双臂组合式外固定支架联合内固定治疗小腿开放性骨折

目的 探讨双臂组合式外固定支架联合内固定治疗小腿开放性骨折的临床疗效.方法 回顾性分析1999年1月～2010年12月收治的有完整随访资料的小腿开放性骨折病例298例,均采用双臂组合式外固定支架联合拉力螺丝钉、克氏针内固定治疗.按Gustilo分型:Ⅰ型82例、Ⅱ型106例、ⅢA型74例、ⅢB型33例、ⅢC型3例.软组...     

钢板内固定与经皮克氏针固定治疗桡骨远端骨折疗效比较

目的 比较切开复位钢板内固定和经皮克氏针固定治疗桡骨远端骨折的临床疗效.方法选取2002年1月-2007年6月收治的110例行切开复位内固定的桡骨远端骨折患者,选取同期107例行经皮克氏针固定的患者,随访比较两组临床疗效. 结果 所有患者随访5-12个月,按Gartland和Werley评分标准,钢板内固定组的优良率为86.4%,经皮克氏针固定组优良率为74.8%(P<0.05).而C3型骨折单独比较,两组优良率分别为76.9%和70.0%(P>0.05). 结论 切开复位内固定治疗桡骨远端骨折总体临床疗效优于经皮克氏针组,但治疗C3型骨折疗效欠佳.     

外固定支架联合加压钢板内固定序贯治疗胫腓骨开放性骨折疗效观察

目的 探究外固定支架联合加压钢板内固定序贯治疗胫腓骨开放性骨折的临床疗效.方法 选取2017年1月至2020年7月舞阳县保和卫生院收治的58例胫腓骨开放性骨折患者作为研究对象,按照治疗方法将其分为序贯治疗组(31例)与终末治疗组(27例),序贯治疗组患者早期行外固定支架治疗后更换为加压钢板内固定治疗,终末治疗组患者单纯...     

早期内固定治疗多发性肋骨骨折40例

对40例多发性肋骨骨折用可吸收肋骨钉行内固定手术治疗.所有病例手术顺利,术后胸痛明显好转,无严重并发症发生.多发性肋骨骨折早期行内固定治疗可以取得良好疗效.     

微型钛板内固定治疗掌骨骨折

掌骨骨折在手部外伤中占有很大比例,以往传统的治疗方法有闭合手法复位石膏固定以及切开复位克氏针钢丝内固定,固定范围较大,固定的牢固程度有限,不足以维持骨折部位的充分稳定,固定时间相对较长,不利于早期功能锻炼,常导致手的功能恢复欠佳.自2002年6月以来我院应用国产微型钛板治疗掌骨骨折28例,术后早期功能锻炼,取得满意疗效.     

后路短节段椎弓根螺钉固定治疗上颈椎损伤

探讨后路短节段椎弓根螺钉固定治疗上颈椎损伤治疗的手术疗效.10例上颈椎损伤患者应用椎弓根螺钉固定,术后经随访内固定牢固无松动,均获得骨性愈合,神经功能恢复好.作者认为短节段椎弓根螺钉固定治疗上颈椎损伤,具有三柱固定、固定牢固优点,手术效果好.     

切开复位内固定与牵引复位外固定支架固定治疗骨盆骨折疗效对比

【摘要】 目的 对比分析切开复位内固定与牵引复位外固定支架固定治疗骨盆骨折的临床疗效。方法 选取2018 年 1 月至 2020 年 4 月铁岭市中心医院收治的 72 例骨盆骨折患者作为研究对象, 按照随机数表法将其随机分为内固定组 (36 例) 与外固定组 (36 例), 内固定组患者采用切开复位内固定治疗, 外固定组患者采用牵引复位外固定支架固定治疗, 对比观察两组患者切口长度等手术相关指标、引流管拔除时间等治疗情况、应激反应水平、术后髋关节功能恢复情况及并发症发生情况。结果 内固定组患者切口长度、手术时间、引流管拔除时间、住院时间以及骨折愈合时间均明显长于外固定组 ( t = 3.801、12.001、6.065、5.818、4.396, P 均<0.001), 术中出血量明显多于外固定组 (t = 12.230, P < 0.001); 术后1周, 内固定组患者血清皮质醇 (Cor)、促甲状腺激素 (TSH) 及肾上腺素 (AD) 水平均明显高于外固定组 ( t = 11.852? 22.016? 10.963, P均<0.001); 术后 6 个月, 内固定组患者髋关节功能恢复优良率为 77.78% , 明显低于外固定组患者的髋关节功能恢复优良率94.44% (χ2= 4.181, P = 0.041); 内固定组患者术后并发症发生率为11.11% ,与外固定组患者的术后并发症发生率 5.56%无明显差异(χ2= 0.727, P = 0.394)。结论 与切开复位内固定相比, 牵引复位外固定支架固定治疗骨盆骨折可明显减轻机体应激反应, 加快术后机体功能恢复, 提高临床疗效。     

