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简介：BACKGROUND&OBJECTIVE:Themajorityofintramedullaryspinalcordtumors(IMSCT)arelow-gradegliomas.RadicalresectionforIMSCTsremainschallenging.Recently,improvedneuroimagingandadvancedmicrosurgicaltechniquehavemadegreatsuccessinsurgicalmanagementoftheintramedullaryspinalcordtumors.METH-ODS&RESULTS:Twenty-ninepatientswithintramedullaryspinalcordtumorsweretreatedbyradicalresectiondur-ingthepast4yearsinourinstitute.Thehistologicalresultswereasfollows:12ependymomas,4astrocytomas,4heman-gioblastomas,4epidermoids,1cavernoma,2lipomas,2metastatics.Agross-totalresection(>95%)wasachievedin25surgicalprocedures.Subtotalresections(80-95%)wereperformedin4cases.Therewasnosurgicaldeath.Whencomparingthepreoperativeand3-monthpostoperativefunctionalgrades,12patientswerestable14improved,and3deteriorated.Patientswitheithernodeficitoronlymilddeficitbeforesurgerywererarelyimpairedbytheproce-dure,reinforcingtheimportanceofearlydiagnosisandtreatment.Themajordeterminantoflong-termsurvivalwashistologi-calcompositionofthetumor.PatientsinwhomanIMSCTwasonlypartiallyresected(<80%)faredsignificantlyworse.CONCLUSIONS:Thelong-termsurvivalandqualityoflifeforpatientswithlow-gradegliomastreatedbyradi-calresectionaloneiscomparableorsuperiortominimalresectionplusradiotherapy.Theoptimaltherapyforpatientswithhigh-gradegliomaisyettobedetermined.Forbenignlesion,suchashemangioblastomaandcavernomacouldbecuredbytotalresectionofthetumor.Forlipomaandepidermoid,fibrousadhesionstothecordmaketotalremovaldifficult,andthus,removalisnotthegoalofsurgery.Thecarbondioxidelaserisparticularlyusefulduringsurgeryforthislesion.

简介：AbstractPurpose:In the surgical treatment of paediatric forearm fractures, plate-screw and titanium elastic nails are used. During the transformation of ligamento-osseous structures from adolescence form into adult form, more stable fixation is required. The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures.Methods:A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture. The included patients were in the adolescent age group (12-17 years), did not meet conservative follow-up criteria and had unstable fractures (>10° angulation and <50% cortex continuity after plaster casting). Patients were excluded from the study if they were aged >18 years or <12 years, had Gustilo-Anderson type 2/3 open fractures, multi-trauma, history of physeal injuries or could not be contacted during follow-up. Patients’ age, gender, body mass index, affected side, and the pronation and supination values during follow-up were noted. Functional evaluation of the patients was performed with disabilities of the arm, shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria. The time to union, infection during follow-up, re-fracture and vascular nerve damage were also examined. Data were analyzed using SPSS 22 Windows package program software.Results:The patients comprised 30 males and 6 females (ratio, 5:1) with a mean age of (14.7 ± 2.1) years (range, 12-18 years). According to the Price criteria, the results of 33 patients were excellent, 3 were good and there were no moderate or poor cases. The mean disabilities of the arm, shoulder and hand score was 11.2 ± 6.1 (range, 4-28). The mean time to union was (8.7 ± 2.2) weeks (range, 6-14 weeks), while patients aged >15 years had prolonged time to union ([11.1 ± 1.8] weeks). There were no non-unions, re-fractures or infections. No complications were observed during implant removal. None of the patients had sensorial radial nerve injury or tendon damage.Conclusion:The locked intramedullary nailing technique, which is minimally invasive and provides biological fixation, was found to be successful and safe in the treatment of adolescent forearm fractures.

简介：ObjectiveStudies证明代替的midclavicular破裂的钉的有弹性的稳定的intramedullary(ESIN)有优秀结果，以及高复杂并发症率和特定的问题。目的fractures.MethodsTotally是讨论midshaft的ESIN锁骨的60个合格病人(年老的18-63年)被使随机化到在2007年1月和2008年5月之间的ESIN组或非起作用的组。锁骨的弄短在损伤和骨状的巩固以后被测量。X光线照相术的联合和复杂并发症被估计。包括经常的肩膀分数和手臂，肩膀和手(破折号)的残疾的功能分析得分在15月的follow-up.ResultsESIN导致了一signifcantly更短的时间到联合以后，被执行，特别为简单破裂。在ESIN组，所有病人得到了骨折联合，5个盒子有中间的皮激怒，因为，1个病人需要修订外科植入失败。在nonoperative组，有3个不属于工会的盒子，2征兆的malunions发展了要求校正截骨术。在在intramedullary稳定以后的15个月，在ESIN组的病人是对肩膀和全面结果的外观满意的更多，并且他们从traumatic以后的大改进有益于很多锁骨的弄短。而且，破折号分数更低，经常的分数与非起作用的group.ConclusionESIN相对照是显著地更高的是有更低的复杂并发症率，到每日的活动的更快的回来，优秀化妆品和更好功能的结果的一种安全最低限度地侵略的外科的技术，为对待中间柄的锁骨的破裂的锁骨的长度的恢复，导致高全面的满足，它能作为板固定或mid-shaf的nonoperative治疗的一种选择是问候

