经尺骨鹰嘴截骨治疗肱骨髁问C型骨折

目的探讨经尺骨鹰嘴关节内垂直截骨及关节外斜形截骨治疗肱骨髁间C型骨折的手术方法及疗效。方法采用2种经尺骨鹰嘴截骨入路内固定治疗肱骨髁间骨折28例，对手术入路、时间、术后肘关节功能，及并发症等进行分析。结果术后随访6～38个月，平均13个月。按Cassebaum法对肘关节功能进行评定，经尺骨鹰嘴关节内垂直截骨组优良率75％，经尺骨鹰嘴关节外斜形截骨组优良率83％。结论经尺骨鹰嘴截骨是治疗肱骨髁间C型骨折较好的入路，尤其是经尺骨鹰嘴关节外斜形截骨更具有易操作，有利于截骨部骨折的愈合，以及术后肘关节功能恢复并发症低等优点。     

闭合复位自制外固定架治疗尺骨鹰嘴骨折

目的：探讨利用弹力克氏针闭合复位结合功能训练法治疗尺骨鹰嘴骨折新方法的可行性和优缺点。方法：1997年6月--2002年6月应用直径2mm、长30cm的克氏针3根以及自制前臂外固定圈组成的外固定架，经闭合穿针徽创手术弹性外固定治疗尺骨鹰嘴骨折18例，透视下复位穿针外固定，术后第一天开始功能训练。结果：18例均在6周--12周内临床愈合，肘关节功能均恢复满意。无感染等并发症发生。结论：弹力克氏针微创手术弹性固定结合功能训练法治疗尺骨鹰嘴骨折操作简单，创伤小，住院时间短，无须二次手术，功能恢复完全，是治疗尺骨鹰嘴骨折可行而有效的新方法。     

鹰嘴骨折手术治疗与并发症分析

目的通过对尺骨鹰嘴骨折术后病例进行分析研究,探讨不同类型的尺骨鹰嘴骨折最佳固定方法。方法尺骨鹰嘴骨折手术内固定153例,其中张力带钢丝组60例,中空螺钉组19例,鹰嘴钢板组74例。根据术后6个月关节功能、X线表现进行综合评价,对比分析术后疗效。结果 153例均获随访,随访时间1~3年,平均随访时间1.2年。发生各种并发症27例,其中张力带钢丝组22例,中空螺钉组2例,鹰嘴钢板组3例。再手术4例,所有骨折均临床愈合。结论尺骨鹰嘴骨折应根据骨折类型选择不同的内固定方式,鹰嘴钢板具有较低的并发症发生率,适用于各种类型尺骨鹰嘴骨折。     

克氏针弹性外固定治疗尺骨鹰嘴骨折（附15例报告）

目的：探讨利用弹性固定原理治疗尺骨鹰嘴骨折的新方法。方法：1996年6月以来临床应用直径2mm、长30cm的克氏针3根及自制前臂外固定圈组成外固定架,弹性外固定治疗尺骨鹰嘴骨折15例,年龄16－45岁,均为横斜性骨折。其中开放性骨折3例,闭合性骨折12例。臂丛麻醉C臂光机透视下复位穿针外固定。结果：15例患者6－12周临床愈合,平均8周,肘关节功能均恢复满意。无感染等并发症发生。结论：克氏针弹性外固定法操作简单,创伤小,住院时间短（其中门诊治疗3例）,无需3次手术,功能恢复完全,是治疗尺骨鹰嘴骨折非常有效的新方法,是弹性（张力带）固定原理的合理运用。     

记忆合金加压固定器治疗尺骨鹰嘴骨折

[目的]报告一种治疗尺骨鹰嘴骨折手术方法。[方法]运用记忆合金加压固定器治疗23例尺骨鹰嘴骨折。[结果]所有病例均获得骨愈合，术后6-8周复查及随访，患侧肘关节功能活动范围与健侧对称，恢复正常生活及工作。[结论]记忆合金加压固定器治疗尺骨鹰嘴骨折较为简便，治疗效果好，值得推广应用。     

