Ischiopubic insufficiency fractures: MRI appearances

Objective. To evaluate the MRI appearances in insufficiency fractures. Design. A retrospective analysis of spin echo MR images with gadolinium-enhancement was undertaken with the emphasis on the signal change and the shape of the fracture gap and the adjacent bone marrow. Patients. Five elderly women who had ischiopubic insufficiency fractures (pubis, 4; ischium 1) underwent MRI to exclude the possibility of pathologic fractures. Results and conclusions. In no case was contrast enhancement noted at the fracture gap or the adjacent bone marrow, but a cleft-life, elongated bright signal area suggesting “fluid collection” was noted within the fracture gap. Absence of contrast enhancement and “fluid collection” at the fracture gap might suggest nonunion of a fracture, which is additional information provided only by MRI.     

骨折端注射“促骨愈合素”对骨愈合影响的实验研究与临床应用

家兔34只,双侧尺骨中段人工锯断,造成2mm骨缺损。左侧(药物侧)于术中当时及术后每隔3天注射“促骨愈合素”0.5ml,15天停药,右侧(对照侧)不注药。术后1～8周X线片及组织学检查结果表明,注药侧骨痂、骨小梁、钙盐等的出现及数量均明显优于对照侧。经两家医院协作治疗13例新鲜骨折和15例骨不连病人,结果满意。证实骨折端注射“促骨愈合素”能促进新鲜骨折愈合,缩短疗程,对骨不连可获完全治愈。     

Management of a nonunion of the distal femur in osteoporotic bone with the internal fixation system LISS (less invasive stabilization system)

We present a case illustrating the successful use of the internal fixation LISS in an osteoporotic nonunion of the distal femur, where classic osteosynthesis has failed. The LISS plate with its angular stability offered the possibility to achieve excellent purchase in the severely porotic and partially destroyed bone. In combination with the use of an autologeous bone graft laterally and a strut cortical autograft medially, a mechanical support and an osteoinductive stimulus was provided and the extremity could be saved by this procedure.     

吻合血管的髂骨骨膜移植治疗骨不连

目的 介绍一种治疗骨不连的方法。方法 应用带血管的髂骨骨膜移植治疗肱骨、桡骨、胫骨骨不连,并随访。结果 所有病例皆在2.5～4月内达临床愈合,愈合率达100％。结论 髂骨骨膜面积大、厚、成骨能力强,血管恒定,吻合血管的髂骨骨膜移植是治疗骨不连的好方法。     

股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连

目的观察股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连的疗效。方法 2006年8月至2016年3月,收治股骨颈骨折骨不连患者33例,男23例,女10例,年龄19～48岁,平均31.5岁,均为GardenⅣ型。术后采用Harris髋关节评分标准进行髋关节评分:总分100分,90～100分为优,80～90分为良,70～80分为可,70分以下为差。结果 33例患者术后获2～12年随访,平均(38.65±25.90)个月,患者全部临床愈合,愈合时间为4～16个月,平均愈合时间为(6.53±2.71)个月。术后无内固定松动失败,1例患者术后伤口感染,给伤口清创,放置万古霉素骨水泥棒后感染愈合。31例患者双下肢等长,无髋内外翻畸形;2例患者出现股骨颈短缩,髋内翻畸形。无股骨头坏死发生,末次随访,Harris髋关节评分标准评分65～95分,平均(88.54±7.46)分:优26例,良3例,可2例,差2例,优良率为89.9%。结论股方肌骨瓣结合髂骨或股骨大转子植骨治疗股骨颈骨不连是一种操作简单、疗效确切的治疗方法。     

双钢板联合自体骨移植治疗无菌性肱骨干骨折不愈合

目的 探讨双钢板联合自体骨移植治疗肱骨干无菌性骨折不愈合的疗效。方法 回顾性分析2017年4月至2021年6月期间于华中科技大学同济医学院附属同济医院行双钢板内固定联合自体骨移植治疗的10例肱骨干骨折不愈合病例。其中,男7例,女3例;年龄20 ～ 68岁,平均年龄45.1岁。初次内固定方式：7例3.5 mm LCP,2例3.5 mm双钢板,1例髓内钉。其中4例初次手术的内固定失效;骨折不愈合分型：有活性骨折不愈合4例,无活性骨折不愈合6例。二次术后行X线或CT检查评估骨折愈合情况。主要观察指标为术前、术后3个月和末次随访时间的MEPI肘关节和Constant-Murley评分。结果 平均随访时间为14个月（10 ～ 24个月）。所有骨折不愈合均愈合,平均愈合时间4.7个月（3.5 ～ 7个月）,未出现并发症。术后3个月时MEPI评分（82.50±10.61）分,Constant-Murley评分（79.60±6.11）分;末次随访,MEPI评分（88.50±5.30）分,Constant-Murley评分（86.90±4.12）分,较术前明显改善。结论 双钢板内固定联合自体骨移植治疗肱骨干骨折不愈合疗效满意。使用双钢板可以提高固定的稳定性,有利于早期功能锻炼,促进骨折愈合。