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股骨粗隆间骨折内固定并发症原因分析

目的 总结股骨粗隆间骨折内固定手术引起的常见并发症和产生的原因。 方法 2002 年1 月－2007 年10 月，股骨粗隆间骨折内固定手术后17 例出现并发症。其中男15 例，女2 例；年龄31 ～ 82 岁。均为闭合性骨折；新鲜骨折16 例，陈旧性骨折1 例；粉碎性骨折15 例。Evan’s 分型Ⅰ型2 例，Ⅱ型5 例，Ⅲ型7 例，Ⅳ型3 例。伤后至就诊时间1 ～ 6 h，平均2.5 h。采用动力髋螺钉固定7 例，动力髁螺钉固定6 例，股骨近端交锁髓内钉固定1 例，2 枚空心钉固定2 例，外院转入麦氏鹅头钉固定1 例。 结果 术后出现断钉后髋内翻3 例、头颈钉突出股骨头5 例、骨折复位不良4 例、感染导致慢性骨髓炎内固定失败1 例、患肢短缩3 例、患肢延长1 例。无股骨干骨折、股骨头坏死等并发症。 结论 股骨粗隆间骨折内固定术后并发症，主要由于内固定方式选择不当，术中骨折复位不良、固定不牢靠、术后处理不当等引起。

PRELIMINARY REPORT OF XENOGENIC BONE GRAFT FOR SIXTY-FIVE CASES

From January 1984 to November 1997, the boiling xenogenic bone (porcine and bovine bone) was applied in 65 patients. The xenogenic bone was used to promote bone healing in 24 cases, intramedullary bone graft in 37 and osteomyelitis in 4. All of the patients were followed up for 2 to 35 months. The results showed that in five cases there was infection after operation, and all other the wounds had primary healing. The xenogenic bone seemed to induce rejection in vivo. In the sevious cases immunosuppressive treatment was often needed. The volume of the bone grafted and the extent of the periosteum being stripped seemed to be important whether xenogenic bone graft would be successful or. There were lots of problem needed investigation.

Progress in surgical treatment of inferior patellar pole fractures

Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.

TREATMENT OF FEMORAL NECK FRACTURE WITH CANNULATED SCREW FIXATION IN YOUNG ADULTS

Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.

TREATMENT OF FRACTURE OF NECK OF FEMUR IN THE AGED WITH HOLLOW COMPRESSION SCREW

OBJECTIVE To summarize the clinical results of hollow compression screw in treatment of fracture of neck of femur in the aged. METHODS: From November 1993 to October, 1998, 52 aged patients with several types of fracture of neck of femur were treated; among them, there were 25 males and 27 females aged from 60 to 83 years (70 years on average). There were 48 cases of fresh fracture and 4 cases of old fracture. Forty-two cases were performed closed reduction internal fixation, 10 cases with open reduction internal fixation. RESULTS: All the patients could sit by themselves 4 to 6 days after operation, and could walk with a crutch 10 to 15 days after operation. The mobility of hip joint was nearly normal 4 weeks after operation. All the patients were followed 26 to 84 months, 48.5 months on average. Bone union was achieved in 50 cases, nonunion in 2 cases. The average healing time was 4.7 months. There were no other complications, such as ankylosis and muscular atrophy, but ischemic necrosis in 3 cases. CONCLUSION: This method has following advantages, convenient manipulation, less injury, stable fixation, and the short-term recovery, which avoid some common complications. It is a reliable method worthy of popularizing.

克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折

目的总结克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折的疗效。 方法2008年9月－2014年3月，对15例远节指骨背侧基底不稳定骨折患者采用切开复位、克氏针双夹扣法固定。男12例，女3例；年龄18～53岁，平均32.5岁。致伤原因：戳伤8例，扭伤2例，摔伤3例，挤压伤2例。损伤指别：示指5例，中指3例，环指2例，小指5例。受伤至手术时间2～9 d，平均3.8 d。 结果患者术后切口均Ⅰ期愈合。15例均获随访，随访时间6～20个月，平均12.5个月。X线片示骨折均愈合，愈合时间5～8周，平均6.1周。术后8～12周，平均9.2周取出内固定物。末次随访时，根据总主动活动度（TAM）评价标准评定手指功能，获优9例，良5例，中1例，优良率93.3%。 结论克氏针双夹扣法固定治疗远节指骨背侧基底不稳定骨折，可使骨折、关节复位且固定牢固，允许手指早期功能锻炼，是一种有效治疗方法。

