LISS钢板在胫骨中下段骨折治疗的临床应用

目的:探讨LISS钢板在胫骨中下段骨折的治疗效果.方法:应用胫骨LISS内固定技术治疗胫骨中下段骨折21例.结果:切口均达一期愈合,术后X线片骨折对位对线良好,6到8W骨折端愈合良好,膝关节功能活动度良好.结论:LISS治疗胫骨中下段骨折对局部血运破坏较少,术后并发症少,下肢功能恢复快,是一种有效的内固定治疗方法.     

微创内固定系统治疗膝关节周围骨折

采用微创内固定系统(LISS),利用间接复位技术,治疗58例膝关节周围骨折.术后随访3～20个月,58例均达到骨性愈合,平均愈合时间为4.8个月.     

关节镜下带线锚钉与空心拉力螺钉内固定治疗胫骨髁间嵴撕脱骨折的疗效评价

目的对比分析关节镜下不同内固定方法治疗胫骨髁间嵴撕脱骨折的疗效,为临床治疗提供参考。方法选取钦州市中医医院骨科2014年5月—2015年7月收治的胫骨髁间嵴撕脱骨折患者42例为研究对象,随机抽签法分为锚钉组和螺钉组各21例,锚钉组患者行关节镜下带线锚钉治疗,螺钉组患者行关节镜下空心拉力螺钉内固定治疗,观察两组患者术后切口愈合、膝关节功能变化以及膝关节活动范围。结果两组患者术后切口均I期愈合,无感染情况出现。术后均成功获得随访,随访时间1年以上,术后即刻X线检查示骨折复位良好。术后3个月复查骨折均骨性愈合,无患肢功能障碍。术前两组患者膝关节功能评分差异无统计学意义(P0.05),术后膝关节功能评分均显著提高(P0.05),但锚钉组膝关节功能评分(92.97±3.15)与螺钉组(89.94±3.28)差异无统计学意义(P0.05)。术前两组患者膝关节活动范围差异无统计学意义(P0.05),术后膝关节活动范围显著增加(P0.05),但锚钉组膝关节活动范围(120.6±11.0)与螺钉组(118.5±10.7)差异无统计学意义(P0.05)。结论胫骨髁间嵴撕脱骨折关节镜下带线锚钉和空心拉力螺钉内固定治疗均有很好效果,带线锚钉固定无需二次手术取出,操作简单。     

LISS钢板治疗股骨远端C型骨折手术技巧的探讨

目的 探讨LISS钢板对股骨远端C型骨折的手术技巧.方法 采用LISS钢板微创切开复位固定股骨远端C型骨折24例,对复位固定技术、术后处理、结果进行分析总结.结果 术后所有患者随访12~18个月,24例全部愈合,按照Merchan评分标准:优3例,良15例,可4例,差2例,优良率75%.结论 运用手术技巧使骨折端达到解剖复位,坚强固定是膝关节在术后早期功能锻炼的重要基础,也是提高手术疗效的关键.     

手术治疗胫骨平台骨折38例体会

对38例胫骨平台骨折进行回顾性分析,35例术后膝关节功能恢复良好,胫骨平台骨折的损伤程度与预后密切相关。手术方法根据骨折的不同类型而异,术前全面评估骨折和软组织损伤的情况,术中注重骨折的复位及固定,尽可能减少损伤周围组织并注重修复损伤的软组织结构,术后正确的功能锻炼及康复治疗,是影响患者功能恢复的重要因素。     

复杂胫骨平台骨折的手术疗效观察

目的探讨锁定钢板、LISS钢板治疗复杂胫骨平台骨折方法及疗效。方法将34例复杂胫骨平台骨折手术患者行锁定钢板、LISS钢板固定,观察治疗效果。结果随访时间11～34个月,平均24个月,据HSS膝关节评分法评价疗效,优20例,良12例,中1例,差1例,总体优良率达97%。结论锁定钢板,特别是LISS钢板固定治疗复杂性胫骨骨折,创伤小、固定可靠、功能满意,是一种有效的内固定方法。     

