外固定架结合克氏针与锁定钢板内固定治疗桡骨远端C型骨折的疗效对比

目的:比较外固定架结合克氏针与锁定钢板内固定治疗桡骨远端C型骨折的临床疗效。方法:选取2007年2月-2014年1月在本院接受治疗的38例C型桡骨远端骨折患者作为研究对象,按照手术方案不同分为A组(采用外固定架结合克氏针固定)与B组(采用掌侧入路切开复位、锁定钢板内固定)。两组患者骨折的AO分型:A组21例,其中C1型5例、C2型8例、C3型8例;B组17例,其中C1型5例、C2型5例、C3型7例。术后定期复查X线片,骨折愈合后对腕关节的功能进行Dienst评分。结果:随访时间为4~13个月,平均8.6个月,骨折愈合时间为3~8个月,平均5.3个月。A组有2例发生针道感染,2例出现克氏针松动、退针。B组2例发生骨折复位后丢失、螺钉进入关节腔。A、B组的C1、C2型骨折间的优良率差异无统计学意义(P>0.05),C3型骨折A组优于B组(P<0.05)。结论:对于闭合性桡骨远端C1、C2型骨折,可选择外固定架结合克氏针固定或锁定钢板内固定术,而对于C3型骨折,选择外固定架结合克氏针固定术疗效相对较佳。     

微型外固定架治疗Bennett骨折20例报告

①目的探讨微型动力型外固定架治疗Bennett骨折方法及其疗效。②方法应用微型外固定架治疗25例Bennett骨折,根据受伤时间和骨折类型选择治疗方法,主要采用闭合外固定架固定,骨折不稳定者可加用闭合复位克氏针固定,闭合复位失败则行切开复位克氏针加外固定架固定。③结果20例病例获得随访,随访时间为6~15个月,平均9个月。20例骨折均完全愈合,闭合复位愈合时间平均为7周、切开复位愈合时间平均为9.5周。评价近远期并发症,总优良率为95%,术后未发生严重并发症,疗效满意。④结论采用微型外固定架治疗Bennett骨折,方法简单,损伤小,复位固定可靠,可有效降低术后关节疼痛、关节活动受限和创伤性关节炎的发生率,是治疗Ben-nett骨折的有效方法。     

有限切开复位克氏针内固定联合外固定架治疗桡骨远端粉碎性骨折

目的:探讨桡骨远端粉碎性骨折有限切开复位克氏针内固定联合动力跨关节型外固定架的治疗效果。方法:应用有限切开复位内固定结合动力跨关节型外固定架治疗28例桡骨远端粉碎性骨折,骨折愈合后拆除外固定架。结果:随访6～24个月,平均12个月。按照Dienst腕关节功能系统评定:优16例,良9例,可3例,优良率为89.3%。结论:有限切开复位克氏针内固定联合外固定架固定治疗桡骨远端粉碎性骨折既能使骨折复位、固定满意,又有利于术后早期手腕部的功能康复锻炼。     

有限切开复位内固定治疗桡骨远端复杂关节内骨折的疗效分析

目的：探讨有限切开复位内固定治疗桡骨远端复杂关节内骨折的临床效果。方法：对20例患者先安装外固定架,手法整复腕关节后锁紧外固定架,然后采用有限切开复位克氏针内固定治疗桡骨远端复杂关节内骨折。随访1～3年。结果：20例患者腕关节功能均恢复,其中,优15例,良4例,可1例,骨折均达到临床愈合。结论：有限切开复位内固定是治疗桡骨远端复杂关节内骨折的理想方法。     

应用外固定架治疗老年性桡骨远端骨折68例

目的 探讨应用外固定架固定治疗老年性桡骨远端骨折的疗效.方法 采用外固定架固定治疗老年性桡骨远端骨折68例,单纯手法复位、外固定架固定23例,其中45例因骨折块不稳定结合克氏针固定.结果 术后功能恢复2-6个月,平均3.5个月.术后随访6-12个月,平均9.1个月.术后功能评价应用改良的Sheap评分：优49例,良11例,中7例,差1例,优良率88.2%.结论 采用外固定架固定治疗老年性桡骨远骨折具有良好的临床疗效.     

弹性克氏针外固定架治疗闭合性近指间关节粉碎性骨折脱位

目的 探讨弹性克氏针外固定支架在治疗闭合性近指间关节粉碎性骨折、脱位中的临床应用效果.方法 对5例近指间关节内闭合性粉碎性骨折患者,使用弹性克氏针外固定支架进行固定,术后即开始指导患者进行患指主动功能康复训练,定期复查,待骨折愈合后取出外固定支架,并对患指功能进行评价.结果 5例患者术后获得8～12个月随访,平均(10.4±0.2)个月,均未发生骨折不愈合或畸形愈合,无针道感染发生.1例患者术后3周出现外固定架失稳表现,给予拆除后改为指骨夹板继续固定1周.术后功能评价:优4例,良1例.结论 弹性克氏针外固定支架在治疗闭合性近指间关节粉碎性骨折、脱位方面,具有创伤小、操作简便、固定可靠、价格低廉、便于基层医院推广等优势.     

