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EFFECTIVENESS COMPARISON BETWEEN ABSORBABLE AND METALLIC SCREWS FOR TREATMENT OF TIBIOFIBULAR SYNDESMOTIC DISRUPTIONS

Objective To investigate the feasibility and effectiveness of absorbable screws for the treatment of tibiofibular syndesmotic disruptions by comparing with metallic screws. Methods Between July 2007 and May 2012, 69 patients with tibiofibular syndesmotic disruptions associated with ankle fractures were treated; absorbable screw fixation was used in 38 cases (group A) and metallic screw fixation was used in 31 cases (group B). There was no significant difference in gender, age, injury causes, the type of fracture, the side of fracture, and disease duration between 2 groups (P gt; 0.05). The fracture healing time, weight bearing time, and complications were recorded and compared between 2 groups. According to Baird-Jackson scoring system, the function of the ankle was assessed after 6 months. Results Infection of incision occurred in 3 cases (7.9%) of group A and 2 cases (6.5%) of group B, and skin necrosis of incision in 1 case (2.6%) of group A and 5 cases (16.1%) of group B, showing no significant difference in the incidences of infection and necrosis of incisions between 2 groups (P gt; 0.05); primary healing of incision was obtained in the other patients. The 69 cases were followed up 12-26 months (mean, 18.6 months). The weight bearing time was (2.97 ± 0.59) months in group A and was (3.16 ± 0.74 ) months in group B, showing no significant difference (t=1.175, P=0.244). X-ray films showed that fractures and tibiofibular syndesmotic disruptions healed in 2 groups; the healing time was (5.71 ± 1.01) months in group A and was (5.81 ± 1.08) months in group B, showing no significant difference (t=0.381, P=0.705). No fixation failure, breakage, or loosening occurred in 2 groups. According to Baird-Jackson scoring system, the results were excellent in 29 cases, good in 5 cases, and fair in 4 cases with an excellent and good rate of 89.5% in group A at 6 months after operation; the results were excellent in 20 cases, good in 7 cases, and fair in 4 cases with an excellent and good rate of 87.1% in group B; no significant difference was found in the excellent and good rate between 2 groups (Z= — 0.991, P=0.321). Conclusion Treatment of tibiofibular syndesmotic disruptions with absorbable screws can get good effectiveness and replace metallic screws because of avoiding additional operation for removing the screw.

闭合复位经皮可吸收螺钉固定治疗踝部骨折

目的 总结闭合复位经皮可吸收螺钉固定治疗踝部骨折的疗效。 方法 2002 年1 月－ 2009 年3 月，采用闭合复位经皮可吸收螺钉固定治疗31 例外伤致踝部骨折患者。男19 例，女12 例；年龄15 ～ 67 岁，平均39 岁。内踝骨折12 例，外踝骨折6 例，双踝骨折10 例，三踝骨折3 例（后踝lt; 1/4）。骨折AO 分型：A 型22 例，B 型6 例，C 型3 例。伤后至入院时间为2 h ～ 7 d，平均4.5 h；入院至手术时间3 h ～ 11 d。 结果 术后患者切口均Ⅰ期愈合。31 例均获随访，随访时间20 ～ 36 个月，平均24 个月。1 例术后2 个月螺钉断裂、骨折移位，二次手术采用金属螺钉固定后3 个月骨折达临床愈合。其余30 例骨折临床愈合时间为3 ～ 4 个月，平均3.2 个月。末次随访时，参照Mast 等疗效评定标准，获优22 例，良7 例，可2 例，优良率93.5%。 结论 闭合复位经皮可吸收螺钉固定治疗易于闭合复位的踝部骨折，创伤小，固定较可靠，避免了二次手术取出，是一种较好的治疗方法。

可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折

目的 总结可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折的疗效。 方法 2003 年6 月－2009 年8 月，应用可吸收螺钉结合丝线环扎加“8”字内固定治疗32 例髌骨闭合骨折。男22 例，女10 例；年龄23 ～ 71 岁，平均36.5 岁。跌伤19 例，车祸伤12 例，棒击伤1 例。粉碎骨折3 例，横形骨折29 例。X 线片示骨折均有分离移位。受伤至手术时间2 h ～ 7 d。 结果 术后切口均Ⅰ期愈合。32 例均获随访，随访时间3 ～ 24 个月，平均9 个月。X 线片示骨折均愈合，临床愈合时间9 ～ 16 周，平均10 周。术后早期活动中未发生丝线断裂、骨折分离等并发症，未出现排斥反应。1 例术后行走时偶有疼痛。根据陆裕朴等疗效评定标准，优27 例，良4 例，可1 例，优良率为96.9%。 结论 可吸收螺钉结合丝线环扎加“8”字内固定治疗髌骨骨折疗效确切，固定牢靠，并发症少，可避免二次手术。

可吸收螺钉结合可吸收缝线张力带治疗青少年髂前上棘撕脱骨折

目的 总结采用可吸收螺钉结合可吸收缝线张力带治疗青少年髂前上棘撕脱骨折的疗效。 方法 2006 年12 月－ 2009 年6 月，采用切开复位可吸收螺钉结合可吸收缝线张力带治疗15 例青少年髂前上棘撕脱骨折。患者均为男性；年龄13 ～ 16 岁，平均14.6 岁。左侧4 例，右侧10 例，双侧1 例。均为运动损伤。X 线片示髂前上棘撕脱骨折，骨折块分离移位1.5 ～ 3.0 cm。受伤至手术时间约3 d。 结果 术后切口均Ⅰ期愈合。15 例均获随访，随访时间3 ～ 12 个月，平均6 个月。患髋活动均良好，无跛行，患处及行走无疼痛，髂前上棘外观恢复满意。术后3 个月X 线片示骨折均达骨性愈合。缝匠肌肌力5 级，可参加体育锻炼。1 例术后大腿外侧皮肤感觉减弱，随访3 个月后皮肤感觉恢复正常；余无延迟愈合、感染、屈髋功能障碍等并发症。 结论 可吸收螺钉结合可吸收缝线张力带固定是治疗青少年髂前上棘撕脱骨折的一种有效方法。

