可吸收棒加骨水泥髓内固定的实验性研究

目的 研究自增强型可吸收棒（PDLLA）联合磷酸钙骨水泥（CPC）髓内固定管状骨骨折的可行性，为用于手部掌、指骨骨折提供实验室依据。方法 将自增强型可吸收棒植入兔股骨干（横形骨折）髓腔内，两端用磷酸钙骨水泥粘合固定（实验组），克氏针髓内固定（对照组）。术后比较两组周围组织的反应，X线片变化及力学强度。结果 术后4周实验组和对照组的股骨干横向截骨均未见明显畸形，X线片示实验组的骨痂量多于对照组；测定股骨三点弯曲最大破坏载荷实验，结果两组无明显差异。术后8周剪切力较术后4周无下降。术后8周两组的骨折均愈合，未出现局部反应性肿胀、积液、感染及全身毒性反应。结论 自增强型可吸收棒与磷酸钙骨水泥在骨内具有良好的组织相容性，两者联合应用行管状骨骨折髓内固定，效能与克氏针固定相当。     

可吸收棒微创髓内固定治疗掌指骨骨折

目的 探讨可吸收棒微创髓内固定治疗掌指骨骨折的临床效果.方法 对19例25处掌指骨中段横形或短斜形骨折采用可吸收棒微创髓内固定.结果 本组获随访3～11个月,可吸收棒固定牢靠,术后疗效评定结果为:优13例,良4例,可1例,差1例.结论 可吸收棒微创髓内固定治疗掌指骨中段横形或短斜形骨折疗效可靠,操作简便,值得推广应用.     

有限切开可吸收棒髓内固定治疗掌骨颈骨折

目的探讨有限切开可吸收棒髓内固定治疗掌骨颈骨折的临床疗效。方法对18例22处掌骨颈骨折采用有限切开可吸收棒髓内固定。结果本组18例术后平均随访6．2个月,骨折均已愈合,骨折端对位对线良好,术后功能无障碍。结论有限切开可吸收棒髓内固定治疗掌骨颈骨折具有良好的复位和固定效果,可进行早期功能锻炼,并发症少,是治疗掌骨颈骨折的理想方法。     

可膨胀髓内钉治疗四肢长骨骨折

[目的]探讨可膨胀髓内钉Fixion^TM系统治疗长管状骨骨折的临床应用效果。[方法]自2004年9月．2006年1月，共30例患者采用Fixion^TM可膨胀髓内钉系统（Disco-O-tech Herzliya，lsreal）进行治疗；所有患者均为外伤引起的四肢长管状骨骨折，其中男17例，女12例，年龄22—82岁；开放性骨折1例，骨不连患者1例；股骨转子间骨折7例，股骨干骨折9例，肱骨骨折7例，胫骨骨折7例。可膨胀自锁髓内钉（IM）18例，可膨胀交锁髓内钉（IL）5例，股骨近端髓内钉（PF）7例。一般术后10d允许患者部分负重，若负重时患者骨折处出现明显疼痛应推迟。[结果]本组30例伤口全部I期愈合，手术时间30～140min，平均65min，术中出血50～1200ml，平均300ml。30例患者全部获得随防，随访时间12～72周，平均40周。术后根据临床和影像学平均愈合时间为：股骨转子间骨折11周，股骨干骨折12．2周，胫骨干骨折13周，肱骨骨折11周。其中1例为肱骨干骨折术后骨不连，再次手术后3个月，骨折处骨痂形成。[结论]可膨胀髓内钉应力分布均匀，避免了应力遮挡效应；一般无需扩髓和锁钉．减少了创伤和手术时间，医生和患者接受的X线剂量少和感染率低；轴相弹性动力化固定，加快了骨折愈合时间，避免了交锁髓内钉2次动力化手术给病人带来肉体和精神上的痛苦等。临床初步应用疗效满意，为长管状骨骨折的治疗提供一种新型的理念和固定技术，在掌握好适应证、正确操作的前提下，采用Fixion^TM可膨胀髓内钉系统治疗长管状骨骨折有可能获得较传统交锁髓内钉更好的效果。     