简介：联锁钉的Intramedullary是为胫骨的柄破裂的治疗的一个标准答案。对损伤第二等的一根钉子弯曲是稀罕复杂并发症，它可以被遇到在愈合或unhealed胫骨的柄破裂。如此的弄弯的钉子的移动总是是挑战。我们报导了这个案例为弄弯的钉子的移动讨论各种各样的技术并且在在被同意进入我们的部门与的一个30岁的人移开一根弄弯的胫骨的intramedullary钉子分享我们的经验由于一个路边事故恰好胫骨的柄重新断裂在起始的外科的治疗以后的二年。intramedullary钉子，由30度的偏好并且在anterioposterior上以及在侧面的拍上可见，被部分切凸的墙第一削弱，然后由使用外部力量弄直，并且最后由使用标准钉子移动方法搬迁了。

简介：客观：为了调查汽车的效果，控制在试验性的骨折愈合和它的机制上锁钉子(AMLN)的微运动。方法：经历大腿骨的柄的横向的截骨术的双方的16只山羊分别地是有AMLN和Gross-Kempf(GK)钉子的固定intramedullary。后续时间是7，14，28和56天。Roentgenographic，简历机械，组织学，显微镜的扫描电镀物品和生物化学的分析是done.Results：(1)在在修理AMLN的组的fractural结束的反压缩，反屈曲和反扭转的力量比GK修理钉子的组的高；而，在折断的结束的压力躲蔽处的率显著地减少了(P<0.01)。(2)在修理AMLN的组的全部的骨胶原，不可溶解的骨胶原，钙和磷酸盐的内容在GK修理钉子的组比那高(P<0.05)。(3)胼胝的组织学的观察和定量分析表明AMLN能支持桥胼胝和骨膜胼胝的生长。因此愈合的制造和早完成的remolding过程，它比传统的GK好一些钉固定。(P<0.05)。(4)7-14天张贴操作，AMLN-fixedgroup的胼胝繁荣并且camellarly安排了，骨胶原纤丝在骨头trabecula的吸收空隙常常形成了。28-56天柱子操作，骨胶原纤丝是在吸收空隙附近繁荣并且与骨头平行“s纵的轴。活跃多骨的吸收和形成被看见，那么是remolding并且重建。Haversian系统是未经触动的，因为钙盐的免职，多骨的结构的网是很强的。任何一个都没在GK修理钉子的组上述调查结果被观察。结论：AMLN的设计与塑料固定理论一致很好。因为无变态的系统由theintramedullary固定仪器和破裂的近似、远侧的结束组成了的几何学是很坚挺的ands，搁置，到在fractural结束散布的物理压力的骚乱是轻的。在fractural部分之间的断断续续的物理压力的Thegeneration和行为能到达在压力行为和压力保护之间的平衡。特征愈合和remolding同时发生加快愈合的fractural过程。

简介：Objective:Toevaluatetheclinicalresultsoftreatmentofmidshafttibialfracturewithexpandableintramedullarynailscomparedwithinterlockingintramedullarynails.Methods:FromJune2003toAugust2005,46patients(27malesand19females,aged20-74years,mean=38.4years)withmidshafttibialfractureweretreatedsurgicallyinourdepartment.Thecausesoffracturesweretrafficinjuryin21patients,fallinjuryin6,tumblinginjuryin11andcrushinginjuryin8.AccordingtoAO/ASIFclassification,TypeAfracturewasfoundin16patients,TypeBin11,TypeC_1in5,andTypeC_2in2.Openfractureswerefoundin12patients,accordingtoGustiloclassification,TypeⅠin9patientsandTypeⅡin3patients.Basedonthepatients'consent,24patientsweretreatedwithexpandableintramedullarynails(GroupA)and22withinterlockingintramedullarynails(GroupB).Theoperationtime,bloodlossduringoperation,X-rayfluoroscopictimes,hospitalizationtime,weightbearingtimeafteroperation,healingtimeoffractureandcomplicationsofallthepatientswererecorded.TheclinicaleffectsofallthecaseswereevaluatedaccordingtothecriteriaofJohner-Wruhs.Results:Allthepatientswerefollowedupfor12-34months(mean=16.2months).Thetimeofoperation,thebloodloss,X-rayfluoroscopictimes,hospitalizationtimeandhealingtimeoffractureofGroupAsignificantlydecreased(P<0.05)comparedwiththoseofGroupB,butthetimeforweightbearingafteroperation,theJohner-WruhsdegreeofclinicaleffectsandcomplicationshadnosignificantdifferencebetweenGroupAandGroupB(P>0.05).Conclusions:Expandableintrameduilarynailcanshortenoperationtime,decreasebloodlossandreduceinvasion,whichisasafeandeffectivetreatmentmethodfortibialmidshaftfracture.

