切开复位锁定钢板内固定治疗肱骨近端骨折

目的评价锁定钢板治疗肱骨近端骨折的临床效果及并发症。方法采用锁定钢板对骨折进行常规手术治疗。术后3、6、12个月对患者进行随访。随访内容包括疼痛、生活情况、力量及Constant评分,并与对侧肩关节进行对照。每次随访时,拍摄肩关节前后位片及"Y"位片,评价骨折愈合情况及可能存在的并发症。结果本组共106例肱骨近端骨折患者。其中,使用5孔钢板95例(90%),其余类型钢板11例(10%)。术后随访发现,患者受伤肩的活动度有明显的提高(P<0.05)。术后12个月,肩关节前伸可达(132°±35°),外展(122°±39°),外旋(45°±23°),内旋(77°±21°);患肩的Constant评分为(70.6±13.7),达到健侧(83.0±8.0)的(85.1%±14.0%),并随时间推移有明显提高(P<0.05)。在完成随访的93个患者中,25人(27%)出现了34例并发症,其中的18例(53%)并发症发生在术后3个月内,而22例(65%)并发症是因手术操作导致的。结论采用锁定钢板治疗不稳定性及老年性肱骨近端骨折有较好的临床效果。尽管也有并发症的发生,但大多是由手术操作造成的,是可以避免的。     

AO钢板内固定治疗跟骨骨折

目的　探讨复杂跟骨骨折治疗方法及AO钢板内固定价值。方法　自 1998年 3月至 2 0 0 3年 10月应用AO钢板治疗累及距下关节的跟骨骨折 2 7例 ,术中注意关节面复位及Gissane角和B¨ohler角的恢复。结果　 2 7例病人经 8个月～ 3年 (平均 18个月 )随访 ,根据张殿英等[1 ] 骨折评价方法 ,2 7例跟骨SandersⅡ、Ⅲ型骨折病人有 2 2例评为优良。结论　距下关节面的复位 ,Gissane角和B¨ohler角的恢复、牢固的内固定和术后足够长时间的负重限制是成功的关键。     

T型钢板内固定治疗Barton骨折

目的分析手术复位T型钢板内固定治疗Barton骨折的临床疗效。方法自1998年6月起，对18例Barton骨折，其中掌侧型15例，背侧型3例，均采用手术复位T型钢板内固定治疗。结果本组18例均获随访，随访时间为12～38个月，平均21．2个月，骨折全部愈合，腕关节功能按改良Mcbride评分和纽约骨科医院腕关节评估标准评定，优10例，良6例，可1例，差1例，优良率为88．9％。结论手术复位T型钢板内固定是治疗Barton骨折理想有效方法。     

双AO锁定钢板固定治疗肱骨远端骨折

目的探讨采用双侧AO锁定钢板内固定治疗肱骨远端骨折的方法及疗效。方法2004年4月至2006年5月使用双侧AO锁定加压钢板内固定治疗肱骨远端骨折15例,男性10例,女性5例;年龄19～58岁,平均32.7岁;按照AO分型,A型4例,B型6例,C型5例。均使用双侧AO锁定钢板切开复位内固定治疗,术后14～28 d开始功能锻炼,术后1、2、6、12个月复查X线片了解骨折情况。结果15例患者均获得随访,随访时间1～3.2年,平均1年6个月。骨折全部愈合,肘关节功能恢复满意。根据Cassebaum方法评定肘关节术后疗效,优5例,良8例,可2例,优良率86.7%。术后出现异位骨化1例,尺神经牵拉损伤1例,经神经营养药治疗后恢复。结论双侧AO锁定钢板内固定治疗肱骨远端骨折,固定可靠,术后可以早期行功能锻炼,肘关节功能恢复满意。     

三叶草钢板治疗肱骨近端移位骨折

目的探讨肱骨近端移位骨折采用三叶草钢板治疗的临床价值。方法用三叶草钢板治疗肱骨近端骨折38例,按N eer分类,二部分骨折20例,三部分骨折13例,四部分骨折5例,其中骨折伴脱位3例。结果36例获得平均13个月(3~28个月)随访,2例失访。36例均骨性愈合,无畸形愈合,无肱骨头坏死。按N eer评分标准评分,优27例,良6例,可2例,差1例,总优良率91.6%。结论采用三叶草钢板内固定治疗肱骨近端移位骨折,固定牢靠,可早期功能训练,术后功能恢复满意,值得提倡。     

