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| Different routes of administration of misoprostol to prevent hemorrhage after cesarean section observation
) Adult Surgical treatment of proximal humeral fractures (with 1l cases) Lv Derong (Second People's Hospital of Zhenjiang City, Department of Orthopaedics, Zhenjiang 212002) [Key words] of proximal humeral fractures: bone graft; zero reset traction [CLC ] R681.7 [Document code] B [Article ID] 1671-7783 (2003) 05-0420-01 proximal humeral fractures is a common fractures, mainly in the elderly, with the accidents, the increase in traffic accidents , its incidence increased year by year. Conservative treatment as a fixed time length, joint adhesions and other shortcomings. Since 1999, our hospital 11 cases of proximal humeral fractures were treated surgically with satisfactory results. Reported below. l Materials and Methods The clinical data of 11 patients 1.1 8 males and 3 females. Aged 35 to 81 years, mean age 57.6 years. According to Neer classification, Ⅲ in 7 cases, Ⅳ type 4 cases. 1.2 surgical patients 3 weeks after injury, received open reduction and internal fixation. Kirschner wire internal fixation and tension band fixation, including the two cases, trefoil plate fixation (6 cases), humeral head resection in 1 case. Thompson Road with modified surgical incision of people with small incision, surgical trauma. Supraspinatus to avoid accidental injury benefits. 2 The results of secondary surgery group were not infected, are to be zero bit traction after 1 to 2 weeks,tory burch flats, beginning two weeks of shoulder function after exercise. 9 cases of 11 patients in the postoperative joint flexion, abduction, extension satisfactory functional recovery. 3 Discussion Neer classification of proximal humerus: the anatomy of the proximal humerus or humeral head of four, large nodule and small nodules, humeral shift relations between the four-part fractures. The classification depends on the degree of displacement. Different characteristics of each type, I type refers to the anatomical structure of the four one or multiple fractures, but the shift between <lcm or angulation <45 degrees, which is called intercalation of clinical fractures. Specific for the elderly patients. Ⅱ type refers to the anatomical structure of two of the four fracture displacement or angulation of each other provisions beyond the scope of the above. This type of shift in the surgical neck of humerus fractures are common. Ⅲ type refers to anatomical structures of the four three fractures each other out of the angular displacement, or range, including within the humeral head from the glenoid prolapse (a fracture dislocation.) Ⅳ type refers to the four anatomical structures, including the shift significantly between the humeral head dislocation, the humeral head into the free state at this time, the loss of its main blood supply. Traction refers to the zero bits forearm on the move 155 degrees, there is no humeral internal rotation and external rotation, the axis of the humerus and scapula Gangji function of the parallel, in this position, supraspinatus, infraspinatus muscles are in relaxed state, the humeral head in this position the most stable. 11 cases of surgical incisions in both the modified Thompson, the gap in the pectoralis major muscle and the deltoid muscle to take oblique incision, rather than using the traditional Surgery should be noted that when the deltoid axillary nerve dissection protection against damage to the deltoid muscle function, I experience that surgery should be based on limited open, simple and fixed, as far as possible the protection of humeral head blood supply. For the humeral head rotation displacement of more than 45 degrees cases, surgery should first make the normal humeral head anatomy, so that with the center of the glenoid was inclusive. The fracture and then reset, to avoid humeral head and glenoid due to central tolerance and the impact of unpaired shoulder function. Should be functional reduction of the fracture and not the pursuit of anatomical reduction. 11 cases were followed up for an annual average seen in the humeral head necrosis. 11 cases, 8 patients underwent bone graft surgery, 8 cases the bone defect surgery significantly, especially in elderly patients, was due to osteoporosis, bone fracture more serious, are to be bone. Bone graft by: autologous iliac bone graft, heterologous small bone graft. Massive bone structure and morphology of proximal humerus is conducive to recovery, and it helps to increase fixation stability. In short, for the adult surgical treatment of proximal humeral fractures should be based on early surgery, limited open, simple and fixed principles. This helps protect the humeral head blood supply, reduce the trauma response. Zero bit early postoperative traction, early exercise can help prevent shoulder adhesions; severe bone graft should be treated. [Received $ Guangdong】 2003-06-16} [4] Wang Yu, He Shirong misoprostol for cervical ripening in late pregnancy and labor induction in clinical application [J], Foreign Medical Sciences (Obstet), 1999.26 (5) :293-295 [5] Xu Yongping, ZHANG Ai-rong, Weide E, pregnant women, premature rupture of membranes such as the application of the rectum: misoprostol for cervical ripening and induction of the clinical observation [J]. Practical Obstetrics and Gynecology, 2000,16 (3) :137-138. [Received Date] 2003-08-20 |
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