交锁髓内钉治疗漂浮膝损伤

目的探讨应用交锁髓内钉治疗漂浮膝损伤的疗效。方法1998年10月～2004年8月采用交锁髓内钉治疗16例漂浮膝损伤患者。除2例胫骨远端骨折患者用钢板内固定外,其余患者均采用交锁髓内钉一次手术完成股骨及胫骨的内固定。术后常规应用广谱抗生素预防感染。结果所有患者获1～3年(平均2年)随访。根据Karlstrom和Olerud功能评定标准评定疗效：优11例,良3例,中2例,优良率为87．5%。所有骨折均一期愈合,愈合时间为3～6个月,患者功能恢复满意。结论交锁髓内钉治疗漂浮膝损伤具有防止骨折分离和旋转移位的作用,可调整为加压固定,可稳定关节及减少感染,能防止骨折畸形愈合、不愈合或膝关节僵直等并发症。     

可吸收材料髓内固定在治疗掌骨干骨折中的体会

目的 探讨使用可吸收棒髓内固定治疗掌骨干骨折的临床疗效.方法 回顾分析了使用可吸收棒髓内固定治疗的28例32处掌骨干骨折,对治疗结果进行功能及影像学方面的评估.结果 所有患者均获得随访,时间为6～10个月.伤口均Ⅰ期愈合,其中2处第5掌骨骨折出现背侧成角移位,1处第5掌骨骨折出现再骨折,所有病例均骨性愈合,掌指关节主动屈伸范围基本正常.结论 使用可吸收棒髓内固定治疗掌骨干骨折是一种安全有效的手术方法.但因其固定强度不能完全满足早期康复的要求,可能出现再骨折或成角移位,特别是第5掌骨骨折术后尚需辅助石膏外固定.     

微创下交锁髓内钉治疗股骨干骨折

目的探讨微创下非导针引导顺行交锁髓内钉内固定治疗股骨干骨折的可行性。方法自2002年2月至2006年2月应用不扩髓非导针引导下小切口顺行交锁髓内钉内固定治疗股骨干新鲜闭合骨折32例，其中股骨干横形骨折12例，斜形骨折8例，粉碎骨折12例；一侧股骨干横形骨折合并同侧胫腓骨干粉碎骨折1例。结果平均随访14个月，骨性愈合且恢复正常负重及行走25例（78％），临床愈合6例（19％），骨延迟愈合1例。本组无感染，髓内钉折弯、折断，无畸形愈合。结论微创下顺行交锁髓内钉内固定治疗新鲜闭合股骨干骨折能防止短缩和旋转，固定牢靠，具有创伤小、骨折愈合快、能早期活动及并发症少等优点。     

胫腓骨骨折带锁髓内钉固定术后护理

<正> 带锁髓内钉是通过交锁的螺钉横行穿过髓内钉而固定于两侧骨皮质上,有效地防止骨折旋转,短缩及成角畸形的发生,达到牢固固定的作用,且创伤小,出血少,可早期下床非负重活动,进行关节功能练习及肌肉训练。1999～2001年我院对33     

带锁髓内钉治疗股骨、胫骨、肱骨骨折

目的：带锁髓内钉治疗股骨、胫骨、肱骨骨折临床应用研究。方法：共实施手术106例，随访7个月以上90例。结果：1例骨折不愈合，其余89例骨折均愈合。关节功能恢复良好，并发症：主钉断裂1例，近端锁钉断裂1例，远端锁钉断裂1例，术中再骨折1例，伤口感染2例，均未影响骨折愈合及功能恢复。结论：带锁髓内固定牢固，防止骨折端旋转，分离移位，术后不需外固定支持，早期负重，骨折愈合率高，手术失败率低，是一种比较理想的内固定方法。     

加锁髓内钉治疗股骨转子骨折生物力学分析及临床疗效

作者参考Ｇａｍｍａ钉有关资料，根据中国人体形特点，制成适合国人使用的加锁髓内钉及其手术器械，治疗股骨转子骨折５３例。５２例患者术后随访１～３．５年，骨折全部愈合。生物力学试验结果显示，加锁髓内钉的抗压缩和抗弯曲强度都远超过人体股骨的强度。作者认为，加锁髓内钉是按照人体股骨近段的解剖特点和生物力学原理设计的，可将股骨头承受的各种应力以最佳方式分解和传递。其髓内棒上、下端均有螺丝钉交锁，可防止骨折段的各种移位和髓内棒的旋转、下沉，起静力性交锁固定作用。适用于各类型股骨转子骨折。     