简介：Objective:　Toanalyzethecausesofdistalfemoralnonunionanddelayedunionandassesstheoutcomeofthecorrespondingtreatment,retrogradeintramedullaryinterlockingnail(RIIN).　　Methods:　FromJune1995toDecember1998,15patients(9malesand6females)withdistalfemoralnonunionanddelayedunionweretreatedwithRIIN.Theaverageageofthepatientswas34.5years(23-46years).Bonegraftingwasperformedin10patients,closedreamingwasdoneintheother5patients.Correctionosteotomywasperformedin2patients,andintra-articularreleaseofkneeadhesionin11patients.X-rayexaminationandkneesocietyclinicalratingsystem(KSS)wereusedtoevaluatetheresults.　　Results:　Allfractureswerefollowedupforatleast9monthswithaveragefollow-updurationof14.5months(9-33months).Solidunionwasdocumentedinallpatientsat6.4monthsonaverage.Therewerenoinfectionsormalunionsinthisseries.Basedonthefinalfollow-updata,acceptablefunctionalrangeofmotion(ROM)ofover90°wasachievedinmostpatients.TheaverageROMwas93.5°withsignificantimprovementof28°(42.7%,P＜0.05)comparedwiththepreoperativeROM.Theaveragekneescorewas96.ExcellentROMemergedin13patients.Thekneefunctionscorewas90.5onaverage.　　Conclusions:　Themaincausesofdistalfemoralnonunionanddelayedunionareimproperindicationsandimproperuseoftheimplants.RIINisaneffectivealternativefortreatmentofdistalfemoralnonunionanddelayedunionbecauseitcanprovideastableandreliablefixationwhichisbeneficialforearlyfunctionalexerciseofknee.Bonegrafting,closedreamingandintra-articularreleaseofkneeadhesionshouldbeconsideredinordertoenhancethebonehealingandimproveROMandthekneefunction.

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简介：Objective:Thepurposeofthismeta-analysisistodeterminewhetherplatingorintramedullarynailing(IMN)foradultdiaphysealboth-boneforearmfractures(BBFF)providesbetterclinicaloutcomes.Methods:MEDLINE,EMBASE,GoogleScholarandTheCochraneLibrarywerecomprehensivelysearcheduntilJuly31,2016.BothretrospectivestudyandprospectivetrailsaboutcomparisonofdualIMNorhybridfixationversusdualplatingfixationinthetreatmentofadultdiaphysealBBFFwereincluded.UsingRevMan5.3software,dataoffunctionalrecovery,theuniontime,operatingtimeandcomplicationwasextractedformeta-analysis.Results:Thepooledanalysisshowedsimilarresultsintheuniontime,functionalrecoveryandtheratesofcomplications,butshowedasignificantdifferenceinoperatingtime.Conclusion:Thismeta-analysisdemonstratessimilarradiographicoutcomes,functionaloutcomesandcomplicationswithplatesorIMNusedinthetreatmentofadultdiaphysealBBFF.IMNfixationforthesefracturesseemstobeanalternativeandeffectivetreatmentwithshorteroperatingtimesandminimallyinvasive.

简介：AbstractPurpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).Results:Average malunion (degrees) in the MIPPO group was 5 (3—7) ± 1.41 vs. 10.22 (8—14) ± 2.04 in the IMIL group (p= 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p= 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p= 0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

简介：客观：为胫骨的intramedullarynails.Methods的远侧的锁住评估帮助thecomputer的汽车框架航行系统的临床的可行性和效果：系统的硬件部件与一个监视器包括了一台PC计算机，汽车机械立体声战术的定位立方的框架，脚持有者和起作用的本地化仪器。特殊航行软件能被用于X光检查fluoroscopic图象和工具的real-timecontrolling航行的登记。近胫骨、腓骨的破裂的21个案例被对待，关上的intramedullary钉其6在中间第三包含了，12在里面中间、更低第三，3在里面降低第三。涉及锁住的过程的C手臂排列和登记时间，fluoroscopic时间和钻的时间被记录。unreamed或铰大的胫骨的钉子的尺寸从8/300-11/330。结果：除了1的所有远侧的洞成功地被锁。在41个锁的洞(21.95%)中的9个里，练习小点摸了没有钉子和临床的后果的损坏，锁洞的运河。荧光检查时间每一些螺丝钉是2.23s±0.31s。结论:为远侧的锁住的帮助计算机的汽车框架航行系统很好被设计，对容易操作并且不在过程期间需要另外的仪器。发达系统使医生能精确用就一些校准计算机的X光线照相术的图象在整个解剖遨游外科的仪器。X光暴露的全部的时间能显著地每过程被减少。