弹性髓内钉治疗儿童双侧胫骨骨折

[目的]探讨弹性髓内钉闭合复位内固定治疗儿童双侧胫骨骨折的疗效.[方法]5例双侧胫骨骨折的儿童患者,男4例,女1例,年龄3～10岁,均采用弹性髓内钉闭合复位内固定治疗.(结果]本组病例均获12～36个月随访,平均27.4个月,无1例发生切口并发症,无继发骨折移位及内固定物失效或断裂.5例骨折全部愈合,骨愈合时间7～13周(平均9.6周),无延迟愈合、骨不连,无旋转畸形及下肢短缩或过度生长,胫骨骨折1足出现向前成角5°,1足向内成角＜5°,无膝、踝关节的功能障碍.[结论]采用弹性髓内钉治疗符合生物学固定原则,创伤小,并发症少,疗效满意,是治疗儿童胫骨骨折的较好方法.     

钛制弹性髓内钉治疗儿童胫骨不稳定骨折

目的 探讨钛制弹性髓内钉治疗儿童胫骨不稳定骨折的临床疗效.方法 应用钛制弹性髓内钉技术治疗儿童胫骨不稳定骨折16例.结果 所有病例均得到随访,时间6～12个月.术后4、8、12、24、48周定期摄X线片复查,骨折均获得愈合,平均愈合时间8周.术后无感染,未发生骨不连、畸形愈合和骨骺损伤.无下肢短缩、内外翻畸形等并发症,功能恢复良好.结论 钛制弹性髓内钉内固定治疗儿童胫骨干骨折,具有创伤小、恢复快、并发症少等特点,值得临床推广应用.     

弹性髓内钉治疗儿童胫骨干骨折

目的探讨弹性髓内钉治疗儿童胫骨干骨折的疗效。方法采用弹性髓内钉治疗40例胫骨干骨折患儿。观察骨折愈合时间、内固定取出时间、术后并发症等。结果患儿均获得12个月随访。骨折均愈合,时间11～16(13. 2±2. 1)周;内固定取出时间9～12(11. 7±2. 3)个月。2例发生钉头部滑囊炎,取出髓内钉后消失。无骨不连、畸形愈合、骨髓炎、延迟愈合、髓内钉移位、切口感染等并发症。末次随访时,患者均可完全负重,膝关节活动范围为-5°～150°。结论采用弹性髓内钉治疗儿童胫骨干骨折,临床疗效满意,并发症发生率低。     

急诊非扩髓交锁髓内钉治疗开放性胫骨干骨折

[目的]评价急诊非扩髓交锁髓内钉治疗开放性胫骨干骨折的临床疗效。[方法]2011年9月~2014年10月本院60例开放性胫骨干骨折急诊采用非扩髓交锁髓内钉治疗,51例获得随访。劈开或不劈开髌韧带插钉;髓内钉直径8 mm、9 mm;稳定性骨折6周内部分负重,不稳定性8~12周内避免负重。[结果]平均愈合时间25.5周(13~60周):8 mm直径髓内钉23周,9 mm 26周;中上段骨折25.9周,中段24.7周,中下段21.9周,差异无统计学意义。合并腓骨骨折比单纯胫骨骨折长5.5周。22例出现膝前痛,劈开和不劈开髌韧带组各11例,差异无统计学意义。1例不愈合,16例延迟愈合,7例畸形愈合,1例骨筋膜室综合征,4例伤口浅部感染,1例深部感染,4例锁钉断裂。[结论]急诊清创、非扩髓交锁髓内钉是治疗胫骨干开放性骨折一种安全、有效的方法。     

动静力型髓内钉及弹性髓内钉治疗胫腓骨干骨折

目的探讨动静力型交锁髓内钉及钛弹性髓内钉治疗胫腓骨干骨折的疗效。方法自2009年10月至2013年10月,25例胫腓骨干中下段骨折患者,男17例,女8例;年龄22~65岁。左侧13例,右侧12例。胫骨使用动静力型交锁内钉内固定,腓骨采用钛弹性髓内钉内固定。结果全部患者均获随访,随访时间7~48个月。按照Johner-Wruhs评价标准评定,优18例,良6例,可1例,未出现感染病例,无骨不连病例,无断钉病例。结论动静力型交锁髓内钉及钛弹性髓内钉治疗胫腓骨干骨折,创伤小、愈合率高、皮肤软组织并发症少,疗效确切,是一种安全、有效的方法。     

