钛制弹性髓内钉固定锁骨中段骨折的疗效

目的评价钛制弹性髓内钉(TEN)固定锁骨中段骨折的疗效。方法应用TEN治疗53例移位的锁骨中段骨折患者。对疼痛VAS评分、Constant评分、临床愈合时间、锁骨短缩程度和并发症等进行评估。结果53例均获随访,时间14～24(18.70±3.36)个月。骨折均获得临床及影像学愈合,愈合时间6～20(11.77±3.61)周。无感染、骨不连、髓内钉断裂和内固定取出后再骨折发生。术后3 d疼痛VAS评分较术前明显减轻(P<0.01)。术后6个月患肩Constant评分为92～100(97.96±2.06)分。结论 TEN治疗非粉碎的锁骨中段骨折微创、美观、功能恢复良好、并发症少。     

弹性髓内钉治疗儿童股骨骨折

2015年8月~2018年2月,我科采用弹性髓内钉内固定治疗20例儿童股骨骨折,临床效果良好,报道如下。1材料与方法1.1病例资料本组20例,男12例,女8例,年龄5~13岁。横行骨折14例,斜行骨折5例,螺旋形骨折1例。受伤至手术时间2~6 d。     

股骨转子周围骨折并股骨中上段骨折的手术治疗

[目的]探讨应用股骨近端髓内钉配合有限切开复位钛捆绑带内固定治疗股骨转子周围骨折并股骨中上段骨折的手术方法和疗效。[方法]对2002年1月～2006年10月收治的21例股骨转子周围骨折并股骨中上段骨折的病人，均采用股骨近端髓内钉固定或配合行有限切开复位钛捆绑带内固定技术治疗。[结果]21例病人全部获得9个月～5年的随访，平均13个月，所有病例均达临床骨性愈合，未出现内固定物折断、松动、脱出等情况。患肢髋膝关节功能均恢复良好。[结论]根据病人的年龄和骨折的类型，采用股骨近端髓内钉或配合行有限切开复位钛捆绑带内固定技术是一种良好的内固定方式，具有创伤小、操作简便易行、固定牢固可靠、利于骨折愈合等优点，良好的保留了患肢的功能。技术的主要关键是在微创的前提下达到解剖复位。     

Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood

Purpose:The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood.Methods:Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed.Results:Mean age at fracture was 10.2 (4.9–16.7) years, and mean follow-up time was 11.1 (3.8–16.8) years. In 8 of 35 participants, the fractured limb was 11–15 mm longer than the non-fractured, and in 16, 1–10 mm longer. In eight participants, the fractured limb was 1–10 mm shorter than the non-fractured, and in three participants, 12–23 mm shorter. The younger the child, the greater the lengthening (R_s = −0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (R_s = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10–24 mm.Conclusion:Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (≥10 mm).Level of evidence:level IV, case series.     

Treatment of pediatric femoral shaft fractures with titanium elastic nails–our experience

Management of femoral diaphyseal fractures in the age group of 6-16 years is controversial. There has been a resurgence worldwide for operative fixation in general and TENS (titanium elastic nailing system) in particular.We performed a retrospective review of pediatric femoral fractures treated by TENS. The data was collected from cases operated between July 2007 and June 2010 at Sohar Hospital, Oman.We had treated 16 children (14 boys and 2 girls) with TENS for femoral shaft fractures. The mean age was 12.5 years (range 7-16 years) and mean hospital stay was 7.6 days (range 4-15 days). All fractures were radio-graphically united at a mean of 7.5 weeks (range 5-10 weeks). The nails were removed in 14 children after a mean of 22 weeks (range 6-38 weeks) postoperatively. At follow-up, we had found leg length discrepancy of 1 cm in one child and 10° of internal rotational deformity in another. No angular deformity had occurred.Titanium elastic nailing seems to be a safe and effective method for the treatment of femoral shaft fractures in children between 7 and 16 years of age.     

