不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

不稳定Hangman骨折的手术治疗

Objective To investigate the clinical effects of pedicle screw fixation in the treatment of unstable Hangman fractures. Methods From October 2001 to April 2006, 15 patients with the unstable Hangman fractures were treated by the pedicle screw fixation after skull traction and reduction through posterior cervical approach. By Levine-Edwards classification, there were 3 cases of Ⅱ type, 4 cases of ⅡA type, 8 cases of Ⅲ type. Results The mean follow-up time was 17 (3 to 30) months. Six cases of Grade D by Frankel classification recovered to Grade E. Postoperative X-rays revealed bony union in all cases. No screw loosening or obvious functional limitation of the cervical vertebrae was found. In the cases of incomplete reduction, C2, 3 fixation was performed for patients without severe dislocation, and additional CA fixation with lateral mass screw was supplemented for patients with serere dislocation. Conclusion Posterior pedicle screw fixation of C2,3 or C2-4 is an effective and safe method for treating the unstable Hangman fractures.     

Treatment of tibiofibular fractures of Gustilo type Ⅲ by vacuum, sealing drainage and external fixation

Objective To report clinical efficacy of vacuum sealing drainage(VSD)and external fixation in the treatment of tibiofibular fractures of Gustilo type Ⅲ. Methods From October 2006 to November 2009,19 cases of Gustilo type Ⅲ tibiofibular fracture were treated in our department.They were 14men and 5 women,with an average age of 30.1 years(from 17 to 62 years).There were 9 cases of type ⅢA,8 cases of Type ⅢB 2 cases of typeⅢC.After emergency debridement,all the fractures were fixed with an extemal fixator following indirect reduction.The wounds were sealed with VSD.When the wounds were clean and granulation appeared,they were repaired by direct suture(5 cases),split-thickness skin graft(9 cases)and flap transposition(5 cases). Results The 19 cases were followed up for 12 to 24 months,with an average of 16.3 months.A11 the wounds were closed'after VSD for 5 to 17 days.Wound infection occurred in 2 cases and was finally repaired by flap transposition following repeated debridement and VSD.The fractures healed after 4 to 10 months(average,5.6 months). Conclusion External fixation combined with VSD is a simple and effective treatment for tibiofibular fractures of Gustilo type Ⅲ.because it can provide not only rapid fixation but also early wound sealing to facilitate fracture healing and reduce incidence of complications.     

掌侧入路AO双螺纹空心加压螺钉治疗舟骨骨折

目的 探讨掌侧人路AO双螺纹加压空心螺钉治疗舟骨骨折的适应证、手术方法及疗效.方法 2000年3月-2008年1月,通过透视机下复位,取掌侧入路AO双螺纹加压螺钉固定治疗2l例新鲜舟骨骨折.术后定期复查X线片,观察骨折愈合情况,按Krimmer评分方法评估腕关节功能.结果 术后21例获得3～24个月的随访,平均15个月.21例骨折均为Ⅰ期愈合,愈合时间平均为10周.按Krimmer法评分:优15例,良4例,可2例;优良率为90.5%.结论 对于舟骨腰部骨折,通过术中透视机下复位,经掌侧入路应用AO双螺纹加压螺钉固定,手术操作简便,创伤小,术后可早期进行活动,能有效提高骨折愈合率,功能良好.     

Bold螺钉治疗新鲜腕舟骨骨折疗效分析

目的探讨使用Bold螺钉内固定治疗新鲜腕舟骨骨折的疗效。方法对本院2004年1月-2007年6月期间采用Bold螺钉内固定治疗的19例新鲜腕舟骨骨折病例进行回顾性分析。骨折根据Herbert分型分为B2型骨折16例,B4型骨折3例。结果19例患者均获得随访,随访时间为7～22个月,平均11个月。骨折均获骨性愈合。末次随访时用改良Mayo法对腕关节功能进行评估,优12例,良5例,可2例,优良率为89．5％。结论对于不稳定的新鲜腕舟骨骨折（Herbert分型B型）,采用Bold螺钉内固定治疗可减少骨折不愈合率,促进腕关节功能恢复,改善预后。     

