桡骨近端解剖型锁定钛板内固定治疗老年桡骨头骨折的疗效

<正>桡骨头骨折为肘部严重的关节内骨折,使用锁定钛板治疗桡骨头骨折国内少见报道。本文对2012²013年采取切开复位解剖型锁定钛板内固定术治疗的5例老年桡骨头骨折患者进行分析,病例资料完整及获得随访。1临床资料1.1材料与方法 5例患者中男4例,女1例;年龄552013年采取切开复位解剖型锁定钛板内固定术治疗的5例老年桡骨头骨折患者进行分析,病例资料完整及获得随访。1临床资料1.1材料与方法 5例患者中男4例,女1例;年龄55⁷6〔平均(67.7±10.7)〕岁;其中左侧2例,右侧3例;损伤原因:     

桡骨远端T型锁定接骨板治疗老年桡骨远端不稳定性骨折的疗效

<正>桡骨远端不稳定性骨折多见于有骨质疏松的老年人〔1〕。传统临床治疗多采用外固定支架治疗,即手术复位后以石膏托进行固定,但是临床报道证实治疗后患者的腕关节活动度受到一定程度的限制,并且会给患者带来不同程度的并发症〔2〕。随着骨折治疗技术的不断进步,通过手术治疗桡骨远端不稳定性骨折逐渐受到临床医生的广泛关注。本研究桡骨远端不稳定性骨折的患者为对照,旨在比较桡骨远端T型锁定接骨板和外固定支架治疗老年桡骨远端不稳定性骨折的临床疗效及术后     

锁定接骨板治疗桡骨远端骨折34例疗效观察

目的评价锁定接骨板治疗桡骨远端骨折的临床效果。方法选取确诊桡骨远端骨折34例患者（左侧14例,右侧20例）,手术切开复位后,利用锁定加压接骨板对桡骨远端骨折行内固定治疗。术前预防性应用抗生素,术后腕关节功能位石膏外固定1周,配合肢体静脉泵消肿治疗,术后1~2周逐渐适度行患肢腕关节功能锻炼。结果患者术后均获得随访,平均随访9个月（6~18个月）。根据Gartland Werley评分标准,优22例,良10例,可2例,优良率达94.12%。结论锁定接骨板治疗桡骨远端骨折效果良好,值得临床推广应用。     

外固定架和切开复位钢板内固定治疗老年桡骨远端AO-C型骨折的疗效

目的探讨外固定架和锁定钢板两种方式治疗老年桡骨远端AO-C型骨折的疗效。方法回顾性分析2013年1月至2015年4月新鲜闭合性桡骨远端AO-C型骨折60例,其中行外固定支架固定术28例(外固定架组),行切开复位钢板内固定术32例(钢板内固定组)。对比两组一般临床资料、腕关节的活动范围、腕关节功能Mc Bride评分及术后并发症,评价两组的治疗效果。结果 60例均获有效随访,外固定架组术中出血量、手术时间、住院时间和骨折愈合时间均优于钢板内固定组(P<0.05)。外固定架组腕关节的活动范围中掌屈、旋后优于钢板内固定组(P<0.05);钢板内固定组背伸优于外固定架组(P<0.05)。腕关节功能Mc Bride评分方面,两组优良率、并发症比较差异无统计学意义(P>0.05)。结论外固定架治疗AO-C型桡骨远端骨折具有操作简单、创伤较小等优势,而外固定架和锁定钢板二者治疗效果均较为满意。     

切开复位内固定治疗桡骨远端不稳定性骨折疗效观察

目的观察切开复位内固定治疗桡骨远端不稳定性骨折的效果。方法采用切开复位T型金属板螺钉或克氏针内固定治疗桡骨远端不稳定性骨折68例。术前掌倾角2.06°±4.88°,尺偏角18.31°±0.92°,桡骨短缩（1.95±0.76）cm。结果 68例患者手术均获得成功,无术中血管、神经损伤。2例出现切口延迟愈合,给予无菌换药分别于术后3、4周愈合。术后随访3-24个月,X线片显示骨折全部愈合,64例关节面平整;掌倾角8.71°±3.15°,尺偏角20.9°±5.5°,均恢复至正常范围;桡骨轴向无明显短缩。根据Mcbridge腕关节评分标准：优25例,良23例,可14例,差6例。末次随访未发现骨折不愈合、内固定物失效、畸形愈合。结论切开复位内固定治疗桡骨远端不稳定性骨折疗效满意。     

