三维可调骨折外固定支架治疗胫腓骨骨折

目的：通过三维可调外固定支架对胫腓骨骨折治疗的疗效。探讨处理多发开放粉碎骨折的治疗手段。方法：胫腓骨骨折患者４２例（４７侧肢体），均采用三维可调外固定支架治疗，步骤为骨折复位穿针和安装固定。术后平均随访１８个月。结果：骨折愈合率９７％。结论：三维可调外固定支架地严重软组织损伤或伤口污染严重的开 折，有感染的骨折具有早期可固定，晚期性固定的特点。     

骨外固定支架治疗开放性胫腓骨骨折

本院自2000年7月-2005年8月，采用半环槽式外固定架治疗开放性复杂胫腓骨骨折50例，取得满意疗效，现报告如下。     

单侧多功能外固定支架治疗不稳定性胫腓骨骨折的护理

单侧多功能外固定支架治疗不稳定性胫腓骨骨折的护理吴越张红宋红翠石华李叶红我科自１９９５年应用单侧多功能外固定支架治疗不稳定性胫腓骨骨折２０例，取得了较满意的效果，再将有关的护理体会报告如下。１临床资料１．１一般资料本组２０例，男１３例，女７例，年龄２...     

骨折外固定支架固定术的护理

2004年1月至2007年6月我科对60例骨折外固定支架固定术患者进行术前、术后护理，收到较好的效果，报告如下。     

应用外固定支架治疗胫腓骨开放性骨折的临床护理

目的:探讨外固定支架治疗胫腓骨开放性骨折患者围手术期的护理方法.方法:对11例胫腓骨开放性骨折患者采用外固定支架治疗,予以围手术期精心护理.结果:本组经积极治疗与精心护理,肢体恢复功能优6例,良4例,差1例,优良率90.9%.骨折平均愈合时间为10～30周,无骨不连或再骨折发生.结论;外固定支架在临床上使用效果满意,认真做好心理护理、术前准备,术后护理、功能锻炼、出院指导,不仅有利于关节功能的恢复,也有利于骨折端血运重建,可促进切口愈合,使患者早日康复.     

外固定架结合有限内固定治疗新鲜胫腓骨开放性粉碎性骨折

胫腓骨骨折是四肢骨折中较常见的一类，受伤机制、损伤类型不同，治疗方法及手段也不同，特别是新鲜的开放性粉碎性骨折，治疗不当并发症较多，严重影响患者生活质量。1997年7月～2004年7月，我科采用外固定架结合有限内固定治疗新鲜胫腓骨开放性粉碎性骨折68例，取得较好的临床效果。报告如下。     

骨外固定治疗胫腓骨开放性骨折的护理

骨外固定治疗胫腓骨开放性骨折的护理第三军医大学西南医院（重庆６３００３８）吴新军我院从１９８５年～１９９４年采用自行研制的半环槽式外固定器［１］治疗胫腓骨开放性骨折１７５例，随访１５６例，获得满意疗效。现将护理体会总结如下。临床资料本组１７５例，男１...     

单侧多功能外固定架治疗胫腓骨骨折内固定术后感染

自1992年8月～1996年3月,作者采用单侧多功能外固定架治疗胫腓骨骨折内固定术后感染病例11例,疗效满意。1　临床资料　　本组共11例,男9例,女2例。年龄16～58岁,平均32岁。交通事故伤6例,重物砸压伤3例,坠落伤2例。小腿骨折部位:上1/3段1例,中1/3段6例,下1/3段4例。骨折类型:粉碎型8例,斜型和螺旋型2例,节段型1例,均系开放性骨折。按Ｇｕｓｔｉｌｏ分类法[1]:Ⅱ类2例,Ⅲ类9例,其中ⅢＡ7例,ⅢＢ2例。所有病例此前均曾行钢板内固定术,术后至接受外固定治疗时间47～117天,平均85天。入院时体检:切口脓瘘3例,切口敞开钢板内固定外露6例,钢板外露…     

转换Taylor空间支架治疗胫腓骨骨折单臂外固定术后对位不良

[目的]介绍应用Taylor空间支架(TSF)调整胫腓骨骨折单臂外固定架术后对位不良的手术经验。[方法]回顾性分析2016年8月～2017年8月本科收治的胫腓骨骨折单臂外固定架术后对位不良患者11例。转换TSF前所有患者复查X线片,发现不同程度的移位、成角、旋转畸形,其中2例为向前成角,5例为向后成角,内翻畸形2例,外翻畸形1例,内旋畸形1例。转换后拍摄小腿正侧位X线片,获取安装和畸形参数。将数据输入计算机配套软件获取调整数据。调整后再次摄片,如合并软组织损伤则转换后二期处理。[结果]经TSF调整所有病例均获得解剖复位。11例患者均获得12～16个月随访,骨折均愈合,无骨外露及软组织问题,固定针无松动,针道无感染。术后参照Johner-Wruhs评分表评价:优9例,良1例,可1例,优良率90.91%。[结论]采取转换TSF治疗胫腓骨骨折单臂外固定架术后对位不良是一种微创、经济、有效的治疗方式。     

A reliable externally fixated murine femoral fracture model that accounts for variation in movement between animals.

