钢针撬拨复位跟骨外固定器固定治疗跟骨关节内骨折48例

跟骨骨折是临床常见的骨折之一,关节内骨折因波及距下关节面及横径加宽,Bo(?)hler角变小等,如治疗不当常可造成病残。我院自1995年6月~2000年5月用钢针撬拨复位跟骨外固定器治疗跟骨关节内骨折48例,取得了较好疗效,能有效恢复跟骨关节面平整及Bo(?)hler角、跟骨横径至正常,减少跟骨骨折的后遗症,现报道如下。     

经皮撬拨复位治疗跟骨骨折

2003年6月～2007年12月,我们采用经皮撬拨复位治疗跟骨骨折22例,疗效满意。     

撬拨复位内固定治疗跟骨舌状骨折

1996年 8月～ 2 0 0 1年 4月 ,作者以撬拨复位骨圆针内固定治疗跟骨舌状骨折 5 4例 ,疗效满意。1　材料与方法1.1　 病例资料　本组 5 4例 (北京积水潭医院骨科 30例 ,新泰市人民医院骨科2 4例 ) ,男 38例 ,女 16例 ,年龄 18～ 5 9岁。均为高处坠落跌伤。左侧 19例 ,右侧 2 8例 ,双侧 7例 ,共 6 1足。按Essex Lopresti分类法均为舌状骨折 :Ⅰ型 12足 ,Ⅱ型 2 8足 ,Ⅲ型 2 1足。侧位X线片示B¨ohler角 0°～ 15° 38足 ,0°～ - 15° 2 3足 ;轴位X线片示跟骨宽度均增加。手术均在伤后 3h～ 9d施行。1.2　治疗方法　硬膜外麻醉或腰麻。单侧…     

跟骨外固定器的研制与临床应用

  目的 探讨自行研制的跟骨外固定器治疗跟骨关节内骨折的临床效果。方法 回顾性分析2006年5月至2009年5月收治的30例跟骨关节内骨折患者的病例,男20例,女10例;年龄15～53岁,平均36岁。根据Sanders等分型,Ⅲ型16例,Ⅳ型14例。先应用自行研制的跟骨外固定器初步进行跟骨骨折的大体复位和固定,然后通过跟骨外侧小切口充分暴露并精确复位跟骨的后关节面。比较术前、术后3 d及术后6个月在跟骨侧位及轴位X线片上测得的跟骨长度、宽度、丘部高度、后关节面最大垂直移位、B?觟hler角的变化。根据Buckley标准,通过CT扫描评估后关节面复位情况。结果　所有患者均获得随访, 随访时间4～45个月,平均29个月。术后3 d和术后6个月时患侧跟骨侧位及轴位X线片示上述跟骨的解剖结构基本恢复至正常范围,并分别与术前比较,差异均有统计学意义;术后6个月与术后3 d比较,差异无统计学意义。末次随访时CT扫描示后关节面解剖复位27例,关节面不平整≤　2　mm者3例。结论 此跟骨外固定器治疗跟骨关节内骨折疗效确切,具有微创、实用、并发症少的特点。     

跟骨骨折跟骨牵伸复位外固定器的研制与临床应用

跟骨骨折是足部最常见的骨折,其中,约７０％～７５％的跟骨骨折波及距下关节面,这种波及是后遗伤残的根源〔１〕。在治疗上,学者们意见分歧,目前仍是探索的课题。作者自１９８８年６月始,依据足生理解剖特点和生物力学结构要求,自行设计研制了跟骨牵引复位外固定器...     

