Closed reduction and intramedullary nailing versus open reduction and locking plate fixation in treatment of middle and upper humeral fractures北大核心CSCD

Objective To compare closed reduction and intramedullary nailing versus open reduction and locking plate fixation in the treatment of middle and upper humeral fractures. Methods A retrospective case-control study was conducted to analyze the clinical data of 62 patients with middle and upper humeral fracture who had been treated at Department of Orthopaedics, The First People's Hospital of Jinmen and at Department of Orthopedics, General Hospital of PLA Central Theater from October 2017 to February 2021. There were 35 males and 27 females, aged from 27 to 86 years. The left side was affected in 24 cases and the right side in 38 cases. All fractures were fresh. According to the AO classification, 16 cases were type A, 32 type B, and 14 type C. Of the patients, 29 were treated with closed reduction and intramedullary nailing (intramedullary nail group) and 33 with open reduction and locking plate fixation (locking plate group). The length of incision, operation time, intraoperative blood loss, hospital stay, fracture healing and complications were recorded and compared between the 2 groups. The pain degree was evaluated by visual analogue scale (VAS) at one week and one month after operation, and the functional recovery of the shoulder was evaluated by Constant-Murley score at one month and 12 months after operation. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P>0.05). The intramedullary nail group was followed up for 12 to 29 months and the locking plate group for 15 to 50 months. In the intramedullary nail group, the length of incision [(4.1±0.7) cm], operation time [(58.3±7.7) min], intraoperative blood loss [(52.7±6.5) mL], and hospital stay [(7.3±1.5) d] were significantly less than those in the locking plate group [(21.7±2.3) cm, (95.8±11.7) min, (237.4±14.9) ml, and (12.3±1.7) d] (P<0.05). The fracture healing time in the intramedullary nail group was (5.0±1.9) months, significantly longer than that in the locking plate group [(3.5±1.7) months] (P<0.05). The VAS scores at one week and one month after operation in the intramedullary nail group [(2.8±0.3) points and (1.2±0.5) points] were significantly lower than those in the locking plate group [(4.3±0.4) points and (1.6±0.5) points], and the Constant-Murley score at one month after operation in the intramedullary nail group [(63.5±7.4) points] was significantly higher than that in the locking plate group [(54.3±6.9) points] (P<0.05). However, at 12 months after operation, there was no significant difference in the Constant-Murley score between the 2 groups (P>0.05). In both groups, the VAS score at one month after operation was significantly lower than that at one week after operation while the Constant-Murley score at 12 months after operation was significantly higher than that at one week after operation (P<0.05). In the intramedullary nail group, intraoperative distal refracture happened in one case; in the locking plate group, incision infection occurred in one case and postoperative radial nerve injury in another. There was no significant difference in the incidence of complications between the 2 groups [3.4% (1/29) versus 6.1% (2/33)] (P>0.05). Conclusion In the treatment of middle and upper humeral fractures, compared with open reduction and locking plate fixation, closed reduction and intramedullary nailing shows advantages of a smaller surgical incision, shorter operation time, less intraoperative blood loss, shorter hospital stay and faster functional recovery. © The Author(s) 2022.     

Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail

Objective: To evaluate the results of reconstructive intramedullary interlocking nail in the treatment of ipsllateral hip and femoral shaft fractures. Methods: From August 1997 to November 2001, 13 patients were treated with the reconstructive intramedullary interlocking nail. Nine patients were associated with ipsllateral femoral neck fractures, three with ipsilateral intertrochanteric fractures, and one with subtrochanteric fracture. Results: The follow-up time was from 6 to 38 months with an average of 14 months. All the femoral shaft and hip fractures healed up well. There was no nonunion of the femoral neck, and only one varns malunion. No patient had avascular necrosis of the femoral head. The average healing time for femoral neck fracture was 4.6 months and for shaft fracture 5.8 months. The joint movement and other functions were fairly resumed. Conclusions: The reconstructive intramedullary interlocking nail, with less trauma, refiable fixation, and high rate of fracture healing, is an ideal method of choice in the treatment of ipsilateral hip and femoral shaft fractures.     

