Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Meta-analysis of the efficacy of volar plate internal fixation versus closed reduction and external fixation in the treatment of adult distal radius fractures

Objective:To compare the efficacy of open reduction and volar locking plate internal fixation with closed reduction and external fixation in the treatment of distal radius fractures by using meta analysis.Methods:The databases of CNKI,Wanfang,Weipu,Chinese biomedical literature,Pubmed,Embase,and Cochrane Library were retrieved,and the randomized controlled studies that directly compared the efficacy of plate internal fixation and closed reduction external fixation in the treatment of distal radius fractures published publicly from the establishment of the database to April 2023 were collected.The two researchers independently screened the retrieved literature according to the inclusion and exclusion criteria,extracted data,used Cochrane risk bias assessment tool for quality assessment,and used RevMan 5.4 software for meta analysis.Results:A total of 10 randomized controlled trials were included,all of which were in English.There were 1042 patients in total,and 9 of them were rated as low risk.Meta analysis results showed that one year after the treatment of distal radius fracture with volar locking plate internal fixation,DASH score[MD=-5.64,95%CI(-7.21,-4.06),P<0.00001];One year later,PRWE score[MD=-5.90,95%CI(-8.88,-2.92),P=0.001];Palm flexion[MD=5.92,95%CI(1.29,10.55),P=0.01];Pronation[MD=2.48,95%CI(0.59,4.36),P=0.01];Postrotation[MD=4.73,95%CI(2.15,7.31),P=0.0003];Grip strength[MD=0.61,95%CI(0.12,1.10),P=0.02];palmar tilt angle[MD=9.84,95%CI(5.66,14.02),P<0.00001];Radial inclination[MD=4.33,95%CI(2.97,5.69),P<0.00001]was superior to closed reduction plaster or splint external fixation.One year later,the European Five dimensional Health Scale(EQ-5D-5L)score[MD=0.02,95%CI(-0.01,0.05),P=0.27];Back extension[MD=2.22,95%CI(-4.15,8.59),P=0.49];Ulnar deviation[MD=3.49,95%CI(-0.80,7.78),P=0.11];Radial deviation[MD=2.05,95%CI(-2.39,6.50),P=0.37];Ulnar variance[MD=-1.14,95%CI(-3.16,0.88),P=0.27];There was no significant difference in complications[MD=0.77,95%CI(0.54,1.10),P=0.16](P>0.05).Conclusion:Based on the current clinical data,internal fixation with volar locking plate is more conducive to mid-term DASH score and grip strength recovery than closed reduction plaster or splint external fixation,but there is no significant difference in the quality of life and complications of patients.For adult distal radius fractures,surgical indications should be carefully grasped,and non operative treatment should be given priority.

Effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures

Objective:To investigate the effect of locking compression plate internal fixation on the injury extent and bone metabolism of Robinson 2A and 2B middle clavicular fractures.Methods:Totally 80 cases of patients with Robinson 2A and 2B middle clavicular fractures admitted to our hospital between March 2017 and January 2019 were divided into the control group(n=41)receiving conventional kirschner wire internal fixation and the observation group(n=39)receiving locking compression plate internal fixation according to the operation plans.The differences in serum contents of inflammatory factors,oxidative stress indexes and bone metabolism indexes were compared between the two groups of patients before patients entered operating room,24 h after surgery and 48 h after surgery.Results:Before patients entered operating room,there were no statistically significant differences in the serum contents of inflammatory factors,oxidative stress indexes or bone metabolism indexes between the two groups(P>0.05).At 24 h and 48 h after surgery,serum inflammatory factors interleukin-1(IL-1),interleukin-17(IL-17),high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α)contents in the observation group were lower than those in the control group;serum reactive oxygen species(ROS)and lipid hydroperoxide(LHP)contents were lower than those in the control group,while catalase(CAT)and glutathione peroxidase(GSH-Px)contents were higher than those in the control group;serum N-terminal propeptide of procollagen type I(PINP),bone gla protein(BGP)and alkaline phosphatase(ALP)contents were higher than those in the control group,while N-telopeptide of typeⅠcollagen(NTX),C-telopeptide of typeⅠcollagen(CTX)and tartrate-resistant acid phosphatase 5b(TRACP5b)contents were lower than those in the control group(P<0.05).Conclusion:Locking compression plate internal fixation can reduce the postoperative trauma extent and help promote the fracture healing in patients with Robinson 2A and 2B middle clavicular fracture.

