改良肱三头肌入路手术治疗肱骨远端C型骨折

正2012年11月~2015年12月,我科使用改良肱三头肌劈开入路手术治疗11例肱骨远端C型骨折患者,肘关节功能恢复满意,报道如下。1材料与方法1.1病例资料本组11例,男3例,女8例,年龄21~79岁。左侧3例,右侧8例。骨折AO分型:C1型2例,C2型3例,C3型6例。其中1例为GustiloⅠ型开放骨折,其余为新鲜闭合骨折。伤后至手术时间5~10 d。     

钉板内固定结合AO外固定架治疗复杂Pilon骨折

复杂Pilon骨折多源于高能量损伤,除骨折严重粉碎外,一般都合并严重软组织损伤,这无疑给治疗带来更大的难度。2001年4月-2006年1月,采用有限钉板内固定结合AO外固定支架治疗复杂Pilon骨折33例,疗效满意,报告如下。1临床资料本组33例,其中男23例,女10例;年龄21~61岁,平均38.6岁。按AO分型:C1型12例,C2型8例,C3型13例。损伤原因:交通事故伤18例,高处坠落伤9例,重物砸伤6例。闭合性骨折21例,开放性骨折12例(按Gustilo分型:Ⅱ型5例,ⅢA型3例,ⅢB型4例)。损伤后至就诊时间:2h~14d。损伤至手术时间:开放性损伤行急诊手术,闭合性损伤伤后7~14d…     

桡骨远端粉碎性骨折的手术治疗

1999年1月~2005年1月,我院采用手术治疗桡骨远端粉碎性骨折32例,取得满意疗效。1材料与方法1.1病例资料本组32例,男21例,女11例,年龄11~68岁。开放性骨折5例,闭合性骨折27例。按AO分类:B1型4例,B2型11例,C1型8例,C2型8例,C3型1例。1.2治疗方法分为3组:①切开复位克氏针内固定组     

桡骨远端骨折合并舟骨骨折的治疗

桡骨远端骨折是最常见的骨折,传统的分型分为Colles骨折、Smith骨折、Barton骨折。文献报道桡骨远端骨折合并舟骨骨折的发生率为0.7%~6.5%[1]。一般多为年轻患者,高能量损伤,桡骨远端严重粉碎不稳定骨折,舟骨骨折移位。传统的手法整复,石膏固定,难以奏效。我院自2003年1月至2005年3月,采用切开复位内固定加外固定支架固定,治疗桡骨远端骨折合并舟骨骨折5例,效果满意。1临床资料1.1一般资料本组5例,男4例,女1例;年龄21~45岁,平均32岁。左侧3例,右侧2例。致伤原因:车祸伤3例,高处坠落伤2例。骨折类型:桡骨远端骨折,按AO分类C2型2例,C3型3例…     

锁定钢板治疗股骨髁间及髁上骨折

<正>2010年5月~2012年5月,笔者对12例股骨髁间及髁上骨折患者采用锁定钢板内固定治疗,疗效满意,报道如下。1材料与方法1.1病例资料本组12例,男10例,女2例,年龄30~62岁。闭合骨折10例,开放骨折2例(GustiloⅠ型1例、Ⅱ型1例)。骨折AO分型:A型6例,B型4例,C型2例。受伤至手术时间3~10d。     

锁定钢板外固定治疗胫腓骨骨折

<正>2009年7月~2012年7月,我们采用小切口锁定钢板外固定治疗21例胫腓骨粉碎性骨折患者,取得良好疗效,报道如下。1材料与方法1.1病例资料本组21例,男15例,女6例,年龄16~60岁。开放骨折7例,闭合骨折14例。骨折按AO分型:B1型4例,B2型7例,B3型5例,C1型2例,C2型3例。开放骨折按GustiloAnderson分型[1]:Ⅱ型5例,Ⅲ型2例。     

髓内钉结合空心钉治疗股骨髁部骨折

目的 :观察逆行髓内钉结合空心钉治疗股骨髁部骨折的临床疗效。方法 :回顾性分析2009年6月至2015年6月收治的股骨髁部粉碎性骨折患者13例,均使用逆行髓内钉结合空心钉治疗,男6例,女7例;年龄19~76岁,平均46.1岁。闭合性骨折10例,开放性骨折3例;骨折按AO分型:C1型4例,C2型7例,C3型2例。术后观察骨折复位及膝关节功能恢复情况。结果:13例全部获得随访,时间12~36个月,平均24个月。X线复查示骨折愈合时间为18~24周,平均21周,无内固定物松动、断裂及再骨折病例。手术后1年膝关节HSS评分90.07±4.99。结论:股骨逆行髓内钉结合空心螺钉治疗股骨髁间骨折临床疗效优良,能提高股骨髁部骨折的解剖复位率,减少并发症发生,促进膝关节功能恢复。     

DVR解剖型接骨板结合注射型人工骨治疗桡骨远端不稳定性骨折

<正>2012年3月~2014年1月,我们采用DVR(distal volaris radius)解剖型桡骨远端锁定接骨板治疗38例桡骨远端不稳定性骨折,同时植入注射型人工骨填充骨缺损,术后早期功能锻炼,获得了较好的治疗效果,报道如下。1材料与方法1.1病例资料本组38例,男21例,女17例,年龄28~72岁。按AO分类:B2型4例,B3型7例,C1型11例,C2型9例,C3型7例。     

有限内固定和超关节AO管状外固定架治疗膝关节骨折

自 1999年 9月 - 2 0 0 1年 7月 ,我们应用有限内固定和超关节AO管状外固定支架治疗膝关节骨折11例 ,取得满意疗效 ,现报道如下。1　临床资料本组男 10例 ,女 1例 ;年龄 18～ 5 7岁 ,平均39 2岁。致伤原因 :车祸伤 4例 ,坠落伤 3例 ,砸压伤 2例 ,其它原因伤 2例 ;闭合伤 9例 ,开放伤 3例 ;胫骨平台骨折 9例按AO分型[1] :B1型 3例 ,C1型 4例 ,C2 型 2例 ,其中 1例B1型、2例C1型胫骨平台骨折合并胫骨近端粉碎性骨折。股骨髁骨折 3例按AO分型 :B2 型 1例 ,C1型 1例 ,C2 型 1例。2　治疗方法患者入院后 ,在纠正休克和处理危及生命的合并伤…     

Y形重建钢板治疗成人肱骨髁间骨折

2000年1月~2004年12月,我院应用切开复位Y形重建钢板内固定治疗成人肱骨髁间骨折18例,疗效满意。1材料与方法1.1病例资料本组18例,男12例,女6例。年龄18~62岁。左侧7例,右侧11例,均为新鲜骨折。按AO/ASIF分类:C1型6例,C2型9例,C3型3例。合并尺神经损伤2例。3例在12 h内急诊手术     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.