Augmentation of the coraco-clavicular ligament suture. Comparison between wire cerclage, vicryl tape and PDS cord

A total of 71 patients (average age 32 years) with acute grade III acromio-clavicular dislocation were all treated with the same surgical procedure: open reduction, transfixation of the acromio-clavicular joint with a Kirschner wire and suture of the coraco-clavicular ligaments with augmentation. The augmentation was done with a 1.2-mm wire cerclage in the first group (22 patients), a 3-mm wide Vicryl tape in the second group (30 patients) and a 1.5-mm PDS cord in the third group (19 patients). At follow-up (average time 4.4 years) the patients were questioned as well as being examined radiologically and clinically. Only two patients were not satisfied with the outcome of surgery. On clinical evaluation after wire cerclage augmentation of the suture, the distal end of the clavicle was found to be dislocated in 23% of cases. The incidence was 20% after Vicryl taping and 58% after PDS cord augmentation. At X-ray examination with 8 kg suspended from the wrist acromio-clavicular dislocation was found in 45% after wire cerclage, 23% after Vicryl taping and 58% after PDS cord augmentation of the suture. The results show that dislocation is more likely to persist after augmentation of the suture of the coraco-clavicular ligaments with wire cerclage or PDS cord than when the suture is augmented with a Vicryl tape. We conclude that a resorbable material is suitable for augmenting the suture of the coraco-clavicular ligaments, but that a filiform augmentation is less appropriate than a band.     

The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients

BackgroundAcromio-clavicular (AC) joint dislocations are very common following falls on the shoulder or an overstretched hand. The best treatment for such lesions remains a matter of debate. Several studies have, however, lent support to the surgical role of the hook plate in Rockwood type III and V AC dislocations. The aim of this study was to evaluate the midterm clinical results and magnetic resonance imaging (MRI) features of coraco-clavicular ligaments 18 months after an AC dislocation treated with an AC Dreithaler hook plate.Patients and methodsThe cohort was made up of a consecutive series of 42 patients, who underwent surgery between November 2002 and December 2006 for an AC dislocation. They were classified, according to the Rockwood classification, as 22 grade III and 20 grade V dislocations. Surgical treatment consisted of open reduction and stabilisation with an AC Dreithaler hook plate. A clinical and radiological follow-up examination was performed 1 and 3 months after surgery, that is, before removal of the plate, and 12 months following removal.Eighteen months after the trauma, an MRI and a clinical examination were performed and the Constant–Murley scores calculated.ResultsAn acceptable joint alignment was achieved in all the patients after surgery; 1 year after plate removal, five cases (12%) of dislocation recurrence were reported. MRI showed the coraco-clavicular ligaments had healed in the remaining 37 cases (88%).ConclusionAn AC plate is a useful technique in acromio-clavicular dislocations because it is easy to implant, requires mini-invasive access and results in early resumption of normal activity. MRI can be used to evaluate healing of coraco-clavicular ligaments. A long-term follow-up study is, however, warranted to assess the likelihood of recurrence.Level of evidenceLevel IV, therapeutic cases series.     

A new method of arthroscopic reconstruction of the dislocated acromio-clavicular joint

BACKGROUND: Symptomatic total acromio-clavicular joint dislocation (Rockwood et al. types III-VI) may be treated by surgical reconstruction. AIM: To describe an arthroscopically assisted technique to reconstruct anatomically the coraco-clavicular ligaments in acute or chronic (> 6 weeks) acromio-clavicular joint dislocation. METHODS: This new technique involves arthroscopic exposure of the coracoid process. Prior to introducing this technique, cadaveric studies were undertaken. RESULTS: Five patients underwent this procedure. All engaged in regular sports or manual-type work. All patients were discharged the same day with the shoulder immobilised for 4 weeks, with no heavy lifting for 3 months. All patients were pain-free at 6 weeks with full function and maximum Constant scores at 3 months. There have been no complications. CONCLUSIONS: A new, safe technique is described which provides a cosmetically acceptable, anatomically solid reconstruction of the coraco-clavicular ligaments.     

