外固定支架治疗儿童股骨骨缺损及肢体短缩

[目的]探讨外固定支架行骨痂延长治疗儿童股骨化脓性骨髓炎后骨缺损及肢体短缩的疗效.[方法]采用外固定支架对27例儿童(平均12.8岁)股骨化脓性骨髓炎后骨缺损及肢体短缩的患者行骨痂延长术,术前患肢平均骨缺损长度1.2 cm(1.0～1.7 cm),患肢平均短缩4.3 cm(3.0～6.8 cm).[结果] 随访30～112个月(平均86个月),骨不连接处全部愈合,骨延长区骨生长满意.骨延长4.0～8.0 cm,平均6.1cm,平均外固定指数39.2 d/cm(36.8-48.4 d/cm).依据Paley的评定标准,骨愈合情况评定:优21例,良6例;功能评定:优19例,良8例.[结论] 外固定支架行骨痂延长是治疗儿童股骨化脓性骨髓炎后骨缺损及肢体短缩的可靠方法.     

长骨骨不连骨缺损治疗中有关问题的探讨(附27例报告)

目的 报道治疗长骨骨不连骨缺损方法。方法 27例长骨骨不连骨缺损,软组织疤痕形成,采用软组织修复一期或二期用静力型交锁髓内钉内固定,自体骨植骨,术后经皮注射自体红骨髓。结果 全部患者术后1个月出现骨痂,6个月骨折愈合。结论 采用静力型交锁髓内钉、自体髂骨移植,注射自体红骨髓是治疗长骨骨不连有效的方法。     

外固定架结合髓内钉延长术治疗股骨缺损和不等长

目的探讨联合应用髓内钉及外固定架治疗股骨缺损和不等长的方法和疗效。方法2001年1月～2003年12月联合应用髓内钉及外固定架治疗2例股骨缺损分别为8 cm和11 cm的患者、3例股骨短缩为4～7 cm的患者。手术于股骨内顺行置入带锁髓内钉(或保留原有髓内钉),带锁髓内钉仅锁定一端,安装外固定架。4例于股骨近段截骨,1例于股骨远段截骨。5例患者中2例使用Ilizarov重建外固定架,3例使用Orthofix重建外固定架。术后平均延迟16．2 d(13～24 d)后开始牵开延长,1mm/d,共分4次完成。对于股骨短缩患者,当股骨达到预期延长长度后再次手术将髓内钉远端锁定,然后去除外固定架,开始早期功能锻炼。对于骨缺损患者,当股骨达到预期延长长度后仍须等待新生骨痂密度有所增加后将髓内钉远端锁定并去除外固定架。结果5例患者获平均36．4个月(22～47个月)随访,平均延长长度为7．2 cm (4～10 cm),外固定架放置时间平均为5个月(3～8个月),外固定架指数平均为0．75个月/cm(0．57～1．00个月/cm)。所有患者股骨延长段未出现轴向偏移或再骨折,坚实化良好。最后随访时,5例患者膝关节活动度平均为107°(80°～135°)。结论联合应用髓内钉及外固定架肢体延长术能够明显缩短外固定架置放时间,避免肢体畸形,有利于膝关节早期功能恢复,在治疗大段骨缺损及肢体不等长中具有一定优势。手术时间长、术中出血多、治疗费用高和手术切口瘢痕增加是其缺点。     

介绍一种股骨粗隆下截骨延长新方法

利用组合式骨外固定器和股骨带锁髓内钉联合行股骨粗隆下截骨延长术 ,经随访疗效满意。1　手术方法术前测量好患肢股骨的长度及髓腔直径 ,准备好合适规格的带锁髓内钉及组合式骨外固定器一套 (半环式构形带延长杆 )。手术在硬膜外麻醉下进行。顺行打入带锁髓内钉后 ,于小粗隆下 1～ 2ｃｍ处横行截骨 ,截骨后缝合骨膜。通过体外定位装置沿近端 2个锁钉孔打入 2枚螺纹半钉 ,于两螺纹钉之间于股前方打入 1枚螺纹半钉 ,与上述 2枚螺纹钉相垂直。并经过髓内钉的内侧 ,用半环将 3枚螺纹钉连为一体。于股骨髁部在冠状面上打入 2枚 3ｍｍ骨圆针 ,2针…     

