经后路椎管骨块推入复位加椎弓根钉固定治疗胸腰段单椎体爆裂骨折

目的探讨应用后路椎管骨块推入复位加椎弓根钉固定治疗胸腰段单椎体爆裂骨折的疗效。方法对17例胸腰段单椎体爆裂骨折,采用后路打开椎管应用"L"形椎体骨块推入器将凸入椎管内的骨块推回爆裂的椎体使其复位,恢复或基本恢复椎管的矢状径,解除骨块对脊髓或神经根的压迫,同时采用椎弓根脊柱撑开固定加椎板或横突植骨术的治疗。结果术后椎管矢状径平均复原92.4%,截瘫指数有1~3分改善,伤椎高度平均恢复至原高度的81.47%。结论后路推入复位加椎弓根钉固定治疗胸腰段单椎体爆裂骨折的方法,能够较好复位凸入椎管内的骨块,有效的解除椎管的骨性压迫,恢复椎体高度和椎管矢状径,损伤小,疗效满意。     

自制椎管内骨块复位器在胸腰椎爆裂骨折椎弓根钉内固定术中的应用

目的观察并评价自制椎管内骨块复位器在后路椎弓根钉内固定治疗胸腰椎爆裂骨折术中的应用效果。方法纳入自2016-01—2017-12采用后路椎弓根钉内固定撑开复位并椎板减压术治疗的40例胸腰椎爆裂骨折,20例术中采用自制椎管内骨块复位器复位椎管内骨折块(观察组),20例术中采用常规器械复位椎管内骨折块(对照组)。比较2组末次随访时脊髓神经功能ASIA分级、疼痛VAS评分、伤椎Cobb角、GQOL-74评分。结果 40例均获得至少12个月随访。观察组术后仅出现1例(5%)尿潴留,对照组出现6例(33%)并发症(1例脑脊液漏,1例硬脊膜撕裂,1例医源性神经损伤,3例尿潴留),观察组并发症发生率低于对照组,差异有统计学意义(P 0.05)。观察组末次随访时脊髓神经功能ASIA分级、疼痛VAS评分、伤椎Cobb角、生活质量GQOL-74评分均优于对照组,差异有统计学意义(P 0.05)。结论自制椎管内骨块复位器能有效复位胸腰椎爆裂骨折患者椎管内占位的骨折块,有利于促进患者神经功能恢复,矫正后凸畸形,并且可以降低并发症发生概率,提高患者生活质量。     

自制C型复位器治疗胸腰椎爆裂骨折的临床观察

对胸腰段爆裂骨折椎体骨折块压迫脊髓神经出现神经损害症状者,需手术治疗,而后路手术在术中需对凸入椎管的骨折块进行复位。2007年1月～2008年4月,我们采用后正中入路椎管减压术治疗胸腰段爆裂骨折患者35例,术中以自制C型复位器复位椎管内骨折块,     

胸腰段爆裂骨折伤椎内植骨术后矢状面形态变化

[目的]分析后路短节段椎弓根螺钉固定联合伤椎内植骨对胸腰段爆裂骨折椎体矢状面形态变化的影响。[方法]回顾性分析2014年1月~2017年1月因胸腰段爆裂骨折在本科行后路短节段椎弓根螺钉固定+伤椎内植骨术的41例患者的临床及影像学资料,根据CT矢状面重建图像,比较分析手术前后椎体前缘高度、椎体中央高度、Cobb角的变化,同时分析椎体骨折块向椎管内压迫程度的改善情况。[结果]41例患者均顺利完成手术,椎体前缘高度由术前(53.31±9.12)%恢复至术后的(98.23±8.68)%(P<0.001),椎体中央高度由术前(64.14±8.79)%恢复至术后的(92.52±6.01)%(P<0.001),Cobb角由术前(22.92±6.88)°恢复至术后的(8.17±6.06)°(P<0.001),骨折块压迫程度由术前(31.12±11.66)%恢复至术后的(9.30±4.68)%(P<0.001),椎体前缘高度恢复量为(44.92±3.90)%,优于椎体中央高度恢复量(28.38±3.67)%(P<0.001)。[结论]后路短节段椎弓根螺钉固定联合伤椎内植骨术能有效恢复椎体前缘高度,矫正后凸畸形,并通过间接复位的方式改善椎管内压迫,但并不能完全有效恢复椎体中央高度。     

