Dislocations of the elbow – An instructional review

Dislocations of the elbow require recognition of the injury pattern followed by adequate treatment to allow early mobilisation. Not every injury requires surgery but if surgery is undertaken all structures providing stability should be addressed, including fractures, medial and lateral ligament insertion and the radial head. The current concepts of biomechanical modelling are addressed and surgical implications discussed.     

从心身同治角度针灸对乳腺癌关节痛患者生命质量改善的临床研究

目的:评价基于《黄帝内经》心身疾病病因的整体选穴与乳腺癌芳香化酶抑制剂(AI)关节痛局部配穴相结合的针灸方法,对乳腺癌康复期AI关节痛患者生命质量及局部关节症状的临床疗效。方法:选取2019年1月至2021年5月南京医科大学第一附属医院乳腺外科筛选使用唑来膦酸的乳腺癌AI患者232例作为研究对象,依据针灸意愿分为对照组(n=19)和观察组(n=16),对照组采用唑来膦酸常规镇痛,观察组在唑来膦酸的基础上采用整体及局部取穴相结合的方法针灸治疗,共治疗4周,分别评价治疗前、治疗2周、4周、8周时的乳腺癌患者生命质量量表(FACT-B)生命质量评分以及简明疼痛评估量表(BPI-SF)关节痛评分,同时评估针灸治疗的安全性。结果:治疗4周以及8周时观察组FACT-B生命质量评分较对照组高,治疗4周时观察组BPI-SF疼痛评分较对照组低,差异有统计学意义(P<0.05)。结论:采用整体配穴调和心身与局部选穴缓急止痛相结合的针灸方法对乳腺癌康复期AI患者的生命质量以及局部关节症状有较好的临床疗效。     

旋提手法治疗颈椎病研究进展

颈椎病(CS)是脊柱常见、多发疾病之一,具有发病率高,且呈年轻化发展的趋势。CS严重影响患者生活质量和心理健康,旋提手法治疗CS具有安全、有效、经济的特点。通过对筋骨理论以及旋提手法的深入挖掘,探讨在筋骨理论指导下颈椎病的发病机制以及旋提手法治疗CS的作用机制,为手法治疗CS提供新思路。     

肩关节后方不稳的诊疗现状

肩关节后方不稳发生率明显低于前方不稳,但是临床上诊疗难度大,误诊和漏诊率较高。其病因、临床表现治疗策略与前方不稳完全不同。因此,深入认识肩关节周围解剖结构、掌握检查方法、基于解剖和受伤方式对肩不稳进行分型对提高诊断准确率具有关键作用。CT三维重建对肱骨头及肩盂骨缺损的评估和核磁共振造影(magnetic resonance angiography,MRA)对于后方盂唇及关节囊病变评估有助于精确诊断。治疗方法分为保守治疗及手术治疗。对肌性不稳建议保守治疗。创伤性及发育不良性不稳建议手术治疗,具体根据肩盂侧或肱骨头侧损伤行不同术式。肩盂侧损伤根据骨缺损情况行软组织手术、植骨手术或截骨手术来重建后方稳定结构;肱骨头侧缺损则根据前方骨缺损面积行植骨术或肩胛下肌填塞术。手术方式有开放手术和关节镜手术,前者优势在于学习曲线短,固定牢固;后者优势在于微创操作及可以多角度观察病变部位并精确控制骨块位置。本文对将上述问题加以综述。     

Vascular anatomy of the first metatarsal bone and surgical implications according to the severity of hallux valgus deformity: A cadaveric study

BackgroundVascular injury after hallux valgus surgery is a rare condition but serious complications can ensue.MethodsWe performed an anatomical study using 26 cadaveric lower extremities. We enhanced first metatarsal bone’s (FMB) vascularization by injecting latex. Each specimen was classified according to the severity of hallux valgus deformity (HVD). Then we measured two distances: one between the first tarsometatarsal joint (FTMJ) to the first dorsal branch’s origin, the other between the first metatarsophalangeal joint (MTP) to the dorsal plexus’s origin.ResultsThe distance between the FTMJ and the first dorsal branch to the FMB ranges from 10 mm in normal feet to 15 mm in severe deformed feet. The distance between the MTP and the dorsal plexus’ origin ranges from 20 mm in normal feet to 25 mm in severe deformed feet.ConclusionsUnderstanding the foot’s vascular anatomy has allowed us to adapt surgical landmarks to the severity of the HVD and to avoid post-operative complications.     

The influence of bariatric surgery on hip and knee joint pain: a systematic review

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI’s Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.     

Extensor hallucis longus distal tenotomy for spasticity in a patient with interphalangeal joint hyperextension after stroke

BackgroundThe extension deformity of the interphalangeal (IP) joint of the hallux is a rare focal clinical entity usually detected in patients with no underlying pathology. It may be due to extensor hallucis longus (EHL) overactivity, although it has not been previously reported in patients with neurological disorders. The lesion should be differentiated from the persistent hyperextension of the great toe at the metatarsophalangeal (MTP) joint. Although MTP hyperextension of the hallux due to hypertonia of the EHL is a typical sequel of stroke, it has also been detected in a wide variety of disorders.Materials and MethodsA patient with right hemiparesis following stroke, which had an almost complete functional recovery, is presented. She was disabled by focal spasticity of the EHL, leading to persistent hyperextension of the IP joint of the hallux. The deformity appeared on the long-term follow-up, on both sides within a 3-year period. It was treated with bilateral percutaneous distal EHL tenotomy. On the left side, a percutaneous dorsal IP joint capsulotomy was additionally performed.Results and ConclusionA complete reduction of the deformity was achieved on both sides with functional rehabilitation. It is assumed that EHL hyperactivity following stroke in our patient was complicated by IP instead of MTP extension deformity, due to the coexistent flexor hallucis longus weakness. Bilateral distal EHL tenotomy, associated with percutaneous dorsal IP joint capsulotomy on the left side, provided satisfactory long-term results.     

改良内侧开放式胫骨高位截骨术治疗膝内侧间室骨性关节炎

目的探索新型改良内侧开放式胫骨高位截骨术(High tibial osteotomy,HTO)治疗膝内侧间室骨性关节炎的有效性和安全性。方法选择2017年7月到2018年7月在我院接受改良内侧开放式HTO的60位膝内侧间室骨性关节炎患者作为研究对象。记录每位患者的手术时间、出血量及手术并发症,并分别于术前和术后3、6个月对患者进行疼痛视觉评分(VAS)和美国膝关节协会评分(KSS评分);比较患者手术前后的胫股角、平台后倾角的影像学治疗。结果术后3、6个月的VAS评分和KSS评分均优于术前(P<0.001),且术后随着时间推移评分存在逐渐好转趋势。患者术后胫股角较术前胫股角减小(P<0.005),术后胫骨后倾角与术前无明显差异(P>0.05)。结论改良内侧开放式HTO治疗膝内侧间室骨性关节炎可显著缓解疼痛症状,重建膝关节功能。