自制臀兜治疗婴儿先天性髋关节脱位

目的：探讨婴儿先天性髋关节脱位的早期发现和新的治疗方案,了解先天性髋关节脱位早期的临床表现,早期诊断。方法：2006年至2010年应用自制臀兜治疗婴儿先天性髋关节脱位95例,男25例,女70例;年龄0～6个月,平均3.2个月。有因换尿布时发现臀部或双下肢臀纹不对称或双下肢肌力活动度不同,来院检查,进一步拍X线片证实为先天性髋关节脱位,并及时给予自制臀兜治疗。结果：患儿及时佩戴自制臀兜治疗,固定期间每月门诊复查1次,每2个月拍片1次至患儿月龄加2个月解除固定。根据刘远忠等疗效评定标准,本组优90例,良2例,可2例,差1例。结论：臀兜穿戴舒适,固定可靠,双下肢能在一定的范围内活动,符合中医正骨动静结合原则,使头臼产生一定的生理刺激,促进髋臼及股骨头的发育。     

纽扣钢板与带袢钢板治疗肩锁关节脱位的疗效比较

目的比较应用纽扣钢板与带袢钢板两种内固定方法治疗新鲜RockwoodⅢ型以上肩锁关节脱位的临床疗效。方法选取60例RockwoodⅢ型以上肩锁关节脱位患者,均为新鲜单纯肩锁关节脱位,不合并肩关节周围其他损伤。按单、双号分为纽扣钢板组(A组)和带绊钢板组(B组),每组30例。记录两组的切口长度、手术时间、术中出血量;采用Constant评分评价两组术前、术后6个月后的患肩功能;术后第3天及术后6个月测定喙锁距离分析复位丢失量。结果患者均获得随访,时间7~24个月。两组切口长度比较差异无统计学意义(P0.05)。手术时间、术中出血量A组均少于B组,差异均有统计学意义(P0.05)。术后6个月Constant评分两组与术前比较差异均有统计学意义(P0.05),两组间比较差异无统计学意义(P0.05)。术后复位丢失量两组比较差异无统计学意义(P0.05)。结论应用纽扣钢板内固定治疗肩锁关节脱位复位丢失较小,固定安全、可靠,是治疗RockwoodⅢ型以上肩锁关节脱位较为理想的方法。     

肩锁关节脱位改良型Dewar手术方法的力学基础

作者介绍了在Ｄｅｗａｒ手术原方法基础上，附加锁骨外侧端切除０．５～１ｃｍ的改良型手术方法及其原理。经１８例肩锁关节完全脱位治疗观察，从临床疗效、Ｘ线摄片和喙－锁间距（ｃ－ｃｄｉｓｔａｎｃｅ）以及三角肌与冈上肌肌电图检查等三方面结果，证实改良型Ｄｅｗａｒ手术可以预防术后肩峰与锁骨端的摩擦和撞击，避免肩锁关节骨性关节炎的发生。平均４年７个月随诊，临床疗效显示，１２例为优，６例为良，肌电图检查发现手术侧三角肌、冈上肌的运动单位电位和峰值电压与健侧对比无差异。上述结果说明，改良型Ｄｅｗａｒ手术符合生物力学原理，具有静力学与动力学双重复位作用，安全、有效，是一种适合于成年人新鲜或陈旧肩锁关节完全脱位的手术治疗方法     

Results on function and safety of the Safyre-t, a hybrid transobturator vaginal sling for the treatment of stress urinary incontinence

AIMS: To examine the efficacy and safety of the Safyre-t vaginal sling. METHODS: 108 women with a Safyre-t were invited for a gynecological follow up examination. RESULTS: 79/108 patients showed up for an examination at 20 +/- 4 months 59.5% stated that they were subjectively dry. Vaginal sling erosion was found in 8.8% of the patients and a pre-erosive state in another 13.9%. The lateral silicone column could be palpated medial to the pubic bone in 47% of the patients indicating dislocation. 6/53 sexually active women complained of dyspareunia and one women stated that her partner had felt discomfort during sexual intercourse since her vaginal sling surgery. CONCLUSIONS: This study shows that despite high patient satisfaction and acceptable subjective continence rates, the Safyre-t was associated with a comparatively high rate of vaginal sling erosions and dislocations.     

