单侧多功能外固定支架治疗胫腓骨骨折的研究

目的:探讨单侧多功能外固定支架治疗胫腓骨骨折的临床应用效果.方法:70例胫腓骨骨折患者随机分为治疗组和对照组,治疗组52例采用单侧多功能外固定支架治疗,而对照组单纯采用跟骨牵引、手法复位加小夹板外固定治疗.术后3天早期功能锻炼,1周后扶拐,3个月后静力改动力,观察骨折愈合情况.结果:本组病例随防5～20个月.治疗组2个月有少量骨痂生长,3个月有较多骨痂生长,6～7个月已达临床骨愈合.愈合最快4月,最慢8月,平均愈合时间6.2个月.全部病例负重功能及膝、踝关节功能完全恢复.其中疗效优良43例(占76.9%),5例疗效一般(占9.6%),总有效率86.5%.而对照组愈合最快5.5月,最慢10月,平均愈合时间7.9个月.其中18例中疗效为优良10例(占55.6%),2例疗效一般(占11.1%),总有效率66.7%.两组疗效比较有显著性差异(P<0.05).结论:单侧多功能外固定支架治疗胫腓骨骨折,能明显缩短骨折愈合时间,提高骨折愈合质量,早期功能锻炼,并发症少,操作简单、值得推广.     

胫腓骨骨折3种手术固定方法疗效比较

目的比较3种手术方法治疗胫腓骨骨折的临床疗效。方法用钢板内固定、外固定支架及交锁髓内钉治疗胫腓骨骨折336例,分别对骨痂出现时间、骨折愈合时间及各种并发症的发生情况作统计学分析。结果336例均获随访,时间1～3年,钢板内固定组骨痂出现时间平均（49±3.92）d,骨折愈合时间平均（176±14.73）d;外固定支架组骨痂出现时间平均（52±4.1）d,骨折愈合时间平均（192±15.73）d;交锁髓内钉组骨痂出现时间平均（38±4.47）d,骨折愈合时间平均（148±11.46）d。交锁髓内钉骨痂出现时间及骨折愈合时间明显缩短、并发症的发生率也最低。结论交锁髓内钉治疗胫腓骨骨折（闭合性和GustiloⅠ、Ⅱ型开放性）优于钢板内固定及外固定支架。胫腓骨骨折手术固定方法选择原则为：①胫腓骨骨折端距关节面≥8 cm,交锁髓内钉应作为内固定物首选。②胫腓骨骨折端距关节面〈8 cm,钢板与外固定支架之间,应优先考虑选用钢板固定。③若胫腓骨骨折为严重开放性粉碎性骨折或骨折伴有皮肤软组织缺损、骨外露或软组织肿胀严重,上钢板无法封闭伤口,可选择外固定支架固定。     

有限内固定结合外固定支架治疗胫腓骨开放粉碎骨折

目的 :介绍应用有限内固定结合外固定支架治疗胫腓骨开放粉碎骨折 38例的经验。方法 :胫骨骨折部行简单的内固定 ,骨折远近端垂直胫骨内侧或外侧骨面分别拧入 2枚螺丝钉 ,单侧多功能外固定支架固定。视伤口情况分别行Ⅰ期、延期或引流、冲洗全层缝合。结果 :骨折位置功能良好。骨折愈合 1 4～ 2 3周 ,2例骨不连。伤口甲级愈合 2 0例 ;乙级 1 7例 ;丙级 1例。结论 :有限内固定结合外固定支架是治疗胫腓骨开放粉碎骨折的有效方法。     

