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PRELIMINARY CLINICAL EFFECT OF PROXIMAL FEMORAL NAIL ANTI-ROTATION TO TREAT FEMORALINTERTROCHANTERIC FRACTURES

Objective To evaluate the primary cl inical effect of proximal femoral nail anti-rotation (PFNAR) in treating femoral intertrochanteric fractures, to summarize operation skills and to analyze correlated curative effective influentialfactors. Methods From July 2006 to May 2007, 19 cases of intertrochanteric fractures (including 8 males, 11 females, aged45-87 years old) were treated with closed reduction and PFNAR fixation. Fractures were caused by fall ing. The locations were left sides in 10 cases and right sides in 9 cases. According to AO classification, there were 14 cases of type A2 and 5 cases of type A3. Operative time, volume of blood loss and weight bear time were analyzed, the condition of fracture union was observed and the hip function was evaluated using Harris criterion after 9 months of follow-up. Results Operative time ranged 23-78 minutes with an average time of 47 minutes, the volume of blood loss ranged 50-120 mL with an average volume of 85 mL, getting-outof- bed time ranged 2-14 days with an average time of 7.4 days; the weight bearing time ranged 10-14 weeks with an average time of 12.4 weeks. No intra-operative femoral fractures and no regional or deep infection occurred during hospital ization period. Seventeen cases were followed up from 3 months to 12 months with an average time of 9.4 months, and achieved bone heal ing within 15-18 weeks with an average time of 16.5 weeks. No compl ications such as delay heal ing, coxa vara or coxa valga, cut-out and screw extraction occurred. Fifteen cases were followed up over 9 months; according to the Harris criterion for evaluation, the results were excellent in 13 cases, good in 1 case and fair in 1 case, the excellent and good rate was 93.3%. Conclusion PFNAR has the advantages of micro invasion, easy-to-perform, less blood loss, less bone loss and stable fixation in treatment of unstable comminuted intertrochanteric fracture, especially in old patients with osteoporosis.

TREATMENT OF COMMINUTED FRACTURES AT DISTAL FEMUR AND PROXIMAL TIBIA WITH LESS INVASIVE STABILIZATION SYSTEMS

Objective To study the clinical outcome of comminuted factures at distal femur and proximal tibia treated with AO less invasive stabilization systems (LISS). Methods The clinical data of 14 cases of distal femoral fracture and proximal tibial fracture from September 2003 to May 2005 were analyzed retrospectively. The injury was caused by traffic accident in 9 cases, by fall in 3 cases and by slipping in 2 cases. Of 14 cases, there were 5 open fractures and 9 close fractures, including 5 cases of distal femoral comminuted fracture and 9 cases of proximal shaft comminuted fractures. According to AO/OTA classification, the fractures were classified as 33C2 in 3 cases，33C3 in 2 cases,41A2 in 2 cases，41A3 in 2 cases，41B2 in 3 cases and 41C2 in 2 cases. All patients were treated by the internal fixation with LISS-distal femur or with LISS-proximal tibia. Healing of wounds, the X-ray films before and after operations, and therecovery of joint function were observed. Results The patients were followed up from 1 month to 20 months (11 months on average). Twelve cases achieved solid osseous unions from 3 months to 5 months postoperativly; 2 cases had a good reduction and recovered smoothly 2-3 months postoperatively. The results were excellent in 10 cases, good in 3 cases and fair in 1 case according to Johner-Wruhs knee scoring. The range of knee flexion-extension was 110-130° in 11 cases, 100° in 2 cases and 80° in 1 case. Conclusion LISS is an effective method of internal fixation for treating comminntedfracture of distal femur or proximal tibia. It has the advantages of less injury, satisfied reduction and reliable fixation.

记忆合金环抱器治疗前臂双骨折

【摘 要】 目的 总结记忆合金环抱器治疗前臂双骨折的临床效果，并与传统钢板方法比较其优越性。 方法 1999 年7 月－ 2002 年7 月，随机选取尺桡骨双骨折患者68 例，均为闭合性骨折，X 线片示骨折部位在尺桡骨直行段。应用镍钛形状记忆合金环抱器固定治疗34 例（A 组），其中男27 例，女7 例；年龄15 ～ 58 岁。交通伤16 例，跌伤18 例。受伤至手术时间2 ～ 7 d。应用钛制前臂接骨板固定治疗34 例（B 组），其中男24 例，女10 例；年龄17 ～ 49 岁。车祸伤19 例，跌伤15 例。受伤至手术时间2 ～ 7 d。 结果 手术及外固定时间A 组为（1.22±0.36）h 及（5.12±0.74）周，B 组为（1.27±0.81） h 及（6.22±1.31）周，差异均有统计学意义（P lt; 0.05）。两组患者均获随访6 ～ 12 个月。A 组33 例骨折于术后10 ～ 12 周Ⅱ期愈合，愈合率为97％；B 组30 例骨折于术后12 ～ 16 周Ⅰ期愈合，愈合率为89％；两组骨折愈合率差异有统计学意义（P lt; 0.05）。 结论 记忆合金环抱器在治疗前臂双骨折，具有手术操作简便、疗效良好、适应证广、愈合率高的优点。

