仰卧位内后侧入路手术治疗胫骨平台内后侧劈裂骨折

目的 探讨仰卧位内后侧入路支撑钢板内固定治疗胫骨平台内后侧劈裂骨折的临床疗效.方法 2005年1月至2008年12月采用仰卧位内后侧入路支撑钢板内固定治疗21例胫骨平台内后侧劈裂骨折患者,男14例,女7例;年龄23～61岁,平均43.5岁.骨折类型:单纯内侧劈裂骨折7例,同时合并外侧平台骨折14例.受伤至手术时间为5～12 d,平均7.6 d.结果 17例患者术后获平均16.4个月(12～20个月)随访,4例失访.17例患者骨折均获愈合,X线片示骨折愈合时间平均为14.2周(11～16周),完全负重时间平均为16.4周(13～20周).术后12个月改良美国特种外科医院膝关节评分平均为87.6分(70～95分).无内固定失败患者.结论仰卧位内后侧入路可直接复位和固定内后侧骨块、减少软组织损伤、避免膝内侧皮肤坏死、可在同一体位下处理外侧平台及允许早期活动膝关节,是一种治疗胫骨平台内后侧劈裂骨折的良好手术入路.     

仰卧位内后侧入路手术治疗胫骨平台内后侧劈裂骨折

目的 探讨仰卧位内后侧入路支撑钢板内固定治疗胫骨平台内后侧劈裂骨折的临床疗效.方法 2005年1月至2008年12月采用仰卧位内后侧入路支撑钢板内固定治疗21例胫骨平台内后侧劈裂骨折患者,男14例,女7例;年龄23～61岁,平均43.5岁.骨折类型:单纯内侧劈裂骨折7例,同时合并外侧平台骨折14例.受伤至手术时间为5～12 d,平均7.6 d.结果 17例患者术后获平均16.4个月(12～20个月)随访,4例失访.17例患者骨折均获愈合,X线片示骨折愈合时间平均为14.2周(11～16周),完全负重时间平均为16.4周(13～20周).术后12个月改良美国特种外科医院膝关节评分平均为87.6分(70～95分).无内固定失败患者.结论仰卧位内后侧入路可直接复位和固定内后侧骨块、减少软组织损伤、避免膝内侧皮肤坏死、可在同一体位下处理外侧平台及允许早期活动膝关节,是一种治疗胫骨平台内后侧劈裂骨折的良好手术入路.     

后侧入路钢板内固定治疗胫骨平台后侧劈裂骨折

目的 探讨胫骨平台后侧劈裂骨折的手术入路及固定方法.方法 对8例胫骨平台后侧劈裂骨折采用后内侧或(和)后外侧入路切开复位钢板内固定并植骨治疗,观察其疗效.结果 8例术后获12～24个月(平均16.4个月)随访,骨折均骨性愈合,愈合时间11～18周,平均15周,术后12个月膝关节功能评定按Hohl评分标准:优5例,良2...     

经后外侧入路治疗胫骨外侧平台单纯后侧、后外侧骨折的初步报告

目的 探讨胫骨外侧平台单纯后侧、后外侧骨折的损伤机制及介绍采用自行设计的后外侧入路进行治疗的经验.方法 自2007年5月至2007年10月,采用自行设计的后外侧人路治疗少见的胫骨外侧平台单纯后侧、后外侧骨折的患者6例.根据AO分型:41-B-2.2.4型即胫骨外侧平台后侧塌陷性骨折2例,41-B-3.1.2型即胫骨外侧平台后外侧塌陷劈裂性骨折4例.采用T型支撑钢板治疗4例,L型支撑钢板治疗2例. 结果 术后X线片检查示所有患者均达到解剖复位,6例术后随访15～37周,平均26.3周.随访3个月时X线片示骨折均已愈合,未见高度丢失,Rasmussen放射评分16～18分,平均17.3分.膝关节总伸屈度100°～135°,平均120°.膝关节功能HSS评分为85～95分,平均89.3分. 结论 胫骨外侧平台后侧、后外侧髁骨折是膝关节屈曲且在不同程度外翻状态下受到轴向暴力所致,而后外侧入路是治疗这种类型骨折较为理想的手术入路,具有暴露清楚、内崮定安放方便、创伤小以及临床疗效好等优点.     

