SF内固定器治疗胸腰椎骨折及腰椎滑脱症

总结ＳＦ内固定器治疗胸腰椎骨折及腰椎滑脱症疗效。方法：在开展Ｄｉｃｋ、Ｓｔｅｆｆｅｅ、ＲＦ手术的基础上,采用ＳＦ内固定器治疗胸腰椎骨折及腰椎滑脱症。随访１２－２６个月。结果：腰椎骨折１５例,１０例完全恢复椎体高度,５例椎体高度不同程度恢复,后凸Ｃｏｂｂ角平均矫正率为８７．８％。     

腰椎滑脱症和胸腰椎骨折的内固定器研制及其临床应用

目的：为了提高脊柱内固定器的复位效果。方法：通过对腰椎滑脱症发病机理的探讨和３１８例胸腰椎骨折治疗的分析，作者设计了一种用于治疗腰椎滑脱症和胸腰椎骨折的新型内固定器（ＳＦ内固定器）。结果：经４２例胸腰椎骨折和１７例腰椎滑脱症临床应用，其中４１例获６个月以上随访（６～３８个月，平均１３．４个月），效果满意，操作简便，值得推广。     

DICK内固定治疗胸腰椎骨折手术失误分析

ＤＩＣＫ内固定治疗胸腰椎骨折手术失误分析陈保光，杨爱德，邱奕军，许兴柏，刘华，杨冰，刘聪自１９９１年以来作者应用ＤＩＣＫ内固定器治疗胸腰椎新鲜骨折或脱位５８例，发生各类手术失误９例１１处，手术失误率为１８．９７％。报告如下：１临床资料本组胸腰椎新鲜骨...     

AF治疗胸腰椎骨折术后内固定器松动断裂的原因及对策

目的 分析AF内固定系统治疗胸、腰椎骨折术后内固定器松动断裂的原因，并探讨其预防对策。方法 1999年5月～2003年9月，我院对125例胸、腰椎骨折患者行AF内固定治疗，其中T11骨折12例，T12骨折37例，L1骨折46例，L2骨折30例。结果 所有患者中的94例获得随访，随访时间624个月，平均11．3个月，其中32枚螺丝钉松动．15枚螺丝钉断裂，4枚纵杆断裂。结论 AF内固定术未修复椎体骨缺损及手术操作不规范是导致手术失败的主要原因，早期植骨和严格操作规程可在一定程度上避免内固定器松动或断裂。     

AF固定器治疗胸腰椎骨折并脊髓损伤

目的探讨应用AF固定器早期手术治疗胸腰椎骨折并脊髓损伤的疗效。方法1995年1月-2001年1月我科应用AF固定器,伤后6～8小时内手术治疗胸腰椎骨折并脊髓损伤46例。进行平均3年4个月随访。结果本组伤椎压缩程度平均恢复39.9%,水平移位完全恢复,Cobb's角平均恢复24.2°。脊髓神经功能按Frankel分级有32例(80%)获Ⅰ级以上恢复,其中12例(30%)达到功能完全恢复。结论应用AF固定器治疗胸腰椎骨折并脊髓损伤,早期解除脊髓神经压迫,合理采用椎管减压技术,能够获好的疗效。     

3种后路脊柱内固定治疗胸腰椎骨折的体会

目的：总结应用Luque棒,Harrington撑开棒和椎弓根螺钉内固定治疗急性胸腰椎骨折的经验。方法：对35例急性胸腰椎骨折分别采用Luque棒,Harrington撑开棒和椎弓根螺钉内固定治疗,结果：35例经年以上随访,按Frankel分级,改善2级11例,改善1级15例,无恢复9例,结论：任何一种内固定器都有一定的优,缺点,应根据骨折类型合理选择,以达到最佳效果。     

FJ内固定系统在胸腰椎骨折中的应用

目的总结FJ系统手术治疗胸腰椎骨折的经验。方法1999年3月～2003年3月,我院用FJ内固定系统手术治疗胸腰椎骨折64例。结果所有患者随访12～48个月,椎体前缘高度由术前45.3%恢复至术后87.6%,椎体后缘高度由术前81.0%恢复至术后96.2%,Cobb角由术前平均18.5°恢复为术后2°。结论FJ系统结构简单、操作方便、固定坚强,是较好的胸腰椎骨折后路内固定器之一。     

