针道加压护理在外固定器治疗骨折不愈合中的应用

目的 减轻股骨干骨折不愈合行外固定支架固定术后患者针道并发症症状.方法 将30例股骨干骨折不愈合患者随机分为两组各15例,外固定支架固定术后第2天,对照组行常规针道护理,观察组在此基础上予无菌敷料加压包扎.结果 外固定支架固定期间,观察组针道并发症症状显著轻于对照组(P＜0.01).结论 股骨干骨折不愈合行支架外固定术后患者,实施针道加压包扎护理干预,可有效减轻针道并发症症状.     

肱骨干骨折术后骨不愈合原因分析及处理方法

目的 探讨肱骨干骨折术后骨不愈合的原因及处理方法.方法 回顾45例肱骨干骨折术后骨不愈合,采用钢板固定30例,钛板固定5例,交锁髓内钉固定6例,外固定架固定4例,植骨45例.结果 本组获随访0.5～2年,骨折愈合率95.6％.结论 肱骨干骨折术后骨不愈合常见原因:治疗方法欠佳、骨折的类型、固定装置不稳定、功能锻炼不规范;坚强合适的内固定加植骨是治疗肱骨干骨不愈合的有效方法.     

股骨骨折早期与延期内固定的比较

本文总结加压钢板内固定治疗新鲜股骨干骨折288例.分伤后36小时内的早期固定组和伤后8～21天的延期固定组做分析统计.结果发现单纯骨折早期固定组.术后4～6周、3个月骨折愈合优于延期固定,6个月时无差异;多发损伤组.早期固定术后4～6个周、3个月与延期固定骨折愈合无差异,但6个月时.早期固定优于延期固定.多发损伤并发症早期固定明显少于延期固定.认为对于股骨骨折,早期固定并不增加骨不连及切口感染.而且有利骨折愈合及减少并发症.     

非感染性四肢长骨骨折不愈合的原因分析与治疗

目的 分析非感染性四肢长骨骨折不愈合的原因,探讨其手术治疗方法及疗效.方法 回顾性分析1996年1月至2011年12月期间行手术治疗的113例非感染性四肢长骨骨折不愈合患者资料,男77例,女36例;年龄11～73岁,平均40.2岁.骨折部位:股骨36例,胫骨30例,腓骨4例,肱骨15例,尺骨17例,桡骨11例.骨折不愈合按Weber-Cech分类:肥大型28例,萎缩型85例.综合患者的临床和影像学资料分析造成骨折不愈合的原因.所有患者最终手术方式包括:接骨板固定42例,髓内钉固定67例,外固定支架固定4例;自体髂骨植骨者80例,人工骨植骨者2例,自体髂骨及人工骨混合植骨者9例,未植骨者22例.术后1、2、3、6、12个月摄X线片评估骨折愈合情况.结果 骨折不愈合的原因包括:手术治疗失败77例,包括固定操作不当、不牢固53例,固定物选择不当42例,手术严重破坏骨折断端血供13例,内固定物弯曲或断裂失效8例,骨折复位不满意、断端明显存在骨缺损7例;石膏外固定失败27例;软组织严重缺损6例;过早负重2例;全身条件差1例.91例患者最终治疗后获12 ～ 36个月(平均25.2个月)随访,均获骨性愈合,愈合时间为2～13个月(平均5.3个月).无术后感染、内固定失败等并发症,无疼痛或骨折断端不稳定表现.结论 医源性因素是导致非感染性四肢长骨骨折不愈合的主要原因.只要充分掌握治疗骨折不愈合的原则,选用正确的内固定物结合植骨治疗,非感染性骨折不愈合可获满意疗效.     