前后联合入路治疗累及后侧的胫骨平台骨折

目的观察前侧联合后侧入路治疗累及后侧的复杂胫骨平台骨折的临床疗效。方法采用前侧联合后侧入路对17例累及后侧胫骨平台骨折行切开复位钢板内固定术,测量术后即刻、6个月、12个月胫骨平台内翻角、后倾角,末次随访时采用Rasmussen评分评定膝关节功能。结果 17例均获随访13~28个月,平均19.8个月。骨折愈合时间12~19周,平均14.7周。术后即刻、6个月、12个月胫骨平台内翻角、后倾角差异无统计学意义（P〉0.05）。末次随访时膝关节功能Rasmussen评分（25.3±3.1）分。结论采用前后联合入路钢板内固定治疗累及后侧的复杂胫骨平台骨折临床疗效满意。     

胫骨平台后柱骨折的手术治疗

目的 介绍胫骨平台后柱骨折的骨折类型、手术方法 及临床疗效,讨论三柱理论在决定后侧平台骨折治疗方案中的作用.方法 2005年2月至2006年8月间,共收治涉及胫骨平台后柱骨折患者36例,均采用支撑钢板内固定.单纯后侧入路20例,其中男13例,女7例;年龄29～52岁(平均38.5岁).前后联合入路16例,其中男11例,女5例;年龄27～49岁(平均37.3岁).结果 经12～15个月(平均14.5个月)随访,36例全部愈合.平均X线愈合时间为15.7周(11～16周),完全负重时间平均为17.6周(13～21周).术后1年膝关节HSS评分68～92分,平均83.4分.1例患者术中内侧腓肠肌膝下内侧血管损伤,术后1例出现切口裂开,1例发生切口皮缘部分坏死,均经保守治疗痊愈.3例术后出现小腿内下方感觉麻木,无螺钉松动、断裂及内固定失效等其他并发症发生.所有病例术后即刻、术后12个月胫骨平台内翻角(TPA)及内、外侧胫骨平台后倾角(PA)度数的F和P值分别为1.186,0.169;4.923,0.536;1.931,0.212,差异均无统计学意义.结论 通过胫骨平台CT水平面三柱结构决定骨折类型后,单纯后侧或前后联合入路支撑钢板固定是治疗胫骨平台后柱骨折的一种有效方法 .     

经后侧入路支持钢板固定治疗胫骨平台后侧骨折

目的探讨经膝关节后侧入路支持钢板固定治疗单纯胫骨平台后侧骨折的临床效果。方法对16例单纯胫骨平台后侧骨折患者经膝关节后侧切口暴露骨折后直视下复位,支持钢板固定。术后对患者骨折愈合情况、功能恢复程度和治疗结果满意度定期随访。结果 16例均获得随访,时间12～24个月。术后1年时行Rasmussen膝关节功能评分:优10例,良4例,中2例。结论膝关节后侧入路能够充分暴露单纯胫骨平台后侧骨折,骨折容易达到解剖复位,支持钢板固定稳定可靠,但术中要熟悉腘窝区解剖结构。正确掌握手术适应证,可获得良好的临床疗效。     

前后联合入路治疗累及后外侧平台劈裂C型胫骨平台骨折

目的 探讨前后联合入路治疗累及后外侧平台劈裂C型胫骨平台骨折的手术方法及临床疗效.方法 7例患者术前均经CT扫描及三维重建,均采用后路和前外侧联合入路后侧和前外侧支撑钢板固定.采用DeCoster评定标准评定骨折复位情况、测定胫骨平台内翻角和采用HSS法行膝关节功能评定.结果 术后X线片检查示达到解剖复位5例,复位良好1例,差1例.1例发生膝内翻.7例均获随访,时间6～18(12±6)个月.骨折全部愈合,愈合时间14～16(15±1)周.胫骨平台内翻角术后1年和术后初次摄片无变化;膝关节功能HSS评分为78～90(80±4)分.结论 前后联合入路并后侧入路支撑钢板固定是治疗累及后外侧孤立劈裂C型胫骨平台骨折的有效方法.     

经膝关节后侧切口后内/外联合入路治疗胫骨平台后髁粉碎骨折

[目的]探讨胫骨平台后髁粉碎骨折的手术入路及操作技巧,总结其临床疗效.[方法]回顾性分析自2009年5月～2012年1月本科收治的胫骨平台后髁粉碎骨折11例,其中男8例,女3例;年龄21 ～53岁,平均36岁;左侧3例,右侧8例;受伤原因:交通事故伤9例,高处跌落伤2例.11例均合并不同程度胫骨内外侧平台骨折.所有病例采取膝关节后侧切口、后内/外侧联合入路、支撑钢板内固定治疗.[结果] 11例患者均顺利完成手术,无手术并发症发生;随访8 ～18个月,平均13个月,骨折均获骨性愈合,骨折愈合时间2～4个月,平均3个月,无骨折再塌陷及膝内外翻畸形发生.根据Rasmussen膝关节功能评分:优6例,良3例,可2例.[结论]经膝关节后侧切口、后内/外侧联合入路、支撑钢板内固定治疗胫骨平台后髁粉碎骨折手术直观、骨折复位固定效果好,无骨折再塌陷等临床并发症发生,获得优良的膝关节功能恢复.     

