肱骨小头背侧撕脱性骨折合并肘关节内侧或后内侧脱位的临床治疗北大核心CSCD

目的分析肱骨小头背侧撕脱性骨折合并肘关节内侧或后内侧脱位的损伤机制,并探讨其治疗方法与预后。方法回顾分析2014年9月—2020年9月收治的4例肱骨小头背侧撕脱性骨折合并肘关节内侧或后内侧脱位患者临床资料。男3例,女1例;年龄13~32岁,平均20.7岁。肱骨小头背侧撕脱性骨折合并肘关节内侧脱位2例,肱骨小头背侧撕脱性骨折+冠突前内侧面骨折合并肘关节后内侧半脱位2例。3例新鲜骨折合并脱位患者先闭合复位,然后2例予以张力带固定,1例予以张力带结合Acumed冠突解剖钢板固定;1例陈旧性骨折不愈合患者先用螺钉固定冠突,再清除肱骨硬化骨块,最后修复外侧副韧带并添加铰链外固定架。结果所有患者术后切口均Ⅰ期愈合,无感染及周围神经损伤等早期并发症。4例患者均获随访,随访时间13~30个月,平均20.8个月。骨折均愈合,愈合时间为70~90 d,平均79.5 d。术后6个月,1例右肘关节后方可见异位骨化形成,患者ALP检测水平正常(67 U/L),拆除张力带清除异位骨化并行肘关节松解;其余患者均无异位骨化形成。末次随访时所有患者肘关节功能恢复良好,Mayo评分为85~100分,平均92.5分,优良率为100%。肘关节屈曲活动度为120°~135°、伸直活动度为10°~20°,旋前、旋后活动度均为75°~85°。结论肱骨小头背侧撕脱性骨折合并肘关节内侧或后内侧脱位可能为单纯内翻应力所致,如果伴冠突前内侧面骨折,则可能为肘关节内翻-后内侧旋转不稳定所致,与Osborne-Cotterill损伤机制相反。对于新鲜肱骨小头背侧撕脱性骨折可采用张力带固定,效果良好。     

应用保留桡骨头桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合的早期疗效

目的探讨保留桡骨头的桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合的早期疗效。方法回顾分析2017年1月至2019年5月广州医科大学附属第二医院创伤骨科采用保留桡骨头的桡骨颈节段性截骨术治疗的创伤性上尺桡关节骨性融合患者7例的临床资料。其中男5例,女2例;年龄为(35±11)岁(19~60岁)。患肢均为右侧。评价术前与随访时患肢前臂旋转活动度、肘和腕关节疼痛程度、握力以及尺骨变异程度和截骨处异位骨化情况并进行比较。采用SPSS 18.0软件对数据进行处理。结果随访(4±0.4)个月(2~6个月)。术前与术后3个月前臂旋转活动度分别为(43±14)°(15°~51°)和(120±31)°(111°~134°),差异有统计学意义(P=0.012);握力分别为(25.5±10.3)kg(21.2~28.6 kg)和(26.3±11.1)kg(21.7~28.4 kg),差异无统计学意义(P=0.074);尺骨变异分别为(-0.13±0.04)mm(-0.15^-0.07 mm)和(-0.12±0.09)mm(-0.14^-0.08 mm),差异无统计学意义(P=0.081)。所有患者术前与术后肘关节与腕关节未见疼痛,术后未见截骨处异位骨化形成。结论应用保留桡骨头的桡骨颈节段性截骨治疗创伤后上尺桡关节骨性融合,方法简单,早期疗效令人满意。     

Mid-term results of open debridement and reattachment surgery for insertional Achilles tendinopathy: A retrospective clinical study

ObjectiveThe aim of this study was to determine the effects of age and body mass index (BMI) on the functional outcomes, satisfaction rates, and recovery time after open debridement and reattachment surgery in non-athletic patients with insertional Achilles tendinopathy (IAT).MethodsIn this retrospective study, 33 non-athletic patients (34 ankles) in whom open debridement and reattachment surgery was performed for IAT from 2006 to 2016 were included. Change in pain intensity was assessed using a Visual Analogue Scale (VAS) preoperatively and at the final follow-up. Functional assessment was done by preoperative and postoperative American Orthopaedics Foot and Ankle Score (AOFAS) and final follow-up Victorian Institute of Sport Tendon Study Group-Achilles Tendinopathy score (VISA-A). Patient satisfaction was evaluated by Roles & Maudsley score (RMS). The recovery time was defined as the time interval from the first appearance to postoperative relief of symptoms and recording. In addition, the recurrent Haglund’s deformity was determined by postoperative control radiographs.ResultsThe mean age at the time of the operation was 51.19 years. The mean follow-up was 61.75±8.49 months. According to BMI, 5 patients were determined as morbid obese, 19 as obese, 3 as overweight, and 6 as normal. The mean VAS score significantly decreased from 8.5 preoperatively to 1.3 postoperatively (p<0.001). The mean AOFAS score significantly improved from 55.8 preoperatively to 92 postoperatively (p<0.001). Postoperative VISA-A score was 86% (range=32%–100%). According to RMS, 22 patients reported the result as excellent, 8 as good, 2 as fair, and 1 as poor. The mean recovery time was 11.8 (range=2–60) months, but one patient did not reach a symptom free status and thus was not included in the recovery time analysis. Postoperative control radiographs revealed signs of recurrence deformity in four patients. Recovery time showed a negative correlation with the age of the patients (r=−0.65). Postoperative scores and BMI showed no significant correlations with the recovery time on the basis of Spearman’s rho test (p=0.196).ConclusionThe results of this study have shown that open debridement and reattachment surgery may be an effective surgical method in relieving pain and improving functional status with high satisfaction rate and acceptable recovery time in the management of non-athletic patients with IAT.Level of EvidenceLevel IV, Therapeutic study     

MicroRNA Profiling Reveals Distinct Signatures in Degenerative Rotator Cuff Pathologies

MicroRNAs (miRNAs) have emerged as key regulators orchestrating a wide range of inflammatory and fibrotic diseases. However, the role of miRNAs in degenerative shoulder joint disorders is poorly understood. The aim of this explorative case-control study was to identify pathology-related, circulating miRNAs in patients with chronic rotator cuff tendinopathy and degenerative rotator cuff tears (RCT). In 2017, 15 patients were prospectively enrolled and assigned to three groups based on the diagnosed pathology: (i) no shoulder pathology, (ii) chronic rotator cuff tendinopathy, and (iii) degenerative RCTs. In total, 14 patients were included. Venous blood samples (“liquid biopsies”) were collected from each patient and serum levels of 187 miRNAs were determined. Subsequently, the change in expression of nine candidate miRNAs was verified in tendon biopsy samples, collected from patients who underwent arthroscopic shoulder surgery between 2015 and 2018. Overall, we identified several miRNAs to be progressively deregulated in sera from patients with either chronic rotator cuff tendinopathy or degenerative RCTs. Importantly, for the several of these miRNAs candidates repression was also evident in tendon biopsies harvested from patients who were treated for a supraspinatus tendon tear. As similar expression profiles were determined for tendon samples, the newly identified systemic miRNA signature has potential as novel diagnostic or prognostic biomarkers for degenerative rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. Inc. J Orthop Res 38:202–211, 2020