组合式外固定器最佳拆除 时间及有关问题探讨

作者１９９２年６月－１９９４年１２月，用组合式外固定器治疗胫腓骨骨折２４例，治疗过程中应用Ｂ超直方图检测骨愈合，为固定器高速及拆除提供量化指标。固定后６周，Ｂ超直方图值达到健侧５０％－６０％，拆除外固定更换夹板或行走石膏，为骨愈合创造较好力学环境，骨折在１０－１４周愈合，比通常认为需要３－５月更短。     

Importance of Albumin, 25(OH)-Vitamin D and IGFBP-3 as Risk Factors in Elderly Women and Men with Hip Fracture

The relative importance of vitamin D deficiency, secondary hyperparathyroidism, nutritional deficiency and low bone mineral density (BMD) as risk factors for hip fracture is not definitely established. In the framework of a case-control study of risk factors for hip fractured, biochemical markers of bone metabolism and nutrition and femoral BMD data were compared in 136 female and 43 male hip fracture patients, 126 female and 44 male age-matched hospitalized controls, and 47 healthy elderly women (8 men). Patients with hip fracture had lower albumin (−10%9 and 25(OH)-vitamin D (25(OH)D; −19%) compared with hospitalized controls, and lower albumin (−28%) and 25(OH)D levels (−52%) compared with the elderly controls. Serum values of IGFBP-3 were also significantly lower (−33%) in hip fracture patients than in community controls. BMD of femoral neck was lower (p < 0.001) in patients than in hospitalized and community controls. In hip fracture patients, parathyroid hormone (PTH) correlated weakly with BMD (neck: r = −0.19, trochanter: r = −0.17; both p < 0.05). When all women were pooled (n = 233), albumin correlated significantly (age-adjusted) with BMD at all sites (neck: r = 0.27, trochanter: r = 0.25; all p < 0.001). Albumin, but not 25(OH)D, also correlated with skinfold thickness (r = 0.19, p < 0.0025) and with body mass index (BMI) (r = 0.14, p < 0.05). Male patients with hip fracture had lower BMD and albumin (both p < 0.001), 25(OH)D (p = 0.02) and IGFBP-3 levels (p <: 0.005) compared with the controls. When male patients and controls were pooled together, albumin, skinfold thickness and BMI were significantly correlated with each other, but not with BMD. IGFBP-3 was highly correlated with albumin (p < 0.0001), 25(OH)D (p < 0.005) and, less significantly, with PTH (p < 0.05), but not with BMI or skinfold thickness. IGFBP-3 was significantly correlated with BMD at all sites (neck: r = 0.27, p < 0.05); trochanter: r = 0.40, p < 0.0005). In conclusion, low albumin and low BMD were both important risk factors for hip fracture. Low serum albumin was the strongest independent variable correlated with hip fractures. In men, IGFBP-3 was correlated with BMD. The femoral BMD depended only weakly on PTH and 25(OH)D, but was correlated at all sites with albumin, a non-specific parameter of nutrition and general health.     

实验性骨折愈合中骨吸收活动的超微结构观察

将50只家兔造成实验性桡骨骨折,分批取骨痂标本,用光镜和电子显微镜观察表明,在骨折愈合过程中,破骨细胞是骨吸收的主要执行者,巨噬细胞能吞噬死骨,但不能吸收骨质。     

Pilon骨折的治疗

作者自1988年1月至1993年12月收治Pilon骨折31例，根据Riled的分类祛：Ⅰ型5例，Ⅱ型10例，Ⅲ型16例．手术治疗22例，保守治疗9例．随访l－4年，疗效按Bourne的标准评定，Ⅰ型骨折手术或保守治疗优良率100％，Ⅱ、Ⅲ型骨折手术治疗优良率85％，保守治疗优良率33．3％．作者认为Pilon骨折Ⅱ、Ⅲ型应手术治疗．保守治疗仅用于Ⅰ型骨折．手术控AO的四步重建法进行．但严重的粉碎骨折或开放骨折伴软组织缺损，内固定确定难干实施者，则改用踝部超关节外固定支架固定．     

The use of frame fixation in the management of open distal extensor mechanism avulsion fracture in a dislocated knee

An avulsion fracture of the tibial tubercle is a common injury in traffic accident. If the fracture is closed, then a comparatively good prognosis can be expected through reinforcement of the bone via osteosynthesis and the use of artificial ligaments. In this case, an open wound was observed in the tibial tubercle, and the wound was so polluted that the healing process was significantly delayed. It was therefore difficult to provide simultaneous surgical treatment and so three operations were required to perform the reconstruction of the extensor mechanism. The reconstruction of extensor mechanism and the frame fixation between the patella and tibia was performed. Six months after the injury, the patient was able to walk without aid, had a range of movement from 5°to 130°, and did not show any indications of ADL disorder. Using this method of frame fixation between the patella and tibia proved to be an effective technique for the reconstruction of the open knee extension mechanism injury.     

