Traumatic atlantal anterior arch fracture with associated avulsion fracture of the transverse ligament attachment: a previously undescribed combined entity

A case of an atlantal anterior arch burst fracture combined with an avulsion fracture of the transverse ligament attachment is presented. Similar cases have dealt with either isolated transverse ligament ruptures and avulsions or with Jefferson fractures associated with transverse ligament ruptures and avulsions. This case probably represents an entity in the spectrum of injury patterns to the atlanto-axial articulation.     

寰椎横韧带损伤的治疗策略

[目的]探讨寰椎横韧带在各种损伤状态下的治疗策略。[方法]本组共收治寰椎横韧带损伤患者26例，分析X线、CT及MRI资料，根据是否合并寰椎（或）齿状突骨折、损伤节段的稳定性及脊髓的损伤情况，4例行枕颈融合术，17例行寰枢椎融合术，5例行保守治疗。[结果]26例患者获6～36个月（平均18个月）随访，21例手术治疗患者疗效满意，5例保守治疗，其中4例效果满意，1例远期效果不佳行手术治疗。[结论]对于寰枢椎脱位、横韧带严重损伤，采用枕颈融合或寰枢椎融合术；对于横韧带部分损伤、寰枢椎稳定的患者采用保守治疗，但必须密切随访，出现不稳症状尽早手术治疗。     

寰椎Jefferson骨折伴横韧带损伤的诊治

目的 分析总结寰椎Jefferson骨折伴横韧带损伤的诊断和治疗。方法 1995年3月-2005年3月收治26例寰椎Jefferson骨折伴横韧带损伤患者。其中新鲜骨折20例，陈旧性骨折6例。所有患者均伴有不同程度的横韧带损伤，23例有神经损害表现。X线检查显示寰椎弓环及侧块不同部位骨折，寰齿间距（ADI）为4．7mm。5例行非手术治疗，其余21例行颈椎后路枕颈融合术或寰枢椎融合术治疗。结果所有患者术后获6～24个月（平均15个月）随访，21例手术治疗患者术后临床症状缓解；5例非手术治疗患者中，4例成功，另1例失败再行颈后路寰枢椎融合术治疗，术后疗效满意。结论 寰椎Jefferson骨折伴横韧带损伤患者的临床表现主要取决于韧带断裂后寰椎前脱位的程度以及是否造成脊髓压迫，诊断以ADI为主、并结合外伤史及临床表现。对于可能存在寰枢椎不稳或已有横韧带损伤且存在典型神经症状的患者，应早期行寰枢椎融合术或枕颈融合术治疗。     

外伤性寰椎横韧带断裂的治疗策略

目的探讨外伤性寰椎横韧带断裂治疗策略。方法回顾性分析一组24例寰椎横韧带断裂病例,其中单纯横韧带断裂15例,合并有寰椎骨折7例,合并齿状突骨折2例。急性损伤20例,陈旧性损伤4例。手术行寰枢椎融合术14例,枕颈融合6例,非手术治疗3例,入院后当天死亡1例。结果23例获得随访,平均随访时间为46个月。20例手术治疗患者中15例完全恢复正常,3例仍有局部症状,2例颈脊髓神经损害改善,无术后神经损害加重病例。3例接受非手术治疗患者中有2例出现寰枢椎不稳及迟发性脊髓损害。结论寰椎横韧带是维持寰枢椎正常解剖关系不可或缺的重要结构,横韧带断裂必然导致寰枢椎不稳定。无论是急性或陈旧性损伤,一旦诊断明确即应在早期行寰枢椎或枕颈融合术。     

后交叉韧带胫骨撕脱性骨折的手术治疗

目的 评价膝后内侧入路治疗后交叉韧带胫骨撕脱性骨折的临床疗效.方法 对于后交叉韧带胫骨撕脱性骨折,采用膝后内侧入路显露,采用空心螺钉或聚乙烯线捆绑固定骨折块,术后支具固定,早期行功能训练.结果 12例病例术后6周所有病例均显示骨性愈合,无骨折块移位.术后3月复查后抽屈试验均为阴性.按膝关节膝关节韧带损伤治疗效果判定标准(JOA),优良率为92%.无血管、神经损伤、关节液漏等并发症.结论 膝后内侧入路显露后交叉韧带胫骨撕脱性骨折,采用空心螺钉或聚乙烯线捆绑固定骨折块,手术创伤小,操作简单,固定可靠.     