THE SYNTHESIS AND CHARACTERIZATION OFPOLY-L-LACTIDE USED FOR THE INTERNALFIXATION OF BONE FRACTURE

A high Mw of PLLA was synthesized, it intended to be used in the manufacture ofbioabsorbable screw applied in bone fracture internal fixation. The optical reactionconditions have been discussed.

Effects of bridge combined internal fixation system internal fixation on fracture healing and shoulder joint function in elderly patients with displaced midshaft clavicle fractures

Objective:To compare the clinical therapeutic effect of bridge combined internal fixation system and locking compression plate internal fixation in the treatment of displaced midshaft clavicle fractures by emphatically observing fracture healing and shoulder joint function.Methods:Totally 44 elderly patients with Robinson type 2B displaced midshaft clavicle fractures were included from the Department of Orthopaedics,Shenyang Fourth People's Hospital during February 2016 and December 2018,including 23 males and 21 females,mean age(69.8±10.2)years old.The patients were divided into a bridge combined internal fixation system group(bridge group,n=22)and a locking compression plate internal fixation group(plate group,n=22)according to the internal fixation methods.The operation time,intraoperative blood loss,fracture healing time,and postoperative complications were recorded.At 12 months after surgery,the shoulder joint Constant-Murley score and DASH score were used to assess the recovery of joint function.The serum levels of bone turnover biochemical markers procollagen I N-terminal peptide(P1NP),cross-linked Carboxy-terminal telopeptide of typeⅠcollagen(CTX-I),and osteoblast specific factor(OSF)were measured before and 3 months after surgery.Results:The operation time,intraoperative blood loss and fracture healing time of the bridge group were significantly shorter than those of the plate group(P<0.05).Constant scores and DASH scores in the bridge group were significantly better than those of the plate group at 12 months after surgery(P<0.05).Serum levels of CTX-I was significantly decreased,while the P1NP and OSF were significantly increased compared with before surgery in the both groups(P<0.05),and the changes were more obvious in the bridge group(P<0.05).The incidence of complications was similar between the two groups(P<0.05).Conclusion:Compared with the locking plate system,the bridge combined internal fixation system can effectively improve the operation efficiency,have more benefits on fracture healing,better promote the recovery of patients'function,and reduce the failure rate of internal fixation,thus providing a better choice to treat displaced midshaft clavicle fractures by intraoperative internal fixation.

Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Artificial tiger bone powder for improving the quality of life in elderly patients with fracture

Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.

Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.

Pulmonary thromboembolism after distal ulna and radius fractures surgery: A case report and a literature review

BACKGROUND Pulmonary thromboembolism(PTE)is a serious postoperative complication that can occur after a fracture.Generally,PTE is caused by the falling off of lower extremity deep vein thrombosis(LEDVT)after lower limb fracture surgery.LEDVT and PTE after upper extremity fracture surgery are very rare.PTE is one of the most common clinical causes of sudden death.Venous thromboembolism includes PTE and DVT.We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery.The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery,and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.CASE SUMMARY We report a 51-year-old Chinese male who had severe fractures of the left distal ulna,radius and little finger after a motorcycle accident.The patient underwent external fixation,open reduction and internal fixation.On the third post-operative day,computed tomographic pulmonary angiography showed PTE.Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins.After a period of anticoagulation therapy,on the 25th d after the PTE,computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared.Furthermore,about 4 mo after the PTE,thrombosis in the deep veins of the lower limbs disappeared.About 1 year after the surgery,X-rays showed good fracture healing,and the function of the wrist joint recovered well.CONCLUSION Though rare,PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

Distal Radius Fracture: What Does the Patient Want?

Distal radius fractures are common and while historically most have been treated nonoperatively the frequency with which distal radius fractures are treated surgically is increasing. Criteria for considering surgical treatment are often based on radiographic appearance of the fracture. Less often discussed is patient preference: what do patients want. We investigated responses of a general population when presented with various treatment options following a hypothetical distal radius fracture. Many respondents chose nonoperative treatment even when told that surgery might result in a better outcome. This information can help during the shared decision-making process when discussing treatment options with a patient who presents with a distal radius fracture.

