胫骨平台骨折术后膝关节功能的康复治疗

[目的]研究胫骨平台骨折术后通过骨科运动康复安全评定表制定个性化康复运动处方的疗效。[方法]随防2003年1月～2007年12月胫骨平台骨折185例采取手术治疗的患者。其中对照组81例,术后采取固定、传统康复等常规治疗;康复组80例,根据骨科运动康复安全评定表制定个性化康复运动处方进行康复治疗。对其进行随访问卷调查,X线检查,并采用HSS膝关节功能评估系统分别评估术后3、6、12个月的膝关节功能。[结果]随访时间2年。其中对照组内固定断裂2例,康复组3例。按照HSS评分,康复组膝关节功能优良率术后6、12个月分别为77%、87%,均显著高于对照组56%、66%(P0.05)。[结论]根据骨科运动康复安全评定表制定个性化康复运动处方进行康复治疗对胫骨平台骨折术后膝关节功能恢复安全、有效。     

肱骨远端骨折术后肘关节功能障碍原因分析

肘关节功能障碍是肱骨远端骨折术后常见并发症之一,常引起患者肢体功能障碍,影响患者工作和生活。对于引起肘关节功能障碍的原因,目前尚不明确。一些研究提示,肱骨远端骨折术后肘关节功能障碍的内源性因素主要包括骨折未能获得解剖复位、内固定选择不当引起骨折移位,外源性因素涉及创伤、围手术期感染、手术操作对软组织破坏引起的瘢痕挛缩,术后功能锻炼过晚,以及异位骨化、骨化性肌炎及关节周围钙化等。该文就引起肱骨远端骨折术后肘关节功能障碍诸多因素作一综述。     

肱骨远端骨折术后肘关节功能障碍因为分析

肘关节功能障碍是肱骨远端骨折术后常见并发症之一,常引起患者肢体功能障碍,影响患者工作和生活.对于引起肘关节功能障碍的因为,目前尚不明确.一些研究提示,肱骨远端骨折术后肘关节功能障碍的内源性因素主要包括骨折未能获得解剖复位、内固定选择不当引起骨折移位,外源性因素涉及创伤、围手术期感染、手术操作对软组织破坏引起的瘢痕挛缩....     

人工肘关节置换术治疗复杂肱骨远端骨折

目的 探讨人工肘关节置换术治疗复杂肱骨远端骨折的意义.方法 2005年5月至2008年10月对12例新鲜肱骨远端骨折接受肘关节置换术的患者进行临床随访.患者平均年龄60岁,平均随访时间12个月.骨折按照AO分型,C2型3例,C3型9例.关节假体均为半限制型Coonrad-Morrey假体.随访内容包括疼痛评估,关节活动度、稳定性检查和肌力检查,并发症检查,Mayo肘关节评分,上肢失能评分(DASH评分),放射学评估,有无假体松动和异位骨化.结果 2例患者有轻度疼痛.平均屈曲98.3°,平均伸直受限17.9°,平均旋前82.9°,平均旋后70.8°.12例患者肘关节检查均为稳定的关节.患者对治疗结果均满意.1例伤口不愈合,2例有尺神经症状.1例肘关节屈伸肌力Ⅳ级.未发现异位骨化和假体松动.Mayo肘关节评分优3例,良9例.DASH评分平均41.3分(25～75分).结论 对于严重骨质疏松、骨折粉碎严重而内固定不能获得稳定固定、关节面严重破坏(骨折或者关节炎病变)预计会发展为创伤性或炎症性关节炎的病例进行肘关节置换可以获得良好功能.     

成人肱骨远端复杂型骨折的治疗

成人肱骨远端骨折 ,尤其是涉及关节面且有明显移位的复杂骨折 ,一直是一个比较难处理的问题。闭合复位困难 ,常采用手术治疗。术中常常发现复位后 ,不易稳定固定而造成畸形愈合 ,影响肘关节功能。我们从 1998年 6月至 2 0 0 0年 6月收治了 15例严重的成人肱骨远端经关节骨折 ,分别采用倒“Y”型钢板与松质骨拉力螺钉相结合及张力带钢丝与松质骨拉力螺钉相结合的两种内固定方法 ,收到了较好的疗效。临床资料一、一般资料　本组 15例 ,男性 9例 ,女性 6例 ,年龄最小 17岁 ,最大 61岁 ,平均 3 8.5岁。均为新鲜骨折。其中 3例为开放性骨折 ,创…     

成人肱骨远端粉碎骨折的治疗

自2002～2004年．收治肱骨远端双柱骨折13例．采用鹰嘴截骨及双钢板内固定,疗效满意,现报告如下。     

成人肱骨远端骨折的手术治疗分析

[目的]探讨成人肱骨远端骨折的手术内固定方法和治疗效果。[方法]2002年1月～2004年6月手术治疗成人肱骨远端骨折患者23例，男16例，女7例，年龄17～42岁，平均32岁，其中陈旧性骨折3例，开放性骨折3例。AO／ASIF分型：A型3例，B型4例，C型16例。按照不同的骨折类型采用相应的内固定并进行功能锻炼。定期随访并手术后1、3、6个月拍片，了解骨折愈合和关节功能恢复情况。[结果]23例均获得随访，随访时间6～24个月，平均13个月，23例均骨折愈合，全部患者肘关节功能恢复满意。[结论]对成人肱骨远端骨折术中充分显露，关节面解剖复位，在髁上部牢靠固定，可以获得满意的治疗效果。     

