动脉血气分析碱剩余在创伤救治中的研究进展

动脉血气分析碱剩余作为创伤早期评估和预后指标,可预测创伤患者的休克、复苏、输血、死亡率及重症监护室（Intensive Care Unit,ICU）入住率等,在儿科创伤、老年创伤和创伤骨科患者的评估中也仍然具有价值。随着急诊床旁即时检验（Point-of-care Testing,POCT）血气分析的发展,其结果也可快速获取。近年来动脉血气分析碱剩余值在创伤救治中已有一定的研究。本文将就动脉血气分析中碱剩余在各种创伤中的应用进行回顾总结,同时提出了碱剩余在未来临床应用中的展望。     

Use of Ilizarov Device to Gain Early Range of Motion in the Treatment of Pediatric Talus Body Fractures: A Series of Four Cases and Literature Review

BackgroundTalus fractures are rare in children but can lead to severe outcomes if untreated. The Ilizarov external fixator has been used in the treatment of a variety of lower extremity pathologies. The purpose of this study was to investigate the clinical outcomes of talus body fractures treated with the Ilizarov external fixator.Case PresentationFour male pediatric patients (age range, 5–11 years) with talus body fractures who were treated by open reduction and internal fixation combined with Ilizarov external fixator between November 2015 and April 2016 were reviewed. Mean follow‐up period was 4 years (range, 4–5). Clinical outcome was evaluated using the clinical rating scale of the American Orthopaedic Foot and Ankle Society (AOFAS). All four patients achieved good to excellent results at the last follow‐up. None of the patients developed avascular necrosis. One patient developed automatic fusion of tibiotalar joint.ConclusionUse of the Ilizarov external fixator to gain early range of motion is a valuable option for treatment of talus body fractures in children.     

The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

ObjectiveOur study compared the results of wedge‐shaped femoral shaft fracture following intramedullary (IM) nailing with or without fixation of the third fragment.MethodsWe retrospectively reviewed patients presenting with femoral shaft fracture with AO/OTA type 32‐B from 2011 to 2016. Patients were divided into two groups: closed reduction without touching the third fragment and open reduction with fixation of the third fragment. The fragment ratio, fragment length, nail size, dynamization or not, mRUST scores, union rate, and union time were compared between the two groups. Risk factors of non‐union were also investigated, including sex, age, fracture pattern, fracture location, dynamization, nail size, fragment ratio, fragment size, and postoperative fragment displacement.ResultsA total of 80 patients met inclusion criteria, 20 patients with wedge‐shaped shaft femoral fracture were managed with IM nailing and open reduction with fixation of the third fragment. Sixty patients were treated with IM nail without touching the third fragment. The union rate for the fixation and non‐fixation groups were 60.0% and 81.7%, respectively. The mean union time for the fixation group was 19 months vs 14 months for the non‐fixation group. Multi‐regression analysis showed larger nail size (odds ratio: 2.26) and fixation of the third fragment (odds ratio: 0.18) influenced fracture healing.ConclusionsFixation of the third fragment in wedge‐shaped shaft femoral fracture results in a longer union time and lower union rate. In the management of femoral fracture with a third fragment, a larger nail size is recommended and fixation should be performed in a closed manner. Fixation of the fragment may achieve better fracture reduction. However, disruption of the vasculature and surrounding structures may further result in nonunion of the fracture site.     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。     

改良口外须颅颌固定在上颌骨骨折中的应用

目的:探讨改良口外须颅颌固定治疗上颌骨骨折的临床效果。方法:对35例上颌骨Le FortⅡ、Ⅲ型骨折患者,先行闭合复位,恢复受伤前的咬合关系,再行改良口外须颅颌固定牵引3～4周。结果:35例Le FortⅡ、Ⅲ型骨折患者总有效率达94.2%。结论:改良口外须颅颌固定牵引治疗上颌骨骨折是一种简单易行、可靠的方法。     

股骨髁支持钢板治疗股骨远端C3型骨折

2001～2005年,我院应用股骨髁支持钢板治疗25例C3型股骨远端骨折患者,取得了良好疗效。     

克氏针横形固定小儿胫骨开放性斜形骨折20例

1996～2005年,笔者采用克氏针横形固定治疗小儿胫骨开放性斜形骨折20例,效果良好. 1 材料与方法 1.1 病例资料本组20例,男12例,女8例,年龄4～13岁.均为新鲜开放性胫腓骨骨折,但胫骨折端为斜形,内外移位骨折16例,前后移位骨折4例.     

镍钛记忆合金环抱器治疗锁骨骨折利弊

锁骨骨折是临床较常见的骨折之一.近几年应用镍钛记忆合金环抱器治疗锁骨骨折的报道较多,但报道其优点较多,很少谈其缺点及不足.2005年1月～2007年1月,我科收治24例锁骨骨折患者,采用镍钛记忆合金环抱器治疗,笔者对其利弊进行分析如下.     

距骨颈骨折的手术治疗

目的探讨距骨颈骨折的手术治疗及并发症防治。方法回顾2000年至2004年手术治疗的距骨颈骨折12例,总结其手术入路、内固定方法及术后处理。结果所有患者均在术后12~14d伤口拆线出院,无伤口感染、不愈合或皮肤坏死发生。12例患者中有10例获得随访,随访7个月至5年,平均3年4个月。按Hawkins标准优2例、良7例、中1例,创伤性骨关节炎4例,距骨无菌性坏死2例。结论对于复位不理想的距骨颈骨折应积极行切开复位内固定,强调骨折的解剖复位,避免术后过早负重,降低术后并发症的发生几率。     

人工股骨头置换治疗高龄股骨转子间骨折

目的探讨人工股骨头置换治疗高龄股骨转子间骨折的临床应用。方法1998年至2005年采用人工股骨头置换治疗高龄股骨转子间骨折25例,年龄75~92岁,平均79.6岁。假体均为骨水泥型,随访时间1~8年,平均3.6年。结果围术期无死亡病例,按Harris评分方法,优11例,良8例,可4例,差2例。2例假体下沉。结论人工股骨头置换治疗高龄股骨转子间骨折是可取的。