扩髓交锁髓内钉治疗胫骨不稳定性骨折（附42例报告）

目的：探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果。方法：对42例胫骨不稳定性骨折病人行扩髓交锁髓内钉治疗，闭合性骨折22例，开放性骨折20例，全部应用静力性固定。结果：平均随访时间12个月（6-20个月），采用Johner-Wruh评分标准。治疗结果：优32例，良8例，一般2例，骨折平均愈合时间；闭合性骨折15周（10-23周），开放性骨折19周（13-36周）。3例延迟愈合，无深部感染，骨髓炎，畸形愈合及骨不连。结论：扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法，可促进骨折愈合。并发症较少。     

带锁髓内钉治疗粉碎性胫骨骨折28例体会

目的 回顾性分析带锁髓内钉治疗粉碎性胫骨骨折的疗效。方法 带锁髓内钉治疗粉碎性胫骨骨折28例，其中闭合性骨折18例，开放性骨折10例。闭合性骨折术中均扩髓，开放性骨折均不扩髓，全部骨折采用静力性固定。结果 18例闭合性骨折平均愈合时间15．8周，10例开放性骨折平均愈合时间21．2周。结论 带锁髓内钉治疗粉碎性胫骨骨折采用闭合复位和早期静力性固定，既有利于骨折的早期愈合和患早期的床上功能锻炼，同时也具有手术操作方便，闭合复位保留血供和减少并发症等优点．     

应用扩髓交锁髓内钉治疗胫骨不稳定性骨折

目的 探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果。方法 对42例胫骨不稳定性骨折患行扩髓交锁髓内钉固定，闭合性骨折22例，开放性骨折20例，均应用静力性固定。结果 平均随访时间12个月，采用Johner—Wruh评分标准，治疗结果：优32例，良8例，一般2例。骨折平均愈合时间：闭合性骨折15周，开放性骨折19周，3例延迟愈合，无深部感染、骨髓炎、畸形愈合及骨不连发生。结论 扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法，可促进骨折愈合，并发症少。     

外固定支架与非扩髓髓内钉治疗开放性胫骨骨折的疗效比较

目的比较外固定支架与非扩髓髓内钉治疗开放性胫骨骨折的临床疗效。方法对2002年1月～2004月12月急诊治疗的156例开放性胫骨骨折患者资料进行回顾性分析，其中93例采用单臂外固定支架治疗，63例采用非扩髓髓内钉治疗。对两组患者的一般资料、骨折AO分型、软组织Gustilo分型、术后骨折愈合时间、骨折延迟愈合例数及并发症进行统计学分析。结果外固定支架组和非扩髓髓内钉组的骨折平均愈合时间分别为7．8个月（3～18个月）、5．3个月（2．12个月）。非扩髓髓内钉组在骨折愈合时间、骨折延迟愈合及骨折畸形愈合方面明显优于单臂外固定支架组（P〈0．05）；两组在感染发生率方面差异无统计学意义（P〉0．05）。结论非扩髓髓内钉治疗开放性胫骨骨折具有骨折愈合时间短、畸形愈合少等优点。对于严重污染的创面及全身多发伤患者，外固定支架的临时固定是首选。     

扩髓交锁髓内钉治疗胫骨不稳定性骨折 (附42例报告)

目的探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果.方法对42例胫骨不稳定性骨折病人行扩髓交锁髓内钉治疗,闭合性骨折22例,开放性骨折20例,全部应用静力性固定.结果平均随访时间12个月(6～20个月),采用Johner-Wruh评分标准,治疗结果优32例,良8例,一般2例,骨折平均愈合时间闭合性骨折15周(10～23周),开放性骨折19周(13～36周),3例延迟愈合,无深部感染、骨髓炎、畸形愈合及骨不连.结论扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法,可促进骨折愈合,并发症较少.     

