股骨骨折切开复合中支点的寻找与力的运用

提出肌骨骨折切开复位中支点的寻找与力的运用之观点，给予论证及临床运用。方法：通过对本组４８例骨折面的分析，寻找力的作用点（支点）利用其对骨折端行撬拨、折顶、挤压、牵引方法，完成很好的复位，为进一步给予固定提供了有利的条件。结果通过临床操作收到了很好的效果，特别是使大斜面骨折、关节骨折、粉碎性骨折得到了良好的复位。     

闭合与切开复位髓内钉治疗股骨中段粉碎骨折疗效比较

目的 比较闭合复位和切开复位交锁髓内钉治疗闭合性股骨中段粉碎性骨折的临床疗效.方法 2001年12月至2012年2月,应用交锁髓内钉治疗闭合性股骨中段粉碎性骨折150 例,其中男114 例,女36 例,年龄18～68 岁,平均35.3 岁.按Winquist-Hansen分类,Ⅰ型35 例,Ⅱ型38 例,Ⅲ型40 例,Ⅳ型37 例.闭合复位76 例（A组）,切开复位自体骨移植74 例（B组）.对两组手术时间、术中出血量、骨折愈合时间、远期疗效等指标进行比较.结果 7 例失访,143 例获得随访,时间为6～21个月,平均9.3个月,术后无切口感染、内固定松动、断裂等并发症,A组中股骨颈骨折1 例,延迟愈合3 例,骨不连1 例,相应治疗后均骨性愈合;B组中延迟愈合2 例,未作特殊处理自行愈合.A组的手术时间、术中出血量均少于B组,差异有统计学意义（P＜0.05）,两组的骨折愈合时间无明显差异,远期疗效按马元璋功能评定标准评定,A组：优39 例,良27 例,可7 例,优良率90.41%;B组：优32 例,良28 例,可10 例,优良率85.71%,经统计两组优良率差异有统计学意义（P＜0.05）.结论 闭合复位交锁髓内钉治疗股骨中段粉碎性骨折,具有手术创伤小、对骨折端及骨块的血运干扰小、不破坏骨折处的血肿、早期进行功能锻炼、远期疗效好等优点,是一种理想的手术方法.但需要掌握手术时机,严格按照程序操作,密切术后随访,定期行影像学检查,及时发现和治疗相关并发症,尽早恢复肢体功能.     

有限切开复位髓内钉固定治疗股骨转子下骨折

目的 探讨有限切开复位髓内钉固定治疗股骨转子下骨折的效果.方法对闭合复位失败的21例股骨转子下骨折患者采用有限切开复位、髓内钉固定治疗.结果 21例均获得随访,时间10～18个月.骨折全部愈合,无内固定物松动、断裂等并发症.术后测量：内外翻成角0°～5°（1.9°±1.7°）;前后成角0°～10°（4.3°±2.6°）;内外旋0°～10°（5.5°±2.6°）;下肢缩短0～1.5（0.4±0.5）cm.结论 有限切开复位髓内钉固定治疗股骨转子下骨折可以获得良好的治疗效果.     

有限切开复位加长PFN固定治疗股骨粗隆下骨折

目的探讨股骨粗隆下骨折的治疗方法和疗效。方法2005年7月至2009年10月股骨粗隆下骨折17例,男13例,女4例;年龄2862岁,平均40.6岁,骨折按Seinsheimer-Bergman分型,Ⅱ型6例,Ⅲ型7例,Ⅳ型4例,均采用骨折局部有限切开复位加长股骨近端髓内钉（proximal femoral nail,PFN）治疗,术后参照由Sandes等推荐的创伤性髋关节等级评分评定疗效。结果17例患者均获随访,随访时间636个月,平均17个月。骨折均于1220周内愈合,平均愈合时间15周,术后创伤性髋关节等级评分评定疗效：优11例,良4例,中2例,优良率为88.2%,所有病例均无断钉、感染、肢体短缩或内翻畸形发生。结论加长PFN能较好地解决股骨粗隆下骨折高应力集中问题,而骨折局部有限切开复位较闭合复位能有效节约手术时间,减少出血,迅速恢复股骨皮质的连续性,促进骨折愈合。 【关键词】 切开; 复位; PFN; 治疗; 股骨粗隆下骨折;     

