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find Keyword "股骨干" 27 results
  • COMPARISON OF TWO SURGICAL METHODS FOR ASEPTIC NONUNIONS OF FEMORAL SHAFT FRACTURES AFTER FEMORAL NAILING

    Objective To compare the outcomes between intramedullary nail change and augmentation plating with a retained intramedullary nail for aseptic nonunion of femoral shaft fractures after femoral nailing, and to analyze the cause so as to guide the clinical application. Methods Between June 2001 and June 2011, 28 patients with aseptic nonunion of femoral shaft fractures after femoral nailing were treated with intramedullary nail change (11 patients, group A) and augmentation plating with a retained intramedullary nail (17 patients, group B), and the clinical data were analyzed retrospectively. There was no significant difference in age, gender, smoking, location of fracture, Association for the Study of Internal Fixation (AO/ASIF) classification, type of injury, associated injury, type of nonunion, and time of nonunion between 2 groups (P gt; 0.05). The patients were followed up by imaging and the clinical function at regular intervals to observe the callus growth and the recovery condition of the affected limb function, and clinical curative effectiveness was evaluated by Tohner-Wrnch standard. Results The operation time, intraoperative bleeding volume, and intraoperative erythrocyte-transported volume in group A were significantly higher than those in group B (P lt; 0.05). There was no significant difference in postoperative drainage volume and hospitalization days between 2 groups (P gt; 0.05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 18.6 months on average (range, 12-36 months). All cases obtained bone union, and time of clinical and radiological bone healing in group B was significantly shorter than those in group A (P lt; 0.05). During follow-up, no following complication occurred: deep incision infection, injuries of blood vessels and nerves, loosening and breakage of internal fixation, loss of reduction, angulated and rotational malunion. According to Tohner-Wrnch standard at last follow-up, the results were excellent in 6 cases, good in 3 cases, and poor in 2 cases, with an excellent and good rate of 81.8% in group A; the results were excellent in 12 cases, good in 5 cases, with an excellent and good rate of 100% in group B; and difference was significant between 2 groups (Z= — 2.623, P=0.021). Conclusion Augmentation plating with a retained intramedullary nail is an ideal treatment for aseptic nonunion of femoral shaft fractures after femoral nailing and can achieve satisfactory clinical outcomes because it has simpler operation, shorter operation time, less blood loss, and less trauma than intramedullary nail change.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 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。

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
  • 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.

    Release date:2016-08-31 04:24 Export PDF Favorites Scan
  • 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。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • 股骨干骨折术后不愈合25例临床分析

    【摘 要】 目的 总结股骨干骨折术后不愈合的原因及再手术方法。 方法 1999 年2 月- 2007 年1 月,收治股骨干骨折术后不愈合患者25 例。男18 例,女7 例;年龄27 ~ 61 岁,平均42 岁。车祸伤14 例,坠落伤6 例,跌摔伤5 例。股骨干骨折部位:上段4 例,中段18 例,下段3 例。原固定方法:国产加压钢板内固定12 例,进口AO 加压钢板内固定4 例,髓内钉固定7 例,外固定架固定2 例。入院X 线片检查无连续骨痂,骨折线明显。骨折至本次手术时间8 ~ 16 个月。术中采用AO 股骨交锁髓内钉固定16 例,AO 加压钢板内固定7 例,AO 单管单臂架外固定2 例。 结果 患者术后切口均Ⅰ期愈合。25 例均获随访6 ~ 14 个月,平均9.4 个月。骨折愈合时间为4 ~ 12 个月,平均7.2 个月。根据Tohner-Wrnch 标准证定临床疗效;优14 例,良9 例,差2 例,优良率92%。 结论 采用恰当内固定方式、术中操作仔细、术后进行正确功能锻炼是治疗股骨干骨折术后不愈合的关键。

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • APPLICATION OF AUTO-CONTROL MICRO-MOTION INTRAMEDULLARY LOCKING NAIL IN THE TREATMENTOF FEMORAL SHAFT FRACTURES

    【Abstract】 Objective The auto-control micro-motion intramedullary locking nail (AMLN) is designed, to reducethe incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and toobserve the cl inical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixalnails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years (ranging from 20 years to 43 years). The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, obl ique, spiral and comminuted fractures of type I, II, III and IV. Three cases were old non-union fractures. The fresh fractures were treated by closed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months (rangeing from 8 months to 22 months). The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt sl ightly unwell at the needl ing point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • 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.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • 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。

    Release date:2016-09-01 09:20 Export PDF Favorites Scan
  • 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.

    Release date:2016-09-01 09:22 Export PDF Favorites Scan
  • 闭合复位带锁髓内钉固定治疗股骨干粉碎性骨折

    目的 评价应用闭合复位带锁髓内钉固定治疗股骨干粉碎性骨折的临床疗效。 方法 1999年8月~2005年4月,采用闭合复位顺行带锁髓内钉固定技术治疗股骨干粉碎性骨折70例。男54例,女16例;年龄17~58岁。骨折均位于股骨转子下2 cm至股骨髁上5 cm。按AO分型: B型17例,C型53例。受伤至手术时间为1~12 d,平均5.8 d。 结果 B型骨折患者手术时间为90~250 min,C型骨折患者60~180 min。70例失血量50~450 ml,平均230 ml。术中3例发生骨劈裂,1例C型骨折远端1枚锁钉锁入失误,7例肢体短缩1.0~1.5 cm。68例获随访10~60个月,平均19个月。63例于术后3~10个月骨折愈合,5例于术后3~4个月行远端锁钉取出动力化后4~10个月骨折愈合。60例髋、膝关节功能活动优良, 余8例髋或/和膝关节功能受限。 结论 闭合复位带锁髓内钉固定是治疗股骨干粉碎性骨折有效方法之一,具有损伤小、失血少、骨折愈合率高、功能恢复好的优点。

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
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