[1]刘涛,鲍飞龙,亢世杰,等.顺势牵引微创治疗在下肢骨折中的应用[J].中华老年骨科与康复电子杂志,2018,(06):321-326.[doi:10.3877/cma.j.issn.2096-0263.2018.06.001]
　Liu Tao,Bao Feilong,Kang Shijie,et al.Homeopathic minimally invasive treatment in lower extremity fractures[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2018,(06):321-326.[doi:10.3877/cma.j.issn.2096-0263.2018.06.001]
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顺势牵引微创治疗在下肢骨折中的应用()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2018年06期
页码:
321-326
栏目:
创新技术
出版日期:
2018-11-23

文章信息/Info

Title:
Homeopathic minimally invasive treatment in lower extremity fractures
作者:
刘涛; 鲍飞龙; 亢世杰; 江涛; 黄东生; 高伟; 耿立杰; 胡义明
266035 山东大学齐鲁医院创伤骨科（青岛）
Author(s):
Liu Tao;  Bao Feilong;  Kang Shijie;  Jiang Tao;  Huang Dongsheng;  Gao Wei;  Geng Lijie;  Hu Yiming
Department of Orthopaedic Trauma, Qilu Hospital of Shandong University (Qingdao), Qingdao 266035, China
关键词:
胫骨骨折;  股骨骨折;  微创外科手术;  顺势双反牵引复位器
Keywords:
Tibial fractures;  Femoral fractures;  Minimally invasive surgical procedures;  Homeopathic bidirectional-traction reduction device
DOI:
10.3877/cma.j.issn.2096-0263.2018.06.001
文献标志码:
A
摘要:
目的 介绍顺势牵引微创治疗在下肢骨折中的应用，分析其复位技巧和闭合复位的成功率。方法 回顾性分析2015年10月到2017年5月山东大学齐鲁医院青岛院区创伤骨科应用双反牵引微创治疗的58例下肢骨折患者。所有患者均采用张氏牵引复位器闭合复位治疗骨折，闭合复位成功后选择接骨板经皮置入或髓内钉内固定。采集闭合复位成功率、术后感染率、神经血管并发症、骨折愈合、功能恢复情况。结果 53例患者获得随访，随访时间为7～24个月，平均（11±4）个月。在顺势双反牵引辅助下，所有骨干骨折闭合复位均获得成功，36例胫骨平台骨折有21例闭合复位成功，15例有关节面塌陷的骨折结合阶梯钻和顶棒复位成功。1例切口出现浅表感染，经换药后愈合，没有血管神经并发症发生，所有患者骨折获得愈合，无内植物松动断裂、复位丢失等并发症。53例患者功能恢复良好，52例患者恢复到伤前生活或工作状态，1例工伤患者未回到工作岗位。结论 在下肢骨折的治疗中，顺势微创技术是一种简单迅速、创伤小、恢复快的治疗方式，值得临床推广。
Abstract:
Objective To introduce the application of homeopathic minimally invasive treatment for the lower extremity fractures, and analyze the tips and successful rate. Methods From October 2015 to May 2017, 58 patients with lower extremity fractures admitted to the trauma center of Qilu Hospital of Shandong University (Qingdao) were included in this study. There were 38 males and 20 females with an average of (36±12) years. All patients were treated with homeopathic minimally invasive methods with the application of Zhang’s bidirectional traction device and followed up regularly. The outcome was evaluated according to successful rate of closed reduction, wound infection, neurovascular complication, fracture union and functional recovery. Results 53 patients were followed up with a mean duration of (11±4) months (range, 7-24 months). With the aid of Zhang’s bidirectional traction device, all patients were obtained satisfactory closed reduction; 21 cases of 31 tibial plateau fractures achieved approximately anatomic reduction, other 15 cases with depressed articular fragments received closed minimally reduction and autograft. One superficial infection occurred and was finally healed with routine dressing changes, no neurovascular injury were found, all fracture healed, no cases showed implant broken or reduction loss. 53 patients obtained satisfactory functional outcome, all expect 1 restored pre-injury activity and work status. Conclusions Homeopathic minimally invasive treatment with Zhang’s bidirectional traction device is a convenient and effective option for lower extremity fractures. It is simple, rapid, minimally invasive and rapid recovery that worthy of clinical promotion.

