Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury

Purpose:To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury.Methods:Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed.All the injuries have been confirmed by intraoperative exploration,computed tomography angiography or digital subtraction angiography.Complete or partial amputation injuries were excluded.Mild artery defect or partial intimal damage was treated by interventional implantation,while other patients received open surgeries,including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm.Patients were divided into open surgery group and stent implantation group based on the treatment they received.Patients were followed up at 2 weeks(first stage)and 6 months(second stage)after operation to investigate limb salvage.Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage.Results:Altogether 50 cases of subclavian artery injury were treated,including 36 cases of open surgery and 14 cases of stent implantation.Combination of nerve injury was observed in 27 cases(75.0%)in open surgery group and 12 cases(85.7%)in stent implantation group.Amputation developed in 3 cases with open surgery and 1 case with stent implantation.Consequently the rate of successful limb salvage was respectively 91.7%(33/36)and 92.9%(13/14),revealing no significant difference(p>0.05).Conclusion:Rapid reconstruction of blood circulation is crucial following subclavian artery injury,no matter what kinds of treatment strategies have been adopted.Interventional stent implantation can achieve a good effect for limb salvage.     

A Galeazzi-variant type fracture-dislocation in adults

Objective：Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint （DRUJ） is not a common injury and is inherently unstable.Here we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury pattern.Methods：The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age （20 to 45 years）.All fractures were closed type.Two fractures involved the same level and three fractures were at different levels of radius and ulna shaft.After thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for DRUJ.Results：All cases were followed up for 24 weeks.The maximum incidence occurred in age group between 31 and 40 years.All the fractures of both radius and ulna were united in average time of 12 weeks.Range of motion of wrist and elbow,supination and pronation at final follow-up were normal.There was no subsequent re-subluxation or dislocation of the DRUJ in any of the cases.Conclusion：Galeazzi variant in adult is a new undescribed pattern of forearm with wrist injury.Stable open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.     

微型万向外固定器与微型钢板治疗掌指骨关节内骨折脱位的疗效比较

Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.     

Comparison of minimally invasive reduction through a bone tunnel combined with Jail screwing and posterolateral locking plating for simple posterolateral tibial plateau fractures北大核心CSCD

Objective To compare the clinical effects of minimally invasive reduction through a bone tunnel combined with Jail screwing and those of posterolateral locking plating in the treatment of simple posterolateral tibial plateau fractures. Methods A retrospective analysis was conducted of the data of 48 patients who had been operatively treated and completely followed up at Department of Orthopedics, Suqian Hospital of Nanjing Drum Tower Hospital Group for simple posterolateral tibial plateau fractures from October 2016 to October 2020. There were 26 males and 22 females, aged from 35 to 68 years. They were divided into a minimally invasive group (25 cases subjected to minimally invasive reduction through a bone tunnel combined with Jail screwing) and an incision group (23 cases subjected to posterolateral locking plating) according to their surgical methods. The operation time, incision length, intraoperative blood loss, fracture healing time, cumulative fluoroscopy time, hospital stay and posterior inclination angles of the tibial plateau and Hospital for Special Surgery (HSS) knee function scores at 1, 3, 6, 9, and 12 months after operation were compared between the 2 groups. Complications in the 2 groups of patients were recorded. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P>0.05). The 48 patients were followed up for 12 to 36 months (average 16.5 months). The minimally invasive group was significantly better than the incision group in operation time [(42.6±9.1) min versus (65.7±11.5) min], incision length [(4.0±0.4) cm versus (15.0±1.5) cm], intraoperative blood loss[(22.6±5.8) mL versus (31.5±8.8) mL], hospital stay [(7.6±1.4) d versus (11.1±2.4) d], and HSS score one month after operation [(84.8±1.9) points versus (72.9±4.1) points], but the cumulative fluoroscopy time in the incision group [(4.1±1.4) s]was significantly less than that in the minimally invasive group [(22.3±4.2) s] (P<0.05). There were no significant differences in fracture healing time, HSS scores at 3, 6, 9, or 12 months after operation, or posterior inclination angle of the tibial plateau between the 2 groups (P>0.05). There were no such complications as wound infection, vascular injury, internal fixation failure, nonunion or malunion of fractures in either of the 2 groups. Two cases in the incision group presented with symptoms of common peroneal nerve injury but recovered 3 months after operation. Conclusions Although both minimally invasive reduction through a bone tunnel combined with Jail screwing and posterolateral locking plating can achieve satisfactory outcomes in the treatment of simple posterolateral tibial plateau fractures, the minimally invasive technique is preferable because it shows the advantages of a smaller incision, less bleeding, shorter operation time, a lower operation risk, quicker postoperative recovery and shorter hospital stay. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

