胫骨近端与远端截骨搬运在胫骨骨髓炎治疗中的效果比较

目的比较胫骨近端截骨搬运与胫骨远端截骨搬运在治疗胫骨骨髓炎清创所致大段骨缺损时对搬运区骨生长矿化情况及足踝功能的影响。方法回顾性分析2012年7月至2017年7月南方医科大学南方医院骨科采用骨髓炎清创及骨搬运手术治疗的42例慢性胫骨骨髓炎患者资料。根据慢性骨髓炎Cierny-Mader分型:42例患者均为弥散型(Ⅳ型)胫骨骨髓炎。根据搬运部位不同分为2组:32例采用胫骨近端截骨搬运(近端组),男27例,女5例;年龄为17~65岁;左20例,右12例。10例采用胫骨远端截骨搬运(远端组),均为男性;年龄25~63岁;左6例,右4例。比较两组患者术后对合端手术干预数、外固定指数(EFI)和美国足踝外科协会(AOFAS)踝-后足功能评分。结果两组患者性别、年龄、骨髓炎部位等一般资料差异均无统计学意义(P>0.05)。两组患者均获完整随访,近端组与远端组随访时间为(590.1±287.3)、(615.6±130.6)d,差异无统计学意义(P>0.05)。搬运后近端组与远端组分别有3例、2例出现足部马蹄内翻畸形,均需手术干预;术后近端组与远端组分别16、3例对合端需手术干预19例;近端组与远端组EFI分别为(76.2±50.0)、(84.3±59.9)d/cm,以上项目两组间比较差异均无统计学意义(P>0.05)。近端组与远端组AOFAS踝-后足功能评分分别为(81.4±10.1)、(60.0±5.9)分,差异有统计学意义(P<0.05)。结论运用骨搬运治疗胫骨骨髓炎清创所致的骨缺损时,胫骨近端骨搬运与胫骨远端骨搬运对搬运区骨生长及对合端骨愈合无明显影响,但胫骨近端骨搬运对足踝功能的不利影响较小。     

Posttraumatic tibial osteomyelitis: a comparison of three treatment approaches.

The treatment of 25 tibias in 25 patients with posttraumatic chronic osteomyelitis was reviewed. The approaches to soft tissue management fell into three groups: 1) muscle flap coverage; 2) primary closure with suction irrigation; and 3) open cancellous bone grafting. Treatment success was judged by the presence or absence of drainage and the local signs or symptoms of infection, and by the status of the tibial nonunion. Overall, 19 of 25 tibias (76%) had successful treatment. We found flap coverage to have a higher success rate (80%) than either primary closure with suction irrigation (45.5%) or open cancellous bone grafting (40%). These results further attest to the refractory nature of chronic osteomyelitis.     

Results of the treatment of femoral and tibial fractures following interlocking nailing and plate osteosynthesis. A comparative retrospective study

The Howmedica lock nail was introduced to an ordinary hospital where femoral and crural fractures had been stabilised in the past almost exclusively by plate-type osteosynthesis. Since only minor change had taken place regarding surgeons and surgical environment, the decision was taken to compare two groups of patients with lock nailing and plate-type osteosynthesis. Most of the nailing patients could immediately expose the injured extremity to load. Hospitalisation for them was as short as twelve days on average. They were fit for work not later than six months from surgery. Plate-type osteosynthesis patients, on the other hand, were hospitalised five weeks, on average. None of the patients could fully use his or her leg, after two months. Pseudoarthrosis was quite frequent in the wake of plate-type osteosynthesis but was not observed at all after lock nailing. The risk of posttraumatic osteomyelitis was considerably reduced. Covered nailing proved to be applicable to the majority of cases. A specifically designed image converter was used in cases of distal locking. Lock nailing proved to provide a great number of advantages, with cost saving being one of them. It is a routine method that can be used at any general hospital, once the surgical team on the spot has been familiarised with the technique.     

Culture results in open wound treatment with muscle transfer for tibial osteomyelitis

Fifty-three patients who underwent a two-staged protocol of debridement and muscle flap coverage for chronic osteomyelitis of the tibia between 1991 and 1996 were evaluated. All patients underwent a thorough debridement of all nonviable tissue and bone at initial debridement. Multiple cultures were taken, including aerobic, anaerobic and fungal cultures from the pus, soft tissue, bone curettings and bone. All patients were treated with open wound management and dressing changes. Between 2 to 7 days, median 4 days, all patients underwent a second debridement with a complete set of identical cultures, and immediate soft tissue muscle transfer. There were 42 free vascularized and 11 local tissue transfers. The 53 patients were classified according to the Cierny-Mader classification for chronic osteomyelitis. Twenty-four patients had Stage IVA osteomyelitis, 10 patients had Stage IIIA osteomyelitis, nine patients had Stage IIIB osteomyelitis, eight patients had Stage IVB osteomyelitis, one patient had Stage IA osteomyelitis, and one patient had Stage IIB osteomyelitis. All 53 patients had positive cultures at the time of their initial debridement, and 14 of 53 (26%) had a positive culture at the time of the second debridement. Based on the results, it seems from a bacteriologic stand-point that the second debridement allows for the opportunity for redebridement and wound sterilization of organisms that still may be present.     

