Malleolar fractures treated with rigid internal fixation and immediate mobilization

Twenty-eight consecutive patients with displaced malleolar fractures were treated with anatomically exact open reduction, rigid internal fixation and immediate postoperative exercises, following the principles of the Swiss ASIF group. There were no operative or postoperative complications. One patient had a minor abscess over a loosened screw, while 1 patient developed pes equinus that required treatment. At follow-up 2 to 12 months after the operation, 25 patients were walking normally. The movements of the ankle joint were excellent or good in 25 patients. The method is recommended.     

犬下颌骨骨折小型钛板坚固内固定的生物力学分析

目的:评价一种新型坚固内固定器械用于治疗犬下颌骨线性骨折的生物力学稳定性。方法:选取10只健康杂种犬做为实验动物,于犬双侧下颌骨人工造成线性骨折,使用膨胀蕊体型坚固内固定器械(实验组)及普通坚固内固定器械(对照组)固定颌骨。2周后处死动物取出下颌骨,在材料试验机上进行两个方向的三点弯曲试验及固位钉拔出试验,测定其最大破坏力,标出载荷位移曲线。结果:实验组侧向、垂直向最大载荷及固位钉拔出力分别为(103±11)N、(275±33)N、(351±14)N。对照组侧向、垂直向及螺钉拔出力分别为(80±7)N,(185±23)N,(262±10)N。实验组与对照组间具有统计学差异(P<0.05)。结论:膨胀蕊体型坚固内固定器械具有良好的生物力学稳定性,可以对下颌骨骨折提供稳固的固定。膨胀蕊体型坚固内固定器械优于对照组.     

Mandibular reconstruction: open reduction and internal fixation of mandibular fractures

Open reduction and internal fixation of mandibular fractures by intraosseous wiring in conjunction with intermaxillary fixation remains the mainstay of mandibular fracture treatment despite the availability of newer methods. The principles of treatment are reviewed, including indications for use of this technique and its advantages and disadvantages. Various surgical techniques are also reviewed and key points in their application emphasized.     

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods：The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar,sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.     

下颌骨髁突囊内骨折不同内固定方式下的应力分布

目的：研究小型钛板和拉力螺钉两种不同内固定方式治疗下颌骨髁突囊内骨折时局部的应力分布情况，从理论上探讨髁突囊内骨折最理想的内固定方式。方法：通过建立下颌骨囊内骨折三维有限元模型，并在此模型基础上模拟下颌骨囊内骨折，在同样的约束及载荷条件下分析小型钛板固定及拉力螺钉固定方式下各自的应力分布情况及骨折断端间相对位移情况。结果：小型钛板和拉力螺钉固定方式均可起到稳定骨折断端的作用，但小型钛板固定方式下其自身及固定螺钉均有着明显的应力集中，应力主要集中于骨折断端附近。结论：拉力螺钉内固定方式较小型钛板固定方式更有利于形成可靠的内固定环境，小型钛板内固定时在骨折愈合早期更应注意下颌制动并避免大的咀嚼力量。     

Posterior cervical fusion with rigid internal fixation

Rigid fixation of the posterior cervical spine offers definite advantages over conventional wiring techniques. These advantages are emphasized in certain high-risk groups of patients, including those with multiple-level traumatic instability, cervical deformities, and unresectable anterior tumor involvement. Early fusion with minimal external fixation is another important advantage. The focus of this article is the concept of rigid internal fixation of the posterior cervical spine and the application of specific techniques used to achieve this goal.     