闭合复位有限扩髓带锁髓内钉治疗胫骨骨折

目的探讨闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折的疗效。方法应用闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折73例,均静力固定。对合并有腓骨骨折的胫骨不稳定性骨折,行腓骨骨折固定。结果患者均获随访,时间6—21（13．6±3．2）个月,骨折均愈合,时间4～10（6．2±1．6）个月。功能恢复按Johner—Wruhs标准：优62例,良11例。3例出现骨折延迟愈合,无骨折畸形愈合、小腿骨筋膜室综合征、断钉等并发症。结论闭合复位、有限扩髓带锁髓内钉治疗胫骨骨折具有固定牢固、微创、加快骨折愈合,减少骨不连、断钉等优势,是治疗胫骨骨折一种较好的内固定方法。     

扩髓的带锁髓内钉治疗胫骨不稳定骨折

作者回顾了２６例不稳定的胫骨骨折，均采用扩髓的带锁髓内钉治疗。其中闭合骨折１９例，开放骨折７例。除了３例闭合骨折失访，其余２３例骨折平均随访２０．４个月（３～６３个月）。最终结果评分采用Ｊｏｈｎｅｒ－Ｗｒｕｈ评分标准，在１６例闭合骨折中，最终评定结果优１３例，良２例，中１例；在７例开放骨折中，优３例，良２例，差２例。骨折平均愈合时间，闭合骨折１３周（８～２０周），开放骨折３０．５周（１２～９６周）。随访的１６例闭合骨折半年内均愈合；在７例开放骨折中，有１例骨折延迟愈合，时间超过１年，其余均在半年内愈合。闭合骨折随访１６例，无１例感染。７例开放骨折有２例感染，其中１例造成骨折延迟愈合。以上２６例病人手术后均无继发性骨筋膜室综合征、神经损伤、钉体或锁钉断裂等情况。作者认为扩髓的带锁髓内钉非常适用于闭合的胫骨不稳定骨折，而在治疗开放的胫骨骨折时，因为感染率高，应谨慎使用。     

不扩髓带锁髓内钉治疗胫骨开放性骨折

目的总结胫骨开放性骨折应用不扩髓带锁髓内钉内固定治疗的经验及体会。方法对52例胫骨开放性骨折行清创复位不扩髓带锁髓内钉内固定。结果50例患者取得随访半年以上，骨折全部愈合，膝踝关节功能完全恢复正常。结论不扩髓带锁髓内钉内固定治疗胫骨开放性骨折固定坚强，操作简单，并发症少，功能恢复良好，疗效确切，结果令人满意。     

胫骨骨折的交锁髓内钉治疗

目的：观察交锁髓内钉在胫骨骨折中的治疗效果。方法：1997年2月－2000年2月对37例胫骨骨折采用交锁髓内钉治疗,男30例,女7例,年龄18－65岁,闭合性骨折28例,开放性骨折6例,陈旧性骨折2例,胫骨骨不连2例,开放性骨折采用非扩髓髓内钉,闭合性骨折采用扩髓髓内钉。结果：37例得到随访,骨折全部愈合,无锁钉及髓内钉松动、断裂,膝踝关节功能正常,迟发性感染1例。结论：交锁髓内钉在治疗胫骨骨折中具有创伤小、固定坚强、骨折愈合率高、能早期活动、感染率低等优点,是一种较好的内固定方法。     

带锁钉治疗胫骨骨折：附36例报告

观察带锁髓内钉治疗胫骨骨折的疗效。方法：１９９７年７月－１９９８年１０月，对３６例胫骨骨折采用带锁髓内钉固定。其中男２１例，女１５例，年龄１８－６２岁。闭合性骨折１９例，开放性骨折１７例。手术采用扩髓１４例，动力型固定４例，静力型变为动力型固定１５例。     

钢板结合髓内钉治疗胫骨单髁伴同侧胫骨干中、远段骨折

 目的 探讨钢板结合髓内钉治疗同侧胫骨平台单髁伴胫骨干中、远段骨折的可行性和临床疗效。方法 2003年 5月至 2008年11月,钢板结合髓内钉固定治疗胫骨平台单髁伴同侧胫骨干骨折21例,男15 例,女6 例;年龄20～55岁,平均34岁。按Schatzer分类,Ⅰ型4例、Ⅱ型11例、Ⅲ型6例。胫骨干骨折按部位分型,胫骨干中段骨折13例、中下1∕3骨折8例。复位后,先钢板固定胫骨平台再髓内钉固定胫骨干19例,先髓内钉固定胫骨干再钢板固定胫骨平台2例。结果 所有病均例获得随访,随访时间0.9～4年,平均2.2年。所有患者均获骨性愈合,胫骨平台平均愈合时间为12周;胫骨干骨折平均愈合时间为29周,3例患者胫骨干骨折延迟愈合,拆除交锁钉使之动力化后愈合。1例胫骨平台未能解剖复位导致骨折畸形愈合。根据HSS膝关节评分标准[2],优17例(80.95%)、良3例(14.29%)、中1例(4.76%)。结论 注意一些技术要点,应用两种熟悉的手术技巧,钢板结合髓内钉能够成功治疗胫骨平台单髁伴同侧胫骨干骨折。     

