Time of survival and quality of life of the patients operatively treated due to pathological fractures due to bone metastases

Background. Aims of the study: 1) evaluation of the quality of life of the patients after surgical treatment of bone metastases, 2) evaluation of survival rate of the patients after surgical treatment of bone metastases,
3) presentation of the authors' clinical score system for evaluation of the treatment results of bone metastases, 4) analysis of general complications rate after surgical treatment of bone metastases.
Material and methods. Retrospective evaluation of 62 patients with bone metastases treated operatively in our Ward during last 13 years was made. Mean age of patients was 63,6 years. There were 41 women (mean age; 62,8 years) and 21 men (mean age: 64,3). In 49 cases (79%) we were able to diagnose primary localization of the tumour: breast carcinoma - 22, ovary cancer - 6, lung cancer - 5, prostate cancer - 5, kidney cancer - 6, gastric cancer - 1, vaginal cancer - 1, hepatocellular cancer - 1, melanoma - 1 and plasmocytoma - 1. We could not reveal primary focus of the tumour in 13 cases (21%). Localizations of bone metastases are as follow: femur - 49 cases, humerus - 10, tibia - 3. After being accepted to operavite treatment, the patients had been cured as quickly as possible - sometimes during emergency service. In 2 cases with metastases in the tibia there were amputations made in femur regions. In remainq patients we made local excisions of metastatic tumours with internal osteosynthesis and bone cement application in 47 cases, with internal osteosynthesis only in 7 cases, with hip arthroplasty in 8 cases.
Results. We have poor results in 4,8%, because of the death of 3 patients. Mean time of follow-up since surgical procedure was 6 months. In 82,3% we have very good or good results - no pain, good function and independence in daily activities. Mean survival time is 17,5 months (range: 5-36 months).
Conclusions. Efficacy of the surgical procedures of pathological fracures due to bone metastases in reliving the pain, improvement of patients' mobility and activiteis of day living are very good. Mean time of survival after surgical treatment of pathological fracture due to bone metastases in study group justifies its applications in spite of higher rate of general complications.
     

The efficacy analysis of partial bone resection procedure in pathological fractures treatment (own experience)

Background. The objective of this paper is efficacy assesment of partial bone resection procedure with subsequent joint exchange as a method of skeletal cancer metastases and pathological fractures surgical treatment within hip and shoulder among patients in our own experience.
Material and methods. 79 patients operated between 1997 and 2002 were assesed.Group I - 68 cases with sceletal cancer metastases and pathological fracture of proximal femur.Group II - 11 patients with sceletal cancer metastases and pathological fracture of humerus.The patients underwent primary or secondary (after complications) partial resection procedure with subsequent joint prosthesis implantation.The range of femur resection was 6-17cm.Various types of total or partial hip and shoulder joint endoprostheses according to indication were used.Additional paliative radiotherapy of mathastases,bisphosphonians and analgetics were used according to the case.The average follow-up period was 9,6 months (0-3y). The efficacy analysis was based on Enneking limb function test and Merle d'Aubigne classification and X-ray analysis in patients with partial proximal femur resection.
Results. Group I-according to Enneking test in 41 patients very good and good results,fair in 22 and bad only in 5 cases were found.According to Merle'd Aubigne classification in 37 cases very good and good outcome was found.In 25 the outcome was fair and bad in 6 patients.The machanical instability complication assesed radiologically were found in 7 patients.
Conclusions. The partial bone resection with subsequent joint exchange procedure is positively assesed in patients subjective opinion and its high rate of very good and good results let us conclude this kind of surgery as a very good method in some types of pathological fracture treatment.However a massive bone and particullary soft tissue resection may produce higher incidence of mechanical complications - especially dislocations.     

Internal fixation with bone cement in reconstruction of bone defects due to bone metaseses

