【摘要】 目的 比較脛骨平臺骨折術后輔助與不輔助持續被動運動（continuous passive motion，CPM）的臨床療效。 方法 對2008年6月-2009年6月86例行手術治療的閉合性、無合并損傷的脛骨平臺骨折患者進行回顧性分析。根據是否輔助CPM分為CPM組27例和非CPM組（對照組）59例。對兩組患者的傷口愈合情況，膝關節屈曲、伸直角度，以及膝關節功能恢復情況進行比較。 結果 兩組傷口甲級愈合率差異無統計學意義（P=0.566）。在術后2周和6周，CPM組患者的膝關節屈曲角度明顯大于對照組（Plt;0.001），但在術后3個月和12個月，兩組的差異無統計學意義（P=0.219，P=0.512）。在術后2、6周，3、12個月，CPM組和對照組患者的膝關節伸直角度差異無統計學意義。在術后12個月的Rasmussen膝關節功能評分方面，CPM組和對照組的差異無統計學意義。 結論 脛骨平臺骨折術后輔助CPM能早期提升膝關節屈曲角度，但并不能提高遠期的膝關節活動度和最終的膝關節功能。【Abstract】 Objective To compare the therapeutic effect of continuous passive motion (CPM) treatment after tibial plateau fractures operation. Methods From June 2008 to June 2009, 86 patients were treated due to closed tibial plateau fractures without combined injuries. The patients were treated with (27 patients, CPM group) and without (59 patients, control group) CPM. The wound healing rates, range of motion and the knee function were compared between the two groups. Results There was no significant difference between the two groups in wound healing rates (P=0.566). Two and six weeks after the operation, there were significant differences between the two groups in flexion degree (Plt;0.001); three and 12 months after the operation, there were no significant differences between the two groups (P=0.219, P=0.512). At the 2nd and 6th week, 3rd and 12th month postoperatively, there were no significant differences between the groups in extension degree. Twelve months after the operation, there were no significant differences between the groups in functional recovery of the knee. Conclusion CPM in the post-operative treatment of tibial plateau fractures is effective increasing knee flexion in the early stage, but is not effective increasing range of motion or knee function in a long term.
Objective To analyze the effectiveness of tuberosity suture combined with autogenous bone grafting in reverse total shoulder arthroplasty for elderly patients with proximal humerus fracture. Methods A clinical data of 28 patients with fresh proximal humerus fractures, who met the selection criteria and admitted between June 2014 and April 2022, was retrospectively analyzed. There were 7 males and 21 females. Age ranged from 65 to 81 years, with an average of 73.8 years. The causes of injury were 21 cases of fall, 6 cases of traffic accident, and 1 case of falling from height. The time from injury to operation ranged from 5 to 20 days with an average of 9.2 days. There were 8 cases of Neer three-part fracture and 20 cases of four-part fracture. The reverse total shoulder arthroplasty was performed, and the greater and lesser tuberosities were sutered and reconstructed with autogenous bone grafting. After operation, the Constant score, American Society for Shoulder Surgery (ASES) score, and visual analogue scale (VAS) score were used to evaluate shoulder function and pain; and the active range of motion of the shoulder joint was recorded, including flexion, external rotation, and internal rotation. X-ray films were taken to observe the position of prosthesis. According to the evaluation criteria proposed by Boileau, the healing of greater tuberosity was evaluated, and the effectiveness was compared between the patients with healed and non-healed (displacement and absorption) greater tuberosity. ResultsAll incisions healed by first intention after operation. All patients were followed up 24-106 months, with an average of 60.9 months. At last follow-up, the VAS score of shoulder joint ranged from 0 to 6 (mean, 1.1). The Constant score ranged from 45 to 100 (mean, 80.1). The ASES score ranged from 57 to 100 (mean, 84.7). The active range of motions of shoulder joint were 60°-160° (mean, 118°) in flexion, 0°-50° (mean, 30°) in external rotation, and corresponding to reaching the S5-T8 vertebral body level in internal rotation. During follow-up, no shoulder joint re-dislocation or severe shoulder instability occurred, and no revision surgery was performed. X-ray film reexamination showed that there was no loosening of the prosthesis. According to the evaluation criteria proposed by Boileau, the greater tuberosity fused in 22 cases (78.6%), displaced in 3 cases (10.7%), and absorbed in 3 cases (10.7%). The shoulder joint function and pain related evaluation indicators in the healed group were significantly better than those in the non-healed group (P<0.05). ConclusionTuberosity suture combined with autogenous bone grafting is a relatively simple procedure that provides a reliable fixation for the anatomic recovery of greater and lesser tuberosities and is beneficial for the recovery of shoulder function in elderly patients with proximal humeral fractures.
ObjectiveTo investigate the effectiveness of total elbow arthroplasty (TEA) with preservation of triceps brachii insertion approach.MethodsBetween January 2012 and September 2017, 17 patients with elbow disease were treated with TEA with preservation of triceps brachii insertion approach. There were 3 males and 14 females, with an average age of 65.2 years (range, 48-85 years). The injuries located on left elbow in 5 cases and on right elbow in 12 cases. There were 11 cases of distal humerus fracture (AO type C1 in 2 cases and type C3 in 9 cases); the interval between fracture and operation was 3-10 days (mean, 4.1 days). There were 3 cases of osteoarthritis and 3 cases of rheumatoid arthritis, with the disease duration of 2-26 years (mean, 8.7 years). The postoperative elbow function and pain was assessed by Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, respectively. The prosthesis position, heterotopic ossification, and periprosthetic fracture were observed by X-ray films.ResultsAll incisions healed by first intention. Sixteen patients were followed up 18-69 months (mean, 40.6 months). Intraoperative ulnar nerve injury occurred in 2 cases, and healed after symptomatic treatment. At last follow-up, the MEPS score was 55-100 (mean, 90.3). The results were excellent in 11 cases, good in 2 cases, fair in 2 cases, and poor in 1 case, with an excellent and good rate of 81.3%. The VAS score was 0-2 (mean, 0.4). X-ray reexamination showed that no polyethylene wear, prosthesis loosening and fracture, abnormal prosthesis position, periprosthetic fracture occurred during the follow-up period, and the prosthesis survival rate was 100%. Heterotopic ossification occurred in 2 and 3 months after operation in 2 cases, respectively.ConclusionThe triceps on approach for TEA are satisfactory for distal humerus fracture, osteoarthritis, and rheumatoid arthritis.