克氏针钢丝张力带固定治疗尺骨冠状突骨折

本院自1996～2003年，治疗有移位的尺骨冠状突骨折12例，均采用切开复位克氏针钢丝内固定法治疗，经6个月～6年的随访，疗效极佳，介绍如下。     

克氏针,钢丝张力带固定治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折系肘部常见损伤 ,直接暴力及间接暴力均可造成 ,成人多见 ,大多数为关节内骨折。由于肘关节伸、屈肌的作用 ,骨折块容易发生分离移位 ,如处理不正确 ,易引起创伤性关节炎和功能障碍。1 987年 1 0月～ 1 997年 1 0月我们用克氏针、张力带固定方法治疗横形、斜形尺骨鹰嘴骨折共 1 0 5例 ,获得十分满意的疗效。临床资料一、一般资料　本组 1 0 5例 ,男 87例 ,女 1 8例。年龄 1 7～ 62岁 ,均为外伤所致 ,包括横形骨折 64例 ,斜形骨折 41例 ,其中开放性骨折 1 4例 ,0～ 7天内进行手术。二、手术方法　本组均采用臂丛神经阻滞麻醉。患…     

克氏针钢丝张力带内固定治疗肱骨近端骨折

对于移位明显的肱骨近端骨折 ,闭合复位很难达到满意效果 ,多需开放复位内固定治疗。 1997年 1月～ 2 0 0 0年 5月 ,笔者采用切开复位克氏针、钢丝张力带内固定的方法治疗肱骨近端移位骨折(不包括单纯大、小结节骨折 ) 2 0例。经过 6个月～ 3年的随访 ,效果满意。1　材料与方法1.1　病例资料　本组 2 0例。男 15例 ,女 5例 ,年龄 10～ 78岁 ,左侧 8例 ,右侧12例。致伤原因 :车祸伤 9例 ,摔伤 10例 ,病理骨折 1例。按Neer分型为 :Ⅱ型 8例 ,Ⅱ型并肩关节脱位 5例 ,Ⅲ型 5例 ,Ⅳ型 2例。伤后至就诊时间 :1h～ 3d。伴肩袖损伤 6例、关节囊损伤…     

经皮克氏针钢丝张力带内固定治疗尺骨鹰嘴骨折

目的评价经皮克氏针钢丝张力带内固定治疗尺骨鹰嘴骨折疗效。方法对本院2005年7月至2009年5月32例尺骨鹰嘴骨折患者采用经皮克氏针钢丝张力带内固定治疗。所有患者均为闭合性骨折,尺骨鹰嘴骨折按Cohon分型：Ⅰ型撕脱型9例,Ⅱ型斜型15例,Ⅲ型8例,对所有患者随访,并对随访患者按Broberg和Morrey评估标准评定。结果手术时间平均为40～60分钟,本组32例全部随访6个月～3年,平均14个月。全部骨性愈合,关节功能恢复良好,无感染、断针、创伤性关节炎等情况。按Broberg和Morrey评估标准,优22,良8例,可2例,差0例,优良率93．8％。结论经皮克氏针钢丝张力带内固定治疗尺骨鹰嘴骨折疗效确切,创伤小,操作简单,并发症少。     

改良克氏针钢丝张力带固定治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折是肘部常见的损伤。治疗方法很多，张力带固定技术的应用，使尺骨鹰嘴骨折的治疗效果得到了很大的改善。自1998年以来，笔采用改良克氏针钢丝张力带内固定治疗尺骨鹰嘴骨折35例，疗效满意，报告如下。     

克氏针联合张力带钢丝内固定治疗掌骨头骨折

目的 研究克氏针联合张力带钢丝内固定治疗掌骨头骨折的临床效果.方法 2003年7月一2009年3月,我院对68例84指掌骨头骨折应用克氏针张力带钢丝进行内固定,并辅以早期的功能锻炼.结果 术后,68例中65例伤口或切口一期愈合,3例骨外露,其中1例因克氏针旋转、钢丝脱落导致骨折移位.随访12～68个月,平均40个月.X片示骨折愈合时间～612周,平均8周,按TAM功能评分标准评定,优良率91%.结论 应用克氏针联合张力带钢丝内固定治疗掌骨头骨折是一种可靠的治疗方法.     

