[目的]评价屈曲牵引下前路手术复位、减压和融合固定关节突交锁下颈椎骨折脱位的临床效果.[方法]2015年1月-2019年1月,采用屈曲牵引,前路开放复位,减压融合固定治疗关节突交锁下颈椎骨折脱位患者45例,男33例,女12例;年龄29～64岁,平均(48.6±7.2)岁.采用NDI、JOA评分、ASIA分级,以及影像检查评估临床效果.[结果]45例患者均顺利完成手术,关节突复位成功率为100.0％,手术时间平均(65.4±22.8)min,切口长度平均(6.1±0.9)cm,术中出血量平均(290.9±90.0)ml.随访时间平均(2.7±1.1)年,随时间推移,NDI和JOA评分,以及ASIA评级较均显著改善(P＜0.05),均未出现脊髓损伤加重表现.影像方面,与术前相比,术后椎间高度颈椎前凸Cobb角显著改善(P＜0.05).未发现内固定物松动、移位、断裂等现象.[结论]屈曲牵引单纯前路复位、减压融合内固定术可有效治疗合并关节突交锁的下颈椎骨折脱位.

Objective:To report our experience of treating open comminuted limb fractures caused by gunshots using the Masquelet technique.Methods:Between January 2016 and July 2018, 3 patients were admitted to Institute of Orthopedics, 920 Hospital of Joint Logistic Service of People's Liberation Army for open comminuted limb fractures caused by gunshots.They were all male, aged from 18 to 41 years (average, 30.7 years).Their fractures were complicated with perforating wounds and belonged to Gustilo type ⅢB for open fractures.The bone defects were 5 to 9 cm in length (average, 6.7 cm), located at the proximal femur in 2 cases and at the upper middle humerus in one.They were treated by standard Masquelet technique at 2 stages.The postoperative functions of the hip, knee and shoulder were evaluated according to the Harris hip score, Lowa knee score and Constant-Murley shoulder function score.Results:The 3 patients obtained an average follow-up of 17.3 months.The bone defects were all repaired in the 3 patients without any signs of infection.The 2 patients with femoral defects were rated as both excellent by the Harris hip score, as excellent in one and as good in the other by the Lowa knee score; the patient with humeral defects was rated as excellent by the Constant-Murley shoulder function score.Conclusion:Masquelet technique is a desirable treat-ment of segmental long bone defects caused by gunshots.

Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.

Objective:To research the application of the fracture tibial plateau and the influence on serum bone morphogenetic protein-2(BMP-2),insulin-like growth faetor-1 (IGF-1) and nail fold microcireulation.Methods:94 cases with fracture tibial plateau who were treated in our hospital from May 2014 to May 2016 were selected and according to the different treatment methods,the patients were divided into the control group and the research group with 47 cases in each group.The patients in the control group were treated with conventional open surgery,while the patients in the research group were treated with arthroscopy.Then the clinical curative effect,blood loss,operation time,flow rate,activity time,serum levels of BMP-2 and IGF-1,loop diamete,loop shape integral,flow integral,loop time integral,complications and fracture healing time in the two groups were observed and compared before and after the treatment.Results:The excellent rate of the research group was 95.74％,which was higher than 80.85％ in the control group (P＜0.05).The bleeding volume,surgery time,drainage and activity time of the research group was better than those of the control group (P＜0.05).The serum levels of BMP-2 and IGF-1,and loop diamete after surgery in the two group were significant higher than before,and the research group was higher than that of the control group (P＜0.05);The loop shape integral,flow integral and loop time integral after surgery in the two group were lower than before,and the research group was lower than that of the control group,and the differences were statistically significant (P＜0.05).The complication rate of the research group was lower than that of the control group,and the fracture healing time was shorter than that of the control group (P＜0.05).Conclusion:Arthroscopic tibial plateau fractures can increase the serum levels of BMP-2 and IGF-1,and improve the foot nailfold microcirculation and fracture healing.

