Anterior discectomy and fusion with internal fixation for unstable hangman's fracture

Between 1999 and 2004, 28 patients (average age: 41, range: 18–70 years) with unstable hangman’s fracture underwent anterior discectomy and fusion with internal fixation at our unit. According to the Levine-Edwards classification, all cases were unstable with type II (10 cases), type IIA (17 cases) and type III (1 case). An average follow-up of 15 months was achieved (range: 3–48 months). The average operative time was 107 min (80–131 min). No patient received blood transfusion. No patient experienced worsening neurological function postoperatively. No other intra- or postoperative complication was observed. All patients were relieved from axial pain. Neurological status improved postoperatively in all four cases with neurological deficit. Each patient showed evidence of a solid anterior C2–3 interbody fusion after six months. No bone graft or plate screws complication was observed in any of the cases during the follow-up period. In our experience the anterior approach with primary internal stabilisation may be a feasible and safe method to treat unstable hangman’s fracture.     

移位髋臼骨折的内固定治疗

目的：对移位髋臼骨折的分类、手术入路及内固定方法的选择进行探讨。方法：对26例按不同类型不同手术入路分别以拉力螺钉、可吸收螺钉、重建钢板作内固定治疗的髋臼骨折进行回顾性总结分析。结果：22例经1年至7年，平均2.7年随访。术后1例出现坐骨神经损伤，半年后恢复；2例出现关节周围异位骨化，轻微疼痛，但不影响关节功能。未发生术后感染及股骨头坏死。19例达到解剖复位，3例满意复位。参照美国矫形外科学会标准评估疗效：优16例，良3例，可2例，差1例，优良率达86．3％。结论：对移位髋臼骨折应积极创造条件进行手术治疗，正确的分型和手术入路选择是手术成功的关键，坚强而有效的内固定是早期功能训练和减少并发症的有力保证。     

经口咽入路钢板内固定治疗不稳定性寰椎骨折

目的:分析应用经口咽入路钢板内固定治疗不稳定性寰椎骨折的临床疗效及安全性。方法:2007年7月至2011年6月,应用经口咽入路钢板内固定治疗不稳定性寰椎骨折8例,男6例,女2例;年龄23～48岁,平均39.5岁;高处坠落伤5例,交通伤3例。双侧寰椎前弓骨折(前1/2 Jefferson骨折,Landells type Ⅰ)3例,单侧寰椎前后弓双骨折(半环Jefferson骨折,Landells typeⅡ)3例,双侧寰椎前后弓双骨折伴单侧侧块骨折(Landells typeⅢ)2例。结果:所有患者获得随访,时间6～24个月,平均13个月。患者的临床症状均得到不同程度的改善。平均手术时间为98min(80～140min);平均出血量为200ml(100～300ml);平均透视时间55s;术中术后均未发生神经、椎动脉损伤和其他手术相关并发症。复查X线片及CT,未发现患者上颈椎失稳或复位丢失,螺钉位置良好,无松动、断钉。结论:经口咽入路采用寰椎侧块螺钉固定钢板重建寰椎前环是治疗不稳定性寰椎骨折的一种可靠及安全的方法。它既保持了寰枢关节的旋转运动功能,同时又恢复了寰枕关节和寰枢关节的协调运动。     

