胸腰椎爆裂型骨折侧前方减压内固定治疗的技术改进

目的针对侧前方减压内固定治疗胸腰椎爆裂型骨折手术创伤大、失血多、技术要求高等问题进行技术改进，并评价改进后技术的优缺点。方法11例患者采用传统经腹膜外入路即常规程序作为对照组，16例选择采用改良“L”形胸腰联合切口（经第11～12肋胸膜外一腹膜后入路）及改进程序。比较2组间在手术时间、出血量等方面是否存在差异，并观察术中、术后并发症情况。结果27例胸腰椎骨折并截瘫患者手术均获成功。技术改进后术中平均出血量450mL，手术操作时间平均119min，手术切口平均长度17cm．。随访4-13个月，平均9．6个月。术后无截瘫加重，脊柱序列正常，无植骨块塌陷及高度丢失现象，无假关节形成和内固定失败。神经功能获1级以上恢复者达94％。结论该技术改进具有切口短、出血少、手术创伤较轻、降低手术操作难度的优点。     

逆行交锁髓内钉治疗合并桡神经损伤的肱骨干骨折

桡神经损伤是肱骨干中下段骨折最常见的并发症，能否得到及时合理的治疗，是神经功能恢复的关键。2003年10月至2006年12月，对13例合并桡神经损伤的肱骨干骨折患者，采用逆行交锁髓内钉固定治疗骨折，同时行桡神经探查修复，经临床观察，效果满意。     

Femoral head density on CT scans of patients following hip fracture fixation by expandable proximal peg or dynamic screw

Computed tomography (CT) is currently considered to be an accurate method for evaluating bone density. We evaluated the CT measurements of bone density using the Hounsfield units (HUs) in 23 patients who had been operated in the past for an extra-capsular hip fracture. Twelve patients were treated with a dynamic hip screw and 11 with a proximal femoral expandable hip nail. All the CTs had been performed for non-orthopedic purposes. Bone density with a region of interest (ROI) could be assessed for both hips. We compared the bone density between the operated versus the non-operated sides as well as between the two surgical groups.Bone density was higher in the hip peg (the femoral component of the expandable nail) side 262.5 (range, 169-351) HU, compared to the opposite non-operated side and to the hip screw group 194 (range, 99-283) HU. The hip screw side had decreased bone density compared to the opposite non-operated side. We were able to define a density index and a difference index: both were higher in the hip peg group. These findings persisted over time. It would be interesting to speculate that increased bone density around an expandable peg provides better fracture stabilization and probably faster healing than a dynamic hip screw.     

钢丝张力带内固定治疗锁骨外侧部Ⅱ型骨折

锁骨骨折是临床常见的一种骨折 ,其中锁骨外侧部Ⅱ型骨折因近折段与喙锁韧带的联结遭到破坏 ,骨折移位 ,为不稳定骨折 ,骨折不愈合率较高〔1〕。1996年 3月～ 1999年 12月我院采用钢丝张力带内固定方法治疗锁骨外侧部Ⅱ型骨折 11例 ,疗效满意。1　材料与方法1.1　病例资料　本组 11例 ,男 9例 ,女 2例 ,年龄 19～ 48岁。左侧 4例 ,右侧 7例。损伤原因均为跌倒时局部直接遭撞击。均为闭合性骨折 ,无其它合并伤。患者均在伤后 1周内手术。1.2　临床表现　伤肩局部肿胀、瘀斑、压痛 ,可见隆起畸形 ;按压有浮动感 ,患肢外展上举受限 ,外展时疼痛…     

Intramedullary hip screw fixation of reverse oblique and transverse trochanteric femur fractures

Introduction  Reverse oblique and transverse trochanteric femur fractures (31A3) are relatively rare. They are associated with a high failure rate, particularly in cases where extramedullary implants are used. This study investigated a second-generation intramedullary nail in this specific fracture type. Methods  Flinders Medical Centre is a level 1 trauma centre and the largest user of the Intramedullary Hip Screw (IMHS, Smith and Nephew, Memphis, USA) in the Southern Hemisphere. Two hundred and forty-eight IMHS cases completed between September 2003 and August 2005 were retrospectively analysed. All fractures were classified using the AO/ASIF system (Muller et al., The comprehensive classification of fractures of the long bones, Springer, Berlin, 1990) and 31A3.1, 2, 3 fractures were selected. The case notes and radiology were reviewed over a 1-year follow-up. Results  Twenty-six cases were classified as 31A3 fractures. Thirty-eight percent of the cases received a long stem IMHS. Mean patient age was 81.9 years with a 1-year mortality of 11.5%. Two of the 26 cases (7.7%) had surgical complications, including one cut-out (associated with a tip-apex distance of 40.9 mm) and one loss of reduction. Both cases required re-operation. There were no femoral shaft fractures or non-unions in this series. Conclusions  This second-generation intramedullary implant, the IMHS, performed well in this often difficult to fix fracture. The complication rate is considerably less than the rate published for extramedullary implants and is comparable to previous studies using a range of intramedullary techniques.     

