前路双钢板螺钉内固定治疗骶髂关节分离损伤

目的总结前路双钢板螺钉内固定治疗骶髂关节分离的手术方法。方法采用骶髂关节前路切开复位加双钢板内固定治疗骶髂关节分离19例,术前、后均行X线片、CT三维重建检查并通过X线片随访。结果术后随访6～20个月,根据Denis评估标准:优13例,良3例,可3例。结论骶髂关节前路双钢板内固定术能直视复位,能有效恢复骶髂关节的稳定性,具有手术操作简单、创伤小、疗效可靠等优点。     

前路双钢板内固定治疗骶髂关节骨折脱位

目的探讨前路双钢板内固定治疗骶髂关节骨折脱位的临床疗效。方法12例骶髂关节骨折脱位患者术前行肠道准备,术中采用骶髂关节前路切开复位加双钢板内固定治疗,术后行功能煅练。结果术后随访5～18个月,12例患者术后无一例感染,无周围神经损伤,2例骶髂关节处轻度疼痛,术后3个月复查见骶髂关节分离约1．0cm。根据Matta功能评定标准,优7例,良3例,一般2例。结论骶髂关节前路双钢板内固定术有直视复位、固定可靠、有效避免神经损伤的优点。且操作简单,临床疗效好,适合基层医院开展。     

骶髂前路蝶形钢板与传统重建钢板治疗骶髂关节损伤的比较研究

目的 比较骶髂前路蝶形钢板(sacroiliac anterior papilionaceous plate,SAPP)和传统重建钢板在骶髂关节损伤治疗中的疗效.方法 回顾性分析2012年1月至2012年10月治疗23例24侧骶髂关节损伤的病历资料,11例11侧行SAPP内固定,男5例,女性6例;平均年龄为(39.6±9.1)岁;Tile B型骨折6例,C型5例.12例13侧行传统重建钢板内固定,男7例,女5例;平均年龄为(39.1±13.5)岁;Tile B型骨折7例,C型5例.两组间比较差异均无统计学意义.记录术中手术时间、出血量、骶髂关节钢板放置时间等,术后即刻行X线检查及Matta评分,术后随访时行X线检查及Majeed功能评分.结果 SAPP组平均手术时间(98.2±31.4) min,出血量(989.7±365.9) ml,钢板放置时间(6.6±3.2)min.传统重建钢板组平均手术时间(110.8±29.6) min,出血量(1136.0±279.3) ml,钢板放置时间(15.4±1.1) min.SAPP组术后Matta评分优4例、良5例、可2例,传统重建钢板组优4例、良6例、可1例、差1例.术中大出血2例,术后出现腰骶干损伤1例,股外侧皮神经损伤7例.SAPP组与传统重建钢板组相比,钢板放置时间明显缩短,Tile B型骨折出血量明显减少,余差异均无统计学意义.结论 骶髂前路蝶形钢板应用于骶髂关节损伤能够获得满意的复位和良好的固定,同传统重建钢板相比较,能易化操作、缩短放置时间、有利于旋转复位、可以减少B型骨折的出血量,并不增加神经损伤风险及感染率.     

骶髂关节脱位直视复位空心螺钉固定的基础研究及临床应用

目的研究总结直视复位、经皮空心螺钉固定骶髂关节脱位的解剖学基础、生物力学稳定性以及初步的临床疗效。方法采用12具(24侧)福尔马林固定的尸体标本,测量骶骨翼上缘L_4、L_5神经根前支和闭孔神经至骶髂关节的距离。采用6具新鲜尸体骨盆标本建立骶髂关节脱位模型,比较本固定法与传统后路经皮骶髂关节螺钉和前路钢板固定的稳定性。同期采用本固定法手术治疗17例Tile C型骨折患者,随访疗效。结果①L_4、L_5神经根及闭孔神经分别距离骶髂关节(20．24±1．12)mm、(23．80±1．43)mm、(16．26±2．07)mm；②本固定方式与后路经皮骶髂关节螺钉的稳定性无显著性差异,但优于前路钢板固定；③临床治疗17例患者,平均随访2．2年,根据Matta功能评定标准,功能恢复均为优良。结论该固定系统具有良好的生物力学稳定性,同时可避免神经损伤、临床效果好、操作简便,便于基层医院开展。     

