加压钢板治疗股骨干骨折30例失败原因分析

加压钢板治疗股骨干骨折３０例失败原因分析郑南生张光强姚伦龙加压钢板治疗股骨干骨折，可以在骨折块之间产生纵向加压力，增强骨块之间稳定性，使患者能够早期无负重功能锻炼，有效地避免骨折并发症，取得较好的临床效果，但由于操作失误或缺乏正确的康复指导，使内固定...     

加压钢板治疗股骨干骨折22例失败分析

股骨干骨折较常见,约占全身骨折的66%.就股骨干骨折的局部生物力学而言,加压钢板内固定并不是治疗股骨干骨折的最好方法,较之交锁髓内钉,加压钢板内固定在设备上要求较少,这正是大多数基层医院选择加压钢板内固定作为治疗股骨干骨折的主要方法的原因,但处理不当常使内固定失效.本院自1990年9月至2002年11月,采用加压钢板治疗股骨干骨折共22例失败病例,其原因分析如下.     

股骨干骨折加压钢板内固定12例失效原因分析

自 1993年～ 2 0 0 0年 ,我院行加压钢板内固定治疗股骨干骨折 112例 ,根据随访 ,其中院内手术 10例 ,外院手术 2例内固定失效 ,作者就失效原因进行分析。临床资料一、一般资料　本组男性 8例 ,女性 4例 ;左侧 7例 ,右侧 5例 ;年龄 2 0～ 43岁 ,平均 2 7岁。受伤原因 :车祸 3例 ,砸伤 4例 ,摔伤 3例 ,其它类型的损伤 2例。骨折类型 :粉碎性骨折 6例 ,斜形骨折 3例 ,螺旋形骨折 2例 ,横形骨折 1例。中段骨折 6例 ,中下段骨折 5例 ,多段骨折 1例。本组院内 10例及外院 2例均首次接受手术 ,其中闭合性骨折 10例 ,开放性骨折 2例。失效距手术时…     

加压钢板治疗儿童股骨干骨折

目的探讨加压钢板治疗儿童股骨干骨折的效果。方法应用加压钢板治疗儿童股骨干骨折18例,对患儿的临床资料进行回顾行分析。结果本组18例患儿均得到随访,随访时间6～18周,平均14.2周。骨折顺利愈合,临床愈合时间为6～10周,平均7.6周,无1例出现感染、骨不连、骨不愈合、钛板螺钉断裂等并发症发生。结论加压钢板是治疗儿童股骨干骨折有效的治疗方法之一。     

加压钢板治疗儿童股骨干骨折

目的探讨加压钢板治疗儿童股骨干骨折的临床治疗效果。方法 2005-01—2008-11应用加压钢板治疗儿童股骨干骨折30例。结果本组32例病人均得到随访,随访时间6～18周,平均14.2周,骨折顺利愈合,临床愈合时间为6～10周,平均7.6周,无1例出现感染、骨不连、骨不愈合、钛板螺钉断裂等并发症发生。结论加压钢板是治疗儿童股骨干骨折有效的治疗方法之一。     

加压钢板治疗儿童股骨干骨折

目的探讨加压钢板治疗儿童股骨干骨折的临床治疗效果。方法对30例股骨干骨折患儿应用加压钢板治疗,回顾性分析患儿的临床资料。结果本组36例患儿均获6~18周随访,平均14.2周。骨折顺利愈合,临床愈合时间6~10周,平均7.6周。未发生感染、骨不连、骨不愈合、钛板螺钉断裂等并发症。结论加压钢板治疗儿童股骨干骨折,效果满意、安全可行。     

加压钢板治疗股骨干下段骨折失误分析

1991～ 1997年 ,我们共收治股骨干下段骨折 146例 ,均行加压钢板固定。其中失误 2 2例 ,失误率 15 0 7% ,均出现成角畸形 ,2 0例行再次手术 ,现报告如下。1　临床资料1 1　一般资料　本组 2 2例中男 16例 ,女 6例 ;年龄 17～ 5 5岁。伤因 :车祸 ,砸伤 ,高处坠落伤。骨折部位 :股骨下段。1 2　首次治疗方法及结果　本失误组均采用国产加压钢板内固定 ,其中 6孔钢板 15例 ,8孔钢板 7例 ;骨折端偏远端螺钉固定于松质骨处 16例 ;骨缺损未行植骨 8例 ;术后均未行外固定。术后 3天起行ＣＰＭ锻炼 ,并下床行主动或被动活动膝关节 ;3个月内扶拐下床…     

