两种方法治疗尺骨鹰嘴骨折发生异位骨化的分析

目的:比较张力带钢丝和解剖钢板治疗尺骨鹰嘴型骨折术后异位性骨化的发生率。方法:运用两种方法治疗尺骨鹰嘴骨折48例,其中张力带钢丝治疗组28例,解剖钢板治疗组20例,均无肘关节脱位,为闭合骨折。结果:术后随访4周和8周复查肘关节x线,张力带组术后8周x线表现出异位骨化3例,解剖钢板组术后4周x线可见异位骨化2例,术后8周复查x线出现异位骨化5例,尺骨鹰嘴骨折解剖钢板治疗组发生异位骨化发生率大于张力带钢丝治疗组。结论:使用尺骨鹰嘴骨折解剖钢板治疗尺骨鹰嘴型骨折有比较满意的效果。     

关节镜下髁间窝成形术治疗髁间窝撞击综合征病人膝关节屈伸功能受限

目的:对髁间窝撞击综合征致膝关节屈伸功能受限患者关节镜下髁间窝成形手术疗效的探讨。方法:2008年2月-2009年7月选择关节镜下确诊骨性关节炎伴髁间窝撞击综合征病人45例,对所有患者行关节镜下髁间窝扩大成形术。结果:术后患者膝关节屈伸功能明显改进,对其中42例患者进行术后6个月随访,发现患者膝关节疼痛明显缓解或消失,关节屈伸功能较术前得到明显改善。术前Lysholm评分平均(48.7±13.1)分(差),术后平均(87.0±7.3()良),关节功能均获明显改善(P<0.001)。结论:髁间窝撞击综合征是导致该病患者膝关节疼痛及屈伸功能受限的主要原因,关节镜下髁间窝扩大成形术对该病有明显的疗效。     

关节镜下不同固定方法治疗胫骨髁间嵴骨折的临床对比研究

目的:对比关节镜下缝合法和钢丝固定治疗胫骨髁间嵴骨折的临床效果。方法:收集我院2012年1月至2014年12月年收治的87例胫骨髁间嵴骨折患者根据手术固定方法:不同分为A组(40例)组(37例),其中A组患者使用缝线法固定组患者使用钢丝固定,分别于术后3、6、12个月后随访患者影像学资料观察两组患者骨折骨折复位愈合情况,包括愈合时间、膝关节功能进行评估关节屈伸活动度,手术时间以及并发症发生情况等。结果:术前Lysholm评分组间差异无统计学意义(P0.05),术后3个月术Lysholm评分组间差异亦无统计学意义(P0.05),术后6、12个月差异具有统计学意义(P0.05);两组术后Lysholm评分与术前相比均逐渐升高差异具有统计学意义(P0.05);两组手术时间差异无统计学意义(P0.05),术后随访第12个月两组患者膝关节屈伸活动度比较A组患者显著优于B组患者A组愈合时间短于B组差异均具有统计学意义(P0.05)。结论:使用关节镜下缝合线固定治疗胫骨髁间嵴骨折具有创伤小、操作简便、固定稳固、利于关节早期的康复,可推广使用。     

显微镜下减压联合前路Zero-P治疗颈椎病的早期临床疗效分析

目的:探讨前路颈椎显微镜辅助下精准减压联合前路椎间隙Zero-P融合器置入治疗颈椎病的早期临床疗效。方法:回顾性分析2016年6月至2018年1月我院收治的43例颈椎病患者,处理节段共73个;患者均行显微镜辅助颈椎前路减压、髓核切除、Zero-P置入融合内固定术。记录患者手术节段、手术时间,术中失血量及并发症。手术前,术后1个月、3个月、6个月、末次随访时的颈部及上肢疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈部日本骨科协会评分(Japanese Orthopedic Association,JOA)和颈椎残障功能指数(Neck Disability Index,NDI),并采用配对t检验对不同时间点的评分进行分析,评估临床疗效。并同期行颈椎X线、CT及MRI检查,测量和评估椎间隙高度、颈椎Cobb角的改变情况和邻近节段异位骨化形成(Adjacent Level Ossification Development,ALOD)。结果:所有患者术后均获得随访,随访时间12-18个月,平均(14.9±2.2)个月。平均手术时间(82.2±20.9)min,失血量(91.5±33.7) m L;未发生神经和血管损伤等严重并发症。与术前相比,患者术后1个月、3个月、6个月及末次随访时的VAS评分、JOA评分、NDI评分、椎间隙高度及Cobb角均明显改善,差异有统计学意义(P0.05)。但术后随访时间点比较,差异无统计学意义(P0.05)。术后出现轻度吞咽困难2例,中度和重度吞咽困难各1例。随访期间,所有患者均获椎间骨性融合,未发生Zero-P融合器松动、滑脱或断裂,椎体未出现继发性骨折。结论:显微镜辅助颈椎前路椎间盘切除、Zero-P融合器置入治疗颈椎病,能够精准的去除神经脊髓组织的压迫,术后短期和中期临床疗效良好,同时显微镜下止血、术中出血少;视野清晰、手术安全性高。     