新型脊柱外固定器的应用护理

目的 探讨新型脊柱外固定器治疗胸腰椎骨折术后患者有效的护理方法。方法 将290例胸腰椎骨折患者随机分成两组，对照组150例采用AF内固定，同时给予常规护理；观察组140例采用新型脊柱外固定器固定，除予常规护理外，注重心理护理、早期协助患者下床活动、预防感染以度重视体位护理等。结果 两组术中失血量，手术前后24h血压差值、术后心率度固定物取出时间等观察指标比较，差异有显著性意义（均P〈0．01）；观察组术后便秘、尿潴留等并发症发生率显著少于对照组（P〈0．05，P〈0.01）。结论 新型脊柱外固定器使用安全，可缩短患者的卧床时间，并发症少，护理在患者治疗康复过程中起到十分重要的作用。     

经皮椎弓根植骨联合脊柱外固定微创治疗胸腰椎骨折

胸腰椎骨折的传统手术治疗主要是前路、前外侧入路、后路椎管减压,植骨融合,内固定术。手术创伤大、出血多、跨节段融合、脊柱活动度丢失。为减少创伤、保留脊柱活动度,我院研制了经皮椎弓根植骨器械和新型脊柱外固定器,自2005年2月至2007年6月应用经皮椎弓根植骨器械联合新型脊柱外固定器微创治疗胸腰椎骨折30例,取得了满意疗效,实现了微创非融合性固定治疗胸腰椎骨折的目的。     

胸腰椎骨折四种不同内固定的生物力学测试与比较

目的：通过生物力学测试，对4种椎弓根内固定器进行评价和比较，以提高脊柱内固定复位内固定效果，使其更符合脊柱生物力学原理，为临床服务。方法：采用新鲜脊柱标本8具，造成胸腰段不稳定骨折，采用4种不同内固定器加以固定，测定它们的生物力学性能，对照比较。结果：胸腰椎骨折采用MRF脊柱内固定，在脊柱强度、刚度和稳定方面比其他3种内固定器械来得强，均具有显著性差异（P＜0．01）。结论：采用MRF脊柱内固定器作脊柱固定，既符合生物力学原理，又具有更强的整复固定性能，临床应用前景广阔。     

Treatment of the humeral shaft nonunion after surgical failure using the Selfdynamisable internal fixator

Introduction A nonunion of the humeral shaft is not a rare condition and is a complication of both nonoperative and operative treatment of the fracture. Several fixation options were used in the nonunion treatment, including various plate techniques, intramedullary nails and external fixator. We applied our Selfdynamisable internal fixator for the treatment of humeral shaft nonunion after surgical failure and evaluated its clinical outcome. Materials and methods Six patients with persistent atrophic nonunion of the humeral shaft were treated with Selfdynamisable internal fixator. The inclusion criteria were mobile, unstable resistant nonunion of the humeral diaphysis which persisted after surgical treatment for nonunion. All patients were men with a mean age of 32 (27–39) years. The initial fracture treatment was external fixator in two patients and plaster cast for four patients. All cases failed to unite after primary treatment. Plate fixation was resorted for fracture union but failed. The revision surgery consisted of removal of hardware, freshening of bone ends and bone grafting, and internal fixation with a Selfdynamisable internal fixator. Results The average follow-up was 33 months. All the nonunions healed after indexed operation. The average time for union was 5.5 months (range 4–9 months). There was no loosening or breakage of the fixation device. The functional results, according to the scale of Constant and Murlay modified by Ring, were excellent in five and good in one patient. There were no complications of nerve injuries or infections related to the operation. Conclusion Selfdynamisable internal fixator with bone graft for the treatment of recalcitrant humeral shaft nonunion provided successful clinical outcome with minimal complications.     

