动力跨关节型外固定架治疗Barton骨折

目的探讨动力跨关节型外固定架治疗Barton骨折的临床疗效。方法28例Barton骨折均采用动力跨关节型外固定架手术治疗。术后随访桡骨长度、掌倾角、尺偏角、腕关节活动范围。结果28例均获随访,时间2～12个月。骨折均达到解剖复位且骨折愈合良好。按照Gartland与Werley评分标准:优12例,良16例。无神经再次损伤、骨折移位、针道感染、肌腱损伤等并发症发生;1例因软组织损伤大,尺神经损伤,骨折愈合延迟。结论动力跨关节型外固定架治疗Barton骨折可良好维持骨折处对位对线,恢复关节面的平整;可有效防止术后骨折再塌陷,维持桡腕关节间隙正常位置,保护早期功能锻炼,是治疗Barton骨折的有效方法。     

应用Hybrid外固定架治疗胫骨远端骨折

目的探讨治疗胫骨远端骨折的有效治疗方法。方法从2000年1月2002年8月，使用hybrid外固定架治疗胫骨远端骨折36例，包括胫骨远端平台骨折和胫骨远端骨折，按照A0分类，A1型3例，A2型3例，A3型3例，C1型6例，C2型12例，C3型9例。其中开放骨折10例，25例(69％)为高能量损伤。结果按照Helfer标准评价，36个病人平均随访14个月，平均愈合时间为5个月，除1例外，全部解剖复位或恢复力线。优12例，良10例，中8例，差6例。12例出现不同的并发症占33％。结论应用hybrid外固定架治疗胫骨远端骨折可以减少手术并发症，比较有效。     

体外钢板固定治疗锁骨中段骨折(附31例报告)

[目的]探讨自行研制的体外钢板治疗锁骨中段骨折的疗效.[方法] 2007年6月～2011年1月,对31例锁骨中段骨折患者采用锁骨体外钢板同定治疗.受伤至手术时间为2～6d,平均3.5d.根据Edward对锁骨骨折愈合的评价指标制定疗效判断标准.[结果]本组病例经9～25个月,平均16个月的随访,骨折均获骨性愈合.0按上述标准评定:优24例,良5例,中2例.[结论]体外钢板固定治疗锁骨中段骨折具有固定可靠,创伤小,无需二期手术取出内固定等优点,有望成为治疗锁骨骨折一种较为理想的术式.     

Pilon骨折三种不同治疗方法疗效探讨

目的探讨Pilon骨折的三种不同治疗方法临床适应证及其疗效评价。方法对2000年2月至2006年3月间治疗的63例Pilon骨折患者进行回顾性分析。其中开放性损伤15例，闭合性损伤48例。根据骨折类型与周围软组织损伤程度，分别采用三种不同治疗方法：跟骨牵引加小夹板固定组（29例）均为闭合性骨折，内固定组（23例），外固定器组（11例）。结果所有患者均获得随访，随访8～31个月（平均15．3个月），骨愈合时间8～14周，平均10周。按Helfet疗效评价标准，本组优良者57例（90．5％），其中Ⅰ型骨折优良者26例，Ⅱ型骨折优良者15例，Ⅲ型骨折优良者16例。结论根据骨折类型及软组织条件，恰当选择固定方法是取得Pilon骨折满意疗效的关键，可有效避免并发症的发生。     

动力跨关节型外固定架在不稳定性桡骨远端骨折中的应用

目的 探讨手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗不稳定性桡骨远端骨折的效果.方法 应用手法复位或辅以内固定结合动力跨关节型外固定架跨腕关节固定治疗35例不稳定性桡骨远端骨折,骨折愈合后拆除外固定架.结果 随访6～16个月,骨折愈合时间7～9周.最后一次随访时,按Cooney腕关节评分系统(包括疼痛、功能状况、腕关节活动度、握力):优18例,良14例,可1例,优良率为91.4%.结论 手法复位或辅以有限内固定结合动力跨关节型外固定架跨腕关节固定治疗桡骨远端骨折既能使骨折复位、固定满意,又有利于术后早期手和腕部的功能康复锻炼,是治疗不稳定性桡骨远端骨折的有效方法.     