内固定治疗锁骨骨折82例

目的：总结锁骨骨折应用重建钢板、锁骨钩钢板内固定的经验及体会。方法：对82例锁骨骨折行切开复位及重建钢板、锁骨钩钢板内固定。结果：82例患者取得随访≥6个月，82例骨折均愈合良好。结论：重建钢板、锁骨钩钢板治疗锁骨骨折操作简单，疗效可靠。     

寰枢椎内固定对陈旧齿状突骨折的作用

目的:观察陈旧齿状突骨折患者在后路寰枢椎坚强内固定融合术后骨折端的变化,探索采用寰枢椎非融合内固定治疗齿状突骨折、尤其是新鲜骨折的可行性。方法:对我院2001年2月~2012年8月采取后路寰枢椎固定融合术治疗的82例陈旧性齿状突骨折患者手术前后的影像资料进行回顾性分析。其中2005年1月~2012年8月42例有完整的术前、术后CT资料可供分析骨折端变化的患者作为研究对象,伤后手术时间3~8周5例、8周以上~36周30例、36周以上7例,40例选择经寰椎侧块-枢椎椎弓根内固定、寰椎后弓枢椎椎板间植骨融合术,2例选择经寰枢侧块关节螺钉固定融合术,术后随访时间截至寰枢间植骨融合为止。结果:所有患者寰枢椎间后方植骨发生融合,其中30例齿状突骨折也发生愈合,4例疑似愈合,8例未愈合。齿状突骨折端愈合时间:28例发生于术后4个月,1例发生于术后6个月,1例发生于术后9个月。结论:对陈旧齿状突骨折患者经后路寰枢椎间内固定可为齿状突骨折愈合提供可靠的稳定性,为采用非融合寰枢椎内固定治疗齿状突骨折尤其是新鲜骨折提供了可靠的临床依据。     

微型钛板坚强内固定在眼眶骨折中的应用

目的探讨微型钛板坚强内固定治疗眼眶骨折的临床疗效.方法术中应用微型钛板、钛钉作为眶骨骨折复位、骨移植的内固定,术后常规行头颅X线平片或CT扫描检查固定的可靠性.结果外伤性眼眶骨折患者56例经6～12个月的随访观察,未发现感染及钛钉、钛板的排异反应,经头颅X线平片或CT扫描检查未见骨折移位复发及移植体的移位.在第2次手术中发现钛钉、钛板固定牢固可靠.结论微型钛板坚强内固定治疗眼眶骨折,其固定性可靠、效果好,并发症少.     

微型钛板坚强内固定在眼眶骨折中的应用

目的　探讨微型钛板坚强内固定治疗眼眶骨折的临床疗效。方法　术中应用微型钛板、钛钉作为眶骨骨折复位、骨移植的内固定 ,术后常规行头颅X线平片或CT扫描检查固定的可靠性。结果　外伤性眼眶骨折患者 5 6例经 6～ 12个月的随访观察 ,未发现感染及钛钉、钛板的排异反应 ,经头颅X线平片或CT扫描检查未见骨折移位复发及移植体的移位。在第 2次手术中发现钛钉、钛板固定牢固可靠。结论　微型钛板坚强内固定治疗眼眶骨折 ,其固定性可靠、效果好 ,并发症少     

Experiences with rigid internal fixation using a low volume titanium implant system in metacarpal and phalangeal fractures

Our experience using the low volume titanium mini-fragment system ”Profile Titan” is presented retrospectively. The system contains self-tapping miniscrews with countersinking heads and very small adaptable plates with rounded edges. The study consists of 53 patients who underwent osteosynthesis, arthrodesis, or corrective osteotomy of the hand skeleton from 1 January 1994 to 31 March 1995. Functional results were evaluated and standard postoperative X-rays were taken at 1, 2, and 4 weeks after injury. Fifty-three patients with 56 fractures were treated. Results show that 78% of patients regained complete recovery of active range of motion. Fractures with and without negative prognostic factors were compared. There were three major postoperative complications not related to the type of implant. Compared to the AO mini system this system has several advantages. Received: 16 April 1998 / Accepted: 19 October 1998     

Biological internal fixation of fractures

Summary Trauma centers treat more and more patients who have sustained multiple injuries during high energy accidents. The techniques of internal fixation of such fractures may be dictated by the concomitant soft tissue trauma, rather than by the bony injury. Three stages of soft tissue injuries are recognised: Stage I delineates compromised soft tissues which may be treated with standard techniques of internal fixation, provided that further devialization by surgery is avoided. Stage II implies partial, non-circumferential destruction of soft tissues, requiring alternative techniques of internal fixation to prevent (mainly septic) complications. In stage III, the soft tissues about the fracture site are destroyed and need early, specific soft tissue reconstruction. Indirect reduction without further devascularization of bone, aiming at perfect alignment rather than anatomical reduction of extraarticular fractures, optimal rather than maximal internal fixation as well as the inclusion of soft tissue reconstructive procedures into the armamentarium of the orthopaedic surgeon, require an intellectual and technical reorientation but can be shown to improve the results of the treatment of fractures with concomitant soft tissue injury.     