经后侧入路支撑钢板内固定治疗后Pilon骨折的疗效观察

目的 探讨后侧入路支撑钢板内固定治疗后Pilon骨折的手术方法及临床疗效.方法 均经后侧入路支撑钢板内固定治疗后Pilon骨折26例,19例获得完整随访.结果 对19例进行4～37个月(平均17.5个月)的随访.骨折全部愈合,平均愈合时间为11周(10～13.5周),完全负重时间10～14周(平均12周),依据Mazur踝关节功能评分系统对术后1年踝关节功能进行评分:优13例,良5例,可1例,平均(94±5)分.术后2例出现切口浅表感染,经非手术治疗痊愈.无螺钉松动、断裂及内固定失效等并发症.结论 支撑钢板固定是治疗后Pilon骨折的一种有效方法,但要熟悉胫骨远端后侧解剖结构,正确掌握手术适应证.     

Open posterior stabilization for recurrent posterior glenohumeral instability

Open posterior capsular shift is used for posterior glenohumeral instability that has failed nonoperative treatment. Few series have fully evaluated the outcome after open posterior stabilization. The purpose of this series was to evaluate the clinical and radiographic outcome after open posterior stabilization of the shoulder. Preoperative and intraoperative factors were analyzed with regard to their impact on results. Forty-eight consecutive shoulders were identified that had undergone primary open shoulder stabilization by use of open posterior capsular shift. Of the shoulders, 4 were lost to follow-up, resulting in a study group of 44 shoulders in 41 patients. Shoulders were evaluated at a range of 1.8 to 22.5 years after surgery by use of the L'Insalata shoulder form, Short Form-36 (SF-36), and a subjective shoulder rating in 44 shoulders. Thirty-nine shoulders were evaluated by physical examination, and thirty-seven underwent radiographic examination. A recurrence of posterior instability occurred in 8 shoulders (19%). Of the patients, 84% were satisfied with the current status of their shoulder. The mean L'Insalata score was 81.25+/-17.8 points, the mean SF-36 physical component score was 50.81+/-7.87, and the mean mental component score was 53.82+/-7.55. Significantly poorer satisfaction and outcome scores were seen in shoulders found to have a chondral defect at the time of stabilization and in patients aged greater than 37 years at the time of surgery. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. Open posterior shoulder stabilization is a reliable procedure for treating significant posterior instability without causing arthritic changes. Patients found to have chondral damage within the shoulder and older patients were found to have less success after stabilization.     

寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用

<正>目前对于治疗寰枢椎不稳或脱位的手术方法有多种,常用术式为后路钉棒系统固定融合术,其中寰椎安全顺利置钉为手术成败的关键,若术中寰椎置钉不成功或不顺利,可能导致手术时间增加,手术风险加大,临床需要一种安全、可靠、操作相对简单的手术补救措施。我科2013年12月~2015年1月收治的寰枢椎不稳患者均行寰枢椎后路固定融合手术,其中4例因术中置入寰椎椎弓根螺钉     

Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects

The aim of this study is to determine posterior compartment topography 1-year after sacrocolpopexy (SC). Women who had SC without concomitant anterior or posterior repairs for symptomatic pelvic organ prolapse (POP) were included. Vaginal topography was assessed at baseline and 1-year postoperatively using POP quantification (POPQ). At baseline, 24% had stage IV POP, 68% stage III, and 8% stage II. One year after surgery, 75% had stage 0/I POP, 24% stage II, and 1% stage III. 112 (75%) were objectively cured (stage 0 or I POP). Anterior compartment was the most common site of POP persistence or recurrence (Ba >/= stage II in 23 women) followed by posterior compartment (Bp >/= stage II in 12 women) and apex (C >/= stage II in 2 women). In 1-year follow-up, SC without concomitant posterior repair restores posterior vaginal topography in the majority of women with undergoing SC.     

