加压钢板与带锁髓内钉治疗肱骨干骨折疗效比较

目的比较加压钢板与带锁髓内钉治疗肱骨干骨折的疗效。方法61例肱骨干骨折患者，骨折复位后38例采用加压钢板、23例采用带锁髓内钉内固定。结果术后平均随访17个月，带锁髓内钉组6个月内骨折愈合率为87．0％（20／23），并发症发生率为0，优于加压钢板组的63．2％（24／38）和23.7（9／38），P〈0．05。结论加压钢板与带锁髓内钉均能可靠固定，但带锁髓内钉能缩短骨折愈合时间，减少并发症，是治疗肱骨干骨折的较好方法。     

不同方法治疗肱骨干骨折的疗效分析

目的通过对比自锁髓内钉与钢板内固定治疗肱骨干骨折的临床疗效,探讨两种方法在肱骨干骨折中的应用。方法选择2010年1月～2011年6月在笔者所在医院诊治的肱骨干骨折患者60例,随机分为研究组和对照组各30例。研究组采用自锁髓内钉固定治疗,对照组采用钢板内固定治疗,对比观察两组的临床疗效。结果研究组骨折愈合时间比对照组短,再骨折率和医源性桡神经损伤均低于对照组,差异有统计学意义（P〈0.05）,两组肩关节功能评定的优良率比较,差异无统计学意义（P〉0.05）。结论自锁髓内钉固定肱骨干骨折并发症及愈合时间比钢板内固定有优势,而且并不降低肩关节功能的优良率。     

肱骨干骨折不同内固定术式的疗效分析简

目的对可膨胀髓内钉与交锁髓内钉在治疗肱骨干骨折中的相关因素进行分析。方法回顾性分析收治的肱骨干骨折52例,其中32例行可膨胀髓内钉内固定,20例行交锁髓内钉固定。结果2组在手术时间、术中出血量、术中透视时间、骨折愈合时间等方面差异有统计学意义（P〈0．05）,在术后并发症、肩关节和肘关节屈伸范围上差异无统计学意SL（P〉0．05）。结论采用可膨胀髓内钉治疗肱骨干骨折较交锁髓内钉效果好。     

肱骨自锁髓内钉治疗肱骨干骨折的临床观察

目的探讨肱骨自锁髓内钉在肱骨干骨折临床治疗上的应用价值。方法对60例肱骨干骨折患者采用肱骨自锁髓内钉治疗30例、肱骨交锁髓内钉治疗30例,观察两组手术时间、出血量、切口愈合情况、早期活动时间、骨折愈合时间和关节功能恢复情况,并进行统计学分析。结果患者均获随访,时间12～18个月。两组手术时间、出血量比较差异有统计学意义(P<0.01);自锁髓内钉组手术时间短,出血量少。两组切口愈合情况、早期活动时间、骨折愈合时间和关节功能的恢复情况比较差异无统计学意义(P>0.05)。结论自锁髓内钉治疗肱骨干骨折具有固定牢靠、操作简单、手术创伤小、出血少的优点,是治疗肱骨干骨折较为理想的方法。     

远端自锁髓内钉与钢板治疗肱骨干骨折疗效比较

目的比较远端自锁髓内钉与钢板治疗肱骨干骨折的临床疗效。方法用远端自锁髓内钉治疗肱骨干骨折18例，钢板内固定35例。结果髓内钉组骨折均获愈合，无内固定折断及再骨折，术后未出现桡神经损伤症状，出现肩部疼痛1例。钢板组1例出现骨折不愈合，于外院行髓内钉固定后愈合，内固定折断及再骨折1例，术后出现桡神经损伤症状2例，取钢板术后出现该症状1例。结论远端自锁髓内钉治疗肱骨干骨折优于钢板。     