外固定支架立体固定联合有限内固定治疗胫腓骨开放粉碎性骨折

目的：探讨胫腓骨开放粉碎性骨折的治疗方式及其效果。方法：回顾分析2009—08～2012—10收治的,使用多功能外固定支架立体固定联合有限内固定治疗胫腓骨开放粉碎性骨折80例,术中可根据骨折复位情况行有限内固定,术后指导患者积极患肢功能锻炼,一周左右持拐不负重下床活动,术后平均随访18个月。结果：80例患者骨折正常愈合,愈合时间4～13个月,平均7．5个月,术后疗效：优58例,良16例,可4例,差2例,优良率92．5％。结论：多功能外固定支架立体固定联合有限内固定治疗胫腓骨开放性粉碎性性骨折是一种简单、安全、创伤小、复位好、固定可靠,可实现患肢早期功能锻炼,是治疗胫腓骨开放粉碎性骨折的较好方法。     

外固定支架结合有限内固定治疗C3型Pilon骨折临床分析

总结应用混合外固定支架结合有限内固定治疗28例C3型Pilon骨折的临床资料,认为其方法对软组织损伤重、腓骨骨折及胫骨十骺端粉粹性骨折是一种效果较好的治疗方法.     

分体式髌骨爪与髌骨环固定治疗髌骨骨折的疗效比较

对27例髌骨骨折采用髌骨爪内固定治疗,对24例髌骨骨折采用髌骨环内固定治疗,所有患者骨折均获愈合.髌骨爪治疗组综合优良率95.05%,髌骨环组综合优良率83.73%.髌骨爪相比较髌骨环治疗髌骨骨骨折,操作简单,固定牢靠,适合各种髌骨骨折.     

桥接组合式内固定系统治疗肱骨骨折疗效观察

目的探讨桥接组合式内固定系统治疗肱骨骨折的疗效。方法随机选取自2013年6月至2014年12月云南省第三人民医院骨伤科收治的肱骨干骨折患者50例。根据手术方法不同进行分组,其中,桥接组患者26例,钢板组患者24例。比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、内固定后并发症、肩肘关节功能评分等指标,对桥接组合式内固定系统治疗肱骨骨折的临床疗效做出评价。结果桥接组患者在手术时间、出血量、骨折愈合时间等方面均优于钢板组,差异均有统计学意义(P<0.05)。两组患者住院时间及肩、肘关节功能评分比较,差异无统计学意义(P>0.05)。两组患者术后均未出现骨不连、桡神经损伤等并发症。结论桥接组合式内固定系统治疗肱骨骨折在临床疗效、愈合时间、并发症、肩肘关节功能恢复等方面均有显著优势。另外,桥接组合式内固定系统在操作方面较锁定钢板更为简便,结构更稳固。     

后路钉棒系统术中复位内固定治疗寰枢椎脱位

目的 分析后路钉棒系统术中复位内固定治疗在寰枢椎脱位的临床效果.方法 回顾分析2007年1月-2009年5月治疗的寰枢椎脱位患者27例,男18例,女9例;年龄13～51岁,平均31岁.其中,陈旧性齿状突骨折11例,齿状突游离小骨5例,寰椎横韧带断裂7例,类风湿性寰枢椎脱位4例.所有患者术前均难以获得良好复位,寰齿间距(atlantodens interval,ADI)8～15 mm,平均11mm.术中采用后路寰枢椎椎弓根螺钉固定,利用弯棒提拉进行复位,并行椎板间植骨.治疗前按美国脊髓损伤协会(ASIA)分级:B级8例,C级15例,D级4例.结果 随访时间6～24个月,平均13个月.所有患者枕颈部症状得到改善,均获得骨性融合.术后ADI为2～4 mm,平均2.8 mm.术后ASIA脊髓神经功能分级:C级4例,D级12例,E级11例.无椎动脉及脊髓神经损伤患者.无内固定脱落、断裂、退钉等并发症.结论 后路钉棒系统能够对寰枢椎脱位进行有效的术中复位,具有操作简单、并发症少、疗效确切的优点.     

