骨科外固定支架对骨生长影响的回顾性研究

目的研究骨科外固定支架对骨折愈合的影响。方法对我院2002年1月～2006年5月在骨科住院使用外固定支架治疗的患者进行回顾性研究，对采用静态固定和动态固定外固定支架的骨折端生长情况进行分析，观察骨折端是否出现局部性的骨质疏松、迟缓愈合、病理骨折等。结果共282例，其中静态固定组191例，骨质疏松的发生率为35．1％（67／191），迟缓愈合率为19．9％（38／191），病理骨折率为7．9％（15／191）。动态固定组中，骨质疏松的发生率为19．8％（18／73），迟缓愈合率为7．7％（7／91），没有发生再骨折的情况。统计分析各项指标P〈0．05，两组之间的差异有统计意义。结论支架外固定是一种治疗四肢骨折有效的方法，简便易行，并发症少。规范合理的外固定支架动态固定对骨折的愈合具有明显的正相影响，能够有效降低应力遮挡，提高骨折生长质量，加快骨折愈合，减少再次骨折的发生。     

外固定架在儿童长骨骨折的应用观察

目的：总结外固定架在儿童长骨骨折中的应用。方法：回顾性分析我科于2001年2月～2008年2月应用外固定架治疗儿童长骨骨折38例。结果：随访2～30个月,平均14个月。所有骨折经手术后达到解剖复位32例,其余功能复位。远期未发现损伤肢体的挛缩及关节僵硬。结论：应用外固定架治疗儿童长骨骨折,具有创伤小、复位理想等优点,有其独特优势。     

AMBLYOPIA IN THE FOUR TO NINE YEAR AGE GROUP. A FOUR-YEAR SURVEY

A guide to the ophthalmologist in the choice of the older child with amblyopia most likely to respond to active intensive visual stimulation in short bursts is presented. A series of 99 children treated on a CAM vision-stimulator is described. Visual improvement of at least two rows of letters on the Snellen chart was maintained for at least three years after treatment in 62% of these patients aged between five and nine years with visual fixation within 3^° of the fovea. Amblyopia following minor trauma or minor pathology also responded well. Children maintaining the visual improvement were those with esophoria up to 13^°. those with hypermetropia up to 11.0 D and those with astigmatism of 1.5 D. Also responding well were children with anisometropia with up to 3.0 D of either hypermetropia or astigmatism     

Hybrid external fixator for the treatment of unicameral bone cysts with pathological fracture in the proximal humerus

Objective: Unicameral bone cyst is a nonneoplastic bone lesion characterized by its tenacity and risk of recurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of hybrid external fixator for the treatment of a unicameral bone cyst with a pathological fracture. Methods: Hybrid external fixator for the treatment of a unicameral bone cyst was performed in twelve patients, These patients presented with a pathological fracture and were managed immediately with hybrid external fixator, of whom four had been managed conservatively at other clinics before they were referred to our department. The cyst was located in the proximal humerus in all patients. The mean age of the patients at the time of surgery was 8.7 years, and the mean duration of follow-up was 32.6 months. Radiographic evaluation was performed according to the criteria of Capanna et al., and the cyst was classified as completely healed, healed with residual radiolucency (osteolysis), recurred, or having no response. Results: The healing period ranged from three to eight months. Eight cysts healed completely, and three healed with residual radiolucent areas visible on radiographs. There was recurrence of one cyst that had healed with residual radiolucency. All of the cysts in the present study responded to treatment. A modulation of hybrid external fixator was necessary in three patients, as the bars had become too short after bone growth or the pins had been loose. No major complications were observed. Conclusion: Hybrid external fixator provides early stability, which allows early mobilization and thus obviates the need for a plaster cast. This method of treatment also allows for an early return to normal activity.     

