Open posterior stabilization for recurrent posterior glenohumeral instability

Open posterior capsular shift is used for posterior glenohumeral instability that has failed nonoperative treatment. Few series have fully evaluated the outcome after open posterior stabilization. The purpose of this series was to evaluate the clinical and radiographic outcome after open posterior stabilization of the shoulder. Preoperative and intraoperative factors were analyzed with regard to their impact on results. Forty-eight consecutive shoulders were identified that had undergone primary open shoulder stabilization by use of open posterior capsular shift. Of the shoulders, 4 were lost to follow-up, resulting in a study group of 44 shoulders in 41 patients. Shoulders were evaluated at a range of 1.8 to 22.5 years after surgery by use of the L'Insalata shoulder form, Short Form-36 (SF-36), and a subjective shoulder rating in 44 shoulders. Thirty-nine shoulders were evaluated by physical examination, and thirty-seven underwent radiographic examination. A recurrence of posterior instability occurred in 8 shoulders (19%). Of the patients, 84% were satisfied with the current status of their shoulder. The mean L'Insalata score was 81.25+/-17.8 points, the mean SF-36 physical component score was 50.81+/-7.87, and the mean mental component score was 53.82+/-7.55. Significantly poorer satisfaction and outcome scores were seen in shoulders found to have a chondral defect at the time of stabilization and in patients aged greater than 37 years at the time of surgery. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. Open posterior shoulder stabilization is a reliable procedure for treating significant posterior instability without causing arthritic changes. Patients found to have chondral damage within the shoulder and older patients were found to have less success after stabilization.     

寰椎后弓螺钉在寰枢椎后路固定融合手术中的应用

<正>目前对于治疗寰枢椎不稳或脱位的手术方法有多种,常用术式为后路钉棒系统固定融合术,其中寰椎安全顺利置钉为手术成败的关键,若术中寰椎置钉不成功或不顺利,可能导致手术时间增加,手术风险加大,临床需要一种安全、可靠、操作相对简单的手术补救措施。我科2013年12月~2015年1月收治的寰枢椎不稳患者均行寰枢椎后路固定融合手术,其中4例因术中置入寰椎椎弓根螺钉     

Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects

The aim of this study is to determine posterior compartment topography 1-year after sacrocolpopexy (SC). Women who had SC without concomitant anterior or posterior repairs for symptomatic pelvic organ prolapse (POP) were included. Vaginal topography was assessed at baseline and 1-year postoperatively using POP quantification (POPQ). At baseline, 24% had stage IV POP, 68% stage III, and 8% stage II. One year after surgery, 75% had stage 0/I POP, 24% stage II, and 1% stage III. 112 (75%) were objectively cured (stage 0 or I POP). Anterior compartment was the most common site of POP persistence or recurrence (Ba >/= stage II in 23 women) followed by posterior compartment (Bp >/= stage II in 12 women) and apex (C >/= stage II in 2 women). In 1-year follow-up, SC without concomitant posterior repair restores posterior vaginal topography in the majority of women with undergoing SC.     

髋臼后柱骨折与后柱伴后壁骨折的诊断和治疗

目的探讨髋臼后柱骨折、后柱伴后壁骨折的诊断和治疗方法。方法15例A2型髋臼骨折均采用手术治疗。手术入路：Kocher-Langenbeck入路6例，改良Kocher-Langenbeck入路9例。结果15例中达到解剖复位13例，复位欠佳2例。获得随访11例，随访时间1～4年，平均2年。关节功能按改良d-Aubigne和Postel功能评定标准，优良10例，可1例。术后异位骨化Brookel Ⅰ度1例、Ⅱ度2例。原发坐骨神经损伤2例，1例在1年后恢复，另1例未恢复。结论只有把患髋前后位片、闭孔斜位片、髂骨斜位片、CT平扫图像、SSD重建图像、MPR图像和VRT重建图像结合起来，才能做出髋臼后柱骨折或后柱伴后壁骨折的诊断。绝大多数髋臼后柱骨折和后柱伴后壁骨折需行玎放复位内固定，复位后柱骨折的最好方法是联合使用Schanz螺钉与Farabeuf钳，术中根据具体情况选择1块或2块后柱重建钢板固定。     

One-stage posterior hemivertebra resection and correction using segmental posterior instrumentation

STUDY DESIGN: A retrospective study of 12 patients with congenital kyphoscoliosis caused by a single hemivertebra who underwent one-stage posterior hemivertebra resection and correction by posterior segmental instrumentation. OBJECTIVES: To evaluate the surgical outcomes of 12 patients with hemivertebra treated by hemivertebra resection by single posterior approach and correction with segmental posterior instrumentation. SUMMARY OF BACKGROUND DATA: Congenital scoliosis caused by hemivertebra causes extremely severe curves in some patients. Posterior fusion or posterior and anterior hemi-epiphysiodesis is performed to prevent progression of the deformity. The results of these procedures have been variable and not promising, especially in an adolescent patient with fixed kyphoscoliotic deformity. Hemivertebra resection offers more certain results and better correction of the deformity. To date, hemivertebra resection is performed by anterior and posterior approaches either by one-stage or two-stage operation. Few reports have been published describing a procedure consisting of one-stage posterior hemivertebra resection and correction of the deformity by segmental posterior instrumentation. METHODS: A total of 12 patients with a single hemivertebra between the ages 8-24 years who underwent operative treatment were evaluated for a minimum of 2 years. All patients had a single nonincarcerated hemivertebra [T9 (1 patient), T10 (2), T11 (2), T12 (4), and L1 (3)]. After posterior hemivertebra resection, segmental posterior instrumentation was used for correction of the kyphoscoliotic deformity [CD (4 patients), Kaneda SR (2), and ISOLA (6)]. Radiographic evaluations were conducted on the preoperative, postoperative, and follow-up standing posteroanterior and lateral radiographs. RESULTS: All 12 patients had kyphoscoliotic deformity. Preoperative scoliosis averaging 49 degrees was corrected to 18 degrees (correction rate, 64%). Preoperative kyphosis of 40 degrees was corrected to 17 degrees of kyphosis. Trunk shift of 23 mm was improved to 3 mm. Correction loss was 2 degrees in the frontal plane and 3 degrees in the sagittal plane, and no patients showed more than 5 degrees of correction loss. No intraoperative complications were noted. Solid fusion was obtained in all patients, and no implant failure was verified at the final radiographic evaluations. CONCLUSIONS: This study indicated that correction of kyphoscoliosis caused by a single hemivertebra can be effectively conducted by one-stage posterior hemivertebra resection and correction using segmental posterior instrumentation. The operation was safe, and no associated adverse complications were noted. This procedure is best indicated for adolescent patients with a structural kyphoscoliotic deformity caused by a thoracic or thoracolumbar single hemivertebra.     

