有限内固定结合外固定支架治疗复杂胫骨平台骨折的疗效分析

目的探讨有限内固定结合外固定支架治疗复杂胫骨平台骨折的临床效果。方法选择2010年1月~2013年6月在新疆维吾尔自治区人民医院米东医院外科收治的复杂胫骨平台骨折患者92例(SchatzkerⅣ型41例,Ⅴ型25例,Ⅵ型26例),男性61例,女性31例;年龄31~77岁,平均54.2岁。所有患者均为开放性骨折(Gustilo分型:Ⅰ型38例,Ⅱ型26例,Ⅲ28例),按照随机数字表法分为观察组和对照组,各46例。观察组采用有限内固定结合外固定支架治疗,对照组采用单纯钢板内固定传统手术治疗。对比两组手术情况、术后骨折愈合情况以及关节炎发生率,并对伤膝关节功能进行评估。结果观察组手术时间、术中出血量、术后愈合时间以及微动移位分别为(183.09±26.47)min、(304.75±51.47)mL、(0.57±0.11)周、(0.14±0.03)mm,均显著低于对照组的(213.47±34.23)min、(361.37±56.83)mL、(0.74±0.15)周、(0.31±0.07)mm;观察组术后膝关节评定优良率以及术后愈合率分别为97.83%(45/46)和93.48%(43/46),均显著高于对照组82.61%(38/46)和78.26%(36/46),而术后关节炎发生率观察组2.17%(1/46)低于对照组13.04%(6/46),上述差异均有统计学意义(P0.05)。结论有限内固定结合外固定支架治疗复杂胫骨平台骨折对患者造成的创伤小,术后恢复快,并且愈合程度高、关节炎发生率低,适合临床推广应用。     

富血小板血浆结合锁定加压钢板内固定治疗四肢长管状骨骨折术后骨不连

运用富血小板血浆(PRP)结合锁定加压钢板(LCP)内固定治疗四肢长管状骨骨折术后骨不连患者29例(35处),术后8个月按照骨折的骨性愈合标准进行评定,29例(35处)全部愈合。此方法治疗四肢长管状骨骨折术后骨不连可以取得满意疗效。     

78例Y型钢板内固定治疗跟骨骨折效果研究

目的探讨Y型钢板内固定在跟骨骨折治疗中的疗效,为跟骨骨折的治疗提供依据。方法选取156例跟骨骨折患者为研究对象,将其分为骨圆针撬拨固定组（对照组）78例和Y型钢板内固定组（观察组）78例,将两组患者的治疗优良率、并发症发生率及住院时间等进行统计分析。结果观察组的治疗优良率明显高于对照组,住院时间短于对照组,并发症发生率也低于对照组,经比较,P均〈0.05,有显著性差异。结论在根骨骨折的治疗中采用Y型钢板内固定治疗的方法 ,优点多,安全性高,值得临床进一步探讨。     

外固定复位器在复杂胫骨平台骨折中的应用

目的观察外固定复位器在治疗复杂胫骨平台骨折的作用。方法采用外固定器复位有限微创双切口内固定治疗复杂胫骨平台骨折30例。结果30例均获随访,随访时间为14~30个月,平均20个月,切口均一期愈合,未发生骨折不愈合,按照Lysholm评分标准,优良率为93.33%。结论外固定器复位有限切开内固定治疗复杂胫骨平台骨折复位容易,手术时间短,对膝关节软组织创伤小,固定牢靠能早期进行功能锻炼,是复杂胫骨平台骨折较为理想的治疗方法。     

