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小儿骨科手术技术(翻译版)

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《小儿骨科手术技术(翻译版)》按解剖部位分为十章,详细描述了60个手术的指征、术前必要的检查、局部解剖、手术步骤和术后护理。同时还有重点地介绍部分手术的诊治要点、潜在的风险并提出对治疗方法的不同意见。每个手术均配以术中照片、x线片以及线条图,图文并茂,使手术步骤一目了然。
Catalogue

第一章肩
手术1治疗高肩胛的改良Woodward手术
手术2肩外旋肌腱转移治疗产伤臂丛神经麻痹
第二章肱骨和肘
手术3肱骨近端骨折:复位及弹性钉固定
手术4移位的肱骨内上髁骨折切开复位螺钉加垫圈内固定
手术5桡骨头/桡骨颈骨折:闭合复位,经皮撬拨复位,切开复位
手术6肱骨外髁骨折:闭合复位经皮穿针固定与切开复位内固定
第三章前臂和腕
手术7前臂骨折:闭合复位
手术8桡骨远端骨折闭合复位和穿针固定
手术9前臂骨折:髓内针固定
第四章手
手术10并指分指术
第五章骨盆和髋关节
手术11髋骨截骨术
手术12Chiari骨盆截骨术
手术13骨盆三联截骨术
手术14单一切口骨膜外髋骨三联截骨术
手术15胭绳肌腱近端撕脱的修复
手术16化脓性髋关节炎
手术17髋关节手术脱位
手术18经皮原位空心螺钉固定术治疗股骨头骺滑移
手术19“Bernese”髋臼周围截骨术
手术20治疗发育性髋关节脱位的前内侧人路
第六章股骨
手术21股骨骨折:弹性髓内钉
手术22导向生长——半骺阻滞术
手术23外固定器行股骨延长
手术24大转子移位/股骨颈相对延长
手术25股骨骨折:大转子外侧人路交锁髓内钉
手术26小儿股骨骨折肌肉下钢板固定
手术27屈曲截骨术治疗股骨头骨骺滑移
手术28股骨骨折:闭合复位和髋人字石膏
手术29股骨远端及胫腓骨近端骺固定术
手术30长管状骨(股骨、胫骨)Sofie1d截骨术和髓内钉固定
第七章膝
手术31外侧盘状半月板
手术32髌骨不稳定:外侧松解和内侧折叠术
手术33脑瘫患儿膝部手术Ⅰ:胭绳肌延长脑瘫患儿膝部手术Ⅱ:股直肌远端转移手术
第八章胫骨和踝
手术34胫骨棘骨折:关节镜和切开复位内固定
手术35剥脱性骨软骨炎:关节镜评估;关节外钻孔和加减固定
手术36剥脱性骨软骨炎固定术
手术37骨骼未成熟病儿经骺板自体胭绳肌腱重建前交叉韧带
手术38骨骼未成熟病儿不经骺板髂胫束重建前交叉韧带
手术39胫骨结节骨折切开复位内固定术
手术40胫骨近端截骨术治疗胫内翻(B1ount氏病)
手术41踝部Ti11aux骨折的手术治疗
手术42用环形外固定器行胫骨延长
手术43关节镜治疗青少年距骨剥脱性骨软骨炎
手术44三平面骨折
第九章足
手术45Ponseti法治疗特发性畸形足
手术46距跟跗骨融合切除和自体脂肪问置
手术47跟舟融合切除自体脂肪间置
……
第十章脊柱
索引
Book Abstract

