A modified approach for eminectomy for temporomandibular joint dislocation under local anaesthesia: report on a series of 50 patients

Conventional eminectomy for habitual dislocation of the temporomandibular joint is usually performed under general anaesthesia. This technique was modified for use under local anaesthesia to treat medically compromised patients. Fifty elderly patients (90 joints) were treated, for whom general anaesthesia was considered a serious risk due to systemic diseases; the dislocation was habitual in 39 and long-standing in 11. Following intravenous sedation and local anaesthesia, a 2-cm superficial vertical skin incision was made directly above the articular eminence. Careful and gentle dissection of the subcutaneous tissue was performed until the lateral joint capsule was exposed. The superior compartment was entered, followed by shaving of the articular eminence in a conventional manner. The surgery was successful in all patients, with a mean operative time of 47 ± 12 minutes. Intraoperative events occurred in 10 patients (20%). Postoperative complications affected 25 patients (50%), varying from severe (two deaths, due to cardiopulmonary arrest and accidental fall) to mild (local infection, etc.). Eleven patients (22%) had facial nerve palsy limited to the temporal branch; all recovered after 6 months. This approach is useful when general anaesthesia is contraindicated due to existing medical conditions. However, prudent consideration may be required to avoid serious complications when local anaesthesia is used.     

Luxation latérale complète en hyperpronation du coude

The authors report an exceptional case of hyperpronated complete lateral elbow dislocation with an associated chip fracture of the radial head after a motor vehicle accident. Closed reduction and physical rehabilitation were performed with a good outcome after 2 years. This exceptional case should be included in Speed classification of lateral elbow dislocations as a type IV according to its anatomopathological and clinical features.     

Horizontal intraarticular dislocation of patella—A case report and review of literature

Dislocation of patella is a known emergency condition. It is more common in adolescents who are involved in activities like sports and dance. We describe here a case of horizontal intraarticular dislocation of patella in an elderly female managed successfully by closed reduction.     

Proximal coracobrachialis tendon rupture,subscapularis tendon rupture,and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation

Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5.     

Do osteotomies of the proximal femur still have a role?

Trochanteric valgus and varus correction osteotomies have been described with or without associated rotational correction. In the last decade, new techniques have been described, including femoral neck osteotomy, femoral head reorientation, relative neck lengthening, greater or lesser trochanter distalization, and femoral head reduction osteotomy. While the overall number of femoral osteotomies in the young patients has decreased because of the efficacy of primary total hip arthroplasties, those osteotomy techniques may expand the indications for femoral osteotomies in select patients who meet the indications.     

关节镜下Twin Tail TightRope带袢钛板Y型固定治疗急性RockwoodⅢb型以上肩锁关节脱位的早期疗效

目的评价Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位的早期临床疗效。 方法回顾性分析2015年6月至2017年6月昆明市第一人民医院采用Twin Tail TightRope带袢钛板内固定系统在关节镜下行Y型固定治疗急性肩锁关节脱位患者共16例。采用视觉模拟评分法（visual analogue scale，VAS）及Constant-Murley评分评估手术效果。 结果所有患者获得随访，随访时间3~12个月，平均（6.48±1.51）个月。术后无血管、神经损伤及切口感染，末次随访时均未发生复位丢失、锁骨应力性骨折、喙突切割等并发症。末次随访时VAS评分（0.36±0.04）分较术前（7.46±1.24）分降低，Constant-Murley评分（90.07±3.13）分较术前（46.13±3.25）分提高。 结论采用Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位可有效解决术后水平、前后方向不稳定问题，此技术具有较低的锁骨、喙突骨折发生率，关节镜下操作可以减少手术损伤、提高精准度。     

类风湿性关节炎继发寰枢椎脱位的手术治疗

目的:总结手术治疗类风湿性关节炎(rheumatoid arthritis,RA)继发寰枢椎脱位的临床疗效。方法:2010年1月~2018年12月收治57例RA继发寰枢椎脱位的患者,男14例,女43例;年龄46~79岁(61.8±12.4岁)。类风湿性关节炎病史2.5~36.8年(17.5±3.7年),诊断RA后出现上颈椎相关症状时间为1.5~19.4年(8.9±2.4年)。患者均有不同程度的枕颈部疼痛、颈部姿势异常和活动受限。术前神经功能ASIA分级:B级3例,C级12例,D级20例,E级22例;JOA评分4~14分(8.7±1.8分),VAS 4~10分(7.4±1.5分)。寰椎前向脱位44例,其中寰齿前间距(anterior atlantodental interval,AADI)>10mm者8例;寰椎后向脱位9例;寰椎前后向脱位4例。6例合并下颈椎不稳,10例合并枕颈部其他畸形。13例枕寰关节先天性融合及骨性融合无枕寰关节活动度者采用枕颈固定融合术治疗(A组);44例有枕寰关节活动度的患者采用寰枢椎融合固定融合术治疗,其中16例寰枢椎脱位牵引不能复位的患者先行前路经下颌下寰枢椎关节松解术再一期后路行寰枢椎融合术治疗(B组),28例寰枢椎脱位牵引能复位的患者直接采用后路寰枢椎融合内固定术治疗(C组)。定期随访患者的临床症状和神经功能改善情况,影像学观察寰枢椎复位和植骨融合情况。结果:患者均顺利完成手术,A组手术时间100~130min(118.2±13.5min),术中出血量100~300ml(190.5±42.8ml);B组手术时间180~240min(221.4±20.3min),术中出血量100~260ml(157.3±36.1ml);C组手术时间100~130min(109.4±12.1min),术中出血量100~200ml(124.1±32.7ml)。术中均未发生椎动脉和脊髓损伤。所有患者随访期间复查颈椎CT及MRI显示寰枢椎序列重建满意,齿状突区域脑脊液线清晰,脊髓无压迫,术后AADI为2~3mm(2.4±0.4mm)。患者均获随访,随访时间12~84个月(34.4±10.3个月),术后12个月随访时,2例ASIA分级B级患者恢复至C级,C级患者6例恢复至D级、3例恢复至E级,9例D级患者恢复至E级,其余患者无变化;JOA评分改善至10~17分(14.6±3.5分),VAS评分降至1~5分(3.6±1.4分),与术前比较均有显著性差异(P<0.05)。1例患者植骨块发生自发性部分吸收,随访1年半时植骨块吸收停止并部分融合,未再次行植骨术;其余患者植骨均融合。随访期间均未发现螺钉松动、移位、断裂和寰枢椎再脱位、失稳现象。结论:RA累及上颈椎时会造成寰枢椎脱位导致脊髓受压,依据枕寰关节活动度情况采用寰枢椎融合术或枕颈融合术治疗可获得良好的临床效果。     

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.