移位髋臼骨折的手术治疗

目的：探讨移位髋臼骨折的手术方法。方法：对38例髋臼骨折不同类型不同手术入路分别用加压螺钉、可吸收螺钉，普通钢板及重建钢板等予以内固定治疗。结果：随访平均19个月（6－42个月）。术后未发生伤口感染、坐骨神经或血管损伤及深静脉栓塞。复位情况按Judet方法评估，达到解剖复位者30例，复位满意者5例，不满意3例。按美国矫形外科研究院标准评估疗效：优23例，良8例，可4例，差3例。结论：开放复位内固定是治疗髋臼骨折较为可靠的方法，正确的骨折分型、手术切口的选择是复位成功的关键，内固定材料的选择是手术疗效的保证。     

切开复位内固定治疗复杂髋臼骨折

目的探讨切开复位内固定手术治疗复杂髋臼骨折的疗效。方法 15例经Letournel分型确诊为复杂髋臼骨折,分别采用Kocher-Langenbeck入路、髂腹股沟入路或前后联合入路显露和复位,应用重建钢板内固定治疗。结果本组均获4～24个月随访,平均12个月。按Matta标准:解剖复位14例,满意复位1例;根据美国矫形外科研究院评分系统评估疗效:优13例,良1例,可1例。结论术前完善的影像学检查,对骨折进行正确的分型,选择合适的手术入路,良好的复位和内固定都是提高复杂髋臼骨折手术疗效的关键。     

移位髋臼骨折的手术治疗

目的　探讨移位髋臼骨折的手术方法。方法　对 38例髋臼骨折按不同类型不同手术入路分别用加压螺钉、可吸收螺钉 ,普通钢板及重建钢板等予以内固定治疗。结果　随访平均 1 9个月 (6～ 42个月 )。术后未发生伤口感染、坐骨神经或血管损伤及深静脉栓塞。复位情况按Judet方法评估 ,达到解剖复位者 30例 ,复位满意者 5例 ,不满意 3例。按美国矫形外科研究院标准评估疗效 :优 2 3例 ,良 8例 ,可 4例 ,差 3例。结论　开放复位内固定是治疗髋臼骨折较为可靠的方法 ,正确的骨折分型、手术切口的选择是复位成功的关键 ,内固定材料的选择是手术疗效的保证     

复杂髋臼骨折的手术治疗

目的总结复杂髋臼骨折的治疗效果。方法手术治疗复杂髋臼骨折16例,根据骨折类型采用重建钢板及拉力螺钉固定。结果患者均获随访,时间3～24个月。复位情况按Matta标准:解剖复位10例,满意复位6例。关节功能按改良D′Aubigne和Postel评定标准:优8例,良5例,可2例,差1例。结论术前明确骨折分类、手术时机适当、合适入路、可靠内固定及满意复位是提高髋臼骨折治疗效果的关键。     

移位髋臼骨折的手术治疗

目的探讨移位髋臼骨折的手术方法。方法对22例髋臼骨折按不同类型、不同手术入路分别用加压螺钉、重建钢板等予以内固定治疗。结果平均随访14个月(5~30个月)。术后发生1例伤口感染和1例坐骨神经牵拉伤,未发生血管损伤及深静脉栓塞。复位情况按Judet方法评估,达到解剖复位者18例,复位满意者4例。按美国矫形外科研究院标准评估疗效,优14例,良5例,可2例,差1例。结论重建钢板内固定治疗移位髋臼骨折是有效的方法,正确的骨折分型、手术切口的选择是复位成功的关键。     