交锁髓内钉和锁定加压钢板治疗肱骨干骨折的临床疗效比较

目的比较交锁髓内钉(locked intramedullary nail, LIN)和锁定加压钢板(locking compression plate, LCP)内固定治疗闭合性肱骨干骨折的临床疗效。方法回顾性分析2016年2月至2018年6月在黄冈市黄州区人民医院行手术治疗的100例闭合性肱骨干骨折病人的临床资料,根据手术选用的内固定方案不同分为LIN组和LCP组。LIN组47例,其中男24例,女23例,年龄为(33.03±11.52)岁;LCP组53例,男28例,女25例,年龄为(32.68±11.74)岁。收集并比较两组病人术中出血量、手术时间、住院时间、骨折愈合时间、术后并发症、Neer肩关节功能评分和Mayo肘关节功能评分。结果 LIN组术中出血量、手术时间、住院时间、术后早期(1、3个月)Neer肩关节功能评分、桡神经相关并发症均低于LCP组,差异均有统计学意义(P均<0.05)。LIN组术后早期(1、3个月)Mayo肘关节功能评分、术后中后期(6、12个月)Neer肩关节功能评分高于LCP组,差异有统计学意义(P<0.05)。结论对于闭合性肱骨干骨折,与传统锁定加压钢板内固定术相比,采用交锁髓内钉内固定术创伤小、桡神经相关并发症少、术后早期肘关节功能和术后中后期肩关节功能更佳。     

非扩髓交锁髓内钉内固定治疗肱骨干骨折39例

目的 评价非扩髓交锁髓内钉内固定治疗肱骨干骨折的疗效.方法 笔者采用非扩髓交锁髓内钉内固定治疗肱骨干骨折39例,骨折按AO分型,A型21例,B型14例,C型4例.结果 36例获得随访,随访时间5～26个月.骨折全部愈合,平均愈合时间5.3个月.本组无伤口感染、继发桡神经损伤、髓内钉断裂,以及肱骨远端骨折等并发症.肩关节功能评估按Neer评分,优28例,良6例,可2例.结论 非扩髓交锁髓内钉是治疗肱骨干骨折的一种有效内固定方法.     

交锁髓内钉治疗肱骨干骨折疗效分析

目的探讨交锁髓内钉内固定对肱骨干骨折的治疗效果。方法对76例肱骨干骨折采用顺行或逆行交锁髓内钉内固定术,并进行随访,观察治疗效果。结果76例病例经6~18个月,平均12个月的随访,依据Joher-Wruhs标准评定,优良率为100%。结论交锁髓内钉是固定肱骨干骨折较为理想的内固定材料。     

不同内固定方法治疗肱骨干骨折疗效对比

目的:比较切开复位钢板内固定、闭合复位顺行及逆行髓内钉内固定治疗肱骨干骨折的效果。方法:采用切开复位钢板内固定治疗肱骨干骨折24例,闭合复位顺行髓内钉内固定治疗肱骨干骨折31例,闭合复位逆行髓钉内固定治疗肱骨干骨折38例。对比3组手术情况、并发症、生物力学、骨折愈合、功能恢复等。结果:3组随访6～16个月,平均6.5个月。3组间手术时间、术中失血量、平均骨折愈合时间无统计学差异;术后并发症顺行髓内钉内固定组和逆行髓内钉内固定组明显低于钢板内固定组。结论:髓内钉内固定操作简单安全、并发症少,优于钢板内固定。逆行髓钉内固定在功能恢复、手术操作等方面优于顺行髓钉内固定。     

带锁髓内钉和锁定钢板内固定治疗肱骨干骨折的疗效比较

目的比较带锁髓内钉和锁定钢板内固定治疗肱骨干骨折的临床效果。方法对38例肱骨干骨折采用带锁髓内钉内固定(髓内钉组)17例,锁定钢板(锁定钢板组)21例。结果髓内钉组发生桡神经损伤1例,锁定钢板组发生2例,差异有统计学意义;髓内钉组发生延时愈合1例,锁定钢板组发生3例,差异有统计学意义;髓内钉组肩关节评分为(78.71±5.64)分,肘关节评分为(90.33±1.73)分,锁定钢板组肩关节评分为(88.23±3.24)分,肘关节评分为(91.44±2.22)分。两组肩关节评分差异有统计学意义,肘关节评分差异无统计学意义。结论带锁髓内钉固定和锁定钢板内固定治疗肱骨干骨折均可获得良好的疗效。髓内钉内固定易影响邻近关节的功能,而锁定钢板内固定更容易引起桡神经损伤及骨折的延时愈合。     

股骨粗隆间骨折三种内固定方法的临床治疗分析(附85例报告)