Functional outcome with special attention to the DASH questionnaire following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third

Introduction Aim of this retrospective study was to obtain a functional outcome following callus distraction and phalangization of the thumb after traumatic amputation in the middle one-third.Materials and methods From January 1998 to June 2001, 12 patients were treated in a staged procedure starting with corticotomy and continuous distraction (1 mm/day) of the first metacarpal bone using a unilateral external fixator device. After distraction until day 31 (range 25–35 days), the first metacarpal bone was stabilized with a plate, and phalangization was performed.Results At follow-up 1 year after surgery, the thumb was lengthened to 25–35 mm (average 28 mm) in all but 1 patient. In 1 patient a bone graft from the iliac crest had to be interposed. Pinch grip improved by 45%; grip strength improved by 55%. The function/symptom score from the DASH questionnaire was 25 points (range 16–38 points). In a 'pick-up test' all patients were able to pick up a pencil, they were able to write and could hold a full cup of water. Nine patients were able to pick up a paper clip, and 8 patients could hold a 1-liter bottle of water.Conclusion Callus distraction can be considered a suitable procedure to reconstruct an amputated thumb levelled at the middle one-third. Additional phalangization proved essential as it deepened the first web space, enabling good motion and grasp. Callus formation was delayed in elderly patients, but adequate lengthening and bone healing also occurred in this age group. The procedure will not be as beneficial in cases of osteoarthritis of the trapezometacarpal joint or when coverage of the stump is insufficient. The DASH questionnaire is very helpful in evaluating the effect of thumb reconstruction on the entire upper limb.     

Possibility of "distraction arthrogenesis": first report in rabbit model

We investigated the possibility of articular cartil-age distraction for use in reconstructing joint structure and for increasing the donor site of osteochondral grafts. Intraarticular osteotomy was performed at the femoral condyle in 12 Japanese white rabbits. The bone segment was fixed with a specially designed external fixator. After a 3-week waiting period, distraction was performed intermittently for 3 weeks (0.7 mm × 3 times per week) in the distraction group (n = 7) and, in the remaining animals (gap group; n = 5), a gap of 6.3 mm in length was made at surgery. All rabbits received etidronate injections (20 mg/kg ×2 times per week) for 5 weeks, to slow mineralization. The femoral condyle was harvested 9 weeks postoperatively and decalcified sagittal sections were stained and evaluated, using a histological grading scale. In the distraction group, distraction of 4.2 ± 1.4 mm was achieved, and the distracted cartilage area was filled with regenerated cartilage, without any gap between the regenerated and the adjacent articular cartilage. This regenerated cartilage showed metachromasia with toluidine blue. In the gap group, newly formed cartilage tissue was folded from the edge of the osteotomy site and fibrous tissue was interposed in the gap. The histological grading score was significantly lower in the distraction group (P < 0.02). Our preliminary results demonstrated the possibility of cartilage distraction; however, long-term observation will be necessary to confirm the characteristics of the distracted cartilage. We may call the process "distraction arthrogenesis", because the entire articular entity, which consists of cartilage, subchondral bone, and bone, could be distracted at once. Received: April 5, 2001 / Accepted: July 15, 2001     

单侧多功能外固定器治疗儿童骨折的体会

目的探讨单侧多功能外固定器在儿童骨折治疗中的适应证、使用方法及应用价值。方法回顾性分析1999年1月-2004年12月107例儿童骨折的治疗，男72例，女35例，年龄0．5～14岁，平均7．6岁。其中股骨干骨折63例（4例为双侧股骨干骨折），胫骨骨折26例（其中15例合并腓骨骨折），骨盆骨折11例（均为骨盆环两处以上的不稳定型骨盆骨折），肱骨骨折7例。致伤原因：车祸63例，跌落伤22例，砸伤9例，其他13例。107例患儿中89例闭合骨折，18例开放骨折。均采用单臂多功能外固定器固定治疗。术后随访观察骨折愈合情况及并发症，术后6～14周拆除外固定器。随访时间3～44个月（平均19个月）。结果本组患儿骨折全部愈合，所有病例术后2～3周均出现骨痂，4～5周后骨痂生长良好。术后4～10周均达到临床愈合标准，无延迟愈合或不愈合、无严重并发症的发生。8例出现针道感染（7．5％），3例固定针松动（2．8％），1例术后再骨折（0．9％），1例术后1周拍片发现骨折端移位，二次调整外固定器重新固定。结论单侧多功能外固定器固定术具有手术操作简单、创伤小、适应证广、固定可靠、并发症少、便于搬动和护理、不损伤骨膜，保留完整骨折处血肿、手术瘢痕小、可门诊拆除外固定免去再次手术等优点，是治疗儿童长骨干骨折、不稳定性骨盆骨折的有效方法之一，内收型骨盆骨折、开放性长骨骨折、粉碎性长骨骨折和骨干骨折并发多发伤患儿尤为适用，可为首选。     

