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1.
目的分析胫骨骨折单臂外固定架固定术后出现足足母下垂的发生率、危险因素、原因及预防措施。方法对110例胫骨骨折单臂外固定架固定的患者进行回顾性分析。结果本组术后5例出现足足母下垂伴趾蹼区麻木,平均年龄30.2岁,均为术后24 h内出现。4例行切开复位外固定术,1例行闭合复位外固定术。3例获得随访,术后6个月2例肌力恢复为Ⅴ级,1例恢复为Ⅳ级。结论腓深神经损伤、亚临床前筋膜室高压、腓深神经血供受损及术中的直接损伤是胫骨骨折单臂外固定架固定术后出现足足母下垂的部分原因,但仍有一些原因不甚明了,在应用外固定架后如何减少足足母下垂的发生率及前筋膜室内腓深神经生理学影响因素等有待进一步分析总结。 相似文献
2.
目的探讨单臂外固定架辅助闭合复位,交锁髓内钉内固定治疗股骨干多节段骨折手术方法及疗效。方法采用单臂外固定架辅助闭合复位,交锁髓内钉内固定治疗股骨干多节段骨折14例。结果本组均获7~24个月随访,平均15.3个月,骨折愈合时间14~25周,平均愈合时间16.8周。所有骨折均愈合,无断钉或邻近关节功能障碍。肢体功能恢复按Karlstron标准评价:优12例,良2例。结论单臂外固定架辅助闭合复位,交锁髓内钉内固定治疗股骨干多节段骨折创伤小,操作简单,复位有效,骨折愈合率高,并发症发生率低。 相似文献
3.
三维多功能外固定架治疗胫骨骨折疗效分析 总被引:2,自引:1,他引:1
目的观察三维外固定架固定胫骨骨折的治疗效果,探讨并发症及处理方法。方法对159例新鲜胫骨骨折采用三维外固定架闭合复位或结合切开复位有限内固定治疗。结果术后随访10~30个月。按Johner-Wruhs评分标准:优110例,良41例,可7例,差1例,总优良率95%。结论三维多功能外固定架治疗胫骨骨折具有操作方便、创伤小、愈合率高、功能恢复快等优点。术中规范化安装外固定架、术后正确管理外固定架及指导功能锻炼可降低并发症发生率。 相似文献
4.
目的探讨单边外固定架固定治疗闭合性胫骨干骨折时采用切开复位的临床效果。方法选择120例胫骨干闭合性骨折的患者,在条件尽可能相近的情况下分为两组,每组60例,一组采用切开复位,另一组采用闭合复位,复位后两组均使用单边外固定架固定。术后随访一年半。对其复位情况、骨折愈合情况、钉道及局部感染以及手术所用时间进行分析,并做统计学处理。结果切开复位组的解剖复位率明显高于闭合复位组(P〈0.01),骨折愈合两组无统计学上的差异(P〉0.05),钉道及局部感染情况两组相似,切开复位平均所用时间较闭合复位短。结论在使用单边外固定架固定治疗胫骨干闭合骨折时采用切开复位是一种很好的方法。 相似文献
5.
混合式单臂外固定架骨延长术治疗感染性骨不连 总被引:12,自引:1,他引:11
目的评价混合式单臂外固定架骨延长术治疗长骨干骺端感染性骨不连的初步临床结果。方法2003年1月至2006年2月采用混合式单臂外固定架固定、局部清创和截骨延长法治疗感染性骨不连21例,男17例,女4例;年龄18~48岁,平均31.5岁。16例为开放骨折内固定术后感染,5例为闭合骨折内固定术后感染。胫骨近端12例,胫骨远端6例,股骨远端3例。12例行骨折端植骨,其中2例二次植骨。结果21例术后随访10~36个月,平均18个月。18例骨折获得初期愈合,3例骨折愈合时仍有局部窦道和渗液,2例骨折尚未完全愈合,1例行截肢术,20例感染得到控制。改良ASAMI骨评定结果为优良13例,中4例,差4例;功能评定结果为优良11例,中6例,差4例。平均骨延长5.6cm,平均愈合时间为11个月。15例发生钉道感染。结论对长骨干骺端感染性骨不连可使用混合式单臂外固定架骨延长术、骨折端开放换药的方法。该方法控制感染好,可自体修复骨缺损,供区畸形发生率低。但固定需采用HA涂层螺钉,严格控制延长速度,一般在1mm/d以内,分次进行延长,手术风险小。 相似文献
6.