Sonographic diagnosis of the injured acromioclavicular joint. A standardized examination procedure]

The possibility of using ultrasound leads to an improvement and extension of the methods conventionally used for diagnostic examination of the injured acromio-clavicular (AC) joint. Periarticular soft tissues can be assessed, as well as the osseous parts making up the joint. Coraco-clavicular ligaments in particular can be visualized well, and the coraco-clavicular distance can be measured precisely. Evaluation of the ultrasound findings makes classification of the grade of severity of injury according to Tossy much easier. We examined 35 injured AC joints of all grades of severity. With two standard planes of examination--a frontal and a sagittal plane--it was possible to obtain information about the grade severity of the injury in every case. Instability of the joint is diagnosed by measuring the coraco-clavicular distance with and without weights pulling on each arm. Standard X-rays of the shoulder remain mandatory to exclude fractures. When ultrasound examination is possible, however, X-ray examination of the shoulder with weights pulling on the arms is unnecessary.     

小切口缝绑法治疗肩锁关节脱位的临床疗效观察

目的研究小切口爱惜邦线缝绑法治疗肩锁关节脱位的临床疗效。方法回顾分析我院2008-01-2010-01采用小切口爱惜邦线缝绑法治疗肩锁关节脱位42例,所有患者均自术后第4天开始在脱位的肩锁关节处外敷自制的中药膏剂,术后均随诊8个月以上,采用Karisson疗效评价标准进行术后临床疗效评价。结果 42例肩锁关节脱位患者术后8个月疗效评价优30例,良12例,差0例。结论小切口缝绑法结合自制中药外敷治疗肩锁关节脱位创伤小,操作简单,临床疗效满意。     

Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study

In a prospective, controlled, randomized study of acute acromioclavicular dislocations, we compared conservative and operative treatment (the Phemister procedure) with regard to the clinical results, complications, and social costs. Forty-one patients were operated on and forty-three patients were treated conservatively. Two patients who were operated on and three who were treated conservatively had to have the lateral extremity of the clavicle resected because of pain. The rehabilitation period was significantly shorter with non-operative treatment, and after thirteen months there was no difference in the clinical results. There were no serious postoperative complications, but about half of the patients who were operated on had problems with the metallic device, such as breakage or migration of the pins, or both, and six patients had a superficial infection. For most patients with total acromioclavicular dislocation we recommend conservative treatment with a sling until the patient is free of pain. Operation should be considered in thin patients who have a prominent lateral end of the clavicle, in those who do heavy work, and in patients whose daily work requires that the shoulder often be held in about 90 degrees of abduction and flexion.     

Posttraumatic osteolysis of the distal ends of the clavicle. Report of three cases

Three cases of posttraumatic osteolysis of the lateral end of the clavicle are described. Two of the patients were judo participants who fell on their shoulder. They were treated primarily as partial acromio-clavicular joint dislocations. The third patient was a woman who fell from her bicycle and was treated surgically by a Knowless nail because of acromio-clavicular dislocation. The clinical and radiological findings of osteolysis developed slowly. The joint line was typically widened in the radiographs. The disorder settled spontaneously within one year. Further judo training was possible without symptoms. Distal osteolysis of the clavicle is a rare condition and it may well occur during injury at sport.     

急性RockwoodⅠ、Ⅱ型肩锁关节脱位非手术治疗疗效分析

目的评估急性RockwoodⅠ、Ⅱ型肩锁关节脱位非手术治疗的疗效。方法对自2009年1月~2010年10月收治的急性RockwoodⅠ、Ⅱ型肩锁关节脱位38例采用非手术治疗。结果 30例平均随访19个月(8～28个月)。最后一次随访平均VAS由(4.4±1.5)分降低到(0.8±0.1)分,Constant评分由(64.9±27.9)分上升到(91.6±14.8)分,按Constant评分优良率为89%。最后随访时9例(30%)有肩锁关节疼痛,3例(10%)有活动受限;影像学上8例(27%)显示肩锁关节半脱位;10例(33%)有肩锁关节退化性改变。结论Ⅰ、Ⅱ型肩锁关节不完全脱位采用非手术治疗可获得满意的临床结果。但同时也有较高的并发症发生率,有必要对影响治疗效果的相关因素进行探索,以取得更好的临床疗效。     

