股骨近端解剖型钢板治疗股骨转子间骨折

目的探讨股骨近端解剖型钢板治疗股骨转子间骨折的临床价值。方法回顾分析38例股骨转子间骨折应用股骨近端解剖型钢板手术治疗临床资料,根据术前术后X线片及术后髋关节功能、站立及行走等恢复情况评价内固定效果。结果38例随访时间6个月至2年,根据黄公怡评定标准,优23例,良12例,差3例。结论股骨近端解剖型钢板是治疗股骨转子间骨折的一个很好的方法。     

Subtrochanteric fractures of the femur. Treatment with locking intramedullary nailing. An experience without C-Arc. The guide-wire stopping method for verify distal locking is described

ObjectiveEvaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C.MethodsA case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell–Taylor Classification were used. The statistic procedure was done with SPSS program. The traumatic hip scale of Sander et al. was used for final evaluation. Technical for doing distal locking is detailed.ResultsThis series evaluated 49 patients: 35 male and 14 female patients. The mean age was 36 years old (range: 18–86 years). Traffic accidents and gunshot wounds were injury forms most frequent. There were not transoperative complications. The surgical time was between 90 and 120 min (mean: 108 min). The mean follow-up was 24 months (range: 18–36 months). According to Sanders score, it was reported 22 excellent results, 20 good results and 7 regular results. All distal locking procedures were successfully performed.ConclusionAlthough this series consists in a few numbers of patients, we recommend the placement of interlocked intramedullary nail (Closs-MB Bioimpianti^® and Orthosintese^®) in subtrochanteric fractures. This device allows placement of distal locking through the insertion frame with safety and precision, even in surgery rooms without arc-C. The guide-wire stopping method allows the verification of distal locking in an objective, accurate, safe and reproducible way.     

跟骨骨折锁定钢板外固定治疗的护理

跟骨骨折占全身骨折的2％，跟骨骨折的治疗同其他骨折一样，即解剖复位、坚强固定和早期功能锻炼。重建跟距关节面的平整及后足的力线是恢复关节功能，减少远期并发症的基本要求。我科2007-2010年对26例29足，通过行锁定纲板外固定治疗、术后护理及康复练习，取得良好效果，现介绍如下。     

Correlations between effective permeability and marrow contact channels surface of vertebral endplates

Homeostasis of the intervertebral disc relies on nutrient supply and waste clearance through the dense capillary network that is in contact with the cartilage endplate (CEP). We developed a micro‐computerized tomography (micro‐CT) method to quantify the marrow contact channel surface (MCCS) with the CEP and to validate the hypothesis according to which MCCS was correlated to the effective permeability of the vertebral endplate (VEP) and influenced by the mechanical stimuli. The influence of compression loading on local vascularization was investigated. Six 4‐week‐old skeletally immature pigs were instrumented with left pedicle screws and rod at both T5–T6 and L1–L2 levels to create asymmetrical spine tethers. After 3 months of growth, three cylindrical specimens of the VEP (one central and two lateral right and left) were obtained from both the instrumented and the control levels. We used a previously validated method for measuring permeability. Micro‐CT analysis (resolution 12 µm) yielded a gray‐scale 2D‐image of the discal end of each specimen converted into a binary 2D‐image to derive the MCCS. Correlations between MCCS and effective permeability were assessed. Effective permeability and MCCS were significantly decreased compared to the control group especially on the tethered side (?41.5%, p = 0.004 and ?52.5%, p = 0.0009, respectively). Correlations were significant and showed maximal value (r² = 0.430, p < 0.0001) on the tethered side involving maximal compressive loadings. Mechanical stimuli, due to unbalanced growth, altered the vascularization and the convective properties of the CEP. The cascade of mechanobiological events should offer perspectives for research on disc degeneration and attempted treatment. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1229–1234, 2010     

External validation of the clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures

IntroductionOn evaluation of the clinical indications of computed tomography (CT) scan of head in the patients with low-energy geriatric hip fractures, Maniar et al. identified physical evidence of head injury, new onset confusion, and Glasgow Coma Scale (GCS) < 15 as predictive risk factors for acute findings on CT scan. The goal of the present study was to validate these three criteria as predictive risk factors for a larger population in a wider geographical distribution.Patients and methodsPatients ≥65 years of age with low-energy hip fractures from 6 trauma centers in a wide geographical distribution in the United States were included in this study. In addition to the relevant patient demographic findings, the above mentioned three criteria and acute findings on head CT scan were gathered as categorical variables.ResultsIn total 799 patients from 6 centers were included in the study. There were 67 patients (8.3%) with positive acute findings on head CT scan. All of these patients (100%) had at least one criteria positive. There were 732 patients who had negative acute findings on head CT scan with 376 patients (51%) having at least one criteria positive and 356 patients (49%) having no criteria positive. Sensitivity of 100% and negative predictive value of 100% was observed to predict negative acute findings on head CT scan when all the three criteria were negative.ConclusionWith the observed 100% sensitivity and 100% negative predictive value, physical evidence of acute head injury, acute retrograde amnesia, and GCS < 15 can be recommended as a clinical decision guide for the selective use of head CT scans in geriatric patients with low energy hip fractures. All the patients with positive acute head CT findings can be predicted in the presence of at least one positive criterion. In addition, if these criteria are used as a pre-requisite to order the head CT, around 50% of the unnecessary head CT scans can be avoided.     