可吸收棒髓内固定联合防旋钉内固定治疗第2～5掌骨干骨折

目的探讨可吸收棒髓内固定联合防旋钉内固定治疗第2~5掌骨干骨折的临床疗效。方法回顾性分析自2014-12—2016-06采用可吸收棒髓内固定联合防旋钉内固定治疗的16例第2~5掌骨干骨折。3根掌骨均骨折、稳定性欠佳的2例术后予以支具或石膏固定。结果 16例术后获得随访5~18个月,平均13个月。骨折愈合时间6~18周,平均9周。末次随访时采用TAM系统评定疗效:优12例,良2例,可2例。1例术后无外固定保护行功能锻炼导致骨折轻度移位,经外固定辅助固定4周,骨折愈合良好;1例出现轻度炎症反应,随访过程中自然消退。结论可吸收棒髓内固定联合防旋钉内固定治疗第2~5掌骨干骨折创伤小,骨折愈合时间短,并发症少,且无需二次手术取出内固定,疗效满意。     

可吸收材料髓内固定在治疗掌骨干骨折中的体会

目的 探讨使用可吸收棒髓内固定治疗掌骨干骨折的临床疗效.方法 回顾分析了使用可吸收棒髓内固定治疗的28例32处掌骨干骨折,对治疗结果进行功能及影像学方面的评估.结果 所有患者均获得随访,时间为6～10个月.伤口均Ⅰ期愈合,其中2处第5掌骨骨折出现背侧成角移位,1处第5掌骨骨折出现再骨折,所有病例均骨性愈合,掌指关节主动屈伸范围基本正常.结论 使用可吸收棒髓内固定治疗掌骨干骨折是一种安全有效的手术方法.但因其固定强度不能完全满足早期康复的要求,可能出现再骨折或成角移位,特别是第5掌骨骨折术后尚需辅助石膏外固定.     

小切口可吸收棒髓内固定治疗锁骨骨折

目的探讨小切口可吸收棒髓内固定治疗锁骨骨折的临床应用价值。方法应用小切口可吸收棒髓内固定治疗锁骨骨折58例,并随访其疗效。结果全部病例随访6～18个月,平均10个月;骨折愈合时间为6～8周,愈合率100%,患者术后功能恢复良好。结论小切口可吸收棒髓内固定治疗锁骨骨折简便易行,创伤小、避免二次拆除内固定,值得临床推广应用。     

带锁髓内钉治疗下肢骨折的并发症及防治

目的：探讨带锁髓内钉治疗下肢长管状骨骨折的并发症原因，提出防治措施。方法：回顾性分析1998年3月-2004年5月用带锁髓内钉治疗的下肢长管状骨骨折101例，发生并发症共19例。锁钉放置失败3例，正确连接或更新瞄准器；术中新骨折2例，更换或辅以其他内固定；感染2例，足量应用敏感抗生素，创口引流、冲洗；延迟愈合2例，变静力为动力固定；骨不连1例，行拔钉、扩髓、换钉、植骨；再骨折4例，二次手术或制动；锁钉断裂、退出4例，未处置；肢体短缩1例，未处置。结果：锁钉放置失败、术中新骨折、延迟愈合、骨不连、术后再骨折、感染，共14例，均骨愈合。锁钉的断裂、退出4例，未影响骨愈合。肢体短缩1例，未影响骨愈合及正常生活。结论：运用带锁髓内钉治疗下肢长管状骨骨折严格掌握适应证及遵循静力和动力固定原则、彻底清创，是减少并发症的有效措施。     

复杂胫腓骨骨折治疗方法的选择

目的探讨严重复杂胫腓骨骨折治疗过程中手术时机、方法及内固定物的选择。方法177例胫腓骨骨折（42C型）患者均为二期行手术治疗。一期以全身及局部情况恢复为主,骨折先予以外固定支架或跟骨结节牵引等暂时固定,待情况稳定后,二期采用微创技术对骨折予以交锁髓内钉（118例）或钢板（59例）内固定,术后不辅以其他外固定。结果所有患者均得到随访,时间6～36个月。伤口愈合可,骨折无延迟愈合、畸形愈合。骨折临床愈合时间：髓内钉组14～16周,钢板内固定组14～17周。根据Johner-Wruhs评分,优良率分别为94%（111/118）及86%（51/59）。结论掌握好手术时机,合理地选择内固定物,结合微创手术技术,是治疗严重复杂胫腓骨骨折手术成功的关键。     