外固定支架转换内固定分期治疗复杂性胫腓骨骨折

目的探讨外固定支架转换内固定分期治疗复杂性胫腓骨骨折的临床效果。方法对51例复杂性胫腓骨骨折患者,一期急诊手术先应用外固定支架治疗,1～2周患者全身情况稳定及局部软组织愈合后,将临时外固定支架转换为确定性内固定治疗,一期转换43例,二期转换8例。其中10例皮肤软组织缺损,一期转换并皮瓣修复8例,二期转换并皮瓣修复2例。结果51例均获随访,随访时间9—36个月,平均18个月。51例伤口全部愈合,其中3例伤口表皮发生坏死,经过换药后愈合。全部患者获得骨性愈合,平均愈合的时间为（7．25±1．85）个月,1例发生骨折延迟愈合,将髓内钉的远端交锁钉拆除,改为动力性加压及植入同种异体骨后,骨折在10个月后愈合。结论骨折外固定支架转换为内固定分期治疗复杂性胫腓骨骨折是一种更加安全有效的治疗方法。     

SGD单臂外固定支架治疗胫腓骨骨折148例报告

目的：探讨SGD单臂外固定支架对胫腓骨骨折的疗效。方法：1991年以来应用SGD单臂外固定支架治疗148例胫腓骨骨折，其中：男112例，女36例；年龄：5－68岁；开放性骨折98例，合并严重软组织损伤17例，闭合骨折50例中手法复位后闭式经皮穿钉22例，骨折处有限切口穿钉28例。结果：91例15周骨折愈合，54例16－28周骨折愈合，2例多 段骨折合并软组织损伤经小腿肌皮瓣转移14－18个月骨折愈合，仅1例不愈合，改用髓内钉植骨内固定治愈。结论：经临床6个月－9年随诊观察，疗效满意。     

单轴双向锁定外固定支架治疗胫骨骨折患儿的护理

对40例胫骨骨折患儿采用单轴双向锁定外固定支架治疗，同时进行术前、术后护理及功能锻炼指导。结果术后4周患儿骨痂生长良好，12周骨折处达临床愈合，无1例发生并发症；随访6～20个月，患儿活动、站立、行走功能正常，X线摄片骨折线消失。     

骨外固定加简单内固定治疗胫腓骨粉碎性骨折

目的：回顾性分析骨外固定结合简单内固定术在胫腓骨粉碎性骨折中的应用,探讨其可行性。方法：３０例接受此手术。利用少量内固定将骨折端较大碎骨片固定于胫骨干后,使不稳定骨折变成稳定骨折,然后用“Ｕ”形骨外固定架固定。结果：术后１个月可适量负重,３～４月摄Ｘ线片示纤维骨痂愈合后,取外固定架。术后１年骨愈合后取出内固定物,患肢功能恢复良好。结论：利用骨外固定结合简单内固定治疗胫腓骨粉碎骨折,创伤小、并发症少     

螺管支架固定牵引器治疗胫腓骨干骨折

目的：介绍螺管支架固定牵引器的使用方法和治疗腓骨干骨折的临床特性。方法：用自蝗螺管支架固定牵引器治疗胫腓骨干骨折80例,并与跟骨牵引组在X线片骨痂,踝关节僵硬,临床痊愈等方面对照研究,结果：螺管支架组在6周后的骨痂X线评分及防止踝关节僵硬,促进骨折愈合等方面明显优于跟骨牵引组,结论：螺管支架固定牵引器适合于胫腓骨干各型骨折,操作简便,疗效可靠。     

低频可控性微动影响长骨骨折愈合的实验研究

目的应用可控性微动外固定支架研究骨折端低频微动对骨痂增殖和骨折愈合的影响。方法绵羊39只,双侧胫骨中段横行截骨,间隙2mm,用连有微动装置的单边外固定支架固定。术后10d,随机选择一侧肢体进行微动,按不同的微动频率分为3组:A组0.5Hz,B组1Hz,C组5Hz;幅度为0.25mm,4周结束(30min/d)。另一侧肢体不微动,为对照组。分别于术后4、6、9周切取标本进行大体观察、X线检查、组织学检测及生物力学测试。结果大体与X线检查显示各实验组均有大量的骨痂生成,4周末达高峰;组织学检测显示微动组骨痂软骨内骨化与类骨质形成的速率在6周最为明显,均快于对照组,以B组形成速率最快。9周末生物力学测试微动组弯曲刚度均强于对照组,以B组的力学强度最大。结论骨折端低频微动在骨折愈合早期均能有效地促进骨痂生长,加速骨痂的矿化,以1Hz频率效果最佳。     

