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1.
Prophylactic intramedullary fixation of the tibia for stress fracture in a professional athlete. 总被引:1,自引:0,他引:1
Prophylactic intramedullary nailing of the tibia for stress fracture was performed successfully in a professional football player, enabling him to resume his career. No similar case has been reported previously. 相似文献
2.
目的 比较髓内钉与髓外内固定治疗不稳定型股骨转子下骨折的疗效. 方法 回顾性分析2005年1月至2011年8月期间收治且获得随访的65例不稳定型(Russell-Taylor分型B型)股骨转子下骨折患者资料,男40例,女25例;年龄为32~ 87岁,平均53.4岁.根据内固定方式不同分为两组:髓内钉组34例,髓外内固定组31例(其中锁定加压钢板内固定治疗21例,动力髋螺钉内固定治疗10例).记录并比较两组患者的手术时间、术中出血量、骨折复位质量、住院时间、骨折愈合时间及术后12个月髋关节Harris评分. 结果 65例患者术后获12 ~ 18个月(平均15.6个月)随访.髓内钉组患者的手术时间[(67.9±19.0) min]较髓外内固定组[(79.8±22.4) min]短,术中出血量[(112.6±63.4) mL]较髓外内固定组[(178.5±97.5)mL]少,骨折愈合时间[(21.0±6.5)周]较髓外内固定组[(28.0±8.7)周]短,术后12个月髋关节Harris评分[(83.4±8.1)分]较髓外内固定组[(79.2±7.4)分]高,差异均有统计学意义(P<0.05).但两组患者的骨折复位质量、住院时间比较差异均无统计学意义(P>0.05).2例患者出现骨不连,均为采用锁定加压钢板固定者,改为髓内钉固定后骨折获愈合;2例患者出现畸形愈合,其中髓外内固定组1例,髓内钉组1例. 结论 髓内钉较髓外内固定治疗不稳定型股骨转子下骨折更有优势. 相似文献
3.
目的探讨髓外固定股骨近端接骨板(PFP)及锁定加压接骨板(LCP)辅助双植骨头钉孔道内松质骨、异体骨混合打压植骨及骨不连断端结构植骨治疗股骨转子下骨折髓内固定术后骨不连的手术技巧和临床疗效。方法回顾性分析2018年1月至2018年12月期间西安交通大学附属红会医院创伤骨科下肢病区收治且完整随访的21例股骨转子下骨折髓内固定术后骨不连患者资料。男15例,女6例;平均年龄为52.3岁(27~65岁)。骨不连类型:萎缩型18例,缺血型3例。患者骨不连手术与骨折初次手术的时间间隔平均为10.3个月(9~13个月),骨折手术均采用髓内固定(PFNA):闭合复位10例,切开复位11例(其中钢丝捆扎8例)。骨不连均采用髓外固定(PFP+LCP)辅助双植骨(头钉孔道内松质骨、异体骨混合打压植骨+骨不连断端结构植骨)治疗。术后12个月采用Harris评分评估髋关节功能。结果21例患者术后获平均11.4个月(10~12个月)随访。所有患者术后骨不连均获愈合,平均愈合时间为5.2个月(4~6个月)。1例患者术后出现皮下血肿,再次行清创术。术后12个月Harris髋关节评分平均为85.7分(84~92分)。结论PFP接骨板能够有效纠正内翻畸形并坚强固定,LCP接骨板+皮质骨结构植骨能够提供内侧力学支撑,松质骨+异体骨混合打压植骨能够有效增加头钉孔道内骨量,增加近端螺钉的把持力。该方法可以极大地提高骨折愈合率,减少并发症的发生,且能获得较好的髋关节功能。 相似文献
4.
5.
