肱骨近端骨折合并肩峰骨折的手术治疗

肱骨近端骨折合并肩峰骨折较为少见.2002年1月～2007年2月,我们收治肱骨近端骨折合并肩峰骨折8例,分别采用肱骨近端锁定钢板和重建钢板切开复位内固定,收到良好的近、远期治疗效果,报道如下.     

锁定接骨钢板治疗肱骨近端严重粉碎骨折

肱骨近端粉碎骨折临床上较常见,自2003年1月～2004年3月笔者采用AO近端锁定肱骨接骨板（LPHP）治疗肱骨近端骨折10例,取得初步的良好效果。现报告如下。     

锁定接骨板治疗老年肱骨近端骨折

目的探讨肱骨近端锁定接骨板内固定治疗老年肱骨近端骨折的疗效。方法2002年1月～2004年1月对35例老年肱骨近端骨折予以锁定接骨板内固定治疗,术后早期功能锻炼。结果术后所有患者平均随访13.2个月,骨折愈合时间平均8.3周(7～12周),1例肱骨头缺血性坏死。按Constant评分标准,平均81.4分(39～95分),其中优22例,良8例,中4例,差1例,优良率85.7%。结论肱骨近端锁定接骨板对于骨质疏松的老年肱骨近端骨折是一种安全有效的治疗方法。     

解剖型钢板固定治疗肱骨近端粉碎性骨折

肱骨近端粉碎性骨折.由于复位固定困难,严重影响肩关节功能的恢复.笔者自2003年3月～2006年12月,采用国产肱骨近端解剖型钢板固定治疗肱骨近端粉碎性骨折32例,治疗效果满意.现报告如下.     

锁定加压钢板治疗肱骨近端骨折的临床疗效分析

目的:探讨肱骨近端锁定加压钢板治疗肱骨近端骨折的临床疗效.方法:对2005年3月～2008年6月期间应用肱骨近端锁定加压钢板治疗26例肱骨近端骨折的临床效果进行回顾性分析.年龄25～64岁,按Neer分型,2部分骨折10例,3部分骨折14例,4部分骨折2例,均给予肱骨近端锁定加压钢板固定.结果:所有病例均获随访,随访时间3～24个月,平均15个月,均获骨性愈合,平均愈合时间4.5个月,肩关节按Neer评分,优17例,良6例,中2例,差1例.优良率88.5%.结论:肱骨近端锁定加压钢板治疗肱骨近端骨折疗效满意,是治疗肱骨近端骨折的比较理想的治疗方法.     

锁定钢板治疗肱骨近端骨折

肱骨近端骨折是一种常见的骨折，发生率4％～5％，其中15％～20％为移位骨折。随着对肱骨近端骨折认识的加深，治疗方法也在不断发展。自2002年8月～2004年5月共收治了13例肱骨近端骨折。现报告如下。     

采用肱骨近端锁定钢板治疗肱骨近端骨折临床分析

目的探讨应用肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效。方法对20例肱骨近端骨折患者行锁定钢板内固定手术治疗,随访半年左右,对其愈合情况和肩关节功能进行评定。结果经过肱骨近端锁定钢板内固定治疗后,20例肱骨近端骨折患者,有19例达到骨折解剖复位标准,有1例达到骨折功能复位标准。所有患者骨折都愈合,术后随访半年,无创口感染、钢板断裂、螺钉脱出、内固定失效等严重并发症。20例肱骨近端骨折患者治疗后,肩关节功能评分:优15例,良4例,可1例,优良率为95.0%。结论应用肱骨近端锁定钢板治疗肱骨近端骨折,复位良好,术后功能恢复较满意,并发症相对较少,值得临床广泛推广。     

肱骨近端骨折肱骨距后内侧的骨质量及骨折线形态

目的:探讨肱骨近端骨折中肱骨距后内侧骨折线形态、骨质量与骨折类型的相关性。方法:回顾性分析2020年6月至2021年6月62例肱骨近端骨折患者的CT扫描资料,其中男27例,女35例;年龄（46.5±16.3）岁范围（19~72岁）。以CT扫描三维重建数据为基础,描述肱骨距后内侧骨折线,代入肱骨近端模板,描绘骨折地图;记...     

20例复杂肱骨近端骨折术后肱骨头坏死的特点分析

目的:分析复杂肱骨近端骨折切开复位解剖锁定钢板固定后出现的肱骨头坏死的特点。方法:回顾性分析自2012年9月至2020年6月北京积水潭医院创伤骨科收治的复杂肱骨近端骨折术后出现的20例肱骨头坏死患者资料。男7例,女13例;年龄平均57.4岁（35~84岁）。分析其骨折分型、肱骨头坏死塌陷的时间,测量内侧残余骨距长度、肱...     

锁定钢板治疗老年肱骨近端骨折临床报告

肱骨近端骨折是指肱骨外科颈以远1～2cm至肱骨头关节面之间的骨折,包括肱骨头、大结节、小结节、肱骨干近端等结构的骨折,约占全身骨折4％～5％。我院自2005年1月-2009年5月,     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Complex coronoid and proximal ulna fractures are we getting better at fixing these?

Technological advances and improved understanding of functional anatomy about the elbow have lead an evolution regarding operative reconstruction of complex proximal ulnar and coronoid fractures. When treating these complex and challenging fractures, goals of anatomic articular restoration along with balanced soft tissue stability can lead to early range of motion and thus, desired functional outcome. The purpose of this review is to outline and provide tips and pearls to achieve desired results, with a comprehensive update on the most recent literature to support the latest fixation methods and techniques.