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股内收肌群痉挛致老年严重骨质疏松患者股骨干再骨折一例

克氏针提拉复位髓内钉固定治疗粉碎性股骨干骨折

目的 总结克氏针提拉闭合复位、交锁髓内钉内固定治疗粉碎性股骨干骨折的临床疗效。 方法 2008 年4 月－ 2010 年3 月，采用克氏针提拉闭合复位、交锁髓内钉内固定治疗新鲜粉碎性股骨干中段骨折23 例。其中男19 例，女4 例；年龄27 ～ 55 岁，平均35 岁。致伤原因：交通事故伤18 例，重物砸伤5 例。左侧10 例，右侧13 例。骨折按Winquist-Hansen 分级：Ⅰ级11 例，Ⅱ级6 例，Ⅲ级3 例，Ⅳ级3 例。受伤至手术时间2 ～ 5 d。 结果 手术时间40 ～ 90 min，平均55 min；术中出血量100 ～ 500 mL，平均310 mL。术后切口均Ⅰ期愈合。23 例均获随访，随访时间13 ～ 30 个月，平均16 个月。X 线片示22 例骨折愈合良好，愈合时间8 ～ 17 个月，平均13 个月；1 例Ⅳ级骨折患者因活动过多，骨折愈合迟缓，经予以制动4 个月后愈合。无深静脉血栓形成、断钉、感染等并发症发生。末次随访时按刘兴炎等股骨干骨折疗效评定标准，获优22 例，良1 例，优良率达100%。 结论 克氏针提拉闭合复位交锁髓内钉内固定治疗粉碎性股骨干骨折，手术方法简便、并发症少、骨折愈合率高。

股骨干骨折伴大腿中段Morel-Lavallée损伤一例

Reamed versus Nonreamed Intramedullary Nailing for Femoral Fractures: A Systematic Review

Objective　To evaluate the effectiveness of reamed versus nonreamed intramedullary nailing for femoral fractures. Methods　Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were identified from MEDLINE (1966-2004.5), EMBASE (1966-2004.5), Cochrane Library (Issue 2, 2004), Cochrane Musculoskeletal Injuries Group Database (2004.5), and CBM disc (1979-2004.5). We handsearched Chinese Journal of Orthopaedy (from establishment to May 2004) and Orthopaedic Journal of China (from establishment to May 2004) . RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. RevMan 4.2.3 software was used for data analysis. Results　Five RCTs and two CCTs were included. The combined results of meta-analysis showed that reamed intramedullary nailing for femoral fractures can reduce the rate of nonunion (RR=0.38, 95%CI 0.17 to 0.83, P=0.01) and the rate of implant failure (RR=0.42, 95%CI 0.20 to 0.89, P=0.02). Conclusions　Compared with nonreamed intramedullary nailing for femoral fractures, reamed intramedullary nailing can reduce the rates of nonunion and implant failure. However, the relation between reaming or pulmonary complications, the time of union, infection, malunion, operative time, and blood loss needs further study.

交锁髓内钉治疗股骨干骨折

目的 总结交锁髓内钉治疗股骨干骨折的临床经验。方法 2000年6月~2004年6月，收治股骨干骨折35例，男21例，女14例；年龄16～69岁，平均31.5岁。其中车祸伤19例，摔伤6例，工地外伤3例，坠落伤7例。开放性骨折13例，Anderson分型Ⅰ型8例，Ⅱ型5例；闭合性骨折22例。新鲜骨折于伤后4 h~5 d、陈旧性骨折于伤后25~56 d入院。35例均采用交锁髓内钉治疗。结果 35例获随访6~49个月。术后达骨性愈合25例(71.4%)，平均愈合时间5.4个月，12~16个月取出内固定；4~8个月临床愈合9例(25.7%)；5个月骨折延迟愈合1例，经取出上端横行锁钉，改为动力型髓内钉固定4个月后骨性愈合。随访期内无感染，髓内钉无折弯和折断，无畸形愈合；锁钉折断与退出各1例。35例功能锻炼后，髋、膝关节功能均基本恢复正常。结论 交锁髓内钉能防止肢体短缩和旋转，骨折固定牢靠，愈合率高，是治疗股骨干骨折的首选内固定方法。

DEVELOPMENT AND CLINICAL APPLICATION OF AN INTRAMEDULLARY CONTROLLED DYNAMIC NAI LING

Objective To describe the design and application of a new intramedullary controlled dynamic nailing(ICDN).〓〖WTHZ〗Methods The new ICDN was made of a stainlesssteel alloy, consists of a nail shaft, innerrod, tensile screw, end cape and two interlocked screws. From December 2005 toFebruary 2007, 48 cases of femoral shaft fractures were treated with ICDN. There were 16 females and 32 males with a mean age of 36.6 years (range, 16-48years). Injury was caused by traffic accident in 26 cases, falling from a height in14, sportsrelated in 7 and crush injury in 1 case. According to Winquist classification, Thirtyseven cases were classified as typeⅠ(13 cases of typeⅠ-1,23 cases of Ⅰ-2 and 1 case of Ⅰ-3), eleven as type Ⅱ fracture ( 2 cases oftype Ⅱ-1, 8 cases of Ⅱ-2 and 1 case of Ⅱ-3). The time from injury to admission was an hour to a week. Emergency operation was performed in 19 cases and the other 29 patients were given operation within 3 days. Results All cases were followed up for an average of 5 months (3-12 months). Among them, the average healing period was 21 weeks (826 weeks) and no nonunion, delayed union and breakage of nailings occurred. The complications included 2 infections, 5 pains, and 4 deformities. Based on Johner and Ｗrubs standard, the results were excellent in 39 cases, good in 7 cases and fair in 2 cases, The excellent and good rate was 95.8%. Conclusions ICDN has excellent biomechanical characteristics which can provide a flexible fixation in treating femoral shaft fractures. The operation is simple and is one of the good techniquesin treating femoral shaft fractures.