成人肱骨远端粉碎性骨折的术后并发症

目的：报告并分析双张力带法治疗成人肱骨远端关节内粉碎性骨折的术后并发症。方法：回顾性分析４２你经双张力带法治疗后的成人肱骨远端粉碎性骨折的术后并发症如退钉、内固定失效、感染、神经损伤等,并与其它治疗方法进行比较。结果：双张力带法治疗肱骨远端粉碎性骨折的主要并发症为１７％,较其它方法低,但约有４０％的患者出现退钉的次要并发症。结论：双张力带法具有操作简便、固定可靠、可早期功能训练的优点,但应注意防止     

掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折

目的 掀起肱三头肌入路钢板固定治疗成人肱骨远端骨折的手术方法 和疗效.方法 对本院2007年10月至2010年12月,12例成人肱骨远端骨折应用掀起肱三头肌入路钢板固定治疗的手术入路、内固定的选择、术后的疗效进行回顾性分析,骨折按AO/ASIF分型法分型,其中B1型3例,B2型5例,B3型3例,C1型3例C2型1例.结果 12例成人肱骨远端骨折患者,参照改良关节功能评定标准Cassebaum评分系统,优5例,良5例,可1例,差1例,优良83.3%.结论 掀起肱三头肌两侧入路钢板固定治疗成人肱骨远端骨折临床上目前较理想的治疗方法.     

双钢板内固定治疗成人肱骨远端骨折

目的:探讨双钢板内固定治疗成人肱骨远端骨折的治疗效果.方法:回顾及分析我院1988年2月～2004年1月应用双钢板内固定治疗肱骨远端骨折17例,骨折按AO/ASIF分型,A 2型3例,A 3型5例,C1型4例,C 2型5例.结果:随访时间10-18个月,平均11个月.按Aitken和Rorabeek标准进行功能评定,结果显示:优12例,良3例,可2例,差0例,优良率88.2％.结论:双钢板内固定治疗肱骨远端粉碎性骨折有适应症广及固定牢靠的优点,疗效满意.     

Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20-130 degrees. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.     

Pulmonary embolism after operative treatment of proximal humeral fractures

There have been multiple studies on the prevalence of pulmonary embolism, the probability of death from a pulmonary embolism, and the risk factors for the development of pulmonary embolism after lower extremity and pelvic trauma. However, there is no information on the risk of pulmonary embolism after the surgical management of proximal humeral fractures. A review of 137 consecutive patients who underwent operative treatment for acute, isolated proximal humeral fractures at our institution between January 1, 1998, and December 31, 2003, was performed to identify all who sustained a pulmonary embolism. Postoperatively, 7 patients sustained a pulmonary embolism that was confirmed by computed tomography. Of these, 4 had been treated with a hemiarthroplasty and 3 had undergone open reduction-internal fixation. The overall incidence of pulmonary embolism in this series was 5.1%. None of the patients sustained a fatal pulmonary embolus. These data suggest that the rate of pulmonary embolism after operative treatment of proximal humeral fractures is not low. This study raises the question of whether prophylactic anticoagulation is needed after routine proximal humeral repair.     

陈旧性肱骨远端复杂性骨折的人工肘关节置换

[目的]研究人工肘关节置换治疗陈旧性复杂性肱骨远端骨折的疗效.[方法] 1998年1月～2008年12月对14例陈旧性肱骨远端复杂性骨折置换人工肘关节14例进行随访,患者平均59.2岁,平均随访时间为8.4年.原骨折按AO分型,C2型4例,C3型10例.假体关节为Coonrad-Morrey半限制性假体.对术前后疼痛、关节活动度、稳定性、肌力和并发症等作为重点,经由Mayo肘关节评价、DASH评价、影像学评价有无假体松动和异位骨化等.[结果]4例在强度屈肘时轻度疼痛,本组肘关节平均屈曲112.6°(0°～144°),平均伸肘7.9°,屈124°,术后平均伸直受限22°.术后平均旋前79.8°,旋后78.2°.14例肘关节稳定,患者对治疗结果满意.并发术中内侧柱骨折、尺神经麻痹和异位骨化各1例.无假体松动.Mayo肘关节评价优(＞90分)7例,良(75～ 89分)7例.DASH评价平均48.2分(24.4～78分).[结论]人工肘关节置换治疗陈旧性肱骨远端复杂骨折畸形愈合或创伤性关节炎患者,是一种疗效肯定的治疗手段.     

