Anatomic Structures at Risk: Curved Hindfoot Arthrodesis Nail—A Cadaveric Approach

Retrograde intramedullary nailing of the hindfoot and ankle is an established procedure for salvage of severe foot and ankle deformity, arthritis, tumor, and instability. In the present study, retrograde hindfoot (tibiotalocalcaneal) arthrodesis nailing was performed using a standardized technique on 7 cadaver specimens by trained senior surgeons. The specimens were then dissected to determine the distance of the subcalcaneal structures at risk from the insertion point of the nail. The findings showed that the distance of the lateral neurovascular bundle from the edge of the nail was 6.5 (range 3.5 to 8, 95% confidence interval 5.9 to 7.1) mm. No neurovascular bundle was compromised, and all were within a previously described “safe window.”     

经皮撬剥复位弹性髓内针固定治疗儿童桡骨颈骨折的疗效

 目的 探讨经皮克氏针撬剥复位弹性髓内针内固定治疗儿童JudetⅢ型、Ⅳ型桡骨颈骨折的手术方法、临床疗效。方法 对首都医科大学附属北京儿童医院2009-01至2017-01采用经皮克氏针撬剥复位弹性髓内针内固定治疗的儿童桡骨颈骨折临床资料进行回顾性病例分析。依据Judet分型对病例进行分型,JudetⅢ型、Ⅳ型患儿采用手术治疗,术后依据Metaizeau整复标准评估手术复位效果,末次随访按 Metaizeau 疗效标准评估患儿预后情况。结果 所有患者均获得随访,随访时间(36.98±18.98)个月(9～100个月)。按Judet分型:Ⅲ型44例,Ⅳa型9例,Ⅳb型7例。单纯桡骨颈骨折41例,18例合并尺骨鹰嘴骨折,1例合并肱骨内上髁骨折。按 Metaizeau 的整复标准,其中优48例,良12例,一般0例,差0例。按Metaizeau疗效标准,优55例,良5例,一般0例,差0例。结论 经皮克氏针撬剥复位弹性髓内针固定桡骨颈骨折手术操作简单,复位效果满意,固定效果可靠,术后可早期活动,肘关节功能恢复好,是一种治疗儿童桡骨颈骨折切实可行的方法。     

自制带螺纹骨圆针内固定治疗锁骨骨折

自1996年3月以来，应用自制带螺纹骨圆针内固定治疗锁骨骨折42例，取得满意效果，报告如下。     

胫骨骨折外科手术方式的选择及其疗效比较(附245例报告)

目的通过回顾分析我院近4年进行手术治疗的胫骨骨折患者245例，评价其不同手术方式的临床疗效。方法对96例带锁髓内钉固定患者、137例钢板固定患者及12例外固定支架固定患者的术后并发症、术后负重时间和术后功能恢复情况进行分析和总结。结果96例带锁髓内钉固定组患者下地负重时间平均为18天，皮瓣坏死2例，骨筋膜室综合征1例，感染2例，疗效优良89例，一般及差7例；137例钢板固定组患者下地负重时间平均为82．9天，皮瓣坏死16例，骨筋膜窒综合征5例，感染6例，骨不连或畸形愈合5例，疗效优良115例，一般及差22例。12例外固定支架固定组患者平均下地负重时间为128．5天，皮肤坏死5例，感染3例，骨不连3例，疗效优良6例，差6例。相互之间比较有显著性差异（P〈0．05）。结论对于闭合性胫骨骨折患者，首选带锁髓内钉治疗，对于GustiloⅠ、Ⅱ、Ⅲa型骨折患者，可选用髓内钉或钢板治疗。而对于GutiloⅢb及ⅢC型骨折患者，忌用内固定治疗，首选外固定支架固定。     

带锁髓内钉治疗178例长骨骨折疗效分析

目的探讨带锁髓内钉治疗股骨、胫骨和肱骨骨折的疗效.方法回顾性分析2001年1月至2007年6月我科收治的178例应用带锁髓内钉内固定治疗长骨骨折患者的临床资料.其中新鲜骨折153例(开放性40例,闭合性113例),陈旧性骨折25例;股骨骨折98例,胫骨骨折58例,肱骨骨折22例;男性142例,女性36例;年龄15～84(48.3±16.4)岁.术中应用"C"型臂或"G"型臂引导闭合复位,对部分闭合复位失败者采用切开复位内固定,陈旧性骨折和骨折粉碎严重的病例行断端植骨,取自体髂骨植骨或自体髂骨加固混合植骨.结果178例骨折均治愈,治愈率为100.0%;骨折平均愈合时间为(18.5±3.2)w,其中正常时间愈合167例(93.8%),延迟愈合9 例(5.1%),2例骨折9个月内不愈合(1.1%);内固定失败 6例,其中主钉断裂 2例,主钉合并远端锁钉断裂1例,远端锁钉退出1例,近端锁钉退出2例;感染2例(1.2%),外伤性骨折 2例(1.2%).结论 应用带锁髓内钉治疗股骨、胫骨和肱骨骨折愈合率高,并发症发生率低,是治疗骨干骨折的一种较为理想的内固定方法.     