微创内固定系统治疗老年股骨髁上骨折疗效观察

目的探讨闭合复位后微创内固定系统(Less Invasive Stabilization System,LISS)治疗老年股骨髁上骨折的临床疗效。方法对2004年1月-2014年10月秦皇岛市第一医院收治的37例老年股骨髁上骨折患者在闭合复位后行LISS治疗,术后予以预防感染、营养支持、早期康复等全身综合治疗,观察治疗效果。结果37例患者术后随访12~18个月,切口均一期愈合;根据最后1次随访结果进行HSS评分,其中优14例,良20例,可2例,差1例,优良率达91.9%。结论闭合复位后采用LISS治疗老年股骨髁上骨折,手术创伤小,术后并发症少,疗效显著。     

膝关节周围骨折术后个体化、规范化康复治疗

我们根据多年的临床经验总结,对膝关节周围骨折术后患者采用个体化、规范化康复治疗模式,使骨折患者的肢体功能恢复取得了满意的效果。1材料与方法1.1对象:1999-10～2011-12共收治116例膝关节周围骨折患者,其中股骨远端粉碎性骨折76例,胫骨近端粉碎性骨折40例;闭合性损伤83例,开放性损伤33例,合并其他损伤17例。交通伤77     

反向微创内固定系统治疗特殊类型股骨近端骨折

目的 分析反向采用微创内固定系统(less invagive stabilization system,LISS)治疗特殊类型股骨近端骨折的手术技术并总结临床治疗效果.方法 自2005年6月至2007年12月,反向应用LISS治疗特殊的股骨近端骨折28例.所有患者均不能经闭合牵引获得复位.转子间骨折8例,采用AO分类法:31 A2.2型3例,31 A2.3型2例,31 A3.1型1例,31 A3.3型2例;转子下骨折19例,采用Seinsheimer分型:ⅡA型3例,ⅢB型1例,Ⅴ型15例;股骨假体周围骨折1例(Vancouver B1型).记录手术时间、术中出血量、术后并发症、骨折愈合时间和术后髋功能评分.结果 手术时间45～120 min,平均88 min;出血量50～700 ml,平均320 ml.术后下肢深静脉血栓2例、心肌梗死发作1例、下消化道出血1例,未出现切口感染.1例乳腺癌患者术后脑转移症状加重死亡,3例失访.24例获得6～33个月、平均18个月随访.1例Seinsheimer V型患者转子下骨折不愈合,术后6个月近端螺钉断裂;其余23例骨折愈合时间2～5个月,平均3个月.Harris评分70～99分,平均84分.结论 反向股骨LISS治疗特殊类型的股骨近端骨折,具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点.熟练掌握复位技术,正确放置A孔导针,避免过早负重是手术成功的关键.     

对血管内栓塞治疗外伤性颈动脉海绵窦瘘手术患者的护理体会

目的:探讨血管内栓塞治疗外伤性颈内动脉海绵窦瘘围手术期的护理方法.方法:例外伤性颈内动脉海绵窦瘘患者进行充分术前准备,术中密切配合医生,精心护理.术后加强病情观察、积极防治并发症.结果:例患者通过积极的手术治疗和有效的护理措施得到良好的治疗效果.术后随访6个月无复发.结论 完善术前准备,加强术后护理,提高栓塞治疗外伤性颈动脉海绵窦瘘效果.降低并发症的发生.     

