早期康复护理用于锁骨骨折内固定治疗患者疗效观察

目的观察与研究早期康复护理在锁骨骨折内固定治疗患者中的护理效果。方法选取在我院接受治疗的56例锁骨骨折内固定治疗患者为研究对象,将其按照治疗顺序进行分组分为常规组与实验组,各28例,常规组实行传统护理,实验组实施早期康复护理,分析两组患者的护理效果。结果实验组患者ADL(日常生活能力)评分、Constant(肩关节功能)评分、骨折愈合时间等临床指标显著优于常规组,具有统计学意义(P<0.05)。结论在锁骨骨折内固定治疗患者中应用早期康复护理,不仅可以提高患者的日常生活能力,促进患者肩关节功能的恢复,还可以有效缩短骨折愈合的时间,应用价值和护理效果比较高。

Y形钢板内固定置入治疗肱骨远端粉碎性骨折18例

目的:观察Y形钢板内固定置入治疗肱骨远端粉碎性骨折的不良反应及临床疗效。方法:回顾性分析2003-01/2006-12本院收治的肱骨远端粉碎性骨折共18例,分别采用3～7孔左右式Y形钢板内固定治疗,钢板材质为不锈钢及钛合金,观察材料及宿主反应。按改良Cassebaum评分进行疗效评定。定期复查X射线片,观察骨折愈合情况;肢体有无疼痛、关节活动情况。结果:平均手术时间134min,平均术中出血量172mL,切口均Ⅰ期愈合。术后随访6个月,骨折平均愈合时间14周,1例截骨处延迟愈合,2例出现克氏针退出,无感染及局部炎症反应和排异反应。18例患者中,优11例,良4例,可2例,差1例,优良率83.3%。结论:用Y型钢板置入后与人体具有良好的生物相容性,肱骨远端粉碎性骨折复位满意,固定牢固,肘关节功能恢复满意。

空心螺钉与钢板内固定治疗后踝骨折疗效分析

目前,临床上对于后踝骨折的治疗多以内固定为主,常用的内固定材料包括空心螺钉、钢板等。为明确空心螺钉与钢板内固定治疗后踝骨折的临床疗效,寻求最佳的内固定方案,本研究主要对我院123例踝关节骨折中后踝骨折内固定治疗患者的临床相关资料进行回顾性分析。现报告如下。

后路内固定治疗胸腰椎爆裂性骨折

目的比较几种后路内固定冶疗胸腰椎爆裂性骨折的效果。方法21例胸腰椎爆裂性骨折伴脊髓损伤的患者,分别应用Luque、Dick、RF治疗胸腰椎爆裂性骨折,观察神经恢复及骨折复位内固定情况。结果Luque、Dick、RF治疗胸腰椎爆裂性骨折均有明显的复位固定作用,RF在矫正后突畸形、恢复病椎高度上较Dick、Luque更好,神经功能恢复上无明显差异。结论RF复位固定效果上优于Dick、Luque,在临床应用上应根据病人的具体情况而定。

三种钢板内固定治疗锁骨中段骨折的疗效比较

比较3种内固定钢板在锁骨中段骨折中的应用疗效。对锁骨中段骨折患者采用3种钢板即普通钢板、重建钢板、锁骨钢板(解剖形、左/右式)切开复位内固定治疗,并对患者手术时间、术后并发症、功能恢复等情况进行统计学对比。结果锁骨钢板内固定治疗锁骨中段骨折具有手术时间短、出血少,内固定坚强、并发症少、术后疗效好等优点。表明锁骨钢板符合人体生物力学原理,是治疗锁骨中段骨折比较理想的内固定材料之一。

28例多根多处肋骨骨折的治疗体会

目的探讨多根多处肋骨骨折的手术内固定治疗与急性呼吸窘迫综合征的防治。方法对28例多根多处肋骨骨折及其引起的15例浮动胸壁患者资料进行回顾性分析。结果28例多根多处肋骨骨折患者中,肋骨骨折数3～9根,其中15例浮动胸壁并呼吸功能障碍行急诊开胸手术内固定,术后使用机械通气5～96h。全组患者均行手术内固定,无死亡病例,术后胸痛显著减轻,胸壁稳定,呼吸功能恢复,痊愈出院。术后2～3个月复查,无明显胸廓塌陷畸形,X线胸片示内固定牢固,肋骨骨折端骨性愈合。结论多根多处肋骨骨折及其引起的浮动胸壁的治疗重点是肋骨骨折手术内固定与ARDS的防治。