Unstable Cervical Spinal Injury in Children – Case Report and Review of the Literature

Large studies about the management of pediatric patients with unstable flexion-distraction injuries of the midcervical spine are rare. We present the case of a 12-year-old girl who sustained a cervical spinal injury with unilateral facet dislocation and discuss details and problems of diagnostic procedures and treatment in the light of the recent literature. The management and pitfalls of a unilateral facet dislocation in a child are summarized. After initial reposition, a multi- segmental instability with neurology developed. Although distraction-flexion cervical spine injuries are common in adults and often occur with concomitant neurological sequelae, they also can occur in the pediatric population. In conclusion, an MRI seems advisable. A treatment of postoperative mal-alignment with reposition via a halo-fixator cannot be recommended. Repositioning is possible but was lost when the fixator was removed. Comparing the historic and recent literature there is only weak evidence overall, nevertheless a ventral fusion seems to be the treatment option of choice.     

单枚斜向Cage、脊柱滑脱复位内固定系统加后路减压术治疗腰椎滑脱症

目的探讨后路腰椎管减压、脊柱滑脱复位内固定系统(spondylolisthesis reduction system,SRS)复位内固定、单枚斜向Cage和小关节突间植骨治疗腰椎滑脱并腰椎管狭窄的临床疗效。方法2002年6月-2006年6月,对58例腰椎滑脱患者行后路腰椎管减压、SRS复位内固定、单枚斜向Vigor Spacer Cage椎间融合和小关节突间植骨的手术治疗。男47例,女11例;年龄32～66岁,平均45.8岁。病程3个月～7年,中位病程25个月。根据Meyerding分类法,Ⅰ度滑脱38例,Ⅱ度滑脱20例。L4、5滑脱21例,L5、S1滑脱37例。44例为峡部裂性,14例为退行性。椎间高度1.5～10.5mm,平均5.1mm。结果患者手术时间50～90min,平均65min;术中出血量200～500mL,平均250mL。术后切口均Ⅰ期愈合,无术后并发症发生。58例均获随访,随访时间10～38个月,平均23.6个月。根据Macrab评定标准,优54例,良3例,可1例,优良率98.3%。Ⅰ度滑脱者完全复位;Ⅱ度滑脱19例完全复位,1例复位1/2;完全复位率98.3%。术后3～6个月57例椎间融合,融合率98.3%。患者椎间高度恢复至9.6～12.5mm,平均11.6mm,且随访期内无高度丢失。结论后路腰椎管减压、SRS复位内固定、单枚斜向Vigor Spacer Cage椎间融合和小关节突间植骨治疗腰椎滑脱,效果良好,复位稳定满意。     

Fractures of the tibial plafond: a comparison of treatment methods

From 1995 to 1999, 19 patients (13 males and 6 females) were treated for Code 43 (distal segment) tibial fractures according to AO and Orthopaedic Trauma Association classification: there were 5 type A, 4 type B and 10 type C fractures. The mechanisms of injury included motor-vehicle accidents (n = 8), falls from heights (n = 8), a chainsaw injury (n = 1), and crushing injuries (n = 2). Five patients had associated injuries. All open fractures were managed acutely with wound debridement and application of an external fixator. Closed injuries were operated 1–16 days after injury (average, 6 days). The method of treatment depended on fracture comminution and soft tissue condition. Patients were available for follow-up for an average of 14 months. Results were evaluated by means of subjective and objective rating systems. All fractures in the series united with an average time to healing of 12 weeks. Anatomic or good alignment was obtained in all but 1 fracture. There were 7 excellent, 5 good, 5 fair and 2 poor results. Complications occurred in 2 patients (8%) and included 1 deep infection and 1 loss of reduction with malunion. The most important variables affecting the final clinical results were the type of fracture, the method of treatment, and the quality of reduction. Received: 15 May 2000/Accepted: 7 June 2000