单侧纵轴动力外固定器治疗胫腓骨骨折致骨延迟愈合的生物力？…

通过对单侧纵轴动力外固定器（ｕｎｉｌａｔｅｒａｌａｘｉａｌｄｙｎａｍｉｃｆｉｘａｔｏｒ,ＵＡＤＦ）的力学测试分析引起骨折延迟愈合的机制。方法对用ＵＡＤＦ固定的胫骨骨折模型进行加载实验。设置不同的骨－架间距,施加不同的载荷,测定骨折端的位移植。结合临床病例对发生骨折延迟愈合的病因进行生物力学的分析。结果骨折端位移与骨－架间距以及施加载荷的大小呈正相关（ｒ１＝０．６１０４,ｒ２＝０．７０９２,Ｐ〈０．     

主动负重和被动加载时骨折局部力学环境的比较研究

目的比较主动和被动加载时长骨骨折局部的生物力学环境，为选择理想的加载模式提供参考。方法建立胫骨中段横行骨折外固定系统的三维模型，通过改变骨痂弹性模量模拟骨折愈合早期（4—8周）愈合骨的刚度，利用有限元法计算主动负重与被动加载时骨折局部的力学环境及钉孔处的应力分布。结果主动负重时骨痂内部始终为压应力；被动加载在骨折愈合早期也为压应力，但随着骨痂刚度的提高，靠近外固定支架侧仍为压应力，对侧逐渐转为张应力。骨折断端的位移随着骨痂刚度的提高而降低，到术后8周位移接近为零。两种载荷方式钉孔处存在较高的压应力，但主动载荷时应力更高。结论在骨折愈合早期，宜采用体外的机械装置对愈合骨施加载荷，其力学影响因素为位移；随着骨痂的生长与钙化，应逐渐改为由患者主动部分和完全负重，其力学影响因素为应力。     

应用单侧纵轴动外固定器治疗骨折的体会

本文报告了１２４例应用单侧纵轴动力外固定器（ＵＡＤＦ）治疗四肢骨折的临床结果。结果提示应用ＵＡＤＦ治疗合并严重软组织损伤的开放性骨白或邻近关节部位的骨折有明显的临床运用价值。     

小切口有限内固定加外固定器治疗胫Fei骨骨折

目的：介绍小切口有限内固定加外固定器治疗复杂胫Ｆｅｉ骨骨折的方法并对治疗结果进行评估。方法：２５５例中８９例复杂胫Ｆｅｉ骨骨折,采用小切口有限内固定（螺钉、钢丝、克氏针或丝线）后加外固定器固定。术后早期酌情纵向加压,外固定器动力化锻炼。结果：术后随访１２￣８４个月,平均愈合时间４￣５个月,再移位数５例（５．８８％）。结论：小切口有限内固定结合外固定器治疗复杂胫Ｆｅｉ骨骨折可以避免伤口并发病,缩短骨折愈合时间,减少骨折延迟愈合、骨不连的出现,是治疗胫Ｆｅｉ骨骨的有效方法。     

双翼股骨干骨折复位固定器的研制与临床应用

目的 探讨自行研制的新型双翼股骨干骨折复位固定器的生物力学性能及临床应用效果。方法 利用试验应力分析方法，测定该复位器强度、刚度及抗扭转力，并对临床应用的158例病例进行应用分析。结果 该内固定器强度及刚度均达到生物力学要求，术中复位时间较前缩短，158例患者随访6～23个月，无骨延迟愈合及不愈合者。结论 双翼股骨干骨折复位固定器复位简便、固定可靠，可大大减少劳动强度、节约手术时间且副损伤小，有利于骨折愈合。     

