单臂外固定架和锁定加压钛板治疗胫骨远端骨折的比较

目的 比较单臂外固定架和锁定加压钛板固定胫骨远端骨折的效果.方法 对2001年1月至2007年1月分别采用外固定架治疗和锁定钛板(LCP)治疗的胫骨远端骨折并获得随访的51例患者的病例资料进行总结,记录固定时间和骨折愈合时间,并按照美国骨科协会足踝外科分会(AOFAS)的标准评价踝关节功能,比较两组的治疗效果. 结果 外固定架组24例获得随访,骨折愈合时间120～276止平均160 d,按照AOFAS标准进行评分:优11例,良8例,可4例,差1例,优良率79.1%,并发症发生率12.5%;LCP组27例获得随访,骨折愈合时间95～184 d,平均143 d,按照AOFAS标准进行评分:优20例,良4例,可3例,优良率88.8%,并发症发生率11.0%,经统计学处理骨折愈合时间两组差异有统计学意义(t=2.561,P=0.014),并发症发生率和功能优良率差异无统计学意义(P＞0.05). 结论 外固定架和锁定钛板都是治疗胫骨远端骨折常用的有效固定方式,关键是遵循微创原则.实现胫骨骨折局部复位,骨缺损处植骨,胫骨支撑固定和腓骨骨折的复位固定,采取上述两种同定方式均可取得良好效果.     

可吸收内固定材料对骺板影响的研究进展

目前，可吸收内固定材料的基础和临床研究日益增多。本文综述了可吸收内固定材料的生物降解吸收性能、机械性能及其对骨矿物质密度的影响，骺板的结构及损伤，可吸收内固定材料对骺板的影响及临床应用研究，并指出存在的问题和今后研究的重点。     

锁定加压钢板和外固定支架治疗桡骨远端C型骨折的疗效比较

目的：探讨锁定加压钢板和外固定支架治疗桡骨远端C型骨折的临床疗效。方法：自2009年1月至2010年6月,分别采用锁定加压钢板和外固定支架两种方法治疗76例桡骨远端骨折患者,其中54例获随访,男29例,女25例;年龄24～68岁,平均45_31岁。采用锁定加压钢板内固定治疗29例（内固定组）,按照A0分型：C1型8例,C2型7例,C3型14例。采用外固定支架治疗25例（外固定支架组）,按照A0分型：C1型6例,C2型8例,C3型11例。比较术后桡骨高度、掌倾角、尺偏角,采用改良Gartland-Werley（GW）评分对术后6、12个月的腕关节功能进行评定。结果：术后除外固定支架组有2例患者发生钉道感染外,其余患者创口均愈合良好。54例患者获随访,时间12~24个月,平均21-3个月。内固定组、外固定支架组术后桡骨高度分别为（9．60±0．72）mm、（9．40±0．70）mm,掌倾角分别为（9．55±0．80）。、（9．47±0．71）。,尺偏角分别为（21．40±0．78）。、（21．20±0．73）°,两组比较差异无统计学意义（P〉0．05）。术后6个月改良Gartland-Werley（GW）评分标准,内固定组（3．31±1．17）分和外固定支架组（5．56±1．58）分,两组比较差异有统计学意义（t=-5．99,P〈0．05）。术后12个月改良Gartland-Werley（GW）评分,内固定组（2．66±1．01）分和外固定支架组（3．08±1．00）分,两组比较差异无统计学意义（t=-1．55,P〉0．05）。结论：对于桡骨远端C型骨折,两种固定方式均能获得较好疗效,锁定加压钢板短期疗效明显,远期疗效两种固定方式无明显差异,对于桡骨远端严重粉碎骨折无法用钢板内固定时,外固定支架是较好的选择。     

Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators)