附加锁定钢板固定联合自体髂骨植骨治疗股骨干骨折髓内钉内固定术后骨折不愈合疗效观察

目的 观察附加锁定钢板固定联合自体髂骨植骨治疗股骨干骨折髓内钉内固定术后骨折不愈合的临床疗效。方法回顾性分析自2018-01—2022-12诊治的85例股骨干骨折髓内钉内固定术后骨折不愈合,观察组42例采用附加锁定钢板固定联合自体髂骨植骨治疗,对照组43例更换髓内钉固定联合自体髂骨植骨治疗。比较两组骨折愈合时间、术后并发症发生率,以及术后1个月、3个月、6个月膝关节功能HSS评分。结果 85例均获得随访,随访时间6～24个月,平均15个月。观察组术后出现1例（2.4%）感染,对症治疗后痊愈,未出现内固定物松动断裂、骨折不愈合、骨折畸形愈合。对照组术后出现8例（18.6%）并发症,其中2例感染（对症治疗后痊愈）,2例内固定物松动（未影响骨折愈合）,3例骨折不愈合（再次手术治疗）,1例骨折畸形愈合。观察组术后并发症发生率明显低于对照组,骨折愈合时间较对照组短,术后1个月、3个月、6个月膝关节功能HSS评分高于对照组,差异有统计学意义（P<0.05）。结论 附加锁定钢板固定联合自体髂骨植骨治疗股骨干骨折髓内钉内固定术后骨折不愈合可以取得满意的疗效,相较于更换髓内钉内固定治疗,骨折愈合更...     

PDLLA可吸收螺钉在断指再植中的应用

目的 分析PDLLA可吸收螺钉在断指再植骨折内固定治疗中的效果.方法 2005年10月-2007年10月,应用PDLLA可吸收螺钉作为髓内钉对9例断指再植进行治疗,其中4例为中节指骨处离断,5例为近节指骨处离断.术后3～4周拆除石膏进行保护性功能锻炼.结果 术后所有再植断指均存活,无骨折再移位或松动,术后6～8周骨折均达到骨性愈合.随访6～28个月,平均12.6个月.9例患指均无伤口肿胀、渗出或感染,断指功能恢复良好.结论 PDLLA可吸收螺钉能有效地固定断指骨折,并在术后3～4周进行功能锻炼,有利于患指功能的恢复.     

股骨干顺行髓内钉固定后同侧股骨颈骨折的治疗

目的：探讨股骨干骨折行顺行髓内钉固定后发现同侧股骨颈骨折的治疗方法。方法：回顾性分析2000年1月至2010年1月股骨干骨折行顺行髓内钉固定后术中或术后发现同侧股骨颈骨折的患者12例,全部以2枚螺钉分别自髓内钉前后方固定股骨颈骨折,定期随访,评估骨折愈合及功能恢复情况。结果：术后随访10—36个月,平均16．5个月。股骨颈骨折平均愈合时间3．6个月,股骨干骨折平均愈合时间5．4个月,无股骨头坏死发生。按Harris评分标准髋关节功能：优7例,良3例,可2例。结论：股骨干骨折顺行髓内钉固定后发现同侧股骨颈骨折,以2枚螺钉分别自髓内钉前后方固定股骨颈骨折方法可行,固定可靠,手术创伤小,骨折愈合率高。     

Custom titanium plating for failed nonunion or delayed internal fixation of femoral fractures

Eight patients with either failed internal fixation of nonunions of the femur (six) or delayed treatment of extensively comminuted femoral fractures (two) were treated with customized titanium plates for internal fixation. All eight patients had fixation problems that surpassed treatment by intramedullary nailing or standard plate osteosynthesis. Custom titanium plates were individually designed from roentgenograms and/or computed axial tomographic (CAT) scans. Plate dimensions were altered to increase strength, height, length, and placement of screw holes to enhance stabilization of the individual femoral anatomy. At an average follow-up period of 33 months, all fractures united; there were no complications, including fatigue or loosening of the custom implants. The implants were well tolerated and provided excellent fixation of difficult fracture problems.     

Treatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. A preliminary report

BACKGROUND AND AIMS: Cancellous bone fractures and arthrodeses have been treated successfully with bioabsorbable polyglycolide and poly-L-lactide implants. In this study bioabsorbable poly-L-lactide lag screws and metallic screws were compared in the fixation of subcapital femoral neck fractures. PATIENTS AND METHODS: Forty patients with femoral neck fractures were treated by internal fixation using three bioabsorbable self-reinforced poly-L-lactide (SR-PLLA) lag screws of 6.3 mm in diameter and 38 patients using three metallic screws of 7 mm in diameter. In addition, one patient was operated on using two and one using four metallic screws. The patients did not differ in age, body weight or primary dislocation of the fracture. There were six males in the lactide group versus 14 in the metallic fixation group. There were two Garden Stage I, 27 Garden Stage II, nine Garden Stage III, and two Garden Stage IV fractures in both groups. RESULTS: In the Garden I and II fractures there were 5/29 redislocations after SR-PLLA fixation and 8/29 after metallic fixation. In the Garden III fractures there were 4/9 and in the Garden IV fractures 2/2 redislocations in both groups. The ability to walk and the range of movement were better after bioabsorbable fixation. CONCLUSION: Self-reinforced poly-L-lactide lag screws can be used safely to fix subcapital femoral neck fractures in Garden Stage I and II fractures and in younger patients in Garden III fractures.     

Bioabsorbable miniplating versus metallic fixation for metacarpal fractures

Bioabsorbable implants offer an attractive alternative to metallic implants to stabilize small bone fractures in the hand. Self-reinforced bioabsorbable miniplating for metacarpal fractures was studied in bones from cadavers and compared with standard metallic fixation methods. One hundred twelve fresh-frozen metacarpals from humans had three-point bending and torsional loading after transverse osteotomy followed by fixation using seven methods: (1) dorsal and (2) dorsolateral 2-mm self-reinforced polylactide-polyglycolide 80/20 plating, (3) dorsal and (4) dorsolateral 2-mm self-reinforced poly-L/DL-lactide 70/30 plating, (5) dorsal 1.7-mm titanium plating, (6) dorsal 2.3-mm titanium plating, and (7) crossed 1.25-mm Kirschner wires. In apex dorsal and palmar bending, dorsal self-reinforced polylactide-polyglycolide and poly-L/DL-lactide plates provided stability comparable with dorsal titanium 1.7-mm plating. When the bioabsorbable plates were applied dorsolaterally, apex palmar rigidity was increased and apex dorsal rigidity was decreased. Bioabsorbable platings resulted in higher torsional rigidity than 1.7-mm titanium plating and in failure torque comparable with 2.3-mm titanium plating. Low-profile selfreinforced polylactide-polyglycolide and poly-L/DL-lactide miniplates provide satisfactory biomechanical stability for metacarpal fixation. These findings suggest that bioabsorbable miniplating can be used safely in the clinical stabilization of metacarpal and phalangeal fractures.     

Absorbable intramedullary implants for hand fractures. Animal experiments and clinical trial.

Biodegradable implants made from polyglycolic and polylactic acid co-polymers undergo degradation by hydrolysis which results in loss of their mechanical strength. The degradation of 1.5 mm polyglycolide rods (Biofix) was studied after intramedullary and subcutaneous implantation in rabbits. Two weeks after implantation there was a 73% reduction in strength of the intramedullary implants and a 64% reduction in the subcutaneous implants. Polyglycolide implants were compared with Kirschner wires for intramedullary fixation of extra-articular fractures in the hand. In one group of patients fractures were fixed with a 1.5 mm intramedullary rod and in a similar group a Kirschner wire was used. In both a wire loop was added for extra fixation. At six months there was no significant difference between the two groups. There were no allergic reactions to the polyglycolide implants.     