切开复位重建钢板内固定治疗累及肩盂的肩胛骨骨折

目的探讨累及肩盂的肩胛骨折的治疗方法。方法回顾性分析2003年1月～2007年1月采用切开复位重建钢板内固定治疗的12例累及肩盂的肩胛骨骨折的疗效,记录术后并发症,骨折愈合时间,肩关节外展活动度,采用Neer和UCLA标准评价肩关节功能。结果10例得到平均15.2个月的随访。无表浅和深部感染,骨折均获得骨性愈合,骨折愈合时间12～16周,平均13.5周,肩关节外展90～180°,平均158°。根据Neer肩关节评分标准:优7例,满意3例。根据UCLA评分标准:优7例,良3例。结论采用切开复位重建钢板内固定治疗累及肩盂的肩胛骨骨折可获得满意的临床效果。     

髋臼骨折的切开复位内固定治疗

目的　对髋臼骨折的分类、手术适应证及内固定方法的选择和操作要领进行研讨。方法　从 1 986年 6月～ 1 998年 8月 , 3 1例髋臼骨折采用切开复位内固定 ,其中新鲜骨折 2 9例 ,陈旧骨折 2例 , 2 3例采用后方切口 , 7例前方切口 , 1例采用前后 联合切口。 2 9例单纯采用加压螺钉固定 ,其中 3例结合使用克氏针 ,另 2例采用钢板固定。术后除 1例外 ,其余均用皮牵引 2 ～ 3周。术后鼓励活动肌肉与关节 ,结合使用ＣＰＭ机进行功能练习 , 2～ 3个月后恢复负重活动。结果　本组 2 6例随访 1年至 1 0年 1个月。术后 2例切口浅层感染 , 6～ 8周治愈。在 2 2例采用后方切口的患者中有 2例发生关节周围骨化 ,但未影响关节 功能。本组无一例发生股骨头坏死。参照美国骨科学会拟定的疗效评定标准 ,本组 2 6例采用内固定治疗的优 1 9例 ,良 4例 , 尚可 3例。优良率占 88 4%。结论　 1 采用Ｌｅｔｏｕｒｎｅｌ和Ｍａｔｔａ相结合的分类法较合理。单纯前后壁或前后柱骨折 ,骨折片小 , 特别是非负重区骨折 (内顶弧角 <3 0°) ,分离移位 <3ｍｍ ,可采用牵引治疗 ; 2前、后壁或 (和 )前后柱两处以上骨折 ,包括 髋臼Ｔ形和Ｙ形骨折 ,分离移位 >3ｍｍ ,影响股骨头及髋臼的对合 ,为手术适应证 ; 3 拉力螺钉     

延期切开复位植骨钢板内固定治疗Pilon骨折

目的探讨延期切开复位结合植骨三叶草钢板内固定治疗Pilon骨折的疗效。方法 26例Pilon骨折患者,6例为开放性骨折,20例为闭合性骨折,对闭合性骨折先行跟骨牵引治疗,待肿胀消退后行切开复位结合植骨三叶草钢板内固定治疗。结果 26例均获术后随访,随访时间842个月。骨折临床愈合时间为1628周,患肢力线正常。术后有3例伤口感染,3例皮肤坏死,5例踝关节功能障碍;未见有骨折不愈合或畸形愈合,无窦道形成及骨髓炎。临床疗效按美国足与踝关节协会踝与后足功能评分：优6例（90100分）,良14例（7589分）,可3例（5074分）,差3例（小于50分）。结论正确评估局部软组织条件,根据Pilon骨折的类型和软组织损伤程度选择合适的手术方式和手术时机,三叶草钢板内固定维持骨折复位和下肢力线,干骺端缺损区充分植骨,修复关节面,早期功能锻炼,晚负重,可使P ilon骨折术后达到良好的临床疗效。     

肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折

目的评价肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折的疗效。方法采用肱骨近端锁定钢板治疗31例老年肱骨外科颈粉碎骨折。平均随访6个月（4-14个月）。结果术后无伤口感染、骨折不愈合和内固定松动发生。骨折愈合时间为术后2．5～6．1个月。肩关节功能按照Constant评分标准，功能优9例，良18例，中4例，优良率87．1％。结论肱骨近端锁定钢板对老年胧骨外科颈骨折固定可靠、并发症少，可早期功能锻炼，具有防止复位丢失、保护板下血运和骨折愈合快等优点。     

Outcomes of Proximal Humerus Fracture Open Reduction Internal Fixation with Concomitant Ipsilateral Shoulder Girdle Injuries: a Case Control Study

Background

Proximal humerus fractures treated in the face of ipsilateral injuries to the shoulder girdle may be predisposed to worse clinical outcomes.

