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创伤后锁骨内侧端骨溶解症一例

EyresⅢA型喙突骨折的手术治疗

目的 总结Eyres ⅢA型喙突骨折手术治疗方法及效果。 方法 2010年8月－2014年8月，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定治疗4例Eyres ⅢA型喙突骨折患者。男3例，女1例；年龄36～41岁，平均39岁。致伤原因：交通事故伤3例，机器伤1例。伤后至入院时间2～12 h，平均6 h。 结果 术后患者切口均Ⅰ期愈合，无感染、皮肤坏死等术后早期并发症发生。4例均获随访12个月。术后4个月取出锁骨钩钢板，保留空心钉。术后8个月CT示骨折完全愈合。随访期间无肩关节再脱位，内固定物松动、断裂，继发骨折等发生。术后12个月根据Neer肩关节功能评分标准评分为83～87分，平均85分。 结论 对于Eyres ⅢA型喙突骨折，采用锁骨钩钢板固定肩关节联合喙突骨折解剖复位后2枚空心钉固定可行且疗效满意。

Application of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique for acute acromioclavicular joint dislocation

Objective To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. Methods A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. Results The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones (P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference (Z=−4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. ConclusionThe treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients’ shoulder joint and facilitate the recovery of shoulder joint function.

Experience in diagnosis and treatment of KD-ⅢM dislocation of knee joint

ObjectiveTo explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. Methods The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). Results The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones (P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation (Z=−4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. ConclusionKD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with “dimple sign” requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.

锁骨钩钢板治疗Ⅲ度肩锁关节脱位

带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位

目的 总结带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位的疗效。 方法 2015 年 10 月—2017 年 6 月，采用带线锚钉重建韧带治疗 8 例陈旧性拇指腕掌关节半脱位患者。男 7 例，女 1 例；年龄 19～63 岁，平均 44 岁。致伤原因：机器撞击损伤 4 例，运动损伤 3 例，交通事故伤 1 例。受伤至入院时间为 4～12 周，平均 8 周。拇、示指捏持无力，影像学检查示拇指腕掌关节对合不全。 结果 术后切口均Ⅰ期愈合。8 例均获随访，随访时间 9～24 个月，平均 18 个月。末次随访时，拇、示指捏持有力，X 线片复查示第 1 腕掌关节对合良好，无再脱位发生。根据中华医学会手外科学分会手指关节总活动度系统评定方法评价疗效，获优 5 例、良 3 例，优良率 100%。 结论 带线锚钉重建韧带治疗陈旧性拇指腕掌关节半脱位，手术操作简便，疗效良好。

陈旧性跖跗关节脱位的足弓重建

目的 总结陈旧性跖跗关节脱位足弓重建的治疗方法及效果。 方法 2004 年9 月－ 2008 年1 月，收治陈旧性跖跗关节骨折脱位26 例。男19 例，女7 例；年龄18 ～ 56 岁，平均38.4 岁。交通伤8 例，重物砸伤10 例，高处坠落伤8 例。根据Myerson 分类法的X 线分型：A 型6 例，B 型5 例，C 型2 例，D 型6 例，E 型3 例，F 型4 例。受伤至手术时间4 周～ 9 个月，平均9 周。采取切开复位、内固定术9 例，足弓重建跖跗关节原位融合术 17 例。 结果 术后切口均Ⅰ期愈合。26 例均获随访，随访时间12 ～ 48 个月，平均22 个月。4 例术后5 个月发生足部转移性疼痛，应用足弓垫治疗，2 例1 年后疼痛缓解，2 例扩大关节融合后疼痛缓解。按Maryland 足部评分标准测定：优 5 例，良17 例，可4 例；优良率84.6%。关节融合全部愈合。 结论 伤后4 ～ 6 周的陈旧性跖跗关节脱位可行切开复位内固定术，疗效满意；6 周以上陈旧性跖跗关节脱位，宜行足弓重建跖跗关节原位融合术。

Application value of hinge position design of Ilizarov circular external fixator for correcting clubfoot deformity in preventing ankle dislocation

Objective To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation. Methods A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy. ResultsThe deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%. Conclusion Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.

Ipsilateral Tibiofibular Fracture and Hip Fracture-Dislocation Associated with Posterior Cruciate Ligament Injuries:7 Cases Report

目的:对同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制及诊断进行分析探讨。方法:对2007年1月至2008年6月收治的7例同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤患者的临床资料、诊治经过和随访结果进行总结分析。结果: 胫腓骨开放性骨折3例(42.9%),闭合性骨折4例(57.1%);髋关节均有后脱位,其中伴有髋部骨折5例(71.4%)。膝后交叉韧带实质部断裂4例(57.1%),胫骨止点撕脱骨折3例(42.9%)。7例患者获平均14.7个月(12～18个月)随访。Lysholm膝关节功能评分术后6月95.8±3.71,术后12月97.6±2.7。结论:明确同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制,全面、准确、系统的问诊查体和完善的辅助检查是早期确诊、提高疗效的关键。

FUNCTIONAL RECONSTRUCTION OF CONGENITAL DISLOCATION OF HIP IN OLD-AGED CHILDREN

Twelve cases (13 hips) of congenital dislocation of hip (CDH)in a group above the age of six were treated by Chiari pelvic osteotomy from Jan. 1991 to Dec. 1992. The results following operative treatment rated as good in 85 percents according to the clinical and radiologic examinations. The indications, and the results with the operation as the functional reconstuction of the hip concerned were discussed.