Results of treatment of tibial spine fracture in children]

In this work there are presented the results of the treatment of 10 patients with avulsion fracture of tibial spine. In this group were 9 boys and 1 girl. The age range was from 9 to 14, and the median age was 11.5. In 6 cases the diagnosed injuries were of I and II degree according to the classification of Meyers and McKeever. These were treated conservatively. In 4 cases the results were very good, in other two there occurred the extension deficiency lower than 5 degrees. 4 patients with the III degree injury underwent operation which constituted in the fracture reposition and stabilization with wire suture. In all cases the clinical results were very good.     

The treatment of acute hematogenous osteomyelitis in children and young adults]

On the basis of own experiences and literature from last three years authors presented the role of surgical treatment in children above two years and young people, suffering from acute haematogenous osteomyelitis. Conservative treatment should be limited to these cases, where we can see a quick recovery, reducing of the pain and decreasing of the level of CRP and ESR. The presence of subperiosteal abscessus, positive bacteriological culture from blood and other complications (i.e. staphylococcal pneumonia), are the absolute indications to decompression of the medullary cavity, and local application of antibiotics.     

Results of the treatment of patients with post-traumatic osteomyelitis]

The author cites the nearest and remote (up to 13 years) results of treatment of 152 patients with posttraumatic osteomyelitis of the bones of crus and femur. On the basis of analysis of clinical data there are recommended the terms (3-6 months) of radical-restorative operations in patients with osteomyelitis and is drawn attention to the considerable frequency of the joint contractures.     

成人股骨干骨折的外科治疗

自1998年6月-2002年6月收治成人股骨干骨折112例,其中手术治疗86例,根据病人的不同情况分别采用切开复位带锁髓内钉或加压钢板内固定,现就两种不同内固定方法,对骨折的愈合及患肢功能恢复情况进行初步总结和分析.……     

Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft

Osteomyelitis of the diaphysis of the tibia in adults is an uncommon but disabling condition. It occurs principally in patients with complex fractures of the tibial shaft in which devitalized bone becomes infected either with a single strain of a virulent organism or with multiple organisms. The outcome of treatment depends on the assessment and management of three interrelated factors, which are the vitality and stability of the bone, the virulence and antibiotic susceptibility of the infecting organism, and the condition of the soft tissues. The impact of the infection on the patient's vitality is of great importance. Successful management depends on control of inflammation, excision of dead bone, and stabilization of the skeleton. Interlocking nailing and local antibiotic treatment are particularly successful strategies. In the future, modification of the inflammatory response with local tissue mediators may become an important adjunctive therapy.     

Minimally invasive treatment of old femoral fractures in adults

ObjectiveExtensive incision associated with large-scale callus exfoliation and internal fixation is the common therapeutic approach employed by the majority of orthopaedists in the treatment of old femoral fractures. Inspired by the surgical techniques of intramedullary fixation and reduction by traction, the present study attempted to treat old femoral fractures with minimally invasive methods utilising the principles of biological osteosynthesis (BO).MethodsA retrospective analysis involving 16 patients with old femoral fractures treated with combined traction, small incision, limited callus treatment, reduction by leverage and intramedullary fixation was conducted. The operative effect was evaluated by the operation time, intraoperative blood loss, bone grafting, healing time of fractures during follow-up, VAS score, and Harris hip score.ResultsIntraoperative observation revealed an average operation time of 1.53 ± 0.34 h and average blood loss of 268.13 ± 97.29 ml without bone grafting in all patients. All enrolled patients had outcomes resulting in effective fixation restoration of limb alignment. Of the 16 enrolled patients, 13 patients completed follow-up with an average follow-up time of 7.42 ± 3.29 months. The average healing time for proximal femoral fractures was 3 months. The average healing time of femoral shaft fractures was 4 ± 1.09 months; two of these cases took 4 months to heal, whereas 1 case demonstrated a delayed healing time of 6 months. The VAS score was 1.15 ± 1.70, 1 patient experienced sciatica, and the Harris hip score was 92.92 ± 5.42. There were no complications of malunion, nonunion or infection among any of the patients who completed follow-up.ConclusionsMinimally invasive treatment is feasible for most patients with old femoral fractures of the trochanter and femoral shaft. This finding is consistent with BO principles, thereby providing a possible new method for the treatment of old femoral fractures.     

Results of the treatment of femoral shaft fractures

The treatment results of 141 femoral bone fractures, including 29 complicated fractures, have been presented. The most frequent cause of femoral shaft fracture was traffic accident (71.6 per cent of the cases). The best results were obtained in the patients treated by the functional method; the worst results were obtained in the group treated surgically by adaptive osteosynthesis with the use of a metal plate and screws. In sum, excellent and good results were obtained in 70.2 per cent, fair in 19.1 per cent, and poor in 10.7 per cent of the cases.