锁骨钩钢板内固定配合康复治疗锁骨远端骨折

目的探讨和分析应用锁骨钩钢板内固定配合康复治疗锁骨远端骨折的新方法。方法42例应用锁骨钩钢板配合术后早期康复治疗锁骨远端骨折的患者全部得到了随访,随访时间2～46个月(平均15.6个月),患者年龄36～57岁,平均45.6岁。术后2d患肩按照制定的康复训练方法进行功能训练,最终随访按Lazzcano评价标准〔1〕评价治疗结果。结果42例患者术后X线检查均达到满意复位与固定,局部Lazzcano功能评定关节功能恢复优良率97.6%。结论应用锁骨钩钢板治疗锁骨远端骨折手术操作简单,配合术后完善的康复治疗,可得到非常满意的结果。     

Indications and limitations of locked plating

The goal of fracture fixation is to achieve bone healing and restore the function of the injured limb in the shortest possible time without compromising safety. Newer technologies such as the locking compression plate (LCP) and its derivatives are valuable additions to the orthopaedic traumatologist's armamentarium. As with any emerging technology, the indications will be extended until a threshold is reached and the limitations of the technology are seen. It is vital that surgeons involved in fracture care are aware of when locked plating is superior to other methods and also when they should use another treatment modality.This paper reviews the use of locked plating as a fixation method. Five topics covered in this review are: a historical perspective on locked plating, general indications, specific modes and techniques, patterns of failure, and an anatomical overview of current indications for locked plating.     

Results of non-operative treatment following hip fracture compared to surgical intervention

We followed all consecutive hip fracture patients admitted between 2004 and 2006, identified cases in which the intention was to treat non-operative and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 days and 1 year mortality, re-admission due to same fracture and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post-fracture mobility, mental confusion and independence. 25 patients were treated non-operative. 22 patients treated surgically over the same time period matched the patient characteristics of the non-operative arm. The mean hospital stay was 13 days in both groups. There were 4 extra-capsular fractures (3 displaced) and 21 intra-capsular fractures (5 displaced) in the non-operative arm and 11 extra-capsular fractures and 9 intra-capsular fractures in the surgically treated arm. 4 patients from the non-operative treatment group underwent late surgery because of persisting hip pain 20 days-2 months after the index event (2 cannulated screws, 1 hemiarthroplasty, 1 total hip arthroplasty). 11 patients in the surgical treatment arm underwent dynamic screw fixation, 1 had cannulated screw, 1 had total hip replacement and 7 had hemiarthroplasty. 14 of the non-operative treated patients were mobile independently or with aid before fracture but only 9 patients retained their pre-fracture mobility following treatment, compared to 16 patients pre-fracture and 11 patients post-fracture after surgery. 16 patients treated non-operative were living independently prior to injury but only 7 went back to their own residence. Of the operatively treated patients 14 patients were living independently and 10 patients went back to their previous residence. 1 month and 1 year mortality in the non-operative treated group was 4/21 and 7/21 respectively compared to 1/20 and 5/20 in the operative fixation group. There was no statistically significant difference in mobility, residence or mortality between the two groups (Fisher exact test, p > 0.05). Non-operative management after hip fracture is suitable for medically unfit patients and does not result in statistically significant difference in functional outcome or mortality compared to patients treated surgically.     

跟骨骨折治疗方法的疗效观察

目的比较跟骨骨折不同治疗方法的效果。方法88例96足跟骨骨折分成三组,分别应用撬拨复位石膏外固定、切开复位钢板内固定、可调节跟骨骨折外固定器治疗,术后从Bhler角的恢复、主观症状、并发症三个方面进行比较分析。结果可调节跟骨骨折外固定组在恢复Bhler角、术后主观症状改善、减少并发症方面优于撬拨复位石膏外固定组及切开复位内固定组。结论可调式跟骨骨折外固定器治疗跟骨骨折疗效优于撬拨组和内固定组。     

Guidelines for external fixation frame rigidity and stresses

Using results from FEM analyses and experiments as references, analytical methods are applied to develop simple approximate formulas to relate frame rigidity, maximal pin stresses, and peak pin-bone stresses in external fracture fixation (EFF) configurations in axial loading to the most important frame, pin, and bone parameters. It is found that, in a realistic range, the parameters can be adapted to vary the frame rigidity from about 13 N/mm to 17,000 N/mm, thereby reducing the maximal stresses in the pins and at the pin-bone interface by a factor of 140. In particular, when compromises have to be established in the frame characteristics in order to ensure a flexible configuration and limit the stress values at the same time, the formulas presented can provide useful guidelines. The side-bar separation and the pin modulus, in particular, can be adapted to decrease the rigidity, while only moderately increasing the stresses, thereby reducing changes for pin failure, pin-bone loosening, and pin-tract infection. A nomogram is presented for a quick reference to estimated relations between frame characteristics, rigidity, and stresses. It is believed that this material may be of use in EFF design and applications in clinical and animal experimental trials.     

