关节镜下内踝骨折内固定远期疗效评价

目的对内踝骨折微创术患者进行远期随访,探讨关节镜下内踝骨折内固定法的临床应用价值。方法关节镜下内固定法治疗内踝骨折61例,设为实验组;随访同期采用传统开放性术式58例患者,设为对照组。观察两组病例术后5年的疗效,均采用AOFAS和Mcgure踝关节评分及X线、MRI检查评定标准评价疗效,比较两组患者远期疗效的差异。结果实验组61例痊愈,AOFAS评分优良率为(88±3.6)%,Mcgure优良率达(91±4.7)%;对照组58例均痊愈,AOFAS评分优良率为(85±4.2)%,Mcgure优良率达(87±5.3)%。两组评分比较差异均有统计学意义(P<0.05)。结论关节镜下内固定治疗内踝骨折创伤小,后遗症少,远期效果较传统切开法好,值得临床深入研究。

新型成人后路寰椎骨折钉板复位内固定系统的设计

背景:目前临床上一直缺乏复位良好、操作简便的后路单节段固定治疗寰椎爆裂性骨折的内固定系统。目的:基于寰椎CT测量数据设计并优化一种符合人体局部解剖结构特征,操作简便且复位优良的新型后路寰椎骨折钉板复位内固定系统。方法:回顾性分析了347例成人的CT图像,在图像上依次测量内倾角0°经后弓侧块螺钉轨迹长度、最大内侧倾斜角与此时经后弓侧块螺钉轨迹的长度、寰椎椎动脉沟底部后弓高度、两侧经后弓侧块螺钉进针点距正中矢状面的距离、寰椎后弓半径、寰椎后结节至枕骨大孔后缘和寰椎后结节至枢椎椎弓上表面的距离,分析数据并设计优化一种符合人体解剖学特征的寰椎骨折复位内固定系统。结果与结论:①所有受试者两侧的内倾角0°螺钉轨迹长度、最大内倾角度、最大内倾角螺钉轨迹长度、寰椎椎动脉沟底部后弓高度、进钉点至正中矢状面距离、寰椎后弓外侧缘半径、寰椎后结节至枕骨大孔后缘距离、寰椎后结节至枢椎棘突上表面距离的差异均无显著性意义(P>0.05),上述各指标在男性与女性组间比较差异均有显著性意义(P<0.05);②研究成功设计了新型寰椎骨折复位内固定系统,并获得国家专利;该内固定系统适合寰椎后弓解剖学特征,既可有效治疗寰椎爆裂性骨折,又可保留枕寰枢关节运动功能。

内固定法治疗股骨远端骨折的临床研究

目的:对内固定法治疗股骨远端骨折的效果进行分析评价。方法:60例股骨远端骨折患者随机分为观察组和对照组两组,每组30例,疗程结束后所有对象均进行调查研究,并对2组患者治疗结果进行比较。结果:观察组在治疗后临床效果明显优于对照组。结论:逆行髓内钉法治疗股骨远端骨折的方式有明显效果,值得在临床推广。

髋关节置换术与内固定术治疗老年股骨颈骨折的临床对比研究

目的探讨老年股骨颈骨折患者采用髋关节置换术与骨折内固定术治疗的临床效果。方法选取该院2016年7月—2017年7月收治的92例老年股骨颈骨折患者为研究对象,将其随机分为两组,观察组46例患者采用全髋关节置换术进行治疗,对照组46例患者采用切开复位内固定术,比较两组患者的治疗效果、手术情况、再手术率和术后并发症发生率。结果观察组患者的优良率为91.30%,对照组患者为76.09%,观察组患者的优良率明显高于对照组患者(P<0.05)。观察组患者的术后卧床时间,明显短于对照组患者(P<0.05)。观察组患者的再手术率和术后并发症发生率分别为0.00%和8.70%,明显低于对照组患者的32.61%和32.61%(P<0.05)。结论老年股骨颈骨折患者采用髋关节置换术治疗,能降低再手术率和并发症发生率,缩短术后卧床时间,提高治疗效果。