关节镜辅助喙锁悬吊固定联合改良Weaver-unn手术治疗陈旧性肩锁关节脱位

目的探讨关节镜辅助喙锁悬吊固定联合改良Weaver-Dunn手术治疗陈旧性肩锁关节脱位的疗效。 方法2016年3月至2017年3月,对8例陈旧性肩锁关节脱位的患者采用关节镜下喙锁间隙悬吊固定联合改良Weaver-Dunn手术,术后随访6~18个月。测量术后即刻与末次随访时的喙锁间隙差值,评估复位丢失情况,采用疼痛视觉模拟（VAS）评分及加州大学洛杉矶分校（UCLA）评分评价患者肩关节功能。 结果术后末次随访时患者喙锁间隙与术后即刻喙锁间隙差值为（0.41±0.26）mm,VAS评分为2.88分,UCLA评分为（173.6±11.3）分,患者肩锁关节丢失率低、术后疼痛及功能均得到明显改善。 结论关节镜辅助喙锁固定联合改良Weaver-Dunn技术治疗陈旧性肩锁关节脱位有较好的疗效。     

改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位的临床观察

目的探讨改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位的初步临床疗效观察。方法回顾性分析2008年3月至2010年8月,采用改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位18例,术后1个月、3个月和1年分别进行门诊随访,并拍摄x线片,采用Constant评分评价术后肩关节功能。结果术后3个月肩关节功能采用Constant评分平均为93．5分,X线片显示无再发脱位和半脱位。结论改良喙肩韧带移位重建结合双Endobutton钢板治疗Ⅲ型肩锁关节脱位是一种有效的方法,手术创伤小,恢复快,并发症少,近期疗效满意,远期疗效有待长期随访。     

Operative treatment of chronic acromioclavicular dislocation

Six patients (median age 35 years) were reviewed at an average of 24 months after operation for chronic acromioclavicular dislocation. The operation consisted of resection of the lateral part of the clavicle and transference of the coracoacromial ligaments as a substitute for the coraco-clavicular ligament. The ligament was secured by an AO screw for 6 weeks. In five patients the reasons for operation were pain, when working and sleeping, and, in one patient, pressure on the skin. Three of the patients complained of weakness. At follow-up the results were excellent in four patients and good in two. Three patients had mild pain when lying on the shoulder and three had complaints where the flake of bone attached to the transferred ligament was inserted into the clavicle. We now recommend a modification of the method, omitting the flake of bone.     

Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw

BACKGROUND: Neer 2 fractures of the distal clavicle are notorious for their high rates of non-union and numerous methods of fixation are recommended. We review a simple method of fixation of these fractures with an intramedullary AO/ASIF malleolar screw. METHOD: Ten patients with Neer type 2 fractures of the distal clavicle were treated between 1996 and 2002. All had open reduction and internal fixation with an intramedullary 4.5 mm AO/ASIF malleolar screw. In all cases the coraco-clavicular ligaments were not repaired, and the screws were removed once the fractures had united. RESULTS: All fractures united at between 6 and 12 weeks. All patients had a good functional result, with an excellent to good Oxford Shoulder score. CONCLUSION: This is a simple technique with a universally available implant and good fracture healing. We report no cases of screw breakage or migration and we question the necessity to repair the coraco-clavicular ligaments.     

Surgical treatment of acute type V acromioclavicular injuries. A prospective study.