OBJECTIVES: To compare 3 different fixation methods for the treatment of humeral shaft nonunions in terms of union time, functional outcome, and complications. DESIGN: Retrospective case series. SETTING: University hospital. PATIENTS: Between 1996 and 2004, 80 patients (mean age, 49; range, 15 to 86; 30 women and 50 men) with nonunions of the humeral shaft were treated surgically in our institution. Circular external fixators (CEF) were used in 35 patients, unilateral limb reconstruction system (LRS) fixators in 24 patients and fixation with plates in 21 patients. INTERVENTION: Surgical procedure included hardware removal in previously operated patients, autogenous grafting in all patients in the plate group and in those patients with atrophic nonunions in the external fixator groups, compression of the nonunion site in all patients. MAIN OUTCOME MEASUREMENTS: Radiological union time, complications, shortening, and disabilities of the arm, shoulder, and hand (DASH) score. RESULTS: Mean follow-up period was 48.1 months (range, 12 to 121). Mean radiological union time was 5.5 months (range, 1.5 to 12) in the CEF group, 5.2 months (range, 3 to 10) in the LRS group, and 5.7 months (range, 3 to 12) in the plate group. Mean DASH score was 23.7 in the CEF group, 18.6 in the LRS group, and 26 in the plate group. There were no statistical differences in terms of union time and the DASH score among the 3 groups. Successful union was achieved in 77 (96.3%) patients. CONCLUSION: Both external fixation and plate fixation produce excellent results in humeral shaft nonunions if applied properly. The procedure can be tailored to the surgeon's experience, keeping in mind that plate fixation demonstrates a longer healing time in those cases that had previous surgeries.     

Comparison of the mechanical performance of three types of unilateral,dynamizable external fixators

Due to the increasing popularity of unilateral dynamizable external fixators for treating tibial shaft fractures, many new devices are being introduced onto the market. Especially in such half-frame fixators, the choice of any particular device depends above all on the stability of its construction. This study compares the biomechanical stability of three systems tested in axial compression, torsion, and both anterior-posterior and medial-lateral bending. In terms of the nondynamized phase, the AO/ASIF tubular fixator (as a one-plane, double-tube, unilateral frame) and the Martin Mono-Dynafix are, in general, less stable than the Orthofix fixator. After dynamization, the AO/ASIF system becomes particularly weak and offers low resistance especially to torque and any force that is perpendicular to the plane of assembly. The other two tested devices evinced much more stability; the Orthofix fixator seems superior to the Dynafix due to the different diameter of its screws.     

Update on external fixators in the treatment of wrist fractures

Fifty fractures of the distal radius in 49 patients were treated by either a Roger Anderson device or a Hoffman C-series external fixator. The radiographic and clinical results were evaluated for comparison of the use of the two fixators. The follow-up period for the entire group averaged 15.9 months. For 12 patients personally examined and 12 returning a questionnaire, the follow-up period averaged 27.7 months. The Hoffman fixator and Roger Anderson device gave predictably good results in the treatment of comminuted intra-articular fractures of the distal radius when used in the active age group. Neither was found to yield superior functional results over the other, although the Hoffman fixator had a more rigid configuration. Serious complications may result from the use of external fixators, but these can be minimized by proper technique and care.     

Complications of hinged external fixators of the elbow

Despite the growing use of hinged external fixators of the elbow, there are no studies regarding the complications associated with their application. The purpose of this study is to report our experience with complications with this procedure. Between 1998 and 2005, we reviewed the records of 100 consecutive patients who were treated with hinged external fixators (including 433 pin sites). Complications specifically related to pin placement were recorded. There were 15 patients with minor complications (15%) involving 21 pins (4.8%) and 10 patients with major complications (10%) involving 29 pins (6.7%). Minor complications included local erythema and nonpurulent drainage lasting greater than 5 days in 9 patients (21 pins) and the need for skin release to decrease tension adjacent to pins in 6 patients (9 pins). Major complications included purulent pin site drainage in 1 patient (2 pins), fixator malalignment in 1, pin loosening in 4 (11 pins), and deep infection in 4. There were no fractures around the pin sites or nerve injuries associated with pin placement. With care, articulated external fixators can be used without a high incidence of major complications. Most of the complications were attributed to local pin site infection. Factors clinically associated with an increased risk of deep infection include a history of prior procedures in the post-traumatic elbow and the complexity of the operative technique.     

