锁定钢板联合内侧异体骨板内固定治疗老年骨质疏松性股骨远端骨折

目的探讨股骨远端外侧锁定钢板联合内侧异体骨板内固定治疗老年重度骨质疏松性股骨远端骨折的临床疗效。方法回顾性分析自2009-01—2016-12采用股骨远端外侧解剖型锁定钢板联合内侧异体骨板内固定治疗的23例老年重度骨质疏松性股骨远端骨折。术中均采用MIPPO技术将钢板、异体骨板分别置入股骨远端外侧和内侧固定。结果23例均获得随访,随访时间平均23(12~39)个月。骨折愈合时间平均6.7(4~12)个月,无内固定松动、骨折不愈合及再骨折。末次随访时按Merchan标准评定膝关节功能:优9例,良11例,可3例,优良率86.9%。结论股骨远端外侧解剖型锁定钢板联合内侧异体骨板内固定为内侧皮质有缺损的重度骨质疏松性股骨远端骨折提供了一种有效的固定方式,配合术后有效抗骨质疏松治疗及积极的康复训练,患者膝关节功能恢复良好,可取得满意疗效。     

复杂股骨远端开放性骨折的分期治疗

目的探讨应用分期治疗复杂股骨远端开放性骨折的临床效果。方法自2005-06—2010-06应用一期清创外固定架固定,二期更换内固定治疗复杂股骨远端开放性骨折6例。结果本组随访时间16~36个月,平均24个月,骨折均愈合,无内固定松动、断裂,膝关节屈伸活动较好。结论合理的分期治疗是复杂股骨远端开放性骨折安全有效的治疗手段。     

小切口复位逆行交锁髓内钉治疗股骨远端骨折

目的探讨小切口复位逆行交锁髓内钉治疗股骨远端骨折的临床效果。方法2003年7月至2006年12月，对24例股骨远端骨折患者的手术治疗进行回顾性分析。按股骨远端骨折AO／ASIF分型，A型16例～型8例，治疗采用小切口复位逆行交锁髓内钉内固定。结果本组病例随访时间6～24个月（平均17．4个月），平均愈合时间为4．6个月，无术后感染，1例远端锁钉断裂，经制动后愈合。按Neer等膝关节评分标准进行评价，优15例，良6例，优良率87．5％。结论小切口复位逆行交锁髓内钉治疗股骨远端骨折，手术操作简单，固定可靠，对软组织破坏少，骨折愈合率明显提高，用于治疗股骨远端复杂骨折手术效果好。     

AO股骨髁支持钢板固定治疗股骨远端复杂骨折

目的探讨应用AO股骨髁支持钢板内固定治疗股骨远端复杂骨折的方法和临床疗效。方法2004年10月至2007年1月对61例股骨远端复杂骨折进行修复重建．其中男51例，女10例；年龄18～66岁，平均39．2岁。左侧34例，右侧27例。闭合性骨折50例，开放性骨折11例。骨折按AO／ASIF分类，A型骨折18例，C型骨折43例。均行切开复位，AO股骨髁支持钢板内固定，对骨缺损较大者行一期植骨，术后行康复治疗。结果患者均获得随访，随访时间7～36个月，平均13．6个月。骨折均愈合．愈合时间8～16个月．平均12．2个月。按Merchan功能评定标准评定，优24例。良31例，可5例，差1例，优良率90．16％。结论严格遵循手术治疗原则，采用AO股骨髁支持钢板内固定治疗股骨远端复杂骨折，固定可靠，操作简单，疗效肯定。     

成人肱骨远端骨折的手术治疗分析

[目的]探讨成人肱骨远端骨折的手术内固定方法和治疗效果。[方法]2002年1月～2004年6月手术治疗成人肱骨远端骨折患者23例，男16例，女7例，年龄17～42岁，平均32岁，其中陈旧性骨折3例，开放性骨折3例。AO／ASIF分型：A型3例，B型4例，C型16例。按照不同的骨折类型采用相应的内固定并进行功能锻炼。定期随访并手术后1、3、6个月拍片，了解骨折愈合和关节功能恢复情况。[结果]23例均获得随访，随访时间6～24个月，平均13个月，23例均骨折愈合，全部患者肘关节功能恢复满意。[结论]对成人肱骨远端骨折术中充分显露，关节面解剖复位，在髁上部牢靠固定，可以获得满意的治疗效果。     