一、手术指征
1.功能受限的病儿需手术治疗,包括肩关节向前屈曲及外展活动减少。肩关节各方向活动度小于120。的儿童,手术的改善潜力很大。
2.由于未下降的肩胛骨外观上很明显也需要手术治疗。
3.根据外形不同,高肩胛症cavendish分级方法有助于评估是否需要手术。对于分级为1度和2度高肩胛症病儿,部分切除肩胛上内角即可,而对于分级为3级和4级的病儿,则需要采用肩胛骨复位的较为复杂的手术,如woodward手术。
l级(非常轻微):肩关节的高度和畸形,在病儿着装时看不到。
2级(轻度):双侧肩关节的高度正常,但病儿着装时可以看到畸形(在颈蹼处突出)。
3级(中度):肩关节升高2~5cm,畸形明显可见。
4级(严重):肩关节升高5cm以上,肩胛骨接近枕骨。
4.治疗年龄:为了能够更好地改善功能,倾向于及早治疗,提倡3~6岁进行手术。有些学者主张提早到6~9个月,但是有些医生仍主张在儿童后期(5~9岁)或青春期进行手术。二、体格检查/影像
1.评价病儿的外观,特别注意肩部的对称性。病儿上肢置双侧,并检查各部位的功能,如果双侧肩胛骨均示下降,肩部不对称可能不明显,但仍看出异常,如图1所示,一名3岁病儿从正面显示的典型右侧单侧高肩胛症外观。
2.测量肩关节活动度,特别注意病儿主动前屈及外展,如图2所示,一名4岁高肩胛症病儿术前(图2A)术后(图2 B)右侧肩关节外展受限的背面观。被动检查肩肱关节外展和旋转均正常。而肩胛和胸壁之间动作明显受限。同时,患侧上肢肌力有所降低。
3.包括有双肩及双锁骨为中心的前后位x线片可以对比观察双侧骨性解剖,如图3所示,一名3岁病儿双肩x线片,右侧肩胛骨发育不良,未下降到正常位置且伴有旋转,与图1所示病儿是同侧畸形。
4.双肩关节CT检查,包括三维重建有助于更加详细了解其解剖。
5.在临床工作中要注意,有无连接肩胛骨上内部和颈椎中下段棘突的肩椎骨(图4),还应拍摄肩关节斜位片及cT检查。
6.要检查病儿有无最常见的并发畸形,包括颈椎畸形。如短颈综合征(30%),先天性脊柱侧凸(25%),胸壁缺陷或发育不良(25%)以及肾脏/泌尿生殖系统异常(10%)。其他相关畸形包括脊髓纵裂,长骨发育不良,手足短骨畸形。对此应考虑行肾脏超声及颈椎CT或MRI检查。
7.在治疗前针对并发的脊柱或胸壁畸形,需请脊柱和(或)整形外科医生会诊。三、外科解剖
1.斜方肌起点广泛,从枕部到胸12棘突,是woodward术式中需松解的主要肌肉之一(图5)。
2.30%的病儿在颈椎与肩胛骨内上角之间存在骨性或软骨性肩椎骨(图4),应予以切除以利矫正。
3.神经血管结构应加以保护。
(1)脊神经的分支支配斜方肌,沿其前方表面纵向分布,与浅颈动脉降支分支(向后方深层)并行。
(2)肩胛背神经分支支配菱形肌。
(3)颈横动脉就位于提肩胛肌止点的前方,当从肩胛骨内上方剥离提肩胛肌时有损伤颈横动脉的危险(图6)。
(4)应限制对肩胛骨近端外侧的剥离,以避免肩胛上方位于肩胛凹的神经血管受损。
(5)在锁骨截骨时有损伤锁骨下血管的风险。用弯的Hohmann牵开器,置于骨膜下起到保护作用。四、体位
1.为了便于锁骨截骨,病儿采用仰卧位,消毒范围应广泛,包括整个上肢(以利于控制锁骨)、胸骨及对侧锁骨的内部(图7)。
2.完成锁骨截骨,缝合切口,粘贴无菌敷料。病儿改为俯卧位。
(1)注意支撑头部和颈部,头部取中立,或轻度屈曲位,纵向侧方垫起腹部避免受压。
(2)整个肩部及上肢超过中线,包括对侧的肩胛骨均做无菌铺巾,以利于肩胛骨有充分活动度,可看到并能触及对侧的结构(图8)。五、入路/显露
1.前方人路
(1)锁骨中部做一个2cm小切口,剥离到骨膜(图9A),尽量保护表皮感觉神经。分离颈阔肌。
(2)沿锁骨长轴切开骨膜环周骨膜下钝剥离。
(3)骨膜下置微型Hohmann撑开器,保护锁骨下动静脉(图9B)。
2.后方人路
(1)从颈5到胸8棘突之间做脊柱中线稍偏外的切口,长10~15cm。
(2)经皮肤、皮下组织,锐性剥离直达背部筋膜,将表浅的组织提起,形成皮瓣以显露肩胛骨及其支撑肌肉(图10)。六、手术步骤
第一步
(1)我们常规逆行锁骨截骨,使下移肩胛骨时减少发生臂丛神经牵拉损伤的风险。
(2)在锁骨中部用骨凿或咬骨钳进行截骨(图11)。
(3)只行锁骨单纯截骨或锁骨一小段行粉碎术。
(4)伤口冲洗,4—0或5—0可吸收线皮内缝合,5—0可吸收线表皮下抽线缝合。
(5)伤口覆盖敷料,改为俯卧位以显露病儿后背。
第二步
1.确认斜方肌远端外侧部分,将其从下方的背阔肌及椎旁肌分离(图12)。这一步有助于确定手术的关键层次。肌肉粘连或发育不良会导致确定这个手术层面非常困难。
2.将斜方肌从尾端向头端从颈到胸椎棘突上锐性分离。向上剥离就会显露出大小菱形肌并将其翻起,图13显示斜方肌与菱形肌从起点处分离并被抬起,提肩胛肌显露在肩胛骨的内上部。这些肌肉的腱性部分要保护好,以用于随后向尾端再固定。在颈4棘突水平,斜方肌横向分开以利于充分松解。
3.在切口的近端,可见捉肩胛肌,约30%病儿有明显的肩椎骨。脊神经支配斜方肌,肩胛背神经分支支配菱形肌,要仔细加以保护。
4.要避免损伤颈浅动脉的降支或颈横动脉。
5.在肩胛骨内上部附着点松解提肩胛肌,颈横动脉就走行在提肩胛肌的下方,松解时要加以保护(图14)。
6.连接肩胛骨和颈椎的肩椎骨或纤维条索一定要用剪刀或咬骨钳松解,要从骨膜外切除肩椎骨。
7.最后,肩胛骨下方与胸壁之间钝性分离,松解全部纤维粘连。
……
Introduction

