髋臼方形区骨折的治疗及研究进展

髋臼是人体的重要承重关节,髋臼方形区是髋臼内侧壁的重要结构,具有特殊的形态结构和重要功能。方形区骨折是髋臼骨折中常遇到的骨折,由于髋臼方形区处于骨盆内侧,所以手术中的显露及复位十分困难。同时,髋臼方形区骨质较薄较难固定,外侧有髋关节,选择合适的内固定和对相关解剖的了解十分重要。方形区骨折后,股骨头容易向内侧移位,甚至突入盆腔造成嵌顿,其复位和治疗一直是骨科中的难点。对于方形区骨折不同的治疗方法,其疗效也不一。本文就方形区的解剖学特点、手术入路选择、内固定治疗方式、治疗要点和疗效等做一综述。     

植入物内固定修复老年下肢骨折:不同麻醉方法对血流动力学及镇痛的影响

背景：目前腰麻-硬膜外联合麻醉中,其用药方式与单独腰麻和硬膜外麻醉用药无太大差别,即先以较大剂量腰麻,而硬膜外用于确保效果和术后镇痛。近年来国内外有学者提出一些新的观点：腰麻先给予小剂量、低浓度的局麻药,再予硬膜外衔接以小剂量、低浓度的局麻药,真正发挥腰麻与硬膜外的联合作用,可以达到完善麻醉效果,以减少不良反应和并发症。
　　目的：分析小剂量低密度腰麻-硬膜外联合麻醉在老年下肢骨折修复手术中的应用效果。
　　方法：选取惠州市中心人民医院择期行单侧下肢手术患者68例,按照麻醉方式分为对照组与观察组,各34例。对照组采用连续硬膜外麻醉,观察组采用小剂量低密度腰麻-硬膜外联合麻醉。对比分析两组患者麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量、下肢改良Bromage评分及血流动力学变化。
　　结果与结论：观察组麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量及下肢改良Bromage评分与对照组比较,观察组优于对照组,差异有显著性意义(P <0.05)。两组患者麻醉后5,10 min平均动脉压显著低于麻醉前(P <0.05),其余指标差异无显著性意义。两组患者术后生命体征平稳,且无术后认知功能障碍发生。提示采用小剂量低密度腰麻联合硬膜外麻醉具有起效快、用量少、阻滞完全、镇痛效果好等优点。临床将其应用于老年下肢骨折修复手术,对患者血流动力学影响较小,且可达到较为完善的镇痛效果。     

LISS钢板与髁钢板置入修复股骨远端骨折:骨愈合及膝关节功能预后差异性

背景：近年来随着对股骨远端骨折的深入研究,治疗方式已经从传统的保守治疗转变为积极的手术治疗。目前关于股骨远端骨折的各种内固定方案报道很多,但是系统的预后比较研究报道较少。
　　目的：对比股骨远端骨折患者分别采取LISS钢板与髁钢板置入内固定对其预后康复影响的差异,并为这类患者内固定方案的选择积累经验。
　　方法：选取2009年3月至2013年1月收治的78例股骨远端骨折患者,按随机数字表法分为两组,每组39例。LISS钢板组采用LISS钢板置入内固定方案,髁钢板组采用髁钢板置入内固定方案。记录两组患者术中及术后相关指标、出院后第12个月末Evanich评分及随访期间不良事件发生率。
　　结果与结论：LISS钢板组切口长度及骨折愈合时间短于髁钢板组(P <0.05)。出院后第12个月末,两组疼痛及稳定性评分差异无显著性意义(P >0.05);而LISS钢板组活动度、股四头肌力量评分及Evanich总分均高于髁钢板组(P <0.05),减分项目少于髁钢板组(P <0.05)。LISS钢板组随访期间不良事件发生率为5%(2/39),髁钢板组不良事件发生率为21%(8/39),两组差异有显著性意义(P <0.05)。提示相较于髁钢板,LISS钢板置入内固定修复股骨远端骨折能有效促进骨折愈合及膝关节功能恢复,并发症较少,是一种较为理想的骨科内固定方式。     

Pathogenesis, diagnosis and treatment of cerebral fat embolism

In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate. In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae. For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc. The early diagnosis and comprehensive treatment can improve prognosis.     

Pediatric medial epicondyle fractures with intra-articular elbow incarceration

BackgroundIntra-articular incarceration of the epicondylar fragment occurs in 5–18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration.MethodsThirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9–16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control.ResultsAll of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion–extension and 2° for pronation–supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient.ConclusionsIn conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications.

Level of evidence

Therapeutic IV.     

经皮椎体成形术治疗新鲜骨质疏松性椎体压缩骨折

目的探讨经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗新鲜骨质疏松性椎体压缩骨折的疗效。方法 2011年1月~2012年12月共治疗骨质疏松性单椎体压缩骨折38例,其中男7例,女31例;年龄55~80岁(平均65.1岁)。患者取俯卧位局麻下行单侧穿刺PVP。测量椎体高度的恢复情况和后凸角改善情况,视觉模拟量表(visual analogue scale,VAS)评分评价疼痛缓解程度,活动能力评分检测活动改善情况,并对并发症进行分析。结果所有手术均顺利完成,每个椎体平均填充骨水泥3.5 m L。随访时间均12个月。椎体前壁高度由术前(19.2±5.7)mm改善至术后(20.0±5.7)mm,椎体中间高度由术前(19.2±5.1)mm改善至术后(20.2±5.0)mm,差异有统计学意义(P0.05);椎体后壁高度和Cobb角术前与术后相比,差异无统计学意义(P0.05);VAS评分术前8.3±1.1,术后12个月时为1.1±0.6,术前、术后差异有统计学意义(P0.05)。活动能力评分术前3.1±0.9,术后12个月时为1.1±0.3,术前、术后差异有统计学意义(P0.05)。骨水泥渗漏9例。结论 PVP可有效治疗新鲜骨质疏松性椎体压缩骨折,创伤小,减轻疼痛,改善功能,无重大并发症。     

Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

Background:

Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures.

Methods:

This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months.

Results:

Out of 78 patients, 69 patients underwent union in 90–150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients.

Conclusions:

The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.     

Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

OBJECTIVE:

The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area.

METHODS:

A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations.

RESULTS:

As the load was added, the displacements were Ap = 0.013; sitting position: p = 0.009) between groups A and B.

CONCLUSION:

The anterior construct plate - 1/3 tube buttress plate fixation provided a better stable construct for early sitting. The standing mode yielded more significant differences between the groups. Placing a 1/3 tube buttress-plate via an anterior approach is a novel method of providing quadrilateral area support in this setting.