非扩髓带锁髓内钉治疗粉碎性股骨干骨折

股骨干骨折是临床常见的多发性骨折 ,特别是在高能量损伤情况下造成股骨干粉碎性、多段骨折 ,复位固定非常困难 ,不仅骨折粉碎程度高 ,而且往往伴有严重软组织损伤。我们自 1998年始采用非扩髓小切口带锁髓内钉对该类骨折进行治疗 ,效果满意。1　临床资料本组 4 5例中男 32例 ,女 13例 ;年龄 2 0～ 63岁 ,平均 35岁。致伤原因 :车祸伤 35例 ,高处坠落伤 6例 ,重物砸伤 4例 ,均属股骨干粉碎性骨折 ;按Ｗｉｎ ｑｕｉｓｔ等[1] 方法分类 :Ⅰ度 12例 ,Ⅱ度 8例 ,Ⅲ度 17例 ,Ⅳ度 8例。2　手术方法开放性骨折急症清创后行带锁髓内钉内固定治疗 ,…     

半圆形动态交锁髓内钉治疗股骨中下段骨折

目的研究治疗股骨中下段骨折的最佳手段。方法采用自行研制的半圆形动态交锁髓内钉（ＳＤＬＩＮ）治疗股骨中下段骨折３２例，其中股骨干骨折１４例，髁上、髁间骨折１８例。ＳＤＬＩＮ两侧钉分别自股骨外、内侧髁进钉，其中央段相互咬合，钉尾上横栓，构成一整体结构。结果２７例获访４～２７个月。无骨折不愈及断钉、断横栓者。２１例新鲜骨折按Ｋｏｌｍｅｒｔ功能评定标准：优良率９０．５％。结论ＳＤＬＩＮ既有其他种类交锁钉的力学优势及Ｅｎｄｅｒ钉、矩钉易进钉的优点，又克服了前者易断钉、断横栓、操作复杂和后者力学性能差的缺陷，可在各级医院推广应用     

Surgical treatment of the femur in osteogenesis imperfecta with intramedullary elongating rods

Surgical Principles Deformation of the femur or fractures of the femur with displacement are corrected with segmental osteotomies and are stabilized with elongating rods according to Bailey-Dubow [1] following reaming the medullary cavity. The rods, which elongate during growth, are anchored transarticularly through the intercondylar notch of the distal femur. Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 122–130 (German Edition).     

Intramedullary spinal cord tumour associated with neurofibromatosis type 1

Summary We investigated the characteristic features of intramedullary spinal cord tumour associated with neurofibromatosis type 1 (NF-1). We have experienced 44 cases of pathologically confirmed intramedullary spinal cord tumour. Diagnosis of NF-1 was done according to the criteria set by the National Institute of Health Consensus Development Conference. Within the described population NF-1 was diagnosed in two patients. Both the patients were male and histopathologically the tumours were anaplastic astrocytoma and glioblastoma multiforme respectively. 6 cases of NF-1 associated with intramedullary spinal cord tumour based on the above diagnostic criteria have so far been reported, including our 2 cases. Of these 6 cases, 5 were male and in one sex was not described. The tumour was an astrocytoma in all 6 cases. This finding suggested that intramedullary spinal cord tumour associated with NF-1 tends to occur predominantly in males and that histopathologically the tumour is likely to be an astrocytoma. We conclude that the criteria proposed by the National Institute of Health Consensus Development Conference are contributory in making an accurate pre-operative pathological diagnosis of intramedullary spinal cord tumour associated with NF-1.     

Surgical removal of brainstem astrocytomas and hemangioblastomas: Report of three cases and review

The surgical removal of a brainstem astrocytoma or hemangioblastoma entails the risk of a major neurological injury, but if injury can be avoided, the benefits of surgery are considerable in some types of these tumors. Most brainstem astrocytomas are widely infiltrative diffuse tumors that frequently undergo malignant change and are not benefitted by surgery. However, dorsally exophytic brainstem astrocytomas, focal cervicomedullary astrocytomas, and focal brainstem astrocytomas have a more benign character and frequently are benefitted by surgical removal or other surgical intervention. Brainstem hemangioblastomas may be extramedullary tumors or cystic intramedullary tumors, and surgical removal of these tumors is usually possible and is the optimal treatment. Three cases are presented to illustrate that excellent results can be obtained by surgical resection of certain types of brainstem astrocytoma or hemangioblastoma. The clinical and radiographic characteristics and the results of surgical treatment for each of these types of brainstem tumor are discussed.