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胸臍皮瓣修復足跟部大面積皮膚缺損一例

三維矯形內固定治療成人特發性脊柱側凸

目的 探討成人特發性脊柱側凸的治療方法及臨床效果。方法 2003年2月～2005年11月，采用脊柱三維矯形技術治療特發性脊柱側凸12例，男4例，女8例；年齡21～35歲。其中腰彎5例，Cobb角46～65°；長胸彎4例，Cobb角85～102°；胸腰彎3例，Cobb角96～108°。以疼痛為主要癥狀8例，以畸形為主要癥狀4例。無明顯神經癥狀。術前常規攝X線片，均有冠狀面上的脊柱側凸及椎體的旋轉，矢狀面上的胸腰椎生理曲度的異常改變，MRI檢查均無明顯的脊柱脊髓異常表現。結果 12例術后均無神經損傷及并發癥出現。5例腰彎患者Cobb角4～15°，平均糾正率84.7%；矢狀面曲度25～40°；身高增長2～4 cm。4例長胸彎患者Cobb角28～43°，平均糾正率60.8%；3例胸腰彎患者Cobb角25～34°，平均糾正率71.3%。長胸彎及胸腰彎患者矢狀面上交界性后凸全部糾正至正常，胸椎后凸及腰椎前凸均在正常范圍之內，增長身高5.0～8.5 cm，平均6.6 cm。12例獲隨訪7～31個月，均無斷釘、斷棒、脫鉤、脫釘等現象及假關節形成，1年以上復查患者全部骨性融合，糾正丟失5%。結論 三維矯形內固定治療特發性脊柱側凸，重建軀干平衡，效果滿意，術中應用體感誘發電位監護及喚醒試驗預防神經并發癥的發生。

CLINICAL STUDY ON EXPANSION OF GROOVE OF ULNAR NERVE AND INTERFASCICULAR NEUROLYSIS IN TREATING SEVERE CUBITAL TUNNEL SYNDROME/

Objective To discuss the curative effect of expanding ulnar nerve groove and interfascicular neurolysis under microscope in treating severe cubital tunnel syndrome (Cub Ts), and to compare with that of the forward moving of ulnar nerve and interfascicular neurolysis under microscope to find out the best way to treat severe Cub Ts. Methods From December 2002 to January 2007, 22 severe Cub Ts cases were treated with expansion of ulnar nerve groove and interfascicular neurolysis under microscope (treatment group), and other 22 cases were treated with forward moving of ulnar nerve and interfascicular neurolysis under microscope (control group). In treatment group, there were 17 males and 5 females, aged 21-66 years (mean 43.8 years). Pathogenic causes were elbow arthritis in 17 cases, ulnar nerve dislocation in 3 cases and elbow ectroption in 2 cases. The locations were left elbow in 8 cases and right elbow in 14 cases. Thecourse of disease was 6-69 months. In control group, there were 18 males and 4 females, aged 20-64 years (mean 42.1 years). Pathogenic causes were elbow in arthritis 16 cases, ulnar nerve dislocation in 3 cases, elbow ectroption in 1 case and narrowing and shallowing of ulnar nerve groove caused by abnormal heal ing of medial condyle fracture in 1 case. The locations were left elbow in 7 cases and right elbow in 15 cases. The course of disease was 5-67 months. Results For all patients of both groups, the wound healed by first intention, and all were followed up for 12-45 months. In treatment group, the numbness in l ittle finger was obviously rel ieved, or disappeared in 22 cases 1 day after operation. In control group, the numbness in l ittle finger was obviously rel ieved or disappeared in 22 cases 3-5 days after operation. EMG showed that conduction speed of ulnar nerve was normal. Evaluated by upper l imbs function standard of China Medical Association, Surgery Association and Lascar grades, the results were excellent in 21 cases and good in 1 case in treatment group; whilet excellent in 19 cases, good in 2 cases and fair in 1 case in control group. There was significant difference between treatment group and control group (P lt; 0.01). Conclusion Either expansion of ulnar nerve groove and interfascicular neurolysis or forward moving of ulnar nerve and interfascicular neurolysis is an effective method to treat severe Cub Ts, but the former is better than the latter.