经皮骶髂关节空心螺钉内固定联合支架外固定治疗骨盆骨折的临床效果分析

目的:探讨经皮骶髂关节空心螺钉内固定联合支架外固定在骨盆骨折中的临床疗效.方法:选取2015年1月-2017年1月佳木斯大学附属第一医院骨外二科收治的经皮骶髂关节空心螺钉内固定联合支架外固定治疗的40例患者(内外固定组),同期收治的采用开放手术治疗的40例骨盆骨折患者(开放手术组)作对照.术后,观察分析两组患者的手术相关指标、Majeed功能评分、临床疗效以及术后并发症发生情况.结果:内外固定组患者的手术时间、术后下床时间均显著短于开放手术组,术中出血量显著少于开放手术组,Majeed功能评分显著高于开放手术组,差异均有统计学意义(P＜0.05).内外固定组患者的治疗总有效率为90.0％(36/40例),显著高于开放手术组的65.0％(26/40例),差异有统计学意义(P＜0.05).内外固定组患者的术后并发症发生率为7.5％(3/40例),显著低于开放手术组的20.0％(8/40例),差异有统计学意义(P＜0.05),术后并发症主要有感染、骨关节炎、下肢深静脉血栓.结论:经皮骶髂关节空心螺钉内固定联合支架外固定相较于开放手术,能够有效缩短手术时间、减少术中出血量、提高治疗优良率及降低术后并发症发生率,值得在临床上推广应用.     

单侧成角度外固定器治疗老年性股骨转子间骨折

目的 :探讨单侧成角外固定器治疗老年股骨转子间骨折中的影响因素及操作技术。方法 :临床应用 5 6例 ,男 2 6例 ,女 3 0例 ,平均年龄 63岁。随访 6～ 3 6个月 ,平均 14个月。结果 :本组骨折全部愈合。髋关节功能根据MerleD’Aubigne评分方法 ,优 3 8例 ,良 15例 ,优良率 94.6%。结论 :本外固定器优点在于 :手术创伤小 ,固定效果可靠 ,能早期下床活动 ,且近端固定针之间呈一定角度 ,充分防止了固定针的松动脱出及穿入髋臼。     

Surgical treatment of injuries of the thoracolumbar transition--3: Follow-up examination. Results of a prospective multi-center study by the "Spinal" Study Group of the German Society of Trauma Surgery

OBJECTIVES: Prospective, multicenter study addressing late results after operative treatment of acute thoracolumbar spinal injuries. METHODS: 682 patients (T10-L2) were included and 372 (80%) were postoperatively followed for 2 1/4 years (4-61 months). RESULTS: Comparing the initially included patients (n = 682) with the study group (n = 372), no differences were observed and results were assumed to be representative. A C-type lesion or polytrauma significantly prolonged the hospital stay. The method of operative treatment did not affect the length of the rehabilitation period. Neurological improvement was observed in 3 out of 7 patients with complete, and in 44 out of 64 (69%) with incomplete lesion. The operative method did not affect the improvement rate. The physical capacity significantly decreased. After a mean of 1/2 year of disability only 71% returned to work. 48% returned to their preoperative physical level. The mean Hannover Spine Score was 68 points (preoperative 94, p < 0.001), indicating permanent impairment of function. The angle-stable internal fixator was superior in restoration of spinal alignment and best radiological results were noted after combined stabilization. Posterior stabilization lead to high re-kyphosing. No correlations between radiologic and clinical parameters were observed. CONCLUSIONS: All treatment methods under study were appropriate for achieving comparable clinical and functional outcome. The internal fixator is superior in restoration of the spinal alignment. Best radiological outcome is achieved by combined stabilization. Merely by direct reconstruction of the anterior column the postoperative re-kyphosing is prevented and a gain in segmental angle is achieved.     

Surgical treatment of fractures in tropical countries]

In tropical countries, the indication for operative treatment of fractures treatment must be restrictive. Based on our own experience and the treatment results, the prerequisites for operative treatment are given and proposals concerning indication, preoperative preparation and operative tactics. The osteosyntheses recommended are the different forms of external fixation, in particular the external fixator (AO) and the transfixational plaster cast technique. The external fixator is the basic tool in tropical traumatology.     

Use of an internal fixator in the femur and tibia. Clinical and roentgenological course in animals

The applicability of a new internal fixator was tested in the femur and tibia of sheep. The device was primarily developed for the spinal column by the association for studies of internal fixation (ASIF). For this investigation 12 sheep were subjected to transverse osteotomy and the bones were then stabilized with a internal fixator: The clinical and radiological follow up shows a stable healing process of the osteotomy within 8 weeks despite full load-bearing on all extremities. During the entire study period the sheep had full freedom of movement. Clinical and radiological observations were confirmed by the results of histological examinations. The results allow the following conclusions: in view of the course of recovery the indications for application of a internal fixator can be extended to fractures of the lower extremities. Further studies pertaining to the suitability of the implant for various fracture types are in progress. The great advantage of this fixation technique is that the fixator is mounted without any damage to either the endosteal or the periosteal circulation.     

Lower leg lengthening using the Ilizarov system. Presentation of the various surgical techniques and analysis of lower leg lengthening procedures performed 1986-1989

The technique of lengthening the tibia with the Ilisarov device is explained. Different variations (bifocal or simultaneous) of the method are demonstrated, as well as the results of 53 cases of tibia lengthening in 37 patients of our hospital between 1986 and 1989. In 14 patients, a second operative procedure was necessary during treatment. In no case was internal fixation or grafting necessary. The Ilisarov ring fixator is very efficient, especially in major lengthening procedures and for simultaneous correction of deformities.     

Fixateur externe und alternative Fixationsmethoden beim offenen Oberschenkelschaftbruch

The external fixator is still an established component of fracture treatment in the lower extremity. It is the treatment of choice for open and closed femoral fractures in association with polytrauma. The advantages are the short operating time, the lack of stress on the lungs, the smaller blood loss and sparing of the soft tissues. When the physical state of the patient is stable we remove the external fixator and implement internal fixation with an unreamed femoral nail. It is not advisable to treat an open femoral fracture in an adult exclusively with the external fixator. The external fixator is also indicated for the entire treatment of open and closed femoral fractures in children. The advantages in this setting lie in the less invasive operative technique, the early possibility of full weightbearing, and the problem-free removal of the hardware. Nonetheless, in the case of isolated open femoral fractures – even if quite severe – successful primary treatment with an unreamed medullary nail (UFN, PFN) is also possible without complications. The results show that definitive single-step surgery is not accompanied by higher rates of infection than the classic treatment with changeover to another method. The patient is spared this without being exposed to a higher level of risk.     

旋入式自锁钉与常规手术治疗肱骨干骨折疗效比较及相关问题探讨

[目的]报告旋入式自锁钉与常规手术治疗肱骨干骨折的临床效果,寻找治疗肱骨干骨折的最佳手术固定方法.[方法]回顾性分析2000年3月～2004年5月手术治疗各型肱骨干骨折135例,其中常规手术组96例,包括应用加压钢板42例、单边外支架26例、形状记忆合金环抱器28例;旋入式自锁钉组39例,对手术和术后的各项指标进行比较.[结果]常规手术组手术时间和失血量明显多于旋入式自锁钉组,医源性桡神经损伤、感染、断钉断板或钉板松动、骨折再移位、骨不连等并发症明显多于旋入式自锁钉组,术后满意率明显低于旋入式自锁钉组.[结论]旋入式自锁钉克服了交锁钉横向锁钉的种种弊端,手术操作简便,创伤性小,固定可靠,有顺行和逆行穿针2种选择,减少了对肩关节功能的影响,常规手术方法存在较多的不足,应根据骨折部位和类型选择应用.     

Results of femoral lengthening over an intramedullary nail and external fixator

INTRODUCTION: Current techniques of operative limb lengthening usually are based on distraction osteogenesis. One of the techniques is limb lengthening over an intramedullary nail. AIM OF PAPER: The goal of this study is to evaluate the results of femoral lengthening over an intramedullary nail. MATERIAL: Between 1999 and 200619 femoral "over nail" lengthenings were performed. There were 7 males and 12 females. Mean patients' age at surgery was 15.8 years, and mean initial femoral shortening was 5.1 cm. Operative technique consisted of one-stage implantation of intramedullary nail and external fixator. Ilizarov apparatus was used in 9 patients, monolateral fixator in 10 cases--ORTHOFIX in 9 patients, Wagner fixator--in 1 patient. Intramedullary nail was locked proximally with screws or Schanz pins from external fixator. After distraction phase, external fixator was removed and distal locking screws were applied. METHODS: Evaluation criteria: obtained lengthening, time of external fixator, treatment time, healing index, external fixation index, range of motion in hip and knee joints and complications according to Paley. RESULTS: The mean lengthening was 4.6 cm, and mean distraction time was 66.6 days. Mean time of external fixation was 115.5 days, and external fixation index was 26.2 days for centimeter. Healing index was 36.9 days for centimeter. In cases with monolateral fixator, healing index did not differ with the whole group. During treatment 18 complications occurred, for a rate of 0.9 complication per segment. CONCLUSIONS: Lengthening over an intramedullary nail reduces the time of external fixator. Over nail femoral lengthening can prevent axis deviation following regenerate bending. Complication rate is similar to lengthenings with the classic Ilizarov technique. There are no differences in the treatment time in relation to the type of external fixator.