动力髋螺钉与Gamma钉治疗高龄股骨转子间骨折

目的对比观察动力髋螺钉、G amm a钉治疗高龄患者股骨转子间骨折的临床疗效。方法选择2008年5月至2009年5月我院骨科收治的股骨转子间骨折患者60例,男38例,女22例;平均年龄（75±3.7）岁。根据T ron-zo-Evans分型系统,60例患者按入院顺序交替分为动力髋螺钉内固定治疗组30例及G amm a钉内固定治疗组30例。记录术中出血量、手术时间,观察骨折愈合情况,术后12个月采用H arris评分标准对患髋功能进行评估。结果所有患者均获得随访。a）G amm a钉内固定治疗组术中出血量、手术时间均少于动力髋螺钉内固定治疗组（P〈0.05）;b）动力髋螺钉内固定治疗组并发髋内翻2例,伤肢短缩1例。G amm a钉内固定治疗组未出现内固定物切出股骨头或断裂等内固定失效现象。c）髋关节H arris功能评分显示,动力髋螺钉内固定治疗组优2 2例,良5例,可3例,优良率90.0%;G amm a钉内固定治疗组优23例,良5例,可2例,优良率93.3%。两组间差异无显著性意义（P〉0.05）。结论应用动力髋螺钉、G amm a钉治疗老年股骨转子间骨折,在疗效方面无明显差异。G amm a钉可缩短手术时间、减少术中出血量及术后并发症。对于稳定性骨折,两种内固定装置均可选择;对于不稳定性骨折,G amm a钉有生物力学上的优势。     

股骨近端抗旋髓内钉微创治疗高龄股骨转子间骨折

2006年11月-2009年2月,我院应用AO股骨近端抗旋髓内钉（PFNA）治疗高龄股骨转子间骨折共82例,取得了满意的临床疗效。     

Long-term outcome after 1822 operatively treated ankle fractures: A systematic review of the literature

The aim of this literature review is to systematically gather the highest level of available evidence on the long-term outcome after operatively treated ankle fractures in the English, German and Dutch literature. A search term with Boolean operators was constructed. The search was limited to humans and adults and the major databases were searched from 1966 to 2008 to identify studies relating to functional outcome, subjective outcome and radiographic evaluation at least 4 years after an operatively treated ankle fracture. Of the 42 initially relevant papers, 18 met our inclusion criteria. A total of 1822 fractures were identified. The mean sample-size weighted follow-up was 5.1 years. The initial number of patients that were included in the studies was 2724, which results in a long-term follow-up success rate of 66.9%. Regarding the fracture reduction we found 4 papers reporting on 106 fractures. Of the fractures that were classified according to Danis-Weber, 736 were eligible for correlation with the long-term outcome. In 442 fractures a comparison was possible between supination-external rotation stage 2 and 4 of the Lauge-Hansen classification. Only one study reported on the influence of initial cartilage lesions on the outcome. Regarding the involvement of the posterior malleolus, two studies reported on the long-term outcome. None of the studies addressed the influence of hindfoot varus or valgus on the long-term outcome after ankle fracture. Only 79.3% of the optimally reduced fractures show good to excellent long-term outcome. The Weber A type fractures do not show a better long-term outcome than Weber B type fractures. Recommendations for future research were formulated.     

旋入髓内钉与交锁髓内钉治疗成人股骨干骨折疗效分析

[目的]评价旋入式自锁髓内钉、交锁髓内钌在治疗成人股骨干骨折的临床疗效.[方法]自2005年6月～2010年6月采用旋入式自锁髓内钉、交锁髓内钉治疗成人股骨干骨折53例,男38例,女15例,年龄21～65岁;53例患者中交锁髓内钉固定治疗28例,旋入式自锁钉固定治疗25例,对两组分别就其平均手术时间、骨折平均愈合时间、HSS knee rating score法评定功能的各项指标进行比较分析.[结果]53例均获随访,随访时间6～24个月,平均10个月.交锁髓内钉固定组断钉1例,伤口浅表感染1例,骨延迟愈合3例;旋入式自锁钉固定组骨折延迟愈合1例,骨折短缩移位1例.交锁髓内钉固定组的平均手术时间为(95±10) min,旋入式自锁钉固定组平均(55±10) min.交锁髓内钉固定组骨折平均愈合时间为(22.0±3.5)周;旋入式自锁髓内钉固定组平均骨折愈合时间为(20.0±2.5)周;HSS knee rating score法评定功能恢复优良率:交锁髓内钉固定组(88.5±3.0)%;旋入式自锁髓内钉固定组(92.5±3.60)%.旋入式自锁髓内钉固定组与交锁髓内钉固定组相比,统计学有显著性意义(P<0.05).[结论]旋入式自锁髓内钉结构简单,操作方便快捷,创伤小,疗效可靠,是治疗成人股骨干骨折的有效方法.     

