Congenital dislocation of the hip: a prospective study comparing ultrasound and clinical examination

Screening for congenital dislocation of the hip by standard clinical methods and ultrasound was compared prospectively in 1503 newborns (1291 girls and 212 boys). A total of 82.8% of the hips (78.8% of the infants) had well developed acetabulae, 14.5% (17.2% of the infants) were shallow (immature) and 2.7% (4.1% of the infants) were dysplastic. Within 1-3 months 96.7% of the infants with clinically stable, but immature hips normalized, while 3.3% did not improve or worsened, and therapy was therefore initiated. Indications for treatment included dysplastic and/or clinically unstable hips, and a higher number of newborns were treated during the study period than in 1982-85 (31.2 vs 19.7 per 1000, p = 0.0002). Thirty-seven percent of the patients had both clinical and ultrasound findings compatible with congenital dislocation of the hip, while the decision to treat was based on clinical findings alone in 25.0% and on ultrasound findings in 38.0%. Infants born during the study period of nine months had a low incidence of late congenital dislocation of the hip compared with our earlier reported results from 1982-85 (0.9 vs 3.5 per 1000, p = 0.012). The study demonstrated major discrepancies between clinical and ultrasound evaluation of hips in the newborn, and the role of ultrasound in the screening for congenital dislocation of the hip requires further evaluation.     

复位五法结合内固定治疗胸腰段脊柱骨折脱位

目的:探讨手法复位技术在胸腰椎骨折脱位中的应用。方法:自2007年至2017年共诊治胸腰椎骨折脱位患者72例,分为治疗组与对照组。治疗组共37例,采用山东省名中医徐展望"牵压旋扳撑"复位五法,手术切开前先行手法复位,术中椎弓根钉棒系统撑开固定矫正残余移位及维持复位后位置。对照组35例只采用术中器械撑开复位固定。术后3 d所有患者均佩戴支具在床上坐起,下肢肌力在3级以上者下地活动。比较两组术后后凸Cobb角的改善以及侧方角度的改善情况,两组椎骨旋转角度改善情况及视觉模拟评分法(VAS)评分。结果:治疗组在侧方角度改善及椎骨旋转角度的改善方面明显优于对照组,治疗组侧方成角从平均17.46°±3.67°恢复到4.39°±1.23°;对照组从18.39°±4.12°恢复到8.12°±2.10°。两组比较差异有统计学意义(P0.01)。在椎骨旋转角度方面,治疗组恢复到6.02°±1.64°,对照组则恢复到14.91°±3.50°,两组比较差异有统计学意义(P0.01)。术后VAS均有明显改善,两组间对比差异无统计学意义。治疗组37例患者中治愈16例(43.24%),好转19例(51.35%),优良率94.59%。对照组35例中治愈11例(31.43%),好转19例(54.29%),优良率为85.71%。组间对比差异无统计学意义。选取典型病例,详细介绍了复位五法的应用情况。结论:手法复位可明显改善移位复杂严重的胸腰段骨折脱位,特别是脊柱的侧方成角以及椎骨的旋转移位。配合术中椎弓根钉棒系统撑开固定可达到满意的复位,且安全实用。     

双Endobutton钢板与锁骨钩钢板内固定治疗Rockwood Ⅲ、Ⅴ型肩锁关节脱位的疗效比较

目的比较双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位的远期疗效。方法回顾性分析自2009-05—2014-06诊治的40例RockwoodⅢ、Ⅴ型肩锁关节脱位,采用双Endobutton钢板内固定治疗12例(双Endobutton钢板组),采用锁骨钩钢板内固定治疗28例(锁骨钩钢板组)。比较2组手术时间、术中出血量、并发症情况,以及末次随访时肩关节疼痛VAS评分、肩关节功能Constant-Murley评分。结果双Endobutton钢板组手术时间较锁骨钩钢板组长,且术中出血量大于锁骨钩钢板组,差异有统计学意义(P0.05)。40例均获得随访24~84个月,平均41.4个月。末次随访时2组肩关节疼痛VAS评分及肩关节功能Constant-Murley评分差异无统计学意义(P0.05)。双Endobutton钢板组术后1例复位丢失,1例异位骨化,3例肩部疼痛;锁骨钩钢板组术后11例肩部疼痛,2例肩关节活动受限,2例肩峰下骨质吸收,未出现复位丢失。结论双Endobutton钢板与锁骨钩钢板内固定治疗RockwoodⅢ、Ⅴ型肩锁关节脱位疗效满意,且双Endobutton钢板内固定对肩关节功能影响小,术后肩痛发生率低,无需取出内固定,但手术技术要求较高。     

The Effect of Pelvic Tilt and Femoral Head Size on Hip Range-of-Motion to Impingement

Background

About 50%-70% of dislocators have cups placed within so-called “safe zones.” It has been postulated that factors such as femoral head size and pelvic tilt, obliquity, or rotation may influence postoperative stability. Therefore, we assessed varying degrees of pelvic tilt and head sizes on the range of motion (ROM) to impingement.

