肱骨的

［Objective］ To observe the clinical experience of artificial caput humeri substitution to senile humerus proximal fracture.

：［目的］介绍高龄肱骨近端骨折患者人工肱骨头置换的临床经验。

In order to recover maximally the shoulder joint functions for post-artificial humeral head replacement, we must try our best to avoid soft tissue damage, reserve the bone of the tuberosity, select appropriate humerus head prosthesis, perform early post-operative staging rehabilitation, as well as maintain a normal retroversion of the prosthesis.

要最大限度恢复人工肱骨头置换后肩关节的功能，置换过程中要尽可能减少软组织损伤，尽量保留大结节部位的骨质，选择与关节盂大小匹配的肱骨头假体，早期分阶段功能锻炼，维持正常的肱骨头后倾角。关键词：肱骨近端骨折；人工肱骨头；置换

The transepicondylar axis of different position has no effect on volume rendering technique measuring the humeral head retroversion angle with multi slice spiral CT.The top view at which lateral epicondyle of the humerus showing minitriangulum and the anterior surface of the distal humerus articulation with the forearm being shaded is more simple,faster and precise for the volume rendering technique measuring the humeral head retroversion angle with multi slice spiral CT.

结论］肱骨头扭转角变异较大，肩关节假体扭转角设计应个性化；肱骨远端不同位置内外上髁轴线对多层螺旋CT容积再现测量肱骨头扭转角没有影响；俯视位观察肱骨，当外上髁露出呈小三角形、肱骨远端前关节面被肱骨头遮盖重叠的位置是多层螺旋CT三维重建测量肱骨头扭转角的更简单、更快捷而且准确的测量位置。

Results: Transverse diameters of left and right humeral heads were (40.67±1.90)mm and (40.49±1.36)mm, vertical diameter (44.54±1.31)mm and (43.45±1.48)mm, retroversion angle (26.59±1.36)° and (26.85±1.61)°, max interval of humeral head-tuberosity (6.63±1.13)mm and (6.80±1.02)mm, humeral head-shaft angle (l34.320±3.49)° and (135.58±1.50)° respectively.

结果：肱骨头横径：左侧(40.67±1.90)mm，右侧(40.49±1.36)mm；肱骨头纵径：左侧(44.54±1.31)mm，右侧(43.45±1.48)mm；肱骨头后倾角：左侧(26.59±1.36)°，右侧(26.85±1.61)°；头结节距（肱骨头最高点至大结节最高点的垂直距离）：左侧(6.63±1.13)mm，右侧(6.80±1.02)mm；颈干角：左侧(134.320±3.49)°，右侧(135.58±1.50)°。

Methods:Fifty paired embalmed cadaveric humeri (twenty-five pairs:fourteen from male donors and eleven from female donors) were scanned in medial-lateral and anterior-posterior position according to the humeral retroversion by CT. Images of the humeri in the transverse planes at the lowest border of neck,20mm and 40mm distal of LBN(LBN-20、LBN-40), isthmus, head-neck anterior-posteriorwere obtained. Sixty-one extracortical and intracortical parameters were measured exactly by image analytic computer software that included offset, head position, head-shaft angle, head to tuberosity height, head thickness, curvature radius, articular surface arc, neck diameter, isthmus position, proximal and distal border of isthmus, maximum coronal and sagittal diameter of medullary canal and thickness of cortical bone in four planes, including LBN, LBN-20,LBN-40 and isthmus.

50根成对防腐肱骨(男14对，女11对)按肱骨头扭转角置于冠状位和矢状位，行肱骨全长，头颈矢状面，解剖颈下缘及其下20mm、40mm，髓腔狭窄部四平面CT扫描，由CT软件测量冠、矢状位髓腔内外参数共61项，包括头心—干轴距，头位置，头干角，头—结节高度差，头厚度，头半径，关节面张角，解剖颈直径，髓腔狭窄部位置，解剖颈下缘及其下20mm、40mm和狭窄部四个平面髓腔的最大冠、矢状径，皮质骨厚度等。

METHODS: A total of 22 patients with complex fracture of proximal humerus, managed by humeral head replacement in Changhai Hospital of The Second Military Medical University from June 2006 to December 2008 were collected, including 12 males and 10 females, with average age of 67 years (52-86 years). During the procedure, soft tissue damage was minimized, the bone of the tuberosity was reserved as much as possible, appropriate matching size of humerus head prosthesis was selected, and early staging functional rehabilitation was performed. Neer's scoring system was used to evaluate the treatment results after replacement.

回顾性分析2006-06/2008-12解放军第二军医大学长海医院骨科收治的肱骨近端粉碎骨折患者22例，男12例，女10例，年龄52~86岁，平均67岁；全部患者均采用人工肱骨头置换，置换过程中尽量减少软组织损伤，保留大结节部位的骨质，选择与关节盂大小匹配的肱骨头假体，早期分阶段功能锻炼，置换后采用Neer评分标准评价人工关节功能。

The operative techniques of open intracapsular reduction and internal fixation with locking proximal humeral plate can enhance validity of reduction and stability of fixation,and alleviate the disturbance on vascular supply of the humeral head.

