面中份骨折小钛板内固定和钢丝骨间结扎治疗的比较观察

目的比较钢丝骨间结扎和小钛板内固定治疗面中份骨折的临床效果。方法采用头皮冠状入路及辅助切口,对40例面中份骨折行钢丝骨间结扎和小钛板坚固内固定治疗。结果钢丝骨间结扎不能获得良好的稳定性,而小钛板坚固内固定则可重建面中份骨骼的支柱结构,获得足够的三维稳定性和重建理想的面部外形。在眶下缘、颧上颌缝区,手术野显露较差,小钛板内固定较钢丝骨间结扎更为方便可靠。结论小钛板坚固内固定是治疗面中份骨折的最佳方法。     

面中份骨折小钛板内固定和钢丝骨间结扎治疗的比较观察

目的比较钢丝骨间结扎和小钛板内固定治疗面中份骨折的临床效果。方法采用头皮冠状入路及辅助切口,对４０例面中份骨折行钢丝骨间结扎和小钛板坚固内固定治疗。结果钢丝骨间结扎不能获得良好的稳定性,而小钛板坚固内固定则可重建面中份骨骼的支柱结构,获得足够的三维稳定性和重建理想的面部外形。在眶下缘、颧上颌缝区,手术野显露较差,小钛板内固定较钢丝骨间结扎更为方便可靠。结论小钛板坚固内固定是治疗面中份骨折的最佳方法。     

小型钛板技术治疗下颌骨骨折45例探讨

目的：探讨小型钛板技术在下凳骨骨折治疗中的应用,术后应注意的事项。方法：口内切口进路小型钛板坚固内固定系统治疗下颌骨骨折。结果：术后患者咬He及面部形态恢复良好。结论：应用小型钛板坚固内固定系统治疗下颌骨骨折,固定可靠,术后无需作颌间结扎,确保患者保持良好的口腔卫生,口内切口进路避免面部遗留瘢痕和影响美观。     

面骨骨折纯微型钛板内固定临床分析

面骨骨折传统常采用钢丝内固定或钢丝悬吊辅助颌间结扎的治疗方法,手术间长,损伤大,操作难度相对较大,术后常需配合颌间结扎以增强固定,骨折愈合后一般需要再次手术取出钢丝,给患者造成了精神上、经济上的负担.随着口腔颌面骨折治疗技术的发展和改进,纯钛微型夹板内固定技术已被广泛接受,手术切开使骨折复位后,在骨皮质上使用微型纯钛板辅以螺钉使骨折牢固固定[1].本院自1993年使用纯微型钛板,共固定面部骨折172例,现报告如下.     

小钛板坚强内固定在颌面创伤治疗中的应用

为提高颌面骨骼创伤后继发畸形的修复效果，保证复位后固定的可靠性，采用小型钛板坚强内固定技术用于截骨后及骨折复位后的固定，自１９９６年１０月－１９９７年８月，共治疗各种颌面创伤畸形病人２０例，结果表明小钛板坚固内固定操作简便灵活，易于塑形，固定牢固可靠，可保证三维立体固定，特别是对于复杂型粉碎性骨折的Ｉ期修复及Ⅱ期重建的均有传统钢丝结扎固定无法顷拟的优点。它不但可以将粉碎的骨折块重新的拼接复位，更重     

三叶草钛板重建股骨大粗隆在人工股骨头置换治疗高龄股骨粗隆间不稳定骨折中的应用

目的探讨骨水泥型人工股骨头置换联合三叶草钛板内固定股骨大粗隆治疗高龄股骨粗隆间骨折的疗效。方法人工股骨头置换术治疗67例高龄股骨粗隆间骨折,股骨大粗隆采用钢丝及张力带重建33例,三叶草钛板内固定34例。结果 67例均获随访3~24个月,钢丝及张力带重建及三叶草钛板内固定重建并发症发生率分别为27.3%和11.8%,差异有统计学意义(P<0.05)。结论人工股骨头置换术中采用三叶草钛板内固定股骨大粗隆是一种有效且值得推广的方式。     

微型钛板内固定治疗颌骨骨折的疗效观察

目的探讨微型钛板内固定治疗颌骨骨折的临床效果。方法选择笔者所在医院收治的颌骨骨折患者80例,随机分为2组,对照组40例采用钢丝骨间结扎内固定治疗,观察组40例用微型钛板内固定治疗。结果治疗6个月随访,对两组患者咬合关系、张口度及颞颌关节区不适进行回顾性比较分析,观察组治愈率为97.5%,对照组治愈率为72.5%。两组效果比较差异有统计学意义（P〈0.05）。结论采用微型钛板内固定治疗颌骨骨折,提高了临床治愈率,安全有效,并发症发生率低,明显提高了患者生存质量。     