钳夹加压固定器治疗尺骨鹰嘴骨折的三维有限元分析

目的 阐明钳夹加压固定器治疗尺骨鹰嘴骨折的工作原理,科学地指导临床应用。方法 在计算机内进行三维有限元造模,模拟肘关节的生理状态,探讨钳夹加压固定器治疗尺骨鹰嘴骨折的最佳固定方式,最佳固定力和最佳功能锻炼方法。结果 提示钩钳位置应放在尺骨鹰嘴背侧,加压力线离中性轴越远越好;横形骨折的最佳固定力为50 N,斜形、粉碎骨折为25 N;早期练功肌肉收缩力不可过大,肱三头肌肌力要小于70 N,肘关节活动锻炼范围为60°～90°。结论 钳夹加压固定器治疗尺骨鹰嘴骨折,符合骨折治疗的弹性固定准则。     

Cable-Pin系统在尺骨鹰嘴骨折治疗中的应用

目的观察分析Cable-Pin系统在治疗尺骨鹰嘴骨折中的疗效。方法应用Cable-Pin系统作为张力带固定治疗尺骨鹰嘴骨折14例,均为横断型的尺骨鹰嘴骨折。结果 14例获得6～18个月随访,平均10个月。骨折全部愈合,无退钉、钢缆松动断裂等并发症发生。采用Broberg-Morrey功能评分标准对肘关节功能进行评分:优11例,良3例。结论Cable-Pin系统对尺骨鹰嘴骨折固定可靠,并发症少,是治疗横断型尺骨鹰嘴骨折较理想的新选择。     

经尺骨鹰嘴截骨治疗肱骨髁问C型骨折

目的 探讨经尺骨鹰嘴关节内垂直截骨及关节外斜形截骨治疗肱骨髁间C型骨折的手术方法及疗效.方法 采用2种经尺骨鹰嘴截骨人路内固定治疗肱骨髁间骨折28例,对手术入路、时间、术后肘关节功能,及并发症等进行分析.结果 术后随访6～38个月,平均13个月.按Cassebaum法对肘关节功能进行评定,经尺骨鹰嘴关节内垂直截骨组优良率75%,经尺骨鹰嘴关节外斜形截骨组优良率83%.结论 经尺骨鹰嘴截骨是治疗肱骨髁间C型骨折较好的入路,尤其是经尺骨鹰嘴关节外斜形截骨更具有易操作,有利于截骨部骨折的愈合,以及术后肘关节功能恢复并发症低等优点.     

锁定钢板治疗粉碎性尺骨鹰嘴骨折20例

目的：研究尺骨锁定钢板治疗粉碎性尺骨鹰嘴骨折的疗效。方法：回顾性分析采用锁定钢板治疗的尺骨鹰嘴骨折20例。结果：术后随访6个月~1年,平均8个月,肘关节功能优良率95%。结论：锁定钢板内固定术符合尺骨鹰嘴骨折解剖特点及损伤机制要求,具有操作简单、固定有效、早期功能锻炼、术后并发症少等优势。     

外固定器治疗胫腓骨骨折的应力适应性

目的：探索临床上如何把握骨外固定治疗胫腓骨骨折的应力适应性。方法：89例胫腓骨骨折病例采用外固定器治疗，就功能锻炼强度，外固定器应力调整，外固定器拆除最佳时机，尤其是超声直方图动态监测定量评价骨折愈合程度的辅助作用进行研究。结果：多数病例10－14w骨折愈合，骨不连或延期愈合的病例6－10月愈合，1例多段骨折发生再骨折改为带锁髓内钉固定。结论：术后1w扶拐下地进行锻炼行走，负重15－25kg，术后6w超声直方图灰阶值达健侧50％－60％，结合X线和临床表现综合分析，拆除外固定器，减少应力遮挡，争取达到与理想骨折愈合相适应的最佳应力状态。     

新型外固定在鹰嘴骨折治疗中的应用

Objective　To introduce a new device of external fixator for olecranon fracture,and evaluate its clinical treatment outcome.Methods　After close reduction under the supervision of the image intensifier,15 cases of olecranon fracture have been treated by the external fixator of self-design.The patients were followed for 6 to 8 weeks postoperatively.Results　Clinical observation and follow-up revealed that all these fractures healed up well with full recovery of elbow joint function.The average period for bony union was 7 weeks,ranging from 6 to 8 weeks.Normal range of motion of the elbow joint was regained,without any complications.Conclusions　This kind of external fixator used for olecranon fractures showed the advantages of minimal invasiveness,simple manipulation, reliable fixation,early post-operative joint movement,and no need for implant removal procedures.The author believes it is worth introduction and using clinically.     

