Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin thre...Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.展开更多
This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with po...This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.展开更多
Ultrasonic fracturing(UF)can be used to form crack networks for oil or gas in the mining industry and hard rock excavation.In this paper,the three-dimensional internal laser-engraved crack method(3DILC)is introduced t...Ultrasonic fracturing(UF)can be used to form crack networks for oil or gas in the mining industry and hard rock excavation.In this paper,the three-dimensional internal laser-engraved crack method(3DILC)is introduced to make penny-shaped internal crack within the samples without any damage to the surfaces.Physical experiments were performed on the transparent samples with internal cracks at different depths.The macro-and micro-fracture fractography characteristics were focused on and analyzed in details.Based on fractography,the mechanisms of the UF were revealed.The propagation paths of cracks of different depths were simulated based on the Paris fatigue model and compared with experimental results.The results show that the 3D-ILC method is a powerful tool for the experimental research on the internal crack propagation in the UF.Under the action of ultrasonic field,fractography shows the characteristics of beach marks,lance-like pattern,rime-like pattern and glass powder.It can be judged that the mechanisms of UF include high cycle fatigue fracture,shear fracture,and friction.The results of the numerical simulation using the Paris fatigue model are consistent with the experimental results.展开更多
Experimental fracture was inflicted to the Junction of the upper and middle thirds of the tibia of 50 rabbits and the fracture was fixed with a half-ring sulcated external fixator to exert axial compression on the 2 f...Experimental fracture was inflicted to the Junction of the upper and middle thirds of the tibia of 50 rabbits and the fracture was fixed with a half-ring sulcated external fixator to exert axial compression on the 2 fragments of the fracture. The changes展开更多
目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,...目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。展开更多
目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和...目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和内固定组。CO接骨架组25例,男7例,女18例;年龄37~56(52.6±11.3)岁;车祸伤7例,跌伤18例;闭合性骨折25例,开放性骨折0例;采用闭合复位CO接骨支架治疗。内固定组23例,男8例,女15例;年龄41~59(53.3±13.7)岁;车祸伤8例,摔伤15例;闭合性骨折23例;采用切开复位钢板内固定方法。评价两组的围手术期资料(受伤至手术时间、手术时长、失血量、住院时间)、术后1年上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、活动范围及握力评估、影像学表现(掌倾角、尺偏角、桡骨长度、关节面台阶、关节内间隙)和并发症等情况。结果:两组术后均获随访,时间0~24(16.0±3.8)个月。CO接骨架组和内固定组比较,CO接骨架组受伤至手术时间[(2.4±3.3)dvs(7.4±3.7)d]短,手术时间[(56.27±15.23)min vs(74.10±5.26)min]短、失血量[(14.52±6.54)ml vs(32.32±10.03)ml]少、住院时间[(14.04±3.24)d vs(16.45±3.05)d]少(P<0.05)。术后12个月两组QuickDASH评分比较[(9.21±1.64)分vs(7.04±3.64)分],差异无统计学意义(P>0.05)。术后6周及1、3个月两组VAS比较,差异均无统计学意义(P>0.05)。末次随访两组活动范围及握力比较,差异均无统计学意义(P>0.05)。术后12个月与内固定组影像学比较,CO接骨架组掌倾角[(17.90±2.18)°vs(19.87±3.21)°]更小、关节面台阶[(0.11±0.03)mm vs(0.17±0.02)mm]更少、桡骨长度[(8.16±1.11)mm vs(9.59±1.02)mm]更短(P<0.05);两组尺偏角度数、关节内间隙比较,差异均无统计学意义(P>0.05)。其中CO接骨架组(25例中的23例)和内固定组(23例中的21例)存在允许范围内的缩小,差异无统计学意义(P=0.29);两组并发症比较,差异无统计学意义(P>0.05)。结论:CO接骨架和切开复位钢板内固定均是治疗不稳定型桡骨远端骨折的有效疗法,且接骨支架术从受伤至手术的等待时间更短、术中出血更少、耗时更短;钢板内固定术控制桡骨短缩更优。展开更多
目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时...目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version6.3,2022)进行信息提取、文献质量评价,采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。结果:(1)共纳入28项研究,患者共计2192例,包括1096例钢板内固定组和1096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93,95%CI(-48.54,-27.31),P<0.00001]、手术时间[MD=-31.58,95%CI(-48.96,-14.20),P=0.0004]、住院时间[MD=-4.58,95%CI(-5.44,-3.71),P<0.00001]、骨折愈合时间[MD=-0.88,95%CI(-1.35,-0.41),P=0.0002]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17,95%CI(-0.95,0.61),P=0.68]、尺偏角[MD=0.22,95%CI(-0.73,1.17),P=0.65]、桡骨高度[MD=-0.24,95%CI(-1.15,0.67),P=0.60],屈伸[MD=-5.63,95%CI(-11.85,0.58),P=0.08]、旋转[MD=-5.80,95%CI(-12.77,1.17),P=0.10]、尺桡偏[MD=-2.86,95%CI(-10.87,5.15),P=0.48],并发症发生率[RR=0.96,95%CI(0.63,1.46),P=0.83],Gartland-Werley腕部临床评分[MD=0.13,95%CI(-0.80,1.06),P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93,95%CI(0.87,1.01),P=0.08]、Cooney腕关节评分优良率[RR=0.99,95%CI(0.62,1.59),P=0.98]、腕关节DASH评分[MD=-4.67,95%CI(-14.96,5.62),P=0.37]的差异均无统计学意义(P>0.05)。结论:与钢板内固定相比,外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间,其影像学解剖指标、腕关节活动度、并发症发生率和腕关节功能评分两者相当。展开更多