弹性髓内钉内固定结合可活动支具外固定治疗儿童胫骨干骨折

目的探讨儿童胫骨干骨折采用弹性髓内钉内固定结合外固定治疗的方法与效果。方法对48例儿童胫骨干骨折采用弹性髓内钉内固定结合可活动支具外固定治疗。结果本组获得随访7~36个月,平均18个月。骨折均正常愈合。内固定物取出时间平均为术后8个月,后期未发现再骨折及膝关节功能受限。2例因保留钉尾偏长,出现钉尾激惹伤口,内固定物取出后伤口愈合良好。16例开放性骨折均正常愈合,未引起感染,软组织恢复良好。结论弹性髓内钉内固定结合可活动支具外固定治疗儿童胫骨干骨折属于微创、生物学固定技术,有利于早期功能锻炼,可在临床推广。     

带锁髓内钉治疗股骨、股骨干骨折的临床应用

目的 带锁髓内钉治疗股骨、胫骨干骨折临床应用研究。方法 应用带锁髓内钉治疗股骨、胫骨干骨折104例。结果 闭合复位穿钉内固定术后6－10周愈合,切开复位内固定8－12周愈合,48周后拔出内固定物。无断钉、骨折延迟愈合或不愈合、感染、脂肪栓塞、关节僵硬等并发症发生。104例均获随访,平均随访20个月,无1例再次骨折。结论 带锁髓内钉内固定治疗股骨、胫骨干骨折与传统钢板螺丝钉内固定相比,具有固定牢固,防止骨折端扭转、分离,术后不需要外固定支持,能早期负重行走,骨折愈合率高,治疗效果可靠的优点。     

弹性髓内钉内固定治疗儿童股骨干骨折的疗效分析

目的探讨弹性髓内钉内固定治疗儿童股骨干骨折的临床疗效及注意事项。方法回顾性分析自2015-10—2018-12采用钛制弹性髓内钉内固定治疗的35例儿童股骨干骨折,分析骨折愈合、肢体功能恢复情况及并发症情况。结果本组手术时间为30~90 min,术中出血量为10~100 mL。35例均获得随访,平均随访时间8(6~19)个月。所有患者骨折均愈合,愈合时间6~32周,平均8.6周。所有患者髋、膝关节活动度恢复良好,未发现入钉点劈裂、切口感染、骨折不愈合、骨折畸形愈合、肢体不等长、主钉断裂等并发症。结论弹性髓内钉内固定治疗儿童股骨干骨折具有创伤小、骨折愈合好、患肢功能恢复快、二次取出内固定简便、并发症少等优点。     

扩髓交锁髓内钉治疗胫骨不稳定性骨折 (附42例报告)

目的探讨扩髓交锁髓内钉治疗胫骨不稳定性骨折的治疗效果.方法对42例胫骨不稳定性骨折病人行扩髓交锁髓内钉治疗,闭合性骨折22例,开放性骨折20例,全部应用静力性固定.结果平均随访时间12个月(6～20个月),采用Johner-Wruh评分标准,治疗结果优32例,良8例,一般2例,骨折平均愈合时间闭合性骨折15周(10～23周),开放性骨折19周(13～36周),3例延迟愈合,无深部感染、骨髓炎、畸形愈合及骨不连.结论扩髓交锁髓内钉是治疗胫骨不稳定性骨折较理想的方法,可促进骨折愈合,并发症较少.     

