双解剖钢板加中空螺钉手术治疗肱骨髁间骨折

目的探讨双解剖钢板加中空螺钉手术治疗肱骨髁间粉碎性骨折的疗效。方法对34例肱骨髁间粉碎骨折患者行双解剖钢板加中空螺钉手术固定治疗,术后第1天行肘关节被动活动,1周后肘关节主动活动。术后定期行X线摄片复查了解骨折愈合情况。结果所有患者骨折复位良好。术后经1.2～3.3年随访,骨折全部愈合,肘关节功能基本恢复正常。根据Casscbaum方法评定肘关节术后疗效:优11例,良17例,可6例,优良率82.4%。结论采用双侧钢板加中空螺钉内固定手术治疗肱骨髁间骨折,骨折复位满意,固定牢靠,术后可早期行功能锻炼,肘关节功能恢复满意。     

锁定跟骨钢板治疗新鲜跟骨骨折

目的 探讨采用锁定跟骨钢板治疗新鲜跟骨关节内移位骨折的临床疗效.方法 2004年10月至2006年10月,治疗34例男性闭合性跟骨关节内移位骨折患者,年龄19～42岁,平均34岁;左足14例,右足20例;高处坠落伤22例,车祸伤12例.受伤至手术时间7～21天,平均13天.术前均对伤足摄正、侧位X线片及跟骨的CT轴位片.根据Sanders分型,Ⅱ型16例,Ⅲ型18例.采用扩大外侧入路对34例患者进行手术,骨折复位后利用锁定跟骨钢板完成骨折内固定.结果 28例患者获得随访,随访时间6～40个月,平均20个月.切口均甲级愈合.B(o)hler角由术前平均7.41°±4.08°改善至术后第7天的29.74°±5.56°和术后3个月的30.00°±5.53°;Gissane角由术前平均163.71°±9.31°改善至术后第7天的122.59°±14.11°和术后3个月的125.85°±19.31°.骨折均愈合,愈合时间为6～12周.术后无一例患者发生撞击或神经、血管损伤等并发症,未出现骨折移位或内固定失败等情况.术前美国足踝外科学会(American Orthopaedic Foot & Ankle Society,AOFAS)评分系统的踝-后足评分为(17.68±9.34)分,术后3个月和6个月分别为(74.79±4.01)分和(74.28±17.92)分.结论 应用锁定跟骨钢板治疗新鲜跟骨骨折,可以获得满意的临床效果,利于患者的功能恢复.

Abstract：

Objective To evaluate the clinical outcome of operative management of displaced intraarticular fractures of the calcaneus using locking plates. Methods From October 2004 to October 2006, 34patients with close displaced intraarticular fractures of the calcaneus were fixed with Calcaneal locking Plates through the extensive lateral approach. The right foot was involved in 20 patients. The mean age was 34 yesrs with a range of 19 to 42 years. Accordiing to Sanders' classification system, there were 16 patients in style Ⅱ and 18 in style Ⅲ The mean interval between injury and operation was 13 days Standard reduction and fixation techniques were performed to realign all components of the intra-articular calcaneal fracture using a locking calcaneal fracture plate. The result were evaluated with AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot scale. Results Twenty-eight patients were followed up. The follow-up duration ranged from six to forty months, with the mean of twenty months. angle and were measured at, The average B(o)hler angle was 29° and 30° and the average Gissane was 122° and 125° seven days and three months after operation. Bone union was achieved in all cases. All incisons had healed smoothly. No patient sustained lateral impingement syndrome or soft tissue complications The mean AOFAS scores that was measured three months and six months after operation was 74. Conclusion The application of the calcaneal locking plates through extended lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of good reduction and early rehabilitation.     

胸锁钩钢板内固定治疗创伤性胸锁关节前脱位的疗效观察

目的 探讨胸锁钩钢板内固定治疗创伤性胸锁关节前脱位的作用及临床疗效.方法 2002年5月至2009年10月,采用自行设计制造的胸锁钩钢板内固定治疗创伤性胸锁关节前脱位患者66例,男47例,女19例;年龄21～68岁,平均32.6岁;左侧25例,右侧41例.受伤原因:交通伤40例,压砸伤21例,摔伤5例.根据Allman分型:Ⅲ型31例,Ⅱ型35例;其中胸锁关节前脱位合并锁骨胸骨端骨折41例.受伤至手术时间3～62 d,平均7.5 d.Rockwood等胸锁关节评分标准对患者术后功能进行评价.结果 手术时间20～48 min,平均33 min;术中出血20～90ml,平均60 ml;术后无一例发生神经、血管损伤;切口均一期愈合.术后X线片及CT扫描示胸锁关节复位满意.66例患者均得到随访,随访时间12～37个月,平均17个月.末次随访时无一例患者发生胸锁关节再脱位和内固定失效.胸锁钩钢板均于术后12个月取出.Rockwood等胸锁关节评分为8～15分,平均为13.2分,其中优50例、良15例、可1例,优良率为98.5%.结论 胸锁钩钢板治疗创伤性胸锁关节前脱位手术安全,固定可靠,术后能允许肩胛带早期进行功能锻炼.