采用切开囊内复位技术和LPHP锁定肱骨近端接骨板内固定治疗肱骨近端骨折可减轻肱骨头血运影响，提高骨折复位的有效性和固定的稳定性。

Results The anterior bundle of ulnar collateral ligament originates from the inferior aspect of the medial epicondyle and inserts immediately adjacent to the joint surface on the ulna near the sublimis tubercle. The posterior bundle originates from the medial epicondyle slightly posterior to its most inferior portion and inserts broadly on the olecranon process. The lateral collateral ligament arises from the inferior aspect of the lateral epicondyle. Two types of conjoined lateral collateral and annular ligamentous insertions on the ulna were observed. Type Ⅰ(61.2％) was bilobate and type Ⅱ(38.8％) was a single broad conjoined type with insertion on the ulna. The anterior band of anterior bundle was more tighten than the posterior band as the elbow flexed less than 60°. When the elbow flexed over 60°, the two parts of anterior bundle were equally tightened. The posterior bundle was tightened as the elbow was flexed more than 90°. The lateral collateral ligament was tightened gradually as the elbow moved in flexion.

结果(1)尺侧副韧带前束起于肱骨内上髁的前下方，止于尺骨冠突内侧的小结节；后束起于肱骨内上髁的内下方，止于尺骨鹰嘴内侧的骨面；(2)桡侧副韧带起于肱骨外上髁的外下方，其纤维部分止于环状韧带，部分止于尺骨冠突的外下方；桡侧副韧带和桡骨环状韧带在尺骨上的止点有两种类型：Ⅰ型占61.2％，桡侧副韧带的部分纤维汇于环状韧带的尺骨止点，另一部分纤维单独止于稍远的尺骨上；Ⅱ型占38.8％，桡侧副韧带和环状韧带形成一宽的纤维止于尺骨上；(3)在肘关节屈曲60°以前，尺侧副韧带前束的外侧部紧张而内侧部较松弛，肘关节屈曲超过60°后，前束内外侧处于同程度的紧张状态；尺侧副韧带的后束在肘关节屈曲超过90°后才被拉紧；(4)桡侧副韧带在肘关节不同屈曲状态时其紧张度逐渐增加，当肘关节屈曲超过90°时，桡侧副韧带被明显拉长。

Results:The anterior bundle of the UCL starts from anterior inferior part of the medial condyle,and ends on the sublimis tubercle in front of the coronoid process of ulna,locating in the deep layer of the flexor carpal ulnar muscle.The distance between ulnar nerve and UCL is (0.9±0.1)cm in the center of cubital tunnel,and (0.6±0.3)cm in the distal foramen of cubital tunnel.The distance from the point of ulnar nerve entering the flexor carpi ulnar muscle to the medial epicondyle is (3.7±0.8)cm.The distance between the closest branch innervated flexor muscle of the median nerve and the approach is (1.6±0.5)cm at the level of medial epicondyle,and (0.9±0.4)cm at the level of ulnar tubercle.

结果：UCL前束起于肱骨内侧髁的前下方，止于尺骨冠突内侧的小结节，UCL前束位于尺侧腕屈肌肱头、尺头之间的深层；尺神经在肘管中部与尺侧副韧带前束的平均距离为(0.9±0.1)cm，在肘管的远侧出口，距尺侧副韧带的尺骨止点(0.6±0.3)cm；尺神经至尺侧腕屈肌尺头肌支的入肌点距肱骨内侧髁的距离为(3.7±0.8)cm；正中神经最靠近切口的分支距切口的距离，在肱骨内侧髁和尺骨结节水平分别为(1.6±0.5)cm和(0.9±0.4)cm。

For supracondylar fracture of humerus with obvious displacement,it is easy to make reduction,but the fixation and the maintenance of reduction is not easy; manual reduction with plaster or splint immobilization,though as the first-chosen method,has such shortcomings as infirm or loosening fixation of plaster or splint which may cause injury to blood vessels or nerves; open reduction may lead to further trauma to soft tissues and tissue adhesion,and to joint stiffness; the closed reduction with cross Kirschners wires under C-arm X-ray can avoid the above mentioned shortcomings and it is easy in operation.

移位明显的肱骨髁上骨折，复位容易，但固定及维持复位困难，手法复位石膏或夹板外固定虽是首选治疗方法，但石膏或夹板固定不牢固，易出现松动甚至可造成血管及神经损伤，而切开复位更易进一步造成软组织创伤，组织粘连，最终导致关节僵直功能障碍。本组C臂下闭合复位交叉克氏针治疗移位明显的肱骨髁上骨折避免了上述缺点，而且方法简单。肱骨髁上骨折；经皮克氏针固定；儿童；闭合复位

However, as the name（read－only memory）implies, CD disks cannot be written onorchanged in any way.

然而，正如其名字所指出的那样，CD盘不能写，也不能用任何方式改变其内容。

Galvanizes steel pallet is mainly export which suits standard packing of European Union, the North America. galvanizes steel pallet is suitable to heavy rack. Pallet surface can design plate type, corrugated and the gap form, satisfies the different requirements.

镀锌钢托盘多用于出口，替代木托盘，免薰蒸，符合欧盟、北美各国对出口货物包装材料的法令要求；喷涂钢托盘适用于重载上货架之用，托盘表面根据需要制作成平板状、波纹状及间隔形式，满足不同的使用要求。