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.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Functional Outcomes of Traumatic Complex Acetabulum Fractures with Open Reduction and Internal Fixation: 200 Cases

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 - 59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 - 109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P Conclusion: Optimal functional and radiological outcomes have been achieved with anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation 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.

Clinical Analysis of Minimally Invasive Single-segment Reduction and Internal Fixation in Patients with Thoracolumbar Fractures

Objective:To study the clinical effect of minimally invasive single-segment reduction and internal fixation in patients with thoracolumbar fractures.Methods:From June 2013 to June 2014,100 patients with thoracolumbar fractures were selected as the subjects and they were randomly divided into observation group(50 cases)and control group(50 cases).The patients in the observation group were treated with minimally invasive singlesegment reduction and internal fixation.The patients in the control group were treated with short segmental fixation.The clinical effects of the two groups were compared.Results:There was no significant difference in the compression rate and Cobb angle between the two groups before and after operation(P>0.05).For all patients who were followed up for the last time,the Cobb angle was significantly lower in the observation group than in the control group(P<0.05).The social function,affective function and physical pain score of the observation group were significantly better than the control group(P<0.05).The amount of bleeding in the observation group was(250.4±41.0)ml,which was significantly lower than that in the control group(267.5±32.8)ml.The time required for the operation was(90.2±35.4)min,which was significantly lower than that of the control group(104.5±22.6)min(P<0.05).After treatment,the prognosis was 70.00%and the excellent and good rate was 98.00%,which was significantly higher than that of the control group(46.00%)and 78.00%(P<0.05).Conclusion:Thoracolumbar fractures in patients with dilated channel minimally invasive single-segment reduction and internal fixation treatment can effectively repair the patient's vertebral height and Cobb angle and the degree of correction after surgery was significantly better,safer and worthy of clinical recommended use.

Internal fixation and unicompartmental knee arthroplasty for an elderly patient with patellar fracture and anteromedial osteoarthritis:A case report

BACKGROUND Open reduction and internal fixation(ORIF)is the traditional surgical treatment for patellar fractures,and unicompartmental knee arthroplasty(UKA),especially Oxford UKA,has been increasingly used in patients with medial knee osteoarthritis(OA).However,the process of choosing treatment for patients with both patellar fractures and anteromedial knee OA remains unclear.We present the case of a patient with a patellar fracture and anteromedial OA.CASE SUMMARY We present the case of a 72-year-old woman with a history of bilateral medial compartment OA of the knees and a right Oxford UKA.She also experienced a recent left patellar fracture.ORIF and Oxford UKA were performed in a single stage.The patient showed excellent postoperative clinical results.CONCLUSION ORIF and Oxford UKA can be performed simultaneously for patients with patellar fracture and anteromedial OA on the same knee.

Clinical effect of distal radius fracture treated with open reduction and internal plate fixation

Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years （mean 57 years）.Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen （AO） standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days （mean 5 days）.All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively （mean 22 months）.The fractures healed within 10-18 weeks after operation （mean 12 weeks）.During the last follow-up,the mean palmar tilt was （7.0±0.9）° and the mean ulnar variance was （21.0±4.2）°,showing significant difference when compared with preoperation （（-5.0±1.2）° and （8.0±3.8）°）.The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open reduction and internal plate fixation was relatively satisfactory.Meticulous operation procedure and individual rehabilitation strategy contribute to the wrist joint functional recovery.

