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目的 比较老年人桡骨远端不稳定骨折治疗方法的优缺点.方法 2005年8月至2010年1月,分别采用闭合复位加石膏外固定,开放复位加钢板内固定,开放或闭合复位加外固定支架固定3种方法治疗老年桡骨远端不稳定骨折55例,采用Sarmiento改良的Gartland-werley评分及DASH上肢功能评估问卷进行功能评定.并采用SPSS13.0软件进行统计分析,比较3种治疗方法的优缺点.结果 钢板内固定组及外固定支架组在Gartland-werley评分结果优良率分别达到89.9%(13/18)和83.3%(10/12),均优于石膏外固定组的76.0%(19/25),但3组DASH评分差异无统计学意义.结论 对于老年人桡骨远端不稳定骨折,应根据骨折的具体情况和老年人的要求选择合适的治疗方法.可减少并发症,并获得良好的效果. 相似文献
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石膏固定与外固定架固定治疗老年骨质疏松性桡骨远端关节内骨折的探讨 总被引:2,自引:0,他引:2
目的回顾性研究石膏固定与外固定架固定治疗老年骨质疏松性桡骨远端关节内骨折的疗效。方法对68例新鲜老年骨质疏松性桡骨远端关节内骨折进行了正、侧位X线片检查,并按照AO分级进行分级。采用以下两种方法之一进行治疗:(1)28例采用闭合复位石膏固定;(2)40例采用外固定架。平均随访1.5年。最终采用功能评分(Sarmiento)判定功能。结果石膏固定组优良率为53%;外固定架组优良率为87.5%。结论尽管手法复位石膏固定经济、方便、快速,但应用外固定架固定治疗骨质疏松性桡骨远端关节内骨折能够取得更加良好的效果。外固定架固定对于恢复腕关节功能以及防止该部位再骨折的发生有积极的作用。 相似文献
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老年桡骨远端不稳定骨折术后早期康复干预对腕关节功能恢复的影响 总被引:2,自引:0,他引:2
老年人桡骨远端骨折是临床常见损伤,大多数病例可采用闭合复位石膏固定或小夹板固定,取得满意疗效.但对累及桡骨关节面的不稳定骨折,闭合复位后由于桡骨短缩,骨折畸形愈合,导致腕关节功能障碍非常严重[1].近年来采用手术治疗不稳定型桡骨远端骨折重建腕关节解剖结构逐渐被接受,但由于术后不能配合有效的康复治疗,疗效受到影响,关节功能不能得到最大程度的恢复.我院2003年4月至2006年12月采用切开复位内固定结合外固定支架对桡骨远端不稳定骨折进行腕关节重建治疗,术后早期进行系统的综合康复治疗,取得满意疗效. 相似文献
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目的探讨切开复位与闭合复位治疗老年桡骨远端骨折的临床效果。方法以随机数字表法将66例老年桡骨远端骨折患者分为切开复位组(33例)与闭合复位组(33例),切开复位组予切开复位内固定治疗,闭合复位组予闭合复位石膏(夹板)外固定治疗。观察两组患者的骨折愈合情况、腕关节恢复与功能情况。结果切开复位组和闭合复位组骨折愈合时间分别为(11.2±2.3)周和(10.8±2.1)周,两组比较差异无统计学意义(P0.05)。切开复位组患者的掌倾角、尺偏角、桡骨恢复情况以及腕关节功能评价情况均优于闭合复位组。结论对于老年桡骨远端骨折,采用切开复位内固定治疗,能可靠恢复桡骨长度,可早期功能锻炼,缩短康复时间,获得理想的复位质量和疗效。 相似文献
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《中国老年学杂志》2016,(2)
目的探讨改良手指延长器外固定治疗老年桡骨远端不稳定骨折的临床疗效。方法选取60岁以上手法复位失败的老年桡骨远端不稳定骨折患者86例,其中石膏外固定37例,改良手指延长器复位外固定49例,采用Gartland-Werley腕关节功能评分及PRWE评分评价治疗后3个月、6个月及1年疗效,记录发生的并发症。结果所有患者均获得随访,在并发症、Gartland-Werley腕关节功能评分及PRWE评分上,改良手指延长器外固定治疗组均优于石膏外固定组(P0.05)。结论对于老年桡骨远端不稳定骨折,手法复位效果失败时使用手指延长器治疗能改善患者腕部功能、减少并发症,是一种安全可靠的方法。 相似文献
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《中国老年学杂志》2017,(3)
目的探讨外固定支架结合小夹板外固定术与切开复位内固定术对老年不稳定性桡骨远端骨折的疗效。方法 2012年10月至2016年1月老年桡骨远端骨折患者40例,按照治疗方式分为外固定支架组和钢板固定组,分别于治疗前和治疗6 w、3、6个月时比较两组患者手术时间、骨折愈合时间、掌倾角、尺偏角、桡骨短缩情况以及Mayo腕关节功能评分。结果外固定支架组患者手术时间显著低于钢板固定组(P<0.05)。两组患者骨折愈合时间无统计学差异(P>0.05)。与治疗前比较,治疗后6 w、3、6个月时两组患者掌倾角、尺偏角、桡骨缩短差异显著(P<0.05),但两组组间不同时间点比较无统计学差异(P>0.05)。治疗后6 w和3个月,钢板固定组Mayo腕关节功能评分优良率均显著高于外固定支架组(P<0.05),治疗后6个月时,两组Mayo腕关节功能评分优良率无统计学差异(P>0.05)。结论外固定支架结合小夹板外固定术与切开复位内固定术在老年不稳定桡骨远端骨折患者的治疗效果均较好,值得推广应用。 相似文献
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目的评估外固定支架治疗桡骨远端骨折合并桡腕关节半脱位的疗效。方法采用外固定支架结合克氏针固定治疗26例桡骨远端骨折脱位患者,测定腕关节的活动范围和影像学指标,对腕关节功能进行Gartland-Werley评分。结果术后3、12个月腕关节的活动范围、桡骨高度和桡偏角较对侧正常腕关节比较无统计学差异(P均〉0.05),掌倾角分别恢复51%和49%,显著小于对侧正常腕关节(P〈0.05)。术后3、12个月Gartland-Werley功能评分优良率分别达80.8%、84.6%。结论外固定支架结合克氏针固定治疗桡骨远端骨折脱位疗效可靠,值得临床推广。 相似文献
