Operative treatment of intertrochanteric hip fractures: an overview of modern advances and techniques

Hip fractures have been one of the most studied injury pattern in adults. The number of hip fractures is increasing exponentially; furthermore, the cost of treatment places great economic strain on society. There have been recent developments in hip-fracture treatment, particularly involving the intertrochanteric region, with emphasis on deformity prevention to try to optimize patient functional outcomes. In this article, we outline some of these developments with an emphasis on changes in implant design.     

股骨转子周围骨折的髓内钉固定

目的探讨带锁髓内钉固定在股骨转子周围骨折中的应用价值以及相关并发症的防治。方法回顾分析了自1993年12月至2001年9月间作者收治的180例(181髋)经髓内钉治疗的转子周围骨折,其中应用亚太型Gamma钉96例(97髋)、股骨重建钉54例、股骨近端钉(PFN)30例。结果平均手术时间65分钟,术中术后输血患者仅占15.6%;平均随访时间为16个月,96%的骨折获得愈合,平均愈合时间为3.5个月;按黄公怡评价标准,髋关节功能优良率为90.2%;发生9种类型的并发症。结论髓内钉固定在治疗股骨转子间骨折中具有较大的临床价值,但仍存在一定的并发症,应引起足够重视。     

尺骨头进针固定尺骨的解剖及临床应用研究

目的 :报道尺骨头进针固定尺骨骨折的解剖基础及其临床应用效果。方法 :观察 7具 1 4侧成人上肢标本 ,测量尺骨茎突的长度。以尺侧腕伸肌腱沟内缘 2mm尺骨茎突远端以上 1 5mm处为进针点 ,测量该点到尺神经手背支的距离、该点在前后两侧到尺骨头环状关节面的距离。以该点进针模拟手术并试用于临床。结果 :①尺骨茎突长为 (6 .0± 1 .2 )mm ;②进针点与尺神经手背支距离为 (1 4 .1± 3 .8)mm ;③进针点在前后两侧到尺骨头环状关节面的距离分别为 (1 6 .7± 0 .7)mm、(1 6 .6± 1 .1 )mm ,配对t检验比较两者差异 (P >0 .0 5) ;④术后随访未见严重并发症。结论 :自尺骨头背侧进针能避免传统的从尺骨鹰嘴进针的并发症 ,且钢针尾部不影响前臂的旋转运动和腕关节活动     

股骨远端骨折两种固定方法对比研究

目的 对比应用逆行交锁髓内钉(GSH)和动力髁螺钉(DCS)内固定治疗股骨远端骨折的效果.方法 采用回顾性研究方法对我院自2000年8月～2004年10月治疗的54例股骨远端骨折病例进行对照研究,按A0分类:A1型17例,A2型14例,A3型11例,B1型2例,C1型6例,C2型3例,C3型1例.其中,DCS内固定30例,GSH固定24例.分组统计手术时间,出血量,骨折愈合时间,并发症,膝关节功能.结果 所有病例经5月～2年随访,平均9个月;骨折愈合时间为4.6月(4～9月).DCS固定组平均手术时间1.5小时(1～2.5小时).出血量105 ml(50～200 ml),骨折愈合时间平均4.7月(4～8月),并发症发生5例(发生率16.7%),根据Kolmert膝关节功能评分,优20例,良6例,可4例,优良率为86.6%.GSH固定组手术时间1.8小时(1.5～3.5小时).术中出血量平均120 ml(100～250 ml),平均骨折愈合时间5.1个月(4.5～9个月),并发症发生5例(发生率28%),根据Kolmert膝关节功能评分标准,优15例,良7例,可2例,优良率为91.7%.两组比较,结果无显著差异(P＞0.05) 结论 逆行带锁髓内钉(GSH)及动力髁螺钉(DCS)均是治疗股骨远端骨折的较好方法,但各有其最佳适应症.选择好适应症以及术者技术熟练有利于骨折愈合及关节功能恢复.     

逆行带锁髓内钉治疗股骨远端骨折的应用解剖

目的:为带锁髓内钉治疗股骨远端骨折提供形态学基础。方法:①选用30例成人干燥股骨测量股骨内外侧髁、内外上髁、髁间窝有关数据进行统计分析。②20侧下肢标本解剖观测膝降动脉及隐神经髌下支的分支、分支等及两者的关系。结果:髁间窝呈U型占35%,V型占65%,此窝最宽处横径:左侧(1.98±0.36)cm, 右侧(2.06±0.29) cm;内侧髁后关节面宽,左侧(2.21±0.23) cm,右侧(2.34±0.29) cm;内、外上髁的距离,左侧(7.30±0.60)cm,右侧(7.43±0.57)cm。膝降动脉髌下支和隐神经髌下支呈紧密的伴行关系。隐神经在缝匠肌中下1/3交界点穿出,有上、下两支分布到膝关节前外侧皮肤。结论:术中注意这些解剖位置特点,避免损伤神经和血管,减少手术出血,防止并发症。     

A Novel Locus for Ectodermal Dysplasia of Hairs, Nails and Teeth Type Maps to Chromosome 18q22.1–22.3

