Results of non-operative treatment following hip fracture compared to surgical intervention

We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically.     

距骨骨折的手术治疗

目的探讨距骨骨折的特点、类型、手术方法及影响疗效的相关因素。方法1998年12月至2004年12月,共治疗距骨骨折39例,根据Hawkins分型方法,型骨折5例,型骨折25例,型骨折9例。型骨折采用松质骨拉力螺钉内固定;、型骨折行急诊手术,其中型骨折采用前外侧切口暴露,解剖复位,2枚松质骨拉力螺钉交叉内固定;型骨折采用踝前内侧切口暴露,解剖复位,松质骨拉力螺钉内固定,伴有内踝骨折时同时复位内固定,并以自体髂骨块跨骨折线嵌入植骨。术后短腿管形石膏外固定12~24周,X线片示骨折线模糊后拆石膏行不负重下踝关节活动,骨折线消失后恢复伤前活动。结果除2例失访外,37例获得随访。随访时间1.5~6年,平均3年。根据Hawkins疗效标准判定,优12例(32.4%),良17例(45.9%),可6例(16.2%),差2例(5.4%),优良率为78.4%。结论距骨骨折虽然并发症多且后果严重,但是通过急诊手术、解剖复位、有效内固定、自体髂骨块嵌入植骨、局部封闭、理疗等综合治疗,可降低病残率。     

Stent fracture: an unusual cause of late restenosis after sirolimus-eluting stent placement.

Stent fracture is uncommon but may have consequences including restenosis. To date, stent fractures reported have been related to aggressive post dilation. We describe a case that involves fracture of a stent deployed to nominal pressure. Unlike most stent fractures reported that involve stent struts only our case demonstrated circumferential disruption with complete separation of the stent segments.     

小切口股骨近端解剖钢板治疗股骨转子间骨折

目的 探讨股骨转子间骨折的治疗方法和疗效。方法小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折17例。结果 随访时间8个月～3年，平均1.6年，优良16例，占94%（16/17）。结论 小切口微创股骨近端解剖钢板内固定治疗股骨转子间骨折具有切口小、出血少等优点，是一种微创手术。     

外固定支架加自体骨髓多能干细胞治疗桡骨远端骨折

[目的]探讨外固定支架结合骨折端局部注射自体骨髓多能干细胞治疗桡骨远端粉碎性骨折的有效性。[方法]应用外固定支架结合骨折端局部注射自体骨髓多能干细胞治疗桡骨远端粉碎性骨折18例。[结果]随访6～15个月(平均8个月),优10例,良6例,可2例,差0例。优良率为88.9%。没有一例出现针道浅表感染等并发症。[结论]外固定支架结合骨折端局部注射自体骨髓多能干细胞是治疗桡骨远端粉碎性骨折的一种方便、有效的方法,不仅骨折愈合效果满意,而且固定确实可靠,并能早期功能调整和训练。     

Osteochondral Fracture of the Fourth Metatarsal Head Treated by Open Reduction and Internal Fixation

Fracture of the metatarsal head is uncommon, and reports of isolated osteochondral fracture of the metatarsal head are rare. Because of the distal location of the fracture, it is difficult to achieve and maintain reduction, and potential complications include avascular necrosis and subchondral fatigue fracture. The authors present a case of an osteochondral fracture in a 40-year-old man, which was treated by open reduction and internal fixation with a single twist-off screw, with good results 12 months postoperatively.     

上胸椎骨折手术治疗方法的探讨

目的 探讨上胸椎骨折的特点及治疗。方法 15例病人按AO分型，A型2例、B型10例、C型3例。均经后路切开复位、脊髓减压、长节段内固定、取髂骨植骨融合术治疗。结果 随访18-24个月，后路长节段固定随访时无一例失败，完全瘫的患者9例中有1例神经功能改善I级．不完全瘫的5例均有Ⅲ级改善，1例无神经损伤。结论 上胸椎骨折损伤严重，后路长节段固定技术是一种合理的有效治疗方法。     

扩髓交锁髓内钉治疗股骨、胫骨干骨折

目的探讨交锁髓内钉治疗股骨、胫骨干骨折的临床效果.方法应用交锁髓内钉治疗不同类型的股骨干骨折18例,胫骨干骨折15例.结果33例患者随访8～24个月,平均15.2个月,33例均骨性愈合.未出观畸性愈合、再骨折、断钉及膝、踝关节僵硬等并发症.结论交锁髓内钉治疗股骨、胫骨干骨折治愈率高,并发症少,效果满意.     

纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的随机对照试验

目的：研究比较纸夹板内收位固定与石膏外展位固定治疗Bennett骨折的疗效差异。方法：选择2005年10月至2007年4月门诊就诊的70例Bennett骨折患者，按区组随机的方法分为试验组35例（纸夹板内收位固定）和对照组35例（石膏外展位固定）进行治疗。骨折达到临床愈合拆除固定后，对患者进行为期6个月的随访观察。分别于骨折后6、8、12、16、20及24周按改良的Gabriele评分系统对其患手功能进行量化评分比较。结果：两组的优良率在8、12、16及20周时比较试验组优于对照组，差异有统计学意义（P〈0．05）；6周和24周时比较差异无统计学意义（P〉0．05）。两组在功能评分方面，8、12、16、20及24周时比较试验组高于对照组，差异有统计学意义（P〈0．05）；6周时积分差异无统计学意义（P〉0．05）。结论：在Bennett骨折的治疗中，纸夹板内收位固定与石膏外展位固定相比能明显加快患手功能的恢复，而且固定轻便、舒适，患者易于接受，可以作为一种有效的固定方法在临床推广。