20 cases were folded, and 7 cases of old fractures were unstable fractures of the lateral clavicle. 21 cases of the lateral end were comminuted, which were caused by trauma. 14 clinical manifestations of the injured shoulder swelling, tenderness, can be seen to the posterior uplift deformity, the pressure has a floating sense, limited activity, increased pain during activities. X-ray films showed displacement of the fracture.
14 surgical methods using cervical brachial plexus block anesthesia, from the outer 1/3 of the acromioclavicular joint to the outer edge of the shoulder for an arc-shaped incision, revealing the shoulder, acromioclavicular joint, distal fracture and condyle, near the fracture end The sagittal plane is punched toward the condyle (forward and downward), and one cortical bone and one cancellous bone screw of appropriate length are selected, and the condyle is fixed on the clavicle to restore the proximal end of the fracture. The cancellous bone screw clavicle The sliding hole is made up, and the two screws are separated by about 0.5~1cm, and the cross is fixed. If the sacral ligament is obviously broken, it can be sutured and repaired. No obvious fracture is seen. No special treatment is given. After the operation, the affected limb is suspended for 2~3 weeks.
14 Results 27 cases were healed within 2-6 months after operation, and all internal fixation was performed within 8 months, followed by 4 months to 24 months. According to Lazzacano shoulder joint recovery criteria: no pain, no deformity, complete recovery of shoulder function. All the 27 patients in this group had excellent recovery and had no complications such as delayed bone healing, nonunion, screw loosening, fracture and nerve injury.
2 There are many treatments for clavicle fractures, but there is no ideal treatment. When the external clavicle fracture and fracture are displaced, the sacral ligament is dissected from the proximal end of the fracture. The distal fracture is displaced by the upper limb gravity traction and moves with the movement of the upper limb and the scapula. Delayed healing or nonunion is prone to occur. Many patients have shortened or prolonged fracture sites, weakened muscles and shoulders, shoulder pain and lateral pain, limited limb abduction and lifting, fractures and chest outlet syndrome. Treatment with this surgical method can reduce the fracture to the solution and reduce the complications of other treatments.
There are many methods for the treatment of external clavicular fractures. The key is reduction and fixation. The fracture reduction is not only affecting the appearance, but also the load-carrying capacity of the clavicle is reduced. It can induce acromioclavicular and sterno-stasis arthritis. Due to the restriction of local anatomical features, the external fixation of unstable fractures in this part is difficult to achieve the purpose, and it is not easy to achieve permanent fixation. The best method is internal fixation. When the Kirschner wire fixes the shoulder joint, it is prone to looseness, bending, slippage and breakage. Hu Zhiyi and other closed reduction, percutaneous needle internal fixation method, need to use C-arm machine, and easy to damage nerves, blood vessels, fracture ends and separation stress. The plate is fixed and peeled off, affecting the blood supply, and the bone healing is more difficult. In addition, the fracture of the distal clavicle is small, and sometimes the fracture end is smashed, it is difficult to achieve effective and strong fixation. The fixation of the wire Kirschner wire needs to affect the shoulder joint through the acromioclavicular joint. activity. Huang Zhuye et al reported that this method was used to treat the external clavicle fracture, and there was also the possibility of secondary subclavian blood vessels, nerves and lung tip tissue damage. Ao ankle joint screw fixation through the clavicular condyle is an internal fixation method actively recommended by the Ao Internal Fixation Society. Journal of Bone and Joint Injury, 1999, 14(1): 23-25 ​​Huang Chuangye, Liang Deen, Huang Xuke. Clinical application of tension band internal fixation for the treatment of clavicular fractures, 2000, Rong Guowei, Qi Guihua, Liu Wei, and other orthopedic internal fixation Beijing: People Xu Shimin. Surgical treatment of unstable lateral clavicle fractures. Journal of Clinical Orthopaedics, 2001, 4(4) (Continued from page 575) Hepatitis E was previously referred to as non-A, non-B hepatitis in the intestine.
In 1983, former Soviet scholar Balayan et al. used immunoelectron microscopy to find a round virus particle with a diameter of 27-30 nm from non-A, non-B hepatitis stools, which was later confirmed to be hepatitis E virus (HEV). In the incubation period of HEV infection and early disease, HEV-RNA can be detected in serum and feces, but its duration is too short, and it is limited as a common indicator for clinical diagnosis. Study f4*5 found that the specific anti-HEVIgM and anti-HEV IgG antibodies that can stimulate the body after viral infection are serological markers for the diagnosis of HEV infection. Most infectious diseases develop specific IgM antibodies in the acute phase, and IgG antibodies in the recovery phase last longer. Purdy et al. have demonstrated in animal experiments that IgM-type and IgG-type anti-HEV antibodies can be detected in the serum of acute hepatitis E and only one anti-HEV IgG antibody can be detected in the recovery phase. Some scholars have carried out serological observation on the epidemic and sporadic cases of hepatitis E in Central Asia. It is found that the detection rate of anti-HEVIgM is 73% and the positive rate of anti-HEVIgG is 93% but anti-HEVIgG is large within 26 days after the occurrence of jaundice. Most persist in serum; 90% of anti-HEV* IgG positive can last for about 24 months.
Clinically used IgM antibodies are used as diagnostic indicators for acute infectious disease infections. This study showed that 86 cases of sporadic HE serum anti-HEVIgG positive conversion rate was 95% higher than anti-HEVIgM (76%), such as anti-HEVIgM as a diagnostic indicator of acute hepatitis E, about 26.6% of HE patients May be missed. A series of serum tests from 56 patients with acute HE showed that the duration of anti-HEVIgM was shorter and 48% was negative in 1 month after onset. Therefore, if the patient is not treated in time, it may be missed. This study also found that anti-HEV IgG appeared earlier, 95% of patients with acute HE were positive for one HEV IgG, and the other 5% of patients had positive or negative for positive or negative, positive change, if combined with other Clinical data and combined detection of anti-HEVIgM can improve the diagnosis rate.
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