外固定架固定术治疗桡骨远端不稳定骨折32例体会

桡骨骨折多为粉碎性骨折,常累及桡骨远端关节面。2000年2月~2005年8月,我们对32例桡骨远端骨折患者行外固定支架固定术,效果满意。现报告如下。一般资料:研究对象为32例桡骨远端骨折患者,男13例,女19例;年龄21~72岁,平均52岁。骨折位于左侧14例,右侧10例,双侧4例;交通伤4例,打击伤7例,摔伤15例,坠落伤6例;其中4例为开放性骨折。术前常规拍患腕正、侧位X线片。掌倾角-42~35,°<20°者10例;尺偏角8~34,°<10°者5例;桡骨短缩22例,平均短缩6.2mm;桡骨远端关节面塌陷移位>2mm者6例。按AO桡骨远端骨折分类,属B 2型8例,B 3型15例,C 2型7例,C 3…     

掌侧入路锁定钢板内固定术治疗桡骨远端骨折疗效观察

采用掌侧入路锁定钢板内固定术治疗桡骨远端骨折41例.随访35例疗效为优18例,良15例,可2例,优良率为94%.认为掌侧入路复位标志明显,创伤小;锁定钢板内固定具有成角稳定,无需预弯;治疗桡骨远端骨折安全有效.     

掌侧锁定加压钢板治疗桡骨远端关节内骨折50例

老年桡骨远端关节内骨折是一种较常见的骨折类型,多见于中老年患者,国内外文献报道约占全身骨折的4%～5%〔1〕。其骨折类型复杂,一直以来是创伤骨科治疗中的难点问题。自2009年10月以来,我科应用锁定钢板(LPHP)内固定法治疗老年桡骨远端关节内骨折,分析其临床疗效。     

微型钛板坚强内固定治疗颌骨骨折280例报告

1999年以来,我们利用微型钛板坚强内固定（RIF）治疗颌骨骨折患者280例.现报告如下临床资料：本组280例中,男264例,女16例;年龄9～56岁.单纯上颌骨骨折43例,单纯下颌骨骨折134例,上、下颌骨同时多发性骨折103例.     

锁定加压钢板内固定治疗肱骨近端骨折

目的探讨锁定加压钢板内固定治疗肱骨近端骨折的疗效。方法 2005-06～2008-06月对39例肱骨近端骨折患者采用锁定加压钢板内固定治疗,并于术后早期进行功能锻炼。结果术后平均随访9个月,按Constant评分标准,平均88分(41～95分),其中优26例,良10例,中2例,差1例,优良率92.3%。结论锁定加压钢板治疗肱骨近端骨折是一种安全、有效的手术方法。     

AO多角度锁定钢板治疗老年桡骨远端C型骨折的初步疗效观察

目的总结应用AO多角度锁定钢板治疗老年桡骨远端C型骨折的初步临床疗效。方法2011年3月至2014年2月,采用切开复位、AO多角度锁定钢板固定治疗47例老年桡骨远端c型骨折,其中男15例,女32例,患者平均67．5岁,其中c1型20例,C2型16例,c3型11例。应用上肢功能（DASH）、Gartland和Werley评分进行功能评价及握力和腕关节运动范围评估。结果47例患者,其中43例获得6～12个月随访,平均8．3月,43例骨折均完全愈合,平均愈合时间7N。47例患者中,42例功能评定为优,无并发症。结论切开复位应用AO多角度锁定钢板是治疗骨质疏松性不稳定桡骨远端骨折的有效手段。     

