前外侧切口治疗合并腓骨骨折的胫骨Pilon骨折

正2011年3月~2014年10月,我科采用切开复位腓骨解剖钢板胫骨L型锁定钢板内固定治疗18例合并腓骨骨折的胫骨Pilon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18例,男11例,女7例,年龄19~70岁。骨折RüediAllgower分型:Ⅰ型1例,Ⅱ型16例,Ⅲ型1例。均为新鲜闭合骨折。伤后7~10 d待皮肤皱纹出现后行手术治疗。     

T形骨块植骨结合锁定钢板治疗胫骨平台骨折

<正>2009年8月~2011年8月,我院应用T形骨块植骨结合锁定钢板治疗31例胫骨平台骨折患者,疗效较满意,报道如下。1材料与方法 1.1病例资料本组31例,男18例,女13例,年龄34~62岁。均为SchatzkerⅢ型胫骨平台骨折。左侧11例,右侧20例,均为新鲜闭合骨折。合并伤:腓骨小头骨折8例,半月板损伤4例,副韧带损伤2例。1.2手术方法腰硬联合麻醉。采用膝前外侧切口,长7~10 cm,显露胫骨     

微T型钢板内固定治疗MasonⅡ型桡骨头骨折

正2009年1月~2015年12月,我科采用微T型钢板内固定治疗18例MasonⅡ型桡骨头骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组18例,男7例,女11例,年龄31~70岁。右侧11例,左侧7例。均为闭合骨折,Mason分型均为Ⅱ型。患者肘关节正、侧位X线片及CT三维重建均显示桡骨头孤立性大骨块倾斜塌陷,骨折线波及桡骨颈,塌陷骨块﹥桡骨头周径1/3,不伴有粉碎性小骨块及肱骨内侧髁骨折;MRI显示无肘关节内侧副韧带损伤。受伤至手术时间     

Judet入路手术治疗肩胛骨骨折

正2010年6月~2013年6月,笔者采用Judet入路手术治疗18例复杂肩胛骨骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组18例,男11例,女7例,年龄23~56岁。骨折按Hardegger分型:肩胛体部11例,肩胛颈7例,肩胛盂骨折11例(其中Ideberg分型:Ⅰ型3例,Ⅱ型3例,Ⅲ型5例),肩胛冈5例。本组患者术前均完善MS CT检查。骨折至手术时间为2~10 d。     

不同直径空心钉闭合复位内固定治疗股骨颈骨折疗效分析

目的:比较两种直径空心钉治疗股骨颈骨折的临床疗效差异.方法:2008年6月至2013年6月,采用闭合复位空心钉内固定治疗117例青壮年股骨颈骨折患者,分别使用6.5 mm空心钉和8.0 mm空心钉,其中6.5 mm组48例,年龄19~60岁,平均(45.61±11.99)岁,男30例,女18例,Garden Ⅰ/Ⅱ型17例,Garden Ⅲ/Ⅳ型31例;8.0 mm组69例,年龄18~60岁,平均(45.17±9.95)岁,男40例,女29例,Garden Ⅰ/Ⅱ型31例,Garden Ⅲ/Ⅳ型38例.记录并比较分析两组病例的一般资料、手术时间、住院时间、复位质量、股骨颈头颈部直径、骨折愈合时间、骨折愈合率、术后并发症情况,术后髋关节功能评分采用Harris评分.结果:两组患者均获随访,时间18~24个月,平均19.6个月.两组病例的手术时间、住院时间、复位质量差异均无统计学意义(P>0.05).两组病例的股骨颈头颈部平均直径、骨折愈合时间、骨折愈合率、术后并发症差异均无统计学意义(P>0.05).两组病例术后髋关节功能Harris评分均较好,疗效显着.Garden Ⅲ/Ⅳ型股骨头坏死发生率高于Garden Ⅰ/Ⅱ型,差异有统计学意义.结论:对于青壮年的股骨颈骨折,闭合复位空心钉内固定治疗是首选的手术方法,两种不同直径空心钉闭合复位内固定治疗股骨颈骨折时不会影响骨折愈合的时间及术后并发症的发生.     

Y形重建钢板治疗成人肱骨髁间骨折

2000年1月~2004年12月,我院应用切开复位Y形重建钢板内固定治疗成人肱骨髁间骨折18例,疗效满意。1材料与方法1.1病例资料本组18例,男12例,女6例。年龄18~62岁。左侧7例,右侧11例,均为新鲜骨折。按AO/ASIF分类:C1型6例,C2型9例,C3型3例。合并尺神经损伤2例。3例在12 h内急诊手术     

股骨近端防旋髓内钉微创治疗老年股骨转子间骨折

2010年1月~2011年8月,我院采用股骨近端防旋髓内钉(PFNA)微创治疗39例老年股骨转子间骨折患者,疗效满意. 1 材料与方法 1.1 病例资料本组39例,男21例,女18例.年龄63~92岁.左侧18例,右侧21例.均闭合性骨折.骨折按 Evans标准[1]分型:Ⅰ型3例,Ⅱ型5例,Ⅲ型 11例,Ⅳ型12例,Ⅴ型8例.患者均有不同程度的骨质疏松且合并有多种内科疾患,其中31例合并有两种以上的内科疾病.     

