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有限内固定结合外固定支具及骨牵引治疗高能量Pilon 骨折

目的 总结采用有限内固定结合外固定支具及骨牵引治疗高能量Pilon 骨折的疗效。 方法 2004 年3 月－ 2008 年8 月，收治高能量Pilon 骨折31 例。其中男23 例，女8 例；年龄32 ～ 66 岁，平均45.3 岁。致伤原因：交通事故伤17 例，高处坠落伤9 例，其他伤5 例。合并腓骨骨折22 例。根据 Ruedi-Allgower 分型标准：Ⅲ型18 例，Ⅳ型8 例，Ⅴ型5 例。其中开放性骨折17 例。31 例均以克氏针和螺钉有限内固定骨折端并植骨，术后跟骨牵引结合支具外固定。 结 果 患者术后均获随访，随访时间12 ～ 39 个月，平均25.6 个月。无伤口感染、皮肤坏死和内固定物外露。骨折均愈合，愈合时间为11 ～ 17 周，平均14.3 周。无骨折块继发移位致力线改变等。踝关节功能根据Mazur 等评分系统评定，获优9 例，良15 例，可5 例，差2 例，优良率77%。 结论 有限内固定结合外固定支具及骨牵引是一种治疗高能量Pilon骨折较满意的方法。

APPLICATION OF MODIFIED TRACTION ARCH OF SKULL IN SKULL TRACTION

ObjectiveTo investigate the feasibil ity and effectiveness of the modified traction arch of skull (crossbar traction arch) for skull traction in treating cervical spine injury by comparing with traditional traction arch of skull. MethodsBetween June 2009 and June 2013, 90 patients with cervical vertebrae fractures or dislocation were treated with modified skull traction surgery (trial group, n=45) and traditional skull traction surgery (control group, n=45). There was no significant difference in gender, age, injury types, injury level, the interval between injury and admission, and Frankel grading of spinal injury between 2 groups (P>0.05). The cl inical efficacy was evaluated after operation by the indexes such as traction arch sl i ppage times, operation time, the infection incidence of the pin hole, incidence of skull perforation, visual analogue scale (VAS), and reduction status of cervical dislocation. ResultsThe traction arch slippage times, the infection incidence of the pin hole, operation time, blood loss, and postoperative VAS score in trial group were significantly lower than those in control group (P<0.05). There was no significant difference in the incidence of skull perforation caused by clamp crooks of traction arch between 2 groups (P=1.000). At 2 weeks after operation, the patients had no headaches, infections, or other complications in 2 groups. In patients with cervical dislocation, 4 of the trial group and 6 of the control group failed to be reset, the reduction rate was 83.33% (20/24) and 68.42% (13/19) respectively, showing no significant difference (χ2=0.618, P=0.432). ConclusionThe operation with modified traction arch of skull has significant advantages to reduce postoperative complication compared with tradition traction arch of skull.

植皮联合分裂式骨牵引矫治脱套伤后手掌横向挛缩一例

阶段性颅骨牵引在颈椎关节突交锁患者快速康复中的临床效果观察

目的 探讨采用调整颅骨牵引角度治疗颈椎关节突交锁型骨折的可行性以及疗效。 方法 采用历史对照的方法，选择 2013 年 12 月—2015 年 12 月入住四川大学华西医院骨科的 100 例颈椎关节突交锁型骨折患者，根据时间先后分为对照组（2013 年 12 月—2014 年 12 月）和试验组（2015 年 1 月—12 月），每组各 50 例。对照组采用传统持续中立位，试验组则采用先过屈性牵引再过伸性牵引的方法进行颅骨牵引。比较采用不同牵引方法后，患者的疼痛视觉模拟评分法（visual analogue score，VAS）评分、牵引复位率和复位时间。 结果 试验组牵引后 24、48、72 h VAS 评分分别为（4.20±1.68）、（3.70±1.43）、（2.00±1.04）分，对照组分别为（5.60±1.94）、（4.90±1.63）、（3.20±1.55）分，差异均有统计学意义（P<0.05）。试验组和对照组患者颈椎脱位的复位率分别为 84.0% 和 62.0%，复位时间分别为（8.1±0.5）、（14.2±0.6）d，差异均有统计学意义（P<0.05）。 结论 颈椎关节突交锁型骨折患者采用改良、调整颅骨牵引角度治疗颈椎脱位，与持续中立位颅骨牵引相比，患者在疼痛控制、复位率、复位时间等方面具有显著优势，具有临床推广意义。

A comparative study on effectiveness of closed reduction and internal fixation of intertrochanteric fracture assisted with skeletal tractor and traction table

ObjectiveTo investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table.MethodsThe clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis (P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups.ResultsThe operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss (P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups (t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups (t=1.768, P=0.080).ConclusionCompared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.

Application of reverse traction device in preoperative treatment of high-energy tibial plateau fracture

Objective To investigate the effectiveness of the reverse traction device in the preoperative treatment of high-energy tibial plateau fractures. Methods A retrospective study was conducted to analyze the clinical data of 33 patients with high-energy tibial plateau fractures who met the selection criteria between December 2020 and December 2023. All patients were treated by open reduction and internal fixation. According to the preoperative traction method, they were divided into the observation group (16 cases, treated with a reverse traction device on the day of admission) and the control group (17 cases, treated with heel traction on the day of admission). There was no significant difference in baseline data such as gender, age, body mass index, affected side, cause of injury, fracture Schatzker classification between the two groups (P>0.05). Preoperative waiting time, preoperative related complications (nail channel loosening, nail channel oozing, nail channel infection, soft tissue necrosis, soft tissue infection, deep vein thrombosis of the lower extremity, etc.), operation time, and total hospitalization time were recorded and compared between the two groups. On the 4th day after traction, visual analogue scale (VAS) score was used to evaluate the pain relief of the patients, the swelling value of the affected limb was measured, and the Immobilization Comfort Questionnaire (ICQ) score was used to evaluate the perioperative hospital comfort of the patients. Results Both groups of patients completed the operation successfully, and the operation time, total hospitalization time, and preoperative waiting time of the observation group were significantly less than those of the control group (P<0.05). There was no preoperative related complications in the observation group; in the control group, 3 patients had nail channel loosening and oozing, and 2 cases had the deep vein thrombosis of the lower extremity; the difference in the incidence of complication between the two groups was significant (P<0.05). On the 4th day after traction, the ICQ score, VAS score, and limb swelling value of the observation group were significantly better than those of the control group (P<0.05). X-ray films showed that the tibial plateau fracture separation and lower limb alignment recovered after calcaneal traction in the control group, but not as obvious as in the observation group. The fracture gap in the observation group significantly reduced, the tibial plateau alignment was good, and the lateral angulation deformity was corrected. Conclusion The use of reverse traction treatment in patients with high-energy tibial plateau fractures on admission can accelerate the swelling around the soft tissues to subside, reduce patients’ pain, shorten the preoperative waiting time, improve the patients’ preoperative quality of life, and contribute to the shortening of the operation time, with a good effectiveness.