Effect of recombinant human basic fibroblast growth factor on angiogenesis during mandible fracture healing in rabbits

Objective: To investigate the effect of recombinant human basic fibroblast growth factor ( rhbFGF) on angiogenesis during mandible fracture healing in rabbit.Methods: Fifty adult white rabbits were used for animal model and randomly divided into a control group (25 rabbits) and an experimental group (25 rabbits). The membranous complex of rhbFGF and bovine type I collagen was prepared and implanted into the rabbit mandible fracture site under periosteum. The animals were sacrificed on 7, 14, 28, 56 and 84 days respectively after operation and the whole mandibles were harvested. The expression of factor Vm related antigen (F8-RA) in callus was examined with immimohistochemical staining.Results: The amounts of microvascular formation in calluses in the rhbFGF-treating group on days 7, 14, 28 and 56 were more than those of the control group (P < 0.01).Conclusions: The results indicated that rhbFGF could stimulate microvascular formation during mandible fracture healing in rabbits.     

Elastic intramedullary nail for treatment of extremity fractures in children

Objective： To assess the clinical therapeutic effects of elastic intramedullary nail on extremity fractures in children.
Methods： From June 2005 to March 2008, 40 children with extremity fractures were treated by elastic intramedullary nail, in whom femoral shaft fractures occurred in 26 cases, tibiofibular fractures in 8 cases, radial capitular fractures in 4 cases, ulnoradial fractures in 2 cases. All patients were treated by closed reduction and elastic intramedullary nail fixation. Results： All the fractures gained satisfactory reduction and healing. The average duration needed for fracturehealing was 1-2 months. Postoperative follow-up confirmed a sound functional recovery.
Conclusions： The elastic intramedullary nail is a minimally invasive and effective surgical approach for treatment of extremity fractures in children. It allows early functional exercises after operation and secures a satisfactory bone union and functional recovery.     

The change of angiotensin Ⅱ production and its receptor expression during wound healing: possible role of angiotensin Ⅱ in wound healing

Objective This study was undertaken to observe the change in the local level of angiotensin Ⅱ (Ang Ⅱ) and the expression of its corresponding receptors AT1 and AT2 during wound healing, and explore the possible role of Ang Ⅱ in wound healing . Methods A model of full-thickness cutaneous wound was developed on the back of C57/BL6 mice. Specimens were taken from the wound of each mouse on the day 0, 1, 3, 5, 7, 9, 11, 13 and 15 after wounding. The change in the generation of Ang Ⅱ in wounded tissue during the healing process was detected with ELISA. The proliferation and the apoptosis of cells were detected by bromodeoxyuridine (Brdu) and terminal deoxyuncleotidyl transferase mediated deoxyuridine triphosphate nick end labeling (TUNEL) method in wounded skin during the healing process, respectively. The cellular localization and the mRNA level change of Ang Ⅱ receptors in wounded tissue during healing were detected with immunostaining and RT-PCR. Results Ang Ⅱ produced in wounded skin was increased in the first 7 days to reach the peak, and then gradually decreased during wound healing. BrdU labeling index was increased gradually in the first 7 days to reach the peak, and then gradually decreased during wound healing. The number of TUNEL-positive cells was increased slowly in the first 7 days after wounding. The increase in the number of TUNEL-positive cells was more markedly after epithelization of the wound. In normal mice, AT1 and AT2 receptor were found positively expressed in the whole epidermal layer, while positive expression was only found in the endothelial cells of the capillary vessels within the dermal layer, and positive expression was also found in appendages of the skin, i.e. hair follicle, sweat gland and sebaceous gland respectively. Positive staining signal of both AT1 and AT2 receptors were increased in the first 7 days to reach the peak, then gradually decreased. Expression of AT2R was increased again following the epithelization of wound. The result of RT-PCR showed that the expression of both AT1 and AT2 receptors was detectable, and AT1 receptor was increased in the first 7 days to the peak, and then gradually decreased during wound healing, while AT2 receptor expression reached its peak value on day 7, then gradually decreased, and increased again following the epithelization of wound. Conclusions These results indicate that Ang Ⅱ participate in wound repair and related to remolding in the late stage of wound healing through the change in production of angiotensin Ⅱ and expression of AT1 and AT2 receptors. AT1 receptor might be closely associated with cell proliferation,while AT2 receptor might play a role in cell apoptosis and remolding during wound healing.     

