MEBO治疗骨折内固定术后感染的临床疗效观察

目的 总结分析湿润烧伤膏(MEBO)治疗骨折内固定术后感染的临床疗效.方法 给予2016年1月至2019年4月黄岛区人民医院收治的32例骨折内固定术后感染患者简单清创并保留钢板及螺丝钉等内固定物后应用MEBO治疗,观察创面愈合效果及创面愈合时间、感染性骨不连骨性愈合情况、疼痛情况及慢性骨髓炎等并发症发生情况.结果 治疗...     

负压封闭引流联合过氧化氢灌洗治疗骨折内固定术后感染

目的研究负压封闭引流(VSD)联合过氧化氢灌洗在治疗骨折内固定术后感染的临床疗效。方法对17例骨折内固定术后感染患者,彻底清创后给予VSD敷料覆盖持续引流,并联合应用过氧化氢灌洗,待创面新鲜感染消退后采取直接缝合或皮瓣移植修复创面。结果 15例早期感染(2周)患者经1次VSD治疗后直接缝合或局部皮瓣转移修复创面成功,2例慢性感染患者(10周)经2次VSD治疗后关闭创面,感染复发,再次清创取出内固定物及VSD治疗,伤口愈合。随访13~25个月,术区无再发感染,骨折均获愈合。结论负压封闭引流联合过氧化氢灌洗是治疗骨折内固定术后早期感染的有效方法,可保留内固定物,缩短治疗周期,值得推广。     

股骨转子间骨折内固定术后骨折愈合不良的危险因素分析

【摘要】 目的 探讨分析股骨转子间骨折内固定术后骨折愈合不良的相关危险因素。 方法 选取2018年6月至2021年6月南阳医学高等专科学校第二附属医院收治的 674 例股骨转子间骨折患者作为研究对象, 收集患者性别、年龄、体重指数、骨折类型、骨折粉碎程度、螺钉位置、术后负重时间、术后感染情况、是否合并糖尿病、是否合并骨质疏松等资料, 并根据股骨转子间骨折内固定术后 3 个月骨折愈合情况将其分为愈合组和愈合不良组, 多因素Logistic回归分析股骨转子间骨折内固定术后骨折愈合不良的危险因素。 结果 股骨转子间骨折内固定术后3个月, 674 例患者中出现骨折愈合不良 66 例 ( 9.79%), 设为愈合不良组; 骨折愈合良好 608 例(90.21%), 设为愈合组。 单因素分析结果显示, 愈合不良组年龄≥60 岁、不稳定型骨折、骨折粉碎程度高、 螺钉位置不理想、术后负重过迟、术后感染以及合并有糖尿病、骨质疏松的患者比例均明显高于愈合组 (χ2 =6.347、 9.520、 9.985、 40.089、 4.176、17.623、4.250、7.125, P= 0.012、 P= 0.002、 P= 0.002、 P<0.001、 P =0.041、 P<0.001、P= 0.039、P= 0.008);多因素 Logistic 回归分析结果显示, 不稳定型骨折、骨折粉碎程度高、螺钉位置不理想、术后负重过迟、术后感染、合并骨质疏松是股骨转子间骨折内固定术后骨折愈合不良的独立危险因素 (95% CI 为 3.831 ~ 15.407、3.588 ~ 13.551、 3.516 ~ 12.868、 3.387 ~ 12.206、5.594 ~ 28.683、 4.799 ~21.792, P 均<0.001)。结论 股骨转子间骨折内固定术后骨折愈合不良与骨折类型、骨折粉碎程度、螺钉位置、术后负重时间、术后感染情况、是否合并骨质疏松有关。     

负压封闭引流结合骨水泥抗生素链珠治疗胫腓骨骨折术后早期感染

使用负压封闭引流(VSD)结合骨水泥抗生素链珠治疗胫腓骨骨折术后早期感染11例,患者均痊愈出院,无一例需取出原内固定物重新或者更换固定材料.该方法可作为治疗胫腓骨骨折术后早期感染的手段之一.     

动力髋螺钉治疗股骨转子间粉碎性骨折内固定取出术后再骨折的分析

目的总结动力髋螺钉(DHS)治疗股骨转子间粉碎性骨折的疗效并探讨内固定取出术后再骨折的原因及防治措施。方法对93例DHS治疗的股骨转子间粉碎性骨折患者进行回顾性分析,A组37例,存在转子下螺钉交叉固定,B组56例避免转子下螺钉交叉固定。对于A组中5例内固定取出术后再骨折,3例采用外固定架固定,2例采用改良Gamma髓内钉内固定。所有病例均在取出内固定后随访8~18个月,平均随访12.3个月。结果 5例内固定取出术后再骨折均发生在A组,B组无1例发生,明显优于A组(P<0.01)。5例再骨折病例术后6~12个月(平均8个月)均达骨性愈合。结论不适当的转子下螺钉固定可导致DHS内固定取出后再骨折的发生。外固定架或改良Gamm a髓内钉治疗此部再骨折疗效满意。     