旋转臂自锁式髓内钉治疗股骨干骨折

目的 探讨旋转臂自锁式髓内钉(RBSN)治疗股骨干骨折的临床效果.方法 对32例股骨干骨折采用切开复位RBSN内固定.结果 患者均获随访,时间10～30(16.2±1.4)个月.全部骨性愈合,时间为12～26(21.3±2.1)周.采用HSS膝关节评分标准评价疗效:优30例,良1例,可1例,优良率96.9%.结论 RBSN治疗股骨干骨折创伤小,操作简便,固定牢固,疗效确切.     

经皮钛制弹性髓内钉治疗儿童长骨骨干骨折

目的 探讨微创弹性髓内钉固定治疗儿童长骨骨干骨折的疗效.方法 采用经皮钛制弹性髓内钉固定治疗儿童下肢长骨骨干骨折35例.结果 所有患儿均获随访,时间5个月～1年,骨折全部愈合,邻近关节活动和患肢功能完全恢复正常.无钉道感染和畸形愈合,1例过度生长0.8 cm的患儿在随访25周时已自我改善,1例发生<5°的外翻成角.所有患儿6个月后患肢行走和负重功能完全正常.结论 钛制弹性髓内钉适合于儿童和青少年股骨,胫骨干横形、短斜形骨折,具有微创、安全、简便等优点.     

弹性髓内钉治疗儿童股骨干骨折

目的探讨弹性髓内钉治疗儿童股骨干骨折的方法和疗效。方法采用弹性髓内钉内固定治疗儿童股骨干骨折32例。结果 32例均获随访,时间5～12个月,骨折全部愈合。按Flynn评分标准:优26例,良6例。无骨不愈合、畸形愈合和骨骺损伤等。结论弹性髓内钉内固定具有微创、不累及骨骺、并发症少等特点,是治疗儿童股骨干骨折的有效方法。     

弹性髓内钉治疗儿童股骨干骨折的疗效

2006年1月～2010年1月,我院采用弹性髓内钉治疗21例儿童股骨干骨折患者,取得满意疗效. 1 材料与方法 1.1 病例资料 本组21例,男13例,女8例,年龄5～12岁.左侧10例,右侧11例.斜形骨折5例,螺旋形骨折6例,横形骨折10例.受伤至入院时间为3 h～7d,受伤至手术时间1～12（7±3）d.     

带锁髓内钉治疗股骨干骨折的临床观察

2004年4月~2005年12月,我科对11例股骨干骨折患者经扩髓带锁髓内钉治疗,疗效满意。1材料与方法1.1病例资料本组11例,男9例,女2例,年龄20~55岁,交通伤5例,坠落伤4例,重物砸伤2例,均为闭合性新鲜骨折。粉碎性骨折5例,斜形骨折3例,横形骨折3例;位于股骨干上1/3段5例,中1/3段4例,下     

青少年型锁定髓内钉治疗儿童股骨干骨折的疗效

目的 评估青少年型锁定髓内钉治疗儿童股骨干骨折的疗效.方法 采用经大转子外侧置入锁定髓内钉治疗21例儿童股骨干骨折.评估患侧髋、膝关节的功能,测量双下肢长度、股骨颈干角及股骨颈直径,记录切口感染、股骨头缺血性坏死、髋外翻和股骨颈狭窄等并发症发生情况.结果 患儿均获得随访,时间8～34个月.骨折均愈合,时间10～28周....     

加长版PFNA治疗股骨转子间骨折合并股骨干骨折的临床疗效研究

【摘要】 目的 研究重建钉和加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效研究。方法 选取2012年1月~2014年6月到我院就诊并住院治疗的股骨转子间骨折合并骨干骨折的患者共60例为研究对象,分为两组: 为重建钉组和加长组,分别采用重建钉和加长型PFNA进行治疗,比较两组患者手术时间、术中出血量、骨折愈合时间、伤口长度、并发症、Harris评分、Lyshonlm评分。结果〓加长组的术中出血量、伤口长度均高于重建钉组(P<0.05),加长组的股骨转子间骨折的愈合时间和股骨干骨折的愈合时间也短于重建钉组(P<0.05),但两组手术时间差异无统计学意义。所有患者中只有一例发生切口感染,无其他严重并发症发生。加长组的Harris评分在术后各时间点均高于重建钉组,而Lyshonlm评分从术后第二个月开始之后的各时间点均低于重建钉组(P<0.05),但术后两周两组的Lyshonlm评分差异无统计学意义。结论 加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效较好,患者恢复更快。     

Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age

Background:

Management of femoral diaphyseal fractures in the age group of 6-16 years is controversial. There has been a resurgence worldwide for operative fixation.