The change of angiotensin Ⅱ production and its receptor expression during wound healing: possible role of angiotensin Ⅱ in wound healing

Objective This study was undertaken to observe the change in the local level of angiotensin Ⅱ (Ang Ⅱ) and the expression of its corresponding receptors AT1 and AT2 during wound healing, and explore the possible role of Ang Ⅱ in wound healing . Methods A model of full-thickness cutaneous wound was developed on the back of C57/BL6 mice. Specimens were taken from the wound of each mouse on the day 0, 1, 3, 5, 7, 9, 11, 13 and 15 after wounding. The change in the generation of Ang Ⅱ in wounded tissue during the healing process was detected with ELISA. The proliferation and the apoptosis of cells were detected by bromodeoxyuridine (Brdu) and terminal deoxyuncleotidyl transferase mediated deoxyuridine triphosphate nick end labeling (TUNEL) method in wounded skin during the healing process, respectively. The cellular localization and the mRNA level change of Ang Ⅱ receptors in wounded tissue during healing were detected with immunostaining and RT-PCR. Results Ang Ⅱ produced in wounded skin was increased in the first 7 days to reach the peak, and then gradually decreased during wound healing. BrdU labeling index was increased gradually in the first 7 days to reach the peak, and then gradually decreased during wound healing. The number of TUNEL-positive cells was increased slowly in the first 7 days after wounding. The increase in the number of TUNEL-positive cells was more markedly after epithelization of the wound. In normal mice, AT1 and AT2 receptor were found positively expressed in the whole epidermal layer, while positive expression was only found in the endothelial cells of the capillary vessels within the dermal layer, and positive expression was also found in appendages of the skin, i.e. hair follicle, sweat gland and sebaceous gland respectively. Positive staining signal of both AT1 and AT2 receptors were increased in the first 7 days to reach the peak, then gradually decreased. Expression of AT2R was increased again following the epithelization of wound. The result of RT-PCR showed that the expression of both AT1 and AT2 receptors was detectable, and AT1 receptor was increased in the first 7 days to the peak, and then gradually decreased during wound healing, while AT2 receptor expression reached its peak value on day 7, then gradually decreased, and increased again following the epithelization of wound. Conclusions These results indicate that Ang Ⅱ participate in wound repair and related to remolding in the late stage of wound healing through the change in production of angiotensin Ⅱ and expression of AT1 and AT2 receptors. AT1 receptor might be closely associated with cell proliferation,while AT2 receptor might play a role in cell apoptosis and remolding during wound healing.     

Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center

Objective： The treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. Methods： Thirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. Results： The mean age of patients was 37,53 years. Most were males between 21-40 years. The dominant mode of injury was traffic accidents （66%）. Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device （group A） and 105 minutes for extramedullary device （group B）. Average blood loss was 100 ml in group A and 200 ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. Conclusion： Intramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.     

The effects of stress- relaxation plate on disorganization and repair of regional bone structure: an experimental study

Objective:To study the influence of stress-relaxation plate on disorganization and repair of the cortex beneath the plate.Methods:A washer made of viscoelastic polyethylene was placed between the screw and the screw hole of conventional stainless rigid plate (RP) to produce a stressrelaxation plate (SRP).Both SRP and RP were applied to osteotomized tibia in 48 New Zealand rabbits.Healing process of the fracture with either SRP or RP fixation (control) was comparatively studied with polarized light microscopy,in situ hybridization of collagen mRNA and immunohistochemical technique from 2 to 36 weeks postoperatively.Results:The study of plated bone remodeling showed that the degree of cortex osteoporosis beneath the plate was similar between the SRP and RP group within 12 weeks postoperatively.In comparison,the disorganization of bone structure in SRP group happened later and milder than that of RP group,and the repair process began at 12 weeks after implantation.As a consequence,the absorption cavities became smaller and the structure of collagen fibers became well oriented along with these changes by polarized light microscopy.In addition to these,the in situ hybridization analysis of collagen genes and the immunohistochemical study of type I,Ⅲ collagen at 8 to 12 weeks after implantation.from this time on ,the changes above became more evident significantly before most of cavities were repaired by 36 weeks.In contrast to the changes in the SRP group,no expression and synthesis of any kind of collagen could be observed during 12 to 36 weeks after implantation in RP group.Conclusions:Without removal of the bone plate,the SRP fixation not only reduces the degree of plated bone osteoporosis,but also makes the disorganized bone structure restored to normal in terms of the expression and synthesis of type I collagen mRNA of osteoblasts lying on the surface of absorption cavities.     

