目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分...目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分为对照组(采取腓骨截骨术进行治疗,20例)与观察组(采取内侧开放性楔形胫骨高位截骨进行治疗,20例),研究观察两种截骨术的临床疗效。结果与对照组相比,观察组失血量较多[(327.62±115.84)mL vs(251.28±84.44)mL],差异有统计学意义(t=2.382,P<0.05);观察组血红蛋白变化量较多,差异有统计学意义(P<0.05);观察组术后16 h的视觉模拟评估量表(Visual Analogue Scale,VAS)分数较低[(1.32±0.57)分vs(1.86±0.97)分],差异有统计学意义(t=2.147,P<0.05);同时较之治疗前,两组患者治疗后膝关节功能(Hospital for special surgery,HSS)分数与骨性关节炎(Weern Otario and Mcmaster Universities Osteoarthritis,WOMAC)分数均更高,差异有统计学意义(P<0.05)。两组手术治疗时间、止血带使用时间、术后8 h与24 h的VAS分数、治疗前后HSS分数与WOMAC分数比较,差异无统计学意义(P>0.05)。结论与腓骨截骨术相比,内侧开放性楔形胫骨高位截骨治疗膝内侧室骨关节炎效果更佳。内侧开放性楔形胫骨高位截骨能够减轻术后疼痛感,值得推荐。展开更多
对开放性楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)的并发症外侧铰链骨折(later hinge fracture,LHF)及其防治方法进行综述。方法:查阅近年来国内外OWHTO及LHF的相关文献,对LHF的病因、并发症及防治方法进行总结分...对开放性楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)的并发症外侧铰链骨折(later hinge fracture,LHF)及其防治方法进行综述。方法:查阅近年来国内外OWHTO及LHF的相关文献,对LHF的病因、并发症及防治方法进行总结分析。结果:LHF的发生与铰链的位置与大小、截骨间隙、内固定的选择及其他因素等有关,LHF的发生可导致截骨部位不稳定、矫正失效及截骨延迟愈合和不愈合,应用拉力螺钉及顶端钻孔可以降低LHF发生的风险。结论:LHF的防治方法理论上有效,但未广泛投入临床使用,仍需进一步床实践验证。展开更多
Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue de...Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months. Results: The size of the flap ranged from 6.6 cm 2 to 28.18 cm 2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series. Conclusions: For soft tissue defect of delayed open tibial fracture Type IIIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for any secondary manipulation; and ③ to use serial debridement to diminish flap failure.展开更多
文摘目的在膝内侧间室骨关节炎临床治疗过程中采取两种截骨术(腓骨截骨、内侧开放性楔形胫骨高位截骨),研究比较其临床治疗。方法选取2021年1月—2022年1月南通市第二人民医院所治疗的40例膝内侧间室骨关节炎患者,根据手术治疗方案将其均分为对照组(采取腓骨截骨术进行治疗,20例)与观察组(采取内侧开放性楔形胫骨高位截骨进行治疗,20例),研究观察两种截骨术的临床疗效。结果与对照组相比,观察组失血量较多[(327.62±115.84)mL vs(251.28±84.44)mL],差异有统计学意义(t=2.382,P<0.05);观察组血红蛋白变化量较多,差异有统计学意义(P<0.05);观察组术后16 h的视觉模拟评估量表(Visual Analogue Scale,VAS)分数较低[(1.32±0.57)分vs(1.86±0.97)分],差异有统计学意义(t=2.147,P<0.05);同时较之治疗前,两组患者治疗后膝关节功能(Hospital for special surgery,HSS)分数与骨性关节炎(Weern Otario and Mcmaster Universities Osteoarthritis,WOMAC)分数均更高,差异有统计学意义(P<0.05)。两组手术治疗时间、止血带使用时间、术后8 h与24 h的VAS分数、治疗前后HSS分数与WOMAC分数比较,差异无统计学意义(P>0.05)。结论与腓骨截骨术相比,内侧开放性楔形胫骨高位截骨治疗膝内侧室骨关节炎效果更佳。内侧开放性楔形胫骨高位截骨能够减轻术后疼痛感,值得推荐。
文摘对开放性楔形胫骨高位截骨术(open wedge high tibial osteotomy,OWHTO)的并发症外侧铰链骨折(later hinge fracture,LHF)及其防治方法进行综述。方法:查阅近年来国内外OWHTO及LHF的相关文献,对LHF的病因、并发症及防治方法进行总结分析。结果:LHF的发生与铰链的位置与大小、截骨间隙、内固定的选择及其他因素等有关,LHF的发生可导致截骨部位不稳定、矫正失效及截骨延迟愈合和不愈合,应用拉力螺钉及顶端钻孔可以降低LHF发生的风险。结论:LHF的防治方法理论上有效,但未广泛投入临床使用,仍需进一步床实践验证。
文摘Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months. Results: The size of the flap ranged from 6.6 cm 2 to 28.18 cm 2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series. Conclusions: For soft tissue defect of delayed open tibial fracture Type IIIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for any secondary manipulation; and ③ to use serial debridement to diminish flap failure.
