切开复位内固定与闭合复位内固定治疗青壮年股骨颈骨折的疗效比较

目的比较切开复位与闭合复位空心钉内固定治疗青壮年股骨颈骨折的临床疗效。方法回顾性分析自2012-12—2016-06诊治的92例青壮年股骨颈骨折,47例采用闭合复位空心钉内固定治疗(闭合复位组),45例切开复位空心钉内固定治疗(切开复位组)。比较2组手术时间、术中出血量、骨折愈合时间、末次随访时髋关节功能Harris评分与并发症情况。结果闭合复位组随访时间(28.3±3.1)个月,切开复位组随访时间(27.5±3.2)个月。与切开复位组比较,闭合复位组手术时间更短,术中出血量更少,差异有统计学意义(P 0.05);但2组骨折愈合时间、术后并发症发生率、末次随访时髋关节功能Harris评分差异无统计学意义(P0.05)。结论对于青壮年股骨颈骨折,闭合复位空心钉内固定创伤小,术后骨折不愈合发生风险较低,而切开复位空心钉内固定术后股骨头缺血性坏死发生风险较低。     

切开复位空心钉内固定及其联合带血管蒂骨组织瓣移植术治疗股骨颈骨折的临床研究

目的比较切开复位空心钉内固定与切开复位空心钉内固定联合带血管蒂骨组织瓣移植术治疗股骨颈骨折的临床效果。方法 97例股骨颈骨折采用切开复位3枚空心钉内固定(对照组,45例)或切开复位2枚空心钉内固定联合带血管蒂骨组织瓣移植术(骨瓣治疗组,52例)治疗,综合评估患者术后髋关节功能Harris评分。结果 92例获平均7.28(1~20)年随访,其中对照组42例,骨瓣治疗组50例。术后6、12个月及末次随访时骨瓣治疗组平均Harris评分均高于对照组,差异有统计学意义(P<0.05)。对照组骨折不愈合发生率9.5%,股骨头缺血性坏死发生率14.3%;骨瓣治疗组股骨头缺血性坏死发生率2.0%,未发生骨折不愈合。与对照组相比,骨瓣治疗组骨折不愈合及股骨头缺血性坏死发生率更低(P<0.05)。结论采用空心钉内固定联合带血管蒂骨组织瓣治疗股骨颈骨折远期疗效优于单纯空心钉内固定术,且骨折不愈合及骨坏死发生率较低。     

多方向空心钉内固定对股骨颈骨折术后颈短缩的控制

[目的]探讨股骨颈骨折多方向空心钉内固定术对股骨颈短缩的影响。[方法]2009年6月~2013年5月,采用闭合复位空心钉内固定术治疗186例中老年股骨颈骨折,年龄55~65岁,将患者随机分为两组,传统平行固定组及多方向固定组。[结果]术后155例患者获得随访,其中平行组患者股骨颈短缩率32.8%,多方向组16.4%,两组比较差异有统计学意义(P0.05);传统平行组患者股骨骨折愈合率91.8%,多方向组89.6%,两组比较差异无统计学意义(P0.05);传统平行组术后髋关节Harris评分(70.58±6.85)分;多方向固定组术后髋关节Harris评分(91.69±8.34)分,传统平行组Harris评分低于多方向固定组,差异有统计学意义(P0.05);平行组术后2年股骨头坏死率44.3%;多方向固定组术后2年股骨头坏死率26.9%,差异有统计学意义(P0.05)。[结论]股骨颈骨折空心钉多方向固定较传统平行固定在有效降低股骨颈短缩率的同时,可更大程度的保护髋关节功能、降低股骨头坏死率。     

