单侧多支点外固定器治疗股骨粗隆间骨折

目的 观察应用单侧多支点外固定器治疗股骨粗隆间折的疗效。方法 采用北大粗隆下穿针越过骨折断端达股骨头软骨下,股骨中上段另行穿针,针尾用外默写器固定治疗粗隆间骨折１０２例。结果 术后随访１年￣１年４个月,骨折均愈合。优８１例,可１４例,差８例。结论 单侧多支点外固定器可使骨折获得有效制动,口才能早期下床活动,术后护理方便。该术式操作简单,使用安全。     

密钙息在老年股骨粗隆间骨折治疗中的应用

目的观察密钙息治疗老年股骨粗隆间骨折的疗效。方法３２例患者随机分成２组，用药组１８例，骨牵引加ｉｍ密钙息５６天；对照组１４例，骨牵引５６天。结果骨痂出现时间：用药组３３．８天±５．５天，对照组３８．０天±４．６天（Ｐ＜０．０５）；有效缓解疼痛：用药组５．２天±１．５天，对照组７．５天±２．１天（Ｐ＜０．０１）；碱性磷酸酶：用药组及对照组治疗前与治疗后差异均有显著性（Ｐ＜０．０１），但用药组与对照组之间差异无显著性（Ｐ＞０．０５）。结论密钙息在老年股骨粗隆间骨折的治疗中有良好的疗效     

股骨粗隆间骨折四种手术方法比较

目的探讨不同手术方法治疗股骨粗隆间骨折的效果。方法采用四种固定方法治疗股骨粗隆间骨折56例,对比分析手术情况、适应证及优缺点。结果 56例骨折均愈合,采用空心拉力螺钉及骨外固定器固定手术时间、术中出血量最少;DHS及解剖钢板固定关节功能优良率较高;骨外固定器的手术并发症发生率最高。结论四种治疗股骨粗隆间骨折的手术方法各有利弊,在选择手术方式时,应针对不同的骨折类型、综合患者的全身状况,选择合适的固定方式。     

应用力臂式外固定器治疗粗隆间骨折105例

应用力臂式外固定器治疗粗隆间骨折１０５例北京市第六医院（１００００７）刘瑞波，顾敏琪，白音，宋建新，刘凤鸣，闫庆明我院从１９８６年２月～１９９４年５月应用孟氏力臂式外固定器［１］治疗１０５例股骨粗隆间骨折患者，报告如下。临床资料１０５例中男５４例，女...     

经皮穿针外固定器治疗股骨颈及粗隆间骨折

我院从1986年9月起,对复位外固定器固定治疗上下肢骨折进行了探讨,现将经皮穿针外固定器治疗股骨颈及粗隆间骨折的体会报告如下：临床资料1986年9年起用外固定器治疗69例股骨颈骨折及粗隆间骨折。其中股骨颈骨折54例,包括6例陈旧性骨折,骨折最长时间达两年。15例粗隆间骨折。     

单侧纵轴动力外固定器治疗胫腓骨骨折致骨延迟愈合的生物力学研究与临床

目的 通过对单侧纵轴动力外固定器（ｕｎｉｌａｔｅｒａｌａｘｉａｌｄｙｎａｍｉｃｆｉｘａｔｏｒ,ＵＡＤＦ） 的力学测试,分析引起骨折延迟愈合的机制。方法 对用ＵＡＤＦ固定的胫骨骨折模型进行加载实验。设置不同的骨－ 架间距,施加不同的载荷,测定骨折端的位移值。结合临床病例对发生骨折延迟愈合的病因进行生物力学的分析。结果骨折端位移与骨－ 架间距以及施加载荷的大小呈正相关（ｒ１ ＝ ０．６１０ ４,ｒ ２ ＝ ０．７０９ ２,Ｐ ＜ ０．０１）,差异有显著性意义。４８ 例骨折延迟愈合中,骨折愈合时间最短７ 个月,最长１５ 个月。因技术失误导致外固定架高刚度固定作用失效者１８ 例;外固定架的高强度特性,误导患者过早负重导致骨折延迟愈合１０ 例;１２ 例忽视了创造骨折端稳定界面对外固定架高刚度固定的重要性; 另外有８ 例只注重于高刚度固定, 而忽视了向弹性固定的转换,由此而发生了骨折的延迟愈合。结论 生物力学是骨折愈合的极其重要因素,使用ＵＡＤＦ发生的骨折延迟愈合,常是多种因素同时存在所致,如：骨－ 架间距的大小、负重载荷超限、骨折端的不相接触或缺损所致的极度不稳定界面以及固定器的高刚度固定维持时间过长等,共同干扰骨折的正常愈合。     

