Search

股骨髁上髓内钉结合进钉点取骨移植治疗股骨远端骨不连

目的 总结股骨髁上髓内钉结合进钉点环锯取骨移植治疗股骨远端骨不连的临床疗效。 方法2002年4月－2010年12月，采用股骨髁上髓内钉结合进钉点环锯取骨移植治疗6例股骨髁上骨不连患者。男4例，女2 例；年龄27～74岁，平均40.3岁。原始骨折中开放骨折1例，闭合骨折5例。交通事故伤5例，摔伤1例。按AO分型：32-A1型1例， 32-A2型1例，32-C1型1例，33-A3型1例，33-C1型1例，33-C2型1例。术后5～16个月发生内固定物相关并发症后再次手术治疗。其中肥大性骨不连2例，萎缩性骨不连4例；钢板断裂3例，螺钉拔出2例，螺钉断裂1 例。 结 果术后5例患者切口Ⅰ期愈合；1例切口感染，经换药后愈合。6例均获随访，随访时间13～120个月，平均40.3个月。X线片示骨折愈合时间4～8个月，平均5.8个月。术后1年膝关节屈曲80～135°，髋关节屈曲120～140°。 结论采用股骨髁上髓内钉结合进钉点环锯取骨移植治疗股骨远端骨不连是一种新尝试，为临床治疗提供了一种选择。

从医源性角度探讨股骨锁定钢板断裂的原因及防治措施

目的 探讨股骨锁定钢板断裂的医源性因素及防治措施。 方法 回顾分析2007 年5 月－ 2009 年8 月收治的11 例股骨骨折内固定术后锁定钢板断裂患者临床资料。其中男7 例，女4 例；年龄22 ～ 65 岁，平均38 岁。原骨折位于股骨干5 例，股骨远端6 例。切开复位锁定钢板内固定术后2 ～ 6 个月钢板断裂；断裂原因：适应证选择不当，违反锁定钢板操作原则，术后功能锻炼及康复训练不到位，医患交流缺失。11 例均再次手术，其中股骨干骨折5 例、股骨远端骨折1 例行髓内钉固定，余5 例股骨远端骨折再次行锁定钢板固定。 结果 二次术后11 例均获随访，随访时间8 ～ 20 个月，平均12 个月。术后4 ～ 8 个月，平均6 个月，所有患者骨折均达骨性愈合。无钢板再断裂及其他相关并发症发生。术后8 个月根据美国特种外科医院（HSS）评分系统对膝关节功能评定：优7 例，良3 例，可1 例；优良率90.9%。 结论 合理选择适应证、规范手术操作、正规康复训练、加强医患交流是防治股骨骨折内固定术后锁定钢板断裂的有效措施。

人工髋关节置换术后股骨骨折原因分析与治疗

目的 总结人工髋关节置换术后股骨骨折的原因及处理方法。 方法 2005 年3 月－ 2010 年1 月，收治18 例人工髋关节置换术后股骨骨折患者。男8 例，女10 例；年龄45 ～ 70 岁，平均64 岁。关节置换术后5 ～ 48 个月发生股骨骨折。17 例有外伤史，1 例为自发性骨折。股骨骨折后1 ～ 32 d 入院。骨折采用Vancouver 分型标准：A型1 例，B1 型7 例，B2 型5 例，B3 型3 例，C 型2 例。术前Harris 评分为（50.4 ± 4.1）分。根据不同骨折分型，分别采用保守治疗、骨折固定、假体翻修、自体髂骨植骨等方法治疗。 结果 手术患者术后切口均Ⅰ期愈合。除1 例患者因合并慢性心功能不全及脑梗死，行皮牵引治疗后2 个月死亡外，余17 例均获随访，随访时间12 ～ 49 个月，平均23 个月。X 线片复查示骨折于术后12 ～ 32 周达临床愈合。术后6 个月Harris 评分为（87.5 ± 3.4）分，与术前比较差异有统计学意义（t=2.241，P=0.021）。 结论 人工髋关节置换术后股骨骨折成功治疗的关键是全面评估患者情况，根据Vancouver 分型标准确定治疗方案，可获得满意临床疗效。

TREATMENT EVALUATION OF DISTAL FEMORAL FRACTURE BY LESS INVASIVE STABILIZATION SYSTEMVIA TWO INCISIONS

To evaluate the cl inical results of less invasive stabil ization system (LISS) for femur supercondylar and intercondylar fractures. Methods From March 2004 to November 2005, 47 patients with 49 intercondylar and supercondylar fractures were treated. Of all the patients, there were 34 males and 13 females with an average of 39.7 years (range 19-56 years). The locations were left side in 21 cases and right side in 28 cases. Fracture was caused by traffic accident in 31 cases, fall ing in 8 cases, violence in 6 cases and others in 2 cases. Forty-nine fractures included 14 intercondylar fractures, 21supercondylar fractures and 14 intercondylar and supercondylar fractures; 32 closed fractures and 17 open fractures. According to the AO typing, there were 6 type 33-A1, 8 type 33-A2 , 10 type 33-A3, 7 type 33-C1, 3 type 33-C2 and 15 type 33-C3. The disease course was 30 minutes to 6 days. Articular surface reduction was first performed, then the LISS plate was inserted via two incisions and locking screws were used later. Results The average operation time was 126 minutes (range 48-248 minutes). The blood loss was 180 mL(range 60-1 200 mL). The average follow-up time was 18.6 months (range 12-23 months). There were 4 patients with AP angular deformity and 5 patients with lateral angular deformity (range 2-5°). External rotation deformity was presented in 2 patients. There were no plate breakage, screw loosen and fixation failure. Average bone union time was 5.6 months (range 3-8 months) without infection case. Six cases were treated with il iac bone transplantation for delayed union. Conclusion LISS is one kind of effective treatment to femoral intercondylar and supercondylar fractures.