Background. Retrospective evaluation of surgical technique, clinical and radiological results and mechanical sufficiency internal fixation with bone cement in treatment of bone defect due to metastatic lesions. Material and methods. 66 patients treated operatively due to pathologic fractures becuase of the bone metastases. Mean age of the patients was 65,5 y. o. There were 40 women and 26 men. In 53 cases (80%) origin of primary tumor was known. Localisation secondary tumors was as follow: femur - 52 cases, humerus - 13 cases and tibia - 1 case. Bone defects after curettage of metastasis were recunstrucated by bone cement and fixations were made by plate technique - 54 cases or intramedullary nail techique - 12 cases. Evaluation of the mechanical suffifciency of applicated recunstuction techniques in treatment of bone metastatic lesions was made accornig to athors' own scale: grade I - good stabilisation, grade II - fair destabilisation, grade III - advanced destabilisation and grade IV - complete destabilisation. Results. There were 2 deaths in early postoperative period (3%). Mean survial time after surgery was 13 months. In 64 cases excellent or good results were achived: good mechanical fixation and no pain. In left 2 cases partial and complete destabilisation of fixation occurred. Conclusions. Mechanical sufficiency of reconstruction techniques in metastatic bone lesions was good in study group. Incidence of local and systemic complications in study group was 3-time higher than in normal trauma fracture population, because of more sever general health status of patients with advaced neoplastic disease.     

The own experience in femoral bone metastases treatment

Background. The objective of this paper is an efficacy analysis of surgical treatment of femoral bone cancer metasases depending on surgical technique and tumor localisation.
Material and methods. 144 patients who underwent surgery in 1996-2002 were assesed. In 32 patients with proximal femur matastases tumor resection and angled plate stabilisation was made, 68 patients underwent THR.
In 20 patients with tumor situated in femoral shaft an intramedullary nailing was performed and the rest 14 patients were treated with plate (AO/ASIF) technique. In 10 patients with distal femoral metastases an angled condylar plate was used.The average follow-up time was 6 months.
Results. The surgery outcome was assesed by functional Enneking test. The cases with proximal femur metastases were assesed by Merle d'Aubigne classification. In cases after resection and subsequent THR very good results were found in 5 patients,good in 34, fair in 23 and bad in 6 patients according to Enneking scale. In Merle d'Aubigne classification the results were as follows:very good in 6, good in 30, fair in 26 and bad in 6 patients.
In the intramedullary nailing group the limb function was found good in 17, in 1 fair and bad in 2 patients. The limb function in patients who were operated using plate condylar or stright(AO/ASIF) plate technique was found fair.
Conclusions. The high patients satisfaction and high ratio of good and very good results in tests after modular THR(proximal femur metastases)and after intramedullary nailing(femoral shaft pathology)are methods of choice in those cases. AO plate stabilisation combined with bone cement augmentation is suitable for pathological fractures management.     

Technique and results of operative treatment of bone metastases to the knee

Background. Bone metastases in the knee are rare. The most difficult challenge in this area is to achieve a stabile fixation. The aim of the study was to evaluate results of various techniques of operative treatment of bone metastases to the knee in relation to its localisation and lesion patomorphology.
Material and methods. We assed 13 patients (5,9%) out of 220 treated operatively. The destruction area was located in femur in 12 patients and in 1 in tibia. Bone metastases were found in physis of femur in 5 patients and cross the line drawn through epicondyles. In 8, metastases were located in the epicondylar area. Pathological fractures were noted in 7 patients.
Results. Successful stabilisation was achieved in 4 patients without pathological fracture and in one patient where we resected distal part of femur and stabilised it with tibia using Küntscher nail, plate and bone cement.
In 8 patients complications were observed. One died due to pulmonary embolism on the fifth day after operation. In 3 patients we observed local recurence of tumor if the curetage alone was performed. In 2 cases where we used 2 rods introduced from the epicondylar area the stabilisation become loose. It was due to short distal femoral part. In one patient we noticed stress fracture of plate and in one the stabilisation of tibia and femur become unstabile because of local progression of metastases.     

A new protocol of surgical treatment of long bone metastases

Background. The choice of proper treatment way is one of the most important things in surgically treated long bones metastases.
The aim of this research was evaluation of the treatment way according to neoplasm's type and metastasis localisation and spreading.
Material and methods. The evaluation underwent 158 patients who were divided in 4 groups. The first one consists of 13 patients with single metastasis of cancer with good prognosis. In the second group were 69 patients with bone fracture. The third group included 36 patients with such bone destruction that fracture was expected. The last fourth one had 40 patients with osteoblastic metastases or osteolitic in unloaded bones.
Results and Discussion. In group I long lasting reconstructive implants are required and postoperative irradiation is recommended, in groups II and III the aggressiveness of treatment should be related to three parameters: survival expectancy, mechanical properties of the affected bone, predictive response to adjuvants. Based on the above parameters the quidelines of the protocol allow to identify the most appropriate reconstructive indication for every single case ranging from simple osteosynthesis (bad prognosis, low fracture risk, goodresponse to adjuvants) to prosthetic replacement (good prognosis, high fracture risk, bad response to adjuvants). Patients from group IV were admitted to oncology treatment ward after biopsy.     

