微型钢板在掌(指)骨骨折内固定对比性生物力学研究

目的比较掌指骨骨折不同内固定方法在生物力学方面的差异。方法采用尸体掌指骨人为造成骨折,分别应用微型钢板、贯穿克氏针、交叉克氏针、钢丝固定,比较其在生物力学方面的差异。结论微型钢板固定治疗掌指骨骨折在抗拉伸、抗压缩、抗弯曲、抗扭转方面较其他几种常用内固定方法具有明显的优越性。结论微型钢板与临床上常用的其它几种掌(指)骨骨折内固定材料相比在生物力学性能方面有明显的优越性     

改良哈氏棒治疗重度双主弯脊柱侧凸的临床研究

目的 通过分析106例重度双主弯脊柱侧凸的疗效，比较单纯哈氏分离棒等力撑开或改良哈氏棒非等力撑开的方法，观察改良哈氏棒的优越性。方法 每套改良哈氏棒包括自制棍间接头1只（用普通下钩磨制加工而成），哈氏分离棒2根，长度为28～45cm，上钩2只，下钩1只，弹簧3支，压力分别为10、15、20kg。结果 改良哈氏棒平均矫正度、矫正率、平均增加身高率均高于单纯哈氏分离棒，且断棒及胸椎关节突压缩性骨折的发生率低。结论 改良哈氏棒要明显优于单纯哈氏分离棒。     

椎体间植骨融合治疗腰椎间盘突出症合并腰椎失稳疗效观察

目的探讨后路椎体间微粒骨嵌压植骨融合治疗腰椎间盘突出症合并腰椎失稳的临床疗效。方法2005年5月~2007年1月腰椎间盘突出症合并腰椎失稳58例,采用后路植骨、椎弓根钉内固定治疗。根据植骨方式不同分为两组:观察组28例行椎间嵌压植骨,对照组30例采用椎旁横突间植骨。结果观察组优良率92.8%,对照组优良率70.0%。58例术后随访4~19个月,平均12个月。观察组与对照组优良率有显著性差异(P<0.05)。结论后路椎体间微粒骨嵌压植骨融合治疗腰椎间盘突出症合并腰椎失稳较椎旁后外侧横突间植骨疗效满意。     

桡骨小头骨折应用可吸收螺钉内固定疗效分析

目的 探讨桡骨小头骨折的治疗方法.方法 自2002-2006年以来,我院对(MasonⅡ型)桡骨小头骨折121例采用可吸收螺钉内固定治疗,疗效满意.结果 121例患者术后经6～12个月随访,均复位固定成功,骨折愈合,其中优103例,食18例,无一般及不良病例.结论 可吸收螺钉治疗桡骨小头骨折的方法虽无法完全解决内固定的术后并发症,但在现有的医疗水平下仍为较佳的治疗方法.且具有以下优点:①操作简单.②无金属的腐蚀反应,不干扰放射影像.③内固定材料可吸收,省去第2次手术,减少患者的痛苦,总体费用低.④无明显的排异反应及感染.⑤愈合相对较快.     

骨折内固定术后感染的诊断和治疗

骨折内固定术后感染的发病机制与黏附其上的微生物有关,大多由开放性骨折和骨折内固定手术中的葡萄球菌引起。按感染的时间分为早期(<2周)、延期(2～10周)和晚期感染(>10周),早期准确诊断骨折内固定术后感染较困难。PET和PET-CT技术的出现为诊断骨折内固定术后感染提供了一种新工具。治疗感染的目的是巩固骨质并预防慢性骨髓炎的发生,要求用合适的外科手术联合6～12周抗生素来彻底治愈感染。本文综述了髓内钉、外固定支架、钢板和螺钉相关性感染的发病机制、分类、诊断及其治疗方法。     

经皮撬拨复位克氏针内固定治疗Sanders2型跟骨舌形骨折

目的:观察经皮撬拨复位克氏针内固定治疗Sanders 2型跟骨舌形骨折的疗效,探讨Sanders 2型跟骨舌形骨折的治疗方案。方法:15例Sanders 2型跟骨舌形骨折患者,采用经皮撬拨复位克氏针内固定治疗,要求后跟距关节面解剖复位,恢复跟骨的长宽高度和Bhler角、Gissane角。术后2年内每月随访1次,根据AOFAS评分标准对患者的术后功能作出评价,并结合X片测量Bhler角及Gissane角,分析比较手术前后两角度的变化。结果:15例全部完成随访。术前Bhler角平均(8.2±1.3)度,术后平均(34.5±2.6)度,差异有高度显著意义(P<0.01);术前Gissane角(107.5±4.8)度,术后平均(116.3±5.1)度,差异有高度显著意义(P<0.01)。术后2年的AOFAS评分平均82.6分。结论:经皮撬拨复位克氏针内固定治疗Sanders 2型跟骨舌形骨折具有关节面复位准确、疗效可靠及创伤小等优点,但必须正视该方法的缺陷。     