微创改良TLIF联合单侧钉棒系统固定治疗腰椎退行性疾病

[目的]探讨采用微创(minimally invasive)改良经腰椎间孔椎体间融合(modified transforaminal lumbar interbody fusion,TLIF)联合单侧钉棒系统治疗腰椎退行性疾病(lumbar vertebrae degenerative disease)的适应证、手术方法、初步疗效及并发症.[方法]2010年1月～2011年3月,随机选取有微创TLIF术适应证腰椎退行性疾病病例30例,其中微创改良TLIF联合单侧钉棒系统固定组(A组)15例,常规开放TLIF组(B组)15例,行各自术式手术并进行对照研究.[结果]术后6个月A组同B组在腰椎椎间植骨融合率、JOA评分等比较差异均显著,具有统计学意义(P(0.05).[结论]微创改良TLIF联合单侧钉棒系统固定治疗腰椎退行性疾病具有软组织损伤小、出血量少、不破坏对侧正常结构、住院时间短、腰椎椎间植骨融合率高、临床症状、体征及括约肌功能改善率高、并发症发生率低的优点,值得在临床推广应用.     

Wiring technique for lesser trochanter fixation in proximal IM nailing of unstable intertrochanteric fractures: A modified candy-package wiring technique

IntroductionThe purpose of this study was to introduce a new surgical technique, that involves modified Candy-package wiring followed by IM nailing fixation and to determine the clinical and radiological results obtained in patients with unstable intertrochanteric fractures with a lesser trochanter fragment.Materials and methodsThis study included 22 patients who were undergone proximal IM nailing with lesser trochanter wiring between January 2014 to June 2015. All patients were treated with minimally invasive technique of candy-package wiring for lesser trochanter fragments. The mean age was 75.8 years (range, 53–88) and average follow-up period was 15.1 months (range, 12–24). Each patient was followed up for a minimum of 12 months and their clinical and radiological results were analyzed.ResultsThe mean period required for fracture union was 16.6 weeks. (range, 8–25) and union was successfully completed in all cases. The WOMAC scores at the last F/U visit (average; 45.4, range; 21–75) were not significantly different to pre-trauma status (average; 36.5, range; 19–59) (p = 0.087). In comparison of ambulatory capacity prior to trauma, ambulatory aggravation was noted in four cases (18.2%), and eighteen cases (81.8%) was sustained walking ability of prior of trauma. Wiring breakage was found in two cases and heterotrophic ossification in one case. There were no functional deficeit related to the radiologic finding in these patients. With regard to postoperative complications, were no cut-outs, breakage, or pullout of screws.ConclusionWhen surgically repairing unstable intertrochanteric fractures with lesser trochanter comminution using proximal IM nailing method, the modified Candy-packaging wiring technique increases the fixation force at the fracture site. Thus, through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.     

Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint

Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided.     

A technique for extraction of the distal segment of a broken femoral nail using a flexible reamer

IntroductionExtraction of broken femoral nails in peri-implant fractures is becoming an increasingly common problem faced by orthopaedic surgeons. Different closed and open techniques for removal of broken nails have been previously described but due to variations in equipment and fracture configurations these methods are not always easily reproducible. We describe an open surgical technique using simple equipment that can be utilised when other methods of extraction have failed.Case presentation and surgical techniqueWe present a case of a peri-implant fracture secondary to non-union involving a short cephalomedullary nail where the broken distal segment of nail was significantly more distal to the femoral fracture site. After multiple failed attempts at extraction with previously described closed techniques a rectangular cortical window was created 2 cm distal to the tip of the broken nail using a saw. An antegrade guide wire was passed through the nail and pulled out of the bony window. A flexible intramedullary reamer was subsequently passed in retrograde fashion over the guide wire and a simple pushout technique was used to push both segments of the broken nail through the original insertion site. An exchange nailing was performed and the cortical window was reattached using a cable.DiscussionThis is a simple technique that does not require any specialist equipment and does not require the fracture site to be disturbed. The use of a flexible reamer as a pushout device is ideal as there are multiple size options allowing the surgeon to match the size of the medullary canal with the reamer. Furthermore, the flexibility of the reamer allows easy access through a lateral bone window.ConclusionBroken femoral nail extraction can be technically challenging and when other closed methods have failed we believe our technique offers a simple alternative that can be added to the armamentarium of solutions.     

旋转臂自锁式髓内钉治疗股骨干骨折

目的 探讨旋转臂自锁式髓内钉(RBSN)治疗股骨干骨折的临床效果.方法 对32例股骨干骨折采用切开复位RBSN内固定.结果 患者均获随访,时间10～30(16.2±1.4)个月.全部骨性愈合,时间为12～26(21.3±2.1)周.采用HSS膝关节评分标准评价疗效:优30例,良1例,可1例,优良率96.9%.结论 RBSN治疗股骨干骨折创伤小,操作简便,固定牢固,疗效确切.     

股骨近端髓内钉-螺旋刀片治疗老年股骨转子间骨折

目的探讨股骨近端髓内钉-螺旋刀片（PFNA）治疗老年股骨转子间骨折的临床疗效.方法对19例老年转子间骨折患者采用PFNA内固定治疗.结果19例均获随访,时间3～15个月。骨折全部愈合,愈合时间10～16周．按黄公怡等的髋关节疗效评价标准：优15例,良4例.结论PFNA是做创治疗老年股骨转子间骨折的理想方法.