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1.
目的 探讨开放复位内固定治疗跟骨关节内骨折的疗效并总结其经验。方法 对19例患22足跟骨关节内骨折进行开放复位,并运用松质骨螺钉和重建钢板及可塑形钢板等进行内固定,其中7例一期植骨。随访4~36个月,平均随访时间为14个月。结果 按Maryland Foot Score评分系统进行评价,优10足,良9足,可2足,21足,优良率为86.4%。结论 开放复位内固定治疗跟骨关节内骨折疗效满意。骨折治疗的关键是尽可能恢复跟距关节面的适应性和跟骨的正常解剖形态,围手术期的正确处理也非常重要。 相似文献
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目的探讨运用微型钛板治疗复杂桡骨头骨折的可行性及疗效。方法 21例复杂桡骨头骨折患者,采用手术切开复位、微型钛板内固定的方法治疗,其中MasonⅡ型14例,Ⅲ型7例。均采用肘关节后外侧切口,骨折复位后克氏针辅助固定,再行指骨钛板螺钉固定,确认关节面平整,关节旋转及伸屈运动无阻碍。术后予石膏外固定2~4周,石膏拆除后开始渐进的功能锻炼。结果本组手术时间50~80 min,平均(65±15)min。均获随访,平均随访时间14.5(5~24)个月,术后3~5个月骨折均获骨性愈合,肘关节屈平均115°(110°~125°),伸平均5°(0°~10°),旋前平均55°(50°~60°),旋后平均50°(40°~60°)。1例遗留轻度肘关节疼痛;无肘关节外翻不稳定及创伤性关节炎发生。根据Broberg和Morrey评分评价肘关节功能:优8例,良10例,可3例,优良率85.7%。结论运用微型钛板固定桡骨头骨折安全可行,能更好地恢复桡骨头关节面的解剖结构,并有效固定,为早期肘关节功能锻炼提供了稳定性,有利于肘关节功能的恢复。 相似文献
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开放复位内固定治疗髋臼骨折 总被引:12,自引:5,他引:12
目的:探索髋臼骨折的有效治疗方法。方法:本组收治42例,男31例,女11例。平均年龄46.4岁。非手术治疗6例,手术复位内固定34例,全髋关节置换术2例。结果:39例平均随访30.1个月,优31例,良2例,可3例,差3例,优良率84.6%。讨论:髋臼骨折的保守治疗与手术治疗互补而非对立,理想的手术时机为损伤后2-10d。重建钢板技术是较好的治疗方法,螺钉的植入方向是其技术关键。髋臼骨折的预后与骨折类型、损伤程度、复位程度密切相关。 相似文献
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目的探讨切开复位内固定治疗成人移位桡骨头骨折的手术技术。方法本组移位桡骨头骨折19例,MasonⅡ型12例,Ⅲ型4例,Ⅳ型3例。17例用肘后外侧Kocher切口,另外2例用肘后正中切口以便同时处理合并的尺骨近端骨折。复位后用微型钢板螺钉固定,并使内固定物不妨碍关节活动。结果平均随访38.5个月,无骨间后神经损伤及感染发生,19例骨折均顺利愈合。按照Broberg和Morrey肘部评分标准:优13例,良6例。结论切开复位内固定治疗移位桡骨头骨折可取得满意疗效,术中应注意以下方面:①保护、修复尺骨外侧副韧带;②防止损伤骨间后神经;③努力达到解剖复位;④固定既要坚强可靠,又要不阻碍关节的运动。 相似文献
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Jason C. Miller DPM FACFAS Sepideh Shever DPM 《The Journal of foot and ankle surgery》2008,47(1):46-50
Management of open, comminuted fractures presents a challenge for the foot and ankle surgeon. Reconstructive surgery for such injuries has a high potential for the development of serious complications, and factors such as the extent of soft tissue injury, neurovascular status to the foot, and fracture stability must be taken into consideration before determining a surgical plan. This article describes the case of a patient who presented with an open, comminuted first metatarsal fracture as a result of a chainsaw injury. The patient was treated with a uniplanar mini-external fixator, demineralized bone matrix, primary wound closure, and external bone growth stimulation. At 1-year follow-up, the interview and examination revealed the patient to be pain free with a functional first ray. ACFAS Level of Clinical Evidence: 4. 相似文献
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This case report describes the first documented arthroscopic reduction and internal fixation of a rare isolated femoral head fracture without associated dislocation. A large suprafoveal osteochondral fracture was arthroscopically reduced by use of crossover techniques gained from experience performing arthroscopic femoroacetabular impingement surgery. An innovative “chopstick” maneuver was used to rotate the mobilized osteochondral fragment into anatomic position, followed by arthroscopic Herbert screw fixation. Relevant surgical techniques and clinical outcome are presented. Although this case shows arthroscopic osteosynthesis for a rare fracture, the techniques described herein may permit broader arthroscopic applications. As hip arthroscopy evolves, the role of arthroscopic surgery in the traumatized hip may expand beyond diagnostic arthroscopy and foreign/loose body removal. An anatomic reduction with stable internal fixation permitting early joint motion trumps the ability to perform outpatient arthroscopic procedures. However, if the equivalent procedure can indeed be accomplished in a safe and minimally invasive manner, one can envision a future expansion of the role of hip arthroscopic surgery in fracture management. 相似文献
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Background
Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures.Methods
Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months.Results
Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases.Conclusions
The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures. 相似文献8.
