切开复位内固定治疗锁骨骨折90例

目的 观察切开复位内固定治疗锁骨骨折的疗效。方法 采用切小口切开复位，克氏针及钢丝内固定治疗锁骨骨折９０例。结果 随访１￣５个月，无一例骨折不愈合或延迟愈合及克氏针脱出，所有病例上肢功能恢复良好。结论 该手术操作简单，复位效果佳，固定可靠，无畸形愈合，疗效满意。     

锁骨骨折4种固定治疗方法的比较

目的 比较锁骨骨折治疗方法的疗效。方法 对167例锁骨骨折的治疗方法进行回顾。结果 随诊6～18个月，平均12个月。外固定组41例，26例畸形愈合，9例延迟愈合，1例出现胸廓出口综合征。克氏针内固定组38例，3例延迟愈合，1例不愈合，4例克氏针退出，5例针尾刺破皮肤，其中3例针道有不同程度感染。钢板内固定组53例，均按预期愈合。接骨器固定组33例，均按预期愈合。结论 治疗锁骨骨折钢板与锁式接骨器的内固定治疗效果优于克氏针与外固定。     

锁骨骨折手术治疗临床观察

目的分析、观察两种手术方法治疗不稳定锁骨骨折临床效果。方法对76例不稳定锁骨骨折分别实施克氏针或钢板内固定治疗。结果随访5～18个月，平均10个月。所有患者术中均无意外发生，无1例伤口感染及骨折不愈合。愈后优良率克氏针组85．3％；钢板组88．5％。结论克氏针或钢板内固定治疗不稳定锁骨骨折安全、有效，粉碎骨折首选采用钢板内固定。     

钢板与克氏针治疗锁骨骨折疗效比较

目的 比较钢板与克氏针治疗锁骨骨折的疗效.方法 手术治疗锁骨骨折168例,其中钢板内固定83例,克氏针内固定85例,比较2种治疗方法在、骨折愈合时间、并发症发生率,以及疗效优良率等方面的差异.结果 术后随访4～12个月,平均7个月.钢板组骨折愈合时间18周,并发症6例,优良率92.8%.克氏针组骨折愈合时间16周,发生并发症8例,优良率90.6%.结论 钢板与克氏针治疗锁骨骨折均可取得良好的疗效.     

锁骨骨折的固定方式选择

目的探讨锁骨骨折的固定方式。方法117例锁骨骨折患，分别用石膏、克氏针及重建钢板固定，分析三组在骨折愈合时间、并发症、畸形愈合的发生率，以及治疗费用的差异。结果石膏固定组畸形愈合发生率高，治疗费用低，克氏针固定组骨折愈合快，并发症多，钢板固定组并发症少，无畸形愈合，但治疗费用高，愈合慢。结论对某一具体的锁骨骨折患要根据骨折类型、部位、年龄以及经济状况等综合权衡，选择最佳固定方式。     

不同内固定方式治疗锁骨骨折疗效观察

目的观察不同内固定方式(带螺纹的克氏针、锁定接骨板、限制加压接骨板)治疗锁骨骨折临床疗效。方法将139例锁骨骨折患者根据治疗方法随机分为A组(采用带螺纹的克氏针进行髓内固定)69例。B组(采用重建接骨板进行固定)39例;C组(采用锁定接骨板进行固定)31例;比较临床疗效。结果 A组骨折愈合优良率98.6%;B组骨折愈合优良率87.1%,C组骨折全部愈合(100%)。结论带螺纹的克氏针、锁定接骨板固定锁骨骨折愈合率高,功能恢复满意。     

交叉克氏针内固定治疗锁骨骨折65例分析

目的探讨交叉克氏针内固定治疗锁骨骨折的临床疗效。方法 65例锁骨中1/3或中外1/3处骨折病人,均用交叉克氏针内固定治疗锁骨骨折。根据骨折愈合时间、质量及肩关节功能情况综合评价疗效。结果随访时间平均为7个月,骨折愈合时间6-15周,平均7周。其中3例出现畸形愈合,无骨折不愈合。肩关节功能优55例,良7例,可3例。结论锁骨中1/3或中外1/3处骨折,用交叉克氏针内固定治疗能使病人尽快恢复功能。     

带锁髓内钉与克氏针治疗锁骨骨折的疗效比较

目的比较带锁髓内钉与克氏针治疗锁骨骨折的疗效以提高锁骨骨折的治疗水平。方法手术治疗50例锁骨中1/3骨折,其中带锁髓内钉固定20例,克氏针固定30例。比较两种术式的手术时间、住院时间、骨折愈合时间,以及并发症的发生情况。结果与克氏针固定相比,带锁髓内钉固定骨折愈合时间提前(P<0.05),手术时间稍长(P<0.05),住院时间两者之间没有统计学差异(P>0.05)。带锁髓内钉固定组未发生骨不连、退钉,以及骨折端旋转等并发症。克氏针固定组中7例出现退针现象,1例出现成角畸形,1例骨不连。所有病例未发生骨感染。结论与克氏针相比,带锁髓内钉治疗锁骨骨折治愈率高,并发症少。     

内固定治疗锁骨骨折90例

目的总结90例锁骨骨折进行内固定治疗的疗效。方法臂丛麻醉下,切开复位,克氏针、钢板、螺丝钉、钢丝固定骨折。结果90例骨折全部治愈,无不良并发症发生。结论内固定治疗锁骨骨折,无畸形愈合,能早期活动,提高生活质量,减少创伤性关节炎发生。     

重建钢板辅助克氏针治疗不稳定性锁骨骨折

目的总结重建钢板辅助克氏针治疗长斜形、粉碎性锁骨骨折的临床疗效。方法 2006年3月至2011年5月,我科采用切开复位重建钢板辅助克氏针内固定治疗137例长斜形、粉碎性锁骨骨折,男95例,女42例;年龄18~72岁,平均38岁。新鲜锁骨骨折101例,陈旧锁骨骨折36例。术后长期随访,根据骨折愈合时间、愈合质量、肩关节功能等情况综合评价疗效。结果所有患者术后均获得6~18个月的随访,平均12个月。骨折全部愈合,愈合时间3~12个月,平均4.5个月。术后随访无切口感染、钢板断裂、克氏针退针等相关并发症,肩关节功能恢复满意。肩关节疗效评价：优116例,良18例,可3例,优良率98%。结论重建钢板辅助克氏针治疗长斜形、粉碎性锁骨骨折,具有易复位、创伤小、坚强固定、并发症少等特点,同时患者可以早期功能锻炼,恢复快,提高患者生活质量。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。