肱骨近端粉碎性骨折内固定临床应用

微型钢板治疗掌指骨骨折的疗效分析

目的 回顾性分析微型钢板治疗掌、指骨骨折的效果，评价其临床应用价值。 方法 2003 年1 月－2007 年6 月，采用微型钢板治疗掌、指骨骨折134 例174 处。男101 例，女33 例；年龄15 ～ 48 岁，平均27.8 岁。掌骨骨折105 处，指骨骨折69 处。闭合性骨折71 处，开放性骨折103 处。其中粉碎性骨折68 处，斜形或螺旋形骨折46 处，横形骨折32 处，粉碎性骨折合并骨质缺损13 处，病理性骨折（内生软骨瘤）合并骨质缺损15 处。合并伸屈肌腱损伤或神经损伤18 处，皮肤缺损11 处，累及关节的骨折16 处。伤后至手术时间2 ～ 72 h，平均6 h。 结果 术后伤口除1 例感染外，均Ⅰ期愈合。皮瓣供区Ⅰ期愈合。患者均获随访，随访时间6 ～ 12 个月，平均8.2 个月。X 线片示骨折线于术后6 ～ 11周消失。伤指外观无明显成角及旋转畸形。术后因疼痛不愿活动致关节僵硬3 指，累及关节的骨折致创伤性关节炎1 指，延迟愈合2 指，伤口感染1 指。无骨不连及畸形愈合。按照TAM 系统评定法，优115 处，良39 处，可12 处，差8 处，优良率88.5%。 结论 微型钢板治疗掌指骨骨折是一种有效的内固定方法

OPERATIVE TREATMENT OF COMPLICATED DISTAL FEMORAL FRACTURES

Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.

Apofix 内固定联合Halo-Vest 支架治疗Hangman 骨折

目的 总结Apofix 内固定联合Halo-Vest 支架治疗 Hangman 骨折的临床疗效，并初步评价其安全性。 方法 2007 年8 月－ 2008 年12 月，收治11 例Hangman 骨折患者。男8 例，女3 例；年龄27 ～ 51 岁，平均38 岁。按 Levine-Edwards 分型标准分型：Ⅱ型5 例，Ⅱ A 型2 例，Ⅲ型4 例，其中2 例合并C2、3 椎间盘突出。脊髓功能根据美国脊髓损伤学会（ASIA）标准：B 级3 例，C 级2 例，D 级3 例，E 级3 例。受伤至手术时间5 ～ 10 d，平均7 d。采用后路Apofix 内固定联合Halo-Vest 支架外固定治疗，其中2 例合并C2、3 椎间盘突出者同期行颈椎前路椎间盘切除、椎间植骨钛板内固定术。术后复查X 线片示骨折愈合后拆除Halo-Vest 支架及Apofix 内固定。 结果 术后切口均Ⅰ愈合。11 例均获随访，随访时间21 ～ 36 个月，平均28.5 个月。术后6 个月X 线片示骨折均获骨性愈合，未见内固定物松动及断裂。9 例未行颈椎前路手术者颈部活动基本正常，2 例术前合并C2、3 椎间盘突出者颈部屈曲受限。末次随访时脊髓功能ASIA评分为（88.6 ± 19.1）分，较术前（55.3 ± 14.3）分显著改善，差异有统计学意义（t=0.009，P=0.002）。根据Mayo（McGrory）颈椎创伤评分标准进行疗效评价，获优8 例，良2 例，可1 例，优良率91.0%。 结论 应用Apofix 内固定联合Halo-Vest支架治疗Hangman 骨折是一种安全、有效的方法。

RESECTION OF SPINAL TUMOR AND RECONSTRUCTION OF SPINAL STABILITY

OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.

BIOMECHANICAL ANALYSIS OF STABILITY OF INTERNAL FIXATOR FOR PROXIMAL HUMERAL FRACTURES

Objective To review the biomechanics of internal fixators for proximal humeral fractures, and to compare the mechanical stabil ity of various internal fixators. Methods The l iterature concerning the biomechanics of internal fixators for proximal humeral fractures was extensively analyzed. Results The most important things for best shoulder functional results are optimal anatomical reduction and stable fixation. At present, there are a lot of methods to treat proximal humeral fractures. Locking-plate exhibites significant mechanical stabil ity and has many advantages over other internal fixators by biomechanical comparison. Conclusion Locking-plate has better fixation stabil ity than other internal fixators and is the first choice to treat proximal humeral fractures.

小切口加撬拨复位治疗跟骨骨折

总结小切口加撬拨复位内固定治疗跟骨骨折的临床疗效。 方法 2005 年6 月－ 2007 年7 月收治跟骨骨折23 例25 足。男20 例，女3 例；年龄23 ～ 55 岁，平均40.5 岁。按Sanders 分型：Ⅱ型7 足，Ⅲ型17 足，Ⅳ型1 足。受伤至手术时间7 ～ 14 d，平均10 d。采用外侧横行小切口加撬拨复位，并行自体髂骨植骨（2 ～ 4 g），松质骨螺钉内固定。 结果 术后伤口均Ⅰ期愈合，无皮肤坏死和螺钉断裂发生。23 例均获随访，随访时间6 ～ 36 个月，平均15个月。术后Bouml;lher 角及Gissane 均较术前明显改善（P lt; 0.05）。患者负重行走6 个月，跟骨高度无明显丢失。根据美国足踝外科学会足部功能评分系统评定，优17 足，良6 足，可2 足，优良率92℅。 结论 小切口加撬拨复位内固定是一种治疗跟骨关节内骨折的有效方法。