前路减压植骨融合及钛板固定治疗Hangman骨折

目的 探讨颈前路减压植骨融合及钛板固定治疗Hangman骨折的临床疗效.方法 2004年6月至2008年12月共收治20例Hangman骨折患者,男14例,女6例;年龄35～62岁,平均49.2岁.根据Levine-Edwards分型标准:Ⅱ型10例,ⅡA型7例,Ⅲ型3例.所有患者术前均经颅骨牵引,14例行颈前路C_(2-3)椎间盘切除、植骨融合钢板固定术,6例行C_3椎体次全切除、植骨融合钢板固定术.治疗前后根据国际脊髓损伤评分(ASIA)标准对患者进行感觉和运动评分,并对手术前后影像学资料进行比较分析.结果 20例患者术后获7～51个月(平均25.6个月)随访,患者神经功能恢复良好.ASIA感觉评分术前、术后1个月及末次随访时平均分别为(145.2±25.6)、(166.2±31.5)、(212.2±33.2)分,三者比较差异均有统计学意义(P<0.05).ASIA运动评分术前、术后1个月及末次随访时平均分别为(53.3±15.2)、(68.5±18.7)、(87.3±21.3)分,三者比较差异均有统计学意义(P<0.05).术后X线片示6个月内植骨均获骨性融合,稳定性良好,无钢板及螺钉松动、断裂等并发症发生.结论 颈前路减压植骨融合及钛板固定治疗不稳定Hangman骨折具有减压彻底、有效恢复生理前凸、植骨融合率高、能早期活动等优点,是一种较好的治疗方法.

Abstract：

Objective To study clinical outcomes of anterior fusion with internal fixation for trau-matic spondylolisthesis of the axis (Hangman's fracture). Methods From June 2004 to December 2008, 20 patients with traumatic spondylolisthesis of the axis were treated operatively. They were 14 males and 6 females, aged from 35 to 62 years, with an average of 49.2 years. According to the classification system designed by Levine and Edwards, the radiological manifestations revealed type Ⅱ in 10 cases, type ⅡA in 7 cases and type Ⅲ in 3 cases. All cases achieved anatomic reduction by skull traction before operation. Fourteen cases underwent anterior C2-3 discectomy followed by insertion of a bone spacer for fusion and an-terior plating. Six cases underwent anterior C3 subtotal vertebrectomy, strut graft insertion, and anterior plating. The sensation and motion of the patients were evaluated pre- and postoperatively according to ASIA scoring system. Results of X-ray, CT and MRI examinations were also measured and compared pre-and post-operatively. Results The average follow-up time was 25.6 (7 to 51) months. All bone grafts ac-quired stable fusion in 6 months, the neurological functions were restored satisfactorily, and no plates or screws broke or loosened. Conclusion Anterior fusion and the internal fixation is a good alternative method for treatment of instable Hangman's fracture, because it has advantages of complete decompression, a high rate of successful bony fusion and early ambulation.     

骨折间隙直视下复位固定后踝移位骨折

[目的]介绍骨折断端间隙直视法下三踝骨折中后踝移位骨折复位固定的手术技术与临床效果。[方法]选择2014年1月~2017年12月手足外科收治的三踝骨折中后踝移位骨折患者42例,采用骨折断端间隙直视法复位固定后踝骨折,采用骨骼肌肉功能评分(SMFA)评定患者术后恢复情况。[结果]所有患者均达到骨性愈合,术后未出现需要进行翻修手术或感染的病例,踝关节背伸跖屈功能良好。患者骨骼肌肉功能评分(SMFA)功能障碍指数平均为(8.01±1.73)分,SMFA困扰指数平均为(2.22±1.31)分。所有患者术后平均3个月进行正常的日常生活活动。[结论]对于三踝骨折中后踝移位骨折的治疗,采用后外侧入路骨折断端直视下复位固定方法可能是一种更好的选择。     

切开复位内固定与植骨治疗跟骨关节内移位骨折

目的:评估切开复位内固定及植骨治疗跟骨关节内移位骨折的临床效果。方法:35例41足跟骨关节内移位骨折,其中男29例,女6例;年龄16-57岁,平均33.1岁;左足18例,右足11例,双足6例。X线片示:Bhler角0°-15°者19足,<0°者22足。按Sanders分类:Ⅱ型14足,Ⅲ型23足,Ⅳ型4足。并行切开复位普通跟骨接骨板内固定及植骨术。结果:41足经平均18个月随访,按Maryland足部评分系统评估手术疗效,其中优(90-100分)31足,良(75-89分)7足,可(50-74分)2足,差(<50分)1足,优良率为92.7%(38/41)。结论:跟骨关节内移位骨折行切开复位内固定术可取得良好临床疗效,植骨术有利于早期负重及避免距下关节面的塌陷。     