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Three-dimensional printing combined with open reduction and internal fixation versus open reduction and internal fixation in the treatment of acetabular fractures:A systematic review and meta-analysis

Purpose:This meta-analysis compared the clinical outcome of three-dimensional(3D)printing combined with open reduction and internal fixation(ORIF)to traditional ORIF in the treatment of acetabular fractures.Methods:We searched the Cochrane Library,PubMed,Embase,VIP database,CNKI,and Wanfang data-base with keywords"acetabular fracture","3D printing","three-dimensional printing","open reduction and internal fixation","Acetabulum","Acetabula"from January 2000 to March 2020.Two reviewers independently selected articles,extracted data,assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’s tools and/or Newcastle-Ottawa scale.When the two analysts had different opinions,they would ask the third analyst for opinion.Randomized controlled trials or retrospective comparative studies of 3D printing combined with ORIF(3D printing group)versus traditional ORIF(conventional group)in the treatment of acetabular fractures were selected.The data of operation time,intraoperative blood loss,intraoperative fluoroscopy times,incidence of complications,excellent and good rate of Matta score for reduction,and excellent and good rate of hip function score were extracted.Stata14.0 statistical software was used for data analysis.Results:Altogether 9 articles were selected,including 5 randomized controlled trials and 4 retrospective studies.A total of 467 patients were analyzed,250 in the conventional group,and 217 in the 3D printing group.The operation time in the 3D printing group was less than that in the conventional group and the difference was statistically significant(standardized mean difference(SMD)=-1.19,95%CI:-1.55 to-0.82,p<0.05).The intraoperative bleeding volume of the 3D printing group was significantly lower than that of the conventional group(SMD=-1.08,95%CI:-1.65 to-0.51,p<0.05).The fluoroscopy times were less in the 3D printing group than in the conventional group and the difference was statistically significant(SMD=-1.64,95%CI:-2.35 to-0.93,p<0.05).The total incidence of complications in the 3D printing group was significantly lower than that in the conventional group(OR=0.43,95%CI:0.24-0.79,p<0.05).There was no significant difference in the excellent and good rate of Matta score for reduction between the two groups(OR=0.60,95%CI:0.34-1.06,p>0.05).There was no significant difference in the excellent and good rate of hip function score at the end of postoperative follow-up between the two groups(OR=0.84,95%CI:0.46-1.56,p>0.05),but the follow-up time varies from 6 months to 40 months.Conclusion:Compared with traditional ORIF,3D printing combined with ORIF has certain advantages in terms that 3D printing not only helps surgeons to understand acetabular fractures more intuitively,but also effectively reduces operation time,intraoperative blood loss,intraoperative fluoroscopy times,and postoperative complications.However,there were no significant differences in the excellent and good rate of Matta score for reduction and the excellent and good rate of hip function score at the end of follow-up.

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.

骨科机器人联合Starr骨盆复位架治疗Tile C型骨盆环骨折

目的:探讨骨科机器人联合Starr骨盆复位架治疗Tile C型骨盆环骨折的临床疗效。方法:2019年10月至2021年5月采用机器人联合Starr骨盆复位架治疗14例Tile C型骨盆环骨折患者,男9例,女5例;年龄33~69岁。14例患者均为新鲜闭合骨折且不合并股骨、胫腓骨骨折等损伤。入院后4~7 d完成手术,术中在可透视碳素床,通过Starr骨盆复位架牵引复位骨盆环,联合骨科机器人治疗C型骨盆环骨折。观察手术时间、出血量、单枚螺钉置入透视次数、骨折复位质量、患肢功能及并发症等。采用Matta评分标准进行放射学复位评价,末次随访采用Majeed骨盆功能评分系统进行临床疗效评价。结果:14例患者均顺利完成手术,手术时间84~141 min,手术出血量20~50 ml,单枚螺钉置入透视次数4~9次。14例患者均获得随访,随访时间12~24个月。术后所有骨折获得骨性愈合,愈合时间3~7个月,未发现内固定断裂、螺钉松动、感染、神经损伤等并发症。依据Matta影像学复位评估标准:优9例,良4例,可1例。末次随访采用Majeed骨盆功能评分系统:优10例,良4例。结论:机器人联合Starr骨盆复位架治疗C型骨盆环新鲜骨折操作简单、缩短了手术和麻醉时间、并发症少,降低了手术风险,实现了骨盆骨折的微创治疗。但对于陈旧性骨折,因骨折复位困难,该技术并不适用。对于螺钉进钉点区域粉碎的骨折,通道螺钉置入困难,建议采用其他方式固定。对于伴有骨盆外伤史或骨盆发育异常者,术前需仔细评估有无经皮螺钉通道,避免损伤神经、血管。