交锁扩髓髓内钉治疗胫骨干C型骨折

目的探讨交锁扩髓髓内钉治疗胫骨干C型骨折的手术方法及临床疗效。方法对29例胫骨干C型骨折患者行交锁扩髓髓内钉治疗。术前积极处理合并伤,行患肢跟骨牵引,术后长石膏托固定8周,并早期进行功能锻炼。结果患者伤口均愈合良好,无感染发生。29例均获随访,时间13～22个月。5例患者术后6个月摄片示胫骨骨折延迟愈合,予髓内钉一端锁钉取出动力化3个月后骨性愈合;末次随访时9例出现膝前痛。患者患肢膝关节及踝关节功能均恢复良好。骨折无畸形愈合,无髓内钉弯曲及断裂、肢体短缩和胫骨成角畸形等并发症。按Johner-Wruhs评分标准进行临床功能评分:优23例,良6例。结论交锁扩髓髓内钉治疗胫骨干C型骨折可提供多向稳定性,结合术后合理的外固定及康复锻炼,疗效确切。     

带锁髓内钉并钢丝固定后股骨干粉碎性骨折不愈合

目前带锁髓内钉固定已成为治疗股骨干骨折的首选方法,能有效地防止骨折处的旋转及短缩,可早期活动及适当负重,随着手术病例数的增加,骨折延迟愈合或不愈合的病例也在逐渐增多。回顾分析自1999年3月至2006年3月行带锁髓内钉并钢丝捆绑固定治疗的股骨干粉碎性骨折173例,     

有限扩髓交锁髓内钉固定治疗胫腓骨骨折

交锁髓内钉因其能够防止短缩、旋转、侧方移位，具有更符合生物力学固定原则．而且固定牢固．有利于早期关节功能锻炼和负重等优点，已广泛应用于临床。笔者自2002年6月至2007年12月．采用国产交锁钉进行有限扩髓内固定治疗胫腓骨骨折36例，疗效满意。现报告如下。     

交锁髓内钉治疗股骨、胫骨干粉碎性骨折

目的：交锁髓内钉治疗股骨、胫骨干粉碎性骨折临床观察。方法：应用小切口切开复位，选择性扩髓，交锁髓内钉内固定治疗股骨，胫骨干粉碎性骨折26例，结果：本组26例随访时间6－24个月，平均14个月，骨折平均愈合时间14周，无术后感染，脂肪栓塞，断钉，骨折不愈合，畸形愈合，关节僵硬，再骨折等严重并发症发生，结论：本组股骨、胫骨干粉碎性骨均属不稳定型骨折，交锁髓内钉固定疗效是确切的，可采用小切口切开复位并选择性扩髓，不主张早期负重或做动力化处理。     

Rods in spinal surgery: a review of the literature

Background context

Spinal instrumentation has been used for more than five decades. Since the introduction of the Harrington rod in 1962, new rod materials and concepts have been developed. Rigid rod fixation has achieved higher fusion rates than previous methods. Recently, semirigid rod fixation devices have been used for both dynamic stabilization and fusion fixation. Memory rods, which have an interesting ability to return to their pre-bent shape when the temperature increases, are expected to be used for scoliosis correction.

Purpose

To review the previous literature regarding biofunctionality and biocompatibility of rods in spinal surgery.

Conclusion

The properties of each type of rod need to be taken into consideration when performing spinal instrumentation surgery.     