The surgical manegement of metastases to humerus-clinical evaluation

Background. The humerus is a common localisation of cancer metastases. The restoration of anatomical order and tumor resection within humerus is important for patients quality of everyday life and for their pain relief. The surgical treatment is one of the most important part of the whole oncological ways of tratment.
The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique.
Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months.
Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases.
In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement.
Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were found after intramedullary nailing compared to common plate technique.     

Total hip arthroplasty for treatment of bone metastases

Background. Bone metastases are observed in many patients with neoplastic disease. Frequently, the first sign of metastasis is a pathological fracture in weight bearing regions. The proximal end of the femur is the most common site of long bone involvement by metastatic disease and pathological fracture. Treatment of metastatic disease should be multidisciplinary: both oncologic and orthopedic. The target of operative procedure is a relief of pain and regaining the ability to walk. In case of changes in proximal end of the femur, the tumor resection and total hip arthroplasty is a procedure of choice.
Material and methods. In the Orthopedic Clinic in Warsaw, 27 patients with bone metastases in proximal end of the femur had total hip arthroplasty performed in the period of 1998-2002. In 16 cases it was possible to collect data about postoperative period - these patients were analyzed. In 14 patients postresective prostheses were used and in 2 procedures - standard prostheses.
Results and Conclusions. This type of treatment reduced pain, restored weight bearing ability of the limb and improved comfort of life. Subjective estimation of treated patients was good. Only in one case the clinical result was poor. Total hip arthroplasty is an efficacious palliative treatment in patients with metastases in proximal end of the femur. Final effect of therapy depends on individual precise preoperative planning and multidisciplinary specialist postoperative care.     

Fixation of pathological fractures and impending long bone fractures in the course of neoplastic disease with the use of polymethylmethacrylate with added methotrexate

Background. The authors present the results of operative treatment in 71 patients with pathological fractures and impending long bone fractures resulting from neoplastic metastases.
Materials and methods. The discussed group of patients consists of 43 women and 28 men aged 36 to 80 years, the follow-up period is 6 to 48 months. After resection the metastatic focus was filled with cement supplemented with 2g methotrexate and stabilised with AO plate or a hip endoprosthesis was set up.
Results. In 37 operated patients the pain subsided completely or markedly eased, 13 patients periodically required non-narcotic analgesics, and in 19 the pain did not subside.
The treatment applied allowed all the patients with fractures within the lower extremities to abandon the bed and to move with the aid of crutches., and in 17 with fractures of the humerus it enabled the performance of daily living and self-care activities. Within the discussed group 9 patients with multiple metastases to the lungs and to the vertebral column died after average of 12 months. The longest survival period was observed in patients with metastases of renal cancer - average of 42 months, breast cancer - 37 months and ovary cancer - 29 months. No postoperative complications were observed; in 2 patients after 8 and 10 weeks destabilisation of the fixation intervened as a result of intensive weight-bearing without the aid of crutches.
Conclusions. Filling the metastatic bone defect with methotrexate supplemented cement and stable fixation of a pathological fracture or an impending fracture enables movement, performance of daily living activities, eases or clears pain completely, improves the comfort of life, facilitates patient care and it may be an element of complex treatment of pathological and impending fractures in the course of neoplastic disease.     

Possibilities of surgical treatment of bone metastases to the proximal epiphysis of the femur: a review of the literature and own experience

Background. The most common complication of bone metastases to the hip is pathological fracture of the proximal epiphysis. The present study presents the indications and contraindications for surgery and the choice of particular surgical techniques, based on the literature and the authors' own experience.
Material and methods. In the period 1992-2002 we treated 25 patients with bone metastases to the proximal epiphysis of the femur. All had suffered pathological fractures. Various surgical procedures were used, depending on the indications. In two cases we used pallative treatment.
Results. There were no intraoperative or immediate post-operative deaths. In all cases but one we observed reduced pain after surgery. 23 patients recovered hip mobility. 22 patients could walk with elbow crutches after surgery. A functional evaluation performed on day 14 post-surgery produced an average score of 13.2, which on Merle d'Aubigne's scale is a "good" outcome. The survival time ranged from 6 weeks to 4 years (average 13.5 months).
Conclusions. Surgical treatment is essential, both in existing and imminent pathological fractures of the proximal epiphysis of the femur, in order to provide relief from persistent pain and enable independent movement. A patient with advanced neoplastic disease and bone metastases to the hip should be operated even before a pathological fracture occurs, which enables the use of a less invasive surgical technique and prevents immobility and worsening of the patient's physical and mental status.     

