Hereditary scoliosis
Hereditary scoliosis
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DOI：
10.1136/bmj.1.3816.328
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发表时间：
1934-01-01
影响因子：
--
通讯作者：
Garland, HG
中科院分区：
文献类型：
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作者：
Garland, HG
骨折固定 R. WATSON JONES 先生宣读了一篇关于“固定不充分和骨折不愈合”的论文。他说，最近对骨折治疗中的早期活动和功能活动的热情是完全合理的，因为可以减少丧失工作能力的时间，并避免许多永久性残疾；但应该认识到，关节松动不得妨碍骨折的绝对完整和不间断的固定。没有什么比固定不充分更容易导致骨不连的原因了。骨质充血导致脱钙。如果受伤创伤最初的充血由于碎片相互移动的频繁重复创伤而持续，脱钙就会持续下去，直到裂纹变成空洞，线性骨折变成间隙骨折。即使是轻微的运动，尤其是旋转运动，也足以解释过度的脱钙。用于股骨颈骨折的惠特曼膏药通常不会阻止骨盆和股骨头的旋转运动，因此，即使在 50% 的情况下也是如此。在经过如此治疗后确实愈合的病例中，通常有股骨颈缩短过度脱钙的证据。另一方面，史密斯-彼得森钉完全阻止了旋转运动，并且在演讲者的一系列 28 例头下骨折中，超过 90% 通过手术治疗。曾经团结过。在尺骨下干骨折中，骨折不愈合是由于在固定六或八周后，骨折愈合之前试图恢复桡尺运动所致。桡尺关节变得僵硬，因此松散的骨折处和僵硬的关节处一样容易发生运动。出于这个原因，在三年内，说话者已经看到了十八处尺骨下干骨折，但在每一个病例中，相关的桡骨骨折（不受旋转应变的影响）都已经愈合。如果这些骨折完全固定三到四个月（这是显示巩固的放射学证据所必需的），则永远不会发生骨不连。手腕舟状骨骨折也说明了同样的原理。最近的骨折通常在六到八周内愈合，但有时需要继续制动数月，如果延迟治疗，可能需要十二到十八个月的绝对制动。如果外科医生准备好等待，几乎在所有病例中都可以实现骨愈合。发言者的结论是，无论其他因素如何影响骨折愈合，只有在固定不完全或没有持续足够长的时间时才会出现骨折不愈合的情况。
Immobilization of Fractures Mr. R. WATSON JONES read a paper on" Inadequate Immobilization and Non-Union of Fractures." He said that recent enthusiasm for'early mobilization and functional activity in fracture treatment was entirely justified, in that incapacity periods were reduced and many permanent disabilities avoided; but it should be recognized that joint mobilization must not interfere with absolutely complete and uninterrupted immobilization of the fracture. There was no more constant cause of nonunion than inadequate immobilization. Hyperaemia of bone caused decalcification. If the initial hyperaemia of the trauma of injury was perpetuated by the frequently repeated trauma of movement of the fragments on each other, decalcification continued until a crack became a cavity, and a linear fracture became a gap fracture. Even slight movement, and especially rotatory movement, was sufficient to account for excessive'decalcification. The Whitman plaster for fracture of the neck of the femur did not as a rule prevent rotatory movement of the pelvis and head of the femur, and for this reason, even in the 50 per cent. of cases which did unite when so treated, there was usually evidence of excessive decalcification in the shortening of the neck of the femur. On the other hand, a Smith-Petersen nail completely prevented rotatory movement, and in the speaker's series of twenty-eight subcapital fractures treated by operation over 90 per cent. had united. In fraLtures of the lower shaft of the ulna, non-union was due to attempted restoration of radio-ulnar movement after six or eight weeks of immobilization, before the fracture was consolidated. The radio-ulnar joint had become stiff, so that the movement could occur just as easily at the unconsolidated fracture as at the stiffened joint. For this reason, in three years the speaker had seen eighteen ununited fractures of the lower shaft of the ulna, although in every case the associated fracture of the radius-which was not subject to rotatory strain-had united. Ifthese fractures were completely immobilized for the three or four months which were necessary to show radiographic evidence of consolidation, non-union never occurred. Fractures of the scaphoid bone in the wrist illustrated the same principle. Recent fractures usually united in six to eight weeks, but sometimes it was necessary to continue immobilization for many months, and if the institution of treatmentwas delayed, twelve to eighteen months of absolute immobility might prove necessary. If the surgeon was prepared to wait for-it, bony union could be secured in practically every case. The speaker's conclusion was that whatever other factors might affect the union of fractures, non-union was only seen if immobilization was incomplete, or if it wasnot continued for a sufficient period.