闭合复位逆行交锁髓内钉治疗股骨干骨折

目的 研究闭合复位逆行交锁髓内钉治疗股骨干骨折的手术方法,以避免交锁髓内钉固定的条件限制、降低治疗费用.方法 手术均在能透视的普通手术台进行,于髌韧带外侧缘做8 cm的切口,经股骨髁间窝开孔,膝关节屈曲手法复位,依次扩髓,逆行穿入带锁钉.全部闭合复位.结果 经平均20.4个月的随访,所有病人均骨性愈合,膝关节功能良好, Kolmert膝关节功能评定优良率90.9%.结论 徒手闭合复位逆行交锁髓内钉治疗股骨干骨折具有操作简单、固定牢固、能早期进行膝关节功能锻炼,且不受条件限制,费用较低等特点.     

股骨转子间骨折股骨近端髓内钉术后中药分期干预的疗效研究

[目的]探讨股骨转子间骨折患者在股骨近端髓内钉术后中药分期干预的临床疗效。[方法]对2011年6月至2012年6月本院收治并行股骨近端髓内钉术后的股骨转子间骨折患者进行筛选得到44例,随机分为实验组和对照组,每组各22例。对照组患者接受常规西医抗感染等基础治疗,实验组患者在对照组基础上联合中药分期治疗,对比两组预后和疗效。[结果]两组患者均未出现术后并发症,总体疗效无统计学差异（P〉0.05）,但实验组患者骨折愈合和下地负重所用时间均显著低于对照组患者（P〈0.01）。[结论]股骨近端髓内钉手术后联合中药分期干预治疗对于患者病情康复起到显著的促进作用。     

可透视的下肢托架设计及其在下肢髓内钉内固定手术中的应用

目的：探讨可透视的下肢托架设计方法及其应用于下肢髓内钉内固定手术的效果。方法：选择31例下肢骨折患者,平均年龄37.6岁,分别行股骨倒打髓内钉（9例）和胫骨髓内钉（22例）内固定术,在术中透视测量插入主钉时膝关节屈曲角。根据插入主钉时膝关节屈曲的最适角度,设计并制作可透视的下肢托架。再选择倒打股骨髓内钉固定患者29例,平均年龄39.4岁;术中使用可透视的下肢托架者20例,记为A1组;未使用托架者9例,为对照组,记为A2组。同时选择胫骨髓内钉固定病例67例,平均年龄33.7岁;术中使用可透视的下肢托架者49例,记为B1组;未使用托架者18例,为对照组,记为B2组。分别记录手术时长、手术方式、骨折愈合时间3项指标。数据使用SPSS16.0软件处理,进行t检验、χ^2检验比较。结果：根据股骨倒打髓内钉及胫骨髓内钉插入主钉时膝关节屈曲的角度设计制作的铝制托架为三角形,内角分别为50°、60°、70°。将该下肢托架应用于下肢骨折的手术中并与未使用托架的病例进行比较：A1组手术时间为（73.7±16.8）min,较A2组明显缩短;A1组闭合复位成功率为75.0%,明显高于A2组;A1组术后至临床骨愈合的时间为（15.7±4.2）周,较A2组明显缩短。B1组手术时间为（64.2±14.8）min,明显短于B2组;B1组闭合复位成功率为91.8%,显著高于B2组;B1组临床骨愈合的时间为（14.1±2.8）周,短于B2组,且差异有统计学意义。结论：根据术中膝关节最佳屈曲角度设计的可透视下肢托架,可使膝关节屈曲至最适角度,降低了手术操作难度,加快了手术进程;托架材料可透X线,便于术中透视观察,提高了闭合复位的成功率;同时还减少了医生手术中的射线暴露、保护了术者,是下肢髓内钉手术中的良好辅助工具。     

颅内生殖细胞瘤综合治疗的初步效果

①目的 探讨颅内生殖细胞瘤的综合治疗方法。②方法 回顾分析18例颅内生殖细胞瘤采用单纯全中枢照射、单纯全脑照射及低剂量全脑照射联合化疗3种治疗方法的疗效及并发症。③结果 放化疗联合组与全中枢照射组4年总生存率及无复发生存率比较差异均无显著性（P＝1．000，0．416）；儿童生长延迟及智力发育障碍发生率以放化疗联合组为低（P＝0．0009，0．001）；单纯全脑照射组复发率高于全中枢照射组及放化疗联合组，差异有极显著性（P＝0．003）。④结论 全脑照射联合化疗的综合治疗方法初步效果满意，且并发症低，尤其适用于儿童病人。对于播散性病变或多灶性病变病人不宜给予单纯全脑照射。     

逆行交锁髓内钉治疗股骨髁间粉碎性骨折12例

目的探讨股骨逆行交锁髓内钉治疗股骨髁间粉碎性骨折的效果。方法应用股骨逆行交锁髓内钉治疗12例股骨髁间粉碎型骨折,随访全部病例并进行临床效果评定。结果经6~20个月随访,12例骨愈合良好。结论股骨逆行交锁髓内钉具有操作简便、固定牢靠等优点,是治疗股骨髁间粉碎性骨折较理想的内固定器械。     