Proximal Femur Bionic Nail (PFBN): A Panacea for Unstable Intertrochanteric Femur Fracture

With the aging population,intertrochanteric femur fracture in the elderly has become one of the most serious public health issues and a hot topic of research in trauma orthopedics.Due to the limitations of internal fixation techniques and the insufficient mechanical design of nails,the occurrence of complications delays patient recovery after surgical treatment.Design of a proximal femur bionic nail(PFBN)based on Zhang’s N triangle theory provides triangular supporting fixation,which dramatically decreases the occurrence of complications and has been widely used for clinical treatment of unstable intertrochanteric femur fracture worldwide.In this work,we developed an equivalent biomechanical model to analyze improvement in bone remodeling of unstable intertrochanteric femur fracture through PFBN use.The results show that compared with proximal femoral nail antirotation(PFNA)and InterTan,PFBN can dramatically decrease the maximum strain in the proximal femur.Based on Frost’s mechanostat theory,the local mechanical environment in the proximal femur can be regulated into the medium overload region by using a PFBN,which may render the proximal femur in a state of physiological overload,favoring post-operative recovery of intertrochanteric femur fracture in the elderly.This work shows that PFBN may constitute a panacea for unstable intertrochanteric femur fracture and provides insights into improving methods of internal fixation.

采用提篮钢板技术治疗粉碎性髌骨下极骨折的疗效分析

目的探讨应用提篮钢板技术治疗粉碎性髌骨下极骨折的临床疗效。方法回顾性分析唐山市第二医院创伤一科2021年3月至2024年3月应用提篮钢板技术治疗的18例粉碎性髌骨下极骨折患者的临床资料,其中男10例,女8例,年龄21~73(44.1±14.2)岁;左膝7例,右膝11例;交通伤8例,摔伤10例。应用提篮钢板技术治疗粉碎性髌骨下极骨折。住院期间观察记录患者年龄、性别、术前疼痛评分(FPS-R)。患者出院后于术后6周、8周、10周、12周、6个月、12个月门诊复查随访,记录骨折愈合时间、膝关节屈曲康复时间、末次随访FPS-R,末次随访B?stman髌骨骨折疗效评分。结果18例患者术前FPS-R评分6(4,6)分,切口均一期愈合,无失访患者;随访时间6~12个月;骨折愈合时间8(6,8.5)周;膝关节屈曲康复时间:90°需3(3,4)周,120°需6(6,8)周,全范围需10(8,10)周;末次随访FPS-R评分2(0,2)分;末次随访B?stman髌骨骨折疗效评分29(28,30)分,优17例,良1例,优良率为100%。18例患者骨折愈合良好,未出现感染、切口愈合不良、内固定物失效、内固定激惹等并发症。结论应用提篮钢板技术治疗粉碎性髌骨下极骨折疗效确切、满意。该技术可达到骨折坚强内固定、早期功能锻炼的目的,术后并发症少,骨折愈合率高,膝关节功能恢复好,疗效优良率高。该技术内固定材料获取容易,手术技术简单,适合在基层医院推广应用。

支架外固定与钢板内固定治疗桡骨远端粉碎性骨折的Meta分析

目的:外固定支架和钢板内固定作为桡骨远端粉碎性骨折的常用治疗方法,在临床上各有利弊。系统评价外固定支架与钢板内固定治疗粉碎性桡骨远端骨折的临床疗效及安全性,为桡骨远端骨折中西医结合诊疗指南研制提供论证依据。方法:系统检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、中国生物医学文献数据库、维普和万方数据库,纳入2013年10月至2023年10月发表的关于外固定支架和钢板内固定治疗粉碎性桡骨远端骨折的随机对照试验文献,按照纳入标准和排除标准筛选文献,使用Review Manager进行文献质量评价和Meta分析。结果:(1)纳入8篇文献,其中中文文献4篇,英文文献4篇、总样本量648例,外固定支架组328例,钢板内固定组320例;(2)术后3个月,钢板内固定组的背伸、掌屈、旋后范围优于外固定支架组;术后12个月,钢板内固定组的握力、掌倾角、掌屈、旋前和旋后范围优于外固定支架组;钢板内固定组在术后感染方面优于外固定支架组,其余结局指标两组差异均无显著性意义。结论:现有8项证据表明,在粉碎性桡骨远端骨折的治疗方式选择上,外固定支架与切开钢板内固定都有良好的治疗效果,综合其他因素钢板内固定更胜一筹,但是对于一些高度严重的粉碎性桡骨远端骨折、骨质较差、严重污染的开放性骨折以及软组织肿胀而无法进行切开手术的特殊患者,外固定支架才是首选。此次研究结果具有局限性,未来还需要开展更多高质量、大样本、多中心的随机对照试验研究,另外需重视远期疗效、其他次要指标的观察,补充优化当前研究结果。