外固定器治疗股骨粗隆间骨折并发症分析

目的 探讨外固定器治疗股骨粗隆间骨折并发症的发生原因及防治办法。方法 回顾我院1987-1999年间使用力臂式外固定器治疗的357例患者,平均年龄75岁,并进行平均12个月的随访。结果 根据临床症状、体征及X线片表现评估疗效：优285例,良51例,可7例,差3例,近端固定针并发症：针道感染40例,拔出10例,切割股骨头9例,穿透股骨头5例,骨髓炎3例,结论 外固定器治疗股骨粗隆间骨折疗效显著,固定针的并发症与术者对手术适应症及外固定器穿针技术的掌握有关。     

股骨小粗隆固定器的临床研究与应用

目的 研究和评估股骨小粗隆固定器在治疗不稳定型股骨粗隆间骨折中的作用。方法 将尸体骨造成股骨小粗隆骨折，使用股骨小粗隆固定器固定小粗隆骨折后进行生物力学测试；临床结合加压滑动鹅颈钉治疗不稳定型股骨粗隆间骨折60例并随访研究。结果 股骨小粗隆固定器能有效固定小粗隆骨块，防止骨折块移位和旋转，有效减轻股骨颈干外侧的张应力，避免了髋内翻的发生，临床使用疗效优良率达93.3%。结论 股骨小粗隆固定器固定可靠，操作简单，手术创伤小，适用于不稳定型股骨粗隆间骨折的小粗隆骨块的固定。     

动力髋螺钉治疗股骨粗隆间骨折的临床疗效观察

目的：分析动力髋螺钉治疗股骨粗隆间骨折的临床疗效。方法选取76例股骨粗隆间骨折患者,随机分为对照组与观察组各38例,对照组给予支架外固定治疗,观察组给予动力髋螺钉内固定治疗,对两组患者治疗效果进行分析。结果观察组骨折愈合时间显著短于对照组,治疗总优良率显著高于对照组（P ＜0.05）。结论动力髋螺钉内固定治疗股骨粗隆间骨折效果显著,值得在临床中推广。     

滑动加压股骨粗隆间骨折外固定器的设计和临床应用

目的报告股骨粗隆间骨折滑动加压外固定器的设计和初步临床应用结果。方法在单侧成角外固定器和动力髋螺钉（DHS）的基础上，设计制作滑动加压外固定器。自2003年5月～2005年12月，用此新型外固定器治疗老年股骨粗隆间骨折22例。结果获随访20例，时间2～30个月，平均12个月。骨折全部愈合，愈合时间10～13周，平均12周。术后针孔感染4例，无深部感染发生，无骨折不愈合及髋内翻，髋关节功能恢复良好。结论滑动加压外固定器使用方便、灵活，兼有加压和滑动双重功能，能根据临床需求进行动静力固定转换，使固定更合理，能防止髋内翻及固定针滑脱或穿越股骨头等情况发生，是治疗高龄股骨粗隆间骨折患者较理想方法。     

Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques

Supracondylar humerus fractures are a common childhood occurrence. Displaced fractures are typically treated with closed reduction and percutaneous pinning. Controversy continues over the appropriateness of various pinning techniques. The most common include crossed or lateral pins. A biomechanical comparison of crossed pins, "parallel" lateral pins, and "divergent" lateral pins was performed using a pediatric synthetic bone model. Mechanical testing of each pin configuration was performed in extension, varus, valgus, internal rotation, and external rotation. The divergent configuration provided statistically greater stability than parallel pins under varus and valgus loading. Divergent pins had similar stability compared with crossed pins in extension, varus, and valgus testing. In axial rotation testing, crossed pins were more stable. If the surgeon feels confident in the ability of lateral pins to provide satisfactory fracture stability, divergent lateral pins provide greater stability than parallel lateral pins while avoiding ulnar nerve injury (associated with crossed pins).     

