椎间盘镜系统辅助股骨下段逆行髓内钉微创取出

2005年12月～2008年12月,我院共收治25例股骨远段骨折逆行髓内钉固定骨折愈合后要求取出髓内钉的患者,均进行椎间盘镜系统辅助下逆行髓内钉微创取出术,效果满意.     

椎间盘镜系统辅助与切开直视逆行髓内钉固定治疗股骨远段骨折的对比研究

[目的]比较椎间盘镜辅助下和切开直视下逆行髓内钉固定治疗股骨远段骨折的疗效,探讨椎间盘镜辅助下逆行髓内钉固定治疗股骨远段骨折的优越性。[方法]2004年8月~2008年8月本院共收治股骨远段骨折患者52例,其中32例采用椎间盘镜辅助下逆行交锁髓内钉内固定,20例采用切开直视下逆行交锁髓内钉内固定;评价两种方法的手术时间、出血量、骨愈合时间及膝关节功能。[结果]52例患者术后随访10~26个月,平均16个月。两组在手术时间、术中出血、功能评价方面差异有显著性(P0.05),其中膝关节功能按Kolment评定标准,椎间盘镜组优良率93.8%,切开组优良率65.0%;两组在骨折愈合时间上差异无显著性(P0.05)。[结论]椎间盘镜辅助与直视切开下股骨逆行交锁髓内钉相比,具有手术时间短、创伤小,并发症少等优点,有利于膝关节功能恢复。     

椎间盘镜系统辅助下微创髓内钉固定治疗浮膝损伤

目的 探讨椎间盘镜系统辅助下置入髓内钉内固定治疗浮膝损伤的方法及临床疗效.方法 2005年12月至2008年12月收治浮膝损伤16例,骨折按Frasert分型均为Ⅰ型,均采用膝关节前正中经髌腱入路在椎间盘镜系统辅助下进行股骨逆行髓内钉及胫骨髓内钉内固定术治疗.术后评价骨折愈合、膝关节功能恢复情况.结果 术后随访10～25个月,15例骨折正常愈合,1例胫骨骨折延期愈合,平均骨折愈合时间为4.2个月:末次随访平均膝关节活动度为117°,按Karlstrom膝关节功能分级评价标准进行评价,优13例,良2例,可1例,优良率94.7%.2例股骨骨折端出现轻度向后成角畸形,平均成角6.5°,其余均未出现神经血管损伤、髌骨撞击痛、感染及内固定松动、断裂等相关并发症.结论 椎间盘镜系统辅助下髓内钉微创内固定治疗浮膝损伤,具有创伤小,置钉准确、并发症少等优点,有利于促进骨折愈合及膝关节功能恢复.     

倒打交锁髓内钉治疗股骨下端骨折

股骨下端骨折包括股骨髁上骨折和股骨髁间骨折 ,是一种严重的损伤 ,传统的治疗方法一般均留有不同程度的病残率。从 1998年起我们应用上海熙可公司提供的Orthofix逆行股骨髓内钉系统治疗股骨下端骨折共 2 4例 ,取得了良好的效果。使病残率降至最低。本文对所有病例均进行了随访 ,现报道如下。1　临床资料1.1　一般资料　本组共 2 4例 ,男 18例 ,女 6例 ;年龄 2 0～ 5 8岁 ,平均 34 .4岁。骨折类型 :股骨髁上 15例 ,股骨髁间 9例。其中闭合性骨折 2 0例 ,开放性骨折 4例。受伤原因 :车祸伤19例 ,摔伤 3例 ,重物砸伤 2例。合并其他骨折 4例 ,…     

倒打髓内钉治疗股骨髁上骨折体会

最近一段时间内,我们运用倒打髓内钉的方法治疗股骨髁上骨折,手术顺利,操作简单,手术时间短,病人创伤小,愈合快,收效满意,现总结如下: 1临床资料 1.1一般资料:本组病例18例均为急诊收住院病人,男16例,女2例,左侧11例,右侧7例,年龄18~42岁。车祸外伤的13例,砸伤5例,合并开放伤的5例,横断骨折12例,粉碎     

椎间盘镜系统辅助下逆行交锁髓内钉并微创植骨治疗股骨下段骨缺损及不愈合

目的探讨椎间盘镜辅助下逆行交锁髓内钉固定及微创植骨治疗股骨远段骨缺损及不愈合的可行性、疗效及优越性。方法收治20例股骨远段创伤性骨缺损及骨折不愈合患者,均采用膝关节前正中经髌腱入路在椎间盘镜系统辅助下进行逆行交锁髓内钉内固定及骨折缺损局部微创植骨术治疗。结果本组术后18例骨折正常愈合,2例再延迟愈合;2例合并轻度向后成角畸形,平均成角6.6°;2例出现轻度肢体短缩,均小于3cm。结论椎间盘镜辅助下逆行交锁髓内钉固定及微创植骨治疗股骨远段骨折后骨不愈合、骨缺损,具有创伤小、置钉准确、骨愈合率高等优点,并发症少,是一种可行、有效的治疗方法。     

