Objective To observe the efficacy of one-stage open reduction and internal fixation for Gustilo Ⅱ and ⅢA open ulna and radius fractures.Methods Retrospective analysis was performed on the data of patients with open fractures of Gustilo Ⅱ Gustilo ⅢA of ulna and radius treated by open reduction and internal fixation surgery in our hospital from January 2017 to January 2022,and follow-up was conducted to observe whether there were superficial infec-tion,deep infection,fracture healing and functional recovery of forearm after surgery.Results Follow-up was 3-13 months,with an average of 4.3 months.A total of 3 stage I unstitched wounds showed superficial infection,and wound healing was finally achieved after repeated debridement and infection control.There were 0 case of deep infection.Callus growth,contrapuntal,line satisfaction and angle-less deformity were seen in all fractures.The functional evaluation of frac-ture healing was excellent in 33 cases,satisfactory in 7 cases,unsatisfactory in 2 cases and poor in 0 case.Conclusion The characteristics of open fractures were carefully evaluated before Gustilo Ⅱ and ⅢA open ulnar and ra-dius fractures.After thorough debridement and one-stage open reduction and internal fixation,satisfactory clinical results could be obtained.Its exact fixation effect is helpful for wound healing,early functional exercise,and is an alternative treatment for open ulnar and radius fractures.

目的 比较切开复位内固定与经皮复位有限内固定结合外固定架固定治疗C型桡骨远端骨折的疗效.方法 回顾性分析2015年1月至2019年12月入我院治疗的50例C型桡骨远端患者,切开复位内固定组(IF组)25例,C1型10例,C2型11例,C3型4例.有限内固定结合外固定架固定组(EF组)25例,C1型9例,C2型11例,C3型5例.比较两组患者的手术时间、术中出血量、术后骨折愈合时间、术后Gartlang-Werley评分.结果 所有患者均随访6至12个月,EF组手术时间、术中出血量及术后骨折愈合时间方面优于IF组,差异有统计学意义(P<0.05).两组间Gartlang-Werley评分即优良率差异无统计学意义(P>0.05).结论 对于C型桡骨远端骨折,经皮复位有限内固定结合外固定架固定更微创、操作简单、出血少,优于切开复位内固定组,但两种术式在术后功能恢复方面无明显差别.

背景:目前世界上尚无老年股骨转子间骨折手术平衡止血和抗凝的共识及指南.将氨甲环酸与利伐沙班联合应用于老年股骨转子间骨折患者围术期止血与抗凝管理的相关文献较少.目的:观察氨甲环酸联合利伐沙班对老年股骨转子间骨折患者围术期出血、输血及术后静脉血栓形成的影响.方法:纳入老年股骨转子间骨折患者60例,计划行股骨防旋髓内钉手术治疗,所有入组的患者给予利伐沙班10 mg/d抗凝,直至手术前24 h.患者分2组,试验组30例术中静脉滴入1.0 g氨甲环酸,对照组例静脉滴入相同体积的葡萄糖溶液.收集两组手术失血量、输血及出院前静脉血栓形成情况进行比较.结果与结论:①试验组的失血量明显低于对照组(P<0.05).两组出院前静脉血栓形成无显著差异;②试验组中3例患者接受了输血,对照组7例患者接受了输血;③结果证实,氨甲环酸联合利伐沙班不仅可以减少老年股骨转子间骨折患者的围术期失血,而且不增加静脉血栓形成的风险.