应用小切口PFNA治疗老年骨质疏松股骨粗隆间骨折

目的探讨采用小切口防旋型股骨近端髓内钉(PFNA)治疗老年骨质疏松股骨粗隆间骨折的疗效。方法回顾分析采用小切口PFNA固定治疗老年骨质疏松股骨粗隆间骨折48例临床资料。结果所有患者随访6~24个月,平均7个月,骨折全部愈合。根据Sanders评分标准:优38例,良8例,可2例,优良率95.83%。结论应用小切口PFNA固定治疗老年骨质疏松股骨粗隆间骨折不仅切口小、创伤小、出血少、手术时间短,且骨折固定牢固、骨折愈合快、可早期功能锻炼,是一种值得临床推广的手术方法。     

PFNA治疗高龄骨质疏松性股骨粗隆间骨折体会

目的探讨股骨近端抗旋髓内钉(proximal fermoral nail anti-rotation,PFNA)在治疗高龄骨质疏松性股骨粗隆间骨折临床疗效。方法应用PFNA治疗36例75岁以上高龄骨质疏松性股骨粗隆间骨折患者,手术采用闭合复位,小切口置入PFNA内固定,同时注重围手术期处理及抗骨质疏松治疗。结果 36例获得随访,时间9～24个月,平均12个月。其中1例90岁患者,于术后9个月死于脑梗塞,其余35例骨折全部愈合,无感染、骨不连、髋内翻、内固定失效等并发症的发生。根据Harris功能评分标准:28例优,4例良,3例中,优良率91.4%。结论 PFNA对于高龄骨质疏松性股骨粗隆间骨折具有微创性,固定可靠,疗效满意等优点。     

微创钢板内固定技术治疗AO-C型股骨远端骨折

目的探讨微创钢板内固定技术治疗AO-C型股骨远端骨折的临床疗效。方法回顾性分析自2012-04—2016-01采用微创钢板内固定技术治疗的31例AO-C型股骨远端骨折。结果本组手术时间40~90 min,平均68 min;术中出血量80~300 ml,平均220 ml。31例均获得随访,随访时间平均15(8~32)个月。所有患者骨折均达到骨性愈合,未出现成角移位,无钢板螺钉断裂、脱出。末次随访时疗效采用Schatzker-Lambert股骨远端骨折功能评分标准评定:优22例,良7例,可2例,优良率93.5%。结论采用微创钢板内固定技术治疗AO-C型股骨远端骨折具有创伤小、固定可靠、骨折愈合快、并发症少、膝关节功能恢复良好的优点。     

AO股骨髁支撑钢板内固定在股骨远端复杂骨折的应用

目的 探讨应用股骨髁支撑钢板内固定治疗股骨远端复杂骨折的方法和临床疗效。方法 回顾分析2001年10月～2004年2月，对23例股骨远端复杂骨折患者进行修复重建，其中男19例，女4例；年龄27～55岁。左侧13例，右侧10例。交通伤16例，高处坠落伤7例。闭合性骨折14例，开放性骨折9例。新鲜骨折21例，陈旧性骨折2例。骨折AO分类：A型关节外骨折6例，C型关节内骨折17例。术前X线片示股骨髁上、髁间粉碎性骨折。患者均行切开复位内固定，对于粉碎性骨折先用克氏针或松质骨螺钉整复股骨内外髁，对齐关节面，外侧置股骨髁支撑钢板固定；对骨缺损较大者行一期植骨，术后行科学合理的康复治疗及随访观察。结果 患者均获随访6～20个月，平均13．7个月。术后14个月X线片示骨折均对位、对线佳。骨折均愈合，愈合时间7～16个月。按Kolmert和Wulff的评价标准，A型6例，优5例，良1例；C型17例，优1l例，良3例，可2例，差1例。结论 采用股骨髁支撑钢板内固定治疗股骨远端复杂骨折，设计合理，操作简便，固定可靠，疗效肯定。     

