目的探讨小切口联合全修复策略治疗Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折的安全性、可行性及临床疗效。方法回顾分析2012年1月-2017年1月采用小切口联合骨折、韧带及骨软骨全修复策略治疗的57例Lauge-Hansen旋前-外旋型Ⅳ度踝关...目的探讨小切口联合全修复策略治疗Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折的安全性、可行性及临床疗效。方法回顾分析2012年1月-2017年1月采用小切口联合骨折、韧带及骨软骨全修复策略治疗的57例Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折患者临床资料。男31例,女26例;年龄21~65岁,平均41.1岁。致伤原因:交通事故伤33例,摔伤24例。其中内踝骨折20例,内踝完整但三角韧带深浅层断裂37例。受伤至入院时间3~34 h,平均9.6 h。术后评估胫骨远端关节面复位质量(采用Ketz-Sanders标准)、下胫腓联合复位情况(踝关节线上10 mm CT断层测量下胫腓联合前、后间距和外踝扭转角)及骨折愈合情况。于踝穴位X线片上测量内踝间隙(medial clear space,MCS)、下胫腓联合间隙(tibiofibular clear space,TFCS)、外踝尖至距骨外侧突距离(distal fibular tip to lateral process of talus,DFTL)。手术前后采用疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)评分评价踝关节疼痛及功能改善情况,并测量踝关节背伸、跖屈活动度。结果术中发现3例距骨骨软骨损伤,均采用微骨折技术处理。术后麻醉清醒后有2例发生止血带麻痹;患者手术切口均Ⅰ期愈合。57例患者均获随访,随访时间24~84个月,平均38.6个月。术后12个月骨折均达骨性愈合,无骨不愈合及畸形愈合发生。术后3个月胫骨远端关节面复位质量达优56例、良1例,优良率为100%。术后12个月患侧与健侧比较踝关节MCS、TFCS、DFTL、下胫腓联合前间距、下胫腓联合后间距及外踝扭转角,差异均无统计学意义(P>0.05)。末次随访时,患侧VAS评分、AOFAS评分、踝关节背伸和跖屈活动度均较术前显著改善(P<0.05)。同时,与健侧比较,踝关节背伸和跖屈活动度差异均无统计学意义(P>0.05)。结论小切口联合全修复策略治疗Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折是有效且安全的,不�展开更多
踝关节骨折是创伤骨科最常见的骨折之一,通过长期的临床实践、研究和教育,踝关节骨折的诊治取得了不错的临床疗效[1],达成了很多共识;目前,切开复位内固定(open reduction and internal fixation,ORIF)已成为旋前-外旋型踝关节骨折治疗...踝关节骨折是创伤骨科最常见的骨折之一,通过长期的临床实践、研究和教育,踝关节骨折的诊治取得了不错的临床疗效[1],达成了很多共识;目前,切开复位内固定(open reduction and internal fixation,ORIF)已成为旋前-外旋型踝关节骨折治疗的标准方案[2]。加速康复外科(enhanced recovery after surgery,ERAS)理念的引入,以患者为中心,为踝关节骨折围手术期治疗的各个环节提供了全面优化标准[3]。随着认识的深入,对年轻活跃、合并韧带损伤的踝关节骨折患者的治疗也引起了新的关注。本团队在ERAS理念指导下,对踝关节损伤结构进行了全修复,以期尽可能恢复踝关节解剖关系,尽早开始功能锻炼,提升患者的满意度和疗效。展开更多
Computer assisted design/computer assisted machining (CAD/CAM) technology has received considerable clinical and research interest from modern dental practices as a means of delivering all-ceramic restorations. Up to ...Computer assisted design/computer assisted machining (CAD/CAM) technology has received considerable clinical and research interest from modern dental practices as a means of delivering all-ceramic restorations. Up to now the CAD/CAM system with zirconia has the highest fracture strength in all all-ceramic materials, and consistently enabled the most esthetic, lifelike reproduction of natural dentition. They have been widely received by both dentists and patients. The CAD/CAM system with zirconia is indicated for crowns and bridges in natural teeth or implants and telescope dentures, the CAD/CAM with zirconia can be placed anywhere in the mouth, and can replace the porcelain crowns and bridges for single crown and bridges less than 6 units. This paper described the techniques of CAD/CAM system with zirconia in fabrication of crowns, bridges, telescope dentures and implant dentures with colored illustrations.展开更多
