Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of...Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of Achilles tendon were measured.Results:The wound of all patients healed well,no complications like Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early Achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.展开更多
Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children...Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.展开更多
The incidence of metatarsal fractures is not precisely known. Malposition might cause future metatarsalgia, mid-foot pain and discomfort, which may dictate an on-going need for in-shoe orthosis, shoe modification and,...The incidence of metatarsal fractures is not precisely known. Malposition might cause future metatarsalgia, mid-foot pain and discomfort, which may dictate an on-going need for in-shoe orthosis, shoe modification and, occasionally, operative correction. To minimize and prevent these problems, we describe a simple technique for reduction and fixation of metatarsal fractures by Kirschner wires. We have found this technique to be a simple and efficient way of reducing and fixing metatarsal fractures. It is applied easily by the closed and open technique.展开更多
目的:通过Meta分析系统评价螺钉及克氏针内固定治疗儿童肱骨外髁骨折的临床疗效。方法:计算机检索PubMed、Embase、Cochrane、Web of Science、中国知网、万方数据库建库至2022年2月国内外发表的有关螺钉和克氏针内固定治疗儿童肱骨外...目的:通过Meta分析系统评价螺钉及克氏针内固定治疗儿童肱骨外髁骨折的临床疗效。方法:计算机检索PubMed、Embase、Cochrane、Web of Science、中国知网、万方数据库建库至2022年2月国内外发表的有关螺钉和克氏针内固定治疗儿童肱骨外髁骨折的文献。根据设定的纳入与排除标准筛选文献并进行质量评价,结局指标为愈合优良率、畸形愈合率、延迟愈合率或骨不连率、感染率、活动受限(>10°)发生率,使用RevMan 5.3软件进行统计分析。结果:共纳入9项回顾性研究涉及647例患者,其中螺钉固定组(含螺钉联合克氏针)255例,克氏针固定组392例。Meta分析显示,与克氏针组相比,螺钉组(含螺钉联合克氏针)在术后有更低的感染率[OR=0.22,95%CI(0.09,0.56),P=0.001]。两组间愈合优良率、畸形愈合率比较,差异均无统计学意义(P>0.05)。亚组分析显示,单纯螺钉组术后感染率显著低于克氏针组[OR=0.18,95%CI(0.05,0.65),P=0.009]。结论:对于手术治疗儿童肱骨外髁骨折,与克氏针内固定和螺钉联合克氏针内固定相比,单纯螺钉内固定拥有更低的感染率。而在愈合优良率、畸形愈合率方面三者无显著差异。就术后疗效及内固定安全性方面而言,更推荐骨科医师使用螺钉进行儿童肱骨外髁骨折的固定。展开更多
目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患...目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。展开更多
目的:探讨克氏针预制弯度内固定治疗儿童前臂骨折的临床疗效。方法:自2019年10月至2022年12月采用克氏针预制弯度内固定治疗儿童前臂骨折32例,男25例,女7例;年龄3~15(8.0±0.5)岁;左侧18例,右侧14例;桡、尺骨双骨折24例,Monteggia骨...目的:探讨克氏针预制弯度内固定治疗儿童前臂骨折的临床疗效。方法:自2019年10月至2022年12月采用克氏针预制弯度内固定治疗儿童前臂骨折32例,男25例,女7例;年龄3~15(8.0±0.5)岁;左侧18例,右侧14例;桡、尺骨双骨折24例,Monteggia骨折3例,Galeazzi骨折4例,桡骨颈“歪戴帽”骨折1例。记录患者手术时间、术中出血量、X线透视次数、骨折愈合时间和并发症,并采用上肢功能评定表(disabilities of arm,shoulder and hand,DASH)和Grace-Eversman前臂双骨折评价系统评估克氏针预制弯度内固定治疗儿童前臂骨折的临床疗效。结果:32例患者获得随访,时间2~12(7.16±2.51)个月。术中出血量(20.68±5.50)ml,X线透视次数(5.80±2.50)次,手术时间(24.34±5.10)min。32例均骨折顺利愈合,愈合时间(8.82±1.62)周。2例出现并发症,其中1例术后拇长伸肌腱断裂,1例术后预制弯度克氏针在骨髓腔旋转导致骨折明显移位。DASH评分0~16(8.32±1.50)分;依据Grace-Eversman前臂双骨折评价系统:优28例,良2例,可2例。结论:克氏针预制弯度内固定治疗儿童前臂骨折具有损伤小,出血少,复位好、固定牢靠,骨折愈合快,功能恢复良好的优点。展开更多
基金It is supported by Scientific Research Planned Project of Taizhou Science and Technology Bureau in Zhejiang:No.031212
文摘Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early Achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of Achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of Achilles tendon were measured.Results:The wound of all patients healed well,no complications like Achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of Achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early Achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.