闭合复位逆行交锁髓内钉治疗股骨远端骨折

目的探讨临床应用闭合复位逆行交锁髓内钉治疗股骨远端骨折的疗效。方法笔者自2002年6月～2005年5月，采用闭合复位逆行交锁髓内钉治疗股骨远端骨折28例。结果获得随访28例，时间4～20个月，平均11个月。骨折平均愈合时间5个月，根据HSS膝关节临床功能评定：优12例，良11例，优良率82．2％，可5例（17．8％），无术后感染及内固定断裂。结论闭合复位逆行交锁髓内钉能提供坚强内固定，出血少，创伤小，有利于骨折的愈合和膝关节功能的恢复，是治疗股骨远端骨折的较理想方法。     

老年脊髓灰质炎后遗症患者股骨远端骨折治疗

目的探讨老年脊髓灰质炎后遗症患者股骨远端骨折的治疗。方法2008年5月至2012年12月,采用微创内固定系统（LISS）治疗老年脊髓灰质炎后遗症患者股骨远端骨折9例,其中男3例,女6例,平均年龄62．7±6．1（56~75）岁。手术采用微创切口,间接复位（关节内骨折除外）,仅对1例再骨折且开放复位患者进行植骨。术后给予抗骨质疏松药物辅助治疗。结果平均手术时间为127±41（80-180）min,术中平均失血198±164（50-600）ml,输血1例;术后患者平均住院4．3±1．2（3～7）d。术后随访16±11（6～42）个月显示,骨折愈合时间为4．1±1．3（3～7）个月,末次随访时患肢膝关节活动度为107°±13°（90°～125°）,美国特种外科医院（HSS）膝关节功能评分为73±7（63-86）分,无切口感染及再骨折等并发症发生。结论采用uSS治疗老年脊髓灰质炎后遗症患者股骨远端骨折可获得良好疗效,有助于保护骨膜及骨折部位血运,对疏松骨质把持力好,固定牢靠,利于骨折愈合与功能恢复。药物辅助治疗对促进老年人骨愈合、改善骨质量、预防再次骨折也至关重要。     

切开复位解剖钢板内固定治疗股骨远端复杂骨折

目的探讨采用切开复位解剖钢板内固定治疗股骨远端复杂骨折的临床疗效。方法2001年1月～2004年6月采用切开复位解剖钢板内固定治疗股骨远端复杂骨折患者67例，25例C3型骨折选用股骨髁上支持钢板，42例A3、c2型骨折选用股骨远端接骨板；其中35例自体髂骨植骨，23例同种异体骨植骨，9例腓骨髓内植骨＋髂骨植骨；全部患者在股四头肌与股骨之间应用生物可吸收医用膜；13例辅助髌骨牵引。术后常规中药熏洗、CPM锻炼等综合方法治疗。结果67例患者获得10．26个月（平均15个月）随访，骨折均获愈合，膝关节功能按Kolment标准评定：优36例，良23例，可5例，差3例，优良率为88．1％。结论切开复位解剖钢板内固定治疗股骨远端复杂骨折，固定可靠，可满足膝关节早期功能锻炼，有效防止股四头肌粘连和膝关节僵硬。辅助局部一期植骨、应用生物可吸收医用膜，部分髌骨牵引、术后中药熏洗、CPM锻炼等综合方法可获得满意疗效。     

髁交锁逆行股骨髓内钉治疗股骨远端髁间骨折

目的 应用髁交锁逆行股骨髓内钉(condyle retrograde femur intramedulla nail,CRFIN)治疗股骨髁间骨折,探讨其手术适应证及疗效.方法 2003年6月至2005年6月应用CRFIN治疗股骨髁间骨折12例,男9例,女3例;年龄25岁～48岁,平均35.2岁.AO分型B2型2例,C1型7例,C2型3例,其中3例合并髌骨骨折,3例合并股骨中段骨折.采取切开复位CRFIN内固定术.结果 平均手术时间85.2分钟.全部病例获得随访12月～24月,平均16月.患者愈合平均时间15.2周(11周～23周),完全负重时间16.5周.术后发生关节僵硬1例,无感染、固定松动、断钉及失败病例.术后一年HSS评分平均88.3分(58分～97分),其中优8例、良3例、中1例.优良率91.2%.结论 CRFIN为治疗股骨远端髁间骨折提供了一种新的治疗方法,特别是对常规方法难以处理的骨折.但是股骨髁间骨折发病率不高,还需要一定的病例和随访的积累才能确定其疗效.     