微型万向外固定器与微型钢板治疗掌指骨关节内骨折脱位的疗效比较

Objective To compare the clinical outcome of external fixation device with Kirschner wire or fragment fixation pin with mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture dislocation. Methods From October 2002 to March 2008, 106 patients with metacarpal and phalangeal articular fracture dislocation were randomly divided into A and B group. The 53 patients in A group were treated with external fixation device with Kirschner wire or fragment fixation pin. There were thumb injury in 24 cases, fracture-dislocation of proximal interphalangeal joint(PIP) in 36 cases, fracture-dislocation of metacarpophalangeal joint (MP) in 17 cases. The 53 patients in B group were treated with mini plate and screw fixation. There were thumb injury in 22 cases, fracture-dislocation of PIP in 30 cases, fracture-dislocation of MP in 23 cases. Duncan rating criteria were used to compare finger range of motion. Results The mean follow-up of 16.8 and 17.5 months in A group and B group. According to Duncan rating criteria, there were excellent in 33 cases, good in 16, fair in 3, and poor in 1 case. The excellent and good rate was 92.5% in A group. There were excellent in 30 cases, good in 17, fair in 5, and poor in 1 case. The excellent and good rate was 88.7% in B group. In A group, 1 case of wound infection was found. The average arc of motion of thumb joint was 134°±21° while the average arc of motion of other fingers was 248°±19°. In B group, no wound infection occurred. The average arc of motion of thumb joint was 122°±18° while the average arc of motion of other fingers was 225°±17°. Conclusion External fixation device with Kirschner wire or fragment fixation pin was better than the application of mini plate and screw fixation in treatment of metacarpal and phalangeal articular fracture-dislocation.     

Comparison of functional outcomes among subtypes of Fraser’s typeⅡfloating knee

Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.     

Biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects北大核心CSCD

Objective To evaluate biplane osteotomy and bone transport combined external locking plating for sequential treatment of massive tibial bone defects. Methods Twenty-eight patients with massive tibial bone defects were reviewed who had been treated at Department of Repair and Reconstruction, Wuhan Puai Hospital from October 2013 to October 2019. They were divided into a bone transport group and a combined bone transport group (bone transport combined external locking plating) according to their surgical methods. In the bone transport group of 14 cases, there were 10 males and 4 females with an age of (38. 6 ±3. 2) years and a bone defect of (8. 0 ± 0. 5) cm; in the combined bone transport group of 14 cases, there were 9 males and 5 females with an age of (39. 1 ± 3. 9) years and a bone defect of (8. 3 ± 0. 3) cm. The time for wearing external fixator, fracture healing time, dock-in-site healing time, postoperative function assessment and complications were observed and compared between the 2 groups. Results There was no significant difference between the 2 groups in their preoperative general data, showing they were comparable (P > 0. 05). The bone transport group were followed up for 12 to 28 months (average, 18. 4 months) and the combined bone transport group for 12 to 26 months (average, 16. 8 months) . The time for wearing external fixator in the combined bone transport group [(8.4±0.7) months] was significantly shorter than that [(13.3±1.4) months ] in the bone transport group (P< 0. 05). No significant difference was observed between the 2 groups in either the fracture healing time [ (8. 4 土1.3) months versus (7. 4 ± 1. 2) months] or the dock-in-site healing time [(210. 2 ±9.1) months versus (206. 2 ± 9. 8) months ] (P > 0. 05). By the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring, the bone healing was excellent in 6, good in 5 and fair in 3 cases in the bone transport group while excellent in 8, good in 4 and fair in 2 cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate (P > 0. 05). By the postoperative functional assessment of the lower extremity, there were 7 excellent, 3 good, 3 fair and one poor cases in the bone transport group while 8 excellent, 5 good and one poor cases in the combined bone transport group, showing no significant difference between the 2 groups in the excellent to good rate (P > 0. 05). In the bone transport group, there were 3 cases of pin track infection, one case of dock-in-site nonunion, 2 cases of poor alignment of lower extremities, 2 cases of skin depression, one case of nail loosening, 5 cases of joint stiffness and 3 cases of delayed union of the distracted bone; in the combined bone transport group, there were one case of pin track infection, 2 cases of poor alignment of lower extremities, 3 cases of skin depression, 3 cases of joint stiffness, 2 cases of delayed union of the distracted bone and one case of refracture. Conclusion In the sequential treatment of massive tibial bone defects, biplane osteotomy and bone transport combined external locking plating can reduce the time for wearing external fixator and increase the satisfaction of patients. © The Author(s) 2022.     