Predictors of wrist function and health status after operative treatment of fractures of the distal radius

PURPOSE: To identify the most important determinants of physician-based and patient-based scoring systems for the wrist and upper extremity after operative treatment of a fracture of the distal radius, with the hypothesis that pain is the strongest determinant of both types of scores. METHODS: Eighty-four patients were evaluated a minimum of 6 months after operative fixation of an unstable distal radius fracture using 2 physician-based evaluation instruments (the Mayo Wrist Score and the Gartland and Werley Score) and an upper extremity-specific health status questionnaire (Disabilities of the Arm, Shoulder, and Hand; DASH). Multivariate analysis of variance and multiple linear regression modeling were used to identify the degree to which various factors affect variability in the scores derived with these measures. RESULTS: The physician-based scoring systems showed moderate correlation with each other and with DASH scores. The results of multiple linear regression modeling were as follows (percent variability accounted for by the best fit model/model with top factor alone): Mayo: 54% grip and flexion arc/47% grip alone; Gartland and Werley: 70% pain, flexion arc, radiocarpal arthritis, and duration of follow-up/53% pain alone; DASH: 71% pain, forearm arc, and type of fracture/65% pain alone. CONCLUSIONS: At early follow-up, pain dominates the patient's perception of function after recovery from an operatively treated distal radius fracture as measured by the DASH score and the physician-based rating according to the system of Gartland and Werley. The Mayo Wrist Score is determined primarily by grip strength rather than pain. Because perception of pain and strength of grip have been shown to be influenced by psychosocial factors in some individuals, both patient-based and physician-based measures of wrist function may be vulnerable to illness behavior. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.     

Periprosthetic humeral fractures after shoulder and elbow arthroplasty

Due to rapidly increasing numbers of arthroplasty surgeries of the upper extremity, periprosthetic humeral fractures after shoulder and elbow arthroplasty, formerly described as rare, may hence increase in the near future. Therefore the aim of the present work was to give an overview of the existing literature including possible classifications as well as an update on treatment concepts and experiences with own cases. After a literature research have been done, existing prevalence, classifications and treatment options, mostly described in case series, were processed to create an overview of the existing state of knowledge. Additionally 7 own cases are described in detail to show the different treatment options used at the authors department. The currently used classification systems take fracture location, angulation and rotation and fixation of the implant into account. Possible solutions for periposthetic fractures of the humerus include conservative management, open reduction and internal fixation for stable prosthesis and long stemmed implants for lose implants as well as the use of additional allo- or autogeneous bone grafting and reverse shoulder arthroplasty in revision cases with rotator cuff dysfunction. After all treatment of periprosthetic humeral fractures after shoulder and elbow arthroplasty remain a challenging problem.     

The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children

The indications for physiotherapy after supracondylar humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. The authors therefore performed a prospective randomized study to assess the effectiveness of physiotherapy in improving the elbow range of motion after such fractures. The authors studied two groups of 21 and 22 children with supracondylar humeral fractures Felsenreich types II and III, all without associated neurovascular deficits. All children were treated by open reduction and internal fixation with Kirschner wires inserted from the radial side of the humerus. Postoperative follow-up at 12 and 18 weeks showed a significantly better elbow range of motion in the group with weekly physiotherapy, but there was no difference in elbow motion after 1 year. In each group, one child had an extension deficit of 15 or 20 degrees. The authors conclude that postoperative physiotherapy is unnecessary in children with supracondylar humeral fractures without associated neurovascular injuries.     

The operative treatment of diaphyseal humeral shaft fractures

Fractures of the humeral shaft comprise 1% to 3% of all fractures. Incidence rates reveal a bimodal distribution in which there is one small peak during adolescence, followed by a larger spike during the fifth and sixth decades of life. Most humeral diaphysis fractures are simple patterns of the mid-diaphysis. This article emphasizes surgical approaches to humeral fractures, providing a review of the surgical spectrum of treatment inclusive of intramedullary nailing and plating, but also includes a brief discussion of the conservative approach.     

Functional treatment of the distal third humeral shaft fractures

OBJECTIVE: The objective of the present study was to determine the effectiveness of functional treatment for distal third humeral shaft fractures in young adults. PATIENTS AND METHODS: A custom-made prefabricated brace was applied for the functional treatment of 21 isolated, closed, distal third humeral shaft fractures of 21 patients (17 male and 4 female). Their average age was 25 years (range 18-37 years). The mean follow-up period was 39 weeks. RESULTS: All of the fractures united. The average time to union was 12 weeks. The average varus angulation was 7.8 deg in 8 patients, and the average shortening of the fractured limb was 10 mm in 4 patients. Minimal motion restrictions mostly occurred in shoulder abduction and lateral rotation. No patient showed a lack of elbow motion. Angulatory deformities and shortening had no effect on the functional outcome. None of the patients suffered radial nerve palsy during the course of treatment or due to entrapment in the callus of the healed fracture. CONCLUSIONS: Young adults who have isolated, closed, distal third humeral shaft fractures are good candidates for functional bracing.