带锁髓内钉治疗损伤性"浮膝"6例报告

目的评价应用带锁髓内钉治疗损伤性“浮膝”近期疗效观察。方法对6例浮动膝损伤的患者均行同侧股骨和胫骨带锁髓内钉的骨固定手术,并对合并症的治疗进行分析、总结。结果“浮动膝”术后随访3月、6月、12月复查X光片,6例患者中,4例同侧股骨和胫骨均同时愈合,1例胫骨和1例股骨延迟愈合。5例膝关节活动度屈曲80°～90°1例膝关节屈曲度60°。全部病人肢体长度无短缩发生,愈合时间6月～18月。结论“浮动膝”是一种高能量的损伤,常常合并重要的脏器损伤,积极治疗全身并发症的同时争取骨折早期内固定,带锁髓内钉有明显的治疗优势,术后膝,踝关节功能障碍发生少,肢体功能恢复较快。     

顺行肱骨交锁钉治疗肱骨干骨折

目的 探讨顺行肱骨交锁钉治疗肱骨干骨折的临床应用价值。方法 对2l例肱骨干骨折患行切开复位、顺行肱骨交锁钉内固定。结果术后随访3～20个月(平均14.6个月)，骨折愈合良好，仅l例出现桡神经一过性损伤。结论 顺行肱骨交锁钉交锁治疗肱骨干骨折疗效满意，还有减少桡神经损伤、感染等并发症、减少创伤，肘关节功能不受明显限制等优点。     

逆行交锁髓内钉治疗股骨髁上骨折及关节僵硬

目的：探讨应用逆行交锁强内钉治疗陈旧性股骨碟上骨折钢板断裂不愈合并膝关节僵硬的临床意义。方法：对5例患采用断裂钢板拆除，手术松解粘连，矫正畸形，股骨碟逆行交锁铝内钉固定，术后早期应用CPM机锻炼。结果：5例随访8—12个月，肢体无畸形，骨折愈合时间6—9个月，平均7．5个月，膝关节功能按Kolmert评定标准，优4例，良1例。结论：应用逆行交锁铝内钉治疗股骨碟上陈旧性骨折钢板断裂骨不愈合并膝关节僵硬，操作简便，固定牢靠，可早期功能锻炼，效果良好。     

交锁髓内钉治疗股骨干骨折及相关问题探讨(附106例报告)

目的:探讨使用交锁髓内钉治疗股骨干骨折的最佳手术方式选择。方法:对1998年6月～2002年10月使用交锁髓内钉治疗106例(118肢)股骨干骨折的疗效进行回顾性分析。手术采用闭合或小切口开放复位,用三维瞄准器锁定骨折远、近端。结果:平均随访14.4个月,肢体、关节功能恢复优良率95.3％,一期骨折愈合率94.0％,平均骨临床愈合时间5.7个月。2例软组织感染,感染率1.9％,2例髓内钉断裂。结论:交锁髓内钉治疗股骨干骨折应常规闭合复位、扩髓、静力固定,不强求解剖复位,本组取得了满意疗效,认为是目前治疗股骨干骨折的首选方法。     

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.     

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.     

股骨逆行交锁髓内钉治疗股骨髁部C型骨折

目的探讨股骨逆行交锁髓内钉治疗股骨髁部C型骨折的方法和疗效。方法应用股骨逆行交锁髓内钉治疗股骨髁部C型骨折47例:C1型19例,C2型22例,C3型6例。结果47例随防6～48个月,平均20个月,骨折均愈合,平均愈合时间18周。根据Neer膝关节功能评分标准:优23例,良14例,可8例,差2例,优良率77.72%。结论股骨逆行交锁髓内钉是治疗股骨髁部C1、C2型骨折较理想手术方法,但对C3型骨折疗效欠满意。     

Effectiveness of Hindfoot Arthrodesis by Stable Internal Fixation in Various Eichenholtz Stages of Neuropathic Ankle Arthropathy

