小腿前内侧入路加压钢板内固定治疗胫腓骨骨折

目的探讨采用小腿前内侧入路加压钢板内固定治疗胫腓骨骨折可行性。方法对按Gustilo分类Ⅰ型、Ⅱ型胫腓骨骨折病例19例，按AO及BO固定原则，经小腿前外侧入路行加压钢板内固定治疗。结果术后随诊平均2．5年(2～5年)。结合临床和X线片等综合评定，愈合率100％。结论采用小腿前内侧入路加钢板内固定治疗胫腓骨骨折，手术损伤小，血运破坏轻，固定可靠，能有效提高骨折愈合率。     

小腿内侧入路钢板内固定治疗胫腓骨骨折

小腿内侧入路钢板内固定治疗胫腓骨骨折胡伯红在创伤骨折中，小腿双骨折最为多见，且钢板内固定是常用的治疗方法。传统的手术方法因考虑到钢板应深埋于肌肉下而置钢板于胫骨外侧面。但从生物力学和解剖学的观点以及ＡＯ技术的原则来分析，小腿双骨折后，胫骨骨折端受小腿...     

小腿前内侧入路加压钢板内固定治疗胫腓骨骨折

自1998—2003年，我院采用小腿前内侧入路加压钢板内固定，共治疗胫腓骨骨折19例，疗效满意，现总结报告如下。     

支持钢板内固定治疗胫腓骨下段骨折

目的：支持钢板治疗胫骨腓骨下段骨折，方法：胫骨内侧入路切开复位，支持钢板置于胫骨内侧固定，同时固定腓骨，结果：术后可以早期功能锻炼，无一感染，骨不连等，踝关节功能恢复满意。结论：胫腓骨下段骨折采用支持钢板内固定，符合生物力这，AO要求，有很好的疗效，是手术治疗胫腓骨下段骨折的主要手段之一。     

小腿单一前外侧切口内固定治疗胫腓骨远端骨折

目的研究小腿单一前外侧切口入路手术治疗胫腓骨远端骨折的临床疗效。方法笔者自2013-03—2015-12采用单一前外侧切口手术治疗18例闭合性胫腓骨远端骨折,均采用单一前外侧切口显露骨折端,胫骨予远端前外侧锁定钢板固定、腓骨予重建钢板固定。结果 1例失访,17例获得随访5~9(5.4±2.5)个月,手术时间(81.5±13.5)min,骨折愈合时间(11.8±2.9)周。末次随访疗效按Mazur评分标准评定:优11例,良4例,可2例。结论胫腓骨远端骨折采用小腿单一前外侧切口入路手术治疗,可明显降低传统双切口的并发症,效果良好,值得临床推广。     

钢板内固定治疗开放性胫腓骨双骨折

开放性胫腓骨双骨折常为高能量损伤，软组织损伤以前内侧为重，因极不稳定，一般采取内固定治疗。钢板固定简便方便，故仍被较多地采用。本文就钢板治疗胫骨开放性骨折的手术切口、钢板置入位置选择及腓骨固定的必要性进行探讨。资料和方法１．一般资料：本组男４２例，女１７例；年龄１７～６５岁。开放性骨折按gustilo分型，Ⅰ型３６例，Ⅱ型１９例，ⅢA型４例。均急诊行切复钢板内固定术。小腿前内侧切口、胫骨内侧钢板固定２４例，小腿前外侧切口、胫骨钢板外侧固定３５例。２．手术方法：小腿前外侧切口及胫骨钢板外侧固定手术方法：…     

开放性胫腓骨骨折的治疗体会

目的：探讨开放性胫腓骨骨折治疗的体会，方法：回顾分析了采用石膏外固定，钢板螺钉或髓内针内固定和外固定器治疗184例（190肢）病人的临床资料，结果：术后骨折一期愈合者168例，计172肢（90．5％）。骨折愈合时间2－5个月，平均3．7个月。结论：力争早期清创、良好复位和坚强固定，稳定骨折（AOI度）可用石膏外固定；不稳定骨折（AOⅡ度和部分Ⅰ度、Ⅲ度）应用小腿内侧入路钢板或带锁髓内钉内固定，骨折处有严重软组织损伤（AOⅢ度）者，可应用外固定器治疗。     

后外侧入路治疗胫腓骨远端开放性骨折

胫腓骨远端开放性骨折常伴小腿前方软组织严重损伤,采用外固定治疗,治疗周期长、疗效差.而经常规前内侧或前外侧入路内固定治疗该类骨折往往会出现较多软组织并发症.2003年7月至2006年12月,我院采用单一后外侧入路Ⅱ期切开内固定治疗32例胫腓骨远端开放性骨折,临床效果满意.     

