桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折

目的探讨桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的临床疗效。方法回顾性分析2013年1月至2016年12月于我院骨科接受手术治疗的4例股骨干骨折合并同侧股骨近端及远端骨折病人的临床资料,其中男3例,女1例,年龄为(33.5±9.3)岁(23~44岁),闭合性骨折3例,开放性骨折1例。3例病人存在合并损伤,其中颅脑损伤1例,胸腹部损伤1例,胫骨平台及骨盆骨折1例。入院后即确诊股骨近端骨折3例,延迟诊断1例,延迟时间为5 d。所有病例均采用桥接组合式内固定系统治疗。观察病人骨折愈合时间,末次随访采用Friedman-Wyman功能评分评价病人功能恢复情况。结果病人术后均获得随访,随访时间为(33.5±16.2)个月(20~57个月),手术时间为(193.3±36.2)min(155~241 min),术中出血量为(484.3±77.4)mL(415~582 mL)。2例病人骨折顺利愈合,股骨近端骨折于术后4~5个月愈合,股骨干骨折于术后6~7个月愈合,股骨远端骨折于术后5~6个月愈合。1例病人术后出现股骨头缺血性坏死,骨折愈合后将股骨内固定物全部取出,但股骨干再次出现骨折,再次手术后骨折愈合;1例病人术后出现股骨干骨不连,再次手术后骨折愈合。末次随访时Friedman-Wyman功能评分优1例,良2例,差1例,优良率为75%。结论股骨干骨折合并同侧股骨近端、股骨远端骨折较为罕见,股骨近端骨折漏诊率或延迟诊断率高,需要详尽的术前检查。桥接组合式内固定系统可作为治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的一种选择。

Bridge-link type combined fixation system for the treatment of femoral shaft fractures with ipsial proximal and distal femoral fractures

Objective To investigate the effect of arthroscopy meniscus forming, posterior horn tibial reconstruction and suture fixation on patients with symptomatic Wrisberg ligament discoid meniscus. Methods From January 2014 to January 2019, 11 patients with symptomatic Wrisberg ligament discoid meniscus injury underwent arthroscopic meniscus formation. The posterior horn tibial junction was reconstructed and sutured to the joint capsule to restore the stability of the meniscus. There were 7 males and 4 females with an average age of 19.5 years (14-25 years). There were 6 cases of left knee, 5 cases of right knee, 5 cases of military training injury and 6 cases of sports injury. All patients were followed up after surgery, and the visual analogue scale (VAS) score and Lysholm knee joint score were compared before and after surgery to evaluate the clinical efficacy of this method. According to Ikeuchi knee joint score, the overall excellent rate was calculated. Results The incisions of all patients healed in first stage after operation, and no related complications occurred. The follow-up time ranged from 12 to 23 months, with an average follow-up time of 16.5 months. Symptoms of knee popping and strangulation disappeared in patients. Pain symptoms disappeared in 10 patients. One patient had significant relief. All joint motions returned to normal at the last follow-up. The VAS score of the patients decreased from preoperative (6.42±1.12) to postoperative (2.05±0.18), and the difference was statistically significant (t=-4.823, P=0.026). Lysholm score increased from preoperative (56.9±7.2) points to postoperative (96.5±5.8) points, and the difference was statistically significant (t=-36.727, P=0.032). According to the Ikeuchi knee score, 7 cases obtained excellent efficacy, 3 good, and 1 fair. The overall excellent and good rate was 91%. Conclusion For symptomatic Wrisberg ligament disc-shaped meniscus injury, meniscus formation, posterior horn tibial stop reconstruction and suture fixation can be performed, which can preserve part of the patient''s meniscus function, and the short-term efficacy is satisfactory.