不扩髓带锁髓内钉治疗胫骨骨折25例分析

目的　探讨应用不扩髓带锁髓内钉治疗胫骨骨折的效果。方法　采用不扩髓带锁髓内钉治疗胫骨骨折 ,闭合复位 2 0例 ,切开复位 5例。结果　全部患者顺利康复 ,出院时复查X线片 ,骨折对位对线均良好 ,其中随访半年以上 2 1例 ,骨折全部愈合。结论　胫骨不扩髓带锁髓内钉治疗胫骨骨折疗效满意 ,是治疗胫骨骨折的较好方法     

髋臼前柱髓内螺钉固定的解剖影像学研究及临床意义

目的 探讨髋臼前柱髓内螺钉治疗髋臼前柱骨折的解剖影像学参数,为临床应用提供参考.方法 取30具国人尸体(男18具,女12具)完整骨盆标本.直视下分别置入右侧顺行和左侧逆行双侧髋臼前柱空心拉力螺钉,通过肉眼观测和多排螺旋CT二维重建,测量螺钉的进钉点、角度、钉道长度、螺钉与髋臼和盆腔的关系,确定最佳进钉点和安全角度.结果 髋臼前柱逆行置钉点在耻骨结节处,距耻骨联合中线垂直距离为(17.15±1.82)mm,距耻骨上缘垂直距离为(20.51±2.19)mm;顺行置钉点距坐骨大切迹顶点的水平距离为(33.25±2.35)mm.逆行进钉的安全角度在矢状面头倾(32.1±2.7)°,冠状面外倾角度为(46.5±3.6)°,顺行置钉角度与逆行置钉角度相同,在矢状面和冠状面呈相反方向,左右侧略有不同(P>0.05).螺钉钉道长度为(119.5±2.2)mm,左右侧比较差异无统计学意义(P>0.05).螺钉的最大直径为7.2 mm.结论 髋臼前柱髓内螺钉固定有较高的准确性,可作为髋臼前柱钢板固定的一种有益的补充.     

TE自锁式髓内钉的研制及临床应用

研制一种新型自锁式髓内钉。髓内钉远端采用可伸缩的矩形框在髓腔内固定 ,近端则采用可取弃的“几”形钉固定。临床 2 5例肱骨及股骨骨折全部愈合 ,随访 9～ 2 4个月 ,平均 15个月。X线片显示出现骨痂时间为术后 6～ 9周(平均 7周 )。认为自锁式髓内钉使手术操作更简单 ,骨折更易愈合。     

MultiLoc髓内钉与PHILOS钢板治疗肱骨近端骨折的疗效对比研究

目的比较Multi Loc髓内钉、PHILOS钢板治疗肱骨近端骨折的临床疗效。方法回顾性分析2017年1月—2018年5月广州市番禺区中心医院收治的99例肱骨近端骨折患者的临床资料,根据不同的治疗方法分为髓内钉组(n=49,给予闭合复位Multioc髓内钉内固定治疗)和钢板组(n=50,给予切开复位PHILOS锁定钢板内固定治疗)。比较两组患者的术中出血量、手术时间、术前至术后24h的血红蛋白变化和术后24h视觉疼痛模拟评分(VAS)。出院后进行为期1年的术后随访,比较两组的愈合时间、Δ颈干角、前屈上举角度、外旋和外展角度、Constant-Murley肩关节功能评分以及并发症发生情况。结果髓内钉组患者的术中出血量为(155. 48±32. 60) mL,手术时间为(113. 15±26. 09) min,术前至术后24h血红蛋白变化量为(20. 38±7. 12) g/L,术后24h的VAS评分为(2. 48±0. 46)分,均少于钢板组[(289. 52±50. 32) mL、(158. 59±23. 71) min、(12. 45±4. 83) g/L和(3. 14±0. 61)分],差异有统计学意义(P 0. 05)。髓内钉组患者愈合时间为(11. 05±2. 61)周,短于钢板组的(15. 70±3. 21)周,髓内钉组患者的Δ颈干角为(3. 30±0. 97)°,小于钢板组的(4. 41±1. 20)°,差异均有统计学意义(P 0. 05)。两组前屈上举、外旋和外展角度及Constant-Murley评分[(156. 04±14. 12)°vs.(160. 63±17. 76)°、(34. 75±8. 24)°vs.(32. 12±7. 05)°、(111. 37±18. 70)°vs.(113. 44±14. 21)°、(73. 02±16. 15)分vs.(69. 20±15. 31)分]比较差异无统计学意义(P 0. 05)。两组的术后并发症发生率(6. 00%vs. 8. 16%)比较差异无统计学意义(P0. 05)。结论 PHILOS钢板和Multiloc髓内钉治疗肱骨近端骨折均能取得较好的效果,但Muhiloc髓内钉有利于减少手术创伤,加快术后恢复,防止术后颈干角丢失。     