髋臼后柱骨折与后柱伴后壁骨折的诊断和治疗

目的探讨髋臼后柱骨折、后柱伴后壁骨折的诊断和治疗方法。方法15例A2型髋臼骨折均采用手术治疗。手术入路：Kocher-Langenbeck入路6例，改良Kocher-Langenbeck入路9例。结果15例中达到解剖复位13例，复位欠佳2例。获得随访11例，随访时间1～4年，平均2年。关节功能按改良d-Aubigne和Postel功能评定标准，优良10例，可1例。术后异位骨化Brookel Ⅰ度1例、Ⅱ度2例。原发坐骨神经损伤2例，1例在1年后恢复，另1例未恢复。结论只有把患髋前后位片、闭孔斜位片、髂骨斜位片、CT平扫图像、SSD重建图像、MPR图像和VRT重建图像结合起来，才能做出髋臼后柱骨折或后柱伴后壁骨折的诊断。绝大多数髋臼后柱骨折和后柱伴后壁骨折需行玎放复位内固定，复位后柱骨折的最好方法是联合使用Schanz螺钉与Farabeuf钳，术中根据具体情况选择1块或2块后柱重建钢板固定。     

Fixation of posterior pelvic ring disruptions through a posterior approach

Objective  Stable internal screw fixation of posterior pelvic ring disruptions through a posterior approach. Indications  Complete, unstable sacroiliac dislocations with incompetence of anterior and posterior sacroiliac ligaments. Sacroiliac fracture dislocations. Displaced vertical sacral fractures. Contraindications  Damage to posterior soft tissues. Acceptable closed reduction of sacrum or sacroiliac joint. Ipsilateral acetabular fractures treated through an anterior approach. Inadequate intraoperative fluoroscopic visualization of posterior pelvis. Surgical Technique  Vertical paramedian incision overlying the sacroiliac joint. Release of origin of gluteus maximus. Inspection and reduction of sacroiliac joint. Stabilization with iliosacral screws under image intensification. Secure repair of gluteal fascia. Results  107 patients with unstable pelvic ring fractures were treated with open reduction and internal fixation of which 83 had an open reduction of posterior ring injuries. Accuracy of reduction: more than 95% of patients had residual displacement of less than 10 mm. Two patients had a deep wound infection postoperatively. Two-thirds of the patients were able to resume their previous occupation. Pain was either absent or occurred only with strenuous activities. 63% had a normal gait.     

One-stage posterior hemivertebra resection and correction using segmental posterior instrumentation

STUDY DESIGN: A retrospective study of 12 patients with congenital kyphoscoliosis caused by a single hemivertebra who underwent one-stage posterior hemivertebra resection and correction by posterior segmental instrumentation. OBJECTIVES: To evaluate the surgical outcomes of 12 patients with hemivertebra treated by hemivertebra resection by single posterior approach and correction with segmental posterior instrumentation. SUMMARY OF BACKGROUND DATA: Congenital scoliosis caused by hemivertebra causes extremely severe curves in some patients. Posterior fusion or posterior and anterior hemi-epiphysiodesis is performed to prevent progression of the deformity. The results of these procedures have been variable and not promising, especially in an adolescent patient with fixed kyphoscoliotic deformity. Hemivertebra resection offers more certain results and better correction of the deformity. To date, hemivertebra resection is performed by anterior and posterior approaches either by one-stage or two-stage operation. Few reports have been published describing a procedure consisting of one-stage posterior hemivertebra resection and correction of the deformity by segmental posterior instrumentation. METHODS: A total of 12 patients with a single hemivertebra between the ages 8-24 years who underwent operative treatment were evaluated for a minimum of 2 years. All patients had a single nonincarcerated hemivertebra [T9 (1 patient), T10 (2), T11 (2), T12 (4), and L1 (3)]. After posterior hemivertebra resection, segmental posterior instrumentation was used for correction of the kyphoscoliotic deformity [CD (4 patients), Kaneda SR (2), and ISOLA (6)]. Radiographic evaluations were conducted on the preoperative, postoperative, and follow-up standing posteroanterior and lateral radiographs. RESULTS: All 12 patients had kyphoscoliotic deformity. Preoperative scoliosis averaging 49 degrees was corrected to 18 degrees (correction rate, 64%). Preoperative kyphosis of 40 degrees was corrected to 17 degrees of kyphosis. Trunk shift of 23 mm was improved to 3 mm. Correction loss was 2 degrees in the frontal plane and 3 degrees in the sagittal plane, and no patients showed more than 5 degrees of correction loss. No intraoperative complications were noted. Solid fusion was obtained in all patients, and no implant failure was verified at the final radiographic evaluations. CONCLUSIONS: This study indicated that correction of kyphoscoliosis caused by a single hemivertebra can be effectively conducted by one-stage posterior hemivertebra resection and correction using segmental posterior instrumentation. The operation was safe, and no associated adverse complications were noted. This procedure is best indicated for adolescent patients with a structural kyphoscoliotic deformity caused by a thoracic or thoracolumbar single hemivertebra.     

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.