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锁骨钩钢板治疗Ⅲ度肩锁关节脱位

伴后外侧平台塌陷的SchatzkerⅤ/Ⅵ型胫骨平台骨折治疗

目的总结伴后外侧平台塌陷的SchatzkerⅤ、Ⅵ型胫骨平台骨折的治疗方法和疗效。 方法2006年5月－2012年8月，收治伴后外侧平台塌陷的SchatzkerⅤ、Ⅵ型胫骨平台骨折22例。男16例，女6例；年龄18～60岁，平均36.5岁。交通事故伤17例，高处坠落伤5例。根据Schatzker分型：Ⅴ型15例，Ⅵ型7例。受伤至手术时间5～12 d，平均8.5 d。通过掀开内侧髁撬拨复位后外侧塌陷平台关节面，双钢板固定骨折。 结果术后1例切口渗液，其余患者切口均Ⅰ期愈合。22例均获随访，随访时间4～24个月。无螺钉松动、钢板断裂，无关节面塌陷及力线丢失等并发症发生。骨折愈合时间4～15个月，平均9个月。末次随访时，根据Merchant等的标准评定疗效，获优10例，良9例，可2例，差1例，优良率86.4%。 结论经内侧髁撬拨复位后外侧平台塌陷具有易显露、直视下复位固定牢靠的优点，是治疗伴后外侧平台塌陷的SchatzkerⅤ、Ⅵ型胫骨平台骨折的有效术式之一。

外踝解剖钢板及松质骨螺钉治疗B、C 型双踝骨折

目的 总结外踝解剖钢板及松质骨螺钉治疗B、C 型双踝骨折的临床疗效。 方法 2004 年1 月－2006 年12 月，采用切开复位外踝解剖钢板、内踝松质骨螺钉或加用克氏针内固定治疗34 例双踝骨折。男23 例，女11 例；年龄24 ～ 52 岁。受伤原因：跌伤17 例，车祸伤12 例，机器损伤5 例。左踝22 例，右踝12 例。根据AO-Danis-Weber 分型：B 型21 例，C 型13 例。其中6 例合并胫骨平台塌陷骨折，3 例合并下胫腓联合分离，2 例为开放骨折。受伤至手术时间为2 h ～ 6 d。 结果 患者伤口均Ⅰ期愈合，无皮缘坏死、钢板外露等并发症发生。34 例均获随访，随访时间1 ～ 3 年，平均18 个月。术后34 例骨折均临床愈合，愈合时间12 ～ 18 周。疗效评定按照Baird-Jackson 踝关节功能评分标准：优29 例，良4 例，可1 例，优良率为97.1%。 结论 外踝解剖钢板及松质骨螺钉内固定是治疗B、C 型双踝骨折的良好选择之一。

CERVICAL LATERAL MASS PLATE WITH ITS CLINICAL APPLICATION

Objective To evaluate the fixation technique of using the cervical lateral mass plate in the cervical posterior approach operation. Methods Eight patients in this group were admitted from September 2001 to November 2006. Among the 8 patients, there were 6 males and 2 females, with their ages ranging from 28 to 78 years. Cervical vertebral fracture with dislocation was found in 4 patients, C2 spinal cord injury in 1, C1 fracture in 1, cervical spinal stenosis in 1, and C2-5 spinal cord neurofibroma in 1. Muscle strength 3-4. TheFrankel grading system was usedin 6 patients with traumatic injury. Before operation, Grade C was observed in 2patients，Grade D in 3，and Grade E in 1. All the operations were performed according to requirements of the Margel’s method. We positioned 40 screws in all the patients, including 4 screws at C2，6 screws at C3，12 screws at C4，4 screws at C5，4 screws at C6，2 screws at C7，and 6 screws at T1. Results The followingup for an average of 14.1 months (range,645 months) revealed that there was no malposition of the screws in the patients. One of the 8 patients developed spinal instability in the fixed segment at 3 months after operation. The headchestbrace was applied to the patient for 3 months, and the spinal fusion was achieved. The further followingup to 45 months indicated that there was no instability occurring. The remaining patients recovered to their spinal stability by the spinal fusion. The patients also recovered in their neurological function after operation. The Frankel assessment showed that 1 patient had Grade E, 3 from Grade D to Grade E, 1 from Grade C to Grade D, and 1 from Grade C to Grade E. Conclusion The cervical lateral mass plate fixation can provide the immediate and b segmental immobilization for the good cervical spine stability.

Orion钛钢板加钛网融合器治疗颈椎病

微创经皮钢板内固定术治疗胫骨近关节部位骨折的临床研究

【摘 要】 目的 总结应用微创经皮钢板内固定术（minimally invasive percutaneous plate osteosynthesis，MIPPO）治疗胫骨近关节部位骨折的临床经验。 方法 2003 年3 月－ 2006 年8 月，采用MIPPO 治疗49 例胫骨近关节部位骨折患者。男31 例，女18 例；年龄14 ～ 55 岁，平均42 岁。致伤原因：交通伤28 例，运动伤16 例，跌伤5 例。左侧18 例，右侧31 例。胫骨平台下骨折36 例，胫骨远端骨折13 例。根据AO 分型：A 型26 例，B 型20 例，C 型3 例。伤后至手术时间5 h ～ 8 d。术前闭合骨折者行跟骨结节牵引至畸形矫正后进行手术，开放骨折者直接手术。 结果 患者切口均Ⅰ期愈合。1 例术后5 周出现浅表感染，对症治疗后愈合。患者均获随访16 ～ 30 个月，平均20 个月。X 线片检查示骨折均于术后8 ～ 26 周愈合，平均17 周。所有患者无钢板松动和断裂，患侧膝关节及踝关节活动良好。疗效采用修正的Rasmussen 评分体系评价，优30 例，良17 例，可2 例，优良率为95.9%。6 例术后1 年采用点状切开抽出法取出钢板、螺钉无松动或断裂。 结论 MIPPO 技术对骨折周围血运的破坏小，不干扰骨折端具有成骨作用的血肿及髓内血运，微侵袭手段能降低骨不连几率及感染率，提高骨折愈合率，是治疗胫骨近关节部位骨折的有效方法之一。

