锁骨钩板治疗锁骨近端骨折并胸锁关节脱位

目的总结锁骨钩板治疗锁骨近端骨折并胸锁关节脱位的方法及疗效,以提高锁骨近端骨折并胸锁关节脱位治疗水平。方法2006年1月至2010年3月对我院收治的4例锁骨近端骨折并胸锁关节脱位采用锁骨钩板固定治疗,其中男性3例,女性1例,4例均为锁骨近端骨折合并胸锁关节半脱位。结果所有患者术后切口愈合良好,外观美观,X线片示骨折脱位复位良好,钢板位置良好。4例均获随访,随访时间1～4年,患者疗效根据Rockwood评分法进行评定,4例均为优,未见内固定失效及再脱位,以及血管、神经及胸膜损伤等副损伤。结论锁骨钩板治疗锁骨近端骨折并胸锁关节脱位符合胸锁关节微动生理功能,保护肩关节功能,防止胸锁关节退变导致慢性疼痛和功能活动受限,具有符合生理功能、术后美观、固定可靠的特点,值得临床推广。     

T形锁定钢板治疗锁骨近端骨折

<正>2019年1月～2021年12月,我科采用T形锁定钢板治疗7例锁骨近端骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组7例,男5例,女2例,年龄28～65岁。均确诊为Edinburgh分型ⅠB型锁骨近端骨折,     

胸锁钩钢板治疗锁骨近端骨折

正2012年2月～2018年8月,我科采用胸锁钩钢板治疗17例锁骨近端骨折患者,疗效满意,报道如下。1材料与方法1. 1病例资料本组17例,男12例,女5例,年龄26～83岁。左侧10例,右侧7例。均为闭合骨折。骨折Edinburgh分型:ⅠB1型10例,ⅠB2型7例。伤后至手术时间为2～4 d。1. 2手术方法气管插管全身麻醉。     

T型钢板固定手术治疗锁骨近端骨折

目的初步探讨T形钢板固定手术治疗锁骨近端骨折临床疗效。方法对2002年5月至2010年5月间用T型钢板固定手术治疗锁骨近端骨折17例患者的临床资料及手术结果进行分析,根据Rockwood评分法进行评分。结果 17例患者均获得骨性愈合。术后功能恢复良好,疗效满意,Rockwood评分优良率100%。结论 T型钢板固定手术治疗锁骨近端骨折操作简便安全、固定可靠,并有较好的维持复位和促进恢复作用,有利于早期功能锻炼,术后患者功能及外观恢复满意。     

锁骨远端锁定钢板治疗胸锁关节脱位及锁骨近端骨折

<正>2010年8月~2013年1月,我科采用锁骨远端锁定钢板治疗8例胸锁关节脱位及锁骨近端骨折患者,疗效良好,报道如下。1材料与方法 1.1病例资料本组8例,男6例,女2例,年龄27~63岁。胸锁关节脱位3例,锁骨近端骨折5例。左侧2例,右侧6例,均为闭合损伤。受伤就诊时间均为2周内。1.2治疗方法全身麻醉。以骨折处为中心沿锁骨方向作一8 cm切口,显露     

应用三维重建结合快速成型技术治疗锁骨近端骨折

目的探索应用计算机三维重建结合快速成型技术,对锁骨近端骨折患者进行手术模拟,实现钢板植入前的个性化设计。方法选取锁骨近端骨折患者,术前行三维CT扫描,应用Mimics软件进行图像分析,虚拟手术复位,钢板固定。打印锁骨近端骨折模型及钢板模型,观察修复后的形态,评估手术效果。结果利用应用数字化技术对锁骨近端骨折患者进行虚拟手术及钢板形态设计,能提高钢板与骨折面的匹配程度,减少手术时间及手术并发症。结论数字化技术有利于提高手术前规划的精确性、可控性,有利于提高手术效果,并可减少术中创伤。     

锁骨远端骨折的治疗进展

锁骨远端骨折在临床上较为常见。为了合理治疗锁骨远端骨折,临床工作中很有必要深入了解锁骨远端的相关解剖、骨折分型,掌握锁骨远端骨折的治疗原则及方法。本文重点对锁骨远端相关解剖、骨折分型、治疗原则及方法、相关并发症及其处理等方面进行了综述。     