关节置换术与内固定术治疗老年人移位型股骨颈骨折的系统评价

目的 系统评价关节置换术和内固定术治疗老年人移位型股骨颈骨折的疗效. 方法 计算机检索Medline(1966年1月至2009年9月),荷兰医学文摘(1966年1月至2009年9月),Cochrane图书馆(2008年第1期)、中国生物医学文献数据库(截止2009年9月),中国学术期刊网(截止2009年9月),手工检索相关参考文献及中文期刊,收集所有关节置换术与内固定术比较治疗老年人(>60岁)移位型股骨颈骨折的随机对照试验(RCT),筛选出符合纳入标准的文献,对其进行严格的质量评价后应用RevMan4.2.8软件进行Meta分析. 结果 共纳入18个RCT,包含2561例患者.Meta分析结果显示,关节置换术术后2年再手术率(RR=0.13,95%CI 0.09～0.17)、5年再手术率(RR=0.11,95%CI 0.06～0.22)及术后2年主要并发症发生率(RR=0.20,95% CI 0.15～0.27)、5年主要并发症发生率(RR=0.18,95% CI 0.1 1～0.30)均低于内固定术.但二者术后1个月和2年病死率差异均无统计学意义(RR=1.42,95%CI 0.89～2.24;RR=1.01,95%CI 0.86～1.18).结论 与内固定术相比,关节置换术治疗老年人移位型股骨颈骨折可明显降低术后主要并发症的发生率及再次手术率,但两种术式的术后2年病死率无明显差异.     

切开复位内固定治疗有移位髋臼骨折的疗效分析

目的观察切开复位内固定治疗有移位髋臼骨折的远期疗效,并分析影响远期疗效的相关因素.方法本组按Letournel-Judet分型简单骨折23例,复杂骨折31例,骨折移位≥3 mm,合并髋关节后脱位16例,中心性脱位13例,股骨头软骨面损伤17例.均采用切开复位钢板螺钉内固定,其中伤后2周内手术42例,3周后手术12例.结果术后平均随访38个月,Matta关节评分＞15分、Liebergall影像学评价A、B的病例43例,优良率79.6%,3年后全髋置换5例,占9.3%.结论切开复位内固定能使髋臼恢复正常解剖形态,有利于关节功能的恢复,远期疗效较好;Letournel-Judet骨折分型、股骨头软骨面是否损伤、骨折后手术时间以及复位质量是主要影响因素,提示髋臼创伤骨折的严重程度直接影响其预后.     

移位桡骨头骨折的内固定治疗

目的探讨内固定治疗移位桡骨头骨折的方法和临床疗效。方法 2005年8月-2009年5月,采用切开复位、可吸收软骨固定钉和/或AO微型接骨板内固定治疗移位桡骨头骨折35例。男28例,女7例;年龄17～48岁,平均28.4岁。致伤原因:交通事故伤16例,摔伤13例,高处坠落伤6例。骨折根据Mason分型:Ⅱ型21例,Ⅲ型9例,Ⅳ型5例。均为闭合性骨折,其中合并桡骨颈骨折6例,尺骨鹰嘴骨折1例,肘关节后脱位3例,肘关节后脱位和尺骨冠状突骨折1例,尺侧副韧带损伤3例。伤后至手术时间3～7d。结果术后1例切口感染Ⅱ期愈合;其余患者切口均Ⅰ期愈合。35例均获随访,随访时间12～25个月,平均17个月。骨折均获骨性愈合,愈合时间8～16周,平均10.2周。末次随访时,肘关节屈伸达95～145°,平均119°;旋转(旋前加旋后)90～175°,平均126°。肘关节功能根据Broberg和Morrey肘关节评分标准评定,获优18例,良13例,可4例,优良率88.6%。结论对于移位桡骨头骨折,根据骨折类型选择可吸收软骨固定钉和/或AO微型接骨板内固定治疗,近期疗效满意。     

