孟氏并科雷氏骨折一例

患儿 ,男 ,9岁 ,左前臂跌落伤 9小时入院。腕部呈银叉样畸形。查体 :右肘部及前臂与腕部肿胀明显。肘部呈半屈曲畸形 ,腕肘部及前臂可触及骨擦音。桡骨小头窝消失。Ｘ线片示 ,上尺桡关节分离 ,桡骨小头向外前方移位 ,尺骨上段粉碎性骨折。桡骨远端向背外侧明显移位。尺骨远段向桡背移位骨折。入院诊断 :①孟氏 (Ｍｏｎｔｅｇｇｉａ)骨折 ;②科雷氏 (Ｃｏｌｌｅｓ)骨折 ;③尺骨远段骨折。入院后立即行手术治疗。术中用克氏针分别固定尺骨近远端骨折、桡骨远端骨骺。复位桡骨小头后修补环状韧带 ,再用一根克氏针从肱骨小头将桡骨小头固定。术…     

外固定器结合植骨治疗尺桡骨骨折内固定术后骨不连

目的:探讨单侧外固定器结合植骨治疗尺桡骨骨折内固定术后骨不连的方法及疗效。方法:应用单侧外固定器结合植骨治疗29例尺桡骨骨折钢板和三棱针内固定术后骨不连,其中男19例,女10例;年龄18-60岁,平均28岁。尺骨14例,其中近段4例,中段7例,远段3例;桡骨15例,其中近段4例,中段6例,远段5例。开放性骨折8例,闭合性骨折21例。粉碎性骨折14例,斜形骨折6例,横形骨折9例。结果:全部病例随访6-23个月,平均手术后16周(13-24周)骨折愈合。肘关节活动度均超过屈130°、伸0°,腕关节活动度均达掌屈60°、背伸50°以上;22例前臂旋转功能旋前、旋后均达80°以上,1例旋前40°,1例旋后50°,2例旋前、旋后均受限,总活动度仅80°。术后无尺、桡骨间骨性融合。结论:单侧外固定器结合植骨治疗前臂骨折内固定术后骨不连是一种操作简便,创伤小,固定牢固并发症少的有效方法,治疗期间可早期功能活动。     

AO中空螺钉并带蒂骨移植治疗舟状骨陈旧骨折

目的探讨AO加压空心钉并桡骨远端骨膜瓣翻转植骨治疗腕舟状骨陈旧性骨折的疗效。方法对11例舟状骨骨折患者应用AO加压空心钉并桡骨远端骨膜瓣植骨治疗,随访6～18个月。结果除1例并发桡腕关节炎的患者行桡骨茎突切除,术后腕部有轻度活动受限外,其余患者均良好愈合。结论采用AO加压空心钉并桡骨远端骨膜瓣翻转植骨是治疗腕舟状骨陈旧性骨折的有效方法。     

盖氏骨折骨不连的治疗和再思考

目的探讨盖氏骨折骨不连的手术失败原因和再手术治疗方法.方法1997年4月～2003年4月收治的盖氏骨折骨不连23例,分析其失败原因,并重新植骨内固定,消除桡骨旋转、短缩及成角畸形,采用改良的尺骨远端切除术处理下尺桡关节再脱位8例,尺骨假关节成形术处理下尺桡关节再脱位15例.结果所有病例经12～24个月的随访,平均随访时间18.7个月.骨折均获得骨性愈合,X线愈合时间为17～33周(平均20.6周).腕部无明显畸形.腕关节功能按照Dienst功能评价标准评价优9例,良11例,可3例,优良率为87%.结论盖氏骨折和骨不连的治疗,必须消除桡骨旋转、短缩及成角畸形,早期宜旋后位固定下尺桡关节;用改良的尺骨远端切除术和尺骨假关节成形术处理陈旧性下尺桡关节再脱位,可取得满意疗效.     

距下关节撑开植骨融合治疗跟骨骨折畸形愈合

目的 报告并评价撑开植骨距下关节融合治疗跟骨骨折畸形的效果.方法 2004年9月至2008年1月共收治32例跟骨骨折畸形愈合患者.按照Stephens CT分型Ⅱ型畸形28例,Ⅲ型4例;术前X线及CT检查,跟骨距骨角均值18.1°,美国足踝外科协会(AOFAS)评分均值36.3.手术采用撑开植骨距下关节融合的方法治疗,术后定期随访,测量距骨跟骨角,行AOFAS评分.结果 32例患者均获随访,随访时间24-65个月,平均34个月.除1例术后创口皮缘浅表坏死经换药愈合外,切口均一期愈合,无感染发生.术后3个月融合处均获骨性愈合.末次随访时,距骨跟骨角均值22.9°,功能评分平均77.5分.与术前比较差异具有统计学意义(P<0.05).结论 撑开植骨距下关节融合及外侧骨突切除能纠正或减轻跟骨骨折畸形愈合的主要病理改变,并有效地改善症状,是治疗跟骨骨折畸形愈合较为实用的方法.     