Fifty-two CFLP mice had an open femoral diaphyseal osteotomy held in compression by a four-pin external fixator. The movement of 34 of the mice in their cages was quantified before and after operation, until sacrifice at 4, 8, 16 or 24 days. Thirty-three specimens underwent histomorphometric analysis and 19 specimens underwent torsional stiffness measurement. The expected combination of intramembranous and endochondral bone formation was observed, and the model was shown to be reliable in that variation in the histological parameters of healing was small between animals at the same time point, compared to the variation between time-points. There was surprisingly large individual variation in the amount of animal movement about the cage, which correlated with both histomorphometric and mechanical measures of healing. Animals that moved more had larger external calluses containing more cartilage and demonstrated lower torsional stiffness at the same time point. Assuming that movement of the whole animal predicts, at least to some extent, movement at the fracture site, this correlation is what would be expected in a model that involves similar processes to those in human fracture healing. Models such as this, employed to determine the effect of experimental interventions, will yield more information if the natural variation in animal motion is measured and included in the analysis.     

The use of a wire frame to fix grafts externally

We have shown the effectiveness of using externally attached frames made of Kirschner wires in fixing grafts. The technique has proved to be useful for securing grafts to graft beds and it has prevented the edges of the grafts from lifting. With simple materials and a simple technique, the tie-over method combined with external wire frames has brought about better results in sheet skin grafting.     

An externally fixed femoral fracture model for mice.

Transgenic and knockout mouse models can be used to help understand the molecular mechanisms of fracture repair. This study examines the feasibility of applying an external fixator to the mouse femur as one model for studying fracture repair. The external fixator consisted of two aluminum blocks connected by two rods. Four pins are used to connect the blocks to the bone. Mechanical characterization of the fixators was carried out prior to their use. Sixty-two wild type mice with bilateral femoral fractures were created using an open technique and fixed using the fixator. The progress of fracture healing was monitored radiologically before sacrifice and by mechanical testing and histology after sacrifice. Initially four mice died intraoperatively from excessive blood loss, the intraoperative mortality was subsequently reduced by subcutaneous saline infusion. The bone healed between 14 and 21 days after fracture and remodeled by 60 days. Both radiological and mechanical assessments showed a steady progression of bone healing. Histology demonstrated callus and endochondral bone formation. This study demonstrated that it is possible to create a mouse femoral fracture model stabilized by external fixation and will provide an additional model to the understanding of fracture healing in transgenic and knockout mice.     

不同内固定方法治疗胫腓骨骨折的疗效分析

<正>2011年5月~2013年4月,我科采用不同内固定方法治疗206例胫腓骨骨折患者,笔者对临床疗效进行分析,报道如下。1材料与方法1.1病例资料本组206例,男159例,女47例,年龄21~72岁。按照患者自愿分成钢板螺钉切开复位内固定组(切开组)及闭合复位髓内钉内固定组(闭合组)。1切开组:97例,男73例,女24     

三种创面处理方法治疗胫腓骨骨折合并骨筋膜室综合征临床疗效分析

目的探讨切开复位内固定结合传统敞开引流无菌敷料敷盖、DR脱细胞异种(猪)皮和持续负压封闭引流技术(VSD)3种创面处理技术治疗胫腓骨骨折合并骨筋膜室综合征的疗效。方法 67例胫腓骨骨折合并骨筋膜室综合征,早期均行切开减张术和内固定术,分别以传统敞开引流无菌敷料覆盖(A组,n=35)、DR脱细胞异种(猪)皮覆盖(B组,n=13)、VSD持续吸引(C组,n=19)处理至创面肉芽组织生长良好后,二期行游离植皮术。结果 C组创面修复及骨折愈合良好,且骨筋膜室综合征得到控制;在换药次数、术后3 d伤口渗出量、减轻小腿肿胀程度、疼痛、伤口感染率、住院时间、二期创面修复时间方面,B、C组均优于A组,差异有统计学意义(P<0.05)。结论切开复位内固定结合VSD技术治疗胫腓骨骨折合并骨筋膜室综合征可缩短治疗时间,降低感染率和渗出量,减轻肿胀和疼痛。尽管DR脱细胞异种(猪)皮不及VSD技术优势明显,但是其价格低廉,适用于基层医院的推广。     

Coumadin related spontaneous hyphemas in patients with iris fixated pseudophakos

Spontaneous hyphemas in iris supported intraocular lenses are considerably more likely to occur in patients on systemic Coumadin therapy. Five cases are presented in which hyphemas appear to be related to Coumadin treatment.     

