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CLINICAL APPLICATION OF ANTERIOR CERVICAL LOCKING PLATE SYSTEMS AND ANALYSIS OF COMPLICATIONS AS WELL AS THEIR COUNTERMEASURES

Objective To summarize the methods andskills of anterior cervical locking plate systems in clinical application and to analyze the causes of some complications as well as give some preventive or remedial countermeasures. Methods From 1998 to 2002, 159 patients with cervical spondylotic myelopathy,fracturedislocation,tumor or tuberculosis of the cervical spine were treated with anterior locking plate systems. The complications were reviewed and analyzed. Results Ten kinds of complications related to anterior locking plate systems occurred in 21 patients. Most of the complications were caused by improperly-selecting implants, experience and technique deficiency. Conclusio The important preventive or remedial countermeasures are correctly-selecting patients, meticulous preoperative preparation, properly-selecting implants, standard and skillful manipulation and rational postoperative protection.

单侧多功能外固定器修复骨支架

报道７６例，８４个肢体，采用单侧多功能外固定器修复骨折后骨支架。术后随访２～１２个月，平均骨愈合时间儿童为６周，成人股骨为４个月，胫骨为４．５个月。全部病例无针眼感染，无畸形愈合等并发症。介绍了手术操作要点，讨论了这种方法的优点等。

创伤性浮膝合并血管损伤的治疗

目的 总结创伤性浮膝合并血管损伤的手术方法及疗效。 方法 2001 年3 月－ 2008 年3 月收治23 例创伤性浮膝合并血管损伤。男14 例，女9 例；年龄21 ～ 63 岁。车祸伤15 例，高处坠落伤5 例，重物砸伤3 例。开放骨折16 例，按照Gustilo 分型：Ⅰ型8 例，Ⅱ型6 例，Ⅲ型2 例。血管损伤类型：横行断裂12 例，纵行裂伤4 例，挫伤缺损4 例，内膜损伤栓塞3 例。受伤至入院时间为30 min ～ 4 h，平均2 h。采用小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管。 结果 骨折均获解剖复位。术后外固定针道感染3 例。4 例于术后7 ～ 10 d 出现切口浅表感染，其余切口均Ⅰ期愈合。1 例于术后12 d 因缺血坏死、感染行截肢术，余22 例保全肢体。22 例术后获随访，随访时间14 ～ 38 个月，平均18.5 个月。骨折均愈合，愈合时间为15 ～ 24 周。术后1 年肢体功能按Karlstrouml;m 等评价标准，优10 例，良8 例，中3 例，差1 例。 结论 小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管，是治疗创伤性浮膝合并血管损伤的一种较好选择。

AESTRACTS CHOICE OF METHODS OF REPAIR OF FIREARM INJURIES OF EXTREMITIES

The causes of development of 56 cases of bone defects from firearm injuries of extremities were analyzed, and the advantages of transfer of vascularized iliac bone graft with deep iliac circumflex vessels in 28 cases and the indications of transfer of vascularked fibular bone graft with fibular vessel in 15 cases and the exporiences in 9 cases from the methed of transter of seapula-cutaneous composite graft were summarized. It was emphatically pointed out that the half-circle typo externa fixators had its unique advantages in the treatment of the bone defects of long bones of extremities from firearm injuries. It would enentually become the method of priority for the treatment of fractures, nonunion of fractures and bone defects of extremities from firearm injuries.

引流管固定器在“T”管固定中的效果分析

目的　对比引流管固定器与传统固定方法在胆道术后患者“ T ”管固定中的效果。 方法　2012年2月－5月，将102例胆道术后留置“ T ”管的患者，按住院号随机分为试验组（52例）和对照组（50例），试验组在传统固定方法的基础上加用引流管固定器固定“ T ”管，对照组采用传统的方法固定“ T ”管，观察比较两种固定方法的效果。 结果　试验组“ T ”管固定良好，无松动和脱落情况发生，仅5例患者存在“ T ”管周围有疼痛刺激，两组比较差异有统计学意义（P＜0.05）。 结论　采用引流管固定器固定“ T ”管能防止“ T ”管的松动和脱落，减轻患者“ T ”管周围的疼痛，且便于医护人员的观察和操作，值得临床推广使用。