FEMORAL SHAFT FRACTURE TREATED WITH CLOSED REDUCTION AND INTRAMEDULLARY NAILING

【Abstract】 Objective To discuss the techniques and advantages of closed reduction and intramedullary nail ing intreating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases offemoral shaft fracture were treated with closed reduction and intramedullary nail ing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120°) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reductionand intramedullary nail ing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more compl icated if cannulated femoral reamer is not available.

Effects of Rehabilitation Education and Training Interventions on Perioperative Patients with Femoral Shaft Fractures

【摘要】　目的　探讨康复宣教与训练等干预手段对股骨干骨折患者围手术期的影响。　方法　2010年6月－2011年3月收治股骨干骨折患者90例，其中男48例，女42例；年龄17~58岁，平均38岁。开放性骨折28例，闭合性骨折62例。股骨骨折部位:上1/3骨折33例，中1/3骨折35例，下1/3骨折20例，多段骨折2例。横形骨折20例，斜形骨折30例，粉碎性骨折40例。将90例患者随机分为康复组（46例）和对照组（44例）。对照组采用骨科术前常规处理，康复组采用骨科术前常规处理加康复宣教与训练。　结果　康复组住院时间为（5.35±1.27） d，对照组为（7.67±1.85） d，两组比较差异有统计学意义（Plt;0.05）。 康复组治疗后发生并发症7例，对照组16例，康复组并发症发生率（15.2%）明显低于对照组（36.4%），差异有统计学意义（Plt;0.05）。治疗后5 d，康复组疗效获优35例，良6例，可3例，差2例，优良率89.1%；对照组获优25例，良5例，可12例，差2例，优良率68.2%；两组疗效比较差异有统计学意义（Plt;0.05）。　结论　康复宣教与训练能预防与改善股骨干骨折围手术期卧床引起的并发症，减轻患者腿部疼痛及肿胀，缩短围手术期时间，使患者能尽早手术，加快住院床位周转，提高患者生活质量。【Abstract】　Objective　To explore the effects of rehabilitation education and training interventions on perioperative patients with femoral shaft fractures.　Methods　A total of 90 patients with femoral shaft fractures were selected from June 2010 to March 2011, including 48 males and 42 females aged from 17 to 58 years (mean 38 years). In these 90 patients, open fracture was in 28 and closed fracture was in 62. Fracture site: upper 1/3 fracture was in 33, middle 1/3 fracture was in 35, lower 1/3 fracture was in 20 and multiple fractures was in 2. There were transverse fractures in 20 patients, oblique fractures in 30 patients and comminuted fractures in 40 patients. All of the patients were randomly divided into experimental group (46 patients) and control group (44 patients). The patients in the control group underwent the routine treatment before the orthopedic surgery; besides the routine treatment, the patients in the experimental group were given the rehabilitation education and training before the orthopedic surgery.　Results　The hospital duration in the rehabilitation group was (5.35±1.27) days while in the control group was (7.67±1.85) days, the difference was statistically significant (Plt;0.05). There were 7 cases who had complications in rehabilitation group compared with 16 patients in the control group; the incidence of the complications in the rehabilitation group (15.2%) was significantly lower than that in the control group (36.4%) (Plt;0.05). After the treatment for 5 days, the therapeutic effect in rehabilitation group were excellent in 35 cases, good in 6 cases, middle in 3 cases and poor in 2 cases (with the good rate of 89.1%); while in the control group were excellent in 25 cases, good in 5 cases, middle in 12 cases and poor in 2 cases (with the good rate of 68.2%); the difference was significant between the two groups (Plt;0.05).　Conclusion　Rehabilitation education and training could prevent the perioperative complications in patients with femoral shaft fracture, decrease the pain and edema, speed up the turnover of hospital beds, and improve the patients’ quality of life.

COMPARISON OF PROXIMAL FEMORAL NAIL ANTIROTATION AND RECONSTRUCTION NAIL FOR IPSILATERAL FRACTURES OF HIP AND FEMORAL SHAFT

Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.

交锁髓内钉动力化治疗股骨干骨折不愈合

目的 总结交锁髓内钉动力化固定对骨折愈合的影响，分析动力化固定后可达到正常愈合的类型。 方法回顾性分析2005年6月－2010年8月30例初始行静力锁定后再行动力化固定患者临床资料。男25例，女5例；年龄18～60岁，平均34岁。股骨干骨折26例，转子下骨折4例。均为闭合损伤。根据AO分型：A1型2例，A2型2例，A3型1例，B1型5例，B2型6例，B3型2例，C1型8例，C2型4例。根据骨折或不愈合端的力学稳定性和生物活性分型：稳定/增生型8例、稳定/萎缩型5例、不稳定/增生型9例、不稳定/萎缩型8例。于初次静力钉术后6～18周，平均14周后行髓内钉动力化固定。 结果术后患者切口均Ⅰ期愈合。30例均获随访，随访时间6～18个月，平均12个月。24例骨折于动力化固定后3～6个月完全愈合，4例于7～11个月延迟愈合，2例不愈合。3例不稳定/萎缩型患者出现明显股骨短缩，1例不稳定/萎缩型患者出现旋转移位。 结论髓内钉动力化治疗股骨干骨折不愈合疗效确切，但不稳定/萎缩型患者行动力化固定术后并发症较多。