经尺骨鹰嘴截骨入路双钢板治疗肱骨髁间骨折

[目的]探讨经尺骨鹰嘴截骨入路应用肱骨内、外髁解剖钢板治疗肱骨髁间骨折的方法和临床疗效。[方法]2002年7月-2006年3月采用经尺骨鹰嘴截骨入路结合肱骨内、外髁解剖钢板治疗肱骨髁间骨折26例，男19例，女7例；年龄15-46岁，平均35岁。按照Riseborough和Radin的分类方法，Ⅱ型6例，Ⅲ型18例，Ⅳ型2例。[结果]术后25例骨折复位满意，1例复位稍差，无切口感染，1例术中牵拉损伤尺神经，22例获得随访，时间6～19个月，平均13．5个月。尺神经损伤恢复，骨折全部愈合，无内固定松动及断裂，愈合时间14～24周，平均17周。根据改良的Cassebaum评分系统评价肘关节功能，其中优5例，良13例，可3例，差1例，优良率81．8％。[结论]经尺骨鹰嘴截骨入路显露骨折充分，肱骨内、外髁解剖钢板固定肱骨髁间骨折牢固可靠，能有效的防止骨折不愈合，并可满足患者早期进行关节功能锻炼。     

经尺骨鹰嘴截骨入路治疗肱骨髁间粉碎性骨折

目的观察经尺骨鹰嘴截骨人路双柱钢板内固定治疗肱骨髁间粉碎性骨折的手术疗效。方法2006年9月至2011年1月我院治疗26例肱骨髁间骨折，其中男17例，女9例，年龄18～58岁，平均40岁。采用肘关节后侧正中切口，经尺骨鹰嘴截骨入路，行骨折复位双钢板进行双柱固定，术后早期进行主动功能锻炼。结果随访6～24个月，平均13个月，骨折全部愈合，骨折愈合时间10～18周。肘关节平均活动度，伸30。，屈130。。无尺、桡神经损伤病例。结论采用尺骨鹰嘴截骨、关节面解剖复位、钢板双柱固定和术后早期主动功能锻炼的方法治疗肱骨髁间骨折，临床疗效良好。     

经尺骨鹰嘴截骨入路双重建钢板后侧固定肱骨髁间骨折34例

[目的]探讨经尺骨鹰嘴截骨入路双重建钢板后侧固定肱骨髁间骨折的疗效。[方法]2005年7月～2011年1月肱骨髁间骨折患者34例,男28例,女6例,年龄17～61岁,平均37.2岁。按AO/ASIF分类:C1型12例,C2型16例,C3型6例。采用经尺骨鹰嘴截骨后侧入路双重建钢板切开复位后侧固定肱骨髁间骨折。根据改良Cassebaum评分系统对患者进行术后肘关节功能评定。[结果]34例患者均获得随访,随访时间6～72个月,平均24.2个月,骨折均愈合,无切口感染、内固定松动及断裂,1例发生迟发性尺神经炎。按改良Cassebaum评分:优15例,良11例,可5例,差3例,优良率为76.5%。[结论]经尺骨鹰嘴截骨入路双重建钢板后侧固定肱骨髁间骨折,能达到骨折解剖复位,操作简单,固定牢靠,有利于患者术后早期功能锻炼,是治疗肱骨髁间粉碎骨折的有效方法。     

尺骨鹰嘴截骨入路双钢板固定治疗肱骨髁间粉碎性骨折效果分析

目的分析尺骨鹰嘴截骨入路双钢板固定治疗肱骨髁间粉碎性骨折的治疗效果。方法对36例肱骨髁间粉碎性骨折采用后方经尺骨鹰嘴入路,解剖型钢板或重建钢板双柱固定治疗,对骨折愈合及术后肘关节功能恢复等情况进行分析。结果患者术后获6~18个月随访,骨折全部愈合,愈合时间4~6个月。末次随访按改良Cassebaum法评定肘关节功能:优19例,良11例,可5例,差1例。术后出现1例创伤性关节炎,尺神经麻痹1例,未发生肘关节挛缩及僵硬等其他并发症。结论经尺骨鹰嘴截骨入路双钢板固定治疗肱骨髁间粉碎性骨折,术野暴露充分、内固定稳固、可促进早期进功能锻炼,利于骨折愈合和关节功能的良好恢复。     

