垫治疗青少年颞下颌关节紊乱病临床疗效的观察

目的:观察利用垫治疗青少年颞下颌关节紊乱病临床症状改善情况。方法:采用热凝塑料垫或全牙弓软塑胶牙垫治疗65例青少年颞下颌关节紊乱患者,观察治疗前后张口度、颔面部疼痛和关节弹响的变化情况。结果:治疗组65例患者中关节弹响51例,张口受限14例,疼痛伴关节弹响24例,疼痛伴张口受限12例,治疗后疼痛及张口受限均得到缓解,缓解率为100%,弹响消失38例,27例弹响减轻。结论:垫对青少年颞下颌关节紊乱病患者的临床症状有显著改善作用。     

髋关节镜术治疗股骨髋臼撞击合并外侧弹响髋

[目的]评估髋关节镜术治疗股骨髋臼撞击综合征(femoroacetabular impingement syndrome,FAI)合并外侧弹响髋(external snapping hip,ESH)的临床疗效.[方法]回顾性分析2014年1月—2019年6月本院行髋关节镜术患者,25例FAI合并ESH的患者列入观察组,...     

误诊为半月板损伤的弹响膝122例分析

目的探讨误诊为半月板损伤患者弹响膝的发生机制、临床表现、诊断和关节镜治疗。方法回顾性分析122例术前误诊为半月板损伤的弹响膝患者资料,所有患者均接受膝关节镜手术。分析不同病因导致膝关节弹响的部位、响度、发生频率、镜下表现,最终评价关节镜手术疗效。结果许多疾病均可出现膝关节弹响,最常见原因为半月板损伤,其次是关节内游离体、软骨病变、滑膜病变、髌股关节紊乱、韧带及肌腱损伤等。其弹响各有特点,关节镜诊治后91．8％弹响症状完全消失,少数患者残余部分症状？结论膝关节弹响来源多样,半月板源性的弹响最为常见。掌握弹响特点有助于术前正确诊断,提高手术疗效,避免过度医疗。关节镜手术是诊治弹响膝的金标准。     

针刀、封闭、理疗治疗弹响髋13例

弹响髋是髋关节在屈伸活动时 ,于转子后可感受或听到如“咔嘣”的响声。患者多见于青年人或运动员 ,伴有患肢的酸痛、活动受限等症状 ,笔者治疗 13例 ,疗效满意 ,报告如下 :1　临床资料1.1　一般资料　男 12例 ,女 1例。年龄18～ 32岁 ,平均 2 4岁。发病时间最短 2个月 ,最长 2年半 ,平均半年。右侧 6例 ,左侧 4例 ,双侧 3例。伴大转子滑囊炎 2例。有髂胫束挛缩者 2例。1.2　诊断要点　 (1)患者在屈伸髋关节时于转子后常有弹响发生。(2 )患侧下肢酸、胀、痛 ,有时向外下方放射 ,转体、伸髋等活动时尤为明显。(3)臀部及转子后有压痛 ,压痛点…     

膝关节置换术后的关节摩擦音或弹响

膝关节置换术后的关节摩擦音或弹响的发生并不罕见,发病率0%~18%不等。其主要机制是髌骨周围纤维组织的增生,在髌骨上极与股四头肌肌腱连接部形成或者不形成明确的纤维结节。导致膝关节置换术后关节摩擦音或弹响的因素有很多,比如假体类型、关节线的改变、髌骨高度、髌骨厚度、髌骨轨迹异常、手术创伤等等。术后关节摩擦音或弹响,特别是伴有疼痛时,对患者术后膝关节功能的恢复和生活质量的提高有着明显影响。治疗方法包括保守治疗、关节直接切开术和关节镜手术。但膝关节置换术后的关节摩擦音或弹响的影响因素及治疗方式仍存在很多争议。     

腱鞘挑开术治疗板机指33例体会

手指屈肌腱腱鞘炎,常在指伸屈活动时出现弹响,临床上又称为板机指或弹响指,以往用局部激素封闭、腱鞘切开手术方法治疗。我院自1984年用腱鞘挑开术治疗33例,男性15例,女性18例;年龄30～80岁。拇指16例,食指6例,中指9例,环指2例。除2例再次作了腱鞘切开,其余病例均在较短时间内使弹响消失,指     

