微侵袭术式治疗股骨远端骨折

目的 :介绍采用微侵袭术式 3种内固定物治疗股骨远端骨折的临床应用效果。方法 :对 13例股骨远端骨折 (按AO/ASIF分类 ,A型 12例 ,C型 1例 )采用股骨外髁前外侧小切口或髌骨外侧纵行小切口入路间接复位 ,不植骨 ,选用 95°角钢板或解剖形钢板或LISS固定。结果 :全部病例随访 8～ 18个月 ,平均 14个月 ,骨折全部愈合 ,无感染 ,膝关节功能恢复满意。结论 :采用微侵袭术式 3种内固定物治疗股骨远端骨折 ,均不进一步破坏骨折处血运 ,有利于骨折愈合 ,是一种理想的内固定治疗方法 ,但LISS具备自钻、自攻、单侧皮质骨螺钉锁固系统 ,同时具备 95°角钢板、DCS具备的角度稳定特点 ,优点更为突出 ,值得临床推广。     

逆行交锁髓内钉治疗股骨远端骨折

目的 探讨逆行交锁髓内钉在治疗股骨远端骨折中的应用价值。方法 采用逆行交锁髓内钉对22例AO分型为A、C型新鲜股骨远端骨折病例行内固定。结果 所有病例均获随访，21例获牢固骨性愈合，未见畸形愈合、感染。1例发生主钉尾端处骨折，1例发生近端锁钉断裂。术后根据KSS评分体系，评价优14例，良6例，一般2例，优良率90．9％。结论 逆行交锁髓内钉适用于股骨远端骨折，具有高度的稳定性，操作简单，出血少，并发症少，功能恢复快。     

Distal femoral fractures: a review of fixation methods

The treatment of distal femoral fractures has evolved; nevertheless, these fractures remain difficult to treat and carry an unpredictable prognosis. Over the years, many different strategies have been used with varying success. This review outlines the problems presented by distal femoral fractures and the results of current surgical techniques.     

两种手术方式治疗股骨干骨折带锁髓内钉固定术后骨不连

目的通过对比性研究评价两种手术方式治疗股骨干骨折带锁髓内钉固定术后骨不连的疗效。方法回顾分析2009年1月至2010年7月针对41例股骨干骨折带锁髓内钉固定术后骨不连患者采用手术治疗的临床效果,20例行髓内钉取出加滑槽植骨锁定加压钢板固定(A组),21例行断端周围植骨加锁定钢板辅助固定(B组),评估手术时间、手术出血量、植骨愈合率等情况。结果两组患者经8～13个月随访,平均11个月。两组手术时间分别为(130±25)min、(90±17)min,两组间比较差异有统计学意义(P<0.05);手术出血量分别为(436±60)mL、(304±37)mL,两组间比较差异有统计学意义(P<0.05);两组植骨融合率分别为90%、95.2%,两组间比较差异无统计学意义(P>0.05)。结论两种手术方法治疗股骨干骨折带锁髓内钉固定术后骨不连均可得到满意的疗效。骨折断端周围植骨加钢板辅助固定治疗的手术方法具有操作相对简单、手术时间短、创伤小、手术并发症少等优点。     

关节镜辅助下逆行髓内钉治疗股骨远端骨折的疗效观察

目的总结采用关节镜辅助下逆行髓内钉系统治疗股骨远端骨折的临床疗效。方法自2008年2月至2012年8月,用关节镜辅助下逆行髓内钉系统治疗股骨远端骨折13例,左侧6例,右侧7例。其中男8例,女5例;年龄20~72岁,平均49.3岁。按AO分型,A1型9例,A2型4例。采用Merchant评分评价术后膝关节功能。结果 13例患者均获得随访,随访时间为10~34个月,平均18.7个月。术后X线片显示股骨骨折均愈合,无血管神经损伤、感染,膝关节内外翻、内固定松动断裂等发生。按Merchant评分评定,优10例,良2例,可1例,优良率92.3%。结论关节镜辅助下逆行髓内钉治疗股骨远端骨折具有创伤小、操作简单、定位准确、固定牢靠、能及时发现并处理膝关节内病变等优点。     

A Systematic Review of Distal Interphalangeal Joint Arthrodesis

Arthrodesis of the distal interphalangeal joint of the hand is a reliable procedure for creating a painless stable joint. Numerous techniques are described within the literature for varying indications. We undertook a systematic review of all studies published within the English literature to provide a comparison of the different techniques. The published studies were predominantly of Level IV evidence. The most commonly employed techniques were Kirschner wire, headless compression screw and cerclage wires. There was no difference in infection rates. Headless compression screws appear to have increased union rates but are associated with complications not seen with other well-established and cheaper techniques. The screw diameter is often similar to or larger than the joint itself, which can result in penetration. Furthermore, they limit the available angle for achieving fusion. Other than in terms of union, there is insufficient evidence to show the headless compression screw is superior to other techniques.     