闭合复位经皮Herbert螺钉内固定治疗新鲜稳定型舟骨腰部骨折

目的：观察闭合复位经皮Herbert螺钉内固定治疗新鲜稳定型舟骨腰部骨折的临床疗效。方法对采用闭合复位经皮Herbert螺钉内固定治疗的12例新鲜稳定型舟骨腰部骨折患者进行随访,采用修订后Mayo腕关节评分标准对临床效果进行评价。结果所有患者均获得随访,随访时间13~23个月（平均15个月）,无感染、螺钉松动、过敏排斥反应及关节炎的发生。所有患者骨折均愈合,骨折愈合时间为8~14周,平均10周。按修订后Mayo腕关节评分标准：优7例,良4例,可1例,优良率91.7%。结论闭合复位经皮Herbert螺钉内固定治疗新鲜稳定型舟骨腰部骨折,具有操作简单,固定可靠,并发症少及能早期进行功能锻炼等优点。     

手术治疗舟骨骨折49例结果及体会

目的报道手术治疗49例舟骨骨折的结果及体会。方法经皮或切开复位Acutrak钉/空心钉/可吸收钉/U形钉内固定舟骨骨折,陈旧性骨折及骨坏死者加做带血管蒂桡骨茎突骨瓣移植,记录术后骨折愈合时间、握力、腕关节活动度、疼痛、恢复工作时间及腕关节功能评分。结果对本组患者进行随访1～8.5年,平均3.6年;骨折愈合时间为7～12周,平均10.8周。腕关节平均评分85.2分;功能优28例,良21例,差0例。所有患者均恢复原来的工作或改为较轻的工作。结论经皮或切开复位螺钉固定、带血管蒂桡骨茎突骨瓣移植是治疗舟骨骨折的一种好方法;骨折类型不同,手术方法也需有所变化。Acutrak钉固定效果好于空心钉或可吸收钉。短期随访,未见有桡骨茎突切除的并发症。桡腕关节桡侧切口有利于显露骨折端及骨瓣制备,值得推荐。带血管蒂桡骨茎突骨瓣移植可缩短骨折愈合时间。     

可吸收棒内固定治疗陈旧性腕舟骨骨折

目的探讨可吸收棒治疗陈旧性腕舟骨骨折的手术疗效。方法对17例陈旧性腕舟骨骨折,按Herbert分类:D1型4例,D2型11例,D3型2例,采用骨折切开复位自体松质骨植骨,可吸收棒内固定术。结果17例获得4~26个月随访,平均9个月。术后伤口均Ⅰ期愈合,骨折愈合时间8~19周,平均13周。腕关节活动范围掌屈[(49.5±8.5)°,x-±s,下同],(达健侧78.3%);背伸(41.5±4.5)°,(达健侧70.5%);桡偏(16.5±2.5)°,(达健侧57.1%);尺偏(24.5±5.5)°,(达健侧60.3%)。15例腕关节活动时无疼痛。2例有疼痛。腕部握力(24.7±3.1)kg,(达健侧83.2%)。术后X线片示17例均未发生腕骨性关节炎及舟骨缺血性坏死。结论可吸收棒治疗陈旧性舟骨骨折手术操作简单,固定牢靠,可缩短骨折愈合时间及提高骨折愈合率,是治疗陈旧性舟骨骨折的一种有效的手术方法。     

早期切开复位Herbert螺钉内固定治疗经舟骨月骨周围脱位

目的 评价早期切开复位、Herbert螺钉内固定治疗经舟骨月骨周围脱位的临床效果.方法 早期采用切开复位、Herbert螺钉内固定治疗新鲜经舟骨月骨周围脱位8例,术后随访X线片了解骨折愈合情况及腕关节轴线恢复情况.Cooney腕关节评分法评价术后腕关节功能恢复程度,DASH问卷调查表行术后腕关节功能自我评价.结果 术后随访时间为7～35个月,平均14个月.根据Cooney腕关节评分:优3例,良2例,中2例,差1例;平均评分值为76.DASH评分值为27.X线片检查舟骨完全愈合,腕关节轴线恢复好.结论 早期切开复位Herbert螺钉内固定能达到舟骨解剖复位、恢复腕关节轴线,术后功能恢复较好,是治疗新鲜经舟骨月骨周围脱位较好的方法.     

