辅助钢板治疗胫骨骨折髓内钉术后骨不连的临床疗效

目的评价辅助钢板联合自体骨植骨治疗胫骨骨折髓内钉内固定术后骨不连的临床疗效。方法 2015年1月—2017年12月苏州中西医结合医院骨科采用单皮质锁定钢板联合自体髂骨植骨治疗胫骨骨折髓内钉内固定术后骨不连患者19例,其中男性11例,女性8例;年龄20～59岁,平均33.5岁。均保留原有髓内钉内固定。术后定期随访,根据X线片及下肢功能评价骨折愈合程度。结果所有病例均获得骨性愈合,愈合时间4～9个月,平均5.5个月。术后无感染、皮肤坏死及内固定失效等并发症,术后患肢功能良好。结论锁定钢板联合自体髂骨植骨是治疗胫骨骨折髓内钉固定术后骨不连的有效方法。     

自制抗生素骨水泥髓内钉结合钢板外固定治疗胫骨感染性骨不连的疗效分析

目的分析自制抗生素骨水泥髓内钉结合锁定钢板(LCP)外固定治疗胫骨感染性骨不连的手术技术和临床效果。方法回顾性分析本院自2005-03—2014-07诊治的13例胫骨感染性骨不连。取出内固定、清创、扩髓并置入自制抗生素骨水泥髓内钉,6~12周后改用LCP外固定+自体骨、Wright人工骨混合万古霉素植骨。结果 13例均获得随访13~24个月,平均15.6个月。所有患者感染均得到控制,在拆除抗生素骨水泥髓内钉时细菌培养均为阴性,血常规、红细胞沉降率、C反应蛋白正常。受伤至抗生素骨水泥髓内钉置入的时间为8~12个月,平均10.3个月。抗生素骨水泥髓内钉放置时间为6~12周,平均8.3周。骨折最终均愈合,其中1例延迟愈合,LCP外固定后骨折愈合时间平均5.8个月。末次随访时根据Olerud-Molander评分标准评定踝关节功能:优10例,良3例。结论自制抗生素骨水泥髓内钉结合LCP外固定治疗胫骨感染性骨不连简单实用、效果确切,值得推广。     

Role of Huntington procedure as a limb salvage surgery for complex gap nonunion of tibia in children

Back groundComplex gap nonunion of tibia following open fractures and osteomyelitis with pathological fractures in children is a treatment challenge with unpredictable outcome. Treatment options available are bone transport, bone grafting, induced membrane technique, allograft reconstruction and Huntington procedure (ipsilateral transposition of vascularized fibula). There is no consensus in the literature about which technique is optimal in the given situation. The purpose of the present study is to evaluate the role of Huntington procedure in the management of complex gap nonunion of tibia in paediatric patients.Material and methodEighteen patients (11 males and 7 females) with a mean age of 8.4 years (range 3–12 years) having complex gap nonunion of tibia with an average bone defect of 6.6 cm (range 5–17 cm) were treated with Huntington procedure between June 2008 to December 2016. The mean follow-up was 4.3years (range 3.5–6 years).ResultUnion was seen in all except one, with an average time to union being 11.5 weeks and13.8 weeks at proximal and distal tibio-fibular synostosis respectively. Revision plating was done in one patient with nonunion. Hypertrophy of fibula was seen in all patients. One patient developed 15° ankle varus and required corrective osteotomy. Ankle was fixed in equinus in three patients with a mean value of 13.3° (range 5°–25°). Lambrinaudi procedure was done to correct 25° fixed ankle equinus in one patient. Fixed flexion deformity of knee was seen in nine patients with a mean value of 9.7° (range 5°–20°). Two patients had iatrogenic foot drop; one recovered completely and one had only partial recovery. Shortening was seen in eight patients with a mean value of 3.5 cm (range 1–5 cm). At final evaluation 9 patients were very satisfied, 8 satisfied and 1 was dissatisfied.ConclusionHuntington procedure is a useful limb salvage surgery for complex gap nonunion of tibia in children. However; further improvements in the surgical technique are needed to increase the patient satisfaction by reducing the risk of complications.     

Outcomes of Vancouver C Periprosthetic Femur Fractures

BackgroundPeriprosthetic femur fractures (PFFs) that occur distal to a total hip arthroplasty, Vancouver C fractures, are challenging to treat. We aimed to report patient mortality, reoperations, and complications following Vancouver C PFFs in a contemporary cohort all treated with a laterally based locking plate.MethodsWe retrospectively identified 42 consecutive Vancouver C PFFs between 2004 and 2018. There was a high prevalence of comorbidities, including 9 patients with neurologic conditions, 9 with a history of cancer, 8 diabetics, and 8 using chronic anticoagulation. Mean time from total hip arthroplasty to PFF was 6 years (range 1 month to 25 years). All fractures were treated with a laterally based locking plate. Fixation bypassed the femoral component in 98% of cases and extended as proximal as the lesser trochanter in 18%. Kaplan-Meier survival was used for patient mortality, and a competing risk model was used to analyze survivorship free of reoperation and nonunion. Mean follow-up was 2 years.ResultsPatient mortality was 5% at 90 days and 31% at 2 years. Cumulative incidence of reoperation was 13% at 2 years. There were 5 reoperations including revision osteosynthesis for nonunion and/or hardware failure (2), debridement and hardware removal for infection (2), and removal of hardware and total knee arthroplasty for post-traumatic arthritis (1). Cumulative incidence of nonunion was 10% at 2 years.ConclusionPatients who sustained a Vancouver C PFFs had a high mortality rate (31%) at 2 years. Moreover, 13% of patients required a reoperation within 2 years, most commonly for infection or nonunion.     

