外固定方法制作的大鼠股骨骨折模型

背景:外固定器抗旋转能力强,不影响局部血运,不固定关节,动物可以自由活动,适合用于骨折模型的制作.目的:创立一种新型的股骨骨折动物模型.方法:SD 大鼠24 只于大鼠右侧股骨截骨,以自行研究设计的微型单边外固定器为固定装置,制成骨折模型,术后通过大体观察、影像学观察及组织学方法观察股骨对位情况和截骨端的愈合情况.结果与结论:术后外固定器保持正常位置,未见螺纹钉拔出,针孔松动,骨折等现象,大鼠股骨保持正常生理位置.固定后第2 周骨断端已经有模糊的原始骨痂形成.第4 周时已有连续性骨痂通过,但骨断端仍较清晰.第8 周时,骨断端已经愈合,髓腔再通,出现骨性愈合.证实微型单边外固定器可以为股骨骨折模型大鼠提供可靠的固定,并且右侧股骨截骨骨折模型大鼠制作合理.     

大鼠股骨开放截骨模型与闭合骨折模型制作的比较

背景:骨折动物模型无疑是研究骨折愈合的基石,其中开放截骨模型与闭合骨折模型是较成熟的两种长骨干骨折模型.就作者所查文献,未见芙于大鼠两种模型比较研究的报道.目的:比较人鼠股骨开放截骨模型与闭合骨折模型的制作过程,并通过X射线摄片比较二者的骨折愈合情况.设计、时间及地点:随机对照动物实验,于2007-01/05在苏州大学附属第二医院骨科实验室完成.材料:SPF级雄性SD大鼠40只,体质量(220±30)g,随机分为开放截骨模型组与闭合骨折模型组,每组20只.电动摆锯;自行改良设计的闭合骨折模型打击器.方法:开放组行开放截骨术造成股骨中段横行骨折,逆行克氏针固定:闭合组行逆行克氏针固后,使用造模支架致股骨中段闭合骨折.主要观察指标:比较两组的平均造模时间,造模成功率及术后2,3,4,8周骨折愈合的X射线情况.结果:开放截骨模型每只造模成功率90%,平均造摸时间为17 min,骨折畸形愈合及不愈合率40%;闭合骨折模型每只造模成功率85%,平均造模时间12 min,未见畸形愈合及不愈合.术后2,3,4周X射线评分开放组均低于闭合组(P＜0.05),8周时开放组X射线评分仍较闭合组低,但差异无显著性意义(P＞0.05).结论:开放截骨模型造模时间长,骨折畸形愈合不愈合发生率高,近中期骨折愈合明显滞后,不适于近中期骨折愈合的研究.     

外固定与内固定法治疗胫骨中、下段骨折的临床疗效比较

目的对比研究外固定法与内固定法对胫骨中、下段骨折的临床疗效,为临床治疗提供一定的参考。方法胫骨中、下段骨折患者60例,随机分为两组各30例,观察组用外固定法治疗,对照组用内固定法,比较两种方法的优缺点。结果观察组患者治疗后优良率(95.8%)高于对照组(75.7%),P<0.05。结论外固定法相对于内固定法手术时间短,治疗效果好,促进了患者的康复进程,值得进一步推广。     

单侧外固定支架对股骨骨折外固定的力学缺陷

目的观察单侧外固定支架在股骨骨折应用中存在的力学缺陷。方法回顾性分析深圳市人民医院1999-01／2003—12应用单侧外固定支架治疗四肢骨折的59例患者，计算各部位骨折再移位比例，观察外固定支架固定后各部位再移位情况。结果：按意向处理分析，59例均进入结果分析。单侧外固定支架在股骨骨折再移位比例明显高于胫腓骨和上肢[33％（4／12）,5％（2／40），0（0／7）。P〈0．01]。结论：单侧外固定支架在股骨骨折应用中存在明显的力学缺陷：成人不足以对抗大腿肌肉力量，小儿存在严重的应力遮挡。     

组合式外固定支架治疗肱骨干骨折

目的 探讨组合式外固定器治疗肱骨干骨折的临床意义。方法 肱骨干骨折患者101例，采用闭合或有限切口暴露骨端，复位组合式外固定器固定。结果 随诊1～5年，101例忠者骨折均愈合，肩肘关节功能正常，无针孔感染等并发症。结论 组合式外固定器治疗肱骨干骨折，具有骨折稳定性强、可随时调整加压、有利于骨折愈合和早期功能锻炼等优点，是治疗肱骨干骨折的有效方法之一。     