中医活血益肾法对三踝骨折切开复位内固定术后踝关节功能康复的影响

目的探究三踝骨折切开复位内固定术后辅以中医活血益肾法治疗的疗效及对踝关节功能康复的影响。方法选择2018年7月—2019年6月在河北省沧州中西医结合医院接受切开复位内固定术治疗的三踝骨折患者116例,随机分为2组,每组58例。对照组在单纯切开复位内固定术后于CPM机上进行足踝部早期功能锻炼,观察组在此基础上予以自拟活血益肾汤治疗4周,观察对比2组康复时间、踝关节功能等康复指标、临床疗效及术后并发症发生情况。结果观察组术后开始下床活动时间、住院时间、骨折愈合时间均短于对照组(P均<0.05),观察组术后4周VAS评分、患肢肿胀程均低于对照组(P均<0.05),观察组术后随访6个月Biard-jackson评分、RUSS评分均高于对照组(P均<0.05)。术后3个月,观察组临床总有效率为93.1(54/58),高于对照组的79.3%(46/58),差异有统计学意义(P<0.05)。观察组术后并发症率为6.9%(4/58),低于对照组的15.5%(9/58),差异有统计学意义(P<0.05)。结论在三踝骨折切开复位内固定术后辅以中医活血益肾汤治疗疗效确切,有助于促进患者早期康复,减轻患肢疼痛及肿胀程度,促进骨折愈合及踝关节功能康复,并可减少术后并发症发生。

医用钛缆环扎加“8”字张力带内固定在髌骨骨折治疗中的应用

目的探讨医用钛缆张力带在髌骨骨折中的应用价值。方法2009年10月至2012年12月102例髌骨骨折，均遵循张力带原则，行环扎加“8”字张力带内固定术治疗，根据内固定材料分成医用钛缆组和带针钢丝组。比较两组术后首次锻炼时间、住院时间、医疗费用、并发症及远期膝关节功能情况。结果102例患者术后随访10周～8个月，末次随访时骨折均达骨性愈合标准。两组患者在术后首次锻炼时间、住院时间方面无明显差异。医用钛缆组费用较高。医用钛缆组在并发症及远期膝关节功能上优于带针钢丝组。结论医用钛缆在行张力带内固定治疗髌骨骨折具有内固定坚强、便于术后早期功能锻炼，弥补带针钢丝内固定强度不足的缺点。

利用折尾加压螺丝钉内固定治疗股骨转子间骨折

股骨转子间骨折是老年人常见的骨折之一,过去多采取保守治疗,如牵引或肢体外展中立位卧床治疗,但需长时间卧床,并发症发生率较高.近年来随着内固定物与治疗方法的不断改进,多采取手术治疗.但是,在众多的手术疗法中,有的操作复杂、创伤较大,有的固定不牢固.参考有关文献,笔者认为加压螺丝钉能有效地避免上述问题.自1995年10月～2001年10月,我院利用折尾加压螺丝钉内固定治疗股骨转子间骨折36例,取得较满意的临床疗效.

Mimics软件和快速成型技术在寰枢椎椎弓根钉个体化置入的应用

目的利用Mimics软件和快速成型技术辅助s设计寰椎椎弓根钉个体化置入方案,辅助行寰椎枢椎骨折、脱位后路复位内固定手术治疗。方法对成人寰枢椎标本进行CT扫描收集数据,将生成数据导入Mimics软件对寰枢椎标本进行三维重建,并利用该软件相关功能在三维重建图像上寻找寰枢椎椎弓根螺钉置入最佳轴线并对相关数据进行测量;以重建三维图像为模板,以寰椎后弓及枢椎棘突为解剖标志,利用卡扣技术设计螺钉置入导向器,将重建椎体模型及3D导向器图像以STL格式导入3D打印机,制作椎体模型及导向器。将应用置钉导向器置钉患者病历资料进行数据分析,与传统椎弓根螺钉手术患者病历资料数据进行对比分析。结果成功建立了与标本相似度极高的寰枢椎三维重建图像和实物模型,并成功的制作了置钉导向器,成功对50例患者在置钉导向器下进行寰枢椎椎弓根置钉,与传统椎弓根螺钉手术患者相比,研究组置钉可接受率为100%显著的高于对照组的置钉可接受率87.5%(P<0.05)。术后患者JOA评分更高(P<0.05)。结论利用Mimics软件和快速成型技术辅助设计寰椎椎弓根钉个体化置入方案能偶显著的提高置钉的准确性,能偶提高治疗效果。

Comparative study of various internal fixation methods for treating patellar fractures by three-dimensional photoelasticity

Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.

Pseudoaneurysm of profunda femoris artery following dynamic hip screw fixation for intertrochanteric femoral fracture

Dynamic hip screw fixation is a com- monly performed procedure for internal fixation of intertro- chanteric femoral fractures. Arterial injury following the operative fixation is a rare but serious event. We present a patient who developed pseudoaneurysm ofprofunda femo- ris artery after internal fixation of intertrochanteric fracture with a dynamic hip screw. The diagnosis was confirmed by angiographic study and it was successfully treated by coil embolization.