前路矫形术治疗胸段脊柱侧凸

目的 总结胸段脊柱侧凸的前路矫形方式及临床效果。 方法 2002 年6 月－ 2007 年4 月，采用前路矫形技术治疗胸段脊柱侧凸23 例。男7 例，女16 例；年龄11 ～ 17 岁，平均13 岁。特发性脊柱侧凸17 例，Chiari畸形Ⅰ型或脊髓空洞伴胸段脊柱左侧凸6 例。病程3 ～ 10 个月。站立正位X 线片示Cobb 角为40 ～ 78°，平均59°。Bending 相自然矫正率为50.0% ～ 67.5%，平均53.5%。 结果 患者术后均无胸腔感染，其中1 例于术后3 周发现乳糜胸、T6 螺钉松动拔出和椎体破裂，经对症处理后治愈。术后2 周站立位X 线片示Cobb 角为3 ～ 20°，平均13.7°，矫正率为76.8%。21 例获随访，随访时间10 ～ 60 个月，矫正丢失2 ～ 8°，平均4.6°。患者固定融合区植骨均愈合良好，均无内固定断裂、明显后凸加重及曲轴现象发生。 结论 只要严格掌握适应证，重视并及时处理并发症，前路矫形是治疗胸段脊柱侧凸有效方法之一。

单侧外固定器结合植骨治疗肱骨干骨折术后不愈合

Long-term effectiveness of Ni-Ti memory alloy tripod fixator in treatment of Kienböck disease

Objective To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease. Methods The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured. Results The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation (P<0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation (P<0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%. ConclusionIn the treatment of stage Ⅲb Kienböck’s disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.

Research progress on correction of severe foot and ankle deformities with digital hexapod external fixators

ObjectiveTo review the research progress on correction of severe foot and ankle deformities with digital hexapod external fixators. Methods The relevant research literature on digital hexapod external fixators at home and abroad in recent years was reviewed and analyzed. Taking Taylor spatial frame (TSF) as a representative, this article elaborates on the research progress of this technology in the treatment of severe foot and ankle deformities from aspects such as device principle, technical characteristics, clinical application, complication management, and controversial perspectives, aiming to provide theoretical references for clinical application. Results The treatment of severe foot and ankle deformities is a complex challenge in orthopedics, often involving multiple plane alignment abnormalities, muscle weakness, soft tissue contractures, and joint dysfunction. The digital hexapod external fixators (such as TSF), based on the principle of six degrees of freedom motion and combined with computer-assisted technology, enables precise correction of multi-dimensional deformities. Conclusion The digital hexapod external fixators provides a minimally invasive and efficient option for the treatment of severe foot and ankle deformities, and shows significant advantages in the treatment of complex post-traumatic deformities, neuromuscular deformities, diabetes Charcot arthropathy, and other diseases.

T 型钢板支撑植骨在桡骨远端塌陷粉碎性骨折中的应用

【摘 要】 目的 总结桡骨远端塌陷粉碎性骨折采用T 型钢板内固定、支撑植骨联合石膏外固定的治疗效果。 方 法 1999 年1 月－ 2006 年7 月，采用切开复位、T 型钢板内固定、支撑植骨联合石膏外固定治疗38 例桡骨远端塌陷粉碎性骨折患者。男24 例，女14 例；年龄20 ～ 74 岁，平均41 岁。闭合骨折30 例，开放骨折8 例。陈旧性骨折11例，新鲜骨折27 例。根据AO 分型：C2 型18 例，C3 型20 例。尺偏角－ 13 ～ 17°。29 例Colles 骨折掌倾角平均－ 45.2°；与健侧比较，桡骨纵轴掌侧平均短缩4.5 mm；背侧平均短缩8.2 mm。9 例Smith 骨折掌倾角平均27.6°，掌侧平均短缩6.5 mm，背侧平均短缩5.1 mm。 结果 患者均获随访，随访时间9 ～ 20 个月，平均13 个月。无钢板断裂和医源性神经血管损伤。X 线片示骨折于术后5 ～ 9 周愈合，平均 7 周。桡骨纵轴长度恢复（与健侧比较），关节面平整；尺偏角16 ～ 24°，平均21.2°；掌倾角7 ～ 16°，平均10.6°。根据Dienst 等功能评估表进行评定，优24 例，良14 例。 结论 T 型钢板内固定、支撑植骨联合石膏外固定治疗桡骨远端塌陷粉碎性骨折，可有效恢复桡骨远端解剖结构、功能及良好外形。