不同手术入路钢板内固定治疗肱骨髁间C型骨折的临床研究

目的 探讨不同手术人路"Y"型钢板内固定治疗肱骨髁间C型骨折的临床疗效.方法 2004年4月至2008年4月收治42例成人肱骨髁间C型骨折患者,按照AO分型:C1型11例,C2型23例,C3型8例,全部为闭合性损伤.其中20例采用尺骨鹰嘴截骨入路,22例采用肘后肱三头肌舌形瓣人路,均采用"Y"型钢板内固定.采用尺骨鹰嘴截骨入路者,术后第3天开始功能锻炼;采用肘后肱三头肌舌形瓣人路者,术后2～3周行主、被动功能锻炼.结果 42例患者术后获8～48个月(平均29个月)随访.根据改良的Cassebaum评分系统评定术后总体肘关节功能:优29例.良9例,可3例,差1例,优良率为90.5%.术前2例尺神经损伤者,1例3个月后恢复,1例有尺神经麻痹症状残留.2例术后发生异位骨化.尺骨鹰嘴截骨入路者:优14例,良4例,可1例,差1例,优良率为90.0%;肘后肱三头肌舌形瓣入路者:优15例,良5例,可2例,优良率为90.9%,两种不同手术入路的优良率差异无统计学意义(x2=2.77,P0.05).结论 采用"Y"型钢板治疗成人肱骨髁间粉碎性骨折配合早期CPM辅助锻炼,多数患者能获得良好的疗效,术后根据入路选择合适的辅助锻炼可促进肘关节功能恢复.     

Correlation between posteromedial or posterolateral displacement and cubitus varus deformity in supracondylar humerus fractures in children

Purpose Cubitus varus deformity is one of the most common complications after displaced supracondylar humeral fractures in children. The purpose of this study was to evaluate the relationship between the fracture displacement and cubitus varus deformity in displaced supracondylar humerus fractures. Methods Seventeen patients (11 males/6 females; mean age 7 years) with cubitus varus deformities occurring after Gartland type III posteromedial or posterolateral displaced supracondylar humerus fractures were evaluated with clinical and serial radiographic examinations. All patients had been treated surgically by open reduction through a medial approach and percutaneous cross-pinning. All fractures were reduced anatomically. Ten of the patients were operated within the first 24 h. The time interval between the initial injury and the surgical procedure for the remaining seven patients was 5.3 days on average (range 2–10 days). The carrying angle and range of motion of the elbow were measured throughout the follow-up period. The mean follow-up time was 3.7 years (range 2–12 years). Results Five patients with type III-B fractures had a mean carrying angle loss of 8.8° (range 6–10°), whereas for the remaining 12 type III-A patients the mean loss was 15° (range 6–29°) (P = 0.019). None of the patients in this study demonstrated limited elbow motion. According to the Flynn criteria, the results were good in five type III-B patients. There was no statistically significant relationship between the loss of carrying angle and the delay before the surgical procedure (P = 0.615 in type III-A, P = 0.096 in type III-B). Conclusions The carrying angle loss was more significant in type III-A fractures compared with type III-B in this series. These results suggest that although anatomic reduction has been achieved by surgical treatment without loss of reduction, there is still a risk for cubitus varus deformity for type III-A fractures due to the initial compression of the medial column or, in other words, physeal injury.     

动力髋螺钉治疗股骨转子部粉碎性骨折

1997年4月～2006年10月，我院应用国产动力髋螺钉（DHS）治疗股骨转子部粉碎性骨折患者62例，取得良好效果。 1材料与方法 1．1病例资料本组62例，男44例，女18例，年龄35～58岁。按AO分类均为A2型。     

动力髋螺钉治疗股骨转子间骨折43例疗效分析

目的:探讨动力髋螺钉(DHS)治疗股骨转子间骨折的临床疗效。方法:选择我院2007年4月～2009年4月股骨转子间骨折患者83例,随机分为对照组和观察组,其中观察组采用动力髋螺钉治疗,对照组采用非手术牵引治疗。观察两组患者的下地活动时间、骨折愈合时间、并发症发生率以及住院时间,评定两组患者临床治疗效果。结果:观察组和对照组并发症发生率比较,差异有统计学意义(P<0.05);观察组下地活动时间、住院时间和对照组比较,差异有统计学意义(P<0.05);观察组骨折愈合时间和对照组比较,差异无统计学意义(P>0.05),观察组优良率(90.60%)明显高于对照组(75.00%)(P<0.05)。结论:DHS治疗股骨转子间骨折,可以使患者尽早下床活动、缩短患者住院时间和减少住院期间并发症的发生率,临床治疗效果显著。     

SACRAL FRACTURES

Objective. To delineate the clinical spectrum and treatment choice of sacral fractures. Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis‘ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurologi-cal deficits were present in seven patients. Thirty seven patients were treated conservatively and two under-went surgical management. Results. Thirty eight patients were followed up for three months to 19 years. Thirty three have recov-ered, four improved, and one remained disabled. Conclusion. The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture re-duction and stability reconstruction. When the patients with pelvic fracture are complicated with neurologi-cal deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.