作者对国产Gamma钉,Richards钉及麦氏鹅头钉三种内固定方法治疗股骨粗隆间骨折的手术时间,术中失血量,术后下床负重时间,住院时间及骨折临床愈合时间进行了临床统计学处理并临床疗效分析。结果表明,三组在手术时间,术中失血量二项指标上无明显差异,而在术后起床负重时间,住院时间及骨折临床愈合时间则存在明显差异作者认为,Gramma钉的设计更符合人体生物力学原理,更有利于骨折部位的愈合及髋关节功能的恢复,是目前治疗股骨粗隆间骨折比较理想的内固定材料。     

甲基质联合甲沟切除重建术治疗嵌甲性甲沟炎

目的：探讨一种治疗嵌甲性甲沟炎的方法并讨论其临床意义。方法：切除嵌甲、炎性肉芽组织及部分患趾甲基质,同时重建甲沟。结果：重建甲沟形态良好,效果满意,复发率低。结论：甲基质联合甲沟切除重建术是治疗嵌甲症的理想方法。     

Posttraumatic ectopic nail: case report

Ectopic nail, also known as onychoheterotopia or onychoheterotropia, is an extremely rare disorder. It is characterized by the growth of nail-like tissue in a different location other than the nail bed. Congenital and acquired deformities have been reported. We describe a case of posttraumatic ectopic nail and review the literature on this unusual condition.     

Treatment of Traumatic Femoral Neck Fractures with an Intramedullary Nail in Osteoporotic Bones

PurposeSufficient anchoring of intramedullary osteosynthesis in the femoral head in a femoral neck fracture is a challenge with increasing age of the patients and decreasing bone quality. For older patients with inferior bone quality, it has not been investigated whether the application of an intramedullary force carrier, as a minimally invasive and rapid intervention, can provide a considerable benefit and reduce the postoperative complication and lethality rate. This retrospective study aimed to investigate the stability and functionality after the acute treatment of a femoral neck fracture in osteoporotic bone using an intramedullary force carrier even with higher grade fracture types.Material and MethodsThe retrospective analysis was based on a collective of 82 patients over 60 years of age with a femoral neck fracture treated with a gliding nail in our centre between 1999 and 2006.ResultsThe average time to follow-up was 69.05 months (median 71.0; minimum 27.0–maximum 108.0). Female patients made up more than two-thirds of the patient collective at 63 of the 82 patients (76.83%). The average age of the patients was 77.76 years (median 78.00; range 60.00–93.00).In 66 patients (80.49%), the implantation showed good results and no complications or further treatments. 24/82 patients of our collective had died in our re-evaluation. In no case, a pseudarthrosis or severe impaction with neck shortening occurred (loss of offset).11/82 patients had femoral head necrosis which led to total hip replacement in 8 cases, a hemiarthroplasty in 2 cases and in 1 case a remaining Girdlestone situation because of a deep infection. Another five patients also had to undergo a total hip replacement because of a central perforation of the blade in one case, breakout of the blade after another fall in another two cases and a lateral dislocation of the blade in two cases.ConclusionThe use of an intramedullary force carrier in the osteoporotic bone can mean distinct advantages for the selected patient as a minimally invasive and rapid surgical method compared to extensive surgery, even in the case of severe injuries. However, the advantages and disadvantages for the patient should be considered critically.     

应用第二套供血系统的全指甲再造术

目的探讨对手指指甲缺损或畸形进行精细重建的技术。方法对2003年12月-2004年6月在我院应用显微外科技术治疗的9例指甲（13指）缺损患者进行回顾性分析。所有患者均利用第二套供血系统以携带最小量组织进行切取包括趾甲、甲床、甲下皮、甲周膜在内的复合组织及其营养动脉、静脉和神经，与受区进行趾-指动脉、静脉、神经的吻合，完成单一全趾甲复合组织移植再造指甲。结果所有再造指甲均顺利成活，外形十分满意，接近原手指指甲的效果，供区的外观和功能无明显影响。结论应用第二套供血系统的全指甲单位再造术，可获得理想的治疗效果。     