前踝骨折诊治分析5例

踝部骨折是最常见的关节内骨折,约占全身骨折的3.9%[1]。自1998年4月至2004年3月收治单纯前踝骨折5例,现报告如下。1临床资料本组5例,均为男性;年龄18～24岁;左侧3例,右侧2例。受伤至住院时间为2h～1d,均为训练时从高处跳下垂直暴力所致。按Lauge-Hansen分类系统踝关节骨折分为     

自增强可吸收内固定治疗儿童肘部骨折

目的评价自增强可吸收内固定治疗儿童肘部骨折的可行性和有效性。方法2002年7月-2003年12月，25例儿童肘部骨折应用自增强可吸收内固定螺钉或棒固定，对其手术方法、骨折愈合、功能恢复进行回顾性分析总结。结果平均随访时间18个月（10-24个月）。所有骨折均于4周内达到临床愈合。1例肱骨髁上骨折因可吸收棒穿于皮下引起疼痛，妨碍关节活动，于术后6周拔除，恢复良好。1例肱骨内上髁骨折予可吸收螺钉固定，为保持骨折复位稳定，术后伸肘位石膏固定3周致关节僵硬，经CPM被动活动锻炼后肘关节活动基本恢复正常。其余病例在最后一次随访时，均关节活动良好，无畸形发生，也未见局部无菌性反应。结论自增强可吸收内固定治疗儿童肘部骨折可靠有效，近期随访效果满意，术后可早期进行功能锻炼。     

胸椎椎弓根根外固定螺钉拔出力的实验研究

目的:比较两种胸椎椎弓根根外固定方法与经椎弓根固定方法的螺钉拔出强度,评价胸椎椎弓根根外固定的生物力学效果。方法:新鲜胸椎标本4具,共32个肋骨-椎骨序列,根据螺钉固定方法不同分为3组,A组采用经椎弓根固定,B组采用经横突-椎体固定,C组采用经改良肋横突法固定。根据所用螺钉规格不同将其分为4种不同测试条件:D1,螺钉直径5.5mm,长度40mm;D2,螺钉直径5.5mm,长度45mm;D3,螺钉直径6.5mm,长度45mm;D4,螺钉直径6.5mm,长度50mm。测试3种固定方法下的螺钉拔出力,并做统计学分析对比。结果:D1条件下A组拔出力为787.0±119.3N,B组为706.2±109.4N,C组为616.1±82.3N,3组间比较有显著性差异(P<0.01);D2条件下A组拔出力为862.3±128.7N,B组为811.4±113.6N,C组为655.1±92.2N,A、B组间比较无显著性差异(P>0.05),A、B组与C组比较有显著性差异(P<0.01);D3条件下,A组拔出力为855.3±117.1N,B组为938.0±131.5N,C组为861.3±117.8N,A、C组间比较无显著性差异(P>0.05),A、C组与B组比较有显著性差异(P<0.01);D4条件下A组拔出力为864.3±120.9N,B组为959.6±135.2N,C组为941.2±115.4N,A组与B、C组比较均有显著性差异(P<0.01),B、C组间比较无显著性差异(P>0.05)。结论:使用直径6.5mm、长度45～50mm的螺钉固定时,胸椎椎弓根根外固定螺钉拔出力优于椎弓根固定,有较好的生物力学效果。     

腰椎后路非融合固定系统的临床应用

复习腰椎后路非融合固定系统的设计原理、临床应用及治疗效果等相关文献,与传统的脊柱融合术相比,应用非融合系统可获得很好的疗效,并可以减少邻近节段退变的发生率。     

高龄股骨转子间骨折两种治疗方法的临床观察

目的:探讨手术治疗高龄股骨转子间骨折的安全性、合理性。方法:股骨转子间骨折患者65例,其中采用动力髋螺钉(DHS)治疗32例,男14例,女18例;年龄65~79岁,平均(70.6±2.3)岁;EvansⅠ型2例,Ⅱ型7例,Ⅲ型15例,Ⅳ型8例。采用单边外固定支架治疗33例,男14例,女19例;年龄68~90岁,平均(74.2±3.8)岁;EvansⅠ型3例,Ⅱ型15例,Ⅲ型11例,Ⅳ型1例,Ⅴ型3例。临床观察包括术中出血量、手术时间、骨折愈合时间、术后并发症及髋部运动功能等。结果:所有病例均获随访,时间1~34个月,平均19个月。两组手术时间、术中出血量、术后并发症发生率差异有统计学意义(P<0.05)。平均愈合时间DHS组为(13.0±2.7)周,外固定支架组为(12.3±3.0)周,差异无统计学意义。Sanders髋关节功能评价:DHS组优19例,良6例,可3例,差2例;外固定支架组优12例,良8例,可8例,差5例。两组优良率差异有统计学意义(P<0.05)。结论:围手术期外固定支架组较DHS组安全简便,术后疗效DHS组优于外固定支架组。