Relationship among bone mineral density, collagen composition, and biomechanical properties of callus in the healing of osteoporotic fracture

Objective： To study the change and relationship among bone mineral density （BMD）, collagen composition and biomechanical properties of the callus in the healing process of osteoporotic fracture. Methods： The osteoporotic rat model and fracture model were established through bilateral ovariectomy （OV＇X） and osteotomy of the middle shaft of the right hind tibiae, respectively. Ninety female SD rats were randomly divided into OVX group and sham group. With the samples of blood and callus, roentgenoraphic and histological observation were performed for the assessment of the healing progress of the fracture, and the serum concentration of TRAP-5b, proportion of type I collagen, BMD and biomechanical properties of the callus were measured. Results： The OVX group experienced a significant delay of fracture healing. The mean serum concentration of TRAP-5b of rats in the OVX group was much higher than that in the sham group after the operation （P 〈 0.05）, but the difference at the same time point after fracture was smaller than that before fracture （P 〈 0.05）. The BMD of the callus in both groups reached the peak value at the 6 th week after fracture while the proportion of the type I collagen and the biomechanical strength reached the peak at the 8th week. Conclusions. The deficiency of estrogen after the ovariectomy could induce the up-regulation of the osteoclasts activities, whereas the potency of further activation after fracture was depressed. Although the synthesis of collagen together with its mineralization determines the biomechanical properties of new bone, the accumulation of collagen could be assessed as an index in the prediction of biomechanical strength of bones independent of the bone mineral deposition.     

A型肉毒毒素局部应用对兔耳增生性瘢痕创面愈合和瘢痕增生的影响

Objective To investigate the effect of botulinum toxin type A (Botox A) injection on hypertrophic scar in rabbit ear model. Methods The hypertrophic scar model was established in 16 Japanese rabbits' ears. These wounds were divided into two groups as group T(treated with Botox A, n =48) and group S (not treated, n = 48). The wounds healing times and scar hypertrophy were observed with 8 specimen of normal skin at the rabbit ears as sham group B. HE stain was used to assess the hypertrophic index(HI). The expression of collagen Ⅰ and Ⅲ was tested by western-blot. The cell cycle of fibroblasts was studied by flow cytometry. Results The [] was significantly lower in group T than in group S(P < 0.01). The expression of collagen Ⅰ and Ⅲ, as well as the ratio of Ⅰ to Ⅲ, was markedly stronger in group S than in group T(P < 0.01). Compared with group T, more fibroblasts were in G2-M in gToup S and fewer in G0-G1 (P <0.05). Conclusions Local injection of Botox A can inhibite the formation of hypertrophic scar and the activity of fibroblasts in rabbit ear model. It can significantly decrease the expression of collagen Ⅰ and Ⅲ in hypertrophic scar, as well as the ratio of collagen Ⅰ to Ⅲ. It serves as the basis for the treatment of hypertrophic scar with Botox A.     