AO钢板内固定治疗跟骨骨折 总被引:10,自引:2,他引:8
目的 探讨复杂跟骨骨折治疗方法及AO钢板内固定价值。方法 自 1998年 3月至 2 0 0 3年 10月应用AO钢板治疗累及距下关节的跟骨骨折 2 7例 ,术中注意关节面复位及Gissane角和B¨ohler角的恢复。结果 2 7例病人经 8个月~ 3年 (平均 18个月 )随访 ,根据张殿英等[1 ] 骨折评价方法 ,2 7例跟骨SandersⅡ、Ⅲ型骨折病人有 2 2例评为优良。结论 距下关节面的复位 ,Gissane角和B¨ohler角的恢复、牢固的内固定和术后足够长时间的负重限制是成功的关键。 相似文献
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Jan De Raet MD Stefan Kemnitz Eddy Verhaven 《European journal of trauma and emergency surgery》2008,34(2):173-176
Abstract A boy, age 9, presented with deformation and pain of the left distal forearm, 1 year after a plate osteosynthesis for a distal
radial metaphyseal fracture. This case showed a pediatric nonunion of a distal radial metaphyseal fracture which caused strong
deformation of the left distal forearm. This is an extremely rare complication in children following an open reduction and
internal fixation for a displaced distal forearm fracture. Key points of pediatric fracture healing are discussed and a review
of the literature is given. 相似文献
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目的探讨有限切开复位钢板内固定治疗Tile C型骨盆骨折的方法和疗效。方法 2010年6月至2012年5月,采用有限切开复位钢板内固定治疗Tile C型骨盆骨折15例。其中:C1型10例,C2型4例,C3型1例。评估术中出血量、手术时间及术后患者功能恢复情况。结果 15例患者术后获12~24个月(平均15个月)随访。骨盆前环手术的手术时间和出血量平均分别为61 min、92 mL;后环手术平均分别为71 min、165 mL。术中均无重要血管、神经损伤等并发症发生。1例耻骨处伤口发生浅表感染,经换药治愈。骨折复位按Matta影像学评分标准评定:解剖复位10例,满意复位4例,可1例。骨折愈合时间为2~6个月,平均2.9个月。末次随访时采用Majeed骨盆骨折评分标准评定疗效:优12例,良2例,可1例。结论通过有限切开复位和钢板内固定可以对Tile C型骨盆骨折进行良好的显露和牢靠的固定,并且不需要暴露神经、血管等结构,具有微创特点,疗效显著。 相似文献
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Dafang Zhang George S. M. Dyer Brandon E. Earp Philip Blazar 《Journal of hand and microsurgery》2023,15(1):45
Introduction The objectives of this study were to assess long-term outcomes, complications, and reoperations after open reduction internal fixation (ORIF) of radial head fractures. Materials and Methods 35 adult patients, who underwent ORIF of an isolated, displaced radial head fracture without elbow instability (Mason classification type II or III) at two tertiary care referral centers from 2000 to 2017, were identified. Patient satisfaction, pain, and QuickDASH scores were assessed by telephone follow-up at median 12.9 years. Results The mean age of the 35 patients in our study was 39 years, and 54% were women. The median length of clinical follow-up was 175 days. Postoperative complications occurred in 54% of patients, and reoperations in 23% of patients. Multivariable logistic regression identified fixation with plate and screws versus screws alone as a risk factor for complications and reoperations. The long-term telephone follow-up response rate was 54%. At 13-year median follow-up, the average patient satisfaction was 9.6/10, the average patient-reported pain was 0.7/10, and the average QuickDASH score was 10.5. Conclusion The long-term outcomes of ORIF of Mason classification type II and III radial head fractures are favorable; however, rates of complication and reoperation are notable and may be higher with plate-and-screw fixation. 相似文献
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有限切开内固定结合石膏外固定治疗复杂Pilon骨折 总被引:1,自引:0,他引:1
目的探讨复杂Pilon骨折延期切开有限内固定结合石膏外固定治疗的临床疗效。方法对26例复杂Pilon骨折(Ruedi-AllgowerⅢ型)均行延期切开有限内固定结合石膏外固定治疗。结果术后发生切口感染4例,3例经植皮治愈,1例经反复换药2.5个月,3个月后取出内固定物后愈合。骨折延迟愈合2例,均为大块髂骨植骨,髂骨面重建踝关节面患者,术后1.5年骨折愈合。26例均获随访,平均31(22~56)个月,按Mazur评分法评定疗效:优10例,良12例,可4例,优良率为84.6%(22/26)。结论根据骨折类型和软组织条件,采用延期有限切开内固定结合石膏外固定治疗复杂Pilon骨折能有效减少局部并发症,并获得较好的踝关节功能。 相似文献