前内前外双切口双钢板治疗复杂胫骨平台骨折

目的:探讨双切口、双钢板切开复位内固定治疗胫骨平台骨折的手术技术及疗效。方法:我院于2004年至2008年间共收治胫骨平台骨折109例,其中Schatzker V、VI型骨折59例,均采用双侧切口双钢板固定骨折。结果:58例切口获得I期愈合,切口及关节腔感染1例,未发生内固定物断裂、深静脉血栓等并发症。术后1年随访50例,膝关节HSS评分平均91.9分(6l一98分),其中优41例,良8例,差1例,优良率98.0%,完全负重时间3～6个月。结论:术前系统的病情评估,准确地掌握手术指征和手术方法,可大大改善患者膝关节功能,获得满意疗效。     

石膏固定和外固定支架在老年骨质疏松性桡骨远端骨折中的疗效比较

目的:分析石膏固定和外固定支架在治疗老年骨质疏松性桡骨远端骨折中的治疗效果,为临床治疗提供参考依据.方法:选取在我院诊治的93例老年骨质疏松性桡骨远端骨折患者作为研究对象,根据治疗方法不同分为石膏固定组和外固定支架组,并采用Jakim评分系统对两组患者腕关节功能进行评价.结果:术后6个月,石膏固定组主观指标评分为(26.7±2.2)分,支架组为(22.3±2.6)分,经t检验,差异有统计学意义,P＜0.05;石膏固定组优良率为83.3％,支架组为86.3％,经卡方检验,差异无统计学意义,P＞0.05.结论:手法复位石膏固定固定和闭合复位外固定支架固定治疗老年骨质疏松性桡骨远端骨折均有较好的治疗效果,石膏固定疗法更易被老年患者接受.     

缝线治疗粉碎性髌骨骨折并修复伸膝装置

目的:探讨缝线治疗严重粉碎性髌骨骨折并修复伸膝装置的临床疗效.方法:采用缝线治疗严重粉碎性髌骨骨折伴伸膝装置损伤19例.术后影像学检查及术后功能恢复情况综合判定治疗效果,并予以临床分级标准评分.结果:术后平均随访23.5个月,术后无需石膏托外固定,无骨折移位,全部达到临床愈合,膝关节功能恢复良好.术后功能恢复情况:优ll例,良6例,可2例.临床分级标准评分平均26.3分.结论:运用缝线治疗严重粉碎性髌骨骨折并修复伸膝装置是一种较为理想的手术方法.     

先天性小耳畸形耳廓再造及 BAHA 安装一期手术的研究

目的:研究通过多孔高密度聚乙烯(MEDPOR)支架植入,一期完成全耳廓再造+骨锚式助听器BAHA安装,术后观察耳廓外形变化,听力恢复程度,了解一期联合手术的初期临床疗效。方法:对前来就诊的先天性小耳畸形患者,术前进行外形,听力,影像学评估,对于Jahrsdoerfer评分小于及等于5分,行多孔高密度聚乙烯(MEDPOR)支架植入,一期耳廓再造术+骨锚式助听器(BAHA)植入术。术后两周起,定期观察患者耳廓改善及听力恢复情况,了解手术的治疗效果。结果:临床病例3例,术后两周起开始随访,再造耳廓外形逼真,无支架外露;所有患者听力均获得较大程度改善。结论:该方法具有疗程短、并发症少、临床效果佳等优点。该方法切实可行,可用于临床推广应用。     

