目的探讨不同内固定方法治疗各型锁骨骨折的可行性及价值。方法回顾性分析分别应用克氏针、重建钢板及锁骨钩钢板内固定治疗且获随访的56例锁骨骨折患者资料。结果全部病例随访6~72个月(平均30.5个月),大部分骨折在2~3个月达骨性愈合,发生针尾及切口感染各1例,骨不愈合2例,克氏针滑出1例,针尾刺痛3例,克氏针及钢板断裂各1例,除2例骨不愈合者肩关节功能轻度受限外,余肩关节功能均正常。结论克低针内固定具有手术操作简单、创伤小、费用低等优点,但固定强度低、并发症多。重建钢板内固定治疗锁骨粉碎骨折内固定强度大,可早期进行功能锻炼,符合AO原则。锁骨钩钢板强度大,适合于锁骨肩峰端骨折或伴有肩锁关节脱位的患者。临床上应根据患者的具体情况选择适当的内固定。

本奈氏(Bennett)骨折是指第1掌骨基底部骨折合并掌腕关节脱位,属于关节内不稳定骨折.常因治疗不当导致骨折畸形愈合,严重影响拇指功能.作者自2001年2月～2004年12月采用切开复位,1～2枚克氏针内固定法治疗本奈氏骨折41例,取得良好的效果.现总结报告如下.

近年来,交锁髓内钉广泛应用于胫骨骨折的治疗,手术并发症也日益多见.自1996年1月至2004年1月,本院应用交锁髓内钉治疗胫骨骨折190例,出现了骨延迟愈合、骨不连、锁钉断裂、感染、小腿骨折端成角畸形、骨筋膜室综合症等并发症共12例,报道如下.

近年来,由于道路交通及车辆的快速增长,高速、高能量所致的髋臼骨折呈明显增多的趋势,而髋臼骨折的病例中有相当部分伴有不同程度的股骨头脱位,由于髋臼骨折本身具有解剖上的复杂性和骨折类型的多样性,如同时伴有股骨头脱位等,则增加了骨折移位的复杂性和围手术期处理的难度[1,2].本院自1995年12月至2002年12月,收治的髋臼骨折病人共72例,其中伴股骨头脱位并获随访的髋臼骨折有16例,报告如下.

踝关节Danis-Weber骨折按外踝骨折与下胫腓联合关系作为准则,分为A、B、C 3型.其中C型是踝关节骨折中较严重类型,一般均需经手术治疗.自1998年1月至2003年6月,本院手术治疗Danis-Weber C型骨折临床37例,疗效满意.现报告如下.

Objective: To provide information for hardware fixation and drill hole placement in the treatment of scapula fractures. Methods: 30 pieces of adult scapula specimen were studied. Linear measurements were made ,while a micrometer measurements of thickness were obtained by a depth gauge. Angular measurements were made by using a goniometer to measure the nearest degree. The overall average, Standard deviation, and range were determined for each of the measurements. Results: The average length of the scapular was 146.3±12.0 mm, the thickness of the medial border at 1 cm from the edge was 4.1±2.5 mm. Anteroposterior thickness of the neck of the scapula at 1 cm and 2 cm from the glenoid was 17.8±3.5mm and 13.4±3.1 mm respectively. The thickness of the lateral border at the point of 1/4,2/4,3/4 length of the lateral border from the surface was 13.5±5.8 mm,11.5±4.5 mm,8.6±5.0 mm respectively. The glenoid faced slightly posteriorly with a tilt angle of 5.6°±3.1°. Conclusions: The medial and lateral borders of the body have sufficient bone mass approximately lcm from the edge to support internai fixation, especially the lateral border which is the most important place for fixation. The glenoid tilt angle and the amount of bone in the neck of the scapula, are particular important in hardware fixation and drill hole placement

胫腓骨远端骨折临床上较为常见,文献[1～5]报道治疗方法较多,传统方法多采用外固定或外固定加有限内固定方法,骨牵引等.由于胫骨远端骨不易固定,距小腿关节(踝关节)不能早期活动,故疗效不理想.笔者于1998年4月～2001年4月共收治15例胫腓骨远端骨折病人,应用通用公司提供的胫骨下段特异型钢板内固定治疗,经6个月～3年随访,疗效满意.

胫骨Pi1on骨折是指胫骨远端1/3累及胫距关节面的骨折,在胫骨和踝关节骨折中占4%～7%[1].由于胫骨远端血运差软组织薄,加上高能量损伤增多,骨折粉碎关节面常有嵌压.治疗较为困难.本院自1998年1月至2002年6月,共收治Pilon骨折26例,取得了良好的治疗效果.报告如下.

胫骨平台骨折是常见骨折,我院自1999年4月至2002年10月,采用胫骨外侧平台钢板治疗复杂型胫骨平台粉碎性骨折53例,随访32例,取得较好效果,报告如下.

手指离断在手外伤中并不少见,显微外科技术的发展为手指离断病人尽可能地恢复手部的功能和外观提供了可能.在我国,显微外科技术已达到相当高的水平,并已在基层医院得到普及,断指再植的成活率也不断提高,但仍有一定的失败率.本院自1984年6月至2001年12月,共行断指再植256指,失败21指,报道如下.