小钛板坚强内固定在颌面创伤治疗中的应用

为提高颌面骨骼创伤后继发畸形的修复效果，保证复位后固定的可靠性，采用小型钛板坚强内固定技术用于截骨后及骨折复位后的固定。自１９９６年１０月～１９９７年８月，共治疗各种颌面创伤畸形病人２０例。结果表明小钛板坚强内固定操作简便灵活，易于塑形，固定牢固可靠，可保证三维立体固定。特别是对于复杂型粉碎性骨折的Ⅰ期修复及Ⅱ期重建均具有传统钢丝结扎固定无法比拟的优点。它不但可以将粉碎的骨折块重新拼接复位，更重要的是通过钛板的塑形，可保证颌面骨固定后特定解剖形态的要求。所有病例无并发症发生，效果良好。小钛板坚强内固定是一种可靠的、效果优良的内固定技术，适用于各种颌面创伤后骨折复位的固定。并对手术操作要点及其优缺点进行了讨论     

口内入路下颌升支矢状劈开术的改良及应用

目的：为便于术中行骨间坚固内固定和增强术后的稳定性，设计改良的口内入路下颌升支矢状劈开术方法并进行应用。方法：66例牙颌面畸形患者均行改良的口内入路下颌升支矢状劈开术。切口设计要点：①软组织切口宜延至第二前磨牙；②骨组织垂直切口应从第一磨牙近中面始垂直向下颌缘；宜在每侧下颌升支骨间斜形线近远骨端两侧用三块小型钛板钛钉行坚固内固定，间隔10mm。术后辅以1～2周颌间牵引固定。结果：无论下颌骨前徙、后退或旋转，下颌骨均较稳定地在设计的位置愈合，获得满意的颜面外形和稳定的咬合关系。结论：该手术改良便于术中骨断端间行坚固内固定，同时钛板钛钉坚固内固定的方法与位置可减少损伤下齿槽神经血管束，增加了术后骨段间的接触面与稳定性并预防了复发。另外，术前与术后正畸治疗的配合是必需的。     

颈前路减压术后颈椎重建的研究进展

颈前路减压后重建颈椎生理曲度、椎间高度及稳定性对保证手术疗效、避免手术并发症较为重要.文中综述了颈前路经间隙椎间盘切除减压和椎体次全切减压后的颈椎重建.经间隙减压后颈椎重建有单纯骨块植骨、骨块植骨钛板内固定、椎间融合器植骨、椎间融合器植骨钛板内固定以及颈椎人工椎间盘置换;椎体次全切减压颈椎重建有单纯骨块植骨、骨块植骨钛板内固定、钛网植骨钛板内固定、椎间融合器和钛网植骨钛板内固定.颈椎融合术后部分患者存在椎间高度丢失和植骨不融合是两个主要的问题.人工椎间盘可保留椎节运动,但适应证较窄.颈椎彻底减压后应选择最合适的方式重建颈椎椎间高度和稳定性.     

柱状植骨结合微型钛板内固定治疗严重粉碎性掌骨骨折

目的：探讨柱状植骨结合微型钛板治疗严重粉碎性掌骨骨折的可行性及临床疗效。方法对7例严重粉碎性掌骨骨折行柱状植骨结合微型钛板内固定治疗。结果所有病例随访18个月,骨折均获愈合,达到解剖复位,植骨块塑形良好。结论柱状植骨结合微型钛板内固定治疗严重粉碎性掌骨骨折临床疗效满意,骨折可获得良好复位及内固定,促进骨折早期愈合,利于手部功能恢复,值得临床推广。     

面中部多发性骨折治疗

目的总结颜面部中1／3多发性骨折的治疗经验。方法对53例面中1／3多发性骨折采用不同切口的骨折复位，微型钛板内固定来恢复咬（牙合）关系及面部外形。结果53例患者术后骨折线对位良好，咬（牙合）关系及张口度恢复良好，面中部无明显不对称。结论微型钛板坚固内固定辅助颌间固定是治疗面中1/3多发性骨折的有效方法。     

Lag screw fixation in midface fractures

Through analysis of case series from medical record review, this article demonstrates how lag screw fixation may be used to effectively treat obliquely oriented maxillary, zygomatic, and orbital rim fractures. Lag screw fixation of midface fractures has been overshadowed by other readily available plate fixation techniques. Nonetheless, lag screw fixation provides quick, stable, and effective reduction of obliquely oriented maxillary, zygomatic, and orbital fractures without risk of plate exposure and with potentially superior primary osteosynthesis. Lag screw fixation remains an excellent alternative to plate fixation techniques in the repair of appropriate midface fractures.     

