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可吸收螺钉临床应用30例

胫骨平台骨折42例的手术治疗

目的 探讨胫骨平台的手术治疗方法。方法 2003年8月～2006年3月，共对42例胫骨平台骨折，其中男28例，女14例；年龄21～86岁，平均44岁。平均住院时间8周。闭合性损伤39例，开放性损伤3例。合并其他部位骨折24例，颅脑损伤10例，半月板损伤3例，交叉韧带损伤2例，髌韧带损伤1例，高血压2例，冠心病2例，慢性肾衰1例。按Schatzker分型：Ⅰ型12例，Ⅱ型14例，Ⅲ型9例，Ⅳ型3例，Ⅴ型2例，Ⅵ型2例。采用解剖钛钢板、松质骨螺钉、骨栓和可吸收螺钉内固定，结合人工骨或自体髂骨植骨。结果 术后3 d内复查X线片，骨折达解剖或接近解剖复位38例，4例术后胫骨平台塌陷移位5 mm。1例伤口严重感染并导致骨感染，经开窗引流持续冲洗、内固定物取出、植骨放置庆大霉素链株、胫前肌肌皮瓣移位修复手术，2年6个月治愈，但遗留膝关节畸形，跛行。所有患者均获随访6个月～25年，41例骨折临床愈合，平均骨折愈合时间26周，无植骨坏死发生。根据Merchant等评分标准，优24例，良12例，可4例，差2例，优良率84%。结论 手术治疗胫骨平台骨折有其优势。

复杂肱骨远端骨折的双钢板内固定治疗

【摘要】　目的　总结双钢板内固定治疗复杂肱骨远端骨折的临床疗效。　方法　2004年1月-2008年5月，采用双钢板内固定治疗15例复杂肱骨远端骨折患者。按照AO/ASIF分型，患者均为C型骨折。其中C1型4例，C2型4例， C3型7例。受伤至手术时间平均2.5 d。C1、C2型骨折复位后用双钢板固定，C3型骨折复位后先用细克氏针固定髁间骨折块，再用双钢板固定。手术后3～5 d佩带活动型肘关节支具进行功能锻炼。随访观察7～16个月，平均13个月。按照Mayo评分标准评定肘关节功能。　结果　15例患者肱骨髁间及髁上骨折均愈合，时间为3～6个月，平均4.5个月。Mayo评分：优8例，良4例，可2例， 差1例，优良率80%。　结论　对复杂肱骨远端骨折采取早期切开解剖复位、双钢板内固定，使用活动型肘关节支具进行早期功能锻炼，能显著降低相关并发症，促进肘关节功能的恢复。

Endovascular intervention for iliac vein compression syndrome with acute lower extremity deep vein thrombosis

ObjectiveTo evaluate the efficacy and safety of intracavitary treatment for iliac vein compression syndrome（IVCS）with acute lower extremity deep venous thrombosis (DVT).MethodsThe clinical data of 57 patients with IVCS and lower extremity DVT, who undergoing with stent implantation, balloon expansion and Angiojet rheolytic thrombectomy from June 2015 to June 2018, were retrospectively analyzed. The effect of treatment was evaluated by the changes of thigh circumference difference between the affected side and the healthy side, and the thrombosis clearance rate in the operating. In addition, the incidence of post-thrombotic syndrome (PTS) and stent patency rate were analyzed after long-term follow-up based on the change of Villaita scale score and ultrasound examination of lower extremity veins.ResultsThe success rate of surgical technique was 100%, and there was no pulmonary embolism during operating and postoperative. Lower extremity deep vein thrombosis clearance levels Ⅲ 48 cases (84.2%), Ⅱ 9 cases (15.8%), the changes of thigh circumference difference between the affected side and the healthy side from preoperative (5.8±1.7) cm to (3.7±1.0) cm. One year follow-up after operation, the primary patency rate of stent was 86.0% and PTS occurred in 8 patients (14.0%).ConclusionStent implantation, balloon expansion and Angiojet rheolytic thrombectomy for IVCS with acute lower extremity DVT is a safe, effective with low incidence of complications and efficient thrombus clearance.