两种切口钢板内固定治疗胫骨平台骨折的疗效比较

目的比较两种切口钢板内固定治疗胫骨平台骨折的疗效。方法将108例胫骨平台骨折患者按照切口不同分为观察组(采用微创切口钢板内固定治疗,54例)和对照组(采用传统切开复位钢板内固定治疗,54例)。记录两组切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间、并发症发生情况、膝关节活动度、膝关节功能优良率。结果患者均获得随访,时间12~18个月。切口长度、住院时间、骨痂形成时间、骨折愈合时间、开始部分负重行走时间观察组均短(早)于对照组(P<0.05)。术后6个月,膝关节功能优良率观察组高于对照组(P<0.01),膝关节屈曲、伸直活动度观察组均优于对照组(P<0.05)。术后并发症发生率观察组低于对照组(P<0.05)。结论与传统切开复位钢板内固定相比,微创切口钢板内固定治疗胫骨平台骨折具有创伤小、住院时间短、并发症发生率低的优点,更利于骨折愈合、患者早期功能锻炼及膝关节功能的恢复。

F型钳辅助复位在股骨干骨折手术中的临床应用

目的:探讨辅助复位工具F型钳在股骨干骨折复位中的临床疗效。方法:回顾性分析2019年1月至2021年12月采用髓内钉内固定手术治疗的45例股骨干骨折患者,根据复位方法不同分为两组。观察组21例,男15例,女6例;年龄27~92(53.38±18.81)岁;左侧9例,右侧12例;骨折AO分型,A型7例,B型8例,C型6例;受伤至手术时间7~13(4.62±3.34)d;采用F型钳辅助复位。对照组24例,男17例,女7例;年龄20~92(51.96±20.43)岁;左侧12例,右侧12例;骨折AO分型,A型11例,B型8例,C型5例;受伤至手术时间2~13(6.29±3.04)d;采用传统复位方式。比较两组手术时间、术中出血量、术中透视次数、术中切开复位比例、骨折临床愈合时间、术后并发症、住院时间、住院费用,并于术后6、12个月采用膝关节Lysholm评分进行临床疗效评价。结果:所有患者获得随访,时间12~24(16.60±3.45)个月。观察组手术时间、术中出血量、术中透视次数、切开复位例数、骨折临床愈合时间分别为(58.19±7.93)min、(88.10±44.45)ml、(25.29±5.54)次、0例、(4.76±0.77)个月,对照组分别为(79.33±22.94)min、(222.92±144.45)ml、(47.46±26.25)次、5例、(7.13±1.80)个月,两组比较差异有统计学意义(P<0.05)。两组术后并发症、住院时间及住院费用比较,差异无统计学意义(P>0.05)。术后6个月观察组膝关节Lysholm评分(88.62±4.48)分,优于对照组(79.21±8.91)分(F=21.948,P=0.000);两组术后6个月支撑物使用、疼痛、下蹲评分比较,差异无统计学意义(P>0.05)。术后12个月观察组膝关节Lysholm评分中爬楼梯、疼痛评分(9.62±1.20)、(19.76±1.92)分,优于对照组(7.83±2.04)、(21.88±2.88)分(P<0.05);两组其他项目评分及总分比较,差异无统计学意义(P>0.05)。结论:F型钳器械操作简单,易学易用,与传统的复位方法相比,在股骨干骨折复位中,能缩短手术时间,减少术中出血量,降低术中透视次数,加快骨折临床愈合,使膝关节获得更加早期的功能恢复。