BACKGROUND： With the development of internal fixation materials, simple operation with internal fixation has become a tendency. Ni-Ti shape memory alloy embracing fixator has such advantages as slight injury, easy op...BACKGROUND： With the development of internal fixation materials, simple operation with internal fixation has become a tendency. Ni-Ti shape memory alloy embracing fixator has such advantages as slight injury, easy operation, security, reliable fixation, and better histocompatibility. The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest.METHODS： The curative effect and long-term follow-up results were observed after internal ？ xation with a shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest from January 2006 to December 2009.RESULTS： All patients were cured with an average hospital stay of 10.31±3.14 days. Post-operative pain was less severe than preoperative pain （P=0.02）.The rate of postoperative complications such as atelectasis, pulmonary infection, etc was 17.65%. There were fewer long-term complications and less in？ uence on daily work and life.CONCLUSIONS： It is practical to perform an operation for fracture of multiple ribs using a Ti-Ni shape memory alloy embracing ？ xator. The ？ xator, which is less traumatic, simple, safe, and reliable, has a good-histocompatibility and fewer postoperative complications.展开更多
Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft w...Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.展开更多
文摘Objective: To compare the biomechanical basis of 3 different internal fixation methods: nitinol patellar concentrator (NT-PC), tension band and wire circle in treating patellar fractures. Methods: The epoxy resin three dimensional photoelasticity patellar models were made by precise moulding, and were fixated by nitinol patellar concentrator (NT-PC), tension band and wire circle respectively. The patellar models with frozen stress stripes were put into the polarized light field and the stress distributions were compared. As for the model fixated by NT-PC, by dividing layer, photographing and tracing, we used the iterative method to calculate the stress value of every internal node of the epoxy resin patellar model, and the character of stress was analyzed. Results: An overall stress field was yielded when the patellar model was fixated by NT-PC, and the stripes were more than that of tension band model and wire circle model, which have only few stress stripes in the fixated layers. Further analysis indicated that there were continuous fixated stresses in the facies articularis and distal pole of patella, and the character of stresses produced by NT-PC were mainly in longitudinal direction, then in transverse direction. The shearing stresses were small. Conclusion: The initiative and continuous memorial stress of NT-PC and its overall stress distribution character are the essence of NT-PC distinguished with tension band and wire circle in treating patellar fractures. The stress character produced by NT-PC is good for the stability of fracture site and prompts fracture healing.
文摘This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with poterior internal fixaton using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence. kyphosis and/or solid fusinon.
基金supported by the National Natural Science Foundation of China(Nos.51739008 and 41831281)the Natural Science Foundation of Jiangsu Province(No.BK20171130).
文摘Ultrasonic fracturing(UF)can be used to form crack networks for oil or gas in the mining industry and hard rock excavation.In this paper,the three-dimensional internal laser-engraved crack method(3DILC)is introduced to make penny-shaped internal crack within the samples without any damage to the surfaces.Physical experiments were performed on the transparent samples with internal cracks at different depths.The macro-and micro-fracture fractography characteristics were focused on and analyzed in details.Based on fractography,the mechanisms of the UF were revealed.The propagation paths of cracks of different depths were simulated based on the Paris fatigue model and compared with experimental results.The results show that the 3D-ILC method is a powerful tool for the experimental research on the internal crack propagation in the UF.Under the action of ultrasonic field,fractography shows the characteristics of beach marks,lance-like pattern,rime-like pattern and glass powder.It can be judged that the mechanisms of UF include high cycle fatigue fracture,shear fracture,and friction.The results of the numerical simulation using the Paris fatigue model are consistent with the experimental results.