目的探讨单臂外固定架治疗胫骨远端骨折的疗效。方法根据骨折分型确定外固定针的安放部位,A型骨折在骨折两端置外固定针;远端骨折块过小不能容纳外固定针者以及B和C型骨折在骨折近端和跟骨及距骨安放外固定针。撑开复位,复位困难者部分切开复位,植骨螺钉或克氏针固定,合并腓骨骨折同时行切开复位内固定。结果22例外固定架固定3.5-8个月,平均5个月,骨折均愈合,无严重深部感染、骨髓炎、骨折不愈合等严重并发症。随访10-32个月,平均20个月,拆除外固定架康复6个月以上,按Tornetta胫骨远端骨折治疗标准,优11例,良7例,可3例,差1例。结论单臂外固定架固定联合有限切开内固定是治疗胫骨远端骨折简单有效的微创治疗方法之一。 相似文献
7.
应用微型外固定架治疗第1掌骨基底部骨折 总被引:12,自引:0,他引:12
目的探讨应用微型动力型外固定架治疗第1掌骨基底部骨折的方法及疗效,分析其治疗时限、适应证和治疗方法.方法自2002年10月至2004年12月,应用微型外固定架治疗37例不同类型第1掌骨基底部骨折,其中Ⅰ型(Bennett骨折)19例,Ⅱ型(Rolando骨折)10例,Ⅲ型8例.根据受伤时间和骨折类型选择治疗方法.新鲜Ⅰ型骨折主要采取闭合复位外固定架固定,如果骨折欠稳定可加用闭合复位克氏针固定;陈旧骨折可先试行闭合复位外固定架牵引,如果复位失败则行切开复位克氏针加外固定架固定.新鲜Ⅱ型骨折先试行闭合复位外固定架固定,如果对位不佳则行切开复位克氏针加外固定架固定;陈旧骨折则直接行切开复位内固定加用外固定架.新鲜Ⅲ型骨折行闭合复位外固定架固定,陈旧骨折行切开复位外固定架固定.结果所有病例均获得随访,随访时间为6~24个月,平均15个月.37例骨折均顺利愈合,闭合复位愈合时间平均为5.5周,切开复位愈合时间平均为7.5周.术后评价疼痛程度、拇指活动度和创伤性关节炎发生率,总优良率为94.6%,术后未发生严重并发症,疗效满意.结论应用微型外固定架治疗第1掌骨基底部骨折,方法简单、损伤小、复位固定可靠、骨折愈合时间短,可有效降低术后关节疼痛、关节活动受限和创伤性关节炎的发生率,是治疗第1掌骨基底部骨折的有效方法. 相似文献
8.
9.
外固定支架穿针致腓总神经损伤5例 总被引:1,自引:0,他引:1
黄恩铭 《中国骨与关节损伤杂志》1998,(1)
自1990年至1995年间曾用Bastiani单侧外固定支架法治疗胫腓骨骨折63例,出现程度不等的腓总神经损伤5例。手术采用硬膜外麻醉,在小腿内侧胫骨骨折两端,分别平行钻入两枚螺纹针,然后安固定器,使固定器与4枚针连接,继之在X线指示下调整复位以达到解剖复位;拧紧各个装置的固定螺丝。术后第2天查房时发现三例患者出现小腿近足外侧皮肤麻木,拇伸肌力减退,患足下垂等症状。考虑为腓总神经损伤所致。在透视下查看骨折断端位置及4枚固定针的位置及走向。发现近端固定针从内侧进针后通过上胫 相似文献
10.
