外固定架结合有限固定分期治疗 SchatzkerⅥ型胫骨平台骨折的临床分析

目的 探讨应用组合式外固定架结合有限切开内固定分期治疗SchatzkerⅥ型胫骨平台骨折的临床效果。方法 选择2010年1月～2013年6月解放军第三○六医院收治的SchatzkerⅥ型胫骨平台骨折患者13例,采用Ⅰ期跨关节组合式外固定架撑开,3～4周后Ⅱ期改用组合式外固定架结合有限切开螺丝钉内固定治疗。对患者治疗效果进行分析。结果 随访6～18个月,平均12个月,所有患者骨折全部愈合,平均愈合时间5．1个月,平均拆除外固定架时间7．8个月。其中1例出现针道感染。膝关节功能按照Rasmussen评分标准：优6例、良5例、可2例,优良率84．6％。结论 组合式外固定架结合有限切开内固定分期治疗胫骨平台骨折,软组织并发症少,手术操作简单,膝关节功能恢复满意,是治疗复杂胫骨平台骨折的一种有效方法 。     

外固定支架治疗儿童胫骨骨折疗效分析

目的探讨外固定支架治疗儿童胫骨骨折的疗效。方法选择2004年1月至2008年1月在我院治疗的40例胫骨骨折患儿,均采用闭合复位或小切口切开复位、外固定支架固定治疗。观察治疗后的疗效。结果所有患儿骨折均愈合,愈合时间为6～12周,平均8周。无一例发生针道感染,无延迟愈合、骨不连,无旋转畸形及下肢短缩或过度生长,膝、踝关节的功能良好。结论外固定支架治疗儿童胫骨骨折,创伤小,并发症少,疗效满意,是一种安全、有效的方法。     

Operative Treatment by External Fixation for Polyostotic Fibrous Dysplasia in The Elbow Joint.

Fibrous dysplasia is a condition in which normal skeletal bone changes into fibroblastic stroma and immature bone. We report our experience of a unilateral external fixator applied for the treatment of polyostotic fibrous dysplasia arising in the elbow. The patient was a 38 year-old man. His main complaint was left elbow pain and a mass, which increased in size. The histological diagnosis from the needle biopsy was fibrous dysplasia. An articulated unilateral external fixator was used for immobilization. The lesions in the left distal humerus and proximal ulna were curetted and cancellous bone was packed into the cavity. An external fixator (Elbow Fixator, Orthofix Inc., McKinney, USA) was applied from the proximal humeral shaft to the distal ulnar shaft for postoperative tentative immobilization and preservation of the affected elbow joint movement. At two years after the operation, the range of motion of the affected elbow was 90 degrees in flexion and -35 degrees in extension. The range of motion in pronation and supination of the left forearm was normal. No evidence of recurrence was noted at two years after surgery. The merits of using an external fixator were: an earlier start of range of motion exercises, and a decrease in the risk of tumor dissemination.     

Operative treatment by external fixation for polyostotic fibrous dysplasia in the elbow joint. A case report

Fibrous dysplasia is a condition in which normal skeletal bone changes into fibroblastic stroma and immature bone. We report our experience of a unilateral external fixator applied for the treatment of polyostotic fibrous dysplasia arising in the elbow. The patient was a 38 year-old man. His main complaint was left elbow pain and a mass, which increased in size. The histological diagnosis from the needle biopsy was fibrous dysplasia. An articulated unilateral external fixator was used for immobilization. The lesions in the left distal humerus and proximal ulna were curetted and cancellous bone was packed into the cavity. An external fixator (Elbow Fixator, Orthofix Inc., McKinney, USA) was applied from the proximal humeral shaft to the distal ulnar shaft for postoperative tentative immobilization and preservation of the affected elbow joint movement. At two years after the operation, the range of motion of the affected elbow was 90 degrees in flexion and -35 degrees in extension. The range of motion in pronation and supination of the left forearm was normal. No evidence of recurrence was noted at two years after surgery. The merits of using an external fixator were: an earlier start of range of motion exercises, and a decrease in the risk of tumor dissemination.     

Treatment of Floating Knee Injury in Children

The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8 % and the curative rate 71.4 respectively. So for children whose age is older than 5 years, it＇s a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.     