有移位髋臼骨折开放复位策略分析

[目的]探讨不同髋臼骨折的手术治疗方法。[方法]1995年1月-2006年3月对126例有移位髋臼骨折进行了开放复位内固定，其中，简单骨折61例，复杂骨折65例；陈旧性骨折14例，新鲜骨折112例。根据骨折复杂程度，首先处理关节腔内游离骨块，将负重区关节软骨下压缩骨折或翻转骨折复位，然后借助器械或手法矫正骨折端旋转或前后（内外）移位，最后解决分离移位，复位后果用重建钢板内固定。[结果]本组无死亡病例，术后解剖复位78例，满意复位42例，不满意复位6例。随访1-12年，髋关节功能优良率90．47％。[结论]不同的髋臼骨折须采取不同的开放复位策略，其选择决定于髋臼骨折的类型、移位方向及其相应的手术入路。     

扩展型髂股切口手术治疗复合型髋臼骨折

目的探讨扩展型的髂股切口的优缺点和手术方法治疗复杂髋臼骨折的疗效。方法回顾性总结了2002年至2005年收治的资料完整的手术治疗髋臼骨折26例．按照Letournel—Judet分型：横行伴后壁骨折2例．T型骨折8例，前方伴后方半横行骨折3例和完全双柱骨折13例，均采用扩展型的髂股切口手术治疗，根据不同骨折类型采用重建钢板和拉力螺钉固定。结果全部患者均得以随访，平均随访14个月．复位情况按Matta评分标准，解剖复位20例，满意复位4例，不满意复位2例。髋关节功能参照Matta评分系统进行评估，优21例，良2例，一般2例，差1例。结论手术治疗是复杂髋臼骨折的有效治疗方法，扩展型髂股人路对复杂髋臼骨折手术治疗是一个良好的选择。     

手术治疗髋臼骨折

目的总结髋臼骨折的治疗效果。方法手术治疗髋臼骨折20例，根据骨折类型采用重建钢板及拉力螺钉固定。结果患者均获随访，时间6～24个月。复位情况按Matta标准评价，解剖复位12例，满意复位8例。关节功能按改良D′Aubigne和Postel评定标准，优9例，良6例，可3例，差2例。结论术前明确骨折分类、手术时机适当、合适入路、可靠内固定及满意复位是提高髋臼骨折治疗效果的关键。     

复杂髋臼骨折手术疗效的影响因素分析

目的探讨影响复杂髋臼骨折手术疗效的关键因素。方法对41例复杂髋臼骨折行重建钢板内固定治疗,从患者年龄、受伤机制、骨折分型、合并损伤、手术时机、复位质量以及有无创伤性关节炎对临床疗效进行Postel-D’Aubigne评分。结果按Matta复位标准:解剖复位19例,满意复位18例,不满意复位4例。41例获得38~92个月随访,平均(54.0±2.8)个月,疗效按髋关节功能Postel-D’Aubigne评分标准:优14例,良16例,可6例,差5例,优良率73.2%。髋臼骨折解剖复位优良率89.5%(17/19),非解剖复位优良率59.1%(13/22),差异有统计学意义(χ2=4.79,P=0.03)。结论早期手术,正确运用复位技巧和固定方法,妥善处理股骨头损伤或股骨颈骨折,尽可能在一个切口内采用重建钢板和拉力螺钉完成骨折固定,预防创伤性关节炎,均是提高髋臼骨折手术疗效的重要环节。     

前柱钢板固定结合后柱逆行拉力螺丝钉治疗复杂髋臼骨折16例

[目的]探讨经髂腹股沟入路治疗复杂髋臼骨折的手术技巧。[方法]经髂腹股沟入路以重建钢板固定前柱、逆行拉力螺丝钉固定后柱治疗复杂髋臼骨折16例，其中双柱骨折10例，前柱伴后半横行骨折5例，“T”形骨折1例。[结果]解剖复位（移位〈1mm）11例，复位欠佳（移位3mm）4例，复位不满意（移位〉3mm）1例。随访11～37个月，根据改良的Merle d Aubigne及Postel髋关节得分进行功能评价，优9例、良4例、可3例。[结论]前柱钢板固定结合后柱逆行拉力螺丝钉固定，使经髂腹股沟入路治疗大部分髋臼双柱骨折、前柱伴后半横行骨折、T形骨折成为可能，避免了联合应用后方切口，减少了手术创伤。     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。