微创经皮钢板固定术治疗胫骨远端骨折38例临床观察

目的观察微创经皮钢板固定术治疗胫骨远端骨折的临床效果。方法选取2005年7月至2010年4月于我科住院的胫骨远端骨折患者38例,全部患者均采用微创经皮钢板固定术治疗。结果术后4、24、48周踝关节平均活动度分别为62°、70°、73°,按johner-wruhs关节功能评定标准预后优16例,良19例,中2例,差1例,优良率为92.1%。结论微创经皮钢板固定术治疗胫骨远端骨折创伤小,效果明确。     

MIPPO微侵入经皮钢板植入技术治疗胫骨远端骨折的临床效果评价

目的探讨评价MIPPO微侵入经皮钢板植入技术治疗胫骨远端骨折的临床效果。方法选取2010年5月~2014年5月在我院治疗的100例胫骨远端骨折患者,将患者随机分成对照组和实验组,其中对照组40例采用传统的常规治疗方法植入普通钢板,实验组60例采用MIPPO微侵入经皮钢板植入技术,观察两组患者治疗的临床效果、术中出血量、手术时间、住院时间和骨折愈合时间。结果实验组治疗的优良率（98.33%）明显高于对照组的治疗优良率（72.50%）,差异有统计学意义（P〈0.05）;实验组患者的手术时间、手术出血量、住院时间和骨折愈合时间均明显少于对照组,差异有统计学意义（P〈0.05）。结论 MIPPO微侵入经皮钢板植入技术在胫骨远端骨折患者治疗中简化了手术过程,减少了患者在手术过程中的出血量,缩短了患者的住院时间和骨折愈合时间,提高医院床位的转换率和治疗优良率,值得在临床上推广使用。     

The Epiperiosteal, percutaneous plate osteosynthesis. A minimally invasive technique under the aspect of biological osteosynthesis

Summary Conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host defence mechanism are general and essential aspects of a biological osteosynthesis. The minimal invasive operating techniques with the use of technical aids and tricks form the necessary presupposition for successful bone healing with a low complication rate. For an epiperiosteal, percutaneous plate osteosynthesis, the technique using a sliding tip and a manipulation handle is demonstrated.      

Fracture Healing: A Concept of Competing Healing Factors

In the discussion concerning the theory of the healing of shaft fractures the demand for absolute stability of the fracture has been a dominating factor. This cannot be an absolute prerequisite because fractures of the tibia or femur heal well even with continued weight-bearing and movement. the ingrowth of vessels is apparently not a crucial factor. It is evident, however, that fractures caused by direct violence with soft tissue damage heal more slowly than fractures caused by indirect violence, irrespective of the treatment. Soft tissue heals with fibrous scar; fractures heal by bone regeneration. the author postulates that the damaged tissue stimulates (possibly via molecular determinants) the structural genes of undifferentiated cells to produce mRNA and proteins for either fibrous tissue or bone formation. the rate of healing of the fracture is determined by the degree of bone damage in relation to soft tissue damage. in fractures with extensive soft tissue injury there occurs a competitive condition in the common haematoma, with a risk of delayed fracture healing due to the dominance of cells that are triggered off by fibrous tissue formation.     

Plate Osteosynthesis for Shaft Fractures of the Tibia

Out of 46 tibial shaft fractures treated by the AO method 42 healed primarily and four had delayed union. Otherwise no serious complications were encountered.     

Anatomical studies and a correlative management of facial skeleton and skull base injuries with bone plate fixation

Summary Miniplate osteosynthesis is an osteoplastic procedure that achieves secure stabilization of the midface, even following extensive fractures of the midface and the floor of the anterior cranial fossa. This procedure can be considered a satisfactory operative treatment in terms of cosmetic and functional results. Correlative osteology is discussed and clinical experiences are reviewed.Dedicated to Professor J.Lang, Director, Anatomical Institute of the University of Würzburg, in honor of his 65th birthdayHead of the ENT Department from 1975 to 1987     

The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella

The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljani? Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.     

Operative Frakturbehandlung

Zusammenfassung Nach einem kurzen historischen Rückblick werden die Prinzipien der operativen Frakturbehandlung unter besonderer Berücksichtigung der Methoden der Schweizer Arbeitsgemeinschaft für Osteosynthesefragen dargestellt. Die stabile Osteosynthese ermöglicht eine sofortige, gipsfreie funktionelle Nachbehandlung. Dadurch lassen sich Weichteilschäden auf ein Minimum reduzieren. Auf die Indikationsstellung wird ausführlich eingegangen.Der Wert der Knochenszintigraphie mit Sr 87m zur Beurteilung der Revitalisierung aus der Blutversorgung ausgeschalteter Fragmente wird hervorgehoben. Die Ergebnisse von 957 operativ behandelten Frakturen werden mitgeteilt.

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Operative treatment of fractures

Summary Following a short historical review the principles of operative treatment of fractures are discussed considering in particular the methods of the Swiss Working Group for Osteosynthesis. Stable internal fixation enables an immediately functional, castfree postoperative care. Soft tissue damage is reduced to a minimum. The indications of osteosynthesis are discussed in detail.The use of bone scanning using Sr-87m for the evaluation of the revitalisation of necrotizing fragments is emphasized. The results of 957 cases of operatively treated fractures are given.

Herrn Univ.-Prof. Dr. F. Spath zum 70. Geburtstag gewidmet.     

微创锁定接骨板技术治疗复杂肱骨干骨折

目的探讨肱骨前方入路锁定钢板微创治疗复杂肱骨干骨折的疗效。方法2005年1月-2008年12月利用微创锁定接骨板技术治疗26例复杂肱骨干骨折（骨折类型采用AO分型标准：B型骨折15例,C型骨折11例）,采用闭合牵引复位,肱骨前侧微创切口,钢板经皮下潜行插入,跨越骨折端,钢板置于肱骨干前表面,经皮进行锁钉螺钉固定。UCLA标准评估肩关节功能。结果26例骨折术后3-5个月,平均4个月愈合。2例出现桡神经损害症状,分别于术后2周、3．5月内神经功能恢复;1例因钢板过高产生肩关节撞击症状,骨折愈合后内固定取出,症状消失。26例术后随访18-36个月,平均26个月,术后6个月肩关节功能UCLA评分优良率92．3％（24／26）。结论微创肱骨前方置人锁定钛板技术是治疗复杂性肱骨干骨折的一种安全有效的方法。     

锁定钢板小切口治疗胫骨干部及穹窿部骨折

目的探讨锁定钢板小切口治疗胫骨干部及穹窿部骨折的疗效。方法对31例胫骨干部及穹窿部骨折患者采用锁钉钢板小切口治疗。结果手术时间60～120（90±30）min。术后X线片显示骨折均达到解剖复位或接近解剖复位。31例均获得随访,时间5～24个月。根据Olerud-Molander评分系统评定：95～100（97.25±2.75）分,优24例,良5例,中1例,差1例,优良率达到93.55%。结论锁定钢板经皮小切口治疗胫骨骨折,固定方法简单,钢板把持力可靠,可早期恢复关节活动,临床效果好。