自控微动带锁髓内钉内固定对骨折愈合影响的扫描电镜观察与生化分析

目的:观察自控微动带锁髓内钉[AMLN]内固定对骨折愈合的影响及机制。方法:对12只山羊两侧股骨干横断截骨,分别采用AMLN和GK钉固定,术后7、14、28、56d分批处死,行生物化学测量,扫描电镜观察。结果(1)电镜观察术后7～14d AMLN固定组骨痂丰富、层叠状有序排列,骨小梁的吸收陷窝内有胶原纤维不断形成;术后28～56d骨胶原纤维在吸收陷窝内外形成丰富,互相平行束状排列,与骨干主应力轴相一致,骨吸收和骨生成活跃,骨塑形改建迅速,哈佛氏系统结构完整,结构网架在骨质钙盐结晶沉积下十分坚韧;而GK钉固定组则无上述特征现象发生;(2)AMLN钉固定组的骨痂胶原、不溶性胶原、钙、磷含量均高于GK钉固定组(P<0.05)。结论:AMLN钉固定使骨折端局部稳定、有轴向生理性应力刺激与应力传导,增加了成骨细胞的代谢活性,使骨小梁沿压应力轴线发育,促进了骨胶原生成、骨盐的沉积及转化、骨痂的形成和强度的提高,加快了骨质重建的速度。     

自控微动带锁髓内钉内固定促进骨折愈合的扫描电镜观察

目的观察采用自控微动带锁髓内钉（autocontrol micromotion locking nail,AMLN）固定对骨折愈合的影响及机制。方法对14只山羊两侧股骨干横断截骨,分别采用AMLN和GK钉内固定,术后1、2、4、8周分批处死,采用扫描电镜观察骨折愈合过程中细胞的超微结构变化。结果术后1～2周AMLN固定组骨痂丰富、排列有序,骨小梁的吸收陷窝内有胶原纤维不断形成;术后4～8周骨胶原纤维在吸收陷窝内外形成丰富,互相平行束状排列,与骨干主应力轴相一致,骨吸收和骨形成活跃,骨塑形改建迅速,哈佛氏系统结构完整,结构网架在骨质钙盐结晶沉积下十分坚韧;而GK钉固定组则无上述特征现象发生。结论AMLN钉固定使骨折端局部稳定、有轴向生理性应力刺激与应力传导,增加了成骨细胞的代谢活性,使骨小梁沿压应力轴线发育,骨折边愈合边塑形,给骨折愈合提供了较佳的力学环境。     

自控微动带锁髓内钉内固定对骨折愈合影响的组织学实验研究

目的 :探讨自控微动带锁髓内钉 (AMLN )固定后骨折局部的组织学改变对骨折愈合的影响及机制。方法 :对 1 2只山羊两侧股骨干横断截骨 ,分别采用AMLN和GK钉内固定 ,术后 1、 2、 4、 8周分批处死 ,行组织学观察。结果 :AMLN钉能以微动间歇性应力方式促进骨折愈合 ,骨外膜骨痂、桥梁骨痂能早期加速形成 ,并逐渐连接骨痂、封闭骨痂 ,使皮质骨松化 ,骨小梁坚韧 ,提高了骨的结构力学特性 ,缩短了愈合周期 ,明显优于GK钉固定。骨痂的定量分析表明 ,两者具有显著性差异 (P <0 .0 5)。结论 :AMLN钉内固定所建立的局部有应力、应变产生及轴向应力传导的生物力学环境 ,可以调控成骨细胞与破骨细胞的活性平衡 ,骨折边愈合边改建边塑形 ,增加了骨折愈合的速度和质量     

两种方式治疗胫骨中下段骨折的疗效比较

目的比较经皮微创锁定钢板内固定(MIPPO)和交锁髓内钉内固定治疗胫骨中下段骨折的疗效。方法将90例胫骨中下段骨折患者按治疗方法不同分为髓内钉组(采用交锁髓内钉内固定治疗,40例)和MIPPO组(采用MIPPO治疗,50例)。记录并发症情况和骨折愈合时间。术后1年采用Johner-Wruhs评分和疼痛VAS评分评价疗效。结果90例患者均获得随访,时间14~24个月。髓内钉组发生膝关节疼痛2例,感染1例;MIPPO组发生浅部感染1例。骨折愈合时间髓内钉组较MIPPO组短,但差异无统计学意义(P>0.05)。术后1年,Johner-Wruhs评分优良率髓内钉组高于MIPPO组,差异有统计学意义(P<0.05);VAS评分髓内钉组低于MIPPO组,但差异无统计学意义(P>0.05)。结论MIPPO和交锁髓内钉内固定治疗胫骨中下段骨折均可取得理想效果,但交锁髓内钉内固定治疗术后功能评分更好。     

