几种固定方式急诊治疗多发伤合并胫腓骨开放性骨折的疗效分析

目的 比较四种固定方法早期固定开放性胫腓骨骨折对严重多发伤患者治疗和预后的影响.方法 回顾性分析243例存在胫腓骨开放性骨折的严重多发伤患者(ISS≥16分)的资料,其中对胫腓骨骨折采用跟骨牵引加夹板治疗48例,带锁髓内钉治疗69例,钢板螺钉治疗54例,外固定支架治疗72例.从病死率、ARDS、脂肪栓塞综合征(FES)、MODS、ICU监护时间等近期指标,以及创面愈合时间、骨折愈合时间、关节功能恢复优良率、骨折并发症等远期指标,对比分析四种早期固定方法对骨折本身和多发伤治疗的疗效.结果 带锁髓内钉治疗胫腓骨骨折在多项指标方面较其他固定方法为优(P<0.05,0.01).结论 带锁髓内钉治疗严重多发伤并胫腓骨中段开放性骨折(Gustilo Ⅰ型、Ⅱ型和Ⅲa型),明显减少并发症发生率,术后骨折愈合较为理想.

Abstract：

Objective To comparethe effects of four different emergency fixation methods for the open tibiofibular fractures on the treatment and prognosis of the multiple trauma patients. Methods A comparative study was carried out on the effect offour different early fixation methods on the fracture and the multiple trauma in aspects of the short-term indicators including mortality rate,acute respiratory distress syndrome(ARDS),fat embolism syndrome(FES),multiple organ dysfunction syndrome (MODS),ICU stay and the long-term indicators including wound healing time,fracture healing time,rate of joint function recovery and fracture complications in 43 multiple trauma patients. Results The locked intramedullary nail wag better than the other fLxation methods including the calcaneal traction,the gypsum external fixation and the internal fixation with steel plate and extemal fixation support in most indexes(P<0.05,0.01). Conclusion The locked intramedullary nail can significantly decrease the incidence rate of complications and obtain sound fracture healing for the patients with multiple trauma combined with open tibiofibular fractures(types Gnstilo Ⅰ,Ⅱ and Ⅲa).     

Isolated bilateral fibular insufficiency fractures: Case report of an unusual entity

Insufficiency fractures are a type of stress fractures that occur due to physiological stress on weakened bones. These have certain sites of predilection of which an uncommon site is fibular shaft. Isolated bilateral fibular fractures have previously only been reported twice, where the causes were repeated trauma and fatigue fracture. Insufficiency fractures of both fibula in isolation have not previously been reported. We present this case where a young patient presented with these fractures and was found to have vitamin D deficiency on subsequent investigations.     

Fibula fixation in the treatment of tibial pilon fractures – Is it really necessary?

BackgroundThere is a lack of consensus about the role of fibula fixation in these complex fractures, with only two clinical studies in the literature. We hypothesize that the fibula fracture need not be fixed in the tibial pilon fractures if primary stability can be achieved with tibial fixation alone.MethodsWe reviewed 79 patients with operatively treated tibial pilon with associated fibula fractures from 2007 to 2017 and divided them into two groups; patients with fibula fracture fixation and those without fixation. The primary outcome measure was any mechanical complications. Secondary outcomes were wound complications and other morbidities.ResultsThere were 54 (68.4%) patients with fibula fixation and 25 (31.6%) patients without fixation. There were no statistically significant differences in mechanical complications between the two groups. However, patients without fibula fixation were noted to have more wound complications (44% vs 25.9%, p = 0.108) although this was not statistically significant. In terms of removal of implant (ROI), there were no differences noted in patients with or without fibula fixation (33.3% vs 28%, p = 0.796). There were also no significant differences in ROI for those fixed with plate and screws when compared to those fixed with Rush rod and K wire within the group with fibula fixation.ConclusionFibula fixation in the treatment of tibial pilon fractures is not routinely necessary and does not result in decreased mechanical complications such as malunion, delayed union, nonunion and implant failure. Fibula fracture fixation should be reserved for cases where it may aid reduction or provide additional stability.     