撬拨治疗跟骨关节内骨折

跟骨关节内粉碎性骨折治疗较为困难，我院2000年1月至2003年12月在跟骨结节牵引下用撬拨手法治疗19例，获得满意疗效，报道如下。     

撬拨治疗跟骨骨折

跟骨骨折是临床一种常见的关节内骨折 ,而且由于其为不规则骨 ,单纯手法临床治疗效果难尽人意 ,现将我院自1995年以来运用撬拨手法治疗的情况作一回顾分析如下。1　临床资料本组 32例均有完整随访资料 ,随访时间 6个月～ 7年。其中男性 2 3例 ,女性 8例 ;年龄 2 1～ 6 3岁 ;左侧 18侧 ,右侧14例。其中 5例为双侧。骨折按ＷａｔｓｏｎＪｏｎｅｓ分型 :Ⅰ型 7例 ,Ⅱ型 14例 ,Ⅲ型 10例。接受治疗距受伤时间为 :伤后当日 8例 ,一周内 12例 ,二周以内 12例。2　治疗方法肌注度冷丁加局部浸润麻醉 14例 ,神经阻滞 10例 ,椎管内麻醉 8例。患足按手…     

经皮撬拨与切开复位治疗跟骨骨折疗效对比

我院于1995年7月-2001年7月,共收治56例跟骨骨折患者,60个跟骨,经皮撬拨整复38个,切开复位22个,现将两种不同治疗方法的疗效对比报告如下.……     

小型跟骨钢板的研制及临床应用

目的 应用自行设计的小蝶形钛钢板经外侧小切口手术治疗简单的跟骨关节内骨折,探讨其固定效果和疗效.方法 对23例27足跟骨关节内骨折,SandersⅡ型13足,Ⅲ型14足,采用小蝶形钢板经外侧有限小切口切开复位内固定治疗,观察跟骨解剖参数和足功能的恢复.结果 19例23足获得随访,所有足的外形恢复良好,主要的X线片观察指标得到了有效的恢复,后关节面平整.按Maryland足评分方法评价术后功能,Ⅱ型骨折11足,优8足,良3足;Ⅲ型12足,优6足,良5足,可1足.未发生明显并发症.结论 对SandersⅡ和部分Ⅲ型骨折,切开复位小蝶形钛钢板内固定能够取得可靠的固定效果,减小软组织并发症,是一种有效的治疗方法.     

Treatment of intra-articular fractures of Os calcis with open reduction,internal fixation and bone graft

Surgical Principles The subtalar joint is a major weight bearing joint in the lower limb. Displaced intra-articular fractures of the os calcis should be treated with anatomical reduction and stable internal fixation to allow early mobilization. Intra-articular fractures of the os calcis lead to loss of joint congruity, and impaction of the cancellous bone. Bone grafting, together with stable internal fixation, allow early mobilization and weight bearing after surgery. The operation is done with the lateral approach which allows direct access to the fracture site. The subchondral bone, the sustentaculum tali and the medio-inferior part of the os calcis provide good bone stock for the purchase of screws. After reduction and fixation of the depressed fragments, the space is filled with cortico-cancellous grafts. The lateral wall of the os calcis is buttressed with a plate. Postoperatively, passive mobilization is started early, walking with a weight relieving calliper lasts for the first six weeks and graduated weight bearing is started on the seventh week.     

The postero-plantar approach to the Os calcis

Surgical Principles Incision in an internervous- and intervascular plane. Development of well vascularized soft tissue flaps. Wide exposure of the os calcis from the dorsal, plantar, lateral and medial sides. Revised Version from: Operat. Orthop. Traumatol. 3 (1991), 254–264 (German Edition).     