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目的 研究老年人髋部骨折围手术期精神障碍的发生、预防、治疗及其影响因素.方法 采用美国精神障碍诊断标准(DSM-IV)诊断老年人髋部骨折围手术期精神障碍,回顾性分析148例老年人髋部骨折的手术治疗,按临床特点进行分类,并将精神障碍组与无精神障碍组之间的数据进行统计学分析.结果 本组患者围手术期26例(17.6%)出现精神障碍,平均持续时间为3d,其中22例(84.6%)发生于术后.所有围手术期精神障碍中,狂躁型15例(57.7%)、抑制型4例(15.4%)、混合型7例(26.9%),无围手术期精神障碍者平均年龄(75.5±7.O)岁,围于术期精神障碍者平均年龄(79.6±7.7)岁(t=2.668,P=0.008).5例有既往精神障碍史的患者均出现围手术期精神障碍,5例外同定架治疗者均未出现围手术期精神障碍.结论 围手术期精神障碍是在老年人中枢神经系统功能退化的基础上,由多种因素引起,影响老年人髋部骨折患者的预后,应将其作为一个独立的病症对待,采取积极的综合防治措施. 相似文献
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W G Polak S Pawlowski J Skora L Morasiewicz D Janczak M Oleszkiewicz P Szyber 《VASA. Zeitschrift für Gef?sskrankheiten》2001,30(2):138-140
Iatrogenic vascular injuries from external fixation in orthopaedics and traumatology are frequent. Three cases of vascular injuries after the treatment with Ilizarov external fixators were treated at our institution. These include two cases of pseudoaneurysms and one case of acute ischaemia of the lower limb. Two patients became symptomatic only after removal of the fixator. In all cases, the diagnosis was made by color flow duplex sonography. All vascular injuries needed surgical repair. 相似文献
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Rationale:Floating ankle is a rare traumatic condition characterized by a combination of tibial and ipsilateral foot fractures, with the ankle remaining intact. It is usually caused by high-energy trauma and also presents with serious soft tissue damage. Its treatment is mainly restricted to external fixation, which results in poor outcomes. We present a patient with a floating ankle who underwent staged treatment and achieved full internal fixation, subsequently returning to normal activity.Patient concerns:A 26 year- old man had an accident with an reel machine and sustained an open fracture on his right lower extremity.Diagnoses:Digital radiograph demonstrated a distal tibial fracture, fibular fracture, and multiple metatarsal fractures, which fulfilled the criteria for a floating ankle.Interventions:Initial ankle-spanning external fixation was performed. After 21 days, the patient underwent open reduction and internal fixation on his first and fifth metatarsals, and K-wire fixation on his fourth metatarsal. The external fixator was replaced by plaster fixation. Seven days later, the patient underwent internal fixation of his leg, open reduction and internal fixation with plating was