Biomechanics of intramedullary fracture fixation 总被引:3,自引:0,他引:3
R F Kyle 《Orthopedics》1985,8(11):1356-1359
Intramedullary rodding allows excellent control of bending forces on long bone fractures when adequate sized rods are used. This is made possible by reaming when necessary. Torsional stability is poor if adequate bone nail contact is not obtained and there is little bone fragment interdigitation. This can be optimized with the interlocking system, especially with proximal and distal fractures. Intramedullary rods allow transmission of compressive load so there must be adequate bone to bone contact without comminution to prevent shortening. If a great deal of comminution is present, an interlocking system must be used to resist compressive loads. The interlocked devices have not been proven to be a detriment to union and indeed are a semi-rigid fixation system when used in comminuted shaft fractures. The strength of an osteosynthesis with an intramedullary rod depends on the geometry of the rod and the geometry of the fracture complex. Both locked and nonlocked intramedullary rods perform extremely well when one understands the mechanical principles involved in intramedullary rodding and pays close attention to detail. 相似文献
6.
Nirav H. Amin Anna Katsman Rajit Chakravarty Susan Harding Douglas L. Cerynik 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2012,22(8):703-707
Intramedullary fixation is the mainstay of treatment for femur fractures in the adult trauma population. With subtrochanteric fractures, accurate reduction and stable fixation become technically challenging. Adjuvant blocking screws in the proximal fragment can effectively be used to prevent varus and apex anterior malalignment when intramedullary nails are used in these fractures. Blocking screws decrease the canal volume, thereby allowing the intramedullary device to control the proximal segment. This aids in improving alignment between the proximal and distal fragments during reduction. We review the cases of six patients with proximal femur fractures who were treated with intramedullary nailing in conjunction with the placement of blocking screws. 相似文献
7.
《中国矫形外科杂志》2016,(10):874-878
[目的]探讨评价闭合复位弹性髓内钉固定技术治疗儿童股骨转子下骨折的效果。[方法]2008年12月~2014年10月,采用闭合复位弹性髓内钉固定技术治疗21例股骨转子下骨折患儿。男15例,女6例;年龄4~12岁,平均7.7岁。左侧12例,右侧9例,致伤因素:交通事故伤13例,高处坠落伤7例,溜冰摔伤1例。均为新鲜闭合骨折。依据Seinsheimer分型:ⅡA型2例,ⅡB型7例,ⅡC型7例,ⅢB型3例,Ⅳ型2例。受伤至手术时间2~9 d,平均5.4 d。术后参照Flynn髓内钉治疗股骨骨折的评分标准评价术后患肢功能。[结果]手术时间25~60 min,平均32 min。术后患者切口均Ⅰ期愈合,无感染、无神经血管损伤等并发症发生。21例均获随访,随访时间18~56个月,平均24个月。术后3个月时骨折均达骨性愈合。随访期间无髓内钉折断、再骨折、骨骺早闭、股骨头缺血性坏死、下肢过度生长等并发症发生。1例SeinsheimerⅣ型患儿术后3个月骨折愈合后患肢较健侧短缩1.5 cm,随访30个月后双下肢等长。末次随访时,患肢功能按Flynn评定标准,获优19例,良2例,优良率100%。末次随访测量X线片有5例(23.8%,5/21)断端向前成角2°~8°,平均3.8°;3例(14.3%,3/21)向后成角2°~6°,平均4.0°;无内外翻成角。[结论]只要规范掌握复位及固定技巧,弹性髓内钉技术能够实现儿童股骨转子下骨折闭合复位及有效的固定,取得满意的手术效果,安全、微创,是一种理想的治疗方法。 相似文献
8.