长短髓内钉治疗老年股骨反转子间骨折的疗效比较

目的通过分析比较短髓内钉与长髓内钉治疗老年股骨反转子间骨折的效果，为反转子间骨折内植物的选择提供临床参考。 方法回顾性分析2012年12月至2016年11月在枣庄市山亭诚德骨科医院治疗的47例老年股骨反转子间骨折的患者，根据内固定物的绝对长度与相对比例以及远端锁定器械不同分为短髓内钉（240 mm）与长髓内钉（300 mm以上）两组，其中短髓内钉组26例（55.3%），长髓内钉组21例（44.7%），观察两组患者的手术时间、术中出血量、输血量、术后负重时间、骨折愈合时间、术后并发症发生情况、髋关节功能恢复情况，日常生活能力评分按照Harris标准对患者功能进行评分。 结果术后1年内有5例患者因意外及心血管疾病等其它的原因死亡，其中短髓内钉组3例，长髓内钉组2例，均与骨折无关，40例纳入研究的患者均完成了1年的随访，随访率（85.1%）。在手术时间、出血量、输血量方面，短髓内钉组患者手术时间为（33.5±1.0）min、出血量为（192±5）ml、输血量为（192±116）ml，明显少于长髓内钉组[（68.7±12.3）min、（313±37）ml、（370±122）ml]，差异具有统计学意义（t=0.018，t=0.004，t=0.001，P<0.05）。短髓内钉组患者的术后负重时间[（8.3±2.8）d]、术后1年Harris评分[（81±3）分]、骨折愈合时间[（14.5±2.1）w]方面与长髓内钉组[（8.4±2.2）d、（80±4）分、（14.8±2.7）w）]比较，差异无统计学意义；两组术后均未发生切口不愈合或者感染、骨折延迟愈合或不愈合、下肢深静脉血栓形成、髋内翻、内固定松动及内固定周围骨折等情况。 结论短髓内钉治疗老年股骨反转子间骨折的手术时间、出血量、输血量要优于长髓内钉，并不存在"中裤效应"，建议使用短髓内钉进行固定。     

不同方法治疗肱骨干骨折的疗效分析

目的通过对比自锁髓内钉与钢板内固定治疗肱骨干骨折的临床疗效,探讨两种方法在肱骨干骨折中的应用。方法选择2010年1月～2011年6月在笔者所在医院诊治的肱骨干骨折患者60例,随机分为研究组和对照组各30例。研究组采用自锁髓内钉固定治疗,对照组采用钢板内固定治疗,对比观察两组的临床疗效。结果研究组骨折愈合时间比对照组短,再骨折率和医源性桡神经损伤均低于对照组,差异有统计学意义（P〈0.05）,两组肩关节功能评定的优良率比较,差异无统计学意义（P〉0.05）。结论自锁髓内钉固定肱骨干骨折并发症及愈合时间比钢板内固定有优势,而且并不降低肩关节功能的优良率。     

AO接骨板与Sanatmetal髓内钉固定治疗尺桡骨单节段双骨折的比较

目的比较加压接骨板与髓内钉固定对闭合性尺桡骨干单节段双骨折的治疗效果。方法 2005年1月至2008年12月,30例闭合性尺桡骨干单节段双骨折分别采用AO接骨板与Sanatmetal髓内钉手术内固定治疗。其中18例行AO接骨板内固定;12例行Sanatmetal髓内钉内固定。骨折分型均为AO：A3型。比较两组手术时间,手术出血量,骨折愈合时间,前臂旋转功能和并发症情况。结果髓内钉组在手术时间与出血量上明显少于接骨板螺钉组,两者有明显差异;而在骨折愈合时间,前臂旋转功能方面无统计学差异。结论髓内钉在治疗成人尺桡骨单节段双骨折中,具有微创,手术时间短,二期取出方便等优点。但治疗效果无明显差异;治疗效果更多取决于术者的经验和骨折类型。     

