骨搬移治疗胫骨感染性骨不连

目的分析骨搬移治疗胫骨感染性骨不连的临床疗效。方法2002年10月至2007年10月采用胫骨感染骨端清创、重建外固定支架加压固定及胫骨干骺端截骨骨搬移治疗胫骨感染性骨不连、纠正肢体短缩畸形45例。结果45例胫骨感染均得到一期控制,软组织缺损创面消灭,4例出现钉道感染;44例骨折愈合,1例骨折端再次形成骨不连;39例双下肢长度基本恢复一致,6例仍有1．5～3cm肢体短缩畸形存在,1例因截骨端提前愈合使肢体未能达到预期长度;术后截骨端骨延长2～9cm,平均延长6cm,无血管及神经损伤的症状出现;术后外固定支架固定6～12个月,平均8个月,所有病例延长区新骨组织形成良好。结论采用骨搬移治疗胫骨感染性骨不连,能达到一次手术兼顾控制骨端感染、消灭皮肤创面、骨折端不需植骨达到骨性愈合及均衡肢体长度的临床治疗作用,是治疗胫骨感染性骨不连的理想方法。     

半环槽式外固定架治疗下肢短缩畸形及骨缺损

目的探讨应用半环槽式外固定架治疗下肢短缩畸形及骨缺损的手术方式和经验。方法单纯下肢短缩畸形者,分别采用股骨远端、胫骨近端或胫骨远端干骺端横行截骨,半环槽式外固定架缓慢牵伸逐渐延长;骨缺损、骨不连、假关节形成、肢体短缩者,除行干骺端截骨延长外,还必须将假关节处两骨端予以修整,使之略成“V”形互相对合嵌插,并加压固定。结果20例患者骨延长3～17cm,平均延长7.5cm,合并成角畸形者同时得到纠正,其中7例有骨缺损、骨不连、假关节形成者均得到良好愈合。结论半环槽式外固定架治疗下肢短缩畸形及骨缺损,具有方法简单、手术创伤小、不需要植骨、固定可靠、并发症少、疗效满意等优点,值得推广应用。     

先天性腓骨缺如并发下肢不等长的治疗(附2例报告)

目的　探讨先天性腓骨缺如合并下肢不等长的手术治疗。方法 :采用胫骨干骺端截骨延长治疗 2例先天性腓骨缺如肢体短缩患者。结果 :2例病人胫骨分别延长 4cm和 1 .5cm。胫骨前弓畸形矫正 ,但未达到双侧肢体等长。结论 :先天性腓骨缺如的纤维索带可能影响胫骨延长术的效果。     

胫骨干骺端截骨延长术的护理

胫骨干骺端截骨延长术是矫正下肢短缩畸形的有效方法,已广泛应用于临床。我院1989～1991年采用此法治疗小儿麻痹症后遗症15例,术后3～8个月骨愈合,胫骨延长2～6cm,疗效满意。临床资料与手术方法15例小儿麻痹症中,男9例,女6例,年龄12～30岁。一侧肢体短缩3～5cm3例,5～6cm8例,6～7cm4例。15例经胫骨干骺端截骨延长术。即在硬膜外麻醉下,截断腓骨,外踝做一小切口,1枚螺钉固定下胫腓关节。胫骨干与髌韧带上方约     

胫骨延长术48例X线分析

本文就我院骨科开展的胫骨上端骨骺牵开延长术及胫骨干骺端截骨延长术 48例患者Ｘ线表现进行分析 ,供临床参考。1　临床资料本组病例均为脊髓灰质炎后遗症致下肢短缩畸形 ,男 32例 ,女 16例。年龄 11～ 2 4岁。肢体短缩 3～ 4ｃｍ 6例 ,4～ 5ｃｍ2 3例 ,6～ 8ｃｍ 19例。其中胫骨上段骨骺牵开延长术 38例 ,延长长度为 4～ 8ｃｍ ,平均延长 6 .5ｃｍ。 10例行胫骨干骺端截骨术 ,延长长度 3～ 6ｃｍ ,平均延长 5ｃｍ。2　Ｘ线观察结果2 .1　术后Ｘ线观察 ,手术后 1周内延长区为空白 ,7ｄ后观察 ,见延长区均显示分离约 1～ 1.3ｃｍ不等 ,分离区…     