直接前侧入路空心钉内固定治疗青壮年股骨颈骨折

[目的]探讨应用直接前侧入路(DAA)切开复位空心钉内固定对股骨颈骨折的临床效果。[方法]回顾性分析2014年2月～2016年7月期间来本院治疗的股骨颈骨折58例患者临床资料,其中行DAA入路切开复位空心钉内固定32例为DAA组,行闭合复位3枚全螺纹空心钉内固定26例为传统组。比较两组患者临床与影像资料。[结果]两组患者手术均顺利完成,术中未发生血管、神经损伤等并发症。DAA组手术时间明显少于传统组(P0.05),两组术中出血量的差异无统计学意义(P0.05),DAA组的术后引流量明显多于传统组(P0.05)。所有患者获得25～36个月随访。DAA组患者完全负重时间显著早于传统组(P0.05),DAA组Harris功能评分显著高于传统组(P0.05)。术后影像显示骨折复位良好,内置物位置及长度满意,DAA组术后Garden复位指数明显优于传统组(P0.05)。DAA组患者骨折愈合时间显著早于传统组(P0.05),DAA组股骨头缺血性坏死发生率和骨折不愈合率均显著低于传统组(P0.05)。随访过程中,影像学检查未出现断钉、螺钉松动、移位情况。[结论] DAA入路切开复位空心钉内固定对于青壮年股骨颈骨折的治疗效果优于传统闭合复位3枚全螺纹空心钉内固定术。     

两种方法治疗青壮年股骨颈骨折的疗效比较

目的 比较切开复位与闭合复位空心钉内固定治疗青壮年股骨颈骨折的疗效。方法 将66例青壮年股骨颈骨折患者按照随机数字表法分为切开复位组(采用切开复位空心钉内固定治疗)和闭合复位组(采用闭合复位空心钉内固定治疗),各33例。记录两组手术情况、骨折复位情况、骨折愈合情况、髋关节功能Harris评分及并发症发生情况。结果 患者均获得随访，时间34～36个月。手术时间切开复位组长于闭合复位组(P<0.05)。术中透视次数、骨折解剖复位率、骨折愈合时间、末次随访时髋关节功能Harris评分切开复位组均优于闭合复位组(P<0.05)。两组术后切口愈合良好，无皮缘坏死、皮肤及关节感染、双下肢深静脉血栓形成等并发症发生；随访期间未出现空心钉断钉、退钉等情况。结论 与闭合复位空心钉内固定相比，采用切开复位空心钉内固定治疗青壮年股骨颈骨折具有术中透视次数少、骨折复位效果好、骨折愈合快、髋关节功能恢复好、并发症少等优点，但手术时间较长。     

两种方法不同手术时间治疗中青年股骨颈骨折的疗效分析

目的比较采用闭合复位经皮空心钉内固定加关节囊穿刺减压术及切开复位空心钉内固定加带缝匠肌髂骨瓣移植术,在不同时间治疗不同骨折类型中青年股骨颈骨折术后骨折愈合及股骨头缺血坏死情况。方法对1998年3月至2010年5月在我院手术治疗并有完整随访资料的258例中青年股骨颈骨折患者进行回顾性分析。按手术方法及手术时间分组,A组：急诊闭合复位经皮空心钉内固定加关节囊穿刺减压术63例,B组：急诊切开复位空心钉内固定加带缝匠肌髂骨瓣移植术67例,C组：择期闭合复位经皮空心钉内固定术58例,D组：择期切开复位空心钉内固定加带缝匠肌髂骨瓣移植术70例。比较术后骨折愈合率及股骨头缺血坏死发生率。结果本组术后均获随访,随访时间18～96个月,平均42个月。其中A组骨折愈合率、股骨头缺血坏死发生率分别为96.82%及6.35%,B组分别为95.52%及7.46%,C组分别为81.03%及22.41%,D组分别为92.86%及8.57%。C组与A、B、D三组间比较,差异有统计学意义（P〈0.05）;A、B、D三组间比较,差异无统计学意义（P〉0.05）。结论手术时间对行闭合复位经皮空心钉内固定加关节囊穿刺减压术的患者术后疗效影响较大,而对行切开复位空心钉内固定加带缝匠肌髂骨瓣移植术的患者术后疗效影响较小。     

