儿童髌骨脱位合并膝外翻畸形的手术治疗探讨

目的探讨治疗儿童髌骨脱位的手术方法。方法回顾性分析我科1986年4月至2002年12月手术的13例儿童髌骨脱位的临床资料。结果随访时间1～4年,13例均无再髌骨脱位,膝关节稳定和患者对膝关节功能满意．6例合并膝关节外翻畸形获得纠正。所有患者均无伤口感染和膝关节活动受限。结论采用软组织与骨骺阻滞联合手术治疗儿童髌骨脱位,能达到既矫治软组织病变,又矫正骨关节畸形的双重目的。     

Management of patella fractures associated with central third bone-patella tendon-bone autograft ACL reconstructions

Patella fractures are an acknowledged complication of cruciate ligament reconstructions that use bone-tendon-bone autografts. Two fracture patterns are seen: a nondisplaced longitudinal patellar fissure fracture recognized interoperatively and the classic displaced transverse fracture that disrupts the extensor mechanism. Rigid fixation techniques are described for each fracture type that minimally affect rehabilitative efforts.     

Incidence and Risk Factors of Iliopsoas Tendinopathy After Total Hip Arthroplasty: A Radiographic Analysis of 1,602 Hips

BackgroundIliopsoas tendinopathy (IPT) can cause persistent groin pain and lead to dissatisfaction after total hip arthroplasty (THA). This study aimed to report the characteristics, incidences, risk factors, and treatment outcomes of IPT after THA.MethodsWe reviewed primary THAs performed at a single institution between January 2012 and May 2018. Clinical and radiographic analyses were performed on 1,602 THAs (1,370 patients). Patient characteristics, component sizes, inclination and anteversion angles, and antero-inferior cup prominence (≥8 millimeters (mm)), were compared between the groups with and without IPT. Changes in teardrop to lesser trochanter distance were measured to estimate changes in leg length and horizontal offset caused by THA. Logistic regression models were used to identify the risk factors for IPT. IPT was identified in 53 hips (3.3%).ResultsPatients with IPT had greater leg lengthening (12.3 versus 9.3 mm; P = .001) and higher prevalence of antero-inferior cup prominence (5.7 versus 0.4%; P = .002). There was no significant difference in inclination, anteversion, and horizontal offset change between the two groups. In multivariate analyses, greater leg lengthening, prominent acetabular cup, women, and higher body mass index were associated with IPT. All patients reported improvement in groin pain after arthroscopic tenotomy, while 35.7% with nonoperative management reported improvement (P < .001).ConclusionsSymptomatic IPT occurred in 53 (3.3%) of the 1,602 primary THAs. Our findings suggest that leg lengthening as well as prominent acetabular cup in THAs can be associated with the development of IPT. Arthroscopic tenotomy was effective in relieving groin pain caused by IPT.     

深层横向弹拨联合浮针治疗冈上肌肌腱炎的临床研究Δ

摘要 目的 探讨深层横向弹拨（DTFM）联合浮针治疗冈上肌肌腱炎的临床效果。方法 根据研究目的和受试对象的标准（诊断标准、纳入标准和排除标准），将东阳市人民医院2021年1月～2022年12月符合标准的80例冈上肌肌腱炎患者作为研究对象，按随机数表法随机分为研究组和对照组，每组患者40例。研究组采用DTFM联合浮针治疗，对照组采用浮针治疗。两组均治疗10 d。治疗结束后、治疗结束后3个月两组患者均进行临床疗效评估，于治疗前、首次治疗后即刻、治疗结束后、治疗结束后3个月采用疼痛视觉模拟评分（VAS）、Constant-Murley肩关节功能评分（C-M）评估两组疼痛程度及肩关节功能，采用量角器测量肩关节外展、前屈角度，采用拉力计测定肌力强度。比较两组治疗期间不良事件发生率。结果 研究组治疗结束后、治疗结束后3个月总有效率大于对照组（P＜0.05）；首次治疗后即刻、治疗结束后、治疗结束后3个月研究组静息、活动时VAS评分小于对照组，C-M评分、肩关节屈伸度及外展肌力大于对照组（P＜0.05）；两组治疗期间均未发生不良事件。结论 DTFM联合浮针治疗冈上肌肌腱炎疗效显著，减轻疼痛，增加肩关节活动度及肌力强度，改善肩关节功能，安全性有保证。