[目的]介绍腓骨头纵形截骨入路切开复位内固定治疗胫骨平台后外侧骨折的手术技术和初步临床疗效.[方法] 2012年1月～2017年12月,手术治疗21例单纯胫骨平台后外侧骨折患者.取俯卧位,行膝后外侧切口,腓骨头内1/2处进行纵向截骨,注意保护腘腓韧带、腘肌腱、股二头肌腱、外侧副韧带等结构,暴露胫骨近端后外侧,撬拨复位,植骨,“T”型钢板固定.[结果]所有患者均顺利手术,无严重并发症.末次随访时,屈膝30°、90°小腿外旋试验均为阴性,内翻应力试验为阴性,膝关节活动度(122.50±18.25)°,膝关节HSS评分平均为(85.50±9.65)分.影像方面,术后X线片显示骨折均达到解剖复位,Rasmussen放射评分平均(17.55±1.65)分.末次随访时骨折均愈合.[结论]腓骨头纵形截骨入路手术治疗胫骨平台后外侧骨折,暴露视野充分,有利于骨折的复位以及内固定的置入.

Background To compare the efficacy of three-point locating versus routine locating techniques for implanting helical blades for proximal femoral nail anti-rotation-II in the treatment of trochanteric fractures. Methods From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70.5 ± 7.2 years. According to the AO classification, there were 45 cases of A2.1, 35 cases of A2.2, and 10 cases of A2.3. Based on locating techniques, the 90 patients were divided into two groups: the three-point group and the routine group, with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation (PFNA); the helical blade was inserted into the femoral neck with the three-point locating technique or by the usual method according to treatment group. Several figures including total operation time, elapsed time for implanting the helical blade, intraoperative blood loss, X-ray exposure time, and tip-apex distance (TAD) were measured and compared. Results The three-point group was significantly superior as compared to the routine group in terms of total operation time [(59.34 ± 9.42) min vs (67.61 ± 12.63) min, P < 0.01], elapsed time for implanting the helical blade [(4.58 ± 1.25) min vs (7.82 ± 2.19) min, P < 0.01], intraoperative blood loss [(92.78 ± 34.09) ml vs (154.01 ± 39.10) ml, P < 0.01], X-ray exposure time [(8.84 ± 1.45) vs (14.62 ± 2.91), P < 0.01], and tip-apex distance [(16.78 ± 1.55) mm vs (21.91 ± 3.01) mm, P < 0.01]. Among the 90 patients, 80 were followed up for an average time of 12 months (10–15 months), including 42 patients who were part of three-point group and 38 patients who were part of the routine group. No spiral blade cut was found on the femoral head in any patient in the three-point group, whereas it occurred in 2 patients in the routine group 1 month after surgery. However, there was no significant difference in the Harris score between the two groups 6 months after the operation. Conclusion The three-point locating method is faster and more accurate than the routine locating method.

小腿严重开放伤多由高能量暴力如交通事故、矿难、战伤等导致,多为碾压伤、机器绞伤、爆炸伤等[1-3].常合并严重的皮肤、皮下软组织损伤(肌肉、血管、神经、肌腱),若处理不当,容易出现严重的并发症,如损伤肢体软组织感染、坏死、骨髓炎,甚至出现感染性休克[4-5].近年来,随着创面VSD和皮瓣移植技术的发展,为下肢严重开放伤提供了较多的修复方法,临床效果较为满意.

Objective To investigate the effects of first external fixator and second locking plate fixation in treating open tibiofibular fractures. Methods We retrospectively analyzed the 36 patients with Gustilo's Ⅲ type tibia and fibula fractures from Jan. 2009 to Dec. 2010. All the patients were treated with first external fixator and second locking plate fixation,and the curative effect and the extremity function were evaluated.Results All patients were followed-up for 18 months(6 to 24 months) in average,and all the fractures were healed in 5.5 months averagely.According the Johner-Wruhs evaluation standard, excellent was in 24 cases, good was 10 cases,and bad was in2 cases. The excellent and good rate was 94%. According the Merchant evaluation standard,excellent was in 26cases,good was in 5 cases,fair was in 4 cases,bad was in 2 cases. The excellent and good rate was 86.1%.The outcome was satisfactory. Conclusion The first external Fixator and second locking plate fixation in treating open tibiofibular fractures can improve the healing rate and the functional recovery.