股骨骨折髓内针固定术后感染的治疗

目的探讨股骨骨折髓内针固定术后合并感染时,是否需要取出髓内针及其相关治疗方法。方法1993～2003年治疗股骨骨折髓内针固定术后感染18例。其中急性感染8例,亚急性感染6例,慢性感染4例,为对比疗效特将病例分为两组Ⅰ组保留髓内针共13例,其中男12例,女1例,平均年龄36岁;Ⅱ组在清创同时取出髓内针改用外固定稳定骨折共5例。其中男4例,女1例,平均年龄41岁。所有患者确诊感染后随访至少1年。结果Ⅰ组所有骨折均愈合,平均愈合时间11个月(9～16个月),平均随访25个月(12～72个月);Ⅱ组4例治疗后平均10个月后骨折愈合(6～24个月),4例出现膝关节活动障碍,2例肢体不等长相差>1cm,1例感染性骨折不愈合在最后随访时仍未愈合,平均随访28个月(12～36个月)。结论股骨骨折髓内针固定合并感染时,如果骨折稳定且感染得到控制髓内针可保留。否则,骨髓炎不能有效控制或感染性骨不连时,应当选择外固定,有骨缺损存在时,常需要植骨。     

股骨骨折的术后护理干预

股骨骨折是骨科的一种常见病,常因外伤、疾病导致剧烈疼痛及功能障碍,机体出现一系列病理生理反映.正确有效的护理能够预防并发症的发生,促进骨折的愈合.     

股骨小转子复位器的研制与临床应用

小转子复位固定的力学意义是恢复股骨距完整形态以提供悬臂梁式强有力的三角支撑,使股骨整体力学性能得到恢复和改善.增加抵抗外载荷的能力.     

儿童股骨骨折髓内针内固定远期疗效观察

目的：观察儿童股骨骨折髓内针固定后对下肢生长发育的影响。方法：我院自１９８７年～１９９８年间,对４ 岁至１３ 岁儿童股骨骨折选择性地髓内针固定５８ 例,术后经过３～１２ 年随访,４９ 例（５７ 个肢体）已年满１６ 岁,身高快速增长的青春期已基本结束,术后及随访结束均拍骨盆平片,对比双侧大转子,股骨颈及股骨头结构,测量双下肢长度。结果：仅有一例遗留有患肢轻微短缩,远期未发现有过度生长现象。结论：髓内针内固定术是治疗儿童股骨骨折的一种简单、安全可靠的方法。     

针刺对实验性骨质疏松大鼠股骨骨折的预防作用

目的研究"健脾益肾强骨针法"对去势SD大鼠股骨骨质疏松性骨折的预防作用。方法 6月龄SD大鼠在去势3个月检测骨质疏松症模型造模成功后,被随机分为3个组:对照组、阿仑膦酸钠组和针刺组。针刺组针刺足三里、肾俞、大杼,每日1次,每周5次,连续治疗6个月;阿仑膦酸钠组每日皮下注射阿仑膦酸钠,每日1次,连续治疗6个月;对照组每日在其他两组治疗期间进行同样抓放。治疗6个月后,检测包括在体股骨骨折最小外力、新鲜股骨形态学、骨密度、骨力学性能等反映股骨的硬度和弹性的指标。结果针刺组、阿仑膦酸钠组的在体股骨骨折最小外力明显大于对照组;针刺组新鲜股骨近端横径明显小于阿仑膦酸钠组和对照组;针刺组、阿仑膦酸钠组骨密度明显大于对照组;针刺组、阿仑膦酸钠组离体股骨的部分力学性能指标(如压缩、拉伸)明显高于对照组。结论 1针刺足三里、肾俞、大杼6个月具有预防绝经后骨质疏松症模型大鼠股骨骨折的作用,其机制可能与针刺促进股骨的形态适应、增加骨密度、提高骨的抗外力性能密切相关。2"健脾益肾强骨针法"与阿仑膦酸钠均能提高绝经后骨质疏松大鼠在体股骨骨折最小外力,但针刺的作用机制与阿仑膦酸钠不完全相同。     

