ObjectiveTo investigate the effectiveness of anterior subcutaneous internal fixator combined with posterior plate in the treatment of unstable pelvic fractures.MethodsBetween January 2015 and January 2019, 26 cases of unstable pelvic fractures were treated with anterior subcutaneous internal fixator combined with posterior plate. There were 16 males and 10 females, with an average age of 42.8 years (range, 25-66 years). According to the Tile classification, 9 of them belonged to type B2, 6 to type B3, 7 to type C1, 3 to type C2, 1 to type C3. The injury severity score (ISS) was 6-43 (mean, 18.3). Four cases combined with brain injury, 7 with limb fractures, 3 with hemopneumothorax, 1 with sciatic nerve injury. The time from injury to operation was 4-12 days (mean, 6.4 days). The intraoperative blood loss, operation time, and the complications were recorded. The fracture reduction and the postoperative function of patients were evaluated.ResultsAll patients were followed up 12-26 months (mean, 16.8 months). The operation time was 65-142 minutes (mean, 72.5 minutes) and the intraoperative blood loss was 42-124 mL (mean, 64.2 mL). There were 2 cases of unilateral lateral femoral cutaneous nerve stimulation, 1 case of femoral nerve paralysis, and 1 case of superficial infection of incision, which were cured after corresponding treatment. X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, according to Matta criteria for fracture reduction, the results were excellent in 8 cases, good in 15 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 88.5%. According to Majeed scoring system for pelvic function, the results were excellent in 10 cases, good in 12 cases, and fair in 4 cases, with an excellent and good rate of 84.6%.ConclusionFor unstable pelvic fractures, the anterior subcutaneous internal fixator combined with posterior plate has fewer operative complications, high security, and achieve good effectiveness.
To fix the ligaments, tendons or other transplantation materials by passing through bone channels was commonly used and a relialde method in the reconstruction of joint stability. Usually an additional incision was necessary on the side of the outlet of the bone channel, that the screws, plates or U-shaped staple could be applied. An instrument was designed that the steel miniplate could be fixed to the bone by noninvasive method. This technique was applied in 20 cases in which anterior cruciate ligament in 14, posterior cruciate ligament in 4, and collateral ligaments in 2 with carbon fibers. The result was successful in all patients. It was shown that it gave simple manipulation, reliable fixation and no need to have an additional incision, and it could lessen patients’ suffering and lead to satisfactory clinical result.
ObjectiveTo observe the influence of different humeral neck-shaft angle on the efficacy in the treatment of proximal humeral fractures with locking plate. MethodsA total of 106 patients with proximal humeral fractures were treated by locking plate between March 2009 and March 2013, and the clinical data were retrospectively analyzed. Of 106 cases, 58 were male and 48 were female, aged from 26 to 71 years (mean, 52.3 years). The causes were traffic accident injury in 54 cases, falling injury from height in 23 cases, falling injury in 21 cases, and others in 8 cases. According to the Neer classification, there were 32 cases of two-part fractures, 65 cases of three-part fractures, and 9 cases of four-part fractures. The time from injury to operation was 1-7 days (mean, 2.7 days). According to neck-shaft angle by X-ray measurements at 1-3 days after operation, the patients were divided into 3 groups:valgus group (>145°), normal group (126-145°), and varus group (<126°) to observe the influence of neck-shaft angle on efficacy. ResultsAccording to postoperative humeral neck-shaft angle, there were 10 cases in valgus group, 75 cases in normal group, and 21 cases in varus group. There was no significant difference in general clinical data among 3 groups (P>0.05). The patients were followed up 6-12 months. The X-ray results showed fracture healing, and no significant difference was found in fracture healing time among 3 groups (P>0.05). After 6 months, the varus angle of femoral head and visual analogue scale (VAS) score of normal group were significantly lower than those of valgus group and varus group (P<0.05). The excellent and good rate of Constant-Murley score was 78.67% (59/75) in normal group, and it was significantly higher than that in valgus group (60.00%, 6/10) and varus group (42.86%, 9/21) (P<0.05), but there was no significant difference between valgus group and varus group (P>0.05). The complication rate was 28.57% (6/21) in varus group, was 10.67% (8/75) in normal group, and was 20.00% (2/10) in valgus group, showing no significant difference among 3 groups (χ2=4.31, P=0.12). ConclusionReconstruction of normal neck-shaft angle is the key to good shoulder function and clinical efficacy in the treatment of proximal humeral fracture.