Intramedullärer Verriegelungs-Kompressionsnagel (IP-XS-Nagel®)

OBJECTIVE: Reconstruction of the anatomy of the ankle joint while protecting the soft tissue, and osteosynthesis to maintain stability for function and weight bearing. INDICATIONS: Distal fractures of the fibula, bimalleolar fractures, and isolated fractures of the medial malleolus. CONTRAINDICATIONS: Very small (< 5 mm) distal fragments (if fixation of the fragments is not possible using a small XXS nail) and very narrow (< 2.5 mm) medullary cavity (conversion to plate fixation). SURGICAL TECHNIQUE: With displaced fibula fractures, open reduction should be performed with fracture retention using wide-armed reduction forceps, insertion of a central guide wire into the medullary cavity, use of a cannulated drill bit, introduction of the nail using an aiming arm and locked fixation with threaded wire. After checking the position using X-ray, the wire should be shortened using the bolt cutters. POSTOPERATIVE MANAGEMENT (Depending on the Weber classification): Full weight bearing for all isolated distal fractures of the fibula (Weber types A and B) and isolated fractures of the medial malleolus. For distal fractures of the fibula (Weber types A and B) with additional fracture of the medial malleolus or involvement of the medial ligament partial weight bearing of 20 kp for 4 weeks, followed by full weight bearing. For all Weber C fractures and/or additional Volkmann fracture only 10 kp of partial weight bearing with a rocker-sole orthosis should be allowed for 6 weeks followed by full weight bearing. No weight bearing for 6 weeks until the screws are removed is only recommended, if positioning screws have been used for Weber C fractures. RESULTS: In the period from 05/2000 to 01/2002, 194 ankle fractures were treated with the IP-XS-Nail((R)). Follow-up examinations were conducted on 162 patients with an average age of 51.2 years after an average of 15 months. 62 Weber B fractures (38.3%) and 45 Weber C fractures (27.7%) were evaluated. There were bimalleolar fractures in 55 cases (34.0%). According to the Olerud Score (clinical and radiologic score), 95 patients (58.6%) had an excellent, 54 (33.3%) a good, nine (5.5%) a moderate, and four (2.4%) an unsatisfactory result.     

胫骨干骨折髓内钉固定术中置钉点的影像学研究及临床应用

目的对胫骨干骨折髓内钉固定术中理想置钉点的进行影像学研究,并探讨其临床疗效。方法 2006年5月至2010年12月,对160例胫骨干骨折通过术前透视确定置钉点的位置,选择性地采用髌韧带内侧入路、髌韧带外侧入路或经髌韧带入路进行切开复位内固定治疗。结果髌韧带宽度为27～43mm,平均34.38±3.69mm。若将髌韧带依宽度划分3等份,42例的理想置钉点位于外侧区域,95例位于中间区域,23例位于内侧区域;若将髌韧带依宽度划分成内外侧2等份,则有90例的理想置钉点位于外侧区域,60例位于内侧区域。本组患者均获随访时间12～85个月,平均39.3个月。根据Johner-Wruhs评分标准,总体优良率为96.3%,术后发生患侧膝关节疼痛共有29例（18.1%）。结论术前通过透视确定置钉点的位置,选择性地采用相应的手术入路,是相当重要的准备工作。个体化的手术入路有利于髓内钉置钉点的显露,膝关节内结构损伤小,疗效可靠,并有效降低膝关节疼痛并发症的发生率。     

预置阻挡钉在治疗胫骨螺旋形骨折合并后踝骨折中的作用

目的 探讨预置阻挡钉在治疗胫骨中下1/3 螺旋形骨折合并后踝骨折中的作用.方法 回顾性分析2018 年5月至2020 年6 月收治的24 例胫骨中下1/3 螺旋形骨折合并后踝骨折患者临床资料.所有患者均采用预置阻挡钉技术,并进行髓内钉及空心钉内固定治疗.术后记录胫骨正位 X 线片上冠状面力线(胫骨远端外侧角)、膝关节疼...     

