关节镜辅助下膝关节粘连松解取逆行股骨交锁髓内钉

目的探讨关节镜介导下取交锁髓内钉同时行粘连松解术的临床疗效。方法对12例股骨髁上骨折行逆行股骨交锁髓内钉内固定术后的患者,关节镜介导下取交锁髓内钉同时行粘连松解术。结果12例均获随访,随访时间6-20月,效果满意。结论本术优点为微创,安全,功能恢复快,利于患者膝关节功能的恢复。     

逆行交锁髓内钉治疗股骨髁间骨折

目的 介绍髁上逆行交锁髓内钉治疗股骨髁间骨折的方法。方法 应用股骨髁上逆行交锁髓内钉治疗股骨髁间骨折58例，54进行临床随访评定效果。结果 54例经6～50个月(平均28月)随访，无近晚期并发症，骨愈合良好，平均愈合时间4个月，术后功能恢复优良率达90％。结论 股骨髁上逆行交锁髓内钉具有操作简便、固定可靠等优点，对于股骨髁间骨折的治疗，逆行交锁髓内钉是一种比较好的内固定方法。     

逆行交锁髓内钉治疗股骨髁间骨折

目地介绍髁上逆行交锁髓内钉治疗股骨髁间骨折的方法.方法应用股骨髁上逆行交锁髓内钉治疗股骨髁间骨折58例,54进行临床随访评定效果.结果 54例经6～50个月(平均28月)随访,无近晚期并发症,骨愈合良好,平均愈合时间4个月,术后功能恢复优良率达90%.结论股骨髁上逆行交锁髓内钉具有操作简便、固定可靠等优点,对于股骨髁间骨折的治疗,逆行交锁髓内钉是一种比较好的内固定方法.     

老年性股骨髁间骨折14例治疗体会

目的：评价股骨逆行交锁髓内钉加自体髂骨移植治疗老年性C型股骨髁间骨折的疗效.方法：对14例老年性C型股骨髁间骨折患者采用股骨逆行交锁髓内钉内固定加自体髂骨移植治疗,术后早期系统功能锻炼.结果：14例患者均获得随访,所有病例均获骨性愈合,平均骨折愈合时间12周,膝关节活动功能良好.结论：对老年性股骨髁间骨折采用股骨逆行交锁髓内钉内固定加自体髂骨移植,早期系统功能锻炼对恢复膝关节功能至关重要.     

关节镜下逆行交锁髓内钉治疗股骨髁上骨折12例体会

近十年来,对于股骨髁上骨折的治疗,出现多种手术治疗方法,多采取切开复位、角钢板、髁钢板、动力髁螺钉及交锁髓内钉固定。与非手术相比,手术治疗能保证解剖复位和坚强内固定,有利于膝关节早期进行功能锻炼,减少关节僵硬致残的机率。我科于2004年9月至2005年12月应用关节镜监视下逆行交锁髓内钉技术治疗12例股骨髁上骨折,现报告如下。1资料与方法1.1临床资料本组病人共12例,其中男性7例,女性5例,年龄28岁~75岁,平均46岁。9例为摔伤,3例交通事故伤;根据骨折AO系统分类,A1型4例,A2型2例,A3型4例,C2型2例。1.2手术方法本组12例病人均采用史…     

逆行髓内钉和钢板置入内固定治疗股骨远端骨折的比较

背景：以髓内钉为基础的中心型固定方法更符合股骨的生物力学特点。 目的：比较股骨远端骨折采用股骨髁上逆行交锁髓内钉治疗与股骨远端解剖型钢板治疗的临床疗效。 方法：用逆行髓内钉治疗35例股骨下端骨折患者和31例钢板内固定患者。内固定后随访1年以上,采用Neer膝关节功能评分标准对膝关节功能恢复程度指标,骨愈合速度指标予以评价。 结果：随访1年患者Neer 膝关节功能评分标准,逆行髓内钉优24例(69%),良9例(26%),可2例(6%),优良率为94%。平均愈合时间4.8个月。股骨远端解剖钢板优21例(68%),良5例(16%),可3例(10%),差2例(6%),优良率为84%,平均愈合时间6.5个月。根据结果进行分析,逆行交锁髓内钉治疗有利于早期下床活动,股骨远端钢板适应证广,对关节面的破坏相对较轻,有利于膝关节功能恢复。2种内固定都能起到较好疗效,应根据股骨远端骨折类型,选择相适应的内固定物。     