克氏针及张力带钢丝固定治疗不稳定性指骨干骨折

2002年3月-2004年5月，我院应用克氏针及张力带钢丝内固定治疗17例22指不稳定性指骨干骨折，术后取得了满意的疗效。     

克氏针张力带钢丝治疗髌骨骨折

自1988年3月～1995年9月，我院手术治疗单纯髌骨骨折86例，效果良好，报告如下。临床资料本组86例中男57例，女29例；年龄19～72岁；新鲜骨折81例，陈旧性骨折5例；横断骨折38例，粉碎性骨折36例，下极骨折12例。治疗方法腰麻或持续硬膜外麻醉，髌前弧形切口，常规显露，消除积血。横断骨折，首先于近骨折端断面定两点，大致位于髌骨中外和中内1／3交界处，矢状面中点或稍偏后方。自两点分别向上逆行打入2mm克氏针，于股四头肌腱近髌上极处穿出，斜形剪断针尾，继续向上推进至针尾与骨折面相平。使骨折复位，大巾钳维持位置，将克氏针顺行打…     

克氏针张力带内固定配合U型石膏治疗Pilon骨折

目的 探讨克氏针张力带内固定配合U型石膏治疗Pilon骨折的临床疗效。方法 采用克氏针张力带内固定配合U型石膏治疗Pilon骨折27例。根据AO分型,C1型4例,C2型19例,C3型4例。按Helfet评价标准进行疗效评价。结果 全部病例获得随访,时间5～36个月,平均13个月。骨折愈合时间9～13周,踝关节功能评分：优20例,良6例,差1例。结论 克氏针张力带内固定配合U型石膏治疗Pilon骨折优良率高,并发症少,手术简单。     

钢丝贯穿环扎内固定治疗尺骨冠状突骨折

尺骨冠状突骨折约占全身骨折的1%以下[1],1998年2月~2004年3月,我科应用钢丝贯穿环扎内固定治疗尺骨移位冠状突骨折21例,取得良好疗效。1材料与方法1.1病例资料本组21例,男12例,女9例,年龄18~54岁。左侧14例,右侧7例。单纯尺骨冠状突骨折3例,尺骨冠状突骨折合并桡骨头骨折4例,肘关节后脱位14例。根据Regan-M arry分型[2]:Ⅰ型:冠状突顶部的小块撕脱骨折;Ⅱ型:单一或多个粉碎的骨块,骨折部分不超过冠状突的50%,常合并肘关节脱位;Ⅲ型:单一或多个粉碎的骨块,骨折部分超过冠状突的50%。本组Ⅰ型4例,Ⅱ型17例,Ⅲ型无。致伤原因:跌伤14例,车祸伤…     

Fractures of the ulnar coronoid process

The ulnar coronoid process plays a central role in elbow stability due to its unique anatomic characteristics. A fracture of the coronoid, although uncommon, represents a serious injury that can adversely affect functional outcome if not treated appropriately. Several surgical interventions addressing different fracture patterns are being increasingly recognised as effective treatment options even for smaller fragments. A review of the literature was performed in order to evaluate different treatment strategies applied to clearly defined fracture configurations. 14 articles reporting data for the management of 236 coronoid fractures met our inclusion criteria and were subjected to critical analysis. The data suggest that recognition of specific coronoid fracture patterns, use of appropriate classification systems and application of staged surgical protocols can stabilise the elbow effectively and lead to favourable outcomes.     

