掌侧锁定钢板治疗桡骨远端骨折

正2014年12月~2016年1月,我科采用掌侧锁定钢板内固定治疗36例桡骨远端骨折患者,取得较好疗效,报道如下。1材料与方法1.1病例资料本组36例,男13例,女23例,年龄25~72岁。骨折按AO分型:C型8例,B型9例,A型19例。左侧13例,右侧23例。伤后至手术时间3~7 d。     

开放复位掌侧锁定加压钢板治疗不稳定老年桡骨Colles骨折

正2013年1月~2015年12月,我们采用开放复位掌侧锁定加压钢板(LCP)治疗23例不稳定老年桡骨Colles骨折患者,效果优良,报道如下。1材料与方法1.1病例资料本组23例,男10例,女13例,年龄65~80岁。15例摔伤,8例交通事故伤,均为闭合新鲜骨折。AO/ASIF分型:A2型9例,A3型6例,B2型5例,C2型2例,C3型1例。合并症:Ⅱ型糖尿病5例,高血压病Ⅱ级6例、Ⅲ级4例。入院行手法复位后,X线片显示复位不佳。伤后至手术时间     

后路克氏针内固定治疗小儿肱骨髁上骨折

正2008年1月~2014年12月,我科采用后路克氏针内固定治疗34例肱骨髁上骨折患儿,效果满意,报道如下。1材料与方法1.1病例资料本组34例,男21例,女13例,年龄6~12岁。均为闭合肱骨髁上骨折。伸直型23例,屈曲型11例。受伤至手术时间6~13 d。1.2治疗方法臂丛麻醉或静脉复合麻醉下手术。肘后侧切口,自鹰咀尖端远侧3~4 cm,于上臂中线向近侧延伸至鹰咀上8~10 cm,显露并整复骨折。由内、外上髁各钻入1枚克氏针,将骨折交叉固定。关闭切口并放置负压引流。     

两种固定方法治疗胫腓骨骨折临床效果分析

胫腓骨骨折为临床上常见的骨折, 治疗方法甚多。本院自 1998年 1月~2003年 12月对 56例新鲜胫腓骨骨折患者,分别行交锁髓内钉、单臂三维万向外固定器 (以下称外固定器) 治疗。今就手术时间、术中失血量、术后膝踝关节活动、住院时间及骨折愈合时间等进行统计分析, 并对有关问题作一讨论。1　临床资料1 1　一般资料交锁髓内钉组 23例, 男 14例, 女 9例。年龄 19~67岁,平均 40 1岁。车祸伤 14例, 砸伤 7例, 摔伤 2例。受伤时间1~32h, 平均 5 6h。开放性骨折 12例, GustiloⅠ型 8例, Ⅱ型 4例。X线片示横断骨折 11例、斜型或螺旋型骨折 6…     

国产2.7mm系统掌侧锁定加压钢板治疗桡骨远端不稳定骨折

<正>2011年8月~2013年2月,我们应用国产2.7 mm系统桡骨远端掌侧锁定加压钢板治疗23例桡骨远端不稳定骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组23例,男19例,女4例,年龄21~49岁。左侧8例,右侧13例,双侧2例。均为新鲜闭合骨折,其中6例合并其他部位损伤或骨折。受伤至手术时间5~20 d。按AO分类:B2型(桡骨远端关节面背侧缘骨折)4例,B3型(桡骨远端关节面掌侧缘骨折)     

Herbert螺钉治疗PipkinⅠ、Ⅱ型股骨头骨折

正2010年1月~2014年12月,我院采用Herbert螺钉治疗15例PipkinⅠ、Ⅱ型股骨头骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男12例,女3例,年龄18~50岁。骨折按Pipkin分型标准:Ⅰ型9例,Ⅱ型6例。受伤至手术时间6~10 h。1.2治疗方法全身麻醉或椎管内麻     

解剖型锁定钢板经皮微创内固定治疗胫骨远端骨折

<正>2010年1月~2015年10月,我们采用解剖型锁定钢板经皮微创内固定治疗32例胫骨远端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组32例,男23例,女9例,年龄21~64岁。闭合骨折29例,开放骨折3例。骨折按AO分型:A型22例,B型7例,C型3例。合并腓骨骨折27例,外踝骨折5例。对3例开放骨折清创缝合后行跟骨牵引,2周拆线后再行骨折复位内固定术;对患肢肿胀不明显的闭合骨折行石膏托外固定;其     