[目的]探讨应用普通带锁髓内钉(GIIN)内固定治疗低位股骨粗隆下骨折(LSFF)的可行性与疗效。[方法]2000年3月-2006年1月应用有限切开GIIN内固定治疗LSFF47例,男38例,女9例;年龄25-78岁,平均41.2岁。致伤原因:车祸伤29例,坠落伤7例,重物砸伤6例,步行跌伤5例。参照Seinsheimer分型:ⅡA型11例,ⅡB型10例,ⅢB型19例,Ⅳ型7例。其中8例合并其它骨折,6例为开放性骨折(GustiloI型4例,Ⅱ型2例)。所有患者均行有限切开复位,采用逆行扩髓技术定位梨状窝进钉点,有限扩髓后顺行置人髓内钉。全部应用静力性固定。手术时间50—130min,平均90min。[结果]随访11个月-2年10个月,平均1年11个月。骨折对位良好。愈合时间2.5—6个月,平均3.9个月,愈合率100%。患肢功能按Sanders髋关节评分系统进行评分,优(55—60分)31例,良(45—54分)14例,差(35—44分)2例,优良率达95.7%,无感染、髓内钉和锁钉断裂、肢体短缩及髋内翻畸形等并发症。[结论]GIIN治疗LSFF具有方法简单、术中不需要X线监视、固定可靠、骨折愈合率高、并发症少、疗效满意等优点,值得推广应用。正确使用GIIN的操作方法、良好的骨折复位和术后积极功能锻炼(即早活动晚负重)是治疗成功的关键。 相似文献
9.
目的探讨重建钢板辅助股骨近端髓内钉内固定治疗股骨转子下骨折的临床疗效。方法采用重建钢板辅助股骨近端髓内钉内固定治疗14例股骨转子下骨折患者。末次随访时采用Harris功能评分评价疗效。结果患者均获得随访,时间6~12个月。骨折愈合时间3~6个月。末次随访时根据Harris功能评分评价疗效:优10例,良3例,可1例,优良率为13/14。无髋内翻畸形、再次骨折、拉力螺钉切割股骨头及断钉发生。结论重建钢板辅助股骨近端髓内钉内固定治疗股骨转子下骨折可以达到坚强内固定,避免了内固定失效和骨折不愈合发生,术后疗效满意。 相似文献
10.
Zu-Bin Zhou Song Chen You-Shui Gao Yu-Qiang Sun Chang-Qing Zhang Yao Jiang 《中华创伤杂志(英文版)》2015,18(6):336-341
Purpose: To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures.
Methods: From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37-72 years (mean 53.5 years). According to Seinsheimer classification, there were 2 cases of type I, 7 type II, 15 type III, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type III fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring (HHS) system.
Results: Patients were followed up for 6e12 months. All fractures were healed except one patient with
delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were
considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%.
Conclusion: Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients'' prognosis. 相似文献
11.
目的 探讨有限切开复位髓内钉固定治疗股骨转子下骨折的效果.方法对闭合复位失败的21例股骨转子下骨折患者采用有限切开复位、髓内钉固定治疗.结果 21例均获得随访,时间10~18个月.骨折全部愈合,无内固定物松动、断裂等并发症.术后测量:内外翻成角0°~5°(1.9°±1.7°);前后成角0°~10°(4.3°±2.6°);内外旋0°~10°(5.5°±2.6°);下肢缩短0~1.5(0.4±0.5)cm.结论 有限切开复位髓内钉固定治疗股骨转子下骨折可以获得良好的治疗效果. 相似文献
12.
《Injury》2021,52(3):582-588
BackgroundBisphosphonates use is a recognised cause of atypical femur fractures. Intramedullary nailing is the first line of treatment for these fractures, but failure is a common problem due to altered biology, resulting in a non-union and a challenging problem.PurposeThere is lack of evidence in the literature on revision surgery for the management of non-union after failed nailing in atypical femur fracture. We present our experience of treating this complex problem.Patient and MethodsA retrospective review of all consecutive cases of revision surgery for non-union of bisphosphonate related subtrochanteric fractures was undertaken. All procedures were performed between 2012 and 2017 by a single surgeon. Revision surgery included removal of failed metalwork, resection of non-union, bone grafting and double plating with a lateral DCS plate and anterior locking compression plate.ResultsTen patients (9 females, 1 male) were included with a mean age of 71.5 years and mean BMI of 34 at the time of revision. All patients received previous Bisphosphonate treatment on average for 6.2 years. One patient was lost to follow up. Mean time for non-weight bearing (NWB) mobilization was 7 months and mean time for union was 14 months.ConclusionsFracture healing can be achieved with bone grafting and compression plating in all patients. However, a prolonged time to achieve union and a long follow-up duration should be expected. 相似文献
13.