2种内固定方法治疗98例踝关节骨折的疗效比较

目的比较闭合复位经皮空心螺钉内固定与传统切开复位内固定治疗踝关节骨折的疗效。方法 2004年3月～2009年8月收治的98例非粉碎型内外踝双骨折根据内固定方法不同分为闭合复位经皮空心螺钉内固定(闭合复位组)和传统切开复位内固定(切开复位组),比较2组患者的手术时间、术中出血量、骨折愈合时间、骨折愈合后外踝有无疼痛及术后1年AOFAS足踝评分。结果闭合复位组术中出血量、术后切口感染发生率及骨折愈合后外踝出现疼痛发生率明显优于切开复位组(P<0.05)。闭合复位组51例术后随访16～81个月,平均29.7月,骨折全部愈合;切开复位组42例随访17～80个月,平均28.3月,4例出现切口红肿、皮缘坏死,经换药后切口愈合,无深部感染发生,1例出现骨折不愈合。结论与传统切开复位内固定比较,闭合复位经皮空心螺钉内固定治疗踝关节骨折具有出血少、术后切口并发症发生率低、骨折愈合后外踝疼痛发生率低的优点,并能获得与切开复位内固定等同的踝关节功能。     

前路钢板螺钉内固定治疗髋臼骨折伴骶髂关节脱位的疗效分析

目的探讨前路钢板螺钉内固定治疗髋臼骨折伴骶髂关节脱位的临床疗效。方法回顾性分析自2011-01—2015-12采用髂腹股沟入路切开复位骨盆重建接骨板加骶髂关节星形接骨板内固定治疗的24例髋臼骨折伴骶髂关节脱位。髋臼骨折复位质量按Matta复位评分标准评定。骶髂关节分离复位评定采用PACS系统分别对术前及术后的CT横断面及矢状面骶髂关节间隙最宽处进行测量。髋关节功能采用Majeed评分标准评定。结果术前CT横断面骶髂关节间隙为(11.86±3.43)mm,术后为(4.05±0.76)mm,手术前后差值为(7.58±2.87)mm;术前CT矢状面骶髂关节间隙为(16.29±3.84)mm,术后为(4.27±0.95)mm,手术前后差值为(11.83±3.19)mm;结果显示术后髋臼及骶髂关节脱位复位良好。24例均获得随访7~30个月,平均12.8个月。骨折愈合时间3~9个月,平均4.8个月。髋臼骨折复位质量按Matta标准评定:优13例,良8例,可3例,优良率为87.5%。髋关节功能采用Majeed评分标准评定:优7例,良11例,可5例,差1例,优良率为75.0%。结论前侧髂腹股沟入路骨盆重建接骨板加骶髂关节星形接骨板内固定治疗髋臼骨折伴骶髂关节脱位是一种简单有效的方法,具有操作安全、骨折复位满意、术后疗效肯定的优点。     

MIPPO双钢板固定与单钢板加空心螺钉固定治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折疗效比较

目的比较MIPPO双钢板固定与单钢板加空心螺钉固定技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效。方法将42例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者按治疗方法分为两组,分别采用切开复位单侧锁定钢板加空心拉力螺钉内固定(单钢板加空心螺钉组,20例)和MIPPO双钢板内固定(MIPPO双钢板组,22例)。比较两组的手术时间、术中出血量、骨折愈合时间、膝关节功能HSS评分以及胫骨平台内翻角(TPA)和胫骨平台内侧后倾角(PSA)的变化。结果患者均获得随访,时间12~18(15±2.8)个月。两组手术时间、术中出血量、术后3 d及术后6个月时TPA、PSA比较差异均无统计学意义(P0.05);骨折愈合时间MIPPO双钢板组少于单钢板加空心螺钉组(P0.05);术后12个月单钢板加空心螺钉组塌陷较MIPPO双钢板组严重(P0.05);术后12个月膝关节HSS功能评分MIPPO双钢板组优于单钢板加空心螺钉组(P0.05)。结论采用MIPPO双钢板内固定技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折疗效理想,具有创伤小、固定牢靠、可早期功能锻炼、并发症少等优点。     

前路钢板螺钉内固定治疗骶髂关节分离损伤

目的总结前路钢板螺钉内固定治疗骶髂关节分离的手术方法。方法自1998年以来,采用前路钢板螺钉内固定治疗骶髂关节分离21例,髂腹股沟入路显露骶髂关节,刮除耳状关节面的软骨,关节复位后用1～2块重建钢板固定,关节间隙植骨融合。结果18例患者获9个月～3.5年(平均2.1年)随访。全部患者下地行走,14例无疼痛,4例轻度疼痛,均无骨盆畸形、下肢短缩等发生。X线复查见手术侧骶髂关节全部骨性融合。结论前路钢板螺钉内固定能有效恢复骶髂关节的稳定性,具有手术操作简单、创伤小、疗效可靠的优点。     