经小腿远端前外侧改良切口内固定治疗胫腓骨远端骨折

目的探讨经小腿远端前外侧改良切口内固定治疗胫腓骨远端骨折的临床疗效。方法 22例胫腓骨远端骨折通过小腿远端前外侧改良切口显露胫骨和腓骨远端,把腓骨钢板置于腓骨外侧;直视下将胫骨骨折复位,通过经皮钢板固定技术将胫骨钢板放置于其远端外侧。结果 22例均获随访平均(38.0±10.6)个月,骨折均于术后3个月愈合,未出现皮肤坏死、切口裂开、骨折延迟愈合及不愈合等并发症。结论采用经小腿远端前外侧改良切口内固定治疗胫腓骨远端骨折效果良好,可以避免传统手术入路导致的并发症。     

前外侧联合后内侧入路治疗合并后髁骨折的复杂胫骨平台骨折

目的探讨前外侧联合后内侧入路钢板内固定治疗合并后髁骨折的复杂胫骨平台骨折的临床疗效。方法自2008-08—2012-12采用前外侧联合后内侧入路钢板内固定治疗31例伴有后髁骨折的复杂胫骨平台骨折,首先取后内侧入路稳定内侧柱,将后髁复位后选用克氏针、螺钉或钢板进行固定;外侧平台骨折采用常规前外侧入路复位固定骨折,存在骨缺损的患者取自体髂骨植骨。结果 31例均获随访10-24个月,平均13.8个月。骨折均获骨性愈合,愈合时间12-16周,平均14.7周。术后12个月膝关节功能HSS评分：优14例,良12例,可5例,优良率83.9%。1例出现小腿内下方感觉麻木,1例发生创伤性关节炎。结论对于合并后髁骨折的复杂胫骨平台骨折,采用前外侧联合后内侧入路钢板内固定是一种良好的手术方式,便于操作,术后疗效满意。     

Plate Fixation for Atypical Fractures of the Femoral Diaphysis

BackgroundPlate fixation for atypical femoral fractures has shown high failure rates compared to intramedullary nail fixation. The aim of this study was to evaluate the radiological results of patients treated with a plate and screws for atypical fractures of the femoral diaphysis.MethodsThis study was conducted retrospectively on 16 patients who had undergone internal fixation using plates for treatment of atypical femoral complete fractures from 2007 to 2015. Nine patients were treated with lag screws and short plates while 7 patients were treated with position screws and long plates, which covered the whole femur. Radiologic evaluation was performed on all patients. Complications were also evaluated.ResultsBone union was achieved in all patients and the average bone union time was 17.7 weeks (range, 14–28 weeks). There was no correlation between the preoperative use of a bisphosphonate, plate length, postoperative teriparatide use, and the time to bone union. Regarding complications, 2 cases of complete fractures and 1 impending fracture occurred at the end of short plates.ConclusionsSatisfactory results were obtained with use of plates for patients with atypical femoral complete diaphyseal fractures, in whom intramedullary nails could not be applied due to severe bowing. In particular, it seemed advantageous compared with intramedullary nail fixation in that it could maintain the leg length through anatomical reduction and prevent iatrogenic fracture.     

股骨干转移性肿瘤的外科治疗

目的探讨股骨干转移性肿瘤的外科治疗方法及临床意义。方法回顾性分析2008年1月至2013年7月手术治疗的13例14肢股骨干转移性肿瘤临床资料。其中男7例,女6例;左侧股骨6肢、右侧股骨8肢;年龄50~83岁,平均68岁。12例患者为股骨单发转移病灶,另一例患者为双侧病理性骨折病例。濒临骨折患者5例,术前Mirls评分8~11分,平均9.4分。病理性骨折肢体9例。术前活检及术后病理检查示来源于肺癌7例,食管癌2例,乳腺癌1例,肾癌1例,胃肠道肿瘤1例,另1例患者未发现原发癌灶。髓内钉固定13肢,钢板固定1肢。术前术后对患者疼痛进行VAS(Visual Analogue Scale,VAS)评分。术后3个月内进行下肢功能评分,采用Enneking评分系统。结果术后9例患者死亡,术后生存2~15个月,中位生存时间8.7个月。其余4例分别随访1、4、6、7个月。所有患者疼痛症状均有明显缓解,术前术后疼痛评分差异有统计学意义(P0.05%)。术后Enneking功能评分9~28分,平均17.8分。9例患者在术后一周内可自行下床或借助助行器活动。另4例患者因综合体质较差仍需他人护理。1例肺癌骨转移患者由于肿胀疼痛,最终行髋关节离断术。本组患者无手术并发症。结论股骨干转移性肿瘤患者可以选择覆盖股骨全长髓内钉内固定术,作为综合治疗手段之一,可有效地缓解疼痛,改善肢体功能,提高生存质量。     