外固定器刚度对骨折愈合的影响

骨折治疗中实施有效的骨折固定，以维持骨连续性，保证骨折愈合生物学反应，促进骨折愈合，避免骨迟延愈合、骨不愈合及再骨折等并发症的发生。合理的固定刚度相当重要，外固定器为骨折提供的固定刚度有别于其他固定方法，可以针对骨折的病理特点、治疗要求，在不同阶段，根据骨再生进程的生物学特征，实施坚强固定、加压固定、轴向弹性固定、综合弹性固定等与骨再生所需理想生物力学环境相符的适应性刚度，使骨折愈合的生物学过程按照骨胚胎原始发育方式完成骨再生与功能重建，直至实现正常骨力学强度。因此，临床实践中，研究和观察骨折固定刚度的有关问题，对指导临床实践，提高骨外固定技术水平和充分发挥骨外固定技术优势至关重要。     

Stiffness characteristics of composite hybrid external fixators

New composite hybrid fixators for fracture stabilization using single or multiple rings with monolateral bars and half-pin fixation may provide clinical advantages such as reduced bulk and easier skin access. However, the mechanical properties of these fixators are difficult to estimate from numerous design parameters. Addressing this problem the following research questions were asked: (1) Do composite hybrid fixators have similar stiffness properties to clinically proven triple-ring fixators; (2) How does the fixation mechanism affect the stiffness properties of external fixators, and, (3) Are there interferences between ring number and fixation method? An experimental study was done on simulated metaphyseal tibial fractures and stiffness of 12 fixators was measured for different loading conditions. The results showed that triple-ring fixators provide approximately 20% stiffer properties than double-ring and single-ring fixators. No influence of ring number on the AP bending properties was found and different fixation methods were associated with large differences in fixator stiffness, whereas significant interferences were found between ring number and fixation method. Although the mechanical properties investigated in the current study cannot predict directly the clinical performance of these fixators, the stiffness data provide useful information for making decisions regarding the treatment of fractures using external fixation.     

Biomechanical comparison of five external wrist fixators

The relative stiffness of five different external wrist fixators currently in use for distal radius fractures was determined using a uniform fracture model consisting of wood dowels to isolate the effects of the fixators themselves. Each construct was loaded in axial compression, eccentric and cantilever modes of bending, and torsion. The stiffest of the fixators varied by a factor of three in compression, five in bending, and three in torsion. Although the ideal stiffness of a wrist fixator is unknown, there is a large variation in the stiffness of existing devices.     

Routine removal of external fixators without anesthesia

OBJECTIVE: To examine the degree of discomfort experienced by patients with routine removal of all external fixators without anesthesia. DESIGN: Retrospective review. SETTING: Outpatient clinic and hospital. PATIENTS: A total of 106 consecutive patients for whom removal of external fixators was indicated. INTERVENTION: External fixators were removed without anesthesia. MAIN OUTCOME MEASUREMENTS: Visual Analog Pain Scale (VAS) following external fixator removal and patients' reported willingness to repeat the procedure without anesthesia. RESULTS: Patients with pin site inflammation had a significantly higher VAS (4.82 vs. 2.92, P < 0.0001). The chi test revealed that pin site inflammation was less common with wrist spanning fixators than with lower extremity and pelvic fixators. No correlation existed between age, site of fixator, closed head injury, use of olive wires, or the duration of fixation and VAS. In all, 95 of 106 patients (89.6%) responded yes when asked if they would undergo removal of their fixator again without anesthesia. Despite the association between inflamed pin sites and a higher VAS, in 84% (37/44) of the cases with inflamed pin sites, the patient would choose to undergo fixator removal without anesthesia again. CONCLUSIONS: Removal of external fixators without anesthesia is well tolerated by the great majority of patients. Inflammation at pin sites is associated with a higher degree of discomfort during external fixator removal. Despite the higher pain score, most patients with pin-site inflammation report that they would repeat the procedure without anesthesia.     

外固定架在创伤骨科中的应用

在内固定的理念和操作技术已经被我国广大创伤骨科医生所熟悉的今天，《中华创伤骨科杂志》推出“外固定支架的应用”专刊，是对读者非常有意义的启迪。近10年来，很多创伤骨科医生把很大精力投入在内固定的学习与实践上，殊不知外固定是骨折治疗的极为重要的手段之一。仅依靠一种治疗方式治疗所有创伤骨科疾患已根本不能满足创伤骨科患者的需要。     

Hinged elbow external fixators: indications and uses

Hinged external fixation of the elbow joint can play an important role in managing complicated fracture-dislocations, joint instability after extensive contracture release, and distraction interposition arthroplasty. Application of these devices requires accurate alignment of the fixator axis with the anatomic axis of the elbow. The primary therapeutic goal is to allow joint motion while protecting the healing ligaments. Common complications include pin loosening, injury to adjacent neurovascular structures, cellulitis, and loss of reduction. Although reported data are limited, this technique is a useful adjunct in patients with complex elbow instability.     

