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骨骼創傷修復和重建的發展

32 例髖臼骨折手術療效

【摘 要】 目的 總結髖臼骨折的手術治療適應證、手術入路、術后處理及并發癥防治。 方法 1998 年5 月－2006 年7 月，收治32 例髖臼骨折患者。男21 例，女11 例；年齡18 ～ 67 歲，平均42 歲。車禍傷20 例，砸壓傷4 例，墜落傷8 例。按Letournel 分類：后壁骨折6 例，后壁及后柱骨折3 例，前壁骨折、前壁及前柱骨折各2 例，雙柱骨折7 例，雙柱伴橫行骨折、髖關節脫位伴髖臼骨折各4 例，股骨頸骨折伴內壁粉碎性骨折、伴髖臼后壁骨折、伴后柱骨折、伴前壁骨折各1 例。術前常規牽引1 ～ 2 周后行手術復位內固定30 例，全髖關節置換2 例。 結果 患者術后切口均Ⅰ期愈合。全部獲隨訪6 個月～ 7 年，平均28 個月。X線片示骨折于術后12 ～ 16 周愈合。3 例發生異位骨化；1 例發生髖關節骨性關節炎，股骨頭壞死，二期行全髖關節置換；1 例坐骨神經損傷8 個月后基本恢復。參照美國矯形外科研究院評價髖關節功能的方法：優25 例，良2 例，可2 例，差3 例，優良率84.4％。 結論 術前明確骨折分類、手術時機適當、合適入路、可靠內固定及滿意復位是提高髖臼骨折治療效果的關鍵，重建鋼板技術是一種較好的治療方法，螺釘的植入方向是技術關鍵。

逆行交鎖髓內釘在股骨遠端骨折中的應用

自制過線器線纜微創內固定治療Neer Ⅱ型鎖骨遠端骨折療效觀察

目的介紹一種微創內固定方法治療Neer Ⅱ型鎖骨遠端骨折，對其臨床療效進行評估。 方法2011年3月-2013年8月，采用一種自制過線器線纜微創內固定治療15例Neer Ⅱ型鎖骨遠端骨折患者。男9例，女6例；年齡23～54歲，平均35歲。致傷原因：重物砸傷1例，交通事故傷14例。均為閉合損傷。傷后至手術時間26～42 h，平均32 h。 結果14例患者獲隨訪，隨訪時間11～24個月，平均13個月。患者均未出現傷口感染、肩鎖關節脫位、肩峰撞擊、關節強直等并發癥。X線片復查示骨折均獲骨性愈合，愈合時間9～12個月，平均11個月；其中1例患者術后骨折輕度移位（移位約3 mm）。末次隨訪時肩關節功能采用Karlsson評分標準評價，獲A級9例、B級5例。 結論自制過線器線纜微創內固定治療Neer Ⅱ型鎖骨遠端骨折操作簡便，學習曲線短，臨床療效較好。

Biomechanical stability evaluation of the fixation technique for crossed rods consisting of occipital plate and C2 bilateral lamina screws

ObjectiveTo evaluate the stability of the fixation technique for the crossed rods consisting of occipital plate and C2 bilateral lamina screws by biomechanical test.MethodsSix fresh cervical specimens were harvested and established an atlantoaxial instability model. The models were fixed with parallel rods and crossed rods after occipital plate and C2 bilateral laminae screws were implanted. The specimens were tested in the following sequence: atlantoaxial instability model (unstable model group), under parallel rods fixation (parallel fixation group), and under crossed rods fixation (cross fixation group). The range of motion (ROM) of the C0-2 segments were measured in flexion-extension, left/right lateral bending, and left/right axial rotation. After the test, X-ray film was taken to observe the internal fixator position.ResultsThe biomechanical test results showed that the ROMs in flexion-extension, left/right lateral bending, and left/right axial rotation were significantly lower in the cross fixation group and the parallel fixation group than in the unstable model group (P<0.05). There was no significant difference between the cross fixation group and the parallel fixation group in flexion-extension and left/right lateral bending (P>0.05). In the left/right axial rotation, the ROMs of the cross fixation group were significantly lower than those of the parallel fixation group (P<0.05). After the test, the X-ray film showed the good internal fixator position.ConclusionThe axial rotational stability of occipitocervical fusion can be further improved by crossed rods fixation when the occipital plate and C2 bilateral lamina screws are used.