逆行交锁髓内钉治疗股骨远段骨折

目的 总结股骨逆行交锁髓内钉应用的适应证、优点及其疗效。方法 2001年6月～2003年6月，采用切开复位股骨逆行交锁髓内钉内固定，治疗股骨远段骨折21例，早期行膝关节功能锻炼。结果 18例获随访，全部骨性愈合，功能恢复良好，无膝痛、跛行、膝关节僵直等。结论 股骨逆行交锁髓内钉治疗股骨远段骨折具有明显优势，固定牢固、坚强，功能恢复快，并发症少等优点，手术不需要C臂X线机和骨科手术牵引床，适合基层医院临床应用。     

双扁形髓内钉系统内固定治疗股骨远段骨折

作者设计一种双扁形髓内钉系统用于股骨远段骨折内固定，它是头窄尾宽、厚３ｍｍ的扁钉，由股骨内、外髁向髓腔各打入１根，尾部用横栓连接形成整体结构。１９９１年６月～１９９４年１２月共治疗３７例，获得１年以上随访者２３例，骨折全部愈合，按Ｋｏｌｍｅｒｔ功能评定标准，优１５例，良５例，一般２例，差１例；无钉弯、钉断、钉退及拔钉后再骨折等并发症。经生物力学测试证实：本器械抗弯抗扭性能明显优于Ｅｎｄｅｒ钉及Ｒｕｓｈ钉，其过伸抗弯性能与“Ｌ”形髁钢板比较无显著性差异。     

微创交锁髓内钉治疗股骨多段骨折

正2012年1月～2016年12月,我科采用微创闭合复位及骨折断端有限切口开放复位交锁髓内钉固定治疗25例股骨多段骨折患者,取得良好效果,报道如下。1材料与方法1. 1病例资料本组25例,男18例,女7例,年龄20～70岁。均为股骨多段骨折。开放骨折2例,闭合骨折23例。骨折按AO/OTA分型:C1型12例,C2型5例,C3型8例。受伤至手术时间为     

股骨髁上交锁髓内钉治疗股骨下段骨折

股骨下段骨折包括髁间骨折系高能量冲击,多伴为粉碎性骨折.骨折粉碎严重,复位困难,加上解剖位置特殊,要牢固固定较为困难,虽有较多的内固定方法,但疗效多不满意.本院自1999年3月～2002年4月间,采用股骨髁上钉逆行交锁髓内钉内固定,初步体会取得较理想的效果.     

逆行髓内钉与锁定钢板治疗股骨远端骨折的疗效比较分析

[目的]探讨采用股骨逆行髓内钉与股骨远端锁定钢板内固定治疗股骨远端骨折的疗效比较。[方法]回顾性分析2007年2月~2014年3月期间收治的54例股骨远端骨折患者资料,男22例,女32例;年龄20~86岁,平均54.6岁。按手术内固定的方式不同分为两组:逆行髓内钉组(采用股骨逆行髓内钉内固定)28例,锁定钢板组(采用股骨远端锁定钢板内固定)26例。记录并比较两组的骨折愈合时间、膝关节功能评定。[结果]54例患者术后获得8~24个月(平均12.8个月)随访。所有病例均获得了骨性愈合,逆行髓内钉组和锁定钢板组,平均骨折愈合时间分别为(22.54±2.95)周和(24.96±3.70)周,两组比较,差异有统计学意义(P<0.05)。根据Kolmert膝关节功能评定,优良率分别为85.7%和80.8%,两组比较,差异无统计学意义(P>0.05)。[结论]逆行髓内钉较锁定钢板内固定治疗股骨远端骨折愈合时间短,更有利于骨折愈合;在膝关节功能恢复方面,两者均能获得满意的疗效。     

Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures

IntroductionAlthough minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures.Patients and methodsOf the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin’s classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures.ResultsCoronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively).ConclusionsRegardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.     

逆行交锁髓内钉治疗股骨远端骨折

目的探讨逆行交锁髓内钉治疗股骨远端骨折的临床疗效。方法采用逆行交锁髓内钉治疗股骨远端骨折37例。结果 37例均获随访,时间6～20个月。骨折均愈合。膝关节功能评分按Duwelius et al标准评定:优25例,良10例,可1例,差1例,优良率为94.6%。结论逆行交锁髓内钉治疗股骨远端骨折,适应证广、膝关节功能恢复快、临床疗效好。     

逆行交锁髓内钉治疗股骨远端A型骨折

目的探讨股骨髁上逆行交锁髓内钉(GSH)治疗股骨远端A型骨折的价值.方法采用髌下小切口经皮插入GSH钉内固定技术,治疗17侧股骨远端A型骨折.结果手术时间平均1.44 h,术中无意外失血;术后无感染、深静脉栓塞形成、内固定物断裂现象;骨折均满意复位,无延迟愈合或不愈合发生;平均随访20.5个月,伤肢膝关节平均活动度为0°(伸)～110°(屈).结论作为一种新的内固定物,GSH钉值得推广使用并进一步总结经验.     

