经髌韧带和胫骨结节双钢丝固定治疗髌骨下极骨折临床分析

目的探讨经髌韧带和胫骨结节双钢丝固定治疗髌骨下极粉碎性骨折的疗效。方法对41例髌骨下极粉碎骨折患者采用经髌韧带钢丝环和髌骨-胫骨结节"8"字钢丝联合固定,回顾性分析患者的临床资料。结果对41例患者随访7~24个月,根据疗效评价标准,优良率90.2%。无骨折移位、钢丝断裂及钢丝切割骨折等并发症。结论经髌韧带和胫骨结节双钢丝固定治疗髌骨下极粉碎性骨折,具有操作简便、复位固定可靠稳定、疗效好、费用低等优点,是有效的手术方法。     

髌骨下极粉碎性骨折保留下极内固定手术新方法

目的介绍一种采用锚钉技术复位骨折、髌韧带重建加固、联合跨髌腱"8"字钢丝内固定技术在髌骨下极粉碎性骨折保留髌骨下极手术新方法的临床疗效分析。方法采用保留髌骨下极碎骨块、应用锚钉锚入髌骨体行骨折复位、髌韧带重建加固,联合跨髌腱经髌骨、胫骨结节"8"字钢丝减张内固定治疗髌骨下极粉碎性骨折18例。结果随访1年,骨折复位良好并全部愈合。按陆裕朴疗效评定标准:优15例,良3例。结论该方法操作简单、方便、疗效确切,对髌骨下极粉碎性骨折提供双重稳定可靠的内固定及髌韧带重建修补的治疗作用。     

髌骨-胫骨结节钢丝固定髌韧带旷置术治疗髌骨下极骨折的疗效观察

目的 探讨应用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗髌骨下极骨折的临床疗效.方法 采用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗髌骨下极骨折19例,术后逐步开展膝关节功能锻炼.结果 随访5～24个月,平均19个月.未发现钢丝断裂及钢丝切割骨折病例.结论 采用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗能有效地复...     

交叉克氏针结合钢丝捆扎治疗髌骨下极骨折

正2013年8月~2016年8月,我们应用交叉克氏针结合钢丝捆扎治疗22例髌骨下极骨折患者,疗效良好,报道如下。1材料与方法1.1病例资料本组22例,男14例,女8例,年龄31~72岁。闭合骨折20例,开放骨折2例。开放骨折急诊手术,闭合骨折于伤后3~5 d手术。1.2治疗方法腰麻下手术。取髌前     

空心钉结合带线锚钉内固定治疗髌骨中下极骨折

髌骨骨折为骨科中较为常见的一种骨折,手术治疗一般常规采用克氏针张力带、环扎"8"字张力带钢丝、聚髌器、空心钉等内固定术。对累及髌骨下极的骨折,有时骨折块较小,常规内固定方法受到限制。笔者自2009年1月~2011年7月采用空心钉结合带线锚钉内固定治疗髌骨中下极骨折36例,取得满     

髌骨爪治疗髌骨粉碎性骨折

正2012年1月~2015年5月,我科应用髌骨爪治疗32例髌骨粉碎性骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组32例,男17例,女15例,年龄20~68岁。左侧19例,右侧13例。均为闭合骨折。受伤至手术时间1~15 d。1.2治疗方法硬膜外麻醉下手术。取髌前正中切口,直视下利用巾钳夹住     

髌骨爪包裹技术治疗髌骨下极骨折

<正>2012年1月~2013年1月,我院采用髌骨爪包裹技术治疗的67例髌骨下极骨折患者,疗效良好,报道如下。1材料与方法1.1病例资料本组67例,男40例,女27例,年龄21~70岁。全部为闭合新鲜髌骨下极骨折。受伤至手术时间为2~12 d。1.2手术方法硬膜外麻醉。取髌前纵行直切口,将骨折端复位,用克氏针或5号爱惜邦线临时缝合固定,对撕裂的     

锚钉结合张力带钢丝治疗髌骨下极骨折

目的研究锚钉结合张力带钢丝治疗髌骨下极骨折的疗效。方法我院于2008年3月至2009年9月采用锚钉结合张力带钢丝方法治疗髌骨下极骨折34例。术中以锚钉固定修补髌骨下极骨折块及髌韧带,并辅以胫骨结节至髌骨中上部的张力带钢丝。结果 34例患者均获12～25个月,平均17个月随访,所有骨折均愈合,2例术后出现局部浅表感染,经换药及相应抗炎治疗后愈合。陆裕朴膝关节功能评定标准评价显示,优27例,良6例,可1例,优良率为97.1%。结论锚钉结合张力带钢丝治疗髌骨下极骨折固定牢靠,并发症少,效果确切。     

单针张力带钢丝在髌骨下极骨折中的应用

目的：探讨单针张力带钢丝在髌下极骨折中的疗效。方法：对22例髌下极骨折行单根克氏针纵行通过髌下极中点及近端中点，髌前应用张力带钢丝，再经过近端中点横行穿钢丝经髌下绝后行半环形结扎手术。结果：随访16例按陈氏标78评定优11例，良4例，差1例，优良率为93．7％。结论：此方法手术简单，疗效满意。     

钢丝环扎+双重髌前“8”字张力带治疗髌骨下极粉碎骨折

[目的]探讨钢丝环扎+双重髌前"8"字张力带治疗髌骨下极粉碎骨折的临床效果。[方法]回顾本院2013年3月~2015年11月收治的22例髌骨下极粉碎骨折患者,采用钢丝环扎+双重髌前"8"字张力带的手术方式,术后观察膝关节最大屈曲度、髌骨长度、骨折愈合情况、内固定情况,评价膝关节功能恢复情况。[结果]22例患者术后至取出内固定物均获得随访,时间9~22个月,平均(13.59±2.56)个月。术后即刻髌骨长度分别与术后3、6个月及取内固定时比较,差异均无统计学意义。骨折均愈合,骨折愈合时间3~6个月,平均(3.95±1.00)个月,膝关节最大屈曲度:术后3个月(126.27±8.58)°、术后6个月(127.00±8.04)°、取内固定物时(127.73±6.57)°。Bostman髌骨功能评分(27.23±2.16)分,其中优13例,良好9例,优良率100%。[结论]钢丝环扎+双重髌前"8"字张力带钢丝固定的手术方式操作简单,扩大了传统钢丝环扎+张力带固定的适用范围,是治疗髌骨下极粉碎骨折值得推荐的手术方法。     

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.