Current Concepts: Aseptic Nonunion of Femoral Shaft Diaphysis

Abstract  In spite of increased understanding of biomechanics and improvements of implant design, nonunion of femoral shaft fractures continues to hinder the treatment of these injuries. Femoral nonunion presents a difficult treatment challenge for the surgeon and a formidable personal and economic hardship for the patient. In most series of femoral fractures treated with intramedullary nailing techniques, the incidence of this complication is estimated to be 1%. A higher frequency has recently been reported due to advances in trauma care leading to increased survivorship among severely injured patients and expanded indications of intramedullary nailing. Whereas the treatment of femoral shaft fractures has been extensively described in the orthopedic literature, the data regarding treatment of femoral shaft nonunions are sparse and conflicting, as most of the reported series consisted of a small number of cases. However, careful review of the existing literature does provide some answers regarding either conservative or operative management. The gold standard for femoral shaft nonunions invariably includes surgical intervention in the form of closed reamed intramedullary nailing or exchange nailing, but several alternative methods have been reported including electromagnetic fields, low-intensity ultrasound, extracorporeal shock wave therapy, external fixators and exchange or indirect plate osteosynthesis. In this paper, a comprehensive review of the current treatment modalities for aseptic midshaft femoral nonunion is presented, after a concise overview of the incidence, definition, classification and risk factors of this complication.     

四肢骨干开放骨折的早期治疗

目的：进一步了解开放性四肢骨干骨折的治疗规律,探索骨折固定的最佳方法。方法：回顾1990年7月－2000年6月以来的431例开放性四肢骨干骨折的早期治疗情况。分析了骨折愈合、伤口感染与软组织伤程度、受伤手术时间、骨折固定方法之间的关系。结果：小夹板或石膏固定和骨牵引治疗的感染、延迟愈合或不愈合发生率偏高;骨折固定方法不同,骨折愈合的情况亦不同。结论：只有对开放性四肢骨干骨折早期彻底清创、早期固定、早期应用有效抗生素、早期进行功能锻炼,才有利于多发伤病人的抢救,有利于骨折的解剖复位,有利于降低并发症,有利于功能的恢复。骨外固定器成为目前治疗骨折特别是开放性、粉碎性、感染性、多发性骨折及骨干不连的良好方法。     

Effects of Alfacalcidol on Mechanical Properties and Collagen Cross-Links of the Femoral Diaphysis in Glucocorticoid-Treated Rats

Bone fragility is increased in glucocorticoid (GC)-induced osteopenia even though GC-treated patients have higher bone mineral density (BMD), suggesting that the impaired bone quality may affect bone strength. This study was conducted to clarify the effects of GC on bone strength and collagen cross-links of adult rats and the effect of coadministration of alfacalcidol (ALF), a prodrug of active vitamin D₃. Six-month-old male Wistar-Imamichi rats (n = 32) were divided into the following four groups with equal average body weight: (1) 4-week age-matched controls, (2) 4-week GC (prednisolone, 10 mg/kg daily, i.m.) with concomitant administration of vehicle, (3) 4-week GC with concomitant administration of ALF (0.05 μg/kg daily, p.o.), and (4) 4-week GC with concomitant administration of ALF (0.1 μg/kg daily, p.o.). At the end of treatment, BMD, collagen cross-links, mechanical properties of the femoral midshaft, bone metabolic markers, and biochemical parameters were analyzed. In the GC group, femoral bone strength decreased without any change of BMD. This was accompanied by a decrease in the content of enzymatic cross-links. ALF (0.1 μg/kg) inhibited the GC-induced reduction in bone strength. The content of mature cross-links in the 0.1-μg/kg ALF group was significantly higher than that in the GC group. GC treatment caused a decrease in bone metabolic markers and serum calcium levels, which was counteracted by ALF coadministration. Preventive treatment with ALF inhibited the deterioration of bone mechanical properties primarily in association with the restoration of enzymatic cross-link formation and amelioration of the adverse effects of GC treatment on calcium metabolism.