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991.
成人齿状突骨折的治疗策略 总被引:3,自引:0,他引:3
对于齿状突骨折的治疗目前无一致意见,且尚无充分证据支持骨折的非手术或手术治疗选择.影响骨折愈合的因素包括骨折平面、是否移位和移位程度以及患者的年龄,笔者建议的手术适应证包括明显移位或成角、年龄>50岁、ⅡA型骨折、非手术治疗不能维持骨折稳定和陈旧性骨折.手术治疗应尽量选择前路螺钉内固定而避免融合. 相似文献
992.
993.
人工半肩关节置换治疗高龄肱骨近端粉碎性骨折的临床研究 总被引:12,自引:10,他引:2
目的 探讨人工半肩关节置换治疗高龄肱骨近端粉碎性骨折的疗效.方法 2004年1月至2007年2月,对42例高龄肱骨近端Neer三、四部分骨折患者行人工半肩关节置换术,术中修复受损的肩袖.重建大、小结节,术后根据Neer康复原则进行早期功能锻炼.结果 42例患者术后获10~28个月(平均12.7个月)随访,疼痛明显缓解.肩关节功能应用ASES评分系统进行评价:优11例,良24例,可4例,差3例,优良率为83.3%.42例患者均未出现假体松动,3例术后出现肩关节假体上移,1例上举轻度受限,4例出现大、小结节吸收.结论 对于高龄肱骨近端Neer三、四部分骨折,可选择人工半肩关节置换. 相似文献
994.
外固定支架在严重多发伤并胫腓骨开放性骨折中应用的病例对照研究 总被引:3,自引:1,他引:2
目的:探讨早期外固定架固定开放性胫腓骨骨折对严重多发伤患者治疗和预后的影响。方法:采用回顾性对比分析,73例严重多发伤(ISS〉16分)患者按胫腓骨骨折手术方法不同分2组。治疗组42例,男31例,女11例;平均年龄40.2岁;均急诊行清创、骨折复位外固定支架固定术。对照组31例,男22例,女9例;平均年龄42.6岁;均急诊行清创、跟骨牵引术或石膏外固定术。比较两组患者急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)发生情况及病死率、小腿创面感染率、创面及骨折愈合时间。结果:两组的并发症(ARDS)发生率差异有统计学意义,行外固定架治疗组低于对照组(P〈0.05),治疗组感染率明显低(P〈0.05),创面愈合时间明显短。结论:外固定架治疗严重多发伤并胫腓骨开放性骨折,明显减少并发症发生率,降低创面感染率。 相似文献
995.
Daniele Marchelli Luca P. Piodi Costantino Corradini Luca Parravicini Cesare Verdoia Fabio M. Ulivieri 《Journal of orthopaedics and traumatology》2009,10(2):55-58
Background Bone repair alteration is hypothesized for nonunion fracture pathogenesis. Since it is involved in osteoclast regulation,
the RANK/RANKL/OPG system (receptor activator of nuclear factor kB/its ligand/osteoprotegerin) may play a role.
Materials and methods Serum OPG, free RANKL, bone alkaline phosphatase (BAP), osteocalcin (OC), and urinary deoxypyridinoline (DPD) were determined
in 16 male patients (20–39 years) with long bone atrophic nonunion fractures. Serum markers were also measured in 18 age-matched
male controls who healed from the same type of fractures within six months, and in 14 age-matched male controls who were healing
from the same fractures one month after injury. One-way ANOVA and Bonferroni’s test were used for statistical analysis.
Results Only OPG was significantly higher (0.56 sd 0.11 ng/ml) in the patients compared to healed (0.26 sd 0.04 ng/ml; P < 0.001) and healing (0.29 sd 0.09 ng/ml; P < 0.001) controls. The patients’ DPD levels were normal. No correlations were found between bone markers and the characteristics
of the subjects in all groups.
Conclusions A normal steady state of bone metabolism seems to be present in patients with atrophic nonunion fractures, despite the high
serum OPG. The reason for the inability of the patients’ OPG to inhibit osteoclastic activity is unknown. Osteoblast activity
also appears normal, so another cellular source of OPG can be hypothesized. 相似文献
996.
A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined.The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug addicts where there was a significantly increased rate of deep infection. Other factors such as smoking, fracture severity and wound closure did not affect the rate of deep infection.Our study shows that delay prior to calcaneal fracture surgery is not associated with a lower infection rate but it is does indicate that surgical experience is important and we believe that these difficult fractures should be treated in specialised centres. 相似文献
997.
折断螺钉内固定治疗股骨转子间骨折 总被引:1,自引:0,他引:1
卜海富 《安徽医科大学学报》1999,34(3)
目的探讨高龄患者股骨转子间骨折内固定方法。方法对30例高龄患者骨转子间骨折采用折断螺钉内固定进行临床观察。结果30例全部愈合,平均愈合时间43个月,无并发症发生。结论该法创伤小,尤为适宜高龄患者,手术安全,术后护理简单,恢复快。 相似文献
998.
999.
Jonathan Rush 《ANZ journal of surgery》1987,57(10):723-725
Closed intramedullary nailing of the humerus using a curved clover-leaf nail (pohl nail) is a relatively minor operative procedure and is associated with few complications. The technique of the operation when performed from below (29 cases) and also from above (7 cases) is that as described initially by kuntscher and his colleagues. This paper presents the technique and the experience from 1978 to 1985 with 36 cases (20 for metastatic bone deposits, four in multiple injury patients, three in patients with a severe head injury, four in patients with multiple fractures in the same limb and five in other patients particularly elderly women with osteoporotic bones). This review demonstrates the efficacy of closed ntramedullary nailing of the humerus particularly when the nail is insetted into the humerus from below just proximal to the olecranon fossa. 相似文献
1000.