Nonunion of an occult fracture in zone III of the sacrum

Summary Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.      

应用桡动脉茎突返支为蒂的桡骨骨瓣或骨膜瓣移植治疗腕舟骨骨折不连接

目的观察以桡动脉返支为蒂的桡骨骨瓣或骨膜瓣移植对腕舟骨骨折不连接的治疗作用.方法20例腕舟骨骨折骨不连,应用桡动脉返支为蒂的桡骨骨瓣移植加桡骨茎突切除治疗12例,应用桡动脉返支为蒂的桡骨骨膜瓣移植加桡骨茎突切除治疗8例.测量手术前后腕关节屈伸和尺桡偏活动度、握力,应用腕舟评分对患者的自觉功能恢复情况进行评定.结果20例腕舟骨骨折骨不连均愈合,愈合时间平均为7±0.2周(6～12周).腕舟骨评分结果为:优16例,良3例,可1例.结论以桡动脉返支为蒂的桡骨骨瓣或骨膜瓣移植加桡骨茎突切除是治疗腕舟骨骨折骨不连的有效方法.     

骨外固定器治疗创伤后感染性胫骨骨不连

目的探讨骨外固定器治疗创伤后感染性胫骨骨不连接的疗效。方法自1994年6月至2004年6月．应用骨外固定器治疗创伤后感染性胫骨骨不连10例,其中单侧外固定支架5例,Ilizarov外固定支架5例。结果所有胫骨骨不连7例得到愈合,骨愈合时间7—11月,平均8．5月;2例随访已5个月,见有明显骨痂生长;1例术后感染复发,经过随访11月,未见明显骨痂生长。结论骨外固定器具有使用方法简单,疗效可靠,是治疗创伤后感染性胫骨骨不连接的理想方法。     

骨折不愈合的治疗研究进展

随着交通的迅猛发展,交通事故的多发,骨折已成为常见的骨科疾病之一。骨折不愈合是骨折常见并发症,形成原因复杂,危害严重。目前对于骨折不愈合的治疗主要有手术、生物刺激、物理治疗和中医药治疗等方法。虽治法多样,但治愈率较低,且临床上尚无标准、统一的治疗方法。该文系统阐述了近几年骨折不愈合的治疗进展,期望能为临床治疗提供参考。     

逆行隐血管蒂股骨内侧髁骨瓣、骨膜瓣加交锁髓内钉治疗胫骨骨缺损、骨不连

目的探讨胫骨缺损、骨不连新的外科治疗方法。方法自2000年3月～2002年6月以逆行隐血管蒂股骨内侧髁骨瓣、骨膜瓣加交锁髓内钉治疗胫骨骨缺损、骨不连9例。结果随访6个月～1年7个月，骨折均愈合良好，采用Johner-Wruh评分标准，治疗结果：优8例，良1例。结论该方法具有固定可靠，加快骨折愈合进程，早期活动关节，疗效可靠，易于推广等优点，是治疗胫骨骨不连的较好方法。     

组合式钢板张力带钢丝固定治疗肱骨髁间粉碎性骨折并骨不连

目的：探讨外伤性成人肱骨髁间粉碎性骨折并骨不连治疗的难题。方法：用组合式钢板张力带钢丝固定治疗成人肱骨髁间粉碎性骨折并骨不连４３例。结果：随访１４～４８个月,效果满意。根据门氏疗效评定标准评价结果：优１８例,良２２例,劣３例。结论：该组合式钢板张力带钢丝内固定,其方法简单、创伤小、组合结构合理,符合力学原理。术后可早期功能锻炼,适合于肱骨髁间粉碎性骨折并骨不连的治疗。     

血管内皮生长因子在骨折愈合中的作用

目的　研究血管内皮生长因子 (VEGF)在骨折愈合过程中的作用 ,探讨应用 VEGF及拮抗VEGF对骨折愈合所产生的影响。方法　利用新西兰大耳白兔 10 5只制作左侧桡骨中段骨折动物模型 ,随机分成三组 ,两组分别应用 VEGF多克隆抗体及 VEGF,另一组为对照组 (不作任何处理 )。在伤后 8、2 4、72小时和 1、3、5、8周利用单光子放射计算机断层显像术测定骨折端血流量变化 ,在 1、3、5及 8周摄 X线片观察骨折愈合情况。结果　应用 VEGF使骨折端血流量在 8小时～ 3周较对照组增高 ,但 X线片却未见明显差异 ;而 VEGF多克隆抗体可导致骨折端血流量在各时相点较对照组明显减少 ,并阻碍了骨折的愈合进程 ,最终使骨折端形成骨不连样改变。结论　骨折愈合过程中缺乏 VEGF将严重影响骨折的正常愈合过程 ,并导致骨不连接 ,应用外源性 VEGF可能通过增加骨折端血流量而对骨折愈合有益     

Factors associated with nonunion of the posttraumatic subtalar arthrodesis after displaced intra-articular calcaneal fractures

BackgroundThis study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA).MethodsWe retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors.ResultsThe overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23–10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62–20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28–36.79) were demonstrated as risk factors for nonunion of posttraumatic SA.ConclusionPatients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion.