影响股骨远端关节内粉碎性骨折手术疗效的因素

目的探讨影响股骨远端关节内粉碎性骨折手术疗效的因素。方法2000年1月至2006年12月,手术治疗股骨远端关节内粉碎性骨折患者119例121侧,男62例63侧,女57例58侧;年龄16～85岁,平均43．1岁。AO分型：B3型15侧,C1型42侧,C2型37侧,C3型27侧。皮肤软组织损伤严重的患者,采用闭合复位＋外固定器固定;开放复位采用髌骨旁切口,显露股骨远端及其关节面,先进行股骨关节面的复位,用克氏针或拉力螺钉固定,然后矫正股骨成角、短缩和旋转畸形,最后选择合适的内固定进行固定。7例7侧采用闭合复位＋外固定器固定;114侧采用开放复位,其中5侧使用外固定器,11侧使用克氏针螺钉固定,8侧使用“T”或“L”形钢板,21侧使用髓内钉系统,37侧使用股骨髁钢板,32侧使用动力髁钢板。术后进行Neer膝关节功能评分和膝关节活动度测量。结果随访时间7—78个月,平均29个月。术后感染4侧。患肢术后膝关节活动度10°～140°,平均109°;Neer评分41—100分,平均63．7分,患肢49侧（40．5％）为优,36侧（29．8％）为良,25侧（20．7％）为可,11侧（9．1％）为差,优良率为70．3％。其中B3和C3型的评分分别为（56．3±15．9）分和（52．14-20．3）分,明显低于C1和C2型的（70．3±16．5）分和（67．7±18．7）分（t=4．6,P〈0．05）。股骨髁钢板内固定组和动力髁钢板内固定组（开放复位）的疗效优于外固定器固定组（闭合复位和开放复位）（t=3．9,P〈0．05）。结论股骨远端关节内粉碎性骨折的类型、不同手术方式是影响术后患肢关节功能的重要因素。     

股骨远端骨折的治疗探讨

目的总结手术治疗股骨远端骨折的疗效,探讨手术方式的选择。方法1996年6月～2004年10月共手术治疗178例股骨远端骨折患者,对其中随访资料完整的105例患者进行分析。用Merchant膝关节功能评定标准判定疗效,并分析骨折类型、内固定方式、手术时间、术后开始功能锻炼的时间等因素与最终功能的关系。结果105例获6～36个月(平均18个月)随访,其中7例发生骨折不愈合。采用Merchant膝关节功能评定标准判定疗效:优36例,良43例,可18例,差8例,优良率为75.2%。结论股骨远端骨折粉碎及移位的程度直接影响预后。应尽早进行手术治疗,选用合适的内固定方式、术中解剖复位、牢固固定、术后指导患者早期进行功能锻炼是提高疗效的重要因素。     

股骨远端骨折的治疗

<正>股骨远端骨折系指股骨下端15 cm以内的骨折,其发病率占全身骨折的0.4%,股骨骨折的4%~7%[1],此部位骨折多为高能量损伤所致,常合并有严重的软组织损伤。同时由于股骨远端的解剖特点,该部位骨折骨折类型多变,并且多累及关节面,预后较差。同时随着老年化社会的到来,越来越多的膝关节骨性关节炎患者进行膝关节置换,导致假体周围骨折的病例逐年增加,这一特殊类型的股骨远端骨折需要更高的技     

Growth plate fractures of the distal femur

Growth plate fractures of the distal femur are challenging to treat, with complications that require a secondary surgery 40% to 60% of the time. These fractures often necessitate operative intervention, even in the youngest patients and even with minimal apparent displacement. Treatment varies with the Salter-Harris (SH) classification and with the extent of initial displacement, ranging from simple casting for nondisplaced SH I fractures to open reduction and internal fixation for almost all SH III and IV fractures. Poor outcomes have been associated with pediatric fracture care of SH III and IV in 29% to 32% of cases. There are many pitfalls that have to be avoided in the treatment of these fractures to prevent malunion, growth arrest, and posttraumatic arthritis.     

复杂髋臼骨折的手术治疗

目的探讨复杂髋臼骨折的治疗方法及疗效。方法对67例Letournel和Judet分型复杂髋臼骨折患者采用骨盆重建钢板及螺钉内固定,其中后侧入路33例,前侧髂腹股沟入路5例,前后联合入路28例,扩大髂股入路1例。结果 67例均获得随访,时间8～47（26.6&#177;12.4）个月。根据Matta影像学评定标准,解剖复位38例,满意复位20例,不满意复位9例;关节功能按Merle d′Aubign啨和Postel评定标准：优24例,良31例,一般6例,差6例。股骨头坏死4例,局部骨化性肌炎6例,髋关节骨性关节炎7例,术后感染1例,术后4周股动脉血栓形成1例;无死亡、骨不愈合发生。结论及时手术、良好复位及早期功能锻炼可使复杂髋臼骨折的治疗获得较好的临床效果。     

肱骨远端C型骨折的手术治疗

1996年1月～2003年6月,我科采用手术治疗肱骨远端C型骨折37例,取得较满意疗效。1材料与方法1.1病例资料本组37例,男23例,女14例,年龄24～71岁。左侧11例,右侧26例。开放骨折1例,闭合骨折36例。按AO/ASIF标准分型:C1型7例,C2型19例,C3型11例。合并尺神经损伤者3例。1.2治疗方法臂丛神经阻滞麻醉。肘后正中切口28例,其中26例采用肱三头肌舌形瓣入路,2例采用尺骨鹰嘴截骨入路;9例采用内外侧联合切口。均于肘管仔细分离出尺神经,对于23例关节面骨折块较大者,将髁间骨折复位,全螺纹松质骨螺钉固定,恢复关节面的平整,使C型骨折变为A型骨折,再…     

Treatment of acute distal femur fractures

An emphasis on indirect reduction techniques to restore limb alignment has improved the rate of fracture healing and decreased infection rates, fixation failure, and the need for bone grafting.     