胸腰段爆裂骨折经后路间接减压的影像学观察

目的本文旨在探讨后路间接减压治疗胸腰段爆裂骨折对椎管减压的效果。方法选择2005年1月-2006年12月,胸腰段爆裂骨折应用后路撑开复位间接减压治疗45例,从影像学方面分析疗效。观察指标为手术前后的伤椎前后缘高度,腰椎后凸畸形(Cobb's角),椎管的正中矢状径的变化。并应用统计学分析。结果伤椎前缘高度由术前51%恢复到术后92%;伤椎后缘高度由术前56%恢复到术后93%;Cobb's角由术前28.6恢复到术后5.8。椎管受压程度,删除椎管开放减压4例,余受压的椎管正中矢状径由术前58%恢复到89%。结论合理选择适应证,后路撑开复位间接减压治疗胸腰段爆裂骨折对椎管减压的疗效满意,术中C臂透视分析影像学椎体后缘骨块形态有助于提高椎管减压效果。     

椎管内骨折块复位器在胸腰椎骨折后路手术中的应用

目的：评估椎管内骨折块复位器在胸腰椎骨折后路手术中的疗效及应用价值。方法：39例病人手术前CT及MRI提示胸腰椎骨折并伴有椎体后缘骨折块突入椎管压迫脊髓，行后路切开复位内固定＋全椎板切除减压，用椎管内骨块复位器在后侧方推挤使椎体后缘骨折块复位，并达到恢复椎管容积的目的。结果：术后X光平片、CT检查37例椎管容积恢复至正常80％以上，2例CT见仍有小骨块突出，经2次手术治疗复位。术后随访6－30个月，Frankel分级平均进步1－2级。结论：椎管内骨块复位器扩大了胸腰椎骨折后路手术治疗适应证范围，复位效果确切，操作简便安全，值得推广。     

伴椎管侵占的A3型胸腰段椎体骨折影像学参数与后路间接减压效果的关系

【摘要】 目的：分析伴椎管侵占的A3型胸腰段椎体骨折患者的影像学参数，探讨其与后路间接减压效果的关系。方法：回顾分析2020年7月~2022年7月收治的58例伴椎管侵占的A3型胸腰段椎体骨折患者的资料，患者均接受后路间接减压内固定手术治疗。根据术中椎管内骨折块复位程度分为复位组（45例）和复位不良组（13例），复位不良组加做半椎板切除椎管减压术。比较两组病例的骨折相关参数，包括术前伤椎椎体压缩比、术中伤椎高度恢复程度、术前节段后凸角、术前骨折块位于后壁的位置、术前骨折块翻转角度、术前椎管侵占率、术前骨折块高度与伤椎体后壁高度比值、术前骨折块宽度与伤椎椎管横径比值及术后神经功能恢复程度。多因素Logistic回归分析影响椎管内骨折块复位的危险因素。结果：复位组的术前伤椎椎体压缩比、节段后凸角及椎管侵占率分别为（34.98±6.06）%、20.64°±3.04°及（46.65±15.99）%，复位不良组分别为（43.20±12.80）%、24.80°±3.71°及（64.70±18.90）%，复位组均小于复位不良组，两组比较差异有统计学意义（P＜0.05）。复位组的术中伤椎高度恢复程度[（89.31±6.78）%]大于复位不良组[（65.87±4.67）%]，差异有统计学意义（P＜0.001）。两组间术前骨折块翻转角度、骨折块位于后壁的位置、骨折块高度与伤椎体后壁高度比值、骨折块宽度与伤椎椎管横径比值及术后神经功能恢复程度比较均无统计学差异（P＞0.05）。多因素Logistic回归分析显示，术前伤椎椎体压缩比、节段后凸角、椎管侵占率及术中伤椎高度恢复程度是影响椎管内骨折块复位的危险因素。结论：对于伴椎管侵占的A3型胸腰段椎体骨折，术前伤椎椎体压缩比、节段后凸角、椎管侵占率及术后伤椎高度恢复程度是影响后路间接减压术后椎管内骨折块复位程度的重要参数。     

