小型犬桡尺骨骨折的PRCL-S5型锁定骨板固定术诊疗

小型犬尤其是玩具型犬的桡尺骨远端骨折的治疗属于临床上的一大难题。治疗过程中需要考虑的问题有很多,如骨折不愈合、延迟愈合、骨髓腔堵塞、应力遮蔽和应力集中等。使用PRCL-S5型锁定骨板对小型犬桡尺骨远端进行内固定治疗,结合适当的术后护理措施,恢复良好。对常用的内固定方案进行了比较分析。

股骨颈加压锁定骨板与空心拉力螺钉治疗青年股骨颈骨折的效果比较

目的比较股骨颈加压锁定骨板与空心拉力螺钉治疗青年股骨颈骨折的效果。方法选取遵义医学院附属第五(珠海)医院2013年1月~2016年3月收治的60例青年股骨颈骨折患者作为研究对象,根据患者手术意愿将其分为观察组(34例)和对照组(26例)。观察组采取股骨颈加压锁定骨板治疗,对照组采取空心拉力螺钉治疗。比较两组的手术时间、手术出血量、骨折愈合时间、术后6个月及12个月的髋关节髋关节功能评分(Harris评分)、术后并发症发生率。结果观察组的手术时间长于对照组,术中出血量多于对照组,差异有统计学意义(P<0.05)。观察组的术后骨折愈合时间短于对照组,术后6个月的髋关节Harris评分及术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。两组术后12个月的Harris评分比较,差异无统计学意义(P>0.05)。结论股骨颈加压锁定骨板治疗青年股骨颈骨折具有减少骨折愈合时间、早期功能锻炼、并发症少的优势,值得临床应用。

股骨颈加压锁定骨板在股骨颈骨折中的应用

目的:为提高股骨颈骨折内固定的稳定性,减少股骨头的坏死率。方法:应用股骨颈加压锁定骨板治疗股骨颈骨折50例。结果:术后随访时间最长2年,最短1年,其中46例获得骨性愈合,关节功能恢复满意,3例因入院时已伤后2～3周,骨折端欠新鲜,后期发生股骨头坏死;1例因术后不遵医嘱过早负重致股骨头变性坏死,改行人工关节置换。结论:股骨颈加压锁定骨板设计合理,贴附性好,固定牢靠,便于术后早期功能锻炼,术后并发症明显减少,是治疗股骨颈骨折理想的内固定材料。

3D打印技术解剖型桡骨远端掌侧锁定骨板应用在桡骨远端骨折中治疗效果分析

目的 分析3D打印技术解剖型桡骨远端掌侧锁定骨板术应用在桡骨远端骨折的治疗效果。方法 选取AO-C型桡骨远端骨折患者126例作为研究对象,根据倾向性评分分为对照组和观察组,每组63例。对照组采取解刨型桡骨远端掌侧锁定骨板固定术治疗,观察组在对照组基础上联用3D打印技术手术治疗,比较两组肘关节活动度、手术相关指标、并发症发生率及腕关节功能恢复情况。结果 观察组背伸、屈曲、旋前、旋后等肘关节活动度均优于对照组(P<0.05);观察组手术时间、术中透视次数、术中出血量均少于对照组(P<0.05);观察组骨化性肌炎、尺神经损伤、钉道感染、肘内翻等总并发症发生率1.59%少于对照组12.69%(P<0.05);观察组疼痛、功能状态、活动范围、握力及腕关节功能总分均优于对照组(P<0.05)。结论将3D打印技术解剖型桡骨远端掌侧锁定骨板手术应用在桡骨远端骨折患者中,缩短手术时间,减少术中透视的次数,减少术后各项并发症的发生,促进肘关节和腕关节功能的恢复,取得显著治疗效果。

Henry入路Acu-Loc掌侧锁定骨板系统与背侧入路钢板内固定治疗复杂桡骨远端骨折的疗效比较

目的比较Henry入路Acu-Loc掌侧锁定骨板系统与背侧入路钢板内固定治疗复杂桡骨远端骨折的临床疗效。方法回顾性分析自2013-05-2018-05诊治的60例复杂桡骨远端骨折,26例采用Henry入路Acu-Loc掌侧锁定骨板系统治疗(观察组),34例采用背侧入路钢板内固定治疗(对照组),比较2组手术时间、切口长度、骨折愈合时间、术后1 d与术后12个月掌倾角、尺偏角、桡骨高度,比较2组术后12个月掌侧入路掌屈、背伸、桡偏、尺偏活动度及末次随访时的疗效。结果 60例均顺利完成手术并获得至少12个月的随访。2组手术时间、切口长度、骨折愈合时间比较差异无统计学意义(P>0.05)。术后1 d 2组掌倾角、尺偏角、桡骨高度比较差异无统计学意义(P>0.05),术后12个月观察组掌倾角、尺偏角、桡骨高度较对照组大,差异有统计学意义(P<0.05)。术后12个月2组掌侧入路掌屈、背伸、桡偏、尺偏活动度比较差异无统计学意义(P>0.05)。末次随访时观察组疗效较对照组好,差异有统计学意义(P<0.05)。结论 Henry入路Acu-Loc掌侧锁定骨板系统与背侧入路钢板内固定治疗复杂桡骨远端骨折均可取得良好的疗效,骨折复位固定效果满意,Henry入路Acu-Loc掌侧锁定骨板系统在术后远期腕部骨折角度和高度丢失较少。