三种内固定方法治疗Pauwels Ⅲ型股骨颈骨折伴前内侧骨缺损的有限元分析

背景:不稳定型股骨颈骨折伴前内侧骨缺损是非常少见且难以处理的,治疗此种骨折的最佳内固定方案一直是骨科医生中持续争论的话题。目的:通过有限元分析评估不同内固定方式治疗Pauwels Ⅲ型股骨颈骨折伴前内侧缺损的生物力学性能,以期为临床手术决策提供实验支撑。方法:利用Mimics 21.0、Geomagic和Solidworks软件构建伴有前内侧缺损且Pauwels角为70°的股骨颈骨折模型,模拟3种内固定方法:A组(3枚空心钉+内侧钢板)、B组(股骨颈动力交叉钉+1枚空心钉)和C组(4枚空心钉“菱形固定”)。在3倍体质量2100 N的载荷下分析3组模型股骨、内固定以及股骨头的应力和位移变化。结果与结论:①A组模型的股骨整体应力最小,且受力更加均匀且分散;B组内固定模型的应力较小,说明其具有更好的应力分散和抗剪切的作用;A组股骨应力侧的应力明显小于其余两组,且未发生应力集中现象;②A组无论是整体股骨模型、内固定或是股骨头的位移均小于其余两组,说明空心钉联合内侧钢板能够起到更好的稳定作用,可减少髋内翻的发生;③3枚螺钉联合内侧支撑钢板应用于垂直、不稳定且前内侧骨缺损的股骨颈骨折,可显著提高骨折的稳定性,提高对变形力的抵抗力,是治疗该类型骨折的不错选择。

纤维带与无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤

背景:Lisfranc韧带是维持足部横弓与纵弓的重要结构,Lisfranc损伤为一种严重的中足损伤。Lisfranc韧带损伤是复杂的,其治疗以及首选的固定方法有争议。目的:比较钢板联合Suturetape与钢板联合无头加压螺钉治疗第1,2跖骨近端粉碎性骨折Lisfranc损伤的短期疗效。方法:回顾性分析东莞市中医院骨七科2019年1月至2022年6月因第1,2跖骨近端粉碎性骨折Lisfranc损伤患者48例,其中25例采用钢板联合Suture tape固定(观察组),23例采用钢板联合无头加压螺钉固定(对照组)。术前参照影像学资料,根据Myerson分类系统进行分型;术后随访根据骨折愈合时间、目测类比评分、美国足踝外科学会标准评估足功能恢复情况,并对两组术后并发症进行比较分析。结果与结论:①两组患者均顺利完成手术并获得随访,随访时间12-36个月,平均(18.0±5.42)个月;②两组患者手术时间、术中出血量比较差异均无显著性意义(P>0.05);③观察组较对照组骨折愈合时间稍长,差异有显著性意义(P<0.05);④术后3,6,12个月随访,观察组较对照组目测类比评分明显降低(P<0.05);⑤术后6,12个月,观察组术后各时间点随访足功能AOFAS评分较螺钉组明显改善(P<0.05),且均较术前显著提高(P<0.05);⑥术后观察组出现1例创伤性关节炎,对照组出现1例切口感染、1例螺钉断裂及2例创伤性关节炎,两组比较差异无显著性意义(P>0.05),考虑与样本量偏少有关;⑦提示对于第1,2跖骨近端粉碎性骨折Lisfranc损伤,实施钢板联合Suture tape内固定治疗Lisfranc关节损伤效果可靠,可改善患者足关节功能,且具有手术创伤小、术后并发症少、远期医源性创伤性关节炎风险低的优势,较无头加压钉更有利于足功能的恢复。

