肱骨干骨折涉及或合并肱骨近端骨折的髓内针治疗

目的 总结肱骨干骨折涉及或合并肱骨近端骨折时,采用髓内针治疗的效果.方法 采用髓内针治疗肱骨干骨折涉及或合并肱骨近端骨折19例,手术均采用闭合复位,近端锁定的髓内针固定.其中14例获得随访,随访9 ～38个月,平均23.5个月.复查时拍片判断骨折愈合情况,采用Constant-Merley绝对值评分方法评价术后疗效.结果 14例新鲜骨折均顺利愈合,平均愈合时间14.2周(10 ～20周),平均Constant-Merley绝对值86.8分(76 ～ 98分),平均前屈上举148.5°,其中优良11例,可3例.结论 髓内针是治疗涉及或合并肱骨近端骨折的肱骨干骨折可选的方法之一.     

后踝骨折切开复位螺钉置入过程中直视观察法与X射线透视法的比较

背景:既往后踝骨折的复位与固定过程中采用的传统X射线透视观察法,内踝脱位法及外踝截骨法等都存在不同程度的不满意之处。直视观察法可从另一种途径提供观察隐蔽的后踝。目的:观察在后踝骨折切开复位螺钉置入过程中直视观察法与X射线透视法的优劣。方法:选择2006-01/12北京积水潭医院创伤骨科收治的踝关节骨折患者26例,按照性别、年龄、骨折类型、受伤至手术时间等分为2组,每组13例。X射线透视组采用传统X射线透视法观察后踝骨折复位固定情况,直视组组采用直视法。结果与结论:直视组随访时间17~29个月,平均23个月;X射线透视组17~28个月,平均22.5个月。所有病例均获得骨性愈合,后踝关节面复位良好。直视组后踝复位及固定时间平均(8.08±1.55)min;X射线透视组平均(20.15±4.22)min,差异有显著性意义(P<0.01)。直视组平均术中后踝X射线透视1次;X射线透视组为3~8次,平均(5.38±1.76)次,差异有显著性意义(P<0.01)。直视组和X射线透视组AOFAS评分均为86~100分,平均96分,其中优各11例,良各2例。提示直视法观察后踝骨折复位及固定情况优于传统X射线透视法。     

有限切开腱周内缝合法治疗新鲜闭合性跟腱断裂

目的探讨新鲜闭合性跟腱断裂有限切开腱周内缝合术的初步临床应用结果。方法对25例新鲜闭合性跟腱断裂患者采用有限切开腱周内缝合术修复跟腱。采用Amer-Lindholm疗效评定标准进行功能评价。结果平均随访31个月。无感染及跟腱再断裂。腓肠神经支配区皮肤感觉正常。功能评定优22例（88%）,良3例（12%）。结论有限切开腱周内缝合法治疗新鲜跟腱断裂,能有效保护断端血运,创伤小,再断裂及感染机会少,功能恢复好,是新鲜闭合性跟腱断裂修复术的又一选择。     

手术治疗闭合复位失败的单纯创伤性桡骨头脱位的疗效分析

目的:探讨手术治疗闭合复位失败的单纯创伤性桡骨头脱位（ITRHD）的疗效。方法:回顾性分析自2011年1月至2020年12月北京积水潭医院创伤骨科共收治的8例闭合复位失败的ITRHD患者资料。男2例,女6例;年龄15~41岁,平均27岁;左侧3例,右侧5例。所有患者均采用手术治疗。末次随访时记录肘关节屈伸活动范围和前臂...     

儿童胫骨结节骨骺骨折

目的 探讨儿童胫骨结节骨骺骨折的特点、治疗及预后.方法 1995年1月至2007年12月,胫骨结节骨骺骨折患儿28例,其中资料完整者25例,男23例,女2例;年龄12～16岁.平均13.5岁;左侧10例,右侧15例,均为单侧受累.损伤方式:打篮球时受伤10例,跳跃时受伤7例,踢足球时受伤8例.根据Ogden分型标准,1A型1例,1B型4例,2A型5例,2B型7例,3A型4例,3B型4例.除1例1A型患儿骨折采用闭合复位长腿石膏前后托固定外,余24例均采用切开复位拉力螺钉内固定.结果 所有患儿均获得随访,随访时间14个月～7年,平均43个月.术后3个月患儿膝关节活动范围0°～140°,术后6个月恢复伤前运动水平.按照Mosier临床评价标准,结果均为优.所有病例手术切口均一期愈合,均未发生胫前间室综合征.骨折愈合时间2～5个月,平均3个月,伸膝装置序列正常,无一例患儿发生切口感染、内固定物失效或肢体畸形.结论 儿童胫骨结节骨骺骨折是一种不常见的特殊类型的骺损伤.在伸膝装置突然加速或减速的运动中,当髌韧带的牵拉力超过胫骨结节骨骺、周围软骨膜以及邻近骨膜的结合力时,就会发生胫骨结节的骨骺骨折.该骨折多见于13～16岁的男性患儿,单侧发病为主;可采用拉力螺钉内固定治疗,术后患儿膝关节功能正常.     