Objective To evaluate the clinical outcome of reconstruction of the superior peroneal retinaculum (SPR) by using a portion of Achilles’s tendon and suture anchors in the treatment of chronic peroneal tendon dislocation .Methods Seven patients in our hospital from January 2010 to January 2015 who underwent surgical reconstruction of SPR by using a portion of Achilles ’ s tendon and suture anchors were evaluated .The ankle ’ s range of motion ( ROM) and The American Orthopaedic Foot and Ankle Society ( AOFAS) ankle-hindfoot score were used to evaluate the clinical outcome .Results All 7 cases were followed up for 6 to 24 months,the average time was 14 months,with-out recurrence.The ankle’s ROM improved from (23.6 ±1.9) °preoperative to (30.0 ±1.5) °at the final follow-up,and the AOFAS An-kle Hindfoot Scale improved from (60.6 ±3.6) point preoperative to (93.6 ±3.9) point at the final follow-up.Conclusion Surgical re-construction of SPR by using a portion of Achilles ’ s tendon and suture anchors may be an effective alternative surgical method for chronic peroneal tendon dislocation .

目的 探讨无近排腕骨骨折的严重腕关节开放性骨折脱位的手术治疗方法.方法 对2008年1月-2014年1月收治的5例无近排腕骨骨折的严重腕关节开放性骨折脱位患者采用彻底清创、腕关节复位固定、血管神经肌腱探查修复进行治疗.术后对患者腕关节屈伸角度、尺桡偏角度、握力以及神经恢复情况进行随访.结果 5例患者均得到随访,时间8～34个月.随访期间腕关节功能良好.腕活动度屈伸75°～115°,平均(95.0±15.0)°.尺桡偏39°～55°,平均(47.4±5.9)o.腕握力为16～21 kg,平均(18.8±1.2) kg.结论 采用彻底清创、腕关节复位固定、神经血管肌腱Ⅰ期修复可有效治疗无腕骨骨折的严重腕关节开放性骨折脱位.

目的使用不同复合工艺制备α-半水硫酸钙/β-磷酸三钙复合人工骨材料,与WRIGHT公司生产的硫酸钙Osteoset进行理化特性和生物相容性的比较。方法对不同工艺制备的α-半水硫酸钙/β-磷酸三钙复合人工骨材料（根据工艺不同分为A、B组）及Osteoset（C组）,进行X射线衍射分析、微观形貌观察及体外细胞毒性实验、溶血实验、热原反应检测,同时对人工骨材料进行肌肉包埋实验,对3种材料进行对比研究。结果 X线衍射分析显示,各组材料出现各自的特征性衍射峰,未出现新的衍射峰;透射电镜微观形态观察提示,各组均呈现较多相互联通的平行的大孔结构,孔隙分布均匀,孔隙结构之间贯通性良好,晶体结构形态相对均匀一致等特点。体外细胞毒性实验提示:A、B、C组各时间点RGR值均大于75%,各实验组毒性分级为I级,阴性对照组毒性级别为0级,阳性对照组毒性级别为Ⅳ级。溶血实验示:A组、B组、C组平均溶血率为分别为0.95%、2.22%、1.05%。热原实验示:A组各时间点体温升高0.2℃,体温升高总和为0.4℃;B组各时间点体温升高0.1~0.2℃,体温升高总和为0.3℃;C组各时间点体温升高0.1~0.2℃,体温升高总和为0.3℃。各实验组体温升高均小于0.6℃,体温升高总和小于1.3℃。人工骨材料肌肉包埋,组织学检查显示肌纤维组织生长结构正常,无明显炎症细胞浸润,无排异反应。各组对细胞生长、增殖无影响,未发现溶血、热原反应及局部炎症反应,是理想的骨替代材料。结论自制的两种复合人工骨材料均表现出良好的生物相容性,是一种具有潜在临床应用前景的新型人工骨材料。