基金supported by Program of the National Natural Science Foundation of China(No.82074233)Scientific Research Foundation for Advanced Talents,Xiang’an Hospital of Xiamen University(No.PM201809170009).
文摘Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.
文摘The incidence of metatarsal fractures is not precisely known. Malposition might cause future metatarsalgia, mid-foot pain and discomfort, which may dictate an on-going need for in-shoe orthosis, shoe modification and, occasionally, operative correction. To minimize and prevent these problems, we describe a simple technique for reduction and fixation of metatarsal fractures by Kirschner wires. We have found this technique to be a simple and efficient way of reducing and fixing metatarsal fractures. It is applied easily by the closed and open technique.
文摘目的:通过Meta分析系统评价螺钉及克氏针内固定治疗儿童肱骨外髁骨折的临床疗效。方法:计算机检索PubMed、Embase、Cochrane、Web of Science、中国知网、万方数据库建库至2022年2月国内外发表的有关螺钉和克氏针内固定治疗儿童肱骨外髁骨折的文献。根据设定的纳入与排除标准筛选文献并进行质量评价,结局指标为愈合优良率、畸形愈合率、延迟愈合率或骨不连率、感染率、活动受限(>10°)发生率,使用RevMan 5.3软件进行统计分析。结果:共纳入9项回顾性研究涉及647例患者,其中螺钉固定组(含螺钉联合克氏针)255例,克氏针固定组392例。Meta分析显示,与克氏针组相比,螺钉组(含螺钉联合克氏针)在术后有更低的感染率[OR=0.22,95%CI(0.09,0.56),P=0.001]。两组间愈合优良率、畸形愈合率比较,差异均无统计学意义(P>0.05)。亚组分析显示,单纯螺钉组术后感染率显著低于克氏针组[OR=0.18,95%CI(0.05,0.65),P=0.009]。结论:对于手术治疗儿童肱骨外髁骨折,与克氏针内固定和螺钉联合克氏针内固定相比,单纯螺钉内固定拥有更低的感染率。而在愈合优良率、畸形愈合率方面三者无显著差异。就术后疗效及内固定安全性方面而言,更推荐骨科医师使用螺钉进行儿童肱骨外髁骨折的固定。
文摘目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性股骨颈骨折术后骨转换状态,促进骨重塑,提供更加稳定的股骨柄骨长入环境,对患者预后恢复疗效显著。
文摘目的:探讨克氏针预制弯度内固定治疗儿童前臂骨折的临床疗效。方法:自2019年10月至2022年12月采用克氏针预制弯度内固定治疗儿童前臂骨折32例,男25例,女7例;年龄3~15(8.0±0.5)岁;左侧18例,右侧14例;桡、尺骨双骨折24例,Monteggia骨折3例,Galeazzi骨折4例,桡骨颈“歪戴帽”骨折1例。记录患者手术时间、术中出血量、X线透视次数、骨折愈合时间和并发症,并采用上肢功能评定表(disabilities of arm,shoulder and hand,DASH)和Grace-Eversman前臂双骨折评价系统评估克氏针预制弯度内固定治疗儿童前臂骨折的临床疗效。结果:32例患者获得随访,时间2~12(7.16±2.51)个月。术中出血量(20.68±5.50)ml,X线透视次数(5.80±2.50)次,手术时间(24.34±5.10)min。32例均骨折顺利愈合,愈合时间(8.82±1.62)周。2例出现并发症,其中1例术后拇长伸肌腱断裂,1例术后预制弯度克氏针在骨髓腔旋转导致骨折明显移位。DASH评分0~16(8.32±1.50)分;依据Grace-Eversman前臂双骨折评价系统:优28例,良2例,可2例。结论:克氏针预制弯度内固定治疗儿童前臂骨折具有损伤小,出血少,复位好、固定牢靠,骨折愈合快,功能恢复良好的优点。