Airway obstruction due to a rigid cervical collar

Airway obstruction after anterior cervical discectomy and fusion (ACDF) is a potentially life-threatening postoperative complication. We experienced a case of airway obstruction after an ACDF attributable to the rigid cervical collar used in the patient's postoperative care, which has not been reported previously.     

小切口治疗前交叉韧带胫骨附丽点撕脱骨折

目的 介绍一种小切口复位固定治疗前交叉韧带胫骨附丽点撕脱骨折的方法.方法 对22例前交叉韧带胫骨附丽点撕脱骨折患者采用小切口下复位固定手术.其中15例骨折复位后钢丝固定,4例用双股2号聚乙烯缝线固定,3例可吸收螺钉固定.对骨缺失影响交叉韧带长度者予以植骨.结果 19例获随访,时间6～24个月.X线及CT检查提示骨折愈合良好.采用Lysholm临床评分系统对膝关节功能进行评估:术前为20～30分,术后为92～100分.关节活动度与对侧相比基本恢复正常.19例均恢复伤前的运动水平(非专业运动).结论 小切口行前交叉韧带胫骨附丽点撕脱骨折复位固定,对膝关节软组织损伤小,有利于术后功能恢复,是一种比较理想的方法.     

Insertion of the Combitube airway with the cervical spine immobilised in a rigid cervical collar

The Combitube is a twin lumen device designed to establish the airway after blind insertion. Under general anaesthesia a rigid cervical collar was used to immobilise the neck in 15 ASA 1 and 2 patients. Insertion of the Combitube airway was then attempted. In 10/15 (66%) patients, blind insertion was not possible. In 5/15 (33%) successful blind insertions the Combitube entered the oesophagus on each occasion. In 8/10 of the failures, re-insertion of the Combitube was attempted with the aid of a Macintosh laryngoscope. In 6/8 cases (75%) satisfactory placement was then possible with the Combitube again entering the oesophagus on each occasion. Ventilation was satisfactory in all patients when insertion was successful. Blood staining of the Combitube was present in 7/15 (47%) patients. The Combitube cannot be recommended for use in patients whose necks are immobilised in rigid cervical collars.     

Arthroscopic treatment of an anterior cruciate ligament avulsion fracture in a skeletally immature patient

Anterior cruciate ligament injuries in skeletally immature patients usually involve tibial bony avulsion fractures rather than the midsubstance tears usually observed in adults. Several surgical techniques have been reported to provide stable fixation and avoid physeal injury in this pediatric population. The authors propose a novel, reproducible surgical technique using bioabsorbable anchors to obtain biomechanical stability and minimal physeal or articular cartilage damage.     

Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability

Twenty normal human subjects and 14 patients with upper cervical spine pathology were studied with axial high-field magnetic resonance (MR) imaging to examine the transverse atlantal ligament. Gradient-echo MR imaging pulse sequences provided reliable visualization of the transverse ligament, which exhibited low signal intensity and extended behind the dens between the medial portions of the lateral masses of C-1. The MR imaging characteristics of the transverse ligament were verified in clinical studies and in postmortem specimens. The clinical MR examinations defined 27 normal ligaments, three ligament disruptions, and four stretched rheumatoid ligaments. Atlantoaxial instability associated with transverse ligament rupture or ligamentous laxity required internal fixation. In contrast, fractures of C-1 or C-2 or atlantoaxial rotatory dislocations associated with an intact transverse ligament healed without instability or nonunion. The transverse ligament is the primary stabilizing component of C-1. The treatment of atlantoaxial instability has previously been based on criteria drawn from computerized tomography or plain radiographic studies, which only indirectly assess the probability of rupture of the transverse ligament. It is concluded that MR imaging accurately depicts the anatomical integrity of the transverse ligament. After transverse ligament failure, the remaining ligaments of the craniovertebral junction are inadequate to maintain stability. The presence of ligament disruption should be considered as a criterion for early fusion.     