Acetabular and Femoral Anteversions in Standing Position are Outside the Proposed Safe Zone After Total Hip Arthroplasty

Background

Although most hip dislocations occur in either standing or sitting position, the safe zone for implant position is defined for the supine position. Our goal was to determine preoperative and postoperative pelvis and hip orientations and whether the safe zone defined in supine position can be used to assess standing radiographs.

TightRope重建喙锁韧带联合锚钉治疗肩锁关节脱位的临床疗效

目的：探讨TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位的疗效。方法回顾性分析2013年5月至2015年5月于我院采用TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗的13例肩锁关节脱位病人（TightRope+锚钉组）及采用肩锁钩钢板治疗的21例肩锁关节脱位病人（肩锁钩钢板组）的临床资料,比较两组的手术时间、术中出血量、术后及末次随访时的X线片及术后3、6个月及末次随访时的Neer肩关节功能评分。结果两组的手术时间、术中出血量比较,差异均无统计学意义（均P＞0.05）。在术后3、6个月及末次随访时,TightRope+锚钉组的Neer肩关节功能评分分别为（84.5±8.1）分、（91.8±9.4）分、（96.1±11.1）分,而肩锁钩钢板组的相应得分分别为（72.4±7.5）分、（86.9±9.6）分、（89.2±9.8）分,TightRope+锚钉组明显优于肩锁钩钢板组,差异均有统计学意义（均P＜0.05）。末次随访时的X线片提示TightRope+锚钉组病人无复位丢失、创伤性关节炎等出现;肩锁钩钢板组出现4例肩峰下撞击征,1例肩峰骨溶解,所有病人均在8~10个月后取出内固定,2例病人取出钢板后出现复位丢失。结论采用TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位,可获得更符合生物力学的复位,肩锁关节稳定,肩关节功能恢复满意,无需二次手术取出内固定。     

Isolated Acute Traumatic Subtalar Dislocations: Review of 13 Cases at a Mean Follow-Up of 6 Years and Literature Review

Isolated acute traumatic subtalar dislocations are quite rare. They correspond to talotarsal dislocation, including the talonavicular and talocalcaneal joints. The purpose of the present study was to evaluate the functional and radiologic outcomes of the treatment of acute traumatic isolated subtalar dislocations. The present retrospective study included 13 patients who had sustained isolated subtalar dislocations during a 10-year period. Of the 13 cases, 10 (76.9%) were medial dislocations and 3 (23.1%) were lateral dislocations. All the patients underwent immediate closed reduction under anesthesia followed by immobilization. No open reduction was required. The mean follow-up period was 72.6 (range 24.4 to 124.8) months. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 80.1 of 100 (range 66 to 90). The score result was good in 69% of cases and poor in 31% of cases. The subtalar mobility was reduced for 8 (61.5%) patients and significantly affected the American Orthopaedic Foot and Ankle Society score (p = .002). Subtalar osteoarthritis was present in 6 (46.1%) cases with talonavicular osteoarthritis in 3 (23.1%) cases. No cases of avascular necrosis of the talus were noted. In accordance with the published data, the prognosis of isolated acute traumatic subtalar dislocations is favorable. Medial dislocations are more frequent than lateral dislocations. Emergent closed reduction makes it possible to remove soft tissue injuries. The risk of post-traumatic subtalar osteoarthritis is significant, even without an initial subtalar lesion. A postreduction computed tomography scan will enable the diagnosis of osteochondral lesions.     

Tibialis Posterior Tendon Dislocation: A Review and Suggested Classification

Tibialis posterior tendon dislocation is a rarely described entity that is easily missed, resulting in delayed diagnosis and treatment. A review of the English published data on the topic showed inconsistency in the reporting of injuries and surgical management techniques, leading us to describe a novel classification system to guide treatment and future reporting. We also describe a case of tibialis posterior tendon dislocation in a professional volleyball player and our surgical technique for correction, including retromalleolar groove deepening.