髌骨鹰嘴化结合张力带钢丝治疗髌骨下极骨折

目的探讨应用髌骨鹰嘴化结合张力带钢丝治疗髌骨下极骨折的临床疗效。方法2001年6月～2004年11月应用髌骨鹰嘴化结合张力带钢丝治疗髌骨下极骨折34例,术后2～3周进行屈膝功能锻炼。结果28例随访9～30个月,平均21个月,按陆裕朴疗效评价方法:优21例,良5例,可2例,优良率92.9%。结论髌骨鹰嘴化结合张力带钢丝治疗髌骨下极可以恢复关节面的解剖关系,有利于膝关节早期运动,避免关节僵硬及创伤性关节炎的发生,是治疗髌骨下极骨折较好的方法。     

Comparing hook plates and Kirschner tension band wiring for unstable lateral clavicle fractures

The purpose of this study was to compare outcomes and complications of clavicular hook plate and Kirschner tension band wiring for fixation of unstable lateral clavicle fractures. The surgical outcomes of 92 consecutive patients (mean age, 49.30 ± 15.54 years) with unstable fractures of the lateral clavicle treated using AO clavicle hook plates were compared with those of 24 patients (mean age, 50.67 ± 17.58 years) treated using K-wire tension banding. Patients in the hook plate and K-wire groups were followed up for 22.76 ± 2.22 and 25.67 ± 2.75 months, respectively (P<.001). The time to hardware removal was significantly shorter (P<.001) in the hook plate group (5.20 ± 1.93 months) compared with the K-wire group (7.58 ± 2.00 months), whereas the Constant-Murley score was significantly higher (P<.001) in the hook plate group (90.43 ± 4.78) compared with the K-wire group (85.63 ± 5.38) at final follow-up. There were 12 complications in the hook plate group and 7 in the K-wire group (P=.069). Complications in the hook plate group included 7 periprosthetic fractures, 4 plate removals, and 1 plate malposition. Complications in the K-wire group included 3 K-wire migrations, 3 losses of reduction, and 1 wire breakage. We found that hook plate fixation of unstable lateral clavicle fractures was associated with statistically better shoulder function and earlier implant removal than K-wire tension band fixation, with an equivalent rate of complications. Our findings suggest that hook plates are useful for treating unstable lateral clavicular fractures.     

克氏针加张力带钢丝治疗胸锁关节脱位

胸锁关节脱位手术复位内固定的方法很多，多因固定不够牢固而遗留不同程度脱位畸形，疗效不理想。特别是合并有胸锁端锁骨骨折时，固定更为困难，为提高疗效，我们改进了克氏针加钢丝的固定方法，经12例临床观察，疗效满意。     

Avulsion fractures of the tibial tuberosity in adolescents treated by tension band wiring

This study deals with the surgical treatment and the results of 7 avulsion fractures of the tibial tuberosity in adolescents. All the patients were treated in our department from 1977 to 1989. These are mainly athletic injuries accounting for less than 3% of all epiphyseal bones and they have not been widely reported in the orthopaedic literature. It is a different entity from Osgood Schlatter disease which is noted as a predisposing factor. The mechanism of injury consists of sudden, unexpected contraction in the quadriceps while the knee is being forcibly flexed. The closing physis of the tuberosity cannot resist the increased tensile forces and it is avulsed. Operative treatment was thought necessary for all our cases due to tibial tuberosity displacement and open reduction, internal fixation with tension-band technique was used. This lessens the need for immobilization at the joint following surgery.Functional results were very good and all the patients returned to their previous athletic activities.     

Treatment of phalangeal fractures by tension band wiring

This retrospective study assessed the outcomes of 30 patients with phalangeal fractures which were treated by open reduction and tension band wiring. Oblique, transverse and comminuted extraarticular fractures, as well as intraarticular fractures, were treated with this technique and they all united in about 8 weeks. There were no significant complications. At a mean follow-up period of 2.3 years, the active range of movement of the involved fingers was excellent in 17, and good in 13 instances. There were no fair or poor results.     