Treatment of Schatzker type IV tibial plateau fracture involving the postero-lateral condyle with a medial support plate and a row of screws北大核心CSCD

Objective To investigate the clinical efficacy of a medial support plate and a row of screws in the treatment of Schatzker type IV tibial plateau fracture involving the postero-lateral condyle. Methods A retrospective analysis was performed of the data of 26 patients who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xian Jiaotong University for Schatzker type IV tibial plateau fracture involving the postero-lateral condyle from December 2015 to December 2020. There were 17 males and 9 females, aged from 19 to 51 years (average, 36. 1 years). All their fracture lines involved the postero-lateral condyle and all fractures were fixated with a medial support plate and a row of screws via one medial and one lateral incisions. Recorded were the operation time, hospital stay, blood loss, incision length, fracture healing, complications, quality of knee joint reduction and knee joint function at the last follow-up. Results The length of hospital stay ranged from 8 to 16 days, averaging 10. 4 days. The 26 patients were followed up for 8 to 18 months, with an average of 14. 3 months. All the fractures got united after 11 to 17 weeks (average, 13. 7 weeks). During the follow-up, no reduction loss, internal fixation failure or surgical complications were observed. Rasmussen radiographic scores at the last follow-up ranged from 11 to 18 points, averaging 16. 1 points. The range of motion of the knee joint ranged from 0° to 140。， averaging 120. 8°. The Rasmussen scores of the knee function ranged from 14 to 28 points, averaging 24. 4 points. Conclusion In the treatment of Schatzker type IV tibial plateau fracture involving the posterolateral condyle, the use of a medial support plate and a row of screws can achieve satisfactory clinical results. © The Author(s) 2022.     

Chinese Journal of Traumatology won the financial aid from ＂Global Influ- ence Promotion Project for Chinese Scientific and Technical Journals＂

Objective： To determine the frequency of adrenal injuries in patients presenting with blunt abdomi- nal trauma by computed tomography （CT）. Methods： During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and ret- rospectively reviewed for adrenal gland injuries. Results： A total of 7 patients were identified as having adrenal gland injuries （6 males and 1 female）. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver （1 case）, spleen （1 case）, retroperitoneum （2 cases） and mesentery （4 cases） were identified. Overall 24 cases with liver injuries （29 %）, 11cases with splenic injuries （13%）, 54 cases with mesenteric injuries （65%）, 14 cases （17%） with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion： Adrenal gland injury is identified in 7 patients （11.7%） out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.     

Repair and reconstruction of severe leg injuries： retrospective review of eighty-five patients

Objective:To explore a good way of the reconstruction of severe tibial shaft fractures by using different flaps and external fixators. Methods: Eighty-five patients of TypeⅢC tibial shaft fractures with average age of 42.5 years were treated in our hospital from 1990 to 2005. Injuries were caused by motorcycle accidents in 66 patients, by machine accidents in 16 patients, and by stone bruise in 3 patients. The management procedures consisted of administration of antibiotics, serial debridment, bone grafting if needed, application of different flaps, such as free thoracoumbilical flaps, fasciocutaneous flaps, saphenous neurocutaneous vascular flaps, sural neurocutaneous vascular flaps and gastrocnemius muscular flaps, and different external fixations, for instance, half-ring fixators, unilateral axial dynamic fixators, AO fixators, Weifang fixators, and Hybrid fixators. The average follow up was 6.3 years. Results: All flaps survived. Eighty-three cases had bone healed. The average bone healing time of different external fixations was 5.5 months in 47 cases with half-ring fixators, 9.2 months in 4 cases treated with unilateral axial dynamic fixators, 8.5 months in 6 cases with AO fixators, 10.7 months in 16 cases with Weifang fixators, and 7.8 months in 10 cases with assembly fixators. Except half-ring fixation, other fixations all needed necessary bone graft. Two cases treated with unilateral axial dynamic fixators had nonunion of bone and developed osteomyelitis. The wounds healed after the removal of the fixators and immobilization by plaster. The last follow up examination showed ankle and knee motion was normal and no pain was noted. Conclusions: The combination of half-ring external fixators with various flaps provides good results for TypeⅢC tibial shaft fractures.     