Influence of fat on ultrasound measurements of the Os calcis

Measurements of the speed-of-sound (SOS) and of the broadband ultrasound attenuation (BUA) on the os calcis were recently proposed to assess osteoporotic fragility. Velocity and attenuation were measured through the heel which can be divided in three phases including hydroxyapatite, soft tissue, and fat. The aim of this study was to evaluate the influence of fat composition and heel width on SOS and BUA. This influence was determined from both in vitro investigations examining fat samples, phantoms, and cadaver heels, and in vivo ones observing adult volunteers as well as a wide sample section of healthy elderly women. Ultrasound velocities on various fat samples were significantly lower than those on distilled water (-65 m/second to -123 m/second). The excision of the surrounding soft tissue from cadaver heels made SOS steadily increase whereas the insertion of a 10 mm piece of lard in the lateral face of cadavers' and volunteers' heels os calcis lowered SOS about 30 m/second. ond. Furthermore, a difference of SOS was estimated at 15 m/second for a 12.5% variation of the marrow fat weight. Among 334 elderly and healthy women aged 75 and over, a significant negative correlation was found between SOS and heel width (r=-0.27; P<0.0001). On the other hand, fat composition had no significant effect on BUA measurement, and no significant relationship was found between BUA and heel width. This study demonstrates that an increase of heel width and fat thickness provides an underestimation of os calcis SOS, but has no significant effect on BUA.     

Ultrasound bone densitometry of Os calcis in elderly Japanese women with hip fracture

We evaluated 138 elderly patients (mean age 79 years) within 2 weeks after hip fracture (67 cervical and 71 trochanteric) using an Achilles ultrasound bone densitometer (Lunar Corporation, Madison, WI). The ultrasound variables of speed of sound (SOS in m/second), broadband ultrasound attenuation (BUA in dB/MHz), and stiffness (%) index were measured on the os calcis. Ultrasound densitometry also was done on 563 normal postmenopausal women to assess normal age changes. An elderly subgroup (n = 138) served as age-matched controls for the hip fracture group. Further subgroups of 33 patients and 33 controls were compared for lumbar spine and femoral neck BMD. There were no statistically significant differences between the hip fracture group and age-matched controls in height and weight, but each ultrasound variable was significantly lower for the hip fracture group (P < 0.0001). For the hip fracture group, SOS was 1470 ± 19 m/second, BUA was 84.3 ± 8.4 dB/MHz, and the stiffness index was 47.8 ± 9.2%, whereas for the age-matched controls, SOS was 1486 ± 27 m/second, BUA was 94.0 ± 11.4 dB/MHz, and the stiffness index was 59.1 ± 12.5%. There were no significant differences between cervical and trochanteric hip fracture groups. Logistic regression analysis showed that a change of the ultrasound values by 1 standard deviation (SD) changed the odds ratio for SOS, BUA, and stiffness index by 2.51, 3.24, and 3.60, respectively. Ultrasound variables, particularly stiffness, were good indicators of hip fracture risk. Received: 7 June 1995 / Accepted: 14 June 1996     

外固定架治疗开放性胫腓骨骨折

目的 观察外固定架治疗开放性胫腓骨骨折的疗效。方法 自1994年7月到1999年12月,收治开放性胫腓骨骨折43例,男27例,女16例;年龄18-62岁。全部采用单侧多功能外固定架治疗。结果 43例全部随访,平均18个月,骨折均愈合,平均愈合时间86天,患肢恢复良好,无骨髓炎、骨不连等合并症。结论 该方法操作简单、创伤小、固定可靠、愈合率高,并发症少。为开放性胫腓骨骨折首选治疗方法。     

The intraarticular depression fracture of the os calcis

Surgical Principle An anatomical reconstruction of all joint surfaces and the shape of os calcis. Regain of all functions thanks to an internal fixation which allows early exercises and does not span any joint. Simple fracture patterns such as the 1-joint-/2-4-fragment fracture are best approached bilaterally and fixed from the medial side. Comminuted fractures are preferably approached through an extensive lateral incision. They are reduced and fixed with a double or triple H-plate (see Figure 11).     

Avulsion fracture of the posterosuperior tuberosity of the calcaneus managed with lag screw fixation

Background

To review the efficacy of lag screw fixation in management of avulsion fracture of the posterosuperior tuberosity of the calcaneus.