[目的]对髓内固定与髓外钉板固定治疗成人股骨转子下骨折的疗效及安全性进行评价。[方法]按照Cochrane图书馆提供的系统评价方法,计算机检索PubMed(19802013年10月)、Cochrane图书馆(2013年第10期)、Embase(19802013年10月)、Cochrane图书馆(2013年第10期)、Embase(19802013年10月)以及CNKI、CBM等中外生物医学数据库,收集关于髓内固定与髓外钉板固定比较治疗成人股骨转子下骨折的文献。对文献进行方法学质量评价。采用Cochrane协作网提供的RevMan 5.2.5进行Meta分析,以比较髓内固定与髓外钉板固定术后疗效及安全性相关指标有无差异。[结果]共纳入5个研究,其中4篇RCTs,1篇非随机临床对照研究。共计241例,其中140例行髓内钉固定,101例行髓外钉板固定。Meta分析结果显示:与髓外钉板固定相比,髓内钉固定组可降低术后内固定失败率[RR=0.25,95%CI(0.10,0.67),P=0.005]和骨折不愈合率[RR=0.17,95%CI(0.04,0.74),P=0.02],并且可提高早期下床活动率,两者在感染发生率、股骨骨折发生率及手术时间、住院天数上差异无明显统计学意义。[结论]髓内钉固定治疗股骨转子下骨折能降低内固定失败率及骨不愈合率,可早期下床活动。 相似文献
14.
目的比较自行设计的改良梅花型交锁髓内钉与国产Gamma钉固定股骨粗隆下骨折的即刻生物力学特性,探讨改良梅花型交锁髓内钉固定股骨粗隆下骨折的可行性。方法 8具成年健康男性股骨标本,按左右侧分为实验组和对照组,分别制作股骨粗隆下横形骨折模型。实验组采用长度350 mm的改良梅花型交锁髓内钉固定骨折,对照组采用长度350 mm国产Gamma钉固定骨折。分别检测抗轴向压缩、抗侧弯及抗扭转力学性能,并进行统计学分析。结果 1 000 N轴向载荷压力下的抗压刚度、1 000 N压力下的抗弯曲刚度及3 N/m下的抗扭转刚度:对照组分别为(2 359.4±200.8)N/mm、(614.7±60.2)N/m、(0.64±0.16)Nm/°,实验组分别为(2 178.1±129.5)N/mm、(439.1±48.2)N/m、(0.48±0.13)Nm/°。两组抗压、抗弯曲、抗扭转3项指标比较差异均无统计学意义(P>0.05)。结论改良梅花型交锁髓内钉具有较好的生物力学性能,可用于内固定治疗股骨粗隆下横形骨折。 相似文献
15.
股骨骨折髓内针固定术后感染的治疗 总被引:1,自引:1,他引:0
目的探讨股骨骨折髓内针固定术后合并感染时,是否需要取出髓内针及其相关治疗方法。方法1993~2003年治疗股骨骨折髓内针固定术后感染18例。其中急性感染8例,亚急性感染6例,慢性感染4例,为对比疗效特将病例分为两组Ⅰ组保留髓内针共13例,其中男12例,女1例,平均年龄36岁;Ⅱ组在清创同时取出髓内针改用外固定稳定骨折共5例。其中男4例,女1例,平均年龄41岁。所有患者确诊感染后随访至少1年。结果Ⅰ组所有骨折均愈合,平均愈合时间11个月(9~16个月),平均随访25个月(12~72个月);Ⅱ组4例治疗后平均10个月后骨折愈合(6~24个月),4例出现膝关节活动障碍,2例肢体不等长相差>1cm,1例感染性骨折不愈合在最后随访时仍未愈合,平均随访28个月(12~36个月)。结论股骨骨折髓内针固定合并感染时,如果骨折稳定且感染得到控制髓内针可保留。否则,骨髓炎不能有效控制或感染性骨不连时,应当选择外固定,有骨缺损存在时,常需要植骨。 相似文献
16.