潘少川教授领衔翻译的《小儿骨科手术技术》一书即将付梓,嘱撰序言,欣然命笔。并祝愿此书广泛畅销,为规范我国小儿骨科技术、提高我国小儿骨科工作者的专业水平,起更大的作用。
回顾这几年,首都医科大学附属北京儿童医院小儿骨科创始人潘少川教授发起翻译了一组国外资料,并亲任主泽,经中华小儿外科分会小儿骨科学组联络各地同道参加翻译,由人民卫生出版社编印发行。先后出版了小儿骨科的三部理论书籍:《Rang小儿骨折》、《实用小儿骨科学》、《小儿骨科学骨科核心知识》。另外,《特发性脊柱侧弯》、《发育性髋关节发育不良》两部专著及《小儿骨科规避后患要略》;连同本书共七部。同属小儿骨科专业,内容各有侧重。英文原著特点为简明实用,介绍了国际先进知识与技术,理论与实践结合,文字简练、图文并茂,可以丰富基层一线工作者特别是青年同道的专业知识,并可以直接引用于临床;高级学者也可借此了解本专业发展的国际动态、开阔眼界,为自主创新的做参考。
本书的译者来自全国各地,包括台湾、香港的同道,都是知名的一线工作学者。通过此项组译工作,首先是团结了同道,共同致力于我国小儿骨科的发展,同时也向各地同道介绍最新国际技术现况和一些国际名人,也介绍了此类系列图书编写的一种可取的模式。参译专家们纷纷反映通过此项工作,在追求翻译的“信、达、雅”标准过程中提高了个人的中英文编写水平和国际交流的能力。
出版社组织此类精美的译著出版,既传播了国际技术,又增进了国际交流,也展示了我国卫生出版业的水平,提高了我国卫生出版业的国际声誉与地位,堪称一举三得。我愿为此书的出版大声欢呼。
中国工程院院士
2013年5月

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Seller will ship the orders within 1-2 business days. The logistics time limit is expected to be 7-15 working days. In case of customs clearance, the delivery time will be extended by 3-7 days. The final receipt date is subject to the information of the postal company.

Yami Points information

All items are excluding from any promotion or points events on Yamibuy.com

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

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About the brand

Jingdong book

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About the brand

Jingdong book