目的 目前对青壮年有移位新鲜股骨颈骨折患者的治疗仍存在许多争议，被认为尚未完全解决难题之一，股骨颈骨折内固定术后常导致骨折不愈合股骨头缺血性坏死。 方法 2003年1月-2008年6月，收治青壮年新鲜移位股骨颈骨折患者12例，年龄17~55岁，平均36.3 岁。所有患者在受伤后1周内采用牵引下闭合复位空心钉内固定加股方肌骨瓣移植术治疗。术后随访1~5年，平均3.5年。 结果 12例患者均达骨性愈合，随访期内未出现股骨头缺血性坏死；术后采用Harris 髋关节评分标准进行评估，获优良10例，一般1例，差1例。 结论 青壮年新鲜有移位股骨颈骨折患者，采用牵引下闭合复位空心钉内固定加股方肌骨瓣转移术治疗效果良好，均能达到骨折愈合，且无股骨头缺血性坏死发生。
Objective To evaluate the primary cl inical effect of proximal femoral nail anti-rotation (PFNAR) in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influentialfactors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures (including 8 males, 11 females, aged45-87 years old) were treated with closed reduction and PFNAR fixation. Fractures were caused by fall ing. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-outof- bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospital ization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone heal ing within 15-18 weeks with an average time of 16.5 weeks. No compl ications such as delay heal ing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especially in old patients with osteoporosis.
Objective To investigate the treatment method of senile patients with femoral intertrochanteric fractures and its cl inical outcomes. Methods From January 2005 to December 2007, 192 senile patients with femoral intertrochanteric fractures were treated, including 85 males and 107 females aged 65-92 years old (average 75 years old). The injury was causedby fall on walking in 106 cases, fall when riding a bicycle in 55 cases, and traffic accidents in 31 cases. According to Evans classification, there were 12 cases of type I A, 43 cases of type I B, 29 cases of type II, 24 cases of type III A, 23 cases of type III B, 26 cases of type IV, and 35 cases of type V. One hundred and fifty patients were associated with cardio-cerebrovascular diseases, 120 patients were compl icated with chronicle hypertension, 90 cases were associated with bronchitis, and 75 cases were compl icated with diabetes. The time from injury to hospital admission was 1 hour to 14 days. Among those patients, 108 were treated with conservative treatment, 68 received dynamic hip screw (DHS) fixation, and 16 underwent proximal femoral Gamma nail fixation. Results All the patients were followed up for 12-36 months (average 18 months). The fracture all reached bone union without occurrence of nonunion and delayed union. Patients could take care of themselves, and there were no occurrences of serious pains and dysfunctions. The therapeutic effect was satisfactory. The conservative treatment group: the average hospital stay length was 48 days; the average bone heal ing time was 14 weeks; 23 cases had different degrees of coxa adducta; Harris score system was adopted to evaluate hip joint function, 45 cases were graded as excellent, 31 as good, 10 as fair, and 22 as poor, and the excellent and good rate was 70.4%. DHS internal fixation group: the average operation time was 60 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 24 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 38 cases were graded as excellent, 21 as good, 8 as fair, and 1 as poor, and the excellent and good rate was 86.8%. Gamma nailfixation group: the average operation time was 70 minutes; the average bleeding volume during operation was 200 mL, the average hospital stay length was 14 days; the average bone heal ing time after operation was 12 weeks; Harris score system was adopted to evaluate the injured hip joint function, 11 cases were graded as excellent, 4 as good, 1 as fair, and the excellent and good rate was 93.8%. Conclusion For geriatric femoral intertrochanteric fractures, operative treatment should be performed, the preoperative preparation should be sufficient, and individual-oriented treatment method should be selected on the basis of physical conditions of patients and the types of fractures.
ObjectiveTo evaluate the effectiveness of posteromedial double plates in the treatment of complex olecranal fracture. MethodsBetween September 2011 and July 2015, 13 patients with complex olecranal fractures were treated with posterior olecranon locking compression plate and medial mini-plate. There were 8 males and 5 females with an average age of 41.6 years (range, 22-68 years). Injury was caused by traffic accident in 4 cases, falling from height in 6 cases, and crush by object in 3 cases. According to the Mayo classification, fracture was rated as Mayo type ⅡB in 5 cases and as Mayo type ⅢB in 8 cases. Of 13 cases, 7 had Regan-Morrey type Ⅲ coronoid fractures, including 5 anterior dislocations of the elbow joint and 2 posterior dislocations. The time between injury and admission ranged from 1.5 to 10.0 hours (mean, 5.7 hours). At last follow-up, the elbow function was assessed according to the Broberg-Morrey evaluation criteria. X-ray films was performed to observe fracture healing. ResultsAll incisions healed at first stage and no neural complications occurred. The patients were followed up 9-38 months (mean, 22.1 months). All patients achieved bone union at 3.0-5.5 months (mean, 3.7 months) according to X-ray results. Subluxation of radial head and mild heterotopic ossification occurred in 1 patient respectively, who had no uncomfortable symptoms of movement disorder, elbow instability and pain, and no special management was performed. At last follow-up, the flexion and extension range of motion (ROM) of the elbow was 95-130° (mean, 116.4°); the rotation ROM of the forearm was 150-175° (mean, 170.8°); and the elbow function was excellent in 4 cases, good in 7 cases, and fair in 2 cases, and the excellent and good rate was 84.6%. No internal fixation failure, elbow stiffness, or traumatic arthritis occurred. ConclusionFor complex olecranal fractures, an early and stable anatomic reconstruction of trochlear notch in the olecranon with posterior olecranon locking compression plate and medial mini-plate can obtain good effectiveness in joint functions.
To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
目的:探讨锁骨接骨板这一技术在治疗锁骨中段骨折中的应用及其临床效果。方法: 通过系统回顾2005年5月至2008年6月我院收治的30例锁骨中段骨折患者，其中男性24例，女性6例；年龄范围从12岁到63岁，平均年龄为34岁，行手术时间为受伤后3～5天，经患侧刀砍形切口切开复位，予锁骨接骨板内固定，术后2周内予颈腕吊带悬吊，同时进行耸肩训练。术后2周后开始肩关节不持重功能锻炼。结果:30例患者手术均获成功，术后随访时间为4～12个月（平均随访时间6.5个月），所有患者局部无疼痛，行X线检查显示均为解剖骨性愈合，外观无畸形，18例患者一年后取出内固定，无再骨折发生，患者能接受切口线状疤痕，肩关节活动度:前屈平均155°，外展平均160°。结论:切开复位锁骨接骨板内固定锁骨中段骨折是一种较好的治疗方法，值得推荐。