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胸脐皮瓣修复足跟部大面积皮肤缺损一例

三维矫形内固定治疗成人特发性脊柱侧凸

目的 探讨成人特发性脊柱侧凸的治疗方法及临床效果。方法 2003年2月～2005年11月，采用脊柱三维矫形技术治疗特发性脊柱侧凸12例，男4例，女8例；年龄21～35岁。其中腰弯5例，Cobb角46～65°；长胸弯4例，Cobb角85～102°；胸腰弯3例，Cobb角96～108°。以疼痛为主要症状8例，以畸形为主要症状4例。无明显神经症状。术前常规摄X线片，均有冠状面上的脊柱侧凸及椎体的旋转，矢状面上的胸腰椎生理曲度的异常改变，MRI检查均无明显的脊柱脊髓异常表现。结果 12例术后均无神经损伤及并发症出现。5例腰弯患者Cobb角4～15°，平均纠正率84.7%；矢状面曲度25～40°；身高增长2～4 cm。4例长胸弯患者Cobb角28～43°，平均纠正率60.8%；3例胸腰弯患者Cobb角25～34°，平均纠正率71.3%。长胸弯及胸腰弯患者矢状面上交界性后凸全部纠正至正常，胸椎后凸及腰椎前凸均在正常范围之内，增长身高5.0～8.5 cm，平均6.6 cm。12例获随访7～31个月，均无断钉、断棒、脱钩、脱钉等现象及假关节形成，1年以上复查患者全部骨性融合，纠正丢失5%。结论 三维矫形内固定治疗特发性脊柱侧凸，重建躯干平衡，效果满意，术中应用体感诱发电位监护及唤醒试验预防神经并发症的发生。

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.