Anterior cruciate ligament function after tibial eminence fracture in skeletally mature patients

We compared anterior cruciate ligament function in skeletally mature patients after treatment of tibial eminence fractures with that of patients in two other groups: patients who had anterior cruciate ligament deficiency and patients who had undergone anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. The Lysholm questionnaire was used to evaluate symptoms and KT-1000 arthrometry was used to determine objective knee laxity at an average follow-up of 5.2 years. Knee joint proprioception was assessed with a new method designed to test joint position sense. The Lysholm score for the tibial eminence group was 94 +/- 7. Only the patients in the anterior cruciate ligament-deficient group demonstrated statistically significantly increased laxity and inferior proprioception when the injured leg was compared with the uninjured leg. Both laxity and proprioception were statistically inferior for the anterior cruciate ligament-deficient group when compared with both the treated tibial eminence fracture group and the anterior cruciate ligament-reconstructed group. No statistically significant difference was observed between the anterior cruciate ligament-reconstructed and treated tibial eminence fracture groups. Correlation was observed between laxity and proprioception when all patients were analyzed. The results demonstrate that appropriate treatment of tibial eminence fractures restores stability and proprioception to the knee.     

Incarcerated patellar tendon in Hoffa fracture: an unusual cause of irreducible knee dislocation

Irreducible knee dislocation due to incarcerated soft tissue structures in associated fractures is extremely uncommon. We report a case of irreducible, closed dislocation of the knee secondary to incarcerated patellar tendon in a Hoffa fracture (unicondylar fracture of femur in the coronal plane) with associated communited fracture of patella and disruption of both cruciates. We treated this case initially with open reduction and internal fixation of fracture and repair of the patellar tendon. During the total followup period of eighteen months, the patient had restricted joint range of motion with no joint instability despite aggressive physiotherapy and further surgical intervention. The prognosis of such complex knee injuries with combination of ligamentous injuries and associated fractures is much worse when compared to either injuries alone.     

空心拉力螺钉结合跟骨锁定接骨板治疗Letenneur Ⅲ型Hoffa骨折的疗效

目的:比较空心拉力螺钉结合跟骨锁定接骨板与空心拉力螺钉治疗Letenneur Ⅲ型Hoffa骨折的临床疗效。方法:采用回顾性队列研究分析2010年1月至2020年6月解放军中部战区总医院收治的41例Letenneur Ⅲ型Hoffa骨折患者临床资料,其中男22例,女19例;年龄28~78岁［（51.9±1.9）岁］。1...     

The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification

Fifty-five patients who presented with the complaint of tibia plateau fractures between January 1998 and November 2001 were retrospectively evaluated. The evaluation was based on their treatment modality. Twenty-five conservatively-treated patients (group 1) and 30 surgically-treated patients (group 2) were evaluated. In group 1, seven patients with proximal fibula fractures had lateral hamstring tightness. Five out of these seven patients had concomitant lateral knee pain. Similarly, nine patients with proximal fibula fractures in group 2 had lateral hamstring tightness, and seven patients in the same group suffered from lateral knee pain. The patients with no fibula proximal fracture in both groups had no hamstring tightness or lateral knee pain. The proximal fibula in the knee joint and its anatomical structures are of utmost importance for the anatomical integrity of the knee and its normal functions. The fibula has rich anatomical relations, some of which are important structures of the knee. These anatomical structures and the fibula provide stability of the knee joint and its functions as well as being an important mechanical support to the knee joint. Therefore, the knee joint will receive the negative effects from the pathologies of the bone or soft tissue that may occur in fibula fractures.     

关节镜下重建膝关节新鲜与陈旧前交叉韧带训练伤疗效对比分析

目的比较部队官兵体能训练所致膝关节前交叉韧带(ACL)损伤手术时机对疗效的影响。方法关节镜下对平均病程(5±0.8)周27例新鲜组和平均病程(76±10.5)周19例陈旧组ACL损伤,均以半腱肌和股薄肌为替代物进行手术重建。结果按Lysholm评分,新鲜组和陈旧组ACL损伤的优良率分别为92.5%和78.9%,两组比较差异有显著统计学意义(P<0.01)。结论体能训练所致膝关节交叉韧带损伤早期关节镜手术重建的疗效优于晚期重建。     