三枚和四枚空心钉内固定治疗股骨颈骨折的比较研究

目的通过回顾性对照研究,比较3枚空心钉和4枚空心钉内固定治疗股骨颈骨折的疗效。方法共54例股骨颈骨折,3枚空心钉内固定组31例,4枚空心钉内固定组23例。统计分析两组间的并发症发生率和髋关节功能Harris评分。结果 54例均获平均35(14～72)个月随访。3枚空心钉内固定组有2例(6.5%)内固定失败和3例(9.7%)股骨头坏死,Harris评分平均(84±13)分,优良率74%;4枚空心钉内固定组有2例(8.7%)股骨头坏死,Harris评分平均(86±10)分,优良率78%。两组间并发症发生率及Harris评分差异无统计学意义(P>0.05)。结论闭合复位空心钉内固定是治疗股骨颈骨折的有效方法,3枚或4枚空心钉内固定均可取得较好的治疗效果;4枚空心钉内固定可以较好地对抗剪切应力,避免早期内固定失败。     

不同复位方式行内固定术对老年移位型股骨颈骨折愈合质量的影响探讨

目的探讨不同复位方式行内固定术对老年移位型股骨颈骨折复位质量的影响。方法选择122例老年移位型股骨颈骨折作为研究对象,随机分为A组和B组,各61例;A组行闭合复位内固定术;B组行有限切开复位内固定术;随访6个月,比较两组围术期各项信息及Harris髋关节功能优良率。结果 B组术中出血量大于A组,差异有统计学意义(P0.05);两组患者均获得随访6个月,B组股骨头缺血性坏死发生率低于对照组,差异有统计学意义(P0.05);两组术后6个月Harris髋关节功能优良率分别为86.89%、91.80%,差异无统计学意义(P0.05)。结论有限切开与闭合复位内固定术治疗老年移位型股骨颈骨折的愈合质量相当,前者的安全性更高,值得临床予以重视应用。     

经皮加压钢板与空心钉内固定治疗股骨颈骨折的比较研究

目的比较经皮加压钢板(PCCP)与3枚空心加压螺钉内固定治疗股骨颈骨折的临床疗效。方法将自2012-01—2014-01诊治且符合选择标准的42例中青年移位型股骨颈骨折随机分为2组,分别使用经皮加压钢板固定(A组)与3枚空心钉固定(B组)。比较2组手术时间、术中出血量、骨折复位质量、住院时间、术后并发症、术后随访髋关节功能评分及疼痛评分。结果 42例均获得随访14~34个月,平均23.7个月,2组手术时间、术中出血量、住院时间、骨折复位质量、末次随访髋关节功能Harris评分及VAS评分上比较差异无统计学意义。A组无骨折不愈合、股骨头坏死及髋关节畸形等并发症发生;B组2例骨折不愈合,股骨头缺血坏死2例,退钉3例,2组并发症发生率比较差异有统计学意义(P=0.004)。结论 PCCP与3枚空心加压螺钉均可用于治疗中青年移位型股骨颈骨折,但PCCP固定更牢固,术后可早期负重行走,较空心加压螺钉固定能有效降低术后并发症的发生率。     

前外侧和外侧入路内固定治疗股骨颈骨折的疗效比较

目的比较前外侧入路和外侧入路切开复位内固定治疗移位股骨颈骨折的临床疗效。方法采用切开复位内固定治疗91例成人股骨颈骨折,其中采用髋关节前外侧小切口切开复位、经皮3枚空心钉内固定治疗55例(A组),采用髋关节外侧入路切开复位、3枚空心钉内固定治疗36例(B组)。结果 91例均获随访23~76个月,平均45个月。B组平均切口长度、手术时间、术中出血量大于A组,差异有统计学意义(P<0.05)。A组骨折达到Garden指数Ⅰ、Ⅱ、Ⅲ和Ⅳ级复位固定分别为39、13、3例,B组骨折达到Garden指数Ⅰ、Ⅱ、Ⅲ和Ⅳ级复位固定分别为13、15、8例,A组复位质量优于B组,差异有统计学意义(P<0.05)。A组3例骨折不愈合,B组5例骨折不愈合,A、B两组骨折不愈合率差异无统计学意义(P>0.05)。A组5例发生股骨头坏死,B组9例发生股骨头坏死,A组股骨头坏死发生率低于B组,差异有统计学意义(P<0.05)。结论对移位的股骨颈骨折行切开复位内固定,前外侧小切口较外侧切口创伤更小、复位更理想,手术并发症较少,是一种理想的微创手术方法。     

