小型钛板联合颌间牵引钛钉在下颌骨骨折中的应用

目的探索小型钛板联合颌间牵引钛钉在下颌骨骨折复位内固定术中的应用及临床效果。方法回顾分析小型钛板联合颌间牵引钛钉,行下颌骨骨折复位内固定术186例的临床资料和应用经验。采用颌间牵引钛钉行颌间牵引,恢复咬牙合关系,经隐蔽微创切口或原开放性创口将下颌骨骨折断端解剖复位,小型钛板骨间固定。结果所有患者创口Ⅰ期愈合,张口度正常,咬牙合关系正常,面部外型、咀嚼功能恢复良好。临床治愈率100%。X线片示:骨折愈合良好,未见钛板螺钉松动、移位、断裂,周围骨质无疏松及吸收现象。结论小型钛板联合颌间牵引钛钉行骨间坚强内固定术,治疗下颌骨骨折,微创,复位准确,简便快捷,效果满意,值得临床推广应用。     

自攻颌间牵引钉配合小型钛板治疗下颌骨骨折的疗效观察

目的:探讨自攻颌间牵引钉配合小型钛板治疗下颌骨骨折的临床疗效。方法:对48例下颌骨骨折患者采用自攻颌间牵引钉联合小型钛板行坚强内固定术。术后对患者的切口愈合情况、张口度、咬合关系、口腔卫生情况以及骨折愈合情况进行观察。结果:48例患者手术切口均为I期愈合,治疗效果满意,咬合关系良好,3个月后影像学复查示骨折线对位良好。结论:自攻颌间牵引钉配合小型钛板坚固内固定治疗下颌骨骨折是目前治疗下颌骨骨折较为理想的方法。     

下颌骨粉碎性骨折的治疗探讨

目的:探讨下颌骨粉碎性骨折的临床特征及治疗方法。方法:分析总结22例下颌骨粉碎性骨折患者的临床信息、治疗方法及随访结果。结果:22例患者共30处骨折,粉碎性骨折部位均只有一个,大都合并全身其它部位损伤。14例于4周内手术,21例采用坚强内固定,绝大多数患者术后获得了满意的面型和下颌功能恢复。结论:以重建钛板作坚强内固定是下颌骨粉碎性骨折首选治疗方法,以小型钛板或钛网固定+术后颌间固定2～3周、单纯颌间固定等是该方法的必要补充。术式的选择受到患者骨折严重程度、全身情况、术者的操作经验等因素的影响。     

下颌骨多发性骨折治疗的临床观察

目的：探讨下颌骨多发性骨折的临床特点及治疗措施。方法：对9例下颌骨多发性骨折病例,根据骨折类型采用切开复位坚强内固定术配合术前或术后颌间牵引治疗或仅行颌间牵引进行治疗。术后1个月、6个月、1年随访,拍摄曲面断层片或CT复查骨折复位愈合情况并检查咬合关系。结果：9例下颌骨多发性骨折病例切口均一期愈合,骨折复位,愈合良好,9例咬合关系恢复正常。结论：下颌骨多发性骨折根据骨折类型选择合理治疗方式,坚强内固定联合术后短期颌间牵引,对保持骨折复位愈合、咬合关系恢复具有重要作用。     

儿童下颌骨骨折的治疗及愈后的临床研究

目的：评价手术坚强内固定在儿童下颌骨骨折中的临床效果。方法对28例下颌骨骨折患儿应用紧贴下颌下缘上方的小型钛板双皮质固定+单颌牙弓夹板固定手术切开复位内固定术。结果28例患儿下颌骨骨折均获得良好的解剖复位,骨折Ⅰ期愈合,面形、开口型均正常,张闭口活动正常,口内咬牙合关系良好,未见骨折部位恒牙萌出异常,患儿无不良反应。结论儿童下颌骨骨折采用紧贴下颌下缘上方的小型钛板双皮质坚固内固定联合牙弓夹板固定术,避免了下颌骨张力带钛板固定对恒牙胚的损伤和下颌骨应力带的扭转,不影响颏顶弹性帽固定对下颌的制动。患儿早期即可进食和进行功能锻炼,减少并发症的发生,对下颌骨的整复固定和功能恢复效果良好。     

小型钛板内固定治疗下颌骨骨折

目的：评估小型钛板内固定治疗下颌骨骨折的临床疗效.方法：对52例下颌骨骨折的患者行切开复位术，使用小型钛板内固定，保留骨折线上的牙齿.结果：52例患者创口均Ⅰ期愈合，骨折愈合良好，51例恢复到术前咬合关系，有1例固定后出现咬合关系不良，经颌间牵引后恢复正常咬合关系，所有患者钛板均未取出.结论：小型钛板内固定具有良好的稳定性，缩短了颌间固定的时间，可早期恢复张口运动，对骨折线上牙齿可以保留，是一种较好的下颌骨骨折内固定方法。     