切开复位空心螺钉固定+肌骨瓣移植治疗青壮年股骨颈骨折

正2010年6月~2014年6月,我科采用切开复位空心螺钉固定+股直肌蒂骨瓣移植治疗44例青壮年股骨颈骨折患者,临床效果满意,报道如下。1材料与方法1.1病例资料本组44例,男31例,女13例,年龄16~47岁。骨折部位:头下型20例,头颈型14例,经颈型10例。骨折按Garden分型:Ⅱ型6例,Ⅲ型15例,Ⅳ型23例。1.2治疗方法硬膜外麻醉。改良     

肘关节前内侧入路锁定钢板治疗尺骨冠状突骨折

正2014年6月~2017年1月,我科采用肘关节前内侧入路锁定钢板治疗6例尺骨冠状突骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组6例,男5例,女1例,年龄20~48岁。均为单纯尺骨冠状突骨折。骨折按Regan-Morrey分型:Ⅱ型1例,Ⅲ型5例。伤后至手术时间为3~7 d。1.2治疗方法臂丛麻醉下手术。在     

肱骨近端锁定钢板治疗儿童股骨转子部骨折

正2009年1月~2013年12月,我科采用肱骨近端锁定钢板内固定治疗10例股骨转子部骨折患儿,疗效满意,报道如下。1材料与方法1.1病例资料本组10例,男7例,女3例,年龄6~12岁,均为闭合骨折。其中转子间骨折4例,根据Evans分型:Ⅰ型2例,Ⅱ型2例;转子下骨折6例,根据Seinsheimer分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例。受伤至手术时间2 h~3d。1.2治疗方法全身麻醉下手术。取     

Type 4 capitellum fractures: Diagnosis and treatment strategies

Background:

Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee) with gadgets available in a district hospital.

Materials and Methods:

Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2) and 2.7 mm AO screws (n=1), under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration.

Results:

All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN.

Conclusion:

Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher''s lateral approach has given good results.     

Torsional Strength of Cortical and Cancellous Bone Grafts After Rigid Plate Fixation

Mechanical properties of cortical and cancellous interposition grafts in rabbit tibio-fibular bones fixed with 6-hole DCP/ASIF plates were tested with torsional loading after intervals of 3 to 52 weeks postoperatively.

In the cortical grafts maximum torque moment at fracture, energy absorption capacity and rigidity increased from 3 to 12 weeks, while the cancellous grafts were more plastic with lower rigidity, higher angular deformation and higher energy absorption.

From 12 to 52 weeks maximum torque moment at fracture, energy absorption, rigidity and angular deformation decreased in grafts of both types, the respective means at 36 weeks being 39, 34, 57 and 82 per cent of the control values for the cortical grafts, and 26, 17, 42 and 58 per cent of the control values for the cancellous grafts. The differences between the torsional properties of the two graft types decreased with time.     

Longitudinal in vivo monitoring of callus remodeling in BMP-7- and Zoledronate-treated fractures

Pharmacological interventions that combine pro-anabolic and anti-catabolic drugs to treat recalcitrant fractures have shown remarkable efficacy in augmenting the regenerative response. Specifically, in rodent models of fracture repair, treatment with BMP-7 and Zoledronate (ZA) has almost uniformally resulted in complete union. However, delayed remodeling may be problematic for ZA-treated fractures. The increase in newly formed bone is substantial but if translated in humans, delayed remodeling may delay functional recovery. Our objective was to determine if, and to what extent, bone morphogenetic protein (BMP) (in synergistically administered BMP-7 + ZA) can modulate the delayed hard callus remodeling caused by ZA. Callus remodeling in BMP-7-only and BMP-7 + ZA-treated osteotomies were monitored using in vivo µCT to follow the progression of healing at 6-week intervals over 24 weeks in an open femoral fracture rat model. None of the groups recovered baseline cortical bone volumes within 24 weeks post-osteotomy. Treatment prolonged the remodeling phase but the kinetics of remodeling appeared to differ between BMP and BMP + ZA groups. However, the mechanical characteristics were largely restored. Callus/bone volumes in BMP-only treated fractures peaked as early as week 3 suggesting that remodeling is stimulated prematurely. However, this rate of remodeling was not maintained as BMP-7 was found to exhibit negligible changes in callus/bone volumes between weeks 6 and 18, whereas declines in callus/bone volumes were present at these time points in the BMP-7 + ZA group. Our findings suggest that inclusion of ZA as an anti-catabolic agent may not be detrimental to the regenerative process despite a prolonged remodeling phase.     