C型臂透视下螺钉治疗移位不稳定型腕舟骨骨折例疗效分析

目的:分析应用螺钉内固定治疗移位不稳定型腕舟骨骨折的效果.方法:总结2009年8月到2011年9月采用Herbert螺钉内固定治疗28例腕舟骨骨折,其中男25例,女3例,年龄23～55岁.腕舟状骨近端骨折5例,远端骨折5例,腰部骨折18例,骨折均为移位骨折.受伤距手术时间平均15天(3 d～1个月).结果:28例患者均受随访,未发生术后感染,无内固定断裂.其中27例骨折达骨性愈合,骨折愈合时间3～12个月,1例骨不连.26例腕关节功能恢复正常,握拳力量恢复正常.2例日常生活中腕部略有疼痛不适.结论:Herbert螺钉是治疗移位不稳定型腕舟骨骨折的首选内固定器材之一.     

力臂式外固定器治疗胫腓骨中下段骨折的体会

自１９９２年以来应用力臂式外国家器治疗不稳定胫腓骨中下段骨折１２例，经随访，骨折愈全时间４１－９０天，平均５８天，无一例发生骨不愈合。作者认为本法优点在于：操作方法简便，固定效果可靠，能早期进行膝、踝关节功能锻炼，促进骨折愈合，尤其对开放性骨折，既能有效地固定骨折，又便于创面换药。     

掌指骨骨折微型钢板内固定术后骨不连及畸形愈合的原因分析

目的分析微型钢板治疗掌、指骨骨折过程出现骨不连及骨折畸形愈合的原因,并提出预防措施.方法1989年以来采用微型钢板内固定治疗掌指骨骨折64例78处,所有病例均随访至骨折愈合,或临床及X线证实骨不连或畸形愈合.结果术后发生骨不连及畸形愈合共5例7处,其中内固定失效3例5处,适应证选择不当2例2处.结论微型钢板内固定治疗掌、指骨骨折效果好,但仍需注意规范操作技术及适应证选择.     

交锁髓内钉治疗胫骨干骨折100例临床体会

目的:探讨交锁髓内钉治疗胫骨干骨折的临床疗效.方法:对本院2003年1月-2008年12月100例胫骨干骨折病人采用交锁髓内钉治疗的疗效回顾分析,其中小切口切开复位66例,闭合复住34例,全部行有限扩髓,一期静力固定.结果:100例患者全部获得随访,平均随访14.2月,骨折愈合率98%,骨折愈合平均时间5.2月;疗效评定按Iowa评分标准,优为92例,良6例,可2例,差0例,优良率98%;骨折不愈2例,胫前皮瓣坏死2例,下肢静脉栓塞2例,10例膝关节疼痛.未出现感染、内固定断裂、脂肪栓塞等其他并发症.结论:胫骨干骨折的治疗首选交锁髓内钉,相比钢板、外支榘等手术方法内固定符合生物力学、骨折愈合率高、愈合时间短等优点.术中骨折复位尽量或接近解剖对位,以利骨折稳定固定和骨折愈合,不强求用舍复位.但对于切开复住病例采用小切口有限切开,根据BO原则不剥离或尽量少剥离骨膜.对于粉碎性骨折必要时加用克氏针固定.术中常规静力固定,避免骨折断端不稳,肢体缩短,旋转畸形等,骨折延迟愈合患者考虐改用动力化固定.小切口切开复位扩髓时可回收骨屑回植到骨折处,促进骨折愈合.     