逆行筋膜蒂桡骨茎突骨瓣移植及BMP复合物植入治疗腕舟骨骨不连

目的 探讨治疗腕舟骨阵旧性骨折骨不连的手术方法。方法 对11例腕舟骨陈旧性骨折骨不连,采用筋膜蒂逆行桡骨突骨瓣移植及骨形态发生蛋白（bone morphogenetic protein,BMP)与纤维蛋白（fibrin sealant,FS)复合物植入的手术方法治疗。结果 术后随访4－24个月,腕部疼痛及无力症状均消失。11例在术后3－6个月内,X线片示骨折已全部骨性愈合。结论 带筋膜蒂的桡骨茎突骨瓣移植及BMP复合物植入法,治疗腕舟骨陈旧性骨折骨不连,操作简单,成骨作用强,并可促进骨折愈合。     

缩短截骨、骨栓植骨术治疗尺骨撞击综合征体会

目的探讨尺骨撞击综合征使用尺骨缩短截骨、骨栓植骨术治疗的价值。方法对15例尺骨撞击综合征的患者使用尺骨缩短截骨、骨栓植骨术,对临床效果进行分析。结果术后所有患者均获得随访,随访时间为12～24个月,采用Cooney腕关节功能评分系统判断治疗效果:优10例,良3例,可1例,差1例,优良率为86.7%。结论使用尺骨短缩截骨术治疗尺骨撞击综合征,疗效肯定,利于缓解腕部尺侧疼痛、手部握力下降、腕部屈伸及旋转活动受限等症状,具有较好的临床应用价值。     

盖氏骨折骨不连的治疗与再思考

目的探讨盖氏骨折骨不连的手术失败原因和再手术治疗方法。方法1997年4月～2003年4月收治的盖氏骨折骨不连23例,分析其失败原因,并重新植骨内固定,消除桡骨旋转、短缩及成角畸形。采用改良的尺骨远端切除术处理下尺桡关节再脱位8例,尺骨假关节成形术处理下尺桡关节再脱位15例。结果所有病例经12～24个月的随访,平均随访18.7个月。骨折均获得骨性愈合,X线愈合时间为17～33周(平均20.6周)。腕部无明显畸形。腕关节功能按照Dienst功能评价标准评价:优9例,良11例,可3例,优良率为87%。结论盖氏骨折骨不连的治疗,必须消除桡骨旋转、短缩及成角畸形,早期宜旋后位固定下尺桡关节;用改良的尺骨远端切除术和尺骨假关节成形术处理陈旧性下尺桡关节再脱位,可取得满意疗效。     

自体骨复合抗生素一期植骨治疗感染性骨折不愈合

目的观察自体骨复合抗生素一期植骨治疗感染性骨折不愈合的临床效果。方法对15例感染性骨折不愈合患者采用自体骨复合抗生素一期植骨治疗。结果 15例获随访,时间8~16个月。骨折均获骨性愈合,时间5~14个月。感染均未复发。14例伤口一期愈合,1例伤口不愈合,行皮瓣转移后伤口愈合。术后6周14例血沉和C-反应蛋白均降至正常水平。术后12周,所有患者血沉和C-反应蛋白均基本正常。结论采用自体骨复合抗生素一期植骨治疗感染性骨折不愈合能有效控制感染,获得良好的骨折愈合。     

截骨延长髂骨植骨治疗桡骨远端陈旧性骨折并下尺桡关节脱位

目的探讨截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位的方法及疗效。方法对30例桡骨远端陈旧性骨折短缩畸形伴下尺桡关节脱位的患者行截骨延长加髂骨块植骨、桡骨远端锁定钢板内固定治疗。结果 30例均获得随访,时间12~15个月。患者腕关节前屈、后伸、尺偏、桡偏、旋前和旋后功能较术前均明显改善(P0.05),术后桡骨短缩、掌倾角及尺偏角与术前比较差异均有统计学意义(P0.05)。根据Garland-Werley功能评定:优21例,良5例,可2例,差2例,优良率86.7%。术后未出现桡骨高度丢失、内固定失败及骨不连等并发症。结论截骨延长、髂骨块植骨加锁定钢板治疗桡骨远端陈旧性骨折并下尺桡关节脱位有利于恢复腕关节的正常解剖结构,明显改善腕关节功能,减少创伤性关节炎的发生。     

Ulnar styloid fracture in children: a retrospective study of 46 cases

Ulnar styloid fractures are frequently ignored in the treatment of wrist fractures in children. Forty-six untreated ulnar styloid fractures (40 tip and six base fractures) associated with radial injuries (45 patients) were retrospectively analysed. At the removal of the cast, we recorded that 80% had a nonunion of the styloid fracture. Thirty-five patients were reviewed at an average of 19 months after treatment. Thirty tip fractures and five base avulsions were found. We recorded 28 patients with a good clinical result despite 21 cases of nonunion, whereas seven patients (all nonunions) had a fair result. All the fair results suffered from intermittent pain during sports and movement, radioulnar joint instability and tears of the triangular fibrocartilage complex. It can be concluded that both distal radius and ulnar styloid fractures should be taken into account in the initial treatment and pain associated with a nonunion of the ulnar styloid in a child may be due to a tear of the triangular fibrocartilage complex.     