关节镜下低温等离子刀治疗膝关节骨性关节炎

目的探讨膝关节骨性关节炎的微创治疗方法。方法在关节镜下利用低温等离子刀治疗46侧膝关节骨性关节炎。结果所有患者均获得平均36个月随访。术后28例主诉疼痛明显减轻或无疼痛,关节肿胀减轻或消失,4例交锁症状消失,12例诉上下楼梯时疼痛较术前减轻,2例仍有弹响症状但无疼痛。采用Lysholm膝关节功能评分:显效24例,有效18例,尚可4例。46例膝关节功能均得到明显改善,患者满意度为85%。结论低温等离子刀治疗膝关节骨性关节炎疗效确切,手术出血少,安全性高,值得推广。     

膝盘状半月板的临床研究

目的 探讨完全型盘状半月板的症状特点及盘状半月板的症状、体征与损伤类型、范围和关节镜手术预后的关系。方法 对关节镜确诊的 64膝盘状半月板的病例进行分析。按不同年龄、关节有无肿胀、绞锁和弹响等症状分组,比较完全型外侧盘状半月板的发生率分布;按不同损伤形态分组,比较有关节弹响症状的发生率分布;按不同损伤类型分组,比较有屈膝挛缩症状的发生率分布;按不同疼痛时间、关节有无肿胀、绞锁、弹响、股四头肌有无萎缩及关节活动度等症状分组,比较盘状半月板行全切除术和次全切除术占所有关节镜手术的百分率。并对上述计数资料进行统计学分析。结果 20岁以下组与 20岁以上组之间（ P0.05）。结论 完全型盘状半月板多见于 20岁以下且关节有弹响症状的青少年,少见于关节有绞锁症状的患者。弹响多见于复杂损伤和广泛损伤,其可作为关节镜手术适应证之一。屈膝挛缩多见于纵行撕裂和广泛损伤;从疼痛时间、临床症状和体征难以对盘状半月板的关节镜手术的预后作出评估。     

髂腰肌腱弹响4例

髂腰肌腱在髂耻结节上滑动产生的弹响髋临床上极少见到,常因为得不到早期诊断而延误了治疗.笔者临床遇到4例,治疗体会如下. 1 典型病例 患者男性,50岁,工人.跌倒即感到腰部疼痛,可行走,伤后第二天行走时右髋部痛伴弹响声,渐重,至不敢行走.休息后疼痛减轻,但弹响在行走时依然出现.其弹响特点是:每在右腿迈步、足跟抬起足尖将要离地时出现弹响;弹响过后疼痛即刻减轻,髋关节亦可屈至正常度数.发病4周后就诊.查体:右髋关节主动伸屈有明显的"喀嗒"弹响声,腹股沟处压痛,当仰卧主动屈髋至约45°时腹股沟处痛加重并出现弹响声,此时检查者用拇指压住腹股沟中点处,可感到明显的弹跳感,弹跳过后可屈髋至90°;当伸髋至大约45°位时又出现疼痛感和明显的弹跳声.大粗隆处未扪到条索状物.髋关节X光拍片检查无异常发现,B超探测腹股沟中点处呈片状密度减低区.诊断为弹响髋(髂腰肌腱弹响).用1%普鲁卡因10ml加强的松龙2ml在髂耻结节周围封团,每周一次,连续2次,局封期间卧床休息,同时口服非甾体类药物和少量抗菌素.2周后逐渐恢复正常活动.半年后复发,疼痛程度较上一次轻,但弹响声明显,又连续局部封闭二次疗效不明显遂于局麻下行髂耻结节剔除术.术中见髂腰肌腱与髂耻结节接触处明显变粗,凿平了异常隆起的髂耻结节.随访6年,未再复发.     

小切口髂胫束松解术治疗外侧型弹响髋

目的探讨小切口髂胫束松解微创外科治疗外侧型弹响髋的可行性。方法回顾性分析本院2008-11—2012-07采用小切口髂胫束松解术治疗12例外侧型弹响髋,对临床病例进行对比研究,评估手术及切口愈合时间、症状改善程度等指标。结果 12例患双侧病变,手术前11例不能并膝下蹲,另1例重症患者分膝也不能下蹲。手术后当天所有患者弹响消失,完全下蹲。手术后平均住院时间2.5 d,无切口血肿、神经损伤等并发症。结论小切口髂胫束松解术软组织微创外科治疗外侧型弹响髋,是一种安全、有效、美观、经济的术式。     

Editorial Commentary: The Indication and Technique of Iliotibial Band Release for External Snapping Hip During Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome

Patients with femoroacetabular impingement syndrome (FAIS) often have extra-articular disorders, such as external snapping hip (ESH). We recommend that obvious ESH be addressed by endoscopic transversal iliotibial band (ITB) release during hip arthroscopy for FAIS because the residual serious snapping caused by ESH negatively affects the outcome of hip arthroscopy. However, for mild ESH without indications for severe trochanteric bursitis on magnetic resonance imaging, we still propose that physical therapy, extracorporeal shock wave therapy, or local injection be performed for pain relief. Surgical interventions for ESH including the Z-plasty technique and the modified Z-plasty technique for lengthening the ITB, as well as endoscopic cruciate or transversal incision in the ITB for release, have been reported with good results. Every technique has advantages and disadvantages, and we believe that surgeons should perform ITB release for ESH at the time of hip arthroscopy for FAIS based on their personal experience and inclination. In any case, excessive release of the ITB should be avoided. Finally, we wish to propose that more attention should be paid to the peri–greater trochanter (GT) space, an anatomic space between the ITB and the GT, which is similar to the subacromial space in the shoulder joint. Greater trochanteric pain syndrome (GTPS), related to the peri-GT space, is a spectrum of disorders, including trochanteric bursitis, abductor tendon pathology, and ESH. Precise diagnosis and proper procedures for concurrent GTPS during surgery may improve the outcome of arthroscopy in patients with both FAIS and GTPS.     

Coxa Saltans: The Snapping Hip Revisited

Coxa saltans, or "snapping hip," has several causes. These can be divided into three types: external, internal, and intra-articular. Snapping of the external type occurs when a thickened area of the posterior iliotibial band or the leading anterior edge of the gluteus maximus snaps forward over the greater trochanter with flexion of the hip. The internal type has a similar mechanism except that it is the musculotendinous iliopsoas that snaps over structures deep to it (usually the femoral head and the anterior capsule of the hip). Intra-articular snapping is due to lesions in the joint itself. Diagnosis of the external and internal types is usually made clinically. Radiography can be useful in confirming the diagnosis, particularly when bursography shows the iliopsoas tendon snapping with hip motion. Other radiologic modalities, such as computed tomography, magnetic resonance imaging, and arthrography, may also be helpful, especially when there is an intra-articular cause. Most cases of snapping hip are asymptomatic and can be treated conservatively. However, if the snapping becomes symptomatic, surgery may be necessary. There may also be a role for arthroscopy in the treatment of intra-articular lesions.     

Snapping during manual stretching in congenital muscular torticollis

Manual stretching frequently is used in the treatment of congenital muscular torticollis in infants. During manipulation, it is not uncommon for the sternocleidomastoid muscle to snap or suddenly give way. The main objective of this study was to evaluate the predisposing causes and clinical significance of such snapping. Four hundred fifty-five patients younger than 1 year of age with congenital muscular torticollis treated with a standardized gentle manual stretching program during a 13-year period were studied. Using prospective standardized assessment parameters, the pretreatment, treatment, and followup results of a group of 41 patients with snapping detected during treatment were compared with the results of a group of 404 patients without snapping during treatment. The group with snapping was associated with a more severe sternomastoid tumor, higher incidence of hip dysplasia, earlier clinical presentation, and shorter duration of treatment. With a mean followup of 3.5 years, the group with snapping was not different from the group that had no snapping in the final assessment score and percentage requiring surgery. From this study, unintentional snapping during the gentle manipulation treatment of congenital muscular torticollis has clinical and ultrasonographic evidence of partial or complete rupture of the sternocleidomastoid muscle. No long-term deleterious effect on the outcome was observed after the snapping.     

Clinical results of multiple fibrous band release for the external snapping hip

Background  External snapping hip is caused by snapping of the thickened iliotibial band or the gluteus maximus over the greater trochanter. We retrospectively reviewed results of the release of multiple fibrous bands of the iliotibial band or gluteus maximus for treatment of external snapping hip in 44 patients. Methods  We wanted to evaluate the functional results of this technique in terms of resolution of symptoms, patient satisfaction, and complications. A snapping hip questionnaire was designed for the evaluation, and the results were evaluated at an average 62 months after surgery. Results  All the patients had resolution of their symptoms after surgery and were satisfied with the treatment. Recurrence of snapping was reported in five patients, but they did not find it severe enough to require a second surgery. Ten patients reported some limp or weakness, and four patients had seroma formation, requiring reinsertion of a drainage tube. Conclusions  We recommend release of multiple fibrous bands of the iliotibial band and gluteus maximus muscle for treatment of external snapping hip, as it has a low rate of recurrence and a high rate of patient satisfaction.     

Postoperative imaging in arthroscopic hip surgery

Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.     

