牵引闭合复位失败的股骨转子间骨折

大多数股骨转子间骨折能成功地进行闭合手法复位，不能闭合复位实属少见。我们对近几年收治的１１２例股骨转子间骨折的病历和Ｘ线片资料进行复习，其中６例闭合复位失败而行开放复位内固定治疗，其发生与特殊的骨折类型及软组织嵌入有关。１　材料与方法　　本组６例，男４例，女２例；年龄１７～６４岁。伤后至复位时间３～１４天，Ｘ线片示：４例骨折线由内侧小转子下向外侧大转子上走行，近折端骨屈曲内收，远折端外展外旋，使骨折端明显分离，重叠移位（图１）；２例骨折线由外侧大转子下向内侧小转子上走行，骨折近端外展、外旋，骨折…     

手法复位夹板固定及骨牵引治疗成人股骨干骨折

作者自 1993年～ 2 0 0 0年 12月 ,对 16 4例成人股骨干骨折患者 ,采用手法复位、自制小夹板固定、胫骨结节骨牵引、中药内服外敷、早期手法理伤及功能锻炼等治疗方法 ,结果骨折全部愈合、关节功能正常 ,现总结如下。1　临床资料　　本组 16 4例中男 10 1例 ,女 6 3例 ;年龄 18～ 72岁 ,平均39 2 5岁。全部为闭合性骨折。车祸伤 77例 ,行走跌倒伤 39例。横断形骨折 4 5例 ,粉碎性骨折 2 5例 ,斜形螺旋形骨折94例。2　治疗方法术前仔细阅读分析Ｘ线片 ,根据骨折粉碎、重叠、旋转移位方向 ,准备好合适的小夹板、棉压垫、约束带及三色散。对骨…     

Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state.

Fifty-six blunt multiple trauma patients (HTI-ISS 22-57) were studied for the effects of immediate versus delayed internal fixation of a femur or acetabular fracture on the pulmonary failure septic state. The pulmonary failure septic state may be defined as an alveolar arterial oxygen tension difference greater than 100, plus fever and leukocytosis. These patients were divided into four groups. Group I (N = 20) had immediate internal fixation, postoperative ventilatory support, and was sitting up at 30 hours. Group II (N = 20) had 10 days of femur traction and postoperative ventilatory support. Group III (N = 9) was immediately extubated after surgery and had 30 days of femur traction. Group IV (N = 7) had special circumstances that should increase the duration of the pulmonary failure septic state. These four groups of patients were statistically identical by 20 different criteria on admission except that Group I had more recognized chest injuries than Group II (12 vs. 9). Group I required 3.4 +/- 2.6 days of ventilator support and 7.5 +/- 3.8 intensive care unit (ICU) days; they had 12 +/- 8.8 elevated white counts, 3.8 +/- 4 febrile days, 0.05 positive blood cultures per patient, four fracture complications out of 93 fractures, 59 injections of narcotics, and 23 +/- 8.6 acute care days. Ten days of femur traction doubled the duration of the pulmonary failure septic state relative to Group I at a statistically significant level for nine out of 10 criteria, while increasing the number of positive blood cultures by a factor of 10, the number of fracture complications by a factor of 3.5, and the use of injectable narcotics by a factor of 2. Thirty days of femur traction increased the duration of the pulmonary failure septic state relative to Group I by a factor of 3 to 5 for all criteria at a statistically significant level, while increasing fracture complications by a factor of 17, positive blood cultures by a factor of 74, and the use of narcotics by a factor of 2. Group IV, which had four out of seven immediate internal fixations, behaved similarly to Group II. Femoral shaft traction should be avoided in the blunt multiple trauma patients because it greatly increases the cost of care and the risk of multiple systems organ failure.(ABSTRACT TRUNCATED AT 400 WORDS)     

Retrograde nailing of femur: surgical technique with tibial traction

A modified surgical technique for femoral retrograde nailing is described. A tibial skeletal traction in the proximal metaphysis is placed to obtain fracture reduction during surgery. This technique enables fracture control during the procedure, avoiding the need of an assistant.     

术前骨牵引与皮牵引对股骨骨折患者手术指标及功能结果的影响

目的：比较术前骨牵引与皮牵引固定对成人股骨骨折手术指标及功能结果的影响,从而指导成人股骨骨折术前牵引方法的选择.方法：2008年2月至2012年9月共收治68例年龄大于18岁的股骨骨折患者,根据入院顺序分成两组,奇数采用胫骨结节骨牵引治疗（A组）,偶数采用皮牵引治疗（B组）.A组男25例,女9例;平均年龄（36.3±9.9）岁;横形骨折11例,斜形15例,螺旋形8例.B组男26例,女8例;平均年龄（37.1±11.0）岁;横形骨折10例,斜形13例,螺旋形11例.对两组的手术时间、术中出血量、输血人数及输血量、骨折愈合时间、血红蛋白、疼痛评分、功能评分等指标进行对比分析.结果：全部病例获得随访,A组随访时间（33.5±6.5）个月,B组随访时间（31.3±7.5）个月.A组手术时间（108.8±14.2） min,术中出血量（383.1±117.1） ml,术后输血14例,输血量（350.0±122.5） ml,骨折平均愈合时间（15.0±3.3）周,B组手术时间（111.6±12.7） min,术中出血量（392.0±116.7）ml,术后输血11例,输血量（327.3±129.1）ml,骨折平均愈合时间（15.5±3.4）周,两组比较差异均无统计学意义.两组在血红蛋白含量、牵引前后疼痛评分、股骨骨折疗效评分、膝关节功能评分及膝关节活动度方面差异均无统计学意义.结论：相对于皮牵引,骨牵引并不能减少成人股骨骨折的手术时间、出血量、疼痛等临床指标,对于骨折愈合速度及肢体的功能结果也无明显提高.     

儿童股骨干骨折并移位的骨牵引治疗

目的总结3～14岁儿童股骨干骨折并移位行股骨髁上骨牵引术的治疗体会.方法屈髋90度,屈膝90度,髋外展30～45度位股骨髁上骨牵引术治疗股骨干骨折.结果 86例患儿疗效均满意.结论该方法简单、有效,既避免了皮牵引的诸多并发症,又减少了切开复位对患儿的身心创伤.     

人工髋关节置换术并发股骨骨折临床分析

目的探讨人工髋关节置换术并发股骨骨折的病因、治疗及预防。方法总结本院１９７２年４月～１９９６年６月行人工髋关节置换术９４５例，其中人工髋关节翻修术１４２例，初次人工髋关节置换术４９３例，人工股骨头置换３１０例。结果术中共发生股骨骨折２５例，总发生率为２．６％，其中人工髋关节翻修术８例，初次人工髋关节置换术１２例，人工股骨头置换５例。结论骨质疏松、医源性、先天性的股骨解剖结构改变以及软组织松解不彻底是发生术中骨折的主要原因。以下措施可有效地预防术中骨折的发生：（１）术前测量髓腔的大小，选择合适的假体；（２）彻底松解髋周软组织，脱位或复位时避免暴力；（３）用长假体应充分扩大髓腔；（４）假体置入时如遇有阻力，应避免强力打入，如突然有突破感，应考虑可能有骨折，应术中透视或照像。     

Management of intraoperative femur fractures associated with revision hip arthroplasty

Femoral fractures sustained during revision total hip arthroplasty (THA) are a serious complication. The incidence of intraoperative femur fractures in the period from 1982 to 1986 was ten in 159 (6.3%) THA revisions. The patients were treated primarily by surgical stabilization with compression plates and screws. All of the fractures healed, but of the ten, only six patients ultimately regained satisfactory THA function.