目的 目前对青壮年有移位新鲜股骨颈骨折患者的治疗仍存在许多争议，被认为尚未完全解决难题之一，股骨颈骨折内固定术后常导致骨折不愈合股骨头缺血性坏死。 方法 2003年1月-2008年6月，收治青壮年新鲜移位股骨颈骨折患者12例，年龄17~55岁，平均36.3 岁。所有患者在受伤后1周内采用牵引下闭合复位空心钉内固定加股方肌骨瓣移植术治疗。术后随访1~5年，平均3.5年。 结果 12例患者均达骨性愈合，随访期内未出现股骨头缺血性坏死；术后采用Harris 髋关节评分标准进行评估，获优良10例，一般1例，差1例。 结论 青壮年新鲜有移位股骨颈骨折患者，采用牵引下闭合复位空心钉内固定加股方肌骨瓣转移术治疗效果良好，均能达到骨折愈合，且无股骨头缺血性坏死发生。
目的:探讨锁骨接骨板这一技术在治疗锁骨中段骨折中的应用及其临床效果。方法: 通过系统回顾2005年5月至2008年6月我院收治的30例锁骨中段骨折患者，其中男性24例，女性6例；年龄范围从12岁到63岁，平均年龄为34岁，行手术时间为受伤后3～5天，经患侧刀砍形切口切开复位，予锁骨接骨板内固定，术后2周内予颈腕吊带悬吊，同时进行耸肩训练。术后2周后开始肩关节不持重功能锻炼。结果:30例患者手术均获成功，术后随访时间为4～12个月（平均随访时间6.5个月），所有患者局部无疼痛，行X线检查显示均为解剖骨性愈合，外观无畸形，18例患者一年后取出内固定，无再骨折发生，患者能接受切口线状疤痕，肩关节活动度:前屈平均155°，外展平均160°。结论:切开复位锁骨接骨板内固定锁骨中段骨折是一种较好的治疗方法，值得推荐。
【摘要】 目的 研究棘突顶端上下缘与椎弓根中心点水平面垂直距离的关系，为微创胸腰段脊柱内固定术椎弓根的体表定位提供实验依据。 方法 20具完整脊柱骨标本，测量标本两侧胸11~腰2椎弓根中心点与棘突旁开距离（CO）、棘突上、下缘至椎弓根中心点水平面垂直距离（AC、BC），以棘突顶端的上、下缘为参照点确定椎弓根的最佳体表投影点。选取20例无神经症状的单节段椎体骨折男性患者；年龄23~54岁，平均37.6岁。损伤部位:胸11、胸12、腰1、腰2骨折椎体各5例。以棘突顶端上缘点为确定椎弓根中心的参考点，行经皮椎弓根螺钉固定，分别测定术前、术后相应椎体Cobb角。 结果 男、女性各椎体左右两侧CO、AC、BC比较差异均无统计学意义（Pgt;0.05）。男女组间相同椎体CO和BO及胸11、胸12椎体的AC比较差异均有统计学意义（Plt;0.05），腰1、腰2椎体的AC比较差异无统计学意义（Pgt;0.05）。男性或女性胸11~腰2的CO依次变大、AC和BC逐渐减小，各椎体间比较差异均有统计学意义（Plt;0.01）。临床应用显示，术前、术后相应椎体Cobb角比较，差异均有统计学意义（Plt;0.05）。 结论 棘突顶端上缘为确定椎弓根中心点的最佳参照点，微创脊柱内固定术体表定位椎弓根时应根据性别和具体骨折椎体确定进针点。【Abstract】 Objective To study the anatomic distances from the upper and lower edges of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch, to provide assistance for the percutaneous positioning of the pedicle of vertebral arch in minimally-invasive transpedicular internal fixation for the thoracic and lumbar vertebrae. Methods We studied 20 integral thoraco-lumbar vertebrae samples, and the distance between the vertical plane including the upper and lower points of the spinous process peak and the horizontal plane of the center of pedicle of vertebral arch was measured and marked as CO. We also measured the distances from the upper and lower points of the spinous process peak to the horizontal plane of the center of pedicle of vertebral arch and marked them as AC and BC respectively. The upper and lower points of the spinous process peak were designated as reference points to define the optimal body surface projective point of the pedicle of vertebral arch. Twenty male patients with single segmental fractured vertebral body and without nervous symptoms were selected. The age of the patients were ranged from 23 to 54 years old, averaging at 37.6. The fractured vertebral bodies included T11, T12, L1, and L2 with 5 cases for each of them. The percutaneous transpedicular internal fixation was carried out with the upper point of the spinous process peak as the reference point to define the body surface projective point of the pedicle of vertebral arch and the preoperative and postoperative Cobb angle of each fractured vertebral body were measured. Results There was no significant differences in CO, AC and BC on both sides between male and female (Pgt;0.05). Statistical difference existed between male and female in CO and BO of the same vertebra, and AC of T11 and T12 (Plt;0.05), while AC of L1 and L2 had no significant difference (Pgt;0.05). In both males and females, CO of the vertebrae from T11 to L2 increased, while AC and BC decreased, and there was a significant difference among different vertebrae (Plt;0.01). Clinical application showed there was a significant difference between the Cobb angle before operation and that after operation (Plt;0.05). Conclusion The upper point of the spinous process peak is the best reference point to define the center of pedicle of vertebral arch. Deciding on the needle insertion spot should be based on gender and specific vertebral body, when minimally-invasive transpedicular internal fixation is performed to define the body surface projective point of the pedicle of vertebral arch.
