Results of the surgical treatment of Lisfranc fracture-dislocations

The authors present a series of 25 patients with Lisfranc fracture-dislocation who were treated by reduction (open or closed) and stabilization with Kirschner wiring. Minimum follow-up was two years. The dislocations were divided based on the Quenu and Kuss classification system. Nonsurgical reduction was possible in 17 patients. Neither the type of dislocation nor the type of reduction influenced the results in progression in our series. Nonetheless, long-term functional results were better when the quality of the reduction was excellent.     

陈旧性跖跗关节骨折脱位

目的分析跖跗关节(Lisfranc)骨折脱位急诊处理的不当所导致的后期功能障碍的原因,并结合现今在这一领域的研究状况进行讨论。方法从2000年3月～2005年2月共收治陈旧性Lis-franc骨折脱位34例,24例行切开复位内固定,10例患者行关节融合术。结果按美国骨科足踝外科协会(AOFAS)中足部分的评分标准,50～60分2例,60～70分4例,70～80分5例,80～90分18例,90～100分5例。结论Lisfranc损伤晚期并发症的出现与复位不彻底、固定不牢靠以及固定时间不充分有关。临床医生在遇到中足扭伤的患者时,要提高警惕,以免漏诊。对大多数患者而言,以伤后6周内进行切开复位内固定为好。     

陈旧性Lisfranc骨折脱位的治疗

目的 探讨陈旧性Lisfranc骨折脱位的治疗,并结合现状分析其产生的原因.方法 2004年3月至2008年3月共收治25例陈旧性Lisfranc骨折脱位患者,男18例,女7例;平均32.0岁.按Hardcastle分型:A型4例,B型19例,C型2例.全部行切开复位内固定治疗.结果 25例患者全部获得随访,时间12～18个月,平均14.3个月.按美国足踝外科协会(AOFAS)中足评分标准评定疗效:优4例,良13例,可6例,差2例.结论 陈旧性Lisfranc骨折脱位多因早期漏诊或诊断后治疗不当所致,其后期功能障碍与复位不彻底及固定不牢固有关.而解剖复位与内固定仍是治疗陈旧性Lisfranc骨折脱位的有效方法.     

Chopart 关节损伤的诊断与手术治疗

Chopart 关节又称跗横关节或跗中关节,是距舟关节和跟骰关节的统称,其骨折脱位临床上相对少见,文献报道其发病率约占所有骨折的0.15%,但致残率较高,如若早期处理不当往往后期会遗留足背痛、中足不稳或创伤性关节炎,甚至需要进行关节融合~([1]).因此,早期诊断和及时正确的治疗显得尤为重要.自1999年12月至2008年12月我科共收治19例Chopart关节损伤患者,现报告如下.     

Intramedullary transmetatarsal Kirschner wire fixation of Lisfranc fracture-dislocations

Lisfranc joint injuries are frequently the result of high-energy accidents. The usual method of treatment is open reduction and internal fixation or closed reduction with percutaneous pinning. In cases in which soft tissue injury may compromise open reduction and internal fixation or traditional pinning techniques, transmetatarsal Kirschner wire fixation may be performed, allowing the placement of temporary hardware away from the site of soft tissue injury. The following report details this technique as it has been used in 3 patients.     

克氏针三柱重建法治疗Lisfranc骨折脱位

目的：探讨多根克氏针内固定治疗Lisfranc骨折脱位的，临床应用效果。方法：49例患者中，男37例，女12例；年龄20—58岁。损伤根据Myserson分型：A型12例；B1型3例，B2型28例；C1型4例，C2型2例。根据中足的结构特点设计多根克氏针进行三柱重建内固定，三柱的重建不仅需要每个独立柱的解剖复位和固定，且需要各柱相互形成一个联体。结果：49例均获随访，按美国骨科足踝外科协会（AOFAS）中足部分的评定标准，优（90-100分）14例，良（80-89分）22例，一般（70-79分）8例．差（60-69分）5例，平均（84、200±9．663）分。结论：Lisfrac骨折脱位的诊断和治疗应依从于三柱重建理论，使中足构成坚固的弓形结构，达到生物力学上的静态平衡．为骨折和软组织愈合提供环境。多根克氏针进行三柱重建内固定是治疗Lisfrac骨折脱位的有效方法。     

Lisfranc损伤的手术治疗研究进展

[目的]跗跖关节损伤即Lisfranc损伤,是以法国军医Jacques Lisfranc的名字命名的,他首次介绍了前足严重损伤行经跗跖关节面截肢术治疗的经验,现代医学所谓的Lisfranc损伤是指跗跖关节的脱位及骨折,可为单纯的韧带损伤或涉及骨质的损伤,该损伤类型临床上较罕见,但有较高的漏诊率,较复杂的局部解剖结构,多变的损伤机制及较差的术后效果加大了此类损伤的诊断及治疗难度。一些术后患者,尤其未明确诊断者后期常发生创伤性关节炎及顽固性疼痛,对日常生活产生严重影响。全面的检查包括影像学检查、体格检查对于明确诊断非常必要,目前观点对于改善患者后期功能倾向于选择手术治疗。随着医疗科技日益创新,以及相关研究进一步深入,对于lisfranc损伤的手术治疗日益进步,置入物种类日益丰富。现就Lisfranc关节的解剖结构、损伤机制、损伤分型及手术治疗方法做以下综述。     