普通钢板与普通梅花型髓内针治疗胫骨干骨折疗效对比分析

目的：对比分析普通钢板和普通梅花型髓内针手术治疗胫骨干骨折的疗效,为临床选择一个列好的治疗胫骨干骨折的方法。方法：把具有可比性的２组胫骨骨折分别采用普通钢板螺丝钉固定和普通梅花型髓内针固定,比较２组治疗结果。结果：４８例用普通钢板治疗的胫骨骨折,优良率６４．６％。４６例采用梅花型髓内针治疗的胫骨干骨折,优良率９１．３％。     

倒置微创锁定接骨板与髓内钉治疗股骨转子部骨折疗效对比分析

 目的 比较倒置使用微创锁定接骨板(less invasive stabilization system,LISS)与髓内固定治疗股骨近端转子部骨折的疗效。方法 回顾性分析2004年3月至2011年5月采用倒置LISS或髓内固定系统治疗362例股骨转子部骨折患者资料,其中采用倒置LISS固定70例(倒置LISS固定组),男32例,女38例;年龄45～87岁,平均73.4岁。采用髓内固定系统治疗292例(髓内固定组),男125例,女167例;年龄14～96岁,平均74.7岁。比较两组患者手术时间、术中出血量及住院时间、骨愈合情况、术后并发症发生率及关节功能。结果 倒置LISS固定组手术时间、术中出血量、住院时间分别平均为120 min、100 ml、12 d,髓内固定组分别平均为80 min、100 ml、10 d。倒置LISS固定组术后3例发生下肢深静脉血栓栓塞,髓内固定组术后10例发生下肢深静脉血栓栓塞、3例发生肺栓塞。倒置LISS固定组63例、髓内组257例获得随访,平均随访时间26.9个月。术后髋关节Harris评分,倒置LISS固定组为平均为75分,优良率42.9%(27/63);髓内固定组为平均77分,优良率41.6%(107/257)。倒置LISS固定组术后7例出现螺钉断裂,并发症发生率为11.1%(7/63);髓内固定组2例发生髋螺钉退出、9例发生螺钉穿入髋臼,并发症发生率为4.3%(11/257)。髓内固定组内固定相关并发症发生率明显低于倒置LISS固定组。结论 倒置LISS和髓内固定均能有效治疗转子部骨折,术后髋关节功能二者无显著差异。倒置LISS术后内固定相关并发症发生率高于髓内固定。     

交锁髓内钉与外支架治疗严重胫骨开放性骨折的疗效分析

目的:评价交锁髓内钉与外支架治疗严重胫骨开放性骨折的临床疗效。方法:严重胫骨开放性骨折患者39例,采用单侧外固定支架固定19例,男13例,女6例;年龄19~72岁,平均39岁;稳定性骨折7例,不稳定性骨折12例;合并其他部位骨折7例,颅脑损伤1例,腹部损伤2例。采用交锁髓内钉固定20例,男14例,女6例;年龄22~70岁,平均42岁;稳定性骨折8例,不稳定性骨折12例;合并其他部位骨折8例,颅脑伤2例,腹部伤1例。两组最初的伤口清创、软组织缺损的皮瓣移植修复是相同的。结果:随访时间平均为20个月(18~35个月),交锁髓内钉组骨折愈合时间(6·0±2·6)个月,外支架组骨折愈合时间为(7·0±2·5)个月。交锁髓内钉组膝关节的活动范围为115°±10°,踝关节为30°±5°,外支架组膝关节的活动范围为110°±5°,踝关节为27°±4°,髓内钉组功能恢复较好,成角畸形小。外支架组1例深部感染,4例钉道感染,髓内钉组1例深部感染。按功能评定标准,髓内钉组中优8例,良7例,中2例,差3例;外支架组中优4例,良5例,中3例,差7例。两组差异具有统计学意义(P<0·05)。比较骨折愈合时间、部分负重时间、踝膝关节的活动范围,两组之间无显著性差异。结论:在彻底清创,并且具备即刻或早期皮瓣修复的技术条件下,交锁髓内钉是治疗严重胫骨开放性骨折的理想选择。