关节镜下空心钉固定治疗前交叉韧带胫骨止点撕脱骨折

正2011年1月~2014年6月,我们采用关节镜下空心钉固定治疗24例前交叉韧带胫骨止点撕脱骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组24例,男18例,女6例,年龄21~58岁。均为新鲜骨折。按Meyers-McK eever和Zaricznyj骨折分型标准:Ⅱ型8例,Ⅲ型14例,Ⅳ型2例。1.2治疗方法全身麻醉下手术。前外侧入路置入关节镜,用小刮匙和刨刀仔细清理骨床,复位骨折。骨折复位理想后,用探钩探查前交叉韧带张力,如仍     

DCS在老年人股骨转子下骨折中的应用

目的探讨股骨动力髁螺钉(DCS)在老年人股骨转子下骨折中的临床应用,提高老年人股骨转子下骨折的治疗效果,减少并发症。方法1999年9月～2003年11月间共收治老年人股骨转子下骨折103例,其中AO分类为31A3型的18例用DCS治疗。结果18例均获得15～36个月的随访,满意率100%。有2例患者膝关节屈曲功能与健侧相比丢失10°～20°,无髋内翻、髋外翻病例发生。结论DCS是老年人股骨转子下31A3型骨折的一种理想治疗方法,其治疗固定可靠,能有效预防该部骨折常见并发症的发生;且价格低廉,可在基层医院推广。     

Herbert螺钉治疗PipkinⅠ、Ⅱ型股骨头骨折

正2010年1月~2014年12月,我院采用Herbert螺钉治疗15例PipkinⅠ、Ⅱ型股骨头骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组15例,男12例,女3例,年龄18~50岁。骨折按Pipkin分型标准:Ⅰ型9例,Ⅱ型6例。受伤至手术时间6~10 h。1.2治疗方法全身麻醉或椎管内麻     

Research Update on Stress Riser Fractures

Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or peri-implant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature.     

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.     

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.     

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.

---

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.

     

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。     

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.     

Complex coronoid and proximal ulna fractures are we getting better at fixing these?

Technological advances and improved understanding of functional anatomy about the elbow have lead an evolution regarding operative reconstruction of complex proximal ulnar and coronoid fractures. When treating these complex and challenging fractures, goals of anatomic articular restoration along with balanced soft tissue stability can lead to early range of motion and thus, desired functional outcome. The purpose of this review is to outline and provide tips and pearls to achieve desired results, with a comprehensive update on the most recent literature to support the latest fixation methods and techniques.     

股骨近端骨折后对侧再次骨折

目的　阐述老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率、相关因素和临床特征 ,提高对二次骨折的认识和防范。方法　对 1997年 1月～ 2 0 0 1年 10月手术治疗的 4 76例股骨颈骨折和股骨粗隆间骨折病例作回顾性分析 ,针对股骨近端骨折的骨折类型、再次对侧骨折的发生率、骨折时的年龄和性别分布、第一次骨折后再次发生对侧骨折的间隔时间、骨折时的合并症等内容进行研究和比较。结果　 4 76例股骨近端骨折中 ,2 6例为第二次发生的对侧骨折 ,老年性股骨颈和股骨粗隆间骨折后再次对侧股骨近端骨折的发生率为 5 5 % (2 6 / 4 76 )。股骨颈骨折后发生对侧的股骨近端骨折 ,6 8 8% (11/ 16 )的病例仍为股骨颈骨折 ;股骨粗隆间骨折后发生对侧的股骨近端骨折 ,90 0 % (9/ 10 )的病例仍然是股骨粗隆间骨折 ,第二次骨折类型往往同第一次相同。第二次骨折和第一次骨折的时间间隔平均为 2 7年 ,第 2～ 3年发生的占 4 2 3%。单侧和双侧骨折群的年龄和性别无明显差异。白内障、老年性痴呆、Parkinson病、脑血管障碍、脊髓灰质炎后遗症和慢性类风湿性关节炎等合并症的持有率双侧群明显高于单侧群。影响行走功能的合并疾病 ,是再次对侧股骨近端骨折的一个重要易患因素。结论　老年性股骨近端骨折后