Strontium-89 in palliative treatement of painfull bone metastases

Background. Bone metastases are observed in 30-70% of patients with cancer. Pain is most frequent symptom that requires regular control and treatment. Systemic palliative radionuclide therapy using beta-emitters is alternative method for analgetic drugs and external beam radiotherapy. The aim of the study was to establish efficacy and risk of side effects of radionuclide treatment in patients with painful osseous metastases.
Material and methods. Sr-89 therapy was performed in 33 patients 13 women and 13 men aged 42 to 79 years (mean 61) with cancer and bone metastases confirmed in MDP-Tc99m whole body scan. Prostate cancer was primary tumour in 18 patients, breast cancer in 12, urinary bladder cancer in 2 and renal cancer in 1 patient.
After intravenous administration of 150 MBq of strontium-89 chloride patients were observed during
3 months and more. Changes in blood counts, intensity of pain, drugs intake, life activity and duration of pain relief was evaluated from 0 to 3 points. Overall Response Index was very good if total points amounted 10-12, good - 7-9, satisfying - 4-6, poor - 2-3 and no response 0-1 points. Myelosuppression was evaluated according to Common Toxicity Criteria by WHO.
Results. Very good response in 6 patients (18%), good in 15 (46%), satisfying in 6 (18%), poor in 2 (6%) and no response in 4 (12%) patients. Transient haemotoxicity post Sr-89 therapy was observed in 16 patients (48%), in 11 patients it was grade I CTC, in 1 grade II CTC, in 3 grade 3 CTC and in one man grade IV which required treatment. Duration of life after therapy was between 21 to 138 weeks (mean 58 weeks). Therapy was repeated in 16 (48%) patients after more than 3 months. Third dose was injected in 2 patients (6%).
Conclusions. Palliative strontium-89 treatment of painful osseous metastases is effective therapy with very mild haemotoxicity.     

中医传统正骨手法结合微创经皮钢板内固定技术锁定加压钢板内固定治疗胫骨远端骨折的临床研究

目的:比较中医传统正骨手法结合微创经皮钢板内固定(MIPPO)技术锁定加压钢板(LCP)内固定和MIPPO技术、LCP内固定治疗胫骨远端骨折的临床疗效。方法:将我院2006年1月-2013年9月收治的胫骨远端骨折患者68例随机分为研究组(n=36)和对照组(n=30),分别采用中医传统正骨手法结合MIPPO技术LCP内固定和单纯MIPPO技术LCP内固定,比较两组疗效。结果:全部病人均获随访3-22个月,平均7.5个月,按Johner-Wruhs评分标准,研究组优良率为94.4%,明显高于对照组的87.5%(P0.05);研究组在手术时间、透视次数、骨痂形成时间、骨折愈合时间和并发症的发生率方面均明显优于对照组(P0.05)。结论:中医正骨手法结合MIPPO技术LCP内固定治疗胫骨远端骨折的术中透视少、骨折愈合快、并发症少,是治疗胫骨远端骨折的有效方法。     

Radiological and functional assessment of indications for operative treatment in patients with long bone metastases

Background. The purpose of the study is to evaluate the risk of fractures in long bones with metastases based on intact cortical bone index (ICBI) and functional assessment.
Material and methods. We evaluate radiograms of 36 (25 fractures) and 86 patients (56 fractures) with the upper and lower extremity metastases, respectively. We measured on radiograms intact cortical bone index (ICBI) using the schedule K-G/K-J x100%, where is K-shaft diameter, G-size of destruction, J-bone marrow diameter above or below the metastases. We asses the extremity function by the ability to elevate and abduct it straight.
Results. We found that fracture occurs if the ICBI is lower than 46% and 40% in upper and lower extremity, respectively. 7 (5,7%) patients develop fracture despite higher ICBI. If the metastases are located in upper part of the femur and humerus and he/she can not elevate or abduct the extremity the fracture inevitably occurs.
Conclusions. Counting the ICBI and simple functional assessment allows to predict fracture in 94,3% of patients with long bone metastases.     