干骺端潜行截骨延长288例

目的;介绍一种治疗肢体不等长的新方法。方法：应用自行研制的“针锯”潜行截骨,用自行研制的“多平面双轨多功能延长器”对短肢进行缓慢延长,使双下肢得以平衡。结果;288例肢体不等长患者,均达到所需延长长度,最短延长3cm,最长11.5cm,平均4.6cm。功能恢复满意。结论：干骺端潜行截骨延长方法安全,可靠,无骨不连接,骨萎缩和迟缓连接等并发症,不需要作内固定和植骨,是肢体延长的一种好方法。     

半环式外固定架骨延长治疗儿童下肢短缩畸形

目的：介绍应用半环式外固定架渐进性骨牵伸／加压技术治疗儿童下肢短缩的经验。方法：单纯下肢短缩采用股骨远端或胫骨近端横行截骨,半环式外固定架牵伸延长,胫骨骨缺损、骨不连性肢体短缩除截骨延长外,还将假关节端修整丰杨互嵌合的“Ｖ”形并加压。结果：１６例患儿骨延长４～８ｃｍ,平均４．７ｃｍ,均达预期长度。结论：半环式外固定架骨延长治疗儿童下肢短缩畸形疗效满意。合并骨缺损、骨不连的肢体短缩是应用半式或外回定     

针锯微创截骨矫形的临床应用

目的总结应用针锯微创截骨矫正肢体畸形的临床经验。方法回顾性研究1980年2月至2008年8月应用针锯对1247例肢体畸形患者行截骨矫形手术的完整资料,男742例,女505例;年龄2～67岁,平均18岁。截骨部位：股骨髁上865例,胫骨近端358例,胫骨远端4例,第1掌骨基底部13例,肱骨上段1例,股骨中段1例,胫骨中段5例。截骨后行骨延长377例,截骨矫正肢体畸形870例。分析针锯的截骨原理和方法、手术后处理情况及术后并发症的防治。结果全部获得随访,随访时间12～26个月,平均16个月。截骨矫形区骨愈合时间6～8周,平均7周;截骨延长区骨愈合时间6～8个月,平均7个月;全部患者截骨处均获得骨性愈合。无一例患者发生神经、血管损伤及骨不愈合,截骨部位术后第2周出现骨生长现象,截骨延长,截骨处邻近关节功能恢复良好。结论应用针锯微创截骨矫形损伤小,安全可靠,无需开放手术,是一种较为理想的截骨矫形方法。     

Ilizarov技术治疗胫骨干感染性骨不连

目的探讨应用Ilizarov技术治疗胫骨干感染性骨不连的临床效果。方法对22例骨创伤后胫骨感染性骨不连患者采取大段病灶切除+旷置并相应的干骺端截骨术。术后10 d以0.25 mm/6 h速度延长,经8～25周固定延长至骨缺损端会师,于骨缺损处两断端加压并继续维持外固定支架至骨愈合。结果 22例均获随访,时间12～24个月。骨延长6～18(9.5±4.5)cm,骨性感染全部治愈。带支架时间6.5～13个月。19例加压固定处及延长部位骨生长良好,达到了骨性愈合;3例断端骨接触后6个月无明显骨愈合,2例行自体髂骨植骨、1例拆除支架后行自体髂骨植骨内固定,4～6个月达到骨性愈合。截骨延长区及骨缺损对合处对位对线良好。结论 Ilizarov技术治疗胫骨感染性骨不连,术后感染控制良好,骨愈合率高。     