Abstract：

Objective To investigate the clinical outcomes of sternoclavicular hook plate in treatment of the anterior sternoclavicular joint dislocation. Methods A new device named sternoclavicular hook plate was devised by our team. Between May 2002 and Octorber 2009, 66 patients with sternoclavicular joint anterior dislocation were treated with the new device, among whom there were 47 males and 19 females,aged 21-68 years old (average, 32.6 years old). Twenty-one cases were caused by crush injury, 5 cases by falling and 40 cases by traffic accident. Anterior fracture-dislocation was found in 41 cases. According to the Allman system, there were 35 cases of type Ⅱ and 31 cases of type Ⅲ. Patients were evaluated with serial clinical and radiographic examinations. Rockwood score were used after the operation to assess the curative effect. Results The average operative time was 33 min (range, 20-48 min). The mean blood loss was 60 ml (range, 20-90 ml). There were no vascular or peripheral nerve injuries in the patients. All incisions healed smoothly. The X-ray and CT showed that the reduction of sternoclavicular joint and the location of internal fixation were satisfactory. All the 66 patients were followed up for 12-37 months (average, 17 months). There was no internal fixation failure, redislocation or other complications. The sternoclavicular hook plate was removed 12 months after operation. The mean Rockwood's score was 13.2 (8 to 15). There were excellent in 50cases, good in 15 cases, and fair in 1 case. Conclusion The sternoclavicular hook plate is a new, safe and liable technique for sternoclavicular fracture-dislocation. This new technique is helpful for early functional exercises.     

Locking Compression Plates for the Treatment of Periprosthetic Femoral Fractures Around Well-Fixed Total Hip and Knee Implants

There are currently few published studies examining the use of locking compression plates for the treatment of periprosthetic femoral fractures. Fifteen total hip or knee arthroplasty patients with 16 Vancouver type B1 and C fractures with an average age of 76 years were fixed and followed clinically and radiographically for 2 years. Fourteen patients achieved radiographic union by 6 months, and 13 patients were ambulatory by 6 months. There were no intraoperative complications. In summary, locking plates offer a viable treatment option for these difficult fractures. We advocate a minimum of 10 cortices of fixation (with unicortical or bicortical screws and cable combinations) above and below the fracture. Bone grafting should be used if the soft tissue envelope is violated with extensive dissection, and cortical struts should be considered in cases of failed hardware and revision fixation.     

Locking plate technology and its use in foot and ankle surgery

This article discusses the history of conventional plating, plate biomechanics, and screw function to provide better understanding of osseous physiology and biology using locking plates. The peer-reviewed and non-peer-reviewed literature have been researched to decipher and share the most pertinent information on this topic.     

Coding accuracy for endophthalmitis diagnosis and cataract procedures in Western Australia: The Endophthalmitis Population Study of Western Australia (EPSWA): Second Report

As an initial phase of the Endophthalmitis Population Study of Western Australia (EPSWA), this paper reports the results from an intensive comparative validation of all possible surgery-related endophthalmitis cases identified for the period from 1980 to June 1999 from the Hospital Morbidity Data System (HMDS) of the WA Record Linkage Project with external sources. The external sources were the microbiology and anaesthetic databases from Royal Perth Hospital (where most of the cases of endophthalmitis were treated) and surgeon logbooks of two vitreoretinal surgeons treating endophthalmitis in Perth over the study period. As it was discovered that a large proportion of all cases coded with endophthalmitis did not have any ocular surgery, the validation also included a sample from these cases. The purpose of validating these cases was to ensure that our count of postoperative endophthalmitis had not excluded any cases whose surgery might not have been recorded in the HMDS database. It was also intended to provide an estimate of all miscoded endophthalmitis cases as a first step towards future improvement of coding accuracy. Since we suspected that phaco-emulsification was under-coded, we also examined a sample of cataract procedures. Of all surgery-related endophthalmitis cases coded in the HMDS, only 50.9% (274 of 538) were found to be valid cases. External sources identified 83 cases of endophthalmitis, 49 did not have endophthalmitis codes but were in the HMDS file with an associated code. Of the remaining externally identified cases, 13 were missing altogether from the HMDS file, 7 of which were correctly coded in the notes while the other 6 were coded with associated codes, and 21 were diagnosed after the date the HMDS file was extracted. The validation of a random sample of the non-surgery-related cases coded with endophthalmitis suggested that the vast majority of them were miscoded (88%, 139 of 158 sampled from 1474 cases). The systematic coding errors reported in this paper may be attributed to both the clinical and the coding departments of the hospital. In any case, coding inaccuracy itself is a serious concern for data quality of any linked database systems and for epidemiological researchers using such data. The increased use of aggregated data in epidemiological research further underscores the importance of coding accuracy and thus data validation. The use of external sources for case identification and case validation are two ways of ensuring data completeness/quality and validity of results.     

