Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results

Introduction: Numerous operative procedures have been described for the reconstruction of acromioclavicular joint separation; however, the arthroscopic reconstruction has been rarely reported. Therefore, our objective was to propose a new technique of arthroscopic acromioclavicular joint surgery and to evaluate the preliminary results. Materials and methods: Thirteen patients with a mean follow-up of 18 months underwent the arthroscopic acromioclavicular joint reconstruction using suture anchors and small titanium plate. The average age was 40.2 years (range 23–54 years). The shoulders were evaluated using Constant score and radiographs. The indications for surgery included acromioclavicular joint dislocation Rockwood type IV–V. Results: Twelve patients returned to their work without pain within 3 months after operation. The average Constant score at last follow-up was 95. Postoperative radiographs confirmed anatomic reduction in ten patients, residual subluxation in two patients and redislocation of the joint in one patient. One patient had radiographic evidence of coracoclavicular ossification. All patients but one were satisfied with results and cosmetic appearance. Conclusion: Considering its less morbidity, excellent cosmesis, no need of hardware removal, and minimal complications from breakage or migration of metal implants, this new technique offers an attractive alternative in acromioclavicular joint stabilization.     

Fastin骨锚固定治疗创伤性胸锁关节前脱位的初步疗效分析

目的 探讨应用Fastin骨锚固定治疗创伤性胸锁关节前脱位的技术,并分析其初步疗效.方法 对2006年3月至2008年4月应用Fastin骨锚固定的14例创伤性胸锁关节前脱位患者的临床资料及手术结果进行回顾性分析,男9例,女5例;年龄21～46岁(平均35岁),术前通过X线片和CT确诊.手术先将胸锁关节复位后用克氏针临时固定,然后于胸骨柄拧入骨锚,骨锚尾部缝线穿过锁骨内侧端并牢固打结.术后3周取出克氏针,进行肩关节功能锻炼.结果 14例患者术后均获12～22个月(平均17个月)随访.随访期间无关节的复位丢失和内固定松动,肩关节功能按Rockwood标准评定:优11例,良3例.结论 Fastin骨锚能够可靠固定胸锁关节脱位,避免了长期滞留克氏针造成的潜在危险,有利于关节功能的恢复.     

桡侧腕屈肌腱部分转位治疗陈旧性第一腕掌关节半脱位

自1999年3月-2003年3月采用桡侧腕屈肌腱部分转位治疗陈旧性第一腕掌关节半脱位18例，疗效满意，报告如下。     

Isolated palmar dislocation of the fifth carpometacarpal joint diagnosed by stress X-rays

Isolated palmar ulnar dislocation of the fifth carpometacarpal (CMC) joint is a rare injury which often yields only subtle radiographic findings that may be easily overlooked, especially when there is no associated fracture. We reported a case of an isolated palmar dislocation of the fifth CMC joint, diagnosed correctly by means of simple stress X-rays (traction and axial compression stress views). This method proved to be useful and needs no special equipment. Received: 7 January 1999     

Outcome of uncemented trapeziometacarpal prosthesis for treatment of thumb carpometacarpal joint arthritis

Background:

Osteoarthritis of the trapeziometacarpal joint of thumb occurs frequently and can be very disabling. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been described for the treatment of trapeziometacarpal joint osteoarthritis. Initial problems of osteolysis and implant loosening have been substantially reduced with improvement in implant design. The aim of this study is to demonstrate that trapeziometacarpal osteoarthritis of the thumb can be effectively treated with uncemented total joint replacement prosthesis.

Materials and Methods:

We retrospectively collected data for 16 trapeziometacarpal joint replacements in 14 patients. One patient was excluded as they required revision with trapeziectomy and ligament reconstruction following fracture of Trapezium. The trapeziometacarpal joint prosthesis was used in all cases and all operations were carried out by one surgeon. Clinical outcome was determined by a pre and postoperative patient rated wrist evaluation (PRWE) and Michigan Hand Questionnaire Score. Range of motion, grip, tip pinch and key pinch strength were measured and compared with the unoperated hand. Radiological assessment was carried out by plain radiographs for preoperative staging of arthritis and postoperative radiographs at latest followup for evaluation of osteolysis and implant loosening. Average followup period was 26 months.

Results:

There was an improvement in hand function and pain level based on PRWE and Mischigan Hand outcome Questionnaire Score. One patient had intraoperative fracture of Trapezium and subsequent radiographs at 14 months followup showed loosening of the trapezial component due to nonunion of the fracture and complete disintegration of the trapezium. There were no cases of dislocation or implant loosening for the remaining 15 CMC joints at the latest followup.