切开复位内固定治疗新鲜Lisfranc关节损伤疗效观察

目的观察新鲜Lisfranc关节损伤治疗中引入切开复位内固定方案的治疗效果。方法回顾性分析2018年4月至2022年8月复旦大学附属闵行医院骨科收治的56例新鲜lisfranc关节损伤患者的临床资料。所有患者均通过足背侧的纵向切口进行手术,复位后应用钢板、螺钉固定内侧柱和中间柱,克氏针固定外侧柱。术后随访8个月,记录随访结果,比较手术前及末次随访足功能恢复情况[美国足踝外科协会(AOFAS)踝与后足功能评分、疼痛视觉模拟评分(VAS)],并记录并发症发生情况。结果45例患者得到有效随访,骨折愈合时间10~14周,平均12.6周;术后77.78%的患者(35/45)切口愈合良好,有3例因第一跖骨基底部粉碎性骨折行跖跗关节融合术;术后6个月影像学评估结果显示39例获得解剖复位,解剖复位率为86.7%。术后末次随访AOFAS踝与后足功能评分为(84.05±6.17)分,明显高于术前的(37.12±9.33)分,而VAS评分为(1.70±0.51)分,明显低于术前的(6.81±2.20)分,差异均有统计学意义(P<0.05);随访期间3例发生内固定断裂,4例患者出现足背皮肤激惹症状,并发症发生率为15.56%(7/45)。结论切开复位内固能够明确关节损伤的范围,解剖复位骨折脱位及可靠固定,是治疗新鲜Lisfranc关节损伤的有效方法。

后交叉韧带胫骨止点撕脱骨折应用缝线桥悬吊固定与切开复位内固定对膝关节损伤的疗效观察

目的 分析后交叉韧带胫骨止点撕脱骨折应用缝线桥悬吊固定与切开复位内固定对膝关节损伤疗效的影响。方法 前瞻性选取2020年3月至2022年3月秦皇岛市第一医院收治的90例后交叉韧带胫骨止点撕脱骨折患者作为研究对象,按照信封法将患者分为观察组45例和对照组45例。观察组接受关节镜下缝线桥悬吊固定疗法,对照组接受切开复位内固定疗法。比较两组临床指标情况(手术时间、术后引流量、住院时间、骨折愈合时间),记录并比较两组术前及术后1、3、6个月的膝关节活动功能[关节活动度(ROM)、Lysholm膝关节功能评分、Tegner运动水平评分及国际膝关节文献委员会膝关节评估表(IKDC)评分]及术后并发症发生情况。结果 观察组手术时间、住院时间分别为(44.46±5.64) min、(6.98±2.16) d,均短于对照组[(67.26±6.89) min、(11.23±1.26) d],差异均有统计学意义(P<0.05),观察组和对照组患者的术后引流量及骨折愈合时间比较,差异均无统计学意义(P>0.05)。观察组与对照组在术前及术后1、3、6个月时的ROM比较,差异均无统计学意义(P>0.05);两组术后1、3、6个月的ROM均高于术前,差异均有统计学意义(P<0.05)。术后1、3、6个月,两组患者的Lysholm评分均较术前升高,且观察组术后1、3、6个月的Lysholm评分分别为(69.98±1.02)、(88.44±3.49)、(94.56±1.23)分,均高于对照组[(67.46±1.45)、(80.55±2.98)、(90.22±0.98)分],差异均有统计学意义(P<0.05)。术后1、3、6个月,两组患者的Tegner评分均较术前升高,且观察组术后1、3个月的Tegner评分分别为(2.33±0.51)、(4.05±0.31)分,均高于对照组[(2.11±0.45)、(3.55±0.45)分],差异均有统计学意义(P<0.05),但在术后6个月时组间Tegner评分比较,差异无统计学意义(P>0.05)。术后1、3、6个月,两组患者的IKDC评分均高于术前,且同时间点组间比较,观察组的IKDC评分分别为(57.32±2.98)、(86.46±3.19)、(94.21±1.65)分,均高于对照组[(53.27±2.08)、(82.01±2.01)、(90.01±1.02)分],差异均有统计学意义(P<0.05)。观察组随访期内并发症发生率为11.11%,低于对照组(28.89%),差异有统计学意义(P<0.05)。结论 后交叉韧带胫骨止点撕脱骨折患者应用缝线桥悬吊固定可以提高治疗效果,与切开复位内固定相比,术后膝关节功能恢复情况更好,能有效缩短手术时间和住院时间,具有较高的临床应用价值。