股骨转子间骨折初次手术失败的翻修策略和研究进展

股骨转子间骨折是最常见的髋部骨折。由于严重骨质疏松及骨折断端粉碎程度高,初始内固定失效或骨折不愈合时有发生。对于功能需求高和（或）预期寿命长的手术失败患者,如何制定更为有效的翻修固定策略尚存在争议。常用的手术方式包括角度稳定钢板髓外系统（动力髁螺钉或动力髋螺钉）固定、股骨近端头颈髓内钉系统（股骨近端防旋髓内钉、Inte...     

应用Ilizarov外固定技术治疗骨不连

为探讨Ilizarov外固定技术治疗骨不连的疗效。自1993～1997年应用Ilizarov外固定器治疗骨不连35例,所有病例均在2.5～8个月内愈合。认为本法对骨折端稍加修整后进行加压外固定,固定牢固可靠,手术创伤小,不切除硬化骨。患者可早期功能活动,下地负重,促进骨不连愈合,关节功能大多恢复正常。     

Ulnar nonunion after osteoclasis for rotational deformities of the forearm

PURPOSE: Osteoclasis, a minimally invasive technique to rotate the radius and ulna, is used commonly to correct forearm rotational deformities in children. The purpose of this investigation was to evaluate objectively osteotomy healing in patients treated with osteoclasis, with specific attention given to the risk for nonunion. METHODS: We identified 69 extremities in 65 children treated with osteoclasis and performed retrospective chart and radiographic reviews to evaluate the time to union of the radius and ulna and factors influencing healing. RESULTS: The average rotational correction was 90 degrees. Twenty-one ulnas had either delayed union or nonunion. Forty-eight of the forearms healed in less than 3 months. Factors correlated with a significantly decreased union rate included increased patient age, percutaneous technique, osteoclasis site in the proximal ulna, and primary diagnoses other than congenital radioulnar synostosis. Preoperative forearm position, magnitude of position correction, and treatment of the periosteum were not associated with changes in union rates. CONCLUSIONS: Forearm osteoclasis has a delayed union rate of 16%. Timely union of the ulna appears to be influenced by both patient-centered factors and surgical technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

桡动脉茎突返支为蒂桡骨茎突骨瓣植入术治疗舟骨骨折不愈合

目的总结以桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合的临床效果。方法2000年3月~2005年6月,对18例舟骨骨折不愈合的患者,以桡动脉茎突返支为蒂在桡骨茎突掀起1.5cm×3.5cm×0.5cm的骨瓣,植入沿舟骨纵轴跨越骨折线所凿同等大小的骨槽内进行治疗。其中男15例,女3例。年龄18~39岁。舟骨腰部骨折11例,近侧1/3骨折7例,其中5例舟骨近端骨折块伴缺血坏死。腕关节活动疼痛,尤以背伸及桡偏时明显,鼻烟窝处有压痛,腕关节活动受限,X线片示10例患者有骨折端硬化及囊性变,骨折线明显加宽。结果术后18例舟骨骨折均愈合,其中5例合并缺血坏死的舟骨骨折块重新成活,骨折平均愈合时间为4个月。术后获随访1~5年,患者腕关节活动良好,腕背伸时无疼痛,日常生活和工作无影响。结论采用桡动脉茎突返支为蒂的桡骨茎突骨瓣移位治疗舟骨骨折不愈合及近端骨折块缺血坏死,操作简便,治疗有效,具有一定临床应用价值。     

Management of complex long bone nonunions using limb reconstruction system

Background:

Management of complex nonunions is difficult due to the presence of infection, deformities, shortening and multiple surgeries in the past. Complex nonunions are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 30 long bone complex nonunions treated by the limb reconstruction system (LRS).

Materials and Methods:

Between April 2009 and September 2012, we treated 30 cases of complex nonunion of long bone with the LRS. 28 were male and 2 females. Average shortening was 5.06 cm and 14 cases presented with infected implants. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 9.68 months. We compressed the fracture site at the rate of 0.25 mm per day for 1-2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved.

Result:

The union occurred in 89.28% cases and eradication of infection in 91.66% cases. Average lengthening done was 4.57 cm. We had 79% excellent, 11% good and 10% poor bony result and fnctional result was excellent in 40% cases, good in 50% and failure in 10% cases using ASAMI scoring system.

Conclusion:

LRS is an alternative to the Ilizarov fixation in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.