Conclusion:

The use of uncemented prosthesis in treatment of Questionnaire Score. Range of motion joint osteoarthritis gives excellent short term results in improving hand function in terms of strength and stability and achieving pain relief.     

Operative treatment of acromioclavicular joint dislocation: a new technique with suture anchors

Objective：To evaluate clinical outcome of suture anchors in strengthening both acromioclavicular and coracoclavicular ligaments in the surgical treatment of acromioclavicular joint dislocation.Methods：Twenty-eight patients with acute traumatic Rockwood Ⅲ,Ⅳ and Ⅴ dislocations of the acromioclavicular joint surgically treated at our institute between October 2010 and January 2012 were recruited.All patients underwent open reduction combined with suture anchors.Function was evaluated using the ConstantMurley shoulder score.Clinical and radiographic shoulder ratings were evaluated using Taft criteria at 3,6 and 12 months.Results：Two cases with fixation loosening were not included in final statistical analysis.Other patients obtained full joint reposition on immediate postoperative radiographs.Follow-up was performed with an average of 15.6 months （range,12-19）.After early range of motion exercises,96.2％ of the patients （25/26） could abduct and elevate their shoulders more than 90 degrees within postoperative 3 months.There was no infection.Average Constant-Murley score was 96.3 points （range,94-100）and mean Taft shoulder rating was 10.7 points （range,8-12） at 12 months.Conclusion：The suture anchor is a relatively simple technique and can avoid screw removal which is helpful in reconstructing both acromioclavicular and coracoclavicular ligaments in acute traumatic acromioclavicular joint dislocation.     

Carpometacarpal joint dislocation of the thumb associated with fracture of the trapezium: a case report

Dislocation of the first carpometacarpal joint with fracture of the trapezium is a rare injury. A case that was initially missed in accident and emergency is described.     

钢板螺钉结合锚钉缝合修补三角韧带治疗Bosworth骨折1例

<正>患者,男,41岁,跌倒伤致右踝关节疼痛1 h来诊。查体:踝关节外旋外翻位畸形,重度肿胀,踝关节外侧压痛有骨擦感,活动受限。右踝关节正侧位X线片示右外踝骨折向外侧移位,踝关节内侧间隙明显增宽,距骨向外侧半脱位(图1a)。螺旋CT三维重建示外踝骨折向外侧移位,腓骨移至胫骨外后方,右侧距骨向外后方半脱位,下胫腓分离,胫骨下胫腓联合处有撕脱性骨折片(图1b,1c)。入院诊断:Bosworth骨折。     

微型骨锚一期重建急性拇指掌指关节尺侧副韧带损伤

目的 评估应用微型骨锚对急性拇指掌指关节尺侧副韧带损伤进行手术修补的临床疗效.方法 2004年7月至2009年5月,对11例急性拇指掌指关节尺侧副韧带完全损伤的患者,采用Mitek micro微型带线骨锚一期植入第一掌骨头或拇指近节指骨基底侧方尺侧副韧带断裂的附着处,用锚尾部的缝合线缝合撕脱的侧副韧带重建起止点.结果 术后随访6个月至4年,平均2.4年.按Saetta标准评定:优7例,良3例,可1例;优良率为90.9%.X线片显示骨锚未见松动、脱落.结论 应用骨锚对急性拇指掌指关节尺侧副韧带损伤进行手术修补不仅操作简便,而且容易掌握,疗效可靠.     

