跟骨接骨板治疗跟骨骨折56例分析

对56例累及距下关节的跟骨骨折用跟骨接骨板内固定治疗的临床资料进行回顾性分析,全组SandersⅡ、Ⅲ、Ⅳ型骨折经治疗后,47例评为优良,优良率83.9%。     

同种异体骨移植结合跟骨接骨板内固定治疗跟骨关节内骨折临床疗效分析

目的探讨通过影像学和功能恢复评估切开复位同种异体骨移植结合跟骨接骨板内固定治疗跟骨关节内骨折的临床疗效。方法笔者收集2005~2013年收治的229例跟骨骨折合并关节内压缩型患者病例,其中121例(A组)行切开复位同种异体骨移植结合跟骨接骨板手术治疗,108例(B组)行切开复位跟骨接骨板治疗。行临床和影像学随访至少2年,根据患者术前术后跟骨侧位片和轴位片测量Bohler's角和Gissane's角,同时测量跟骨高度。依据美国足踝骨科协会标准(AOFAS)评分评估功能恢复情况。结果术后A组平均负重时间(平均3.5个月)较B组(平均5.3个月)显著缩短(P0.05),Bohler's角A组较B组显著增加(P0.05)。Gissane's角恢复及跟骨高度A组较B组高,但无统计学差异。两组AOFAS评分无统计学差异。术后伤口延迟愈合发生率A组较B组显著增高(P0.05),创伤性关节炎发生率B组较A组高(P0.05)。结论术中骨移植不仅有利于患者跟骨Bohler's角度恢复,防止后期跟骨的塌陷和跟骨高度的解剖重建,而且有利于早期负重,但并发症发生率高,两组术后临床功能评估无显著差异。     

微创钢板接骨术和交锁髓内钉内固定术治疗肱骨干骨折的疗效比较

目的 比较微创钢板接骨术(MIPO)与顺行交锁髓内钉(LIN)内固定术治疗肱骨干骨折的效果.方法 回顾性分析2013年2月—2020年5月福建省立医院急诊外科收治的66例新鲜肱骨干骨折患者临床资料,32例采用MIPO治疗(微创钢板组),34例采用闭合复位顺行LIN内固定治疗(髓内钉组).微创钢板组男性19例,女性13例...     

开放植骨治疗跟骨骨折术后慢性跟骨骨髓炎

跟骨骨折采用切开复位内固定手术治疗，术后伤口感染甚至并发慢性跟骨骨髓炎已不少见，治疗非常困难。1996—2006年我科收治跟骨骨折术后慢性骨髓炎伴溃疡瘘管或皮肤缺损患者11例，采用病灶清除，Ⅰ期或Ⅱ期自体髂骨开放植骨的方法治疗，取得了满意效果。     

生物聚酯人工韧带加可吸收内固定与金属内固定治疗三踝骨折的疗效比较

笔者对 2 6例合并下胫腓韧带损伤的三踝骨折患者 ,分别采用生物聚酯人工韧带 可吸收内固定重建下胫腓韧带和金属内固定两种方法进行治疗。现就其不同疗效报告如下。内固定材料介绍1.生物聚酯人工韧带 :法国ＡＴＩＣＡＬ公司生产 ,品名Ｂｉｏｐｌｙｐｏｌｙｅｓｔｅｒｌｉｇａｍｅｎｔ,编织成不同的形状供不同的用途。本研究中选用的多功能加固韧带 ,其抗拉强度 >6 5 0Ｎ ,在体内 1年左右完全降解 ,具有良好的生物相容性 ,植入体内无任何毒性[1 ] 。2 .可吸收螺钉 :芬兰ＢＩＯＮＸ内植物公司产品 ,品名Ｂｉｏｆｉｘ ,直径 2 .0ｍｍ或3 .2ｍ…     