桡骨远端C1型骨折三种内固定方式的有限元分析

背景:桡骨远端C1型骨折属于关节内不稳定型骨折,治疗上存在较大的难度。目前对桡骨远端骨折不同内固定接骨板的临床研究较少,缺乏多种内固定接骨板的生物力学对比研究,在内固定接骨板的选用上仍存在争议。目的:通过有限元分析法比较不同内固定接骨板在桡骨远端C1型骨折治疗中的生物力学特性。方法:使用一名健康女性志愿者的桡骨模型,顺序导入Mimics 21.0、Geomagic Wrap 2017、Solid Works 2021等软件进行处理,制作桡骨远端C1型骨折模型。根据厂家提供的接骨板数据,分别建立桡骨远端掌侧斜T形锁定板、桡骨远端掌侧蝶形锁定板、桡骨远端掌侧万向锁定板和螺钉的三维模型,并且和骨折模型进行装配,在ANSYS 19.0中赋予材料属性,设定各接触面相互作用关系并定义载荷及边界条件,模拟其腕关节压缩、背弯、掌屈和扭转等4种载荷工况,比较其生物力学性能。结果与结论:①3组内固定模型在4种载荷工况下,内固定模型整体位移主要集中在桡骨远端关节面上;模型在背弯、掌屈和扭转载荷工况下的最大位移是轴向载荷下位移的2-6倍,表明轴向载荷工况下内固定系统最稳定;②内固定上的应力远大于骨折块上的应力,内固定物应力主要集中于接骨板在骨折断端附近区域,其中万向锁定板和蝶形锁定板应力分布较为均匀,斜T形锁定板应力集中现象最为明显;③在压缩和扭转载荷下,骨折块的应力主要集中在螺钉孔周围,掌屈和背伸载荷下则是从桡骨远端向近端逐步扩展;在同样的载荷工况下,斜T形锁定板固定状态下骨折块应力最大,万向锁定板固定系统骨折块所受应力峰值最低,蝶形锁定板与万向锁定板固定状态下的骨折块峰值应力仅仅相差0.2-6.0 MPa;④相比于斜T形锁定板和蝶形锁定板,万向锁定板在桡骨远端C1型骨折内固定中应力分布更均匀,固定模型关节面位移更小、稳定性更佳。

3D打印辅助微创经皮钢板接骨与髓内钉治疗AO12-C型肱骨中上段骨折的比较

背景:AO12-C型肱骨中上段骨折通常由高能量损伤引起,骨折粉碎,伴有较多的蝶形骨块,难以获得良好复位和有效固定;随着对骨与软组织生物学特征的认识逐渐提高,目前手术治疗也逐渐向微创钢板和髓内钉内固定等方式转变,但对于微创经皮钢板接骨和髓内钉哪项是治疗肱骨骨折的最佳技术迄今尚未达成共识。目的:比较3D打印辅助微创经皮钢板接骨与髓内钉治疗AO12-C型肱骨中上段骨折的疗效。方法:回顾性分析2020年1月至2022年12月北京积水潭医院贵州医院收治的符合纳入标准的36例AO12-C型肱骨中上段骨折患者,根据手术方式将患者分为微创钢板组和髓内钉组,每组18例。微创钢板组在3D打印辅助进行术前规划的基础上进行微创钢板接骨治疗;髓内钉组进行髓内钉内固定治疗。比较两组患者手术时间、术中出血量、住院时间及骨折愈合时间;对比两组术后1,3,6个月的疼痛目测类比评分、末次随访时肩关节功能、Constant-Murley评分、快速肩臂手功能障碍评分以及并发症等指标情况。结果与结论:①所有患者平均随访(15.56±4.05)个月,两组患者住院时间和骨折愈合时间相比差异无显著性意义(P>0.05),微创钢板组手术时间更短(P<0.05),髓内钉组术中出血更少(P<0.05);②术后1,3个月时髓内钉组目测类比评分低于微创钢板组(P<0.05),但在长期随访时两组患者目测类比评分、末次随访时Constant-Murley评分、快速肩臂手功能障碍评分及肩关节功能均无显著差异(P>0.05);③两组患者均未出现骨不连及伤口感染等并发症,微创钢板组患者术后出现2例桡神经麻痹,均在术后3个月内恢复,而髓内钉组出现1例肩袖损伤;两组患者的术后并发症发生率无显著差异(P>0.05);④提示微创经皮钢板接骨技术及髓内钉治疗AO12-C型肱骨中上段骨折均可获得良好的临床疗效,能够有效改善患者的肩关节功能,但微创经皮钢板接骨技术在3D打印术前辅助下具有手术时间短的优势,是治疗AO12-C型肱骨中上段骨折一种有价值、有效且安全的方法。