Use of self-reinforced polylactide osteosynthesis devices in craniofacial surgery: a long-term follow-up study

Self-reinforced polylactic acid or polylactide (SR-PLA) is a biodegradable polymer, which is strong enough to fix weight-bearing cortical bone fractures and osteotomies. We report our experience and follow-up of the use of SR-PLA plates in 15 clinical cranioplasties. Two of the cases are described in greater detail. In one of them SR-PLA plates were used in addition to titanium plates, and in the other an SR-PLA plate fixed with mini-titanium screws was used as the only fixation material. In the other patients SR-PLA plates or wire were used in addition to titanium. So far no complications have been observed in these 15 patients. The only small superficial fistula was associated with a titanium plate and titanium screws. The longest follow-up has been over eight years. Recent results show metal-like deformation properties in addition to complete late resorption, making SR-PLA osteosynthesis devices promising for use in craniofacial surgery.     

Use of self-reinforced polylactide osteosynthesis devices in craniofacial surgery: a long-term follow-up study.

Self-reinforced polylactic acid or polylactide (SR-PLA) is a biodegradable polymer, which is strong enough to fix weight-bearing cortical bone fractures and osteotomies. We report our experience and follow-up of the use of SR-PLA plates in 15 clinical cranioplasties. Two of the cases are described in greater detail. In one of them SR-PLA plates were used in addition to titanium plates, and in the other an SR-PLA plate fixed with mini-titanium screws was used as the only fixation material. In the other patients SR-PLA plates or wire were used in addition to titanium. So far no complications have been observed in these 15 patients. The only small superficial fistula was associated with a titanium plate and titanium screws. The longest follow-up has been over eight years. Recent results show metal-like deformation properties in addition to complete late resorption, making SR-PLA osteosynthesis devices promising for use in craniofacial surgery.     

Gelenknahe Fraktur

Juxta-articular fractures by definition involve the metaphyseal bone. Depending on the age of the child and the direction of displacement, there is a good potential for spontaneous correction due to the proximity to the growth plate; therefore, many of these fractures do not need an implant and can be conservatively treated. On the other hand, there may be damage to the growth plate with subsequent growth arrest. These aspects have to be considered when choosing the optimal fixation method. On the one hand stable fracture fixation is required but on the other hand the growth plate should not be significantly damaged. The most commonly used method is Kirschner wire osteosynthesis. Compression screw fixation can be an alternative in Salter and Harris type II fractures with an adequately large metaphyseal fragment. Screw fixation is also used in displaced metaphyseal avulsions or apophyseal fractures. With respect to the method of stabilization, the transition between the diaphyseal and metaphyseal regions poses a special challenge. Usually pin fixation does not lead to sufficient stability. Also elastic stable intramedullary nailing is not considered to be well suited for fractures in this region. Alternatives can be external fixator or plate osteosynthesis.     

Die Versorgung der distalen Radiusfraktur

Background

How effective is open reduction and internal fixation with palmar locking plates compared to closed reduction and internal fixation with K-wires in the treatment of fractures of the distal radius?

Method and materials

A systematic review of the literature was performed for the years 2002 to 2012 to find controlled studies comparing K-wires and locking palmar plates. Follow-up, complications, functional results, radiographic results and peculiarities of the studies were analyzed.

Results

A total of five controlled studies could be found and additionally the data of one unpublished controlled prospective study were added. In two studies a better function (DASH) could be achieved following palmar locking plate osteosynthesis, in one study better results were found following K-wire osteosynthesis and three studies found no significant differences. Ulna variation was found to be better restored following palmar locking plate osteosynthesis in two, palmar inclination in two and radioulnar inclination in one study. There were 7.3% complications following palmar locking plate osteosynthesis compared to 20% following K-wire fixation; however, the complications following plate osteosynthesis were more severe.

Conclusions

Palmar locking plates as well as K-wire fixation are suitable techniques for the treatment of fractures of the distal radius. The higher stability of locking plates seems to lead to an earlier functional recovery but this possible advantage disappears in the long-term follow-up.     

普通钢板挤压复位接骨术治疗胫骨骨折

目的 评价普通钢板挤压复位接骨术治疗胫骨骨折的临床疗效。方法 2001年3月～2003年9月，采用普通钢板挤压复位接骨术治疗48例胫骨骨折患者。结果 全部病例均经6—24个月随访，平均15个月。骨折愈合时间12—16周，平均14周。无延迟愈合或不愈合，无感染及内固定失败等并发症。结论 普通钢板挤压复位接骨术治疗胫骨骨折符合生物力学的固定原则，有利于骨折的愈合。