目的 评估消毒铺巾后去除外固定架再一期转换为内固定治疗开放性胫骨干骨折时手术部位感染的风险。方法 纳入自2018-08—2020-12采用外固定架临时固定需转为内固定治疗的78例开放性胫骨干骨折,43例去除外固定架后再进行消毒铺无菌巾、内固定手术操作(A组),35例消毒铺无菌巾后去除外固定架并直接进行内固定手术(B组)。比较A组与B组骨折闭合复位患者比例、手术时间、切口放置引流管患者比例、手术部位感染发生率。结果 A组与B组骨折闭合复位患者比例、手术时间、切口放置引流管患者比例、手术部位感染发生率比较差异无统计学意义(P>0.05)。结论 对于初始治疗采用外固定架固定的开放性胫骨干骨折患者,只要具备了一期转换内固定的条件,建议在充分保护术区的前提下,将消毒铺无菌巾后再去除外固定架作为常规操作流程。 相似文献
11.
腓骨骨折术后并发(足母)趾屈曲畸形的治疗 总被引:3,自引:0,他引:3
目的 探讨腓骨骨折切开复位内固定术后并发拇趾屈曲畸形的病因、临床表现、解剖学特征、诊断及治疗方法。方法 1996年10月至2004年3月,腓骨骨折术后并发拇趾屈曲畸形患者33例,男19例,女14例;年龄22-49岁,平均33.2岁。其中合并踝关节骨折24例,根据Lauge—Hansen分型:旋前-外旋型18例,旋后-外旋型4例,旋前-外翻型2例;胫腓骨远端1/3螺旋形骨折9例。腓骨骨折均行切开复位钢板螺钉内固定术。患者均于术后1-5个月,平均3个月出现拇趾屈曲畸形。其中单纯拇趾屈曲畸形19例,伴二、三趾屈曲畸形8例,伴二至五趾屈曲畸形6例。采用单纯肌腱粘连松解术、单纯拇长屈肌腱延长或合并趾长屈肌腱延长术矫正畸形。结果19例单纯拇趾屈曲畸形患者,7例行单纯拇长屈肌腱粘连松解术,12例行拇长屈肌腱延长术。14例合并其余足趾屈曲畸形患者,6例行单纯拇长屈肌腱延长术,8例行拇长屈肌腱合并趾长屈肌腱延长术。术后随访2-10个月,平均6个月,所有患者足趾畸形完全矫正,疼痛缓解,步态及穿鞋改善,无畸形复发。结论 腓骨骨折术后并发拇趾屈曲畸形,拇长屈肌腱与骨折处粘连是重要因素。在Henry结部位,拇长屈肌腱与趾长屈肌腱之间存在腱性连接的解剖变异,对于足部矫形手术具有特殊的临床意义。 相似文献
12.
Robinson CM O'Donnell J Will E Keating JF 《The Journal of bone and joint surgery. British volume》1999,81(3):481-484
We made a prospective study of 208 patients with tibial fractures treated by reamed intramedullary nailing. Of these, 11 (5.3%) developed dysfunction of the peroneal nerve with no evidence of a compartment syndrome. The patients with this complication were significantly younger (mean age 25.6 years) and most had closed fractures of the forced-varus type with relatively minor soft-tissue damage. The fibula was intact in three, fractured in the distal or middle third in seven, with only one fracture in the proximal third. Eight of the 11 patients showed a 'dropped hallux' syndrome, with weakness of extensor hallucis longus and numbness in the first web space, but no clinical involvement of extensor digitorum longus or tibialis anterior. This was confirmed by nerve-conduction studies in three of the eight patients. There was good recovery of muscle function within three to four months in all cases, but after one year three patients still had some residual tightness of extensor hallucis longus, and two some numbness in the first web space. No patient required further treatment. 相似文献
13.
Ariffin HM Mahdi NM Rhani SA Baharudin A Shukur MH 《Strategies in trauma and limb reconstruction (Online)》2011,6(1):21-26
High-energy tibial plateau fractures associated with severe soft tissue injury are difficult to manage. The risk of wound
complications following open reduction and internal fixation is notably high owing to extensive soft tissue dissection. Alternatively,
application of hybrid external fixator minimizes soft tissue dissection and provides adequate fracture stabilization to allow
early range of motion and correction of any mal-alignment. With this technique, soft tissue complications particularly surgical
site infections are expected to be significantly reduced. This prospective study aims to determine the effectiveness of a
modified hybrid external fixator in the management of high-energy tibial plateau fractures. Thirty-three patients with high-energy
Schatzker V and VI tibial plateau fracture with severe soft tissue injury precluding formal open reduction were enrolled into
the study. The fixator was a construct combining the Ilizarov ring with a monolateral external fixator. The results—bony union,
range of motion, and associated complications of the treatment—were assessed. All fractures united within an average time
of 14 weeks. Neither loss of reduction nor surgical site wound breakdown/osteomyelitis was noted. Eight patients developed
superficial pin track infection and one septic arthritis of the knee joint. Hybrid external fixation is a safe option for
complex high-energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and protection of
soft tissue healing to achieve bony union. The complication is mainly related to pin tract infection. 相似文献
14.