影响老年髋部骨折病人术后自理能力恢复的危险因素分析

目的探讨影响老年髋部骨折病人术后自理能力恢复的危险因素。方法回顾性分析西安交通大学医学院附属红会医院2017年6月至2018年12月收治的195例老年髋部骨折病人的临床资料,并通过门诊复查、电话询问和社区走访等方式获取病人术后康复信息,根据病人术后1年的Barthel指数将病人分为不能自理组(Barthel指数评分≤60分)和基本自理组(Barthel指数评分>60分)。先采用单因素分析筛选危险因素,再通过多因素Logistic回归确定独立危险因素。结果 195例病人中,不能自理组65例,基本自理组130例。单因素分析显示年龄、美国麻醉医师协会(America Society of Anesthesiologists,ASA)分级、术前合并内科疾病种类、受伤至手术时间、术前血浆白蛋白、血红蛋白、居住环境、术后是否行抗骨质疏松治疗、术后是否于康复机构康复均与老年髋部骨折术后自理能力恢复有关(P均<0.05);多因素Logistic回归分析显示高龄[OR=1.326,95%CI(1.036,1.096),P=0.025]是老年髋部骨折病人术后自理能力恢复的独立危险因素,术前血浆...     

Perioperative mortality for patients with a hip fracture

IntroductionStudies on mortality following hip fracture surgery have hitherto focused on the 30 day to 1 year period and beyond. This study focuses on the immediate perioperative period. It examines mortality rates, patient characteristics, operative details and post-operative complications.Patients and methodsA retrospective study of a hip fracture database in a large District General Hospital in the United Kingdom, from 1986 to 2015. A dataset of 9393 patients was identified, including patients undergoing surgery for curative and palliative purposes, over fifteen years of age and with no upper age limit imposed. It compared patients who survived the first 48 h from start of surgery with those who died within this perioperative period.Results9393 patients were treated surgically and included within this study, with a mean age of 80.13 and consisting of 7130 female and 2263 male patients. The all cause mortality within 48 h from start of surgery was 0.8% (72 patients). Increased risk of perioperative mortality was associated with increasing age, ASA grade 3 and above, in-hospital falls, impaired mobility prior to the fall and a reduced mental test score on admission. For the patient with a perioperative death, the most common circumstances identified in this study involved being found dead in bed by attending staff within 48 h of surgery.DiscussionThere has been significant attention paid to the optimization of patient management leading up to hip fracture surgery and its attendant impact on medium and longer term survival. The information from this study may be used to identify patients most at risk of death in the 48 h after surgery. The importance of this dataset is that it provides large numbers, which are needed in order to look for associations, given the low 48 h mortality rate found.ConclusionWe are unable to highlight any correctable or alterable factors associated with mortality. Further studies with detailed collection of data on a national scale may be needed to assess the impact of levels of postoperative care for hip fracture patients and perioperative mortality.     

微创经皮钢板固定术联合锁定钢板治疗胫腓骨中下段骨折的疗效分析

目的评价微创经皮钢板固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)联合锁定加压钢板(locking compression plate,LCP)治疗胫腓骨中下段骨折的临床疗效。方法回顾性分析2010年1月至2013年6月我院收治的胫腓骨中下段骨折病例90例,按手术方法分为两组:MIPPO组,45例,应用MIPPO技术联合LCP治疗;传统术式组,45例,采用传统切开复位内固定手术。记录并分析两组病例的手术治疗指标和骨折愈合效果。结果随访时间3.0~24.0个月,平均随访18.5个月。MIPPO组与传统术式组相比,在伤口长度(胫腓骨累计切口长度)、出血量、住院时间、平均放射量、伤口甲级愈合率、Johner-Wruhs功能评分优良率、骨折愈合时间这几个方面,MIPPO组较传统术式组优势明显,差异均有统计学意义(P<0.05或P<0.01),无骨折延迟愈合及不愈合等并发症。结论 MIPPO技术联合LCP治疗胫腓骨中下段骨折,既符合生物力学原理,又增强钢板抗扭转及剪切应力,增加骨折稳定性及踝关节稳定性,促进骨折的愈合,能够减少患者创伤,减少并发症,值得推广。