微创钢板接骨术与肱骨头置换治疗老年Neer四部分骨折

目的 通过前瞻性研究探讨微创钢板接骨术(minimally invasive plate osteoynthesis,MIPO)与肱骨头置换治疗老年Neer四部分骨折的疗效. 方法 胸大肌三角肌间隙人路,采用锁定钢板结合MIPO技术治疗老年新鲜Neer四部分骨折28例(A组),行人工肱骨头置换治疗相同骨折27例(B组),应用Neer评分、Constant - Murley评分以及简明肩关节问卷(simple shoulder test,SST)等评估治疗结果. 结果 A组平均随访32.1个月,2例螺钉进入关节间隙,1例大结节向后上移位,肱骨头缺血性坏死1例.平均疼痛视觉模拟评分(visual analog scale,VAS)、平均肩关节Neer评分和平均Constant - Murley评分分别为2.2分、88.6分和86.5分.SST中回答“是”的问题平均为9.0个.B组平均随访34.6个月,4例出现肩关节脱位或者半脱位,8例出现大结节移位或过度复位问题.平均VAS评分、平均Neer评分和平均Constant - Murley评分分别为2.4分、78.9分和77.3分.SST问卷中回答“是”的问题平均为8.0个.两组VAS评分比较差异无统计学意义,而并发症、Neer评分、Constant - Murley评分及SST评分结果比较差异有统计学意义,A组优于B组. 结论 对于大多数老年Neer四部分骨折,在严格掌握手术适应证及手术技巧的前提下,应用MIPO可以获得满意的结果,而人工肱骨头置换术仍存在较多尚未解决的问题,选择时需慎重.     

跟骨骨折术后切口并发症的临床分析与防治

采用切开复位钢板内固定治疗40例46足跟骨骨折,随访8～26个月,根据Maryland足部评分标准,优良率为84．7％。发生切口并发症5足,发生率为10．8％。合适的手术时机、细致的切口处理及必要时植骨,可减少手术并发症。     

X线片与内固定取出术的联系

随着病人对骨折复位要求的不断提高，骨折切开复位内固定术，以其复位准确结构牢固的优点，在临床的应用逐渐扩大。切开复位内固定术后，在骨折愈合较好的情况下，要进行内固定器械的取出术。“取出术”较为简单，但有时由于准备不充分会有意想不到的麻烦。我们曾经遇到一例。     

交锁髓内钉内固定与经皮微创接骨板内固定治疗胫骨远端骨折疗效对比

【摘要】 目的 对比分析交锁髓内钉 (IIN) 内固定与经皮微创接骨板内固定 (MIPPO) 治疗胫骨远端骨折的临床疗效。 方法 选取 2018 年 12 月至 2020 年 12 月济源市第二人民医院收治的 58 例胫骨远端骨折患者作为研究对象, 根据不同治疗方式将其分为 IIN 组 (28 例) 和 MIPPO 组 (30 例), IIN 组患者采用 IIN 内固定治疗,MIPPO 组患者采用 MIPPO 治疗, 对比观察两组患者手术相关情况、骨折愈合情况、膝关节功能、踝关节功能及术后并发症发生情况。结果 IIN 组患者术中出血量、手术时间及骨折愈合时间与 MIPPO 组均无明显差异 ( t =0.268、1.161、0.309, P= 0.790、0.251、0.759); 术后 3 个月, IIN 组患者膝关节功能及踝关节功能评分与MIPPO 组均无明显差异 (t = 0.406、0.586, P= 0.687、0.561); IIN 组患者术后 1 年感染、延迟愈合发生情况与MIPPO组均无明显差异 ( χ2 = 0.301、0.003, P = 0.583、0.960), 而畸形愈合与关节疼痛发生例数均明显多于MIPPO 组 (χ2 = 4.469、4.870, P= 0.034、0.027)。 结论 IIN 内固定与 MIPPO 治疗胫骨远端骨折的术中出血量?手术时间及骨折愈合时间均无明显差异, 且均能够有效促进膝关节功能及踝关节功能恢复, 但 MIPPO 术后骨折畸形愈合和关节疼痛发生率均明显低于 IIN 内固定, 更具优势。     

生物内固定治疗锁骨斜形骨折17例

锁骨骨折以往多采用克氏针加钢丝捆绑内固定。2001-2003年，我们采用生物内固定治疗锁骨斜形骨折17例，手术方法简便，避免了二次手术折除内固定，效果满意。     

Complications of osteosynthesis in the x-ray picture

Internal and external fixation devices are widely used in traumatology and orthopedic surgery. Early radiographic detection of complications due to bone surgery is based on a thorough knowledge of the different types of implants and their biomechanical properties. The development of early and late complications is demonstrated.     