低温环境下羊肢体枪伤骨折早期三种固定方法的疗效对比

目的对比观察低温环境下羊肢体枪伤骨折后,采用三种不同固定方法的疗效。方法新疆绵羊15只,置于野外-25℃低温环境3h后,以77式手枪枪击一侧小腿,致胫骨中段骨折,伤后6h清创,骨折分别采用石膏外固定、外固定器固定和钢板内固定,然后连续观察伤口、骨折愈合和伤肢膝关节活动情况。结果钢板内固定组伤口愈合好,无感染;石膏及外固定器固定组,部分伤口及外固定针道有分泌物,培养有细菌生长。X线片见钢板内固定组骨折对线对位及愈合最好,外固定器组次之,石膏固定组最差。病理观察三个组均无骨髓炎,相比之下钢板内固定组骨生长及骨重建最快,石膏组最慢。骨折固定方法对肢体关节活动度及肌萎缩的影响,石膏组最大,钢板内固定组最小。结论低温环境下肢体枪伤骨折早期钢板内固定并一期闭合伤口,不仅不会增加伤道感染,相反还可以防止感染的发生,有利于伤口及骨折的愈合。     

高能量Pilon骨折分期治疗两种不同固定方法疗效的比较

 目的 比较高能量Pilon骨折分期治疗中锁定加压钢板内固定与有限内固定结合外固定的疗效。方法 回顾性分析2009-01至2013-10治疗的56例高能量Pilon骨折患者的临床资料。早期采用跟骨牵引或支具、石膏外固定后,二期按手术固定方法不同分为两组:A组27例行切开复位锁定加压钢板内固定,B组29例行微创有限内固定结合外固定。比较术后两组患者骨折愈合的时间、踝关节功能恢复、并发症情况。结果 A组骨折愈合时间(4.9±0.6)个月,B组(5.2±0.7)个月,两组比较差异无统计学意义。A组踝关节功能恢复优良率(81.5%)与B组(75.9%)比较,差异无统计学意义。A组共发生并发症5例(18.5%),B组7例(24.1%),两组比较差异无统计学意义;但感染发生率比较,A组(14.8%)高于B组(0)(P＜0.05)。结论 在高能量Pilon骨折分期治疗中,上述两种治疗方法均能取得满意效果且疗效相当,但对伴有重度软组织伤者,微创有限内固定结合外固定较切开复位锁定加压钢板内固定治疗,感染的风险更低。     

经皮自体骨髓血移植治疗四肢骨折内固定术后延迟愈合的疗效观察

目的探讨经皮自体骨髓血移植治疗四肢骨折内固定术后骨折延迟愈合的疗效。方法将30例四肢骨折内固定术后骨折延迟愈合患者随机分为观察组15例,对照组15例;观察组采用经皮自体骨髓血移植治疗,对照组采用制动、定期观察等传统治疗。结果观察组15例治疗后全部愈合,愈合时间为4～12个月,平均8个月。对照组15例,14例愈合,愈合时间为7～18个月,平均12个月。1例演变为骨不连,予手术内固定植骨而愈。结论经皮自体骨髓血移植在骨折延迟愈合部位有成骨作用,对四肢骨折术后骨折延迟愈合病例可选用经皮自体骨髓移植治疗。因其操作简便,确有一定效果,易于推广。     

切开复位有限内固定治疗跟骨骨折

目的：探讨跟骨骨折的切开复位有限内固定治疗方法和疗效。方法：对我院25例跟骨骨折患者采用切开复位克氏针内固定手术治疗的方法、术后处理和疗效进行总结。结果：经过平均18个月的随访，无严重并发症，结果满意。结论：切开复位有限内固定治疗跟骨骨折有利于骨折的复位、愈合及关节功能恢复，是治疗跟骨骨折的有效方法。     

有限内固定结合外固定支架治疗四肢骨折79例分析

四肢开放性骨折大多是由高能量暴力引起的骨折,手术难度大,易出现皮肤坏死、感染、骨髓炎、骨不愈合,2003年6月至2009年1月,我们采用简单内固定结合外固定支架及植骨治疗此类骨折79例,报道如下。     