有限内固定结合外固定支架治疗胫腓骨复杂骨折疗效分析

目的探讨外固定支架结合有限内固定治疗胫腓骨复杂骨折的疗效。方法采用外固定支架结合有限内固定治疗复杂胫腓骨骨折34例,其中开放性骨折19例,闭合骨折15例。结果 34例均获随访,时间12～36个月。骨折平均临床愈合时间6个月。患肢力线正常,膝、踝关节功能满意(优良率79.4%)。结论使用外固定支架结合有限内固定能整复关节面、维持骨折复位和下肢力线,对骨折局部血供影响小,能促进早期功能锻炼,是治疗复杂胫腓骨骨折的一种合理有效的方法。     

克氏针外固定牵引架在治疗近节指间关节骨折脱位中的应用

目的：观察可活动型克氏针外固定牵引架治疗近节指间关节骨折脱位的疗效。方法自2011年2月～2013年9月,应用手部自制克氏针－橡皮筋可活动型外固定牵引架治疗近节指间关节骨折脱位患者12例,均为新骨折,其中闭合性骨折11例,开放性骨折1例,单纯性骨折11例,粉碎性骨折1例。结果12例患者均获得随访,随访时间6～26个月,平均随访时间11．5个月。12例患者均达到完全骨性愈合,愈合时间为8～16周,平均愈合时间12周,无骨不愈、针道感染并发症。手部功能恢复按TAM系统评定标准,优7例,良3例,可2例,优良率为83．3％。结论可活动型外固定牵引架能够对近节指间关节骨折脱位起到稳定固定,利于术后早期功能锻炼及恢复,是一种简单、有效的治疗方法。     

小切口或加有限内固定结合单侧外固定支架治疗胫腓骨骨折

目的探讨治疗胫腓骨骨折符合“生物学固定(BO)”有效手术方法。方法本组采用小切口或加简单、有限内固定结合单侧外固定支架治疗胫腓骨骨折。结果51例中48例获得随访,无骨延迟愈合或骨不连发生。结论本方法对局部软组织及血运破坏少,有限内固定可使骨折类型由不稳定型转为稳定型,从而发挥单侧外固定支架的固定优点,是一种符合“BO”理念的治疗方法。     

外支架治疗学龄前儿童股骨干骨折的临床应用

目的观察应用外支架治疗学龄前儿童股骨干骨折的临床疗效。方法应用外支架治疗19例学龄前儿童股骨干骨折。结果 19例全部获得随访,随访时间3个月～1年,骨折全部愈合,无髋膝关节功能障碍,患肢增长不超过1.5cm,骨折完全愈合,未出现跛行。结论外支架治疗学龄前儿童股骨干骨折稳定可靠,操作简便。     

外固定架终极治疗成年人胫骨干闭合性骨折的临床研究

目的 探讨外固定架终极治疗成年人胫骨干闭合性骨折的临床疗效。方法 2012年6月—2017年6月应用外固定架终极治疗成年人胫骨干闭合性骨折患者47例,术前根据骨折类型设计外固定架构型,术中X线透视机确认闭合复位骨折满意后安装外固定架,术后加强钉道护理预防感染,定期随访,根据X线片所示骨愈合矿化情况逐步拆除固定组件。结果 47例患者随访12～36个月,平均为(19.96±1.42)个月。其中45例患者骨折愈合良好,2例发生骨不连,骨愈合率为95.74%,骨折愈合所需时间4～14月,平均为(5.63±0.78)个月。其中1例患者发生骨不连采取二次手术更换钢板并取自体髂骨植骨后愈合,另1例患者发生萎缩性骨不连通过使用环形外固定架骨搬运技术治愈。3例患者发生轻度的钉道感染,经清创换药外用抗菌药物治愈。所有骨折患者均未采用跨关节固定构型,膝踝关节活动功能无明显影响。结论 外固定架终极治疗成年人胫骨干闭合性骨折临床疗效满意,合适的外固定构型可为骨折愈合提供稳定可靠的固定强度,并且可以根据骨愈合情况调整固定强度改善应力遮挡,避免二次手术治疗,具有一定的临床应用价值。