椎板薄化分解结合根黄通道治疗单节段胸椎黄韧带骨化合并脊髓损伤

目的:探讨椎板薄化分解结合根黄通道治疗单节段胸椎黄韧带骨化症(OLF)合并脊髓损伤的临床疗效及安全性。方法:回顾性分析2010年6月-2014年12月我院接受椎板薄化分解结合根黄通道治疗并获得随访的52例单节段胸椎OLF,其中男34例,女18例;手术时年龄55~72岁,平均63.8岁。节段分布:T10/11 21例,T11/12 18例,T9/10 8例,T8/9 5例。记录手术时间,术中出血量,比较术前及末次随访时JOA,ASIA神经功能评分变化,通过CT及MRI扫描观察椎管减压及植骨融合情况。结果:52例患者均随访12月。本组患者手术间120±24 min,出血量240±60 m L。括约肌功能JOA评分、下肢运动功能JOA评分、ASIA运动功能评分、ASIA感觉能评分分别从术前1.56±0.78、1.98±0.66、68.3±9.86、79.2±10.23提高到术后12月2.67±0.56分、3.62±0.82分、93.5±15.82、102.3±21.65,具有统计学意义(P0.01)。按Epstein和Schwa H评分标准,优37例,良13例,可1例,差1例;优良率92.3%。术后3例发生神经症状加重,给予营养神经药物治疗后6月恢复到术前水平;5例发生脑脊液漏,行保守治疗治愈。CT提示减压彻底,植骨融合,未见内固定失败。结论:椎板薄化分解结合根黄通道治疗单节段胸椎OLF减压彻底,侵袭小,手术安全性可靠,疗效确切。     

经皮与开放手术椎体椎弓根固定术治疗多椎体压缩性骨折的临床疗效比较

目的:研究和比较经皮椎体椎弓根固定术与开放手术治疗多椎体压缩性骨折的临床疗效及安全指标。方法:回顾性分析我科自2013.06至2015.06诊断为多椎体压缩性骨折并行内固定外科手术治疗的共计56例患者。根据手术方法的不同,分为实验组(经皮椎弓根固定组,32例)和对照组(开放手术固定组,24例)。对患者在术前即术后的各项临床指标进行随访和统计,对其VAS疼痛指标、JOA功能评分及患椎的前缘高度比进行比较。并比较两组患者的切口愈合,内固定松动等并发症。并比较两组患者的手术时间,出血量、下地时间等围手术期指标。结果:本次研究结果显示:经皮和开放椎体椎弓根固定术治疗的患者在术后及6月,12月的VAS及JOA评分中均获得了良好的改善,且两组之间并无统计学差异。在椎体前缘高度比值的比较中,术后开放组优于经皮固定组,但两者之间并无统计学差异。在并发症的比较中,经皮固定组显著优于开放手术组。在围手术期指标的比较中,经皮手术组在手术时间,出血量,下地时间等指标中都显著优于开放手术组。结论:对于多椎体压缩性骨折,经皮椎体椎弓根固定术能够达到与开放手术相似的临床治疗效果,但能够有效的减少并发症,并在手术时间,出血量,下地时间等指标中充分体现微创手术的优势。在多椎体骨折的治疗中可以进一步的进行推广。     

Biomechanical influences of pin placement and elbow angle on hinge alignment and joint distraction of bridged elbow-pin-fixator construct

Joint distraction and mobilization with a hinged external fixator preserves elbow stability and mobility. However, the alignment of both elbow and fixator hinges was the initial prerequisite of the arthrodiatasis technique. The main goal of this study was to numerically evaluate the kinematic influence of the device, surgery, and joint factors on hinge alignment. The kinetic effects of the pins placement and elbow angle on concentric distraction and mobilization were also discussed. A unilaterally hinged elbow-fixator system with a 14 links and 10 degrees-of-freedom was instrumented into a humeroulnar model. The Denavit–Hartenberg method with the homogeneous transformation matrixes was applied to perform kinematic analysis of the linkage system. The predicted results revealed that the concurrence of hinge alignment (i.e., kinematic) and concentric distraction (i.e., kinetic) necessitates two telescopic tubes orthogonal to the elbow hinge. The degrees-of-freedom arrangement of the fixator articulators plays a significant role in hinge alignment. After joint distraction, two hinges might be misaligned due to the difference in the structural rigidity of the pins, fixator, and stiffened elbow. Furthermore, those two prerequisite are interactive and sensitive to elbow angle, fixator design, and pin placement of the bridged elbow-pin-fixator construct. In addition, the ideally concentric distraction might occur only at an elbow angle of 120° owing to the ulnar anatomy. Meticulous planning is necessary for such highly technically demanding surgery.     