Primary total knee arthroplasty for complex distal femur fractures in elderly patients

Fractures of the distal femur in the geriatric population are associated with a high incidence of postoperative complications and poor results. Nonunion, loss of fixation, and malunion of these fractures occur with all types of treatment. The postoperative treatment of these patients demands a lengthy period of limited weightbearing that can increase the rate of medical complications. Our experience with these challenging fractures caused us to consider the use of a primary distal femur replacement total knee arthroplasty with the goals of elimination of fracture healing issues, early mobilization, and immediate weightbearing. Twenty-four distal femoral replacement knee arthroplasties were done from July 1998 to January 1999. Reviewed with a mean followup of 11 months, 17 patients (71%) resumed their preoperative level of ambulation. Knee range of motion averaged 1 degree - 103 degrees. No major surgical or significant medical complications were experienced by these patients. Our experiences with this small number of patients have shown that an immediate arthroplasty offers many advantages over open reduction and internal fixation for geriatric patients with poor bone quality, preexisting degenerative joint disease, and medical problems.     

The epidemiology of fractures of the distal femur

Between 1980 and 1989, reports on 2,165 fractures of the distal part of the femur (1,051 women and 1,114 men) were collected by AO Documentation and are analyzed in the present paper. The number of fractures showed a bimodal pattern with a marked variation in the number of fractures in relation to gender and age. A larger prevalence of fractures was observed either in young men (about 20 years old, traffic or sport) and in old women (about 70, fall at home, osteoporosis).     

Current concepts in fractures of the distal femur

This paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. The treatment of distal femoral fractures has improved with the evolution of plating and nailing technologies. The commonly selected surgical approaches are outlined and surgical treatment techniques including both internal and external fixation are discussed.     

双侧板联锁固定股骨远端粉碎性骨折

目的　为股骨远端粉碎性骨折设计新的内固定方法 ,从生物力学角度提供其科学依据 ,以解决复位困难、固定不牢及内外翻等畸形和并发症。方法　选用 10例新鲜成人尸体股骨 ,在髁上 -髁间截骨造成粉碎性骨折模型 ,用钢板与聚乙烯板双板组合固定 (简称双板固定 ) ,对照组采用传统的单侧钢板固定 (简称单板固定 ) ,分别进行压缩、弯曲、扭转刚度试验和双板固定屈服试验。结果　双板固定组的抗弯曲、抗扭转能力较单板固定组显著增强 (P <0 0 1)。双板固定强度试验 ,其承受轴向载荷可达 115 4 0N ,前、后、内、外弯曲载荷分别可达 70 0、10 82、5 93、10 10N。结论　双板固定股骨远端粉碎性骨折可维持碎骨块解剖复位、增强骨折内固定的稳定性和牢固性 ,能满足早期功能锻炼的需要     

Periprosthetic distal femur fractures: current concepts

Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and revision arthroplasty. This article reviews the treatment options for these challenging fractures with a particular focus on the management of displaced fractures with a stable prosthesis.     

Surgical management of delayed union and nonunion of distal radius fractures

Ten patients with malaligned fractures of the distal radius that demonstrated either delayed healing or the development of an atrophic or synovial nonunion on standard radiographs were treated with surgical realignment, stable internal fixation, and autogenous iliac crest bone grafting. All 10 fractures healed with acceptable radiologic alignment within 3 months of the index procedure. After an average follow-up period of 3 years 6 months (range, 2 years to 8 years 6 months) patients had an average of 105 degrees wrist flexion and extension, 145 degrees forearm rotation, and 73% grip strength compared with the opposite limb. In the treatment of malaligned, ununited fractures of the distal radius, specific techniques and implants must be tailored to the deformity of the distal radius and the shape of the distal fragment. A stable, well-aligned wrist with preservation of at least 50 degrees mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 3 patients.     

Predicting the outcome of physeal fractures of the distal femur

BACKGROUND:: Distal femoral epiphyseal fractures are uncommon but have a high incidence rate of complications. It is not clear whether there are any reliable predictor factors and whether the type of fracture, displacement (degree and direction), and treatment method alter the outcome. METHODS:: We retrospectively reviewed the medical charts and images of all patients who sustained a distal femoral epiphyseal fracture and were treated at 2 large level I pediatric centers during the past 10 years. RESULTS:: The selected group included 73 patients (boys, 59; mean age, 10 years). On the basis of the Salter-Harris classification (SH), 43 fractures (59%) were of type II. Fifty-nine percent of the fractures were displaced; 36 fractures were managed conservatively with long leg cast (with or without pelvic band) in 33 patients, cylinder cast in 2, and posterior splint in 1. Thirty-seven patients underwent surgery, and 34 underwent closed reduction followed by percutaneous fixation (crossed Steinman pins, 20; cannulated screws, 13; open reduction, 3; external fixation, 1). The overall complication rate was 40% (29/73), and growth arrest was the most frequent. The SH classification significantly correlated with the incidence of complications (P = 0.031). There was also a significantly higher (P < 0.0001) incidence rate of complications among displaced fractures (48.8% vs 26.6%); the amount and direction of displacement did not correlate with the outcome (P > 0.05). The group treated conservatively had a lower incidence rate of complications (25%) than did the surgical group (54%) (P < 0.05). Among the surgical group, a higher incidence rate of complications occurred when the physis was violated by hardware (65% vs 30%; P = 0.06). CONCLUSIONS:: Both SH classification and displacement of the fracture are significant predictors of the final outcome. The degree and the direction of displacement do not statistically correlate with outcome. The treatment method may influence the final outcome.