Effectiveness comparison of two minimally invasive plate osteosynthesis techniques for proximal humeral shaft fractures

ObjectiveTo compare the effectiveness of lateral approach minimally invasive plate osteosynthesis (MIPO) and helical plate MIPO in the treatment of proximal humeral shaft fractures. Methods The clinical data of patients with proximal humeral shaft fractures who underwent MIPO via lateral approach (group A, 25 cases) and MIPO with helical plate (group B, 30 cases) between December 2009 and April 2021 were retrospectively analyzed. There was no significant difference in gender, age, injured side, cause of injury, American Orthopaedic Trauma Association (OTA) fracture classification, and time from fracture to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy times, and complications were compared between two groups. The angular deformity and the fracture healing were evaluated according to anteroposterior and lateral X-ray films postoperatively. The modified University of California Los Angeles (UCLA) score for shoulder and the Mayo Elbow Performance (MEP) score for elbow were analyzed at last follow-up. Results The operation time in group A was significantly shorter than that in group B (P<0.05). However, the intraoperative blood loss and fluoroscopy times presented no significant difference between the two groups (P>0.05). All patients were followed up 12-90 months, with an average of 19.4 months. There was no significant difference in follow-up time between the two groups (P>0.05). In terms of the quality of postoperative fracture reduction, there were 4 (16.0%) and 11 (36.7%) patients with angulation deformity in group A and group B, respectively, and there was no significant difference in the incidence of angulation deformity (χ2=2.936, P=0.087). All fractures achieved bony union, there was no significant difference in fracture healing time between group A and group B (P>0.05); delayed union occurred in 2 cases and 1 case in group A and group B, respectively (healing time was 30, 42, and 36 weeks after operation, respectively). In group A and group B, 1 patient had superficial infection of incision, respectively; 2 patients and 1 patient had subacromial impact after operation, respectively; and 3 patients in group A had symptoms of radial nerve paralysis of different degrees; all of them were cured after symptomatic treatment. The overall complication incidence of group A (32%) was significantly higher than that of group B (10%) (χ2=4.125, P=0.042). At last follow-up, there was no significant difference in the modified UCLA score and MEPs score between the two groups (P>0.05). Conclusion Both lateral approach MIPO and helical plate MIPO can achieve satisfied effectiveness in the treatment of proximal humeral shaft fractures. Lateral approach MIPO may be beneficial to shorten the operation time, while the overall complication incidence of helical plate MIPO is lower.

锁定加压钢板治疗Pilon 骨折

目的 总结采用锁定加压钢板内固定治疗Pilon 骨折的临床疗效。 方法 2005 年6 月－ 2008 年5 月，采用锁定加压钢板内固定治疗39 例Pilon 骨折。男19 例，女20 例；年龄21 ～ 83 岁，平均45.3 岁。交通事故伤15 例，高处坠落伤12 例，重物砸伤9 例，跌伤3 例。骨折按Ruedi-Allgower 分型：Ⅰ型3 例，Ⅱ型17 例，Ⅲ型19 例。受伤至入院时间为1 h ～ 7 d，平均38 h。28 例入院后8 h 内手术；11 例伴软组织严重损伤者于2 ～ 14 d 后手术。 结果 术后5 例切口不愈合，经对症处理后愈合；其余切口均Ⅰ期愈合。术后患者均获随访，随访时间12 ～ 30 个月，平均16.3 个月。术后4 个月1 例出现内固定松动，螺钉断裂，予再次固定植骨后愈合。骨折均获临床愈合，愈合时间3 ～ 16 个月，平均6.5 个月。术后12 个月根据美国骨科协会足踝外科分会足与后踝主观评分标准，优13 例，良20 例，可4 例，差2 例，优良率84.6%。 结 论 锁定加压钢板具有良好的稳定性、手术操作简便、对软组织创伤小，是治疗Pilon 骨折的有效方法之一。

Short-term effectiveness of Endobutton plate in reconstruction of Lisfranc ligament

ObjectiveTo observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury.MethodsBetween March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsThe average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values (P<0.05). There was no significant difference between the time points after operation (P>0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] (t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%.ConclusionThe reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.

Treating Fracture of Distal End of Femur by AnatomicTCP， LTCP and DCS

目的:探讨股骨髁解剖钢板、L钢板及DCS在治疗股骨远端骨折中的应用价值。方法:采用股骨髁解剖钢板内固定治疗股骨远端骨折26例,L钢板内固定治疗股骨远端骨折32例, DCS内固定治疗股骨远端骨折21例。结果:79例经3～15月随访,其中采用解剖钢板26例中23例疗效满意,优良率为885％。采用L钢板32例中23例疗效满意,优良率为719％采用DCS 21例中17例疗效满意,优良率为809％。结论:解剖钢板内固定是治疗股骨远端骨折较为有效的方法,是预防膝关节并发症的积极措施。