原位缝合联合单束重建治疗前交叉韧带损伤

目的应用原位缝合及原位缝合联合单束重建技术治疗前交叉韧带(ACL)损伤,并研究短期随访的临床结果。 方法选择2016年1月至2018年6月福建医科大学附属第一医院ACL损伤患者作为观察组。纳入标准：确诊为前交叉韧带股骨端损伤的男性患者;排除标准：多发韧带损伤或受伤时间大于3月的患者。根据Sherman分型分为两个亚组并选择不同手术方式,Sherman-Ⅰ型亚组选择原位缝合(原位缝合组),Sherman-Ⅱ/Ⅲ型选择原位缝合联合单束重建(联合重建组)。选择2015年1月至12月在同单位行ACL重建手术(单束重建)的患者数据作为对照组,同样根据Sherman分型分为Sherman-Ⅰ型亚组和Sherman-Ⅱ/Ⅲ型亚组。原位缝合及原位缝合联合单束重建患者进行1年临床随访。观测指标包括：膝关节评分(IKDC);信噪比(SNQ);Opti Knee三维膝关节运动测试;Lachman试验,前抽屉试验及轴移试验,GNRB膝关节稳定度测量仪检测关节稳定度。结果进行亚组间比较。连续性变量使用t检验,计数变量使用卡方检验。 结果原位缝合及原位缝合联合单束重建17例患者获得随访,韧带重建对照组回顾性资料共获得28例完整数据。其中Sherman-Ⅰ型共19例,8例行原位缝合,11例为ACL重建(对照); Sherman-Ⅱ/Ⅲ型共26例,9例为联合重建组,17例为ACL重建(对照)。在IKDC评分,GNRB膝关节稳定度测试,Lachman试验,前抽屉试验及轴移试验等方面,各组间差异均无统计学意义(均为P>0.05)。术后MRI提示原位缝合组的SNQ值(9.8±3.2)高于联合重建组(6.4±1.9)(t＝2.6,P<0.05)。Opti Knee三维运动测试显示原位缝合组无论步行还是慢跑状态下,外旋角度均较健侧减小[步行状态健侧(22.3±1.2)°,患侧(15.0°±2.0)°,(t＝3.2,P<0.05);慢跑状态健侧(23.0±1.3)°,患侧(14.1±1.8)°,(t＝4.0,P<0.05)]。股骨近端位移均较健侧减少[步行状态健侧(1.2±0.2) mm,患侧(0.5±0.1)mm,(t＝2.9,P<0.05);慢跑状态健侧(1.1±0.3)mm,患侧(0.5±0.2)mm,(t＝3.1,P<0.05)]。而联合重建组无论是步行还是慢跑状态下健侧与术侧在各个方向的位移无明显差异。 结论Sherman-Ⅰ型急性ACL损伤进行单纯原位缝合可以获得相当于韧带重建的临床疗效,针对Sherman-Ⅱ、Ⅲ型损伤,原位缝合联合单束重建术后1年的运动学评估可以完全恢复到健侧相同水平。     

带线锚钉与锁骨钩钢板治疗肩锁关节脱位疗效比较

目的 比较带线锚钉与锁骨钩钢板治疗肩锁关节脱位的优缺点。方法 将自2010-09-2012-08收治的53例新鲜肩锁关节脱位随机分为2组：A组,29例,采用锁骨钩钢板内固定;B组,24例,在喙锁韧带和肩锁韧带处采用3枚带线锚钉内固定。结果 所有患者获得随访12-18个月。A组和B组的平均手术时间分别为（52.0±10.1）min和（56.0±15.3）min。术后1年,肩关节功能恢复参照Constant Murley评定标准,A组和B组的优良率分别82.8%（24/29）和87.5%（21/24）（P〈0.05）;其中A组出现10例肩峰下撞击征,1例内固定松动;B组出现2例内固定锚钉松动（P〈0.01）。结论 对于肩锁关节脱位,2种固定方法都能获得满意的疗效。锁骨钩钢板固定强度较高,但存在肩峰下撞击征及需要再次拆除内固定等缺点;采用3枚带线锚钉固定,手术技能要求较高,具有术后并发症少、无需拆除内固定等优点。     

Bilateral Carpometacarpal Joint Dislocations of the Thumb

A traumatic carpometacarpal joint dislocation of the thumb accounts for less than 1% of all hand injuries. Optimal treatment strategies for this injury are still a subject of debate. In this article, we report a case of bilateral thumb carpometacarpal joint dislocations: a unique combination of injuries. We believe our case is the second report of bilateral carpometacarpal joint dislocation regarding the thumb in English literature. It was successfully treated with closed reduction and percutaneous K-wires fixation on one side, and an open reduction and reconstruction of the ligament on the other side.     

