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目的探讨截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位的方法及疗效。方法对30例桡骨远端陈旧性骨折短缩畸形伴下尺桡关节脱位的患者行截骨延长加髂骨块植骨、桡骨远端锁定钢板内固定治疗。结果 30例均获得随访,时间12~15个月。患者腕关节前屈、后伸、尺偏、桡偏、旋前和旋后功能较术前均明显改善(P0.05),术后桡骨短缩、掌倾角及尺偏角与术前比较差异均有统计学意义(P0.05)。根据Garland-Werley功能评定:优21例,良5例,可2例,差2例,优良率86.7%。术后未出现桡骨高度丢失、内固定失败及骨不连等并发症。结论截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位有利于恢复腕关节的正常解剖结构,明显改善腕关节功能,减少创伤性关节炎的发生。 相似文献
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外固定支架联合带血管骨瓣植骨在距骨颈骨折治疗中的应用 总被引:9,自引:2,他引:7
目的探讨外固定支架联合带血管骨瓣植骨治疗距骨颈骨折的疗效。方法回顾性分析2004年1月~2005年3月收治的7例距骨颈骨折患者,按Hawkins分型:Ⅱ型6例,Ⅲ型1例,分别采用手法闭合复位(1例)和切开复位(6例)经皮空心螺钉内固定治疗,7例患者均在上述处理后加外固定支架跨关节固定联合带血管的骨瓣植骨治疗。术后观察骨愈合、骨坏死及后足功能情况。结果7例患者均获得随访,随访13~24个月,平均17个月。7例均获骨性愈合,无一例发生缺血性骨坏死。后足功能按Maryland评分系统进行评估,结果:优5例,良2例。1例合并距骨体骨折患者出现明显的胫距关节骨关节炎,最后行胫距关节融合术。结论外固定支架联合带血管骨瓣植骨能有效地防止距骨颈骨折后缺血性骨坏死,但远期效果尚须进一步观察。 相似文献
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Watanabe R Sato K Nakamura T Obara Y Toyama Y Ikegami H 《The Journal of hand surgery》2011,36(5):816-819
We report the case of a 43-year-old man with steroid-induced osteonecrosis of the distal humerus in both arms. Costal osteochondral autografts were used to restore both joints with satisfactory outcomes. 相似文献
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Background:
Pseudarthrosis of surgical neck of humerus is uncommon condition. Different methods of improving the stability of fixation have been described, including impaling the shaft into the head, placing a tension suture through the rotator cuff, or using an intramedullary cortical graft. We report our results of cortico-cancellous strut graft medially to counter the varus force, in conjunction with a fixed-angle implant on the lateral side.Materials and Methods:
We used this technique in seven cases of pseudarthrosis of surgical neck of the humerus. There were four women and three men, ranging in age from 22 to 65 years. All were treated with a tricortical medial buttress bone graft and fixed-angle fixation device on the lateral side. A locking proximal humerus plate (Synthes) was used in six cases, and a bent reconstruction plate (Synthes) was applied in one case. The one in which reconstruction plate was applied was operated before the advent of locking plates. The limb was immobilized in 30° of abduction over a cushion for 6 weeks, followed by a sling for another 6 weeks.Results:
The followup varied from 18 to 96 months. All our cases healed within mean 5.1 months (range 4–6 months). There was one case of avascular necrosis. All cases had useful function of shoulder.Conclusion:
The medial buttressing by strut graft with external fixation by laterally placed fixed angle plate is successful to achieve fracture union in pseudarthrosis of surgical neck of humerus. 相似文献7.