带锁髓内钉与钢板内固定治疗长管骨骨折疗效分析

目的　分析比较带锁髓内钉与钢板内固定治疗长管骨骨折的优缺点。方法　将在我院接受内固定治疗的 18岁以上的肱骨、股骨、胫骨三大长管骨骨折 4 33例作回顾性分析。其中带锁髓内钉固定组 191例 ,钢板内固定组 2 4 2例。平均随访 36 5个月。对二组的术前一般情况、术中创伤、术后骨折愈合时间、并发症及功能恢复情况作比较分析。结果　带锁髓内钉组固定强度大可早期负重 ,功能恢复好。但由于对髓内血供的破坏 ,术后出现骨痂时间 (平均 3 89个月 )和骨折完全愈合时间 (平均 15 4 3个月 )较对照组术后出现骨痂时间 (平均 3 2 3个月 )和骨折完全愈合时间 (平均 9 92个月 )迟。统计学分析差异有显著性 (P <0 0 5 )。而闭合复位带锁髓内钉固定的病例出现骨痂时间 (平均 2 73个月 )和骨折完全愈合时间 (平均 12 12个月 ) ,明显早于切开复位内固定者。结论　带锁髓内钉固定切开复位时髓内及髓外血供都要破坏 ,电动扩髓产热引起内侧皮质骨坏死 ,将影响骨折愈合 ,且骨髓炎及骨不连的风险较大。因此带锁髓内钉尽量作闭合复位或微小切开复位。     

骨痂植骨带锁髓内钉固定治疗增生型骨不连

目的分析骨不连的原因,探讨骨痂作植骨材料的可行性和优点及带锁髓内钉固定的优势.方法对48例增生型骨不连先顺行扩髓带锁髓内钉固定,骨折端钻孔并植入骨痂.结果所有病例均4～7个月内达骨性愈合.结论骨痂具有取材方便且与自体松质骨相同的促愈合生物学活性,带锁髓内钉具有固定牢固且对骨折端有一定加压作用,是增生型骨不连治疗的理想植骨材料和固定方法.     

长骨骨不连骨缺损治疗中有关问题的探讨（附27例报告）

目的：报道治疗长骨骨不连骨缺损方法。方法：27例长骨骨不连骨缺损,软组织疤痕形成,采用软组织修复一期或二期用静力型交锁髓内钉内固定,自体骨植骨,术后经皮注射自体红骨髓。结果：全部患者术后1个月出现骨痂,6个月骨折愈合。结论：采用静力型交锁髓内钉、自体髂骨移植,注射自体红骨髓是治疗长骨骨不连有效的方法。     

骨感染

长骨骨折内固定术后迟发性感染的综合治疗；髓内延长修复儿童股骨骨髓炎后骨缺损；带血管骨皮瓣移植治疗胫骨感染性骨不连；前路内固定在治疗胸腰椎结核中的作用；游离髂骨皮瓣移植一期修复胫骨创伤后骨髓炎骨缺损；胸腰椎结核稳定性前路重建26例分析；应用纳米羟基磷灰石；单臂外固定架下骨内移位技术治疗胫骨感染性骨不连；17例颈椎结核外科手术治疗分析     

交锁髓内钉联合骨瓣、骨膜瓣治疗四肢骨不连及骨缺损

目的　探讨应用交锁髓内钉联合带血管的骨瓣、骨膜瓣治疗四肢骨不连、骨缺损的临床效果。方法　应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损 2 4例。全部患者得到随访 ,平均随访时间 1 6年。其中采用带血管腓骨移植 1 5例 ;带血管蒂腓骨转移 2例 ;带血管髂骨瓣 3例 ;带血管股骨内髁骨瓣移植 1例 ;带血管腓骨骨膜移植 4例 ;带血管胫骨骨膜瓣转移 1例。结果　 2 4例患者全部临床愈合 ,未出现感染、髓内主钉及锁钉断裂等并发症 ,关节功能良好。结论　应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损是一种确实有效的方法。     

交锁髓内钉联合骨瓣、骨膜瓣治疗四肢骨不连及骨缺损

目的 探讨应用交锁髓内钉联合带血管的骨瓣、骨膜瓣治疗四肢骨不连、骨缺损的临床效果。方法 应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损24例。全部患者得到随访，平均随访时间1．6年。其中采用带血管腓骨移植15例；带血管蒂腓骨转移2例；带血管髂骨瓣3例；带血管股骨内髁骨瓣移植1例；带血管腓骨骨膜移植4例；带血管胫骨骨膜瓣转移1例。结果 24例患者全部临床愈合，未出现感染、髓内主钉及锁钉断裂等并发症，关节功能良好。结论 应用交锁髓内钉联合带血管的骨瓣、骨膜瓣移植治疗四肢骨不连、骨缺损是一种确实有效的方法。     