Die tibiotalare Arthrodese mit dem Kompressionsmarknagel

OBJECTIVE: Arthrodesis of the ankle joint in proper position (neutral position in respect to flexion/extension, 5 degrees external rotation, 0-5 degrees of valgus). Pain-free weight bearing of the affected limb. INDICATIONS: Painful osteoarthritis of the ankle joint resistant to conservative approaches even in the presence of poor bone quality of the distal tibia such as after pilon fractures and osteoporosis. Failure of other methods of internal fixation. CONTRAINDICATIONS: Osteitis. Partial necrosis of the talar dome. Medullary canal of tibia not patent. SURGICAL TECHNIQUE: Lateral approach and resection of lateral malleolus. If the joint position is normal, removal of articular cartilage of tibia and talus. If axial correction is necessary, wedge resection of articular surfaces with underlying bone. Opening of proximal tibial medullary canal, insertion of compression nail into tibia and talus. Compression osteosynthesis and cancellous bone grafting. Alternatively, the arthrodesis can be achieved with the dowel technique. RESULTS: Between September 1993 and March 2001, 137 patients (43 women, 94 men, average age 49 years [21-79 years]) were operated. Follow-up of 110 patients after 42 months: successful bony fusion in 99 patients (90%). In six patients (5.5%) the goal of treatment was obtained after revision with recompression of the nail and bone grafting. Nonunion in five patients (4.5%). Complications: one tibial shaft fracture, one hematoma needing evacuation, three superficial infections, and eight deep infections. Three patients developed an osteoarthritis of the subtalar joint. 70 patients (63.6%) reported an improvement, 37 (33.6%) no notable change of symptoms, and three (2.7%) a deterioration.     

Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients

We describe the surgical technique and report the outcome after closed reduction and percutaneous plating in 21 closed extraarticular distal tibial fractures using titanium LC-DCP. A long plate was pushed subcutaneously through a small incision at the medial malleolus and fixed with screws through stab incisions. Fracture reduction was anatomical or nearly anatomical without angular displacement in 14 cases, and considered acceptable in four cases. Two patients were reoperated because of malreduction. Seventeen fractures healed within 6 months. There were two delayed unions, and two non-unions. There were two deep infections, both in diabetic patients. Follow-up by an independent observer at on average 14 (5-25) months showed various symptoms such as slightly reduced ankle mobility (9/20), reduced walking ability (11/20) or tenderness around the plate (11/20). No patient complained of knee symptoms related to the surgery. Operative treatment of closed distal tibial shaft fractures with a long titanium plate provided good anatomical results and allowed in most patients early weight-bearing. In patients with soft tissues in good condition and no risk factor for infection percutaneous plate osteosynthesis might become an attractive treatment option for fractures in the distal tibia.     

An intramedullary nail with multifunctional interlocking for all types of fracture in both femurs

Objective: A femoral compound interlocking intramedullary nail (FCIIN) was designed to treat all types of fractures between the trochanter and epicondyle of both femurs. It could substitute for femoral interlocking intramedullary nails (FIIN) at five points. Methods: According to the morphological characteristics of the femoral medullary canal, the nail is designed to accommodate a 1250 mm radius of radian and a 135° neck‐shaft angle. Three interlocking holes of 6.5 mm diameter are located at the proximal end of the FCIIN, making crossing of the screws possible. The hole is designed to be vertical (90°) or oblique (45° upper or lower). At the tip of the proximal interlocking screws, whose root diameter gradually increases from 3.5 mm to 6.5 mm, a self‐tapping cancellous screw is placed. There are two types of distal interlocking screws. One is a fine thread and the other a bolt screw. Two interlocking holes and a recess 4.5 mm in diameter are located at the distal end of the FCIIN. Under biomechanical destructive testing, the proximal interlocking screw device has satisfactory strength and reasonable structure. A total of 47 patients (31 males and 16 females, with an average age of 39.83 years) with femoral fractures were assessed in this study. Fourteen cases were diagnosed as intertrochanteric, 7 as subtrochanteric, 18 as femoral shaft, and 8 as supracondylar fractures. All 47 patients were treated with the FCIIN. Results: Of the 47 patients, anatomic reduction was achieved in 34, good reduction in 11, and forced line reduction in 2 cases. Reduction was excellent or good in 95.87% of the fractures. The removal time of the FCIIN was 12 to 21 months (average, 16.9 months). One patient with an intertrochanteric fracture who had a fixation failure combined with non‐union achieved healing with an external fixator at 18 months. Failure to insert the distal interlocking screws occurred in 5 patients but did not affect bone healing. Conclusion: The FCIIN is a useful device in the treatment of a variety of femoral fractures.     