中西医结合逆行带锁髓内钉治疗股骨中下段骨折

目的 评估中西医结合逆行带锁髓内钉治疗股骨中下段骨折的临床效果。方法 回顾25例股骨中下段骨折，用带锁髓内钉经股骨两髁中心逆行倒打内固定结合中医治疗，随访时间5～20个月。结果 解剖复位16例，近于解剖复位9例，术后5～7天基本消肿、镇痛，无不良反应，伤口均一期愈合，骨折愈合时间5～12个月，无松动、断钉等并发症。结论 中西医结合逆行带锁髓内钉治疗股骨中下段骨折固定可靠，疗效确切，功能恢复情况好。     

中西医结合逆行带锁髓内钉治疗股骨中下段骨折

目的评估中西医结合逆行带锁髓内钉治疗股骨中下段骨折的临床效果. 方法回顾25例股骨中下段骨折,用带锁髓内钉经股骨两髁中心逆行倒打内固定结合中医治疗,随访时间5～20个月.结果解剖复位16例,近于解剖复位9例,术后5～7天基本消肿、镇痛,无不良反应,伤口均一期愈合,骨折愈合时间5～12个月,无松动、断钉等并发症.结论中西医结合逆行带锁髓内钉治疗股骨中下段骨折固定可靠,疗效确切,功能恢复情况好.     

髓腔延长顺行交锁髓内钉治疗股骨远端骨折基础与应用研究

目的探讨髓腔延长顺行交锁髓内钉治疗股骨远端骨折的临床疗效。方法：(1)107例成人股骨X线正、侧位片观测髓腔形态结构特点；(2)在X线片上测量估算髓内钉可达到股骨远端的最远距离，复位骨折，术中X线临测扩髓延长股骨远端髓腔至关节面上10～15mm，采用髓腔延长顺行交锁髓内钉治疗股骨远端骨折12例，2例不稳定骨折髓内钉同定后均加用小钢板单侧骨皮质螺钉同定。结果：12例骨折均达解剖复位或接近解剖复位，全部愈合。结论：髓腔延长顺行交锁髓内钉治疗股骨远端骨折具有创伤小，基本不损伤膝关节，术中出血少，稳定性好，膝关节功能恢复良好，骨折愈合率高等优点，值得临床推广和应用。     

逆行交锁髓内钉联合骨卡环置入内固定治疗股骨髁上骨折

背景：逆行交锁髓内钉联合记忆合金骨卡环置入内固定治疗股骨髁上A型骨折,固定稳定有利于骨折愈合,可早期锻炼。 目的：探讨逆行交锁髓内钉联合记忆合金骨卡环置入内固定治疗股骨远端骨折的临床疗效。 方法：纳入患者19例。根据AO分型：33A1型11例,33A2型6例,33A3型2例。其中男12例,女7例：年龄17-68岁,平均37.2岁。全部患者均通过逆行交锁髓内钉联合记忆合金骨卡环置入内固定治疗。 结果与结论：17例患者获得随访4-24个月(平均8个月),骨折临床愈合时间12-18周,平均愈合时间14周;无内固定物松动、断裂及畸形、关节感染、骨不连等发生,术后发生切口表浅感染2例,膝关节滑膜炎2例,原有骨性关节炎一过性加重1例。按HSS膝关节临床功能评定,优12例,良3例,优良率88%,可2例(12%)。说明采用逆行交锁髓内钉联合记忆合金骨卡环置入内固定治疗股骨髁上A型骨折生物力学稳定,能有效恢复股骨髁上骨折的稳定性及完整性,固定可靠,能促进骨折愈合,有利于早期进行功能锻炼。     

The use of quantitative ultrasound to monitor fracture healing: a feasibility study using phantoms

Fracture healing has traditionally been monitored subjectively using manual manipulation of the fracture site and evaluation of radiographic images. A more objective method of monitoring would provide obvious advantages, allowing healing progress to be quantitatively assessed and so providing the opportunity for early detection of problems. A tibia phantom was used to investigate whether the longitudinal propagation velocity of ultrasound across a fracture site could be used quantitatively to assess fracture healing. The characteristic of fracture healing simulated by the phantom was the changing gap between the bone ends at the fracture site. The ultrasound velocity was measured using a recently developed machine, the SoundScan 2000 (Myriad Ultrasound Systems Ltd, Israel). The precision of the SoundScan 2000 was found to be 0.4% in vitro. Ultrasound velocity predicted the simulated fracture gap with a high degree of accuracy (R²=0.994). The measured and the theoretically calculated velocity for different widths between the simulated bone ends was found to be highly correlated with a coefficient of determination of 0.998. This result shows that the use of quantitative ultrasound to monitor fracture healing warrants further investigation in vivo.     