带锁髓内钉治疗胫骨骨折临床疗效分析

目的探讨带锁髓内钉治疗胫骨骨折的临床效果。方法对2000年1月至2006年1月期间78例胫骨骨折应用带锁髓内钉扩髓内固定治疗,其中男47例,女31例,开放性骨折32例(G ustiloⅠ度11例,Ⅱ度21例),行闭合复位38例,术后第1天开始应用CPM进行关节功能锻炼。结果75例随访4~28个月,平均13个月。骨折愈合时间6~30周,平均14周。骨延迟愈合2例,无断钉、骨髓腔感染、脂肪栓塞、关节僵硬及再次骨折等并发症。结论交锁髓内钉治疗胫骨骨折具有创伤小、固定坚强、骨折愈合率高、能早期活动、感染率低等优点,可作为治疗胫骨骨折的内固定方法。     

Elastic stable intramedullary nailing of tibial shaft fractures in children

Most pediatric tibia shaft fractures are amenable to nonoperative treatment with satisfying results, yet surgical stabilization is necessary in certain cases. The purpose of our study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in severe pediatric tibial fractures. We retrospectively reviewed 24 tibia shaft fractures in 24 patients that were treated operatively by elastic stable intramedullary nailing between 1997 and 2005 at our institution. Extensive review of all charts and radiographic data was completed at Cincinnati Children's Hospital Medical Center. There were 8 closed and 16 open fractures. The average union time for all tibia fractures was 20.4 weeks. The average union time for closed and open fractures was 21.5 and 20.2 weeks, respectively. Complications include 2 (8%) neurovascular, 2 (8%) infections, 2 (8%) malunions, and 1 (4%) leg-length discrepancy. Although complications do exist, elastic stable intramedullary nailing of pediatric tibia shaft fractures using Nancy nails is an effective treatment option.     

Titanium elastic nails for pediatric tibial shaft fractures

Purpose  The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs). To our knowledge, this is the largest series reported in the literature of this specific fixation technique. Methods  We reviewed all children with tibial shaft fractures treated operatively at our tertiary care children's hospital to find those patients who underwent fixation with TENs. Between 1998 and 2005, we identified 19 consecutive patients who satisfied inclusion criteria. The average age of the patients in our series was 12.2 years (range 7.2–16 years), and mean follow-up was 15.7 months (range 6–28 months). Patient charts and radiographs were retrospectively reviewed to gather the clinical data. Outcomes were classified as excellent, satisfactory, or poor according to the Flynn classification for flexible nail fixation. Results  All patients achieved complete healing at a mean of 11.0 weeks (range 6–18 weeks). At final follow-up, mean angulation was 2° (range 0°–6°) in the sagittal plane and 3° in the coronal plane (range 0°–9°). Five patients (26%) complained of irritation at the nail entry site; there were no leg length discrepancies or physeal arrests as a result of treatment. Two patients required remanipulation after the index procedure to maintain adequate alignment. According to the Flynn classification, we had 12 excellent, six satisfactory, and one poor result. Conclusion  Although the indications for operative fixation of pediatric tibial shaft fractures are rare, occasionally surgical treatment is warranted. Based on our results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique which allows rapid healing of tibial shaft fractures with an acceptable rate of complications. No authors received any financial support or compensation for this study.     

空心钉结合髓内钉固定治疗同侧胫骨平台伴胫骨干骨折

目的探讨空心钉结合髓内钉固定治疗同侧胫骨平台伴胫骨干骨折的方法和疗效。方法采用空心钉结合髓内钉固定治疗同侧胫骨平台伴胫骨干骨折12例,先以空心钉固定胫骨平台骨折,部分关节面粉碎塌陷较严重、怀疑合并半月板及韧带损伤者使用关节镜辅助探查及复位胫骨平台关节面,再以髓内钉固定胫骨干骨折。结果本组获平均17（8～33）个月随访,均获得骨性愈合,胫骨平台骨折平均愈合时间为12周,胫骨干骨折平均愈合时间为23周。疗效根据Lowa膝关节功能评价标准评定：优8例,良3例,可l例。结论空心钉结合髓内钉既有效固定了两处骨折。又充分保护了软组织,是治疗同侧胫骨平台伴胫骨干骨折的有效方法。     

Treatment of unstable tibial shaft fractures by closed intramedullary nailing with flexible (Ender-type) pins.