Objective To determine the effect of X-ray radiation and microgravity on bone metabolism.Methods Male Wistar rats were divided into a control group,an X-ray radiation group (X-ray group),a hindlimb suspension group (HLS group),and a hindlimb suspension and X-ray radiation group (HLS + X-ray group).The X-ray radiation dose was 4 Gy,and the hindlimb suspension was adopted to simulate microgravity environment.The bone mineral density,trabecular number,trabecular separation,trabecular thickness,bone volume/trabecular volume,and structural model index were detected,and the changes of bone alkaline phosphatase (ALP),tartrate-resistant acid phosphatase (TRAP),osteocalcin (OCN),and bone regulatory genes (Rankl,Runx2 and Nfatcl) were analyzed.Results The hindlimb suspension and X-ray radiation caused significant reduction (P ＜ 0.05) in bone mineral density,trabecular number,trabecular thickness,and bone volume/trabecular volume in the HLS group,X-ray group and HLS + X-ray group.The bone loss was the most severe in the HLS + X-ray group (P ＜ 0.05).The expression of Rankl,Nfatcl and TRAP were significantly increased (P ＜ 0.05) in the HLS group,X-ray group and HLS +X-ray group,while the expression of ALP and OCN was significantly decreased (P ＜ 0.05).Moreover,Runx2 was not changed in the HLS group and X-ray group,but was down-regulated in the HLS + X-ray group (P ＜ 0.05).Conclusion The combination of hindlimb suspension and X-ray radiation can more severe bone loss than alone.

Objective To investigate surgical treatment of chronic osteomyelitis of the lower limb following intramedullary nailing by Ilizarov technique and windowing continuous irrigation of the medullary cavity.Methods From January 2012 to December 2014,we treated 12 patients with chronic osteomyelitis of the lower limb following intramedullary nailing.They were 9 men and 3 women,26 to 47 years of age (average,36 years).The surgical procedures included windowing continuous irrigation of the medullary cavity followed by debridement,external fixation,and bone transport or bone lengthening after metaphysis osteotomy.There were 4 cases of femoral infection and 8 of tibial infection.Irrigation was carried on after operation for an average of 4 weeks (range,3 to 5 weeks).Wound healing,bone union and joint function of lower extremity were followed up postoperatively.Results All patients were followed up for 8 to 20 months (average,10.3 months).All wounds healed without recurrent infection.Five patients had pin tract infection which responded to change of dressing in 4 cases and removal of Kirschner wire.Intramedullary infection did not reoccur.Fine bone union was achieved in all after an average bone lengthening or bone transporting of 5.2 cm (from 4 to 7 cm).The healing indexes ranged from 34 to 69 d/cm (average,52.7 d/cm).The fixation time ranged from 7 to 17 months (average,13 months).Limb isometry was achieved in all but one case whose affected limb was 2 cm shorter because of undue stop of bone lengthening.Joint function of the lower extremity was basically normal in all.Conclusion The chronic osteomyelitis of the lower limb following intramedullary nailing can be cured by Ilizarov technique and windowing continuous irrigation of the medullary cavity.

OBJECTIVE:To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament (MPFL) for the treatment of patellar dislocations.METHODS:From September 2008 to June 2013, 16 patients with patellar dislocation underwent MPFL reconstructions. There were 2 males and 14 females, aged 11 to 27 years old (16 years old on average). Patellar dislocations occurred in 11 left and 5 right knees. The disease course ranged from 3 to 10 years. The frequency of dislocation ranged from 9 to 33 times (19 times on average). Affected knee joints showed patellar instability; the range of action for patella obviously increased. The X-ray films showed patellar dislocation. The preoperative Q angle was (36 ± 9)°, and the congruence angle was (63 ± 18)°. Reconstruction was performed via allograft tendon. Allograft tendon was fixed through the superomedial pole of the patella, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All the patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, complications, and reoperations were assessed.RESULTS:Primary healing was achieved in all cases. No infection or necrosis and absorption of grafts was observed. All the patients were followed up for an average of 16.4 months (ranged, 10 to 24 months) postoperatively. At the latest follow-up, all the patients had no pain, swelling and patellar instability; neither patella redislocation nor fracture occurred. The X-ray films showed good position of tunnel 6 months after operation, and the congruence angle was (5 ± 9)°, showing statistically significant difference when compared with preoperation (P < 0.05). The postoperative Q angle was (17 ± 8)°, the Kujala knee function score improved significantly from 45.20 ± 9.20 to 89.30 ± 6.40 at the latest follow-up, showing statistically significant difference (P < 0.05).CONCLUSION:MPFL reconstruction improves clinical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offers good recovery of the premorbid patella mechanics. The interference screw provides firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.