可吸收螺钉治疗青壮年股骨头骨折

总结股骨头骨折治疗中手术入路选择及可吸收螺钉内固定的应用。 方法 2002 年6 月－2006 年12 月，采用可吸收螺钉内固定治疗12 例股骨头骨折患者。男9 例，女3 例；年龄16 ～ 46 岁。车祸伤10 例，高处坠落伤2 例。左侧5 例，右侧7 例。12 例均为闭合性损伤，新鲜骨折伴髋关节后脱位。股骨头骨折按Pipkin 分类：Ⅰ型5 例，Ⅱ型4 例，Ⅳ型3 例。 结果 术后切口Ⅰ期愈合。12 例患者获随访6 个月～ 5 年，平均2 年6 个月。无关节积液、滑膜炎、退钉等现象。X 线片检查骨折愈合时间为12 ～ 18 周，平均15 周。髋关节功能按Brumback 评价标准：优9 例，良3 例。 结 论 采用可吸收螺钉治疗股骨头骨折，固定可靠，疗效满意，避免了二次手术。3 种手术入路方式各有优点，应根据患者情况进行选择。

TREATMENT OF OLD SCAPHOID FRACTURE WITH ABSORBABLE SCREW

To explore a new approach to treat old scaphoid fracture by grafting bones from distal radius and fixing absorbable screws. Methods From January 2002 to May 2007, 18 patients with old scaphoid fractures were treated by grafting bones from distal radius and fixing absorbable screws. All of the 18 patients (13 males and 5 females, aged from 17 to 41 years old) had the injury history of the palm of hand touching the ground. They felt tenderness on the anatomical snuff-box and tubercle of scaphoid bone. The grasping force decreased. The range of motion of the wrist was (36 ± 2)° extension/(30 ± 3)° flexion, (8 ± 3)° radial is/(13 ± 2)° ulnaris. Results The average postoperative follow-up period was 15.7 months．A total of 18 cases achieved bone union. The range of motion of the wrist in the 16 healed cases was (68 ± 2)° extension/(65 ± 3)° flexion, (15 ± 3)° radial is/(28 ± 5)° ulnaris. There was no pain of motion and symptom of powerlessness. As to the other 2 cases, the range of motion of the wrist was (40 ± 8)° extension/(35 ± 6)° flexion, (8 ± 5)° radial is/(12 ± 5)° ulnaris; no obvious improvement was found; the patients occasionally felt painful in daily l ife; the extension force decreased. No infection and break of internal fixation were seen. Conclusion The absorbable screw as a new biomaterial for internal fixation has obvious advantages of good biocompatibil ity, promoting union of the fracture and no need of a second operation for removal．

可吸收螺钉临床应用30例

可吸收螺钉改良Dewar术治疗陈旧性Ⅲ度肩锁关节脱位

COMPARISON OF INTERNAL FIXATION TREATMENT OF TIBIA INTERCONDYLAR EMINENCE FRACTURE BETWEEN ABSORBABLE SCREW AND METALLIC SCREW

Objective To compare advantage and disadvantage of internal fixation method for tibia intercondylar eminence fracture between absorbable screw and metallic screw. Methods From 1996 to 2002, 200 patients with fracture of tibia intercondylar eminence were divided into group A (with absorbable screw, n=120) andgroup B (with metallic screw, n=80). And the biological compatibility, biomechanics, bone union and complications were compared between two groups.Results There were no obvious differences in operating time and circumstance of recovery position between two groups. Group A was obviously better than group B in biological compatibility, biomechanics, bone union, joint function recovery. The average healing time of group A was three months, that of group B was three and half months. The good rates of joint function in two groups were 98.0% and 95.0% respectively. The occurrence rates of wound arthritis were 1.7% and 3.7%. There wassignificant difference between them(P＜0.01). Conclusion Absorbable screw is a more ideal material of internal fixation to treat tibia intercondylar eminence fracture.

OPERATIVE TREATMENT OF DISPLACED TALAR NECK FRACTURES WITH ABSORBABLE LAG SCREW

OBJECTIVE: To study a new kind of operation for displaced talar neck fractures. METHODS: From April 1996 to March 2001, 9 talar neck fractures were treated by internal fixation of absorbable lag screw with a medial approach and cut of medial malleolus to expose the fractures. A non-weight-bearing below-knee cast was applied for 6 to 12 weeks after operation. Once union of the fracture site is apparent, the patient should remain non-weight bearing in a removable short-leg and keep exercise every day. RESULTS: All the patients received follow-up from 15 to 60 months with an average of 28 months. The fractures healed from 20 to 42 weeks. The excellent and good rate of function was 77.8% (7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS). One case had the complication of superficial infection of wound and skin edge necrosis after operation, which was Hawkins type III. Late complication included two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type II was caused by early weight-bearing five weeks after operation and gained the fair score. The other AVN of Hawkins type III was inefficient to conservative therapy and proceeded ankle fusion in the end. The AOFAS of the patient was bad. CONCLUSION: Treatment of talar neck fractures by internal fixation of absorbable lag screw with a medial approach is an ideal method. It can gain a satisfactory result by the operation, strict postoperative care and rehabilitation.