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Objective

Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.

Methods

Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.

Results

Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall  = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients).

Conclusions

The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.     

III度膝关节内侧副韧带损伤缝合锚重建术后异位骨化8例临床分析

目的:分析8例III度膝关节内侧副韧带损伤的患者行缝合锚重建术后异位骨化发生与损伤的关系。方法:回顾性收集8例Ⅲ度膝关节内侧副韧带损伤行缝合锚重建术后发生异位骨化的患者,对其临床一般资料、损伤程度及部位、膝关节活动度及异位骨化程度等进行分析。结果:8位中Ⅰ度异位骨化4例,膝关节活动度73.75°~176.25°,平均125°,Ⅱ°异位骨化4例,膝关节活动度78.75°~157.25°,平均117.4°。在发生内侧副韧带异位骨化的8名患者中,仅有1名为单纯内侧副韧带损伤导致,其余7名患者中5名合并前叉或前、后叉韧带损伤,1例伴有胫骨髁间棘的撕脱骨折,1例合并胫骨平台骨折,4例合并胫骨或股骨髁骨折。结论:膝关节内侧异位骨化是异位骨化的好发部位,其发生与膝关节多发韧带损伤有关。     

锁骨骨折内固定失效的原因分析及对策

目的：探讨锁骨骨折切开复位内固定术后内固定失效的原因,并寻找补救方案。方法：选择我院2007年5月~2010年5月收治的184例锁骨骨折患者,其中男性123例,女性61例,年龄24~76岁,对手术切开复位内固定失败病例的内固定方法进行对比,分析内固定失效的原因,并选取记忆合金环抱器或天鹅型记忆接骨器作为再次手术的内固定器械,分析其临床疗效。结果：本组所有病例均获得6~24个月随访,所有患者首次手术均行钢板内固定治疗,其中应用重建钢板治疗48例,解剖钢板治疗86例,锁骨钩钢板治疗50例,3例术后发生钢板或螺钉断裂患者选用记忆合金环抱器重新手术内固定治疗,2例痊愈,1例记忆合金环抱器再次发生断裂,改用天鹅型记忆接骨器治疗获得痊愈。3例骨不连患者均选择天鹅型记忆接骨器配合植骨内固定治疗,术后恢复良好。结论：锁骨骨折切开复位内固定术后内固定失败的原因主要与所使用内固定技术不合理及患者早期不正确的功能锻炼有关。记忆合金环抱器和天鹅型记忆接骨器均可作为钢板内固定失败术后的补救方案,但天鹅型记忆接骨器较记忆合金环抱器可提供更好的纵向加压作用,治疗钢板断裂及骨不连患者更为可靠。     

Six-year survival of reimplanted talus after isolated total talar extrusion: a case report

Background

Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation.

Case presentation

A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up.

Conclusions

In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.

     

Operative Treatment of Terrible Triad of the Elbow via Posterolateral and Anteromedial Approaches

The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O’Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.     