ObjectiveTo discuss the biomechanical stability of locked reconstruction plate for internal fixation of transverse and posterior wall acetabular fracture so as to provide a reliable basis for clinical application. MethodsThe models of transverse and posterior wall acetabular fracture were established in 16 anti-corrosion acetabular specimens from 8 adult cadavers, which were randomly divided into experimental group and control group (n=8). Fracture was fixed with 10-hole posterior column locked reconstruction plate in the experimental group, and with 10-hole posterior column reconstruction plate combined with anterior column lag screw and posterior wall screws in the control group. Biomechanical testing machine was used for loading of 5/6 donor body mass the specimen in a speed of 15 N/s; the loading time was calculated and vertical loading.The longitudinal and quadrilateral body displacements of fracture were recorded to compare the biomechanical stability was performed. ResultsThe quadrilateral body displacement of the experimental group[(1.99±0.32) mm] was greater than that of the control group[(1.75±0.22) mm], but there was no significant difference (t=-1.735, P=0.105). The longitudinal displacement[(1.56±049) mm] and the displacement of the posterior wall fracture block[(0.86±0.33) mm] in the experimental group were lower than those of the control group[(1.64±0.51) and (1.01±0.35) mm], showing no significant difference between 2 groups (t=0.293, P=0.772; t=1.516, P=0.154). ConclusionFor transverse and posterior wall acetabular fracture, application of locked reconstruction plate can provide sufficient biomechanical stability, reduce the risk of screw placement to acetabular joints.
目的 探讨应用经皮接骨板固定技术（MIPPO）结合锁定钢板（LCP）固定治疗胫腓骨骨折的疗效。 方法 2009年11月－2012年1月应用MIPPO技术结合LCP固定治疗胫腓骨干骨折62例。其中男42例，女20例；年龄16～85岁，平均45岁。骨折按AO分型：A1型10例，A2型3例，A3型3例，B1型18例，B2型8例，B3型4例，C1型10例，C2型5例，C3型1例。闭合骨折47例；开放骨折15例，根据Gustilo-Anderson分型，Ⅰ型8例，Ⅱ型6例，ⅢA型1例。伤后内固定时间3 h～10 d，平均6 d。 结果 开放骨折有3例伤口Ⅱ期愈合，其中1例伤口皮缘坏死，1例钢板部分外露经换药和清创减张缝合后伤口愈合，1例骨外露经皮瓣转移愈合；其余患者术后伤口均Ⅰ期愈合。62例均获随访，随访时间6～16个月，平均9个月。无感染、神经损伤、骨筋膜室综合征发生。术后2～4个月骨折均愈合。根据Johner-Wruhs疗效评价，优48例，良14例；开放性骨折15例中优10例，良5例。 结论 MIPPO技术结合LCP固定治疗胫腓骨干骨折，具有创伤小、骨折愈合快等优点。
目的 比较外固定支架与锁定加压钢板（LCP）治疗桡骨远端die-punch骨折的疗效及适应证。 方法 2007年1月－2011年1月，分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧，其中LCP固定19侧，外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义（P＞0.05）。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节，克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间，术后腕关节活动范围等。 结果 两组患者手术切口均Ⅰ期愈合，无感染发生。患者术后均获随访，随访时间6～24个月，平均13个月。所有患者骨折愈合良好，愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义（P＞0.05）；术后6个月腕关节尺偏活动度分别为（20.8 ± 3.6）°和（18.0 ± 2.8）°，LCP组优于外固定支架组（P＜0.05）；LCP组和外固定支架组桡骨高度分别为（10.9 ± 2.8）mm和（13.4 ± 2.3）mm，Gartland-Werley评分分别为（5.3 ± 2.4）分和（8.4 ± 3.6）分，两组差异有统计学意义（P＜0.05）。 结论 对于桡骨远端die-punch骨折，LCP可提供有效固定及早期活动，但对于关节面的塌陷及桡骨高度的恢复，外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。