颞骨关节结节骨折的CT表现分析

目的 探讨颞骨关节结节骨折在CT中的表现.方法 通过多层螺旋CT扫描,采用多平面重建(SPR)、最大密度投影(MIP)技术(其中部分病例普通CT横轴位扫描,冠状位重建)对18例20侧颞骨关节结节骨折根据骨折部位分为2类:颅段骨折和颅外段骨折.颅外段骨折又根据骨折线通过关节结节最外下后方突起的位置分为突起内侧骨折、突起骨折和突起外侧骨折3种亚型.结果 18例20侧骨折中,颅段骨折1例,颅外段骨折17例19侧.后者突起内侧骨折8例,突起骨折5例,突起外侧骨折6例,其中2例突起骨折伴对侧突起外侧骨折.结论 CT能对颞骨关节结节骨折的类型作出正确判断.     

64排螺旋CT在骨性外耳道骨折中的诊断

目的 研究骨性外耳道骨折在CT中的表现.方法 应用64排螺旋CT对13例15侧骨性外耳道骨折进行扫描,以横轴位为基础层面,辅以多平面重建(MPR),最大密度投影(MIP)和容积重建(VR)技术观察CT表现,并根据骨折发生原因进行分类.结果 将骨性外耳道骨折根据骨折发生原因分为3种情况:①髁状突向后撞击骨性外耳道前壁所致的骨折,有时伴髁状突骨折,本组有4例6侧外耳道前壁间接骨折.②乳突骨折所致的骨性外耳道骨折,本组有8例,均为单侧骨折.③外力和骨性外耳道前壁直接相互作用所致的骨折,本组仅遇到1例.结论 应用64排螺旋CT能对骨性外耳道骨折做出准确诊断和分类.     

尺骨茎突骨折并发桡骨骨折发病机制X线分析

尺骨茎突骨折常为腕关节部骨折、脱位的合并损伤,尺骨茎突骨折合并桡骨骨折在临床较为常见.本文收集132例尺骨茎突骨折X线片资料进行总结分析,意在探讨尺骨茎突骨折与桡骨骨折的相互关系及机制,以便提高对尺桡骨骨折的诊断水平.     

AO股骨近端髓内PFN治疗股骨粗隆下骨折

股骨粗隆下骨折是指发生于小粗隆下缘平而以远5cm区域内的骨折。由于髋部外展肌群、髂腰肌及股内收肌群对其影响,可以导致骨折近段外展外旋、屈曲,骨折远段向内上方的特殊移位,而易发生进行性髋内翻畸形。在解剖上,股骨粗隆下骨折位于皮质区域,股骨端接触面积较粗隆间骨折小,骨折愈合亦较粗隆间骨折慢。由于其骨折部位的特殊性,在髋部骨折中是一种较难处理的骨折类型。     

2006～2012年交通伤与跌倒所致骨折的流行病学分析

目的：研究大连市交通伤与跌倒所致骨折的流行病学特点,为创伤骨折的救治和预防提供依据。方法从信息中心调取2006年1月～2012年12月收治的骨折患者资料,按照损伤原因分为交通伤骨折和跌倒骨折：交通伤骨折8037例,死亡16例（0.20％）;跌倒骨折4172例,死亡9例（0.22％）。回顾性分析患者的性别、年龄、骨折部位、住院日和住院费用。结果交通伤骨折病例每年相当,而跌倒骨折例数呈明显上升趋势,但两组死亡率无统计学差异（P＞0.05）。交通伤骨折多发生于第3、4季度（54.65％）和青壮年男性（20～60岁,73.97％）;跌倒骨折高发于第1、4季度（53.40％）和老年女性（＞55岁,65.56％）。交通伤和跌倒骨折分别以下肢骨折和髋部骨折常见,而交通伤脊柱骨折死亡率最高（0.62％）。交通伤骨折患者的平均住院日（21.73d）比跌倒骨折患者平均住院日（12.55d）长（P＜0.05）,交通伤骨折所需平均住院费用也高于跌倒骨折患者（26765元VS 23675元,P＜0.05）。结论交通伤骨折的伤害形势严峻,同时跌倒骨折的危害也日趋严重,应根据各自流行病学的特点制定科学的防范措施,进而降低创伤骨折危害加剧。     

脊椎附件骨折的多层螺旋CT表现

目的 探讨脊椎附件骨折的多层螺旋CT表现.方法 回顾性分析50例脊椎骨折患者的16层螺旋CT资料.结果 50例脊椎骨折患者,附件骨折发生率为66%,其中单纯附件骨折者18例,附件合并椎体骨折者15例.横突骨折25例(74处),骨折线多为纵行或斜矢状方向.椎弓根骨折8例(9处),椎板骨折8例(11处),多发生于椎体爆裂骨折患者,椎弓根骨折线均为横行方向,椎板骨折线多为纵行.关节突骨折5例(7处),均为粉碎性骨折,关节脱位1例,椎弓峡部骨折2例(3处),骨折均为横行骨折线.棘突骨折4例(7处),4处骨折线为横行,3处为纵行骨折线.结论 脊椎附件骨折分布及骨折线类型较复杂,多层螺旋CT横断面平扫图像、多平面重组图像及容积再现图像相互补充,能全面准确地诊断脊椎附件骨折.     

