of osteotomy,the length and speed ,the post-operative complications et al. were unknown. Conclusion: The Modified Ilizarov Method has the advantages of simple handling minimally invasive and low incidence of complications,but the long-term results of each treatment method are unknown. The method are still require.【Key words】 Metacarpal and Phalange lengthening Ilizarov technique Limb lengthening Synchronous lengthening device Bone defect