肩袖关节侧部分撕裂的手术方式及疗效分析

目的探讨和分析关节镜下修补肩袖关节侧部分撕裂(PASTA)的手术方法，包括穿肌腱修补法和转全层修补法治疗Ellman 3级肩袖关节侧部分撕裂的疗效及优缺点。 方法本次回顾性研究，分析了2015年3月至2017年6月期间因肩袖关节侧部分撕裂于南京医科大学第一附属医院骨科行手术治疗的全部患者，肩袖撕裂程度Ellman 3级(排除Ellman 1级和2级)的病例纳入本次研究，共42例。术中关节镜下根据滑囊侧残留肩袖组织的完整性、质地和张力等情况进行评估后，按手术修补方式分为穿肌腱修补组(肌腱组)20例，和转全层修补组(全层组)22例。肌腱组患者术中保留滑囊侧残留的肩袖组织，采用穿肌腱法修补肩袖；全层组患者术中清除滑囊侧残留的肩袖组织，直接转为全层撕裂，然后进行单排固定修补肩袖。术前、术后24 h及末次随访时对所有入组患者采用视觉模拟评分(VAS)进行疼痛评估。术前及术后末次随访时采用Constant-Murley肩关节评分(CSS)及洛杉矶加利福尼亚大学评分(UCLA)对所有入组患者进行肩关节功能评估。对比分析两组患者术后疗效及并发症发生情况，计数资料(性别、优势手和肩部外伤史等)采用χ²检验，同一组内术前术后计量资料对比采用配对t检验。 结果42例患者均获得随访，随访时间6～30个月，平均(16±7)个月。两组患者术后24 h及末次随访时VAS评分均较术前明显降低，差异具有统计学意义(P<0.05)。平均CSS评分从术前的(49.6±5.5)、(51.3±5.2)分别增加至(84.2±7.2)、(82.6±6.5)，平均UCLA评分从术前的(18.4±3.2)、(17.7±2.3)分别增加至(32.1±2.2)、(31.2±2.2)，差异具有统计学意义(P<0.05)。两组患者术后24 h时疼痛评分对比存在差异，具有统计学意义(t＝2.8, P<0.05)。比较两组患者末次随访时的疼痛评分及肩关节功能评分，差异均无统计学意义(P>0.05)。随访期间所有患者均未发生严重的术后并发症。 结论对于Ellman 3级的肩袖关节侧部分撕裂，关节镜下穿肌腱修补法和转全层修补法均可获得较满意的疗效，而穿肌腱修补法可以保留滑囊侧的肩袖组织，足印区的修补更加符合解剖基础，从而达到更好的腱骨愈合。在两种手术方法均可以熟练掌握的前提下，穿肌腱修补是更为理想的手术方式。     

How ultrasonography can contribute to diagnosis of craniosynostosis

IntroductionThe aim of this article was to provide an overview of ultrasound (US) techniques for the investigation of cranial sutures in infants.Material and methodsWe first describe a high-resolution sonography technique and its limitations. We then analyze the reliability, effectiveness and role of ultrasonography in routine practice using a PubMed literature review.ResultsTen studies reported excellent correlations between ultrasonography and 3D-CT. Cranial US for the diagnosis of a closed suture had 100% sensitivity in 8 studies and 86–100% specificity before the age of 12 months. Negative findings mean imaging investigation can be stopped. If ultrasonography confirms diagnosis, neurosurgical consultation is required. Thus, 3D-CT can be postponed until appropriate before surgery.ConclusionCranial suture ultrasound is an effective and reliable technique for the diagnosis of craniosynostosis. It has many advantages: it is fast and non-irradiating, and no sedation is required. It should be used as first-line imaging in infants below the age of 8–12 months when craniosynostosis is clinically suspected.     

应用Fast-fix 360全内缝合技术修复半月板Ramp区损伤的临床研究

目的探讨应用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤的方法和疗效。方法2016年10月至2018年4月,中部战区总医院骨科足踝与运动医学中心使用Fast-fix 360缝合技术修补经镜下确诊为内侧半月板Ramp区损伤病人15例,其中男14例,女1例,平均年龄为23.6岁,病人均合并前交叉韧带(anterior cruciate ligament,ACL)断裂,均予以一期行ACL自体腘绳肌单束重建,6例合并外侧半月板损伤亦同期处理。术后行膝关节标准化功能康复。收集病例手术时间、术中出血量、术后并发症情况;术前、术后半年、术后1年的Lysholm膝关节评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分;术后半年、1年分别复查患膝关节MRI,评估Ramp区损伤修复情况。结果病人随访13~26个月(平均17.8个月)。手术时间为(90.8±21.4)min,术中出血量为(50.5±10.6)ml。术后2例病人移植肌腱供区伤口浅表感染,经延长换药后均愈合;无伤口深部感染及膝关节感染;未出现腘窝血管神经损伤情况。术后半年及1年的Lysholm膝关节评分、IKDC评分均显著高于术前,差异均有统计学意义(P均<0.05)。术后半年MRI评估Ramp区的愈合率为73.3%,术后1年其愈合率提高至86.7%。结论使用Fast-fix 360全关节内缝合技术修补半月板Ramp区损伤,同时一期重建ACL,可获得较满意的临床疗效,方法简单、手术时间短,可作为半月板Ramp区损伤的一种常规修复方法。     