文摘Experimental fracture was inflicted to the Junction of the upper and middle thirds of the tibia of 50 rabbits and the fracture was fixed with a half-ring sulcated external fixator to exert axial compression on the 2 fragments of the fracture. The changes
文摘目的:探讨老年股骨转子间骨折患者接受髓内钉固定术后发生髋螺钉切出的危险因素。方法:回顾性分析2008年1月到2018年8月接受髓内钉治疗的518例股骨转子间骨折老年患者资料,其中,男167例,女351例;年龄65~97岁。根据是否发生髋螺钉切出,将其分为愈合组508例和切出组10例。对两组患者的一般资料、手术资料、影像学资料进行比较,再按照性别、年龄、身体质量指数(body mass index,BMI)、美国麻醉师协会(American Society of Anesthesiologists,ASA)对切出组进行倾向性评分匹配,按照1∶4的比例,匹配出愈合组40例。对影响髋螺钉切出的潜在危险因素进行分析,采用多因素Logistic回归模型对影响髋螺钉切出的独立危险因素进行分析。结果:愈合组和切出组患者在年龄、性别、BMI、ASA分级、AO分型方面的差异均无统计学意义,两组在复位质量方面的差异具有统计学意义(P=0.003),两组在尖顶距方面的差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示复位质量差[OR=23.138,95%CI(2.163,247.551),P=0.009]和尖顶距≥25 mm[OR=30.538,95%CI(2.935,317.770),P=0.004]是导致髋螺钉切出的独立危险因素。结论:复位质量差和尖顶距≥25 mm是老年股骨转子间骨折患者接受髓内钉固定术治疗时发生髋螺钉切出的独立危险因素。尖顶距的最佳数值仍有待进一步研究。
文摘目的:探讨中医接骨学(Chinese osteosynthesis,CO)理论指导下接骨支架与切开复位钢板内固定在治疗不稳定型(AO-23C型)桡骨远端骨折的近期临床疗效。方法:回顾性分析2022年1月至2023年2月48例不稳定型桡骨远端骨折患者,分为CO接骨架组和内固定组。CO接骨架组25例,男7例,女18例;年龄37~56(52.6±11.3)岁;车祸伤7例,跌伤18例;闭合性骨折25例,开放性骨折0例;采用闭合复位CO接骨支架治疗。内固定组23例,男8例,女15例;年龄41~59(53.3±13.7)岁;车祸伤8例,摔伤15例;闭合性骨折23例;采用切开复位钢板内固定方法。评价两组的围手术期资料(受伤至手术时间、手术时长、失血量、住院时间)、术后1年上肢功能障碍评分量表(disabilities of the arm,shoulder and hand,DASH)缩略版(QuickDASH)评分、疼痛视觉模拟评分(visual analogue scale,VAS)、活动范围及握力评估、影像学表现(掌倾角、尺偏角、桡骨长度、关节面台阶、关节内间隙)和并发症等情况。结果:两组术后均获随访,时间0~24(16.0±3.8)个月。CO接骨架组和内固定组比较,CO接骨架组受伤至手术时间[(2.4±3.3)dvs(7.4±3.7)d]短,手术时间[(56.27±15.23)min vs(74.10±5.26)min]短、失血量[(14.52±6.54)ml vs(32.32±10.03)ml]少、住院时间[(14.04±3.24)d vs(16.45±3.05)d]少(P<0.05)。术后12个月两组QuickDASH评分比较[(9.21±1.64)分vs(7.04±3.64)分],差异无统计学意义(P>0.05)。术后6周及1、3个月两组VAS比较,差异均无统计学意义(P>0.05)。末次随访两组活动范围及握力比较,差异均无统计学意义(P>0.05)。术后12个月与内固定组影像学比较,CO接骨架组掌倾角[(17.90±2.18)°vs(19.87±3.21)°]更小、关节面台阶[(0.11±0.03)mm vs(0.17±0.02)mm]更少、桡骨长度[(8.16±1.11)mm vs(9.59±1.02)mm]更短(P<0.05);两组尺偏角度数、关节内间隙比较,差异均无统计学意义(P>0.05)。其中CO接骨架组(25例中的23例)和内固定组(23例中的21例)存在允许范围内的缩小,差异无统计学意义(P=0.29);两组并发症比较,差异无统计学意义(P>0.05)。结论:CO接骨架和切开复位钢板内固定均是治疗不稳定型桡骨远端骨折的有效疗法,且接骨支架术从受伤至手术的等待时间更短、术中出血更少、耗时更短;钢板内固定术控制桡骨短缩更优。