Y型钢板治疗肱骨髁间骨折的手术入路探讨

[目的]评估采用三头肌劈开和尺骨鹰嘴截骨两种不同入路下"Y"型钢板治疗肱骨髁间骨折的临床效果。[方法]2005年4月-2008年12月,86例肱骨髁间骨折患者均接受切开复位"Y"型钢板内固定手术,其中43例采用三头肌劈开入路,43例采用尺骨鹰嘴截骨入路。[结果]所有患者随访时间为8～48个月,平均30.6个月。Mayo[1]肘关节评分、上肢、肩、手功能障碍(disabilities of the arm,shoulder and hand,DASH)评分[2]和Knirk评分[3]均显示两组差异无统计学意义(P0.05)。并发症包括6例延迟愈合,1例严重的肘关节僵硬,3例异位骨化,2例尺神经麻痹,1例6个月后恢复,1例留有尺神经麻痹症状。[结论]"Y"型钢板治疗肱骨髁间骨折辅以适当辅助锻炼,大多数患者均能获得良好的疗效,三头肌劈开入路和尺骨鹰嘴截骨入路均可获得相似的临床效果。     

经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间骨折

目的 探讨经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间骨折的手术方法及疗效.方法 采用经尺骨鹰嘴截骨双钢板内固定治疗肱骨髁间骨折患者65例.结果 65例均获随访,时间5个月～2年.骨折愈合时间3～6个月.无骨不连、骨化性肌炎、迟发性尺神经受压、内固定失效等并发症.按Aitken Rorabeck评分标准评定肘关节功能:优43例,良12例,可10例,优良率84.6%.结论 经尺骨鹰嘴截骨是治疗肱骨髁间骨折的较好入路,手术解剖复位重建肘关节稳定,术后早期功能锻练,是肘关节功能恢复的重要因素.     

经尺骨鹰嘴V形截骨双钢板内固定治疗肱骨髁间粉碎性骨折

目的探讨经尺骨鹰嘴截骨入路并应用肱骨内外侧柱双钢板固定治疗肱骨髁间粉碎性骨折的方法和疗效。方法 2004年4月至2009年1月采用经尺骨鹰嘴V形截骨双钢板内固定治疗粉碎性肱骨髁间骨折33例,其中C1型7例,C2型15例,C3型11例。全部获得随访,随访时间5～30个月（平均19个月）,用改良Cassebaum评分系统对其疗效评定。结果 33例骨折全部愈合,平均愈合时间18.7周。术后疗效优17例,良11例,可4例,差2例,优良率84.8%。结论解剖复位骨折,重建肘关节的稳定性以及早期的功能锻炼是肘关节功能恢复的关键因素。经尺骨鹰嘴截骨入路显露骨折充分,肱骨内、外侧柱双钢板固定肱骨髁间骨折牢固可靠,并可满足患者早期进行关节功能锻炼。     

经尺骨鹰嘴截骨治疗肱骨髁问C型骨折

目的探讨经尺骨鹰嘴关节内垂直截骨及关节外斜形截骨治疗肱骨髁间C型骨折的手术方法及疗效。方法采用2种经尺骨鹰嘴截骨入路内固定治疗肱骨髁间骨折28例，对手术入路、时间、术后肘关节功能，及并发症等进行分析。结果术后随访6～38个月，平均13个月。按Cassebaum法对肘关节功能进行评定，经尺骨鹰嘴关节内垂直截骨组优良率75％，经尺骨鹰嘴关节外斜形截骨组优良率83％。结论经尺骨鹰嘴截骨是治疗肱骨髁间C型骨折较好的入路，尤其是经尺骨鹰嘴关节外斜形截骨更具有易操作，有利于截骨部骨折的愈合，以及术后肘关节功能恢复并发症低等优点。     

AO锁定接骨板治疗肱骨髁间骨折31例

目的探讨采用后路尺骨鹰嘴截骨入路,双AO锁定接骨板治疗肱骨髁间骨折的疗效。方法2006年1月至2008年6月应用AO锁定接骨板治疗肱骨髁间骨折31例,按AO/ASIF分类：C1型7例,C2型18例,C3型6例。所有患者均采用后路经尺骨鹰嘴截骨入路,双AO锁定接骨板内固定。术后尽早行肘关节的主动功能锻炼。结果全部获得随访,随访时间为8～36个月,平均14.8个月,骨折均愈合。根据Cassebaum评分系统,优9例,良17例,可4例,差1例,优良率为83.9%。结论采用后路尺骨鹰嘴截骨入路,双AO锁定接骨板治疗肱骨髁间骨折,疗效满意。     

尺骨鹰嘴V型截骨AO重建钢板治疗复杂肱骨髁间骨折

目的：探讨尺骨鹰嘴V型截骨入路加AO重建钢板治疗复杂肱骨髁间骨折的疗效。方法：对54例肱骨髁间骨折患者1周内采用尺骨鹰嘴V型截骨入路加AO重建钢板治疗,术后3 d内行肘关节被动活动,1周后开始肘关节主动功能锻炼。结果：术后随访1～20个月（平均16个月）,关节功能采用Cassebaum方法评价,优32例,良19例,可2例,差1例。结论：尺骨鹰嘴V型截骨入路加AO重建钢板内固定治疗复杂肱骨髁间骨折,可获得满意疗效。     

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.     

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.

     

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     

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。     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.