Gluteal and thigh reduction: reclassification,critical review,and improved technique for primary correction

A technique for combined gluteal and thigh reduction is described, which produces a smooth lateral contour and improved buttock shape, with reduced operative time, less pain, and a lower complication rate. To date 22 patients have had gluteal and thigh reduction employing this technique, with a high degree of patient satisfaction.     

Secondary reduction mammaplasty: does initial pedicle design matter?

Reduction mammaplasty is one of the most common plastic surgical procedures performed in the United States. Occasionally patients will require a second reduction to address persistent or recurrent symptomatic macromastia. When the vascular pedicle of a primary breast reduction is unknown, there is uncertainty regarding how best to proceed with a secondary reduction. When the pedicle is known, we include at least the primary pedicle in our operative plan. When unknown, we performed a modified central mound (MCM) reduction technique. The MCM reduction respects the blood supply to the nipple-areolar complex (NAC) by preserving any remaining vascularity that is present within the central mound tissue while also maintaining superior and inferior vascular pedicles. We avoid using a free nipple graft.Thirty patients (60 breasts) underwent repeat breast reductions between 2009 and 2016. Patients were placed into two groups whether their primary vascular pedicle was known or unknown, and then further grouped based on the type of reduction they received. There was no significant difference in the complication rate between patients that underwent an MCM reduction versus those that underwent reduction with other techniques. Most patients maintained breast sensation and none required a free nipple graft.Patients can be offered repeat reduction mammaplasty with the possibility of nipple sensation preservation and a normal-appearing NAC regardless if the primary vascular pedicle is known. If the primary pedicle is unknown, the MCM technique is an excellent option.     

跟骨关节内骨折切开复位与撬拨复位治疗比较

目的评价跟骨关节内骨折切开复位与撬拨复位的疗效。方法我院自2005年1月至2009年12月收治85例共98足跟骨骨折,成功随访51例58足,其中撬拨复位24足,切开复位34足。按Maryland评分标准进行评价患者术后功能,术后X片Bohler角的恢复情况,患者术后踝关节的活动角度以及VAS疼痛评分法评价患者术后日常生活的自我舒适度。结果随访51例58足,随访率为62．4％;随访时间为3个月～4年,平均23个月。随访时切开复位内固定组及撬拨复位管型石膏固定组Maryland评分、术后踝关节的活动角度以及VAS疼痛评分,各指标比较显示切开复位内固定组均明显优于撬拨复位管型石膏固定组,差异有统计学意义（P〈0．05）。结论对于跟骨关节内骨折,特别是Sanders分型Ⅲ-Ⅳ型患者宜采取切开复位内固定治疗。     

A reduction clamp for an aiming component in associated acetabular fractures

Background:

The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed.

Materials and Methods:

In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures.

Results:

This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp''s aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use.

Conclusion:

This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.     

跟骨骨折的治疗选择

目的 探讨不同类型跟骨骨折的治疗方法。方法对87例不同类型跟骨骨折分别采用手法复化小夹板外固定、切开复位内固定和矫形术。结果87例获3～15个月随访,根据ketournel评分标准,疗效优良80例,可4例,差3例,优良率91．95％。结论对不同类型的新鲜跟骨骨折,应严格掌握手法复位和开放复位的适应证,严格技术操作规范;对陈旧性跟骨骨折,应根据创伤后发乍的不同病理改变,采用相应的矫形手术治疗。     