克氏针结合可调式外固定架治疗桡骨远端骨折32例

目的 :探讨克氏针结合可调式外固定架治疗桡骨远端骨折的疗效及可行性;方法:对复杂性桡骨远端骨折32例使用克氏针结合可调式外固定架,将克氏针针针尾留于皮外,1²月后拔除,手术均行术中X线C型臂透视,14例闭合复位,18例切开复位,采用Gartland评分对手术效果及预后进行评价。结果:32例患者均获得随访,随访时间112月后拔除,手术均行术中X线C型臂透视,14例闭合复位,18例切开复位,采用Gartland评分对手术效果及预后进行评价。结果:32例患者均获得随访,随访时间11²3个月,平均16个月,优26例,良5例,1例因针道感染于术后1个月取除外固定,改支具,经处理后愈合。结论:克氏针结合可调式外固定架治疗桡骨远端骨折,具有疗效肯定、治疗简单,周期较短,创伤较小,避免二次手术等特点。     

闭合复位加外固定支架治疗Colles骨折临床分析

目的分析闭合复位加外固定支架治疗粉碎性不稳定Colles骨折临床临床疗效.方法回顾性分析应用外固定器治疗粉碎性不稳定Colles骨折26例.手法牵引复位﹢外固定架12例;克氏针撬拨复位﹢外固定架14例.结果骨折均获得临床愈合,愈合时间平均3.5个月.功能恢复较满意,优良率达93.3%.结论闭合复位加外固定支架治疗粉碎性不稳定Colles骨折临床疗效肯定,而且操作简便,创伤小,并发症少.     

锁定加压钢板与外固定架治疗C型桡骨远端骨折疗效比较

目的:探讨锁定加压钢板内固定治疗C型桡骨远端骨折的临床疗效。方法:桡骨远端骨折32例中,采用切开复位LCP钢板内固定治疗14例（钢板组）;闭合复位外固定架治疗18例（支架组）,其中4例闭合复位后关节面不平整,予以小切口撬拨克氏针固定,术后8~10周根据骨折愈合情况拆除外固定支架活动腕关节。结果:32例均获随访,随访时间8~24个月。2组患者在掌倾角和尺偏角差异均无统计学意义（P>0.05）。3个月随访时钢板组腕关节掌曲、背伸及Gartland-Werley功能评分与支架组差异均有统计学意义（P<0.01）,6个月随访时,差异均无统计学意义（P>0.05）。结论:钢板内固定对早期恢复腕关节活动度方面优于外固定架,但长期临床疗效两者无差异,C型桡骨远端不稳定骨折应根据具体的情况选择合适的固定方式。     

小切口有限内固定结合单侧外固定架治疗胫腓骨骨折

目的　总结小切口有限内固定结合单侧外固定架治疗胫腓骨骨折 47例的应用经验。方法　采用小切口有限内固定 (钢丝、螺钉、克氏针和丝线 )加单侧外固定架固定 ;术后 2～ 3周扶拐杖下地活动 ,骨性愈合后取外固定架。结果　术后随访 6～ 18个月 ,所有病例均获骨性愈合。结论　认为小切口有限内固定结合单侧外固定架治疗胫腓骨骨折并发症少 ,骨折复位良好 ,固定可靠。能早期下床活动进行功能锻炼 ,骨折愈合快 ,是治疗胫腓骨骨折的有效方法。     

桡骨远端粉碎骨折的手术治疗

目的：总结闭合复位结合外固定架治疗桡骨远端粉碎骨折的体会。方法：2004年4月至今对桡骨远端粉碎骨折AO分型B2型及C1-3型骨折,采用闭合复位外固定架结合微创克氏针固定或有限切开复位内固定治疗,共计24例31侧。结果：20例27侧6个月～24个月随访,4例失访,腕关节功能评定结果,优14侧、良7侧、可3侧、差3侧。结论：采用闭合复位外固定架结合微创克氏针固定或有限切开复位固定技术对于不稳定桡骨远端粉碎骨折治疗可收到较好效果。     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire （K-wire） fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 （mean 18） months and all fractures healed in 8-13 weeks after surgery （mean 10 weeks）. The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system （modified by Stewart）. Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

外固定架结合克氏针治疗桡骨远端不稳定骨折

目的探讨外固定架结合克氏针治疗桡骨远端不稳定骨折的临床疗效。方法选取30例桡骨远端不稳定骨折患者,按AO分型,其中A3型6例,B3型8例,C2型7例,C3型9例。所有患者均采用外固定架结合克氏针内固定治疗。结果术后随访6～18个月,平均13.7个月。术后测量患者的尺偏角为16°～28°（21.8°±2.7°）,掌倾角为8°～18°（12.4±1.9）。结合Dienst功能评价标准和沈忆新的解剖评价标准来评价疗效：优18例,良8例,可4例,优良率为86.7%。1例针道感染,2例螺钉松动。结论对于桡骨远端不稳定骨折,采用外固定架结合克氏针内固定治疗,疗效满意。     