动力加压钢板螺钉治疗成人股骨干骨折56例体会

2004年8月～2010年3月,我科采用动力加压钢板螺钉固定治疗56例股骨干骨折患者,均取得满意疗效。1材料与方法1.1病例资料本组56例,男32例,女24例,年龄20～62(40±20)岁。上1/3骨折11例,中1/3骨折33例,下1/3骨折12例,受伤至手术时间3～7(5±2)d。     

钢板治疗股骨干骨折失效32例原因分析

作者对32例钢板治疗股骨干骨折失效的病例进行了分析,认为造成钢板失效的主要原因是:①骨折未能解剖复位;②未修复骨缺损、骨结构的完整性;③内固定不牢固;④过早负重;⑤术后功能锻炼不当等。作者强调解剖复位、坚强固定、正确功能锻炼、避免过早负重是预防钢板失效的重要措施。     

股骨干骨折和加压钢板与髓内针固定疗效分析

股骨干骨折为骨科常见损伤 ,且多采用手术治疗 ,其内固定方式有钢板类及髓内针类 ,为比较两者的治疗效果 ,作者对我院 1988年 5月～ 2 0 0 1年 5月资料完整的股骨干骨折病人 12 5例进行回顾性分析 ,现报告如下。临床资料一、一般资料　本组共 12 5例 ,男 94例 ,女 3 1例 ,年龄2 3～ 76岁 ,平均 3 6.5岁。骨折按 AO分类 :3 2— A2 2 0例 ,3 2— A314例 ,3 2— B1 11例 ,3 2— B2 2 4例 ,3 2— B32 6例 ,3 2— C1 17例 ,3 2— C2 8例 ,3 2—C35例。股骨中上段骨折 2 9例 ,中段骨折 79例 ,中下段骨折 17例。受伤原因 :车祸伤 86例 ,坠落伤 …     

桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折

目的 探讨桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的临床疗效.方法 回顾性分析2013年1月至2016年12月于我院骨科接受手术治疗的4例股骨干骨折合并同侧股骨近端及远端骨折病人的临床资料,其中男3例,女1例,年龄为(33.5±9.3)岁(23～44岁),闭合性骨折3例,开放性骨折1例.3例病人...     

Ender钉治疗儿童股骨干骨折

目的探讨Ender钉治疗儿童股骨干骨折的疗效. 方法对24例儿童股骨干骨折采用小切口Ender钉内固定,术后单侧髋人字石膏固定患肢4周. 结果随访 6个月～2年,无一例出现骨折不愈合、延迟愈合 .有4例出现双下肢不等长,均小于1 cm.无明显跛行,下肢功能完全正常. 结论只要严格掌握其适应证和禁忌证,Ender钉治疗5～10岁儿童股骨干骨折具有切口小,解剖复位,不破坏骨膜、利于骨折修复,住院时间短,功能恢复快等优点.     

Complications of plate fixation of femoral shaft fractures in children and adolescents

Purpose

This study aims to critically analyze the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures.

Methods

The medical records of skeletally immature patients (6–15 years of age) who underwent plate fixation of a diaphyseal femur fracture at a tertiary-care level-1 pediatric trauma center between 1/2003 and 12/2010 were reviewed. Demographic and clinical information regarding the mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intraoperative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan–Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up.

Results

Over an 8-year period, 85 skeletally immature patients (83 % males, mean age 10.2 years) underwent plate fixation for diaphyseal femur fractures. Overall, complications were identified in 11 patients (13 %). Major complications, defined as those resulting in unplanned reoperation (excluding elective removal of asymptomatic plate/screws), occurred in five patients (6 %) and included two patients (2 %) with wound infections requiring irrigation and debridement, two patients (2 %) with distal femoral valgus deformity (DFVD) leading to osteotomy and hardware removal, respectively, and one patient (1 %) with a 3-cm leg length discrepancy (LLD) requiring epiphysiodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in six patients (7 %) and included two patients (2 %) with delayed union, two patients (2 %) with symptomatic screw prominence, one patient (1 %) with a superficial wound infection effectively treated with oral antibiotics, and one patient (1 %) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of postoperative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61 %) underwent routine elective removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20 months (range 0–65 months), though major complications occurred at a later time point (mean 29.1 months, range 0–65 months) than minor complications (mean 12.5 months, range 0–40.1 months). Longer follow-up was associated with higher occurrence of a complication [p = 0.0012, odds ratio = 1.05, 95 % confidence interval (CI): 1.02–1.08].