Satoshi Nagoya Masato Nagao Junichi Takada Hiroki Kuwabara Takuro Wada Yutaka Kukita Toshihiko Yamashita 《Journal of orthopaedic science》2004,9(6):566-570
We reviewed the results of 35 operations performed on 29 patients with osteonecrosis of the femoral head in which a pedicle iliac bone was utilized. The average age was 35 years (17–62). There were 28 patients of stage 2 and 7 of stage 3; there were 17 type C-1 hips and 18 type C-2 hips. The pedicle bone was inserted in the anterolateral direction of the femoral head. The average follow-up period was 8 years and 7 months. Collapse of the femoral head occurred in 19 hip joints. Although 16 of 28 stage 2 hips showed collapse, all 7 stage 3 hips resulted in collapse. Thirteen of 17 hips did not show collapse in patients with type C-1 necrosis, whereas 15 of 18 hips developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral direction of the femoral head, incidence of collapse was reduced. These results indicate that deep circumflex iliac pedicle bone graft may be indicated for stage 2 type C-1 necrosis, and that the penetration of the graft into the anterolateral aspect of the lesion is essential for the procedure to succeed. 相似文献
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PURPOSE: In this ex vivo biomechanical study we compared the maximum anterior/posterior bending moment, maximum torque, torsional stiffness, and twist angle at failure of distal radial shaft (Galeazzi) fractures stabilized with lateral plating (LP) and anterior plating (AP) and subjected to 4-point anterior/posterior bending and torsion. METHODS: Simulated fractures (oblique osteotomy between the middle and distal thirds of each radius) were created in 21 pairs of fresh, unembalmed, cadaver radii. One radius from each pair was stabilized with AP (n = 21); the contralateral radius was stabilized with LP (n = 21). Eleven pairs of specimens were tested to failure in torsion; the remaining 10 pairs were tested to failure in 4-point anterior/posterior bending. Differences between plating groups were checked for significance using paired t-tests. RESULTS: AP fixation was stronger in torsion (12.8 +/- 5.6 N-m) and anterior/posterior bending (40.1 +/- 25.7 N-m) than LP fixation (10.7 +/- 5.6 N-m and 36.0 +/- 30.5 N-m, respectively), although the differences were not significant. Similarly there was no significant difference in twist angle at failure (29 degrees +/- 13 degrees vs 23 degrees +/- 10 degrees ) or in torsional stiffness (0.6 +/- 0.2 N-m/ degrees vs 0. 6 +/- 0.2 N-m/ degrees ) between AP and LP fixations, respectively. CONCLUSIONS: Because LP fixation was not mechanically superior to AP fixation and required additional tendon elevation and dissection of the dorsal sensory nerve and possibly of the lateral antebrachial cutaneous nerves, AP fixation appears to be the preferable treatment for Galeazzi fractures. 相似文献
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目的: 探讨抗生素骨水泥柱占位联合髂骨植骨在股骨远端开放骨折骨缺损治疗中的有效性及初步疗效。方法: 回顾性分析2014年10月至2021年3月采用抗生素骨水泥柱占位联合髂骨植骨技术治疗股骨远端开放骨折骨缺损16例,其中男12例,女4例;年龄28~68岁。车祸伤11例,高处坠落伤5例,Gustilo分型Ⅰ型3例,Ⅱ型5例,ⅢA型8例。采用AO分型:C2型9例,C3型7例。从受伤至接受最终植骨手术时间为4~119 d。骨缺长损度2~10 cm。记录患者骨折愈合时间、并发症、膝关节功能Merchan评分。结果: 本组16例患者均获得随访,随访时间9~29个月。16例患者切口均Ⅰ期愈合,无术后感染、钢板断裂、肢体短缩及膝内外翻畸形等并发症。骨折愈合时间为4~10个月。膝关节功能根据Merchan评分标准评估,优8例,良4例,可3例,差1例。结论: 采用抗生素骨水泥柱占位联合髂骨植骨治疗股骨远端开放复杂骨折骨缺损有助于预防感染、协助骨折复位,增加固定强度,减少植骨量,是一种有效的手术方式。 相似文献
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The use of tricorticocancellous bone graft in severely comminuted intra-articular fractures of the distal radius 总被引:1,自引:0,他引:1
