人工关节置换术治疗股骨粗隆间骨折内固定失败的老年患者

目的:报告采用人工关节置换治疗老年患者股骨粗隆间骨折内固定术后失败病例的疗效。方法:本组13例,男5例,女8例。年龄73~88岁,平均79岁。内固定失败时间6~15个月,平均11个月。初次骨折固定方法:PFN(股骨近端髓内钉)固定5例,DHS(滑动加压鹅头钉)固定6例,短重建钉固定2例。患肢活动受限且均有明显疼痛,基本丧失行走能力,8例经常服用止痛药,5例间断服止痛药。13例均采用骨水泥型人工关节置换治疗,其中10例人工股骨头置换,3例人工全髋关节置换。结果:全部患者均顺利通过手术。术后11例有随访结果,随访时间5~15个月,平均9个月,均可扶助行器或手杖行走,达到生活自理或大部分自理。结论:老年股骨粗隆间骨折内固定术后失败导致骨不连或严重畸形,采用人工关节置换治疗,是一种拯救性的治疗措施,疗效满意。     

双钢板垂直和平行放置治疗C型肱骨远端骨折的对比研究

Background Double plate osteosynthesis is the standard treatment for intra-articular fractures of the distal humerus. However, there is still controversy concerning dual plate positions in terms of providing optimal stability. The purpose of this retrospective study was to compare the clinical outcomes in patients with type C intra-articular distal humeral fractures using perpendicular and parallel plating methods.

Methods Between March 2008 and June 2011, a total of 45 patients with type C distal humerus fractures were treated using two different dual plating methods. Of them, 24 patients were treated by perpendicular plating (group I) and 21 patients were treated by parallel plating (group II). The surgical time, blood loss, and union time were compared between the two groups. The flexion-extension arc, the total range of flexion and extension at the end of follow-up were compared between the two groups. The Mayo Elbow Performance Score (MEPS) was used to determine the elbow functional results.

Results All patients were followed up. The mean duration of follow-up was 16 months (range 12–25 months) in group I and 15.5 months in group II (range 12–25 months). There were no significant differences in the surgical time, blood loss, and the bone union time between the two groups. In group I, the mean elbow flexion-extension arc was 101° and the mean MEPS was 85 points. The rate of excellent and good results was 87.5%. In group II, the mean flexion-extension arc was 100° and the mean MEPS was 86.1 points. The rate of excellent and good results was 90.5%. There were no significant differences in the MEPS, flexion-extension arc, and the total range of flexion and extension between the two groups.

Conclusions Perpendicular and parallel plate configurations with the appropriate surgical techniques can provide anatomical reconstruction and stable fixation of type C intra-articular distal humeral fractures and allow early mobilization of the elbow after an operation. The occurrence of post-operative elbow stiffness can be reduced and good outcomes can be obtained.

     

严重骨盆骨折的治疗

正2017年11月17日,中华医学会第十九届骨科学术会议暨第十二届COA国际学术大会在珠海召开,来自德国的Michael Nerlich教授应邀在创伤骨科论坛上就"严重骨盆骨折的治疗"作了专题演讲,从骨盆骨折的急救、固定方式、后期治疗等多角度进行了详细的阐述。经Nerlich教授同意,受学组委托,将其讲演内容整理成文,与骨科同道分享。     

国产全膝关节置换术辅助机器人系统的尸体实验研究

目的 通过尸体实验验证骨圣元化全膝关节置换术辅助系统(YUANHUA-TKA)的操作性能、精准性及安全性,以进一步优化系统,为其临床应用提供依据.方法 6具单侧成年下肢尸体标本,实验前行CT三维扫描,然后使用YUANHUA-TKA 系统术前软件进行分割,获取股骨及胫骨三维模型,从而规划假体植入物型号以及截骨量和截骨角度...     