Radius-only intramedullary nailing for both-bones diaphyseal forearm fractures in children

Both-bones diaphyseal forearm fractures are common injuries in the paediatric age group and are potentially unstable. Both-bones intramedullary nailing for these fractures is a minimally invasive procedure that maintains alignment, and promotes rapid bony healing. Good results have also been shown with single-bone fixation. We report our experience in treating these common injuries with radius-only intramedullary nailing in 29 children. The clinical notes and radiographs were reviewed retrospectively. There were 9 girls and 20 boys; the mean age at the time of operation was 9 years (range: 5 to 17 years). Closed reduction was achieved in 21 patients, while eight patients required open reduction. Mean duration of follow-up was 6.8 months (range: 4 to 12 months). All fractures achieved clinical and radiological union at 6-8 weeks. Radius-only intramedullary nailing is a sufficient and effective option in treating both bones paediatric forearm displaced unstable type AO 22-A3 fractures, with excellent functional outcome and union rates.     

Intramedullary fixation for pediatric unstable forearm fractures

Forty-nine children with diaphyseal both-bone forearm fractures were treated with either both-bone intramedullary wire fixation (24), single ulnar intramedullary wire fixation (22), or single radial intramedullary wire fixation (3). Six fractures were open and 43 were closed. A limited open approach to one or both bones was necessary for insertion of the intramedullary wire in 10 of 43 closed fractures. All both-bone and single radial intramedullary wire fixations healed with less than 5 degrees angulation. Progressive reangulation of the nonfixed radial fracture after an initial satisfactory reduction was seen in seven of the 22 fractures treated with single ulnar intramedullary wire fixation. In four patients, the reangulation was controlled by a change of cast and molding of the fracture and was between 8 degrees and 12 degrees at union. In two other patients a second operative procedure was required to reduce and internally fix the radius. One fracture healed with a radial angulation of 25 degrees. Three fractures in older patients showed late reangulation after early removal of intramedullary wires at 5 weeks. The results of the current study suggest that the radius and ulna should be stabilized with intramedullary wires and that the wires should be buried to reduce the need for early removal.     

Successful treatment of scaphoid fractures and nonunions using bioabsorbable screws: report of six cases

PURPOSE: A variety of implants have been used for the fixation of scaphoid fractures, but we have found no reports on bioabsorbable screws used for this purpose. We report 6 cases of scaphoid fractures treated with bioabsorbable screws. METHODS: Six patients with scaphoid waist region fractures (3) and nonunions (3) treated using bioabsorbable self-reinforced poly-L-lactide screws. Interposition of a bone graft from the iliac crest was used in 4 cases. Immobilization in a short arm-thumb spica cast was applied after surgery for an average of 8 weeks. RESULTS: Solid union was achieved in 5 cases. Using the Mayo modified Green-O'Brien wrist score, we graded the results as excellent in 1 case, good in 4 cases, and poor in the single case of nonunion. CONCLUSIONS: These results suggest that bioabsorbable self-reinforced poly-L-lactide screws might offer an alternative in the fixation of scaphoid fractures and nonunions in the future, provided that cannulated screws of appropriate size will be available.     

Double fixation of displaced patella fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands

Purpose

To evaluate the effectiveness and safety of a new double fixation technique for displaced patellar fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands.

Methods

Fifteen patients (mean age of 46.2 years) with displaced transverse or comminuted patella fractures were enrolled in this prospective study. All of the patients were treated via the open reduction internal fixation (ORIF) procedure using bioabsorbable cannulated lag screws and braided polyester suture tension bands. The patients were followed post-surgery to evaluate (1) the time required for radiographic bone union, (2) the knee joint range of motion at the time of radiographic bone union, (3) the degree of pain assessed using the visual analogue scale (VAS), (4) the function of the knee using the Lysholm score and (5) the presence of any additional complications from the surgery.

Results

All of the patients were followed post-treatment for more than 1 year (range, 12–19 months; mean post-treatment follow up time, 14 months). The bone union of the fractures as seen radiographically occurred approximately 3 months from surgery in all cases without implant failure or redisplacement of the fractured site. The mean knee joint range of motion was from 0 to 134.6°, and the mean VAS score was 0.7 at the time of bone union. The mean Lysholm scores at the time of bone union and 12 months post-surgery were 86.7 and 95.7, respectively. No postoperative complications, such as infection, dislocation or breakage of the implants, were observed. Moreover, all of the patients returned to their previous activity level.

Conclusion

This new double fixation technique using bioabsorbable cannulated lag screws and braided polyester suture tension bands resulted in satisfactory outcomes for patella fractures without any obvious complications.