力臂式外固定器治疗股骨粗隆间骨折实验研究和临床应用

目的观察改进的穿针方法力臂式固定器治疗股骨粗隆间骨折的生物力学效应和临床疗效。方法（１）１２个人工股骨模型按不同骨折类型分为４组,分别采用交叉、桁架、交手架、平行穿针法外固定,对其进行力学测试,数据用统计学处理。（２）１９８６年２月～１９９６年５月治疗病人１５９例,平均固定１０周。结果（１）１２个模型在纵向载荷时断端较稳定;桁架穿针固定在纵向、侧向刚度都有所增强（Ｐ＜００５）;交手架穿针固定反粗隆间骨折在侧向载荷时不稳定（Ｐ＜０００１）。（２）１５９例病人除９例死于内科疾病外,全部骨折愈合。结论改进的穿针法力臂式外固定器治疗股骨粗隆间骨折承载效果满意,操作简单,创伤小,并扩大了手术适应症     

轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用

目的探讨外固定器轴向载荷力学测试用于指导临床骨折术后拆除外固定器时间判断的安全性及有效性。方法 2014年1月-2015年8月,收治27例因外伤致胫、腓骨骨折患者。男21例,女6例;年龄19~63岁,平均45岁。闭合骨折7例,开放骨折20例。X线片复查示:螺旋型不稳定骨折4例,粉碎型不稳定骨折23例。一期行外固定器固定。其中3例外固定术后出现感染致骨不连,1例发生骨折不愈合伴骨缺损;行二期胫骨截骨延长术。外固定后待正侧位X线片复查明确骨折处均有连续性高密度骨痂形成后,行外固定器轴向载荷力学测试。当外固定器轴向载荷分担比10%时,拆除外固定器。结果经外固定治疗21~85周(平均44周)后,行外固定器轴向载荷力学测试。测试结果显示,26例外固定器轴向载荷分担比10%,拆除外固定器;拆除外固定器后随访6周,患者下肢完全负重,恢复正常生活,无再骨折发生。1例术后85周外固定器轴向载荷分担比为14%,X线片检查显示骨折成角畸形未完全愈合,拆除外固定器后发生再骨折,改行髓内固定术。结论外固定器轴向载荷力学测试可以客观反映并定量评价骨折愈合情况,可用于指导外固定器拆除时间的确定。     

单侧钩槽式外固定器治疗股骨远段骨折

目的探讨单侧钩槽式外固定器治疗股骨远段骨折的疗铲。方法 将ＵＨＳＥＦ治疗的２４例股骨远段骨折的疗效与２６例石膏外固定，６例钢板内固定及１４例牵引的疗效进行比较。结果 ＵＨＳＥＦ治疗的２４例股骨下段骨折术后愈合时间１０－１４周，平均１２周，术后２周骨折邻近关节开始活动。与石膏固定，钢板内固定及牵引疗法相比，关节活动早，卧床时间短，并发症少，骨愈合率高。     

外固定器加微创植骨治疗胫骨骨折不愈合、延迟愈合

目的：探讨运用外固定器加微创植骨治疗胫骨骨折不愈合、延迟愈合，观察其疗效。方法：运用外固定器行胫骨复位加压固定，对骨折不,连接处用磨钻磨除骨折端纤维及硬化骨质，行骨折端闭合植入微粒松质骨。结果：17例手术切口均一期愈合，全部病例经1年以上随访，骨折合部愈合，愈合时间在3个月－6个月。结论：骨外固定器加微创植骨，骨折固定牢稳，不破坏断端血运，有利于骨的修复，创伤小，是治疗胫骨骨折不愈合、延迟愈合的一种较好方法。     

半环槽式外固定器治疗严重开放粉碎性胫腓骨骨折(附23例报告)

本文报告一组23例严重开放粉碎性胫腓骨骨折应用半环槽式外固定器治疗结果.发生软组织感染2例,感染率8.70%,骨折愈合优良率达95%以上.本治疗方法解决了胫腓骨严重开放粉碎性骨折的固定困难问题,从骨折的创面处理、固定、功能锻炼、护理及骨愈合等方面均有许多优点.尤其是外固定架的刚度可调性,为骨愈合提供了有利条件.     