新型持骨器与复位钳修复锁骨骨折的结果比较

背景：目前用于锁骨骨折固定的方法主要是重建钢板或解剖钢板,而用于维持骨折对位并行钢板内固定的专用器械现有文献中还罕有报道。目前多数医生是用复位钳来维持骨折对位并夹持钢板进行内固定,但用复位钳来维持骨折对位并夹持钢板的方法有很多缺点,如损伤大、固定不牢、不便于钢板折弯塑形等。 目的：比较新型持骨器与复位钳用于修复锁骨骨折的疗效。 方法：纳入2011年12月至2013年12月南京医科大学附属淮安第一医院骨科收治的75例锁骨骨折患者,按随机方法分为2组,新型持骨器组39例,复位钳组36例。新型持骨器组采用手术切开,复位钳复位,新型持骨器维持骨折对位并钢板内固定;复位钳组采用手术切开,复位钳复位,复位钳维持骨折对位并钢板内固定。比较两组在切口长度、手术时间、失血量、骨折愈合时间和临床疗效等方面的差异。 结果与结论：所有病例均取得半年以上随访。两组患者在手术切口长度方面差异无显著性意义（P〉0.05）;在手术时间、失血量、骨折愈合时间等方面,新型持骨器组明显优于复位钳组,差异有显著性意义（P〈0.01）。新型持骨器组临床疗效优良率明显高于复位钳组。提示与复位钳相比,应用新型持骨器修复锁骨骨折具有操作方便、组织损伤少、固定牢靠、手术时间短、骨折愈合快的优点。     

交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的Meta分析

背景：临床中治疗成人胫骨中下段骨折的微创内固定方式包括交锁髓内钉技术和微创经皮钢板技术。大量回顾性研究都证实这两种策略临床有效,但两种治疗方法孰优孰劣,目前仍无定论。目的：评价交锁髓内钉技术与微创经皮钢板技术治疗成人胫骨中下段骨折的临床疗效差异。方法：计算机检索PubMed、Embase、Cochrane、CBM、万方、CNKI数据库中比较交锁髓内钉与微创经皮钢板治疗成人胫骨中下段骨折的文章,并手工检索相关中英文杂志,纳入随机对照试验和半随机对照试验。然后,按照CochraneCollaboration标准对相关文献进行严格的质量评估,选取手术时间、骨折愈合时间、骨组织愈合相关不良事件、软组织愈合相关不良事件、胫骨功能恢复作为评价指标,并用RevMan5．1统计学软件对结果进行Meta分析。结果与结论：共纳入7篇文献,包括377例患者,其中交锁髓内钉组188例,微创经皮钢板组189例。Meta分析结果显示：在治疗胫骨中下段骨折的比较中,两种方法在手术时间[WMD=0．58,95％c／（-28．91,30．07）,P=0．97]、软组织相关不良事件发生率[RR=0．51,95％C／（0．22,1．18）,P=-0．11]及胫骨术后Johnner-Wruhs功能评价优良率[RR=1．03,95％C／（0．91,1．17）,P=0．63]等方面差异无显著性意义;而相比于交锁髓内钉组,微创经皮钢板组骨折愈合时间较短[WMD=I．99,95％C1（0．15,3．83）,P=0．03],骨组织愈合相关不良事件发生率较低[RR=I．84,95％C／（1．03,3．27）,P=0,041。说明利用交锁髓内钉和微创经皮钢板治疗成人胫骨中下段骨折的疗效基本一致,但微创经皮钢板可缩短患者骨折愈合时间,减少骨折愈合相关不良事件的发生。     

Surgical outcome in patients with spinal metastases in the period 1993-2002

Background. Authors introduced ways and results of treatment operating patients with spinal metastases, treated in Orthopaedic Clinic of Central Military Hospital in years 1993-2002.
Material and methods. In introduced period in Clinic 54 patients was treated with spinal metastases. 37(68,6%) was treated surgical and 17(31,4%) conservatively. In Clinic following indications were established to operating treatments: pathological fracture of vertebrae, growing neurological symptoms, as well as uncompromising pain in conservative treatment. Advancement of neoplasmatic disease and very bad prognosis was most important contraindication to operating treatment. Following operating method treatments: posterior stabilization by Harrington method and stabilization by transpedicular screws. Percutaneous vertebroplasty was applied.
Results. In Frankel scale following results were noted down: in front of operation E-5, D-23, C-7, B-2, A-0, after operation E-8, D-24, C-5, B-0, A-0.
Conclusions. Authors affirm, that operation treatment in choose cases is only effective way of supply patients with spinal metastases.     