股骨近端防旋髓内钉导针定位装置的临床研究

目的评价股骨近端防旋髓内钉导针定位装置在亚洲型股骨近端防旋髓内钉(proximal femoral nail antirotationⅡ,PFNAⅡ)中的作用,并与常规徒手插入导针方法进行比较,探讨股骨近端防旋髓内钉导针定位装置的临床应用效果。方法 2014年9月~2016年5月东莞市第八人民医院创伤骨科收治住院的65例老年性股骨转子间骨折患者,根据其不同的手术方式纳入实验组及常规组,其中实验组32例;常规组33例。两组患者性别、年龄、骨折AO分型等一般临床资料差异无统计学意义,其中实验组应用股骨近端防旋髓内钉导针定位装置行股骨大转子导针插入;常规组应用常规徒手插入导针方法插入股骨干导针。记录并比较两组患者术中导针准确定位步骤花费时长及导针定位步骤中C型臂X线机透视次数。结果实验组导针置入花费时长为(8.1±1.7)min,透视次数为(5.5±1.2)次;常规组操作时间为(10.6±2.4)min,平均透视次数为(7.2±1.7)次。两组间导针置入操作时间、透视次数差异有统计学意义(P1=0.010;P2=0.037)。结论股骨近端防旋髓内钉导针定位装置较徒手插入导针方法可缩短导针插入时长,减少术中透视次数。     

股骨近端直型髓内钉对股骨前侧皮质撞击的影响及进针点的选择

目的分析股骨近端直型髓内钉对股骨前侧方皮质撞击的影响因素,寻求相对理想的髓内钉入针点。方法 2010年1月—2016年12月安徽医科大学附属省立医院创伤骨科收治180例行股骨近端髓内钉患者,其中男性65例,女性115例;年龄59～92岁,平均72. 2岁。由3位骨科医生通过医学影像存档与通信系统(picture archivingcommunication system,PACS)将股骨侧位片放大6倍观察髓内钉钉尖与股骨前侧皮质接触即定义为撞击。记录患者性别、年龄、股骨前弓角、BMI,并对撞击患者的上述数据进行多元回归分析,同时在股骨侧位片上将股骨近端分成前、中、后3等份,观察髓内钉轴线所在位置并比较差异性。结果 180例股骨近端髓内钉中,出现撞击106例(撞击率58. 8%);其中男性31例,女性75例;年龄65～92岁,平均73. 4岁;股骨前弓角(12. 1±1. 4)°,BMI(33. 6±1. 8) kg/m2;回归分析提示与前侧皮质撞击有关的因素包括性别、年龄、BMI和前弓角。股骨近端进针点前1/3的撞击发生率23. 8%,低于中1/3(66. 1%)以及后1/3(84. 6%)的发生率。结论老年女性通常合并较大的股骨前弓角,较大的前弓角是导致髓内钉与股骨皮质撞击危险因素,临床上对股骨前弓角较大者应尽量避免选用短直钉。在进针点上应在股骨近端的前侧1/3,而非传统的中后1/3。     

