Wei Zhengchao, Cai Daozhang, Jin Wentao, et al. Microsurgical treatment of vascular injuries in extremities. Chinese Journal of Microsurgery, 200124: 215 Zhang Jingjian, Pan Borong, Tian Qiuyue, et al. China misdiagnosed a grand view. Beijing: China Medical Science and Technology Press, 1994747748 Cao Shouyuan, Liu Kebin, Peng Xuguang. Microsurgical repair of pseudoaneurysm and nerve injury Chinese Journal of Hand Surgery, 199612:62 Dynamic iliac screw for the treatment of distal femoral fractures. Department of Orthopaedics, Hubei Provincial Health Workers Medical College Hospital, Department of Orthopaedics, Peng Songming, Zhang Jien, distal femoral fracture including femoral and external The fracture of the ankle and the supracondylar fracture of the femur are serious injuries, and the treatment is difficult. The incidence of complications such as nonunion, delayed healing and limited knee function is high. We have applied dynamic sputum screw 1 clinical data since 2001. 1.1 Case data: In this group, 16 males and 10 females.
Age 29 to 53 years old. Injury factors: 12 cases of traffic accident injuries, 2 cases of high ground fall, 1 case of fall injury, 1 case of heavy object crush. Fracture 1.2 surgical methods: lateral position, anterior lateral incision, revealing the fracture end and femoral condyle. The screw insertion point is 2cm at the proximal end of the joint surface and 2/3 at the front and the outer iliac crest. A Kirschner wire was inserted into the patellofemoral articular surface and the distal femoral articular surface for a 3-position positioning needle. Then screw in the guide pin and the é« screw, select the appropriate steel plate to connect, and finally pressurize. Three cases had bone defects for bone grafting. One of the C3 fractures was severely smashed due to the ankle, and was replaced by an anatomical plate. The entire operation was completed under C-arm fluoroscopy.
2 The result is that the alignment is good for the alignment. There was no infection in 1 case, and the wound was removed after 2 weeks. Thirteen patients did not need external fixation after operation. On the second day, they exercised quadriceps and exercised CPM exercise 1 week later. Three patients with intraoperative bone grafting including anatomical plate fixation were treated with gypsum external fixation. After 1 month, X-ray films were reviewed and osteophyte formation was performed for passive activity. The follow-up period was from March to August, and the fracture healing time was from 3 to 6 months. Knee joint function evaluation according to Merchan et al; improper use of internal fixation for fracture nonunion and delayed healing and knee joint function loss in recent years, due to the widespread promotion of AO technology, a variety of internal fixation materials for the treatment of distal femoral fractures, such as sacral plate, anatomy Type steel plates have been widely used in clinical practice, but they have certain shortcomings. It is difficult to control the separation between the two sputum plates, and there is no pressure; the anatomical plate can be accurately reset, and the type of C3 type bone graft is poorly fixed. Not conducive to early functional exercise. We understand that DCS treatment of distal femoral fracture has the following advantages: 1 can correctly select the é« screw entry point, the steel plate is easy to match the axis of the backbone; 2 é« screw can maintain two é« stability, automatic pressure during the screwing process, will not produceé«Separation; 3 é« steel plate is thicker and firmer. The firm fixation can provide a good bone grafting bed, help patients to perform early functional exercise, and help to maintain limb length. For C-type fractures, DCS has more advantages. prominent.
DCS operation should pay attention to the problem: the X-ray film should be carefully analyzed before surgery, if necessary, CT should be used to understand the displacement of the ankle, measure the distance of the contralateral normal ankle, and select the appropriate length of the screw. Intraoperative two joint gap positioning needles are very important to ensure the accuracy of the screw insertion. The surgical procedure is performed under fluoroscopy and can be accurately reset to prevent knee valgus and rotational deformity. The femoral shaft was comminuted to crush the C2 and C3 fractures. Before the upper condyle screw, the fracture blocks separated from the intercondylar comminuted fracture were repositioned, and the iliac crest was fixed by a lag screw or a Kirschner wire. The anatomical reduction was flat, and then the é« screw was screwed in and the é« steel plate was installed.
Indications and shortcomings of DCS in the treatment of distal femoral fractures: 1 other fractures should be selected from the distal articular surface more than 10 cm from the distal articular surface; such as antegrade, retrograde interlocking intramedullary nail. The crotch is severely crushed. It is difficult to fix the anatomical plate by fixing one or two lag screws into one. 2 The sacral plate needs to be widely peeled off to affect the fracture healing. In the process of C-type fracture healing, there is adhesion of the epiphysis of the femoral condyle and the quadriceps muscle, resulting in unsatisfactory recovery of knee joint function. How to solve these problems needs further research.
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