重建钢板内固定手术治疗锁骨近端骨折的疗效分析

目的 采用重建钢板内固定手术治疗锁骨近端骨折并于术后长期随访评价其疗效,探讨该治疗方法的可靠性及稳定性.方法 自2009年4月至2012年6月应用重建钢板内固定手术治疗锁骨近端骨折患者12 例,其中男性8 例,女性4 例,年龄19～67 岁,平均40 岁.左侧7 例,右侧5 例.所有病例均为单侧闭合性骨折,受伤至手术时间2～5 d,平均3 d.根据Craig分型,Ⅱ型4 例,Ⅲ型2 例,Ⅴ型6 例.均采用切开复位重建钢板内固定手术治疗.结果 12 例患者均获得随访,随访时间12～18个月,平均15个月.所有患者均获得骨性愈合,无切口感染、神经血管损伤、胸膜及肺损伤、骨不愈合及畸形愈合等并发症.术后锁骨近端骨折均复位良好,外观及功能恢复良好,疗效满意.根据Rockwood评分法评定疗效,优10 例,良2 例,优良率100%.结论 重建钢板内固定手术治疗锁骨近端骨折安全可靠,可较好的维持复位和促进恢复,利于早期功能锻炼,能最大程度地恢复肩关节功能.     

老年肱骨近端骨折治疗进展

老年肱骨近端骨折临床治疗方法仍存在争议.普通钢板治疗逐渐淘汰,锁定钢板广泛用于治疗各型肱骨近端骨折并取得较满意疗效,髓内钉应用已取得很大进展,半肩关节置换技术也日益成熟.老年骨质疏松性肱骨近端骨折患者经植骨、骨水泥加强内固定及抗骨质疏松药物治疗的预后更好.该文就老年肱骨近端骨折的治疗进展作一综述.     

肱骨近端骨折的手术治疗进展

肱骨近端骨折较常见，国内文献报道其发生率约占全身骨折的2．5％，国外文献报道为4％-5％。骨折的分类方法有AO分类和Neer分类。应用最广泛的是Neer分类，1970年由Neer提出的根据骨折块多少及移位情况进行分类。他观察到肱骨近端骨折可出现的4个主要骨折块：（1）关节部或解剖颈；（2）大结节；（3）小结节；（4）骨干或外科颈。这些骨折块中有3个与其在肱骨近端的骨化中心一致（1个在肱骨头，大、小结节各有1个），这些骨化中心在结合部的融合形成易骨折的薄弱部。     

手术治疗不稳定型锁骨中段骨折

2007年4月～2010年10月,我科应用克氏针、重建钢板或解剖钢板及锁定钢板3种手术方法治疗不稳定型锁骨中段骨折116例,取得了较满意疗效。1材料与方法1.1病例资料本组116例,男77例,     

Superior clavicle plate with lateral extension for displaced lateral clavicle fractures: a prospective study

Background

Until now there have been no prospective studies describing the results of using the superior clavicle plate with lateral extension in patients with displaced lateral clavicle fractures (Neer type 2). The purpose of this study was to evaluate the results of applying this plate for this specific type of fracture.

Materials and methods

In this prospective study, seven patients (mean age 43, M:F; 6:1) with a fresh displaced lateral clavicle fracture were evaluated with a mean follow-up of 10 months. Analysis included functional and subjective outcome, time until union, time until return to work, and complications.

Results

All patients achieved clinical and radiological union within 6–12 weeks. Full range of motion as well as a return to work was achieved in most cases within 2 weeks. The mean Constant score was 98 (range 90–100), the DASH score was 3.6 (range 0–11.4), and the Shoulder Rating Questionnaire score was 97 (range 96–100). No major complications were encountered. Three patients required plate removal: two because of a prominent and subcutaneous plate and one because of an intra-articular screw.

Conclusions

In this study, use of the superior clavicle plate with lateral extension yielded excellent results in the treatment of this difficult fracture. In particular, patients acquired full range of motion within 2 weeks, reflecting the stability of the osteosynthesis achieved with this implant.     

