外固定架加抗生素溶液同期植骨治疗感染性骨不愈合

对于骨折因感染所形成的骨不愈合,因其病情复杂,不易控制,是骨科领域的重要难题之一,以往的分期疗法由于疗程长给患者带来了过多的痛苦和经济负担,我院近年来采取了扩创,单臂多功能外固定架固定,加抗生素灌洗,同期植骨的方法治疗感染性骨不愈合,取得了良好的疗效. 1 临床资料 本组共11例,其中男9例,女2例.年龄21～47岁,平均34岁.感染性骨不愈合部位及治疗情况见表1.     

榫式成形术治疗中青年股骨颈骨折不愈合

为对中青年股骨颈骨折不愈合的治疗寻找更好的方法,作者设计了头颈部榫式成形治疗15例。经2～6年随访,骨折愈合率达100％,其中4例股骨头有程度不同的缺血坏死(27.0％)。认为本术式操作方便,易于掌握,复位质量保证,移位应力减小,固定效果确切,临床疗效满意。     

Effect of a single dose of pamidronate administered at the time of surgery in a rabbit posterolateral spinal fusion model

Spinal fusion is usually performed on patients who receive bisphosphonates (BP); however, limited data on their action on spinal fusion are available. Previous studies in animal models have shown that chronic administrations of BP reduced spinal fusion rates, and only one study has shown that a single dose administration of zolendronic acid increased fusion rate. The objective of the present study was to evaluate if pamidronate (PA), which was previously demonstrated to reduce spinal fusion rate when administered continuously for 8 weeks, would increase the spinal fusion rate if administered in a single dose at the time of surgery in a rabbit model. Thirty-two New Zealand rabbits underwent an L5–L6 posterolateral intertransverse fusion with iliac crest autograft. Animals were randomized to receive either PA 3 mg/kg in a single dose immediately after surgery, or normal saline. Animals were killed 8 weeks after surgery and fusion was determined by manual palpation and radiographic analysis. Fusion healing was obtained in eight rabbits (50%) in the PA group and in four animals (25%) in the control group, p = 0.137. In a rabbit model, a single dose of PA did not decrease lumbar spinal arthrodesis consolidation rates, but it obtained a nonsignificant higher spinal fusion rate.     

冲击波治疗四肢骨折内固定术后骨不连的临床分析

目的 探讨体外冲击波治疗四肢骨折内固定术后骨不连的机理和疗效.方法 对21例有切开复位＋内固定或外固定支架固定手术史患者（其中带锁髓内钉内固定6例,钢板内固定8例,记忆合金环抱器内固定4例,外固定支架固定3例;尺骨骨折2例,肱骨骨折4例,股骨骨折6例,胫骨骨折9例）.均采用体外冲击波治疗2～3次.结果 所有患者均获随访,经2次体外冲击波治疗后21例中16例获得骨折愈合,治疗3个月无明显骨痂生长5例,再行第三次体外冲击波治疗,2例获得骨折愈合,最终成功18例,治愈率为85.7%.2例患者出现局部表浅皮肤破损,治疗中未观察到神经、血管损伤等并发症.结论 体外冲击波治疗骨不连具有创伤小、并发症少、费用低、无需住院、疗效确切等优点,对促进骨不连愈合有较好的作用,临床治疗效果满意.     

两种植骨术治疗四肢陈旧性骨折骨不连的疗效对比

目的对比分析小切口环锯法植骨术与传统切开植骨术治疗四肢陈旧性骨折骨不连的疗效。方法选取2008年1月至2010年12月期间武冈市人民医院收治的四肢陈旧性骨折骨不连患者94例作为研究对象,将这些患者随机分为2组,观察组47例,接受小切口环锯法植骨术治疗;对照组47例,接受传统切开植骨术治疗。结果观察组的骨折愈合效果显著优于对照组,两组比较差异有统计学意义(P<0.05);观察组的骨折愈合时间显著短于对照组,两组比较差异有统计学意义(P<0.05)。结论小切口环锯法植骨术治疗四肢陈旧性骨折骨不连具有疗效好、恢复快等优点,该术式值得在临床上推广与应用。     

Shaft fractures of the clavicle: current concepts

Fractures of the clavicle are common and have been typically addressed to nonoperative treatment. Favorable results, which predominantly were achieved in the young and adolescents, were supposed to be usual in midshaft clavicular fractures. However, in the presence of comminution or complete displacement, especially when occurring in females or elderly patients, there is a marked risk of nonunion, malunion, and poor outcome. Thus, many authors prefer primary surgical stabilization, when risk factors add up. Plate fixation and intramedullary stabilization seem to be equally favored. Though, indications for operative management remain controversial. Further prospective randomized comparative clinical trials are necessary for a well-founded risk-benefit analysis.     