目的 探讨后路经伤椎置钉短节段复位固定治疗单节段胸腰椎骨折的临床疗效、方法 采用后路经伤椎短节段椎弓根螺钉复位固定对30例单节段胸腰椎体爆裂性、压缩性骨折患者进行治疗,对术前评估有神经损伤、椎管占位患者同时行椎管减压,术后复查伤椎前缘压缩率、Cobb角、椎管矢状径占有率以及美国脊柱损伤协会(ASIA)神经功能分级,并定期随访.结果 患者均获得随访8～20个月(平均11.3个月),植骨均获骨性愈合.末次随访时伤椎前缘高度比由术前的(50.3±5.4)％恢复至(93.0±4.7)％,Cobb角由术前(31.1±4.4)°恢复至(4.3±1.1)°.术后神经功能ASIA分级:2例A级无变化外,其余均有1～3级恢复.所有患者均未出现椎弓根钉拔钉、断裂.结论 采用后路经伤椎椎弓根螺钉复位固定是治疗单节段胸腰椎爆裂、压缩性骨折的有效方法,椎体外形矫正率高,术后高度丢失小,疗效满意.

Objective To evaluate the clinical effect of expandable pedicle screw ( EPS) system and intervertebral fu-sion in osteoporosis lumbar spinal stenosis. Methods 25 gerontal patients with lumbar spinal stenosis and severe os-teoporosis received EPS fixation and intervertebral fusion. The JOA lumbar spine surgery scoring system was used in the post-operative evaluation. The plain films were conducted to evaluate the spinal fusion rate and fixation effective-ness of the EPS according to the methods of Burkus et al and Singh et al. Results All patients were followed up for 6~25 months. At last follow-up, the improvement rate of JOA scores were 19 patients with obvious effect, 4 patients with effect and 2 with no effect. The score of screw stabilization was 2. 9 ± 0. 3. The fusion index was 2. 8 ± 0. 2. There was no loosening,breakage or pullout of the EPS. Conclusions The EPS fixation and intervertebral fusion can achieve excellent clinical effect in osteoporosis lumbar spinal stenosis with high spine fusion rate and low complica-tion.

2009年8月～2012年6月，笔者采用改良掌长肌肌腱移植治疗陈旧性腱性锤状指17例，疗效满意，报道如下。 <br>　　1材料与方法 <br>　　1．1病例资料本组17例，男15例，女2例，年龄15～37岁。左手4例，右手13例。损伤部位：食指9例，中指5例，环指2例，小指1例。治疗史：术前保守治疗无效6例，急诊手术时未对肌腱进行修补5例，未治疗6例。就诊时间：伤后1～26个月。临床表现：远侧指间关节（DIP）背侧肿胀，色素沉着，锤状指畸形明显（DIP屈曲30°～55°畸形），局部压痛，主动背伸不能，屈曲受限，被动活动范围正常，近侧指间关节（PIP）伴有不同程度的背伸。全部为闭合损伤或创面已愈合。X线片均证实无末节指骨基底部骨折。

Objective To investigate the surgical methods of treating scaphoid fractures by the self developed memory alloy nail-foot-fixator (MANFF) and evaluate the clinical outcomes.Methods Open reduction and internal fixation using the MANFF were carried out in 66 patients with scaphoid fractures.Postoperatively the patients were follow-up regularly to observe healing of the scaphoid fracture and evaluate the treatment results.Results The patients were follow-up for 8 to 24 months.Fractures were healed in all the patients.There were no infection,nonunion and traumatic arthritis and other complications.Wrist function was assessed using Krimmer's score and the overall results were rated as excellent in 50 cases,good in 9 cases and fair in 7 cases,the excellent and good rate being 89.4％.Conclusion Treatment of scaphoid fractures with MANFF leads to high rate of fracture healing and satisfactory clinical results.It is worthy of wide application.