TREATMENT OF INTERTROCHANTERIC FRACTURES WITH DYNAMIC HIP SCREW AND FEMORAL NECK ANTI-ROTATION SCREW

Objective To investigate the appl ication of anti-rotation screw after dynamic hi p screw (DHS) in treatment of intertrochanteric fracture. Methods Between April 2006 and January 2010, 22 cases of intertrochanteric fractures underwent DHS fixation operation with an anti-rotation screw, including 15 males and 7 females with an average ageof 66.3 years (range, 54-83 years). Fractures were caused by sl ipping in 16 cases, traffic accident in 5 cases, and fall ing from height in 1 case. All cases showed closed fractures, including 13 cases in the left and 9 cases in the right. Eighteen cases were simple intertrochanteric fracture, 4 cases were intertrochanteric fractures compl icated with Colles fractures. According to Evans classification standard, there were 14 cases of type I, 6 cases of type II, 1 case of type III, and 1 case of type IV. The time from wound to operation was 3-7 days (mean, 4.5 days). Results The operation time ranged from 51-95 minutes (mean, 72 minutes). The intraoperative blood loss was 150-350 mL (mean, 270 mL). The hospital ization days were 12-35 days (mean, 16.8 days). Primary heal ing was observed in all cases. All cases were followed up 6-17 months (mean, 14 months). Union of fracture was observed at 12-16 weeks (mean, 13.6 weeks); no fracture or internal fixation loosening occurred. According to HUANG Gongyi’s standard of efficacy assessment, the results were excellent in 19 cases and good in 3 cases. Conclusion Appl ication of an anti-rotation screw can help to improve the strength of the DHS for the internal fixation of intertrochanteric fracture, especially the anti-rotation abil ity, which does not increase the operation time obviously.

簡易Feloy’S尿管行腸排列外固定術治療復發性粘連性腸梗阻3例體會

近關節骨折鎳鈦記憶合金騎縫釘內固定治療探討

1984年6月～1989年10月,應用鎳鈦記憶合金騎縫釘治療近關節或關節內骨折71例,取得了滿意效果。傷口均Ⅰ期愈合。隨訪6個月～5年,未見不良反應。

Application of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures

ObjectiveTo investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures.MethodsThe clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.1 years (range, 18-60 years). The cause of injury included traffic accidents in 27 cases, tumbling in 5 cases, fall from height in 4 cases, twisted injury in 6 cases, sports injuries in 4 cases, and bruises in 7 cases. According to Lauge-Hansen classification, there were 44 cases of pronation external rotation stage Ⅳ and 9 cases of pronation abduction stage Ⅲ. The interval between injury and operation was 4-10 days (mean, 7 days). Postoperative pain and function of ankles were assessed by American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue pain scale (VAS) score. The medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle were measured by X-ray films and CT of bilateral ankle joints.ResultsThe tourniquet application time was 55-90 minutes (mean, 72.5 minutes); the frequency of fluoroscopy was 5-13 times (mean, 8.9 times). All incisions healed by first intention and no infection, deep vein thrombosis occurred after operation. All patients were followed up 28-48 months (mean, 36 months). There was no significant difference in postoperative MCS, TFCS, DFTL, the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle between bilateral ankle joints (P>0.05). At last follow-up, no ankle instability occurred and the degenerative changes of ankle joints (Kellgren-Lawrence grading Ⅱ) occurred in 5 cases. The average AOFAS score of the ankle joint was 90.84 (range, 85-95); mean VAS score was 1.23 (range, 0-5). The average dorsiflexion and plantar flexion of ankle joints was 20.24° (range, 15-25°) and 42.56° (range, 30-50°), respectively.ConclusionAnatomical approach osteoligaments repair technique in treatment of pronation ankle fractures can expose the talocrural joint and lower tibiofibular syndesmosis clearly, repair the osteoligaments injury directly, and assist the syndesmosis and talocrural joint reduction, and decline the incidence of ankle degeneration.

PRELIMINARY APPLICATION OF ABSORBABLE FIXATION SYSTEM ON CRANIAL BONE FLAP REPOSITION AND FIXATION AFTER CRANIOTOMY

Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.