Surgical management of delayed union and nonunion of distal radius fractures

Ten patients with malaligned fractures of the distal radius that demonstrated either delayed healing or the development of an atrophic or synovial nonunion on standard radiographs were treated with surgical realignment, stable internal fixation, and autogenous iliac crest bone grafting. All 10 fractures healed with acceptable radiologic alignment within 3 months of the index procedure. After an average follow-up period of 3 years 6 months (range, 2 years to 8 years 6 months) patients had an average of 105 degrees wrist flexion and extension, 145 degrees forearm rotation, and 73% grip strength compared with the opposite limb. In the treatment of malaligned, ununited fractures of the distal radius, specific techniques and implants must be tailored to the deformity of the distal radius and the shape of the distal fragment. A stable, well-aligned wrist with preservation of at least 50 degrees mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 3 patients.     

青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗

目的 探讨青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗方法.方法 采用短缩尺骨、重建下尺桡关节法,对7例桡骨陈旧性骨折、短缩,下尺桡关节重度脱位患者进行治疗.术后对患者腕关节外形、功能进行随访.结果 所有患者外形恢复良好,功能评价优6例,良1例.结论 短缩尺骨、重建下尺桡关节法是治疗桡骨陈旧性骨折、短缩,下尺桡重度脱位的有效方法.     

Childhood nonunion of ulna presenting with wrist deformity in an adult: a case report

We describe an adult patient with traumatic, nonunion of ulna sustained at 11 years of age who presented with wrist deformity. The possible pathogenesis, differential diagnoses and its successful management are described. A 23-year- old right hand dominant male presented with a progressive wrist deformity of his right upper limb. At 11 years of age, he sustained an isolated open fracture of the right forearm. He had nonoperative treatment. He had 60 degrees of ulnar deviation at wrist. He had no pain in the wrist or elbow. He was able to do all activities using his right upper limb. Radiograph revealed a nonunion of ulna in mid-shaft. The radius was bowed. Radiographs at the time of injury revealed a displaced both bones forearm fracture in mid-shaft. He underwent open reduction, internal fixation of ulna with bone grafting and a corrective osteotomy of the radius. The contracted Extensor carpi ulnaris was Z lengthened. Seven months postoperative, both the nonunion of ulna and radius osteotomy were consolidated. The wrist had no deformity. He had returned to preoperative activity level. Though nonunion is rare in pediatric forearm fractures, asymmetric bone and soft tissue growth can lead to deformities even in the absence of physeal injury. In addition to the standard treatment of nonunion, maintenance of the relative lengths of radius and ulna is essential, to obtain optimum function.     

Posttraumatic radial club hand

Fifteen adult patients with an unstable ununited fracture of the distal third of the radius and severe radial deviation deformity resembling a radial club hand were retrospectively reviewed at an average of 25 months after operative treatment. There were eight women and seven men with an average age of 57 years (range, 33-79 years). The average duration of nonunion was 56 months (range, 6-252 months). Six patients had a concomitant fracture of the ulna and four had dislocation of the distal radioulnar joint. Three patients were treated with wrist arthrodesis and 12 with plate fixation and autogenous bone grafting. The distal ulna was excised and used for bone graft in eight patients. Correction of deformity was facilitated by z-lengthening of the brachioradialis and flexor carpal radialis in four patients and distraction histogenesis (llizarov) in two patients. One patient failed to heal the fracture and was treated with wrist arthrodesis. Functional alignment and use of the hand was restored in all patients.     

The Influence of Non-union of the Ulnar Styloid on Pain, Wrist Function and Instability after Distal Radius Fracture

The influence of non-union on the outcome of distal radius fractures is debated. We tested the null hypothesis that there is no difference in pain, wrist function, or instability between patients with union or non-union of an ulnar styloid base fracture after operative treatment of a fracture of the distal radius. Eighteen adults with an ulnar styloid base non-union were compared to 16 patients with union of an ulnar styloid base fracture with a mean post-operative follow-up of 30 months. None of the patients had distal radioulnar joint instability, there were no significant differences in pain, complications, or function, and patients with nonunion had significantly greater grip strength. Ulnar styloid nonunion is not associated with pain, instability, or diminished function after fracture of the distal radius.     

