Vertebroplasty and Kyphoplasty in Spinal Trauma

Abstract Kyphoplasty and vertebroplasty have become recognized procedures for the treatment of vertebral fractures, especially in patients with osteoporosis. In most cases of osteoporotic spinal vertebral fracture in elderly patients, polymethylmethacrylate (PMMA) cement is used to fill the defect and stabilize the vertebral body. The techniques of vertebroplasty and kyphoplasty differ in the possibility of realignment and reconstruction of the vertebral body and spinal column. Long-term results in terms of integration of the cement and bioreactivity of the vertebral body are still lacking; so, these procedures are still no options in the treatment of younger patients. Vertebroplasty and kyphoplasty show different success in the management of fresh traumatic spine fractures. The acute traumatic vertebral fracture has to be classified sensitively, to find the right indication for cement augmentation. Mild acute compression fractures can be treated by vertebroplasty or kyphoplasty, severe compression and burst fractures by combination of internal fixation and kyphoplasty. The indications for use of biological or osteoinductive cement in spinal fracture management must still be regarded as restricted owing to the lack of basic biomechanical research data. Such cement should not be used except in clinical studies.     

Emergency Treatment of Multiply Injured Patients with Unstable Disruption of the Posterior Pelvic Ring by Using the “C–Clamp”

Abstract Purpose: Evaluation of the therapeutic usefulness of the “pelvic C–clamp” (PCC) during emergency treatment of multiply injured patients with unstable disruption of the posterior pelvic ring. Patients and Methods: The data of 28 patients with polytrauma in combination with an unstable fracture of the posterior pelvic ring (average Injury Severity Score [ISS]: 49 points; average Polytrauma Score [PTS]: 41 points) were retrospectively analyzed from the moment they were admitted to the emergency room until 48 h after admittance. The PCC was used immediately for primary stabilization of the pelvis after clinical diagnosis of the unstable pelvic fracture. Main outcome measurements: development of mean blood pressure, development of oxygenation level, period of time until the PCC was placed, number of blood units needed, period of time until circulatory stabilization occurred. Results: The PCC was applied in all cases within an average of 64.7 min after trauma. Seven patients (25%) died within the first 45 min after admission. The surviving patients showed:• an increase in mean blood pressure of 25% 20 min after application of the PCC,• a hemodynamic stabilization 6 h after application of the PCC,• a stabilization of the oxygenation level 6 h after application of the PCC,• a decrease in the number of required blood units 6 h after application of the PCC. Conclusion: The present study shows, that the application of the PCC to critically injured patients with unstable pelvic fractures leads to stabilization of the vital parameters within a short period of time.     

手术治疗Ⅱ型锁骨外侧端骨折

目的 介绍一种治疗Ⅱ型锁骨外侧端骨折的手术方法。方法 取用锁骨与喙突间螺丝钉加压固定，喙锁韧带修复。结果 24例患术后骨折端全部愈合，关节功能恢复良好，内固定物无松脱，肩锁关节无创伤性关节炎。结论 本术式治疗成人Ⅱ型锁骨外侧端骨折，操作方便，固定可靠，效果确切，并发症少，是理想的手术方法。     

膝前框形钢丝内固定治疗髌骨骨折

目的　总结采用钢丝环扎 +膝前方框形张力带钢丝内固定法治疗髌骨骨折的经验和临床效果。方法　对 3 5例髌骨骨折应用此方法治疗 ,其中男性 2 4例 ,女性 11例 ,3 0例获得 3～ 2 4个月随访。结果　优 19例 ,良 10例 ,可1例 ,优良率 96 7%。术后未出现骨折再移位 ,无伤口感染。愈合时间 6～ 12周。结论　该方法符合生物力学原理 ,操作简便 ,适应证广 ,能早期关节活动 ,是治疗髌骨骨折的理想方法之一。     