Eighty patients with unstable tibial diaphyseal fractures were treated by closed intramedullary nailing with Ender-type flexible pins. The majority of injuries occurred from falling while snow skiing. Sixty-six fractures were closed and 14 were open. Fifty-eight fractures involved the distal, 21 fractures the middle, and one fracture the proximal one third of the tibial shaft. The average time to roentgenographic union was 15.5 weeks (range, ten to 34 weeks) for closed and open Grade I and II fractures. The time to union in Grade III fractures was 50 weeks (range, 36-64 weeks). There were two nonunions and two delayed unions. Both nonunions occurred in Grade IIIA open shaft fractures. Intramedullary stabilization with flexible, Ender-type pins provides good control of unstable tibial shaft fractures. The use of pins with a smaller diameter (3.5 or 4 mm) allows the surgeon to place more pins across the fracture site. The use of multiple pins and packing the intramedullary canal may provide better rotational stability. The use of Ender-type pins for fixation of Type IIIA open tibial shaft fractures is contraindicated.     

弹性髓内钉固定与外固定支架治疗儿童股骨干骨折疗效比较

目的：比较弹性髓内针与外固定支架治疗儿童股骨干骨折的疗效。方法：2002年9月至2008年8月治疗儿童股骨干骨折共67例,使用弹性髓内针治疗儿童股骨干骨折36例,男23例,女13例,年龄5～11岁,平均（7.1±1.6）岁;外固定支架治疗31例,男19例,女12例,年龄3～12岁,平均（6.5±2.3）岁。所有病例均为闭合复位,对两种不同内固定术后骨折愈合时间、术后并发症进行比较分析。结果：全部病例均获随访,时间9～24个月,平均（12±3）个月。弹性随内针组治疗小儿股骨骨折在骨折临床愈合时间和骨性愈合时间均短于外固定支架组（P〈0.05）。外固定支架组,继发钉道感染5例,骨折延迟愈合3例,再骨折2例,螺钉断裂1例;弹性髓内针组钉尾激惹3例。结论：弹性髓内针治疗儿童股骨干骨折有很大优势,而对高能量骨折及多发伤的病例外固定支架则不失为一种良好的选择,股骨近端和远端骨折尽量避免使用弹性髓内针固定。     

钢板结合髓内钉治疗胫骨单髁伴同侧胫骨干中、远段骨折

 目的 探讨钢板结合髓内钉治疗同侧胫骨平台单髁伴胫骨干中、远段骨折的可行性和临床疗效。方法 2003年 5月至 2008年11月,钢板结合髓内钉固定治疗胫骨平台单髁伴同侧胫骨干骨折21例,男15 例,女6 例;年龄20～55岁,平均34岁。按Schatzer分类,Ⅰ型4例、Ⅱ型11例、Ⅲ型6例。胫骨干骨折按部位分型,胫骨干中段骨折13例、中下1∕3骨折8例。复位后,先钢板固定胫骨平台再髓内钉固定胫骨干19例,先髓内钉固定胫骨干再钢板固定胫骨平台2例。结果 所有病均例获得随访,随访时间0.9～4年,平均2.2年。所有患者均获骨性愈合,胫骨平台平均愈合时间为12周;胫骨干骨折平均愈合时间为29周,3例患者胫骨干骨折延迟愈合,拆除交锁钉使之动力化后愈合。1例胫骨平台未能解剖复位导致骨折畸形愈合。根据HSS膝关节评分标准[2],优17例(80.95%)、良3例(14.29%)、中1例(4.76%)。结论 注意一些技术要点,应用两种熟悉的手术技巧,钢板结合髓内钉能够成功治疗胫骨平台单髁伴同侧胫骨干骨折。     

交锁髓内钉治疗胫腓骨骨折

目的 观察交锁髓内钉治疗胫腓骨骨折的疗效及并发症防治。方法 用交锁髓内钉治疗胫腓骨骨折46例,均采用扩髓及静力型固定。结果 46例均得到随访,平均20个月（6个月-3年）,愈合时间为3-12个月,平均4个月,感染4例均为开放性骨折,肢体短缩1例,成角畸形2例,延迟愈合7例,无不愈合。根据Johner-Wruh评分标准,优36例,良7例,中2例,差1例。结论 交锁髓内钉治疗胫腓骨骨折是一种很好的方法。但仍有一些并发症,在应用中必须引起重视;开放性骨折以不扩髓为宜。     