脑外伤合并四肢长管状骨骨折患者不同时间段血清瘦素浓度变化

 目的 观察脑外伤合并四肢长管状骨骨折患者不同时间段血清瘦素浓度变化.方法 连续选择21例脑外伤合并四肢长管状骨骨折患者(观察组)和26例单纯四肢长管状骨骨折患者(对照组),入选对象均在骨折后第1、3、7、14天接受了血清瘦素浓度测定,同时统计下床活动时间、骨折愈合时间和住院总时间等疗效指标.结果 两组患者骨折后第1天时检测血清瘦素浓度无明显区别(P＞0.05);而第3、7、14天,观察组血清瘦素浓度均明显高于对照组(P均<0.05).观察组的骨折愈合时间明显短于对照组,而前者住院总时间明显多于对照组(P均<0.05).结论 脑外伤合并四肢长管状骨骨折患者病后第3、7、14天时间段血清瘦素浓度明显升高,骨折愈合时间较短.     

桥接组合式内固定系统治疗肱骨骨折疗效观察

目的探讨桥接组合式内固定系统治疗肱骨骨折的疗效。方法随机选取自2013年6月至2014年12月云南省第三人民医院骨伤科收治的肱骨干骨折患者50例。根据手术方法不同进行分组,其中,桥接组患者26例,钢板组患者24例。比较两组患者手术时间、术中出血量、住院时间、骨折愈合时间、内固定后并发症、肩肘关节功能评分等指标,对桥接组合式内固定系统治疗肱骨骨折的临床疗效做出评价。结果桥接组患者在手术时间、出血量、骨折愈合时间等方面均优于钢板组,差异均有统计学意义(P<0.05)。两组患者住院时间及肩、肘关节功能评分比较,差异无统计学意义(P>0.05)。两组患者术后均未出现骨不连、桡神经损伤等并发症。结论桥接组合式内固定系统治疗肱骨骨折在临床疗效、愈合时间、并发症、肩肘关节功能恢复等方面均有显著优势。另外,桥接组合式内固定系统在操作方面较锁定钢板更为简便,结构更稳固。     

胫骨干骨折内固定与外固定疗效的比较

探索胫骨干骨折内固定和外固定的疗效。认为对稳定性胫骨干骨折,加压钢板及髓内针内固定明显优于单纯石膏外固定。     

Initial fixation strength of a hybrid technique for femoral ACL graft fixation

Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screws provides a higher fixation strength when compared to an aperture fixation using only a screw matching the size of the tunnel and also reduces the risk of graft laceration. This research is an experimental laboratory study. We evaluated the initial fixation strength at time-zero of an extracortical-, a hybrid- and an aperture fixation in ACL reconstruction using extracortical buttons and different sized interference screws in porcine knees. The tests were performed using a single cycle and cyclic loading protocol. Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. Cyclic loading tests showed a statistically significant difference between hybrid and aperture fixation. The use of an undersized screw alone in aperture fixation resulted in insufficient fixation strength. The initial fixation strength of the hybrid technique with undersized screws is higher compared to an interference screw fixation alone. The hybrid fixation technique is an alternative for ACL graft fixation.     

Arthroscopy-assisted fracture fixation

Purpose  

The purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation.     

Orthopedic fixation devices

Orthopedic fixation devices are used in the treatment of fractures, soft-tissue injuries, and reconstructive surgery. After fracture reduction, internal, external, or intramedullary fixation devices may be used to provide stability and maintain the alignment of bone fragments during the healing process. They must be strong and secure enough to allow early mobilization of the injured part, as well as the entire patient. Compression is used whenever possible to increase the contact area and the stability between fragments and to decrease the stress on the implant. Screws are used primarily to provide interfragmental compression or to attach plates, which can then provide compression, prevent displacement, and support the fragments during healing. Pins and wires can be used for fixation of small fragments or fractures in small bones and for attachment of external fixation devices and traction. A basic understanding of the devices and principles of use is needed to interpret radiographs obtained after the treatment of musculoskeletal injuries.     

