经股动脉导管药盒系统植入术的并发症分析

目的研究经股动脉途径植入导管药盒系统导致并发症的原因,进一步提高其临床应用的价值。方法对76例中晚期恶性肿瘤采用经股动脉途径植入导管药盒系统,定期或不定期经皮经药盒灌注化疗和栓塞,总结其并发症。结果发生并发症13例,发生率为17.1%(13/76)。包括留置导管尖端移位4例,靶动脉闭塞2例,迟发出血2例,留置导管堵塞1例,切口延期愈合1例,药盒外露1例,留置导管与药盒分离1例,靶动脉假性动脉瘤形成1例。结论经皮股动脉途径导管药盒系统植入术的并发症只要处理得当,是可以控制的。本技术不失为一种安全可靠的治疗手段,值得临床应用。     

中晚期恶性肿瘤药盒植入术及动脉留管药泵灌注治疗的临床体会

目的 研究中晚期恶性肿瘤药盒植入及动脉留管治疗的疗效与护理体会。方法 对92例中晚期恶性肿瘤采用经皮锁骨下动脉穿刺、胸壁下药盒植入16例，经股动脉穿刺腹壁药盒植入24例，大腿内侧植入药盒3例，股动、静脉插管选择性留管19例。结果 5年生存者2例，3年生存者7例，2年生存者19例，1年生存者36例，半年生存者28例。结论 中晚期恶性肿瘤药盒植入术及动脉留管药泵灌注治疗可重复性好、疗效高、操作简便，骨髓抑制较轻，是一种有效的新疗法。     

经皮注射自体骨髓治疗骨折延迟愈合与不愈合

目的 探讨经皮注射注入自体骨髓移植治疗骨折延迟愈合与不愈合的治疗效果。方法 21例患者抽取自体红骨髓离心后在C臂X线机透视下经皮注射至骨折延迟愈合与不愈合部位,定期随访观察骨折愈合进展情况。结果 20例获随访,骨折愈合18例,2例未愈合,愈合率90％,愈合时间4-11个月,平均8个月。21例患者经注射后无局部及全身感染并发症,未见异位骨化。结论 经皮注射自体骨髓移植治疗骨折延迟愈合与不愈合具有安全、有效、创伤小等优点,是临床上可供选择的治疗方法,值得深入研究及推广。     

经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合

目的 探讨经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合的疗效.方法 对胫骨中下段骨折延迟愈合18例、骨折不愈合5例患者,将自体红骨髓植入至骨折断端,定期摄X线片复查.结果 23例均获得随访,时间4～16个月,患者骨折均愈合,愈合时间3～12个月,未见骨折畸形愈合、异位骨化及感染等并发症.结论 经皮自体红骨髓植入治疗胫骨中下段骨折延迟愈合及不愈合是一种有效、安全、简易、实用的方法.     

经双侧药盒行耙动脉灌注吉西他滨治疗膀胱癌的护理体会

目的:总结112例膀胱癌患者经双侧药合行动脉灌注化疗药的护理经验.方法:经介入手术将导管经双侧股动脉植入,头端到达膀胱肿瘤供血血管,尾端连接药合形成一埋植系统,化疗时将穿刺针直接刺入药合注射座进行药物加压灌注.结果:112例患者治疗总有效率75%.埋植药盒植入成功率100%,注射座穿刺成功率100%,一针穿刺成功率98%,有6例在注药前试注操作时无回血或回血不充分,经在DSA下照影显示导管通畅继续用药,有2例化疗4个疗程药盒导管堵塞经手术拔除.     