文摘目的:Meta分析钢板与外固定架固定治疗AO-C型桡骨远端骨折的临床疗效。方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普和SinoMed数据库所有关于AO-C型桡骨远端骨折的随机对照临床试验的文献,检索时限均从各数据库建库到2023年6月30日。纳入研究参照Cochrane手册(Version6.3,2022)进行信息提取、文献质量评价,采用RevMan 5.4软件进行发表偏倚风险评价、检验异质性并进行Meta分析。结局指标为:影像学解剖指标(掌倾角、尺偏角、桡骨高度)、腕关节活动度(屈伸、旋转、尺桡偏)、并发症发生率、手术治疗情况比较(手术出血量、手术时间、住院时间、骨折愈合时间)和腕关节功能评分及相关量表。结果:(1)共纳入28项研究,患者共计2192例,包括1096例钢板内固定组和1096例外固定架组。(2)Meta分析结果显示:外固定架组的手术出血量[MD=-37.93,95%CI(-48.54,-27.31),P<0.00001]、手术时间[MD=-31.58,95%CI(-48.96,-14.20),P=0.0004]、住院时间[MD=-4.58,95%CI(-5.44,-3.71),P<0.00001]、骨折愈合时间[MD=-0.88,95%CI(-1.35,-0.41),P=0.0002]均显著优于钢板内固定组(P<0.05)。(3)两组的掌倾角[MD=-0.17,95%CI(-0.95,0.61),P=0.68]、尺偏角[MD=0.22,95%CI(-0.73,1.17),P=0.65]、桡骨高度[MD=-0.24,95%CI(-1.15,0.67),P=0.60],屈伸[MD=-5.63,95%CI(-11.85,0.58),P=0.08]、旋转[MD=-5.80,95%CI(-12.77,1.17),P=0.10]、尺桡偏[MD=-2.86,95%CI(-10.87,5.15),P=0.48],并发症发生率[RR=0.96,95%CI(0.63,1.46),P=0.83],Gartland-Werley腕部临床评分[MD=0.13,95%CI(-0.80,1.06),P=0.78]、Gartland-Werley腕部临床评分优良率[RR=0.93,95%CI(0.87,1.01),P=0.08]、Cooney腕关节评分优良率[RR=0.99,95%CI(0.62,1.59),P=0.98]、腕关节DASH评分[MD=-4.67,95%CI(-14.96,5.62),P=0.37]的差异均无统计学意义(P>0.05)。结论:与钢板内固定相比,外固定架治疗AO-C型桡骨远端骨折可以显著减少手术出血量、缩短手术时间与住院时间和骨折愈合时间,其影像学解剖指标、腕关节活动度、并发症发生率和腕关节功能评分两者相当。
文摘BACKGROUND： With the development of internal fixation materials, simple operation with internal fixation has become a tendency. Ni-Ti shape memory alloy embracing fixator has such advantages as slight injury, easy operation, security, reliable fixation, and better histocompatibility. The present study was to explore curative effect and postoperative results of Ti-Ni shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest.METHODS： The curative effect and long-term follow-up results were observed after internal ？ xation with a shape memory alloy embracing ？ xator in patients with multiple fractured ribs and ？ ail chest from January 2006 to December 2009.RESULTS： All patients were cured with an average hospital stay of 10.31±3.14 days. Post-operative pain was less severe than preoperative pain （P=0.02）.The rate of postoperative complications such as atelectasis, pulmonary infection, etc was 17.65%. There were fewer long-term complications and less in？ uence on daily work and life.CONCLUSIONS： It is practical to perform an operation for fracture of multiple ribs using a Ti-Ni shape memory alloy embracing ？ xator. The ？ xator, which is less traumatic, simple, safe, and reliable, has a good-histocompatibility and fewer postoperative complications.
文摘Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.