累及背侧关节面桡骨远端骨折的骨折线地图特征:螺钉有效固定治疗术后移位

背景:掌侧锁定钢板固定是桡骨远端骨折临床上最常用的固定方式,但当骨折线累及背侧关节面时,掌侧钢板固定则存在术后背侧骨块移位风险,尤其是乙状切迹背侧骨块术后移位风险较高。目的:分析桡骨远端骨折累及背侧关节面的骨折线特点,进而深入研究累及乙状切迹背侧骨块发生术后移位的危险因素,为临床上提高复位成功率提供依据。方法:对2021年1月至2022年9月在广州中医药大学第三附属医院就诊的桡骨远端骨折患者进行回顾性分析。根据术前CT影像桡骨远端背侧骨折块数量1,2,3块及以上分别记为Ⅰ,Ⅱ,Ⅲ型骨折,分别绘制骨折线地图,分析其背侧骨折线形态特征。对存在乙状切迹背侧骨折的患者进行3个月以上随访,根据术后是否发生乙状切迹背侧骨块移位分为移位组和无移位组,比较两组患者年龄、性别、术前和术后CT解剖参数。结果与结论:①对AO/OTA分型C型累及背侧关节面145例患者进行骨折线地图分析,其中根据背侧骨折块数量:Ⅰ型25例(17.2%)、Ⅱ型82例(56.6%)、Ⅲ型38例(26.2%);骨折线地图显示Ⅰ型骨折块骨折线主要累及乙状切迹,Ⅱ型主要累及乙状切迹和lister结节,Ⅲ型则累及乙状切迹、lister结节和桡侧柱背侧。145例患者中86.2%(125/145例)累及乙状切迹,其中Ⅲ型累及比例高达94.7%(36/38例),Ⅱ型88.0%(72/82例),Ⅰ型68%(17/25例)。②76例AO/OTA分型C型累及乙状切迹背侧患者纳入进一步研究,其中术后未移位组65例,移位组11例;在单因素分析中,两组患者的年龄、性别、受伤部位、术前CT乙状切迹背侧骨块背侧边长(d1)、尺侧边长(d2)、乙状切迹背侧骨块背侧高度(d4)和钢板距桡骨尺侧边缘距离(d5)比较差异均无显著性意义(P>0.05);乙状切迹背侧骨块累及下尺桡关节占比[d2/(d2+d3)]、乙状切迹背侧骨块关节面占比(s1/s2)、尺侧螺钉尾端距背侧乙状切迹边缘的距离(d6)和乙状切迹背侧骨块螺钉固定的数量比较差异有显著性意义(P<0.05)。③Logistic多因素回归分析显示,乙状切迹骨块螺钉固定的数量是影响尺背侧乙状切迹骨块移位唯一的危险因素(P<0.05)。④提示在累及桡骨背侧的桡骨远端关节内骨折中,Ⅱ型最常见,Ⅲ型和Ⅰ型次之,大部分患者均存在乙状切迹背侧骨块。而乙状切迹背侧骨块其受下尺桡关节韧带影响易发生术后移位,术中至少1枚有效螺钉固定能降低其移位风险并有助于提高治疗效果。