前臂交锁髓内钉治疗尺桡骨多段骨折

目的探讨交锁髓内钉治疗前臂多段骨折效果。方法对11例尺桡骨多段骨折采用闭合复位交锁髓内钉固定。结果术后随访6~15个月。骨折愈合时间为12~22周,术后1例延迟愈合,无感染及骨不连。按Anderson评分:优8例,良2例,可1例。结论交锁髓内钉固定是治疗前臂多段骨折的良好方法。     

非扩髓带锁髓内钉治疗开放性胫腓骨骨折

2004年3月~2005年11月,我科使用非扩髓带锁髓内钉治疗开放性胫腓骨骨折18例,效果满意。1材料与方法1.1病例资料本组18例,男12例,女6例,年龄21~65岁。胫骨的解剖分区:Ⅲ~Ⅴ区17例,Ⅵ区1例;骨折类型按Gustilo评定系统分为:Ⅰ型7例,Ⅱ型5例,ⅢA型5例,ⅢB型1例。急诊手术8例,10例伤     

Clinical and financial impacts of flexible intramedullary nailing in pediatric diaphyseal forearm fractures: A case–control study

Purpose:Flexible intramedullary nailing is regularly applied for pediatric displaced unstable forearm fractures. When compared to closed reduction and casting (orthopedic treatment), flexible intramedullary nailing decreases malalignment, shortens immobilization time, and should decrease follow-up controls. Comparing flexible intramedullary nailing and orthopedic treatment in the clinical, radiological, and financial managements of these fractures was performed.Methods:Retrospective 5 years study of pediatric cases in two pediatric orthopedic university departments. Treatment method, post-operative course, and radiological follow-up were reviewed. Number of radiographs, follow-up controls, type and duration of immobilization, final bone angulation, and reported complications were compared. Extensive financial analysis was completed.Results:Of 73 girls and 168 boys included in the study, 150 were treated by flexible intramedullary nailing and 91 by orthopedic treatment. No difference was noted with regard to total number of radiographs (7.3 vs 7.2, respectively). Total number of follow-ups was 6.4 and 5.5, respectively. Malalignment occurred in two flexible intramedullary nailing and sixteen orthopedic treatments. The least expensive cost was ambulatory orthopedic treatment.Conclusion:Flexible intramedullary nailing treated children had similar numbers of radiographs or follow-up consultation, but less malunion when compared to orthopedic treatment. Orthopedic management was systematically cheaper than flexible intramedullary nailing. Unless post-operative management guidelines decreasing the number of radiographs and follow-ups are implemented, flexible intramedullary nailing will remain a costly procedure when compared to conventional orthopedic treatment.Level of evidence:level III case–control retrospective study.     

闭合复位交锁髓内钉并治伤散外敷治疗闭合性胫腓骨骨折

目的:探讨闭合复位交锁髓内钉并治伤散外敷治疗胫腓骨骨折的临床疗效。方法:98例闭合性胫骨骨折患者随机分为两组,均应用带锁髓内钉治疗闭合性胫骨骨折98例,观察组52例以治伤散外敷,对照组46例以云南白药外敷。于治疗用药后第2d、5d、10d、15d分别观察记录临床症状及评分,检测血液流变学变化情况,以评价临床疗效。结果:观察组显效率64.64%,总有效率为95.97%;对照组显效率21.70%,总有效率为76.76%。两组总体疗效有非常显著性差异(P<0.01)。在体征评分及血液流变学改善方面,观察组明显优于对照组。结论:闭合复位交锁髓内钉并治伤散外敷治疗胫腓骨骨折的临床疗效好,值得推广。     

Anatomical Limitation of Posterior Spinal Myelotomy for Intramedullary Hemorrhage Associated with Ependymoma or Cavernous Malformation of the High Cervical Spine

Spinal intramedullary tumors such as ependymoma or vascular lesions such as cavernous malformation are often at risk of intramedullary hemorrhage. Surgical procedures involving the high cervical spinal cord are often challenging. This technical note included four patients who presented with acute, subacute, or gradual onset of spinal cord dysfunction associated with intramedullary hemorrhage at the C1 or C1/2 level of the high cervical spine. The mean age was 46.3 years (16-74 years). All patients underwent posterior spinal cord myelotomy of the posterior median sulcus or posterolateral sulcus. It was not to exceed the caudal opening of the fourth ventricle (foramen of Magendie) and was assumed to be as high as the caudal medulla oblongata. Total removal of the intramedullary ependymoma or cavernous malformation occurred in three of four cases, and the remaining case had subtotal removal of the ependymoma. None of the patients showed postoperative deterioration of the neurological condition. Pathological examination of all cases revealed intramedullary hemorrhage was associated with ependymoma or cavernous malformation. Posterior spinal myelotomy should be limited to the caudal opening of the fourth ventricle (foramen of Magendie), that is the caudal medulla oblongata, to avoid the significant deterioration after surgery.