胸锁关节的CT研究

目的 了解正常胸锁关节、锁骨胸骨端和胸骨柄在CT图像上的径线长度,确定由内固定物向胸骨柄钻孔的安全角度和长度.方法 对50名健康志愿者的胸锁关节进行CT扫描成像,成像角度包括矢状面、冠状面和横断面.测量锁骨近端的高度与前后径、锁切迹的长度与前后径、锁切迹与胸骨的成角、胸骨柄与身体长轴的成角、胸骨柄的厚度、胸锁关节间隙大小以及锁骨间距.并确定由内固定物向胸骨柄钻孔的安全角度和长度结果左、右侧的各项测量指标比较,差异均无统计学意义(P＞0.05).冠状面上胸骨柄锁切迹的长度和锁骨内侧端的长度接近,差异均无统计学意义(P＞0.05).横断面上锁切迹的前后径比锁骨内侧端的前后径短,差异有统计学意义(P＜0.05).胸骨后方重要组织中,头臂干、左右头臂静脉贴近胸骨柄的后缘,术中应以安全角度(α＞46°β＜-49°)进钻,或将进钻深度控制在安全深度(2.38±0.61)cm以内.结论 本研究明确了 CT图像上正常胸锁关节的特征,并定量描述了胸骨柄与其后方重要组织的伴行关系,对胸锁关节脱位的诊断与治疗提供了参考.

Abstract：

Objective To investigate anatomical features of the sternoclavicular joint on computed tomography (CT) scans to determine the safe angle and length of drilling into the manubrium sterni for implants. Methods CT scans were taken in 50 healthy human volunteers.Reconstructive images on coronal,sagittal and transverse planes of the sternoclavicular region,from the superior border of the clavicle to the sternal angle,were obtained.Measurements were conducted on the images to determine the height and the anteroposterior dimension of the proximal end of the clavicle,the length and the anteroposterior dimension of the clavicular notch,the angle between the clavicular notch and the sternum,the angle between the manubrium sterni and the trunk,thickness of the manubrium sterni and the distance between the bilateral clavicles.The safe angle and length of drilling into the manubrium sterni for implants were determined.Results There were no significant differences between the above left and right measurements (P＞ 0.05).There were no significant differences in length between the clavicular notch and the internal extremity of clavicle on the coronal image (P＞0.05).The anternposterior dimension of the clavicular notch was significantly shorter than that of the internal extremity of clavicle on the cross section ( P ＜ 0.05 ).Of the tissues behind the sternum,the anonyma and the bilateral innominate veins were the nearest to the manubrium sterni.The safe angle and length of drilling into the manubrium sterni for implants were α ＞ 46° or β ＜-49° and 2.38 ± 0.61 cm respectively. Conclusion This investigation provides specific and quantitative CT data of the sternoclavicular joint which may help clitical diagnosis and treatment of the sternoclavicular dislocation.     

锚钉固定缝合治疗三角韧带陈旧性损伤

 目的 探讨锚钉固定重叠缝合治疗三角韧带陈旧性损伤的疗效。方法 回顾性分析2007年1月至2011年12月,治疗17例三角韧带陈旧性损伤患者资料,男11例,女6例;年龄18～58岁,平均32.1岁;均有踝关节扭伤史,病程为7～25个月,平均14.2个月。患者术前均行踝关节负重正、侧位X线片、双足正、斜位X线片、MRI及B超检查。确诊为内侧三角韧带损伤后,患肢行踝关节镜检查再次明确诊断并清理关节内增生的滑膜及合并损伤的关节软骨。切开踝关节内侧间隙,清理韧带残端瘢痕组织,其中2例同时清理陈旧性内踝尖撕脱骨折片。将三角韧带深层断端缝合于内踝尖,三角韧带浅层重叠缝合于内踝骨膜,使用锚钉固定。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分评价手术前后踝关节。结果 17例患者均获得随访,随访时间12～34个月,平均20.1个月。影像学与术中检查均发现三角韧带损伤且已瘢痕化。距骨-第一跖骨角及Saltzman位后足力线角分别从术前5.4°±1.8°和8.2°±2.6°降至术后4.0°±0.9°和5.3°±1.3°。AOFAS踝与后足评分,术前为平均(76.8±7.0)分 ,末次随访时为平均(94.1±3.3)分;其中优10例,良6例,可1例,优良率为94.1%(16/17)。17例患者疼痛均有效缓解。末次随访时,无一例患者出现三角韧带再损伤。结论 锚钉固定缝合治疗三角韧带陈旧性损伤可以获得良好的效果。     