儿童桡骨远段骨不连并重度腕部畸形的手术治疗

目的 探讨小儿桡骨远段骨不连并腕部畸形的治疗方法.方法 收治小儿桡骨远段骨不连并腕部畸形9例,其中开放性骨折合并感染7例,闭合性骨折2例.全部采用尺骨缩短、桡骨撑开植骨延长手术治疗.结果 术后随访6～30个月,平均22个月,骨不连全部愈合.8例取得良好外观和满意功能.术后感染1例,经治疗后愈合.腕部畸形复发1例,经再次行尺骨缩短联合远端骨骺阻滞术后改善.结论 治疗成功的关键是保证尺桡骨同步发育、促进骨折愈合和矫正畸形,尺骨缩短、桡骨撑开植骨延长是一种可行的方法.     

Open reduction and internal fixation of intraarticular tibial plateau nonunions

The vast majority of tibial plateau fractures heal uneventfully, and no case series on intraarticular tibial plateau nonunions exists. The purpose of the present study was to evaluate the radiographic and clinical outcome of these nonunions following surgical treatment in a single surgeon series. Five patients with tibial plateau nonunions were treated at our institution using a specific treatment protocol consisting of open reduction and debridement, deformity correction, internal fixation including lag screws, bone graft augmentation, and selective knee joint arthrolysis. Patient outcomes were assessed using radiographs and the Knee Society questionnaire scores. Following surgical treatment of the nonunion, all healed at an average of 12.8 weeks, and average follow-up was 44 months. Preoperative coronal plane deformity was corrected in all patients. The final knee motion arc averaged 120 degrees postoperatively. Both the pain and function subscales of the Knee Society Rating scale improved significantly. Four of the five returned to their normal pre-injury activities, but two patients required total knee arthroplasty which was performed successfully after healing of the nonunion. With meticulous surgical technique and a standard protocol, healing may be reliably achieved. Arthrosis occurs frequently, and may occur primarily at the time of injury or from chronic alteration of intraarticular contact forces secondary to development of a nonunion.     

Sliding trochanteric osteotomy in acetabular fractures: a review of 30 cases

OBJECTIVE: To assess the results of using sliding trochanteric osteotomy as an adjunct procedure for acetabular fractures. DESIGN: Retrospective review. SETTING: Level 1 trauma centre. METHODS: Thirty patients (19 men, 11 women, mean age 40 years, range 23-80 years) having fracture of acetabulum underwent sliding trochanteric osteotomy for a better exposure of the fracture involving the dome of acetabulum during the period January 1999-January 2004. MAIN OUTCOME MEASUREMENTS: Clinical evaluation was based on modified Merle d' Aubigne and Postel scoring. Motor strength of the abductors was evaluated according to the Medical Research Council (MRC) grading system. Radiographic evaluation of the joint was also documented. RESULTS: All the osteotomies healed within 12 weeks without any proximal migration except for one patient with infection in whom nonunion occurred. Two patients underwent removal of implants from greater trochanter because of irritation. The strength of the abductors was of Grade 2/5 in one patient, Grade 3/5 in one patient, Grade 4/5 in six patients and Grade 5/5 in the rest. Clinical scoring was excellent to good in 77%. Heterotopic ossification occurred in six patients and was of modified Brooker's classes 1 and 2. CONCLUSIONS: This technique can be relied upon to provide an adequate exposure of the dome of acetabulum without the associated complications like malunion, non-union, etc., known to occur with standard oblique osteotomy.     

Nonunion of distal radius fracture and distal radioulnar joint injury: a modified Sauvé–Kapandji procedure with a cubitus proradius transposition as autograft

The Sauvé–Kapandji (SK) procedure is indicated in distal radius nonunion or malunion and distal radioulnar joint (DRUJ) instability. It can also be used to treat the rheumatoid wrist with severe degenerative changes in the DRUJ. The main objective is to allow a pain-free range of movement. We present a patient with rheumatoid arthritis and distal radius nonunion who, after three operations, was treated with the SK procedure. The clinical and radiological results were excellent. A 53-year-old woman diagnosed with rheumatoid arthritis fell on her forearm at home 2 years ago. Examination at an outpatient clinic revealed a distal radius fracture classified as type V according to the Frykman classification. She had been operated three times with open reduction internal fixation using a plate, screws, and bone allograft. She came to our institution with a distal radius nonunion, positive post-traumatic ulnar variance, and ulnar nerve paresis. The range of movements was 20°–10° flexion-extension and 40°–30° pronation–supination, and she needed daily fentanyl. We performed a modified SK procedure with an autologous iliac crest bone graft and ulnar bone graft from the osteotomy area (cubitus proradius), bone morphogenetic protein, and a low profile distal radius plate. After 1 year of follow-up, the distal radius fracture has healed and the wrist is pain-free with a complete range of movement in flexion-extension and pronation-supination. The main indication for the SK procedure is post-traumatic positive ulnar variance and associated ulnocarpal impaction. The cubitus proradius bone graft transposition is an interesting technical note that makes this case a challenge for skilled orthopedic hand surgeons.