切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折患者的比较研究

目的:比较切开复位钢板内固定及闭合复位外固定架固定治疗不稳定型桡骨远端骨折的临床疗效,为临床治疗方式的选择提供参考。方法:选择2014年1月至2016年1月间于我院骨科就诊的桡骨远端骨折患者102例作为研究对象。按患者的治疗方式分为内固定组(n=52)和外固定组(n=50)。内固定组患者采用切开复位钢板内固定进行治疗,外固定组患者采用闭合复位外固定架固定进行治疗。术后3个月及术后1年通过影像学测量两组患者的关节面台阶、掌倾角和尺偏角,同时测量患者腕部功能情况。随访1年,比较两组患者疗效,并观察患者并发症发生情况。结果:术后3个月及术后1年,内固定组患者关节面台阶、掌倾角和尺偏角均低于外固定组患者,差异均具有统计学意义(P0.05)。术后3个月,内固定组的旋前旋后活动度、屈伸活动度、桡尺偏活动度、捏力、握力均明显高于外固定组(P0.05),但两组的上述指标在术后1年比较无统计学差异(P0.05)。内固定组患者治疗有效率为86.54%,外固定组患者治疗有效率为86.00%,差异无统计学意义(P0.05)。内固定组并发症发生率为15.38%,外固定组并发症发生率为18.00%,差异无统计学意义(P0.05)。结论:与闭合复位外固定架固定相比,切开复位钢板内固定治疗对患者关节面台阶、掌倾角和尺偏角的恢复效果较好,同时患者能及早进行腕部功能锻炼,近期疗效更加明显。     

Comparison of two systems for tibial external fixation in rabbits

BACKGROUND AND PURPOSE: Use of rabbits in orthopedic investigations is common. In this study, focus is on factors that influence bone healing and on distraction osteogenesis. Biomechanical characteristics of two external fixator systems (Orthofix device and Hoffmann device) for long bones were tested. METHODS: Twelve freshly dissected tibiae were obtained from six skeletally mature New Zealand White rabbits, and four-point bending stiffness in two planes (90 and 180 degrees to the fixator pins) and torsional stiffness and strength of the bone-fixator complex were evaluated by use of a material testing machine. RESULTS: In four-point bending, Orthofix device had higher stiffness and strength, compared with Hoffmann device. When the load was applied 180 degrees to the pins, both devices had higher stiffness, compared with that at 90 degrees. In torsional testing, Orthofix device had significantly higher stiffness and strength. CONCLUSIONS: Significant differences in structural properties between the two systems were evident. Loading direction and gap conditions were important factors in determining properties of the systems. Therefore, type of external fixation system and fixation technique should be considered when designing experiments, using the rabbit long bone model.     

桡骨远端不稳定骨折的治疗策略

目的：探讨桡骨远端不稳定骨折的最佳治疗方案,以便能够获取更好的功能康复。方法：2007年1月-2011年12月共收治桡骨远端不稳定骨折51例,其中采用外支架撑开复位外固定5例,后路复位钢板内固定治疗23例,前路钢板固定17例,前后路联合固定6例,术后均早期进行关节功能锻炼。结果：51例均获得随访,X片提示均已骨性愈合。采用Gartland和Werley评分系统评估腕关节功能,其中外支架固定,优1例,良1例,中2例,差1例,优良率40％;后路固定,优12例,良6例,中3例,差2例,优良率78-3％;前路固定,优9例,良6例,中1例,差1例,优良率88．2％;前后路联合,优2例,良1例,中2例。差1例,优良率50％。结论：桡骨远端不稳定骨折正确的手术策略能够获得更好的功能恢复,其中前路手术固定效果优于后路固定。     

Complications of Open Elbow Arthrolysis in Post-Traumatic Elbow Stiffness: A Systematic Review

Objective

The objective of this study was to systematically review the literature for a more comprehensive understanding of the complications of open elbow arthrolysis in patients with post-traumatic elbow stiffness and provide a reference for better prevention and treatment of them.

Methods

The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched for therapeutic studies with a set of inclusion and exclusion criteria. Data were extracted from selected articles, and a statistical analysis was performed to evaluate related factors and management of the complications.

Results

Twenty-eight articles published between 1989 and 2013, involving 810 patients, were included. Most of the complications included in the selected articles were nerve complications, heterotopic ossification, elbow instability, infection, pin-related complications and repeat elbow contracture. The total complication rate was 24.3% ± 3.0%, and the reoperation rate was 34.0%. Furthermore, the statistical analysis revealed that preoperative range of motion (β = -0.004, P = 0.01) and proportion of female (β = 0.336, P = 0.04) were the independent factors affecting the total complication rate.

Conclusions

Various risk factors are related to each of the complications, and we found that patients with less preoperative ROM and a higher proportion of female gender may point to a higher total complication rate. Therefore, to further improve the overall outcomes of this procedure, more and larger prospective studies should be performed to further elucidate the effects of prophylactic interventions targeting the risk factors, thus improving the methods of prevention and treatment of complications.