股骨外侧壁在股骨粗隆间骨折的髓内与髓外固定中的生物力学研究

目的：观察股骨外侧壁的完整性对髓内与髓外固定治疗股骨粗隆间骨折的生物力学影响,指导临床选择内固定方式。方法：采用成人尸体同侧股骨标本12具,均造成股骨粗隆间骨折AO 分型A1型骨折,随机分为外侧壁完整PFNA组、外侧壁完整PF-LCP组、外侧壁破损PFNA组、外侧壁破损PF-LCP组,每组3具,4组股骨标本采用万能材料测试机进行压缩载荷实验,观察股骨标本的最大载荷力,并用游标卡尺测量骨折断端的压缩前后的间隔位移及骨折远、近端沿粗隆间的滑动位移进行相互比较。结果：外侧壁完整PFNA组的最大载荷力大于外侧壁完整PF-LCP组,并且外侧壁破损PFNA组的最大载荷力也大于外侧壁破损PF-LCP组,差异均具有统计学意义（P<0.05）;压缩前4组股骨标本的骨折端间隔距离相互比较差异无统计学意义（P>0.05）,压缩后外侧壁完整PFNA组的骨折端间隔距离、压缩前后的骨折端位移及骨折远、近端的滑动位移与外侧壁完整PF-LCP组相互比较差异均无统计学意义（P>0.05）,但外侧壁破损PFNA组的骨折端间隔距离、压缩前后的骨折端位移及骨折远、近端的滑动位移均小于外侧壁破损PF-LCP组,差异均具有统计学意义（P<0.05）.结论：髓内固定治疗股骨粗隆间骨折具有更强的载荷力,股骨外侧壁完整时髓内与髓外固定均有较强的稳固性,但股骨外侧壁破损时髓内固定具有更强的稳固性,可见髓内固定是治疗股骨粗隆间骨折的首选方式。     

单侧单管AO外固定器治疗股骨粗隆间骨折

为探讨AO外固定器治疗股骨粗隆间骨折的疗效及优点,对103例用单侧单管AO外固定器治疗的股骨粗隆间骨折进行回顾性的分析研究。该组病例经1/2～8年的随访,骨折全部愈合,5例有轻度髋内翻,占4.85％。年轻患者均已恢复原工作,老年患者95％髋关节功能恢复满意或较满意。认为该外固定器结构简单轻巧牢固,适应证宽,手术创伤小,易于掌握,可满足早期活动的需要,是治疗股骨粗隆间骨折可供选择的较为理想的方法之一。     

两种常用内固定治疗股骨转子间骨折的有限元分析

目的比较动力髋螺钉(DHS)与股骨近端防旋髓内钉(PFNA)内固定治疗AO2.1型股骨转子间骨折的生物力学稳定性。 方法运用有限元分析法,通过Mimics软件以及Geomagic软件分别建立正常股骨、DHS固定骨折模型、PFNA固定骨折模型,通过有限元分析软件模拟股骨负重时(单腿站立时股骨所承受的最大峰值),通过股骨应力分析、股骨内外侧应力、股骨头位移和内固定自身应力及位移等观察指标,来比较两种内固定方法对股骨生物力学的影响。 结果PFNA组在股骨的内外侧应力以及股骨头位移均小于DHS组,且内固定本身应力及位移也小于DHS组。 结论在治疗AO2.1型股骨转子间骨折中,PFNA组的股骨内外侧应力、股骨头位移、内固定自身应力及位移的值均小于DHS组,且更加接近于正常股骨,PFNA相比于DHS有着生物力学上的优势。     