Questions/Purposes

The purpose of this investigation was to examine outcomes of proximal humerus fractures treated with open reduction internal fixation (ORIF) using an endosteal augment in the presence of a concomitant shoulder girdle injury in comparison to isolated proximal humerus fractures treated with ORIF and endosteal augment.

Methods

A prospective database was used to identify proximal humerus fractures with ipsilateral shoulder girdle injuries (glenohumeral and acromioclavicular dislocation, fractures of the acromion, clavicle, scapula, or humeral diaphysis). These were compared to isolated proximal humerus fractures treated in the same fashion (ORIF with endosteal augment). Minimum of 1 year follow-up was required for inclusion. Outcomes assessed included range of motion (ROM), development of avascular necrosis (AVN), hardware-related complications, reoperation, and subjective outcome assessments including the Disabilities of Arm Shoulder and Hand questionnaire (DASH), Constant score, UCLA rating scale, and the Short Form-36 (SF-36).

Results

Fifteen ipsilateral injuries were seen in 14 patients. Seventy-seven isolated proximal humerus fractures were available for comparison. The ipsilateral injury group had significantly worse forward flexion (141 vs 156°, p?=?0.02), external rotation (56 vs 64°, p?=?0.03), higher rates of avascular necrosis (4 of 14, 28.6% vs 1 of 77, 1.3%, p?=?0.002), and inferior SF-36 physical health scores (48.5 vs 63.5; p?=?.04). Despite these differences, no significant differences were seen with hardware-related complications or DASH, Constant score, or UCLA rating scale results. No patients required secondary reconstructive procedures.

Conclusion

Despite a statistically higher rate of AVN and decreased ROM, patient-based outcomes of proximal humerus fractures with ipsilateral shoulder injuries approached those seen in isolated proximal humerus fractures. This suggests that these injuries can achieve similarly good clinical results provided any associated shoulder pathology is identified and treated appropriately.

     

Open Reduction and Internal Fixation Better than Percutaneous Plate Osteosynthesis in Distal Tibial Fractures

ABSTRACT

Minimally invasive percutaneous plate osteosynthesis (MIPPO) was compared with traditional open reduction and internal fixation (ORIF) in treating distal tibial fractures. Patients diagnosed with displaced extraarticular distal tibial fractures during October 2005–June 2007 were randomly assigned to a closed (treated using MIPPO) and an open (treated using ORIF) group. Ninety-four patients with fractures were treated and followed up, of which 42 and 52 patients were enrolled in the open and closed groups, respectively. The 94 fracture cases were classified into three types: Type A, 52 (55.3%); Type B, 24 (25.5%); and Type C, 18 (19.1%). The average follow-up time was 15.6 and 16.2 months for the open and closed groups, respectively. In the open group, 35 fractures healed within six months. Delayed union was observed in three fractures and nonunion in four fractures. Two cases had superficial wound infection after operation. No malunion was observed. In the closed group, 47 fractures healed within six months. Delayed union was observed in four fractures. Locking plate was broken nine months after operation in one case. Malunion was observed in five cases: two rotational and three posterior angular deformities. No statistically significant differences were observed in the healing time of Types A and B between the open and closed groups (p > .05). The healing time of Type C in the open group was longer than that in the closed group (p < .05). The first choice for Type C fractures is MIPPO, whereas that for Type A is open reduction.     

对99例髋臼骨折内固定治疗的分析

从1972年11月到1994年3月,401例髋臼骨折病人中的99例经手术治疗并获随访,包括30例双柱骨折,13例横骨折伴后壁骨折,9例后壁骨折,9例后柱骨折,9例前往骨折伴前壁骨折,13例T形骨折和16例横骨折.平均随访时间为7年(2～14).外科手术入路的选择,后入路53次,髂腹股沟入路23次,延长的髂股骨入路11次,放射状入路9次和结合性入路6次.复位情况用X线平片来评判,解剖复位的有59例(59.6%),接近解剖复位(<2mm的错位)的有19例(19.2%).总结果用Harris Hip Score来评判,优秀的有53例(53.5%),良好的有25例(25.3%),一般的有14例(14.1%),差的有7例(7%).并发症中,有10例(53%)为感染,7例(37%)为静脉栓塞.这些结果表明,对于错位严重的髋臼骨折,切开复位内固定是一种可以选择的治疗方法.     

