【摘要】 目的 探討康復宣教與訓練等干預手段對股骨干骨折患者圍手術期的影響。 方法 2010年6月－2011年3月收治股骨干骨折患者90例，其中男48例，女42例；年齡17~58歲，平均38歲。開放性骨折28例，閉合性骨折62例。股骨骨折部位:上1/3骨折33例，中1/3骨折35例，下1/3骨折20例，多段骨折2例。橫形骨折20例，斜形骨折30例，粉碎性骨折40例。將90例患者隨機分為康復組（46例）和對照組（44例）。對照組采用骨科術前常規處理，康復組采用骨科術前常規處理加康復宣教與訓練。 結果 康復組住院時間為（5.35±1.27） d，對照組為（7.67±1.85） d，兩組比較差異有統計學意義（Plt;0.05）。 康復組治療后發生并發癥7例，對照組16例，康復組并發癥發生率（15.2%）明顯低于對照組（36.4%），差異有統計學意義（Plt;0.05）。治療后5 d，康復組療效獲優35例，良6例，可3例，差2例，優良率89.1%；對照組獲優25例，良5例，可12例，差2例，優良率68.2%；兩組療效比較差異有統計學意義（Plt;0.05）。 結論 康復宣教與訓練能預防與改善股骨干骨折圍手術期臥床引起的并發癥，減輕患者腿部疼痛及腫脹，縮短圍手術期時間，使患者能盡早手術，加快住院床位周轉，提高患者生活質量。【Abstract】 Objective To explore the effects of rehabilitation education and training interventions on perioperative patients with femoral shaft fractures. Methods A total of 90 patients with femoral shaft fractures were selected from June 2010 to March 2011, including 48 males and 42 females aged from 17 to 58 years (mean 38 years). In these 90 patients, open fracture was in 28 and closed fracture was in 62. Fracture site: upper 1/3 fracture was in 33, middle 1/3 fracture was in 35, lower 1/3 fracture was in 20 and multiple fractures was in 2. There were transverse fractures in 20 patients, oblique fractures in 30 patients and comminuted fractures in 40 patients. All of the patients were randomly divided into experimental group (46 patients) and control group (44 patients). The patients in the control group underwent the routine treatment before the orthopedic surgery; besides the routine treatment, the patients in the experimental group were given the rehabilitation education and training before the orthopedic surgery. Results The hospital duration in the rehabilitation group was (5.35±1.27) days while in the control group was (7.67±1.85) days, the difference was statistically significant (Plt;0.05). There were 7 cases who had complications in rehabilitation group compared with 16 patients in the control group; the incidence of the complications in the rehabilitation group (15.2%) was significantly lower than that in the control group (36.4%) (Plt;0.05). After the treatment for 5 days, the therapeutic effect in rehabilitation group were excellent in 35 cases, good in 6 cases, middle in 3 cases and poor in 2 cases (with the good rate of 89.1%); while in the control group were excellent in 25 cases, good in 5 cases, middle in 12 cases and poor in 2 cases (with the good rate of 68.2%); the difference was significant between the two groups (Plt;0.05). Conclusion Rehabilitation education and training could prevent the perioperative complications in patients with femoral shaft fracture, decrease the pain and edema, speed up the turnover of hospital beds, and improve the patients’ quality of life.
The treatment of open reduction and internal fixation was carried out in 480 cases of fractures offemoral shafts. Patients were followed up in an average of 7. 6 years, 50 cases, rate of occurrence of10. 4%, had varying degrees of functional impairment of knee. It was considered that thecharacteristics of fractures, the time of oporation , selection of incision , the types of internal fixationdevices, and the duration of external immobilization were the main causes related to the occurren...
Objective To describe the design and application of a new intramedullary controlled dynamic nailing(ICDN).〓〖WTHZ〗Methods The new ICDN was made of a stainlesssteel alloy, consists of a nail shaft, innerrod, tensile screw, end cape and two interlocked screws. From December 2005 toFebruary 2007, 48 cases of femoral shaft fractures were treated with ICDN. There were 16 females and 32 males with a mean age of 36.6 years (range, 16-48years). Injury was caused by traffic accident in 26 cases, falling from a height in14, sportsrelated in 7 and crush injury in 1 case. According to Winquist classification, Thirtyseven cases were classified as typeⅠ(13 cases of typeⅠ-1,23 cases of Ⅰ-2 and 1 case of Ⅰ-3), eleven as type Ⅱ fracture ( 2 cases oftype Ⅱ-1, 8 cases of Ⅱ-2 and 1 case of Ⅱ-3). The time from injury to admission was an hour to a week. Emergency operation was performed in 19 cases and the other 29 patients were given operation within 3 days. Results All cases were followed up for an average of 5 months (3-12 months). Among them, the average healing period was 21 weeks (826 weeks) and no nonunion, delayed union and breakage of nailings occurred. The complications included 2 infections, 5 pains, and 4 deformities. Based on Johner and Ｗrubs standard, the results were excellent in 39 cases, good in 7 cases and fair in 2 cases, The excellent and good rate was 95.8%. Conclusions ICDN has excellent biomechanical characteristics which can provide a flexible fixation in treating femoral shaft fractures. The operation is simple and is one of the good techniquesin treating femoral shaft fractures.