Ⅱ、Ⅲ型Pilon骨折的治疗策略

目的探讨治疗Ruedi—AllgowerⅡ、Ⅲ型Pilon骨折的治疗方法。方法采取切开复位内固定或有限切开内固定结合外固定的两种治疗方法治疗Pilon骨折42例。结果优20例，其中Ⅱ型12例，Ⅲ型8例；良16例，其中Ⅱ型4例，Ⅲ型12例；可5例，差1例，优良率85．7％。结论腓骨长度的恢复和解剖复位，胫骨远端关节面骨折的解剖复位，干骺端骨缺损松质骨植骨及尽可能的坚强固定，踝关节的早期活动是治疗Pilon骨折的关键。影响Pilon骨折疗效的因素，不仅是骨折的整复固定，更重要的是如何避免局部软组织的有关并发症。     

跟骨骨折治疗方法的疗效观察

目的比较跟骨骨折不同治疗方法的效果。方法88例96足跟骨骨折分成三组,分别应用撬拨复位石膏外固定、切开复位钢板内固定、可调节跟骨骨折外固定器治疗,术后从Bhler角的恢复、主观症状、并发症三个方面进行比较分析。结果可调节跟骨骨折外固定组在恢复Bhler角、术后主观症状改善、减少并发症方面优于撬拨复位石膏外固定组及切开复位内固定组。结论可调式跟骨骨折外固定器治疗跟骨骨折疗效优于撬拨组和内固定组。     

Pilon骨折20例手术治疗体会

目的 探讨Pilon骨折的手术方法及手术时机的选择.方法 回顾性分析根据骨折分型和软组织损伤程度应用不同内固定方法手术治疗的20例Pilon骨折病例.结果 所有病例临床观察平均18个月,均骨性愈合,Ruediand-Allgawer Ⅰ型优良率为100%,Ⅱ性型优良率为80%,Ⅲ型优良率67%.结论 根据患者年龄、全身状况,骨折及关节面软骨、软组织损伤程度等不同因素,选择适宜手术方法及手术时机治疗Pilon骨折,疗效满意.     

Ruedi-AllgowerⅢ型Pilon骨折的疗效分析

目的回顾分析我院治疗Pilon骨折的病例,探讨Ruedi-Allgower型Pilon骨折的治疗方法。方法对2001年10月至2004年10月共16例Ruedi-Allgower型Pilon骨折给予有限内固定结合外固定治疗,同时术后给予必要的对症治疗与合理的功能锻炼。结果随访10~24个月,平均16个月。按照Mazur评分系统评估疗效,16例患者,优6例,良8例,中1例,差1例,优良率达87.5%。1例发生伤口感染,无深部感染;1例胫前软组织坏死,骨质裸露;1例外固定器针眼感染;1例关节退行性变。结论有限内固定结合外固定治疗Ruedi-Allgower型Pilon骨折,可以减少并发症,取得良好治疗效果。     

同期加压延长治疗伴有骨缺损、肢体短缩的长骨不连

目的探讨外固定支架同期加压延长治疗伴有骨缺损、肢体短缩的长骨不连的疗效。方法回顾性分析2003年3月~2005年10月使用Ⅳ型镶嵌式外固定器同期加压延长治疗伴有骨缺损、肢体短缩的长骨不连15例,同时处理骨缺损与骨不连。结果15例随访9~39个月,骨缺损段新生骨生长良好,骨不连断端完全骨性愈合,愈合时间平均6.6(4~13)个月,肢体短缩畸形基本矫正。骨折端成角2例,均<8,°未予特殊处理;针孔感染2例,经对症、抗感染处理后痊愈。结论使用Ⅳ型镶嵌式外固定器同期加压延长治疗伴有骨缺损、肢体短缩的长骨不连,能缩短治疗时间,并可取得良好疗效。     

组合式外固定器治疗老年股骨转子间骨折

2001年3月~2003年11月,我院应用组合式外固定器治疗老年股骨转子间骨折11例,取得较好疗效。1材料与方法1.1病例资料本组11例,男5例,女6例,年龄73~85岁。按Boyd和G rif-fin[1]分类,Ⅰ型1例、Ⅱ型8例、Ⅲ型1例、Ⅳ型1例。合并症:合并有糖尿病3例,高血压心脏病5例,慢性支气管炎1例,脑血栓1例,糖尿病、高血压心脏病、脑血栓1例,受伤至手术时间4~13d。1.2手术方法入院后给予胫骨结节骨牵引。根据全身检查结果积极有效地治疗合并症。采用局麻或局麻强化,患者仰卧于手术牵引床上, C臂X线机监视下牵引闭合复位,常规消毒术区,铺洞巾。术中监测心电…     

有限内固定结合踝关节外固定架治疗复杂开放性踝关节骨折46例

目的探讨有限内固定结合踝关节外固定架治疗复杂开放性踝关节骨折的手术方法及临床疗效。方法采用后外侧入路有限内固定结合踝关节外固定架手术治疗的复杂开放性踝关节骨折患者46例,其中男25例,女21例;年龄15~72岁,平均年龄39.3岁,并对其疗效进行分析。结果 46例患者均获完整随访,时间3~21个月。根据美国足与踝关节协会(AOFAS)评分:优24例,良18例,可4例,优良率为91.3%。结论对于复杂开放性踝关节骨折,采用后外侧入路有限内固定结合踝关节外固定架治疗,既可以保证踝关节获得较为满意的复位,又可以最大限度地避免内固定感染的发生。     

Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

Background:

Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG) for the treatment of humerus shaft nonunion following previously failed surgical treatment.

