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STUDY AND CLINICAL APPLICATION OF AUTO-COMPRESSIVE AND ANTI-CIRCUMROTATE INTRAMEDULLARY NAIL

ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.

帶鎖髓內釘治療股骨干骨折

雙側非典型股骨骨折術中再骨折的治療

Research on the burden of femoral fracture disease in China from 1990 to 2021 and future trends

ObjectiveTo analyze the changing trends in disease burden of femoral fractures in China from 1990 to 2021, evaluate the impacts of age, period, and cohort effects, and project the age-standardized prevalence rate and age-standardized incidence rates of femoral fractures from 2022 to 2036. MethodsUtilizing open data from the 2021 Global Burden of Disease (GBD) study, this research characterized the disease burden of femoral fractures in China between 1990 and 2021, including trends in incidence, prevalence, and years lived with disability (YLDs). Age-standardized rates were calculated, and Joinpoint regression models were employed to estimate annual percentage changes (APC) and average annual percentage changes (AAPC). An age-period-cohort (APC) model was applied to quantify the effects of age, period, and birth cohort on disease burden. A Bayesian age-period-cohort (BAPC) model was further utilized to project age-standardized prevalence rates and age-standardized incidence rates from 2022 to 2036, with stratified analyses by age, sex, and time period. ResultsFrom 1990 to 2021, age-standardized prevalence (AAPC=0.138 5%), incidence (AAPC=0.294 2%), and YLD rates (AAPC=0.128 3%) exhibited sustained upward trends. Unintentional injuries constituted the predominant etiology of femoral fractures, followed by transport accidents and interpersonal violence/self-harm. In 2021, disease burden escalated with advancing age, with females over 60 years demonstrating significantly higher burdens than males. Age effect coefficients showed a monotonic increase, period effects displayed a U-shaped trajectory (decline followed by rebound), and cohort effects exhibited an inverted U-shaped pattern (rise then decline). Projections indicated continued growth in age-standardized prevalence rates and age-standardized incidence rates through 2036. ConclusionAs the population aging intensifies in China, the disease burden of femoral fractures in our country remains extremely severe. Among them, the elderly female group has become the key focus for prevention and control due to the high prevalence of osteoporosis.

新生兒股骨骨折的護理體會

目的探討新生兒股骨骨折的護理方法及護理效果。 方法回顧性分析 2010 年 1 月-2014 年7 月收治的 41 例新生兒股骨骨折的護理體會。 結果41 例患兒均予股骨垂直懸吊式牽引即 Bryant 牽引的治療方式。牽引時間 14～28 d，平均 23.4 d。拆除牽引裝置后 14 例患兒出現皮膚并發癥。出院后門診隨訪 6～12 個月，41 例患兒成角畸形正位片均<10°，側位片均<15°，縮短均<10 mm。 結論Bryant 懸吊牽引是治療新生兒股骨骨折的常用方法，臨床效果良好。由于新生兒無表達能力，故治療期間需保證牽引的持續有效；定時觀察肢端循環及合理的健康教育對預防并發癥的發生至關重要，是患兒順利康復的必要條件。

老年人股骨骨折后壓瘡預防的護理

目的討論老年股骨骨折患者壓瘡預防的護理方法。 方法對2013年1月－6月收治的33例股骨骨折老年患者，入院后即行壓瘡預測評估，并根據評估情況采取使用軟床墊、及時變換受壓部位、保護骨隆突處等預防措施，同時對患者和家屬進行個體化的健康教育及加強護士交接班預防措施，積極預防和減少壓瘡的發生。 結果院外帶入的1例Ⅲ期壓瘡患者通過治療和護理轉為Ⅰ期，4例Ⅰ期、2例Ⅱ期壓瘡患者均治愈，住院期間無新發壓瘡患者。 結論積極的護理措施可預防股骨骨折老年患者壓瘡的發生，減輕患者的痛苦，提高護理質量和患者的滿意度。