不同复位固定方式对儿童肱骨髁上骨折的临床疗效对比研究

目的:探讨不同复位固定法对儿童肱骨髁上骨折的疗效。方法:将肱骨髁上骨折儿童126例患者,随机分两组,观察组63例用闭合复位经皮克氏针内固定,对照组63例用手法复位联合外固定支架固定,比较两组疗效。结果:观察组优42例,良15例,可5例,差1例。术后3～5周均获骨性愈合,屈伸活动度基本恢复正常,肘内翻1例。对照组优32例,良16例,可10例,差5例。58患儿术后骨性愈合,5例骨折移位,肘内翻2例。两组患者患肘屈伸受限、提携角测量,优良率比较差异有统计学意义(P<0.05)。结论:闭合复位经皮克氏针内固定治疗儿童肱骨髁上骨折是一种稳定可靠的治疗方法,手法简单、疗效确切,具有无创伤、痛苦小等优点,值得临床应用。     

单臂外固定支架在Pilon骨折中的应用

目的：探讨单臂外固定支架治疗Pilon骨折的可靠性及结果。方法：10例Pilon骨折（AO分型，C3）以单臂外固定支架治疗，男性8例，女性2例，年龄21-54例，平均35岁。所有病例腓骨骨折均切开复位内固定，然后在C臂机监视下经皮克氏针撬拨复位胫骨关节面，用单臂万向外固定支架行胫距或胫跟固定。结果：平均随访16月，结果优5例，良4例，可1例，优良率达90%，骨折平均临床愈合时间14周，无骨不连，骨坏死，关节强直，关节不稳等并发症发生。结论：单臂万向外固定支架治疗Pilon骨折具有手术方法简单，创伤小，手术及时，时间短，可早期功能锻炼，特别对于开放骨折有特殊意义。     

有限内固定结合T形外固定支架治疗Pilon骨折的临床应用

目的:探讨有限内固定结合T形外固定支架治疗Pilon骨折的临床应用。方法:自2002年3月至2007年4月,手术治疗18例Pilon骨折患者,根据Ruedi-Augower分型,II型7例,III型11例,采用钢针、螺丝钉等有限内固定结合T形外固定支架治疗。结果:所有患者均获得随访,平均随诊18个月,骨折均愈合,愈合时间3~5个月,平均3.2个月,疗效评定采用Bourne等制定的踝关节症状与功能评分标准;优良15例,可3例,优良率83%。结论:应用钢针、螺丝钉等有限内固定结合T形外固定支架治疗Pilon骨折是有效方法之一。     

肘外侧小切口克氏针对儿童肱骨踝上骨折的治疗效果观察

目的探讨对儿童肱骨髁上骨折用肘外侧小切口克氏针内固定的治疗效果。方法对我院2008年10月至2010年5月收治的76例儿童肱骨髁上骨折经肘外侧小切口行克氏针内固定方法进行治疗并随访,观察患者骨折愈合情况。结果所有患者肱骨髁上骨折均达到解剖复位。随访3～12个月,所有患者肘关节功能均得到恢复,恢复时间为3～6个月,其中肘关节功能优者67例,良者5例,优良率为94.74%。肘关节功能尚可者4例,均肘关节屈曲受限20～30°。3例合并有尺神经损伤者,尺神经功能感觉均得到良好恢复。结论经肘外侧小切口行克氏针内固定术能有效促进骨折解剖复位和早期肘关节功能恢复,值得临床推广。     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.     

Treatment of type C3 distal radius fracture resulted from high-energy injuries by volar plate in combination with external fixator

Background With a type C3 distal radius fracture it is extremely difficult to maintain the reduction and to restore congruity of the articular surface because the support for the volar and dorsal bone cortex has been lost. An external fixator crossing wrist in combination with Kirschner wire (K-wire) fixation was popularly used by most studies in recent years. But loss of reduction often occurred especially in the volar sides. Methods A total of 30 cases of type C3 distal radius fracture were treated by a volar buttress plate combined with a transarticular external fixator and other techniques such as K-wire fixation and bone grafting if necessary. The postoperative volar tilt angles, ulnar inclinations, radial heights, range of motion, grip strength and complications were recorded to assess the therapeutic effects. Results Of the 30 patients, 27 patients were followed up for 12-29 (mean 18) months and all fractures healed in 8-13 weeks after surgery (mean 10 weeks). The wrist function was excellent in 8 cases, good in 16 cases and fair in 3 cases according to the Sarmiento scoring system (modified by Stewart).Conclusions For type C3 comminuted fracture with severe volar and dorsal instability, fixation by volar buttress plate combined with transarticular external fixator should be adopted. Dorsal instability could be further stabilized by other techniques such as Kirschner wire fixation, and bone grafting.