Anterior cruciate ligament reconstruction with a multistrand hamstring graft fixed with a Ligament Tension Screw: a new device that can be used to readjust graft tension after fixation

We developed a new fixation device for reconstruction of the anterior cruciate ligament with a multistrand hamstring graft. This device allows the graft tension to be readjusted after fixation. This device, called a Ligament Tension Screw, consists of three parts, a screw, a washer, and a post. To create the graft, the tendons were formed into a loop. The device was hung from one end of the loop of the graft and a Kennedy-ligament augmentation device (LAD) artificial ligament was hung at the other end. The Kennedy-LAD artificial ligament was used extraarticularly for fixation at the tibia with double staples. Graft tension was increased by turning the screw, which pulls on the post suspending the graft. Fifty-two patients were evaluated after a minimum 2-year follow-up. The evaluation included physical examination, stability measurement with a KT2000 arthrometer, a Cybex muscle strength measurement, a functional test, and scoring of the knee according to the International Knee Documentation Committee (IKDC). Pivot test was negative in 47 patients (91%), but glide occurred in 5 patients (9%). No patient had a "clunk" or markedly poor result on the pivot test. All patients recovered full extension. Seven patients lost full flexion, but the loss of flexion was less than 5° in all seven. The KT 2000 arthrometer measurement with 133 N anterior drawer force indicated that 46 patients (88%) had less than 3-mm side-to-side difference. The mean muscle strength of the quadriceps and hamstrings was 91% and 94%, respectively, compared with the findings in the contralateral limb. The functional test showed a one-leg hop distance equal to 94% of that the opposite side. According to the final IKDC evaluation, 48 patients were graded as normal or nearly normal, and 4 patients as abnormal; none was severely abnormal. This study demonstrated satisfactory results for the reconstruction with a multistrand hamstring graft fixed with the new Ligament Tension Screw. Received: February 15, 2001 / Accepted: July 30, 2001     

A technique of tongue fixation after total mandibulectomy: the Oji spatula

When ameloblastoma presents late, as is often the case in Nigeria, it can affect the whole mandible. The treatment of choice is total mandibulectomy. The procedure may necessitate the resection of the musculature of the floor of the mouth to which a large portion of the tongue is attached. In our hospitals, immediate reconstruction is not undertaken for various reasons. Consequently, the musculature of the floor of the mouth cannot be reattached to a graft. The purpose of this paper is to illustrate a simple and patient-friendly method for fixation of the tongue after total mandibulectomy to achieve a secure airway. The tongue is tied to a wooden spatula, which stretches horizontally across the mouth. It is in contrast to the conventional technique of rigid fixation of the tongue to the pectoral muscle. This technique was used for 11 patients with large ameloblastomas. For the purpose of comparison, the conventional technique was used in 4 patients. The method of using a wooden spatula as a means of tongue fixation is known in the maxillofacial unit of the University of Nigeria Teaching Hospital, Enugu as the Oji spatula after the surgeon who developed it. All 11 patients tolerated this method well, but the 4 patients who had their tongues tied to the pectoral muscle complained of pain and discomfort. All the patients survived the procedure without postoperative blockage of the airway by the tongue. Follow-up for up to 6 months established that the patients had no respiratory problems.     

骨膜瓣移植联合常规固定治疗骨不连的临床效果

目的:分析骨不连发生的原因,并探讨骨膜瓣移植联合常规固定治疗骨不连的临床效果.方法:对36例骨不连患者的临床资料分析总结,判断其发生的原因.术中清除病灶,髂骨植骨,常规内、外固定,并联合骨膜瓣移植进行治疗.所有患者术后随访1～2.5年,观察手术效果.结果:33例在术后3～6个月均临床愈合,未出现感染、错位、内固定断裂等并发症;3例延迟至术后1年愈合.X线片显示,一般术后1个月骨折端周围出现骨痂,3个月后有连续骨痂形成,6～10个月关节功能恢复正常.结论:临床发生骨不连的主要原因是血运被破坏,固定措施不当,复位不准和感染.采用骨膜瓣移植联合常规固定方法治疗骨不连是一种较为理想的方法.     

交锁髓内钉在开放性胫腓骨骨折中的应用

目的观察开放性胫腓骨骨折两种内固定的疗效。方法开放性胫腓骨骨折,彻底清创后分别给予钢板螺钉,交锁髓内钉内固定。结果随访5～72个月,术后深部感染:钢板螺钉组2/67(2.9%);交锁髓内钉0例。内固定失败率:钢板螺钉组5/67(7.5%);交锁髓内钉0例。结论交锁髓内钉治疗开放性胫腓骨骨折疗效满意;钢板螺钉次之。