Less invasive stabilising system plate versus retrograde intramedullary nail for osteoporotic distal femoral fracture

Introduction  

Distal femoral fractures are not as common as proximal femoral fracture in elderly, but they can lead to significant post-injury morbidity and mortality. These types of fractures have been treated mainly operatively over the last few decades. Elderly patients have poor bone quality and they do not tolerate a major open surgery. A less invasive stabilising system (LISS) plate overcomes many of these problems. We looked into the results of treatment with LISS plates and retrograde intramedullary (IM) femoral nail in osteoporotic distal femoral fracture treated in our hospital.     

微创侧卧位置入髓内钉治疗股骨干骨折的近期疗效

目的 探讨微创侧卧位置入髓内钉治疗股骨干骨折的近期疗效.方法 自2007年6月至2008年9月采用侧卧位闭合复位髓内钉内固定治疗28例股骨干骨折患者,男22例,女6例;左侧18例,右侧10例;年龄21～46岁,平均37.3岁.根据AO分型:A1型4例,A2型5例,A3型4例;B2型5例,B3型3例;C1型3例,C2型2例,C3型2例.记录手术时间、术中出血量、术中透视时间、改为切开复位内固定的病例数、术后近期并发症及术后住院时间等. 结果平均手术时间为75 min(40～115 min),平均出血量为133 mL(90～240 mL),术中平均透视时间为103 s(54～216 s).所有患者术后获8～12个月(平均10个月)随访,骨折临床愈合时间为6～10个月(平均8个月).术后疗效按Klemm功能恢复分级标准[4]评定:优22例,良6例,优良率为100%.无明显的术后近期并发症. 结论侧卧位闭合复位髓内钉固定治疗股骨干骨折具有手术时间短、出血少、创伤小及无需牵引床等优点,是微创治疗股骨干骨折可供选择的术式,但急诊手术患者应慎用,多发伤患者应属禁忌.     

Second-generation intramedullary supracondylar nail for distal femoral fractures

The objective of this study was to review the use of intramedullary supracondylar (IMSC) nails for distal femoral fractures. We reviewed 24 fractures treated with second-generation IMSC nails. The fractures consisted of 18 type A1, one type A2, two type C1, one type C2, and two type C3 fractures. The relationships between clinical results and fracture type, approaches, and patient age were retrospectively reviewed. All fractures healed clinically and radiographically. Twenty-one patients maintained gait performance equivalent to that before injury. Average operating time was 108 min +/- 43 min. ROM in the knee of all patients was -5 degrees +/- 6 degrees in extension and 102 degrees +/- 38 degrees in flexion. Extension lag was influenced by surgical approach. The final knee arc was inversely correlated to patient age (R: 0.49, P<0.05). There were three varus/valgus deformities, two cases with loosening, and two with breakage of the distal locking screws, but no failure of the nail itself. Second-generation IMSC nailing for distal femur fractures was satisfactory in patients younger than 60 years of age.     

Functional outcome of retrograde intramedullary nailing for femoral fractures

We evaluated the functional outcome of 12 femoral fractures treated using retrograde intramedullary nailing via an intercondylar approach. Patients were 9 men and 3 women with an average age of 39.4 years (range, 16–69 years). The follow-up period was 13–185 months, with an average follow-up of 95 months. Functional outcome was assessed by the knee-rating system of the Hospital for Special Surgery (HSS) and Neer's criteria. The average score was 76 points (44 –100 points) by HSS, and 77 points (36–100 points) by Neer's criteria. The outcomes over good results were seen in 67% (8/12) and 58% (7/12), according to respective rating system. Although retrograde nailing for the femoral fractures is useful method, it is still problematic about its efficacy on the basis of our acceptable rate.     

逆行交锁髓内钉微创内固定治疗股骨下段及髁上骨折

目的探讨便携式下肢手术支架下逆行交锁髓内钉内固定治疗股骨下段及髁上骨折的效果。方法采用自制便携式下肢手术支架、牵开复位器等辅助逆行交锁髓内钉微创内固定治疗55例股骨下段及髁上骨折患者。结果手术时间50～110(78±22)min;术中出血量100～600(260±110)ml。患者均获得随访,时间12～35个月。根据Karlstrom和Olerud功能评定标准进行疗效评定:优27例,良24例,中4例,优良率为92.7%。结论应用便携式下肢手术支架、AO牵开复位器及带手柄的Schanz钉辅助骨折复位等方法,使股骨逆行交锁髓内钉的手术操作更加便捷。