中医临床护理路径在小儿肱骨外髁骨折患儿中的应用

目的探讨中医临床护理路径在小儿肱骨外髁骨折围手术的作用。方法小儿骨科手术患儿46例,分为两组,即研究组(中医临床护理路径)、对照组(传统护理治疗);评估两组的患儿家属满意度、住院天数及不良反应。结果研究组在患儿家属满意度及住院天数等方面研究组明显优于对照组(P<0.05),而两者的不良反应无明显差异。结论中医临床护理路径可以有效提高患儿家属的满意度,减少住院时间。

早期康复护理在切开复位内固定术治疗跟骨骨折术后的应用效果

目的分析切开复位内固定术治疗跟骨骨折术后对患者进行早期康复护理的效果。方法将60例切开复位内固定术治疗跟骨骨折术后患者分为两组,对常规组进行常规护理,研究组以常规护理为基础,实施早期康复护理,对比两组患者护理效果。结果在护理结束后,研究组护理效果优于常规组,两组差异有统计学意义(P>0.05)。结论对切开复位内固定术治疗跟骨骨折术后的病人实施早期康复护理,能够缓解患者的疼痛程度,患者满意度较高。

手术室整体护理配合用于PFNA内固定治疗老年股骨粗隆间骨折患者价值评价

探讨老年股骨粗隆间骨折PFNA内固定患者在手术室整体护理效果。方法 选取在2020年6月至2022年9月期间,本院收治的160例老年股骨粗隆间骨折 PFNA内固定患者,将其随机分成两组,分别为:对照组80例,观察组80例。两组患者均接受了常规手术室护理,而观察组患者常规护理基础上采用手术室整体护理。对两组患者的手术时间,骨折愈合时间,术中失血情况、并发症及不良事件发生率进行了对比分析。结果 与对照组相比,观察组的手术时间、骨折愈合时间缩短,术中出血量减少,并发症及不良事件的发生率也有所下降(P<0.05)。结论 老年股骨粗隆间骨折PFNA内固定患者中应用手术室整体护理,使其手术时间、住院时间、术中出血量、并发症和不良事件的发生率显著下降,值得在临床上推广。

空心钉之父Sven Christian Johansson

上一篇文章我们介绍了股骨颈骨折内固定治疗的先驱Smith Petersen教授,这一篇介绍发明了空心钉,将Smith Petersen教授股骨颈骨折切开复位内固定术转化为闭合复位内固定的Sven Christian Johansson教授。甚为有趣的是,两位教授均来自髋部骨折高发的北欧地区,并最终在股骨颈骨折治疗领域青史留名,可以说是命运的安排。

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.

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

Treatment of Gustilo grade Ⅲ leg fractures by external fixation associated with limited internal fixation

Objective： To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade Ⅲ leg fractures. Methods： From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IliA cases and 10 Gustilo ⅢB cases at the first operation. But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage （VSD）. Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved. Results： The first operations were completed within 90-210 minutes （170 minutes on average）. The blood trans- fusions were from 400 ml to 1500 ml （those used for antishock preoperatively not included）. All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor. Conclusion： External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

Objective： To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractureS. Methods： The clinical data of 42 cases ofSehatzker IV- VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 re- ceived surgical treatment within 12 h after injury, （Group I）, the other 2 [ were first treated by traction or piaster fixation followed by a delayed internal fixation after soft tissue swell- i ing subsided （Group II）. The surgical time, comPlications, length of hospital stay, cost of hospitalization, and time for i fracture union, as well as functional recovery were analyzed and compared between the two groups. Results： After 10-28 months follow-up （mean 16.5 months）, except 5 cases who lost to follow-upl no differ-ences were found between the two groups regarding surgi- cal time, preoperative and postoperative complications, heal- ing time or the Hospital for Special Surgery （HSS） score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation （P〈0.05）. Conclusion： Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.

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.

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar, sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.