The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

Purpose： Complete visualization of certain acetabular fractures of posterior wall or column with cranial extension involving superior dome from standard surgical exposures is a challenge. Osteotomy of the greater trochanter has been used to enhance fracture visualization, especially the dome, in posterior and lateral exposures of the acetabulum, it also decreases the need for excessive muscle retraction. The purpose of the study was to investigate the outcome associated with trochanteric flip osteotomy in the management of certain acetahulum fractures. Methods： From January 2011 to December 2013, 25 displaced acetabular fractures were treated by open reduction and internal fixation. The fractures were managed using a Kocher-Langenbeck approach along with trochanteric flip osteotomy. At 3rd, 6th and 24th month follow-up, all patients had radiographic examination and underwent a final clinical evaluation based on the modified Merle d＇Auhigne and Postei score. The strength of the abductors was assessed according to the Medical Research Council （MRC） grading system. Results： Congruent reduction was achieved in all patients and all osteotomies healed within an average period of 3.8 months. All our patients were allowed full weight bearing at the end of 3 months and with no abductor lurch at the end of 6 months follow-up. There were no cases of avascular necrosis of femoral head. None of the patients had any neurovascular complication or infection by the end of the follow-up period. Conclusion： Truchanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant com- plications compared with conventional way.

Preparation of chitosan rods with excellent mechanical properties: One candidate for bone fracture internal fixation

Chitosan (CS) is one promising material as a temporary mechanical supporter for bone fracture internal fixation.In our previous work,we successfully fabricated CS rods through one in situ precipitation route.But bending strength and bending modulus of CS rods need to be improved to match the commercially available devices used for bone fracture internal fixation.In this research,CS rods were reinforced effectively through cross-linking reaction by using glutaraldehyde as the coupling reagent.Schiff’s base was detected by FTIR due to the chemical reaction between amino groups and aldehyde groups.Crystal plane space of CS rods became small during the formation of network structure.Microstructure was observed by SEM,indicating that layer-by-layer structure became much tighter after cross-linking reaction,and cracks in one layer turned around when they reached another layer to absorb energy.Bending strength and bending modulus of cross-linked CS rods could reach 186.3 MPa and 5.17 GPa,respectively.Compared with uncross-linked CS rods,they are increased by 101.6% and 26.1%,respectively.As a result,mechanical properties of CS rods are equivalent to the commercially available biodegradable devices.CS rods with excellent mechanical properties are a good candidate for bone fracture internal fixation.

Screw placement of pedicle of vertebral arch-pay great attention to segmental differences of the pedicle

Objective: To investigate appropriate ways for screw placement of pedicle of vertebral arch in the horizontal plane. Methods: Fifteen preserved thoracolumbar spine specimens (T 11 L 5) were used and divided into three groups at random. Firstly four anatomic parameters indicating screw positions in the horizontal plane were measured. Secondly the methods of Roy camille, Magerl, and authors’segmental differences were used to place successively the screws of the pedicles with 5 mm, 6 mm, and 7 mm in diameter. Coincidences between the drilling point, drilling direction and pedicle axis, and ruptures of the pedicle as well as the length of the screw in the vertebral body were observed. Results: Four anatomic parameters at various segments showed significant differences (P < 0.05 ). The drilling point by the Roy camille’s method deviated medial to pedicle axis in most segments, and its drilling direction did not coincide well with most E angles of the pedicles. The drilling point by Magerl’s method coincided relatively well with pedicle axis in lumbar vertebrae, but there were still some differences between its drilling direction and E angles of the pedicles. The method of segmental differences coincided the best with the pedicle axis. The lengths of screw in the vertebra were relatively long by both Magerl and segmental difference methods. When 5 mm diametral screw was used by the three methods, the rupture rate was very low. When 6 mm and 7 mm diametral screws were placed, the rupture rate was accordingly increased. Of the three methods, Roy camilles method showed a relatively high rupture rate, while the method of segmental differences a comparatively low rupture rate. Various degrees of rupture of the pedicle of vertebral arch were found at the juncture of the thoracic and lumbar vertebrae when 6 mm or 7 mm diametral screws was used by any screw placement method. In contrast, the rupture was seldom seen at the lower lumbar vertebrae when 7 mm diametral screws were used.Conclusions: The segmental difference method is proved to have the anatomic safety and screw biomechanical stability. It is appropriate to choose different diametral screws, different drilling points and directions according to different segments of the vertebra.