Lisfranc关节损伤手术治疗的疗效评估

目的：探讨手术治疗Lisfranc关节损伤的临床疗效。方法：自2003年1月至2009年9月,手术治疗Lis-franc关节损伤57例,男41例,女16例;年龄20～64岁,平均33.8岁。按照Myerson分类：中柱损伤31例,中柱合并内侧柱损伤15例,三柱损伤11例。受伤当日手术25例,受伤后3～11d（平均7d）手术32例。结果：切口均一期愈合,平均手术时间50min;所有患者获随访,时间4～70个月,平均35个月。患者平均AOFAS评分为（84.73±14.26）分,患者术后5.1个月（3～12个月）恢复正常生活。52例解剖复位患者平均AOFAS评分（87.63±13.71）,5例未解剖复位者平均AOFAS评分（74.31±21.96）。多柱损伤患者26例平均AOFAS评分（76.58±11.51）。有8例患者并发创伤性骨关节炎,是患者中最主要的并发症。结论：手术治疗Lisfranc关节损伤能够重建跖跗关节复合体的稳定性,可取得满意的复位和临床疗效。术中复位质量与治疗结果密切相关。     

Charcot foot and ankle reconstruction: current thinking and surgical approaches

The surgical repair of unstable diabetic neuropathic osteoarthropathy of the midfoot or the hindfoot and ankle remains a challenge with little guidance available in the medical literature. The authors present their proposed surgical intervention techniques regarding the use of external fixation with or without combined internal fixation. A step-by-step guide through the authors' preferred technique for these difficult limb salvage cases is presented in detail.     

手术治疗Lisfranc关节损伤13例的疗效分析

目的:探讨手术治疗Lisfranc关节损伤的临床疗效及影响因素.方法:自2009年1月至2011年11月,共收治Lisfranc关节损伤13例14足,男9例,女4例;年龄18～61岁,平均42岁.Myerson分型:A型1足,B型9足,C型4足.所有患者在伤后22 d内接受手术,手术采用切开复位螺钉或克氏针内固定(1例开放性采用外固定架固定).术后采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足评分标准进行功能评估;术前、术后摄X线正斜或侧位片,进行影像学评估.结果:所有患者获得随访,时间5～30个月,平均20个月.术后根据AOFAS足评分,优8足,良4足,中2足.X线片示12例获得解剖复位,所有患者骨性愈合1例出现皮肤切缘坏死,经换药后愈合;1例开放性骨折皮肤回植后出现坏死,行皮瓣修复后愈合.其余病例未见任何手术并发症.结论:切开复位内固定是治疗Lisfrancs关节损伤的有效方法,术前软组织损伤的评估、术中骨折复位及术后复位的维持可影响临床结果.     

Treatment of Lisfranc joint injury: current concepts

Injuries to the tarsometatarsal joint complex, also known as the Lisfranc joint, are relatively uncommon. However, the importance of an accurate diagnosis cannot be overstated. These injuries, especially when missed, may result in considerable long-term disability as the result of posttraumatic arthritis. A high level of suspicion, recognition of the clinical signs of injury, and appropriate radiographic studies are needed for correct diagnosis. When surgery is indicated, closed reduction with percutaneous screw fixation should be attempted. If reduction is questionable, open reduction should be performed. Screw fixation remains the traditional fixation technique.     

HCC: current surgical treatment concepts

PURPOSE: The purpose of this study is to review indications and results of surgical treatments of hepatocellular carcinoma (HCC). This tumor, which represents one of the most common malignancies worldwide, is characterized by its prominent development in patients with chronic liver disease (CLD). Liver transplantation (LT) is considered as the ideal treatment of limited HCC removing both tumor(s) and the pre-neoplasic underlying diseased liver. However, this treatment, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. The risk of recurrence is minimized in patients fulfilling the Milan criteria with a tendency to accept slight expansion of size in patients with favourable natural history and low AFP level. Increasing duration in the waiting list before LT leads several teams to use neoadjuvant therapies such as percutaneous ablation, TACE and liver resection. Liver resection in cirrhotic patients with good liver function remains the most available efficient treatment of patients with HCC. Better liver function assessment, understanding of the segmental liver anatomy with more accurate imaging studies and surgical technique refinements are the most important factors that have contributed to reduce mortality with an expecting 5 years survival of 70%. There is considerable interest in combined treatment associating resection and LT. Transplantable patients with good liver function should be considered for liver resection as primary therapy and for LT in case of tumor recurrence. This salvage strategy is refined using pathological analysis of the resected specimen which identifies histological pejorative factors allowing selecting patients who should transplanted before recurrence. CONCLUSIONS: The improvement of survival in HCC patients after surgical treatment results from refinements in surgical technique and better identification of adverse prognostic factors.     