Radiotherapy of skeletal metastases

Radiotherapy plays an important role in treatment of bone metastases.
The mayor problem associated with bone metastases is pain, pathological fractures and a spinal cord compression. Radiotherapy is employed as a palliative treatment, mainly to relieve pain.
1.Radiotherapy with a single dose of 5-8 Gy/T is an efficient method of pain management especially in patients with bone metastases outside the vertebral column. This treatment can be provided as a day procedure.
2.Multi-fractionated irradiation - patients receive 20 Gy/T in 5 fractions or 30 Gy/T in 10 fractions. This is advocated for patients with metastases in the vertebral column or bones of the pelvis.
3.Half- body irradiation is designed for patients with multiple bone metastases. It's a single dose treatment. The upper half of body is irradiated with a dose of 6 Gy/T, the lower part with a dose of 8 Gy/T. Patients need a special preparation beforehand (steroids, hydratation) and hospitalization afterwards.     

病灶清除植骨合克氏针内固定对儿童肱骨近端病理性骨折疗效观察

目的:探讨病灶清除植骨联合克氏针内固定治疗儿童肱骨近端病理性骨折临床疗效。方法:回顾性分析2015年1月~2017年1月收治的行病灶清除植骨联合克氏针内固定治疗的22例肱骨近端病理性骨折患儿临床资料。观察术后并发症、影像学检查结果、骨折愈合时间及临床疗效。结果:21例患儿骨折愈合良好,平均9周骨折愈合,无骨折延迟愈合或不愈合及针道感染等发生;1例因术后过早、过度负重活动导致克氏针松动及骨折断端成角,再次手术后行Samfiento支具固定,术后12周骨折愈合;按照Conmanl-Murley评分法评定疗效,优19例,良2例,可1例,优良率为95.5%。结论:病灶清除植骨联合克氏针内固定治疗儿童肱骨近端病理性骨折具有创伤小、对骨折愈合影响小、避免二次切开取内固定等优点。     

克氏针髓内固定治疗腓骨中下段骨折的临床疗效分析

目的 总结分析克氏针髓内固定治疗不同类型腓骨中下段骨折的临床疗效,为腓骨中下段骨折的治疗提供依据。方法 回顾性分析我院自2015年6月-2017年5月采用克氏针髓内固定治疗256例腓骨中下段骨折的临床疗效,其中合并踝关节骨折94例(其中Lauge-Hansen分型旋前外展型9例,旋前外旋型47例,旋后外旋型35例),合并胫骨骨折162例。结果 本研究中256例均获得随访,无一例退钉,美国矫形协会(AOFAS)踝与后足评分系统对患者踝关节功能进行评分(总分100分),末次随访评分中,其中优(90～100分)191例;良(75～89分)60例;可(50～74分)4例;差(50分以下)1例,为44分;总优良率为98.0%;在腓骨中下段骨折克氏针髓内固定的患者中,合并胫骨骨折比合并踝关节骨折的患者术后踝关节功能优良率高。结论 克氏针髓内固定治疗腓骨中下段骨折总体临床疗效确切,合并踝关节不稳定型骨折时,钢板固定可能临床疗效更好。     

AO经皮微创锁定钢板治疗胫骨远端粉碎性骨折

目的探讨AO经皮微创锁定钢板治疗胫骨远端粉碎性骨折的临床效果。方法自2008年至2011年应用经皮微创内固定技术(MIPPO),使用AO经皮微创锁定钢板治疗40例胫骨远端粉碎性骨折。术后6～8周进行部分负重锻炼。AO分型:A型12例,B型18例,C型10例。结果 36例均获随访,时间9～20个月,平均12个月。骨折愈合时间15～24周,平均19.5周。按照Johner-Wruhs方法评价功能,本研究病例优29例,良4例,中3例,差0例;优良率91.7%。结论 MIPPO技术结合AO经皮微创锁定钢板治疗胫骨远端粉碎性骨折符合生物力学固定原则,内固定牢靠,有利于骨折的愈合及软组织的修复。