Broadband ultrasound attenuation of the os calcis in female postmenopausal patients with cervical and trochanteric fracture

The broadband ultrasound attenuation (BUA) of the right calcaneus was measured in 78 women with hip fracture (45 trochanteric and 33 cervical) and in 85 normal women (mean age 78 years and 63 years, respectively). All cases were postmenopausal and the hip fractures had resulted from a fall from standing position or less. The women with hip fracture had lower BUA (41 dB/MHz) than normals (67 dB/MHz), but about 10 dB/MHz of this difference was associated with age. There was no significant difference in BUA between cases with trochanteric (41 dB/MHz) and those with cervical fracture (39 dB/MHz). It is worth noting that 35.5% of the women with trochanteric fracture were suffering from osteoarthrosis of the knees but only 15% of the women with cervical fractures had the same problem. Over 90% of the cases with hip fracture had BUA lower than 61 dB/MHz and 80% had lower than 51 dB/MHz.     

撬拨复位拉力螺钉内固定与小切口复位接骨板内固定治疗跟骨骨折的病例对照研究

目的:比较单纯撬拨复位拉力螺钉内固定与小切口复位接骨板内固定治疗跟骨骨折的临床疗效。方法 :回顾性分析2015年6月至2018年6月收治的88例(98足)跟骨骨折患者的临床资料。根据骨折分型及治疗方法不同分为撬拨复位拉力螺钉内固定术组(A组)50例,男32例,女18例;年龄(32.6±6.7)岁;SandersⅡ-Ⅲ型30例,SandersⅣ型20例。小切口复位接骨板内固定术组(B组)48例,男30例,女18例;年龄(31.9±7.2)岁;SandersⅡ-Ⅲ型28例,SandersⅣ型20例。分别于术前、术后1个月及1年比较两组患者的B觟hler角、Gissane角及AOFAS评分以评价其临床疗效。结果:所有患者获得随访,时间13～24(14.6±6.3)个月。术后两组B觟hler角、Gissane角及AOFAS评分均得到不同程度改善。对于SandersⅡ-Ⅲ型患者,两组术前、术后1个月及1年B觟hler角、Gissane角比较差异无统计学意义;术后1年AOFAS评分比较差异无统计学意义。对于SandersⅣ型患者,B组术后1个月、1年时B觟hler角[(35.40±1.85)°、(35.15±1.90)°]和Gissane角[(127.80±5.49)°、(127.00±3.06)°]高于A组B觟hler角[(27.85±3.42)°、(27.25±1.80)°]和Gissane角[(118.00±4.13)°、(117.50±5.04)°](P0.05);两组术后1个月、1年时B觟hler角、Gissane角均较术前提高(P0.05); B组术后1年AOFAS评分91.00±5.46高于A组84.50±4.64(P0.05)。结论:对于SandersⅡ-Ⅲ型中度跟骨骨折,两种治疗方法疗效相当;但对于SandersⅣ型重度跟骨骨折,与撬拨复位拉力螺钉内固定术相比,小切口复位接骨板内固定术可获得更好的复位和可靠固定,改善患足功能。     

Os calcis fractures: Analysis of interobserver variability in using sanders classification

The os calcis is the most frequently fractured tarsal bone. In 1992 Sanders developed a classification system based on coronal and axial computed tomography (CT) scans of the calcaneus. This classification is the one used most frequently today in treatment decision making and reporting of results. The objective of this study was to assess the degree of interobserver variability in using this classification system. Thirty CTs of calcaneal fractures were chosen randomly from the past 5 years in 2 tertiary care centers. The CTs were reviewed by 3 orthopedic surgeons and one senior orthopedic resident who classified the fractures according to Sanders' classification. The results were first tabulated and analyzed by using a weighted kappa test including the subcategories. The weighted kappa value achieved was.56, with a 95% confidence interval of.45-.67. The subcategories of the classification were then further combined and a second weighted kappa test was performed to assess agreement between general classes. The weighted kappa value achieved was.48, with a 95% confidence interval of 0.37-0.59. We concluded that Sanders' classification system did prove to achieve moderate agreement among users, thus representing a useful classification system.