BIOMECHANICAL TEST OF INTRAMEDULLARY CONTROLLED DYNAMIC NAILING

【Abstract】 Objective To explore the biomechanical properties of a new intramedullary controlled dynamicnail ing (ICDN). Methods Ten pairs of specimens of adult femurs, with the age of 18 to 55 years, were divided into twogroups (groups A1 and B2, n=10). The length of the specimens was (438 ± 10) mm , and the external diameter was (26.4 ± 1.5) mm. The specimens of the two groups were osteotomized transversely after the biomechanical test. ICDNs and GK nails were randomly implanted into the femurs, respectively (groups A2 and B2). Torsional, bending and axial compressive tests were made in each group, and the effect of dynamic compression between the fracture fragments was tested. Results The resistance to compression of groups A1, B1, A2 and B2 were (0.19 ± 0.18) × 106, (0.22 ± 0.12) × 106, (1.67 ± 0.68) × 106 and (0.86 ± 0.32) × 106 N/mm, respectively. There was statistically significant difference between groups A2 and B2 (P lt; 0.01). The bending stiffnesses of coronal section of groups A1, B1, A2 and B2 were (0.94 ± 0.25) × 103, (1.10 ± 0.21) × 103, (0.70 ± 0.22) × 103, (0.64 ± 0.21) × 103 N/mm, respectively. The bending stiffness of sagittal plane of groups A1, B1, A2 and B2 were (1.06 ± 0.26) × 103, (0.96 ± 0.25) × 103, (0.67 ± 0.25) × 103, (0.61 ± 0.18) × 103 N/mm, respectively. There were no statistically significant differences between groups A1 and B1 or between groups A2 and B2 (P gt; 0.05). When the torque was 5 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.00 ± 2.54), (4.76 ± 1.93), (0.50 ± 0.63), (0.35 ± 0.31) Nm/°, respectively. When the torque was8 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.30 ± 3.27), (3.94 ± 2.01), (0.42 ± 0.52), (0.36 ± 0.18) Nm/°, respectively. There were statistically significant differences between groups A1 and A2 or between groups B1 and B2 (P lt; 0.05), and no statistically significant difference between between groups A2 and B2 (P gt; 0.05). The average maximal pressure generated between the fracture fragments which were fixed with ICDN was 21.6 N, and the pressure between the fracture fragments which were fixed with GK nail ing could not be tested. Conclusion The design of ICDN conforms to the special anatomical structure of the femur. ICDN could provide a completely different structure, a different fixation principal and a more balancedfixation than GK nail. ICDN incorporates the flexible and rigid fixation, which is l ikely to be the trend of the fracture fixation.

TREATMENT ON FEMORAL FRACTURES WITH INVERSE LIMITED MARROW CAVITY RASPING INTRAMEDULLARY INTERLOCKING NAIL

Objective To evaluate the results of the treatmenton femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail . Methods From Jun. 1999 to Sep. 2003, 74 patients with femoralfractures were treated by intramedullary interlocking nail (inverse limited marrow cavity rasping) .There were 62 males and 12 females. Among them, 5 caseswere type 32A1, 7 cases were type 32A2, 12 cases were type 32A3, 35 cases were type 32B2, and 15 cases were type 32C2. Results Seventyfour patients were followed up for 13 to 29 months(15.4 months in average). Thetime for fracture union ranged from 3 to 5 months(3.8 months in average). The overall rate of excellence was 98.7% by Wuyuesong grading. There was 1 case of non-union, 1 case of delayed infection, and 2 cases of bent screw. Conclusion The treatment on femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail is easy to operate and has minimum impairment to local circulation. It also promotes the healing and early function. 

带锁髓内钉治疗股骨干骨折

STUDY AND CLINICAL APPLICATION OF AUTO-COMPRESSIVE AND ANTI-CIRCUMROTATE INTRAMEDULLARY NAIL

ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.

老年人股骨骨折后压疮预防的护理

目的讨论老年股骨骨折患者压疮预防的护理方法。 方法对2013年1月－6月收治的33例股骨骨折老年患者，入院后即行压疮预测评估，并根据评估情况采取使用软床垫、及时变换受压部位、保护骨隆突处等预防措施，同时对患者和家属进行个体化的健康教育及加强护士交接班预防措施，积极预防和减少压疮的发生。 结果院外带入的1例Ⅲ期压疮患者通过治疗和护理转为Ⅰ期，4例Ⅰ期、2例Ⅱ期压疮患者均治愈，住院期间无新发压疮患者。 结论积极的护理措施可预防股骨骨折老年患者压疮的发生，减轻患者的痛苦，提高护理质量和患者的满意度。

新生儿股骨骨折的护理体会

目的探讨新生儿股骨骨折的护理方法及护理效果。 方法回顾性分析 2010 年 1 月-2014 年7 月收治的 41 例新生儿股骨骨折的护理体会。 结果41 例患儿均予股骨垂直悬吊式牵引即 Bryant 牵引的治疗方式。牵引时间 14～28 d，平均 23.4 d。拆除牵引装置后 14 例患儿出现皮肤并发症。出院后门诊随访 6～12 个月，41 例患儿成角畸形正位片均<10°，侧位片均<15°，缩短均<10 mm。 结论Bryant 悬吊牵引是治疗新生儿股骨骨折的常用方法，临床效果良好。由于新生儿无表达能力，故治疗期间需保证牵引的持续有效；定时观察肢端循环及合理的健康教育对预防并发症的发生至关重要，是患儿顺利康复的必要条件。