Six cases of old fracture of the tibia with large sear, bony defect, and shortening deformity of the limb were treated by elongation osteotomy at epiphysis and compression fixation of the fracture with external semilunar fixation frame. The bony defect ranged from 3cm to 6cm. Bony healing developed in all patients 4-7 months after operation. Early postoperative movement was suggested. The results revealed that there was an obvious improvement of the joint function and the shortened legs were corrected. The advantages of this method are that there is no need of bone grafting and operative treatment of the scar prior to treatment of the bone.
Objective To investigate the antibacterial and osteogenic capabil ities in vivo of hydroxyapatite (HA)/silver (Ag) coating. Methods HA/Ag coating (Ag qual ity percentage was 3%) and HA coating were deposited to external fixator Schanz screws. The tibial fracture model was establ ished in right hindl imb of 18 adult male Beagle dogs (weighing 15-20 kg). Thetibia was stabil ized with an external fixator and 2 Schanz screws of HA coating at proximal tibia (control group, n=18) and HA/Ag coating at distal tibia (experimental group, n=18), and every screw incision was infected with Staphylococcus aureus. Infection in screw holes and the changes of bone-screw interface were observed by wound grading and X-ray films. Results In control group, wounds infection became worse with time (χ2=13.492, P=0.001), while in experimental group, no obvious change was observed (χ2=0.208, P=0.901). The wound grading of experimental group was significantly better than that of the control group at 1, 2, and 3 weeks (P lt; 0.05). Laser scanning confocal microscope showed that there was bacterial adhesion on the surface of screws in 2 groups, viable becteria mainly in control group and non-viable becteria mainly in experimental group. The scanning electron microscope (SEM) observation results of the fractured sclerous tissue section showed that an obvious transparent boundary between screw and bone in control group, but no obvious boundary in experimental group. The osseointegration ratios were 76.23% ± 15.54% in control group and 93.42% ± 5.53% in experimental group, showing significant difference (t=8.843, P=0.000). The SEM observation showed that HA/Ag coating integrated with new bone and the surface of implant was filled with new bone in experimental group; obvious interspace was seen between the HA coating and new bone in control group. Conclusion HA/Ag coating has good antibacterial and osteogenic capabil ities, so it can take effects in preventing infection in screw holes and loosening of implants.
目的:评价外固定支架治疗桡骨远端骨折的疗效。方法:2004年3月至2008年8月以外固定支架或辅以克氏针、可吸收螺钉内固定治疗桡骨远端骨折３7例。结果:31例获得4～28 个月(平均14 个月)的随访,所有骨折均临床愈合,平均愈合时间8周。腕关节功能按Sarmiento标准进行评定,优17例,良9例,可4例,差1例,优良率839%。结论:外固定支架治疗桡骨远端骨折疗效可靠,值得推广。
Objective To summarize the effect and complication of treatment for Pilon fracture using limited internal fixation combined with external fixation. Methods From April 1996 to June 2003, 20 patients with Pilon fracture were treated with limited internal fixation combined with external fixation as the treatment group and 22 patients with Pilon fracture with other methods as the control group. The X-ray films, clinical effect and complication were analyzed and compared between 2 groups. Results All cases were followed up for 8 to 26 months(15.2 months on average). According to Helfet’s criterion forclinical effect, the excellent and good rates were 75% in the treatment group and 72.7%in the control group, being no significant difference (Pgt;0.05). According to Burwell-charnley criterion for reduction, the X-ray film resultsshowed the excellent and good rates were 90% in the treatment group and 86.4% in the control group, being no significant difference (Pgt;0.05). But there was significant difference in complications between 2 groups (Plt;0.05). Conclusion Limited internal fixation combined with external fixation is better in resuming ankle joint function and remarkably reducing complication, especially in reducing soft tissue complication and collapse of bone joint; it is useful in the treatment of Pilon fracture.
目的:探讨有限内固定结合外固定支架在地震伤员膝关节周围开放性骨折早期治疗中的应用。方法:对汶川大地震中25例膝关节周围开放性骨折早期采用有限切开复位有限内固定,同时结合外固定支架治疗,其中胫骨平台骨折13例,(SchatzkerⅤ型4例,SchatzkerⅥ型 9例),股骨远端骨折12例,(AO分型C1型3例,C2型5例,C3型4例),25例开放性骨折按Gustilo分型:GustiloⅡ型5例,GustiloⅢA型8例,GustiloⅢB型10例,GustiloⅢC型2例。结果:术后至患者转院治疗期间两周内,25例开放性伤口均闭合,8例伤口术后出现表浅感染,经加强局部换药感染控制,无伤口深部感染。术后复查X线片无关节面塌陷,骨折无成角畸形,患者出院时无外固定支架钉道松动。结论:有限内固定结合外固定支架为不适宜做内固定治疗的膝关节周围严重开放性骨折提供了一种有效的治疗方法,特别是对于地震等重大灾害所造成的复杂伤情不失为一种较理想的方法。
Forty cases of intertrochanteric fractures of femur were treated with percutaneous nonmetallic external fixator. The patients were followed up for 6 months to 3 years, and the fractures were all united without coxa vara or shirtening deformities. There was no mortality in this series. This method had the advantages ofbeing simple, save time and effort, less traumatic and early ambulation. The design of the apparatus tallied with the biomechanics of the neck and shaft of the femur.
ObjectiveTo study the effectiveness of trifocal bone transport by using monolateral rail system in the treatment of bone defects caused by post-traumatic tibial osteomyelitis.MethodsThe clinical data of 28 patients with tibial defects caused by post-traumatic osteomyelitis treated with trifocal bone transport technique by using monolateral rail system between January 2012 and June 2017 were retrospectively analyzed. There were 26 males and 2 females, aged 22-59 years (mean, 41.3 years). The causes of injury included 13 cases of traffic accident injury, 9 cases of falling from height, 4 cases of heavy object injury, and 2 cases of crushing injury. The disease duration was 4.5-17.0 months (mean, 7.1 months). The length of bone defect was 6.5-16.8 cm (mean, 10.3 cm). And the range of soft tissue defect ranged from 3.5 cm×2.0 cm to 18.0 cm×11.0 cm. The bone transporting time, external fixation time, duration of regenerate consolidation, and external fixation index were recorded, and the complications were observed. At last follow-up, the bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of the Ilizarov (ASAMI).ResultsAll patients were successfully followed up after removing the external fixator with an average of 35 months (range, 24-65 months). The bone transporting time was 41-136 days (mean, 60.2 days), the external fixation time was 7.5-20.0 months (mean, 13.4 months), the external fixation index was 1.1-1.9 months/cm (mean, 1.4 months/cm), the duration of regenerate consolidation was 6.0-16.5 months (mean, 10.5 months). Pin tract infection occurred in 12 cases, delayed union on docking site was occurred in 9 cases, axial deviation was observed in 2 cases, poor regenerate consolidation was presented in 1 case, and refracture on docking site after fixator removal was occurred in 1 case. There was no recurrence of infection, amputation, vascular and neurologic complications, and osteofascial compartment syndrome. At last follow-up, according to ASAMI criterion, the bone healing results were excellent in 17 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 85.7%; the functional results were excellent in 15 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 89.3%.ConclusionTrifocal bone transport by using monolateral rail system is an effective method in the treatment of bone defect caused by post-traumatic osteomyelitis which can reduce bone transport time, external fixation time, and complications.