A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly

Purpose: To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old. Methods: A retrospective analysis of 178 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted from January 2008 to December 2013. There were 85 males (47.8%) and 93 females (52.2%) with the age of 65e89 (70.2±10.8) years. The patients were treated by closed reduction and long or short intramedullary nail (Gamma 3) fixation. The length of short nail was 180 mm and that for long nail was 320e360 mm. The general data of patients, operation time, intraoperative blood loss, length of hospital stay, preoperative hemoglobin level, blood transfusion rate, postoperative periprosthetic fractures, infections, complications, etc were carefully recorded. Results: There were 76 cases (42.7%) in the long intramedullary nail group and 102 cases (57.3%) in the short nail group. All the cases were followed up for 12-48 (21.3±6.8) months, during which there were 21 deaths (11.8%), mean (13.8±6.9) months after operation. The intraoperative blood loss was (90.7±50.6) ml in short nail group, greatly less than that in long nail group (127.8±85.9) ml (p=0.004). The short nail group also had a significantly shorter operation time (43.5 min±12.3 min vs. 58.5 min±20.3 min, p=0.002) and lower rate of postoperative transfusion (42.3% vs. 56.7%, p=0.041). But the length of hospital stay showed no big differences. After operation, in each group there was 1 case of periprosthetic fracture with a total incidence of 1.1%, 1.3% in long nail group and 0.9% in short nail group. At the end of the follow-up, all patients achieved bony union. The average healing time of the long nail group was (6.5±3.1) months, and the short nail group was (6.8±3.7) months, revealing no significant differences (p=0.09). Postoperative complications showed no great differences either. Conclusion: Both the intramedullary long and short nail fixation has a good clinical effect in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of therapeutic effect, hospital stay and postoperative complications. The incidence of periprosthetic fractures treated by either length of nails was low. But short intramedullary nailing can obviously decrease the intraoperative blood loss, operation time and postoperative blood transfusion.     

Clinical and radiological midterm results from using the Fixion expandable intramedullary nail in transverse and short oblique fractures of femur and tibia

Background  A locked nail is the principal method used to eliminate rotatory components in femoral and tibial fractures. Nevertheless, weight bearing is not directed onto the fracture site, slowing down the healing process; another possibility is to use a large-diameter nail and ream the canal to obtain as much adherence as possible and increase the grip, but this can cause a number of complications. The expandable nail is a new option that in theory should remove some problems with previous techniques. Materials and methods  This was a retrospective nonrandomized study encompassing 21 femoral fractures and 27 tibial fractures in 45 patients. They were classified according to the AO classification. Clinical and radiological checks were done at one, three, and six months and at one year from the surgery in order to check for signs of clinical and radiological healing. A good alignment was considered to be the presence of a deformity of less than 5° in the sagittal and lateral planes and the absence of rotatory clinically evident problems. This protocol was adhered to up to six months after surgery by all of the patients, while only 62.2% performed the last control. The mean follow-up was 15 months. A second group of 48 consecutive fractures (24 femural and 24 tibial) treated with locked nail was created to compare surgical times. Results  Appropriate alignment was observed in all cases; the healing process appeared slower: radiological healing occurred in most cases at six months. The following complications were reported: a case of intraoperative fracture widening with no effect on the treatment; a case of a lesion of the tip of the nail with pneumatic system rupture that necessitated nail substitution; two cases of retarded consolidation at six months, with both tibial fractures treated successfully by intralesion platelet gel; a case of incarcerated nail on 17 removals, resolved by shearing. We had no cases of clinically evident compartment syndrome or pulmonary embolism. Conclusions  The expandable Fixion nail presents significant advantages in the treatment of transverse and short oblique fractures of femur and tibia because it is easy to use, involves minimal X-ray exposure and can control rotations. Nevertheless, it high cost limits its use. We consider it as an alternative to locked nail.     

The role of intramedullary fixation in ankle fractures – A systematic review

Background

Ankle fractures are one of the most commonly occurring fractures in the elderly population. The overall incidence has been reported to be up to 184 fractures per 100,000 persons per year, of which 20–30% occur in the elderly. Medical co-morbidities, osteoporosis, suboptimal skin quality and poor toleration of non-weight bearing status all contribute to difficulties in managing these injuries in this population. Intramedullary implants are advantageous as they utilise smaller incisions, minimise soft tissue disruption and may allow early weight bearing. This systematic review aims to analyse the use of both fibula nails and talo-tibial-calcaneal (TTC) implants in the management of fragility ankle fractures.