Pediatric scaphoid nonunion

PURPOSE: To report the outcome of pediatric scaphoid nonunions treated with a Herbert screw and bone graft. METHODS: This is a retrospective review of 12 cases of scaphoid nonunion in 12 skeletally immature patients treated with a uniform approach consisting of open reduction, iliac crest bone grafting and Herbert screw fixation. All patients were boys and presented with nonunions of the scaphoid waist. The final follow-up evaluation was at a mean of 32 months, ranging from 22 to 45 months, and consisted of assessing anatomic snuffbox tenderness, wrist arc of motion, grip strength, calculation of the Modified Mayo Wrist score, and assessment of union based on plain radiographs. RESULTS: At the latest follow-up evaluation, all patients were pain free (including absence of snuffbox tenderness) except one who experienced slight discomfort during extreme activities. There was no statistically significant difference in the arc of motion between the surgically treated and healthy sides, and the average grip strength was 96% that of the contralateral extremity. Clinical and radiographic union was present in all cases at a mean of 3.4 months after surgery. The Modified Mayo Wrist score was excellent in 11 patients and good in 1. There were no complications. CONCLUSIONS: Open reduction and internal fixation with a Herbert screw reliably obtained union in all patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Operative management of pediatric scaphoid fracture nonunion

Fractures of the scaphoid are uncommon childhood injuries that can usually be successfully managed by standard immobilization techniques. However, scaphoid waist fractures are less frequent in children and may proceed to nonunion. The authors retrospectively reviewed the charts and radiographs of 19 adolescents with 20 scaphoid waist fractures that had required operative intervention for nonunion from January 1975 to December 2000. All cases had undergone a trial of plaster immobilization, averaging 4.2 months, before operative intervention was performed. Operative management resulted in a 100% rate of union. Herbert or AO screw fixation and grafting was performed in 11, 2 had K-wire fixation and bone grafting, 6 had bone grafting and no fixation, and one had screw fixation with no graft. All but three patients were available for telephone interview, with an average follow-up of 6.1 years. One reported having mild pain at rest, 4 had discomfort with heavy activity, and the remaining 12 were pain-free. Only two had restriction of activity because of pain, with the remainder returning to previous levels of function. All but one reported complete satisfaction with the results of their operation. Operative intervention of nonunion of scaphoid waist fractures in children consistently offers successful fusion, with very low rates of nonunion and a high rate of patient satisfaction.     

The Herbert screw for fractures of the scaphoid. A review of results and technical difficulties

We have reviewed 22 patients with scaphoid fractures treated by internal fixation with the Herbert screw. Three patients had trans-scaphoid perilunar dislocations, one had an oblique displaced fracture of the waist of the scaphoid and 18 had fractures with delayed or non-union. Corticocancellous bone grafts were added in nine of the cases of non-union. Results were excellent or good in 80% of cases after a mean duration of postoperative immobilisation of four weeks. The technical difficulties are analysed and the problems of applying the jig and of operative exposure are discussed.     

Osteosynthesis for scaphoid fractures through a dorsal approach: one or two Herbert screws?

The aim of this work is to show the merits of retrograde scaphoid fixation through a dorsal approach using two Herbert screws in both recent and old fractures, without the need for bone grafting. Fifty three scaphoid fractures were operated on by the author between 1992 and 2000, using a dorsal approach (mean follow-up 4 years). The time between trauma and surgery, the type of fracture, the mode of bone fixation, the time of immobilisation, and the clinical and radiological results were all been evaluated. All fractures but one united, in a mean time of 75 days. The time needed to achieve bone union increases with the delay in treatment, as does the time for clinical healing which may be as long as one year. The technique of retrograde scaphoid fixation with two Herbert screws is described, evaluated from the biomechanical point of view, and compared to other methods of fixation. In contrast to a single screw, two Herbert screws give complete stability of fixation, and guarantee a good clinical result provided the correct indications have been selected. This technique has advantages as an alternative procedure, especially in fractures that present after a significant delay, and enables one to avoid having to bone graft.