Fractures of the coronoid process

INTRODUCTION: A retrospective study has been made of a series of 22 cases, and the classification and treatment of fractures of the coronoid process of the ulna have been discussed. MATERIAL, METHODS AND RESULTS: A report has been made of 22 cases of coronoid process fracture (18 males and four females). The mean age was 26 years (range: 19-47 years). According to the Reagan and Morrey Classification, there were 11 type I (avulsion of the tip of the bone), seven type II (a fragment of less than 50% that was detatched from the coronoid process), and four type III cases (a fragment of more than 50% that was detatched from the coronoid process). Elbow dislocation was present in 16 cases, and a radial head fracture was associated in four cases. All type I fractures were treated by immobilization of the elbow in a plaster cast for ten to 15 days, with eight excellent and three good results. In type II fractures, open reduction, internal fixation with antero-posterior lag-screw and early post-operative movement in three patients gave better results than immobilization for three weeks, which was the procedure used in four cases (after transosseous reinsertion in one case). In type III fractures, good results were obtained following open reduction and internal fixation with antero-posterior lag-screw in three patients. The result was average in the fourth case, with immobilization for four weeks. CONCLUSION: The Reagan and Morrey classification is most useful for the classification of coronoid process fractures. If there is no comminution of the detatched fragment, open reduction and internal fixation with antero-posterior lag-screw is the treatment of choice in type I and II fractures. In type I fractures, immobilization for about two weeks gives good results.     

Fractures of the coronoid process

Proper treatment of coronoid fractures requires an understanding of the bony and soft tissue anatomy of the elbow and the various injury mechanisms that occur. Newer fracture classifications help direct treatment based on the size and location of the fracture, injury mechanism, and associated stability of the elbow.     

分叉克氏针治疗尺骨鹰嘴骨折

尺骨鹰嘴骨折是临床上较常见的骨折之一，治疗方法较多，其中应用最普遍的是张力带钢丝固定。但尺骨鹰嘴粉碎性骨折及小块撕脱骨折仍较难处理，为此我们自行改制了一种分叉克氏针，从2003年4月～2006年5月，应用该种克氏针治疗尺骨鹰嘴骨折30例，取得了较好的疗效。本文介绍了分叉克氏针的治疗方法，并与张力带钢丝治疗方法进行比较，旨在评价其疗效。     

Biomechanical comparison of tension band suture fixation and tension band wiring in olecranon fractures

PurposeTraditional tension band wire fixation (TBWF) of olecranon fractures is associated with high revision rates due to implant-related complications. The purpose of the study was to compare the strength of fixation in olecranon fractures between TBWF and an all-suture based technique.MethodsA transverse fracture was created in 20 paired fresh-frozen human cadaveric elbows. Fractures were randomly (alternating right-left) assigned for fixation with either tension band suture fixation (TBSF) or TBWF. The elbow was fixed in 90° of flexion and underwent cycling loading by pulling the triceps tendon to 300 N for 200 cycles. Fracture displacement was optically recorded using digital image correlation (DIC). Finally, load-to-failure was assessed by a monotonic pull to 1000 N and failure mechanism was recorded.ResultsTwo specimens in the TBSF group were excluded from the cycling loading analysis due to technical difficulties with the DIC. After cyclic loading, median (min-max) fracture displacement was 0.28 mm (0.10–0.44) in the TBSF group and 0.18 mm (0.00–1.48) in the TBWF group (p = 0.315). No difference was found between the two groups in the repeated measures analysis of variance (p = 0.329). In the load-to-failure test, 6/10 specimens failed in the TBSF group (median load-to-failure 791 N) vs. 8/10 in the TBWF group (median load-to-failure 747 N). The TBSF constructs failed due to fracture of the dorsal cortex, suture breakage or triceps failure. The TBWF constructs failed due to breakage of the wire.ConclusionThere was no difference in fixation strength between the TBWF and TBSF constructs. Our findings suggest TBSF to be a feasible alternative to TBWF and we hypothesize that a non-metallic implant may have fewer implant-related complications.Level of evidenceBasic science study