放散状与聚焦状冲击波治疗骨折延迟愈合或不愈合的疗效比较

目的 比较放散状与聚焦状冲击波治疗骨折延迟愈合或不愈合的疗效. 方法 对2011年4月至8月收治的47例骨折延迟愈合或不愈合患者资料进行回顾性分析,男38例,女9例;年龄21 ～56岁,平均35.0岁.所有患者均为肥大型稳定性骨折延迟愈合或不愈合.骨折延迟愈合或不愈合部位:股骨24例,肱骨6例,胫骨17例.初次内固定方法:钢板固定37例,外固定支架固定8例,带锁髓内钉内固定2例.23例患者接受放散状冲击波治疗(放散组),24例患者接受聚焦状冲击波治疗(聚焦组),根据不同骨折部位选择合适的冲击能量、频率和剂量进行治疗.患者每个月复查X线片,了解骨痂生长情况.比较两组患者的治愈率和有效率. 结果 所有患者术后均获9个月随访.放散组23例患者中,22例有较明显的骨痂生长,其中21例完全愈合,1例部分愈合,1例无效,治愈率为91.3％,有效率为95.7％.骨折愈合时间为8～24周,平均12周.聚焦组24例患者中,17例完全愈合,7例无效,治愈率和有效率均为70.8％.骨折愈合时间为8～40周,平均18周.两组患者治愈率比较差异无统计学意义(P=0.137),有效率比较差异有统计学意义(P=0.048).两组分别有4、9例患者出现肢体血管损伤. 结论 体外冲击波是治疗骨折延迟愈合或不愈合较理想的方法;放散状冲击波治疗骨折延迟愈合或不愈合的有效率优于聚焦状冲击波.     

重建钢板三维固定治疗锁骨中段不稳定骨折

目的 探讨重建钢板三维固定治疗锁骨中段不稳定骨折的疗效.方法 采用切开复位重建钢板三维固定治疗锁骨中段不稳定骨折70例.结果 随访12～15个月,无一例出现骨折延迟愈合或不愈合,平均愈合时间3个月.术后6个月,功能恢复情况按JOA肩关节评分系统评价:优55例,良12例,一般2例,差1例,优良率95.7%.术后12个月时优良率为100%.结论 重建钢板三维固定治疗锁骨中段不稳定骨折更加符合人体生物力学特性,治疗效果肯定,是目前锁骨中段不稳定骨折的理想固定方法之一.     

Free vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia

Five patients with congenital pseudarthrosis of the tibia treated by a free vascularized fibular graft are described. Follow-up evaluation ranged from 15 to 81 months, with a mean of 40 months. Bony union was attained in three of five cases as determined roentgenographically. The remaining two cases failed to attain bony union. All cases except one, who was treated with a below-knee amputation, subsequently attained bony union. However, four cases had five fractures after bony union. We discussed unsolved problems regarding the free vascularized fibular graft and fracture after bony union.     

Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome

PurposeHigh-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome.MethodsTwenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9–158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out.ResultsTwenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the occurrence of infection.ConclusionsStaged MIPO for proximal tibial fractures with acute compartment syndrome may achieve satisfactory bony union and functional results, while decreasing deep infections and soft tissue complications.     

Monteggia fracture dislocation in a neonate resulting from birth trauma: a case report

Birth-related injuries in an uncommon location may be missed initially and may result in significant morbidity. We report for the first time a case of a Monteggia fracture dislocation in a neonate resulting from birth trauma. The delayed presentation at 7 days made open reduction necessary in this otherwise nonoperatively managed injury because of the accelerated rate of bony union in infants. All high-risk births, including 2nd-born twins, should be thoroughly screened to avoid initial misdiagnosis.     

组合式外固定支架治疗严重胫骨开放性骨折

目的探讨组合式外固定支架治疗严重胫骨开放性骨折的疗效。方法 2006年7月～2011年6月,对31例胫骨严重开放骨折进行组合式外支架固定治疗。结果随访8.0～30.0个月,其中21例术后6.0个月骨性愈合,5例8.0个月愈合,3例14.0个月愈合,1例19.0个月愈合,1例27.0个月愈合;发生感染6例,其中4例为伤口感染,2例为钉道感染。按Johner-Wruhs标准评分,优15例,良11例,可5例。结论在严重胫骨开放性骨折临床治疗中,组合式外固定支架疗效可靠,有时甚至是唯一选择。     

半环槽式外固定支架治疗胫腓骨严重开放性骨折

目的探讨半环槽式外固定支架治疗胫腓骨严重开放性骨折的疗效。方法对36例胫腓骨严重开放性骨折进行半环支架固定治疗,其中9例为已行钢板内固定术后钢板松动或断裂者。结果随访1～4年,29例术后6个月骨性愈合,2例12个月愈合,2例13个月愈合,1例16个月愈合,2例24个月愈;发生钉道感染7例,无慢性骨髓炎发生。结论在胫腓骨严重开放性骨折的临床治疗中,半环外固定支架疗效较好,对减少并发症和促进骨折愈合具有积极的意义。     