文摘目的探讨小切口联合全修复策略治疗Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折的安全性、可行性及临床疗效。方法回顾分析2012年1月-2017年1月采用小切口联合骨折、韧带及骨软骨全修复策略治疗的57例Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折患者临床资料。男31例,女26例;年龄21~65岁,平均41.1岁。致伤原因:交通事故伤33例,摔伤24例。其中内踝骨折20例,内踝完整但三角韧带深浅层断裂37例。受伤至入院时间3~34 h,平均9.6 h。术后评估胫骨远端关节面复位质量(采用Ketz-Sanders标准)、下胫腓联合复位情况(踝关节线上10 mm CT断层测量下胫腓联合前、后间距和外踝扭转角)及骨折愈合情况。于踝穴位X线片上测量内踝间隙(medial clear space,MCS)、下胫腓联合间隙(tibiofibular clear space,TFCS)、外踝尖至距骨外侧突距离(distal fibular tip to lateral process of talus,DFTL)。手术前后采用疼痛视觉模拟评分(VAS)及美国矫形足踝协会(AOFAS)评分评价踝关节疼痛及功能改善情况,并测量踝关节背伸、跖屈活动度。结果术中发现3例距骨骨软骨损伤,均采用微骨折技术处理。术后麻醉清醒后有2例发生止血带麻痹;患者手术切口均Ⅰ期愈合。57例患者均获随访,随访时间24~84个月,平均38.6个月。术后12个月骨折均达骨性愈合,无骨不愈合及畸形愈合发生。术后3个月胫骨远端关节面复位质量达优56例、良1例,优良率为100%。术后12个月患侧与健侧比较踝关节MCS、TFCS、DFTL、下胫腓联合前间距、下胫腓联合后间距及外踝扭转角,差异均无统计学意义(P>0.05)。末次随访时,患侧VAS评分、AOFAS评分、踝关节背伸和跖屈活动度均较术前显著改善(P<0.05)。同时,与健侧比较,踝关节背伸和跖屈活动度差异均无统计学意义(P>0.05)。结论小切口联合全修复策略治疗Lauge-Hansen旋前-外旋型Ⅳ度踝关节闭合骨折是有效且安全的,不�
文摘踝关节骨折是创伤骨科最常见的骨折之一,通过长期的临床实践、研究和教育,踝关节骨折的诊治取得了不错的临床疗效[1],达成了很多共识;目前,切开复位内固定(open reduction and internal fixation,ORIF)已成为旋前-外旋型踝关节骨折治疗的标准方案[2]。加速康复外科(enhanced recovery after surgery,ERAS)理念的引入,以患者为中心,为踝关节骨折围手术期治疗的各个环节提供了全面优化标准[3]。随着认识的深入,对年轻活跃、合并韧带损伤的踝关节骨折患者的治疗也引起了新的关注。本团队在ERAS理念指导下,对踝关节损伤结构进行了全修复,以期尽可能恢复踝关节解剖关系,尽早开始功能锻炼,提升患者的满意度和疗效。
文摘Computer assisted design/computer assisted machining (CAD/CAM) technology has received considerable clinical and research interest from modern dental practices as a means of delivering all-ceramic restorations. Up to now the CAD/CAM system with zirconia has the highest fracture strength in all all-ceramic materials, and consistently enabled the most esthetic, lifelike reproduction of natural dentition. They have been widely received by both dentists and patients. The CAD/CAM system with zirconia is indicated for crowns and bridges in natural teeth or implants and telescope dentures, the CAD/CAM with zirconia can be placed anywhere in the mouth, and can replace the porcelain crowns and bridges for single crown and bridges less than 6 units. This paper described the techniques of CAD/CAM system with zirconia in fabrication of crowns, bridges, telescope dentures and implant dentures with colored illustrations.