单侧与双侧生长棒治疗早发性脊柱侧凸的疗效的Meta分析

目的评价单侧与双侧生长棒治疗早发性脊柱侧凸的效果及并发症发生率的差异。方法计算机与手工检索中英文数据库及相关文献书籍,按照纳入标准及排除标准对检索文献进行筛选,对纳入文献进行NOS评分（Newcastle-Ottawa scale）,对单侧与双侧生长棒治疗效果及手术并发症发生率进行比较。结果共有4篇文献符合纳入标准,统计分析发现双侧组在冠状位矫形率（MD 0.26,95%CI 0.16-0.36）、初次手术前后脊柱延长高度（MD1.85cm,95%CI 0.92-2.77）、脊柱每年平均生长高度（MD 0.74cm,95%CI 0.44-1.05）方面均优于单侧组。两组总手术并发症发生率无明显差异（OR 1.17,95%CI 0.65-2.08）,随机效应模型发现内固定物相关并发症两组无明显差别（OR 0.42,95%CI 0.1-1.85）,敏感性分析后使用固定效应模型发现双侧组内固定物相关并发症的发生率低于单侧组（OR=0.22,95%CI 0.1-0.47）。结论双侧生长棒治疗早发性脊柱侧凸在矫形效果和维持脊柱生长方面均优于单侧生长棒,而两者总并发症发生率无明显差异,单侧组内固定物相关并发症发生率可能高于双侧组。     

Antibiotic coated hinged threaded rods in the treatment of infected nonunions and intramedullary long bone infections

IntroductionLocal delivery of high dose antibiotics in the form of antibiotic impregnated polymethyl methacrylate (PMMA) cement beads or coated rods is commonly used in the management of long bone infections. The downsides of antibiotic cement beads for intramedullary long bone infections are associated with difficulty in removal from the medullary canal, bead breakage, and lack of stability. Antibiotic cement-coated smooth flexible guide wires, rods and nails can have complications such as delamination or debonding of the cement. In addition, the current techniques for cement rod insertion have a risk of iatrogenic joint contamination.To improve upon this technique and decrease potential complications, we propose the use of an antibiotic cement-coated hinged threaded rod as a temporary intramedullary spacer. This technique utilizes both an antegrade and retrograde insertion of the threaded rod into the medullary canal through the bony defect site with connection at the hinge to treat intramedullary long bone infections and infected nonunions.Material and MethodsA total of 40 patients were included in the study. The details in making the cement rod were well documented. The shape of cement rod and the integrity of the cement at the time of rod insertion and rod removal were compared to identify any cement debonding or delamination. Potential postoperative complications including iatrogenic joint infection, displacement or breakage of the threaded cement rods, and fracture displacement were all carefully documented. The preliminary biological effect of the initial debridement and antibiotic cement rod placement was determined using the negative conversion rate of intraoperative cultures.ResultsA single antibiotic coated threaded rod was inserted in 18 cases. Two separate antibiotic coated threaded rods were inserted and connected via hinge in 22 cases. There were zero cases of rod breakage and no secondary loss of reduction from antibiotic rod placement to the definitive staged operation. There were zero iatrogenic joint infections. There were zero cases of cement debonding or delamination from the rod. The conversion rate to a negative culture after initial debridement and antibiotic rod placement was 85% (34/40 cases).ConclusionsThe use of an antibiotic coated cement threaded rod with a hinge as an intramedullary spacer provides the benefits of local antibiotic delivery, offers improved construct stability, makes implant removal easier without delamination of the cement mantle, and utilizes the versatility of a hinge to prevent violation of native joints when treating infected nonunions and intramedullary long bone infections.     

Surgical advances in the treatment of neuromuscular scoliosis

Neuromuscular disorders are a group of diseases affecting the neuro-musculo-skeletal system. Children with neuromuscular disorders frequently develop progressive spinal deformities with cardio-respiratory compromise in the most severe cases. The incidence of neuromuscular scoliosis is variable, inversely correlated with ambulatory abilities and with a reported risk ranging from 80% to 100% in non-ambulatory patients. As surgical and peri-operative techniques have improved, more severely affected children with complex neuromuscular deformities and considerable co-morbidities are now believed to be candidates for extensive surgery for spinal deformity. This article aimed to provide a comprehensive review of how neuromuscular spinal deformities can affect normal spine balance and how these deformities can be treated with segmental instrumentation and sub-laminar devices. Older concepts have been integrated with newer scientific data to provide the reader with a basis for better understanding of how treatment of neuromuscular scoliosis has evolved over the past few decades. Recent advances, as well as challenges that remain to be overcome, in the surgical treatment of neuromuscular curves with sub-laminar devices and in the management of post-operative infections are outlined.     

