桥接组合式内固定系统治疗肱骨长节段骨折

目的探讨桥接组合式内固定系统治疗肱骨长节段骨折的临床效果。方法采用桥接组合式内固定系统治疗15例肱骨长节段骨折患者。结果 15例均获得随访,时间10~16个月。骨折愈合时间5~8个月。肩关节功能按照Neer评分标准评定:优11例,良2例,可2例。结论桥接组合式内固定系统操作简单、手术损伤小、并发症少,是肱骨长节段骨折治疗的有效方法。     

MIPPO技术结合LCP内固定治疗胫骨远端骨折

目的探讨胫骨远端内侧锁定加压钢板结合微创接骨板固定技术内固定治疗胫骨远端骨折的临床疗效。方法对37例胫骨远端骨折采用胫骨远端内侧锁定加压钢板结合MIPPO技术内固定治疗。结果 37例均获随访6~18个月,骨折均愈合。末次随访时疗效按Johner-Wruhs评分标准评定,优29例,良3例,可5例,优良率86.49%。结论胫骨远端内侧锁定加压钢板结合MIPPO技术内固定治疗胫骨远端骨折可保护骨断端生物学环境及踝关节功能。     

胫骨远端内侧锁定加压钢板内固定治疗胫骨远端骨折

目的探讨胫骨远端内侧锁定加压钢板结合微创接骨板固定技术(MIPPO)内固定治疗胫骨远端骨折的手术方法及疗效。方法对30例胫骨远端骨折采用胫骨远端内侧锁定加压钢板结合MIPPO技术内固定治疗。结果 30例均获随访6~24个月,骨折均愈合,末次随访时疗效按Johner-Wruhs评分标准评定:优23例,良5例,可2例,优良率93.3%。结论胫骨远端内侧锁定加压钢板结合MIPPO技术内固定治疗胫骨远端骨折可最大限度恢复骨折端血运及踝关节功能。     

小切口经皮钢板内固定治疗胫骨远端骨折

目的探讨小切口经皮钢板内固定治疗胫骨远端骨折的临床疗效。方法采用小切口经皮钢板内固定术治疗胫骨远端骨折19例。结果18例术后随访10~24个月,1例失访。骨折愈合时间12~20周。按Tormetta评分标准,优11例,良5例,可2例。结论小切口经皮钢板内固定治疗胫骨远端骨折能有效保护骨折端血运,手术创伤小,固定牢靠。     

桥接组合式内固定系统治疗高龄股骨粗隆间骨折的临床研究

目的探讨桥接组合式内固定系统在治疗高龄股骨粗隆间骨折的临床应用及疗效。方法自2012—03—2013—04,笔者应用桥接组合式内固定系统切开复位内固定治疗高龄股骨粗隆间骨折6例,采用髋关节功能Harris评分评估其术后临床疗效。结果6例均获得随访6—13个月,平均10．5个月。随访期间均未出现内固定系统松动、断裂现象。X线片显示骨折愈合情况良好,6例均恢复了生活自理能力。末次随访时按髋关节功能Harris评分标准评定疗效：优5例,良1例。结论桥接组合式内固定系统是治疗高龄股骨粗隆间骨折的又一种可靠的内固定方法,操作简单,疗效确切,特别适合高龄及伴有骨质疏松症的患者。     

桥接组合式内固定系统治疗老年股骨粗隆间骨折

目的探讨采用桥接组合式内固定系统治疗老年股骨粗隆间骨折的临床疗效。方法回顾性分析自2015-01—2020-01采用切开复位桥接组合式内固定系统治疗的42例老年股骨粗隆间骨折,骨折复位后置入股骨近端解剖固定块,通过连接棒与固定块完成组合。连接棒可按照股骨形态塑形,固定块的位置和数量则依据骨折类型与形态调整,股骨近端解剖固定块置入3枚导针固定。再次透视确认骨折复位与导针位置满意后,于近端股骨颈方向及骨折远端分别置入空心钉与多枚锁定钉固定。结果 42例均获得随访,随访时间平均12(8~20)个月。1例糖尿病患者切口出现局部延迟愈合,严格控制血糖、连续换药并再次缝合后愈合。随访期间未出现感染、下肢深静脉血栓形成、内固定失效、骨折不愈合。骨折均获得愈合,骨折愈合时间4~8个月,平均4.5个月。末次随访时髋关节功能Harris评分:优35例,良7例。结论桥接组合式内固定系统治疗老年股骨粗隆间骨折并发症少、固定可靠,可确保骨折顺利愈合并获得良好功能。     