掌侧T形加压钢板治疗桡骨远端不稳定骨折43例的疗效探讨

目的探讨掌侧T形加压钢板治疗桡骨远端不稳定骨折的临床效果。方法应用掌侧人路T形加压钢板治疗桡骨远端不稳定骨折43例。结果41例随访时间平均8．6（3．5～26）个月,所有骨折均获得骨性愈合,按GarlandandWeley评分方法评定腕关节功能：优28例,良11例,可3例,差1例,优良率为90．7％。结论应用掌侧T形加压钢板治疗桡骨远端不稳定骨折具有稳定内固定、骨折愈合率高、早期功能锻炼、防止骨质疏松等优点,适宜临床推广。     

肱骨近端锁定型钉板治疗老年人移位的肱骨近端骨折

目的 探讨肱骨近端锁定型钉(PHILOS)板治疗老年人移位的肱骨近端骨折的疗效。方法 回顾性分析2004年2月至2007年3月用PHILOS板治疗的36例肱骨近端骨折患者,Neer分型二部分骨折14例,三部分骨折17例,四部分骨折5例。统计手术时间、输血量和手术并发症,评价肩关节功能。 结果 患者平均年龄72.2岁,平均随访14.5个月。术中平均输血165.2 ml,术后X线显示骨折复位满意,无神经、血管损伤病例,心脑血管意外1例,肺炎1例,骨折愈合时间3～5个月,未发现肱骨头坏死,Neer评分：30例(83.3％)优良。分析显示骨折类型（Neer分型）、受伤至手术时间（术后3d内早期手术）与骨折愈合后肩关节功能恢复具有相关性,年龄、性别、美国麻醉医师协会(ASA)评分与Neer评分两组比较差异无统计学意义。 结论 PHILOS板是治疗老年人移位的肱骨近端骨折的有效方法,固定牢固稳定,可早期功能锻炼,适合于伴有骨质疏松的老年患者。     

肥胖对桡骨远端骨折锁定钢板治疗效果的影响

目的探讨肥胖对桡骨远端骨折锁定钢板治疗效果的影响。 方法回顾性分析从2015年1月至2019年6月因桡骨远端于揭阳市人民医院住院行手术治疗的患者共87例,其中体质量指数（BMI）≥28 kg/m²的共36例（肥胖组）,BMI<28 kg/m²的共51例（非肥胖组）,对比两组术前和术后6个月影像学结果得到桡骨高度,桡骨掌倾角度,尺偏角度的变化值,记录所有术前、术后6个月的屈伸活动范围、和旋前活动范围,采用Quick-DASH上肢功能评分评估上肢的功能情况。 结果肥胖组和非肥胖组患者的手术时间、术中出血量、术后住院时间对比差异均无统计学意义（P>0.05）。两组患者术前和术后6个月的屈伸活动范围、和旋前活动范围对比差异无统计学意义（P>0.05）。两组术前的Quick-DASH评分对比差异无统计学意义（P>0.05）,术后3个月和术后6个月肥胖组Quick-DASH评分显著高于非肥胖组,差异有统计学意义（P<0.05）。 结论肥胖患者桡骨远端骨折采用锁定板固定后,其术后腕关节功能恢复较非肥胖患者差,表明肥胖是影响桡骨远端骨折内固定术后功能恢复的风险因素。     

Numerical simulation and biomechanical analysis of locking screw caps on clavicle locking plates

Background:The risk of displaced and comminuted midshaft clavicle fractures is increased in high-energy traumas such as sport injuries and traffic accidents. Open reduction and plate fixation have been widely used for midshaft clavicle fractures. Among various plates for clavicle shaft fractures, superior locking compression plates (LCPs) have been mostly used. In plate fixation, nonunion caused by implant failure is the most difficult complication. The most common reasons for metal plate failure are excessive stress and stress concentration caused by cantilever bending. These causes were easily addressed using a locking screw cap (LSC).Methods:The clavicle 3-dimensional image was made from a computed tomography scan, and the clavicle midshaft fracture model was generated with a 10-mm interval. The fracture model was fixed with a superior LCP, and finite element analysis was conducted between the presence (with LSC model) and absence (without LSC model) of an LSC on the site of the fracture. The stresses of screw holes in models with and without LSCs were measured under 3 forces: 100 N cantilever bending force, 100 N axial compression force, and 1 N·m axial torsion force. After the finite element analysis, a validation test was conducted on the cantilever bending force known as the greatest force applied to superior locking plates.Results:The mean greatest stress under the cantilever bending force was significantly greater than other loading forces. The highest stress site was the screw hole edge on the fracture site in both models under the cantilever bending and axial compression forces. Under the axial torsional force, the maximum stress point was the lateral first screw hole edge. The ultimate plate stress of the with LSC model is completely lower than that of the without LSC model. According to the validation test, the stiffness, ultimate load, and yield load of the with LSC model were higher than those of the without LSC model.Conclusions:Therefore, inserting an LSC into an empty screw hole in the fracture area reduces the maximum stress on an LCP and improves biomechanical stability.     