Fratture esposte meta-epifisarie distali di femore e meta-epifisarie prossimali di tibia

Open fractures around knee are difficult to treat because of the high rates of early and late complications such as wound healing or deep infection. Open reduction and early internal stabilisation remain controversial. Early wound closure, huge washing, large debridements, antibiotic prophylaxis reduce the rate of infection. Temporary external fixation is mandatory in comminuted unstable open fractures with soft tissue damage and allows for the management of polytraumatised patients in keeping with the orthopedic damage control principles. To avoid further complications of definitive internal fixation, knee bridging frames of external fixation should be used. The aim of this article was to summarise the management of open proximal tibia and distal femur fractures since the admission in emergency room to the definitive treatment.     

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures

OBJECTIVE: To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients. SETTING: Two academic level I trauma centers. SUBJECTS AND PARTICIPANTS: One hundred nineteen consecutive patients with 123 distal femur fractures (OTA type 33 and distal type 32 fractures) treated by 3 surgeons. One hundred three fractures (68 closed fractures and 35 open fractures) in 99 patients were followed up at least until union (mean follow-up = 14 months, range: 3-50 months). INTERVENTION: Surgical reduction and fixation of distal femur fractures. MAIN OUTCOME MEASUREMENTS: Perioperative complications, radiographic union, infection rate, loss of fixation, alignment, and range of motion. RESULTS: Ninety-six (93%) of 103 fractures healed without bone grafting. All fractures eventually healed with secondary procedures, including bone grafting (1 of 68 closed fractures and 6 of 35 open fractures). There were 5 losses of proximal fixation, 2 nonunions, and 3 acute infections. No cases of varus collapse or screw loosening in the distal femoral fragment were observed. Malreductions of the femoral fracture were seen in 6 fractures (6%). The mean range of knee motion was 1 degrees to 109 degrees . CONCLUSIONS: Treatment of distal femur fractures with the LISS is associated with high union rates without autogenous bone grafting (93%), a low incidence of infection (3%), and maintenance of distal femoral fixation (100%). No loss of fixation in the distal femoral condyles was observed despite the treatment of 30 patients older than 65 years. The LISS is an acceptable surgical option for treatment of distal femoral fractures.     

Treatment of distal femoral fractures with intramedullary supracondylar nails in elderly patients.

30 acute fractures of the distal femur in 29 elderly patients were treated with a Russell-Taylor intramedullary supracondylar nail (IMSC). 26 of the 30 fractures (87%) united in 2-8 months. Two patients died before fracture union for reasons unrelated to the fracture. Two patients were reoperated upon, in one case the fracture was not adequately reduced at the first operation; in the other patient the nail broke 4 months after operation. In all patients knee flexion reached at least 90 degrees. No infections or thromboembolic complications were seen. The IMSC nail provided the necessary stable fixation with only a few complications in this group of elderly patients without the need to prolonged immobilisation.     

Retrograde intramedullary nailing of supracondylar femoral fractures: design and development of a new implant

Since 1992 we have developed an implant in which the distal (condylar) screws have a diagonal configuration so that the screws can be closer to the distal end of the nail, allowing more distal fractures to be fixed. It also utilises the denser bone of the posterior condyles for more secure fixation in osteoporotic patients. The new implant was used for 24 extra-articular fractures from September 1994 to September 1997, and for 14 articular fractures from February 1995 to December 2000. There was no significant difficulty with obtaining fixation in very distal fractures and in osteoporotic bone. Early weightbearing was encouraged in those with extra-articular fractures. All fractures united within 3 months except one which required a bone graft (but no revision of implant) at 6 months. Average knee flexion at final followup was 101 degrees for extra-articular fractures and 106 degrees for articular fractures. Complications included quadriceps adhesions requiring further surgery in two patients who had open fractures, and malunion in one patient who had an early design of the implant and a 4.5mm condylar screw broke. Nine patients required late removal of condylar screws due to local soft tissue irritation.     

