单边外固定架治疗胫骨骨不连的疗效

目的 探讨单边外固定架治疗胫骨骨不连的疗效.方法 回顾性分析2010年1月至2013年12月我院收治的28例胫骨骨不连患者的临床资料,均行外固定架植入、胫骨截骨、骨延长.截骨术后l0d开始延长,每天延长1mm.结果 随访时间1～4年,平均2.5年.所有患者均获得骨和软组织缺损修复.根据改良Paley骨延长评分,18例为优,8例为良,2例为可.结论 单边外固定架操作简便、创伤小、预后良好,是胫骨骨不连患者的有效治疗方法.     

Ilizarov技术治疗骨不连的研究进展

骨不连是骨折常见并发症,治疗棘手.Ilizarov技术生物学理论是张力-应力法则,是治疗骨不连的有效手段,特别是治疗伴软组织缺损的感染性大段骨缺损类骨不连,相比传统治疗方法具有突出的优越性.随着研究的深入和应用方法的创新,Ilizarov技术的临床应用日益广泛,研究进展也备受到关注.本文就Ilizarov技术治疗骨不连...     

股骨粗隆下不愈合骨折治疗体会

目的研究与探索股骨粗隆下不愈合骨折的临床治疗体会。方法从选取33例股骨粗隆下不愈合骨折患者,应用切开复位股骨近段解剖钢板和重建钉内固定的方法治疗并对其术后结果追踪分析。结果对33例术后患者通过对手术前后×光的情况对比、是否能站立、是否行走等情况表明在1年的追踪中．其中采用重建钉内固定的方法治疗的患者恢复速度和治愈情况比应用切开复位股骨近段解剖钢板治疗的患者疗效显著。结论应用解剖钢板治疗股骨粗隆下不愈合骨折是临床中比较常用的手术方法,在临床中比较容易实施但选用这种方法所产生的并发症比较多,相对的采用重建钉内固定虽然在临床开展比较难,但对于患者的康复等各项指标的恢复效果极佳。     

Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis

Percutaneous transosseous Ilizarov wiring, whilst preferred in the tibia because of its unique properties, carries a high risk of complications in the femur. The aim of this work was to evaluate the efficacy of a more patient-friendly semicircular pin external fixator module built up from parts of the Ilizarov fixator components and its use in managing diaphyseal femoral nonunions. A group of 20 patients with infected diaphyseal nonunions of the femur after internal osteosynthesis were included in this study. The mean age of the patients at the time of surgery was 46 years (range 16–60, SD 15.6). The mean morbidity time since the original trauma was 10.2 months (range 6–15, SD 2.5). All the cases were fixed by the described external fixator module. Bony union with resolution of infection occurred in 18 (94.7 %) out of 19 cases after a mean period in the fixator of 11.2 months (range 8–18 SD 2.9). After a mean follow-up period of 3.5 years (range 2–9, SD 2.6), there were 14 excellent, 3 good, 1 fair and 1 poor results from radiological evaluation and 10 excellent, 7 good, 1 fair and 1 poor results from functional assessment. In conclusion, the described semi-circular pin fixator module is patient-friendly and effective in managing infected nonunions of the femoral diaphysis.     

Recurrent peripheral embolism following nonunion of the clavicle

Vascular complications in closed clavicular fractures are uncommon, with an incidence of only 0.4%. Subclavian artery injury can present acutely or can have a delayed presentation with arm ischemia. We report the case of an undetected subclavian pseudoaneurysm in a patient with a nonunion fracture clavicle who was referred with persistent ischemia following attempted brachial embolectomy at another center, along with a review of literature to support the hypothesis that in addition to repair of the aneurysm, treatment of the psuedarthrosis by fixation of the clavicle is essential.     

骨不连治疗的研究与技术应用进展*

背景：骨不连是骨折晚期常见的临床问题，数十年来，在各种新式内外固定材料、普及的显微外科技术、创新的植骨材料，尤其是分子生物学技术的全面帮助下，骨不连的治疗取得了突破性进展。
　　目的：总结骨不连治疗的研究进展，为以后更好地治疗骨不连提供技术理论和方法选择。
　　方法：由第一作者运用计算机检索系统检索1990年1月至2013年5月发表的有关骨不连原因及治疗方法的文献，以“fracture nonunion，treatment，progress”或“骨不连，治疗方法，进展”为检索词。同一领域则选择近期发表或者发表在权威杂志的文章。
　　结果与结论：排除重复性研究及时间跨度大的文献，从检索结果中共选择了48篇文章进一步分析。骨不连治疗手段主要有两种：非手术方式和手术方式，目前临床上以手术方式为主且高效。骨折愈合是多环节参与的复杂过程，一旦骨不连发生，应具体问题具体分析，根据患者的实际情况采取个体化治疗原则，重视软组织的保护，必要时联合运用多种手术及非手术方法，才能取得满意的疗效。     

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study

Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.     

Nonunion fracture healing: Evaluation of effectiveness of demineralized bone matrix and mesenchymal stem cells in a novel sheep bone nonunion model

Nonunion treatment has a high rate of success, although recalcitrant nonunion may determine the need for amputation. Therefore, new treatment options are continuously investigated in order to further reduce the risk of nonunion recurrence. This study aimed to (a) develop a new large animal model for bone atrophic nonunion and (b) compare the efficacy of demineralized bone matrix (DBM) and DBM in combination with mesenchymal stem cells (MSC) in the new nonunion model. The new model consists of a noncritical, full‐thickness segmental defect created in the sheep tibia, stabilized by an intramedullary nail, and involves the creation of a locally impaired blood supply achieved through periosteum excision and electrocauterization of the stump ends. Six weeks after defect creation, lack of hard tissue callus and established nonunion was observed in all operated tibiae both by radiographic and clinical evaluation. Nonunion was treated with allogeneic DBM or autologous MSC cultivated on DBM particles (DBM + MSC) for 1 day before implantation. Twelve weeks after treatment, radiographic, microtomographic, histologic, and histomorphometric analysis showed the formation of bone callus in DBM group, whereas the fracture healing appeared at an early stage in DBM + MSC group. Torsional strength and stiffness of the DBM group appeared higher than those of DBM + MSC group, although the differences were not statistically significant. In conclusion, a new sheep bone nonunion model resembling the complexity of the clinical condition was developed. DBM is an effective option for nonunion treatment, whereas MSC do not improve the healing process when cultivated on DBM particles before implantation.