2021年新年致辞

亲爱的全国创伤骨科同仁:值此2021年新年来临之际,我谨代表中华医学会骨科学分会外固定与肢体重建学组全体委员,向全国骨科同仁致以诚挚的敬意和问候,祝愿大家在新的一年里身体康健,工作顺心,不畏艰难,砥砺前行!2020年是极不平凡的一年。年初,突如其来的新冠肺炎疫情席卷全国,打破了平静的工作和生活。在以习近平同志为核心的党中央英明领导和科学决策下,全国人民打了一场漂亮的抗击新冠肺炎的人民战争。在这场抗击新冠肺炎的阻击战中,学组在中华医学会骨科学分会主任委员张英泽院士带领下,闻令而动,与兄弟单位和同仁一起,白衣执甲、逆行出征、披荆斩棘,谱写了一曲曲壮美的英雄赞歌。     

老年髋部骨折治疗方法的选择与进展

<正>髋部骨折是一种常见且严重的骨折类型,已成为全球的公共健康问题。我国骨质疏松患病率在2018年已经高达24%,尽管采取了预防措施,但随着我国社会老化进程的加剧,据估计到2050年我国髋部骨折的总数将稳步增加^[1-3]。髋部骨折后1年病死率高达25%～30%,且医疗费用昂贵,此问题不容小觑,值得我们深切关注^[4-6]。     

应用外固定支架治疗不稳定性胸锁关节脱位

胸锁关节脱位在临床比较少见,仅占肩胛带损伤的3%,诊断治疗却比较困难,尤其是不稳定性胸锁关节脱位,复发率高,手术并发症多而严重。自2003年1月-2005年12月,应用外固定支架治疗不稳定性胸锁关节脱位6例,取得了满意的效果,现报告如下。1临床资料本组6例,男5例,女1例;年龄18~45岁;左侧2例,右侧4例,皆为新鲜脱位。受伤原因:车祸撞击伤4例,运动伤1例,骑车摔跌伤1例。其中,G radeⅢ型[1]胸锁关节脱位5例,RockwoodⅤ型[2]肩锁关节脱位1例,皆为不稳定性脱位。合并伤2例,包括同侧肩锁关节脱位、肱骨外科颈骨折、肋骨骨折。主要症状及体征:6例均有明…     

LCP钢板和带锁髓内钉治疗新鲜胫骨干骨折的对比研究

目的回顾性分析LCP钢板和带锁髓内钉两种方法治疗新鲜胫骨干骨折的效果。方法2003年10月～2006年4月,收治55例胫骨干新鲜骨折患者。其中男39例,女16例;年龄14～62岁,平均39岁。左侧27例,右侧31例,其中3例为双侧。34处骨折采用带锁髓内钉固定治疗(髓内钉组),24处骨折给予LCP钢板内固定治疗(LCP组)。髓内钉组和LCP组伤后至手术时间分别平均为3d和3.1d。评估两组患者手术时间、膝、踝关节活动度、骨折愈合时间以及术后并发症。结果术后获随访8～26个月,平均13个月。手术时间髓内钉组为84.0±9.2min,LCP组为69.0±8.4min;平均住院费髓内钉组为19297.78元,LCP组为14116.55元,差异均有统计学意义(P<0.05)。髓内钉组膝关节屈曲为139.0±3.7°,LCP组为149.0±4.2°,伸直分别为4.0±0.7°和0±0.4°,差异均无统计学意义(P>0.05)。髓内钉组、LCP组踝关节背屈分别为13.0±1.7°、10.0±1.4°,跖屈分别为41.0±2.6°、44.0±2.3°,差异均无统计学意义(P>0.05)。骨折愈合时间LCP组略早,平均为3.1个月;髓内钉组平均为3.3个月。髓内钉组术后X线片示1例下肢短缩2.5cm,1例骨折延迟愈合,3例钉尾问题,1例旋转畸形(20°),6例膝前疼痛;LCP组1例开放骨折(AO分型为42B型)的患者术后1周发生感染,1例胫骨远端1/3骨折出现成角畸形。结论带锁髓内钉和LCP钢板内固定治疗胫骨骨折均可取得理想效果。两种方法在膝关节和踝关节背屈度及跖屈度方面影响很小,都可保证骨折愈合。LCP钢板内固定并发症较少,且在手术时间和住院费用上更加有优势。