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     

A standardized experimental fracture in the mouse tibia

The increased use of transgenic mice as experimental animals provides new opportunities to study the biology of fracture repair. We have developed a technique for the production of a standard closed experimental fracture in the mouse tibia. A 0.2 mm stainless-steel rod was introduced into the medullary cavity and the pre-nailed tibial shaft was fractured by an impact device, which resulted in a reproducible transverse or slightly oblique fracture pattern. The intramedullary rod maintained axial alignment, and the fractures united without displacement. On the basis of measurements of callus geometry, four-point bending tests, biochemical analyses, and quantitative histology, the progress of callus formation and remodeling occurred in a predictable sequence of healing phases. The ultimate bending loads of the fractures increased with time, reaching 74% of the strength of intact control tibias in 4 weeks. The stiffness values of the fractures returned to normal levels and, as determined radiographically, the fractures united by external callus in 4 weeks. Radiographically, callus size, cross-sectional callus area, and callus mass peaked at 2 weeks and decreased thereafter, indicating the start of external remodeling. Histologically, the amount of mesenchymal tissue was maximal at days 5 and 7. The callus cartilage area peaked at day 9; at its maximum, it accounted for 46% of the total callus area. Early periosteal formation of membranous new bone, followed by endochondral ossification, resulted in a linear increase of callus bone during the healing process. The healing sequence of the mouse tibial fracture was similar to that seen in the rat tibia. The major difference is the small size of the mouse, which makes the surgical technique and anesthetic procedures more demanding.     

儿童闭合性胫腓骨骨折的外固定架治疗

目的探讨儿童闭合性胫腓骨骨折Orthofix单臂外固定架治疗的疗效,分析外固定架治疗的优缺点。方法 2001年8月～2008年11月,应用单臂外固定架(Orthofix SRL公司)治疗169例儿童胫腓骨骨折,其中单侧闭合骨折97例纳入本组。采用在C形臂或G形臂透视下进行闭合复位,Orthofix外固定架固定。结果手术时间35～160min,平均54min;出血量都在10ml以下。17例固定过程中出现Ⅰ～Ⅱ级针道感染,通过换药等手段控制,无一例因针道感染导致外固定架失效。固定过程中膝关节及踝关节活动均不受影响。骨性愈合时间12～24周,平均14.2周。23例过度生长不超过1cm。97例术后随访15～39个月,平均31个月,骨折全部骨性愈合。结论应用外固定架治疗儿童闭合性胫腓骨骨折,不破坏骨折端血运,且可提供牢固固定,允许早期关节活动及负重练习,减轻了护理负担。     

微创经皮钢板内固定治疗胫腓骨骨折的体会

目的报道以生物学内固定及间接复位技术为基础，微创经皮LC-DCP钢板内固定治疗胫腓骨骨折的临床疗效。方法应用间接复位技术，通过建立胫骨内侧皮下隧道，采用LC-DCP钢板内固定治疗胫腓骨折28例。结果全部病例获得随访，时间为10～18个月(平均15个月)。X线片见骨痂为4～7周(平均4．6周)，骨愈合时间为12～18周(平均12．8周)。全部病例Ⅱ期骨愈合，无骨不愈合或延迟愈合，无钢板松动等并发症，其中15例已拆除钢板，无再骨折现象发生。结论微创经皮LC-DCP钢板内固定治疗胫腓骨骨折符合生物学固定的原则，疗效满意。     