外固定器固定治疗跟骨关节内骨折

目的 探讨支具固定治疗跟骨关节内骨折的临床效果。方法 30例33侧跟骨关节内骨折,根据Paley分类：B1型骨折14侧,B2型9侧,C1型4侧,C2型6侧。17侧闭合复位,16侧开放复位。全部采用跟骨、前列跗骨、胫骨穿针,经皮“V”形支具固定。随访18个月～6年,平均35个月。结果 根据张铁良等跟骨关节内骨折评分标准,B型：优11侧,良7侧,中4侧,差1侧;C型：优2侧。良4侧,中2侧,差2侧。总优良率73％。结论 经皮“V”形支具固定治疗跟骨关节内骨折操作方便、复位容易、固定灵活而稳定,疗效满意。     

Mechanical strength and wear of used EBI external fixators

Thirty-one EBI external fixators (Dynafix; EBI, Parsippany, NJ) subjected to one or two clinical uses underwent static mechanical testing identical to that performed on new devices prior to market approval. No fixator exhibited catastrophic mechanical failure. For all fixators tested, the mean load to failure was not significantly different from that of identical testing of new devices. Although loss of material from serrated joints was observed in some joints, mechanical strength was not affected. Additional testing of fixators of a variety of designs is necessary to expand on the results of this investigation. The results of this study represent a first step in validating the safety of external fixator component reuse.     

基于3D打印技术的个性化外固定支具设计

[目的]探讨基于3D打印技术的个性化外固定支具应用于下肢骨折康复治疗中的匹配性和患者满意度。[方法]对60例入组患者随机分成两组进行前瞻性对照研究。分别采用传统石膏外固定,个性化支具外固定。评估两组患者的并发症及患者满意度,并进行个性化支具与骨折部位的贴合度分析。[结果]个性化外固定支具与骨折部位的五组特征尺寸差异均无统计学意义(P0.05),尺寸误差范围在0.02~0.04 mm之间,两者贴合度较好。两组患者的并发症无差异,个性化支具组的患者满意度较传统石膏组高。[结论]相对于传统石膏外固定,个性化外固定支具辅助下肢骨折康复治疗,患者匹配性较好,满意度更高。     

外固定支架在儿童骨折中的应用研究

目的根据儿童骨折特点,探索外固定支架在儿童骨折中的应用价值。方法自1999年1月至2001年8月,采用外固定支架的方法治疗各类复杂的儿童骨折25例,术后早期进行患肢功能练习。结果平均随诊10个月,25例骨折全部愈合,肢体功能康复优良率88%,远期疗效待观察。结论对于复杂不稳定的儿童骨折,通过外固定支架治疗,做到了骨折的确切固定,同时满足了骨折固定后的肢体和皮肤的观察和管理,更有利于术后的功能练习和康复,骨折愈合及肢体康复后可以随时去除固定针和外固定支架。最大限度的满足了儿童骨折的治疗特点及愈后和康复问题。对于各类复杂的儿童骨折具有重大的临床应用价值。     

Mechanical performance of pin clamps in external fixators

Insufficient holding strength on a pin within a clamp may result in the diminution of the overall fixation rigidity as well as pin movement at the pin-bone interface. In this study the holding strength of pin fixation clamps in two representative external fixators (Hoffmann and Orthofix) was evaluated by determination of the torque resistance of pins within a clamp. In the standard Hoffman clamp, the pin-clamping effect was satisfactory in the symmetric two-, three-, and four-pin configurations, whereas the standard Orthofix clamp provided higher holding strength in the symmetric two- and three-pin configurations. All other pin configurations in both clamps resulted in a high variation of pin torsional resistance, and sometimes one of the pins registered low or had no resistance to torsion. The results indicated that the holding power of the clamps was adequate only if certain guidelines were followed at the time of external fixator application. An instrumented torque wrench may be helpful to assess the pin-fastening strength within the clamp. This wrench should also be used to introduce appropriate and uniform tightening torques to the pin clamp screws. However, these results do not apply to those fixators in which each pin will be tightened individually.