御风行的BLOG

十、胫骨的Pilon骨折

胫骨远端平台骨折、pilon骨折或胫骨远端爆裂骨折，这些名词均用来描述胫骨下端经关节内的骨折。这些名称均表达特定的骨骼损伤，其范围包括从低能量的旋转暴力引起的骨折，到由车祸或高处坠落所产生的高能量轴向压缩暴力引起骨折。高能量所致的骨折常为开放性损伤，或伴有严重的软组织闭合性创伤。骨折可有明显的干骺端或关节面粉碎，或向骨干延伸。为选择理想的治疗方案和评价预后，对这些骨折进行分类非常重要。其中85%的病人有腓骨骨折，而距骨的损伤程度有所不同。

踝部旋转骨折，可以被看作是从单踝骨折、到双踝骨折、再到累及关节面的胫骨远端骨折这样一个连续的进展过程。Lauge-Hansen介绍一种旋前背屈损伤，造成内踝斜形骨折、较大的胫骨前唇骨折、关节面以上腓骨骨折及胫后骨折。Giachino和Hammond介绍一种由外旋、背屈及外展联合造成的骨折，包括内踝斜形骨折和胫骨远端平台前外侧骨折。这种骨折往往很少粉碎，不显著累及干骺端，软组织损伤较小。其治疗与其它踝部骨折类似，如腓骨骨折内固定，及通过小切口用拉力螺丝钉固定胫骨远端关节面骨折。

目前所设计的分类系统，可非常准

16岁以前发病的强直性脊柱炎称幼年强直性脊柱炎（JAS）。幼年强直性脊柱炎实际上并不少见，约占强直性脊柱炎的10～12％，占幼年慢性关节炎的15％～20％。大多数JAS发病时腰背痛等中轴关节症状少见，常表现为周边关节炎，较晚才有典型的骶髂关节炎，预后较差。由于幼年骨骼发育尚未成熟，骨盆X线检查对早期骶髂关节炎的诊断帮助不大，脊椎强直更是发生在本病其他表现如外周关节炎、附着点病等出现多年之后，所以目前幼年强直性脊柱炎多是属于回顾性诊断。
      一般认为，Ｘ线骶髂关节炎见于12岁以上病人，脊柱病变极少见于病程短于15年，或者年龄在25岁以下病例。目前的看法是，JAS是以诸如炎症性外周关节炎、附着点病、关节周围其他结构以及关节外组织炎症发病、与HLA-Ｂ27显著相关为特点的多种综合征谱的终端。

      （1）临床特点：本病多见于年长幼儿，发病年龄平均13．4岁。男多于女，男女比例约为7：1。80％～90％病例以外周关节或附着点炎为为首发症状，且一般以下肢为主。主要表现为单关节炎或寡关节炎，受累关节一般少于10个。可持续

ANTEROLATERAL APPROACH

前外侧入路

TECHNIQUE 1-82 (Thompson［1］；Henry［2］)

Incise the skin in line with the anterior border of the deltoid muscle from a point midway between its origin and insertion, distally to the level of its insertion, and then proceed in line with the lateral border of the biceps muscle to within 7.5 cm of the elbow joint (Fig. 1-97). Divide the superficial and deep fasciae and ligate the cephalic vein. In the proximal part of the wound retract the deltoid laterally and the biceps medially to expose the shaft of the humerus. Distal to the insertion of the deltoid, expose the brachialis muscle, split it longitudinally to the bone, and retract it subperiosteally, the lateral half to the lateral side and the medial half to the medial. Retraction is easier when the tendon of the brachialis is relaxed by flexing the elbow to a right angle. The radial nerve as it winds about the humeral shaft is protected by the lateral half of the brachi

Americans are still split in their opinions about genetically engineered foods.  The finding is from one thousand adults questioned for the Pew Initiative on Food and Biotechnology.  This is a project of the University of Richmond in Virginia supported by the Pew Charitable Trusts. 

Support increased when people were told that most processed foods contain at least small amounts of genetically engineered organisms. 

After that, forty-five percent thought the foods were safe.  But twenty-nine percent still believed they were unsafe. 

Only twenty-one percent said that five years ago when the project firs