基于胸腔镜的复位内固定术治疗老年肋骨骨折患者的临床疗效研究

目的探讨基于胸腔镜的复位内固定术对老年肋骨骨折患者康复进程以及功能恢复的影响。方法选取收治的85例老年肋骨骨折患者为研究对象,按照不同治疗方案分为对照组(n=41,开胸内固定手术)和观察组(n=44,基于胸腔镜的复位内固定手术)。比较2组手术指标(血氧饱和度恢复时间、呼吸频率恢复时间、机械通气时间、住院时间和骨骼愈合时间)、疼痛评分、肺功能指标[第1秒用力呼气容积(FEV 1)、用力肺活量(FVC)和最大呼气峰流速(PEF)]、血气指标{动脉血氧分压[p a(O 2)]、动脉血二氧化碳分压[p a(CO 2)]}、临床疗效及并发症发生率。结果观察组的血氧饱和度恢复时间、呼吸频率恢复时间、胸腔引流管留置时间和住院时间及骨折愈合时间短于对照组,胸管引流量少于对照组,差异有统计学意义(P<0.05)。术后7 d,2组视觉模拟评分法(VAS)评分、p a(CO 2)水平低于术前,且观察组低于对照组,差异有统计学意义(P<0.05)。术后7 d,2组FEV 1、FVC、PEF、FEV 1/FVC水平及p a(O 2)水平高于术前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组临床总有效率为93.18%,高于对照组的78.05%,差异有统计学意义(P<0.05)。观察组并发症总发生率为4.55%,低于对照组的19.51%,差异有统计学意义(P<0.05)。结论基于胸腔镜的复位内固定手术治疗老年肋骨骨折患者的临床疗效显著,可有效缩短康复进程,缓解患者疼痛,促进其肺功能恢复,且安全性高。

不同复位条件下股骨颈骨折最优固定方式的有限元分析

背景:股骨颈骨折的传统固定方式为3枚空心螺钉倒三角固定,对于未达到解剖复位的股骨颈骨折的最优固定方式尚无定论。目的:基于有限元分析法比较空心钉固定不同复位条件下头下型股骨颈骨折的生物力学性能。方法:选取一名健康成年男性股骨近端CT数据重建三维模型,进行头下型骨折造模,将骨折模型分为解剖复位组、髋内翻组、髋外翻组,各骨折模型组均分出3个亚组,用标准组、螺钉压低组、螺钉抬高组进行转配,于髋臼顶向股骨头施加垂直向下1400 N的应力,观察不同固定方式下股骨及内固定物的位移和应力分布,对比股骨和固定物的应力和位移最大值。结果与结论:①解剖复位时,标准组、螺钉压低组、螺钉抬高组固定物应力峰值分别为41.35,31.27,43.32MPa,螺钉抬高组的股骨应力峰值最大(28.58 MPa),股骨的位移峰值标准组最大;②髋内翻时,3个亚组的应力均相对分散且均匀;标准组的股骨应力峰值最小,但位移峰值最大,固定的稳定性可能不佳;螺钉压低组股骨的位移峰值最小;③在髋外翻时,螺钉压低组出现明显的螺钉应力集中,且位移峰值为3个亚组中最大,出现in-out-in现象;螺钉抬高组螺钉的应力峰值为3个亚组中最大,但位移峰值最小;④提示在头下型股骨颈骨折中,当完全解剖复位时,推荐采用标准的倒三角置钉方式固定;当出现复位标准允许范围内的髋内翻及髋外翻,置入螺钉时,推荐采用随髋内或外翻同方向转动相应的角度置入倒三角螺钉固定。