Materials and Methods:

Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod), autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening) and functional outcome using the University of California, Los Angeles (UCLA) rating scale.

Results:

The mean follow-up was 35 months (range 24 to 52 months). Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83%) and unsatisfactory in 3 cases (17%) due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months). The external fixator time averaged 4.5 months (range 3.2 to 8 months). Superficial pin tract infection occurred in 39% (28/72) of the pins. No cases of nerve palsy, refracture, or deep infection were encountered.

Conclusion:

The proposed technique is effective in treating humeral nonunion especially in the presence of osteoporosis and short bone segments. The inclusion of intramedullary rod as internal splint improves stability of fixation and prevents refracture after fixator removal.     

有限内固定结合外固定支架与钢板治疗胫骨平台骨折的疗效分析

[目的]探讨有限内固定结合外固定支架与钢板在胫骨平台骨折治疗中的应用及其疗效.[方法]2007年1月～2011年1月从胫骨平台骨折患者中选取58例,男38例,女20例;年龄19～ 54岁,平均(42.7±8.9)岁,按Schatzker分型:Ⅳ型17例,Ⅴ型31例,Ⅵ10例,其中外支架组31例,钢板内固定组27例,术后随访6～17个月,平均14.1个月.[结果]有限内固定结合外支架固定组平均手术时间(57.4±12.1)min,平均术中出血量(161.3±17.0) ml,平均骨折愈合时间为(12.4±1.5)周,切口感染率为6％,针道感染率为9％,Lysholm评分:优21例,占67％,良8例,占25％,差2例.钢板内固定治疗组平均手术时间(105.4±23.8) min,平均术中出血量(252.4±28.9)ml,平均骨折愈合时间为(15.5±2.5)周,切口感染率为4％,Lyshol评分:优16例,占60％,良10例,占37％,差1例.手术时间、术中出血量、骨折愈合时间,评分组间比较有显著差异(P＜0.05),切口感染率、Lysholm评分组间无显著差异(P＞0.05).[结论]两种方法治疗胫骨平台骨折,功能恢复佳,疗效满意,外固定架是目前治疗胫骨平台开放性骨折较为理想的治疗方式,尤其适用于胫骨平台骨折合并有严重的软组织损伤与缺损患者.     

Mechanical Testing of Seven Fixation Methods for Generation of Compression Across a Midtarsal Osteotomy: A Comparison of Internal and External Fixation Devices

The purpose of this study was to assess 7 methods of fixation for a midtarsal osteotomy. Polyurethane foam models (N = 6) and cadaver specimens (N = 4-7) were used to examine the force generated by the different constructs of fixation. A midtarsal osteotomy was performed on each specimen in the test groups. The osteotomies were fixated either with 2 parallel 0.062-in Kirschner wires and 40-mm-long, 4-mm partially threaded, cancellous, cannulated titanium screws, an external ring fixator (frame), a frame with wires tensioned (tension), a frame with wires tensioned and compressed toward the osteotomy (tension and compression), a frame with tension, compression, and parallel Kirschner wires, or a frame with tension, compression, and two 4.0 cannulated parallel screws, respectively. Each model was fixated, and the force generated by the construct across the osteotomy was recorded via the use of pressure-sensitive film. Statistical analysis of the data in the polyurethane foam group determined that the use of frame with tension, compression, and two 4.0 parallel cannulated screws was statistically superior to 1) frame, 2) frame with tension, 3) 2 parallel Kirschner wires, 4) two 4.0 cannulated parallel screws, and 5) frame with tension and compression. A cadaver study determined that the frame with tension, compression, and 2 parallel Kirschner wires was statistically superior to 1) frame and 2) two parallel Kirschner wires. These findings suggest that there is a difference in the force generated by the type of fixation construct across a midtarsal osteotomy.     

Bone healing after metal plate fixation and external fixation of the osteotomized rabbit tibia

Controversy still exists as to the best method of treatment of long bone fractures. The purpose of the present study was to compare the effects on the healing bone of external fixation and metal plate fixation. In an experimental model on the rabbit tibia the stiffness of the fixation corresponded intentionally to that of the same methods in human fracture treatment.

