股骨近端空心钉锁定板治疗青壮年股骨颈骨折

正2010年3月~2015年1月,我科采用股骨近端空心钉锁定板内固定治疗20例青壮年股骨颈骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组20例,男14例,女6例,年龄21~51岁。骨折按Garden分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型11例,Ⅳ型3例。均为新鲜闭合骨折。受伤至手术时间为3 h~4 d。1.2治疗方法腰麻或全身麻醉下手术。在C臂机透视下复位,股骨大转子     

肱骨近端锁定钢板治疗儿童股骨转子部骨折

正2009年1月~2013年12月,我科采用肱骨近端锁定钢板内固定治疗10例股骨转子部骨折患儿,疗效满意,报道如下。1材料与方法1.1病例资料本组10例,男7例,女3例,年龄6~12岁,均为闭合骨折。其中转子间骨折4例,根据Evans分型:Ⅰ型2例,Ⅱ型2例;转子下骨折6例,根据Seinsheimer分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例。受伤至手术时间2 h~3d。1.2治疗方法全身麻醉下手术。取     

小切口辅助复位髓内钉内固定治疗股骨转子间骨折

正2011年2月~2014年1月,我们对16例闭合复位不满意的股骨转子间骨折患者在透视下小切口借助相关工具复位,行髓内钉固定,缩短了手术时间,报道如下。1材料与方法1.1病例资料本组16例,男9例,女7例,年龄56~85岁。骨折Evans分型:Ⅲ型4例,Ⅳ型7例,Ⅴ型5例。受伤至手术时间2~11 d。1.2治疗方法患者经牵引及手法复位骨折端位置仍欠佳,硬膜外麻醉下手     

股骨近端锁定钢板联合植骨治疗老年股骨转子下粉碎骨折

正2012年1月~2013年12月,我科采用股骨近端锁定钢板联合植骨治疗25例老年股骨转子下粉碎骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组25例,男17例,女8例,年龄61~75岁。骨折按Seinsheimer分型:Ⅲa型17例,Ⅳ型6例,Ⅴ型2例。伤后至手术时间5~11d。1.2治疗方法硬膜外麻醉下手术。在C臂机监视下牵引复位,从大转子至     

微创固定系统倒置治疗股骨转子下骨折

[目的]探讨微创固定系统(less invasive stabilization system,LISS)倒置治疗股骨转子下骨折的治疗方法和临床疗效。[方法]2007年10月～2009年5月,采用倒置LISS治疗31例股骨转子下骨折。本组男23例,女8例;年龄27～83岁,平均48.6岁。致伤原因:交通伤12例,坠落伤6例,压砸伤4例,摔伤9例。骨折按Seinshei-mer分型,ⅡC型4例,ⅢA型12例,ⅢB型6例,Ⅳ型6例,Ⅴ型3例。手术方法:麻醉满意后利用牵引床对股骨转子下骨折进行闭合复位,此后通过大转子外侧切口将对侧的LISS钢板倒置插入,骨折复位满意、钢板位置适宜后,在瞄准臂引导下分别在远、近骨折段钻入4～5枚锁定螺钉。[结果]本组手术时间35～80min,平均50min;术中出血60～150ml,平均失血量90ml。31例患者随访平均15.6个月,术后平均18.2周X线片显示明显骨痂形成或骨折线消失。无内固定松动及深部感染。患肢髋关节平均活动度为:屈曲115°,外旋35°,内旋15°,内收15°,外展36°。采用改良Harris髋关节评分法进行评估,平均92.6分(82～100分),优24例,良7例,无疗效不良病例。[结论]倒置LISS微创固定股骨转子下骨折效果良好,具有固定可靠、手术创伤小等优点,是一种治疗股骨转子下骨折的有效方法。     

人工关节置换术治疗高龄股骨转子间粉碎性骨折

目的探讨人工关节置换术治疗高龄股骨转子间骨折的方法及疗效。方法对38例高龄（≥75岁）股骨转子间粉碎性骨折患者用骨水泥型人工髋关节置换术治疗,术中尽量复位大小转子并张力带钢丝固定。结果手术时间58~98 min,出血量200~380 ml。无切口感染及肺栓塞发生,2例出现尿道感染。患者均获随访,时间12~48个月。骨折愈合时间为3~6（4.5±0.5）个月。术后12个月Harris评分为76~94（84±3）分。结论人工关节置换术治疗高龄股骨转子间骨折患者手术时间短、出血少、可早期下地行走、关节功能恢复快、近期效果满意,是高龄股骨转子间骨折患者的一种理想手术方式,但掌握手术适应证及操作要点是关键。     

经跗骨窦切口切开复位空心钉内固定治疗跟骨骨折

正2008年3月~2014年6月,我们采用经跗骨窦切口复位空心钉内固定治疗13例跟骨骨折患者,近期疗效满意,报道如下。1材料与方法1.1病例资料本组13例,男11例,女2例,年龄28~62岁。骨折Sanders分型:Ⅱ型10例,Ⅲ型3例。受伤至手术时间7~12 d。1.2治疗方法硬膜外麻醉或全身麻醉下手术。自外踝尖下向第4跖骨基底切开,显露跟骨外侧壁及后跟距关节面     

外固定支架辅助牵引复位内固定治疗股骨远端骨折

2015年3月~2018年10月,我科采用外固定支架辅助牵引复位内固定治疗23例股骨远端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组23例,男18例,女5例,年龄37~68岁。骨折AO分型:A型12例,B型7例,C型4例。伤后均先行胫骨结节骨牵引。受伤至手术时间3~10 d。1.2治疗方法硬膜外麻醉下手术。在同侧髂前下棘和胫骨结节处分别打入1枚4.0 mm斯氏针,安装复位外架牵开器。转动调整螺丝牵开复位,C臂机透视确认骨折复位后,在股骨髁外侧、股骨近端外侧分别取3 cm切口,采用微创经皮钢板固定(MIPPO)技术,用股骨外侧长钢板固定骨折端,两侧分别上4~5枚螺钉,透视无误后关闭切口。放置引流24~48 h,石膏外固定3~4周。     

股骨近端防旋髓内钉治疗老年股骨转子间及转子下骨折

<正>2010年6月~2013年6月,我科采用股骨近端防旋髓内钉(PFNA)治疗26例老年股骨转子间及转子下骨折患者,疗效满意。1材料与方法1.1病例资料本组26例,男11例,女15例,年龄65~87岁。其中股骨转子间骨折18例,按AO分类:A1型8例,A2型9例,A3型1例。股骨转子下骨折8例,按AO分类:A型4例,B型4例。均为闭合非病理性骨折。24例患     

可吸收螺钉内固定治疗Pipkin Ⅱ型股骨头骨折

<正>2009年1月~2011年8月,我科采用可吸收螺钉内固定治疗7例PipkinⅡ型股骨头骨折患者,效果满意,报道如下。1材料与方法 1.1病例资料本组7例,男4例,女3例,年龄21~56岁。均为PipkinⅡ型股骨头骨折。受伤至手术时间3~7 d。1.2术前准备患者均于受伤6 h内急诊在腰麻或静脉全身麻醉下行Allis手法复位,复位成功后行股骨髁上骨牵     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.