膝关节多发韧带损伤一期修复与重建

目的：探讨膝关节多发韧带损伤关节镜下重建前交叉韧带（anteriorcruciateligament,ACL）和后交叉韧带（posteriorcruciateligament,PCL）,及同期修复内副韧带（medialcollateralligament,MCL）、后外侧复合体（posteriorlateralcomplex,PLC）的手术方法及临床疗效。方法：2009年6月。2011年12月,30例病人（31膝）膝关节多发韧带损伤患者采用自体或同种异体肌腱关节镜下重建ACL和PCL,铆钉缝合修复内侧副韧带,铆钉缝合修复或部分股二头肌腱修复后外侧复合体,术后早期功能锻练。根据国际膝关节文献委员会（InternationalKneeDocumentationCommittee,IKDC）评分和Lysholm膝关节功能评分表对患膝功能进行评估。结果：30例病人（31膝）例随访18—30个月,平均24个月。患者在0和200应力测试时稳定性均完全恢复,IKDC评分入院时均为显著异常（D级）,术后随访时正常（A级）18例（58．0％）,接近正常（B级）10例（32．3％,）,异常（C级）3例（9．7％）。Lysholm评分由术前平均（48．7±4．5）分提高到（87．6±2．6）分,差异有统计学意义（t=-8．432,P〈0．01）。所有患者膝关节功能较术前明显改善。结论：关节镜下一期重建ACL、PCL,同期行关节外韧带修补或重建具有损伤小,能早期功能锻炼,能有效恢复关节功能,治疗效果满意。     

第4跖趾关节并跖跗关节脱位1例

患者，男，43岁，摔伤致左足背肿痛不能站立约10h，次日来我院就诊。检查：左足背肿胀甚，皮肤呈青紫色，第4跖骨头和基底部压痛明显，触摸第4跖骨头背侧凹陷，跖侧可摸到突起的第4跖骨头，左足诸趾未梢血液循环和感觉正常。X线片示：左足第4跖趾关节并跖附关节脱位，第4跖骨头明显向跖侧内侧移位；     

缝线锚钉修复腱性组织止点区断裂伤的失效原因分析

目的 通过对缝线锚钉修复腱性组织止点区断裂伤的失效原因进行分析,旨在提高此类内固定修复腱性组织止点区断裂的疗效,减少锚钉失效的发生率.方法 2006年6月至2008年6月,对收治的7例应用缝线锚钉治疗腱性组织止点区断裂失效患者进行回顾性研究,其中男5例,女2例;年龄22～64岁,平均41岁.跟腱断裂2例,肩袖撕裂1例,喙锁韧带断裂1例,髌韧带撕脱1例,膝内侧副韧带断裂1例,胫前肌腱止点处断裂1例.7例患者于伤后5 h～4个月行切开腱性组织修复术,锚钉类型为强生GⅡ快速增强缝线锚钉(形状类似倒钩)和强生FastinRC带螺纹锚钉.术后随访10d～3周发现锚钉失效.结果 7例失效患者全部为锚钉脱出,无缝线断裂及锚钉毁损,且原始损伤均为较粗大腱性组织断裂.锚钉失效原因:手术操作不当4例,锚钉选择失误2例,患者依从性差而过早活动1例.患者因患处疼痛均于术后2个月左右行锚钉取出术.结论 应用锚钉前需要对锚钉装置有详细的了解,骨质、锚钉类型、锚钉置入方向及手术技巧的掌握等都影响锚钉固定的疗效.     

A modified surgical technique for reconstruction of an acute acromioclavicular joint dislocation

We report a modified surgical technique for reconstruction of coracoclavicular and acromioclavicular ligaments after acute dislocation of acromioclavicular joint using suture anchors. We have repaired 3 consecutive type III acromioclavicular dislocations with good results. This technique is simple and safe and allows anatomical reconstruction of the ligaments in acute dislocations.     

Biomechanical effect of increasing or decreasing degrees of freedom for surgery of trapeziometacarpal joint arthritis: A simulation study

Osteoarthritis of the trapeziometacarpal (TMC) joint can be treated by arthrodesis and arthroplasty, which potentially decreases or increases the degrees of freedom (DoF) of the joint, respectively. The aim of our study was to bring novel biomechanical insights into these joint surgery procedures by investigating the influence of DoF at the TMC joint on muscle and joint forces in the thumb. A musculoskeletal model of the thumb was developed to equilibrate a 1 N external force in various directions while the thumb assumed key and pulp pinch postures. Muscle and joint forces were computed with an optimization method. In comparison to that of the 2‐DoF (intact joint) condition, muscle forces slightly decreased in the 0‐DoF (arthrodesis) condition, but drastically increased in the 3‐DoF (arthroplasty) condition. TMC joint forces in the 3‐DoF condition were 12 times larger than the 2‐DoF joint. This study contributes to a further understanding of the biomechanics of the intact and surgically repaired TMC joint and addresses the biomechanical consequences of changing a joint's DoF by surgery. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1675–1681, 2011