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目的比较关节镜下使用2枚Endobutton钢板与切开复位使用空心螺钉固定后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床疗效。方法2015年3月至2018年6月我科收治急性PCL胫骨止点撕脱性骨折患者56例,其中男35例,女21例;年龄18~55岁,平均(29.51±15.02)岁。56例患者随机分为两组,26例采用关节镜下使用2枚Endobutton钢板结合高强线固定(关节镜组),30例采用改良的膝关节后内侧切口使用2枚空心螺钉固定(切开复位组)。比较两组患者的手术时间、住院费用,术前、术后3 d、术后1个月、术后1年膝关节疼痛评分,末次随访膝关节活动度、Lysholm评分、后抽屉试验阳性率及术后并发症等情况。结果两组患者均获随访,随访时间12~19个月,平均(14.55±2.63)个月。末次随访所有患者骨折均愈合,无内固定失败、再次骨折发生。关节镜组较切开复位组手术时间长、住院费用高,两组比较差异有统计学意义(P<0.05)。关节镜组术后3 d膝关节疼痛评分小于切开复位组,两组比较差异有统计学意义(P<0.05);两组患者术前、术后1个月、术后1年膝关节疼痛评分比较差异无统计学意义(P>0.05)。两组患者末次随访膝关节活动度、ysholm评分、后抽屉试验阳性率比较,差异无统计学意义(P>0.05)。结论关节镜下使用2枚Endobutton袢钢板与改良膝关节后内侧入路使用空心螺钉治疗PCL止点撕脱骨折,均可获得良好的手术效果。关节镜组有微创、早期疼痛程度轻的优点,但手术时间较长、费用稍高。 相似文献
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闭合复位穿针内固定治疗肱骨近端骨折 总被引:1,自引:0,他引:1
目的探讨采用闭合复位经皮穿针内固定治疗肱骨近端骨折的疗效。方法肱骨近端骨折患者32例,均在C臂X光机透视下行闭合复位、经皮克氏针内固定治疗。结果32例均获随访,平均8(3~15)个月,骨折均愈合。克氏针松动9例,脱出3例,针孔感染4例。无神经损伤、骨髓炎、肱骨头坏死等并发症。疗效按Neer肩关节功能评分:优19例,良7例,可5例,差1例,优良率81.2%。结论闭合复位经皮穿针内固定具有操作简单、创伤小、利于骨折愈合等优点,是治疗肱骨近端骨折的有效方法之一。 相似文献
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颈椎骨折脱位内固定治疗方式的选择 总被引:1,自引:0,他引:1
目的:评价不同手术内固定方式治疗颈椎骨折脱位伴颈髓损伤的效果及其必要性。方法:采用6种不同的内固定方法,于伤后1-5d内治疗不同类型的颈椎骨折脱位伴颈髓损伤34例,并进行术前术后临床比较。结果:34例固定效果均良好,按ASIA评分标准,术后脊髓功能恢复良好。结论:及时有效的减压、准确稳固的内固定能使颈椎、颈髓损伤病人主动、有效地恢复功能,内固定方式应根据骨折机制、损伤部位及类型选择最佳方法。 相似文献
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Jun-Beom Kim In-Soo Song Byeong-Seop Park Chi-Hoon Ahn Cheol-U Kim 《The Journal of foot and ankle surgery》2017,56(4):713-717
The aim of the present study was to evaluate and compare the clinical and radiologic results of internal fixation with a headless cannulated screw versus a locking compression distal ulna hook plate for fractures at the base of the fifth metatarsal bone, zone 1. From April 2012 to April 2015, 30 cases (29 patients) were retrospectively evaluated. The mean follow-up period was 13 months. The patients were divided into 2 groups stratified by the fixation method: screw (group A, n = 15) or plate (group B, n = 15). We measured the displacement to diastasis of the fracture on the foot oblique radiographs taken pre- and postoperatively in each group, recorded the time to bony union, and measured the difference in the reduction distance in each group. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society midfoot score at 12 months postoperatively. In group A, the mean interval to union was 54.2 ± 9.3 days, the mean displacement to diastasis had improved to 0.3 ± 0.4 mm postoperatively (p < .001), and the mean reduction distance was 2.9 ± 1.0 mm postoperatively. In group B, the mean interval to union was 41.5 ± 7.0 days, the mean displacement to diastasis had improved to 0.06 ± 0.2 mm postoperatively (p < .001), and the mean reduction distance was 4.1 ± 1.6 mm. The American Orthopaedic Foot and Ankle Society midfoot scale score was 97.7 ± 3.4 in group A and 98.2 ± 3.2 in group B. The interval to union was significantly different between the 2 groups (p = .01). No complications were recorded. Our findings have shown that the plate is a reasonable and alternative method for the surgical treatment of fifth metatarsal base fractures. 相似文献