Clinical fractures cluster in time after initial fracture

A history of fractures is a well recognised risk factor for a new clinical fracture. However, this subsequent fracture risk is not constant, but fluctuates over time, with the greatest increase in the years immediately after the initial fracture, followed by a gradual waning of risk toward the population risk. The clustering of fractures occurred regardless of age, gender and initial fracture location. It is therefore likely that fracture risk models, which take into account this fluctuation of fracture risk over time, will be more relevant in predicting an individual's subsequent fracture risk. Regardless of the cause of this clustering, these studies all strongly support the need for early action after an initial fracture to reduce the preventable risk of subsequent fractures with medical interventions that have been shown to immediately decrease the risk of fractures.     

髋部骨折临床治疗与效果分析

目的探讨髋部骨折的临床治疗。方法我院2016年6月至2017年7月我院住院治疗的髋部骨折66例,参照AO分类法分型。其中56例行手术治疗,10例未行手术。手术组中粗隆间骨折27例28髋,股骨近端解剖锁定板固定1例,全髋置换1例,PFNA内固定25例26髋;股骨颈骨折29例,空芯加压螺钉固定8例,半髋置换18例,全髋置换3例;手术前后采用Harris评分对照。结果手术组56例患者中,1例股骨颈骨折空心钉内固定位置欠佳但术后获得无痛髋,其余手术患者髋关节功能都获得恢复,Harris评分由术前的(39.43±5.06)分提高到术后的(84.54±10.35)分,P<0.01,具有显著的统计学差异。未手术的10例髋部骨折均为粗隆间骨折,2例建议保守治疗,随访中达到骨愈合;4例建议手术而患者未手术,半年内死亡2例,另2例轮椅代步;4例不建议手术的半年内3例死亡,1例仍卧床或轮椅代步。结论髋部骨折的积极手术治疗对于恢复患者的运动功能具有重要意义。     

跟骨关节内骨折手术治疗临床分析

目的探讨手术治疗跟骨关节内骨折的临床疗效。方法 30例32侧有移位跟骨关节内骨折,采用外侧入路切开复位钢板内固定术治疗,观察分析骨折愈合及并发症发生情况。结果随访8～34个月,平均16个月。按Maryland足部评分标准,优17侧,良10侧,可3侧,差2侧,优良率为81%。结论有移位的跟骨关节内骨折,切开复位、钢板内固定,疗效满意。     

万向式骨外固定器治疗桡骨远端不稳定性骨折的临床应用

目的评价万向式骨外固定器治疗桡骨远端不稳定骨折的疗效。方法应用万向式桡骨远端骨外固定器治疗159例（145人次）桡骨远端不稳定骨折,53例因骨折严重外加克氏针固定,11例因关节面塌陷骨缺损同时采取植骨。结果随访时间12～28个月,平均随访18．12个月,按Dienst等推荐的测量方法制定的解剖评估标准、功能评估标准及影像学评估标准,解剖复位优良者147例,优良率92．45％;功能优良者148例,优良率93．08％。结论应用万向式骨外固定器治疗桡骨远端不稳定骨折是目前理想的手术方法。同时验证了此万向式骨外固定器的灵活性、可操作性及固定后的稳定性,尤其适合于广大基层医院推广。     

纤维桩修复离体牙抗折强度的研究进展

纤维桩因其良好的力学性能和生物相容性,在临床上得到广泛应用。临床上纤维桩的抗折强度对纤维桩的固位起着非常重要的作用,因此学者们进行了一系列体外实验研究纤维桩的抗折强度。本文主要从纤维桩的长度、不同桩核系统、纤维桩表面处理等方面对影响纤维桩核抗折强度的因素做一综述,以期能为纤维桩核修复提供一定的临床依据。纤维桩核系统可以增强离体牙的抗折强度,折裂模式均为可修复性,利于牙根的保留,能够满足临床的治疗需要。     