Treatment of mid-shaft clavicle fractures: A comparative study

We retrospectively evaluated 51 patients (17 in each of three groups) with mid shaft clavicle fractures. Group 1 underwent intramedullary stabilization using clavicle pins. Group 2 underwent open reduction and internal fixation using plates and group 3 underwent non operative treatment with a sling. Group1 patients progressed to union within 8 to 12 weeks. In Group 2, six patients had scar related pain and two had prominent metal work and discomfort and in group 3, three patients developed non union and one had symptomatic malunion. Our results suggest that the displaced and shortened midshaft clavicle fractures require operative fixation and the techniques of clavicle pinning resulted in less complications, short hospital stay and good functional outcome.     

锁骨外侧端不稳定骨折的手术治疗

目的 探讨有外侧端不稳定骨折的手术治疗方法及疗效。方法 钢丝环绕锁骨、喙突固定,不暴露骨折端,治疗１６例锁骨外侧端不稳定Ⅱ型骨折。结果 随访６～１８个月,无畸形愈合、延迟愈合及不愈合,患肢功能恢复良好。结论 该方法不暴露骨折断端,操作简便,损伤小,疗效好,是治疗锁骨外侧端不稳定骨折的良好方法。     

手术治疗合并锁骨骨折的肩胛骨体部骨折

<正>2010年9月~2012年9月,我们采用切开复位重建钢板固定治疗13例合并锁骨骨折的肩胛骨体部骨折患者(为第一作者单位资料),取得了良好效果,报道如下。1材料与方法1.1病例资料本组13例,男11例,女2例,年龄26~43岁。均为肩胛骨体部合并锁骨骨折。左侧8例,右侧5例。合并伤:多发肋骨骨折或血气胸或创伤     

Natural history of medial clavicle fractures

BackgroundFractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre.MethodsA retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV).ResultsSixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n = 53), with a median age of 53.5 years (interquartile range (IQR) 37.5–74.5 years). The most common mechanism of injury was motor vehicle accident (n = 28). The in-hospital mortality rate was 4.4%.The fracture pattern was almost equally distributed between extra articular (n = 35) and intra-articular (n = 33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n = 31). All fractures were initially managed non-operatively, with a broad arm sling.Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome.Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1–6 years). The mean ASES score was 80.3 (SD 24.8, range 10–100,), and the mean SSV score was 77.0 (SD 24.6, range 10–100).ConclusionSixty eight patients with medial clavicle fractures were identified over a 5 year period, with excellent functional results seen following conservative management.     

股骨近端防旋髓内钉治疗股骨转子间骨折

<正>2010年3月~2012年8月,我们对46例股骨转子间骨折患者采用股骨近端防旋髓内钉(PFNA)固定治疗,获得良好疗效,报道如下。1材料与方法1.1病例资料本组46例,男19例,女27例,年龄61~85岁。按Evans骨折分型:Ⅱ型6例,Ⅲ型21例,Ⅳ型19例。受伤至手术时间2~7 d。1.2治疗方法全身麻醉。C臂机透     

A new technique for medial-end comminuted clavicle fractures

Fractures of the medial comminuted clavicle are rare injuries but are associated with significant morbidity and mortality. Although rare, such injuries deserve rapid diagnosis and effective treatment to avoid future complications. An optimal, standardized operative treatment has not yet been established. We presented a medial-end comminuted clavicle fracture and demonstrated successful results using a bridging plate technique across the sternum maintaining reduction and achieving union. We aim to provide an alternative technique to fix a displaced periarticular medial clavicle fracture, which we believe is simple, safer and promising.     

Dynamic treatment of displaced proximal phalangeal fractures

We report a splint system for a protected mobilization program (termed dynamic treatment) of proximal phalangeal fractures. This program can be used for nonoperative treatment or after operative treatment. Intra-articular fractures of the proximal phalanx at the metacarpophalangeal joint were included. The custom-molded 2-component thermoplastic splint allows motion of the proximal and distal interphalangeal joints. It was developed to allow bone healing and recovery of motion at the same time. We evaluated the clinical and radiologic results of a consecutive series of 48 displaced proximal phalangeal fractures in 45 patients who received dynamic treatment. Fracture consolidation was achieved in all patients and bone healing and recovery of full active motion was achieved simultaneously in all but 4 patients by 6 weeks. The advantage of this splint system is the variability of its application. The splint can be used both for nonsurgical and surgical management. It can be removed to change dressings and for radiologic evaluations. The period of dynamic treatment can be determined individually in each case.