近年来,髋臼骨折的手术治疗越来越受到重视.而选择适当的手术径路,对于术中骨折的显露和复位以及术后取得满意的疗效具有重要的意义[1].自1995年12月～2001年12月手术治疗髋臼骨折52例,报告如下.

OBJECTIVETo investigate the clinical outcome of open reduction and internal fixation of calcaneal interarticular fractures.METHODSFrom August 1998, 38 calcanneal interarticular fractures in 35 cases, including 8 of type II, 14 of type III and 16 of type IV according to Sander's classification, were treated by open reduction to restore the posterior articular facet, subtalar facet, Bohler angle and Gissane's angle, following internal fixation by plastic titanic alloy plate. Thirty-three calcanneal interarticular fractures were followed up for 6 to 22 months, 12.3 months on average; and the healing time and joint function were evaluated according to Maryland Foot Score System.RESULTSThe average healing time of fracture was 7.1 weeks, ranging from 5 to 12 weeks; and the joint function was excellent in 18 calcanneus, good in 13 calcanneus, and the satisfactory rate was 93.9%.CONCLUSIONOpen reduction and internal fixation with plastic titanium plate is a good choice for calcanel interarticular fractures.

目的比较可吸收线环扎张力带与钢丝环扎、Magnuson钢丝、AO张力带钢丝和Weber改良张力带钢丝固定髌骨骨折的生物力学特性.方法取20具新鲜膝关节标本,随机分为5组,制成骨折模型,分别用5种方法固定,用膝关节生物力学试验机KJ一20型测定5种内固定的生物力学性能,骨折断端分离1.0mm为固定失败.结果5种内固定方法均能满足1KN股四头肌收缩力,可吸收线环扎张力带与其它内固定方法相比,无明显差异(p＞0.05).结论可吸收线环扎张力带治疗髌骨骨折具有优越的生物力学性能和良好的骨折断端稳定性,免除了二次手术之苦,扩大了手术内固定的适应范围,避免了许多不必要的髅骨切除.

Objective To investigate the surgical treatment of intra-articular fracture of the calcaneus Method 26 cases of intra-articular calcaneal fractures were treated with open reduction and internal fixation from June 1998 to March 2001.Among them 5 cases were treated with reconstruction plate and cancellous screw fixation and 21 cases with plastic titanic alloy plate.Results All had successful results and the articular surface,B*ihlers angle,Gissanes angle,height,length and width of the calcaneus were restored almost to the normal standards after operation.The mean period of follow-up was 14 5 months (from 6 to 33 months).According to the Marylands standard,16 cases had excellent results,7 good and 3 fair.Conclusion The surgical treatment of intra-articular calcaneal fractures with open reduction and internal fixation successfully achieved rigid fixation and normal anatomic position;it is an effective method.

目的探讨跟骨关节内骨折手术治疗的可行性,评价切开复位内固定治疗跟骨关节内骨折疗效.方法对15例跟骨关节内骨折行切开复位内固定,其中5例行重建钢板加松质骨螺钉内固定,10例可塑型钢板内固定.结果 15例手术均获得成功,与术前相比跟骨关节面、Bohler角、Gissane角、跟骨高度长度及宽度均达到或接近正常,内固定牢固,术后不用外固定,无明显并发症.经6～18个月(平均11.5个月)随访,优8例,良5例,可2例.结论对于涉及关节面的跟骨骨折进行手术治疗,以达到牢固的内固定,并尽可能恢复其正常的解剖位置,是治疗跟骨关节内骨折的有效方法.

Objective To study the biomechanical properties of four techniques of internal fixation of transvers patella fractures.Methods Twenty fresh cadaver knee joint specimens were divided into 4 groups randomly and transvers osteotomy of the patella were performed. The simulated fractures were fixed with the following 4 techniques:Cerclage wire,Magnuson's wire,AO tension band and Weber's modified tension band. The techniques were evaluated by the KJ-20 biomechanical tests machine. It was defined that the gap of fracture ends ≥1.0mm was fail in internal fixation.Results All techniques were satisfied in 1 kN tensile force of the quadriceps. The AO tension band and Weber's modified tension band techniques resulted better than Magnuson's wire and cerclage wire. But there were no significant differences(P0.05) among the four techniques in resisting the tensile loading within the range of knee motion.Conclusion The operation technique should be properly selected individually in the treatment of patella fractures. The rigid internal fixation and early exercise after operation were required and the unnecessary patellectomy should be avoided.

动脉损伤在创伤外科中并不少见，早期正确的处理十分重要，如发生漏诊或延误治疗，将导致肢体严重病度，甚至肢体坏死或危及生命.我科自1990年10月至1999年5月，共收治20例病人，25条动脉损伤，取得较满意的疗效.作者认为对于肢体动脉损伤，应强调正确的早期诊断及精确的动脉修复，此外，正确及时的急救处理，妥善处理合并伤及有效的术后观测及处理对于挽救病人生命，提高疗效有着十分重要的意义.

我科自1995年12月～1997年12月开展交锁钉内固定治疗下肢长骨干骨折25例,其中股骨干骨折10例,胫腓骨骨折15例,经8至10个月随访,所有骨折均获愈合,取得良好效果.

我科于1995年12月～1998年6月用交锁髓内钉内固定治疗严重胫腓骨开放性骨折15例.经8～10个月随访,所有骨折均获愈合,取得良好效果,报告如下.