Nonunion as a complication of an open reduction of a distal radial fracture in a healthy child: a case report

Nonunion of a distal radial fracture is rare in children. We report one referred case of a nonunion of the distal radius after an open reduction. The patient is a 10-year-old healthy male with a displaced bicortical fracture of the distal radius and an undisplaced ulnar fracture. This fracture was initially treated by the referring orthopedist with open reduction and single Kirschner wire fixation, as closed reduction was thought to be difficult to achieve. The patient was seen with a distal radius nonunion at 14 months following the initial procedure. A complete workup revealed a healthy child with no general or local pathologies. He was treated with open reduction of the nonunion site, correction of angular deformity, and plate fixation. This resulted in bony union with no limitation of motion. Potential reasons for the development of nonunion and suggestions to avoid this complication are discussed.     

Correction and lengthening for deformities of the forearm in multiple cartilaginous exostoses

Background Multiple cartilaginous exostoses cause various deformities of the epiphysis. In exostoses of the ulna, the ulna is shortened and the radius acquires varus deformity, which may lead to dislocation of the radial head. In this study, we present the results of exostoses resection, with correction and lengthening with external fixators for functional and cosmetic improvement, and prevention of radial head dislocation. Methods We retrospectively reviewed seven forearms of seven patients who had deformities of the forearm associated with multiple cartilaginous exostoses. One patient had dislocation of the radial head. Operative technique was excision of osteochondromas from the distal ulna, correction of the radius, and ulnar lengthening with external fixation up to 5 mm plus variance. We evaluated radiographs and the range of pronation and supination. Furthermore, we conducted a follow-up of ulnar length after the operation. Results Dislocation of the radial head of one patient was naturally reduced without any operative intervention. At the most recent follow-up, six of the seven patients showed full improvement in pronation–supination. Ulnar shortening recurred with skeletal growth of four skeletally immature patients; however, it did not recur in one skeletally mature patient. Overlength of 5 mm was negated by the recurrence of ulnar shortening about 1.5 years after the operation. Conclusions We treated seven forearms of seven patients by excision of osteochondromas, correction of radii, and gradual lengthening of ulnas with external fixators. The results of the procedure were satisfactory, especially for function of the elbow and wrist. However, we must consider the possible recurrence of ulnar shortening within about 1.5 years during skeletal growth periods in immature patients.     

髂骨植骨尺骨延长治疗多发性骨软骨瘤前臂畸形的疗效评价

目的：探讨髂骨植骨尺骨延长治疗遗传性多发性骨软骨瘤所致前臂畸形的疗效。方法：保留尺骨远端骨骺部分，使尺骨一次性延长1．5～4cm，根据临床分型辅加环状韧带重建术和桡骨截骨术以矫正前臂弯曲畸形。结果：除1臂外，全部随访病例前臂畸形均获明显改善，肘腕关节活动与正常侧比较无明显差异。X线片示尺骨发育与桡骨近于匹配。结论：保留尺骨远端骨骺，行尺骨远端骨软骨瘤切除，同时髂骨植骨，一次性延长尺骨治疗遗传性多发性骨软骨瘤所致的前臂弯曲短缩畸形、下尺桡关节脱位及尺偏手效果良好，可使患儿获得近于正常的发育，提高生活质量。     

Radius lengthening for the treatment of Bayne and Klug type II and type III radial longitudinal deficiency

PURPOSE: We performed radius lengthening to treat radial deviation of the wrist in patients with Bayne and Klug type II and type III radial longitudinal deficiencies. The purpose of this investigation was to review our results of radius lengthening for radial longitudinal deficiency. METHODS: Beginning in 1991 radius lengthening was performed to treat 4 patients with radial longitudinal deficiency whose mean age at the initial lengthening was 16 months. The corrections for radial deviation of the wrists were performed simultaneously by soft-tissue distraction of the wrist. According to Bayne and Klug's classification 2 patients had type II and 2 patients had type III deficiencies. All but 1 patient had lengthening several times to correct the recurring discrepancy between the radius and the ulna. RESULTS: The corrections were achieved just after the lengthening but deformities recurred because of growth discrepancies between the radius and the ulna as the children grew. The radius was lengthened by a mean of 28 mm, with a mean length gain of 79%. The mean period in the fixator was 136 days. Two patients had both functionally and cosmetically acceptable correction after several lengthening procedures. In the other patient we abandoned this treatment method because of severe bone absorption at the distal end of the lengthened radius. One patient died of cardiac disease after one lengthening. CONCLUSIONS: Radius lengthening for Bayne and Klug type II and type III deficiencies may be accomplished successfully with the primary benefit of maintaining wrist and forearm motion. It is likely that at least 3 lengthenings may be required and this may need to be accompanied by a soft-tissue distraction at the ulnar carpal joint as well. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.