微小切口空心拉力螺钉内固定治疗距骨颈骨折的疗效分析

目的总结微小切口空心拉力螺钉内固定治疗距骨颈骨折的临床疗效。方法回顾性分析2008年1月~2013年11月我院诊治的28例距骨颈骨折患者临床资料。骨折按Hawkins分型:Ⅰ型2例,Ⅱ型22例,Ⅲ型3例,Ⅳ型1例。均在C臂X线机透视下行急诊闭合复位(7例)或开放微小切口切开复位(21例),空心拉力螺钉内固定治疗,术后定期复查、随访。结果本组患者手术时间平均60(50~80)min,术中出血约30 ml,无一例发生伤口感染、皮肤软组织坏死等围手术期并发症。28例患者均获随访,平均18(6~36)个月。本组骨折愈合时间10~14个月,平均(12.0±0.5)月。根据Hawkins标准评估疗效:优23例,良4例,差1例,优良率为96.4%。1例HawkinⅣ型患者发生距骨体明显硬化坏死。结论微小切口空心拉力螺钉内固定是有效治疗距骨颈骨折的方法之一,可以明显减少距骨缺血性坏死并发症的发生。     

术中实时三维导航下经皮骶髂关节螺钉固定术的初步探讨

目的 探讨基于术前CT扫描的术中实时三维导航技术应用于经皮骶髂关节螺钉置入术的可行性. 方法 术前沿着5具正常骨盆标本髂骨翼各置入1枚钛钉后行CT扫描.将扫描数据导入SuperImage软件完成骨盆的三维重建.将三维模型导入导航软件中,获得钛钉标识点在三维虚拟空间的坐标,并规划骶髂关节螺钉置入的安全路径.术中通过导航探针,获取钛钉的实际空间坐标,并与虚拟标识点进行配准;通过导航系统实时跟踪术中骨盆及手术器械的空间位置.在实时三维导航下按照虚拟规划的安全路径,在5具骨盆标本上各完成1枚经皮骶髂关节螺钉的置入,并记录手术操作时间.术后行骨盆CT扫描及三维重建,观察螺钉的位置,并与术前规划结果进行对比. 结果 在5具正常骨盆标本上按照术前虚拟规划的路径各顺利置入1枚骶髂关节螺钉.术后CT扫描显示5枚螺钉位置均满意,与术前虚拟规划结果基本一致.手术操作时间为19～ 23 min,平均21.6 min. 结论 术中实时三维导航技术充分利用术前虚拟规划信息,术中螺钉置入精度高,且无需X线透视,操作流程简单、快捷,在经皮骶髂关节螺钉固定术中具有良好的可行性.     

股骨转子间骨折髓内钉固定术后稳定性X线三柱评分标准的提出及其临床应用

目的:提出股骨转子间骨折髓内钉固定术后稳定性的X线三柱评分标准,并探讨其临床应用价值。方法:回顾性分析2015年1月至2019年6月期间山东省临沂市人民医院骨科采用股骨近端防旋髓内钉固定治疗的378例股骨转子间骨折患者资料。男161例,女217例;年龄为60~97岁,平均72.5岁;骨折AO分型：31-A1型109例,...     

带锁髓内钉内固定与髂骨植骨治疗股骨骨不连

2003年9月~2005年8月,笔者采用股骨带锁髓内钉内固定,取自体髂骨植骨治疗股骨骨不连12例。现对手术方法及疗效分析如下。1材料与方法1.1病例资料本组12例,男8例,女4例,年龄42~68岁。已做手术平均2次,最多者4次。发生骨不连距骨折固定后时间2~12年。车祸伤8例,其他外伤4例。就诊     

Subtrochanteric fractures of the femur. Treatment with locking intramedullary nailing. An experience without C-Arc. The guide-wire stopping method for verify distal locking is described

ObjectiveEvaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C.MethodsA case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell–Taylor Classification were used. The statistic procedure was done with SPSS program. The traumatic hip scale of Sander et al. was used for final evaluation. Technical for doing distal locking is detailed.ResultsThis series evaluated 49 patients: 35 male and 14 female patients. The mean age was 36 years old (range: 18–86 years). Traffic accidents and gunshot wounds were injury forms most frequent. There were not transoperative complications. The surgical time was between 90 and 120 min (mean: 108 min). The mean follow-up was 24 months (range: 18–36 months). According to Sanders score, it was reported 22 excellent results, 20 good results and 7 regular results. All distal locking procedures were successfully performed.ConclusionAlthough this series consists in a few numbers of patients, we recommend the placement of interlocked intramedullary nail (Closs-MB Bioimpianti^® and Orthosintese^®) in subtrochanteric fractures. This device allows placement of distal locking through the insertion frame with safety and precision, even in surgery rooms without arc-C. The guide-wire stopping method allows the verification of distal locking in an objective, accurate, safe and reproducible way.     