Posterolateral dislocation of the knee joints:analysis of 9 cases

Posterolateraldislocationofthekneejointisrare .Till 1981,only 2 7caseswerereportedinEnglishliteratures1andnocaseswerereportedafterwards.2 ,3Thiskindofinjuryislikelymisdiagnosedasligamentdisruptionorirreducibledislocationdueto”buttonholing”ofthe jointmedially4 (Fig .1 1)Between 1979and 2 0 0 19casesofposterolateraldislocationofkneejointsweretreatedinourhospital.The pathologicalcharacteristics ,complicationsandtreatmentareanalyzedanddescribedinthispaper .Fig .1 1.Buttonholingoffemoralmedialc…     

选择性胫骨外髁U形截骨入路治疗胫骨外侧平台塌陷粉碎骨折

目的:探讨选择性胫骨外髁"U "形截骨入路治疗胫骨外侧平台塌陷粉碎骨折的方法和临床疗效。方法:自2014年1月至2019年10月,采用选择性胫骨外髁" U"形截骨入路对15例胫骨外侧平台塌陷粉碎骨折患者进行手术治疗,其中男9例,女6例;年龄25~70(38.5±7.7)岁。按照胫骨平台外侧髁骨折ABC分型,A型2例,B型6例,BC型4例,C型3例;合并内侧平台骨折5例;左膝8例,右膝7例。伤后至就诊时间1~14(3.4±1.2) d。所有患者CT提示胫骨外侧平台塌陷>2 mm,粉碎骨块>2块,胫骨外侧髁皮质完整。术后12个月采用Rasmussen骨折复位解剖学评分评价骨折复位情况,并采用Rasmussen功能评分评价膝关节功能。结果:15例患者选择性"U "形截骨一次成功,手术时间55~110(85.6±20.0) min,外侧平台手术时间20~60(30.5±10.5) min。所有患者获随访,时间12~24(14.6±2.5)个月。骨折愈合时间12~24(13.6±3.6)周。术后12个月膝关节Rasmussen骨折复位解剖学评分14~18(17.5±0.3)分,其中优13例,良2例。膝关节Rasmussen功能评分13~30(26.8±2.5)分;其中优12例,良1例,可2例。2例外侧平台高度分别丢失2 mm和4 mm,1例膝关节5°外翻畸形,1例关节僵硬(10°~100°)。未发生腓总神经损伤、腘血管损伤,术后无感染、内固定失效等严重并发症。结论:采用选择性胫骨外髁" U"形截骨入路治疗胫骨外侧平台塌陷粉碎性骨折,具有手术切口简单、骨折显露直接、复位固定准确、手术时间短,并发症少等优点,是一种有效、可靠的方法。     

经改良腓骨小头上入路L型钢板治疗累及后外侧髁的胫骨平台外侧骨折的临床研究

目的 探讨单一L型钢板治疗累及后外侧髁的胫骨平台外侧骨折的临床疗效。方法 回顾性分析2016年10月至2021年3月山东大学附属山东省立医院收治的23例累及后外侧髁的胫骨平台外侧骨折病人的临床资料,其中男12例,女11例,年龄为22～73岁,平均40.5岁。受伤原因：高处坠落10例,交通事故10例,重物挤压3例,均为闭合性骨折。病人受伤至入院时间为2～72 h,入院至手术时间为3～14 d。均采用改良的腓骨小头上入路,骨折复位后L型钢板固定,一期处理合并前交叉韧带及半月板损伤。末次随访采用美国特种外科医院（American Hospital for Special Surgery,HSS）膝关节评分评价膝关节功能。结果 平均手术时间为53 min(45～71 min),平均术中出血量为122 m L(55～150 m L),平均随访时间为16.1个月（11～20个月）。X线复查结果示骨折均愈合,愈合时间为12～17周。末次随访时膝关节伸直度为0°～35°,膝关节屈曲度为100°～150°,HSS评分平均为92.2分（81～100分）。结论 单一L型钢板可以同时有效地固定胫骨平台后外侧髁...     