微型钛板与记忆合金环抱器治疗掌指骨骨折的对比研究

目的对比分析微型钛板内固定和记忆合金环抱器内固定治疗掌指骨（近中节指骨）骨折的临床疗效。方法采用微型钛板治疗组（A组）66例104处及记忆合金治疗组（B组）61例92处,对比分析两种手术治疗效果。随访3～12个月,平均6个月,以TAFS评分为评价标准,并记录伤口感染、骨折愈合时间、骨折延迟愈合、骨不连、关节僵硬、肌腱粘连、内置物外露等并发症发生情况。结果127例均达骨性愈合。A组（104处骨折）优良率93．29％,B组（92处骨折）,优良率79．9％。两组TAFS功能评分结果差异有统计学意义（芹=4．14,P〈0．05）,A组明显优于B组。A组延迟愈合3处（2．88％）;B组延迟愈合7处（7．59％）。B组病例延迟愈合率高于A组。A组骨折愈合时间平均31．5d：B组骨折愈合时间平均54．6d。无骨不连发生。两组结果差异有统计学意义（t=2．23,P〈0．05）,A组骨折愈合时间明显短于B组,两组术后感染率无差异。结论微型钛板治疗掌指骨骨折在术后关节功能恢复情况、骨折愈合时间、骨折延迟愈合、关节僵硬、肌腱粘连、内置物外露等并发症发生指标上明显优于记忆合金环抱器治疗组．是目前掌指骨骨折较为理想的治疗方法。     

应用单侧纵轴动力外固定器矫正下肢畸形

作者于１９８９年１０月～１９９４年１２月，采用截骨矫形加单侧纵轴动力外固定器固定的方法，治疗不同类型的下肢畸形６０例７８个部位。结果显示：７７处截骨均为一期愈合，１处延迟愈合；针孔感染率为０．６％。平均随访时间２．５年，全部病例肢体畸形矫正满意，关节功能恢复好。作者认为，应用本固定器创伤小、操作简单、固定牢固。由于具有弹性固定作用，可促进骨痂生长、加速骨愈合，对关节功能影响小，并发症少，最突出的优点是可将肢体畸形矫正至理想角度。     

The unilateral axial dynamic fixator study of its biomechanical property and clinical application

The home made UADF after Bastiani's pattern was mechanically tested in our lab on fracture of cadaveric femurs. For comparison, the same test was also carried out with conventional semicircular external fixator. The results showed that the rigidity and stability of fixation closely related with the diameter of the bone-pin used. The diameter of the treated pins used in UADF was one time larger than that of the round pin used in conventional semicircular external fixator. The compression rigidity of the former frame was 3.5 times stronger than that of the latter one; the extent of displacement of the fragments happened in the former frame was much less than that occurred in the latter one. Clinical Application of UADF. on fracture of tibia and fibula in 31, of femur in 8, knee arthrodesis and osteotomy of tibia and fibula one in each, brought bony healing on successfully. It is apparent that the UADF is multifunctional, universal and adaptable in use, leading to success.     

下肢长骨严重粉碎性骨折的治疗

目的：探讨下肢长骨严重粉碎性骨折的治疗方法。方法：41例患者，其中27例应用支架外固定治疗，14例应用联合内固定治疗。结果：骨折均愈合，愈合时间5－14个月，平均8．6个月。钉眼感染5例，骨折延迟愈合5例，再骨折1例，成角畸形3例。结论：支架外固定与联合内固定均为下肢长骨严重粉碎性骨折有效的治疗方法。支架外固定可使骨折满意复位，提供稳定的固定，可以维持肢体长度，特别适合合并有软组织病损的患者。     