Materials and Methods:

Twenty-two children (18 boys, 4 girls) aged 6-16 years with recent (> 3 days) femoral diaphyseal fractures (20 closed, 2 open) were stabilized with Titanium Elastic Nail (TEN). These fractures were in proximal third (n=3), middle third (n=15) and in the distal third (n=4) 17 patients underwent surgery within seven days of their injury. The results were evaluated using Flynn''s scoring criteria. Statistical analysis was done using Fischer''s exact test.

Results:

All 22 patients were available for evaluation after a mean of 26 months (14-36 months) of followup. Radiological union in all cases were achieved in a mean time of 8.7 weeks. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The results were excellent in 13 patients (59.0%), successful in six (27.2%) and poor in three patients (13.6%). All patients had early return to school.

Conclusion:

Intramedullary fixation titanium elastic nailing is an effective treatment of diaphyseal fractures of the femur in properly selected patients of the 6-16 years age group.     

交锁髓内钉手术治疗肱骨干骨折

目的介绍采用交锁髓内钉手术治疗肱骨干骨折。方法自1999年1月～2003年1月采用交锁髓内钉(远端不交锁)治疗肱骨干骨折36例。男28例，女8例；年龄19～59岁，平均38岁。AO分型，A型24例，B型11例，C型1例，均采用闭合复位、顺行插钉技术，远端不交锁，术后第2天肩肘带保护下开始功能锻炼，不采用其它外固定。结果随访26例，随访时间3～38个月，平均20个月，所有病例伤口Ⅰ／甲愈合，骨折无延迟愈合及不愈合。平均愈合时间9周，术后肩肘关节功能恢复良好。结论交锁髓内钉是治疗肱骨干骨折较好方法，远端可不交锁。     

逆行和顺行置髓内钉治疗股骨干骨折的疗效比较

目的比较逆行和顺行置髓内钉治疗股骨干骨折的临床疗效。方法将57例股骨干骨折患者按置钉方式的不同分为对照组(经大转子顺行置髓内钉治疗,25例)和观察组(经股骨髁逆行置髓内钉治疗,32例)。比较两组术中透视次数、手术时间、术中出血量、骨折愈合时间、术后6个月Harris评分。结果患者均获得随访,时间7~12个月。手术时间、术中出血量观察组明显短(少)于对照组(P<0.05);术中透视次数、骨折愈合时间以及术后6个月Harris评分两组比较差异均无统计学意义(P>0.05)。结论逆行和顺行置髓内钉治疗股骨干骨折均能取得满意的临床疗效,但逆行置髓内钉具有手术操作简单、无需使用牵引床、手术时间短、术中出血量少等优点,更利于基层医院使用。     

分叉式交锁髓内钉治疗肱骨干骨折

目的报告肱骨分叉式交锁髓内钉(BLIN型钉)治疗肱骨干骨折的疗效。方法用BLIN型钉治疗肱骨干骨折20例,钢板治疗肱骨干骨折29例,分别从手术情况、并发症、生物力学、骨折愈合情况、功能恢复等方面进行比较。结果随访4～16个月,钢板组平均骨折愈合时间4.2月,术后桡神经麻痹4例,螺钉松动、钢板弯曲1例,骨不连2例。BLIN型钉组平均骨折愈合时间9.6月,术后无一例发生桡神经麻痹,无一例钢钉折弯或断裂,骨折愈合牢固可靠,功能恢复良好。结论肱骨分叉式交锁髓内钉治疗肱骨干骨折,虽然骨折愈合时间较钢板长,但其他方面均优于钢板。     

A biomechanical study on flexible intramedullary nails used to treat pediatric femoral fractures

