跟骨关节内骨折的手术治疗

目的 总结应用跟骨解剖型钢板治疗跟骨关节内骨折的临床效果。方法 回顾分析1999年1月～2003年9月治疗的82例跟骨骨折的病例，所有患者手术前后均行常规的X线检查和CT半冠状位扫描，根据骨折粉碎情况和移位程度决定治疗的方法。其中Sanders分型Ⅲ型36例和Ⅳ型9例，共有45例采用外侧L型切口跟骨解剖型钢板内固定手术治疗。结果 45例患者应用跟骨解剖型钢板内固定手术基本恢复跟骨的高度、长度和宽度，术后切口感染3例，经治疗切口愈合。4例患者术后明显的距下关节炎，行二期跟距关节融合术。平均随访38个月，根据美国足踝外科协会跟骨骨折的评分标准，优6例、良26例、可7例、差6例。优良率达71.1％。结论 应用跟骨解剖型钢板治疗Sanders Ⅲ型、Ⅳ型跟骨关节内骨折，可以恢复跟骨的大体形态，能够获得较好的临床治疗效果。     

跟骨骨折手术中的螺钉问题

目的 总结钢板螺钉治疗关节内跟骨骨折手术的螺钉问题。方法 应用解剖型AO跟骨钢板治疗关节内跟骨骨折60例。对术后早期出现的螺钉并发症进行分析。结果 随访22个月，螺钉松动1例，螺钉位置不当2例。结论 解剖型AO跟骨钢板治疗关节内跟骨骨折能充分恢复跟骨形态，但需充分术前准备增加螺钉固定位置的准确性，降低手术并发症。     

切复内固定治疗陈旧性跟骨骨折

目的：探讨陈旧性跟骨骨折行切复内固定治疗的临床效果。方法：我们采用切除骨痂，再次骨折的办法，重新复位、对合关节面，矫正跟骨力线，恢复Bohler角和Gissane角的关系，植骨充填缺损，钢板螺钉内固定的方法，有选择性的对17例陈旧跟骨骨折患者进行了治疗。其中关节外骨折4例，涉及关节面骨折13例，所有患者术前X线片均无明显创伤性关节炎改变。结果：所有骨折术中均取得较好复位，术后皮缘部分坏死4例，浅表伤口感染1例，均经换药治愈。随访5～20个月，平均10个月，骨折全部愈合，X线示关节面Bohler角及Gissane角恢复较满意。Manyland足部评分；优9足；良5足：可2足：差1足；优良率82．4％。结论：对陈旧性跟骨骨折患者有选择性的采用切复内固定术的治疗，可以取得较好效果。     

手术治疗距下、跟骰关节损伤的跟骨骨折

对累及距下、跟骰关节面的跟骨骨折的治疗方法较多，复位方式及内固定选择上的分岐也较大，作者有选择地手术治疗涉及距下、跟骰关节损伤的跟骨骨折31例（35足），获得满意疗效。     

累及距下关节跟骨骨折6例的手术治疗体会

目的探讨植骨加钛板内固定治疗累及距下关节跟骨骨折的优点及手术方法。方法采用植骨加钛板内固定治疗累及距下关节跟骨骨折6例。结果本组6例，疗效均优。结论植骨加钛板内固定治疗累及距下关节跟骨骨折，最大限度恢复了跟骨的形态、关节面平整及Bohler角，减少并发症。     

手术治疗移位的跟骨关节内骨折

目的评价手术治疗移位的跟骨关节内骨折的临床疗效。方法对28例(32足)移位的跟骨关节内骨折行跟骨外侧入路切开复位内固定，其中26例予以植骨。结果26例获得随访，随访时间8～20个门，平均13个月，骨折均完全愈合，参照跟骨关节内骨折评分标准：优15例，良9例，可2例。术后创口局部渗液5例，皮缘局限性坏死1例，经换药后治愈。结论跟骨外侧入路切开复位内固定并植骨术是治疗移位的跟骨关节内骨折的有效方法。     

跟骨牵引加延期内固定治疗Pilon骨折治疗体会

目的 跟骨牵引加延期内固定治疗对Pilon骨折临床疗效的影响。方法 对24例Pilon骨折采用跟骨牵引加延期内固定手术处理的临床资料进行分析、总结。结果 根据胫骨远端骨折治疗效果的评定标准综合评定疗效，优20例，良3例，差1例。结论 采用跟骨牵引加延期内固定治疗Pilon骨折，可使踝关节功能得到最大限度地恢复。     

钢板内固定治疗跟骨关节内骨折

目的探讨跟骨钢板治疗跟骨关节内骨折的临床效果。方法对45例跟骨骨折患者采用外侧L形切口跟骨钢板内固定手术治疗。结果 45例均获随访,时间为3个月～2年。根据Maryland评分标准进行疗效评定：优30例,良12例,可3例,优良率为93.3%。骨折愈合时间为3～6个月。术前B hler角0～20（10.0±4.5）°,术后B hler角恢复至25～40（35.0±3.5）°。无严重并发症发生。结论应用跟骨钢板治疗跟骨关节内骨折可以恢复跟骨的大体形态,能够获得较好的临床治疗效果。     

锁定跟骨钢板治疗跟骨关节内骨折

目的 探讨采用锁定跟骨钢板治疗跟骨关节内骨折的临床疗效.方法 2011年2月～2012年1月,采用锁定跟骨钢板治疗10例跟骨关节内移位骨折,患者均为男性;左侧6例,右侧4例.采用AOFAS踝与足评分系统评定锁定跟骨钢板治疗跟骨骨折的疗效.结果 所有患者术后均获得骨性愈合,愈合时间为6～12周.术后无一例患者发生神经血管损伤并发症,未见骨折移位或内固定失败等情况.结论 应用锁定跟骨钢板治疗跟骨关节内骨折,可以获得满意的效果,利于早期功能恢复.     

外侧低位切口手术治疗跟骨关节内骨折

目的探讨跟骨外侧低位手术切口对涉及跟距关节跟骨骨折手术的治疗效果。方法自2011年2月至2012年12月在广东省东莞市黄江医院手术治疗38例40足距下关节塌陷性跟骨骨折患者,按照Sander分型,Ⅱ型20例22足,Ⅲ型15例15足,Ⅳ型3例3足。骨折手术切口采用跟骨外侧低位切口,骨折内固定材料选用跟骨"Y"型钛板。结果术后随访12~18个月,平均14个月。跟骨外侧切口术后全部愈合,跟骨骨折全部愈合,骨折愈合时间为10~20周。按美国足踝外科协会的Maryland足部评分标准评定,优28足,良9足,中3足,优良率为92.5%。结论涉及跟距关节面跟骨骨折采取手术治疗可以尽可能恢复跟骨形态和关节面平整,而采用跟骨外侧低位手术切口可减少术后并发症发生。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.