斯氏针弹性髓内固定治疗胫腓骨中下段骨折

胫腓骨中下段骨折是骨科常见的疾病,其治疗方法颇多,根据弹性模式理论,我院自1995-2000年对收治的208例胫腓骨中下段骨折患者,47例采用斯氏针弹性髓内固定,临床效果满意.……     

单侧矩形钉重叠髓内固定治疗胫腓双骨折

小腿胫腓双骨折临床上常见,治疗方法多,但感染、骨畸形、骨不连、关节僵硬等并发症较多。1995年8月-2005年8月,我科应用单侧矩形钉(2枚矩形髓内钉重叠固定)髓内固定治疗154例,辅以正骨手法,疗效满意,报告如下。1临床资料154例患者,男98例,女56例;年龄16~83岁,平均37岁。致伤原因:车祸伤78例,工作伤42例,生活伤34例。骨折部位:中上1/3段26例,中段84例,中下1/3段44例。骨折类型:开放性骨折58例,闭合性骨折96例。Gustilo分型:Ⅰ型82例,Ⅱ型38例,ⅢA型29例,ⅢB型4例,ⅢC型1例。骨折性质:稳定性骨折(横断、裂纹)51例,非稳定性骨折(粉碎、斜面、…     

Clinical and instrumental evaluation of implant stability after free fibula flaps for jaw reconstruction

Osseointegration is a direct union between bone and an allograft with no soft tissue interposition. It represents the morphological basis of secondary stability. Introduction of Resonance Frequency Analysis (RFA) as a commercially available technique has made it possible to measure implant stability as an Implant Stability Quotient (ISQ) unit at any time during the course of implant treatment and loading. The study aims to clinically and objectively analyze the stability of implants loaded upon revascularized free fibula flaps on patients who underwent maxilla or mandible reconstruction following trauma, oncological resection or class V–VI Cawood's atrophy treatment. Of the 105 patients that underwent jaw bone reconstruction with free fibula flaps in our division between 1993 and 2003, 37 were eligible for implant-supported dental rehabilitation. Of these, the last 12 were selected and included in the study. Primary and secondary implant stability assessments involved a clinical evaluation, radiograms and RFA measurements using the Osstell (Integration Diagnostics, Savedalen, Sweden) at the time of implant insertion, at 6 months and at 1 year of functional loading. 76 implants were loaded in 12 patients. All of them were clinically stable at each evaluation. Radiograms showed modest bone resorption after 1 year of functional load in 16 implants (21%). Implant stability levels ranged from 48 to 74 ISQ (mean 59.9±7.8 ISQ) at 6 months. At 1 year, the mean ISQ level was higher (62.6±7.2) but still coherent according to the radiographic evidence. Implant-supported dental rehabilitation of the reconstructed jawbone is not always possible. Free fibula flap represents a good substrate for implant osseointegration being a bicortical bone capable of structural remodelling after masticatory load enhancement. When possible, instrumental evaluation of implant stability with RFA and supported by radiograms represent the best objective way to assess osseointegration as a clinical evidence alone is unable to offer a definitive assessment.Presented at the 16th Annual Meeting of the European Association of Plastic Surgeons (EURAPS), May 26–28, 2005, Marseille, France.     

外固定支架联合小夹板治疗儿童复杂胫腓骨骨折

复杂的胫腓骨骨折在儿童骨折中不多见,其治疗方式的选择也较棘手,治疗不当会导致患儿的终生残疾。自2000年以来共收治AO分类为C2型的儿童胫腓骨干骨折22例,使用单侧多平面金属外固定支架联合小夹板进行治疗,取得较满意的效果,现报告如下。1临床资料本组22例患儿中,男14例,女8例;年龄3~14岁,平均8·6岁。其中车祸伤19例,摔伤3例;受伤均为单侧小腿,其中左侧9例,右侧13例;18例合并有腓骨骨折;开放性骨折12例,闭合性骨折10例。所有病例按胫腓骨干骨折的AO分类均为C2型。均使用单侧多平面金属外固定支架。2方法2·1治疗方法本组术前均采用跟骨…     

吻合血管游离腓骨移植修复长段骨缺损

传统骨移植术，由于缺乏血液供应，植入骨块需经长久的爬行替代过程才能愈合，且易发生骨不连、骨吸收及感染率高等缺点。１９９０年以来，采用吻合血管腓骨移植修复外伤性骨缺损７例，骨肿瘤及肿瘤样病变切除致长段骨缺损５例，骨髓炎骨缺损１例，均获成功。经随访６个月～７年均达骨愈合，其中４例携带腓骨头移植修复桡骨下端缺损重建桡腕关节，功能恢复满意。１例胫骨长段骨缺损行吻合血管移植术后９个月、１２个月，先后两次发生疲劳性骨折。认为，移植之腓骨虽愈合增粗，但可能因负重而发生疲劳性骨折，适当延长术后外固定时间，是防止骨折的重要措施。     

游离腓骨(皮)瓣移植修复上肢长段骨缺损

目的 探讨游离腓骨(皮)瓣移植修复上肢长段骨缺损的临床应用及效果.方法 自2000年6月至2010年12月,应用游离腓骨骨瓣修复上肢长段骨缺损12例,其中携带皮瓣4例.男11例,女1例;年龄19～ 55岁,平均35岁.修复肱骨缺损2例,尺骨缺损6例,桡骨缺损4例.腓骨瓣切取范围1.5 cm× 2.0 cm～ 12.0 cm× 16.0 cm,腓骨移植长度6.0～ 20.0 cm.结果 12例均成功并获得随访,随访时间平均2年5个月.4例携带皮瓣全部存活;创面Ⅰ期愈合11例,Ⅱ期愈合1例,愈合时间12～18 d;腓骨移植骨愈合时间3～6个月,平均4个月.应用Enneking上肢功能标准评分为22～29分,平均27分;供区无功能障碍.结论 游离腓骨(皮)瓣移植修复上肢长段骨缺损可一期完成骨缺损修复,且可同时解决软组织缺损.虽难度大、风险高,但仍是一种很理想的治疗方法.     