手法复位经皮微创锁定钢板固定治疗胫腓骨远端骨折60例

目的：探讨闭合手法整复经皮微创锁定钢板内固定治疗胫腓骨远端骨折的临床疗效。方法：自2009年至2011年采用闭合手法复位经皮微创锁定钢板内固定治疗60例胫腓骨远端骨折患者,其中男32例,女28例;年龄14-70岁,平均（41.22±2.06）岁。按AO骨折分型：A1型5例,A2型22例,A3型21例,C1型12例。术后观察并记录手术时间、术中出血量、骨痂出现时间、骨愈合时间,并采用Mazur踝关节评分系统对术后疗效进行评价。结果：术后Ⅰ期愈合58例,胫骨远端切口感染2例。手术时间45-90 min,平均（62.34±5.66）min;术中出血30-150 ml,平均（80.57±5.59）ml;X线片示骨痂出现时间4-12周,平均（8.24±2.06）周;骨愈合时间3-6个月,平均（4.50±1.13）个月。根据Mazur踝关节评分系统评价功能：优40例,良18例,中2例。结论：采用闭合手法整复经皮微创锁定钢板内固定治疗胫骨远端骨折,能更好地保护骨折部位的血供,同时取得更小微创切口条件下的可靠骨折固定,可获得满意的临床疗效,是治疗胫骨远端骨折的最佳选择之一。     

Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures

BACKGROUND: While fracture healing has been well characterised in long bones, there is scant data relating to this process in acute vertebral body fractures. AIM: To characterise the histological process of fracture healing in acute osteoporotic vertebral body fractures using qualitative and quantitative bone histomorphometry. SUBJECTS AND METHODS: Transpedicular bone biopsy was performed in patients undergoing percutaneous vertebroplasty. Undecalcified biopsy specimens were prepared from cores of cancellous bone harvested from vertebral bodies with MRI evidence of bone marrow oedema. These were analysed by light microscopy using grid analysis and defined using bone histomorphometry criteria. Normative data obtained from 5 age-matched volunteers without evidence of metabolic bone disease or osteoporosis was used for comparison. RESULTS: Adequate biopsy specimens were obtained in 72 of 90 patients (15 men and 57 women), mean age 75.6 years. All biopsies confirmed severe osteoporosis with reduced cancellous bone volume (mean of 13.5%; P<0.001 compared to controls). The timing of biopsies varied from 1 to 24 weeks (median of 6 weeks) after the fracture event. There were 4 stages of fracture callus healing observed: Stage I in 17 (24%) patients, Stage II in 16 (22%), Stage III in 22 (30%) and Stage IV in 17 (24%). An overlap between the various stages was evident with 55 (76%) patients demonstrating at least 2 or more of the stages of fracture healing in the same biopsy specimen. The time interval since fracture event was the most important predictor of the stage of the fracture callus (R=0.32; P<0.001). CONCLUSION: Our data demonstrates a mixed fracture callus with overlapping of the various stages of fracture healing. This suggests that individual vertebra may be susceptible to multiple fractures over the course of the healing process.     

形状记忆锯齿臂环抱内固定器固定后骨折愈合的动物实验观察

以镍钛形状记忆合金制成锯齿臂环抱内固定器作犬股骨干骨折固定,对骨折愈合过程中外骨痂和连接骨痂行组织学观察.结果表明骨折为典型的Ⅱ期骨折愈合:固定1月后可见明显外骨痂,骨痂内多为典型编织骨结构,胶原纤维稀疏、紊乱;术后2月骨痂量更多,骨痂的不少部位已转化为板层骨,胶原纤维趋向密集整齐;术后3月骨痂已为板层骨结构,已有哈氏系统形成.作者认为,该内固定器消除了骨折端的剪切力和扭转力,保留了压缩应力,同时对髓内血管、骨内膜无损伤,有利于骨折愈合,为长骨干骨折的内固定治疗提供了一种新方法.     

