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"踝部骨折" 4 results
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目的
总结采用锁定钢板联合纽扣钢板线缆系统治疗Weber-C型踝部骨折的疗效。
方法
2011年2月-9月,对25例Weber-C型踝部骨折采用锁定钢板固定外踝、空心螺钉固定内踝及后踝、纽扣钢板线缆系统重建下胫腓联合治疗。男16例,女9例;年龄22~44岁,平均33.4岁。致伤原因:扭伤14例,交通事故伤9例,高处坠落伤2例。左侧12例,右侧13例。受伤至手术时间2~7 d,平均2.6 d。 结果术后第2天踝部正侧位X线片检查示,下胫腓联合间隙、踝穴均恢复正常。患者切口均Ⅰ期愈合,无相关并发症发生。25例均获随访,随访时间12~28个月,平均25.2个月。骨折均愈合,愈合时间9~13个月,平均12个月;无骨折复位丢失以及下胫腓联合固定失效发生。术后12个月根据美国矫形足踝协会(AOFAS)踝关节功能评分系统评分,获优21例,良4例,优良率为100%。 结论锁定钢板联合纽扣钢板线缆系统治疗Weber-C型踝部骨折,避免了单螺钉固定下胫腓联合的相关并发症,近期疗效满意。
Release date:2016-08-31 10:53
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目的 总结闭合复位经皮可吸收螺钉固定治疗踝部骨折的疗效。 方法 2002 年1 月- 2009 年3 月,采用闭合复位经皮可吸收螺钉固定治疗31 例外伤致踝部骨折患者。男19 例,女12 例;年龄15 ~ 67 岁,平均39 岁。内踝骨折12 例,外踝骨折6 例,双踝骨折10 例,三踝骨折3 例(后踝lt; 1/4)。骨折AO 分型:A 型22 例,B 型6 例,C 型3 例。伤后至入院时间为2 h ~ 7 d,平均4.5 h;入院至手术时间3 h ~ 11 d。 结果 术后患者切口均Ⅰ期愈合。31 例均获随访,随访时间20 ~ 36 个月,平均24 个月。1 例术后2 个月螺钉断裂、骨折移位,二次手术采用金属螺钉固定后3 个月骨折达临床愈合。其余30 例骨折临床愈合时间为3 ~ 4 个月,平均3.2 个月。末次随访时,参照Mast 等疗效评定标准,获优22 例,良7 例,可2 例,优良率93.5%。 结论 闭合复位经皮可吸收螺钉固定治疗易于闭合复位的踝部骨折,创伤小,固定较可靠,避免了二次手术取出,是一种较好的治疗方法。
Release date:2016-08-31 05:44
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目的 评估CT 扫描诊断下胫腓联合损伤的应用价值,为临床诊断下胫腓联合损伤提供有效的诊断方法。 方法 2007 年3 月- 2009 年2 月,收治68 例闭合性踝部骨折患者。男45 例,女23 例;年龄18 ~ 63 岁,平均36.7 岁。Lange-Hanson 分型:旋前外旋型23 例,旋前外展型19 例,旋后外旋型12 例,旋后内收型11 例,垂直压缩型3 例。Denis-weber 分型:A 型7 例,B 型28 例,C 型33 例。受伤至手术时间6 ~ 144 h,平均94 h。术前常规摄X 线片及行CT扫描诊断下胫腓联合损伤情况。采取切开复位内固定治疗,术中探查下胫腓联合损伤情况并作为“金标准”,与术前X 线片和CT 扫描结果进行统计学比较分析。 结果 术中手术探查46 例存在下胫腓联合损伤,22 例未见损伤。术前X 线片诊断下胫腓联合损伤真阳性25 例,真阴性16 例,假阳性6 例,假阴性21 例,灵敏度54.34% ± 14.38%,特异度72.72% ±18.60%,准确度60.29% ± 11.62%,阳性预测值80.64% ± 13.89%,阴性预测值43.24% ± 20.34%;术前CT 扫描诊断真阳性43 例,真阴性21 例,假阳性1 例,假阴性3 例,灵敏度93.47%±7.11%,特异度95.45% ± 8.66%,准确度94.11% ± 5.58%,阳性预测值97.72% ± 4.39%,阴性预测值87.50% ± 13.21%;CT 扫描各指标均明显高于X 线片(P lt; 0.05)。Kappa 指数显示CT 扫描与手术探查结果存在一致性,可靠性高;X 线片可靠性低。 结论 单纯根据X 线片诊断下胫腓联合损伤可靠性低,CT 扫描诊断下胫腓联合损伤可靠性高、真实性好,能够提供重要的临床参考价值。
Release date:2016-09-01 09:08
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To evaluate the biomechanical action of lateral malleolar’s anatomical hook-plate in treatingWeber A-type ankle fracture. Methods Forty-eight cadaveric specimens of adult’s inferior extremities from June 2005to October 2006 were observed, consisting of 26 males and 22 females and aged 18-55 years. The external malleolus of the specimens were transected by using a wire saw at the ankle joint level, and then were divided into 4 groups randomly (groups A, B, C and D). Four distinct internal fixation instruments were used: lateral malleolar’s anatomical hook-plate in group A, general screws in group B , 1/3 tubular plate in group C and standard tension band in group D. Each group was further divided into 2 subgroups, A1-D1 and A2-D2. A1-D1 groups underwent anti-pressure and A2-D2 groups underwent anti-torsion biomechanically comparative analysis. Results The peak values of anti-pressure experiments in groups A1-D1 were (799.83 ± 105.47), (699.17 ± 63.81), (598.83 ± 123.14) and (453.00 ± 111.67) N respectively, group A1 was significantly higher than groups B1, C1 and D1 (P lt; 0.01); meanwhile, the peak values of anti-torsion experiments in groups A2-D2 were (37.17 ± 1.81), (30.33 ± 2.22), (20.50 ± 2.92), (24.83 ± 3.47) Nm respectively, group A2 was significantly higher than groups B2, C2 and D2 (P lt; 0.01). Conclusion The lateral malleolar’s anatomical hook-plate represents a definite biomechanical superiority, when compared with other 3 internal fixation instruments in treating fracture of external mlleolus.
Release date:2016-09-01 09:14
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