多层螺旋CT在可吸收消旋聚乳酸混合壳聚糖髓内钉治疗掌、指骨骨折中的应用

目的 探讨多层螺旋CT(MSCT)横轴位像、多平面重组(MPR)、遮盖容积重组(SVR)和透明化X线模拟投影(4D)在可吸收消旋聚乳酸(PDLLA)混合壳聚糖(CTN)髓内钉治疗掌、指骨骨折中的应用价值.资料与方法 回顾性分析60例术前X线诊断为单纯性骨折,用可吸收PDLLA混合CTN髓内钉治疗掌、指骨骨折的患者资料,均于术后1天、2周、12周行X线和4层螺旋CT检查,观察骨质细节、髓内钉与骨折断端的关系、骨折愈合情况.结果 CT可清晰显示可吸收髓内钉与骨折断端的关系、软骨痂形成和软组织改变,而X线平片均无显示.MPR可从任意平面观察可吸收髓内钉与骨折断端的关系,SVR和4D可以立体显示骨折复位和愈合情况.结论 MSCT在可吸收PDLLA混合CTN髓内钉治疗掌、指骨骨折中是一种具有重要价值的检查方法.     

撬拨辅助钉道控制在闭合治疗股骨转子下骨折中的意义

目的 评估术中使用斯氏针撬拨辅助钉道控制闭合复位的效果. 方法 23例股骨转子下骨折,术中用斯氏针置入股骨大转子后部协助复位,闭合复位后股骨近端髓内钉(PFN)或抗旋股骨近端髓内钉(PFNa)固定. 结果 23例患者手术时间30～55 min,平均39 min,出血量50～120 ml,平均76 ml.术中透视、术后X线复查骨折对位对线优良,骨折全部获得愈合,无严重并发症. 结论在髓内钉治疗股骨转子下骨折时,股骨近侧置入斯氏针撬拨辅助钉道控制能较好纠正和控制股骨转子下骨折近端骨折块的移位,手术时间短,创伤小,固定可靠.     

何为正常的儿童胫骨曲度?一项放射学的研究

正摘要目的明确胫骨X线影像上的骨性标志来确立描述与年龄相关的儿童生理性胫骨弯曲的正常值。材料与方法选取526例0~17岁病人的常规下肢X线影像,由2名放射科医生进行单盲的回顾性阅片。在正侧位片上,3条线确定胫骨的长度和成角。A线连接胫骨近端和胫骨干骺端的最远点,B线、C线相当于胫骨干骺端的两侧连线。A/B角是指近端角,A/C角是指远端角。胫骨曲度用与A线平行的D线和胫骨皮质切线之间的角度表示。用线性回归方法计算出正常值。应用Bland-Altman图形检验同一观察者不同时间和不同观察者之间的一致性。结果同一观察者不同时间的一致     

髓内钉联合小钢板固定与阻挡钉治疗胫骨近端骨折骨折愈合与下肢力线恢复效果比较

目的 比较髓内钉联合小钢板与阻挡钉治疗胫骨近端骨折的骨折愈合与下肢力线恢复效果.方法 选取江北人民医院自2018年6月至2020年6月收治的106例胫骨近端骨折患者为研究对象.采用随机数字表法将其分为A组与B组,每组各53例.A组采取髓内钉联合小钢板治疗,B组采取髓内钉联合阻挡钉治疗.记录并比较两组患者围术期指标(手术...     

Varus tibial osteotomy

Varus tibial osteotomy for early lateral compartment osteoarthritis is controversial because of the induced obliquity ofthe joint line. Many practitioners favor a femoral osteotomy, but both procedures can be criticized. A varus femoral osteotomy is efficient in extension, but at 90° of flexion it is inefficient, and we can observe an internal rotation of the epiphysis compared with the diaphysis. The tibial osteotomy is efficient both in flexion and extension but creates an oblique joint line. In our experience, we found that a varus tibial osteotomy can give good results in patients younger than age 60 with stable knees having an early lateral compartment localized at the peripheral rim in the meniscal area. The goal is to create a normal axis with no more than a 10° obliquity of the joint line. This value must be calculated preoperatively with regard to both femoral and tibial mechanical axis. The purpose of this report is to discuss the indications of a varus tibial osteotomy based on mechanical analysis and clinical experience. This type of intervention is oriented toward mild lateral compartment osteoarthritis. For the purpose of this report we have excluded both intraarticular and extraarticular malunion which are responsible for other specific problems.     