锁定接骨板治疗肱骨近端骨折

目的探讨肱骨近端锁定接骨板治疗肱骨近端骨折的疗效。方法 19例肱骨近端骨折,其中男10例,女9例。患者平均年龄51.5岁（32-84岁）。按Neer分类法,二部分骨折7例;三部分骨折8例;四部分骨折4例。结果 X线片观察骨折愈合时间7.5周（7-12周）,无不愈合。按照Constant评分标准,功能优8例;良8例,中3例,优良率84.2%。结论肱骨近端锁定接骨板治疗肱骨近端骨折手术简单、微创、内固定可靠、并发症少、骨折愈合率高,特别是老年骨质疏松患者首选治疗方法 。

股骨近端锁定髁骨板治疗成人股骨粗隆间骨折15例疗效观察

目的:探讨骨股近端锁定髁骨板治疗成人股骨粗隆间骨折的临床疗效。方法:2013年1月-12月收治股骨粗隆间骨折患者15例,进行股骨近端锁定髁骨板治疗。结果:平均随访11个月,骨折均顺利愈合,愈合平均时间8个月,关节功能良好。结论:股骨近端锁定髁骨板治疗成人股骨粗隆间骨折疗效满意,值得临床推广。

肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折

目的评价肱骨近端锁定钢板治疗老年肱骨外科颈粉碎骨折的疗效。方法采用肱骨近端锁定钢板治疗31例老年肱骨外科颈粉碎骨折。平均随访6个月(4～14个月)。结果术后无伤口感染、骨折不愈合和内固定松动发生。骨折愈合时间为术后2.5～6.1个月。肩关节功能按照Constant评分标准,功能优9例,良18例,中4例,优良率87.1%。结论肱骨近端锁定钢板对老年肱骨外科颈骨折固定可靠、并发症少,可早期功能锻炼,具有防止复位丢失、保护板下血运和骨折愈合快等优点。

2例印度羚骨折内固定手术及护理

印度羚四肢骨折多为外力撞击所致,是动物园野生动物中常见的创伤性骨折。为探讨印度羚骨折的手术治疗方法,本文选用美托咪啶、丙泊酚配合异氟烷吸入麻醉的方法对2头印度羚进行化学保定,在麻醉效果确切的前提下,采用PRCL动物专用锁定骨板系统和双板固定技术进行前肢桡尺骨骨折的内固定手术。结果：整个手术过程约3 h,期间各项监护指标相对在正常范围：ETCO_2 60~64 mmHg、SPO_2 89%~99%、脉搏102~121t/min、体温36.8~37.1℃。术后X光检查可见骨头断端吻合。40 d后病兽仅前肢稍显萎缩,创口愈合良好,断面基本愈合,运动时可见有着地,X光检查发现骨痂生长良好。79 d后患肢着地行走自如,放回展区合群饲养。结论：利用PRCL动物专用锁定骨板系统和双板固定技术对印度羚骨折具有良好的医疗效果,值得推广应用。

一例犬髂骨骨折的诊断与治疗

1只中华田园犬在散放奔跑过程中被快速行驶的轿车侧面撞伤,其右后肢拒绝触地并发出痛苦呻吟。为了对该病例进行治疗,试验采用临床检查、实验室检查、影像学检查的方法进行诊断。结果表明:该犬诊断为髂骨骨折,通过髂骨外侧切开手术入路及采用PRCL锁定骨板系统骨板进行内固定治疗,术后该犬骨折端愈合良好,术后第30天电话回访,该犬行走恢复正常。说明对于犬的髂骨骨折治疗,采用内固定的方法能有助于骨折的正确复位。

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.

Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial frac- tures

Objective： To investigate the efficacy of the locking internal fixator （LIF）, which includes the locking compression plate （LCP） and the less invasive stable system （LISS）, in the proximal and distal tibial fractures. Methods： We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthe- sis （MIPO） technique. The data consisted of 43 proximal tibial fractures （type AO41 C3） and 55 distal tibial fractures （type AO43C3）. Results： No complications were observed in all patients after operation. The mean healing time was 8.4 months （range 5-14 months）. Only two cases of delayed union oc- curred at postoperative 10 months. No infections were re- ported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at post- operative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion： Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

Distal tibial fracture： An ideal indication for external fixation using locking plate

Objective： To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures. Methods： In this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years （19-63）. According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal metaphysis and diaphysis. The radiographic and clinic results were evaluated. Results： All patients were followed up for the average of 16 months （ranging from 12 to 21 months）. The average surgery duration was 38 （25-60） minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4±3.37 （p 〈 0.05） weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00± 2.06 （p 〉 0.05） in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed. Conclusions： Distal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.