胫骨平台后内侧骨折的内固定治疗

目的探讨钢板内固定治疗胫骨平台后内侧骨折的疗效。方法回顾性分析2008年8月至2012年6月在我院行钢板内固定治疗且获得随访的23例胫骨平台后内侧骨折患者的病例资料。所有病例均采用后内侧入路,行钢板内固定治疗,术后进行临床和影像学随访。结果 23例患者均获得随访,随访时间14.0~54.0个月,平均20.2个月。无患者发生血管、神经损伤、内固定松动、断裂等情况。所有骨折均获得愈合,愈合时间为14.0~27.0周,平均17.3周。患者的完全负重时间平均为术后18.2周。骨折愈合后,根据Rasmussen膝关节功能评分标准评定疗效:优15例,良5例,中3例,优良率为87.0%。结论胫骨平台后内侧骨折采用后内侧或内侧入路进行钢板内固定治疗,并发症少,疗效满意。     

锁定加压接骨板微创固定治疗肱骨二或三部分骨折的初步报告

目的 探讨肱骨前方入路结合锁定加压接骨板微创治疗肱骨二或三部分骨折的疗效. 方法 2005年3月至2008年10月,经肱骨前方入路应用锁定加压钢板(LCP)或肱骨近端内固定系统(PHILOS)钢板微创治疗22例肱骨二或三部分骨折患者,男13例,女9例;年龄46～78岁,平均63.4岁);左侧7例,右侧14例.骨折类型:肱骨干骨折伴肱骨近端骨折11例,肱骨干骨折伴肱骨远端骨折8例,肱骨干骨折伴肱骨近端骨折及肩关节脱位2例,肱骨干骨折合并肱骨近端、远端骨折及肩关节脱位1例.其中2例术前伴桡神经损伤,急诊行桡神经探查后再复位固定骨折.记录手术时间及术中出血量.采用Neer肩关节评分标准及肘关节HSS评分标准分别对患者患侧肩关节和肘关节进行评分.结果 评价以1年为标准,其中1例患者术后随访不到1年,以随访终末时间为结点. 结果 22例患者的手术时间78～150 min,平均107.9 min;术中出血量110～450 mL,平均274 mL.20例术后获平均9.4个月(8～22个月)随访,2例失访.20例患者骨折均获愈合,愈合时间8～16周(平均11.5周).骨折端无移位,螺钉无松动、拔出及断钉发生.2例术前伴桡神经损伤患者,1例3 d后功能恢复,另1例4个月后功能恢复.肩关节功能按Neer评分标准评定:优12例,良5例,中3例,优良率为85.0%.肘关节功能按HSS评分标准评定:优16例,良4例,优良率100%. 结论 肱骨前方切口经皮置入锁定加压接骨板具有创伤小、不损伤腋神经及桡神经等优点,治疗肱骨二或三部分骨折可获得较理想的临床疗效.     

桡骨远端T形锁定钢板内固定治疗儿童肱骨近端骨折

目的探讨采用桡骨远端T形锁定钢板内固定治疗儿童肱骨近端骨折的临床疗效。方法回顾性分析自2010-01—2014-01采用切开复位桡骨远端T形锁定钢板内固定治疗儿童肱骨近端骨折32例,观察骨折愈合情况及术后关节功能。结果 32例均获得平均12(10~14)个月随访。骨折愈合时间2~3个月,平均2.6个月。患肢功能恢复良好,按Neer骨折关节功能评定标准:优18例,良8例,可6例,优良率81.3%。结论对儿童肱骨近端骨折行桡骨远端T形锁定钢板内固定治疗,钢板塑形后可在同一平面多方向置入螺钉,骨折端固定牢固,术后患肢功能恢复良好。     

PHILOS钢板在肱骨近端骨折治疗中的应用

目的 探讨PHILOS钢板治疗肱骨近端骨折的疗效.方法采用PHILOS钢板治疗34例肱骨近端骨折患者.结果 失访6例,28例获得随访,时间2～24个月.患者均获得骨性愈合.术后12个月按Constant-Murley评分标准评定临床疗效：优9例,良16例,可3例.结论 PHILOS钢板内固定治疗肱骨近端骨折,手术创伤小,骨折愈合快,肩关节功能恢复良好,是治疗肱骨近端骨折特别是合并骨质疏松患者的理想术式.     