Comparison of Robot‐Assisted Percutaneous Cannulated Screws Versus Open Reduction and Internal Fixation in Calcaneal Fractures

ObjectiveAccurate placement of the screws is challenging in percutaneous cannulated screw fixation of calcaneal fractures, and robot‐assisted (RA) surgery enhances the accuracy. We investigated the outcome of percutaneous cannulated screw fixation of Sander''s type II and III calcaneal fractures.MethodsThis retrospective study analyzed clinical data of 26 patients with fresh closed calcaneal fractures (28 fractures) who were admitted to our center from January 2022 to July 2022. All fractures were divided into the RA group and the open reduction and internal fixation (ORIF) group according to the surgeries performed. RA surgery was performed by closed reduction or open reduction combined with a tarsal sinus approach. Age, sex, operation time, preoperative waiting time, length of postoperative hospital stay, wound complications, and American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS) at 3 months postoperatively were compared. Preoperative and postoperative radiographic parameters (calcaneal length, width, height, Böhler angle, and fixation rate of the sustentaculum tali) were documented. The chi‐square test, one‐way analysis of variance, and Wilcoxon test were used for the comparison of categorical, normally distributed, and nonnormally distributed continuous variables, respectively.ResultsThe calcaneal width, height, and Böhler angle were significantly corrected postoperatively in both groups. The postoperative calcaneal lengths in both groups were also corrected. However, no significant difference was found. No significant differences in calcaneal length, width, height, and Böhler angle were observed between the two groups. The operation time (p < 0.001), preoperative waiting time (p < 0.001), and length of postoperative hospital stay (p = 0.003) in the RA surgery group were significantly shorter than those in the ORIF group. The fixation rate of the sustentaculum tali (p < 0.001) in the RA surgery group was significantly superior to that in the ORIF group. All wound complications occurred in the ORIF group. All fractures healed within 3 months. The AOFAS scores at 3 months postoperatively were not significantly different.ConclusionRA percutaneous screw fixation of the calcaneal fracture is a safe, effective, rapid, and minimally invasive surgical option for surgeons.     

Predictive Indicators for Complications of Proximal Humerus Fractures Treated with Locking Plate or Intramedullary Nail Fixation

ObjectiveThe purpose of this study was to evaluate the best placement of calcar screws in proximal humerus fracture surgeries.MethodsThis retrospective cohort study included clinical and radiographic outcomes of 98 patients treated with proximal humerus fracture surgeries between January 2017 and June 2020. Demographic data of patients were obtained from medical records. The surgical and radiographic results were also collected: operation time, blood loss, time to surgery, fibular allograft, disruption of medial region hinge, Neer classification, and recovery of medial support. Patients were allocated into two groups: the locking plate group (n = 65) and the intramedullary nail group (n = 33). In this study, we proposed new predictive indicators, named horizontal ratio (HR) and vertical ratio (VR), to quantify the placement of calcar screws in these two groups. A receiver operating characteristic (ROC) analysis was conducted to display the accuracy of these indicators. Shoulder activity, visual scale analog (VAS) score, and Constant score were performed to evaluate postoperative clinical outcomes at 1 year follow‐up.ResultsIn the multivariate logistic regression analysis, only time to surgery and effective medial support were considered statistically significant factors of postoperative complications (p < 0.05). Significant differences were observed between medial support and postoperative complications both in the locking plate group and the intramedullary nail group (p < 0.05). Only the vertical ratio of locking plate (VRLP) was a statistically significant predictor of postoperative complications (p < 0.05). The area under curve was calculated to assess the predictive value of VRLP, which came to 0.84. In addition, a ROC analysis found quantifiable thresholds of the VR was 0.1713 as measures to avoid postoperative complications in the locking plate fixation.ConclusionIn locking plate fixation, the incidence of postoperative complications increased significantly when the VR of calcar screws greater than 0.1713, which was beneficial to surgeons to place calcar screws.     

解剖型锁定钢板内固定治疗肱骨远端C型骨折

目的探讨应用解剖型锁定钢板内固定治疗C型肱骨远端骨折的疗效。方法肱骨远端C型骨折28例,按AO/ASIF分类:C1型10例,C2型15例,C3型3例;均采用采用尺骨鹰嘴截骨入路,解剖型锁定钢板内固定。受伤至手术时间平均5.8 d(2 h~10 d)。结果术后28例均获随访,平均20(2~30)月。骨折愈合时间平均3.5(2~10)个月。根据Cassebaum评分系统评定肘关节功能:优10例,良12例,可5例,差1例,优良率为78.6%,结论采用尺骨鹰嘴截骨入路,早期切开解剖复位、解剖型钢板内固定及早期有计划地康复训练治疗肱骨远端骨折,复位良好,固定可靠,能最大限度地恢复肘关节功能。