经皮微创LCP钢板固定术治疗胫骨干骨折体会

目的探讨经皮微创LCP钢板固定术治疗胫骨干骨折的疗效。方法对18例胫骨干骨折患者采用经皮微创LCP钢板固定术治疗。结果术后18例患者得到随访,未发生不愈合病例。1例骨折延迟愈合,愈合时间(13.5±2.7)周。1例皮肤出现少量坏死,经换药愈合,患肢功能均恢复良好。结论采用经皮微创LCP钢板固定术治疗胫骨干骨折,效果良好。     

经肝动脉灌注抗生素治疗细菌性肝脓肿疗效分析

回顾性分析5例接受肝动脉灌注抗生素治疗的细菌性肝脓肿患者的临床资料。此5例患者无法进行经皮穿刺引流并且对静脉注射抗生素治疗无效。应用介入手术操作将剪短的溶栓导管插入肝动脉并固定, 同时给予持续全身肝素化。将抗生素通过溶栓导管泵入。药物均选择注射用亚胺培南西司他丁钠, 给药剂量和频率参考体静脉给药。5例患者均取得良好疗效。平均临床症状缓解时间为3 d, 平均动脉置管灌注时间为9 d。无明显并发症发生。本研究显示经肝动脉灌注抗生素是治疗细菌性肝脓肿的有效手段。     

经皮空心螺钉内固定治疗耻骨支骨折

目的探讨经皮空心螺钉内固定治疗耻骨支骨折的临床疗效。方法对19例耻骨支骨折（均为不稳定性骨盆前环骨折）患者行闭合复位经皮空心螺钉内固定治疗。结果患者均获随访,时间5-24个月。骨折均获骨性愈合,愈合时间3-5.5（3.9±0.6）个月。无切口感染、无内固定松动、无神经血管损伤、无尿路损伤。2例出现再移位,经卧床、延迟下地时间后达骨折愈合。结论经皮空心螺钉内固定治疗耻骨支骨折是一种安全、有效的治疗方法。满意的复位、准确的进针点和角度对手术疗效具有重要意义。     

下肢动脉急性栓塞双点穿刺阻流取栓的临床研究

目的评价经皮健侧股动脉穿刺,应用球囊在患侧髂外动脉阻断血流,患侧股动脉穿刺,应用长鞘或导引导管负压反复抽吸血栓治疗下肢动脉急性栓塞的疗效。方法23例下肢动脉急性栓塞的患者(房颤17例,左房黏液瘤1例,动脉粥样硬化斑块5例),行经皮双点穿刺阻流取栓术。结果23例患者均成功的去除栓子,动脉开通。20例痊愈;2例截肢;1例48h后死亡。结论经皮双点穿刺阻流取栓术治疗下肢动脉急性栓塞,是一种简便有效的方法。早期诊断、早期治疗是降低截肢率和死亡率的关键。     

微创钢板内固定术治疗胫骨远端Pilon骨折

目的探讨经皮微创钢板内固定技术治疗胫骨远端Pilon骨折的方法和临床效果。方法39例Pilon骨折患者采用经皮微创钢板内固定方法治疗。其中男28例,女11例,平均年龄31．8岁。开放骨折8例,闭合骨折31例。按Roedi—Allgower进行分型．Ⅰ型9例,Ⅱ型19例,Ⅲ型11例。结果39例患者中35获临床随访,随访7～34个月,平均15个月。骨折无延迟愈合及畸形愈合,骨折平均临床愈合时间3．4个月,以Mazur方法评估手术疗效,优20例、良11例、可4例,优良率88．6％。术后骨折无延迟愈合及畸形愈合。结论经皮微创钢板内固定术治疗胫骨远端Pilon骨折,创伤小,并发症少,骨愈合率高,是治疗Pilon骨折的有效方法。     

体外冲击波治疗与手术治疗骨折延迟愈合临床疗效对比分析

目的 对比体外冲击波治疗（ESWT）与手术治疗骨折延迟愈合的临床治疗效果。方法 将30例在2017年1月至2018年1月于我院就诊且被诊断为骨折延迟愈合的患者随机分为手术治疗组和冲击波治疗组,每组各15例患者。手术治疗组行手术治疗,每月定期复查X线,冲击波治疗组采用体外冲击波治疗仪治疗,治疗期间每疗程治疗结束后复查X线片,通过观察治疗前与治疗后第1、第2、第3疗程的骨折处X线骨痂生长情况,对两组患者的骨痂形成情况进行评分,通过骨痂形成情况评分的高低、骨折愈合时间的长短和骨折愈合标准评价及治疗费用的高低,以此来探讨ESWT治疗骨折延迟愈合的临床疗效。结果 治疗后至少随访18个月,阅复查X线片示,两组患者的骨痂X线评分均高于治疗前。冲击波治疗组13例患者成功愈合,1例未完全愈合,骨折愈合时间平均为8.267个月,1例至随访结束骨折处未出现放射学愈合迹象。手术治疗组14例患者成功愈合,骨折愈合时间平均为8.714个月,1例至随访结束骨折处未出现放射学愈合迹象。两组患者至随访结束均未见明显血管神经损伤或内固定断裂等并发症发生。结论 ESWT对骨折延迟愈合有显著的临床疗效,且因其具有非侵入性、方法简单、安全有效、并发症率较低且费用相对较低等优点。     