营养支持联合康复锻炼对下颌骨骨折切开复位内固定术病人营养状况及康复效果的影响

目的:观察营养支持联合康复锻炼对下颌骨骨折切开复位内固定术病人营养状况及康复效果的影响。方法:选取2021年7月—2022年6月于我院治疗的下颌骨骨折切开复位内固定术病人100例为研究对象,其中2021年7月—12月收治的50例病人设为对照组,2022年1月—6月收治的50例病人设为试验组,对照组给予下颌骨骨折切开复位内固定术常规护理,试验组在此基础上给予营养支持联合康复锻炼,比较两组干预后营养风险筛查量表评分、创伤愈合时间、住院时间、并发症及生活质量等。结果:试验组营养风险筛查量表评分低于对照组,创伤愈合时间、下颌功能恢复时间、住院时间短于对照组,并发症发生率低于对照组,生活质量评分高于对照组,差异有统计学意义(P<0.05)。结论:采用营养支持联合康复锻炼对下颌骨骨折切开复位内固定术病人进行干预,可改善其营养状态,推动康复进度,降低并发症发生率,提高生活质量。

髓内复位与撬拨复位结合锁定钢板治疗复杂老年肱骨近端骨折的疗效比较

目的比较髓内复位技术与撬拨复位技术结合锁定钢板治疗复杂老年肱骨近端骨折的疗效。方法选取2020年9月至2022年9月在我院就诊的肱骨近端骨折病人,采用随机数表法分为A组(撬拨复位组)与B组(髓内复位组),每组各24例。记录并比较2组手术时间、透视时间,术后3 d、12个月时的影像学指标、Constant-Murley肩关节功能评分与VAS评分,术后12个月复位丢失发生情况。结果B组的手术时间、透视时间均短于A组(P<0.05或P<0.01)。2组术后3 d、12个月时的颈干角及肱骨头高度差异均无统计学意义(P>0.05),但A组颈干角丢失量及肱骨头高度丢失量大于B组,差异均有统计学意义(P<0.05)。术后12个月,2组VAS、Constant-Murley肩关节功能评分均较术后3 d显著改善,且B组的Constant-Murley肩关节功能评分高于A组,VAS评分低于A组,差异均有统计学意义(P<0.05)。B组复位丢失率显著低于A组(4.2%比33.3%,P<0.05)。结论髓内复位技术治疗老年骨质疏松肱骨近端骨折可以缩短手术时间,减少病人及医护人员在射线下的暴露时间,同时,可以提高肱骨距的复位质量,降低术后发生复位丢失的风险,改善术后肩关节功能。

手法复位夹板外固定和闭合骨折复位内固定治疗儿童闭合性肱骨髁上骨折的效果对比研究

对比手法复位夹板外固定和闭合骨折复位内固定治疗儿童闭合性肱骨髁上骨折的效果。选取2020年1月—2021年12月广东省佛山市中医院收治的242例闭合性肱骨髁上骨折患儿为研究对象,根据治疗方法的不同将患儿分为两组,分别为对照组(n=52)和观察组(n=190)。对照组患儿接受手法复位夹板外固定手术治疗,观察组患儿接受闭合骨折复位内固定手术治疗,比较两组患儿治疗效果。结果显示,观察组患儿各项关节功能评分均高于对照组(P<0.05),并发症总发生率低于对照组(P<0.05),疼痛评分低于对照组(P<0.05),住院时间短于对照组(P<0.05)。研究发现,在儿童闭合性肱骨髁上骨折手术治疗中,闭合骨折复位内固定手术治疗法所取得的治疗效果显著优于手法复位夹板外固定治疗法,其更有助于改善患儿关节功能,预防并发症的出现,减轻患儿疼痛感,促进患儿骨折愈合。