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TREATMENT OF ISCHEMIC NECROSIS OF THE FEMORAL HEAD BY TRANSPLANTATIONOF PEDICLED BONE FLAP WITH DEEP ILIAC CIRCUMFLEX VESSEL

Objective To investigate the treatment method of ischemic necrosis of the femoral head by the transplantation of pedicled bone flap with deep iliac circumflex vessel in adult and to assess its curative effect. Methods From February 1996 to September 2003, 46 adult patients with ischemic necrosis of thefemoral head (58 coxas) were treated by transplantation of pedicled bone flap with deep iliac circumflex vessel. The locations were the left side in 34 coxas and the right side in 24 coxas（stage Ⅱ in 16 coxas, stage Ⅲ in 39 coxas and stage Ⅳ in 3 coxas）.Results Thirty-seven patients (40 coxas) were followed up 6 months to 10 years after operation. According to the assess of FanQishen,the result was excellent in 19 cases (21 coxas), good in 11 cases (12 coxas), fair in 5 cases (5 coxas) and poor in 2 cases (2 coxas). The postoperative excellent and good rate was 81%. Conclusion Operative treatment of ischemic necrosis of the femoral head in adult by transplantation of bone flap pedicled with deep iliac circumflex vessel has the characteristics of restoration of blood supply ofthe femoral head, decompression of marrow cavity, elimination of necrotic bone and support of the femoral head. It is an effective and advanced method for treatment of ischemic necrosis of the femoral head in adult.

雙側非典型股骨骨折術中再骨折的治療

不同方法治療股骨粗隆間骨折

【摘 要】 目的 探討不同方法治療股骨粗隆間骨折的手術適應證及療效。 方法 1999 年1 月－ 2006 年12 月，收治176 例股骨粗隆間骨折患者。男103 例，女73 例；年齡34 ～ 91 歲，平均63.5 歲。交通傷31 例，高處墜落傷11 例，跌倒傷134 例。按AO 分型：31A1 型79 例，31A2 型18 例，31A3 型7 例，31B 型15 例，32A 型34 例，32B 型12 例，32C型11 例。病程2 h ～ 7 d。35 例采用非手術治療，83 例采用動力髖螺釘（dynamic hip screw，DHS）固定，23 例采用股骨近端髓內釘（proximal femoral nails，PFN）固定，27 例采用動力髁螺釘（dynamic condyle screw，DCS）治療，8 例采用解剖鋼板手術治療。 結果 患者均獲隨訪6 個月～ 7 年，平均15.2 個月。非手術治療組3 例骨折不愈合，均放棄治療。解剖鋼板手術治療組1 例術后10 周發生鋼板斷裂，予對癥處理骨折愈合。余患者于術后10 ～ 15 周骨折達臨床愈合。6 個月后髖關節功能根據Brumback 評價標準評定，非手術治療者優9 例，良18 例，差8 例；DHS 手術治療者優68 例，良12例 ，差3 例；PFN 手術治療者優18 例，良5 例；解剖鋼板手術治療者優5 例，良1 例，差2 例；DCS 手術治療者優15 例，良11 例，差1 例。 結論 股骨粗隆間骨折首選手術治療，手術方案應綜合考慮骨折類型、內固定器材特點以及患者病情，采取個性化的治療方案。

Effects of Rehabilitation Education and Training Interventions on Perioperative Patients with Femoral Shaft Fractures

