目的 比较外固定支架与锁定加压钢板（LCP）治疗桡骨远端die-punch骨折的疗效及适应证。 方法 2007年1月－2011年1月，分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧，其中LCP固定19侧，外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义（P＞0.05）。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节，克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间，术后腕关节活动范围等。 结果 两组患者手术切口均Ⅰ期愈合，无感染发生。患者术后均获随访，随访时间6～24个月，平均13个月。所有患者骨折愈合良好，愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义（P＞0.05）；术后6个月腕关节尺偏活动度分别为（20.8 ± 3.6）°和（18.0 ± 2.8）°，LCP组优于外固定支架组（P＜0.05）；LCP组和外固定支架组桡骨高度分别为（10.9 ± 2.8）mm和（13.4 ± 2.3）mm，Gartland-Werley评分分别为（5.3 ± 2.4）分和（8.4 ± 3.6）分，两组差异有统计学意义（P＜0.05）。 结论 对于桡骨远端die-punch骨折，LCP可提供有效固定及早期活动，但对于关节面的塌陷及桡骨高度的恢复，外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。
ObjectiveTo evaluate the effectiveness of locking compress plate (LCP) for the treatment of aseptic diaphyseal humeral nonunions. MethodsBetween January 2006 and January 2012, 23 patients with aseptic diaphyseal humeral nonuninons were treated with LCP and autologous iliac crest bone graft, and the clinical data were retrospectively analyzed. There were 15 males and 8 females with the average age of 42.5 years (range, 28-60 years). The fracture located at left side in 11 cases and right side in 12 cases. The mechanism of the injury was traffic accident in 15 patients, and falling from height in 8 patients. Fracture was treated by internal fixation in 20 cases and external fixation in 3 cases. And 6 patients had open fractures and other 17 had close fractures. Based on the Weber-Cech classification, 6 cases were rated as atrophic nonunions, and 17 cases as hypertrophic nonuninons. Shoulder function was evaluated by Constant-Murley score and elbow function was evaluated by Mayo score. ResultsAfter operation, 2 patients had transient radial nerve symptoms of numbness and 1 patient had superficial infection. Primary healing of incision was obtained in the other patients. All patients were followed up 22.22 months on average (range, 16-30 months). Normal range of motion of the shoulder was found in 11 cases; and limited movements of abduction, elevation, and posterior extension were observed in 12 cases. And osseous union was observed clinically and radiographically in all patients. The average union time was 16.95 weeks (range, 12-24 weeks). The average Constant-Murley score was 81.87 (range, 50-98); and shoulder function was excellent in 14 cases, good in 6, and fair in 3. And the average Mayo score was 87.78 (range, 70-96); and the result was excellent in 14 cases, good in 7, and fair in 2. ConclusionAseptic diaphyseal humeral nonunions can be successfully treated with LCP, coupled with the use of autologous iliac crest bone graft.
Objective To summarize the cl inical appl ication of minimally invasive percutaneous locking compression plate (LCP) internal fixation in the treatment of tibial fractures and to evaluate its cl inical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old (27 on average). Among them, the fractures were caused by traffic accidents in 3 cases, by fall ing in 5 cases, by fall ing from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days (2.5 days on average). Results All incisions obtained heal ing by first intention. All patients were followed up for 10-18 months (13 months on average). All fractures reached cl inical heal ing, and the heal ing time was 12-20 weeks (16 weeks on average). There was no delayed fracture heal ing, nonunion, infection and internal fixation failure. No compl ications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 (90 on average), and the range of motion was 100-130° (120° on average). According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 (92.4 on average). Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set principles and beneficial for tibial fracture heal ing and reconstruction of soft tissues.
Objective To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). Methods From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparingtechnique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures includedpain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. Results Theaverage length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with anaverage of about 4 months. At 1 year follow-up, 83% (n=20) of patients felt no pain and 17% (n=4) of patients had mildpain; 83% of patient can gain a flexion range of more than 100°; according to Mayo elbow performance score, the meanscores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of typeA fracture was significantly better than that of type B and C (P=0.034). Four patients had postoperative compl ications.Conclusion Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functionalresult and bony union despite of age.
Objective To investigate the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and proximal femoral locking compression plate (PFLCP) for intertrochanteric fracture in elderly patients combined with hemiplegia due to cerebral infarction. Methods The clinical data of 67 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2013 and January 2017 were retrospectively analyzed. Among them, 32 cases were treated with PFNA internal fixation (PFNA group), and 35 cases were treated with PFLCP internal fixation (PFLCP group). There was no significant difference in gender, age, injury side, modified Evans classification of fracture, preoperative medical disease, and interval from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative bed time, incidence of perioperative complications, time of fracture healing, and hip Harris score at 6 months and 1 year after operation were recorded and compared. Results Both groups were followed up 12-24 months with an average of 14 months. Compared with the PFLCP group, the PFNA group had shorter operation time, less intraoperative blood loss, and shorter bed time, and the differences were significant (P<0.05). X-ray films showed that the fractures healed in both groups. The fracture healing time of the PFNA group was shorter than that of the PFLCP group, but the difference was not significant (t=0.743, P=0.460). During hospitalization, there were 3 cases of pulmonary infection, 2 cases of deep venous thrombosis of lower limbs, and 1 case of urinary tract infection in the PFNA group; and the incidence of perioperative complications was 18.8% (6/32). There were 4 cases of pulmonary infection, 6 cases of deep venous thrombosis of lower limbs, 1 case of recurrent cerebral infarction, and 1 case of stress ulcer in the PFLCP group; and the incidence of perioperative complications was 34.3% (12/35). There was no significant difference in the incidence of perioperative complications between 2 groups (χ2=2.053, P=0.152). At 6 months after operation, the Harris total score and individual scores in the PFNA group were higher than those in the PFLCP group (P<0.05). At 1 year after operation, there was no significant difference in the Harris total score and pain score, life ability score, and walking ability score between the PFNA group and the PFLCP group (P>0.05); However, the joint deformity and activity score of the PFNA group was significantly better than that of the PFLCP group (t=4.112, P=0.000). Conclusion For intertrochanteric fracture in elderly patients with cerebral infarction hemiplegia, the PFNA has shorter operative time, less intraoperative blood loss, shorter bed time after operation, and better short-term hip function when compared with the PFLCP.