腓骨小头复合皮瓣重建足前掌部缺损的生物力学实验与临床研究

目的：本文通过７例下肢标本，测试足前掌部外伤性缺损与重建后足的生物力学变化。方法：模拟第一跖骨头缺损，然后应用腓骨小头复合皮瓣重建足前掌部的缺损，进行生物力学实验，结果：此方法不仅能满足下肢强度，刚度和稳定性的要求，而且符合足生物力学原理。结论；其两者形态结构上的均符合生理要求，重建后构成了合理的足弓力学结构，而重建后的下肢的应力，应变，位移和轴向刚度上与原始标本无显著性差异，而与缺损下肢呈显著性     

几种固定方式急诊治疗多发伤合并胫腓骨开放性骨折的疗效分析

目的 比较四种固定方法早期固定开放性胫腓骨骨折对严重多发伤患者治疗和预后的影响.方法 回顾性分析243例存在胫腓骨开放性骨折的严重多发伤患者(ISS≥16分)的资料,其中对胫腓骨骨折采用跟骨牵引加夹板治疗48例,带锁髓内钉治疗69例,钢板螺钉治疗54例,外固定支架治疗72例.从病死率、ARDS、脂肪栓塞综合征(FES)、MODS、ICU监护时间等近期指标,以及创面愈合时间、骨折愈合时间、关节功能恢复优良率、骨折并发症等远期指标,对比分析四种早期固定方法对骨折本身和多发伤治疗的疗效.结果 带锁髓内钉治疗胫腓骨骨折在多项指标方面较其他固定方法为优(P<0.05,0.01).结论 带锁髓内钉治疗严重多发伤并胫腓骨中段开放性骨折(Gustilo Ⅰ型、Ⅱ型和Ⅲa型),明显减少并发症发生率,术后骨折愈合较为理想.

Abstract：

Objective To comparethe effects of four different emergency fixation methods for the open tibiofibular fractures on the treatment and prognosis of the multiple trauma patients. Methods A comparative study was carried out on the effect offour different early fixation methods on the fracture and the multiple trauma in aspects of the short-term indicators including mortality rate,acute respiratory distress syndrome(ARDS),fat embolism syndrome(FES),multiple organ dysfunction syndrome (MODS),ICU stay and the long-term indicators including wound healing time,fracture healing time,rate of joint function recovery and fracture complications in 43 multiple trauma patients. Results The locked intramedullary nail wag better than the other fLxation methods including the calcaneal traction,the gypsum external fixation and the internal fixation with steel plate and extemal fixation support in most indexes(P<0.05,0.01). Conclusion The locked intramedullary nail can significantly decrease the incidence rate of complications and obtain sound fracture healing for the patients with multiple trauma combined with open tibiofibular fractures(types Gnstilo Ⅰ,Ⅱ and Ⅲa).     

腓骨高位截骨在膝关节骨性关节炎的应用

目的:探讨腓骨高位截骨术对膝关节骨性关节炎的短中期疗效。方法:2014年10月至2016年7月,采用腓骨高位截骨治疗膝关节骨性关节炎76例,男22例,女54例;年龄47~82岁,平均61.62岁。术前查体膝关节内侧压痛,内侧麦氏征阳性,摄膝关节负重正侧位X线片显示内侧间隙变窄,术后行膝内侧间隙、股骨胫骨角、VAS疼痛评分及AKS评分进行评价。结果:术后随访10~18个月,平均8.9个月。与术前相比,术后膝内侧间隙明显变宽,股骨胫骨角度变大。术前VAS疼痛评分5.70±1.56,术后1周3.70±1.03,1个月3.20±0.95,3个月2.35±0.99,1年2.10±0.97。膝关节功能AKS评分术前疼痛14.45±1.76,活动度12.60±1.98,稳定性12.15±1.72;末次随访疼痛42.60±2.28,活动度21.80±2.14,稳定性20.85±2.16。VAS评分术前与术后各时间段相比差异有统计学意义,AKS评分术前与术后差异均有统计学意义。结论:腓骨高位截骨操作简单,并发症少,能有效减轻膝关节疼痛,改善膝关节功能,临床效果满意。     

复杂性胫腓骨骨折137例

目的 探讨复杂性胫腓骨骨折治疗中骨折与软组织损伤处理的方法。方法 对１３７例复杂性胫腓骨骨折的治疗进行分析。其中胫腓骨多段骨折８９例,伴有软组织缺损的胫腓骨开放粉碎骨折２７例,合并血管神经损伤的胫腓骨骨折２１例,有１１８例获得１０个月￣５年２个月的随访,平均随访２年３个月。