胫骨平台骨折的手术治疗进展

现代骨科学对骨折治疗要求微创、生物学内固定，因此对骨折适应证的选择，切开复位内固定的各方面，外固定架及关节镜的治疗都产生了较大的影响，现将近几年的胫骨平台骨折手术治疗的新进展综述如下。     

先天性膝关节脱位1例

患儿女性,1.5岁,足月顺产,产前及产时检查宫内位置为枕左前位。产后第2天即发现左膝关节过伸畸形,过伸约45°,屈曲受限80°,膝前部皮肤皱褶明显,窝皮肤皱褶消失,左足背贴于右大腿上,髌骨被推向外侧。被动屈膝时有弹性反抗,可触及髌骨,髌骨形态正常,股骨髁向后,胫骨向前移位,被动活动膝关节过伸45°以上,胫骨可前后推移,股四头肌无挛缩,髌上囊触不清,无其他畸形,X线片示胫骨向前移位(附图)。家族史无类似病例,其母亲无致畸药物服用史。附图先天性膝关节脱位X线片治疗经手法整复,左膝关节可恢复至屈曲80°,但有一定张力,行石膏托外固定。2周…     

亚急诊双空心加压螺纹钉治疗老年股骨颈骨折

股骨颈骨折为中老年人常见的骨损伤,因其较高的骨折不愈合率及股骨头坏死率一直未能得到满意疗效.目前临床上对股骨颈骨折的治疗主要有2种方法：即以保存自身股骨头为目的复位内固定术及关节置换术,二者利弊存在争论.我们通过回顾分析84例经亚急诊闭合复位、小切口双空心加压螺纹钉内固定治疗的股骨颈骨折疗效满意,报道如下.     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折的手术治疗方法。方法回顾分析自1998年6月至2006年6月收治的经手术治疗的28例肩胛骨骨折的临床资料。根据Miller和Ada的分型方法，ⅠA型4例，ⅠB型2例，ⅠC型4例，ⅡA型5例，ⅡB型3例，ⅠC型6例，Ⅲ型10例，Ⅳ型15例。其中混合型骨折21例，伴有合并损伤者24例。通过前方、后方、后上及前后联合入路分别对不同类型的肩胛骨骨折使用重建钢板或拉力螺钉等固定。结果28例患者全部获得随访，随访时间6个月～7年，平均3．1年。根据Hardegger的疗效评价标准，优20例，良3例，可3例，差2例，优良率为82％。术后主要并发症包括创伤性关节炎2例，异位骨化1例，肩关节不稳2例，肩胛上神经卡压1例。结论根据肩胛带功能恢复的要求，按照Miller局部解剖分型。结合术前详尽的放射学检查，掌握好手术指征，选择合适的手术入路，手术治疗肩胛骨骨折安全有效。     

甲下骨疣误诊为嵌甲症1例

1 病例资料 患者,男, 30岁.因穿鞋右拇趾末端疼痛,甲沟局部反复感染2年内行5次拔甲,趾甲成形1次均无效来诊.患者右拇趾末端肿胀,趾甲畸形,甲下局部隆起变形,甲床增厚,局部压痛,甲下脓性分泌物.X线摄片发现末节趾骨甲下骨性突起病变,边界清楚,骨突的基底较宽与趾骨皮质相连续,诊断为甲下骨疣.见图1.     

改良双克氏针内固定法治疗锁骨骨折

双克氏针固定锁骨骨折因为针细弹性好保证进针在髓腔内有足够的长度，双克氏针于髓腔内紧靠上下两侧皮质，支撑力强，对抗弯曲及旋转力强，固定更可靠，临床应用比较广泛。然而传统双克氏针内固定法在肩锁部皮下埋针，由于肩背部肌肉丰厚，过长针尾长时间干扰肩胛带活动导致肩关节疼痛、僵硬以及针尾感染。自1996年3月-2003年3月，作者以改良双克氏针内固定法治疗锁骨骨折52例。取得满意疗效。现总结报告如下。     

断面与空钉对压板连接治疗管状骨骨折稳定性的分析

目的研究断面与空钉对压板连接治疗管状骨骨折稳定性的差异．为压板连接治疗管状骨骨折适应证的选择、接骨板的安放及后续治疗提供依据。方法将新鲜人体胫骨与长轴成45。角截骨,制作单斜面、双斜面、三斜面3种骨折模型,采用AO固定技术进行压板连接固定骨折,骨折两端至少各有3个螺钉固定。测量2N、5N作用力下骨折处加压、扭转、弯曲状况下的应变,对应变数据进行综合分析。结果不空钉情况下2N、5N加压、扭转、弯曲情况下应变（Y）与断面变量（p）关系分别如下：y2=25．6-3．5μ,Y2=-63．8-11／x,Y2=75．6—2．5μ,Y5=44．6—0．5μ,Y5=-413—5μ,Y5=104．3＋5．5μ。加压、扭转、弯曲情况下应变（Y）与空钉变量（μ）关系分别如下：y2=11．6＋26．1μ,Y2=-112．9—10014μ,Y2=66．4＋29．6p,Y5=35．9＋61．4灿,Y5—423．9—107．4μ,y5：125．5＋99μ。结论本实验表明压板连接治疗管状骨骨折稳定性受骨折断面多少的影响很小。空钉使压板连接治疗骨折的稳定性明显下降,空钉越多稳定性越差,空钉对稳定性的影响成线性变化。     

切开复位内固定踝关节骨折：联合带线锚钉修复三角韧带损伤的意义

BACKGROUND: Ankle joint fracture combined with triangular ligament injury is a common type of injury, and is easy to have an impact on the anatomy of the ankle joint, leading to the occurrence of joint instability; the treatment is extremely easy to lead to a variety of complications. For injured triangular ligament, it is controversial whether it is necessary to repair in the clinic. OBJECTIVE: To investigate the effect of a wire anchor for repairing triangular ligament in ankle joint fracture fixation. METHODS: The clinical data of 36 cases of ankle fractures combined with triangular ligament injury, who were treated in the Department of Orthopedics of the Seventh People’s Hospital of Zibo City from May 2013 to May 2014, were retrospectively analyzed. The ankle fractures combined with triangular ligament injury were treated with open reduction plate fixation. The patients were followed up for 12 months. The recovery of ankle joint function was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and foot function score. Gravity stress X-ray examination was performed before and after treatment. Space of medial malleolus was measured. Adverse events were observed.  RESULTS AND CONCLUSION: The patients were followed up 3, 6 and 12 months after treatment. AOFAS score of the ankle joint was increased and significantly higher at 12 months than that before surgery (P < 0.05). Gravity stress X-ray examination revealed that the space of medial malleolus of the affected side was smaller at 12 months than that before treatment (P < 0.05). No injuries to nerves and blood vessels were found during surgery, and the incision was healed in the first stage, and no infection was observed. Adverse events such as fixator breakage and loosening were not visible. However, partial function of the ankle joint was limited after repair in triangular ligament injury. Results confirmed that open reduction and internal fixation combined with a wire anchor obtained good effects in the repair of ankle joint fracture with triangular ligament injury.         

第五跖骨基底部骨折治疗的研究进展

第五跖骨基底部骨折在临床常见,若治疗不当可造成一系列的并发症,影响日常活动。目前第五跖骨基底部骨折的临床分型明确,但其最佳手术治疗方案尚未形成统一共识。本文对第五跖骨基底部骨折治疗方法及效果的研究进展进行了综述,探讨总结各治疗方式的临床疗效及优缺点。