Ectodermal dysplasias (EDs) are developmental disorders affecting tissues of ectodermal origin including hair, nails, teeth and sweat glands. Ectodermal dysplasia of hair, nails and teeth is a rare type of congenital disorder characterized by sparse and thin hair, dystrophic finger-and toenails and missing and abnormal teeth. In an effort to understand the molecular basis of this form of ED a family of Pakistani origin with an autosomal recessive pattern of inheritance was ascertained from a remote region in Pakistan. The clinical features of the affected individuals included thin and fine hair on the scalp, dystrophic and flat nails, absent or sparse eyebrows and eyelashes, missing and abnormal teeth, and thin body hair. A human genome scan carried out using microsatellite markers mapped the disease locus in this family to chromosome 18q22.1–18q22.3. A maximum two-point LOD score of 2.73 (θ= 0.0) was obtained at marker D18S541. Multipoint linkage analysis resulted in a maximum LOD score of 3.42 obtained with several markers, including D18S1125, ATA82B02, D18S848, D18S488, D18S1091, and D18S485, which supported the linkage. The linkage interval is flanked by markers D18S857 and D18S815, which corresponds to a region of 17.32 cM according to Rutgers combined linkage and physical map (build 36). This region covers 8.63 Mb according to the sequence-based physical map. Three candidate genes, CDH7, CDH19 and ZNF407 , from the linkage interval were sequenced and found to be negative for functional sequence variants. This study is the first step towards the identification of a gene involved in hair, nails and teeth type ED.     

尖头梅花髓内针与带锁髓内针治疗胫腓骨骨折比较

目的　比较改良的尖头梅花针与带锁髓内针治疗胫腓骨干骨折的临床综合疗效 ,正确选取内固定物。方法　分别用改良的尖头梅花针与带锁髓内钉内固定治疗胫腓骨干骨折 74例 ,比较两组的综合疗效。结果　改良梅花针组 48例 ,轻度外旋畸形 2例 ,无骨不愈合 ,平均骨折愈合时间 3.5个月 ,平均手术时间 40 mim ,住院费用 30 0 0元 (人民币 ) ,优良率93.75 % ;带锁髓内钉组 2 1例 ,发生骨延期愈合 2例 ,平均骨折愈合时间 5个月 ,平均手术时间 6 0 mim ,住院费用 5 5 0 0元(人民币 ) ,优良率 95 .2 4%。除胫骨远端下 1/ 3或严重的粉碎性骨折外 ,两组疗效无明显差异 (P >0 .0 5 )。结论　改良尖梅花针内固定操作简单、价格低廉、疗效确切 ,仍有较高的临床使用价值 ;带锁髓内钉能满足胫骨各种类型的骨折 ,扩大了髓内固定的适应症 ,随着成本的降低 ,已逐渐成为治疗胫腓骨骨折髓内固定的方向。     

逆向交锁髓内钉治疗股骨髁上骨折

目的探讨逆向交锁髓内钉在股骨髁上骨折中的应用价值.方法采用静力型交锁技术对16例股骨髁上骨折病例行经髁逆向交锁髓内钉治疗,其中陈旧性骨折6例,4例患者同期行植骨术.对伴有膝关节僵硬的病例,术中采用手法或(和)手术松解膝关节,术后辅以持续被动活动.结果随访8～36个月,骨折均愈合.愈合时间新鲜骨折2.5～5个月,平均3.5个月;陈旧性骨折7～11个月,平均8个月.结论逆向交锁髓内钉是治疗股骨髁上骨折的良好方法之一,其提供的力学固定有利于骨折愈合和膝关节功能的康复.     

Post-retrieval functionality testing of PRECICE lengthening nails: The “Sleeper” nail concept

IntroductionPRECICE intramedullary magnetic lengthening nails, introduced in 2011, have changed the landscape of long bone limb lengthening. The implants have a stroke ranging from 5 to 8 cm, but it may be desirable to perform part of the lengthening at one treatment, allow bone healing, leave the implant in place, dormant, and then return one or more years later to re-lengthen with the same implant. We call this the “sleeper” nail concept. This strategy may be gentler for the joints and soft tissues. Would the nail mechanism still be functional one or more years later?MethodsWe tested 102 intact, consecutively explanted nails. Using a “fast magnet,” the male part was lengthened to 5 mm short of its maximum stroke capacity and retracted back to 35 mm (all nails start with the male part exposed 30 mm). The nails passed the test if the male part succeeded in lengthening to 5 mm short of the maximum stroke capacity and back to 35 mm (or only retract in case fully deployed at testing). During our testing, the nails were prevented from reaching their full capacity of lengthening/retraction to avoid jamming the gears. Failure was defined as the inability or partial ability to complete the process.ResultsEighty-six nails (84.3%) performed successfully according to our testing standard. When comparing successful and failed nails in terms of nail type, generation, diameter, length and in vivo interval, there was no statistical significance. Comparing both groups in terms of status at testing (fully deployed or not) showed statistical significance with 9 of the 16 failed nails fully deployed at testing (p < 0.001).ConclusionDormant PRECICE nails can be reactivated for further lengthening. The results imply that full deployment may damage the mechanism, making future re-use by retracting and then re-lengthening unsuccessful. The candidate nails for this purpose should not have any signs of clear damage (bending or breakage) and should not have been fully deployed. However, surgeons and patients should be aware of the need for possible nail exchange if the “sleeper” nail fails to wake up.Level of evidenceLevel IV case series analysis of retrieved surgical implants.