Locking plates in distal humerus fractures： study of 43 patients

Objective： The treatment of multi- fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu- merus fractures. Methods： Forty-three consecutive patients with ar- ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment,range of motion, and Mayo elbow performance score. Results： Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years （18-73 years）. Clinical and ra- diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks （9-14 weeks）. The average follow-up was 12 months （10-18 months）. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients （82.5%）. One pa- tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion： Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early post- operative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation.

Sanders II-III calcaneal fractures fixed with locking plate in elderly patients

Purpose： To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture （Sanders II-IIl） in elderly patients. Methods： From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture （Sanders Ⅱ-Ⅲ） were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years （range： 65-79 years）. According to Sander＇s classification, 16 cases （16 feet） were type II fractures and 7 cases （7 feet） were type llI fractures. Anteroposterior, lateral and axial views of X-ray were taken to detect the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Radiological assessment was performed using Bohler＇s angle and Gissane＇s angle. Functional outcome was assessed using the Maryland foot score. Results： All the patients were followed up for 13.7 months on average （10-20 months）. The mean time of bone union was 3.2 months （3-4 months）. The mean time of complete weight bearing was 3.2 months （3.1-4.0 months）. The soft tissue necrosis was found in 1 case. The mean Bohler＇s angle and Gissane＇s angle were 25.31° and 117.5° respectively. The overall excellent to good rate was 82.6%. Conclusion： Open reduction and internal fixation with locking calcaneal plate can obtain good functional outcome for Sanders II-III calcaneal fractures in elderly patients.

Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures

Purpose： Tibial fracture is the most common long bone fracture. Distal third tibial fractures are chal- lenging though open reduction and plating can result in anatomical reduction and rigid fixation. This paper aimed to evaluate and compare the results of medial and lateral locking compression plates for distal third tibial fractures. Methods： This prospective clinical study involved 36 patients with distal tibial fractures admitted in Department of Orthopaedics, Sawai Mansingh Medical College ＆ Affiliated Hospital, Jaipur, India, from June 2011 to May 2012, including 29 closed fractures and 7 open fractures at the mean age of 38.9 years. Thirty-six patients were divided equally into two groups based on treatment method, including medial plating group （18 patients） and lateral plating group （18 patients）. They were followed up for at least 5 months after discharge. The functional outcomes were evaluated using Tenny and Wiss clinical assess- ment criteria. Results： Malunion was found in 3 cases of medial plating group and in 1 case of lateral plating group. In the medial plating group, there were 5 cases of superficial infections, 1 deep infection, 1 nonunion and 3 wound dehiscence. In the lateral plating group, there was 1 case of superficial infections, 1 deep infection and 1 nonunion, in the lateral plating group, 4 patients reported feeling the plates and screws but none of them asked to remove the hardware. In the medial plating group, 9 patients reported symptomatic hardware problems and 7 asked to remove the hardware. The number of cases graded as excellent/good/ fair was 1/8/7 in the medial plating group and 3/7/7 in the lateral plating group respectively. In the medial plating group, the final range of motion was 17.2° in ankle dorsiflexion and 30.7° in ankle plantar flexion. In the lateral plating group, the final range of motion was 19° in ankle dorsiflexion and 34.2° in ankle plantar flexion. Conclusion： Lateral plating of distal tibia is safe and feasible, which can provide biological fixation and prevent the soft tissue complications associated with medial plating.

Role of locking plates in treatment of difficult ununited fractures： a clinical study

Objective： To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods： Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture （3 patients）, supracondylar fracture of femur （gap nonunion）, fracture of clavicle, fracture of both forearm bones （radius and ulna） fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac- ture of humerus （one patient each）. Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results： Minimum follow-up was 6 months （range, 6 months to 2.5 years）. Average time for union was 3.4 months （range 2.5 to 6 months）. None of the patients had plate- related complications or postoperative wound infections. Conclusion： Along with achieving stability with locking compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our armamentarium for treating difficult fracture nonunions.

Dsteosynthesis with long volar locking plates for meta- physeal-diaphyseal fractures of the distal radius

Objective：Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with rotation of the radial shaft and maintenance of radial bow and interosseous space.We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates.Methods：This prospective study involved 27 patients （22 males and 5 females） with metaphyseal-diaphyseal fracture of the distal radius.Their mean age was （30.12±11.48） years （range 19-52 years） and the follow-up was 26.8 months （range 22-34 months）.All patients underwent open reduction and internal fixation with a long volar locking plate.According to AO/OTA classification,there were 7 type A3,13 type C2 and 7 type C3 fractures.Subjective assessment was done based on the disabilities of the arm,shoulder and hand （DASH） questionnaire.Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle,radial length,volar angle and ulnar variance.The final assessment was done according to Gartland and Werley scoring system.Results：Postoperative radiological parameters were well maintained throughout the trial,and there was significant improvement in the functional parameters from 6 weeks to final follow-up.The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up.Final assessment using Gartland and Werley scoring system revealed 66.67%（n=l8） excellent and 33.33% （n=9） good results.There was one case of superficial infection which responded to antibiotics and another carpel tunnel syndrome which was managed conservatively.Conclusion：Volar locking plate fixation for metaphyseal-diaphyseal fractures of distal radius is associated with excellent to good functional outcome,early rehabilitation and minimal complications.