重建钢板辅助股骨近端髓内钉内固定治疗股骨转子下骨折

目的探讨重建钢板辅助股骨近端髓内钉内固定治疗股骨转子下骨折的临床疗效。方法采用重建钢板辅助股骨近端髓内钉内固定治疗14例股骨转子下骨折患者。末次随访时采用Harris功能评分评价疗效。结果患者均获得随访,时间6~12个月。骨折愈合时间3~6个月。末次随访时根据Harris功能评分评价疗效:优10例,良3例,可1例,优良率为13/14。无髋内翻畸形、再次骨折、拉力螺钉切割股骨头及断钉发生。结论重建钢板辅助股骨近端髓内钉内固定治疗股骨转子下骨折可以达到坚强内固定,避免了内固定失效和骨折不愈合发生,术后疗效满意。     

Gamma-3髓内钉微创治疗股骨转子间骨折疗效分析

目的探讨Gamma-3髓内钉微创治疗股骨转子间骨折的疗效。方法对120例股骨转子间骨折患者行闭合复位、Gamma-3髓内钉固定。术后早期功能锻炼。结果 120例均获随访,时间6～18个月。患者骨折全部愈合,时间3～6个月。患髋行Harris髋关节功能评分:优31例,良71例,中18例,差0例,优良率为85%。未发生股骨干骨折、拉力螺钉切割出股骨头、髋内翻畸形等严重并发症。结论采用Gamma-3髓内钉微创治疗股骨转子间骨折,术后可早期功能锻炼,并发症低,创伤小,疗效好。     

股骨重建髓内钉治疗股骨转子下骨折的疗效

目的 探讨股骨重建髓内钉治疗股骨转子下骨折的疗效。方法 采用股骨重建髓内钉治疗42例股骨转子下骨折患者。记录手术情况、骨折愈合情况、术后并发症发生情况，末次随访时采用髋关节功能Harris评分、膝关节功能HSS评分评价疗效。结果 患者均获得随访，时间15～20个月。手术时间44～91(68.88±13.28)min,术中出血量40～120(83.21±17.42)ml,术后住院时间3～8(5.31±1.16)d。38例骨折愈合时间为3～6(4.03±0.72)个月，2例骨折在术后第10、11个月愈合，2例骨折不愈合经再次手术后愈合。术后切口感染2例，中重度贫血(血红蛋白<70 g/L)4例，螺钉退钉切出2例，髋内翻畸形1例，压疮2例。末次随访时，髋关节功能Harris评分为78～97(93.86±3.14)分，其中优39例，良1例，可2例，优良率为95.24%;膝关节功能HSS评分为91～97(94.69±1.52)分，42例均为优。结论 股骨重建髓内钉是治疗股骨转子下骨折良好的内固定方式，尤其适用于中青年患者。     

3种内固定治疗骨质疏松性股骨转子间骨折的疗效比较

目的 比较InterTan髓内钉、股骨近端防旋髓内钉(PFNA)、Gamma钉治疗骨质疏松性股骨转子间骨折的疗效.方法 将48例骨质疏松性股骨转子间骨折患者根据内固定方式不同分为InterTan组、PFNA组和Gamma钉组,每组16例.比较3组手术情况、术后并发症以及髋关节功能恢复情况.结果 患者均获得随访,时间18...     

PFNA在老年股骨粗隆骨折中的应用

目的 探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的效果. 方法 采用股骨近端防旋髓内钉(PFNA)内固定治疗老年转子间骨折患者. 结果 随访30例,时间6～20个月,骨折愈合时间14～20周,平均16周,关节功能恢复良好. 结论 股骨近端防旋髓内钉(PFNA)治疗老年转子间骨折,固定可靠,可早期关节活动,缩短卧床和住院时间,疗效可靠.     

闭合复位结合股骨近端抗旋髓内钉治疗高龄股骨转子间骨折

目的 探讨闭合复位结合股骨近端抗旋髓内钉(PFNA)治疗高龄股骨转子间骨折的疗效.方法 采用闭合复位结合PFNA治疗35例高龄股骨转子间骨折患者.结果 35例均获随访,时间8～15个月,骨折均愈合.无内固定松动、感染和股骨头坏死等并发症.疗效按Harris评分标准评定:优18例,良13例,可4例.结论 闭合复位结合PFNA治疗高龄股骨转子间骨折手术操作简单,损伤小,内固定稳定,可早期功能锻炼,骨折愈合快,临床效果满意.     