ObjectiveTo investigate the biomechanical influence of the oblique locking plate on the fixation of femoral shaft fracture.
MethodsForty imitation artificial femur model with mechanical properties similar to human femur were selected and randomly divided into groups A, B, C, and D, 10 in each group; the femur fracture model was made by transverse osteotomy at 15 cm and 17 cm below the lesser trochanter of the femur and fixed with locking plate with 12 holes and cortical bone screws. The plate was placed in the middle of the longitudinal axis of the femur in group A, and was placed at 5, 10, and 15° angle axis in groups B, C, and D respectively. The axial compression, three-point bending, torsion tests were carried out to measure the strain.
ResultsWith the compressive load and bending load increasing, the medial and lateral strains were significantly increased in each group (P<0.05); but no significant difference was found in strains under compressive load and bending load among 4 groups (P>0.05). With increasing torque, the strain was significantly increased in each group (P<0.05). At 10 N·m torque, there was no significant difference in the strain values among 4 groups (P>0.05); the strain value was significantly higher in groups C and D than groups A and B (P<0.05) and in group D than group C (P<0.05) at torque of 20 and 50 N·m, but no significant difference was found between groups A and B (P>0.05).
ConclusionUnder different stress, the strain will be significantly increased when the plate is placed at >10° angle axis.
【Abstract】 Objective The auto-control micro-motion intramedullary locking nail (AMLN) is designed, to reducethe incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and toobserve the cl inical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixalnails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years (ranging from 20 years to 43 years). The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, obl ique, spiral and comminuted fractures of type I, II, III and IV. Three cases were old non-union fractures. The fresh fractures were treated by closed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months (rangeing from 8 months to 22 months). The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt sl ightly unwell at the needl ing point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.
Objective To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley’s nonunion evaluation criteria. Results All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley’s nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.
Objective
To compare the outcomes between intramedullary nail change and augmentation plating with a retained intramedullary nail for aseptic nonunion of femoral shaft fractures after femoral nailing, and to analyze the cause so as to guide the clinical application.
Methods
Between June 2001 and June 2011, 28 patients with aseptic nonunion of femoral shaft fractures after femoral nailing were treated with intramedullary nail change (11 patients, group A) and augmentation plating with a retained intramedullary nail (17 patients, group B), and the clinical data were analyzed retrospectively. There was no significant difference in age, gender, smoking, location of fracture, Association for the Study of Internal Fixation (AO/ASIF) classification, type of injury, associated injury, type of nonunion, and time of nonunion between 2 groups (P gt; 0.05). The patients were followed up by imaging and the clinical function at regular intervals to observe the callus growth and the recovery condition of the affected limb function, and clinical curative effectiveness was evaluated by Tohner-Wrnch standard.
Results
The operation time, intraoperative bleeding volume, and intraoperative erythrocyte-transported volume in group A were significantly higher than those in group B (P lt; 0.05). There was no significant difference in postoperative drainage volume and hospitalization days between 2 groups (P gt; 0.05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 18.6 months on average (range, 12-36 months). All cases obtained bone union, and time of clinical and radiological bone healing in group B was significantly shorter than those in group A (P lt; 0.05). During follow-up, no following complication occurred: deep incision infection, injuries of blood vessels and nerves, loosening and breakage of internal fixation, loss of reduction, angulated and rotational malunion. According to Tohner-Wrnch standard at last follow-up, the results were excellent in 6 cases, good in 3 cases, and poor in 2 cases, with an excellent and good rate of 81.8% in group A; the results were excellent in 12 cases, good in 5 cases, with an excellent and good rate of 100% in group B; and difference was significant between 2 groups (Z=
—
2.623, P=0.021).
Conclusion
Augmentation
plating with a retained intramedullary nail is an ideal treatment for aseptic nonunion of femoral shaft fractures after femoral nailing and can achieve satisfactory clinical outcomes because it has simpler operation, shorter operation time, less blood loss, and less trauma than intramedullary nail change.
ObjectiveTo review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation.MethodsThe results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed.ResultsThe AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment.ConclusionCompared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