逆行交锁髓内钉治疗股骨远端骨折延迟愈合及不愈合

目的 观察逆行交锁髓内钉治疗股骨远端骨折延迟愈合、不愈合的临床疗效。方法 9例股骨远端骨折延迟愈合及不愈合,并伴膝关节不同程度关节功能活动障碍患者,行手术取出内固定,膝关节软组织松解,骨折复位,逆行交锁髓内钉内固定,并取自体髂骨植骨,术后配合CPM行患肢膝关节功能锻炼。结果 术后随访16～26个月全部患者均获得骨性愈合,无内固定物松动、断裂。膝关节功能活动观显改善。结论 逆行交锁髓内钉治疗股骨远端骨折延迟愈合、不愈合,临床效果满意,特别适宜在其它内固定物失败的情况下使用。治疗的关键在于术中膝关节软组织充分松解,骨折块准确复位,扩髓并正确插入合适的髓内钉,静力固定,植骨及术后积极地功能锻炼。     

Management of Periprosthetic Femur Fractures Treated With Distal Fixation Using a Modular Femoral Stem Using an Anterolateral Approach

The authors retrospectively analyzed 27 hips with periprosthetic femoral fractures (types B2 and B3) treated with distal fixation using a modular, fluted, femoral stem. The average follow-up was 4.8 years. Most fractures (25 hips) were united (92.6%), and mean Harris Hip Score at follow-up was 84.7. Subsidence was noted in 2 patients within 6 months postoperatively, but despite the subsidence, one achieved union. One patient developed peroneal nerve palsy. Two hips were defined as failure: one nonunion associated with infection, and the other one had 10 mm more subsidence. No dislocation occurred in any of the patients. This technique has proven to be reliable in the treatment of difficult fractures in the acute stage, although concerns regarding the subsidence remain when using this femoral stem.     

Femoral Neck Fractures in Young Adults

A total of 110 fractures of the neck of femur were studied in 108 patients 17 to 50 years old. The aims were to analyze why these fractures occur in young adults, and what results can be expected after internal fixation.

Severe trauma caused about half of the fractures. In the remaining group chronic and disabling disorders were usually present at the time of injury. Seventeen patients were known to abuse alcohol. Aseptic necrosis with late segmental collapse occurred in 41 per cent of the hips (45/110), comparatively more often in patients who were 45 years or younger. Only 16 of the 73 patients who were seen at follow-up (22 per cent) had a perfect result.

It is concluded that femoral neck fractures in patients younger than 45 years occur because of significant trauma in a healthy subject, or minor trauma in a subject with predisposing disease. The incidence of late segmental collapse is greater than in elderly patients with femoral neck fractures. A less satisfactory result can therefore be expected.     

Femoral Neck Fractures in Young Adults

A total of 110 fractures of the neck of femur were studied in 108 patients 17 to 50 years old. The aims were to analyze why these fractures occur in young adults, and what results can be expected after internal fixation.

Severe trauma caused about half of the fractures. In the remaining group chronic and disabling disorders were usually present at the time of injury. Seventeen patients were known to abuse alcohol. Aseptic necrosis with late segmental collapse occurred in 41 per cent of the hips (45/110), comparatively more often in patients who were 45 years or younger. Only 16 of the 73 patients who were seen at follow-up (22 per cent) had a perfect result.

It is concluded that femoral neck fractures in patients younger than 45 years occur because of significant trauma in a healthy subject, or minor trauma in a subject with predisposing disease. The incidence of late segmental collapse is greater than in elderly patients with femoral neck fractures. A less satisfactory result can therefore be expected.     

股骨重建钉治疗同侧股骨干骨折合并股骨颈骨折

目的:评价Russell-Taylor股骨重建钉治疗同侧股骨干合并股骨颈骨折的临床疗效.方法:对2006年11月至2010年01月有完整临床资料的13例采用Russell-Taylor股骨重建钉治疗同侧股骨干合并股骨颈骨折患者进行回顾性分析.其中男10例,女3例;年龄19～55岁,平均35岁.结果:13例患者平均随访22(13～29)个月,全部股骨干和股骨颈骨折均获得骨性愈合.术后未出现股骨头缺血性坏死.无内固定物失效或感染等并发症,采用Sanders髋关节创伤后功能评分,11例优秀,2例良好.结论:采用股骨重建髓内钉治疗同侧股骨干合并股骨颈骨折,效果可靠,并发症少,疗效满意.     

Clinical Outcome of Free Vascularized Fibula Graft for Nonunion of Garden IV Femoral Neck Fracture of 13 Years Duration: A Case Report

BackgroundFemoral neck fractures in young patients are mostly caused by high‐energy trauma and demonstrate more displacement and vertical fracture surfaces, which increase nonunion and osteonecrosis risks. Free vascularized fibula graft (FVFG) is effective in treating old femoral neck fractures and nonunion; however, available data are limited to patients within 2 years after injury or revision surgery. We present the case of a patient who was diagnosed with femoral neck fracture at the age 9 and treated with FVFG 13 years later.Case presentationA 9‐year‐old Asian girl who experienced left hip pain after an injury was diagnosed with Garden IV left femoral neck fracture, which was treated through manipulation reduction and fixed with splints. At age 16, the pain worsened after another injury and was considered to be in the physical development stage. She refused surgical treatment; hence, the fracture was fixed externally with splints. At age 22, she was hospitalized owing to a 12‐day left hip pain with restricted movement caused by a fall. She was diagnosed with old Garden IV femoral neck fracture nonunion and treated with FVFG. Seven years postoperatively, imaging showed that the left femoral neck was internally fixed, the fracture had healed, and the Harris score was 90 points. The 36‐Item Short Form Health Survey responses revealed that the patient''s physiological functioning, emotional well‐being, energy, and mental health were normal. She achieved satisfactory functional results and resumed her normal daily life.ConclusionFVFG could provide satisfactory outcomes for long‐term old femoral neck fractures.     

Incidence and Stability of Trochanteric Femoral Fractures

Sex, age and stability were recorded in 376 cases of trochanteric femoral fractures. In 168 cases the age and sex specific incidence was determined. When comparing our results with those in previous studies from the same region there was no increase that could not be related to age. This is in contrast to other reports from Scandinavia where investigators have found an increase in fracture incidence that could not be explained by the increasing number of old people. We, as others, have found a high proportion of unstable fractures. The unstable fractures did not occur more frequently in the oldest age groups.