Site-specific CGRP innervation coincides with bone formation during fracture healing and modeling: A study in rat angulated tibia.

Sensory neuropeptide involved in local bone turnover is known, but poorly understood. In the present study, we analyze the occurrence of neuronal CGRP during healing and modeling of straight and angular tibial fractures in 74 rats. Bone healing and modeling was assessed by radiography and reinnervation by semi-quantitative immunohistochemistry method at fracture site between 1-12 weeks postfracture. The regenerating nerve fibers containing CGRP were observed in fracture callus as well as in close proximity to chondrocytes, with woven bone in both fractures already at week 1. Notably, it located predominantly on the concave side of angulated fracture in the manner of sprouting into bone from weeks 3 to 5 postfracture. In both fractures, fracture calluses peaked radiographically at week 3 postfracture. In angulated fracture, a reduction of 11% in callus thickness on convex side and an increase of 365% on concave side were noted from weeks 3 to 12. A 27-fold increase in total neuronal CGRP in straight fracture and 38-fold increases in angular fracture compared to intact bone was observed at week 3. In both types of fracture, neuronal CGRP was greater on the concave side than the convex; this difference was more pronounced in the angulated fracture. CGRP immunoreactivity clearly coincides with amount of new bone formation especially on the concave side of angulated fracture. The combined results suggest that fracture evokes an intense, localized in-growth of new nerve fibers containing CGRP, which may prove to be a prerequisite of fracture healing and modeling.     

Changes in total alkaline phosphatase level after hip fracture: comparison between femoral neck and trochanter fractures

Background Biochemical bone metabolic markers are affected by fractures, and total alkaline phosphatase (ALP) is considered one of the bone formation markers. Only a few reports have dealt with changes in bone formation markers during the healing process of bone fragility hip fractures. Despite the difference in the amount of callus formation and bone fusion rate, no significant differences in longitudinal change of total ALP between femoral neck and trochanter fracture have been reported. Methods A total of 69 osteoporotic patients with femoral neck or trochanter fracture whose serum concentrations of total ALP were examined at least four times at six periodic examination points (1, 2, 3, 4, 6, and 8 weeks after surgery) and whose state of bone union was obtained within 24 weeks after surgery were selected for this retrospective study. The characteristic longitudinal change of total ALP during the healing process was shown, and the possibility of total ALP as a predictive factor for the state of osteosynthesis of hip fractures is discussed. Results Changes in the total ALP level according to the healing process were similar for femoral neck and trochanter fractures. The concentration of total ALP rose to a maximum at 3 weeks after surgery and then gradually decreased for both fractures. However, the range of change was significantly greater for trochanter fractures than for femoral neck fractures. For trochanter fractures, total ALP decreased from 3 to 6 weeks after surgery in all but one patient. Conclusions Increases in the concentration of total ALP after surgery and the subsequent decreases may reflect the normal healing process. A significant difference in the changes of total ALP after surgery between femoral trochanter and neck fractures was shown. Periodic measurement of total ALP might be useful for obtaining information on the osteosynthesis state.     

体外冲击波在促进骨愈合中的应用

目的:观察体外冲击波促进骨折愈合、治疗骨不连的疗效。方法:选取22例外伤性骨折愈合延迟、骨不连患者进行体外冲击波冲击治疗,治疗后每4～6周进行X线片复查,观察骨折愈合情况。首次冲击波治疗12周后如骨折处无明显骨痂形成,则进行第2次冲击波治疗。冲击波能量为0.4mJ/mm2,每次脉冲总数为1600～2400次。结果:22例下肢外伤性骨折愈合延迟及骨不连经体外冲击波治疗后,骨性骨痂形成的时间为4～12周,20例有明显骨痂形成,其中17例在治疗后3～6个月内骨折完全愈合。2例胫骨下段骨折冲击波治疗无效。结论:体外冲击波在治疗骨不连,促进骨折愈合方面效果满意,有广阔的应用前景。