交锁髓内钉治疗胫腓骨骨折

目的 观察交锁髓内钉治疗胫腓骨骨折的疗效及并发症防治。方法 用交锁髓内钉治疗胫腓骨骨折46例,均采用扩髓及静力型固定。结果 46例均得到随访,平均20个月（6个月-3年）,愈合时间为3-12个月,平均4个月,感染4例均为开放性骨折,肢体短缩1例,成角畸形2例,延迟愈合7例,无不愈合。根据Johner-Wruh评分标准,优36例,良7例,中2例,差1例。结论 交锁髓内钉治疗胫腓骨骨折是一种很好的方法。但仍有一些并发症,在应用中必须引起重视;开放性骨折以不扩髓为宜。     

Distal articular involvement in tibial shaft fractures: an evaluation of 125 consecutive cases

Purpose

To report the incidence and morphology of ipsilateral distal articular involvement (DAI) in a consecutive series of tibial shaft fractures.

Method

A retrospective review was performed on 115 patients who underwent intramedullary nailing for tibia shaft fractures. Ankle evaluations included preoperative radiographs and computed tomography (CT) scans in all patients.

Results

Thirty-two patients (27.8%) in our series presented with tibial shaft fractures associated with DAI. Tibial spiral fractures (42A1) were significantly related to DAI (RR: 1788). In 28 (87.5%; 28/32) articular fractures, posterior malleolus fractures (PMF) were present; 22 were isolated, and six (18.8%) occurred in combination with medial malleolus or anterolateral fractures. The remaining (12.5%; 4/32) were isolated medial malleolus fractures. Ten (31.2%; 10/32) articular fractures were occult on the radiographs and only detected on CT scan.

Conclusion

DAI is common in tibial shaft fractures. CT evaluation is mandatory due to the high number of occult fractures. Although isolated PMF is the most frequent pattern of DAI involvement, 31.3% of the cases exhibited different patterns.

     

股骨复合型带锁髓内钉的设计及临床应用

目的 阐述股骨复合型带锁髓内钉(femoral compound interloeking intramedullary nail,FCIIN)的设计原理,探讨其临床疗效.方法 根据股骨髓腔形态学特点,没计FCIIN的主钉弧度半径为1250 mm,近端斜形交锁角度(钉的颈干角)为135°.主钉近端有三个直径6.5 mm的锁钉孔,使锁钉可以横穿,也可以向左上或下、右上或下45°斜穿.主钉远端有两个直径4.5 mm的锁钉孔和一个相同直径的凹槽.近端锁钉尖部有长30～40 mm自攻松质骨螺纹,螺纹直径由3.5 mm逐渐增大至6.5 mm.远端锁钉有两种:一种是螺纹锁钉,另一种是螺栓锁钉.2000年1月至2004年12月,用FCIIN治疗股骨骨折患者47例,男31例,女16例;年龄18～74岁,平均39.83岁;转子间骨折14例,转子下骨折7例,股骨干骨折18例,髁上骨折8例.其中不扩髓顺行打钉30例.结果 所有患者均获得随访,随访时问21～36个月,平均25.9个月.骨愈合时间6～18个月,平均8.4个月.解剖复位34例,良好复位11例,力线复位2例,复位优良率95.74%.取钉时问12～21个月,平均16.9个月.1例转子间骨折固定失败并骨不愈合患者,采用辅助外固定支架治疗,18个月后骨折愈合.远端锁钉安装失败5例,未做任何处理骨折均愈合.结论 FCIIN 临床应用效果理想,可用于治疗各类股骨骨折.