局部修甲治疗嵌趾甲的效果观察

目的观察采用局部修甲治疗嵌趾甲的效果。方法将嵌趾甲患者114例随机分为治疗组52例和对照组62例。治疗组采用常规消毒后在神经阻滞麻醉下局部修甲,7天换药1次;对照组按传统方法常规消毒后在神经阻滞麻醉下拔全甲,7天换药1次。观察患趾愈合情况。结果治疗组和对照组平均愈合时间分别为9.46天和30.16天,两组比较有显著性差异（P〈0.01）,平均换药次数分别为1.08次和4.03次,两组比较有显著性差异（P〈0.01）。结论局部修甲治疗嵌趾甲,操作简单,创面损伤小,患者容易接受,换药次数和愈合时间明显少于对照组。     

Use of nail and oral pigmentation to determine ART eligibility among HIV‐infected Ugandan adults

Objectives To evaluate the use of grey/distal banded nails as an indicator of advanced immunosuppression, and thus eligibility for ART, in resource poor settings. Methods We tested whether grey/distal banded nails and/or oral pigmentation could be used to identify patients with low CD4 cell counts at two cut‐offs: <200 and <350 cells/μl in ART naive adults. Results Four hundred and three nail and oral cavities were photographed and assessed. Grey/distal banded nails and/or oral pigmentation were significantly associated with a CD4 cell count <200 cells/μl (P < 0.001), with a sensitivity of 66%, a specificity of 50% and a negative predictive value of 77%. However, there was no association when a CD4 cell count cut‐off of <350 cells/μl was used. Inter‐observer agreement (k 0.46) was fair/moderate. Conclusions While grey/distal banded nails and/or oral pigmentation are associated with low CD4 counts, the sensitivity and kappa score are too low for this method to be recommended as a tool to guide ART initiation; large number of individuals eligible for ART would be missed.     

后路椎弓根钉治疗多节段胸腰椎骨折

目的 探讨后路椎弓根钉内固定手术治疗多节段胸腰椎骨折的指征和治疗效果.方法 经后路切开复位,椎弓根钉内固定治疗多节段胸腰椎骨折16例,其中相邻节段椎体骨折10例,距1节段椎体骨折4例,跨2节段椎体骨折2例.结果 经12～36个月随访,平均21.5个月,Cobb角度术前10°～37°,术后恢复到0°～9°;椎体高度术前10%～60%,术后恢复到88%～99%.术后神经损伤大部分有所改善或恢复正常,骨折椎体高度无明显丢失,内固定物无松动、断裂.结论 胸腰椎多节段骨折造成椎体严重不稳,需及时手术治疗,经后路椎弓根钉棒系统内固定和有限的椎管减压,可重建脊椎的稳定性,促进受损神经功能的恢复.     

带锁髓内钉治疗下肢长骨多段骨折43例疗效观察

目的观察带锁髓内钉治疗下肢长骨多段骨折的效果。方法采用股骨PFN钉、股骨带锁髓内钉、股骨髁上钉或胫骨带锁髓内钉治疗股骨或胫骨多段骨折43例,观察骨折愈合及并发症发生情况。结果所有病例骨折愈合良好,骨折愈合时间4.5~11个月,平均6.7个月,2例发生膝关节活动轻度受限,1例发生髋内翻。结论带锁髓内钉治疗下肢长骨多段骨折效果可靠、并发症少。     

带锁髓内钉治疗胫骨多段骨折的疗效分析

目的 探讨带锁髓内钉治疗胫骨多段骨折中的治疗效果。方法 回顾性分析了39例胫骨多段骨折，全部采用手术切开复位，带锁髓内钉内固定。结果 39例患者全部得到随访，38例骨折愈合，无锁钉及髓内钉松动、断裂，膝踝关节功能正常；1例出现并发骨髓炎。结论 带锁髓内钉在治疗胫骨多段骨折中具有创伤小，固定坚强，骨折愈合率高，能早期活动等优点。