锁骨骨折复位外固定三角架的设计及应用

目的探讨锁骨骨折复位外固定三角架的设计及应用。方法自1998年至2002年间共收治锁骨骨折74例。复位后采用自行设计的三角架外固定。结果治疗效果佳者82.43%。结论锁骨骨折复位后三角架外固定是治疗锁骨骨折的有效方法之一。     

悬吊牵引协同Pavlik挽具固定治疗新生儿股骨骨折的护理

总结54例悬吊牵引协同Pavlik挽具固定治疗新生儿股骨干骨折的护理经验。随访5月～2年，平均1年，所有病例骨折断端愈合良好，骨折断端重叠1．2cm，向前成角10°～20°，已会行走的患儿步态正常，无跛行或下肢畸形，双下肢长度差均不超过1cm，随访最长者20个月，双下肢已等长。认为应用悬吊牵引协同Pavlik挽具固定治疗新生儿股骨干骨折，方法简便，效果可靠，没有不良后果或并发痘发生。     

牵引加外固定治疗小儿股骨骨折

股骨是人体中最长的管状骨，股骨干是指粗隆下至股骨髁以上的部分。根据我科临床实践证明，治疗小儿股骨干骨折举不胜举，尤其是男孩多于女孩。笔者对小儿股骨干骨折运用牵引加外固定治疗10例，收到较满意的效果，现报告如下：     

外固定支架与股骨近端防旋髓内钉在老年股骨粗隆间骨折中的应用

目的比较外固定支架与股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折的临床疗效。方法将55例老年股骨粗隆间骨折患者分为PFNA组27例和外固定支架组28例,分别釆用PFNA和外固定术进行治疗,比较2组手术时间、术中出血量、住院时间、术后卧床时间、骨折愈合时间及术后并发症发生情况等,采用Harris髋关节评分标准对髋关节进行功能评定。结果与PFNA组比较,外固定组手术时间及住院时间明显缩短,出血量明显减少(P0.01)。PFNA组术后卧床时间、骨折愈合时间显著短于外固定组(P0.05)。2组半年后Harris评分及术后并发症发生率差异无统计学意义(P0.05)。结论外固定支架与PFNA各有优势,多数粗隆间骨折可选用PFNA,对于不能耐受切开复位内固定术的老年性股骨粗隆间骨折患者可选择外固定支架。     

Nursing the patient with an external fixator

External fixators are an effective way of fixing broken bones while at the same time optimising patients' mobility. In this article Julie Santy describes the major issues nurses need to be aware of to contribute effectively to patient care.     

The child with an Ilizarov external fixator

The Ilizarov External Fixator is gaining popularity as the most effective method to correct limb length deficiencies, correct angular deformities, and aid in the restoration of a limb compromised by traumatic injuries. Nurses caring for a child having this procedure need an understanding of the device application and appropriate nursing strategies.     

单臂外固定架治疗老年人股骨粗隆间骨折临床疗效观察

目的探讨单臂外固定支架治疗老年人股骨粗隆间骨折的临床疗效。方法采用单臂外固定支架治疗老年股骨粗隆间骨折患者28例。结果 28例均获得3~8个月的随访,根据Harris评分标准:优11例,良12例,可4例,差1例。优良率达82.14%。结论单臂外固定架治疗老年人股骨粗隆间骨折操作简单,并可减少并发症,疗效满意。     

颅骨外固定牵引器定量牵引治疗颧眶复合体骨折

目的用颅骨外固定牵引器探索一种便捷实用的牵引治疗颧眶复合体骨折的手术方法。方法收集颧眶复合体骨折并需要手术治疗的患者6例,术前摄颅颌骨三维CT,利用软件测量分析颧眶复合体移位情况。在颅骨上固定颅骨外固定牵引器并根据所测得的数据将骨折段持续牵引复位。术后复查CT评价疗效。结果颅骨外固定牵引器操作简单,固定稳固,术后患者面型及功能恢复好。结论颅骨外固定牵引器便捷实用,实现了微创、快速牵引复位与持续牵引复位固定相结合治疗颧眶复合体骨折的目的 。     