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.     

Fixation of posterior pelvic ring disruptions through a posterior approach

Objective  Stable internal screw fixation of posterior pelvic ring disruptions through a posterior approach. Indications  Complete, unstable sacroiliac dislocations with incompetence of anterior and posterior sacroiliac ligaments. Sacroiliac fracture dislocations. Displaced vertical sacral fractures. Contraindications  Damage to posterior soft tissues. Acceptable closed reduction of sacrum or sacroiliac joint. Ipsilateral acetabular fractures treated through an anterior approach. Inadequate intraoperative fluoroscopic visualization of posterior pelvis. Surgical Technique  Vertical paramedian incision overlying the sacroiliac joint. Release of origin of gluteus maximus. Inspection and reduction of sacroiliac joint. Stabilization with iliosacral screws under image intensification. Secure repair of gluteal fascia. Results  107 patients with unstable pelvic ring fractures were treated with open reduction and internal fixation of which 83 had an open reduction of posterior ring injuries. Accuracy of reduction: more than 95% of patients had residual displacement of less than 10 mm. Two patients had a deep wound infection postoperatively. Two-thirds of the patients were able to resume their previous occupation. Pain was either absent or occurred only with strenuous activities. 63% had a normal gait.     

后方入路治疗胫骨平台后髁冠状位骨折的疗效分析

目的探讨后方入路治疗胫骨平台后髁冠状位骨折的临床疗效,分析该类骨折形态、手术入路的选择以及对Schatzker分型的再认识。方法回顾分析2003年6月-2009年6月23例采用后方入路治疗胫骨平台后髁冠状位骨折患者的临床资料。男15例,女8例;年龄32～56岁,平均38岁。均为闭合性骨折。致伤原因:高处坠落伤5例,交通事故伤15例,运动损伤3例。骨折按Moore分型:Ⅰ型10例,Ⅱ型9例,Ⅳ型4例。常规行膝关节正侧位X线片、CT扫描及三维重建。患者受伤至手术时间为3～14d,平均6d。结果骨折获解剖复位17例,一般复位6例。术后切口均Ⅰ期愈合。23例均获随访,随访时间12～36个月,平均24个月。骨折于术后6～9个月达临床愈合,平均7.6个月。无神经、血管损伤、内固定失效、关节僵硬、创伤性骨关节炎、畸形愈合等并发症发生。末次随访时根据Rasmussen评分系统评定膝关节功能,获优14例,良7例,可2例,优良率为91.3%。结论胫骨平台后髁冠状位骨折少见,有其独特的形态特点,Schatzker分型不能完全涵盖该类骨折。采用后方入路可在直视下复位关节面,固定牢靠,术后可早期行功能锻炼,并发症少,是较好的手术治疗方案。     

Chronic posterior instabilities

As an introduction, isolated posterior, posterolateral, posteromedial, as well as combined posterior stability are defined. Rupture of the posterior cruciate ligament leads to pathological patterns for both concentric and eccentric quadriceps movements. Special attention is drawn to the significance of the peripheral stabilizers and their influence on instability. Ruptures of the posterior cruciate ligament are commonly followed by a phase of functional adaptation, functional tolerance, and arthrotic decompensation. Diagnosis should not only be based on the posterior drawer test, but also consider stability tests in the frontal plane and eventual rotational instabilities. What constitutes adequate therapy is still a subject of controversy today. Among the operative procedures, the most common are the pes anserinus graft according to Hey-Groves and Lindemann, the gastrocnemius graft of Hughston and Insall, the free patellar ligament graft, and synthetic replacement. The decision about indications for surgery should not be made earlier than 18 months after the accident, when the phase of functional adaptation has been completed.     

后内侧改良L形切口治疗复杂后pilon骨折的临床效果

背景:在后pilon骨折中,对于后内侧骨折块移位明显,累及内踝前丘或完全内踝骨折,或存在Die-punch骨块的复杂骨折,传统体位及手术入路常存在骨折显露不充分及复位困难等问题.目的:探讨俯卧位下后内侧改良L形切口治疗复杂后pilon骨折的手术技巧及临床疗效.方法:选取2016年5月至2018年12月收治的复杂后pil...     

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures

Objective： To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. Methods： We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients＇ age ranged from 8 to 53 years （mean 27 years ）. Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years （ mean 8 years ）. Results： Among the 77 patients treated by perineal approaches, 69 （95.8 % ） were successfully repaired and 27 out of the 29 patients （93. 1% ） who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases.Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Conclusions： Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucnsa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2. 5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2. 5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely （5.7 % ） to urethroplasty.