锁骨骨折4种固定治疗方法的比较

目的 比较锁骨骨折治疗方法的疗效。方法 对167例锁骨骨折的治疗方法进行回顾。结果 随诊6～18个月，平均12个月。外固定组41例，26例畸形愈合，9例延迟愈合，1例出现胸廓出口综合征。克氏针内固定组38例，3例延迟愈合，1例不愈合，4例克氏针退出，5例针尾刺破皮肤，其中3例针道有不同程度感染。钢板内固定组53例，均按预期愈合。接骨器固定组33例，均按预期愈合。结论 治疗锁骨骨折钢板与锁式接骨器的内固定治疗效果优于克氏针与外固定。     

锁骨骨折不同固定方式疗效分析

目的探讨锁骨骨折不同固定方式的疗效。方法152例锁骨骨折患者,分别用“8”字石膏绷带、切开复位克氏针、重建钢板及闭合手法复位克氏针固定,分析四组在骨折愈合时间、并发症、畸形愈合的发生率上的差异。结果“8”字石膏绷带固定组畸形愈合发生率24．3％,明显高于其他三组;切开复位克氏针固定组骨折愈合时间短,但并发症28．6％明显高于其他三组;重建钢板固定组并发症少,无畸形愈合,但骨折愈合时间明显高于其他三组;闭合复位克氏针固定仅有4．3％并发症,疗效最为满意。结论对锁骨骨折患者要根据患者年龄、骨折类型、骨折部位以及经济状况等综合因素权衡选择最佳固定方式。     

交叉克氏针内固定治疗锁骨骨折65例分析

目的探讨交叉克氏针内固定治疗锁骨骨折的临床疗效。方法 65例锁骨中1/3或中外1/3处骨折病人,均用交叉克氏针内固定治疗锁骨骨折。根据骨折愈合时间、质量及肩关节功能情况综合评价疗效。结果随访时间平均为7个月,骨折愈合时间6-15周,平均7周。其中3例出现畸形愈合,无骨折不愈合。肩关节功能优55例,良7例,可3例。结论锁骨中1/3或中外1/3处骨折,用交叉克氏针内固定治疗能使病人尽快恢复功能。     

钢板与克氏针治疗锁骨骨折疗效比较

目的 比较钢板与克氏针治疗锁骨骨折的疗效.方法 手术治疗锁骨骨折168例,其中钢板内固定83例,克氏针内固定85例,比较2种治疗方法在、骨折愈合时间、并发症发生率,以及疗效优良率等方面的差异.结果 术后随访4～12个月,平均7个月.钢板组骨折愈合时间18周,并发症6例,优良率92.8%.克氏针组骨折愈合时间16周,发生并发症8例,优良率90.6%.结论 钢板与克氏针治疗锁骨骨折均可取得良好的疗效.     

锁骨骨折手术治疗临床观察

目的分析、观察两种手术方法治疗不稳定锁骨骨折临床效果。方法对76例不稳定锁骨骨折分别实施克氏针或钢板内固定治疗。结果随访5～18个月，平均10个月。所有患者术中均无意外发生，无1例伤口感染及骨折不愈合。愈后优良率克氏针组85．3％；钢板组88．5％。结论克氏针或钢板内固定治疗不稳定锁骨骨折安全、有效，粉碎骨折首选采用钢板内固定。     

切开复位螺纹针内固定治疗锁骨骨折

为探讨锁骨骨折的最佳固定方法,作采用小切口切开复位、螺纹针内固定方式治疗锁骨骨折29例。随访3～12个月,所有病例骨折愈合良好,6个月后取出螺纹针,全部病例患侧肩关节活动良好。认为该术式操作简单,骨折断端接触紧密,愈合快,固定牢靠,早期活动患侧肩关节螺纹针不会退出,疗效优于克氏针内固定方法。     

克氏针加针尾圈螺钉固定治疗锁骨骨折

锁骨骨折是一种常见骨折，临床上锁骨骨折复位固定的方法很多，如切开复位克氏针内固定、钢板固定记忆合金固定、张力带固定等。其中以普通克氏针髓腔内固定最为常用，且经济、方便，但其最大问题是术后针体极易松动、滑移脱出。曾有人提出使用克氏针加针尾圈钢丝固定方法治疗锁骨骨折以限制克氏针脱出。但经临床实践证明该方法手术操作复杂，并存在很多有待解决的问题。为此本人设计了改进术式，即克氏针加针尾圈螺钉固定方法治疗锁骨骨折。并取得了满意效果。     

锁骨骨折的治疗

2000年3月～2004年6月，我科治疗锁骨骨折60例，采用手法复位、“8”字绷带外固定治疗20例，切开复位克氏针内固定25例，锁骨钢板内固定15例，现将各种治疗方法及其疗效介绍如下。     

内固定治疗锁骨骨折90例

目的总结90例锁骨骨折进行内固定治疗的疗效。方法臂丛麻醉下,切开复位,克氏针、钢板、螺丝钉、钢丝固定骨折。结果90例骨折全部治愈,无不良并发症发生。结论内固定治疗锁骨骨折,无畸形愈合,能早期活动,提高生活质量,减少创伤性关节炎发生。     

锁骨骨折手术112例治疗体会

目的探讨锁骨骨折手术治疗方法的选择。方法锁骨骨折112例治疗回顾。结果随诊6～15个月，平均12个月，克氏针组74例，2例延迟愈合，3例针道感染；钢板组34例，2例延迟愈合。钢丝内固定术组4例。结论应用钢板和克氏针、钢丝治疗锁骨骨折疗效无明显差异，临床上可以根据患者经济情况和骨折情况选择。     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last few years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of National Hip Fracture Databases, to allow us to audit the care provided. With this focus we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Management of hip fractures in the elderly

A fracture of the proximal femur (or hip fracture) is a devastating injury to an elderly patient. Nearly all patients require surgery as part of their treatment but their care necessitates complex multidisciplinary involvement. In the last ten years there have been a number of initiatives to help improve care for this challenging patient group, as well as establishment of The National Hip Fracture Database, to allow us to audit the care provided. With this focus, we have seen both mortality and length of stay decrease. The aim of this article is to summarize the current recommendations for patients who suffer a hip fracture.     