外展位尺骨鹰嘴牵引治疗严重肿胀肱骨髁上骨折70例

目的观察外展位尺骨鹰嘴牵引治疗严重肿胀肱骨髁上骨折的疗效。方法从1993年7月～2001年7月对70例严重肿胀肱骨髁上骨折行尺骨鹰嘴牵引配合小夹板外固定治疗。结果术后获得随访为100％,随访时间1-4年,本全组优良率达到94．2％。结论尺骨鹰嘴牵引治疗严重肿胀肱骨髁上是骨折是一种简便有效的方法。并发症少,疗效好。     

外固定器固定结合骨膜骨瓣转移治疗尺骨不连接

目的：为尺骨中上段骨不连接的治疗提供一种改进术式。方法：从血液供应与生物力学两方面,设计以骨间返动脉为蒂的尺骨上段骨膜骨瓣,转移植骨结合外固定,器固定治疗骨不连接。结果：经采用该术式治疗尺骨中、上段骨不连12例,均取得良好疗效。结论：骨质返动脉骨膜骨瓣,解剖恒定、血供可靠,不损伤主要血管骨外固定器创伤微小、固定牢固,操作简便,且可早期功能锻炼,防止关节僵硬、,有折端有生理应力刺激,两者结合从多方面促进骨折愈合,是治疗尺管中上段骨不连的有效方法。     

可调节外固定支架治疗高龄开放性肘关节损伤的临床疗效分析

目的:探讨应用可调节外固定支架治疗高龄肘关节开放性损伤的临床疗效分析。方法:自2013年8月至2019年3月,我们采用可调式外固定支架治疗肘关节开放性损伤高龄患者5例。肘关节开放性损伤包括肘关节后脱位、桡骨头骨折、尺骨鹰嘴骨折、肱骨髁骨折、冠状突骨折等病例。术后随访应用Mayo肘关节功能评分进行疗效评价。结果:术后所有...     

尺骨上段合并鹰嘴骨折内固定的生物力学研究

目的比较克氏针张力带、重建钢板联合张力带及鹰嘴解剖钢板固定尺骨上段合并鹰嘴骨折3种方式的生物力学稳定性,为临床选择内固定提供理论依据。方法 8个自愿捐献的新鲜成人尸体肘关节标本,均为男性;年龄26～43岁,平均34.8岁。于尺骨上段及尺骨鹰嘴分别截骨制作尺骨上段合并鹰嘴骨折模型。每个标本分别采用克氏针张力带(A组)、重建钢板联合张力带(B组)及鹰嘴解剖钢板(C组)3种方式对骨折端固定。采用生物力学测试系统进行单轴压缩试验,记录载荷-位移曲线,内固定系统的稳定性采用骨折端压缩位移为2 mm时所加的载荷值进行评价。结果实验过程中未出现克氏针退出、钢板螺钉断裂、标本破坏,标本与夹具固定无松动。3组标本均表现为位移随载荷增加而逐渐增长,但B、C组的载荷-位移曲线斜率明显高于A组。当骨折端压缩位移为2 mm时,A、B、C组的所加载荷值分别为(218.6±66.9)、(560.3±116.1)、(577.2±137.6)N,B、C组所加载荷值均显著高于A组,差异有统计学意义(P<0.05);B、C组间差异无统计学意义(t=0.305,P=0.763)。结论尺骨上段合并鹰嘴骨折多为不稳定骨折,重建钢板联合张力带、鹰嘴解剖钢板固定均能满足要求,临床上可根据患者情况合理选用。克氏针张力带固定不够牢固,临床上应避免单独使用。     

Post-traumatic forearm nonunion in healthy skeletally immature children: A report on 15 cases