【摘要】　目的　探討康復宣教與訓練等干預手段對股骨干骨折患者圍手術期的影響。　方法　2010年6月－2011年3月收治股骨干骨折患者90例，其中男48例，女42例；年齡17~58歲，平均38歲。開放性骨折28例，閉合性骨折62例。股骨骨折部位:上1/3骨折33例，中1/3骨折35例，下1/3骨折20例，多段骨折2例。橫形骨折20例，斜形骨折30例，粉碎性骨折40例。將90例患者隨機分為康復組（46例）和對照組（44例）。對照組采用骨科術前常規處理，康復組采用骨科術前常規處理加康復宣教與訓練。　結果　康復組住院時間為（5.35±1.27） d，對照組為（7.67±1.85） d，兩組比較差異有統計學意義（Plt;0.05）。 康復組治療后發生并發癥7例，對照組16例，康復組并發癥發生率（15.2%）明顯低于對照組（36.4%），差異有統計學意義（Plt;0.05）。治療后5 d，康復組療效獲優35例，良6例，可3例，差2例，優良率89.1%；對照組獲優25例，良5例，可12例，差2例，優良率68.2%；兩組療效比較差異有統計學意義（Plt;0.05）。　結論　康復宣教與訓練能預防與改善股骨干骨折圍手術期臥床引起的并發癥，減輕患者腿部疼痛及腫脹，縮短圍手術期時間，使患者能盡早手術，加快住院床位周轉，提高患者生活質量。【Abstract】　Objective　To explore the effects of rehabilitation education and training interventions on perioperative patients with femoral shaft fractures.　Methods　A total of 90 patients with femoral shaft fractures were selected from June 2010 to March 2011, including 48 males and 42 females aged from 17 to 58 years (mean 38 years). In these 90 patients, open fracture was in 28 and closed fracture was in 62. Fracture site: upper 1/3 fracture was in 33, middle 1/3 fracture was in 35, lower 1/3 fracture was in 20 and multiple fractures was in 2. There were transverse fractures in 20 patients, oblique fractures in 30 patients and comminuted fractures in 40 patients. All of the patients were randomly divided into experimental group (46 patients) and control group (44 patients). The patients in the control group underwent the routine treatment before the orthopedic surgery; besides the routine treatment, the patients in the experimental group were given the rehabilitation education and training before the orthopedic surgery.　Results　The hospital duration in the rehabilitation group was (5.35±1.27) days while in the control group was (7.67±1.85) days, the difference was statistically significant (Plt;0.05). There were 7 cases who had complications in rehabilitation group compared with 16 patients in the control group; the incidence of the complications in the rehabilitation group (15.2%) was significantly lower than that in the control group (36.4%) (Plt;0.05). After the treatment for 5 days, the therapeutic effect in rehabilitation group were excellent in 35 cases, good in 6 cases, middle in 3 cases and poor in 2 cases (with the good rate of 89.1%); while in the control group were excellent in 25 cases, good in 5 cases, middle in 12 cases and poor in 2 cases (with the good rate of 68.2%); the difference was significant between the two groups (Plt;0.05).　Conclusion　Rehabilitation education and training could prevent the perioperative complications in patients with femoral shaft fracture, decrease the pain and edema, speed up the turnover of hospital beds, and improve the patients’ quality of life.

動力髖螺釘在股骨粗隆間骨折的應用

縫匠肌蒂髂骨瓣及加壓螺釘在中青年

目的 總結切開復位、加壓螺釘內固定及縫匠肌蒂髂骨瓣移植術治療中青年股骨頸骨折患者的臨床效果。方法 2003年2月～2005年11月，采用縫匠肌蒂髂骨瓣移植，3根空心加壓鈦螺釘內固定術，治療中青年股骨頸骨折患者52例。男37例，女15例；年齡19～52歲，平均46.4歲。車禍傷29例，墜落傷15例，跌傷8例。左側23例，右側29例。股骨頸骨折頭下型27例，經頸型18例，基底型7例。骨折按Garden分型：Ⅱ型16例，Ⅲ型25例，Ⅳ型11例。傷后至手術時間4h～15d。結果 術后切口均Ⅰ期愈合。39例獲隨訪6～41個月。35例術后23～39周骨折愈合，4例股骨頭壞死。療效評定按粱雨田等標準：優19例，良14例，可2例，差4例。髖關節功能按Harris評分標準：優良33例，平均86.1分；可2例，平均65.0分；差4例，平均51.3分。結論以縫匠肌為蒂的髂骨瓣移植及3枚空心加壓鈦螺釘內固定，可提供股骨頸骨折后股骨頭的血供，有植骨支撐，促進骨折愈合，是手術治療中青年股骨頸骨折的有效方法之一。

AN EXPERIMENTAL OSTEONECROSIS OF FEMORAL HEAD INDUCED BY A COMBINATION OF A SINGLELOW-DOSE LIPOPOLYSACCHARIDE AND METHYLPREDNISONE

【Abstract】 Objective To investigate both incidence and mechanism attributing to steroid-associated osteonecrosisof femoral head(ONFH) using an experimental protocol with a single low-dose l i popolysaccharide (LPS) injection andsubsequently three injections of high-dose methylprednisolone (MPS). Methods Twenty-five New Zealand white rabbits with body weight of (3.0 ± 0.3) kg were divided randomly into 2 groups. In treatment group, 19 rabbits received one intravenous injection of LPS (10 μg/kg); 24 hours later, three injections of 20 mg/kg of MPS were given intramuscularly at an interval of 24 hours. Additional 6 rabbits which received normal sal ine injection at the same time point were used as controls(control group). The blood samples were collected for hematological examinations before and after LPS injection, MRI was performed on bilateral hip six weeks after last MPS injection, meanwhile, bone marrow was aspirated from femoral head region to evaluate stem cell’s activity. Bilateral femoral heads were harvested to make histopathology examination. Results All animals survived throughout the experiment period except one death on the second day after LPS injection. In the histopathological examinationfor the femoral head, ONFH+ was observed in 16 rabbits (88.9%), and the lesions were mainly in the metaphysis. In ONFH+ rabbits, micro vessels fibrous thrombosis and extravascular marrow fat cell size increasing were found around necrotic bone; The femoral heads of control group had no changes. MRI accurate ratio was 93.8% (15/16). Compared to basel ine, a significant decrease in ratio of tissue plasminogen activator/plasminogen activator inhibitor 1 and activated partial thromboplatin time, and a significant increase in ratio of low-density l ipoprotein/high-density l ipoprotein were only found in ONFH+ rabbits (P lt; 0.05). Meanwhile there was a significant decrease in the number of CFU-F (8.50 ± 9.63) compared with the control (70.17 ± 7.78, P lt; 0.05). Conclusion A single low-dose LPS injection and subsequent three injections of high-dose MPS is effective on building steroid-associated ONFH model, coagulation and l ipometabol ism abnormal ity, activity degeneration of stem cell may be the key factors of ONFH.