骨外固定加压治疗胫骨干骨不连

目的 :通过观察半环槽式外固定器治疗胫骨骨不连的治疗效果 ,评价加压外固定对骨损伤修复的作用。方法 :采用半环槽式外固定器骨外加压固定治疗胫骨干骨不连 49例 (男 37例 ,女 12例 ) ,骨不连时间为 7～ 132个月。其中 7例感染性骨不连偏侧性骨缺损者 ,行病灶清除开放性植骨 ;5例感染性骨不连行病灶清除、内固定物取出、小腿皮瓣转位 ;10例骨不连、骨缺损伴伤肢短缩者 ,行胫骨干骺端截骨或骨骺牵伸延长。结果 :植骨全部成活 ,创面植皮获Ⅰ期愈合 ,肢体延长幅度 4.5～ 13 .5cm ,平均 7.5cm ,达到预期目标 ,49例患者均于术后 2 .5～ 10个月 ,获得骨愈合 ,平均 5 .4个月。结论 :骨外固定加压治疗胫骨干骨不连不仅具有确实的效果 ,而且有以下优点 :(1)方法简便、创伤小、局部血运干扰少 ;(2 )在局部感染的条件下仍可使用 ;(3)骨端始终保持有均匀的压应力和肢体功能锻炼时产生的生理应力刺激 ,有利于促进骨愈合 ;(4)可配合肢体延长联合使用 ,既治愈了骨不连 ,又均衡了双下肢长度 ,有利于肢体功能恢复。     

Limb lengthening in children with osteogenesis imperfecta]

The authors operated on 7 children (5 girls, 2 boys) suffering from osteogenesis imperfecta (oi) type I according to Sillence classification, with lower limbs discrepancy. We elongated 10 segments (7 femurs and 3 tibias). Mean age at operation time was 14.7 years (13-17 years). The mean leg length discrepancy was 9.3 cm (4-18 cm), and shortening of one bone was 6.5 cm (4-9 cm). We used Ilizarov technique twice in tibial lengthening. We used Wagner technique in one tibial elongation and in 7 femur elongation. Except for one tibia, in the remaining cases there was Rush rod inserted intramedullary in the bone being elongated. During tibial elongation we fixed lateral malleous by screw. The osteotomy was performed in proximal metaphysis of the 5 femurs and 3 tibias, and in distal femurs in two cases. The elongation was 1 mm for day, with frequency 4 x 1/4 mm. The mean bone lengthening achieved was 5.5 cm (2-9 cm); the mean lengthening of the limb was 7.9 cm (2-18 cm). The mean time of elongation was 2.8 months (2-5 months). Elongation index was 26 days for 1 cm of lengthening. The mean time of fixator removal was 9.2 months (4-13 months). Healing index was 58 day/1 cm (overall number of days for 1 cm lengthening). The complications occurred in all the patients. Although the risk of numerous complication is high, lower limbs lengthening in children with type I osteogeneis imperfecta is possible to perform and allows equalizing discrepant limbs or, at least reducing the difference.     

股骨或胫骨滋养动脉结扎对血供的影响

目的：了解滋养动脉损伤后股骨或胫骨的血供变化。方法：采用放射性核素显像法，观察滋养动脉结扎后兔股骨或胫骨血供的变化。结果：滋养动脉结扎后当天，股骨或胫骨各骨段的血供均有不同程度的下降，其中骨干下降最多，上干骺端次之，下干骺端最少。第4d，除胫骨远段骨干外，股骨或胫骨的各骨段血供均恢复正常或超过健侧。术后第9－16d，超过健侧的血供重新恢复正常。胫骨远段骨干的缺血直至第24d才恢复正常。结论：滋养动脉结扎对股骨或胫骨各骨段血供均有影响，以骨干最重，上干骺端次之，下干骺端最轻。除胫骨远段骨干外，其余各骨段血供恢复较快，不造成长期影响。而胫骨远段骨干的较持久缺血可能是该段骨折愈合困难的重要原因。     