A transverse, midshaft osteotomy was made on one tibia, and fixed with a steel plate (45 × 5 × 1 mm) or external mini-fixation. The animals were killed after 4, 6 or 12 weeks. The bone healing was evaluated by radiography, histology and biomechanical testing in three-point bending. There were no significant differences between plate fixation and external fixation in the pattern of bone healing, as it occurred by periosteal, in-tramedullary and intercortical callus after both methods. The stiffness increased more rapidly than the strength, and reached normal values after about 6 weeks. No significant differences in stiffness between the two methods were found. The strength was significantly greater after plate fixation than after external fixation at 6 weeks, while no significant differences were found at either 4 or 12 weeks.

It is concluded that the speed of bone healing was more rapid after plate fixation. However, in the later stages of healing the plated bones were secondarily weakened because of the stress-protecting effect of the plate.     

动力型外固定架结合经皮穿针治疗桡骨远端C型骨折

目的探讨动力型外固定架结合经皮穿针治疗桡骨远端C型骨折的效果。方法对15例桡骨远端C型骨折患者采用闭合复位、动力型外固定架结合经皮克氏针固定治疗。结果 15例均获得随访,时间11~24个月。末次随访X线检查显示:掌倾角8°~16°(13.2°±4.1°),尺偏角20°~29°(24.7°±5.1°)。腕关节活动度:背伸32°~50°(38.11°±16.01°),掌屈38°~59°(45.62°±12.67°),桡偏12°~17°(14.05°±4.23°),尺偏20°~28°(24.76°±6.34°)。按Dienst标准评价:优10例,良4例,可1例。1例出现针道浅表感染,经治疗后好转。结论动力型外固定架结合经皮穿针内固定治疗桡骨远端C型骨折复位满意,并发症少,关节功能恢复满意。     

(iv) The Ilizarov method in the treatment of fresh fractures

A growing base of literature supports the use of ring fixators, but clinical studies that definitively determine the optimum treatment for complex fractures are lacking. Further studies are needed to produce outcomes of treatment of both low- and high-energy fractures with the Ilizarov method, but the use of ring fixators must be included in the algorithm of the management of trauma of the lower extremity. Each method of fracture treatment has its own advantages and disadvantages, and limitations. The best treatment method, based on fracture morphology, the condition of the soft-tissues, the available facilities, and perhaps, most importantly, the experience of the surgeon, must be chosen to cater to the needs of the individual patient.     

Ensuring precision in lower limb deformity correction through a combination of temporary external fixation followed by internal fixation: Results of a retrospective study

Background:

It is important to plan preoperatively when contemplating internal fixation following deformity correction. Surgeons often find it difficult to retain the achieved correction till the end of internal fixation. To maintain precise correction we used hybrid technique which uses both external and internal fixation. The objective of the study was to evaluate the effectiveness of this hybrid technique in achieving and retaining desired correction.

Materials and Methods:

In this retrospective study, we evaluated the magnitude of deformity with radiological parameters. We compared correction which was planned and correction which was achieved. The technique was used during surgery for corrective osteotomies. Before carrying out the osteotomy, rail fixator with two swivel clamps was applied. After osteotomy swivel clamps were loosened. Desired correction was achieved. While fixator held the fragments in corrected position, definitive internal fixation was carried out. External fixator was removed after completion of internal fixation. Position of mechanical axis ratio, mechanical lateral distal femoral angle and mechanical medial proximal tibial angle were measured before and 12 weeks after surgery. Student t-test was used to analyze the difference between correction which was planned and correction which was achieved.

Results:

There was no statistical difference between the desired correction and the correction achieved.

Conclusions:

Temporary use of external fixator while correcting angular deformities of lower limb allows to achieve accurate correction.     

体外钢板固定治疗锁骨骨折的对比性生物力学研究

[目的]探讨自行研制的体外钢板治疗锁骨骨折的生物力学性能,为微创手术治疗提供理论依据.[方法]采集12具成人新鲜锁骨标本,制成锁骨中段骨折模型,分别采用锁骨体外钢板、单枚克氏针和重建钢板内固定,运用生物力学实验技术手段测试各组的生物力学性能并进行比较分析.[结果]锁骨体外钢板在强度、刚度和稳定性方面优于单枚克氏针固定(P<0.05),与重建钢板内固定相比无明显差异(P>0.05).而锁骨体外钢板固定应力遮挡小,明显优于重建钢板内固定(P<0.05).[结论]体外钢板固定治疗锁骨骨折不但生物力学性能优越,而且应力遮挡小,优于克氏针内固定和重建钢板内固定,符合自然重建理念,是锁骨骨折一种较为理想的术式.