带锁髓内钉治疗股骨干粉碎性骨折疗效观察 总被引:2,自引:0,他引:2
目的探讨带锁髓内钉治疗股骨干粉碎性骨折的疗效.方法使用带锁髓内钉治疗股骨干粉碎性骨折67例,均取前外侧切口,扩髓、静力型固定.结果67例均获随访,时间6~28(16±8)个月.切口均一期愈合.63例术后4—8个月骨折骨性愈合,4例4个月改为动力型固定,11个月愈合,无其他合并症.膝关节功能按Merchant评分标准评定:优43例,良19例,可4例,差1例,优良率92.5%.结论带锁髓内钉治疗股骨干粉碎性骨折可获得满意疗效. 相似文献
17.
K G Heiple D B Brooks B L Samson A H Burstein 《The Journal of bone and joint surgery. American volume》1979,61(5):730-737
A new intramedullary rod has been developed for the treatment of subtrochanteric fractures. The stepped fluted rod is designed as a single unit and has exceptional bending strength and rigidity as well as excellent torsional load-carrying capacity. It has been used successfully in eighteen patients with a variety of subtrochanteric fractures. Union was achieved in all instances and no failure of the implant occurred. The simplified technique of insertion, the strength of the device, and the results of this study indicate that the fluted subtrochanteric rod has several advantages over other available devices. 相似文献
18.
D. Collins K. Mulhall T. Higgins J. O'Byrne 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2002,12(1):51-52
. The Russell-Taylor intra-medullary nail provides a stable construct for the management of subtrochanteric femoral fractures. Implant failure with this system typically involves the distal locking screws. Proximal screw cut-out and back-out have been reported [2]. Breakage of both proximal locking screws has not previously been described. We present a case of failure of both proximal locking screws in a Russell-Taylor delta reconstruction nail implant. Résumé. L'enclouage centro-médullaire selon Russel-Taylor procure un montage stable pour le traitement des fractures sous-trochantériennes du femur. L'échec du montage est classiquement lié à un éventuel problème du verrouillage distal. Des fractures et des expulsions de la vis de verrouillage proximal ont également été décrites. Une fracture simultanée des deux vis de verrouillage proximales n'a par contre pas été décrite jusqu'à ce jour. Nous rapportons un cas. 相似文献
19.
The purpose of this article is to describe a novel technique and implant system for fixation of unstable (Arbeitsgemeinschat fur Osteosynthesesfragen Types A and B) distal radius fractures. Currently the most common complications directly related to distal radius plate fixation includes tenosynovitis, tendon attrition, and rupture, often necessitating hardware removal. With the advent of this new device, a decrease in soft tissue complication is expected. The implant utilizes the principles of load sharing, subchondral screw divergence, and locked fixed-angle fixation. It is inserted through a small skin incision at the radial styloid and does not further devascularize the fracture fragments. The limited surgical dissection and rigid fracture fixation allow for minimal postoperative immobilization and an early return of function. The authors believe that this system is a valuable addition to the arsenal of distal radius fracture treatment options and can quickly get patients back on the road of recovery. 相似文献
20.
The mechanics and biology of intramedullary fracture fixation 总被引:3,自引:0,他引:3
Intramedullary (IM) fracture fixation serves to stabilize fracture fragments and maintains alignment, while permitting motion at the fracture site during functional activities. Acting as an internal splint, the implant serves as a load-sharing device and fracture healing progresses with the formation of peripheral callus. By allowing motion of adjacent joints, rehabilitation is concurrent with treatment, and stress-shielding is thought to be minimal using these techniques. Recently, IM nails have been introduced to widen indications for their use based on variations in the cross-sectional geometry, length and shape of nails, interlocking designs, and surgical techniques. Although the most important mechanical factors in the design of IM nails are strength, stiffness, and rigidity, anatomic constraints and surgical technique limit nail variations. Closed nailing is preferred to open procedures to preserve periosteal blood supply and minimize surgical trauma adjacent to the fracture. Blood flow to the fractured bone is elevated in nailing experiments, although callus maturation is somewhat delayed. However, the end result in terms of healing was similar to that of plate fixation. 相似文献