参考文献/References:

1 张英泽. 临床创伤骨科流行病学 [M] . 北京: 人民卫生出版社, 2009 .
2 Zhang YZ. Minimally invasive reduction and fixation in orthopedic trauma [J]. Chin Med J (Engl), 2016, 129(21): 2521-2523.
3 Cook GE, Markel DC, Ren W, et al. Infection in orthopaedics [J]. J Orthop Trauma, 2015, 29(Suppl 12): S19-S23.
4 Shirwaiker RA, Springer BD, Spangehl MJ, et al. A clinical perspective on musculoskeletal infection treatment strategies and challenges [J]. J Am Acad Orthop Surg, 2015, 23(Suppl): S44-S54.
5 Antonova E, Le TK, Burge R, et al. Tibia shaft fractures: costly burden of nonunions [J]. BMC Musculoskelet Disord, 2013, 14: 42.
6 Audigé L, Griffin D, Bhandari M, et al. Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures [J]. Clin Orthop Relat Res, 2005, 438: 221-232.
7 Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update [J]. Orthop Clin North Am, 2016, 47(2): 365-375.
8 Somersalo A, Paloneva J, Kautiainen H, et al. Increased mortality after lower extremity fractures in patients <65 years of age [J]. Acta Orthop, 2016, 87(6): 622-625.
9 Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position [J]. J Trauma, 2010, 68(1): 231-235.
10 Topliss CJ, Webb JM. Interface pressure produced by the traction post on a standard orthopaedic table [J]. Injury, 2001, 32(9): 689-691.
11 Wu CS, Chen PY, Shih KS, et al. Modified patient position on a fracture table for hip fixation [J]. Orthopedics, 2007, 30(7): 518-520.
12 Flierl MA, Stahel PF, Hak DJ, et al. Traction table-related complications in orthopaedic surgery [J]. J Am Acad Orthop Surg, 2010, 18(11): 668-675.
13 张英泽. 尊重科学规律 不断求实创新 [J]. 中华老年骨科与康复电子杂志, 2017, 3(1): 1-3.
14 Chen W, Zhang T, Wang J, et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation [J]. Int Orthop, 2016, 40(1): 167-172.
15 常恒瑞, 于沂阳, 邢欣, 等. 顺势牵引微创治疗胫骨平台骨折 [J]. 中华关节外科杂志:电子版, 2017, 11(1): 24-28.
16 常恒瑞, 郑占乐, 陈伟, 等. 双反牵引快速复位器微创治疗胫骨中下段骨折的初步临床应用 [J]. 河北医科大学学报, 2015 (12): 1470-1471.
17 邵佳申, 郑占乐, 吕红芝, 等. 双反牵引微创治疗后外侧胫骨平台骨折的疗效分析 [J]. 中华老年骨科与康复电子杂志, 2017, 3(5): 302-305.
18 苏喧. 张英泽:双反牵引微创复位固定治疗胫骨平台骨折 [J]. 中国医药科学, 2016, 6(5): 1-3.
19 王娟, 李升, 臧砚超, 等. 应用四肢长骨骨折快速复位器治疗股骨骨折 [J]. 河北医科大学学报, 2014, 35(2): 220-221, 封3.
20 叶丹丹, 李升, 侯志勇, 等. 牵引复位器治疗四肢长骨骨折的生物力学特性分析 [J]. 河北医科大学学报, 2017, 38(10): 1229-1231.
21 郑占乐, 常恒瑞, 吕红芝, 等. 胫骨平台骨折张氏微创手术中研磨复位技术处理过度复位的临床研究 [J]. 中华老年骨科与康复电子杂志, 2017, 3(3): 157-161.
22 郑占乐, 张飞, 何泽阳, 等. 双向牵引闭合复位微创治疗胫骨平台骨折的初步临床应用 [J]. 河北医科大学学报, 2015, 36(4): 491-492.
23 Schatzker J, Mcbroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975 [J]. Clin Orthop Relat Res, 1979 (138): 94-104.
24 Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment [J]. J Bone Joint Surg Am, 1973, 55(7): 1331-1350.
25 Karlstrom G, Olerud S. Ipsilateral fracture of the femur and tibia [J]. J Bone Joint Surg Am, 1977, 59(2): 240-243.
26 Jeffrey MM, Roland JM, Reinhold GM, et al. Planning and reduction technique in fracture surgery: springer Berlin Heidelberg [M]. Berlin Heidelberg: Springer, 1989.

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备注/Memo

备注/Memo:
基金项目：青岛市医疗卫生重点学科建设项目（QDZDXK-A-2017005）
更新日期/Last Update: 2018-11-23