肱骨近端、髋部骨折老年女性骨密度和骨代谢指标对比研究

目的对髋部、肱骨近端骨折老年女性的骨密度和骨代谢指标进行对比分析,进一步揭示上述骨折部位女性患者骨密度和骨代谢指标特征性变化情况。方法经患者及家属同意,共纳入62例老年髋部骨折女性患者(其中股骨颈骨折39例,股骨粗隆间骨折23例)、肱骨近端骨折21例,收集患者年龄、检测患者骨密度、血清骨转换指标(Ⅰ型胶原氨基端延长肽,P1NP;Ⅰ型胶原C端肽β降解产物,β-CTX)。结果肱骨近端骨折女性患者平均年龄为(66.1±8.0)岁,明显小于股骨颈骨折、粗隆间骨折女性患者(P<0.05);肱骨近端骨折女性髋部(T=-1.19±0.66)、腰椎骨密度(T=-1.67±1.00)明显高于粗隆间骨折女性髋部(T=-2.36±1.17)、腰椎骨密度(T=-2.61±1.42)(P<0.05),同时显著高于股骨颈骨折患者髋部骨密度(T=-2.33±0.99)。股骨颈骨折、股骨粗隆间骨折患者髋部、腰椎骨密度相比差异无统计学意义;三组间血清P1NP比较差异没有统计学意义,粗隆间骨折女性血清β-CTX(732.18±334.37μg/L)要明显高于肱骨近端骨折患者(529.66±292.34μg/L)(P<0.05)。结论相对于髋部骨折患者,肱骨近端骨折老年女性患者年龄较低,骨密度相对较高;骨吸收活跃可能是导致粗隆间骨折女性骨密度下降的原因。     

The Healing of Experimental Fractures by Compression Osteosynthesis: I. Torsional Strength

Biomechanical properties of osteotomized rabbit tibio-fibular bones fixed with 6-hole stainless steel AO/DCP plates were investigated with torsional loading 3 to 24 weeks postoperatively.

During the first 9 weeks maximum torque capacity, energy absorption and torsional rigidity increased, reflecting progressive bony union between the fractured bone ends. From 9 to 24 weeks the values of torque capacity and energy absorption decreased, whereas torsional rigidity seemed to reach a steady state without further significant changes. For the three parameters considered, the mean percentage differences between the osteotomized plated bones and their paired sham-operated controls were 69, 64 and 80 per cent, respectively.

The results suggest that internal fixation of fractured bones provides conditions for undisturbed fracture healing, but that subsequently the rigid nature of the implant has an adverse effect on the cortical bone, which slowly loses strength. Thus the optimal time for removal of the plate seems to be shortly after the fracture has healed and before the bony tissue has been weakened by secondary changes, such as cancellous transformation and spatial rearrangement of the tubular bone.     

一期骨搬移治疗胫骨开放性骨折伴骨缺损

目的探讨急诊一期行骨短缩-延长骨搬移治疗胫骨开放性骨折伴骨缺损与常规分期手术治疗的优缺点。方法随机选择胫骨开放性骨折伴骨缺损60例,分成A组（一期骨短缩延长治疗组）和B组（常规分期手术治疗组）,A组根据Ilizarov牵张成骨理论,采用可同时短缩延长型外固定架进行断端的加压短缩、干骺端的截骨延长一期修复骨缺损;B组常规一期清创外固定、二期修复骨缺损治疗,比较住院时间、手术次数、平均住院费用、平均骨愈合时间、感染概率、取髂骨植骨率、患者满意率。结果 A组住院时间、手术次数、平均住院费用、平均骨愈合时间、感染概率、取髂骨植骨率均少于B组,患者满意率高于B组。结论急诊一期骨搬移治疗胫骨开放性骨折伴骨缺损,选择合适病例,掌握好适应证,应用价值更高。