Open wedge tibial osteotomies influence on axial rotation and tibial slope

Inaccurate coronal plane and inadvertent sagittal plane realignment is a common problem after high tibial osteotomies (HTO). While the effects of an HTO on the coronal have been studied extensively, the influence on axial rotation has not been described in detail. The current study examines the effect of HTO on tibial rotation in the axial plane as determined by computed tomography. We hypothesized that high tibial osteotomies have an effect on tibial rotation in the axial plane and that depending on the predefined osteosynthetic implant used, a corresponding change in the tibial slope would occur. HTOs with a tapered 12.5 mm Puddu plate were performed on 13 limbs under computer-navigated control. All limbs were CT scanned before and after the HTO. Using specific software, the CT data was converted into 3D computer models and the following parameters compared: (a) varus-valgus leg alignment; (b) tibial axial rotation; (c) tibial slope (including determination of lateral and medial tibial slope, (d) leg length including determination of the tibial length. Results revealed: (a) a varus-valgus alignment increase of 11 ± 4.7° (P < 0.005); (b) an axial tibial rotation of 2.7 ± 6.3° (P < 0.075) occurred with external rotation in 10 out of 13 limbs (12° max external; 9.5° max internal); (c) tibial slope revealed differences of 4.2 ± 5.9° (P < 0.025); (d) the tibial length increased after HTO by 7.1 ± 3.7 mm (P < 0.005), while there was no significant change in overall leg length. In summary, tibial rotation does occur in high tibial osteotomies with though the degree of external rotation in this study tended not to be statiscally significant. Tapered implants do not guarantee maintenance of a steady tibial slope, while tibial length changes significantly when HTOs are performed. The combined use of CT and 3D software measurement techniques is reproducible and can be used without any further invasive fixation devices.     

胫骨远端解剖型钢板内固定治疗胫骨远端骨折

目的:探讨胫骨远端解剖型钢板内固定结合非骨膜剥离技术治疗胫骨远端骨折的疗效.方法:对62例胫骨远端骨折的闭合及开放性骨折病人,在软组织条件允许下采用胫骨远端解剖型钢板,应用非骨膜剥离技术进行切开复位内固定手术.结果:57例随访病人均在术后12个月内实现骨折愈合,较传统骨膜剥离技术提前6个月以上,功能恢复优良率100%.结论:胫骨远端骨折采用胫骨远端解剖型钢板,应用非骨膜剥离技术进行手术可缩短骨折愈合时间,明显提高骨折愈合率,更好恢复患肢功能.     

解剖型胫骨髓内钉治疗胫骨远端骨折的临床研究

目的 评估解剖型胫骨髓内钉(expert tibial nail,ETN)治疗胫骨远端骨折的临床疗效.方法 选择2007年10月-2008年6月采用ETN治疗的胫骨远端骨折患者13例,其中男8例,女5例;年龄25～47岁,平均33.8岁.骨折按国际内固定研究协会(AO/ASIF)分型:43-A1型3例,43-B1型4例,43-B2型4例,43-C1型2例.除3例Gustilo-Anderson Ⅰ型开放性骨折,其余均为闭合性骨折.对其临床资料进行分析,并评估其临床疗效.结果 所有患者术后随访3～13个月(平均8.4个月),均达到解剖复位并获得稳定固定.术后均愈合良好,无ETN断裂、伤口感染、骨折不愈合或肢体短缩等并发症发生.所有患者按Johner-Wruhs标准进行功能评分,其中优10例,良3例.结论 与常规切开复位钢板内固定治疗胫骨远端骨折相比,ETN具有微创、软组织损伤轻、手术时间短、固定可靠、术后康复锻炼早、功能恢复快等优点.