跟骨压缩性骨折切开复位与撬拨复位治疗比较

目的评价切开复位与撬拨复位治疗跟骨骨折的疗效。方法1997年6月～2002年12月收治跟骨关节压缩性骨折62例，其中切开复位33例，撬拨复位29例。结果按Maryland足部评分系统评价术后功能，切开复位组优良率明显高于撬拨复位组。结论切开复位能较好的恢复跟骨的解剖结构，从而取得较好疗效。     

胸锁关节脱位

本文报道了胸锁关节脱位３３例。其中手术治疗１０例，保守治疗１３例，未治１０例。在随访的２０例中，手术治疗８例，疗效优良者５例；保守治疗１２例，疗效优良者１０例。作者认为保守疗法对消除症状恢复功能都比手术疗法成功率高。手术疗法仅在特定情况下才用。     

Misconceptions About Mandible Reduction Procedures

Mandible reduction procedures are currently very popular in Asian countries. But many misconceptions or differences in concepts about these procedures still exist, mainly because of preconceived ideas and restriction in communication. The author reviewed articles and found some misconceptions about these procedures. Also, the author added some opinions regarding new ideas about these procedures (i.e., minimal incision technique and botulinum toxin), as well as logical backgrounds of associated concepts. The intraoral approach is the safest and most effective procedure. The sagittal split ostectomy is the most important procedure for mandible reduction.     

Deskinning Versus Deepithelialization for Inferior Pedicle Reduction Mammoplasty: A Prospective Comparative Analysis

Background: Deepithelialization is time consuming, but has been performed traditionally in reduction mammaplasty to ensure a better blood supply to the transposed nipple–areolar complex. Methods: For this study, 18 patients were recruited, and each patient served as an individual control by undergoing both deskinning and deepithelialization of the contralateral breast. The patient’s age, body mass index, specimen weight, complications, and subjective cosmetic assessment were recorded. Results: The mean age was 42 years, and the mean body mass index was 27.94 respectively. There were no differences recorded in terms of complications or patient perceived cosmetic outcomes. The only statistical difference involved the times required for deepithelialization (15.5 min) and deskinning (6 min). Deskinning thus saved approximately 9 min. Conclusions: Deskinning is as effective as deepithelialization and is significantly more expedient, with no added risk to the patient.     

Improving the human–robot interface for telemanipulated robotic long bone fracture reduction: Joystick device vs. haptic manipulator

Objectives

Intramedullary nailing is the treatment of choice for femoral shaft fractures. However, there are several problems associated with the technique, e.g. high radiation exposure and rotational malalignment. Experimental robotic assistance has been introduced to improve the quality of the reduction and to reduce the incidence of rotational malalignment. In the current study, we compare two devices for control of the fracture fragments during telemanipulated reduction.

Methods

Ten male and ten female subjects were asked to participate as examiners in this experiment. A computer program was developed to render and manipulate CT‐based renderings of femur fracture bone fragments. The user could manipulate the fragments using either a simple joystick device or a haptic manipulator. Each examiner performed telemanipulated reduction of 10 virtual fracture models of varying difficulty with each device (five in a ‘training phase’ and five in a ‘testing phase’). Mixed models were used to test whether using the haptic device improved alignment accuracy and improved reduction times compared to using a joystick.

Results

Reduction accuracy was not significantly different between devices in either the training phase or the testing phase (P > 0.05). Reduction time was significantly higher for the Phantom device than for the Joystick in the training phase (P < 0.0001), but it was no different in the testing phase (P = 0.865). High spatial ability with electronics had a significant effect on the alignment of fracture reduction and time to reduction.

Conclusions

The Joystick and the Phantom devices resulted in similarly accurate reductions, with the Joystick having an easier learning curve. The Phantom device offered no advantage over the Joystick for fracture telemanipulation. Considering the high cost of the Phantom device and the lack of a demonstrable advantage over the Joystick, its use is not justified for implementation in a fracture telemanipulation workflow. The Joystick remains as a low‐cost and effective device for developing 3D fracture telemanipulation techniques.