BackgroundNonunion is a rare but severe complication following forearm fracture in skeletally immature patients. The purpose of this study is to describe a case series of pediatric forearm nonunions treated at our Institute.Materials and methodWe retrospectively reviewed medical charts and radiographs of healthy children affected by post-traumatic nonunion of the forearm, from April 1992 to July 2015. An overall series of 15 cases was included in the study. Nonunion developed at ulna in 5 cases and at radius in 10 cases, at a mean time of 9 months (range 6–12) from fracture. Surgical treatment was performed in 14 cases out of 15. Stabilization of the nonunion was achieved with Kirschner wires (5 cases), plates (4 cases), rush rods (2 cases) and unilateral external fixator (3 cases). Iliac crest bone autograft was used in 11 cases, strut cortical bone allograft was used in 2 cases while in one case no bone graft was applied. In 2 cases an additional shortening osteotomy of the ulnar shaft was necessary to obtain adequate compression of the bone fragments. Cast immobilization was maintained for 6 to 8 weeks after surgery, then a brace was applied for further 8 to 12 weeks.ResultsThe average follow-up was 54 months (range 12–129); nonunion healed in 14 cases (93%) at an average time of 4 months (range 2–8). One case of nonunion did not heal 12 months after surgery; other complications included: radio-ulnar fusion and radial nerve palsy (1 case), myositis ossificans at the ulna (1 case), olecranon bursitis with residual elbow stiffness (1 case). One case was treated conservatively and healed after 18 months with residual malalignment.ConclusionsThe present study describes the largest series of pediatric forearm nonunions in the current literature. Whether the surgical management of pediatric forearm nonunion provides satisfactory results in terms of bone healing, it may be accompanied by several complications, permanent sequelae and residual functional impairment. Any effort must be undertaken to avoid this serious complication.     

钳夹加压固定器治疗尺骨鹰嘴骨折

应用钳夹加压固定器治疗尺骨鹰嘴骨折２１０例，经３个月～８年随访，解剖及近解剖复位率达９７。６％，关节功能恢复优良率达９８．８８％。现在认为，该器械可用于各类型尺骨鹰嘴骨折，关键在于根据骨折的不同类型，选取适当固定点。     

Experimental study of vascularized bone grafts: hypertrophy of the grafted bone

The mechanism underlying hypertrophy of experimentally vascularized bone grafts was studied in 15-week-old rats. The segmental ulna was grafted to the tibial defect with an external fixator. In experiment 1, 24 rats were classified into four groups to evaluate conventional (non-vascularized), cuff (periosteum-encased, non-vascularized), and vascularized bone grafts, and vascularized segmental grafts with fracture. In experiment 2, 12 rats were classified into two groups according to the presence of mechanical loading. This involved vascularized bone grafts with external fixators, and vascularized bone grafts with external fixators removed after bone union. The bone dynamics of the grafts were investigated by several methods, including roentgenographic analysis, histologic studies, and fluorochrome labeling. In experiment 1, a slight bone formation was recognized in the conventional bone graft, while irregular bone formation with creeping substitution was observed in the cuff graft. The vascularized bone graft showed significant hypertrophy; hypertrophy of the vascularized bone with fracture was greater than that without fracture. In experiment 2, markedly circumferential bone formation was observed after removal of the external fixator, while slight new bone formation was observed during the late postoperative period in bone with an external fixator. These results suggest that hypertrophy can be promoted by artificial fracture of the grafted bone, and that mechanical loading is an important factor for remodeling of grafted bone.     

镍-钛记忆环抱器治疗四肢骨折

目的 探讨记忆环抱器治疗四肢骨折的特点、机理与疗效。方法 对2001年5月～12月收治的97例患回顾性分析：锁骨骨折54例，尺、桡骨骨折30例，腓骨中下段骨折5例，肱骨骨折4例，股骨骨折3例，跖骨骨折1例。骨折通过切开复位，镍．钛记忆环抱器固定，体部置于张力侧。单纯骨折不用外固定。结果 97例患随访9～16月，均于术后3～10周达到临床愈合。54例于3～6月完全骨性愈合。结论 镍-钛记忆环抱器用于四肢骨折内固定，具有手术简单、时间短、固定牢固、骨折端血运破坏少、骨折愈合快、可早期功能锻炼，是一种治疗骨折的好方法。     

应用半环槽外固定架治疗小腿伤病

目的 回顾性评价半环槽外固定架治疗小腿伤病的疗效。方法 42例小腿伤病，其中新鲜胫腓骨骨折21例，陈旧性骨折畸形愈合、不愈合或合并骨髓炎5例，小儿麻痹症后遗单侧下肢短缩12例，骨病畸形4例．采用半环槽外固定架作固定、延长或畸形矫正。结果 随访8月～3年(平均13个月)。骨折26例均愈合，愈合时间为12～24周；儿麻12例延长4～8cm，骨病畸形4例均获矫正。并发症为针道感染8例12针，创面感染2例，早期邻近关节功能受限4例，早期拆架致骨折端轻度畸形l例。优良率95．2％。结论 半环槽外固定架适应证广泛，固定确切，操作简单、并发症少，适合在基层医院开展。