Flexible intramedullary nails have been indicated to treat femoral fractures in pediatric patients. The purpose of this study was to examine the stability of simulated transverse fractures after retrograde intramedullary flexible nail fixation. Various nail diameter combinations were tested using composite femurs in bending, torsion, and a combined axial/bending test where a vertical compressive force was applied to the femoral head. The cross-sectional percent area fill of the nails within the femurs was also determined. In 4 point bending, the greatest repair stiffness was 12% of the intact stiffness. In torsion, the greatest stiffness was 1% of the intact stiffness for either internal or external rotation. The greatest repair stiffness was 80% of the intact stiffness for a compressive load applied to the femoral head. Nail combinations with single nail diameters greater than 40% of the mid-shaft canal width, as measured from an AP radiograph, prevented the fracture from being reduced and left a posterior gap. Flexible intramedullary nails may be of value in the treatment of pediatric femoral fractures, but care must be taken to insert nails that are correctly sized for the canal and to protect the healing fracture from high torsional and bending loads.     

闭合复位交锁髓内钉固定治疗股骨干骨折

目的探讨闭合复位交锁髓内钉治疗股骨干骨折的疗效。方法对32例股骨干骨折应用闭合复位交锁髓内钉治疗，均闭合复位顺行置钉。结果所有患者随访6～26个月，术后复位满意，骨折平均愈合时间12周，术后均愈合良好，无主钉或锁钉断裂，无肢体短缩、功能障碍、感染。结论闭合复位交锁髓内钉是治疗股骨干骨折的一种创伤小、并发症少、骨愈合时间短、术后患者恢复好的内固定方法。     

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Background:

Ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a high energy trauma. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced reconstruction nails. All these approaches have their own difficulties. We studied the outcome of long proximal femoral nail (LPFN) in the management of concomitant ipsilateral fracture of the proximal femur and femoral shaft.

Materials and Methods:

We analysed the prospective data of 36 consecutive patients who had sustained a high energy trauma (30 closed fractures and 6 open shaft fractures) who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with LPFN between December 2005 and December 2011. The mean age was 39 years (range 28-64 years). Twenty nine males and seven females were enrolled for this study.

Results:

The patients were followed up at three, six, twelve, and eighteen months. The mean healing time for the neck fractures was 4.8 months and for the shaft fractures was 6.2 months. The greater trochanter was splintered and widened in two cases which eventually consolidated. Two patients had superficial infection, two patients had lateral migration of the screws with coxa vara which was due to severe osteoporosis detected during the followup. We had two cases of nonunion of shaft fracture and one case of nonunion of neck fracture. Two cases of avascular necrosis of femoral head were detected after 2 years of followup. No cases of implant failure were noted. Limb shortening of less than 2 cms was noted in four of our patients. The functional assessment system of Friedman and Wyman was used for evaluating the results. In our series 59.9% (n = 23) were rated as good, 30.6% (n = 11) as fair, and 5.5% (n = 2) as poor.

Conclusion:

Long PFN is a reliable option for concomitant ipsilateral diaphyseal and proximal femur fractures.     

Titanium elastic nails for pediatric tibial shaft fractures

Purpose  The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs). To our knowledge, this is the largest series reported in the literature of this specific fixation technique. Methods  We reviewed all children with tibial shaft fractures treated operatively at our tertiary care children's hospital to find those patients who underwent fixation with TENs. Between 1998 and 2005, we identified 19 consecutive patients who satisfied inclusion criteria. The average age of the patients in our series was 12.2 years (range 7.2–16 years), and mean follow-up was 15.7 months (range 6–28 months). Patient charts and radiographs were retrospectively reviewed to gather the clinical data. Outcomes were classified as excellent, satisfactory, or poor according to the Flynn classification for flexible nail fixation. Results  All patients achieved complete healing at a mean of 11.0 weeks (range 6–18 weeks). At final follow-up, mean angulation was 2° (range 0°–6°) in the sagittal plane and 3° in the coronal plane (range 0°–9°). Five patients (26%) complained of irritation at the nail entry site; there were no leg length discrepancies or physeal arrests as a result of treatment. Two patients required remanipulation after the index procedure to maintain adequate alignment. According to the Flynn classification, we had 12 excellent, six satisfactory, and one poor result. Conclusion  Although the indications for operative fixation of pediatric tibial shaft fractures are rare, occasionally surgical treatment is warranted. Based on our results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique which allows rapid healing of tibial shaft fractures with an acceptable rate of complications. No authors received any financial support or compensation for this study.