加压空心螺纹钉治疗股骨颈骨折

股骨颈骨折是骨科常见的创伤,术后常出现骨折不愈合和股骨头坏死,致残率较高,仍是骨折治疗中的一个难题。2004年3月至2006年7月用3枚空心加压螺纹钉内固定治疗股骨颈骨折52例,效果满意,报告如下。     

交锁髓内钉治疗肱骨骨折术后并发症的临床分析

过去对于肱骨髓内钉并发症的报道较多[1],但对其并发症产生原因研究却较少。为此,我们对2001年1月-2004年6月68例在我院使用肱骨交锁髓内钉治疗的患者进行了并发症的初步研究,目的在于了解产生并发症的可能原因及提出相应的预防对策。1临床资料1·1一般资料本组68例,男40例,女28例;平均年龄36·8岁（18⁵6岁）。其中56例为外伤性肱骨骨折,12例为肱骨骨不连。外伤性肱骨骨折患者中,48例为闭合性骨折,其余为开放性骨折（GustiloⅠ型5例,Ⅱ型2例,ⅢA型1例）。骨不连患者中,10例曾有手术史。4例外伤性骨折患者及1例骨不连患者存在桡神经麻痹。1·2手术指征手法复位不满意、多于两     

桡骨远端骨折治疗失败的分析

桡骨远端骨折为全身中最常见的骨折,约占整个骨折患者的1/6,多见于老年患者。收治了桡骨远端骨折骨不连及畸形愈合的患者28例,分析原因如下。1临床资料1998-2004年,共治疗桡骨远端骨折治疗失败病例28例,其中桡骨远端粉碎骨折7例,骨不连21例。桡骨远端粉碎骨折组中,男4例,女3例;年龄21~65岁,平均41.3岁。其中石膏固定导致骨折再移位4例,外固定支架固定导致骨折再移位2例,克氏针内固定导致再移位1例。骨不连组中,男14例,女7例;年龄34~70岁,平均55.7岁。其中采用普通钢板固定7例,三棱针固定7例,克氏针加钢丝固定2例,单纯克氏针固定2例,外固定架…     

经皮TriGen髓内钉与股骨近端髓内钉治疗老年股骨转子间骨折的疗效比较

目的 比较经皮TriGen髓内钉（美国Smith Nephew公司）与股骨近端髓内钉（PFN）（瑞士AO／SYNTHES公司）治疗股骨转子间骨折的临床疗效，探讨治疗老年股骨转子间骨折更为合理的方法。方法 分析本院2001年10月-2005年1月收治的股骨转子间骨折患者56例，年龄〉60岁。随机分为两组：A组21例，采用经皮TriGen髓内钉固定；B组35例，采用PFN固定。对两组手术切口长度、手术时间、术中出血量、术中输血、术后引流量、骨折愈合时间、术后至出院时间、髋关节功能优良率进行分析比较。结果 两组间手术切口长度、手术时间、术中出血量、输血量、术后引流量、手术至出院时间比较，差异均有统计学意义（P〈0．05）。术后部分负重时间、骨折愈合时间、髋关节功能评价等差异均无统计学意义。结论 与PFN固定相比，经皮TriGen髓内钉具有手术时间短、出血量少、手术组织损伤小等优点，降低了手术风险，用于治疗老年股骨转子间骨折具有一定优势。     

老年股骨颈骨折围手术期的治疗分析

目的探讨老年人股骨颈骨折的治疗及围手术期的处理。方法回顾性分析2003年1月～2006年12月手术治疗的201例老年股骨颈骨折患者资料，其中男51例，女150例，年龄60～98岁，平均78．2岁。按Garden分型，Ⅱ型20例，Ⅲ型86例，Ⅳ型95例。采用多枚中空螺钉固定、Morre型人工股骨头置换术或双极人工股骨头置换手术进行治疗。结果本组患者平均住院10～14d，5～7d即能早期下床活动，住院期间及术后1年内无一例死亡。85％患者获得8个月～4年（平均2年）的随访，功能恢复按Harris评分，优良率为85％。结论老年人各脏器机能衰退，多同时合并各种内科疾病，手术治疗存在风险，但老年人股骨颈骨折的手术治疗仍能取得满意疗效。     