Supplemental pinning improves the stability of external fixation in distal radius fractures during simulated finger and forearm motion

External fixation is commonly used in the treatment of distal radius fractures. In this in vitrod study, we investigated changes in fracture stability when using supplemental radial styloid pinning in combination with external fixation. Eight previously frozen cadaveric upper extremities were mounted in a computer-controlled wrist-loading apparatus. This device was used to generate finger and forearm motions through loading relevant tendons. An unstable extra-articular distal radius fracture was simulated by removing a dorsal wedge from the distal radius metaphysis. An electromagnetic tracking system measured fragment motion following randomized application of a Hoffman external fixator, a Hoffman external fixator with 2 supplemental radial styloid pins, and a dorsal 3.5-mm AO plate. Regardless of the fixation technique used in this unstable fracture model, fragment motion occurred when postoperative finger and forearm motions were simulated. The addition of radial styloid pins to a construct stabilized by an external fixator significantly improved fragment stability, approaching that achieved with the dorsal AO plate. (J Hand Surg 1999;24A:992–1000. Copyright © 1999 by the American Society for Surgery of the Hand.)     

不同方法固定胫骨不稳定 pilon 骨折的生物力学研究

目的 探讨不同方法 固定胫骨不稳定pilon骨折的生物力学性能. 方法 用7具新鲜国人踝关节标本制备Ruedi-Allgower Ⅲ型pilon骨折,根据不同固定方法 分5组,A组:内侧支撑钢板固定,B组:胫骨远端前外侧解剖型钢板加内侧空心钉固定,C组:外侧外固定支架加内侧空心钉固定,D组:外侧外固定支架加内侧支撑钢板固定,E组:内侧外固定支架加胫骨远端前外侧解剖型钢板固定.比较各组的强度、刚度、失效载荷等生物力学性能. 结果 A、B、C、D、E组胫骨远端的抗压应力值分别为(1.31±0.10)、(1.61±0.14)、(1.17±0.13)、(0.90±0.08)、(0.98±0.08)MPa,轴向刚度分别为(1224.49±115.40)、(1016.95±102.32)、(1395.34±140.12)、(1935.48±180.42)、(1764.71±174.76)N/mm,水平剪切刚度分别为(3076.92±304.20)、(2553.19±250.73)、(3529.41±344.42)、(4800.00±490.61)、(4444.45±451.52)N/mm,失效载荷分别为(2448±208)、(2034±184)、(2791±265)、(3871±382)、(3529±342)N,等效刚度值分别为(703±56)、(583±62)、(805±74)、(1100±108)、(1035±110)N·m/Deg. 结论 对于胫骨不稳定性pilon骨折,采用胫骨内侧支撑钢板或胫骨远端前外侧解剖型钢板附加外固定支架固定,不但具有优越的生物力学性能,等效刚度高,而且固定坚强、可靠,操作方便,踝关节稳定性好,为Ruedi-Allgower Ⅲ型pilon骨折切开复位手术固定选择提供了理论参考.     

Treatment of intertrochanteric fractures by external fixation

In this study, we aimed to evaluate the results of treatment of intertrochanteric fractures of the femur by external fixation in 33 patients with an average age of 65.9 years. Patients in the study had Evans stable type 1 intertrochanteric fractures and unstable type 1 fractures that could be reduced to anatomical or nearly anatomical position by closed manipulation under fluoroscopy. The average follow-up period was 24 months (range, 12 to 40 months). There was no mortality in the early postoperative period, but the mortality within six month following surgery was 39%. Complete fracture healing was achieved in all patients. The fixator was removed after an average of 94 days (75 to 130 days) at the outpatient clinic. Varus malalignment of more than 20 degrees and limb shortening greater than 2 cm were noted in 3 patients. Pin-tract infection was seen around 10 pins (7%). Osteomyelitis was not noted in any patients. Treatment of intertrochanteric fractures by external fixation is simple and can be done under local anesthesia together with narcotic analgesic support. It allows early mobilization, and implant removal is easy. Therefore we think that external fixation is a valuable alternative in high-risk geriatric patients.     