创伤性耻骨联合分离合并骶髂复合体损伤的手术治疗

目的:探讨创伤性耻骨联合分离合并骶髂复合体损伤适应证、手术方法及疗效。方法:2002年3月-2004年6月,对20例创伤性耻骨联合分离合并骶髂复合体损伤患者,采用前路切开复位重建钢板内固定治疗耻骨联合分离和后路在CT引导下经皮空心拉力螺钉固定治疗骶髂复合体损伤。男12例,女8例;年龄18～65岁,平均42.6岁。通过影像学检查明确20例患者有34侧骨盆骶髂复合体损伤。按照AO骨盆环损伤方法分型:B型8例,其中B2型5例,B3型3例;C型12例,其中C1型4例,C2型5例,C3型3例。结果:20例均获随访,随访时间4～21个月,平均14.2个月。平均入院后第8天手术。前路手术时间平均150min,后路手术时间平均60min。前路术中平均失血200ml,后路术中平均失血30ml。20例共置入骶髂螺钉34枚。术后3周患者可扶双拐下地行走,3～4个月可完全负重行走,并逐渐恢复体力劳动。未发生神经损伤及螺钉断裂现象。耻骨联合分离患者术后影像学显示解剖学形态完全恢复,耻骨联合间隙<2cm。结论:前环耻骨联合分离时要考虑可能有后环骶髂复合体损伤存在。耻骨联合分离与骶髂关节损伤应分别根据具体情况采用相应的固定术式。     

经皮骶髂螺钉与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的疗效比较

目的比较经皮骶髂螺钉与切开复位重建钢板内固定治疗Tile B、C型骨盆骨折的疗效。方法回顾性分析自2015-01—2017-12诊治的52例Tile B、C型骨盆骨折,26例行经皮骶髂螺钉内固定(经皮组),26例行切开复位钢板内固定(切开组)。比较2组手术时间、术中失血量、切口长度、住院时间、骨折愈合时间、并发症发生率、术后骨折复位情况、术后3个月患者康复情况。结果 52例均获得随访,随访时间平均18(12～24)个月。与切开组比较,经皮组手术时间、住院时间明显缩短,术中失血量更少,切口长度更短,骨折复位质量更好,术后3个月Majeed评分更优,术后并发症发生率更低,差异有统计学意义(P 0.05)。结论与切开复位重建钢板内固定相比,经皮骶髂螺钉内固定治疗Tile B、C型骨盆骨折创伤更小,骨折复位程度更优,患者功能恢复更好,符合快速康复理念,值得临床推广应用。     

Piezoelectric Bone Surgery. Overview in Applications and Proof of Feasibility in Hand and Plastic Surgery

PurposePiezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine whether piezosurgery was suitable and advantageous for performing osteotomies in Hand and Plastic reconstructive surgery.MethodsThe authors overviewed a variety of applications for Piezosurgery^® Device, from Mectron, in bone reconstructive surgery with over the last 8 years. An overall number of 156 bone cutting procedures in adults and children was described at the phalanges, metacarpal bones and distal radius level, as well as in bone graft harvesting and bone remodeling following carpal scaphoid nonunion, scapho-lunate bone-ligament-bone reconstruction and fibula free flap in maxillofacial defects.ResultsThe consolidation rate was 87.5% in scaphoid nonunion grafting and fixation. Bone healing was achieved in all other cases. No intra-operative complications were recorded.ConclusionPiezosurgery^® allowed high precision in bone cutting as well as custom-made graft and surface roughness were obtained, while preserving nerves, vessels and tendons integrity. The instrument may be handling moved into the surgical space in absence of vibrations, with a clear view onto the bone. The mechanical and biological characteristics of the piezoelectrical effect perfected this technique as an effective and useful instrument in Hand and Plastic surgery. The selective bone cutting properties avoided injuries to the surrounding soft tissues and thermal damage of the bony cells. Best advantages were described in feasibility and flexibility for intra-articular osteotomies, custom-made grafts and reconstructive microsurgical techniques.     

腓骨移植术33例分析

目的 介绍我院1981年8月至1999年10月采用吻合血管的游离腓骨移植术修复四肢长骨干骨缺损33例的手术治疗方法。方法 带血管蒂的游离腓骨移植至受区时,其动脉吻合采用动脉双口吻合法或叫“T” 嵌入端端吻合法;在带血管蒂的游离腓骨取材入路上作了简化。结果 经随访6个月至5年,平均2．5年,经X线摄片检查,术后移植骨临床愈合时间为2－5个月,平均3．5个月。肢体功能基本恢复正常。结论 带血管蒂的游离腓骨移植是修复四肢长骨长段骨缺损的有效方法;在血管吻合时采用动脉“T”形,嵌入端端吻合法,该法既保证移植骨的血供,又使受区供血动脉原供区血液供应不受影响,在带血管蒂的腓骨取材上,本术式入路操作简便。     

Effects of Weight Loss on Bone Status after Bariatric Surgery: Association Between Adipokines and Bone Markers