Proposed technique for evaluation of endotracheal tube fixation and comparison of four fixation methods

BACKGROUND: The fixation of an endotracheal tube must be rapid in conditions involving numerous casualties, such as a chemical warfare (CW) situation. The tube also should be fixed and strong to prevent unplanned extubations. METHODS: We developed a technique for the evaluation of fixation methods. This technique was used to evaluate four methods. Three commercial fixators were compared with the fixation method used today in the Israeli Defense Forces (IDF) and commonly used in different out-of-hospital settings. The exercises were performed on adult intubation mannequins with and without CW protective gear. The fixations were timed, and their quality was evaluated by the participants and inspectors. RESULTS: The time score for the method used today in the IDF was significantly higher compared with the commercial fixation methods. The quality scores for the Thomas fixator and the IDF method were significantly higher than for the fixators by VBM and Rusch. The CW protective gear significantly prolonged the time but did not affect the quality of the fixation. CONCLUSIONS: With this technique, a good estimation of the time and quality of fixation can be achieved.     

Analysis of initial fixation strength of press-fit fixation technique in anterior cruciate ligament reconstruction

We performed a controlled laboratory study to evaluate the initial fixation strength of press-fit technique. Forty porcine lower limbs were used and divided into four groups according to the method of fixation; group 1 (press-fit+1.4 mm), in which the diameter difference between the bone plug and the femoral tunnel was 1.4 mm; group 2 (press-fit+1.4 mm, 30 degrees), in which the diameter difference was the same with group 1, but the tensile loading axis was 30 degrees away from the long axis of the femoral tunnel; group 3 (titanium), in which a titanium interference screw was used for fixation; group 4 (bioabsorbable), in which a bioabsorbable interference screw was used for fixation. The graft in the press-fit group was harvested with a hollow oscillating saw with inner diameter of 9.4 mm to obtain consistent and completely circular shape of the bone plug. The femoral tunnel with diameter of 8 mm was drilled at the original ACL insertion. Following the bone plug insertion into the femoral tunnel and applying a preload of 20 N, the specimen underwent 500 loading cycles between 0 and 2 mm of displacement. Thereafter the specimen was loaded to failure. There was no fixation site failure during the cyclic loading test. Significant differences in the stiffness, linear load, or failure mode among the groups were not found. The average ultimate failure load of group 1 and group 2 were not significantly different from those of group 3 and group 4. The press-fit groups demonstrated sufficient fixation strength for the rehabilitation and interference screw groups. The completely circular shape of the bone plug and increased diameter difference between the bone plug and the femoral tunnel seemed to contribute to the strong fixation.     

闭合穿针内固定治疗胫骨干骨折的临床观察

对23例胫骨干骨折治疗资料进行回顾性分析,本组采用闭合穿针、普通髓内钉治疗,随访20例,骨折均完全愈合。作者认为闭合穿针内固定治疗胫骨干骨折最大限度地保护骨折处血循环。     

内固定和外固定应用于髌骨骨折固定中疗效及依从性比较

目的对临床常用的髌骨骨折内外固定方法的疗效及手术依从性进行分析,证实抓髌器外固定的临床优势。方法将我院2007年1月-2012年12月间手术治疗的128例髌骨骨折患者随机分为2组,每组研究对象64例。一组使用抓髌器外固定,为观察组;一组使用克氏针张力内固定,为对照组;治疗后对两组研究对象的骨折愈合、并发症、关节功能、患者满意率等临床数据进行比较及统计学分析。结果观察组62例、对照组58例骨折愈合良好,观察组愈合优良率（96．9％）高于对照组（90．6％）,且具有显著差异性（P〈0．05）;在感染发生率及关节功能的比较中,观察组均优于对照组,且具有显著差异性（P〈0．05）;观察组患者满意率为98．4％,均优于对照组,且具有显著差异性（P〈0．05）。结论抓髌器外固定在髌骨骨折治疗中的疗效及依从性较克氏针张力内固定具有显著优势,尤其在髌骨粉碎性骨折中优势更加明显,适于临床推广使用。