低温环境下羊肢体枪伤骨折早期三种固定方法的疗效对比

目的对比观察低温环境下羊肢体枪伤骨折后,采用三种不同固定方法的疗效。方法新疆绵羊15只,置于野外-25℃低温环境3h后,以77式手枪枪击一侧小腿,致胫骨中段骨折,伤后6h清创,骨折分别采用石膏外固定、外固定器固定和钢板内固定,然后连续观察伤口、骨折愈合和伤肢膝关节活动情况。结果钢板内固定组伤口愈合好,无感染;石膏及外固定器固定组,部分伤口及外固定针道有分泌物,培养有细菌生长。X线片见钢板内固定组骨折对线对位及愈合最好,外固定器组次之,石膏固定组最差。病理观察三个组均无骨髓炎,相比之下钢板内固定组骨生长及骨重建最快,石膏组最慢。骨折固定方法对肢体关节活动度及肌萎缩的影响,石膏组最大,钢板内固定组最小。结论低温环境下肢体枪伤骨折早期钢板内固定并一期闭合伤口,不仅不会增加伤道感染,相反还可以防止感染的发生,有利于伤口及骨折的愈合。     

股骨转子下骨折的治疗进展

股骨转子下区域是一个应力高度集中的部位,后内侧骨质重建是此处骨折治疗的关键。髓内固定是股骨转子下骨折的重要治疗方法,术后常发生髋内翻、畸形愈合、不愈合及各种内固定物相关并发症。尽管股骨转子下骨折的治疗取得了一定进展,但治疗中仍然存在难点。本文对股骨转子下骨折的分型及手术治疗进行综述。     

动力髋螺钉治疗股骨转子间骨折疗效分析

目的：探讨股骨转子间骨折手术内固定术临床疗效。方法：在C形臂X线机透视下闭合复住,设计手术入路,经皮动力髋螺钉（DHS）内固定术治疗股骨转子间骨折46例,其中男32例,女14例;年龄41—74岁,平均57、5岁。结果：46例患者随访11-26个月,平均18、5个月．所有病例骨折均愈合,无一例发生感染、内固定失败和骨不连等并发症。结论：应用经皮DHS内固定术治疗股骨转子间骨钎,手术简便快速,创伤少,固定可靠,愈合快,术后并发症少,是股骨转予间骨折较为有效的治疗方法。     

动力髋螺钉治疗股骨转子间骨折

目的探讨动力髋螺钉（dynamic hip screw DHS）手术治疗股骨转子间骨折的疗效。方法采用DHS治疗股骨转子间骨折26例，Ⅳ型骨折术中加用防旋拉加力螺钉。结果25例获得随访，骨折愈合时间5—10月，无切口感染，无髋膝关节功能障碍，2例发生轻度髋内翻。结论DHS手术治疗股骨转子间骨折具有固定牢固，断端加压，骨折愈合快等特点，加用防旋拉加力螺钉后可有效防止骨折端的旋转，畸形发生率低。     

股骨重建髓内针治疗股骨干骨折合并骨侧髋部骨折36例

目的 评价股骨重建髓内针治疗股骨干骨折合并同侧髋部骨折的临床疗效,并指出手术操作中应注意的问题。方法 选取股骨干骨折合并同侧髋部骨折36例（包括股骨颈骨折27例,转子间骨折9例）,均用股骨重建髓内针（reconstruction nail)治疗。结果 所有病例随访6－36个月,平均20个月。全部股骨干骨折均在术后6个月内获得愈合,股骨颈骨折除1例发生迟延愈合外,其余均在3个月内愈合。1例近端锁钉打断。无髓内针和远端锁钉断裂。未发生感染和栓塞等并发症。结论 股骨重建髓内针治疗股骨干骨折合并同侧髋部骨折是一种比较理想的内固定 方法,可同时对两个部位的骨折进行固定,并且可采取不切开骨折端的闭合方式植入,手术切口小、时间短、固定效果可靠,减少了手术中出血和对骨折端血运的破坏,有利于骨折的愈合。     

MACHO fracture: distal fifth metacarpal fracture revisited

Background: The term “boxer's fracture” has been used to describe fractures to the fifth metacarpal. In fact, boxers do not fracture their fifth metacarpal but their second or third metacarpals. Methods: We reviewed demographic data for 51 patients with boxer's fractures. Sex, age, hand involved, hand dominance, method of injury, ethanol intoxication, and presence of anger at the time of injury were evaluated. Results: Only 18 % of our cases involved a patient hitting another person. Fifty-one percent of the cases occurred when the patient intentionally struck a hard object. Thirty-one percent of fractures were accidental or due to crush injury. Of those injured from an intentional blow, nearly all of the patients were male. Patients were commonly angry at the time of injury. Conclusions: Based on the characteristics of our patients with these fractures, we believe a more appropriate name for this injury is the MACHO fracture (Men Angrily Cuffing Hard Objects).     