Effects of leptin on femoral fracture in rats

In this study, our objective was to evaluate effects of leptin on fracture healing in rats. Seventy two male SpragueDawley (SD) rats were randomized into 3 groups. Standardized femoral fractures were created in all the rats. Group A was treated with 1 mL normal saline (NS), group B with 0.3 μg/kg leptin in 1 mL NS, and group C with 0.5 μg/kg leptin in 1 mL NS for 2 weeks intraperitoneally. Each group was divided into three subgroups including 8 rats for evaluation at 2, 4 and 8 weeks. Radiological evaluation showed that callus formation of group B and C was all significantly higher than group A at 8 weeks (P = 0.04 and P = 0.013, respectively). There was no statistically significant difference in fracture healing between group B and group C at 8 weeks (P = 0.197). Histological evaluation revealed fracture healing of group B and C was better than group A at 4 weeks (P = 0.01 and P = 0.002, respectively) and 8 weeks (P = 0.008 and P = 0.003, respectively). Micro-computed tomography (Micro-CT) analysis demonstrated that greater amounts of bony callus and evidence of bone fusion were observed in group B and C at 4 weeks (P = 0.02 and P = 0.04, respectively) and 8 weeks (P = 0.005 and P = 0.001, respectively) compared to group A. Group C also had better fracture healing than group B at 8 weeks (P = 0.01). In conclusion, leptin has a positive effect on rat femoral fracture healing.     

小切口复位经皮钢板内固定治疗胫腓骨骨折

目的：介绍小切口复位经皮钢板内固定治疗胫腓骨骨折，并观察其疗效。方法：应用小切口间接复位，经皮置入钢板内固定治疗胫骨骨折23例。小切口间接复位后，在胫骨内侧骨折两端建立皮下隧道，钢板经此隧道安放在胫骨内侧骨膜外，少数螺钉固定。结果：随访23例，所有病例伤口均一期愈合。骨折临床愈合时间10～16周，平均12周。无骨折延迟愈合及不愈合，钢板固定可靠，未见断裂与松动。结论：小切口复位经皮钢板内固定符合生物学固定原则，有利于骨折的愈合，是治疗胫腓骨骨折的有效方法。     

累及内踝后丘的特殊型三踝骨折的临床治疗

目的探讨累及内踝后丘的特殊三踝骨折的损伤机制、手术方法和治疗效果。方法自2007年1月~2010年1月间,手术治疗累及内踝后丘的闭合三踝骨折共19例。其中6例合并踝关节后脱位,7例合并踝关节后半脱位。急诊先予踝关节复位并做跟骨牵引维持,外伤后平均4天施行手术治疗,经踝关节后方双侧入路,根据骨块大小和关节稳定程度以及软骨面的塌陷情况,分别采用后侧支撑钢板或多枚拉力螺钉固定。术后踝关节中立位支具或石膏固定并卧床2~3周,约3月后完全负重行走。结果17例获随访,随访时间12~24个月,切口均正常愈合,骨折愈合时间6~10周。术后一年采用AOFAS踝-后足评分,平均92.6分,未见踝关节不稳征象。结论累及内踝后丘的三踝骨折,常伴有胫骨远端关节面塌陷和踝关节后脱位或半脱位,其损伤机制可能不属于Lauge-Hansen分型。手术采用俯卧位经踝关节后方双侧入路,伴有胫骨远端后内侧关节面塌陷时需先复位,然后依次复位内踝、后踝和外踝,可以获得良好的临床疗效。     

Treatment of Medial Epicondyle Fracture without Associated Elbow Dislocation in Older Children and Adolescents

Purpose

Displaced medial humeral epicondyle fractures with or without elbow dislocation have been treated with open reduction and fixation using K-wires or screws. The purpose of this study is to evaluate the clinical and radiological outcomes of surgical treatments of medial humeral epicondyle fracture without elbow dislocation according to the fixation methods.

Materials and Methods

Thirty-one patients who had undergone open reduction and fixation of the displaced medial humeral epicondyle fracture without elbow dislocation were included. Group I consisted of 21 patients who underwent fixation with K-wires, and Group II comprised 10 patients who underwent fixation with cannulated screws. Immediate postoperative, final follow-up and normal anteroposterior radiographs were compared and the clinical outcome was assessed using the final Japanese Orthopaedic Association (JOA) elbow assessment score.

Results

On the immediate postoperative radiographs, the distal humeral width in Group II was larger than that in Group I. On the final follow-up radiographs, the epicondylar position in Group I was lower than that in Group II. There was no significant difference in the distal humeral width, epicondylar position and joint space tilt between the immediate postoperative, final follow-up radiographs and the normal side within each group. There was no significant difference in the final JOA score between groups.

Conclusion

Open reduction followed by K-wire fixation or screw fixation of the displaced medial humeral epicondyle fracture without elbow dislocation in older children and adolescents resulted in improved radiologic outcome and good elbow function in spite of diverse radiologic deformities.