TREATMENT EVALUATION OF DISTAL FEMORAL FRACTURE BY LESS INVASIVE STABILIZATION SYSTEMVIA TWO INCISIONS

To evaluate the cl inical results of less invasive stabil ization system (LISS) for femur supercondylar and intercondylar fractures. Methods From March 2004 to November 2005, 47 patients with 49 intercondylar and supercondylar fractures were treated. Of all the patients, there were 34 males and 13 females with an average of 39.7 years (range 19-56 years). The locations were left side in 21 cases and right side in 28 cases. Fracture was caused by traffic accident in 31 cases, fall ing in 8 cases, violence in 6 cases and others in 2 cases. Forty-nine fractures included 14 intercondylar fractures, 21supercondylar fractures and 14 intercondylar and supercondylar fractures; 32 closed fractures and 17 open fractures. According to the AO typing, there were 6 type 33-A1, 8 type 33-A2 , 10 type 33-A3, 7 type 33-C1, 3 type 33-C2 and 15 type 33-C3. The disease course was 30 minutes to 6 days. Articular surface reduction was first performed, then the LISS plate was inserted via two incisions and locking screws were used later. Results The average operation time was 126 minutes (range 48-248 minutes). The blood loss was 180 mL(range 60-1 200 mL). The average follow-up time was 18.6 months (range 12-23 months). There were 4 patients with AP angular deformity and 5 patients with lateral angular deformity (range 2-5°). External rotation deformity was presented in 2 patients. There were no plate breakage, screw loosen and fixation failure. Average bone union time was 5.6 months (range 3-8 months) without infection case. Six cases were treated with il iac bone transplantation for delayed union. Conclusion LISS is one kind of effective treatment to femoral intercondylar and supercondylar fractures.

TREATMENT ON FEMORAL FRACTURES WITH INVERSE LIMITED MARROW CAVITY RASPING INTRAMEDULLARY INTERLOCKING NAIL

Objective To evaluate the results of the treatmenton femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail . Methods From Jun. 1999 to Sep. 2003, 74 patients with femoralfractures were treated by intramedullary interlocking nail (inverse limited marrow cavity rasping) .There were 62 males and 12 females. Among them, 5 caseswere type 32A1, 7 cases were type 32A2, 12 cases were type 32A3, 35 cases were type 32B2, and 15 cases were type 32C2. Results Seventyfour patients were followed up for 13 to 29 months(15.4 months in average). Thetime for fracture union ranged from 3 to 5 months(3.8 months in average). The overall rate of excellence was 98.7% by Wuyuesong grading. There was 1 case of non-union, 1 case of delayed infection, and 2 cases of bent screw. Conclusion The treatment on femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail is easy to operate and has minimum impairment to local circulation. It also promotes the healing and early function. 

人工髖關節置換術后股骨骨折原因分析與治療

目的 總結人工髖關節置換術后股骨骨折的原因及處理方法。 方法 2005 年3 月－ 2010 年1 月，收治18 例人工髖關節置換術后股骨骨折患者。男8 例，女10 例；年齡45 ～ 70 歲，平均64 歲。關節置換術后5 ～ 48 個月發生股骨骨折。17 例有外傷史，1 例為自發性骨折。股骨骨折后1 ～ 32 d 入院。骨折采用Vancouver 分型標準：A型1 例，B1 型7 例，B2 型5 例，B3 型3 例，C 型2 例。術前Harris 評分為（50.4 ± 4.1）分。根據不同骨折分型，分別采用保守治療、骨折固定、假體翻修、自體髂骨植骨等方法治療。 結果 手術患者術后切口均Ⅰ期愈合。除1 例患者因合并慢性心功能不全及腦梗死，行皮牽引治療后2 個月死亡外，余17 例均獲隨訪，隨訪時間12 ～ 49 個月，平均23 個月。X 線片復查示骨折于術后12 ～ 32 周達臨床愈合。術后6 個月Harris 評分為（87.5 ± 3.4）分，與術前比較差異有統計學意義（t=2.241，P=0.021）。 結論 人工髖關節置換術后股骨骨折成功治療的關鍵是全面評估患者情況，根據Vancouver 分型標準確定治療方案，可獲得滿意臨床療效。

從醫源性角度探討股骨鎖定鋼板斷裂的原因及防治措施

目的 探討股骨鎖定鋼板斷裂的醫源性因素及防治措施。 方法 回顧分析2007 年5 月－ 2009 年8 月收治的11 例股骨骨折內固定術后鎖定鋼板斷裂患者臨床資料。其中男7 例，女4 例；年齡22 ～ 65 歲，平均38 歲。原骨折位于股骨干5 例，股骨遠端6 例。切開復位鎖定鋼板內固定術后2 ～ 6 個月鋼板斷裂；斷裂原因：適應證選擇不當，違反鎖定鋼板操作原則，術后功能鍛煉及康復訓練不到位，醫患交流缺失。11 例均再次手術，其中股骨干骨折5 例、股骨遠端骨折1 例行髓內釘固定，余5 例股骨遠端骨折再次行鎖定鋼板固定。 結果 二次術后11 例均獲隨訪，隨訪時間8 ～ 20 個月，平均12 個月。術后4 ～ 8 個月，平均6 個月，所有患者骨折均達骨性愈合。無鋼板再斷裂及其他相關并發癥發生。術后8 個月根據美國特種外科醫院（HSS）評分系統對膝關節功能評定：優7 例，良3 例，可1 例；優良率90.9%。 結論 合理選擇適應證、規范手術操作、正規康復訓練、加強醫患交流是防治股骨骨折內固定術后鎖定鋼板斷裂的有效措施。