微创经皮钢板内固定治疗胫骨远端骨折

目的比较微创经皮钢板内固定与传统内固定治疗胫骨远端骨折的疗效。方法自1998年10月至2002年5月，80例胫骨远端骨折患者随机分为2组，微创经皮钢板内固定组与传统切开复位内固定组各40例。结果术后平均随访20个月，微创经皮钢板内固定组中所有骨折均愈合，平均骨折愈合时间为11．9周。传统切开复位内固定组中，骨不连7例，伤口感染6例，钢板外露6例。结论微刨经皮钢板内固定治疗胫骨远端骨折，骨折愈合快，感染率低，是1种较好的生物学固定方法。     

Osteomyelitis after Operative Fracture Treatment: A Report of 62 Cases Treated with Radical Surgery and Lincomycin (Lincocin®)

During the years 1967-1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients.

Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance.

The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3-12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation.

At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent.

Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.     

采用MIPPO技术治疗胫骨远端骨折

目的 探讨胫骨远端骨折的治疗方法。方法 采用微创接骨板固定技术（MIPPO）治疗胫骨远端骨折42例，对其进行分析评定。结果 本组42例病人中，除外1例因开放损伤软组织损伤严重而出现创周皮肤坏死外，其他病人均伤口一期愈合，骨折如期愈合，功能恢复良好，无感染及内固定松动等并发症。结论 用MIPPO技术治疗胫骨远端骨折，具有手术简便易行、手术损伤小、出血少、手术时间短、骨折固定牢靠、愈合快、不易产生并发症、关节功能恢复良好、易被患者接受等优点，是一种较好的治疗胫骨远端骨折的方法。     

髓内钉生物学固定技术治疗严重股骨骨折

目的总结应用闭合复位髓内钉内固定技术，按生物学固定原则（biologic osteosynthesis，BO）治疗严重股骨骨折的经验．方法自2002年3月至2004年6月间，应用闭合复位髓内钉内固定技术，按BO原则治疗46例严重股骨骨折．结果无围手术期并发症及术后感染病例．术后随访6月-2a，平均12月，骨折达到临床愈合时间4—12月，平均6．8月，下肢功能恢复按膝关节Merchant评分标准，优31例，良13例，中2例．结论采用闭合带锁髓内钉生物学固定技术治疗严重股骨骨折可以获得满意的疗效．     

Computer-assisted virtual technology in intracapsular condylar fracture with two resorbable long-screws

Our aim was to fix intracapsular condylar fractures (ICF) with two resorbable long screws using preoperative computer-assisted virtual technology. From February 2008 to July 2011, 19 patients with ICF were treated with two resorbable long screws. Preoperatively we took panoramic radiographs and spiral computed tomography (CT). Depending on their digital imaging and communications in medicine (DICOM) data, the dislocated condylar segments were restored using the SimPlant Pro™ software, version 11.04. The mean (SD) widths of the condylar head and neck from lateral to medial were 19.01 (1.28) mm and 13.84 (1.13) mm, respectively. In all patients, the mandibles and the ICF seen intraoperatively corresponded with the preoperative three-dimensional and virtual reposition. All patients were followed up for 6–46 months (mean 21). Occlusion and mouth opening had been restored completely in all but one patient, and absolute anatomical reduction was also achieved in most cases. Computer-assisted virtual technology plays an important part in the diagnosis of ICF, as well as in its preoperative design. Fixation with only two resorbable long screws is an effective and reliable method for fixing ICF.     

微创经皮钢板固定治疗胫骨骨折

目的 为胫骨骨折治疗探索一种新的内固定技术。方法 运用微创技术经皮钢板内固定治疗45例胫骨骨折。在胫骨内侧建立皮下隧道；通过此隧道将钢板安放在胫骨内侧骨膜上，骨折间接复位，少数螺钉予以固定。结果 所有病例得到随访，时间12－24个月，平均15个月。骨折愈合时间2.5-4.5个月，平均3.1个月，未见骨不连及钢板断裂、松动。结论 微创钢板接骨术能减低对骨折处血;运的干扰，提高骨折愈合率。     

股骨远端复杂类型骨折微侵治疗的疗效分析

目的 评价微侵袭接骨板技术(minimally invasive plate osteosynthesis,MIPO)治疗股骨远端复杂类型骨折的治疗效果. 方法 2005年7月-2006年12月,通过MIPO联合股骨远端锁定加压钢板(locking compression plate,LCP)内固定治疗41例高能量创伤所致的股骨远端复杂类型骨折.其中男31例,女10例;平均年龄38岁(17-65岁).AO/OTA 33-A311例,C222例,C38例.开放性骨折16例.以临床功能和X线检查评定治疗效果. 结果 41例均获随访,平均随访时间8个月(2-18个月).41例骨折全部愈合,平均愈合时间13周(7～16周).未发生内固定失败和骨不愈合,浅表感染1例.膝关节活动度45°～135°,平均110°.美国特种外科医院(Hospital for Special Surgery,HSS)膝关节功能评分:优良36例,优良率88%.术后第2天与最后一次随访时相比,股骨下端轴线与股骨远端关节面切线夹角变化没有大于5°者. 结论 通过MIPO联合股骨远端LCP内固定治疗股骨远端复杂类型骨折创伤小,对软组织干扰少,能够获得并维持稳定固定,有利于骨折早期愈合,减少并发症发生.