股骨近端防旋髓内钉治疗老年股骨转子间骨折

目的探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨转子间骨折的疗效。方法对45例老年股骨转子间骨折患者应用PFNA治疗。结果 45例均获得随防,时间12~24(15.1±4)个月。骨折均骨性愈合,无股骨头切割及髋内翻等并发症发生。根据Harris髋关节功能评分:优21例,良20例,中3例,差1例,优良率为91.1%。结论 PFNA治疗股骨转子间骨折具有创伤小、下床早、并发症少、内固定可靠、骨折愈合率高等优点,尤其适合老年骨质疏松患者。     

InterTan髓内钉治疗青壮年股骨转子间骨折的疗效

目的 探讨InterTan髓内钉治疗青壮年股骨转子间骨折的疗效。方法 采用InterTan髓内钉治疗30例青壮年股骨转子间骨折患者。记录手术情况、骨折愈合情况及术后并发症发生情况,根据髋关节Harris功能评分标准评价疗效。结果 患者均获得随访,时间7～22个月。切口均一期愈合。骨折愈合时间3～4个月。术后未出现下肢深静脉血栓、肢体短缩、头颈切出或短缩、髋内翻、骨折再移位及内固定松动、失效等并发症。末次随访时根据髋关节Harris功能评分标准评价疗效：总分75～95(86.37±5.66)分,优12例,良14例,可4例,优良率26/30。结论 InterTan髓内钉治疗青壮年股骨转子间骨折固定可靠,并发症少,骨折愈合率高。     

股骨近端髓内钉内固定治疗股骨转子下及转子间不稳定骨折的临床研究

目的探讨股骨近端髓内钉内固定治疗股骨转子下及转子间不稳定骨折的临床疗效。方法采用回顾性分析的方法,分析本院收治的股骨转子下、股骨转子间骨折患者临床资料,依据治疗方式不同分为观察组和对照组。结果观察组手术时间、术中出血量、术后引流量均明显低于对照组,观察组髋关节功能评分优良率明显高于对照组,观察组内固定松动、内固定断裂、骨折不愈合并发症发生率明显低于对照组,P〈0．05,差异均有统计学意义。结论股骨近端髓内钉固定治疗股骨转子下及转子间不稳定骨折的手术创伤小,减少了血运干扰,提高骨折愈合率,有较好的临床疗效。     

三种股骨近端髓内钉治疗股骨转子间骨折的临床疗效分析

目的分析比较应用三种股骨近端髓内钉治疗股骨转子间骨折的疗效。方法自2009年4月至2012年1月应用股骨近端髓内钉(proximal pemoral nail,PFN)、股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)、第四代髓内钉(InterTan组)三种髓内固定手术方式治疗转子间骨折(EvansⅠ~Ⅳ型)共153例,并进行回顾性总结分析。PFN组47例,PFNA组65例,InterTan组41例。结果本组153例患者中,121例获得随访,随访14~41个月,平均26.7个月。手术时间、术中出血量三组间比较差异均有统计学意义(P0.05),PFNA组时间最短、出血量最少,InterTan组次之,PFN组手术时间最长、出血量最多;骨折愈合时间三组间两两比较差异均无统计学意义(P0.05);术后髋关节评分三组间两两比较差异均无统计学意义(P0.05)。结论三种股骨近端髓内钉均是治疗股骨转子间骨折的有效手段,选择自己操作熟练的股骨近端髓内钉将缩短手术时间、减少出血量,临床上将更有优势。     