对背伸位固定治疗Colles骨折的新认识

目的 探讨Ｃｏｌｌｅｓ骨折的治疗方法。方法 采用腕关节背伸位固定治疗Ｃｏｌｌｅｓ骨折１００例。结果 其中有移位的７２例获得平均１１个月的随该一部获得骨性愈合。根据腕关节运动功能综合评定,优５５例,良１１例,差６例,结论 腕关节背伸位固定可以维良好的骨折整复固定可以维持良好的骨折整复固定位置,获得最佳的功能恢复效果。     

钢板加异体骨板固定治疗股骨干骨折髓内钉固定术后骨折不愈合

目的:探讨采用钢板加对侧异体骨板固定治疗股骨干骨折交锁髓内钉固定术后骨折不愈合的临床疗效.方法:分析自2006年2月至2013年6月21例股骨干骨折髓内钉固定术后不愈合患者采用钢板加对侧异体骨板固定治疗,男12例,女9例;年龄18～62岁,平均34.8岁.骨折不愈合时间9～18个月,平均12.8个月.术后采用Merchan标准评定临床疗效.结果:21例患者伤口均Ⅰ期愈合,无感染、内固定物断裂、脂肪栓塞、旋转畸形及明显的短缩畸形等并发症.术后随访8～24个月,平均13.2个月.19例患者术后达到骨性愈合,平均愈合时间为6.2个月(4～9个月),2例出现骨折延迟愈合,经7～13个月观察获得骨性愈合.术后1年膝关节功能按Merchan标准评定:优13例,良6例,差2例.结论:应用钢板加对侧异体骨板固定治疗股骨干骨折髓内钉固定术后骨折不愈合具有治愈率高,并发症少,术后功能恢复良好的特点,能够提高骨折稳定性及促进骨痂生长.     

Assessment of fracture healing by vibration.

The wave signal from percussion of a bone (i.e. percussion-note) has been used to evaluate the extent of bony consolidation after fracture. Forty-one cases with a fresh tibial fracture and eight cases of delayed union of the tibia were investigated. The medial malleolus of the tibia was struck with a tapper and the vibration signal was picked up at the medial region of the tibial tuberosity. The changes in the signal waveform of the percussion-note with time were investigated. As healing proceeds, the signal waveform of the fractured bone approaches that of intact bone. In cases of delayed union, the character of the wave does not improve sufficiently with time. The authors are convinced that this is a promising new method for the early diagnosis of delayed union.     

External fixation of fractures of the tibia: clinical experience of a new device

The performance of a new external fixator was assessed in 50 cases of various types of fractures of the tibia. The fixator comprises an adjustable single outrigger bearing offset pins which offers considerable versatility in its use. The angle at which the pins are offset gives the device considerable torsional and angulatory stability, but its compressive strength is low, allowing axial loading of the fracture during weight bearing. The incidence of complications such as non-union, malunion, and pin-track infection was low. The time to bony union was shorter in cases in which the fixator was applied without exposure of the fracture, compared with those in which the fracture was reduced under direct vision. The time to bony union was also slightly shorter in cases where external fixation was the primary form of treatment, compared with those receiving preliminary os calcis traction.     

Assessment of Fracture Healing by Vibration

The wave signal from percussion of a bone (i.e. percussion-note) has been used to evaluate the extent of bony consolidation after fracture.

Forty-one cases with a fresh tibial fracture and eight cases of delayed union of the tibia were investigated. The medial malleolus of the tibia was struck with a tapper and the vibration signal was picked up at the medial region of the tibial tuberosity. The changes in the signal waveform of the percussion-note with time were investigated.

As healing proceeds, the signal waveform of the fractured bone approaches that of intact bone. In cases of delayed union, the character of the wave does not improve sufficiently with time. The authors are convinced that this is a promising new method for the early diagnosis of delayed union.