后路不同复位方式治疗胸腰椎爆裂骨折的临床疗效观察

目的探讨后路不同复位方式治疗胸腰椎爆裂骨折疗效比较。方法对55例AO分类为A型及部分B1、B2型的胸腰椎骨折患者临床资料进行回顾性分析:均采用后路手术,伤椎置钉;其中一组(A组)以单纯后方轴向撑开复位骨折椎体;另一组(B组)以伤椎椎弓根螺钉按撬拨、矫形原理恢复生理弧度及椎体高度,再适当撑开或不撑开,分别从伤椎前缘压缩比、侧位Cobb角、椎管面积比对比两组的治疗效果。结果 2组术前、术后椎体前缘压缩比、Cobb角及椎管面积比均有统计学意义(P<0.05),在椎体前缘压缩比和Cobb角恢复方面,B组明显优于A组,差异显著(P<0.05),并且无后方韧带复合结果过撑现象。结论伤椎置钉技术对胸腰爆裂椎骨折具有良好的即时复位效果,但通过伤椎螺钉撬拨复位优于单纯后方轴向撑开。     

嵌击骨块复位结合AF钉治疗胸腰椎爆裂骨折

自2002年3月～2005年3月采用后路单侧椎板椎弓根入路,用嵌击复位器使椎体骨折向后移位的骨折块复位,复位方便、迅捷、有效,解除脊髓的压迫彻底,同时采用AF钉内固定治疗胸腰段爆裂骨折62例,收到良好效果.报告如下.     

对AF系统整复压缩爆裂骨折椎体高度及椎管横截面的观测

目的 :量化评价AF系统恢复胸腰段压缩爆裂椎体高度椎管截面积的效果。方法 :测量AF系统治疗的 72例胸腰段压缩爆裂骨折术前后影像。统计椎体前后缘高度、Cobb角、椎管截面积资料。结果 :术后伤椎前缘高度恢复至 ( 96.5± 2 .3 ) %后缘高度恢复至 ( 98.2± 0 .9) % ,Cobb角恢复至 ( 5 .4± 1.5 )° ,椎管截面积恢复至 ( 97.2± 2 .1% ) ,各项指标与术前比较有非常显著性差异 (P <0 .0 0 1)。术后随访 0 .5～ 3 .5年 ,神经功能按Frankel评定 :60例提高 1～ 3级。结论 :AF系统能恢复或基本恢复胸腰段压缩爆裂骨折椎体的前后缘高度、Cobb角、椎管容积 ,为脊髓神经功能的恢复提供一个良好的环境。是治疗脊柱胸腰段压缩爆裂骨折较好的内固定器。     

Talar body fracture combined with bimalleolar fracture

The incidence of talar fractures is relatively low affecting usually young patients, while recent epidemiological studies have shown that talar body fractures represent a significant proportion of the total number of talar fractures. Talar body fractures are usually high-energy injuries and often a combined talar neck and body fracture is noted. An association between talar body fractures and ankle fractures has also been recorded involving the medial or lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture that was found in the literature is referred to a talar neck fracture. In this report, a combination of a talar body fracture and bimalleolar ankle fracture in a polytraumatised young patient is presented. This combined injury pattern seems to be very rare, since a similar case was not found in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. Minimal osteoarthritic changes of the tibiotalar joint were noted at 3 years follow-up with satisfactory functional results.     

伴有Tillaux-Chaput骨折块的成人踝关节骨折的手术治疗

目的 :探讨手术治疗伴有Tillaux-Chaput骨折块的成人踝关节骨折的临床疗效。方法:2014年1月至2018年12月采用手术治疗15例伴有Tillaux-Chaput骨折块的成人踝关节骨折患者,其中男9例,女6例;年龄27～67(45.6±14.3)岁;左侧8例,右侧7例。观察患者骨折愈合及并发症情况,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价踝关节功能恢复情况。结果:15例患者均获随访,时间18～70(38.1±9.9)个月。所有切口Ⅰ期愈合。X线片复查示骨折愈合良好,无内固定物松动、断裂等并发症发生。2例患者有腓浅神经损伤症状,经营养神经治疗后逐步恢复;3例患者踝关节屈伸活动轻度受限。末次随访AOFAS评分(85.6±7.9)分,其中优9例,良4例,可2例。结论 :齿状钢板固定Tillaux-Chaput骨折块,操作方便,固定牢靠,有利于踝关节功能恢复。下胫腓联合无须常规使用螺钉固定。     

手术治疗胫骨中下段骨折合并后踝骨折

正2011年1月~2014年1月,我科手术治疗20例胫骨中下段骨折合并后踝骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组20例,男14例,女6例,年龄20~65岁。左下肢8例,右下肢12例。致伤原因:摔伤10例,扭伤4例,车祸伤6例。螺旋形骨折15     