The surgical treatment of dislocations and fracture-dislocations of cervical vertebrae 3-7

The authors have analysed the results of the treatment of 131 patients with dislocations and dislocation fractures of C 3-7. The stabilization of the injured segment by posterior surgical approach with a fixative draw was performed in 64 cases of dislocations of the cervical vertebrae when the compression of the spinal cord and its roots was eliminated by the setting of the dislocation. Anterior compression of the dural sac and disturbances in the supportability of the spinal column was an indication for anterior decompression and corporodesis in 67 cases.     

Lisfranc joint injuries: diagnosis and treatment

Injuries to the tarsometatarsal or Lisfranc joint, though rare, are often undiagnosed or inadequately treated, resulting in poor long-term outcomes. Clinical and radiographic data are needed to recognize and treat these injuries for optimal outcomes. In this article, we review the anatomy, biomechanics, injury mechanisms, clinical presentation, radiographic evaluation, injury classification, treatment, outcome, and complications of Lisfranc joint injuries.     

Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents

Posterior sternoclavicular joint (SCJ) dislocations and posteriorly displaced physeal fractures of the medial clavicle require prompt diagnosis and treatment to prevent persistent symptoms, recurrent instability, and potential complications. The purpose of this investigation was to review one institution's experience with these injuries. A retrospective review of 13 patients with posterior SCJ fracture-dislocations was performed. Average patient age was 14.6 years, and 85% of injuries were sustained during sporting activities. Patients with posterior dislocations underwent ligament repair and those with posteriorly displaced medial clavicular physeal fractures had open reduction and suture stabilization. At an average of 22.2 months follow-up, all patients had excellent functional outcomes. There were no respiratory or neurovascular complications. Skeletally immature patients may expect excellent functional outcomes following surgery for posterior SCJ dislocations or posteriorly displaced physeal fractures of the medial clavicle.     

Jugular foramen schwannomas: surgical approaches and outcome of treatment

Twelve cases of schwannomas of the jugular foramen that involved surgery in our department between 1983 and 1997 are described. Eight were women and 4 were men (mean age, 40 years), and the duration of their symptoms, the most predominant of which were hearing loss and tinnitus, ranged from 1 month to 20 years (median, 8.5 months). Depending on their radiological and surgical features, tumors were classified as type A, a tumor primarily at the cerebellopontine angle with minimal enlargement of the jugular foramen (n = 5); type B, a tumor primarily at the jugular foramen with or without intracranial extension (n = 4); type C, a primarily extracranial tumor with extension into the jugular foramen (n = 0); or type D, a dumbbell tumor with both intracranial and extracranial components (n = 3). A retrosigmoid suboccipital craniectomy (RSSOC) was performed for type A tumors; for types B and D, the RSSOC or staged infratemporal fossa approach (ITFA)/RSSOC was used. Total removal was achieved in 6 cases, near total removal in 3, and subtotal removal in 3. The most common complication was lower cranial nerve dysfunction (n = 5). The follow-up period ranged from 6 to 173 (mean, 48) months, and there was no recurrence. Two patients showed regrowth of the tumor after subtotal resection, however. In 1 of these, the residual tumor had progressed within 12 months of initial surgery, it was again resected and linac radiosurgery was successful. In the other, the residual mass had progressed within 8 months of initial surgery, and the pathological report indicated malignant peripheral nerve sheath tumor. Conclusively, type A tumors could be totally resected with the retrosigmoid approach alone. For type B and D tumors, however, combined ITFA and retrosigmoid approach showed the better results. In spite of our limited data, cases showing adhesion to critical structures can be managed by subtotal or near total resection followed by radiosurgery to reduce postoperative complications.     

Intracranial arterial stenoses: current viewpoints, novel approaches, and surgical perspectives

Ten percent of all strokes occurring in the USA are caused by intracranial arterial stenosis (IAS). Symptomatic IAS carries one of the highest rates of recurrent stroke despite intensive medical therapy (25 % in high-risk groups). Clinical results for endovascular angioplasty and stenting have been disappointing. The objectives of this study were to review the contemporary understanding of symptomatic IAS and present potential alternative treatments to resolve factors not addressed by current therapies. We performed a literature review on IAS pathophysiology, natural history, and current treatment. We present an evaluation of the currently deficient aspects in its treatment and explore the role of alternative surgical approaches. There is a well-documented interrelation between hemodynamic and embolic factors in cerebral ischemia caused by IAS. Despite the effectiveness of medical therapy, hemodynamic factors are not addressed satisfactorily by medications alone. Collateral circulation and severity of stenosis are the strongest predictors of risk for stroke and death. Indirect revascularization techniques, such as encephaloduroarteriosynangiosis, offer an alternative treatment to enhance collateral circulation while minimizing risk of hemorrhage associated with hyperemia and endovascular manipulation, with promising results in preliminary studies on chronic cerebrovascular occlusive disease. Despite improvements in medical management for IAS, relevant aspects of its pathophysiology are not resolved by medical treatment alone, such as poor collateral circulation. Surgical indirect revascularization can improve collateral circulation and play a role in the treatment of this condition. Further formal evaluation of indirect revascularization for IAS is a logical and worthy step in the development of intracranial atherosclerosis treatment strategies.