三针外固定器在关节显微外科治疗中的应用

目的：报道在四肢骨关节部位行显微外科治疗，应用可调外固定器固定使关节早期活动、简化手术的临床效果。方法：在四肢关节部位有骨缺损或骨折伴有血管损伤、皮肤缺损等病例，应用带血管的骨关节块移植、游离血管移植或各种皮瓣移植等显微外科方法修复后的同时，用三针可调外固定器跨关节外固定治疗骨关节损伤，保持各关节的自由活动。结果：治疗手部骨关节缺损１１例；下肢关节部位的不完全离断４例；胫骨近端慢性骨髓炎合并骨和皮肤缺损３例。修复后的骨关节对位对线好，关节间隙存在，术后１～３个月关节活动接近正常，皮瓣全部成活，修复血管后的肢端血运好。结论：该方法在四肢骨关节和血管损伤伴有皮肤缺损的显微外科修复中具有简化手术、损伤小、骨折固定可靠、便于早期关节功能锻炼、方便护理等优点     

Assessment of Fracture Healing by Vibration

The wave signal from percussion of a bone (i.e. percussion-note) has been used to evaluate the extent of bony consolidation after fracture.

Forty-one cases with a fresh tibial fracture and eight cases of delayed union of the tibia were investigated. The medial malleolus of the tibia was struck with a tapper and the vibration signal was picked up at the medial region of the tibial tuberosity. The changes in the signal waveform of the percussion-note with time were investigated.

As healing proceeds, the signal waveform of the fractured bone approaches that of intact bone. In cases of delayed union, the character of the wave does not improve sufficiently with time. The authors are convinced that this is a promising new method for the early diagnosis of delayed union.     

Assessment of fracture healing by vibration.

The wave signal from percussion of a bone (i.e. percussion-note) has been used to evaluate the extent of bony consolidation after fracture. Forty-one cases with a fresh tibial fracture and eight cases of delayed union of the tibia were investigated. The medial malleolus of the tibia was struck with a tapper and the vibration signal was picked up at the medial region of the tibial tuberosity. The changes in the signal waveform of the percussion-note with time were investigated. As healing proceeds, the signal waveform of the fractured bone approaches that of intact bone. In cases of delayed union, the character of the wave does not improve sufficiently with time. The authors are convinced that this is a promising new method for the early diagnosis of delayed union.     

Bone mineral density after the removal of intramedullary nails: a cross-sectional and longitudinal study

 We measured bone mineral density (BMD) using dual X-ray absorptiometry (DXA) at several sites in both fractured and nonfractured limbs in eight patients with femoral shaft fracture and six with tibial shaft fracture at the time of the intramedullary (IM) nail removal. Seven patients were followed up for an average of 13 months. The BMD at the proximal part of the femur and tibia was from 3% to 11% lower in the fractured side as compared to the nonfractured side. The greatest bone loss (13%–21%) was found in the operated distal tibia of the patients with tibial shaft fractures. At the fracture site of the femur, BMD was 10.5% (P < 0.05) higher, possibly owing to fracture callus formation, whereas tibial shaft BMD was not increased. However, a calculated apparent volumetric BMDvol at the fracture site was 15%–16% decreased. Although BMDs of the fractured side almost reached the baseline level of the nonfractured side (96.9%–102.1%) by the final follow-up (>12 months), the absolute deficit was still 3%–9%. Surprisingly, significant BMD increases (5%–6%) were also detected in all proximal femoral measurement sites of the contralateral limb, which indirectly suggests that the uninjured limb may also suffer from bone loss after lower-extremity trauma. We conclude that clinically important bone loss exists in the proximal femur and proximal and distal tibia of the fractured limb at the time of IM nail removal. Although areal BMD was higher at the femoral fracture site, the lower apparent volumetric BMDvol sug-gests decreased mineralization and reduced strength of the fracture site. Although the present results do not suggest special recommendations for restricted weight bearing after the removal of IM nails, the relationship between decreased bone density and increased risk of fractures should be borne in mind. Received: May 14, 2001 / Accepted: December 5, 2001     

Fractures of the distal tibial metaphysis in children: patterns of injury and results of treatment