3种桩核系统修复喇叭形根管的抗折性比较

目的 :比较 3种桩核系统修复喇叭形根管的牙根修复后的抗折性及其折断模式。方法 :30个完整的上颌中切牙 ,在根管治疗后 ,沿釉牙骨质界弧形顶点冠方 2mm切除牙冠 ,将根管上 1/3敞开形成喇叭形根管 ,样本随机分成 3组 :A组 ,铸造桩核金属全冠修复 ;B组 ,玻璃纤维树脂核全冠修复 ;C组 ,成品不锈钢平行螺纹桩树脂核全冠修复。样本固定于MTS810测试机上 ,与牙体长轴呈 135°加载 ,测试折断强度并观察折断模式。结果采用方差分析。结果 :铸造桩核修复抗折强度最高 [(76 3.86± 86 .38)N],其次是成品螺纹桩树脂核修复 [(6 19.91± 118.89)N],玻璃纤维树脂核组最小 [(40 5 .5 4± 111.86 )N],统计学分析差异具有显著性。结论 :铸造桩核树脂核修复后抗折强度最高 ,玻璃纤维树脂核修复最低 ,但后者折断模式最有利于重新修复 ,而前者通常无法再行修复。     

逆行交锁髓内钉治疗股骨远段骨折

目的 总结股骨逆行交锁髓内钉应用的适应证、优点及其疗效。方法 2001年6月～2003年6月，采用切开复位股骨逆行交锁髓内钉内固定，治疗股骨远段骨折21例，早期行膝关节功能锻炼。结果 18例获随访，全部骨性愈合，功能恢复良好，无膝痛、跛行、膝关节僵直等。结论 股骨逆行交锁髓内钉治疗股骨远段骨折具有明显优势，固定牢固、坚强，功能恢复快，并发症少等优点，手术不需要C臂X线机和骨科手术牵引床，适合基层医院临床应用。     

股骨转子间骨折GAMMA钉治疗临床分析

目的：评价GAMMA钉治疗股骨转子间骨折的效果。方法：对32例股骨转子间骨折采用GAMMA钉治疗。结果：经6～18月随访，所有病例均获骨性愈合，下肢功能及关节活动良好。其中1例为粉碎性骨折内固定后出现髋内翻，按X线评分标准90％病人满意。结论：GAMMA钉治疗股骨转子间骨折效果满意。     

Medpor填充治疗早期爆裂性眼眶壁骨折疗效观察

目的探讨早期眼眶壁爆裂性骨折Medpor填充治疗效果。方法做经典的睫毛下切口或者眉内侧切口,充分暴露眼眶骨折部位、松解嵌顿的眶内容物,骨膜下填充Medpor修复治疗早期眼眶壁爆裂性骨折。结果随访期内没有出现Medpor脱出及排斥现象。20例(20只眼)患者术后均无明显的眼球内陷,1例仍有轻度复视。结论眼眶壁爆裂性骨折应早期治疗,Medpor填充是有效治疗方法。     

股骨干骨折扩髓腔髓内钉固定对凝血机能和肺换气功能的影响

【目的】探讨股骨干骨折扩髓与不扩髓髓内钉固定对凝血机能和肺换气功能的影响。【方法】 38例股骨干骨折分别采用扩髓 (RFN)和不扩髓 (UFN)髓内钉固定 ,在手术开始前至术后 4 8h内 7个不同时间段监测血小板、纤维蛋白原、凝血酶原时间 (PT)和部分凝血活酶激活时间 (APTT)的变化 ,并动脉血气分析 ,计算肺泡 动脉血氧分压递差 [P(A aDO2 ) ]。【结果】RFN组 ,扩髓后血小板开始减少 ,P(A aDO2 )升高 (P<0 0 5 ) ;髓钉插入后 30min纤维蛋白原减少 ,PT、APTT延长 (P <0 0 5 ) ;UFN组表现出同样的趋势 ;两组中各项指标均在 2 4～ 4 8h内恢复正常 ;动脉血气分析各时间段和组间差异无显著性 (P >0 0 5 )。【结论】扩大髓腔的髓内钉固定 ,和不扩髓相比 ,并不影响肺换气功能 ,对凝血机能的影响是一个自限过程 ,单纯股骨干骨折 ,可耐受扩髓固定手术。     

髋臼双柱骨折合并后壁骨折的手术治疗

目的 探讨髋臼双柱合并后壁骨折的临床特点和手术疗效.方法 对29例髋臼双柱合并后壁骨折采用双切口分步入路切开复位,重建钢板内固定.结果 按Matta标准,解剖复位21例,满意复位5例,不满意复位3例.随访13～38个月,平均19个月,关节功能按d'Aubinge-Possel评分系统评定,优17例,良6例,可3例,差3例.结论 双切口分步入路,重建钢板固定是治疗髋臼双柱合并后壁骨折的有效方法.