Heterologous fibrin sealant potentiates axonal regeneration after peripheral nerve injury with reduction in the number of suture points

The use of suture associated with heterologous fibrin sealant has been highlighted for reconstruction after peripheral nerve injury, having the advantage of being safe for clinical use. In this study we compared the use of this sealant associated with reduced number of stitches with conventional suture after ischiatic nerve injury. 36 Wistar rats were divided into 4 groups: Control (C), Denervated (D), ischiatic nerve neurotmesis (6 mm gap); Suture (S), epineural anastomosis after 7 days from neurotmesis, Suture + Fibrin Sealant (SFS), anastomosis with only one suture point associated with Fibrin Sealant. Catwalk, electromyography, ischiatic and tibial nerve, soleus muscle morphological and morphometric analyses were performed. The amplitude and latency values of the Suture and Suture + Fibrin Sealant groups were similar and indicative of nerve regeneration.The ischiatic nerve morphometric analysis in the Suture + Fibrin Sealant showed superior values related to axons and nerve fibers area and diameter when compared to Suture group. In the Suture and Suture + Fibrin Sealant groups, there was an increase in muscle weight and in fast fibers frequency, it was a decrease in the percentage of collagen compared to group Denervated and in the neuromuscular junctions, the synaptic boutons were reestablished.The results suggest a protective effect at the lesion site caused by the fibrin sealant use. The stitches reduction minimizes the trauma caused by the needle and it accelerates the surgical practice. So the heterologous fibrin sealant use in nerve reconstruction should be considered.     

Preoperative morphologic changes of the medial meniscus correlate with suture translations during knee flexion in pullout repair of medial meniscus posterior root tear

BackgroundMedial meniscus (MM) translates and extrudes posteriorly during knee flexion in MM posterior root tear (MMPRT) knees, and transtibial pullout repair of MMPRT has been performed to regulate the MM extrusion. This study aimed to calculate each suture translation during knee flexion in transtibial pullout repair of MMPRT, and to investigate the morphologic features of the MM that lead to longer suture translations during knee flexion.MethodsThirty patients with MMPRT who met the operative indication of pullout repair were enrolled and investigated prospectively. Pullout repair was performed by using two simple stitches (outer and inner sutures) and an all-inside suture in the posteromedial part of the MM. Each suture’s translation from 0° to 90° of knee flexion was measured intraoperatively. The MM morphologic features, including MM medial extrusion (MMME) and MM posterior height (MMPH), were measured using preoperative magnetic resonance imaging, and the correlation between these values and each suture translation was evaluated.ResultsThe average outer, inner, and all-inside suture translations were 4.8 mm, 3.9 mm, and 1.3 mm, respectively. Significant correlations were observed between the outer suture translation and MMME, and MMPH (p < 0.001 and <0.01, respectively). The thresholds for preoperative MMME and MMPH for longer outer suture translations (≥6 mm) were 2.1 mm and 5.4 mm, respectively.ConclusionsPreoperative longer MMME and higher MMPH were associated with longer meniscus translations during knee flexion during MMPRT repair.     

缝合锚钉在踝关节骨折合并三角韧带完全断裂修复中的应用

【目的】探讨缝合锚钉在踝关节骨折合并三角韧带完全断裂修复中的临床应用价值。【方法】回顾性分析本院2015年1月至2020年1月收治的69例踝关节骨折合并三角韧带完全断裂患者的临床资料。按患者手术中是否应用缝合锚钉修复三角韧带深层,将其分为修复组(36例)和未修复组(33例)。对比两组术后1个月、术后6个月内侧间隙(MCS)、美国足踝外科协会踩后足评分(AOFAS)及疼痛视觉模拟评分(VAS)变化以及术后6个月踝关节活动度,评价两组临床疗效与安全性。【结果】两组术后6个月AOFAS评分均较术后1个月升高,VAS评分均较术后1个月下降,且修复组术后1个月、术后6个月MCS、VAS评分均低于未修复组,AOFAS评分高于未修复组;术后6个月,修复组踝关节趾屈、背伸角度均大于未修复组,临床优良率高于未修复组(86.11%vs 69.70%),其差异均有统计学意义(均P<0.05)。修复组术后并发症发生率为2.78%,低于未修复组的21.21%,差异有统计学意义(P<0.05)。【结论】缝合锚钉修复三角韧带深层能够促进踝关节骨折合并三角韧带完全撕裂患者术后踝关节功能恢复、减轻术后疼痛,降低术后复位不良等并发症风险,具有较好的临床应用价值。