Hybrid外固定支架治疗胫骨远近端重度开放性骨折的初步报告

目的 探讨应用Hybrid外固定支架治疗胫骨远、近端严重粉碎性、开放性骨折的疗效.方法 自2004年3月至2008年12月采用Hybrid外固定支架治疗27例严重粉碎性、开放性胫骨远、近端骨折患者,男16例,女11例;年龄13～80岁,平均56.2岁;胫骨近端骨折19例,远端骨折8例.按GustiloAnderson分型:Ⅱ型10例,ⅢA型12例,ⅢB型5例.22例患者采用Hybrid外固定支架同定,5例患者采用SheffieldHybrid外同定支架同定.必要时结合有限内固定:6例采用骨片钉固定,4例采用可吸收螺钉固定,3例采用钢丝固定.结果 27例患者术后获7～58个月(平均27个月)随访.外固定支架使用时间平均为6.0个月(4～8个月),骨折愈合时间平均为6.7个月(4～12个月).无伤口感染、神经及血管损伤等并发症发生.仅5例发生针道局部感染,经换药后治愈.患肢功能按JohnerWruhs方法评价:优17例,良8例,中2例,优良率为92.6%.结论 应用Hybrid外固定支架治疗严萝粉碎性、开放件胫骨远、近端骨折具有手术创伤小、固定可靠、可避免伤口并发症和骨小连的发生、能更好地恢复关节面的解剖关系、有利于关节早期活动及避免关节僵硬等优点,是一种较好的治疗方法.     

AO微创内固定系统在股骨远端及胫骨近端粉碎性骨折的应用

目的探讨应用AO微创内固定系统(lessinvasivestabilizationsystems,LISS)治疗下肢股骨远端与胫骨近端粉碎性骨折的临床效果。方法回顾性分析2003年9月~2005年5月采用LISS治疗14例下肢骨折患者,其中男13例,女1例;车祸伤9例,坠落伤3例,摔倒跌伤2例。开放性骨折5例,闭合性骨折9例。骨折部位包括股骨髁上及髁间粉碎性骨折5例,胫骨上段粉碎性骨折9例。骨折按照AO/OTA分类:股骨骨折中,33C2型3例,33C3型2例;胫骨骨折中,41A2型2例,41A3型2例,41B2型3例,41C2型2例。分别应用股骨远端或胫骨近端LISS行内固定手术。术后对其伤口愈合、术前及术后X线片检查及关节功能恢复情况进行观察。结果患者术后切口均期愈合。均获随访1~20个月,平均11个月。12例骨折均在术后3~5个月愈合,另2例经术后2~3个月观察,效果良好。关节功能根据Johner-Wruhs关节功能评定标准:优10例,良3例,可1例;优良率为93%。11例膝关节屈伸范围达110~130°,2例为100°,1例为80°。结论LISS对股骨远端或胫骨近端粉碎性骨折是一种有效的内固定方法,具有创伤小,固定可靠,临床效果良好等优点。     

解剖型钢板在四肢近关节端骨折中的临床应用

目的 介绍一种四肢近关节端骨折的新型内固定方法，并观察其临床应用效果。方法 46例(52个部位)中，肱骨近端骨折7例，远端4例，桡骨远端骨折3例，股骨近端骨折12例，远端骨折4例，胫骨近端骨折14例，远端骨折8例。均采用解剖型钢板内固定。结果 随访40例，3．5～22个月，平均7．3个月；骨折愈合时间1．6～4．6个月，平均2．5个月。无不愈合，内固定松动、折断、弯曲及感染等并发症。膝关节按照Merchant评分标准，其它部分骨折按照自行拟定骨折愈合的评分标准。本组优26例，良11例，可2例，差1例，总优良率92．5％。结论 解剖钢板因其特有的解剖构型，具有利于复位、固定牢靠及手术简单的优点，对近关节端骨折的复位和固定有良好效果，可早期功能锻炼，值得推广临床应用。     

A New Injectable Brushite Cement: First Results in Distal Radius and Proximal Tibia Fractures