PURPOSE: We report the results of a retrospective study of the use of tricorticocancellous iliac crest bone graft in 12 patients with acute AO type C3.2 or type C3.3 fractures of the distal radius who were followed up for at least 1 year. METHODS: Twelve of 17 patients treated with the protocol were available for follow-up evaluation. All fractures were treated with open reduction and combined internal and external fixation. Five fractures were plated dorsally, 1 volarly, and 5 volarly and dorsally. RESULTS: Five patients had AO type C3.2 fractures and 7 had AO type C3.3 fractures. Nine of 10 radiographic parameters that were restored to near-normal values during the surgery were maintained at near-normal levels at the final follow-up evaluation at a mean of 28 months after surgery. Nine fractures had less than 2 mm of articular step-off of the distal radius and 8 had less than 3 mm of total articular incongruity (gap plus step-off). In 10 patients the radial length was restored to at least 10 mm. The mean arc of flexion-extension was 67% and the mean grip strength was 57% of that of the uninjured side. According to the Gartland and Werley demerit-point system 5 of the patients had good or excellent results. According to the modified Green and O'Brien clinical rating system 2 patients had good or excellent results. Poor results for 2 patients according to the demerit-point system and for 6 patients according to the Green and O'Brien clinical rating system were associated with severe ipsilateral soft-tissue and osseous injuries of the wrist, forearm, and arm. The total articular incongruity had a moderately strong correlation with the outcome as assessed by the demerit-point system. CONCLUSIONS: Tricorticocancellous bone grafting in conjunction with combined internal and external fixation is a satisfactory treatment that can lead to a high rate of return to work and sports, a high level of patient satisfaction, and a low rate of complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV. 相似文献
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Use of vascularized pedicle iliac bone graft in the treatment of avascular necrosis of the femoral head 总被引:4,自引:0,他引:4
A vascularized pedicle iliac bone graft was performed in patients with extensive necrosis in whom the necrotic area occupied
more than two-thirds of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to
the avascular femoral head. Our series consisted of 18 hips. The patients’ age at surgery ranged from 21 to 55 years. Fourteen
hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric
anterior rotational osteotomy of the femoral head was done additionally in 10 stage II joints and 4 stage III joints. In the
group who underwent iliac bone graft alone, the mean Japanese Orthopedic Association (JOA) score improved from 58.5 to 63.8
(mean follow-up 52 months). In the group who underwent combination procedure with osteotomy, the mean JOA score improved from
71.7 to 85.0 (mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone
graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at more than
1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered
promising for joint preservation.
Received: 19 October 2000 相似文献
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多肌蒂髂骨瓣治疗陈旧性股骨颈骨折 总被引:1,自引:1,他引:0
目的探讨治疗陈旧性青壮年股骨颈骨折的新技术:方法对11例陈旧性股骨颈骨折切开复位、二枚螺纹钉内固定,用缝匠肌阔筋膜张肌蒂髂骨瓣植骨、克氏针固定,适度制动及功能锻炼。结果术后平均132d骨折均获愈合,平均随访36个月,按Harris评分优7例,良2例,可1例,关节功能满意,恢复日常工作,无股骨头缺血坏死。结论采用切开复位内固定加多肌蒂髂骨瓣植骨治疗陈旧性青壮年股骨颈骨折,对促进骨折愈合、预防股骨头缺血坏死具有重要价值。 相似文献
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带旋髂深血管蒂髂骨瓣转移治疗青壮年陈旧性股骨颈骨折 总被引:1,自引:0,他引:1
目的:探讨用带旋髂深血管蒂髂骨瓣转移治疗青壮年陈旧性股骨颈骨折的疗效。方法:采用经前路切开复位带旋髂深血管蒂髂骨瓣转移及多螺钉内固定治疗青壮年陈旧性股骨颈骨折36例,结果:经1.5-5年随访,优良率为89.2%,股骨头无菌性坏死率为3%,疗效满意,结论:带旋髂深血管蒂髂骨瓣具有充足血供,能明显提高股骨颈骨折的治愈率,减少股骨头无菌性坏死的发生,对治疗青壮年陈旧性股骨颈骨折有重要价值。 相似文献
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