空心钉和骨圆针固定治疗股骨转子间骨折的力学随机对照试验

目的:通过与4枚斯氏针固定比较,利用生物力学方法评价多枚空心钉固定股骨转子骨折的适应证和可靠性。方法:使用Sawbone股骨模型,模拟EvansⅢA型骨折,分别用2种多枚空心钉方法(矩外空心钉和矩内空心钉法)及多枚骨圆针固定,在CSS-11101力学实验机上进行载荷试验,取300 N载荷下股骨头垂直位移和张口位移数值,比较3种方法的轴向刚度。通过扭转实验比较3种固定方法的抗扭转能力。结果:3种固定方法在轴向刚度方面差异有统计学意义(P<0.05),而抗扭转能力方面差异无统计学意义(P>0.05)。结论:矩外空心钉固定力学性能相似于4枚骨圆针,而矩内空心钉固定弱于4枚骨圆针。应用多枚空心钉固定应选择稳定型股骨转子间骨折。     

切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折

目的探讨切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折的疗效。方法1999年10月-2005年4月，对62例平均年龄7．5岁的患儿，应用切开复位克氏针固定治疗Gartland Ⅲ型肱骨髁上骨折。其中伸直尺偏型41例，伸直桡偏型18例，伸直中间型3例；无伴发血管、神经损伤和筋膜室间隔综合征。闭合性骨折47例，开放性骨折15例。结果术后56例获得随访，随访时间为6～15个月，平均11．5个月。所有骨折均获得愈合。根据Flynn标准进行疗效评价，其中优22例（占39．3％），良21例（37．5％），可9例（16．1％），差4例（7．1％）。伤后8h内手术的优良率为89．7％，伤后8h后手术的优良率为63．0％。直接手术治疗的优良率为90．1％，曾接受手法复位的优良率为67．7％。结论切开复位内固定治疗Gartland Ⅲ型肱骨髁上骨折可取得满意的疗效，是安全、有效的治疗方法。     

经尺骨鹰嘴截骨入路双钢板治疗肱骨髁间骨折

[目的]探讨经尺骨鹰嘴截骨入路应用肱骨内、外髁解剖钢板治疗肱骨髁间骨折的方法和临床疗效。[方法]2002年7月-2006年3月采用经尺骨鹰嘴截骨入路结合肱骨内、外髁解剖钢板治疗肱骨髁间骨折26例，男19例，女7例；年龄15-46岁，平均35岁。按照Riseborough和Radin的分类方法，Ⅱ型6例，Ⅲ型18例，Ⅳ型2例。[结果]术后25例骨折复位满意，1例复位稍差，无切口感染，1例术中牵拉损伤尺神经，22例获得随访，时间6～19个月，平均13．5个月。尺神经损伤恢复，骨折全部愈合，无内固定松动及断裂，愈合时间14～24周，平均17周。根据改良的Cassebaum评分系统评价肘关节功能，其中优5例，良13例，可3例，差1例，优良率81．8％。[结论]经尺骨鹰嘴截骨入路显露骨折充分，肱骨内、外髁解剖钢板固定肱骨髁间骨折牢固可靠，能有效的防止骨折不愈合，并可满足患者早期进行关节功能锻炼。     

小切口动力髋螺钉治疗高龄股骨转子间骨折

[目的]探讨应用小切口动力髋螺钉(DHS)微创固定治疗高龄股骨转子间骨折的方法及临床效果.[方法]回顾性分析2001年8月～2006年1月应用闭合复位、小切口DHS固定治疗37例高龄股骨转子间骨折患者,其中男15例,女22例;年龄72～92岁,平均81.5岁.在C型臂X线机监视下,先将1～2枚克氏针经皮通过大转子打入股骨头上部.另将1枚导针按135°颈干角打入股骨头中央,在导针下做一长约4～5.5 cm纵切口,经导针拧入粗拉力螺纹钉.拔出导针将带套管接骨板沿肌层下插入,并将接骨板的套管套入螺纹钉的尾端.[结果]手术时间40～75 min,平均60 min.术中平均出血55 ml.术后与术前血红蛋白值比较无明显变化.37例均获11～18个月随访,骨折愈合时间10～15周.轻度髋内翻2例,无切口感染、内固定失效及旋转畸形.按董纪元疗效评定标准,优良率94.6%.[结论]小切口DHS微创技术具有手术时间短、出血少、创伤小、并发症少、康复快的特点,是治疗高龄股骨转子间骨折较理想的方法.     

三叶草钢板治疗肱骨近端3、4部分骨折

我院于2003-2006年运用三叶草钢板对32例肱骨近端3、4部分骨折进行手术治疗取得满意结果,现报告如下。1临床资料32例肱骨近端骨折,男21例,女11例;年龄25~82岁,平均54·4岁。根据Neer分型[1],其中Ⅳ型3部分11例,4部分4例;Ⅴ型3部分12例,4部分3例;Ⅵ型3部分1例,4部分1例。病程1~10 d,平均4·5 d。损伤原因:跌伤22例,交通伤7例,高处坠落伤3例。2治疗方法选用臂丛麻醉或全麻,患者取“沙滩椅”位,采用改良Thompson切口。将上臂外展以利切口暴露,以肱二头肌肌间沟作为解剖标记。如有肱骨头脱位应先复位,将钢板根据肱骨外形塑形,精确匹配肱骨近端…     

Surgical treatment of complex tibial plateau fractures by closed reduction and external fixation. A review of 32 consecutive cases operated

Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained. Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for the optimal clinical long-term results.     

关节镜下改良张力带固定治疗髌骨骨折患者的康复护理

对38例新鲜髌骨骨折患者行关节镜直视下骨折复位,改良张力带固定,术前和术后给予及时有效的功能康复和护理指导,取得满意的效果。平均随访18.6个月,骨折平均愈合时间7.5周,所有病例愈合良好,无并发症出现。关节镜治疗髌骨骨折为髌骨骨折提供了一种新的治疗方法。应针对其解剖特点制订科学、有效的护理方法。     

Simultaneous Bilateral Tibial Tuberosity Avulsions—Over 6-Year Follow-up

Abstract Simultaneous bilateral avulsions of the tibial tuberosity are rare injuries. The authors found only five reported cases in the orthopedic literature. We add a further case of bilateral avulsions of the tibial tuberosity with the longest reported follow-up.