Objective To study the surgical reconstruction for correction of enophthalmos deformity caused by orbital blowout fractures. Methods From December 1996 to March 2004, 56 cases of enophthalmos deformity caused by orbital blow-out fracture were repaired. There were 37 cases diplopia, 35 cases with worsened visual acuity than pretrauma. Typical sub-ciliary incision was employed to expose the fractured area.The dissection was done beneath the medial and inferior obital periosteum. The fracture areas were exposed and the tissues protrusing to sinus maxillaries were released through the space between fractural bones. After the medial and inferior orbital walls and orbital floors were exposed，the herniated orbital contents were released and reduced to the orbital cavity. The fractured orbital walls were repaired precisely with Medpor which were fixed to the area beneaththe periosteum with 2 plates at least. Results All 56 cases ofenophthalmos deformity caused by orbital blow-out fracture repaired with this technique recovered well and their facial appearance improved greatly. With a follow-up ranged from 2 months to 5 years, the degree of enophthalmos stabilized at within 2 mm, no relapse and other complications occurred. Of 34 patients with diplopia, 27 were improved. Of the 35 cases with worsened visual acuity, 9 were improved with different degree. No diplopia or visual acuity worsening occurred. Conclusion It is safe and effectiveto correct the orbital blow-out fractures. The earlier it is repaired, thebetter the effect will be. Medpor with its advantages like better histocompatibility, easier sculpturing, moderate hardness, lower absorptivity, fewer complications and permanence effect is the preferable implantation material for correcting enophthalmos deformity.
Objective To analyze the epidemiological features of clavicle fractures.Methods A total of 363 cases of clavicle fractures were treated from February 1993 to November 2002, their case history data were reviewed and evaluated by epidemiological method.Results Out of 363 cases, there were 269 males and 94 females, aged from new born to 96 years. The locations of fractures were on left side in 159 cases and on right side in 204 cases. Neonatal clavicle fracture occurred in the case of delivery (0.28%). The causes of disease for adult clavicle fractures were traffic injury (52.1%) and daily falling injury(31.1%). There were232 cases of simple fractures and 131 cases of comminuted fractures. The fracture positions included inner(6 cases), middle(328 cases) and outer parts(29 cases). Multiinjuries occurred in 78 cases, the rib fractures concomitant with clavicle fractures were the commonest(31 cases).Conclusion The clavicle fractures are the common injury. Of them, traffic injury and daily falling injury arethe most common. The rib fractures are always accompanied with clavicle fractures.The main position of fracture is on the middle part.
Objective To evaluate the effectiveness of InterTan in the treatment of femoral intertrochanteric fractures. Methods Between April 2009 and July 2009, 57 patients with femoral intertrochanteric fracture were treated with InterTan. There were 33 males and 24 females with an average age of 68 years (range, 45-88 years). The locations were left side in 31 cases and right side in 26 cases and all fractures were closed fractures. According to Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification, there were 23 cases of type 31-A1, 27 of type 31-A2, and 7 of type 31-A3. The disease duration was 2 to 8 days with an average of 3.3 days. The data of operative time, blood loss, perioperative blood transfusion, hospital ization day, fracture heal ing time, and Harris hip score were recorded. Results The operative time and the blood loss were (74.5 ± 19.7) minutes and (148.8 ± 79.6) mL, respectively. There were significant differences in the operative time and the blood loss among the AO/OTA subgroups (P lt; 0.05). Twenty-five patients required a blood transfusion and the transfusion volume was (264.0 ± 90.7) mL. The average hospital ization days were 7 days (range, 6-9 days). Thirty-five patients were followed up 12 to 15 months (13.3 months on average). X-ray films showed that all fractures healed within (2.8 ± 0.8) months. The heal ing time of fracture was (2.4 ± 0.6), (2.9 ± 0.9), and (3.8 ± 0.5) months in 31-A1 subgroup, 31-A2 subgroup, and 31-A3 subgroup, respectively. There was no significant difference in heal ing time of fracture between 31-A1 subgroup and 31-A2 subgroup (P gt; 0.05), and there were significant differences between 31-A3 group and 31-A1 subgroup, 31-A2 subgroup (P lt; 0.05). No shortening, cut-out, varus malposition, femoral shaft fracture, or implant failures was found. The Harris score at the final follow-up was 84.5 ± 8.2 with an excellent and good rate of 80% (15 cases of excellent, 13 of good, 6 of fair, and 1 of poor). Twenty patients (57%) recovered the walking abil ity. Conclusion The new intertrochanteric antegrade nail of InterTan can be used to treat femoral intertrochanteric fractures with good cl inical outcomes, high union rate, and less compl ications.
Objective To explore an improved method of surgical operation for reposition of the articular surface with Type Ⅲ Pilon fractures. Methods From January 1999 to December 2005, 20 patients (22 sides) with Type Ⅲ Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males,15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a fallingaccident was found in 12 patients (14 sides), and due to a traffic accident in 4patients (4 sides). Results The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 971 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny’s judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and thehealing of the first intention (stage Ⅰ) in 94.4% (17/18). According to the Mazur’s criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%. Conclusion Propermanagement of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, b internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.
目的:對同側脛腓骨骨折、髖關節骨折后脫位合并膝后交叉韌帶損傷的創傷機制及診斷進行分析探討。方法:對2007年1月至2008年6月收治的7例同側脛腓骨骨折、髖關節骨折后脫位合并膝后交叉韌帶損傷患者的臨床資料、診治經過和隨訪結果進行總結分析。結果: 脛腓骨開放性骨折3例(42.9%),閉合性骨折4例(57.1%);髖關節均有后脫位,其中伴有髖部骨折5例(71.4%)。膝后交叉韌帶實質部斷裂4例(57.1%),脛骨止點撕脫骨折3例(42.9%)。7例患者獲平均14.7個月(12～18個月)隨訪。Lysholm膝關節功能評分術后6月95.8±3.71,術后12月97.6±2.7。結論:明確同側脛腓骨骨折、髖關節骨折后脫位合并膝后交叉韌帶損傷的創傷機制,全面、準確、系統的問診查體和完善的輔助檢查是早期確診、提高療效的關鍵。
摘要:目的:探討地震傷員中膝關節損傷的機制、類型及處理方法。 方法:對我院收入住院的2728例 5·12汶川特大地震傷員傷情特點進行分析,篩選出有膝關節損傷的病例進行分析。 結果: 膝關節損傷前三位分別是髕骨骨折(42.15%)、脛骨平臺骨折(21.05%)、股骨髁骨折(13.16%),這與人們在地震時奔跑摔傷以及被房屋倒塌砸傷有很大關系。結論:地震后膝關節損傷其發病率、受傷機制、損傷類型、合并傷情況及治療處理均有其特點,總結這些特點和規律將對地震傷膝關節損傷患者的處理產生積極作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.