Abstract：

Objective To study the clinical effect of expert tibial nail (ETN) in the treatment of distal tibial fractures. Methods From October 2007 to June 2008,ETN was performed in 13 patients with distal tibial fractures. There were eight males and five females, at age range of 25-47 years (33.8 on average). According to AO/ASIF classification, there were three patients with 43-A1 fractures, four with 43-B1 fractures, four with 43-B2 fractures and two with 43-C1 fractures. All the patients were with close fractures except for three patients with Gustilo-Anderson type Ⅰ fractures. Their clinical data were analyzed for assessing the clinical effect of ETN. Results All patients were followed up for a mean time of 8.4 months (range 3-13 months), which showed that all the fractures obtained stable fixation and sound healing, with no complications like breakage of ETN, wound infection, fracture nonunion or limb shortening. According to Johner-Wruhs standard, the functional results were excellent in 10 patients and good in three. Conclusion ETN has advantages of minimal invasion, shorter operation time, stronger fixation,better soft tissue protection and better functional recovery for distal tibial fractures in comparison with traditional open reduction and buttress plate fixation.     

Medial tibial stress syndrome

MTSS is a benign, though painful, condition, and a common problem in the running athlete. It is prevalent among military personnel, runners, and dancers, showing an incidence of 4% to 35%. Common names for this problem include shin splints, soleus syndrome, tibial stress syndrome, and periostitis. The exact cause of this condition is unknown. Previous theories included an inflammatory response of the periosteum or periosteal traction reaction. More recent evidence suggests a painful stress reaction of bone. The most proven risk factors are hyperpronation of the foot, female sex, and history of previous MTSS. Patient evaluation is based on meticulous history taking and physical examination. Even though the diagnosis remains clinical, imaging studies, such as plain radiographs and bone scans are usually sufficient, although MRI is useful in borderline cases to rule out more significant pathology. Conservative treatment is almost always successful and includes several options; though none has proven more superior to rest. Prevention programs do not seem to influence the rate of MTSS, though shock-absorbing insoles have reduced MTSS rates in military personnel, and ESWT has shortened the duration of symptoms. Surgery is rarely indicated but has shown some promising results in patients who have not responded to all conservative options.     

High tibial slope correlates with increased posterior tibial translation in healthy knees

Purpose

Notwithstanding the importance of the tibial slope (TS) for anterior tibial translation, little information is available regarding the implications on posterior laxity, particularly in healthy subjects. It was hypothesized that increased TS is associated with decreased posterior tibial translation (PTT) in healthy knees.

Methods

A total of 124 stress radiographs of healthy knees were enrolled in this study. Tibial slope and the posterior tibial translation were evaluated using a Telos device with a 150-N force at 90° of knee flexion. Two blinded observers reviewed independently on two different occasions.

Results

One hundred and twenty-four patients [35 females and 89 males; 41 (range 18–75) years] were enrolled in this study, with a mean PTT of 2.8 mm (±1.9 mm; range 0–8 mm) and a mean TS of 8.6° (±2.6°; range 1°–14°). Pearson correlation showed a significant correlation between the PTT and TS in the overall patient cohort (P < 0.0001) with r = 0.76 and R ² = 0.58. There was no statistical difference between female and male patients regarding the PTT or the TS. Subgrouping of the patient cohort (four groups with n = 31) according to their TS (groups I < 7°; II = 7°–8.5°; III = 9°–10.5°; IV ≥ 11°) revealed significant differences between each subgroup, respectively. Furthermore, there was a weak but significant correlation between age and PTT (P = 0.004, r = 0.26).

Conclusion

In addition to the substantial variance in tibial slope and posterior laxity among healthy knees, high tibial slope significantly correlates with increased posterior tibial translation. Increasing age is further associated with a greater magnitude of posterior tibial translation. Consequently, knowledge of the tibial slope facilitates simple estimation of posterior knee laxity, which is mandatory for PCL reconstruction and knee arthroplasty.

     

Acute tibial tubercleavulsion fractures

Acute tibial tubercle avulsion fractures are commonly seen in athletes involved with jumping sports, especially basketball. These injuries typically occur in well-muscled, mature-appearing boys, 15 to 16 years of age, who generate high tensile forces at the tubercle junction. Possible associated injuries include patellar and quadriceps tendon avulsions, as well as collateral and cruciate ligament and meniscal damage. Treatment is based on the magnitude of injury. Recovery is rapid and the outcome is usually excellent, even in type III injuries.