颌间牵引在坚强内固定治疗复杂颌骨骨折中的应用

目的回顾46例复杂颌骨骨折开放复位坚强内固定术后的咬合关系记录，探讨颌间牵引在骨折术后咬合关系恢复中的作用。方法46例复杂的颌骨骨折，均采用开放复位坚强内固定术治疗。其中26例术前和（或）术后各1周采用颌间牵引术。术后1～3个月检查咬合关系。结果26例行颌间牵引患者咬合关系完全恢复。20例单纯坚强内固定患者有13例完全恢复，5例调合多次后基本恢复，2例调合无效最后只能通过修复治疗恢复咬合。结论在颌骨骨折治疗中短时的颌间牵引有助于咬合关系的恢复，特别是粉碎性、多发性的复杂骨折、陈旧性骨折，术前术后颌间牵引很有必要。     

下颌骨骨折的临床回顾性研究

目的：探讨下颌骨骨折后治疗方法的适应证和治疗效果。方法：对从2005年1月～2010年1月来我院就诊的143例下颌骨骨折患者的治疗效果及随访结果进行总结。结果：牙槽突骨折采用颌间拴丝或牙弓夹板,髁突颈骨折多采用颌间牵引固定;大部分患者采用切开复位,断端选用钛合金小型钛板或钢丝结扎固定,少部分患者采用颌间结扎、颌间拴丝弹性牵引辅以颅颌绷带保守治疗,均取得较好效果,总成功率为95.4%。通过术后1～6年的随访,按3个等级进行分类：Ⅰ级：伤口愈合好,骨折端无错位愈合,钛板无感染或暴露需二次手术取出,无开口困难等功能障碍;Ⅱ级：伤口愈合良好,骨折端无错位愈合或轻微错位不影响功能,钛板无感染或暴露需二次手术取出,无或者轻中度功能障碍;Ⅲ级：伤口感染,骨折断端感染或长期不愈合,钛板感染或暴露需要二次手术取出,有重度开口困难等功能障碍;随访结果3个等级分别为Ⅰ级40例,占27.9%,Ⅱ级92例,占64.8%,Ⅲ级11例,占7.3%。结论：下颌骨骨折正确地选择适应症是各种治疗下颌骨骨折方法取得满意疗效的关键。准确诊断,及时复位、固定,选择正确固定方式,防止感染,待别是应用坚强内固定技术能有效提高颌骨骨折治愈率。     

90例下颌骨骨折坚强内固定术治疗体会

目的评估坚强内固定术治疗下颌骨骨折的临床疗效。方法回顾分析使用坚强内固定技术治疗的90例下颌骨骨折患者的临床资料,总结临床应用经验。结果90例中85例I期愈合,咬合关系系恢复良好,颌面部外形和咀嚼功能得以恢复,张口度正常;5例出现不同程度感染。造成钛板外露,但经临床处理均达到Ⅱ期愈合。术后3月、6月、1年分别X线片和三维CT复查骨折愈合良好,均未见钛板或钛钉移位、断裂．周围骨质无疏松、吸收等现象。结论微型钛板坚强内固定技术效果确切,但术前评估和手术时机的选择也是至关重要。     

桡骨远端粉碎性骨折手术治疗分析

目的探讨桡骨远端粉碎性骨折的手术治疗方法以及临床效果。方法对17例桡骨远端粉碎性骨折患者按AO原则分类,根据不同的类型分别采用钛板螺钉内固定、简单内固定加外固定架固定及单纯外固定架固定。结果 17例患者全部获8~18个月随访,平均11.3个月。腕关节功能按Sarmiento标准进行评定,优9例,良7例,可1例,优良率94.1%。结论桡骨远端粉碎性骨折通过手术治疗,能最大限度地恢复桡骨与尺骨的长度、关节面的平整、掌倾角及尺偏角,术后配合合理的康复锻炼,可获良好治疗效果。     

单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折

目的报告单臂外固定架配合跟骨牵引治疗胫腓骨粉碎性骨折的疗效。方法186例胫腓骨粉碎性骨折,其中开放骨折42例,闭合骨折142例,均采用单臂外固定架,配合跟骨牵引治疗。结果随访185例,183例骨愈合,平均愈合时间6个月,按Johner-Wrichs,优113例,良69例,差2例。针为17.5%。结论单臂外固定支架配合跟骨牵引治疗胫腓骨粉碎性骨折,方法,疗效肯定。     

单指反向牵引外固定架在指骨关节内粉碎性骨折中的应用

目的 探讨单指反向牵引外固定架用于指骨关节内粉碎性骨折的治疗及体会.方法2003年1月至2009年11月,采用自制单指反向牵引外固定架治疗手部指骨关节内粉碎性骨折35例.结果 术后35例随访期间无针道感染及手指坏死发生,骨折愈合时间3～6周,无骨不连及骨髓炎并发症.术后随访平均时间为12.5个月,根据1975年美国手外科学会推荐的手指总的主动活动度(total active move-ment,TAM)系统评定方法评定:优19例,良15例,可1例,差0例,优良率为97.14％.结论 单指反向牵引外固定架结构简单,制作方便实用,固定指骨稳定,特别是对指骨关节内的粉碎性骨折有良好的复位及固定作用,临床可以推广应用.     