Objective To observe biomechanical changes of two Ⅲ b treatments lunate osteonecrosis operation period,and provide biomechanical basis for the clinical treatment of Kienbtick's disease.Methods Eighteen fresh upper limb specimens of adult patients were randomly divided into 3 groups,group A (normal wrist joint),group B (STT fusion) and group C (the capitatenavicular arthrodesis).The touch pressure sensor was put between wrist radial navicular and radial lunate clearance,specimens of proximal and distal were fixed separately with biaxial hydraulic material test system (MTS),which was connected to the computer I-scan system,dynamically specimen pressure value per unit area of radial navicular and radial lunate joint clearance in neutral position and stretch a pressure on wrist to 100 N in 20 s were recorded,two kinds of operative methods on the biomechanics effects were observed.Results Wrist joints under neutral position,group A radial-scaphoid joints pressure intensity was(41.39 ± 6.93) N/cm2,radial lunate joints pressure intensity reached (39.22 ± 6.61) N/cm2.Group B radial-scaphoid joints pressure intensity and the value of radial-lunate joints were(83.89 ± 11.27) N/cm2 and (22.55 ± 11.27) N/cm2,respectively.Group C radial-scaphoid joints pressure intensity arrived (86.45 ± 8.10) N/cm2,radial-lunate joints pressureintensity was (34.11 ± 8.10) N/cm2.Wrist under neutral position in group A,through radial scaphoid,radial lunate clearance joints of average load was very uniform (P ＞ 0.05).Radial lunate clearance joints of average load in group B and group C were less than those of group A (all P values ＜ 0.05),while the radial lunate joint clearance were significantly greater than the average load in group A (all P values ＜ 0.05),and radial clearance of average load reduction in group B is more obvious.Conclusions Both STT fusion and capitatenavicular fusion can significantly reduce the radial-lunate clearance of the bearing.STT fusion can reduce more effectively on the lunate pressure load.In the treatment of Ⅲb phase of Kienbock's disease,compared with the two operations above,STT fusion is an appropriate option for the patients from biomechanics.

BACKGROUND:There is little evidence on the use of al ogeneic tendon graft in the reconstruction of ankle joint. <br> OBJECTIVE:To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft in patients with chronic ankle instability. <br> METHODS:Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity. <br> RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from (48.4±3.7) points preoperatively to (88.2±3.8) postoperatively, while that in the group of anterior talofibular ligament was improved from (50.0±6.4) points preoperatively to (89.5±3.4) points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.

目的 观察负载抗生素的骨移植物特性,比较不同骨移植物抗菌能力和成骨效果.方法 双侧胫骨近端慢性骨髓炎造模成功后,48只兔随机均分为4组接受治疗:A组:胫骨病灶清创并万古霉素皮下注射;B组:胫骨病灶清创并以预制的硫酸钙万古霉素颗粒填充清创后遗留的空腔;C组:胫骨病灶清创并以预制的磷酸钙万古霉素颗粒填充清创后遗留的空腔;D组:胫骨病灶清创并以预制的同种异体脱钙骨万古霉素颗粒填充清创后遗留的空腔.在胫骨病灶清创术后1、2、3个月末,每组各处死动物4只,解剖尸体并取胫骨纵剖两半行细菌学检查及病检.结果 B与C组及A与D组间细菌阳性率无统计学差异,而B、C组细菌阳性率低于A、D组.成骨能力:A组成骨比例低于其余各组,B、C、D组间成骨比例无统计学差异;2、3个月末成骨比例,A组＜B组、D组＜C组.结论 负载万古霉素的硫酸钙、磷酸钙治疗慢性骨髓炎效果满意;而吸附万古霉素的同种异体骨治疗慢性骨髓炎感染率较高,可能因万古霉素释放过快,感染灶内难以维持较长时间的抗生素有效浓度所致.磷酸钙万古霉素组能够在控制感染的同时促进新骨生成而修复缺损区.