高龄患者股骨粗隆间骨折外固定器术后的康复治疗

目的：探讨高龄患者粗隆间骨折外固定器术后早期康复和并发症防治。方法：应用外固定器治疗高龄患者粗隆间骨折82例，术后进行早期康复，加强针道护理，防治并发症。结果：随访6～36个月，骨愈合时间为3-6．5个月，平均4．5个月。无髋内翻畸形、肢体短缩和骨不连发生。术后髋关节功能恢复良好，Harris髋关节功能评分为67-94分，平均85．7分。结论：重视围术期处理和早期康复治疗可明显减少并发症，有效控制各种并发症，外固定器治疗高龄患者粗隆间骨折安全且疗效肯定。     

护理干预对下肢骨折后外固定支架患者的影响

目的观察护理干预对下肢骨折后外固定支架患者的影响。方法将72例下肢骨折后行外固定支架术的患者分为对照组和干预组,2组患者的一般情况和手术方式无显著差异。前者在出院前只进行常规的出院指导,而干预组则针对每个患者的具体情况制订适合个体的干预措施,提供全面的护理干预内容。比较2组外固定支架患者在家中相关知识掌握情况。结果两组差异有显著统计学意义。结论为患者提供有效的护理干预、强化自我护理知识,可加快患者康复进程,减少并发症,提高生活质量。     

Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator

OBJECTIVE: The aim of this study was to determine the stiffness characteristics of the standard and hybrid Ilizarov fixators. DESIGN: Five different frame models (one standard and four hybrid Ilizarov) were designed. Four full rings were used in the standard Ilizarov frame. Two rings were placed proximal and two rings were placed distal to the osteotomy line with two wires at 90 degrees to each other on each ring. The distal tibial fixation of all the hybrid configurations and standard Ilizarov fixator were the same, and only the proximal fixations were different. In hybrid models, different numbers of 90 degrees femoral arches (1-3) were fixed to the proximal segment by using the half-pins with different numbers (2-4) and different angles to each other (45 degrees and 90 degrees ). BACKGROUND: Numerous investigations have been performed to compare the mechanical properties of different frames. The Ilizarov method of fracture fixation and limb lengthening has recently gained international recognition. But its application is difficult in some anatomic localization, so that hybrid ring fixation frames of various configurations are gaining clinical popularity. METHODS: Five different frame models were applied to the sheep tibial bones. The midpoint of the tibial bones was osteotomised and the osteotomy distracted for 2 cm. Four identical samples for each model were created and each identical sample of each model (n=1) were tested four times in axial compression, antero-posterior and medio-lateral bending, and torsion. RESULTS: In standard Ilizarov fixator, axial and bending stiffness was found to be more than all hybrid Ilizarov fixator models. Between the hybrid fixators, higher axial and bending stiffness was found when the number of femoral arches and half-pins were increased. Different angles between the half-pins formed 67% alteration in medio-lateral bending stiffness. No significant difference was found for torsional stiffness between the fixator models. CONCLUSIONS: For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used and these half-pins should be placed at 90 degrees angles and at different planes to each other. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model. RELEVANCE: For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model.     

Design and biomechanical study of slide-poking external fixator for hip fracture

BackgroundFemoral head collapse and coxa vara lead to internal fixator failure in elderly patients with hip fracture. External fixator application is an optimal choice; however, the existing methods have many disadvantages.MethodsType 31-A1.3 hip fracture models were developed in nine pairs of 1-year-old fresh bovine corpse femur specimens. Each left femur specimen was fixed by a dynamic hip screw (control group), and each right femur specimen was fixed by the slide-poking external fixator (experimental group). Vertical loading and torsion tests were then performed in both groups.ResultsIn the vertical loading experiment, a 1000-N load was implemented. The mean vertical downward displacement of the femoral head in the experimental and control groups was 1.49322 ± 0.116280 and 2.13656 ± 0.166374 mm, respectively. In the torsion experiment, when the torsion was increased to 10.0 Nm, the mean torsion angle in the experimental and control groups was 7.9733° ± 1.65704° and 15.4889° ± 0.73228°, respectively. The slide-poking external fixator was significantly more resistant to compression and rotation than the dynamic hip screw.ConclusionThe slide-poking external fixator for hip fractures that was designed and developed in this study can provide sufficient stability to resist compression and rotation in hip fractures.