外后侧弧形切口双肌间隙入路治疗胫骨后外侧平台塌陷骨折

 目的 探讨外后侧弧形切口双肌间隙入路治疗胫骨后外侧平台塌陷骨折的临床疗效。方法 回顾性分析 2009年 8月至 2013年 3月,采用外后侧弧形切口双肌间隙入路治疗 32例伴有后外侧劈裂、塌陷的胫骨平台骨折患者资料,男 15例,女 17例;年龄 28~77岁,平均 46.25岁;均为闭合性骨折,均未合并神经及血管损伤;受伤至内固定手术时间为 3~ 18 d,平均 7.13 d。通过外后侧入路在胫前肌、腘肌和比目鱼肌间隙两个间隙分别显露胫骨前外侧髁及后外侧髁,在直视下复位骨折,分别用“高尔夫”与“T”形锁定钢板固定胫骨前外侧和后外侧骨折。术后按 Rasmussen 评分评价胫骨平台骨折复位情况,按美国特种外科医院（hospital for special surgery, HSS）评分评价膝关节功能。结果 32例患者均获得随访,随访时间 6~36个月,平均 15.3个月。术后 X线片均示骨折复位良好,关节面未见明显塌陷。骨折全部愈合,愈合时间 6~ 14周,平均 11.2周。末次随访时,Rasmussen评分为 6~18分,平均 14.06分,其中优 14例,良 15例,可 3例,优良率为 90.62%（29/32）。HSS评分为 57~92分,平均 78.25分,其中优 11例,良 17例,可 3例,差 1例,优良率为 87.5%（28/32）。无一例发生腓总神经损伤及重要血管、神经损伤、手术区皮肤坏死、感染或内固定松动。结论 胫骨平台后外侧塌陷骨折采用外后侧弧形切口双肌间隙入路治疗,在一个切口内既可显露胫骨前外侧平台骨折又可兼顾后外侧塌陷骨折,无须腓骨小头截骨,创伤小,切口间皮瓣坏死及钢板外露的发生率低,是一个值得推广的入路。     

膝关节周围创伤伴腘窝血管伤的早期诊断与救治

目的 :探讨膝关节周围创伤伴腘窝血管伤的早期诊断与救治。方法 :回顾性分析2007年1月至2013年1月15例膝关节周围骨折、脱位伴腘窝血管损伤患者的临床资料,其中男9例,女6例;年龄26~62岁,平均39.2岁。结合临床症状、体征,运用血氧饱和度监测仪、彩色超声、DSA介入造影及手术探查等方法明确血管损伤,分别采用组合式外固定支架、钢板螺钉股骨髁逆行交锁钉内固定骨折及膝关节脱位,并根据具体情况对损伤血管进行取栓、修补、自体静脉移植重建血循环,分析手术时间、住院天数、保肢指数、输血量、医疗费用及感染发生情况,明确早期诊断及有效救治的作用。结果:本组患者死亡1例,截肢8例,6例手术成功修复腘动脉、胫前及胫后动脉。6例肢体存活患者随访12~60个月,平均28.3个月。保肢成功且关节功能优良4例。结论:膝关节周围创伤伴腘窝血管伤具有伤情复杂且严重、易误漏诊、预后差、保肢风险高等特点,应结合患者的创伤机制、损伤部位局部解剖特点、临床表现及适当的辅助检查来把握膝关节周围创伤伴腘窝血管伤的早期诊断,掌握合适的保肢与截肢指征以高效救治患者。     

Ein modifizierter posterolateraler Zugang für die operative Versorgung von Tibiakopffrakturen

Objective

Open reduction and internal fixation of posterolateral tibial plateau fractures.

Indications

Tibial plateau fractures involving the posterolateral quadrant.

Contraindications

Critical soft-tissue conditions. Tibial plateau fractures which do not involve the posterolateral quadrant.