股骨重建钉治疗复杂股骨骨折的临床研究

目的探讨股骨重建钉治疗复杂股骨骨折的临床应用及疗效。方法36例复杂股骨骨折,男25例,女11例;年龄18~45岁,平均28.8岁。闭合性骨折32例,开放性4例,均采用股骨重建钉固定治疗。结果随访36例,其中优20例,良10例,差6例,优良率为83.33%。以上病例均未出现感染及股骨头坏死等并发症。结论股骨重建钉是目前治疗复杂股骨骨折较有效的方法之一。     

Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.     

儿童股骨干骨折手术治疗的探讨

目的：探讨儿童股骨干骨折的三种内固定手术治疗效果,方法：对50例儿童股骨干骨折的手术治疗方法及结果进行回顾性总结。结果：髓内针固定16例,钢板螺钉固定23例,多枚螺钉固定11例,所有骨折于术后4－8周临床愈合,1例术后6个月钢板断裂,其他病例均于术后4－12个月（平均6．5个月）骨性愈合后取出内固定物,随访时间1－8年（平均奖4．5年）,与手术有关的并发症有钢板断裂,再骨折,晚期扁平髋各1例,占6％,结论：髓内针固定操作简单,适于股骨上,中段骨折,但选择时需慎重,钢板螺钉固定对骨折复位满意,固定确切,适于复杂股骨干骨折,但创伤大,多枚螺钉固定适于长斜行或螺旋形股骨干骨折。     

重建交锁髓内钉治疗股骨多段骨折

目的　报告 2 5例股骨多段骨折的治疗情况。方法　使用Reconstruction钉治疗股骨多段骨折。结果　随访 6～ 2 5个月。优良为 2 1例 ,一般 2例 ,较差 2例。结论　由于对于累及股骨粗隆、股骨干和股骨髁三者的骨折无合适的内固定 ,因此作者提出一种手术方法 ,以期用单一内固定来治疗较为复杂的骨折 ,并取得较满意的疗效。     

股骨粗隆间粉碎性骨折不同内固定疗效分析

目的观察探讨动力髋螺钉(DHS)、Gamma Nail(γ钉)、股骨近端髓内钉(PFN)在不稳定性粗隆间骨折治疗中的应用和疗效。方法对90例不稳定性粗隆间骨折行DHS、γ钉、PFN内固定治疗。结果经术后2～23个月随访,DHS组优良率为87.2％、γ钉组优良率为91.3％、PFN组优良率为97.4％。结论各种固定有其自身特点。PFN是治疗转子间骨折最牢固的髓内固定方式,尤其适用于不稳定转子间粉碎性骨折．     

开放复位加骨水固定治疗继发于缺血坏死的股骨头骨折的初步报告

对股骨头缺血坏死的早期治疗已取得较好的结果,但对股骨头已塌陷治疗效果并不满意,我们采取开放复位加骨水泥内固定治疗这类病人21例(22侧髋),均属于股骨头坏死Ⅲ期,随访1～3年,平均1.7年,术前术后根据Harris髋关节评分标准,骨性关节炎指数和SF36健康状况调查表评定治疗效果,所有病人均感到术后疼痛减轻,功能改善.三个评分指标分别为54.2～82.2(P<0.05),55.8～28.7(P<0.05),27.5～43.1(P<0.05).6例病人进行了全髋置换.该方法简单,病人恢复快,但长期随访及预后有待进一步研究.     