Objective To explore the clinical effect of cryopreserved allograft tendon transplantation in repairing old Achilles tendon rupture. Methods 32 cases with old Achilles tendon rupture caused by acute trauma hospitalized in the period from Jan. ,2010 to Sept. ,2012 were selected;the defects were 3-6 cm long with the average length of(4. 6 ± 1. 0)cm;the tendons used in the operation were cryopreserved allograft tendons of tibialis anterior muscle;Kessler method was applied to end to end anastomosis with 2-0 absorbable Vicryl at the distal and proximal end of the tendon;after surgery,the ankle joint was fixed at routine plantar flexion 20-30°;fixation with coasting or plasterboard lasted from 4 weeks to 6 weeks;sural nerve flap transplantation was made to cover the wound in 3 cases complicated with skin defects;the score of American Orthopedic Foot and Ankle Society(AOFAS)was adopted in the evaluation of curative effect. Results Follow-up lasted for over 1 year with the average of(15.0 ±3.5)months;incision primary healing was found in 29 cases and secondary healing in 2 cases;graft rejection was found in 1 case and the transplanted tendon had to be removed;ankle joint function recovered well after surgery, AOFAS scores went from(50.5 ± 5. 5)before surgery up to(90. 5 ± 6. 5)after surgery. Conclusions Old Achilles tendon rupture can be effectively repaired by cryopreserved allograft tendon,which avoids the second injury caused by autologous tendon and is easy for patients to accept;the graft can be stored for long;while the long-term effect needs follow-up of long period.

目的 探讨青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗方法.方法 采用短缩尺骨、重建下尺桡关节法,对7例桡骨陈旧性骨折、短缩,下尺桡关节重度脱位患者进行治疗.术后对患者腕关节外形、功能进行随访.结果 所有患者外形恢复良好,功能评价优6例,良1例.结论 短缩尺骨、重建下尺桡关节法是治疗桡骨陈旧性骨折、短缩,下尺桡重度脱位的有效方法.

Objective To evaluate curative efficacy of vancomycin calcium sulphate or vancomycin cement applied topically to treat osteomyelitis after surgery of open tibial fracture.Methods From May 2005 to August 2013,418 patients with osteomyelitis following surgery of open tibial fracture were treated in our center.They were 257 males and 161 females,with an average age of 35.6 years (from 19 to 55 years).There were 163 cases of Gustilo type Ⅰ,132 cases of Gustilo type Ⅱ,56 cases of Gustilo type ⅢA,and 67 cases of Gustilo type Ⅲ B.The initial fractures were fixated at other hospitals with plate in 334 cases,with intramedullary nails in 21 cases,and with external fixators in 63 cases.By the Cierny-Mader classification,the osteomyelitis was type Ⅰ in 21 cases,type Ⅱ in 26 cases,type Ⅲ in 366 cases,and type Ⅳ in 5 cases.We removed the internal hardware and fixated all the fractures with external fixators.For the 266 patients without bone exposure,vancomycin calcium sulfate beads (n =201) or vancomycin cement (n =65) were inset into the wounds; for the other 152 patients with bone exposure,vancomycin calcium sulfate beads were inset into the wounds which were then repaired by flap transfer.Results Follow-ups ranged from 12 to 108 months (average,37.5 months).Of the 201 patients treated with only vancomycin calcium sulfate beads,osteomyelitis was healed in 174 (86.6％) and fracture united in all (100.0％).In the 65 patients treated with only vancomycin cement,osteomyelitis was healed in 57 (87.7％) and fracture united in all (100.0％).In the 152 patients treated with vancomycin calcium sulfate beads and flap transfer,osteomyelitis was healed in 131 (86.2％) and fracture united in 147 (96.7％).Osteomyelitis was healed for the 362 patients after an average time of 3.0 months (from 2 to 14 months).Fractures united for the 413 patients after an average time of 14.0 months (from 3.5 to 20.0 months).Pin track infection was found in 23 cases.Conclusions The optimal fixation for open tibial fracture complicated with osteomyelitis is external fixators.For the wounds without soft tissue defects,vancomycin calcium sulfate beads and vancomycin cement are similar in high therapeutic efficacy.For the wounds with soft tissue defects,combination of vancomycin calcium sulfate beads and flap transfer can lead to satisfactory treatment outcomes.