The optimal time to treat neuropathic (Charcot) arthropathy of the ankle and peritalar joint is controversial because of the various treatment options available and the variable results reported in published studies. We sought to determine the outcome of hind foot arthrodesis with stable internal fixation in patients with different Eichenholtz stages of arthropathy. We prospectively studied patients with substantial disabilities caused by neuropathic arthropathy in deformed, unstable ankle and peritalar joints, with or without ulcerations, who had undergone treatment from July 2007 to December 2012. All patients underwent ankle arthrodesis, autologous iliac crest bone grafting, and subtalar joint arthrodesis, with or without talonavicular joint arthrodesis, fixed internally with an intramedullary hindfoot nail, with or without an additional plate or cancellous screws. Of the 33 enrolled patients, 9 (27.3%) had stage I, 13 (39.4%) had stage II, and 11 (33.3%) had stage III Charcot arthropathy. The cause of arthropathy was diabetes mellitus in 25 (75.8%) patients. The duration of symptoms ranged from 1 to 120 (median 7) months. The mean follow-up period was 40 (range 12 to 76) months and did not differ markedly among the groups. The hindfoot scores, rate of salvage or amputation, or complication rates did not differ significantly across Eichenholtz stage. For the patients with stage I, II, and III, the preoperative hindfoot score was 50, 49, and 48, respectively (p = .9). The corresponding postoperative scores were 68, 68, and 70 (p = .5). We found no evidence that the effectiveness of hindfoot arthrodesis by stable fixation varied across the Eichenholtz stage of Charcot arthropathy involving ankle and peritalar joint. Furthermore, we found that stable internal fixation and bone grafting using a hindfoot nail results in an 84.84% union rate and salvages the unstable and disabled foot in 90.9% of patients with ankle and peritalar Charcot arthropathy.     

交锁髓内钉与锁定钢板内固定治疗Neer 2、3部分肱骨近端骨折疗效比较

目的比较肱骨近端锁定钢板与交锁髓内钉内固定治疗Neer 2、3部分肱骨近端骨折的疗效。方法回顾性分析自2012-01—2014-12诊治的128例Neer 2、3部分肱骨近端骨折,采用肱骨近端锁定钢板内固定治疗70例(锁定钢板组),采用交锁髓内钉内固定治疗58例(髓内钉组)。比较2组切口长度、手术时间、术中出血量、骨折愈合时间,以及术后12个月Constant-Murley肩关节功能评分及VAS评分。结果 128例均获得随访14~18个月,平均16.2个月。与锁定钢板组比较,髓内钉组手术时间更少,切口长度更短,术中出血量更少,差异有统计学意义(P0.05);但2组骨折愈合时间差异无统计学意义(P0.05)。术后12个月时,锁定钢板组与髓内钉组Constant-Murley评分、VAS评分差异无统计学意义(P0.05)。锁定钢板组并发症发生率为34.3%,髓内钉组并发症发生率为24.1%,但2组并发症发生率差异无统计学意义(P0.05)。结论交锁髓内钉和锁定钢板内固定治疗Neer 2、3部分肱骨近端骨折均可获得可靠疗效。在临床工作中,需综合考虑患者骨折情况、骨质疏松程度,以及术者手术操作熟练程度,合理选择内固定手术方案。     

磁力导航髓内钉小切口微创治疗胫骨干骨折

目的探讨磁力导航髓内钉小切口微创治疗胫骨干骨折的临床效果。方法 2008年8月至2010年2月我院对收治的32例胫骨干骨折患者,实施了骨折闭合复位或小切口切开复位磁力导航带锁髓内钉内固定手术。结果闭合复位成功12例,小切口开放复位20例,锁定钉远端一次性锁定30例,成功率93.8%。髌韧带内侧切口平均长度3.1 cm,骨折端切口平均长度2.6 cm。无感染及切开皮肤坏死病例。随访28例,平均随访6.3个月,骨折平均愈合时间为2.8个月,无骨折不愈合及髓内钉松动断裂。功能按Johner-Wruhs评定标准进行评价,优20例,良7例,中1例,优良率96.4%。结论磁力导航髓内钉小切口微创治疗胫骨干骨折锁钉定位准确,损伤小,疗效好,优于传统髓内钉内固定技术。