胫骨平台骨折及膝关节附属结构损伤的MRI诊断

目的评价胫骨平台骨折合并膝关节附属结构损伤的MRI表现.资料与方法 27例胫骨平台骨折病例经X线平片检查后作MRI扫描,分析不同类型胫骨平台骨折所合并的膝关节附属结构损伤的MRI形态学表现.结果 MRI能准确显示骨折所合并的膝关节附属结构的损伤性病变,包括关节软骨断裂、半月板撕裂和移位、侧副韧带和肌腱的撕裂、关节腔脂肪血性积液等,其中双髁骨折引起的损伤最为严重,撕脱骨折引起的损伤较轻.结论 MRI能准确诊断胫骨平台骨折合并的膝关节附属结构损伤,应作为膝关节外伤的常规检查手段.     

Knee joint proprioception in patients with posttraumatic recurrent patella dislocation

In 30 healthy volunteers with clinically inconspicuous knee joints and nine patients with posttraumatic recurrent patella dislocation, the proprioceptive abilities of the knee joint were evaluated by an angle reproduction test. The results of the control goup showed no gender-or dominant-specific difference. The patient group showed a significant deterioration of proprioceptive capability in the injured knee joint. Even in the contralateral, uninjured knee joint, the angle reproduction test result was significantly reduced compared with the control group. After applying an elastic knee bandage, the control group and the patients with patella dislocation showed a significant improvement of the proprioceptive capability.     

髌上入路、髌下入路胫骨髓内钉治疗胫骨干骨折的对比研究

目的比较髌上入路和髌下入路胫骨髓内钉治疗胫骨干骨折的疗效,为胫骨髓内钉置入路径的选择提供依据。方法回顾性分析南京医科大学第二附属医院2015年9月—2017年12月收治的58例胫骨干骨折患者,男性42例,女性16例;年龄19~73岁,平均50.3岁。均采用髓内钉内固定手术,按手术入路分为髌上入路(SPN)组和髌下入路(IPN)组,各29例,统计并比较两组手术时间、出血量、骨折愈合、膝前疼痛、膝关节功能评分。结果定期电话及门诊随访13~20个月,平均15.6个月。SPN组手术时间(100.66±6.78)min短于IPN组(110.07±8.92)min;SPN组与IPN组相比,膝前疼痛程度较轻(VAS评分1.07±1.00 vs.1.66±1.40),膝关节功能评分较高(Lysholm评分96.28±4.08 vs.93.93±4.62,Oxford评分53.28±3.96 vs.51.17±3.55),P<0.05。SPN组与IPN组在出血量[(79.31±11.00)mL vs.(83.10±11.37)mL]、骨折愈合方面(RUST评分27.03±2.34 vs.26.72±2.20),差异无统计学意义,P>0.05。结论与髌下入路组相比,髌上入路髓内钉治疗胫骨干骨折,操作简便,手术时间短,术后膝关节功能评分高,值得临床推广。     

关节镜下应用不同内固定材料治疗胫骨髁间棘骨折的疗效分析

目的比较应用不同内固定材料治疗胫骨髁间棘骨折的临床疗效。方法将收治的胫骨髁间棘骨折患者3l例,按应用钢丝、空心螺钉为内固定材料分别分为A、B两组,根据膝关节功能（HSS）评分和Lysholm评分对膝关节的功能效果进行评估。结果所有病人均随访6～18个月,平均（11．4土2．8）个月。所有病例术后骨折均愈合,A、B两组的平均HSS评分分别为（90．8土2．4）和（91．5土2．0）,平均Lysholm评分分别为（91．1土2．3）和（92．4士1．9）,两组差异无统计学意义（P〉0,05）。结论关节镜下复位后钢丝或空心螺钉内固定治疗胫骨髁间棘骨折均疗效满意,术后膝关节功能良好。