结合外支架复位经皮钢板固定治疗胫骨远端骨折疗效分析

目的胫骨远端骨折是一种比较常见的高能量骨折,我们采用外固定支架临时复位,经皮钢板内固定治疗胫骨远端骨折,并评价其疗效。方法以2004年10月至2005年4月来我院治疗胫骨远端骨折的患者为研究对象,开放性胫骨远端骨折不在本次的研究范围之内。所有患者入院后均行择期手术,手术时先利用外固定支架复位,维持下肢力线,后通过内踝远端小切口逆行将钢板插入皮下,进行固定。关闭切口后去除外固定支架。术后要求患者早期负重锻炼。结果平均手术时间74．9min,其中外支架固定时间10．6min。钢板平均9．4孔;使用螺钉7．8枚。住院平均时间7．5d。所有患者均未出现切口感染及皮肤坏死。本组患者的随访时间为8～24个月,平均15．4个月。在32例骨折中．24例（75％）6月内骨折愈合,平均愈合时间4．7个月。5例（15．6％）骨延迟愈合,平均愈合时间为8．6个月。3例（9．4％）出现骨不连,其中2例通过髂骨植骨在植骨后6个月骨折愈合,1例未愈。8例患者出现踝关节活动受限：8例患者诉小腿前内侧钢板放置处疼痛不适。结论结合外固定支架经皮钢板固定是一种治疗胫骨远端骨折的有效且可靠的方法。     

四肢长骨开放性骨折早期内固定治疗的探讨

目的探讨早期内固定系统治疗四肢长骨开放性骨折的临床效果。方法86例四肢长骨开放性骨折患者，采用早期彻底清创，切开复位内固定治疗，其中采用钢板螺钉57例，髓内钉加钢丝14例，克氏针加钢丝10例，钢丝加外固定支架5例。Ⅰ期缝合65例，延迟缝合10例，皮瓣转移11例。结果随访77例，平均10.5（3-22）个月，骨正常愈合73例，延迟愈合或骨不连4例。结论早期内固定治疗四肢长骨开放性骨折能尽量把开放性骨折转变为闭合性骨折，从而提高其愈合能力。     

脱钙骨基质治疗长骨骨折延迟愈合及骨不连

目的探讨脱钙骨基质(decalcifiedbonematrix,DBM)治疗长骨骨折延迟愈合和骨不连的疗效。方法长骨延迟愈合、骨不连共57例,男45例,女12例;年龄21~65岁,平均42岁。开放性骨折17例,闭合骨折40例。骨折延迟愈合32例中,肱骨4例,股骨10例,胫骨18例;骨不连25例中,肱骨5例,股骨4例,胫骨16例。全部采用DBM于骨断端处和骨缺损区植入治疗。结果57例患者均获随访,随访时间4~37个月,平均7.8个月。骨折延迟愈合32例中骨折愈合31例,1例胫骨骨折未愈合;骨不连25例中骨折愈合23例,2例未愈合,其中胫骨1例、肱骨1例。愈合时间3~6.6个月,平均4.7个月。结论DBM治疗长骨骨折延迟愈合及骨不连,其疗效满意、并发症少。     

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.     

Fracture stiffness in callotasis determined by dual-energy X-ray absorptiometry scanning

Assessing healing after distraction limb lengthening is essential to manage patients undergoing callotasis for leg lengthening or bone transport. Direct measurement of fracture stiffness can assess healing but the equipment may not be available. In addition, it requires removal of the fixator, which may be complicated for ring fixators. The present study investigates whether an equivalent measure of healing can be based on the mineral density pattern from dual-energy X-ray absorptiometry (DXA) scans. Nine consecutive patients undergoing callotasis were studied. Bending stiffness of the distraction segment was measured and DXA scans were performed regularly starting 6 weeks after completing distraction. In all, 23 simultaneous readings of bending stiffness and DXA scans were obtained. All density patterns showed a distinct minimum value of bone mineral density. We found a high and significant correlation between fracture bending stiffness and the square of the total mineral content at the location of minimum bone density (r2 = 0.77, P < 0.001). We conclude that DXA scans can be used reliably and effectively to determine fracture bending stiffness, valuable for determining both time of frame removal and delay in union.     

Development of a variable stiffness external fixation system for stabilization of segmental defects of the tibia

The mechanical properties of a variable stiffness external fixation system were explored. Initial testing of a unilateral fixator configuration demonstrated that system rigidity could be increased by maximizing pin separation distance in the fracture component and the number of pins used while minimizing pin separation distance across the fracture site and the sidebar offset distance from bone. A triangulated system composed of half pin frames mounted anteriorly and medially on the tibial aspects and linked by crossbars was devised. Progressive disassembly of the frame was shown to result in progressive decreases in fixator rigidity in all planes.