Fracture of the talus

Summary A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and 2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.

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Résumé Les auteurs ont étudié 218 traumatismes de l'astragale en tenant particulièrement compte de la nature et de l'étendue des lésions associées. Chez 96 blessés (44%), il existait une fracture d'un os voisin, à savoir: 59 fractures du cou-de-pied, 27 du calcanéum et 11 du scaphoïde tarsien. Sept fois, la lésion astragalienne était associée à une fracture du cou-de-pied et du calcanéum. Parmi les cas compliqués de fractures bimalléolaires, 15 étaient ouverts (25%) et plusieurs (37%) siégeaient au niveau de la poulie astragalienne.Trente-six (61%) des lésions associées du cou-de-pied étaient des fractures par supination, 5 étaient des fractures par pronation et 2 par supination-rotation externe. La moitié environ des traumatismes astragaliens survenus sur un pied en supination étaient des fractures par cisaillement du col de l'astragale. Parmi les 27 fractures du calcanéum, 11 étaient des fractures par compression, avec enfoncement thalamique, tandis que les autres étaient des fractures sans déplacement, par cisaillement, ou des fractures par avulsion.Les auteurs concluent qu'en règle un traumatisme de l'astragale n'est pas isolé mais associé à des lésions régionales plus étendues et qu'une force s'exerçant en supination constitue le facteur déterminant des lésions traumatiques de l'astragale.

     

Trochanteric and Subtrochanteric Fractures: One Year Follow-up of a Prospective Study of Ender and McLaughlin Osteosynthesis

The clinical and social status of 110 patients with trochanteric and subtrochanteric fractures was evaluated in a prospective and comparative study 1 year after Ender or McLaughlin osteosynthesis.

In both groups the mortality rate during the first year was 21 per cent. There were no significant differences between the two groups concerning pain, hip movement, walking ability or the social status of the patients. Of the 110 patients surviving the first year, 35 per cent were unable to walk, 20 per cent walked with a cane or crutches and 30 per cent had periodic pains in the hip or knee. About 20 per cent of the patients admitted from their own home now lived in nursing homes.     

严重Pilon骨折的手术治疗

目的探讨严重Pilon骨折的不同手术方法、手术时机及治疗效果。方法对1999年5月至2006年6月间46例严重Pilon骨折分别采用有限内固定、有限内固定结合外支架固定及三叶草钢板内固定等方法进行手术治疗。按AO分类方式，所有患者均为C型，C1型10例，C2型22例，C3型14例。开放性骨折11例。闭合性骨折35例。结果所有患者术后均获得8～48个月的随访，平均20个月。踝关节功能按Mazur评价，优21例，良12例，可8例，差5例。主要并发症包括2例皮肤坏死，2例皮肤软组织感染，1例骨感染。5例钉道感染。结论 严重Pilon骨折根据不同的骨折类型、软组织损伤程度及医疗条件选择不同的手术方式和手术时机，均可取得良好的治疗效果。     

Decision-making in burst fractures of the thoracolumbar and lumbar spine

The most common site of injury to the spine is the thoracolumbar junction which is the mechanical transition junction between the rigid thoracic and the more flexible lumbar spine. The lumbar spine is another site which is more prone to injury. Absence of stabilizing articulations with the ribs, lordotic posture and more sagitally oriented facet joints are the most obvious explanations. Burst fractures of the spine account for 14% of all spinal injuries. Though common, thoracolumbar and lumbar burst fractures present a number of important treatment challenges. There has been substantial controversy related to the indications for nonoperative or operative management of these fractures. Disagreement also exists regarding the choice of the surgical approach. A large number of thoracolumbar and lumbar fractures can be treated conservatively while some fractures require surgery. Selecting an appropriate surgical option requires an in-depth understanding of the different methods of decompression, stabilization and/or fusion. Anterior surgery has the advantage of the greatest degree of canal decompression and offers the benefit of limiting the number of motion segments fused. These advantages come at the added cost of increased time for the surgery and the related morbidity of the surgical approach. Posterior surgery enjoys the advantage of being more familiar to the operating surgeons and can be an effective approach. However, the limitations of this approach include inadequate decompression, recurrence of the deformity and implant failure. Though many of the principles are the same, the treatment of low lumbar burst fractures requires some additional consideration due to the difficulty of approaching this region anteriorly. Avoiding complications of these surgeries are another important aspect and can be achieved by following an algorithmic approach to patient assessment, proper radiological examination and precision in decision-making regarding management. A detailed understanding of the mechanism of injury and their unique biomechanical propensities following various forms of treatment can help the spinal surgeon manage such patients effectively and prevent devastating complications.     

Unusual combined scaphoid and lunate fracture of the wrist: a case report

All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.     

Case report of a fracture of the base of the acromion in association with mal-union of the clavicle

Summary Isolated acromial fractures are very rare in practical traumatology. Acromion fractures are usually due to violent trauma, associated with other serious lesions. Following observation of a clinical case of a fracture at the base of the acromion associated with a mal-union of the ipsi-lateral clavicle, the authors have reviewed the literature of isolated acromial fractures. The clinical observation reported here confirms the involvement of the claviculo-scapular system in the production of these fractures.