A delayed transverse avulsion fracture of the superior pole of the patella after anterior cruciate ligament reconstruction

Patella fractures following anterior cruciate ligament (ACL) reconstruction using central one third patella-tendon autograft is a recognized although rarely reported complication of this procedure. Twelve reports of patella fractures after ACL reconstruction exist in the literature, although only half of these fractures occurred postoperatively. Two of the nonacute fractures occurred approximately 6 months postoperatively, one of them being an avulsion of the inferior pole of the patella and the other being a displaced transverse avulsion fracture of the patella. We report on a nondisplaced transverse avulsion fracture of the superior pole of the patella that occurred 1 year after ACL reconstruction despite bone grafting the defect in the patella at the time of surgery. We are unaware of any report of this kind in the literature.Arthroscopy 1998 Jan-Feb;14(1):85-8     

后交叉韧带胫骨止点撕脱骨折的手术治疗体会

2002年6月-2006年3月,我院对19例后交叉韧带胫骨止点撕脱骨折进行了手术治疗,疗效满意。     

关节镜下治疗前交叉韧带胫骨髁间嵴撕脱骨折

目的探讨关节镜下对前交叉韧带胫骨髁间嵴撕脱骨折应用缝合线加钢缆进行复位和内固定的疗效。方法 56例前交叉韧带胫骨髁间嵴撕脱骨折患者(Ⅱ型13例,ⅢA型15例,ⅢB型13例,Ⅳ型15例),关节镜下应用Ethibond X519缝合线加钢缆对胫骨髁间嵴撕脱骨折区进行缝合捆绑,通过胫骨髁前置双隧道牵引复位、固定。结果术后X线片显示胫骨嵴撕脱骨折完全复位。56例均获随访,时间18～21个月。末次随访时骨折完全愈合。Lachmen试验(-)56例;前抽屉试验(-)55例,1例弱阳性。IKDC评定:术前C级30例,D级26例;术后A级55例,B级1例。Lysholm评分:术前37～52(42.7±0.34)分;术后91～96(95.7±0.56)分,平均提高53.0分±0.43分,术前、术后比较差异有统计学意义(P<0.01)。结论关节镜下应用缝合线加钢缆内固定治疗膝关节前交叉韧带胫骨髁间嵴撕脱骨折,可以对移位的撕脱骨折很好地复位,最大限度地加大单位面积上的压力,增加刚性稳定。并可早期功能锻炼。     

Tibial tubercle fracture with avulsion of the patellar ligament: a case report

Fractures of the tibial tubercle are infrequent injuries in adolescents. A combined injury of the tibial tubercle and patellar ligament is an even more rare event. The literature includes only a few case reports of this injury pattern. In this article, we describe another case and a repair technique and try to increase awareness of this combined injury.     

Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management

BACKGROUND: Avulsion fractures of the posterior cruciate ligament have long been regarded as rare injuries. In the past, it was common practice to use cast immobilization as an external adjunct after open reduction and internal fixation of fractures. METHODS: Sixteen patients with displaced avulsion fractures of the posterior cruciate ligament were treated with open reduction and internal fixation between August 1989 and July 1993. Malleolar screws were chosen as fixation devices in 14 patients. In the other two, pull-through sutures were used because the size of the fractured fragments was too small to obtain purchase of screws. The postoperative management protocol evolved from an initial regimen of 6 weeks' immobilization in a cast with the knee flexed to 40 degrees for the first five patients (group I), to 4 weeks' immobilization in a cast for the next six patients (group II), to the present protocol of immediate postoperative range of motion (40-70 degrees) with muscle-strengthening exercises in a functional brace for the last five patients (group III). The average follow-up period was 36 months (range, 24-58 months). Hughston's criteria were used to assess the clinical results. RESULTS: Overall, there were 12 (75%) good and 4 fair (25%) results. There was no poor result. CONCLUSION: Avulsion fractures of the posterior cruciate ligament should be treated with open reduction and stable internal fixation if any displacement is seen on initial radiographs at presentation. With the use of functional brace and aggressive postoperative rehabilitation program (i.e., immediate range of motion of 40-70 degrees with muscle-strengthening exercises), satisfactory results can be expected and achieved.