股骨长节段严重粉碎性骨折的外科治疗

目的探讨股骨长节段严重粉碎性骨折的临床特点与外科治疗方法。方法回顾性分析32例股骨长节段严重粉碎性骨折的临床资料并进行总结。32例均行切开复位与内固定。结果随访时间10个月～4年2个月,平均3.5年,全部患者均获骨性愈合,愈合时间3～7个月,平均4.6个月,本组病例无股骨短缩或成角畸形,肢体功能恢复满意。结论股骨长节段严重粉碎性骨折多系高能量暴力所致,受伤机制复杂。内固定宜选择整体化的骨折内固定方式。     

Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm

PurposeFractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. MethodsThis paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available.ResultsThe type of fracture—closed or open; stable or unstable—needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6–12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization.ConclusionAn age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.     

Passive Pneumatic Stabilization Device for Assisting in Reduction of Femoral Shaft Fractures

Abstract During treatment of femoral shaft fractures, not only the actual fracture reduction but also the retention of the achieved reduction is essential. Substantial forces may apply to the bone fragments, due to multidirectional muscular contraction. Furthermore, forces from manipulation of one bone fragment may be transferred over the soft tissues onto the other fragments, thus hindering accurate fracture reduction. Once a sufficient reduction has been achieved, this position must be retained whilst definitive internal fixation is performed. Conventional methods comprise mounting patients on a traction table and applying manual distraction or employing special distraction devices, such as the AO distractor device. These approaches, however, only insufficiently stabilize both main fragments. For example, on the traction table the proximal femoral fragment can pivot around the hip joint thus complicating precise reduction. A novel pneumatic stabilization device to assist surgeons during operative procedures is described. This passive holding device “Passhold” connects to one main fragment through a minimally invasive bone interface and statically locks the fragment’s position. Thereafter, only the other main fragment is manipulated to achieve reduction. Mutual interference of the reciprocal fragment positions, due to soft-tissue force transfer during manipulation, is avoided. The authors examined the stability of the novel retention device on a test rig and proved its functionality under sterile settings using cadaver tests. It is concluded that this device largely facilitates the operative procedure in femoral shaft fractures, is sufficiently stable and ergonomically suitable for intraoperative deployment.     

Current Trends of Stem Use in Hemiarthroplasty for Femoral Neck Fracture in South Korea

Background

Hemiarthroplasty is a common operation to treat femoral neck fracture in elderly patients. The choice of whether to use cemented stem or cementless stem in hemiarthroplasty has been controversial in clinical practice. However, recent trends regarding stem choice in South Korea are not known or documented. In this study, we assessed the trends of stem fixation in hemiarthroplasty for femoral neck fractures in South Korea.

Methods

Data of patients with femoral neck fractures, who were operated on between the years of 2007 and 2011 and were ≥ 50 years old at the time of operation, were obtained from the Health Insurance Review and Assessment Service. All new visits or admissions to clinics or hospitals for femoral neck fractures were identified using the International Classification of Disease Tenth Revision diagnostic code (S720). The trends in the utilization of cemented and cementless hemiarthroplasty were then analyzed.

Results

The proportion of cementless hemiarthroplasty increased from 42.7% of all surgical procedures in 2007 to 61.4% of all surgical procedures in 2011 (p < 0.001), while the use of cemented hemiarthroplasty demonstrated a corresponding decrease.

Conclusions

There was a current trends towards using cementless stems in hemiarthroplasty for femoral neck fractures in South Korea.     

Hansson Pin 治疗股骨颈骨折的生物力学测试与临床应用分析

目的　探讨HanssonPin治疗股骨颈骨折的疗效。方法　临床治疗39例,并作生物力学测试。结果　全部病例得到随访,时间4～36个月,平均23个月。骨性愈合31例,其中12例有滑针、股骨颈缩短表现,半年内出现滑针、塌陷移位3例;股骨头缺血性坏死5例。生物力学性能显示HanssonPin的承力效果优于骨圆针。结论　HanssonPin作为股骨颈内固定操作简单,但术后早期负重行走滑针率较高。