微型外固定器治疗髌骨骨折

用微型外固定器治疗髌骨骨折32例,随访1～3年,优良率达90．6％。微型外固定器治疗髌骨骨折具有固定坚实、操作方便、简单易行、创伤小、取出方便等优点。     

内、外固定结合治疗合并髁部骨折的股骨干复杂骨折

目的 探讨合并髁部骨折的股骨干复杂骨折(A0 C2、C3型)的外固定支架手术治疗方法及后续治疗的临床效果评价.方法 对2001年1月-2007年1月通过手术治疗的累及股骨髁骨折的42例股骨干粉碎性骨折患者的治疗结果进行分析.按AO/ASIF原则分类,股骨干中远端骨折分别为C2型(多段骨折)18例,C3型(不规则)骨折24例.手术采用简单内固定加外固定架固定C3型,单纯外固定架固定C2型;4例采用续贯固定.结果 42例患者全部获随访,按Kotmert股骨远端骨折功能评价标准,膝关节功能满意35例(83%),可6例(14%),不满意1例(2%).结论 通过外固定支架的方法治疗合并髁部骨折的股骨干复杂骨折(A0 C2、C3型)可最大限度地恢复股骨的相对长度,且便于在术后对股骨关节面与股骨干纵轴进行水平和纵向调整,使其与对侧股骨中下段达到解剖平行对称关系;术后配合合理的康复锻炼,能使膝关节功能得到最大的恢复.股骨管状结构重建在此类骨折的治疗中应受到重视.     

External fixation combined with limited internal fixation in the treatment of pilon tibia fractures

BACKGROUND/AIM: Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. METHODS: The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Nis (1995-2004). Within the analayzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitkovi?" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. CONCLUSION: Considering the results obtained in this study, it can be concluded that external fixation by the "Mitkovi?" external fixator with the minimal internal fixation is a satisfactory method for the tratment of fractures of the tibial plafond causing less complications than internal fixation.     

克氏针张力带内固定并外固定支架治疗Ⅲ型Pilon骨折27例

对27例Ⅲ型Pilon骨折采用切开复位克氏针张力带内固定 外固定支架治疗,平均随访14个月,关节功能按Mazur[1]评分系统评定,优16例,良7例,可2例,差2例.认为本方法对骨折血运破坏小,局部软组织切开少,手术方法简单,通过其独特的牵开作用牵开肌腱,韧带,关节囊等软组织使骨折复位.     

有限内固定结合外固定架治疗胫骨中段B型骨折

有限内固定结合外固定架方法治疗胫骨中段B型骨折45例,平均骨折愈合时间为2个月;无手术损伤并发症,患者膝踝关节功能恢复良好。     

Graft healing in a bone tunnel: bone-attached graft with screw fixation versus bone-free graft with extra-articular suture fixation

The purpose of this study was to clarify differences in tendon graft–to–bone tunnel healing between bone-attached tendon grafts with interference-screw fixation and bone-free tendon grafts with extra-articular suture fixation. In 42 Japanese White rabbits, anterior half replacement of the medial collateral ligament was performed using half of the ipsilateral patellar tendon. At the femoral attachment, the bone-plug-attached graft was fixed with an interference screw (group A). The bone-plug-free graft was fixed by the extra-articular suture fixation technique with sutures tied over a button (group B). Biomechanical and histological evaluations were performed at 2, 4 and 8 weeks postoperatively. In biomechanical evaluation, at 2 or 4 weeks 27 of 28 specimens (96%) were pulled out from the femoral tunnel, while one 4-week specimen and all four 8-week specimens failed at the grafts mid-substance. At 2 weeks, the maximum failure load was 25±10 N and 24±6 N for group A and group B respectively (mean±SD). At 4 weeks, the maximum failure load was 42±17 N and 35±15 N respectively. There were no significant differences in maximum pullout failure load between the groups at 2 or 4 weeks postoperatively. (P=0.887 at 2 weeks and P=0.339 at 4 weeks using ANOVA measurement). Histologically, the bone-attached grafts showed partial bone–to–bone union at the graft–bone tunnel interface at 4 weeks, and complete bony union at 8 weeks. The bone-free grafts exhibited newly formed Sharpey-like collagen fibers at 4 weeks, and strong connection by mature granulation tissue at 8 weeks. Graft–to–bone tunnel healing of bone-attached graft with screw fixation and bone-free graft with extra-articular suture fixation are comparable in terms of biomechanical evaluation during the early postoperative periods.     

Anatomical double-bundle MPFL reconstruction with an aperture fixation

Since biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the main restraint against lateral patella displacement, reconstruction of the MPFL has become an accepted method of restoring patellofemoral stability and numerous techniques were described. Due to biomechanical examinations and clinical results, an anatomical double-bundle reconstruction of the “sail-like” MPFL is a reasonable method for achieving stability during complete extension and lower flexion degree. This method also serves to avoid rotation of the patella, providing immediate stability throughout the normal range of motion. However, until today, an aperture fixation technique at the patellar insertion with two bundles has not been described previously. This technique can provide an immediate stability to allow an early rehabilitation with full range of motion.