Surgical Technique

90° side positioning on the contralateral side, skin incision along the fibular head, exposure of the peroneal nerve, lateral arthrotomy and exposure of the joint, dissection of the popliteal cavity between the lateral head of the gastrocnemius muscle and soleus muscle. Blunt preparation between popliteus muscle and soleus muscle under preservation of the popliteal artery and vein. Sharp dissection of the soleus muscle from the dorsal parts of fibula and tibia until the peroneal nerve at the fibular neck enters into the muscle. Exposure of the posterolateral tibial head. The dorsal joint capsule and the popliteal corner are prevented from any soft-tissue damage. Visual control of fracture reduction by viewing in the joint gap through lateral arthrotomy. Reduction of the fracture from dorsal with pointed reduction forceps. A conventional or locking radius T-plate can be pinched off with lateral cutters and anatomically bent for fracture fixation and is dorsally fixed at the tibial plateau.

Postoperative Management

10 kg partial weight bearing for 6–8 weeks. Limited range of motion 0-0-90° for 6 weeks.

Results

In a period of 2 years, seven patients with posterolateral tibial plateau fractures received open reduction and internal fixation by using the modified posterolateral approach. The patients were examined at follow-up between 12 and 24 months after surgery. Six patients were free of pain with full range of motion and stable knee joints. Radiologically, a good fracture reduction was achieved in six cases. In one patient with a posterolateral comminuted dislocation fracture, a small fracture step and a gap could be observed. No approach-related complications were found.     

Ruptur des vorderen Kreuzbands

Rupture of the anterior cruciate ligament (ACL) is the most common ligamentous knee injury. The knee is stabilized by the cruciate ligaments and the collateral ligaments. The ACL originates from the inner surface of the lateral condyle of the femur, runs in an anterior medial direction and inserts at the tibial plateau in the intercondyle area. The most common injury is an indirect knee trauma, typically a joint torsion in sports. Patients often describe a snapping noise followed by hemarthrosis. Concomitant injuries are lesions of the medial collateral ligament, the medial meniscus (unhappy triad) and chondral fractures. The age peak is between 15 and 30 years with a higher incidence in females. The cardinal symptom of the ACL rupture is the giving way phenomenon. The clinical diagnosis is provided by a positive Lachman test, a positive pivot shift test and the anterior drawer test. Fractures can be excluded by X-ray examination. Magnetic resonance imaging (MRI) allows the evaluation of the internal knee structures. ACL repair is carried out by arthroscopically assisted bone-tendon-bone or semitendinosus grafting techniques. Early rehabilitation is important for a good functional outcome.     

Posteromedial approach of gastrocnemius for reduction and internal fixation of avulsed tibial attachment of posterior cruciate ligament

Posteriorcruciateligament(PCL)injuriesarenotfrequentlyencounteredinclinicalpractice.ForthereasonthatPCLpossessesthestrengthastwiceasanteriorcruciateligament(ACL),bony avulsionofthePCLfromthetibiahappensmore frequently.Thetraditionalapproachfromthepopliteal fossatothetibialattachmentofthePCLtofixthisbony avulsiononthetibiaisdifficulttoexposetheinjured site,istime consumingandhazardoustothepopliteal neurovascularbundles,whichleftalongskinincision andmadeameticulousprocessinthedeeparea.1,2F…     

膝关节脱位多韧带损伤Ⅰ期修复重建的临床观察

目的:探讨关节镜下Ⅰ期异体肌腱重建并结合关节外微创技术治疗膝关节脱位合并多发韧带损伤的临床疗效。方法:2008年1月至2012年1月共收治48例膝关节脱位患者,排除腘血管损伤,采用关节镜下Ⅰ期重建前后交叉韧带,并结合关节外微创技术修复膝关节韧带损伤。男38例,女10例;年龄20～59岁,平均35.6岁;左膝22例,右膝26例;伤后至手术时间2 d～2周。前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)及后外侧复合体(PLC)损伤2例,ACL、PCL及MCL损伤36例,ACL、PCL及PLC损伤10例。合并腓总神经损伤4例。比较术前及末次随访时Lysholm 评分以评价膝关节功能。结果:所有患者获得随访,时间12～30个月,平均(18.2±6.3)个月,患者关节活动度和稳定性明显改善,Lysholm评分由术前40.3±4.1提高为随访时87. 0±6.4.结论:关节镜下应用同种异体肌腱Ⅰ期重建膝关节脱位并多韧带损伤,能较好地恢复关节稳定性,保留关节功能。术前训练指导及术后个体化康复是膝关节功能恢复的关键。