颈椎骨折或骨折脱位的早期外科治疗

本文报告了对３６例颈椎骨折及骨折脱位的病人早期施行颈椎前路减压及稳定性重建的结果，其中３４例获得随访，２５例不完全损伤者神经功能均有不同程度的改善。对颈椎骨折及骨折脱位的治疗应以及时、彻底的减压，纠正畸形、重建颈椎的稳定性为原则，前路手术是达到手术目的的理想方式，手术的时机应在病人全身情况良好的条件下尽早进行．减压及植骨融合后若辅以颈椎前路钢板内固定，将使融合节段更加稳定。     

Paratrooper's Ankle Fracture: Posterior Malleolar Fracture

BackgroundWe assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes.MethodsFifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity.ResultsThe patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome.ConclusionsPosterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to undergo surgical repairs.     

新型跟骨钢板治疗跟骨骨折

目的研究和评估切开复位治疗跟骨骨折及跟骨钢板在跟骨骨折治疗中的作用.方法为18例跟骨骨折患者行切开复位跟骨钢板内固定.结果18例中15例获随访≥12个月.所有病例均完全愈合,无1例发生钢板螺钉松动、断裂等并发症.结论AO新型钢板能提供有效的固定节段稳定性,是治疗跟骨骨折较好的内植物,为临床提供了一个良好的治疗跟骨骨折的方法.     

Fracture Risk Following an Atypical Femoral Fracture

Atypical femoral fractures (AFFs) occurring during the course of osteoporosis treatment usually lead to discontinuation of anti-resorptive (AR) drugs. However, the risk of fracture after an AFF is unknown. We conducted a follow-up study of patients with AFF matched 1:3 for age and gender with patients with a peripheral major osteoporotic fracture (pMOF), in the setting of a fracture liaison service, to investigate the incidence of subsequent low-trauma fractures. Fifty-five patients with AFF (95% women, age [mean ± standard deviation] 75 ± 10 years, 89% exposed to AR drugs), followed for 6.2 ± 3.7 years, were compared to 165 matched controls with a pMOF (hip 85%) followed for 4.3 ± 2.6 years. During the follow-up, 38% of patients in the AFF group and 16% in the pMOF group received AR therapies. Continuation of AR drugs after an AFF was associated with contralateral AFF in 27% of subjects. The risks of new low-trauma, major osteoporotic and imminent (within 2 years) fractures, were similar between the two groups: incidence rate ratio (95% confidence interval [CI]) of subsequent fracture following AFF relative to pMOF, 1.30 (95% CI, 0.82–2.04), 1.28 (95% CI, 0.74–2.15), and 1.11 (95% CI, 0.54–2.15), respectively. Moreover, the risk of sustaining multiple fractures per participant was significantly increased among patients with AFF compared to pMOF (hazard ratio 1.48 [95% CI, 1.00–2.19]; p = 0.049). When taking mortality into account, the risk of subsequent fractures tended to be higher in the AFF group (sub-hazard ratio 1.42 [95% CI, 0.95–2.12]). In conclusion, patients who sustained an AFF are at high risk of subsequent fragility fractures, at least equal or even greater to the risk observed after a pMOF. However, continuation of AR drugs increases the risk of contralateral AFF. Therefore, optimal modalities for secondary fracture prevention after AFF require further evaluation. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

手术治疗髋臼合并同侧股骨干骨折的临床研究

目的总结髋臼合并同侧股骨干骨折的手术方法和治疗效果。方法从2003-2006年共手术治疗12例。股骨干骨折根据AO的Muller分类法，A1型3例，A2型2例，A3型3例，B2型3例，C2型1例。髋臼骨折按AO的Letournel～Judet分型，A1型2例，A2型1例，B型5例，C型4例。根据不同骨折类型，分别采用不同手术入路进行骨折复位内固定。结果12例患者平均随访15．8个月，根据Matta影像学评分，解剖复位7例，满意复位3例，不满意复位2例。根据D’Aubign6和Postel功能评分法，优6例（50．00％），良2例（16．67％），可3例（25．00％）），差1例（8．33％）。根据Epstein影像学标准评价，优7例，良2例，可2例，差1例。发生股骨头坏死合并创伤性关节炎1例（8．33％），异位骨化1例（8．33％）。无手术死亡、感染及骨折不愈合发生。结论把握合适的手术时机，准确的评估骨折类型，选择正确的手术入路，配合术中灵活的处理，是提高疗效的关键。     

Acute and Long-Term Increase in Fracture Risk after Hospitalization for Vertebral Fracture

The aims of this study were to determine the magnitude of the increase in risk of further fracture following hospitalization for vertebral fracture, and in particular to determine the time course of this risk. The records of the Swedish Patient Register were examined from 1987 to 1994 to identify all patients who were admitted to hospital for thoracic or lumbar vertebral fractures. Vertebral fractures were characterized as due to high- or low-energy trauma. Patients were followed for subsequent hospitalizations for hip fracture, and for all fractures combined. A Poisson model was used to determine the absolute risk of subsequent nonvertebral fracture and compared with that of the general population. We analyzed 13.4 million hospital admissions from which 28.869 individuals with vertebral fracture were identified, of which 60% were associated with low-energy trauma. There was a marked increase in subsequent incidence of hip and all fractures within the first year following hospitalization for vertebral fracture in both men and women. Thereafter, fracture incidence declined toward, but did not attain, baseline risk. Increased risks were particularly marked in the young. The increase in fracture risk was more marked following low-energy vertebral fracture than in the case of high-eneergy trauma. We conclude that the high incidence of new fractures within a year of hospitalization for vertebral fractures, irrespective of the degree of trauma involved, indicates that such patients should be preferentially targeted for treatment. It is speculated that short courses of treatment at the time of first vertebral fracture could provide important therapeutic dividends. Received: 6 June 2000 / Accepted: 28 September 2000     

Smith's Fracture

Smith's fracture is not common below the age of 20 years. The left wrist is more commonly involved. The ratio between Types 1, 2 and 3 of the fracture is 4:2:1. Pronation injury is the commonest mechanism. A fall on the back of the hand and compression with shearing force are the other two mechanisms. Closed manipulation and immobilisation in plaster extending from the middle of the arm up to the knuckles with the forearm in full supination is an excellent method of treatment. We have obtained excellent, good or fair results in 86.4% of our cases.     

Dupuytren骨折及其分型

目的：探讨Dupuytren骨折的定义及其分型。方法：通过60例归入观察对象的旋前型踝关节损伤病人的治疗，结合回顾病人的病史、体检及影像学资料，描述Dupuytren骨折并对其分型。结果：对Dupuytren骨折作了较合理的定义，将其分为I、Ⅱ、Ⅲ3型。结论：该定义及其分型有助于提高对这类损伤的全面认识．更好地指导临床诊断和治疗。     

老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了102名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Singh指数、股骨颈皮质骨指数和股骨外侧皮质骨厚度,结果表明两骨折组与正常对照组之间均有非常显著(P<0.01)或显著(P<0.05)之统计学差异,认为骨质疏松是老年人髋部骨折的主要影响因素之一,而采用X线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值.