锁定加压钢板内固定治疗肱骨近端骨折39例分析

目的探讨锁定加压钢板内固定治疗肱骨近端骨折的疗效。方法取肩关节前侧人路,采用切开复位锁定加压钢板内固定治疗肱骨近端骨折39例,术后早期功能锻炼。结果 39例患者术后随访6～12个月,平均9个月。伤口全部一期愈合,钢板无折断,螺钉无松脱,无再移位发生。肩关节功能评估优26例,良8例,可5例,优良率为87.2%。1例发生肱骨头无菌性坏死。结论应用锁定加压钢板内固定治疗肱骨近端骨折,固定牢固,操作简单,允许早期功能锻炼,肩关节功能恢复良好,是一种理想的手术方法。     

Postoperative early and proactive grip strength training program for distal radius fractures promotes earlier recovery of grip strength: A retrospective study

The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training—using a gripper with a load of 0.7 kg—was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)—occurring from immediately postsurgery to 6 months after surgery—were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.     

A comparative study protocol of external fixation versus volar plate in treating distal radius fracture

Background:The superiority of the open reduction and internal fixation (ORIF) and external fixation remains uncertain owing to the limited sample size involved in the literature. This retrospective cohort research was implemented for the comparison of the efficiency of ORIF and external fixation utilizing the locked volar plating in treating the intra-articular fractures of distal radius. We hypothesized that compared with the external fixation, ORIF can improve the functional scores and reduce complications.Methods:We conducted a retrospective and single-center cohort trial that was approved by institutional review committee of Gansu Provincial Hospital. From June 2016 to July 2018, in our experiment, 178 patients with intra-articular fractures of the distal radius were recruited. Inclusion criteria in this cohort study were designed as follows: the age of patients is between 18 and 65 years, the patients with American Society of Anesthesiologists level I–III, and with the AO-type C3 or C2 fractures of distal radius confirmed by computed tomography scans, the patients with radiographic clinical follow-up for 1 year or >1 year. The patients participating in the trial would be divided into 2 groups: the patients treated via the external fixation and the patients treated by the ORIF utilizing volar plate. The main functional results were the grip strength and the range of motion of wrist. Radiographic measurement and complications were also evaluated in our study.Results:This study protocol will guide and clarify our assignments, and the final outcomes and conclusion will further enrich the clinical knowledge in the literature.Trial registration:This study protocol was registered in Research Registry (researchregistry6116).     

锁定钢板内固定与人工肱骨头置换治疗老年复杂肱骨近端骨折的比较研究

目的 比较锁定钢板(PHILOS)切开复位内固定和人工肱骨头置换(HA)治疗复杂肱骨近端骨折的疗效差异.方法 回顾性分析2010年6月-2013年6月行手术治疗的肱骨近端3部分和4部分骨折(或伴脱位)47例,其中PHILOS组29例和HA组18例.观察记录患术后3m、6m及12m的Constant-Murley评分和DASH评分,术后12m的SF-36量表评分以及术后并发症和二次手术情况.结果 两组术后3m的Constant-Murley评分总分、DASH评分、术后12 m的SF-36量表评分、两组术后并发症的差异无统计学意义,而术后6m、术后12m的Constant-Murley评分总分、DASH评分PHILOS组优于HA组,PHILOS组2例行二次手术,HA组无二次手术.结论 与人工肱骨头置换相比,锁定钢板治疗复杂肱骨近端骨折具有更好的功能结果,相近的并发症,生活质量相似.     

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study

Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.