新型PEEK棒半刚性固定系统应用于腰椎退变性疾病手术治疗的临床疗效

目的 :观察聚醚醚酮(polyetheretherketone,PEEK)棒半刚性固定系统应用于腰椎退变性疾病后路减压、椎体间融合手术治疗的临床效果。方法:回顾性分析2010年1月~2012年1月收治的51例行后路椎间植骨融合术(PLIF)的腰椎退变性疾病患者,PEEK棒内固定组24例,钛合金棒固定组27例;均行标准腰椎后路减压、椎间融合、内固定术。通过腰痛VAS评分及下肢痛VAS评分、ODI评分等指标评价临床疗效;采用改良Brantigan椎间融合标准评价植骨融合情况。结果:所有患者均获得完整的术后随访资料。两组术后不同时间点腰痛及下肢痛VAS评分、ODI评分较术前比较差异有统计学意义(P0.01);末次随访时,PEEK棒组患者腰痛VAS评分(1.9±0.4)明显优于钛棒组(2.1±0.4),差异有统计学意义(P0.05),两组间下肢痛VAS评分及ODI评分差异无显著性(P0.05)。根据改良Brantigan椎间融合标准,术后3个月PEEK棒组(83.3%,20例)融合率显著高于钛棒组(55.6%,15例),两组间差异有显著性(P0.05);术后6个月,PEEK棒组融合率为91.7%,而钛棒组融合率为81.5%(22例),两组间差异无显著性(P0.05);术后12个月两组植骨融合率差异无显著性(P0.05)。结论 :PEEK棒-椎弓根螺钉半刚性内固定系统应用于腰椎退变性疾病临床治疗中可获得满意的临床疗效,与传统钛棒内固定系统比较术后腰痛持续缓解明显,其长期疗效仍需要进一步观察。     

骶骨棒微创小切口治疗骶骨纵行骨折

[目的]探讨应用骶骨棒小切口微创治疗骶骨纵行骨折及疗效评价。[方法]牵引复位后，骶骨棒小切口微创治疗骶骨纵形骨折13例，男9例，女4例。年龄18～63岁，平均36岁。其中6例行骨盆前环固定，7例有骶丛损伤。[结果]手术时间40～75min，平均54min。术后住院时间8-20d，平均11d。12例获得随访，时间9-24个月，平均17．5个月。无骶髂部疼痛10例，轻度疼痛2例；7例骶丛损伤者，6例完全恢复。[结论]骶骨棒小切口微创治疗骶髂关节脱位和骶骨纵行骨折是一种安全、有效的治疗方法，手术创伤小，并发症少，手术时间短，康复快。     

A hard object in the right iliac fossa

An unusual case of a Harrington rod migrating out of the abdominal cavity.     

LUQUE ROD FIXATION IN MENINGOMYELOCELE KYPHOSIS: A PRELIMINARY REPORT

A preliminary report is given of four cases of kyphosis in the thoracolumbar and lumbar regions in paraplegic meningomyelocele patients treated by means of segmental spinal (Luque) rod fixation. The system, incorporating fixation at multiple levels and the principle of the three-point pressure system, appears highly effective in obtaining and maintaining correction in a deformity which has previously proven refractory in a high proportion of cases.     

哈氏棒加多节段椎板下钢丝治疗脊柱侧凸

目的　总结单纯哈氏棒加多节段椎板下钢丝治疗脊柱侧凸的疗效。方法　在脊柱凹侧用哈氏棒撑开配合多节段椎板下钢丝固定治疗脊柱侧凸 32例。结果　随访 4个月～ 7 6年。术前侧凸平均Cobb角 6 7 1° ,术后 39° ,矫正率 47%。 1例上钩脱位 ,1例出现深部感染。结论　该方法手术过程简单 ,固定牢固 ,可减少骨折、脱钩等并发症 ,提高了矫正率     

Tibial rotational osteotomy with intramedullary nail fixation

There are several theoretic advantages of using intramedullary rod fixation for tibial osteotomy fixation. We performed a retrospective review of patients who were treated with a mid-diaphyseal osteotomy of the tibia fixed with an intramedullary rod for isolated, symptomatic tibial torsion. Forty patients (59 tibias) were included in the study and were followed for a minimum of 12 months or until rod removal (average follow-up 22.6 months). Major complication rate was 8.5%, which is comparable to alternative methods of fixation. We believe that intramedullary rods are a safe alternative for fixation of tibial rotational osteotomy in patients with physeal closure.