Experimental fracture investigations concerning the hyoid bone fracture

IntroductionExtensive literature exists concerning the etiology and morphology of fractures of the hyoid bone (h.b.) in cases of fatal strangulation. There is an agreement to the effect that fractures are mostly located within the distal third of the cornua majora (c.m.). Although several predictors have been described very accurately, the fracture analysis has neither been based on the osseous construction nor on the stress distribution of the c.m. under strangulation resulting from the configuration and its details. This especially applies to the apex of the distal ends of the big horns, the bulbi. The objective of the experimental break tests that were performed was to contribute to elucidating the biomechanics of the horizontal and vertical fractures and to fractures of the bulbi.Materials and methodsBreak tests in the a.p. direction line were carried out on 28 unfixed h.b. of adults on a specially constructed test bench by continuously increasing the tension until a fracture/dislocation occurred. The test arrangement followed the constellation of typical-symmetrical hanging. The selection criteria were the symmetry of the h.b. and the gender. Before and after the experiments, a radiological depiction (DIMA system 20 kV, 10 sec; Institute for Diagnostic Radiology, University-Hospital Goettingen) was carried out, followed by a preparative depiction under magnifying glass control. The h.b. configuration was classified according to the following types: hyperbole-, parabola-, and horseshoe-type. Following this classification, the results were related to the findings achieved by the photo-elastic model experiments. By this, the results of the experimental fracture tests could be specifically compared to the tension distribution within the model.ResultsA total of 70 % of the experimentally-produced fractures were located within the distal third of the c.m. This matches with the frequency distribution in real typical symmetrical hanging. Following the radiological and preparative investigations that were carried out, the c.m. have to be viewed as tubular bones. The transition regions of different osseous strength/elasticity are thus to be considered as areas of increased vulnerability. For the distal third of the c.m., it is the level at which the dense spongiosa/compacta of the shaft part turn into wide-meshed spongiosa and tender compacta of the bulbi. Additionally, the bulbi themselves represent a locus of reduced strength in which the fractures were located basally and/or apically in the transition. It was not only in the whole c.m. that the direction in which the fragment was snapped off or fractured was not random, as all fractures were located on the broad side of the horn, following the applied force.ConclusionsThe experimental fracture tests explained the known accumulation of fractures in the distal third of the c.m. in cases of hanging with the knot of the rope located against the neck. It could be demonstrated radiologically and preparatively that, anatomically, the big horn of the h.b. is a tubular bone. From this, a new approach to the forensic reconstruction of trauma can be derived. The transitional area from the shaft into the bulbus represents a locus minoris resistentiae. In case of pressing the h.b. towards the cervical spine under ventral application of force, one could expect a point load of the bulbi. Two different types of bulbus fractures showed that this load is diagnostically relevant.The fracture direction is also of diagnostic value. It depends on the angle that is formed by the c.m. with their broad side towards the horizontal. This angle may even change for about 90° for the c.m. in the course from proximal to distal movement.By adjustment of the alignment of the broad side with the stress distribution within the different types of the h.b., a mechanically justified answer can be given to the question of why a horizontal fracture appears in the one case and a vertical fracture in the other.     

Tillaux's fracture

Tillaux fracture or fracture of the antero-lateral portion of the distal tibia has a vertical fracture line either at the middle of the epiphysis or close to the external malleolus. It is seen around 13-14 years. Distance from the fracture line to the external malleolus depends of the degree of closure of the epiphyseal plate. When the medial aspect of the physis is open, the fracture line is more medial. The location of the fracture line in the epiphysis therefore depends on the maturity of the physis as shown by closure of its medial portion. Tomography is frequently necessary to see the fracture line and mainly to appreciate the fracture gap. If the gap is less than two millimeters non operative treatment with plaster cast is sufficient.     

游离骨折块移位距离对骨折愈合影响的实验研究

目的 探讨长骨干粉碎性骨折游离骨折块移位距离对骨折愈合的影响. 方法 在120只新西兰大白兔右桡骨中部截取楔形骨块,制成实验模型,用2枚克氏针将骨块复位固定并使之与主骨存有一定的间距,并分为五组:A组(原位固定)、B组(骨块与骨干间距为桡骨干直径1/5)、C组(桡骨干直径2/5)、D组(桡骨干直径3/5)、E组(桡骨干直径4/5).每组动物分别于术后2,4,6,8周分批处死,摄X线片观察各组骨折愈合情况,用改进Gary X线评分标准评分;取材HE染色,观察骨折愈合的组织形态学变化,免疫组化测定BMP-2的表达. 结果 (1)X线摄片显示:A、B组骨折愈合无差异,C、D组骨折愈合延迟,E组骨块吸收骨不连.(2)组织形态学观察:A、B组骨折局部形态学变化相同,而其他各组与A组相比,骨痂出现及改建的时间明显较晚,呈延迟愈合和不愈合的表现.(3)BMP-2表达:2周时BMP-2表达B组与A组差异无统计学意义(P＞0.05),C、D、E组与A组比较差异有统计学意义(P＜0.01),4周时只有E组与A组差异有统计学意义(P＜0.01);6周和8周时各组之间差异无统计学意义(P＞0.05). 结论游离骨折块移位距离会影响骨折的愈合,移位距离越大,对骨折愈合产生的影响越明显,当游离骨折块移位距离达到其骨干直径的2/5以上时,骨折将发生愈合障碍.