Delayed L2 Vertebrae Split Fracture following Kyphoplasty

Kyphoplasty is an accepted therapeutic modality for the treatment of painful osteoporotic vertebral compression fractures. Complication rates are reported between 1% and 3% for osteoporotic fractures. Most previously reported complications, however, have occurred perioperatively. In this article, we report a case in which balloon kyphoplasty was performed as described by manufacturer guidelines. Four weeks after a successful kyphoplasty, the patient presented with a painful split vertebral fracture with anterior deformity at the same level where the kyphoplasty was initially performed. A recurrent fracture at the same level of a previous successful kyphoplasty may be considered in the differential diagnosis of a patient who presents with new pain at a similar level.     

Campbell肘后入路鹰嘴窝钢板内固定治疗肱骨髁间骨折

目的:探讨Campbell肘后入路鹰嘴窝钢板内固定治疗肱骨髁间骨折的手术疗效.方法:15例肱骨髁间骨折,采Campbell肘后入路,骨折复位后用鹰嘴窝钢板固定.结果:随访6～28个月,骨折全部愈合,骨折愈合时间8～16周,肘关节平均活动度105度(95～135度).Mayo肘关节评分良好13例,可2例.尺神经麻痹2例.结论:采用Campbell肘后入路鹰嘴窝钢板内固定治疗肱骨髁间骨折临床疗效良好.     

有限内固定结合外固定架治疗C2、C3型Pilon骨折

目的探讨有限内固定结合外固定架治疗C2、C3型Pilon骨折的临床价值。方法2001年9月至2006年9月,采用有限内固定结合外固定架治疗C2、C3型Pilon骨折16例。结果所有患者获得随访,随访时间1~2年,平均1.4年。参照Mazur制定的踝关节功能评分标准,优9例,良4例,可2例,差1例。优良率81.3%。结论有限内固定结合外固定架是治疗C2、C3型Pilon骨折的一种有效方法。     

31例有并存症的老年股骨颈骨折髋关节置换术疗效分析

目的：评价实施有并存症的老年股骨颈骨折髋关节置换术的疗效等问题。方法：自1999年1月以来收治的65岁以上，GardenⅢ、Ⅳ型股骨颈骨折伴有并存症患者31例，分别采用全髋关节置换术（THR）和半髋关节置换术（PR）。结果：31例经20～81个月，平均37个月的时间随访。髋关节功能按照Harris评分标准，结果：全髋置换组：优12例，良6例，可2例，优良率为90．0％；半髋置换组：优5例，良4例，可2例，优良率为81．82％；本组优良率为87．10％，经X^2检验（x^2=0．73），两组优良率差异无显著性（P〉0．05）。结论：根据术前评估并将其分级认为：选择全髋或半髋关节置换都是治疗伴有并存症的老年股骨颈骨折的较好的方法，Ⅰ级和部分Ⅱ级选择全髋置换术，Ⅲ级以半髋关节置换术为佳，达到病人安全度过手术期，恢复功能活动，提高患者生活质量。     

椎弓根螺钉内固定结合经椎弓根植骨治疗胸腰椎爆裂性骨折

目的探讨经椎弓根椎体内植骨和椎体成形术治疗胸腰椎爆裂性骨折的临床疗效.方法32例胸腰椎爆裂性骨折患者采用短节段椎弓根螺钉内同定结合经椎弓根伤椎内注射骨水泥治疗。术后观察骨折椎体前后缘压缩率变化,Cobb角改善情况及并发症.结果术后随访12～24个月,平均17.5个月。骨折椎体前后缘均恢复满意,术前椎体前、后缘压缩率分别为(47.5±6.4)%和(19.1±2.7)%,术后椎体前后缘压缩率分别为(9.2±1.4)%和(1.6±0.4)%。术后与术前比较差异均有统计学意义(P<0.05),矢状位Cobb角由术前平均17.6~*矫正至4.3~*,平均矫正12.3~*.无术后并发症.结论经椎弓根植骨椎弓根螺钉固定治疗胸腰椎骨折,可在早期稳定的基础上为前柱提供长期稳定,能同时恢复椎体高度及强度,是治疗老年胸腰椎爆裂性骨折的有效方法.