儿童胫骨结节骨骺骨折

Objective To discuss the characteristics, treatment method and prognosis of tibial tuberosity avulsion fracture in children. Methods From January 1995 to December 2007, there were 25 cases (23 boys and 2 girls). The age at injury ranged from 12 to 16 years(average 13.5 years). All cases were unilateral involved (10 of left, 15 of right). All of the injuries resulted from participation in athletic activities, 10 in basketball, 7 while jumping, and 8 in football game. According to the classification of Ogden, there were 1 type 1A, 4 type 1B, 5 type 2A, 7 type 2B, 4 type 3A, and 4 type 3B fractures. One type 1A fracture was treated nonoperatively with east immobilization, and other 24 fractures with open reduction and internal fixation. Results All of 25 cases were followed from 14 months to 7 years (average 43 months). The range of motion of knee joint was 0°-140° 3 months after operation, and all of them recovered to pre-injury levels of activity by 6 months after operation. According to Mosier clinical assessment system, the final outcome was evaluated as excellent in all. Wound healed primary, no compartment syndrome was found. The time of bony union ranged from 2 to 5 months, with the mean time of 3 months. No complications of infection, ex-tremities deformity and inner fixation failure were found. Conclusion The tuberosity avulsion fracture in children is an uncommon and special type of epiphyseal injury. These fractures occur in the narrow range of 13 to 16 years of age. The majority of patients are males, and most of them are unilateral involved. This in-jury has an excellent outcome without deformity or functional loss, once adequate reduction and fixation of fracture fragments have been achieved.     

不稳定肩胛颈骨折的手术治疗

目的 探讨不稳定肩胛颈骨折的手术治疗方法及疗效. 方法对2001年6月至2007年11月手术治疗且获得随访的13例不稳定肩胛颈骨折患者资料进行回顾性分析,其中男10例,女3例;左侧8例,右侧5例.单纯肩胛颈解剖颈骨折8例,肩胛颈骨折同时合并肩关节悬吊复合体损伤5例.手术采用肩关节后方入路,于因下肌与小测肌间隙进入,沿肩胛骨外缘到肩胛颈后方,复位固定肩胛颈骨折,同时固定合并的锁骨骨折、肩锁关节脱位及肩峰骨折.本组12例周定肩胛颈骨折的患者术前关节孟均向上倾斜,平均22.7°.采用Constant-Murley绝对值评分方法评价疗效. 结果 13例患者术后获平均45.1个月(10～90个月)随访.Constant-Mudey绝对值评分平均为81.2分(40～98分),平均前屈上举147.7°;优6例,良3例,可2例,差2例.术后12例固定肩胛颈骨折患者关节面向上倾斜平均为5.0°. 结论肩胛颈骨折的移位程度是影响预后的主要因素,采用肩关节后方入路复位固定移位的肩胛颈骨折可获得良好的临床效果.     

双钢板内固定与入工全肘关节置换术治疗老年肱骨髁间C型骨折的早期疗效比较

目的 比较老年肱骨髁间C型骨折应用双钢板内固定与人工全肘关节置换术的疗效.方法 2003年4月至2009年9月,采用双钢板内固定或人工全肘关节置换术治疗新鲜老年肱骨髁间骨折42例,骨折分型均为AO分型C型.对其中随访资料较完整的22例进行回顾性分析.双钢板内固定10例,男5例,女5例;年龄60～70岁,平均63.2岁;1例Gustilo Ⅰ型开放骨折,余9例均为闭合性骨折.人工全肘关节置换术12例,均为女性;年龄60～74岁,平均65.2岁;均为闭合性骨折.术后1、2、3、6个月、1年进行复查,之后每年复查1次.采用Mayo肘关节功能评分(Mayo elbow performance score,MEPS)进行评估,观察术后肘关节屈伸活动度、功能评分、优良率及并发症.结果 双钢板内固定组随访8～56个月,平均27.6个月;人工全肘关节置换组随访15～54个月,平均28.2个月.双钢板内固定组平均屈伸范围84.5°,人工全肘关节置换组平均屈伸范围107.5°,两组比较差异有统计学意义(P=0.007);双钢板内固定组MEPS评分平均75.5分,人工全肘关节置换组平均87.9分,两组比较差异有统计学意义(P=0.047);双钢板内固定组MEPS优良率60%,人工全肘关节置换组MEPS优良率83.3%,两组比较差异无统计学意义(P=0.348).双钢板内固定组术后并发症包括2例尺神经炎,2例异位骨化;人工全肘关节置换组术后并发症包括1例尺神经炎,1例肱三头肌肌力减弱,1例异位骨化.结论 对老年肱骨髁间C型骨折,一期行人工全肘关节置换术较双钢板内固定能获得更好的疗效.

Abstract：

Objective To compare the clinical outcomes of open reduction and internal fixation (ORIF) with total elbow arthroplasty (TEA) for type C inter-condylar fractures of the distal humerus in the elderly. Methods Twenty-two patients who were treated with ORIF or TEA from April 2003 to September 2009 were included in the study. All fractures were OTA classification 13C. Among them, 10 patients who were treated with ORIF were follow up for 8-56 months, while 12 patients who were treated with TEA were followed up for 15-54 months. The Mayo elbow performance score (MEPS) and the complications were compared. Results Using the MEPS, there were 2 in excellent, 4 in good, 4 in fair in the patients treated with ORIF. Complications included heterotopic ossifications (2 cases) and ulnar nerve dysfunction (2 cases).There were 6 in excellent, 4 in good, 2 in fair in the patients treated with TEA. Complications included 1heterotopic ossification (1 case), ulnar nerve dysfunction (1 case), the weakness of musculus triceps brachii (1 case). The patients treated with TEA had significantly better range of motion (107.5° vs 84.5°, P=0.007),also had better MEPS (87.9 vs 75.5, P=0.047) than those with ORIF had ones. Conclusion TEA is a liable option for type C inter-condylar fractures of the distal humerus in the elderly.     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.