前臂交锁髓内钉治疗尺桡骨粉碎骨折的临床研究

目的探讨应用前臂交锁髓内钉治疗尺桡骨粉碎性骨折的可行性及其疗效。方法应用前臂交锁髓内钉采用切开或闭合复位技术治疗尺桡骨粉碎性骨折18例,男15例,女3例;年龄32～63岁,平均42岁。骨折按AO分型,A 1型4例,A 2型1例,A 3型2例,B 2型1例,B 3型3例,C 2型3例,C 3型4例。手术均在伤后1周内进行。结果所有病例术后随访8～10个月,骨折愈合时间8～16周,平均12周。所有患者均未发生骨不连、术后感染及桡神经深支损伤病例;术后有2例前臂旋转功能恢复欠佳,1例骨折延迟愈合,其余患者功能恢复满意。根据B erton评定标准进行评价,优10例,良5例,可2例,差1例,优良率为83.3%。结论应用前臂交锁髓内钉技术治疗尺桡骨骨折,具有手术创伤小、固定牢靠、骨折愈合率高、功能恢复快等优点,是治疗前臂骨折较理想的手术方法,尤其适用于多段骨折、粉碎性骨折。     

桡骨远端骨折的手术治疗

目的总结桡骨远端骨折的手术治疗方法及疗效。方法采用背侧接骨板内固定、掌侧T形接骨板内固定或外固定架治疗桡骨远端骨折73例,其中植骨9例。结果73例全部获得随访,时间6-41个月。所有病例骨折愈合良好,无不愈合或延迟愈合。采用改良Mcbride评分和纽约骨科医院腕关节评估标准：优49例,良18例,可6例,优良率为91.78%。结论选择合适的手术方法治疗不同类型的桡骨远端骨折,使内固定稳妥可靠,可早期功能锻炼。     

固骼生促进新鲜骨折愈合的临床观察

目的 探讨骨缺损修复材料——固骼生(Nova．Bone)应用于四肢骨折内固定手术的临床效果。方法 对四肢骨折实施内固定手术时，在骨折线内及周围均匀植入固骼生材料2～5mm3，共治疗64例，同时选择32例未应用固骼生组作为对照组随访观察。结果 全部病例经12～20周随访，应用固骼生组骨折愈合时间12～16周，无骨折延迟愈合及不愈合。对照组(未应用固骼生组)骨折愈合时间16。20周，2例发生骨折延迟愈合。结论 固骼生是一种新型的骨缺损修复材料，在四肢骨折内固定术时植入骨骼生能明显加速骨折愈合过程。     

脱钙骨基质治疗长骨骨折延迟愈合及骨不连

目的探讨脱钙骨基质(decalcifiedbonematrix,DBM)治疗长骨骨折延迟愈合和骨不连的疗效。方法长骨延迟愈合、骨不连共57例,男45例,女12例;年龄21~65岁,平均42岁。开放性骨折17例,闭合骨折40例。骨折延迟愈合32例中,肱骨4例,股骨10例,胫骨18例;骨不连25例中,肱骨5例,股骨4例,胫骨16例。全部采用DBM于骨断端处和骨缺损区植入治疗。结果57例患者均获随访,随访时间4~37个月,平均7.8个月。骨折延迟愈合32例中骨折愈合31例,1例胫骨骨折未愈合;骨不连25例中骨折愈合23例,2例未愈合,其中胫骨1例、肱骨1例。愈合时间3~6.6个月,平均4.7个月。结论DBM治疗长骨骨折延迟愈合及骨不连,其疗效满意、并发症少。     

Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures

Introduction

Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union.