An externally fixed femoral fracture model for mice.

Transgenic and knockout mouse models can be used to help understand the molecular mechanisms of fracture repair. This study examines the feasibility of applying an external fixator to the mouse femur as one model for studying fracture repair. The external fixator consisted of two aluminum blocks connected by two rods. Four pins are used to connect the blocks to the bone. Mechanical characterization of the fixators was carried out prior to their use. Sixty-two wild type mice with bilateral femoral fractures were created using an open technique and fixed using the fixator. The progress of fracture healing was monitored radiologically before sacrifice and by mechanical testing and histology after sacrifice. Initially four mice died intraoperatively from excessive blood loss, the intraoperative mortality was subsequently reduced by subcutaneous saline infusion. The bone healed between 14 and 21 days after fracture and remodeled by 60 days. Both radiological and mechanical assessments showed a steady progression of bone healing. Histology demonstrated callus and endochondral bone formation. This study demonstrated that it is possible to create a mouse femoral fracture model stabilized by external fixation and will provide an additional model to the understanding of fracture healing in transgenic and knockout mice.     

Triangular support intramedullary nail: A new internal fixation innovation for treating intertrochanteric fracture and its finite element analysis

BackgroundProximal femoral nail anti-rotation (PFNA) and Gamma nail were recommended for intertrochanteric fracture, however, with high rate of post-operation complications. The triangular support intramedullary nail (TSIN) was designed to reduce the risk of postoperative complications related to Gamma nail and PFNA, and the aim is to compare the biomechanical characters of Gamma nail, PFNA and TSIN for fixation of intertrochanteric fracture and prove the rationality of the concept of triangle fixation in the treatment of intertrochanteric fractures.MethodsThe finite element model of proximal femur was constructed according to the CT data of femur. Intertrochanteric fracture models with Evans type Ⅰ and Ⅳ were established and fixed with Gamma nail, PFNA and TSIN by UG-NX 12.0. The finite element analysis software was used to compare the stress distribution and displacement of three implants fixation models.ResultsUnder axial loading of 600 N, the peak stress and maximum displacement of intact proximal femur was 13.78 MPa and 1.33 mm, respectively. The maximum stress of TSIN for fixation of Evans type Ⅰ and Ⅳ intertrochanteric fractures was 86.23 MPa and 160.63 MPa which was significantly lower than that of Gamma nail and PFNA. The maximum relative displacement of fracture section in Gamma nail and PFNA fixation models was 0.18 mm and 0.19 mm which has 135% and 148% higher than in TSIN fixation models for fixing Evans type Ⅰ intertrochanteric fracture, and 0.47 mm and 0.59 mm which has 91% and 140% higher than in TSIN fixation models for stabilization of Evans type Ⅳ intertrochanteric fracture.ConclusionCompared with Gamma nail and PFNA fixation, TSIN has superior advantages in stress distribution and construct stability. We believe that triangle fixation concept help to reduce the risk of post-operative complications associated with PFNA and Gamma nail and improve the clinical effect of intertrochanteric fracture.     

加压空心钉式外固定架与动力髋螺钉治疗老年股骨转子间骨折的生物力学比较

目的评价加压空心钉式外固定架(PHN-EFP)和动力髋螺钉(DHS)治疗老年股骨转子间骨折的生物力学效果。方法采集8具新鲜人体股骨标本,进行贴片模拟临床生物力学试验,比较两种固定方法的生物力学特性。结果与DHS相比,PHN-EFP在抗压、抗弯和抗扭等生物力学性能上具有优势,失效载荷高于DHS 13%,差异具有统计学意义(P<0.05)。结论 PHN-EFP治疗老年股骨转子间骨折具有生物力学优势,手术操作方便,固定可靠,尤其对于老年股骨转子间骨折的治疗是理想的术式。