Management of limb fractures in a teaching hospital： comparison between Wenchuan and Yushu earthquakes

Objective： To comparatively analyze the medical records of patients with limb fractures as well as rescue strategy in Wenchuan and Yushu earthquakes so as to provide references for post-earthquake rescue. Methods： We retrospectively investigated 944 patients sustaining limb fractures, including 891 in Wenchuan earthquake and 53 in Yushu earthquake, who were admitted to West China Hospital （WCH） of Sichuan University. Results： In Wenchuan earthquake, WCH met its three peaks of limb fracture patients influx, on post-earthquake day （PED） 2, 8 and 14 respectively. Between PED 3-14, 585 patients were transferred from WCH to other hospitals out- side the Sichuan Province. In Yushu earthquake, the maxi- mum influx of limb fracture patients happened on PED 3, and no one was shifted to other hospitals. Both in Wenchuan and Yushu earthquakes, most limb fractures were caused by blunt strike and crush/burying. In Wenchuan earthquake, there were 396 （396/942, 42.0%） open limb fractures, includ- ing 28 Gustilo I, 201 Gustilo II and 167 Gustilo III injuries. But in Yushu earthquake, the incidence of open limb fracture was much lower （6/61, 9.8%）. The percent of patients with acute complications in Wenchuan earthquake （167/891,18.7%） was much higher than that in Yushu earthquake （5/53, 3.8%）. In Wenchuan earthquake rescue, 1 018 surgeries were done, composed of debridement in 376, internal fixation in 283, external fixation in 119, and vacuum sealing drainage in 117, etc. While among the 64 surgeries in Yushu earthquake rescue, the internal fixation for limb fracture was mostly adopted. All patients received proper treatment and sur- vived except one who died due to multiple organs failure in Wenchuan earthquake. Conclusion： Provision of suitable and sufficient medi- cal care in a catastrophe can only be achieved by construc- tion of sophisticated national disaster medical system, pre- diction of the injury types and number of injuries, and con- flrmation of participating hospitals＇ exact role. Based on the valuable rescue experiences after Wenchuan earthquake, the rescue was faster, more orderly and effective in Yushu earthquake. Nevertheless, there is still a long way to go in the development of a stronger emergent response to the disasters.

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.

A Galeazzi-variant type fracture-dislocation in adults

Objective：Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint （DRUJ） is not a common injury and is inherently unstable.Here we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury pattern.Methods：The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age （20 to 45 years）.All fractures were closed type.Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft.After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.Results：All cases were followed up for 24 weeks.The maximum incidence occurred in age group between 31 and 40 years.All the fractures of both radius and ulna were united in average time of 12 weeks.Range of motion of wrist and elbow,supination and pronation at final follow-up were normal.There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.Conclusion：Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury.Stable open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

Comparative study on treatment of midshaft tibial fracture with expandable and interlocking intramedullary nails

Objective ： To evaluate the clinical results of treatment of midshaft tibial fracture with expandable intramedullary nails compared with interlocking intramednilary nails. Methods： From June 2003 to August 2005, 46 patients （27 males and 19 females, aged 20-74 years, mean =38.4 years ） with midshaft tibial fracture were treated surgically in our department. The causes of fractures were traffic injury in 21 patients, fall injury in 6, tumbling injury in 11 and crushing injury in 8. According to AO/ ASIF classification, Type A fracture was found in 16 patients, Type B in 11, Type C1 in 5, and Type C2 in 2. Open fractures were found in 12 patients, according to Gustilo classification, Type Ⅰ in 9 patients and Type Ⅱin 3 patients. Based on the patients＇consent, 24 patients were treated with expandable intramedullary nails （Group A ） and 22 with interlocking intramedullary nails （Group B ）. The operation time, blood loss during operation, X-ray fluoroscopic times, hospitalization time, weight bearing time after operation, healing time of fracture and complications of all the patients were recorded. The clinical effects of all the cases were evaluated according to the criteria of Johner-Wruhs. Results： All the patients were followed up for 12,34 months （ mean = 16.2 months）. The time of operation, the blood loss, X-ray fluoroscopic times, hospitalization time and healing time of fracture of Group A significantly decreased （P 〈 0.05 ） compared with those of Group B, but the time for weight bearing after operation, the Johner- Wruhs degree of clinical effects and complications had no significant difference between Group A and Group B （P〉0.05）. Conclusions： Expandable intramedullary nail can shorten operation time, decrease blood loss and reduce invasion, which is a safe and effective treatment method for tibial midshaft fracture.