股骨头毁损三联征:股骨头骨折-脱位合并股骨颈骨折

股骨头合并同侧股骨颈骨折是一种严重而复杂的创伤,保髋手术大多会失败。其治疗的难点及预后的关键在股骨颈骨折上。鉴于股骨颈骨折的发生与股骨头骨折-脱位之间存在明显的、前后关联的贯序特点,笔者认为以股骨头毁损三联征（disastrous triad of femoral head,DTFH）来概括这种类型的损伤,更能反映其损伤机制和预后特点。结合临床观察和文献资料,DTFH可分为3个类型：Ⅰ型,普通型DTFH,股骨颈骨折的发生紧随于股骨头骨折-脱位之后,是同一暴力造成的损伤;Ⅱ型,医源型DTFH,是在股骨头骨折-脱位的诊疗过程中发生了医源性股骨颈骨折;Ⅲ型,应力型DTFH,发生于股骨头骨折-脱位的治疗之后,在股骨头骨折面的远侧缘发生应力性股骨颈骨折。本文对各型DTFH的临床特点进行了初步的讨论。     

Distal femoral allograft for massive proximal femoral deficiency

Background?Although indomethacin is effective in preventing heterotopic ossification (HO) after primary total hip arthroplasty, side effects are frequently observed. In the last decade a new class of drugs—the COX-2 selective nonsteroidal anti-inflammatory drugs—has been developed. To investigate the effect of these COX-2 selective NSAIDs on heterotopic ossification (HO) after primary total hip arthroplasty (THA), we conducted a randomized controlled trial using either indomethacin or rofecoxib for 7 days.

Methods?186 patients received either indomethacin 3 times daily, or rofecoxib twice, and 1 placebo, daily for 7 days. HO was graded according to the 1-year postoperative radiographs according to the Brooker classification.

Results?12 of the 186 patients included discontinued their medication before the end of the trial due to side effects. The remaining 174 patients were included in the analysis. In the indomethacin group (n = 89), 77 patients (87%) showed no HO, 9 showed HO of grade 1 and 3 showed HO of grade 2 according to the Brooker classification. In the rofecoxib group (n = 85) 73 patients (86%) showed no ossification, 9 showed grade 1, and 3 showed grade 2.

Interpretation?The prophylactic effect of rofecoxib for 7 days in preventing heteropic ossification after primary total hip arthroplasty is comparable to the effect of indomethacin given for 7 days. These results indicate that the development of HO follows a COX-2 pathway.     

Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum

Whereas excess femoral anteversion and its related symptoms have been described many times, excess femoral retroversion is less well documented. We report the case of a 30-year-old woman who had a history of chronic bilateral hip and knee pain and evidence of excess femoral retroversion, genu valgum, early-onset lateral and patellofemoral compartment osteoarthritis of both knees, and hip arthritis. She experienced symptomatic relief after undergoing staged bilateral simultaneous proximal femoral rotational and distal femoral lateral opening wedge osteotomies. Although this combination of alignment problems is not an infrequent clinical occurrence, we have found no literature on this condition or treatment. The patient provided written informed consent for print and electronic publication of this case report.     

Proximal femoral nail for treatment of trochanteric femoral fractures

PURPOSE: To report outcomes of 87 consecutive patients treated with a proximal femoral nail (PFN) for trochanteric femoral fractures. METHODS: 17 men and 70 women aged 58 to 95 (mean, 85) years with trochanteric femoral fractures underwent PFN fixation using an intramedullary nail, a lag screw, and a hip pin. Fractures were classified according to the AO system; the most common fracture type was A2 (n=45), followed by A1 (n=36) and A3 (n=6). The position of the lag screw within the femoral head was measured. The lateral slide of the lag screw after fracture consolidation was measured by comparing the immediate postoperative and final anteroposterior radiographs. RESULTS: 90% of lag screws were placed in an optimal position. The length of lateral slide of the lag screw in stable A1 fractures was significantly less than that in unstable A2 fractures; it was over 10 mm in 7 of 45 patients with A2 fractures. Cut-out of lag screw did not occur, suggesting that free sliding of the lag screw facilitates direct impaction between fragments. CONCLUSION: A PFN is useful for the treatment of trochanteric femoral fractures.     

股骨颈骨折后股骨头坏死

简要叙述股骨颈骨折后股骨头坏死的早期诊断和坏死预测等的最新进展。为使骨折后骨坏死尽量减少，早期手术和关节穿刺减压，避免髋关节放置在伸直及内旋位是必要的，建议屈曲位牵引。应用Gd-DTPA增强MRI T1脂肪浸润扫描，可预测股骨头坏死的可能性。建议将股骨头坏死分为静息型骨坏死和临床型骨坏死．