Improved healing of experimental long bone fractures in rabbits by delayed internal fixation.

Experiments in rabbits were conducted to test the clinical propositions that a) the risk of nonunion in certain long bone fractures can be sharply reduced by open reduction and internal fixation, and b) that there is an optimum critical period following trauma in which this procedure should be carried out to facilitate healing. Bilateral standard open fractures of rabbit radii were internally fixed by intramedullary K-wires immediately or at 5, 10, and 17 days after trauma. These bones were subjected to stress and histometric analyses at 4-56 days after the initial fractures. The observations suggested that the pace of fracture healing could be optimized by time-delay surgery. The most exuberant and strongest calluses developed when the bones were fixed 10 days after fracture, and the rate of healing was improved. Delay times of 5 or 17 days did not provide better healing than that achieved by an immediate operation. Callus quality, in terms of the proportion of fiber bone, lamellar bone, and cartilage, was similar in all groups. The tensile strengths of the bones during callus formation were highly correlated with the ratio of callus/cortical bone areas (p less than 0.01).     

Ankle fractures treated with non-rigid internal fixation

Two hundred and thirty-seven fractures of the ankle treated with non-rigid internal fixation were reviewed with regard to classification, congruency of joint surface, range of motion and the patients' subjective symptoms. The fractures were divided into either severe fractures consisting of two or more skeletal injuries or simple fractures consisting of only one skeletal injury. Successful operation, i.e. congruency of the joint, was seen in 50 per cent of the severe and in 73 per cent of the simple fractures (significant, P less than 0.001). Disability was significantly more frequent after severe fractures and with incongruent joints. This study shows that the operative technique using non-rigid internal fixation is not sufficient for treating severe fractures, as exact anatomical reconstruction of the joint was not obtained.     

脊柱骨折再手术原因及疗效

[目的]分析脊柱骨折再次手术翻修的原因及疗效相关因素。随着脊柱创伤手术在基层医院的开展和普及,部分没有得到完善治疗的病例因为各种原因不得不再次进行翻修手术。本科自2000年1月~2003年12月收治外院手术治疗后失败的脊柱损伤患者19例,进行了再次手术翻修并平均随访3.5年,对再手术原因及疗效分析作初步探讨。[方法]19例脊柱骨折再手术患者,平均随访3.5年,通过问卷调查的方式,随访观察患者感觉、运动功能恢复、疼痛、生活质量及对再次手术的个人评价。[结果]减压不充分以及内固定物的不当使用是再次手术翻修的主要原因。不完全截瘫患者再手术后肌力均得到一级以上恢复,然而再手术前神经功能为FrankelA级患者术后肢体运动功能无明显改善。17(89%)例患者术后生活质量得到提高,对疗效表示满意。[结论]良好的脊柱外科技术和正确应用内固定是治疗脊柱骨折的重要因素,对于正确选择适应证的病例,再次手术翻修能有效提高患者生活质量。     

骨折生物学内固定技术进展

坚强牢固的骨折内固定忽略对骨组织血运的保护,增加了术后感染率。实验和临床研究表明生物学内固定技术有利于骨折愈合、降低术后并发症,因而骨折固定理念由以往直接解剖复位和坚强内固定逐渐向间接解剖对线和弹性固定,达到相对稳定方面转变,强调相对稳定并达到生物学固定之二期骨愈合过程,主张应用长钢板或桥式钢板。生物学内固定技术最大限度地保留骨组织血运,骨痂形成快,有利于骨折愈合及降低内固定失败率。