微创经皮钢板骨桥接术联合锁定加压钛板治疗胫骨远端骨折

目的探讨微创经皮钢板骨桥接术（minimallyi nvasive percutaneous plate osteosynthesis，MIPPO）联合锁定加压钛板（locking compression plate，LCP）治疗胫骨远端骨折的近期疗效。方法2004年6月～2006年3月采用MIPPO联合LCP治疗胫骨远端骨折16例，AO分型：43A1型7例，43A3型5例，43B1型2例，43C3型2例。采用3种方法复位胫骨骨折后插入LCP，用锁定螺钉固定。结果16例随访5～20个月，平均11，5月。16例切口一期愈合，骨折无延迟愈合、畸形愈合、断钉、断板等并发症。术后X线检查4～12周（平均7．6周）骨痂形成并开始部分负重，8～20周骨性愈合（平均16周），此时开始完全负重。3例出现胫骨远端内植物局部不适。根据美国足踝骨科学会评分系统对踝关节功能评分，优14例（87．5％），良2例（12，5％）。结论MIPPO具有创伤小、固定牢靠、可早期功能锻炼等优点，近期疗效满意，是治疗胫骨远端骨折的有效方法。     

Closed tibial pilon fractures treated with external fixation

Fractures of tibial pilon are due to a high energy trauma. Associated skin complications are frequent as those of surgery of this pattern. Thus we performed external fixation as treatment for these fractures. Authors report a retrospective study of 17 closed fracture of tibial pilon, type C of Ruedi and Heim classification, treated by osteotaxis using external fixation of Hoffman with osteosynthesis of fibula by screwed plate. Our patients are of a mean age of 34 years with 11 men and 6 women. The right side was most frequently involved (12 patients). Skin injuries as phlyctena were seen in 6 patients. Delay of treatment did not exceed 72 h. We performed a closed reduction of the fracture of tibial pilon after internal fixation of fibula by screwed plate. Results were assessed after 24 months of study. Track pins infection was noted in three cases. Reduction was usually good, despite one case of recurvatum, one case of valgus, one case of Sudeck’s atrophy, three cases of arthritis have been noticed. Mobility decreased at about 30%. External fixation is a real alternative solution for treatment of these fractures for which osteosynthesis is not suitable. It allows us to avoid skin complications despite mobility decreasing.      

浮膝损伤的临床治疗研究

目的：探讨浮膝损伤的治疗方法。方法：对2002年10月到2006年9月收治的48例浮膝损伤,在积极治疗各种危及生命的并发症的基础上均早期予以骨折内固定,术后加强患肢功能锻炼。结果：随访6个月-2年,平均1年2个月,按Karlstrom评定标准,优34例,良10例,可4例,优良率91.7%。方法：浮膝损伤患者在生命体征平稳后均应根据骨折类型和患者的个体差异尽早选择手术并早期功能锻炼。     

外固定架治疗桡骨远端爆裂骨折

目的 探讨外固定支架治疗桡骨远端爆裂性骨折的效果．方法 对23例桡骨远端爆裂性骨折病例，ⅣB型13例，ⅣC型10例，采用外固定支架或外固定支架加克氏针治疗．术后随诊并评价疗效。结果 23例随诊6～18个月，优15例，良6例，优良率94．7％。影像学评分，20例优良，3例发生再移位。结论 桡骨远端爆裂骨折采用手法整复外固定架或外固定架加克氏针固定能获得理想的解剖复位和腕关节功能恢复。     

Pullout reattachment of tibial avulsion fractures of the anterior cruciate ligament: a firm,effective suture-tying method using a tensioner

We describe a firm, effective suture-tying method using a tensioner for reattaching tibial avulsion fractures of the anterior cruciate ligament. Our simple method achieves strong, firm reattachment of the fracture. In addition, it prevents fixation loosening during suture tying effectively. Since pullout repair using nonabsorbable sutures is commonly used to fix various avulsion fractures, the tensioner helps attain strong, firm reattachment of avulsion fractures simply and effectively.     

切开复位解剖型钢板内固定治疗肱骨远端骨折

[目的]探讨采用切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折的临床疗效。[方法]2001年2月-2006年4月采用切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折共22例，采用尺骨鹰嘴截骨方法显露肱骨远端及关节面骨折者11例，采用肱三头肌舌形瓣方法显露骨折者11例。术后常规中药熏洗、CPM机训练、手法等综合治疗。[结果]22例患者随访时间均超过1a，平均28个月（13—32个月），骨折全部愈合，平均愈合时间为5．7个月（4～10个月），根据Mayo肘关节功能评估指数，结果：优9例（40．9％），良7例（31．81％）。[结论]切开复位解剖型钢板（“Y”形）内固定治疗肱骨远端骨折，固定可靠，为术后早期进行功能锻炼创造了条件；术后早期开始个体化患肢功能锻炼，结合中药熏洗、CPM训练、手法等方法可获得满意疗效。     

单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并大面积皮肤撕脱伤

目的探讨单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤的疗效。方法18例患者先进行急诊清创,采用单臂AO外固定支架固定骨折、腓肠肌内侧头肌皮瓣局部旋转覆盖外露胫骨。撕脱的皮肤修成全厚皮片回植供皮区,其中5例仍有缺损,另取同侧大腿全厚皮片移植。结果均无感染,15例旋转皮瓣完全成活,2例皮瓣远端表皮坏死,经换药治愈,1例皮瓣远端全层坏死,经植皮治愈。撕脱皮片回植13例成活,5例小部分坏死,其中3例经换药治愈,2例经中厚皮片植皮愈合。5例大腿皮片完全成活。平均随访19.5(10~36)个月,骨折平均愈合时间4(3.5~6)个月。所有患者行走正常,3例膝关节屈伸活动受限,4例踝关节屈伸受限。结论采用单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤,疗效肯定。     

Distal radial fractures Injectable calcium phosphate bone cement versus conventional treatment

AMEDLINEsearchwasconductedtoidentifystudiespublishedfromJanuary1999toMarch2004thatcom-paredinjectablecalciumphosphatebone(NorianSRS)cementwithconventionaltreatmentindistalradialfrac-tures.Fromalistof13articlesidentifiedfromthesearchstrategy,fourarticleswe…     

A Pelvic Ring Fracture Complicated by Acute Traumatic Obstructed Direct Inguinal Hernia

Abstract A young male motorcyclist presented to the Pelvic Unit with an open-book fracture of his pelvis and an acute obstructed direct inguinal hernia. He was managed operatively and made an excellent recovery. Traumatic abdominal wall hernias are rare. This is a unique combination of injuries that the trauma surgeon should be aware of.