带血管的骨膜瓣和比目鱼肌瓣联合移植治疗骨折并骨外露软组织缺损

目的 探讨应用带血管的骨膜瓣和比目鱼肌瓣联合移植，覆盖骨折并骨外露软组织缺损的临床疗效。方法 用带血管的腓骨膜瓣包绕骨折端，骨膜瓣的外周再用比目鱼肌内侧半肌瓣覆盖，修复软组织缺损。临床应用19例。结果 术后2个月有明显的骨痂生长，骨折线模糊，4～6个月骨折线消失，骨折愈合，肌瓣全部成活，仅有其中4例远端边缘小部分坏死，经换药处理，创面愈合。结论 应用带血管的骨膜瓣和比目鱼肌瓣联合移植治疗难治性骨折并骨外露软组织缺损，是一种较为有效的手术方法。     

锁定肱骨近端接骨板治疗肱骨近端骨折

目的探讨锁定肱骨近端接骨板治疗肱骨近端骨折的临床价值：方法采用切开复位AO锁定肱骨近端接骨板(LPHP)内固定治疗肱骨近端骨折12例。结果所有患随访3～13个月，平均7．5个月。临床疗效评估：优7例，良3例，进步2例，优良率为83．3％。结论LPHP具有固定可靠、减少软组织损伤、保护血运、利于关节囊和肩袖修复、有助于骨折愈合和肩关节功能恢复的特点，值得提倡。     

应用透视图像导航下微创人工股骨头置换术的初步经验

目的探讨应用透视图像导航下微创手术进行人工股骨头置换治疗老年股骨颈骨折的临床疗效。方法应用透视图像导航下微创小切口（5—6cm）实施人工股骨头置换手术30例。骨折类型：按Garden分类，其中Ⅱ型3例，Ⅲ型10例，Ⅳ型17例；结果术后随访6—12个月。术后伤口疼痛较轻，髋部无明显肿胀。伤口一期愈合，无切口感染。无关节脱位。术后下床时间7—14d，平均10d。术后住院时间14—20d。按Harris髋关节置换评分标准及术后X线评定，结果属优18例，良10例，中2例。优良率96％。未并发坐骨神经损伤和血管损伤；无出现下肢深静脉栓塞。结论透视图像导航下微创小切口人工股骨头置换治疗老年股骨颈骨折，创伤小，术中及术后出血量少，疼痛轻，关节功能恢复好，疗效满意，可以达到缩短住院时间，康复更快的目的。     

手术治疗臀肌挛缩症17例报告

通过17例双侧臀肌挛缩症的手术治疗、认为：手术应在早期进行，发病时间过长会影响疗效，但术后髋关节的活动可有改善。     

手术治疗臀肌挛缩症17例报告

通过１７例双侧臀肌挛缩症的手术治疗，认为：手术应在早期进行，发病时间过长会影响疗效，但术后髋关节的活动可有改善。     

等离子刀在膝关节镜手术中的应用

目的探讨等离子刀在膝关节镜手术中的作用。方法对68例(74膝)关节病损的患者进行了膝关节镜视下等离子刀手术,采用Lysholm膝功能评分标准,全部病例获得12～24个月,平均18.2个月随访。结果病例膝关节功能恢复良好,治疗前膝评分为(45.5+6.5),治疗后膝评分(87.2+9.4)(t=12.24,p<0.01),二者比较,有显著性差异。术后发生并发症3例,1例膝痛无缓解,1例膝痛加重,反应性关节炎1例,无关节血肿等并发症。结论等离子刀是关节镜手术有效的辅助工具,使镜下手术操作简单、出血少、术后反应小。     

导航下与传统方法应用动力髋螺钉治疗老年股骨转子间骨折的疗效比较

Objective To compare the navigational and traditional dynamic hip screw (DHS) fix-ations in the treatment of intertrochanteric fractures in elderly patients. Methods A retrospective study was conducted to analyze the elderly patients with intertrochanterie fracture who had been treated in our de-partment from April 2005 to April 2007 and whose clinical data were complete. Enrolled in the present study were 25 cases that had received navigational DHS fixation and 31 cases who had received traditional DHS fixation. In navigational group, there were 10 males and 15 females, with an average age of 82. 1 years. They were 14 eases of Evans type Ⅰ and 11 Evans type Ⅱ. In traditional group, there were 12 males and 19 fe-males, with an average age of 82. 8 years. They were 16 cases of Evans type Ⅰ and 15 Evans type Ⅱ. The 2 groups were compared in incision length, operation time, bleeding volume, X-ray exposure time, bed-ridden time, medical and implant complications, and one-year functional recovery. Results In navigational group, 23 patients were followed for 11 to 20 (average, 14) months and 2 were lost. In traditional group, 30 patients were followed up for 14 to 23 (average, 18) months and 1 died from cardiovascular disease within 1 year. Compared with traditional group, navigational group had a smaller incision, less blood loss, shorter bed-ridden time and less X-ray exposure time, a higher rate of fracture healing at 3 months, with statistically significant differences (P <0.05). The Harris hip function scores at postoperative 1 year were of no significant difference between the 2 groups (P > 0.05) . In navigational group there were 3 medical and 1 implant complications. In traditional group there were 9 medical and 5 implant complications. There was no significant difference between the 2 groups (P > 0.05). Conclusion In the treatment of intertrochanteric fractures for the elderly patients, the navigational DHS fixation is superior to traditional DHS fixation due to its ad-vantages of smaller incision, less blood loss, shorter bed-ridden time, faster fracture healing and betterfunctional recovery.     

复杂踝关节骨折的手术内固定及康复治疗

目的 :探讨复杂踝关节骨折的手术内固定及康复治疗。方法 :分析我科从 1995年以来 5 6例踝关节复杂骨折病人的手术治疗情况 ,按Danis Weter分类 ,B型 42例 ,C型 14例。采用AO技术 ,克氏针张力带钢丝固定 ,1/ 3环形钢板固定或螺丝钉固定 ,术后常规弹力绷带固定及患肢主动功能锻炼。结果 :5 6例中 5 1例得到随诊 5～ 2 4个月 ,平均 13个月 ,按Teeny和Wiss提出的评分标准 ,临床疗效优良者 48例 ( 94% )。结论 :应用AO技术 ,采取有效、坚强的内固定和早期积极功能锻炼是治疗复杂踝关节骨折的较好方法。     

加长型PFNA联合线缆环扎内固定治疗极不稳定股骨粗隆下骨折

目的探讨采用加长型股骨近端防旋髓内钉(PFNA)联合线缆环扎内固定治疗极不稳定股骨粗隆下骨折的疗效及手术技巧。方法回顾性分析自2012-02—2016-04诊治的21例极不稳定股骨粗隆下骨折,在牵引床牵引下手术,先行股骨粗隆下骨折切开复位并用1~3股线缆对骨折环扎固定,然后用加长型PFNA髓内固定。结果 21例均获得随访,随访时间平均16(12~24)个月。骨折愈合时间平均16(12~20)周。随访期间无内固定失效、骨折延迟愈合或骨折不愈合等并发症发生。术后1年所有患者患肢功能状况恢复至伤前水平,患肢THRS评分平均52(47~64)分。结论对于极不稳定股骨粗隆下骨折,线缆环扎固定可有效提高加长型PFNA内固定的稳定性,而且对骨膜血运无不良影响。