Imaging of biodegradable osteosynthesis materials by ultrasound

OBJECTIVE: Biodegradable osteosynthesis materials are not radio-opaque and therefore not visible on conventional X-rays. The aim of this study is to investigate the use of ultrasound for imaging biodegradable materials to detect and monitor the degradation process. METHODS: Forty-six patients had two different polylactide osteosynthesis fracture plate materials used for the fixation of midfacial fractures. A 7.5 MHz ultrasound transducer with a 4.2 x 0.9 cm footprint was used by two examiners at approximately 4-month intervals over 36 months to monitor changes of the latero-orbital and infra-orbital rims. RESULTS: Intrinsically amorphous 50 : 50 poly(D,L)lactide reached the maximum of thickness (about 300% of the initial thickness) between 14 and 18 months post-implantation and was totally resorbed in clinical and ultrasound examinations 30 months post-implantation. In 85 : 15 poly(L,D)lactide plates, the maximum of thickness (about 300% of the initial thickness) was reached between 22 and 26 months post-implantation and resorption was still in progress 36 months post-implantation. CONCLUSION: Ultrasound examinations are suitable for detecting and monitoring the degradation process of biodegradable osteosynthesis plates in the peri-orbital region.     

Percutaneous osteosynthesis of pelvic fractures with CT control

Pelvis fractures, most often multiple, are frequently unstable. Orthopedic treatment is hardly bearable (traction in bed sometimes up to 45 days), the open reduction and internal fixation (ORIF) is heavy. Percutaneous fluoroscopy guided fixation lacks precision in depth. Percutaneous screw fixation with CT scan control answers these drawbacks and represents a quick solution, with few hazard when performed by a trained team and allows a very early resumption of standing.     

Percutaneous osteosynthesis in the pelvis in cancer patients

Purpose

Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. We report our experience in cancer patients.

Material/methods

We retrospectively reviewed all cases of percutaneous osteosynthesis (PO) of the pelvic ring and proximal femur performed in our hospital. PO were performed for fracture palliation or for osteolytic metastases consolidation. Screws were inserted under CT- or cone-beam CT- guidance and general anaesthesia. Patients were followed-up with pelvic-CT and medical consultation at 1 month, then every 3 months. For fractures, the goal was pain palliation and for osteolytic metastases, pathologic fracture prevention.

Results

Between February 2010 and August 2014, 64 cancer patients were treated with PO. Twenty-one patients had PO alone for 33 painful fractures (13 bone-insufficiency, 20 pathologic fractures). The pain was significantly improved at 1 month (VAS score?=?20/100 vs. 80/100). In addition, 43 cancer patients were preventively consolidated using PO plus cementoplasty for 45 impending pathologic fractures (10 iliac crests, 35 proximal femurs). For the iliac crests, no fracture occurred (median-FU?=?75 days). For the proximal femurs, 2 pathological fractures occurred (fracture rate?=?5.7 %, median-FU?=?205 days).

Conclusion

PO is a new tool in the therapeutic arsenal of interventional radiologists for bone pain management.

Key Points

? Screw fixation (osteosynthesis) can be performed percutaneously by interventional radiologists. ? CT- or CBCT-guidance results in high technical success rates for screw placement. ? This minimally invasive technique avoids extensive surgical exposure in bone cancer patients. ? Osteosynthesis provides pain relief for bone-insufficiency fractures and for pathologic fractures. ? Osteosynthesis plus cementoplasty provide prophylactic consolidation of impending pathological fractures.