Editorial Commentary: The Cause of Groin Pain Is Difficult to Determine: The Elusive “Nether-Nether Region”

As one of the many causes of groin pain, iliopsoas tendinitis can be hard to identify and even harder to treat. It occurs in the setting of both the native hip joint and following total hip arthroplasty. Internal snapping, or coxa saltans, can result from the iliopsoas snapping over the anterior hip capsule or iliopectineal eminence and can be a source of labral pathology. The snapping can be painful or painless. Iliopsoas impingement over total hip components either from the cup or collar of a femoral stem are causes of anterior groin pain. However, there are multiple other causes of groin pain, both intra- and extra-articular, that can make finding the source of the pain difficult. Referred pain from the spine, gynecologic, and gastrointestinal systems can all cause pain in the groin. Core muscle injuries and athletic pubalgia can all cause groin pain and frequently mimic intra-articular hip pathology or iliopsoas tendinopathy. Ultrasound-guided diagnostic injection into the iliopsoas bursa or the juxtaposed hip joint (intra-articular injection) can be helpful in differentiating the source of the pain. Combining a clear history, detailed physical, basic and advanced imaging, as well as diagnostic injection is essential in diagnosing this elusive entity and guiding appropriate treatment.     

弹响髋病因探讨

目的　探讨弹响髋发病病因 ,为臀腿痛合并弹响髋提供一种改进术式。方法　通过 30例 35侧弹响髋的治疗观察和对儿童臀肌挛缩症导致弹响髋的分析 ,并对 3具新鲜尸体臀髋部肌肉筋膜组织的局解实验观察。结果　弹响髋大多先有臀部软组织的劳损或外伤史。臀部软组织的疼痛性痉挛和挛缩 ,致使与其有连带关系的髋部肌筋膜受牵紧张并在大转子处反复磨擦损伤 ,形成了增厚的束带而产生弹响。结论　提示弹响髋病因与臀肌筋膜组织损伤有关 ,在臀或髋部实施软组织松解术 ,既可治疗臀腿痛 ,又可治愈弹响髋     

Snapping hip of internal origin]

The paper presents an unusual case of internal snapping hip in an 18 year old female, due to abnormal iliopsoas tendon tension. Operative treatment with precision of the fibrous slip over the rim of the pelvis gave a very good result, with slight limitation of active hip flexion. Various opinions on the pathogenesis and treatment of this rare condition have been presented. Lack of snapping in a supine position during clinical assessment has been emphasized.     

The Snapping Scapula: Diagnosis and Treatment

As a largely under-recognized problem, snapping scapula stems from the disruption of normal mechanics in scapulothoracic articulation. It is especially common in the young, active patient population, and symptoms are frequently seen with overhead and throwing motions. Understanding the anatomy of the scapula and surrounding neurovascular structures is crucial in making a differential diagnosis and providing both nonoperative and surgical treatments. Common causes of snapping scapula include bursitis, muscle abnormality, and bony or soft-tissue abnormalities. Anatomic variations, such as excessive forward curvature of the superomedial border of the scapula, may also be a cause for snapping. Benign tumor conditions of the scapula can also predispose one to snapping scapula syndrome and should be thoroughly investigated during the course of treatment. Patients with snapping scapula syndrome typically present with a history of pain with overhead activities. Snapping scapula is associated with audible and palpable crepitus near the superomedial border of the scapula. Various imaging studies may be used to rule out soft-tissue and bony masses, which may cause impingement at the scapulothoracic articulation. In most cases nonoperative treatment is curative and includes physical therapy for scapular muscle strengthening and nonsteroidal anti-inflammatory medications. Corticosteroid injections may also be used for therapeutic and diagnostic purposes. In most cases overuse injuries and repetitive strains respond well to nonoperative treatments. When nonoperative measures fail, surgery is a proven modality, especially if a soft-tissue or bony mass is implicated. Both open and arthroscopic techniques have been described with predictable results.     

Snapping scapula syndrome: Conservative and surgical treatment

The aim of this work was to assess the clinical results in 13 snapping scapulas treated between 1990 and 1996. This is an infrequent source of shoulder discomfort characterized by painful, audible and palpable abnormal scapulothoracic motion. It may or may not have a demonstrable mechanical etiology, but often no obvious cause can be identified with imaging techniques. We report a series of 13 cases, of whom 8 were operated. The mean age was 23 years; there were 4 women and 9 men. All patients underwent a CT-scan and X-ray imaging. Initial treatment was conservative in 10 cases without obvious etiology, and surgical in three osteochondromas. Five patients who did not improve by a nonoperative approach were operated. After a mean follow-up of 24 months, pain and snapping were completely relieved. Surgery was the appropriate treatment in the cases of failure of conservative treatment and allowed patients to return to normal activities and work.