Patients and methods

An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury.

Results

285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant.

Discussion

Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion.

Conclusion

Despite modern treatment, the patient-reported outcomes of lower limb long bone shaft fractures do not return to normal at one year. Patients with delayed union or nonunion can expect poorer outcomes.     

A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures

A total of 45 tibial shaft fractures, all conservatively treated and with union delayed for more than 16 but less than 32 weeks were entered in a double-blind multi-centre trial. The fractures were selected for their liability to delayed union by the presence of moderate or severe displacement, angulation or comminution or a compound lesion with moderate or severe injury to skin and soft tissues. Treatment was by plaster immobilisation in all, with active electromagnetic stimulation units in 20 patients and dummy control units in 25 patients for 12 weeks. Radiographs were assessed blindly and independently by a radiologist and an orthopaedic surgeon. Statistical analysis showed the treatment groups to be comparable except in their age distribution, but age was not found to affect the outcome and the effect of treatment was consistent for each age group. The radiologist's assessment of the active group showed radiological union in five fractures, progress to union in five but no progress to union in 10. In the control group there was union in one fracture and progress towards union in one but no progress in 23. Using Fisher's exact test, the results were very significantly in favour of the active group (p = 0.002). The orthopaedic surgeon's assessment showed union in nine fractures and absence of union in 11 fractures in the active group. There was union in three fractures and absence of union in 22 fractures in the control group. These results were also significantly in favour of the active group (p = 0.02). It was concluded that pulsed electromagnetic fields significantly influence healing in tibial fractures with delayed union.     

The management of tibial fractures in acute spinal cord injury patients

Of 34 tibia fractures in 28 acute spinal cord injuries, 13 patients had complete and 15 had incomplete neurologic lesions. Tibia fractures were divided into three groups: Group I, nonoperative treatment; Group II, early open reduction and internal fixation; and Group III, Type III open injuries. Group I included 17 fractures, of which nine (53%) had delayed union, malunion, or nonunion. The average time to union was 6.5 months. Seven patients had pressure sores and pulmonary emboli. Eleven fractures were noted in Group II. One delayed union (9%), one superficial wound infection that healed uneventfully, and one deep vein thrombosis were noted. The average time to union was 12 weeks. All six Group III tibias had delayed and nonunions, regardless of treatment. Nonoperative fractures healed at a prolonged rate, while open reduction and internal fixation enhanced the rate and time to union. Fractures treated with early open reduction and internal fixation, excluding Group III patients, had the least orthopedic and medical complications. Open reduction and internal fixation is a justifiable alternative to nonoperative treatment in the uncomplicated tibia fracture regardless of neurologic lesion for improved medical and fracture care.     

Extracorporeal shockwave therapy: A systematic review of its use in fracture management

Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies'' overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures). However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.     

Strength of union in human tibial shaft fracture. A prospective study of 104 cases

In a consecutive prospective series of 104 tibial shaft fractures, the strength at the site of union was observed by a noninvasive technique at regular intervals. Eighty-one patients were male and 23 were female. Six fractures were open, and 13 patients had multiple injuries. The primary treatment was conservative with cast immobilization in 86 patients, external fixation by a quadrilateral system in 14, and open reduction and internal fixation in four. A measure of the strength of union is obtained by calculating a quotient between induced deflection between the fracture fragments and the applied bending moment. By plotting this quotient against time-since-injury, a curve describing the changes in stability can be constructed. With this curve it is possible to define united fracture and normal union, and the differentiation between delayed union and true nonunion is possible. Time-to-union in all 104 patients was 16 +/- 15.2 weeks. In 14 with delayed union, surgical measures intended to promote union could be avoided because repeated measurements indicated progressive increase in stability. Bone grafting was performed in 13 fractures for treatment of nonunion. Statistical analysis based on objective measurement of stability failed to identify a specific factor responsible for delayed union or nonunion.