Femoral lengthening over a humeral intramedullary nail in preadolescent children

BACKGROUND: Femoral lengthening over an intramedullary nail has been described in adults. A technique of femoral lengthening over a humeral intramedullary nail in children is described, and the results and complications are presented. METHODS: Nine preadolescent patients (average age, nine years and ten months) with femoral length discrepancy were treated with femoral lengthening over a humeral intramedullary nail. After nail insertion, a monolateral external fixator was placed with half-pins either anterior or posterior to the intramedullary nail, and lengthening was performed through a proximal osteotomy. RESULTS: The femora were lengthened a mean of 6.1 cm (range, 5.0 to 8.0 cm), 19.5% (range, 15.9% to 26.2%) of the preoperative femoral length. Patients had a mean lengthening index of 12.2 days/cm of length (range, 9.5 to 16.9 days/cm of length). Five complications including osteomyelitis, failure of the distal interlocking site, and femoral fracture at the distal end of the nail occurred in four patients; four of the complications led to surgical intervention. No case of proximal femoral valgus secondary to nailing through the greater trochanter had developed by the time of final follow-up. All patients were followed for a minimum of two years postoperatively, with a mean of 128 weeks (range, 111 to 161 weeks). CONCLUSIONS: The technique is effective but has a high rate of complications, including osteomyelitis, which developed in two of the nine patients. No avascular necrosis or proximal femoral valgus was noted.     

Spontaneous bone regeneration in surgically induced bone defects in young rabbits

Defects of the femoral shaft (15%, 20%, 25%, and 30% of the femoral length) with intact periosteum were made in young rabbits to investigate differences in union time. The mean union time was 7.3, 7.1, 7.4, and 7.0 weeks, respectively and there was no significant difference ( >0.05) between the groups. The mean healing indices were 6.7, 4.6, 3.9, and 3.1 weeks/cm, respectively and these were significantly different ( <0.05) between the 15% bone defect group and the other bone defect groups. These results suggested that union time was not affected by the amount of bone defect. Femoral lengthening of 20% was performed to compare the quality of callus with those of the femoral defect of 20%. The mean healing indices of defect and lengthening were 4.6 and 5.7, respectively and the difference was significant ( = 0.004). The callus stiffness of femoral defect was higher ( = 0.02) than that after femoral lengthening whereas the bone mineral density of the callus showed no significant difference ( = 0.37) between two groups. The method of filling bone defect with callus generated from the intact periosteum may be a new therapeutic option for the reconstruction of large bone defects in children when other treatments are not available.     

Interlocking nailing of complex fractures of the femur and tibia

The interlocking nail widens the range of indications for medullary osteosynthesis of femoral and tibial shaft fractures. Stability is achieved by transverse threaded bolts in prefabricated holes in the nail, which anchor the implant directly to cortical bone, thereby controlling length, alignment, and rotation of the limb. Two hundred eighty-three femoral and 401 tibial fractures were treated with an interlocking nail and followed for an average of 20 months. Overall, 97% of the femurs and 94.3% of the tibias were judged to have an excellent or good result, based on both clinical and radiographic parameters. Delayed union or nonunion requiring bone grafts occurred in 2% of the femurs and 0.7% of the tibias following interlocking nailing. Deep infection developed in 2.4% of the femurs and 2.2% of the tibias. All of these patients eventually healed their fractures without evidence of chronic osteomyelitis. The main advantage of interlocking nails is that surgery can be performed using closed nailing techniques, allowing early protected weight-bearing and joint motion. The rates of nonunion and infection are very low, and there is little risk of refracture after implant removal.     

有限接触式髓内钉对异体骨愈合及微循环影响的研究

目的设计、制造一种可与人工表面关节结合的有限接触式股骨髁上型带锁髓内钉,构成人工半膝关节系统,用于提高儿童保肢手术效果。方法以家猪为实验对象,分为实验组与对照组两组,植入不同类型髓内钉,建立股骨下段异体骨关节移植动物模型。通过放射影像、微血管墨汁造影及组织学观察,研究髓内钉对异体骨愈合及微循环的影响。结果有限接触式髓内钉对骨再血管化进程的影响小于无槽髓内钉,两组间有显著差异;异体骨愈合速度也较无槽髓内钉快,骨痂密度较高。结论有限接触式髓内钉减少了对骨原有生物环境的破坏,有利于宿主骨-异体骨结合面的愈合,可与人工表面关节结合应用于异体骨关节移植,有较好的临床应用价值。     