三踝骨折的手术治疗

2001年1月~2005年3月,笔者收治31例三踝骨折患者,均进行了手术治疗,疗效满意。1材料与方法1.1病例资料本组31例,男21例,女10例,年龄18~40岁。右侧18例,左侧13例。所有病例均为新鲜骨折且骨折移位明显。按Weber的AO分型,B型19例,C型12例。1.2治疗方法硬膜外麻醉。如骨折片位于胫     

三踝骨折手术治疗体会

正2010年4月~2012年4月,我们手术治疗35例三踝骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组35例,男23例,女12例,年龄20~58岁。骨折按Lauge-Hansen分型:旋后外旋型16例,旋后内收型4例,旋前外展型7例,旋前外旋型8例。均为新鲜闭合骨折。待肿胀消退后手术,伤后至手术时间5~     

An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia

INTRODUCTION

Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral.

PRESENTATION OF CASE

This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia.

DISCUSSION

Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia.

CONCLUSION

Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen.     

Old nutcracker fracture of cuboid

Nutcracker fractures of the cuboid (compressed) are rare and often missed at an initial visit. We report a 21-year-old patient presented with a 9 months old cuboid fracture. He presented with a localized pain around his left foot. Radiograph revealed the shortening of the lateral column with old cuboid fracture. The lateral column of foot was reconstructed. The patient remained symptom-free and no radiographic evidence of recurrence was observed 1 year postsurgery.     

Segmental fracture of the scaphoid: report of a rare fracture pattern

Introduction:To the best of our knowledge, there are no reports in the orthopaedic and trauma literature of true segmental fracture of the scaphoid bone. We present such a case with a brief discussion of the morphology and mechanisms of injury of scaphoid fractures and the problems they present, particularly in diagnosis. Case history: A 43-year-old male with polytrauma sustained in a motorcycle road traffic accident was treated at our hospital. His injuries included a fracture initially thought to involve the waist of the scaphoid. Because he had bilateral upper limb injuries, we elected to treat the fracture surgically to facilitate rehabilitation. At the time of surgery, the fracture was noted to be truly segmental, an unsuspected and rare finding. The fracture was internally fixed, with a satisfactory result. Discussion: Scaphoid fracture patterns are generally consistent and predictable, occurring most commonly through the waist of the bone. Mechanism for injury is thought to be hyperextension of the wrist. Comminution, with or without a butterfly fragment, is occasionally seen, as are simultaneous tuberosity fractures. We suggest that the mechanism in this case may have been multiple or secondary trauma, or an effect of loaded rotation. We highlight the need for careful imaging of the scaphoid bone prior to choosing treatment.     

Pilon骨折合并同侧跟骨骨折1例

患者,男,69岁,2 d前从约2 m高处坠落,左足着地后出现左下肢畸形、肿胀,于2019年4月26日入我院治疗。判断患者生命体征平稳后,摄左胫腓骨DR片显示左Pilon骨折及左跟骨骨折(图1A);CT检查显示骨折类型为左Pilon骨折,AO分型C2型,左跟骨骨折SandersⅣ型(图1B)。入院后给予左距骨骨牵引以保持左下肢稳定及力线,同时积极给予脱水消肿。13 d后肿胀消退及左下肢力线、皮肤软组织条件等均良好,行左Pilon骨折及左跟骨骨折切开复位内固定术。术后摄左踝关节DR片复查显示骨折对位对线良好,内固定在位(图1C)。出院后患者定期门诊复查,行临床及影像学评估。术后2个月,患者左下肢无负重、后部分负重到完全负重。术后3个月骨折愈合尚可,AOFAS踝-后足功能评分85分,患者的踝关节运动功能基本正常。     

Hoffa骨折的临床特点及治疗

目的探讨Hoffa骨折的临床特点及治疗方法。方法对5例Hoffa骨折患者1例保守治疗、4例切开复位内固定治疗。结果5例均获随访，时间13—31个月。功能恢复参照Letenneur方法进行评估：优良3例，可2例。结论Hoffa骨折的临床特点以膝关节屈曲外翻位损伤多见，外髁发生率较高。X线对诊断价值有限，多借助CT检查。治疗原则是解剖复位，坚强内固定，早期功能康复锻炼。