不同方法治疗股骨粗隆间骨折

【摘 要】 目的 探讨不同方法治疗股骨粗隆间骨折的手术适应证及疗效。 方法 1999 年1 月－ 2006 年12 月，收治176 例股骨粗隆间骨折患者。男103 例，女73 例；年龄34 ～ 91 岁，平均63.5 岁。交通伤31 例，高处坠落伤11 例，跌倒伤134 例。按AO 分型：31A1 型79 例，31A2 型18 例，31A3 型7 例，31B 型15 例，32A 型34 例，32B 型12 例，32C型11 例。病程2 h ～ 7 d。35 例采用非手术治疗，83 例采用动力髋螺钉（dynamic hip screw，DHS）固定，23 例采用股骨近端髓内钉（proximal femoral nails，PFN）固定，27 例采用动力髁螺钉（dynamic condyle screw，DCS）治疗，8 例采用解剖钢板手术治疗。 结果 患者均获随访6 个月～ 7 年，平均15.2 个月。非手术治疗组3 例骨折不愈合，均放弃治疗。解剖钢板手术治疗组1 例术后10 周发生钢板断裂，予对症处理骨折愈合。余患者于术后10 ～ 15 周骨折达临床愈合。6 个月后髋关节功能根据Brumback 评价标准评定，非手术治疗者优9 例，良18 例，差8 例；DHS 手术治疗者优68 例，良12例 ，差3 例；PFN 手术治疗者优18 例，良5 例；解剖钢板手术治疗者优5 例，良1 例，差2 例；DCS 手术治疗者优15 例，良11 例，差1 例。 结论 股骨粗隆间骨折首选手术治疗，手术方案应综合考虑骨折类型、内固定器材特点以及患者病情，采取个性化的治疗方案。

RESEARCH ADVANCEMENT OF LUMBAR INTER-SPINOUS PROCESS NON-FUSION TECHNIQUES

Objective To elucidate the new development, structural features and appl ication of the lumbar interspinous process non-fusion techniques. Methods With the review of the development course and important research works in the field of the lumbar inter-spinous process non-fusion techniques, the regularity summary, science induction, and prospect were carried out. Results The lumbar inter-spinous process non-fusion technique was a part of non-fusion insertof spinal division posterior surface. According to the design, it could be divided into two major categories: dynamic and static systems. The dynamic system included Coflex and device for intervertebral assisted motion; the static system included X-STOP, ExtenSure and Wall is. The lumbar inter-spinous process non-fusion technique was a new technique of spinal division, it could reserve the integrated function of intervertebral disc and zygapophysial joint, maintain or recover the segmental movement to a normal level, and have no adverse effect on the neighboring segments. A lot of basic and cl inical researches indicated that lumbar inter-spinous process insert had extensive appl ication to curatio retrogression lumbar spinal stenosis, discogenic low back pain, articular process syndrome, lumbar intervertebral disc protrusion and lumbar instabil ity and so on. Conclusion With the matures of lumbar inter-spinous process non-fusion techniques and the increased study of various types of internal fixation devices, it will greatly facil itate the development of treatment of lumbar degenerative disease. But long-term follow-up is needed to investigating the long-term efficacy and perfect operation indication.

肱骨近端粉碎性骨折内固定临床应用

Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture

目的　探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。 方法　2008年5月－2010年12月，选择38例胸腰椎骨折患者，采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例，女10例；年龄21～65岁，平均36.5岁。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受伤至手术时间3～7 d，平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。 结果　术后患者切口均Ⅰ期愈合。38例获随访12～18个月，平均15个月。骨折均获得骨性融合，无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善（P＜0.05）。术后X线片复查示伤椎高度恢复达90%以上，外形正常；CT复查示椎管内有效矢状径恢复满意，椎管前方无明显骨性压迫，伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善（P＜0.05）；术后12个月随访椎体高度无丢失。 结论　经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。