applied of the fibular fracture, and minimally invasive plate osteosynthesis of the tibial fracture.Outcomes:At 1-year follow-up, bone union was identified by digital radiograph; after 2 years, his ankle function had fully recovered, and he resumed his normal activities.Lessons:In the staged treatment protocol of the floating ankle, temporary external fixation provided traction and immobilization of the skeletal and soft tissues. Secondary internal fixation maintained the reduction and alignment and allowed early exercise, which is critical to the prognosis of a floating ankle. 相似文献
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Rationale:To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury.Patient concerns and diagnosis:Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3–10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function.Interventions:All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited.Outcomes:Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73–90) days. The bone transport time was 97 (88.3–105.3) days, and the bone mineralization time was 164.5 (156.8–181.3) days, and the healing time of the docking sites was 6.8 (6.1–8.3) months. The external fixator time was 14.5 (12.5–17) months with the external fixation index was 1.5 (1.4–1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases.Lessons:One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications. 相似文献
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吴丽妮 《实用心脑肺血管病杂志》2009,17(6):515-516
目的通过护理干预观察应用关节镜结合外固定架治疗胫骨远端骨折术后的护理效果。方法总结从2005年9月瑚8年10月共62例Pilon骨折患者临床资料及护理过程,根据手术特点,提出护理问题,制定护理于预计划措施。结果近37%的针眼有渗出(82/248枚),平均在3~4周左右经局部换药痊愈。62例患者中随访骨折全部愈合,平均愈合时间3.2个月,平均去除外固定架时间为4.2个月。无感染、无骨折不愈合。术后随访时Mazur踝关节症状与功能评分量表评定中,总分达92分以上者,46例;总分为87—92分者,10例;总分为65—86分者,6例。无总分低于65分者。结论早期进行关节功能锻炼的康复护理,能有效保证有效功能训练,防止关节肌腱韧带粘连、挛缩,减少踝关节功能障碍的产生,提高术后的功能恢复,Pilon骨折患者术后功能恢复良好。 相似文献
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目的比较Ilizarov外固定架(伊氏架)和截骨融合两种治疗创伤性马蹄足的手术方法。方法选择创伤性马蹄足患者86例,采用截骨融合方法治疗25例,采用伊氏架治疗61例。比较2组术前畸形状态、手术时间、出血量、术后的功能状况及并发症和再手术情况。采用AOFAS评分和VASFA评分评估患者功能恢复情况。结果伊氏架组的跖屈畸形平均52.5°,截骨融合组的跖屈畸形平均47.6°,两组之间没有统计学差异(P=0.739)。术中出血截骨组为(136.2±110.7)ml,伊氏架组为(26.0±35.6)ml,截骨组出血量多于伊氏架组(P〈0.01)。两组手术时间、AOFAS评分、VASFA评分差异均无统计学意义(P〉0.05)。结论 Ilizarov外架和截骨融合两种方法疗效相似,术后功能恢复程度相近,且手术创伤较小。 相似文献
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目的:探讨外固定支架行损伤控制治疗在创伤骨科修复中的作用。方法选取该院骨科2011-01~2012-12收治的创伤性股骨骨折患者92例随机分为两组,对照组46例行一期切开复位内固定术;观察组46例行一期外固定术,待病情稳定后行二期切开复位手术。比较两组患者手术时间、切口长度、骨折愈合时间、乳酸持续时间和凝血恢复时间等指标。结果观察组的手术时间、切口长度、骨折愈合时间、乳酸持续时间和凝血恢复时间均明显短于对照组( P<0.01)。结论外固定支架在骨科修复时进行创伤控制效果良好,值得临床推广应用。 相似文献