Conclusions

The plating of pediatric femur fractures is associated with 6 and 7 % rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10–62 %) associated with titanium elastic nail fixation of similar fracture types. Most complications occurred >4 months postoperatively, with major complications occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected.

Level of evidence

Retrospective case series, Level IV.     

股骨干骨折内固定失败36例分析

目的分析股骨干骨折行内固定术失败的原因并提出相关预防措施。方法回顾性分析了1994-2003年所收治的股骨干骨折内固定失败患者36例的临床资料。结果内固定失败发生于术后21天至11个月。分别表现为：内固定断裂、变形或松动，骨折不愈合、延迟愈合或畸形愈合。结论引起股骨干骨折内固定术失败的主要原因是：忽略生物力学原则，欠缺内固定的基本理论和经验，未正确掌握不同内固定物的适用范围，术后功能锻炼不当。严格遵循AO原则行内固定术是避免内固定失败的关键。     

Treatment for ipsilateral fractures of femoral neck and shaft

Background

Concomitant ipsilateral femoral shaft and neck fractures present a challenge to the orthopaedic surgeon, and no consensus has yet emerged on the optimal treatment method. We report the results of a retrospective study of 43 patients with these complex fractures who were treated at a single Level 1 trauma centre.

Patients and methods

The study participants consisted of 28 males and 15 females with a mean age of 43 years. The mean follow-up period was 48 months. Four different treatment methods were used: (1) antegrade reamed intramedullary nailing of the shaft with cancellous screw fixation of the neck, (2) dynamic hip screw (DHS) fixation of the neck and low-contact dynamic compression plate (LCDCP) fixation of the shaft, (3) cancellous screw fixation of the neck and LCDCP fixation of the shaft, and (4) reconstruction nailing of both shaft and neck.

Results

No statistically significant differences in amount of blood loss, duration of surgery, total complication rate, nor clinical results were found among the four treatment methods. For femoral neck fracture, however, the complication rate of cannulated screw with antegrade intramedullary nailing fixation was 11 times that of DHS with LCDCP fixation.

Conclusions

Antegrade nail with screw fixation is not a recommended treatment method in patients with ipsilateral femoral shaft and neck fractures.     

股骨干骨折合并同侧股骨颈骨折治疗的临床观察

目的：探讨股骨干合并同侧股骨颈骨折的治疗特点和不同固定方法的疗效。方法：股骨干骨折合并同侧股骨颈骨折27例,男22例,女5例;年龄14～65岁,平均35岁。动力髋螺钉（DHS）固定3例,加压钢板加空心加压螺钉固定12例,重建钉固定8例,顺行髓内钉加空心加压螺钉固定4例。13例固定术前用克氏针临时固定股骨颈骨折。结果：术后随访36～75个月,平均44个月。25例股骨颈骨折平均愈合时间4.5个月,2例股骨颈骨折不愈合。27例股骨干均愈合,平均愈合时间6个月。未用克氏针临时固定股骨颈骨折14例中,2例出现股骨颈不愈合,3例轻度髋内翻畸形。结论：股骨干合并同侧股骨颈骨折有许多固定方法可供选择,加压钢板加空心加压螺钉固定简便易用,在实施固定术前用克氏针临时固定股骨颈骨折可避免股骨颈骨折再移位和损伤。     

Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures

Introduction Complex femoral fractures pose considerable therapeutic challenges to orthopedic surgeons. We present a retrospective review of 25 patients with complex femoral fractures treated with intramedullary locked nailing and supplemental screw fixation.Materials and methods Fifteen patients with ipsilateral femoral neck and shaft fractures (group 1) and 10 patients with ipsilateral femoral shaft and distal femur fractures (group 2) were treated from 1990 to 1998. High-energy injuries occurred in all patients. There were 4 open fractures. Antegrade, locked nailing of diaphyseal fractures was performed in all cases. Supplemental screws for the neck were used in all patients in group 1 and in 3 patients in group 2.Results All of the fractures united during the follow-up. Five patients in group 1 underwent reoperation (33.3%): one due to a delayed union, the second due to an implant failure, the third due to a nonunion of a neck fracture, and the last two because of an initially missed femoral neck fracture. None of the patients in group 2 underwent reoperation. Angular malalignment of the shaft was found in 6 fractures in group 1 (average 4.8^o, range 3^o–11^o) and in 4 fractures in group 2 (average 6^o, range 3^o–12^o). Shortening of the limb occurred in 3 patients in group 1 (average 1.4 cm, range 1–1.8) and in 1 patient in group 2 (2 cm). Loss of fixation was seen in 1 patient in each group. Avascular necrosis and infection were not seen in any case in both groups.Conclusion Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. New nail designs, usually more expensive than the conventional nails, have been introduced into the market for this purpose. One has to keep in mind that antegrade, locked nailing of femoral shaft fractures combined with neck or distal femur fractures is a technically demanding but efficacious procedure. The success rate is high when the technique is meticulously implemented.     

扩髓髓内钉与锁定接骨板治疗股骨干骨折的疗效比较

目的观察股骨扩髓髓内钉（RIN）和锁定接骨板（LCP）治疗股骨干骨折患者的临床疗效。方法对50例股骨干骨折患者分别采用RIN内固定（25例）和LCP内固定（25例）治疗。对比两组患者手术时间、术中失血量、切口长度、住院时间、术后8周骨痂面积、功能评价情况。结果50例均获得随访,时间RIN组11～28个月、LCP组10～32个月。术中出血量、住院时间及Flynn功能评价两组差异均无统计学意义（P〉0．05）。RIN组手术时间较LCP组长、切口长度较LCP组短、术后第8周骨痂面积比LCP组大,差异均有统计学意义（P〈0．05）。结论RIN与LCP两种内固定方式均能取得良好的治疗效果,但RIN组术后骨痂形成较多,骨折愈合情况更为理想。     

股骨LISS钢板外固定治疗胫骨近侧干骺端骨折

目的探讨股骨LISS钢板外固定技术应用于胫骨近侧干骺端骨折的治疗效果。方法自2011-07—2012-09诊治45例胫骨近侧干骺端骨折,闭合性骨折33例,开放性骨折12例。采用股骨LISS钢板进行外固定,将钢板放置于胫骨前内侧面。观察手术时间、骨折愈合时间、邻近关节功能、术后并发症等情况,评价手术疗效。结果本组手术时间平均42(30~60)min。45例均获得平均15.6(12~19)个月随访,无切口感染、深部感染、骨折不愈合、钢板螺钉松动断裂发生。骨折临床愈合时间10~20周,平均13.8周。3例分别在术后3周、2个月、4个月时出现局部1或2枚外固定螺钉钉道持续渗出,2例接受每天3次、为期1周的酒精清洗后渗液消失,另1例经过1周酒精清洗后仍有渗液,拆除局部螺钉后钉道愈合。术后1年膝关节功能HSS评分:优38例,良4例,可3例,优良率93.3%;踝关节功能AOFAS评分:优39例,良4例,可2例,优良率95.6%。结论胫骨近侧干骺端骨折应用股骨LISS钢板外固定治疗能获得良好的效果,该手术具有操作简便、创伤小、钢板拆除简便等优点。     

可消毒止血带在股骨干中下段骨折切开复位内固定术中的应用价值

目的探讨可消毒止血带在股骨干中下段骨折切开复位内固定术中的应用价值。方法回顾性分析同一手术组使用（试验组,45例）和不使用（对照组,45例）可消毒止血带行股骨干中下段骨折切开复位内固定术的资料。结果2组切口均一期愈合,无血管神经损伤和感染发生。患者均获随访12～32个月,平均16．7个月。骨折均愈合,无内固定断裂、再骨折和骨不连等并发症发生。2组骨折愈合时间差异无统计学意义（P〉0．05）。末次随访时,试验组膝关节功能HSS评分优14例、良31例,对照组优13例、良32例,2组HSS评分优良率均为100％,差异无统计学意义（P〉0．05）。试验组手术时间、术中出血量、输血量和实际总失血量均小于对照组,差异有统计学意义（P〈0．05）。结论使用可消毒止血带行股骨干中下段骨折切开复位内固定术对患者膝关节功能恢复、骨折愈合时间和并发症发生率无影响,但可以有效减少出血和输血量．缩短手术时间。