Ipsilateral fractures of the femur and tibia. 总被引:7,自引:0,他引:7
From October 1987 to September 1990, 32 patients with ipsilateral fractures of the femur and the tibia were treated. There were 20 men and 12 women with a mean age of 27 years (range 18-75 years). All were caused by road accidents. There were 7 femoral and 22 tibial open fractures. The management of the fractures was partially the same. The tibial fractures were reduced and stabilized by a unilateral external fixator, while in 29 out of 32 femoral fractures, a closed intramedullary nailing was performed. The remaining three patients with an open grade III fracture were initially treated by external fixation, with two of them converted into nailing. The time of hospitalization ranged from 12 to 105 days (mean 30 days). The femoral fractures healed in an average of 15.5 weeks, while the tibial fractures healed in 18.5 weeks. The evaluation of our results was made according to Karlstrom and Olerud's criteria. We achieved 81 per cent excellent or good results and 19 per cent acceptable or poor, in a follow-up time of 19.5 months. 相似文献
15.
组合式外固定架治疗胫腓骨骨折 总被引:17,自引:5,他引:12
目的探讨组合式外固定支架治疗胫腓骨骨折的临床意义、疗效及指征。方法回顾分析自1996年1月至2001年11月间采用组合式外固定支架治疗的胫腓骨骨折152例,其中开放性骨折63例,闭合性骨折89例。采用小切口直视下解剖复位45例。改良了螺纹半针代替拉力螺钉治疗斜形、螺旋形或蝶块分离较大的不稳定性骨折。结果随访3~32个月,平均12个月,146例骨性愈合,占96%。骨折愈合时间2~8个月,平均5个月。其中解剖复位螺纹半针折块间加压组2.5个月,功能复位组5.3个月。带外固定架时间2~9个月,平均4.7个月。术后17例针道轻度感染,3例胫腓骨远端重度开放性骨折术后骨髓炎,无其它严重并发症发生。6例骨折不愈合的患者改为带锁髓内钉固定后愈合。结论组合式外固定架适用于严重开放性、粉碎性及邻近关节面的骨折。小切口直视下解剖复位有利于骨折的早期愈合。 相似文献
16.
Peter Reynders 《Injury》2009,40(4):449-454
Aim
To evaluate the Less Invasive Stabilisation System (LISS) in the treatment of segmental tibial fractures.Methods
A prospective series of 23 consecutive open acute segmental tibial fractures were treated with a long LISS plate, in a university hospital. All but three fractures were temporarily fixed with a unilateral external frame. The minimal follow-up was 2 years.Results
Mean age of the casualties was 34 (17-72) years, all but two were male and all were involved in high-energy accidents, had multiple injuries and open fractures. Of the fractures, 4 were grade IIIA, 16 grade IIIB and 3 grade IIIC. It was possible to span the distal fracture with the LISS plate in 20 cases; of these, 3 developed compartment syndrome. Two people with trifocal fractures required additional distal plates, one of which became loose and infected, resulting in a malunion of 8°. Dermatofasciotomy was performed in 13 cases, in 10 of these as a preventive measure and in 3 because of impending compartment syndrome. In five cases a post-fixation neural palsy of the extensor hallucis longus was observed. All except three fractures healed; mean time for union for the proximal fractures was 16 (10-24) weeks and for the distal fractures was 22 (16-44) weeks.Conclusion
Use of the LISS plate in fixing these difficult fractures is commended, but immediate fixation should be avoided. A staged sequential procedure with a temporary spanning external fixation and definitive treatment after soft-tissue healing is preferred. 相似文献17.