肋骨骨折、不全骨折临床观察(附322例报道)

回顾性分析2010~2014年收治的322例肋骨骨折病例,包括完全骨折、不全骨折以及合并其他部位严重创伤病例,共断裂702根,完全骨折601根,占85.6%,不全骨折101根,占14.4%;合并其他部位损伤(多发伤)197例。直接暴力在骨折断裂处能量释放,形成喇叭口向内的不全骨折或骨折;间接暴力传导至肋骨腋段,此处肋骨最为薄弱,造成不全骨折或完全骨折;肋骨不全骨折是完全骨折的前期。肋骨骨折常合并躯干其他部位的迟发损伤。     

交锁髓内钉内固定治疗老年股骨近端骨折28例

股骨近端骨折主要是指股骨颈和股骨粗隆部骨折,包括顺粗隆间骨折、逆粗隆间骨折和颈部骨折等.2004年12月～2007年5月,我们采用交锁髓内钉内固定治疗老年股骨近端骨折28例,疗效满意.现分析报告如下.     

螺旋CT骨三维重建在汶川大地震关节内及其它部位骨折诊断中的应用

目的 探讨螺旋CT骨三维重建在汶川大地震关节内及其它部位骨折诊断中应用价值.方法 对25例汶川地震中关节内及其它部位骨折患者行多层螺旋CT容积扫描,在工作站上对图像进行包括多平面重建及表面遮盖骨三维重建处理,观察重建图像对骨折的显示.结果 25例患者共36处骨折,采用骨三维重建方法均清楚显示.膝关节骨折6处,显示X线平片漏诊胫骨后交叉韧带止点撕脱性骨折1处;踝关节骨折3处,其中1例为Pilon骨折;肩关节骨折5处,发现X线漏诊肩关节盂前唇骨折1处;肘关节骨折3处;颈椎骨折2处,胸椎骨折4处,腰椎骨折5处,其中2例为爆裂性骨折,均伴关节突关节骨折,1例伴椎体滑脱;骨盆骨折8处,其中1处为骶髂关节骨折伴骶髂关节分离.本组中开放性骨折4例,骨折伴脱位6例,25例骨折病例周围软组织均不同程度肿胀.结论 螺旋CT骨三维重建能直观、逼真地显示骨折情况,为临床诊断及治疗提供更加充分的资料.     

胫骨Pilon骨折16例治疗体会

Pilon骨折是指涉及负重关节面的胫骨远端骨折,亦被称为胫骨穹隆部骨折,约占胫骨骨折的3％～10％。受伤原因多由高能量损伤所致,骨折类型复杂,常伴有腓骨骨折及严重软组织损伤。1997年10月～2003年12月,我们共收治胫骨Pilon骨折16例,疗效满意。     

桥接组合式内固定系统治疗肱骨骨折疗效观察

目的探讨桥接组合式内固定系统治疗肱骨骨折的疗效。方法随机选取自2013年6月至2014年12月云南省第三人民医院骨伤科收治的肱骨干骨折患者50例。根据手术方法不同进行分组,其中,桥接组患者26例,钢板组患者24例。比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、内固定后并发症、肩肘关节功能评分等指标,对桥接组合式内固定系统治疗肱骨骨折的临床疗效做出评价。结果桥接组患者在手术时间、出血量、骨折愈合时间等方面均优于钢板组,差异均有统计学意义(P<0.05)。两组患者住院时间及肩、肘关节功能评分比较,差异无统计学意义(P>0.05)。两组患者术后均未出现骨不连、桡神经损伤等并发症。结论桥接组合式内固定系统治疗肱骨骨折在临床疗效、愈合时间、并发症、肩肘关节功能恢复等方面均有显著优势。另外,桥接组合式内固定系统在操作方面较锁定钢板更为简便,结构更稳固。     

胫骨干骨折内固定与外固定疗效的比较

探索胫骨干骨折内固定和外固定的疗效。认为对稳定性胫骨干骨折,加压钢板及髓内针内固定明显优于单纯石膏外固定。     

Initial fixation strength of a hybrid technique for femoral ACL graft fixation

Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screws provides a higher fixation strength when compared to an aperture fixation using only a screw matching the size of the tunnel and also reduces the risk of graft laceration. This research is an experimental laboratory study. We evaluated the initial fixation strength at time-zero of an extracortical-, a hybrid- and an aperture fixation in ACL reconstruction using extracortical buttons and different sized interference screws in porcine knees. The tests were performed using a single cycle and cyclic loading protocol. Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. Cyclic loading tests showed a statistically significant difference between hybrid and aperture fixation. The use of an undersized screw alone in aperture fixation resulted in insufficient fixation strength. The initial fixation strength of the hybrid technique with undersized screws is higher compared to an interference screw fixation alone. The hybrid fixation technique is an alternative for ACL graft fixation.     