Abstract Objective:   The restoration of metaphyseal defects remains a challenge for the treating surgeon. Although injectable brushite cements may help to refill bone defects stabilized with internal fixation, human data remains unavailable. The main goal of this prospective multicenter study was to observe the performance of this material in a clinical setting. Patients and Methods:   The study conducted in seven trauma units included closed metaphyseal distal radius and proximal tibia fractures with bone defects, stabilized with internal fixation and subsequent filling with brushite cement. At 6- and 12-month follow-ups, patient satisfaction (visual analog scale [VAS]) was recorded, as well as complications. Results:   Thirty-eight proximal tibia fractures and 37 patients with distal radius fractures were included. Overall patient satisfaction with the treatment was high (mean VAS = 92 and 91 for proximal tibia and distal radius, respectively), despite the loss of reduction being described in 11% of proximal tibia and 24% of distal radius fractures; the majority of them included severe fracture types. Radiological evaluation showed postoperative cement leakage in 20 cases, where the majority occurred at the distal radius (n = 15). In 13 distal radius fractures, the leakage was resorbed by the final examination. Conclusion:   The tested material showed good outcome in the majority of patients and adequate resorption characteristics, even in the case of extravasation. Stable internal fixation, sufficient bone quality, and no contact between the cement and joint are essential requirements for chronOS Inject, which can be considered as an alternative to existing augmentation materials.     

肱骨近端解剖接骨板治疗骨质疏松型后踝骨折

目的 探讨肱骨近端解剖接骨板(anatomy of the proximal humerus plate,APHP)治疗骨质疏松型后踝骨折的临床疗效.方法 选取我院2010年1月至2013年1月的18例骨质疏松型后踝骨折患者(其中1例为螺钉内固定失败患者行二次固定),采用小腿后内侧入路,应用肱骨近端接骨板内固定治疗,术后石膏固定4周,早期分阶段行功能康复锻炼.根据美国矫形足踝协会(AOFAS)踝与后足评分标准评估治疗效果.结果 伤口均一期愈合,无伤口感染、皮肤坏死等严重并发症,随访时间为12～24个月,平均16个月.X线检查示骨折于术后6.0～16.0个月愈合,平均9.2个月;根据AOFAS踝与后足评分标准进行功能评估:优12例,良5例,中1例,优良率为94.4％.结论 肱骨近端接骨板符合胫骨远端后外侧的解剖形态,接骨板与后踝贴合良好,覆盖面积大,通过加压,使得接骨板的作用力较均匀地分散在后踝骨折块上,避免了拉力螺钉内陷、松动等并发症,效果良好.     

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.     

Surgical treatment and outcomes of extraarticular proximal tibial nonunions

INTRODUCTION: Although malunion of proximal tibial metaphyseal fractures are not infrequent, nonunion of the proximal tibia is rare. These nonunions can present particular challenges in management, such as malalignment, a short proximal segment, and soft tissue compromise. Few treatment guidelines and long-term outcomes are available. The purpose of this study was to determine the long-term functional outcomes of patients treated with open reduction and internal fixation. MATERIALS AND METHODS: Sixteen patients with a proximal tibial nonunion were treated between 1992 and 2005. Five fractures were originally open injuries, but all were aseptic at the time of definitive fixation. All nonunions were treated with a consistent approach of debridement, deformity correction, lateral plating, tensioning and compression, lag screws and bone grafting. Patients were reviewed radiographically and with a Knee Society questionnaire at a mean follow-up of 39 months (range 10-113 months). RESULTS: All nonunions healed at an average of 4 months, and alignment was within 5 degrees of anatomic in all cases. Knee Society function and knee scores improved significantly, to 87.4 and 89.4, respectively (P < 0.05 for both). Functional outcomes were excellent overall. Fourteen of the patients (88%) subjectively returned to their previous activities and were satisfied with their result. CONCLUSIONS: Using an algorithmic approach of débridement, deformity correction, lateral tension band plating with compression, and rigid stabilization, fracture healing and functional outcome can be reliably restored in these difficult fractures.     

Distal tibial metaphyseal fractures: the role of fibular fixation

Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia.     

Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

Objective: To investigate the efficacy of the locking internal fixator (LIF), which includes the locking compression plate (LCP) and the less invasive stable system (LISS), in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the operation with LIF by the minimally invasive plate osteosynthesis (MIPO) technique. The data consisted of 43 proximal tibial fractures (type AO41C3) and 55 distal tibial fractures (type AO43C3). Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months). Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.     

External Fixation Using Femoral Less Invasive Stabilization System Plate in Tibial Proximal Metaphyseal Fracture

BackgroundThe locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia.MethodsWe prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months).ResultsAll fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively.ConclusionsFor proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.