Posterior Acromioclavicular Dislocation with Clavicular Fracture and Trapezius Entrapment

AbstractBackground: Posterior acromioclavicular dislocation is rare. Dislocation associated with fracture of the clavicle and simultaneous entrapment of the lateral end of the clavicle by trapezius muscle has not been reported. Posterior dislocation occurs frequently owing to forceful move of the scapula anteriorly and superiorly or from direct force applied to the lateral end of the clavicle and this may be associated with clavicular fracture. In acute dislocations, open reduction, internal joint stabilization and soft tissues reconstruction have been recommended.Case Study: Acute posterior dislocation occurred in a 32-year-old man. The lateral end of the clavicle was displaced posteriorly and inferiorly, and firmly entrapped in trapezius muscle. The clavicular fracture was undisplaced. The coracoclavicular ligaments were stretched but intact. Open reduction was secured with two smooth Kirschner wires. The disrupted soft tissues were repaired. The clavicular fracture was not explored. Shoulder movement started at 6 weeks. Wires were removed. 10 years later he had pain-free, unrestricted shoulder movement, and the radiographs showed wellreduced, essentially normal acromioclavicular joint.Conclusion: Open reduction, internal joint stabilization and soft tissue reconstruction will result in return and long lasting unrestricted pain-free function of the shoulder.     

胫骨延长后骨痂直径与新生骨预后关系的临床分析

目的探讨胫骨延长后骨痂直径与新生骨预后的关系.方法 1996年1月～2001年12月,对68例胫骨延长者测量达所需延长长度时的骨痂直径,计算骨痂直径率(callus diameter ratios,CDR);统计拆除外固定架后2～4周时新生骨发生骨折例数及畸形角度,比较骨折和成角畸形与CDR的关系.结果拆除外固定架前胫骨前屈角度5度以上畸形19例,其中11例发生骨折;拆除外固定架后胫骨出现5度以上畸形6例,其中2例骨折;其余43例胫骨延长骨痂正常愈合.计算CDR值:CDR值小于80% 23例,其中发生新生骨骨折13例,成角畸形5度以上者21例;CDR在81%～85%之间6例,成角畸形5度以上4例;CDR值超过86% 39例,无畸形或新生骨骨折.结论胫骨延长时CDR小于80%时,容易发生新生骨骨折和畸形;CDR大于85%时,无新生骨骨折和畸形发生;两组间具有统计学意义(P＜0.05).CDR是判断骨痂能否正常愈合较为理想的检测指标.     

经皮穿刺椎体成形术治疗合并肺气肿的胸椎压缩性骨折

目的 探讨合并严重肺气肿的胸椎压缩性骨折进行经皮穿刺椎体成形术的技术特点和治疗效果。方法 7例(10个椎体)合并严重肺气肿并且透视椎体显示不清的胸椎骨质疏松椎体压缩骨折患，侧卧位在CT结合C型臂透视引导下进行经皮穿刺椎体成形术。术前、术后2d和随访时分别测定疼痛强度评分、止痛药使用和活动能力评分。随访2-8个月，平均5个月。结果 7例皆顺利完成手术，注射骨水泥的量平均2．2ml／椎体(1．0～4．0m1)，无临床并发症，手术时间2—3．5h／例。疼痛强度评分值术后2d比术前平均减低3．9，随访时进一步下降0．2—2．9，活动能力和止痛药使用术后均明显改善。结论 合并肺气肿的胸椎压缩性骨折患行经皮穿刺椎体成形术治疗前应进行骨折椎体透视检查，显示不清选择侧卧位在CT结合C型臂透视引导下穿刺注射可获得良好疗效。     

老年股骨髁部骨折的治疗分析

目的探讨治疗老年股骨髁部骨折的内固定器选择及应用要点。方法治疗82例老年股骨髁部骨折,A型26例,B型17例,C型39例。分别采用95°角翼钢板(19例)、T型钢板(5例)、AO股骨髁支持钢板(11例)、动力髁螺钉(dynamiccondylarscrew,DCS)(23例)、股骨髁上带锁髓内钉(greenseligsenhenry,GSH)(24例)进行治疗,共28例采用自体髂骨或同种异体骨植骨。结果经平均14.6个月随访,按Merchan等评分标准评定膝关节功能,总优良率为90.2%。结论老年股骨髁部骨折具有特殊性,针对骨折类型选择内固定器是治疗的重要环节。手术的关键在于保持股骨髁关节面的完整性和牢固固定。     

Vertebroplasty and Kyphoplasty in Spinal Trauma

Abstract Kyphoplasty and vertebroplasty have become recognized procedures for the treatment of vertebral fractures, especially in patients with osteoporosis. In most cases of osteoporotic spinal vertebral fracture in elderly patients, polymethylmethacrylate (PMMA) cement is used to fill the defect and stabilize the vertebral body. The techniques of vertebroplasty and kyphoplasty differ in the possibility of realignment and reconstruction of the vertebral body and spinal column. Long-term results in terms of integration of the cement and bioreactivity of the vertebral body are still lacking; so, these procedures are still no options in the treatment of younger patients. Vertebroplasty and kyphoplasty show different success in the management of fresh traumatic spine fractures. The acute traumatic vertebral fracture has to be classified sensitively, to find the right indication for cement augmentation. Mild acute compression fractures can be treated by vertebroplasty or kyphoplasty, severe compression and burst fractures by combination of internal fixation and kyphoplasty. The indications for use of biological or osteoinductive cement in spinal fracture management must still be regarded as restricted owing to the lack of basic biomechanical research data. Such cement should not be used except in clinical studies.