Orthopedic fixation devices

Orthopedic fixation devices are used in the treatment of fractures, soft-tissue injuries, and reconstructive surgery. After fracture reduction, internal, external, or intramedullary fixation devices may be used to provide stability and maintain the alignment of bone fragments during the healing process. They must be strong and secure enough to allow early mobilization of the injured part, as well as the entire patient. Compression is used whenever possible to increase the contact area and the stability between fragments and to decrease the stress on the implant. Screws are used primarily to provide interfragmental compression or to attach plates, which can then provide compression, prevent displacement, and support the fragments during healing. Pins and wires can be used for fixation of small fragments or fractures in small bones and for attachment of external fixation devices and traction. A basic understanding of the devices and principles of use is needed to interpret radiographs obtained after the treatment of musculoskeletal injuries.     

Arthroscopy-assisted fracture fixation

Purpose  

The purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation.     

Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods

BACKGROUND: The fixation of an endotracheal tube must be rapid in conditions involving numerous casualties, such as a chemical warfare (CW) situation. The tube also should be fixed and strong to prevent unplanned extubations. METHODS: We developed a technique for the evaluation of fixation methods. This technique was used to evaluate four methods. Three commercial fixators were compared with the fixation method used today in the Israeli Defense Forces (IDF) and commonly used in different out-of-hospital settings. The exercises were performed on adult intubation mannequins with and without CW protective gear. The fixations were timed, and their quality was evaluated by the participants and inspectors. RESULTS: The time score for the method used today in the IDF was significantly higher compared with the commercial fixation methods. The quality scores for the Thomas fixator and the IDF method were significantly higher than for the fixators by VBM and Rusch. The CW protective gear significantly prolonged the time but did not affect the quality of the fixation. CONCLUSIONS: With this technique, a good estimation of the time and quality of fixation can be achieved.     

Analysis of initial fixation strength of press-fit fixation technique in anterior cruciate ligament reconstruction

We performed a controlled laboratory study to evaluate the initial fixation strength of press-fit technique. Forty porcine lower limbs were used and divided into four groups according to the method of fixation; group 1 (press-fit+1.4 mm), in which the diameter difference between the bone plug and the femoral tunnel was 1.4 mm; group 2 (press-fit+1.4 mm, 30 degrees), in which the diameter difference was the same with group 1, but the tensile loading axis was 30 degrees away from the long axis of the femoral tunnel; group 3 (titanium), in which a titanium interference screw was used for fixation; group 4 (bioabsorbable), in which a bioabsorbable interference screw was used for fixation. The graft in the press-fit group was harvested with a hollow oscillating saw with inner diameter of 9.4 mm to obtain consistent and completely circular shape of the bone plug. The femoral tunnel with diameter of 8 mm was drilled at the original ACL insertion. Following the bone plug insertion into the femoral tunnel and applying a preload of 20 N, the specimen underwent 500 loading cycles between 0 and 2 mm of displacement. Thereafter the specimen was loaded to failure. There was no fixation site failure during the cyclic loading test. Significant differences in the stiffness, linear load, or failure mode among the groups were not found. The average ultimate failure load of group 1 and group 2 were not significantly different from those of group 3 and group 4. The press-fit groups demonstrated sufficient fixation strength for the rehabilitation and interference screw groups. The completely circular shape of the bone plug and increased diameter difference between the bone plug and the femoral tunnel seemed to contribute to the strong fixation.     

闭合穿针内固定治疗胫骨干骨折的临床观察

对23例胫骨干骨折治疗资料进行回顾性分析,本组采用闭合穿针、普通髓内钉治疗,随访20例,骨折均完全愈合。作者认为闭合穿针内固定治疗胫骨干骨折最大限度地保护骨折处血循环。     

External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

BACKGROUND/AIM: Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. METHODS: The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Nis (1995-2004). Within the analayzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitkovi?" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. CONCLUSION: Considering the results obtained in this study, it can be concluded that external fixation by the "Mitkovi?" external fixator with the minimal internal fixation is a satisfactory method for the tratment of fractures of the tibial plafond causing less complications than internal fixation.