BACKGROUND: Fractures of the tibia are common in children. Fractures of the distal tibial metaphysis have been only described in fracture texts without reference to a peer-reviewed study. The purpose of the present study was to review this fracture pattern and report the results of treatment. METHODS: The medical records and radiographs of children seen at our institution with a fracture of the tibia were reviewed. The patients with fractures of the distal tibial metaphysis who had been followed until healing were included. Fractures of the distal tibial diaphysis, toddler's fractures, and pathologic fractures were excluded. RESULTS: Twenty-six children met these criteria and were included in the study. The mechanism of injury was indirect in 13 fractures and direct in 12 fractures. In 1 patient, the mechanism of injury was unknown. The main cause of indirect injury was fall (11 cases). The most common was the transverse type of fracture (14 patients) followed by the oblique type (11 patients). Only 8 cases were nondisplaced. Valgus angulation was usually associated with a recurvatum deformation, whereas varus angulation was associated with procurvatum angulation. These patterns were present in 14 patients. We observed shorter healing time when the fracture was oblique than transverse. Children with the oblique pattern of injury were younger than children with a transverse fracture. CONCLUSIONS: The patterns of displacement of the distal tibial metaphyseal fractures reported in our study vary from those presented in textbooks. Distal tibial metaphyseal fractures can present with 2 types of displacement: valgus recurvatum and varus procurvatum. Fractures of the fibula always present with the same pattern as the tibia. Primary union of the distal tibial metaphyseal fracture may be expected in all cases regardless of the type of fracture, age, and gender.     

应用Ilizarov技术治疗下肢复杂畸形

目的：总结应用Ilizarov技术治疗下肢短缩，大段骨缺损合并其他病变的复杂畸形的体会。方法：应用骨段皮质截骨延长输送或楔形骨压缩迟延延长等方法治疗开放性骨缺损伴骨髓炎4例；股骨或胫骨肿瘤瘤段切除3例；肢体短缩伴成角畸形3例。结果：10例均恢复了支体长度和持重功能。2例股骨延长者发生膝关节屈曲受限，1年后恢复。1例儿童出现胫骨过生长。结论：Ilizarov技术是治疗短肢，修复创伤，炎症，肿瘤等所致骨缺损的简单而有效的新方法。     

211例下肢长骨骨折带锁髓内钉固定的临床评价

目的 对211例下肢长骨骨折带锁髓内钉内固定治疗的临床结果进行评价。方法 用不扩髓带锁髓内钉为主要固定方法，对211例股骨、胫骨骨折进行手术复位内固定治疗，术后进行包括CPM在内的有序功能锻炼。结果 获得随访189例，时间4～26个月，平均9个月。全组病例获得骨性愈合，无骨不连发生，骨折延迟愈合7例，膝关节功能受限4例。按Johner-wruch标准：优158例，良22例，中9例，优良率95．2％。结论 带锁髓内钉是治疗下肢长骨骨折较好的方法，其适应证较以往有进一步的拓展，术中骨折复位与保存骨折块血供并重的理念是正确的。     

Quantification by dual photonabsorptiometry of local bone loss after fracture

Total bone mineral and bone mineral density modifications were evaluated during fracture healing of long bones in patients with traumatic fractures of the lower limbs, using an experimental model based on the dual photonabsorptiometry technique. Seven patients (five males and two females; mean age, 19.5 years; range, 17-23 years) with tibia and fibula midshaft open fractures treated with osteosynthesis were studied. Dual energy gadolinium-153 photonabsorptiometry was used to measure distal leg bone loss at a skeletal segment distant from the fracture to exclude callus formation. Total bone mineral (TBM) and bone mineral density (BMD) of the tibia and fibula both in the fractured leg and in the healthy contralateral leg were measured on Days 10, 20, 30, 40, 60, and 120 after trauma. TBM and BMD of the healthy contralateral leg did not present any significant modifications at the different observation times. Both TBM and BMD of the fractured leg showed a progressive reduction that reached statistical significance starting on Day 30 with maximum reduction on Day 120 when TBM and BMD were reduced to almost one-half the initial value.