弹性髓内钉治疗稳定和不稳定性儿童股骨干骨折的病例对照研究

目的:探讨弹性髓内钉治疗稳定及不稳定性儿童股骨干骨折的疗效,指导其临床应用。方法:选择我院2008年1月至2010年10月的儿童股骨干骨折44例,男24例,女20例,年龄5～12岁,平均7.4岁。根据骨折稳定性分为2组,稳定性骨折组(S组)23例,不稳定性骨折组(U组)21例。所有患儿行弹性髓内钉手术固定治疗,对复位固定不满意或体重>30kg者,术后给予牵引或小夹板保护。随访观察2组骨折愈合时间,有无钉尾激惹症状(疼痛、囊肿等),愈合时X线片上有无畸形(>5°内外翻或前后成角),患肢短缩或延长及优良率等。结果:所有患者获随访,时间5～19个月,平均13个月,末次随访时骨折全部愈合,平均愈合时间10.2周(8～14周)。U组畸形愈合5例,平均成角9°(6°～12°),发生率比S组(0例)高(P<0.05)。S组骨折愈合时间平均(10.6±1.3)周,U组(9.9±1.2)周;S组患肢缩短0例,U组3例,平均缩短1.0cm(0.5～1.8cm);S组患肢延长3例,平均延长1.1cm(0.5～2.1cm),U组1例,延长0.6cm;S组钉尾激惹2例,U组4例;S组优20例,良2例,差1例,U组优15例,良3例,差3例。以上指标2组比较差异无统计学意义(P>0.05)。U组中,5例畸形愈合中4例发生于术后无牵引或小夹板组,发生率较术后牵引或小夹板组高,差异有统计学意义(P<0.05)。结论:弹性髓内钉对儿童股骨干稳定及不稳定性骨折的短期疗效均较好,术后给予牵引或小夹板保护可以减少不稳定性骨折畸形愈合的发生。     

Management of infected tibial intramedullary nailing using an organized treatment protocol

Twenty cases of osteomyelitis following intramedullary nailing of the tibial shaft fracture were managed with a prospective treatment protocol comprising intramedullary reaming debridement, antibiotic-bead depot, external skeletal fixation, microvascular muscle flap and early cancellous bone grafting. The follow-up period ranged from 25 to 48 months (average, 34.3 months). Pseudomonas aeruginosa (37.5%) and staphylococcus aureus (20.8%) were the organisms most commonly involved. There were 8 united and 12 ununited fractures after reaming debridement surgery. Nineteen infections were initially arrested by one debridement. One infection was arrested by two sequential debridements. All 12 ununited fractures were stabilized by Hoffmann unilateral external fixation until the fracture healed. The time spent in external fixation ranged from 3 to 7 months (average, 5.2 months). Early cancellous bone grafting was successfully accomplished for 9 ununited fractures with major debridement bone loss. The average union time of the 9 fractures with bone grafting was 7.2 months (range, from 6 to 8 months). We believe that this treatment protocol gives a predictable and rapid recovery. The complications were infection recurrence in two cases at the old tibial shaft fracture sites, minor pin tract infection of Hoffmann external fixators in two cases, and stiffness in two ankles and one knee.     

Autologous platelet gel for delayed union of tibial shaft treated with intramedullary nailing

Early recognition of a potential nonunion followed by early intervention reduces the ultimate time to union, and lessens the frustration for both patient and surgeon. The aim of this study was to evaluate the efficacy of treatment with autologous platelet gel (PG), rich in growth factors, in the treatment of delayed unions of tibial shaft fractures treated with locked intramedullary nailing. We treated 15 atrophic delayed unions of unstable tibial shaft fractures, stabilized with locked intramedullary nail. The mean time between the acute treatment of the fracture and PG application was 151 days. PG was injected into the site of unhealed fracture during closed surgery. The planned treatment programme was 3 radio-guided applications of PG at intervals of 3–4 weeks. Clinical and radiological evaluations 2, 4 and 6 months after the first application of PG showed gradual improvement of the clinical picture and progressive formation of bone callus. In almost all cases there were clinical and radiological improvements and it was possible to remove the synthesis aid an average of 12 months after the start of the therapeutic programme.