单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并大面积皮肤撕脱伤

目的探讨单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤的疗效。方法18例患者先进行急诊清创,采用单臂AO外固定支架固定骨折、腓肠肌内侧头肌皮瓣局部旋转覆盖外露胫骨。撕脱的皮肤修成全厚皮片回植供皮区,其中5例仍有缺损,另取同侧大腿全厚皮片移植。结果均无感染,15例旋转皮瓣完全成活,2例皮瓣远端表皮坏死,经换药治愈,1例皮瓣远端全层坏死,经植皮治愈。撕脱皮片回植13例成活,5例小部分坏死,其中3例经换药治愈,2例经中厚皮片植皮愈合。5例大腿皮片完全成活。平均随访19.5(10~36)个月,骨折平均愈合时间4(3.5~6)个月。所有患者行走正常,3例膝关节屈伸活动受限,4例踝关节屈伸受限。结论采用单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤,疗效肯定。     

有限手术配合分期外固定治疗胫腓骨远端骨折

20世纪90年代AO学者Gerber、Palmar等相继提出生物学固定(biological osteosynthesis,BO)的新概念以来,出现了以生物学固定为基础的经皮微创接骨板内固定技术,这一崭新的骨折治疗方法已逐渐应用临床并取得了优良的治疗效果[1-2]。自2005年1月-2006年4月采用微创锁定加压接骨板内固定治疗胫骨骨折18例,取得了良好的临床效果,现报告如下。1临床资料本组18例,男12例,女6例;左7例,右11例;年龄18~54岁,平均32岁。其中交通伤10例,跌伤4例,砸伤4例。合并同侧腓骨骨折15例。按AO长管状骨骨折的综合分类法:42-B1型5例,B2型6例,B3型2例;42-C1型2…     

Mortality rate after hip hemiarthroplasty: analysis of risk factors in 299 consecutives cases

Abstract The femoral neck fracture is actually the most important traumatic event in the elderly, because of its high rate and terrible complications. We reviwed clinical records of 314 patients treated in our institution with a bipolar implant for femoral neck fracture. At a mean follow-up of 5 years, 15 patients (4.8%) were lost to followup so data for 299 patients was studied to identity factors associated with mortality. Ten predictor variables were examined: age, sex, waiting time for surgery, pulmonary dysfunction, fracture etiology, and comorbidity with ischemic heart disease, and heart failure, hypertension, cerebrovascular disease, and chronic renal failure. Cumulative mortality rate during the first 6 months was 19% (55 of 299 patients) and in the first year it was 25% (76 of 299). At logistic regression analysis, mortality was associated with age, male gender, waiting period for surgery and presence of neoplastic disease or pathological fracture. Waiting for surgery was a significant factor for mortality at 6, 12 and 24 months: patients surgically treated in the first 24 hours had lower mortality than those who waited longer. The risk of mortality in the first 6 months doubled for an age increase of 12 years, while mortality within 2 years doubled for an age increase of 9 years. Although the motality rate after surgery for femoral neck fracture was high in the first year (25%), it dropped off in successive years to levels observed in a healthy population. Thus, we agree with the literature that femoral fracture is a risk factor for survival only in the first year after trauma, above all in the elderly.     

Bilateral Mid-Diaphyseal Femoral Stress Fractures in the Elderly

Abstract Background: Osteoporosis is characterized by low bone density and poor bone mineralization. Mid-diaphyseal stress (insufficiency) fractures of the femur caused by osteoporosis are rare. The symptoms of these lesions are vague and confusing. The physician must be alert to the possibility of femoral shaft stress fractures when evaluating an elderly patient complaining of back, hip or leg pain. Case Study: A 72-year-old osteoporotic female patient with bilateral mid-diaphyseal stress fractures of the femur is reported. The diagnosis of femoral shaft stress fracture in the elderly is very difficult when based on physical findings and plain radiography only. A magnetic resonance imaging (MRI) scan or nuclear scintigraphy is necessary for early diagnosis. In the described case, the patient had an excellent result after surgical treatment with intramedullary nails. Conclusion: MRI or nuclear scintigraphy must be obtained to exclude the possibility of femoral shaft stress fractures in the elderly. In the absence of contraindications, surgery is the best solution for this kind of lesion.