Forty-one consecutive tibial diaphyseal fractures that required operative stabilization were treated using the external fixator and concepts of compression-distraction of Ilizarov. Eleven fractures had bone loss greater than 1 cm and were managed by simultaneously compressing the fracture gap and distracting through a corticotomy site to maintain extremity length. Thirty tibial fractures consisted of closed unstable and open fractures that were managed using the external fixator, emphasizing immediate weight bearing and gradual compression at the fracture site. Twenty-six fractures in 23 patients were available for follow-up evaluation six to 9.5 months after bone healing. There were six closed, two Grade I, eight Grade II, five Grade IIIA, and five Grade IIIB fractures. Serial wound debridements, wet-to-dry-dressing changes, wound- and fracture-site compressions (13 fractures), and split-thickness skin grafts (eight wounds) were used to accomplish wound closure. Chronic infections did not occur. All fractures healed from 12 to 47 weeks without bone grafting. Eight transosseous fixation wires are used, only two of which transfixed significant muscle. Approximately 10% of the 248 wire sites became inflamed and nine wire sites were treated for infection with antibiotics, skin release around the offending wire, or wire removal. Three wires fractured and one wire was replaced. One ring sequestrum occurred and responded to curettement. Angulation of 7 degrees-9 degrees occurred in five fractures (19%). The results were good or excellent in 25 fractures. One patient with 9 degrees varus in a distal fracture refused correction. Operative time was 60 to 90 minutes after developing a satisfactory protocol for frame application. This method allows immediate functional stabilization of tibial diaphyseal fractures and postoperatively allows ease of fracture gap closure and compression. The frame can be left in place for the duration of the fracture care. Application of the Ilizarov external fixator is slightly more complicated than traditional large pin fixators and requires more attention to detail intraoperatively and postoperatively, but can be a versatile tool in the management of complex tibial shaft fractures. 相似文献
18.
《The Journal of foot and ankle surgery》2014,53(6):791-793
The present study reports a case with concomitant tethering of the flexor tendon and extensor tendon of the hallux after closed tibiofibular shaft fractures. We have obtained good clinical results using tenotomy of the flexor hallucis longus tendon and Z-plasty lengthening of the extensor hallucis longus tendon. Because few studies have described the clinical results and operative methods for this type of combined deformity, we report a case with dynamic positional deformity of the hallux. 相似文献
19.
单边外固定器治疗股骨髁上髁间复杂性骨折 总被引:1,自引:0,他引:1
目的探讨应用单边外固定器治疗股骨远端复杂骨折的适应证及治疗效果。方法21例股骨髁上髁间粉碎性骨折患.先采用膝前内侧切口。行股骨髁间骨折复位,解剖复位关节面,于股骨外髁部定位直视下用特制外固定螺纹针加压固定两髁部骨折。透视下闭合牵引复位髁上骨折,并撬拨整复游离骨折片,于骨折近端定位置人外固定针。安装紧固外固定器行骨折固定。结果随访时间8~24个月。平均13.2个月。骨折在4~7个月内全部愈合,并去除外固定器。2例患外固定针道感染,经去除固定针局部换药后愈合。根据Rasumssen评分(总分30分,膝关节活动功能0~6分)评价患膝关节功能恢复情况,优良16例(76.2%),一般4例(19%),差1例(4.8%)。结论单边骨外固定器治疗股骨髁上髁间复杂性骨折,具有创伤小。血运破坏少。骨折复位满意,可以早期功能练习等优点。尤其适用于应用内固定难以处理的长节段股骨髁上髁间粉碎性骨折,外固定器可多向、多部位调节,对骨折起到牵引、复位和固定的作用。 相似文献
20.
Mehmet Subasi Ahmet Kapukaya Huseyin Arslan Emin Ozkul Oguz Cebesoy 《Journal of orthopaedic science》2007,12(4):347-353
Background The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal
internal fixation and circular external fixation frames.
Methods Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was
reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line
or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue
reconstruction, and stabilization of the fracture using a circular external fixator were carried out.
Results The patients were followed for an average of 32 months (range 24–54 months). The average time to union of the fractures and
frame removal was 22.8 weeks (range 16–44 weeks). The quality of the reduction of the joint surface was rated as anatomical
in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss
of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good,
one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion,
and four with loss of reduction.
Conclusions This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior
wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction
in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal
fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures. 相似文献