颈前路植骨融合内固定术治疗不稳定性Hangman骨折

目的 探讨颈前路植骨融合内固定术治疗不稳定性Hangman骨折的疗效和应用价值。方法 对6例不稳定性Hangman骨折患者行颈前路植骨融合，Zephir颈前路钢板系统内固定术。术后进行10～18个月(平均14个月)随访。结果 术后症状明显恢复。全部病例颈椎生理前凸维持良好，C2椎弓骨折线模糊。术后6个月植骨融合率达到100％。无内固定系统松动和断裂现象存在。结论 应用颈前路植骨融合内固定术治疗不稳定性Hangman骨折具有可获得术后上颈椎即刻稳定，防止植骨块移位，无须行石膏固定，维持颈椎生理前凸，促进骨折愈合和植骨融合率高等优点。     

外侧小切口空心螺钉内固定治疗关节面移位的跟骨骨折

目的:观察外侧小切口复位内固定治疗关节面移位的跟骨骨折的疗效.方法:自2006年1月至2009年9月30例(31足)关节面移位的跟骨骨折,其中男23例,女7例;年龄18～60岁,平均36.5岁.SandersⅡ型21足,Ⅲ型8足,Ⅳ型2足.采用腓骨尖至第4足跖骨基底的外侧直切口显露,复位后空心螺钉内固定.结果:30例31足全部获得随访,时间3～24个月,平均14个月.31足术后无切口感染、皮肤坏死或切口愈合不良、腓肠神经损伤等软组织并发症.25足术后X线片示关节面复位良好、跟骨外形恢复满意,6足关节面、跟骨外形基本恢复正常.据Maryland评分标准,优6足,良20足,可5足.结论:跟骨外侧微创小切口空心钉内固定对软组织损伤小,并发症少,关节面显露清晰,适用于SandersⅡ、Ⅲ型,是治疗关节面移位的跟骨骨折一种较好选择.     

Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee

Anatomic reduction, typically obtained by direct visualization through an arthrotomy and internal fixation (open reduction and internal fixation), is the traditional treatment method for displaced intraarticular condylar fractures of the distal femur. We present a case report describing an alternative treatment method, namely, arthroscopic reduction and internal fixation, of a displaced, malrotated intraarticular lateral femoral condyle fracture of the knee. The potential benefits of decreased blood loss, shortened operative time, excellent intraarticular visualization, decreased soft tissue dissection, and shortened postoperative recovery are outlined.     

Closed reduction, internal fixation with quadratus femoris muscle pedicle bone grafting in displaced femoral neck fracture

Background:

Management of femoral neck fracture is still considered as an unsolved problem. It is more evident in displaced fractures where this fracture is considered as some sort of vascular insult to the head of the femur. We have used closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting in fresh displaced femoral neck fractures.

Materials and Methods:

From April 1996 to December 2004 we operated 73 consecutive patients of displaced femoral neck fracture in the age group of 24 to 81 years, mean age being 54.6 years. The patients were operated within one week of injury, the mean delay being 3.6 days. Closed reduction internal fixation along with quadratus femoris muscle pedicle bone grafting was done in all cases. They were followed up for an average period of 5.6 years (range 2-11 years).

Results:

Results were assessed according to modified Harris Hip Scoring system and found to be excellent in 53, good in 12, fair in six and poor in two patients. Bony union occurred in 68 cases, no patient developed avascular necrosis (AVN) till date.

Conclusion:

For fresh displaced femoral neck fracture in physiologically active patients closed reduction, internal fixation and quadratus femoris muscle pedicle bone grafting is a suitable option to secure union and prevent development of AVN.     

Hangman骨折后Zephir钢板颈前路内固定技术的应变电测研究

目的比较Hangman骨折后两种不同前路手术方式的生物力学特性。方法对6例新鲜尸体Hangman骨折模型后,依次采用C2-3开槽植骨融合钢板内固定术(C2-3组)和C3椎体大部分切除、植骨内固定术(C2-4组)2种术式,采用电测法测定其螺钉的拔出应力。结果 C2-3组在屈曲和伸展运动状态下,在不同载荷下所承受的应力均大于C2-4组(P0.05),在左右旋转时两组间无显著性差异(P0.05)。结论生理环境下C2-3植骨融合内固定术可能相对容易出现内植物相关并发症。