游离股前外侧皮瓣带锁髓内钉内固定治疗伴有软组织缺损的胫腓骨骨折

目的探讨用股前外侧皮瓣及带锁髓内钉治疗伴有软组织缺损的胫腓骨骨折的临床疗效。方法伴有软组织缺损的胫腓骨骨折25例,其中GustiloⅢA型12例,ⅢB型13例。清创后皮肤缺损面积(6 cm×11 cm)~(11 cm×25 cm),应用游离股前外侧皮瓣修复。皮瓣以降支及外侧支为蒂21例,横支为蒂2例,横支降支联合为蒂2例。吻合股外侧皮神经与受区皮神经17例,未吻合皮神经8例。骨折均采用带锁髓内钉内固定。结果平均随访14(6~36)月,19例皮瓣完全成活,6例皮瓣边缘部分坏死,经换药和皮片移植而愈合。骨折正常愈合22例,延迟愈合3例,无髓内钉和锁钉断裂,无继发感染及骨髓炎发生。19例有保护性感觉恢复。结论股前外侧皮瓣及带锁髓内钉是修复伴有软组织缺损的胫腓骨中下段骨折较为理想的术式。     

闭合复位交锁髓内钉固定治疗股骨干骨折

目的探讨闭合复位交锁髓内钉治疗股骨干骨折的疗效。方法对32例股骨干骨折应用闭合复位交锁髓内钉治疗，均闭合复位顺行置钉。结果所有患者随访6～26个月，术后复位满意，骨折平均愈合时间12周，术后均愈合良好，无主钉或锁钉断裂，无肢体短缩、功能障碍、感染。结论闭合复位交锁髓内钉是治疗股骨干骨折的一种创伤小、并发症少、骨愈合时间短、术后患者恢复好的内固定方法。     

Indications and results of interlocking nailing of the femur

Since the introduction of an interlocking nail in 1972, different systems have been developed for the management of unstable femoral fractures. At the Clinic for Traumatology at the University Hospital of Zürich, the system of Grosse and Kempf was utilized until 1986, after which the AO universal nail system has been and still is used. Between 1981 and 1987, 63 femoral fractures in 62 patients have been treated with interlocking nails. The fractures were produced by a variety of mechanisms of injury, of which 75% were caused by traffic accidents. Associated injuries to other organ systems were sustained by 73% of the patients, overall there were 33% considered to have multiple trauma. 25% of the fractures were open. 44% (n = 28) required stable fixation, 15 were dynamized. The remaining 35 fractures were treated with dynamic nailings, 8 proximal and 27 distal. 15% were open nailings. Following dynamic stabilization full weight bearing was obtained after 56 and stable fixation after 120 days. A bridging callus was observed after an average of 8 weeks, and cortical bridging at 26 weeks following nailing. Complications included displacement of transversal screws in 3, local infections around the distal or proximal transversal screws in 3 and osteomyelitis at the fracture site in 3 cases.     

肱骨骨不连的手术治疗

目的探讨肱骨骨不连的手术治疗方法及疗效。方法1998年12月～2005年5月共收治肱骨骨不连患者25例,均为肱骨骨折内固定术后发生骨不连,其中3例并发骨髓炎,6例合并不同程度肱骨骨缺损,骨缺损长度为3～6cm。骨不连病程8个月～5年。15例行吻合血管游离腓骨移植,10例采用加压交锁髓内针进行肱骨固定并辅以自体骨植骨。结果术后25例均得到随访,时间6个月～6年2个月。吻合血管游离腓骨移植组中移植的腓骨段均与肱骨干形成骨性愈合,平均骨性愈合时间为3．1个月；交锁髓内针组平均骨愈合时间为3．8个月。按Crates和Whittle肩肘关节功能评价标准,腓骨移植组：优9例,良4例,差2例；交锁髓内针组：优5例,良3例,差2例。结论应用加压交锁髓内针辅以自体骨移植对硬化性肱骨骨不连是一种有效的外科治疗方法；对合并骨髓炎、大段骨缺损及严重骨质疏松的肱骨骨不连,采用吻合血管游离腓骨移植可一期进行修复与重建。     

交锁髓内钉内固定术在股骨干骨折的临床应用

目的探讨交锁髓内钉治疗股骨干骨折的临床应用。方法采用小切口切开复位、交锁髓内钉内固定治疗股骨干骨折164例。结果全部病例均获随访,平均随访14个月,骨折均获得牢固骨性愈合,平均愈合时间为6个月,无感染、断钉等并发症。结论采用小切口开放复位、静力固定治疗股骨干骨折,固定牢固,骨折愈合率高,便于早期关节功能锻炼,是治疗股骨干骨折的最好方法。