動力髖螺釘結合拉力螺釘治療股骨轉子間骨折

目的 探討動力髖螺釘（dynamic hip screw， DHS）結合拉力螺釘治療股骨轉子間骨折的療效。方法 1996年4月～2005年5月，采用DHS結合拉力螺釘治療股骨轉子間骨折78例。其中男42例，女36例；年齡30～90歲，平均65歲。骨折按TronzoEvans分類：Ⅰ型2例，Ⅱ型51例，Ⅲ型16例，Ⅳ型6例，Ⅴ型3例。傷后3～12 d行手術。 結果 術后患者切口均Ⅰ期愈合。72例獲隨訪6個月～4年，平均2年。X線片檢查示骨折斷端對位對線良好，8～14個月骨折線消失，骨折愈合。根據黃公怡療效評定標準，優29例，良36例，可6例，差1例，優良率90.2%。 結論 DHS結合拉力螺釘治療股骨轉子間骨折具有固定確切、抗旋轉等優點，是一種治療股骨轉子間骨折的有效方法。

ABSTRACTSTHE CAUSES AND PROPHYLAXIS OF FUNCTIONAL IMPAIRMENT OF KNEE FOLLOWINGINTERNAL FIXTION OF FRACTURE OF FEMUR

The treatment of open reduction and internal fixation was carried out in 480 cases of fractures offemoral shafts. Patients were followed up in an average of 7. 6 years, 50 cases, rate of occurrence of10. 4%, had varying degrees of functional impairment of knee. It was considered that thecharacteristics of fractures, the time of oporation , selection of incision , the types of internal fixationdevices, and the duration of external immobilization were the main causes related to the occurren...

Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients

ObjectiveTo compare the effectiveness of femoral neck system (FNS) and cannulate compression screw (CCS) in the treatment of femoral neck fractures in young and middle-aged patients. MethodsThe clinical data of 82 young and middle-aged patients with femoral neck fracture treated between January 2018 and September 2020 were retrospectively analyzed. They were divided into FNS group (24 cases) and CCS group (58 cases) according to different surgical methods. There was no significant difference between the two groups (P>0.05) in general data such as gender, age, height, body mass, cause of injury, complications, fracture location, and fracture classification (Garden classification and Pauwells classification). The operation time, intraoperative blood loss, complications (nonunion, osteonecrosis of the femoral head, shortening of femoral neck, etc.), visual analogue scale (VAS) score at 2 days after operation, clinical healing time of fracture, and Harris score of hip joint after operation were recorded and compared between the two groups. ResultsThe operation time and VAS score at 2 days after operation in FNS group were significantly lower than those in CCS group (P<0.05); there was no significant difference in intraoperative blood loss between the two groups (t=0.263, P=0.796). The patients in CCS group were followed up 6-18 months, with an average of 13.6 months; and the follow-up time in FNS group was 3-12 months, with an average of 7.3 months. There was no complication of internal fixator loosening in both groups. There were 2 cases of osteonecrosis of the femoral head, 1 case of bone nonunion, and 13 cases of femoral neck shortening in CCS group and only 2 cases of femoral neck shortening in FNS group. The difference in the incidence of complications between the two groups (27.6% vs. 8.3%) was significant (χ2=36.670, P=0.015). In CCS group, 3 cases underwent secondary artificial hip arthroplasty due to bone nonunion and osteonecrosis of the femoral head, and the remaining 55 cases achieved clinical healing; in FNS group, 6 patients excluded in the statistics because the follow-up time was less than 6 months, and the remaining 18 fractures healed clinically; there was significant difference in fracture healing time between the two groups (t=4.481, P=0.000). The difference of Harris score of hip joint between 9 months and 6 months after operation in FNS group was significantly higher than that in CCS group (P<0.05), and the Harris score at 9 months after operation was significantly higher than that at 6 months after operation in both groups (P<0.05). ConclusionFNS can accelerate the healing of femoral neck fractures in young and middle-aged patients, so that patients can start functional exercise as soon as possible, thereby reducing the incidence of related complications.