股骨转子间骨折内固定失效后的全髋关节置换:隐性失血的模型预测

背景:股骨转子间骨折在老年人和骨质疏松患者中尤为多见,治疗常需内固定手术来稳定骨折并促愈合。但内固定手术偶可失效,引发骨折不愈合、畸形愈合或再骨折等严重问题。目的:探讨股骨转子间骨折内固定后失效行人工全髋关节置换的效果及术后隐性失血的影响因素。方法:收集2019年5月至2022年9月于阳泉市第一人民医院治疗且随访资料完整的股骨转子间骨折内固定失效患者86例,采用人工全髋关节置换治疗,记录患者相关临床指标,对患者手术前后的Harris评分、疼痛目测类比评分以及SF-36评分进行对比分析。对全髋关节置换后隐性失血的影响因素进行单变量和多变量Logistic回归分析,建立Logistic回归模型和神经网络模型预测隐性失血,通过绘制受试者工作特征曲线对比2种模型的预测效能和准确性。结果与结论:(1)86例股骨转子间骨折患者在内固定失效后,均通过人工全髋关节置换手术成功治疗;(2)与术前相比,患者在术后3,6,12个月的Harris评分、目测类比评分、SF-36评分及患髋主动活动幅度均显著改善(P<0.05);(3)高隐性失血组的年龄、高血压比例、糖尿病比例、骨质疏松比例、手术时间、总失血量、术中失血量、术后引流量及血红蛋白下降量均高于低隐性失血组(P <0.05);低隐性失血组的骨水泥型假体构成比、前方入路构成比及2-3级髋关节间隙高于高隐性失血组(P <0.05);两组在性别比例、体质量指数、慢性支气管炎比例、侧别比例、麻醉方式及髋臼杯直径方面差异无显著性意义(P> 0.05);(4)通过多因素Logistic回归分析,年龄、糖尿病、骨质疏松、假体类型、手术入路、髋关节间隙、总出血量、术中出血量、术后引流量及血红蛋白下降量是全髋关节置换后高隐性失血的危险因素(P <0.05);(5)将影响因素纳入到Logistic回归模型和神经网络模型预测隐性失血,绘制2个模型受试者工作特征曲线的曲线下面积分别为0.882和0.923,灵敏度分别为0.879和0.886,特异度分别为0.854和0.908,约登指数分别为0.733和0.794,准确性分别为0.867和0.897;2个模型的曲线下面积、约登指数和准确性均为神经网络模型更高;(6)提示全髋关节置换在治疗股骨转子间骨折内固定术后失效方面具有显著的临床效果,髋关节活动度恢复较好;年龄、糖尿病、骨质疏松、假体类型、手术入路、髋关节间隙、总出血量、术中出血量、术后引流量及血红蛋白下降量是人工全髋关节置换后高隐性失血风险的重要因素,基于危险因素构建的Logistic回归模型和神经网络模型对隐性失血的预测结果相差不大,神经网络模型更优。

单侧骨牵引架辅助改良PFNA内固定在老年股骨粗隆间骨折中的应用效果

目的:观察单侧骨牵引架辅助改良股骨近端防旋髓内钉(PFNA)内固定在老年股骨粗隆间骨折中的应用效果。方法:回顾性选取2019年5月—2023年8月德化县医院收治的100例老年股骨粗隆间骨折患者。根据治疗方法的不同将其分为人工股骨头置换术(AFHR)组(n=47)和PFNA组(n=53)。AFHR组给予AFHR,PFNA组给予单侧骨牵引架辅助改良PFNA内固定。比较两组围手术期指标,术前及术后1个月、3个月、6个月髋关节功能,并发症。结果:PFNA组切口长度短于AFHR组,术中出血量少于AFHR组,手术时间及住院时间均短于AFHR组,术后下床时间晚于AFHR组,差异有统计学意义(P<0.05)。两组术后1个月、3个月、6个月Harris评分高于术前,术后3个月、6个月Harris评分高于术后1个月,术后6个月Harris评分高于术后3个月,差异有统计学意义(P<0.05);术后1个月,PFNA组Harris评分显著低于AFHR组,术后3个月、6个月,PFNA组的Harris评分显著高于AFHR组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:单侧骨牵引架辅助改良PFNA内固定及AFHR治疗老年股骨粗隆间骨折均可获得一定治疗效果,但单侧骨牵引架辅助改良PFNA内固定远期手术效果更佳。