【摘要】 目的 探讨关节镜辅助下经腘窝小切口应用锚钉固定治疗后交叉韧带胫骨止点粉碎骨折的临床效果。 方法 2007年2月-2008年12月对22例急性后交叉韧带胫骨止点骨折患者，采用关节镜辅助下经腘窝小切口切开复位，利用缝合锚钉重建止点，固定治疗后测试交叉韧带的张力和稳定，采用Lysholm膝关节功能评分评定膝关节功能。 结果 骨折平均愈合时间为6周，平均屈膝活动度（120±3）°。Lysholm膝关节功能评分为（92±2）分。 结论 关节镜辅助经腘窝小切口锚钉固定治疗后交叉韧带胫骨止点粉碎骨折，可协助诊断关节内韧带及骨折损伤情况，对韧带止点进行重建，操作简便，早期功能锻炼有助于关节功能恢复。【Abstract】 Objective To explore surgical technique and the results of arthroscopic reduction and fixation for the treatment of comminuted fracture of the posterior cruciate ligament (PCL) from the tibia using suture anchor through an posterolateral portal via popliteal fossa. Methods Twenty-two patients who were operated through an posterolateral portal via popliteal fossa, the fragment was fixed by using suture anchor to reestablish the insertion, test the tension and stabilization of PCL. Lysholm score was used to evaluate the knee function. Results The bone union was confirmed by X-ray films at the 6 weeks postoperatively. The ROM of knee joint relaxation was 120±3°. The Lysholm score was 92±2. Conclusion The displaced fragment of the comminuted fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the suture anchor arthroscopicly. Using suture anchors demonstrate a reliable and easy to use technique. Operation under arthroscopy helps diagnose and treat other complications inside knee joint. In addition, early functional exercise contributes torapid recovery of knee joint’s function.
Objective To explore the relative prognostic factors of Tile C pelvic injury after iliolumbar fixation. Methods Between March 2007 and March 2010, 60 patients with Tile C pelvic injuries were surgically treated with iliolumbar fixation, including 39 males and 21 females with an average age of 37 years (range, 17-66 years). Of them, 27 cases were classified as Tile C1, 20 as Tile C2, and 13 as Tile C3. The preoperative injury severity score (ISS) was 12-66 (mean, 29.4). The time from injury to surgery was 2-25 days (mean, 8.1 days). Iliolumbar fixation was performed in all patients. Unconditional logistic analysis was used to analyze the relationship between the age, sex, body mass index (BMI), operation opportunity, the preoperative combined injury, classification of fracture, the postoperative complication, reduction outcome, sacral nerve injury, and the time of physical exercise and the prognosis. Results All 60 patients were followed up 12-56 months (mean, 27.3 months). Infection of incisions occurred in 12 cases and were cured after dressing change; healing of incision by first intention was obtained in the other patients. Delay sacral nerve injury was found in 15 patients, 6 patients underwent nerve decompression, and 9 underwent conservative treatment. Ten patients had nail protrusion of Schanz screws at the posterior superior illac spine, and 3 patients had pain, which was relieved after removal of the internal fixator. One patient had bone-grafting nonunion of sacroiliac joint, which was improved by pressured bone graft. Five patients had the beam breakage without significant effect. Six patients had deep vein thrombosis, among them 4 underwent filter and 2 underwent nonsurgical treatment. The healing time of fracture was 3-6 months (mean, 3.9 months). According to the Matta function score, the results were excellent in 31 cases, good in 24 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 91.7% at last follow-up. Majeed score was 58-100 (mean, 86), 28 were rated as excellent, 12 as good, 16 as fair, and 4 as poor with an excellent and good rate of 66.7%. The logistic analysis showed that the age, sex, BMI, and postoperative complications were not prognostic factors; early operation (within 10 days), early function exercises (within 7 days), the better reduction quality, and the less sacral nerve injury were in favor of prognosis; and the worse preoperative combined injury and pelvic injury were, the worse the prognosis was. Conclusion Operation opportunity, the preoperative combined injury, reduction outcome, sacral nerve injury, and the time of physical exercise are all significantly prognostic factors of Tile C pelvic injuries