Isolated fibular stress fractures: Radiographic parameters

BackgroundFibular stress fractures are uncommon injuries with an incompletely understood pathogenesis and predisposing characteristics. This study investigated the demographic and radiographic risk factors for fibular stress fractures.MethodsA retrospective chart review from 2010 to 2018 revealed thirteen patients with isolated fibular stress fractures. Demographics, history of fracture, fracture location, bone quality, and heel alignment were collected.ResultsThe cohort consisted of six men and seven women with a mean age of 41.8 years. The average BMI was 28.5 kg/m². Three patients used tobacco. 69.2% of fractures were in the distal third, 23.1% proximal third, and 7.7% middle third. No patients had evidence of osteopenia. Distal fibula stress fractures were more common in women (66.7%) and associated with hindfoot valgus.ConclusionDistal third fibula stress fractures were most common and associated with hindfoot valgus. This could be due to a greater amount of axial force through fibula in this alignment.Level of evidenceLevel IV, Retrospective Case Series.     

经皮插入钢板微创治疗胫腓骨粉碎骨折

目的 介绍一种胫腓骨粉碎性骨折的微创治疗方法.方法 采用闭合复位,经皮插入钢板内固定微创治疗胫腓骨粉碎性骨折23例(包括胫腓骨多段骨折4例).开放性骨折6例,闭合性骨折17例.AO分型42-C2.1型7例,42-C2.2型5例,42-C3.1型8例,42-C3.3型3例,术后不辅以其他外固定,第二天起即开始不负重关节功能锻炼.结果 全部病例随访时间8-18周,均达骨性愈合,无骨不连及感染,平均骨折愈合时间14.2周.根据Johner-Wruhs评分:优良率85%.结论 经皮插入钢板内固定是治疗胫腓骨粉碎性骨折的有效方法.     

腓骨高位截骨在膝关节骨性关节炎的应用

目的:探讨腓骨高位截骨术对膝关节骨性关节炎的短中期疗效。方法:2014年10月至2016年7月,采用腓骨高位截骨治疗膝关节骨性关节炎76例,男22例,女54例;年龄47~82岁,平均61.62岁。术前查体膝关节内侧压痛,内侧麦氏征阳性,摄膝关节负重正侧位X线片显示内侧间隙变窄,术后行膝内侧间隙、股骨胫骨角、VAS疼痛评分及AKS评分进行评价。结果:术后随访10~18个月,平均8.9个月。与术前相比,术后膝内侧间隙明显变宽,股骨胫骨角度变大。术前VAS疼痛评分5.70±1.56,术后1周3.70±1.03,1个月3.20±0.95,3个月2.35±0.99,1年2.10±0.97。膝关节功能AKS评分术前疼痛14.45±1.76,活动度12.60±1.98,稳定性12.15±1.72;末次随访疼痛42.60±2.28,活动度21.80±2.14,稳定性20.85±2.16。VAS评分术前与术后各时间段相比差异有统计学意义,AKS评分术前与术后差异均有统计学意义。结论:腓骨高位截骨操作简单,并发症少,能有效减轻膝关节疼痛,改善膝关节功能,临床效果满意。     

复杂性胫腓骨骨折137例

目的 探讨复杂性胫腓骨骨折治疗中骨折与软组织损伤处理的方法。方法 对１３７例复杂性胫腓骨骨折的治疗进行分析。其中胫腓骨多段骨折８９例,伴有软组织缺损的胫腓骨开放粉碎骨折２７例,合并血管神经损伤的胫腓骨骨折２１例,有１１８例获得１０个月￣５年２个月的随访,平均随访２年３个月。     

外固定器治疗儿童开放性胫腓骨骨折

<正>儿童开放性胫腓骨骨折是临床上常见的儿童下肢骨折,治疗不当极易造成残疾。自2000年1月至2009年6月对开放性胫腓骨骨折的患儿行外固定器治疗,取得满意疗效,现进     

腓骨肌(皮)瓣一期修复下颌骨缺损

目的：总结应用腓骨肌（皮）瓣一期修复下颌骨缺损的经验.方法：根据7例患者下颌骨缺损的部位和特征,对其腓骨进行截骨和塑形,以恢复其下颌骨的形态和功能,并以大钛板进行坚固内固定.结果：7例以腓骨肌（皮）瓣修复下颌骨缺损患者全部成功,伤口愈合良好.结论：腓骨肌（皮）瓣可根据下颌骨缺损的部位和形态进行截骨和塑形,是用来修复下颌骨缺损的一种理想的方法.