In a prospective study, 28 consecutive patients with an acute Type V acromioclavicular sprain were treated with a coraco-clavicular repair using a double velour Dacron graft. All patients were reviewed after a mean follow-up period of 5.1 years (range: 1 to 9 years). At follow-up, 20 patients (71.4%) showed good or excellent results, according to the Imatani evaluation system, and 8 patients (28.6%) demonstrated a fair or poor result according to the same system. Loss of reduction was encountered in 11 shoulders (40%), despite an initial anatomical reduction. No correlation was seen between the overall scores at follow-up and the degree of residual dislocation, between the overall scores and the presence of coraco-clavicular calcifications or ossifications, between the overall scores and the development of posttraumatic arthritic changes, or between the overall scores and the presence of osteolysis of the distal clavicle.     

寰枢椎椎弓根螺钉内固定术治疗儿童寰枢椎脱位的初步报告

目的:探讨寰枢椎椎弓根螺钉内固定手术治疗儿童寰枢椎脱位的可操作性和近期疗效。方法:2005年9月~2011年3月对16例儿童寰枢椎脱位患者采用寰枢椎椎弓根螺钉内固定术治疗,男9例,女7例;年龄5～13岁,平均9.1岁。均有枕颈部疼痛、颈部僵硬;3例有高位颈脊髓病表现,ASIA分级:D级2例,C级1例。术前均行颈椎正侧位及过伸过屈位X线片、CT和MRI检查,均诊断为寰枢椎脱位,其中寰椎横韧带断裂1例,寰枢椎骨折脱位1例,先天性齿状突畸形12例,寰枢椎固定旋转半脱位2例;颈脊髓受压5例。寰椎后弓(椎弓根)高度2.5~3.8mm,平均3.0mm;寰齿前间隙6~14mm,平均9mm。术前常规行牵引1~2周复位,完全复位7例,部分复位5例,不能复位4例。术中采用"寰椎椎弓根显露置钉法",在直视下行C1、C2置钉,复位固定,植骨融合。随访患者症状和神经功能改善情况,定期行颈椎X线片及CT复查,了解内固定及植骨融合情况。结果:16例均行双侧寰枢椎椎弓根螺钉内固定,手术过程顺利,64枚螺钉均成功置入,复位固定满意,无术中、术后神经和血管并发症。术中出血150~650ml,平均300ml;手术时间100~190min,平均130min。12例随访12~72个月,平均28.5个月,术后3~6个月寰枢椎均骨性融合;末次随访时,颈枕症状明显改善,3例术前有脊髓功能损害者均好转,2例术前ASIA分级D级者恢复到E级,1例术前ASIA分级C级者恢复到D级;未发现螺钉松动、断钉和寰枢椎再移位现象,未发现曲轴现象。结论:采用"寰椎椎弓根显露置钉法"行寰椎椎弓根螺钉内固定可操作性强,置钉安全性高;寰枢椎椎弓根螺钉内固定治疗儿童寰枢椎脱位的近期疗效满意。     

Dynamic repair of acromio-clavicular dislocation.

Twenty patients with complete acromio-clavicular dislocation treated between 1967 and 1973 were reviewed with a follow-up time of from 1-6 years, the average being 3 years. They were treated by transposition of coraco-brachialia, short head of biceps and a third of pectoralis minor from their origin in the coracoid process to the clavicle together with repair of the acromio-clavicular joint. The results were evaluated according to pain, motion, deformity and x-rays with 90 per cent excellent results, 5 per cent fiar and 5 per cent poor. Discussion of the other types of treatment is presented.     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位的并发症分析

【摘要】 目的 分析锁骨钩钢板内固定治疗锁骨远端骨折及肩锁关节脱位并发症的原因及其防治措施。方法 我科自2009年10月至2012年11月,对应用锁骨钩钢板内固定治疗锁骨远端骨折及肩锁关节脱位126例病人资料进行回顾性分析,其中男性81例,女性45例;年龄16~79岁,平均37.6岁。结果 全部病例获得随访,随访时间3个月~2年,平均时间11月,其中39例患者出现钩钢板直接相关的并发症有肩痛、应力性骨折、脱钩等。疗效评价采用肩关节Constant评分评定疗效,获优32例,良68例,可16例,优良率79.4%。结论 大多数并发症可以预防,正确手术和内固定置入及术后合理功能锻炼是预防并发症的关键。