Management of distal femoral fractures in elderly patients using retrograde titanium supracondylar nails

We present our experience with a retrograde supracondylar nail used for the management of fractures of the distal femur in elderly patients. Eighteen fractures of the distal femur in 18 patients were treated with AIM titanium supracondylar nails. Sixteen patients with a median age of 83 years (62-100 years) were finally available for review. All 16 fractures were classified as extra-articular type A according to the AO classification. The average operative time was 58 min. Follow up ranged between 4 and 35 months (average 20.4 months). Fifteen fractures (93.7%) united in an average duration of 3.6 months. The average range of motion achieved at the knee was 100. 6 degrees. There were no implant failures, knee sepsis or wound healing problems. One non-union and two stress fractures of the femur above the nail were the main complications in this series.We concluded that the AIM titanium supracondylar nail is a useful alternative implant for the management of the osteoporotic fractures of the distal femur particularly the extra-articular AO type A fracture in the elderly population.     

Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation

The records on fifty-two supracondylar-intercondylar fractures of the femur were reviewed twenty to 120 months after injury. More than one-third of the fractures had been open. All of the fractures were treated in a single trauma center, using: (1) a single lateral incision, (2) internal fixation with ASIF interfragmentary screws and plates, (3) bone-grafting of comminuted metaphyseal segments, (4) impaction of comminuted metaphyseal segments in osteoporotic elderly patients, and (5) repair of any associated torn ligaments and patellar fractures. Postoperatively, early active motion of the knee was encouraged, and for selected patients a brace was used only to protect the repair of associated disruptions of ligaments or of the extensor mechanism. The fractures were classified by the ASIF system, with C1 being a simple Y pattern, C2 having additional supracondylar comminution, and C3 having intra-articular comminution. The final results were rated using the system that was described by Neer et al. for fractures of the distal end of the femur. The average time between the operation and full weight-bearing (healing) was 13.6 weeks and ranged from 12.3 weeks for C1 fractures (as graded using the ASIF classification) to 15.4 weeks for C3 fractures. The average final arc of motion of the knee was 107 degrees, ranging from 113 degrees for C1 fractures to 99 degrees for C3 fractures. C1 fractures had a better outcome (92 per cent excellent and good results) than did C2 and C3 fractures (77 per cent excellent and good results). Two amputations and one arthrodesis were done to treat infection, and infection accounted for three of the four poor results. Age did not influence the final results, although elderly patients had a longer period of hospitalization. Supracondylar-intercondylar fractures of the femur should be analyzed separately from other fractures of the distal end of the femur because of their intra-articular involvement and associated ligamentous injuries and patellar fractures. Rigid internal fixation permits early functional rehabilitation of the patient and decreases the incidence of malunion, non-union, and loss of fixation.     

The effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty

BACKGROUND: Bone mineral density around the knee is related to the mechanical properties of bone. Alendronate has been shown to be effective for the treatment of osteoporosis and for reducing the rate of osteoporotic fractures. The purpose of the present study was to investigate the effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty in women. METHODS: Ninety-six women with an average age of seventy years who were undergoing total knee arthroplasty were randomly divided into two groups. Patients in the study group received oral alendronate at a dose of 10 mg/day for six months, whereas patients in the control group did not. The bone mineral density in the distal part of the femur and proximal part of the tibia was determined preoperatively and at six and twelve months postoperatively. RESULTS: In the control group, the bone mineral density showed significant decreases of 13.8% (p < 0.001) and 7.8% (p = 0.003) in the distal part of the femur and of 6.5% (p = 0.002) and 3.6% (p = 0.141) in the proximal part of the tibia at six and twelve months, respectively. In the study group, however, the bone mineral density showed significant increases of 10.0% (p = 0.010) and 1.9% (p = 0.049) in the distal part of the femur and of 9.4% (p < 0.001) and 5.4% (p = 0.032) in the proximal part of the tibia at six and twelve months, respectively. The overall differences in bone mineral density between the study and control groups were significant (p = 0.011 for the proximal part of the tibia, and p = 0.033 for the distal part of the femur). CONCLUSIONS: We found significant postoperative decreases in bone mineral density in the distal part of the femur and proximal part of the tibia in women who had undergone total knee arthroplasty. Oral administration of alendronate for six months postoperatively significantly improved the bone mineral density. While the clinical benefits of alendronate after total knee arthroplasty remain unproven and the duration of follow-up in the present study was quite short, the improvement in bone mineral density may have a clinically important effect on prosthetic fixation and the rate of periprosthetic fractures after total knee arthroplasty.