股骨近端抗旋髓内钉在高龄骨质疏松性股骨转子间骨折中的应用

目的探讨股骨近端抗旋髓内钉（PFNA）在治疗高龄骨质疏松性股骨转子间骨折中的临床疗效。方法25例高龄骨质疏松性股骨转子间骨折患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PFNA内固定治疗。结果23例获得随访,时间13～24个月,其中1例94岁患者因尿毒症术后1年死亡。余22例X线片显示骨折均一期愈合,愈合时间为（8.2±3）个月。无感染、骨不连、内固定失效、螺旋刀片滑脱、再骨折及髋内翻等并发症发生。根据Harris功能评分评定疗效：优18例,良2例。结论PFNA治疗高龄骨质疏松性股骨转子间骨折的初期疗效满意,内固定可靠,允许早期功能锻炼。     

Alternatives in the treatment of ipsilateral fractures of the hip and femur

Eight cases of ipsilateral femoral neck and shaft fractures were reviewed. The diagnosis of the femoral neck fracture was delayed in two cases. Seven of the femoral shaft fractures were comminuted. In six cases, both fractures were treated with rigid internal fixation. A combination of traction and internal fixation was used in two cases. Two cases of avascular necrosis of the femoral head were observed. The fracture reduction was insufficient in both cases and the diagnosis of femoral neck fracture was delayed in one case. A radiograph of the pelvis is mandatory in high-velocity trauma victims. Ipsilateral fractures of the femoral neck and shaft should be stabilized by internal fixation as early as possible. Intramedullary locked nailing seems to be an attractive alternative in the treatment of the comminuted femoral shaft fracture.     

Rigid internal fixation with miniplates and screws: a cost-effective technique for treating mandible fractures?

Traditional methods of fixation for stabilization of mandible fractures primarily center around intermaxillary fixation with or without open reduction. During the past decade, rigid internal fixation with miniplates and screws has attained widespread acceptance in the management of acute traumatic injuries to the mandible. With continuing emphasis on cost containment in health care delivery, plastic surgeons will be expected to justify their therapeutic methods as beneficial as well as cost-effective. This is particularly important when a number of acceptable procedures are readily available. The purpose of our investigation was retrospectively to compare treatment with intermaxillary fixation alone, interosseous wire osteosynthesis, and rigid internal fixation with miniplates and screws. We analyzed the hospital records of three such treatment groups, each consisting of 25 patients. Despite initial purchase costs, increased operating time, and the need to develop the skills required to apply the hardware, our study clearly demonstrated that miniplates and screws remain a cost-effective approach to caring for fractures of the mandible. Associated advantages include a quicker return to a preinjury life-style, decreased weight loss, improved oral hygiene and wound care, and protection of the airway, thereby eliminating monitored intensive care unit admissions.     

Midfacial fractures in the pediatric population.

Fractures to the midface in the pediatric age group are rare because the mandible and cranium provide protection and absorb most of the traumatic impact. In addition, these midfacial bones are extremely elastic. When caring for midfacial fractures, standard reconstructive procedures directed toward restoration of form and function must be met. Unfortunately, diagnosis of facial fractures may be difficult because it is very dependent on the site and severity of injury as well as the child's age. Fracture management is similar to that seen in adults with the major exception related to the developing dentition, which requires adjustments in the securing of intermaxillary fixation. Children will usually recover quickly and, fortunately, complications remain rare. It is important for clinicians to closely evaluate these patients for other associated injuries. Unfortunately, due to the small numbers and poor long-term follow-up, definitive conclusions are often difficult to obtain.     

Subtrochanteric fractures of the femur: a review of 130 patients.

A review of 130 patients with subtrochanteric fractures of the femur has led to a new classification based upon fracture pattern. Type I is a short oblique, Type II a long oblique, and Type III any comminuted fracture of the subtrochanteric area. Twenty-two patients were treated with traction and 108 patients treated by surgical operation. Stable fractures treated in skin traction did well and extensively comminuted fractures appeared to be best treated with 90-90 skeletal traction. In the Type I and Type II fractures, it was determined that these fracture patterns were stable and any strong nail-plate device will provide adequate fixation. The Type III fracture may be converted to Type I or Type II by lag screw fixation and then fixed accordingly but if stability cannot be obtained by this method, a sliding screw type of device appeared to offer the best fixation. Supplementary bone graft where necessary to restore the medial buttress offered singularly better healing. Delayed weight bearing until fracture healing was secure gave the best chance of primary bone healing without deformity.