Lateral approach for fixation of the fractures of the distal tibia. Outcome of 20 patients

Introduction The treatment of fractures of the distal third of the tibia remains still controversial. It is often difficult to get and retain good reduction by non-operative or nailing methods. Open reduction and plate fixation offers good reduction and retention of the achieved position. However, increased soft tissue damage and high complication rate has led to search less invasive surgical methods such as minimal invasive plating technique. Material and methods Lateral approach for the distal tibia allows to reduce and to plate both the fibula and the tibia using only one skin incision. We have used lateral approach for 20 consecutive tibia fracture patients and report clinical and radiological results after an average follow-up of 31 months. Results All fractures united, but two malunions were developed after good primary reduction. Seventeen patients achieved excellent or good subjective result while one had moderate and two poor results. Four superficial wound infections were noticed and they were treated conservatively. Conclusion We conclude that lateral approach for the distal tibia is a demanding, but useful surgical method for treatment of the distal tibia fractures especially in cases where no medial comminution of the tibia is present and when the fibula has to be fixed, too.     

Plating after lengthening (PAL): technical notes and preliminary clinical experiences

Introduction Shortening the period of time for the external fixator after limb lengthening decreases the complication rate and increases the patient satisfaction. Material and method We describe the plating after lengthening (PAL) as a new technique on five patients with limb length discrepancy (1 femoral, 4 tibial) who had lengthening procedure with Ilizarov technique. The mean amount of lengthening was 50 mm. The mean lengthening period was 100 days (5–135 days). When the lengthening period ended, the locking compression plate was applied percutaneously by using the technique of minimal invasive plate osteosynthesis, and the Ilizarov external fixator was removed. Results The fixator-free period was achieved at the beginning of the consolidation phase, except in two patients, which were delayed for plating because of pin-tract infection. No complication was encountered except in one patient who had limited flexion of knee joint. There was no need for blood transfusion. Discussion The PAL, which shortened the period of time for the external fixator, was an easy and safe method for the fixation of the bone after limb lengthening.     

不同内固定方法治疗老年股骨粗隆间骨折的疗效比较

目的比较解剖型钢板（AP）、解剖型锁定板（LCP）治疗老年股骨粗隆间骨折的疗效。方法对93例老年股骨粗隆间骨折的患者分别行AP、LCP治疗,比较两种治疗方法的疗效。结果全部患者均顺利通过手术,72例获随访,随访5—24月（平均16个月）。优良率：AP组66．7％、LCP组88．2％。结论AP治疗老年股骨粗隆间骨折优良率较低,并发症多;LCP优良率高,并发症少,可以作为首选。     

后外侧切口双钢板治疗胫骨平台外侧及后外侧髁骨折

目的探讨后外侧切口双钢板治疗胫骨外侧平台伴后外侧髁骨折的手术方法及临床疗效。方法 2010年9月至2012年6月,采用后外侧切口双钢板治疗9例胫骨外侧平台伴后外侧髁骨折患者,男性6例,女性3例,平均年龄41.70岁,交通事故伤6例,高处坠落伤2例,重物砸伤1例,均为胫骨外侧平台伴后外侧髁骨折。术后采用Rasmussen膝关节功能和放射学评分法评估疗效,并观察神经损伤、皮肤坏死、切口感染等并发症出现情况。结果 9例患者均获得随访,时间4～19个月(平均12.11个月),骨折均愈合。术后Rasmussen膝关节功能评定评分标准:优5例,良3例,可1例,差0例,优良率为88.90%。术后Rasmussen放射学评分标准评价:优7例,良2例,可0例,差0例,优良率为100%。术后无神经损伤、皮肤坏死及切口感染,无内固定松动及断裂,无骨折不愈合及骨折再移位,无膝关节内外翻畸形。结论胫骨外侧平台伴后外侧髁劈裂塌陷骨折时,采用后外侧切口双钢板治疗,于直视下进行复位及固定,便于操作,术后近期疗效满意。