1 Clinical data In this group of 15 patients, 11 males and 4 females. The youngest is 15 years old, the largest is 47 years old, and the average age is 285 years old. Fracture site: 2 at the base of the first metacarpal, 9 at the metacarpal stem, 2 at the neck, 7 at the proximal phalanx, 5 at the middle phalanx, and 1 at the distal phalanx. Type of fracture: 2 at the horizontal shape, 5 at the short oblique fold, 9 at the spiral fold; 10 at the crushing type. There were 8 cases of tendon injury, including 6 cases of nerve injury and 1 case of skin defect.
Results Twenty-six fractures occurred in 21 patients with anatomical reduction, 4 with near anatomical reduction, and 1 with articular fusion due to bone defect.
2 surgical methods oblique fracture, the direction of the Screw is more perpendicular to the backbone, the lag screw used in combination with the steel plate should be perpendicular to the fracture line, otherwise it is difficult to obtain effective compression fixation. Fractures of the phalanx and long oblique or spiral fractures can be fixed by screws alone.
Short oblique and transverse fractures need to be combined with steel plates. Comminuted fractures and fractures with defects in the bones are not fixed by pressure. The 2 fracture sections are bridged with steel plates to maintain the alignment and alignment of the bones. Then the broken bones are filled at the fracture ends to facilitate fracture healing.
3 Results 1 case of healer in 14 cases, 1 case of infection. All 15 cases were followed up. The follow-up period was 3 weeks to 5 months. Follow-up results: the clinical healing time of fractures was 4 weeks, the hand function was excellent in 10 cases, good in 2 cases, and fair in 1 case. The other 1 case was 4 weeks after surgery.
4 Discussion of hand fractures requires fracture anatomical reduction, because the hand function is fine and complex, such as the failure to reach anatomic reduction, will affect the function of the hand. Especially in patients with open fracture and tendon injury, if the finger has an angular deformity to the volar side, it can lead to flexion of the flexor digitorum and even break due to friction; at the same time, the tension between the flexor and the extensor tendon is unbalanced, so the finger cannot be completely Straighten and fully flex. If the fracture has a rotational deformity, it causes the fingers to cross each other when they flex.
In clinical practice, it is realized that the simple plaster external fixation method, the Kirschner wire internal fixation method or the combination of the two methods have the disadvantages of weak fixation, long braking time and affecting the function of the hand, and the AO plate screw is used for the metacarpal bone. The internal fixation of the fracture has the advantages of relatively firm, no need for external fixation, and early functional exercise.
The application of the internal fixation of the plate screw in the hand injury has started as early as 1946. With the increasing miniaturization of the steel plate and the screw, the fixation firmness is obviously enhanced, and the postoperative finger can be active early, and it gradually becomes a common clinical use. One of the internal fixation methods. At present, the most commonly used steel plates and screws are micro-compressed steel plates and micro-screws designed by the Swiss Internal Fixation Research Institute (AO/ASIF). Our most common technique is lag screw technology. The screw screwed into the bone causes a compression effect. The cross-section of the bone block is tight, the frictional resistance is obviously increased, and the activity between the ends is nearly disappeared. This compression effect is beneficial to fracture healing. After compression fixation, the fracture reduction is very stable, usually active on the next day, and patients with tendon injury can perform passive exercise and possible active exercise.
This is an advantage that is not available with K-wires and absorbable rods. 1 Through anatomical reduction and compression between fractures, AO plate and screw can obtain firm fixation without fracture of tendon and nerve injury. After surgery, the affected finger and the finger need no need to use external fixation such as plaster support. Starting with functional exercise, this is the biggest advantage. Patients with tendon injury can exercise as early as possible to minimize tendon adhesion. 2 For comminuted fractures, good alignment and alignment can be guaranteed. The steel plate screws on the outside of the 3AO hand are made of titanium alloy, and the tissue is compatible. It does not need to be removed twice. 4 can shorten the recovery period and reduce medical expenses overall.
However, it also has a number of shortcomings: if the operation is complicated, the peeling is more extensive, which can aggravate soft tissue damage. Some fractures are difficult to be temporarily fixed temporarily before compression fixation, and the position of the steel plate is easily skewed, which affects the effect of compression fixation. Therefore, we believe that the rational application of AO plate screws on the basis of careful selection of indications can improve the quality of open hand fractures.
(Editor: Liu Xuezhen) (Received period: 2002 - Application of mitomycin C in pterygium excision Du Qun, Jiang Bo, Ren Xiuqing (Department of Ophthalmology, Jixi People's Hospital, Jixi, Heilongjiang 15810 (1) pterygium (below) Referred to as å¸¸è§ meat) is a common disease in ophthalmology, drug treatment is often not effective, the current treatment is still based on surgical resection, but the recurrence rate after routine surgery is as high as 24% to 89% Q] Our hospital 2001-01 began in the operation The use of mitomycin C (mitomycin C, MMC) to prevent the recurrence of pterygium has achieved satisfactory results. The report is as follows.
1 data and method 11 objects ~ 62 years old. Primary 20 eyes, recurrent 3 eyes. The onset time ranges from 3 to 12 years. The head of the meat is invaded into the limbus by more than 2 mm.
12 surgical methods are performed under the operating microscope. 1 First, cut the ball joint along the limbus to continue to separate the carcass tissue on the surface of the sclera, remove the subconjunctival lesions as much as possible, and completely remove the head and body of the carcass to the tears. During operation, avoid injury to the rectus muscle, burn and stop bleeding 2 on the exposed limbus and the 2 mm sclera behind the limbus, place 3imnX4mm~3mnX6mm cotton with 02mg/ml mitomycin C, and discard it after 3min. 50ml saline was fully rinsed. 3 The conjunctival wound edge was fixed on the superficial sclera with 5-0 silk thread. The sclera was exposed 3mm near the limbus. After each operation, the ginseng ointment was applied, and the multivitamin was taken orally. After 5 days, the wound was removed. Conjunctival suture, conventional antibiotics and corticosteroids for about 2 weeks until the irritation subsides.
2 Results The first day after operation, patients had mild irritation, conjunctival smoothing, localized hyperemia (moderate), and smooth corneal surface. After 2~3 days postoperatively, the irritation symptoms were alleviated, bulbar conjunctival hyperemia was relieved, and corneal epithelium was smooth. The visual acuity is increased by 1~2 lines. Postoperative membrane pain points - ball a sharp with a sharp knife in the outpatient clinic for regular review to y. months 4 no 1 month after not
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