Background The prevalence of overweight and obesity is increasing dramatically worldwide. As a consequence, bariatric surgery for morbid obesity is in constant development. Although bariatric surgery has proven its efficiency at achieving weight loss and correcting comorbidities, it may cause vitamin deficiencies and subsequent complications. The goal of this review is to assess the impact of obesity surgery on bone metabolism and to analyze the underlying mechanisms and relationships with adipokines. Our review focuses on gastric banding, vertical banded gastroplasty, and gastric bypass. Methods The articles were located via PubMed database, using the key words “bariatric surgery,” “weight loss,” “bone loss,” and “bone metabolism” and published until May 2006. Results Five main studies were reviewed concerning gastric banding and six concerning Roux-en-Y gastric bypass. An early increase in bone markers (formation and resorption) is constantly found, prevailing on bone resorption, and resulting in early bone loss. Conclusion According to the few studies available, bone loss frequently occurs after bariatric surgery and particularly in a more pronounced way after gastric bypass, but its clinical significance is still under discussion. In addition, the physiopathology of these changes remains unclear, but could implicate adipokines such as leptin and adiponectin.     

Laparoscopic drainage of retroperitoneal abscess secondary to pyogenic sacroiliitis

Retroperitoneal abscesses are rare complications of pyogenic sacroiliitis. Diagnosis is often delayed due to the initial non-specific symptoms and signs and also a low awareness of the clinical presentation and diagnostic procedures among clinicians. We describe a case of an 18-year-old man who was diagnosed with septic arthritis of his left sacro-iliac joint which was complicated by a retroperitoneal abscess. After discussion with the radiologist and orthopaedic surgeons, the abscess was successfully drained via minimally invasive surgery transperitoneally.     

Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease

Summary The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Among patients older than 50 years, the rate of osteoporosis in males was 14.5% and the rate osteoporosis in females was 51.3%. We strongly recommend an evaluation and treatment for osteoporosis in the patients requiring spine surgery, especially in females over 50 years old. Introduction Because lifespan is increasing, there is an increase in the incidence of osteoporosis in elderly spine surgery patients. The osteoporosis may adversely influence the fusion rate and the surgical outcome. The purpose of this study is to evaluate the incidence of osteoporosis in patients requiring spine surgery. Methods A total of 1,321 patients underwent spine surgeries at our institute from January 1, 2005 to December 31, 2005. Among them, there were 562 patients (42.5%) younger than 50 years old, and 759 patients (57.6%) older than 50 years old. Prior to operation, we evaluated the patients for osteoporosis on both the femur head and lumbar spine by measuring the bone mineral density (BMD) by the dual-energy X-ray absorptiometry (DXA). Based on the World Health Organization (WHO) criteria for osteoporosis, we chose the T-score to determine normal (>−1), osteopenia (−1≥, >−2.5), and osteoporosis (≤−2.5). Among the 562 patients younger than 50 years, DXA was performed in 22 (3.9%) patients and there were 13 (2.3%) cases of osteopenia and 2 (0.3%) cases of osteoporosis. Results Among 759 patients older than 50 years, DXA was performed on 516 (68.0%) patients, 193 males and 323 females. Among the male patients, there were 89 (46.1%) patients with osteopenia and 28 (14.5%) with osteoporosis. Among the female patients, there were 134 (41.4%) with osteopenia and 166 (51.3%) with osteoporosis. The incidence of osteoporosis was higher in female patients and significantly increased with increasing age. Among 759 patients older than 50 years, 676 patients underwent a major spine operation with or without fusion. Among these patients, DXA was performed in 446 (66.0%) patients and there were 207 (46.4%) patients with osteopenia and 139 (31.1%) with osteoporosis. Conclusions The patients over 50 year-old who need spine operation have osteoporosis often. In conclusion, the number of spine operations in elderly patients is increasing and the incidence of osteoporosis in spine surgery patients is also increasing. We strongly recommend an evaluation for osteoporosis and post-operative treatment for osteoporosis in patients over 50 years old, especially for female patients.     

Chicken or the leg: Sigmoid colon perforation by ingested poultry fibula proximal to an occult malignancy

INTRODUCTIONColonic perforation by ingested foreign bodies is exceedingly rare, with the diagnosis made more challenging by patients infrequently recalling any inadvertent ingestion and the poor sensitivity of plain radiography.PRESENTATION OF CASEThe presented case demonstrates that bony perforation of the large bowel might occur immediately proximal to an otherwise occult colonic malignancy.DISCUSSIONIngestion of foreign bodies is common and rarely results in colonic perforation. However, bony ingestion is not usually remembered and can be missed even with cross-sectional imaging. If present, consideration should be given to the presence of an adjacent concealed colon cancer.CONCLUSIONThe co-existence of separate pathology should be carefully assessed in these patients, since this has important implications for relevant investigations and appropriate surgical management.     

A simple method for bone-graft handling during spine surgery

Morsellized bone-graft handling during spine surgery to get vertebral fusion can be a slow, laborious and time-consuming procedure. It is not absolutely exempt from complication risk. An easy, quick and inexpensive alternative technique is described.