关节镜下缝线“8”字捆扎固定治疗后交叉韧带胫骨止点撕脱骨折疗效探讨

目的 探讨关节镜下缝线“8”字捆扎固定治疗后交叉韧带(PCL)胫骨止点撕脱骨折的疗效。方法 收集该院2017-01～2018-12收治28例符合纳入标准的PCL胫骨止点撕脱骨折患者的临床资料,其中22例获得完整随访。记录手术时间、出血量、膝关节稳定性、Lysholm膝关节评分、膝关节活动度。结果 22例患者术后获得12～20个月(平均14. 8个月)随访。所有患者未出现切口感染、骨折不愈合或畸形愈合。末次随访时X线显示骨折均获得骨性愈合。末次随访时膝关节后抽屉试验阴性率(阴性21例,阳性Ⅰ度1例)较术前(均为阳性,Ⅰ度6例,Ⅱ度12例,Ⅲ度4例)明显提高(Z=6. 026,P 0. 001);末次随访时Lysholm膝关节评分为(87. 27±4. 88)分,较术前(35. 45±5. 52)分明显提高(t=32. 235,P 0. 001);末次随访时膝关节活动度为(123. 55±3. 93)°,较术前(44. 64±6. 26)°明显增大(t=48. 951,P 0. 001)。结论 关节镜下缝线“8”字捆扎固定治疗PCL胫骨止点撕脱骨折具有手术切口小、创伤小、术后恢复快以及近期临床疗效满意的优点。     

关节镜下治疗Ⅴ、Ⅵ型胫骨平台骨折并前交叉韧带撕脱骨折的疗效观察

目的 探讨在关节镜辅助下治疗Ⅴ、Ⅵ型胫骨平台骨折并前交叉韧带(ACL)撕脱骨折的临床疗效.方法 选择Ⅴ、Ⅵ型胫骨平台骨折并ACL损伤患者12例,Schatzker分型为Ⅴ型9例、Ⅵ型3例.在关节镜辅助下行胫骨平台骨折锁定钢板有限切开复位内固定术,用Ethibond聚乙烯缝线固定ACL下止点撕脱骨折.术后进行随访,并行Rasmussen膝关节功能评分.结果 术后随访10～24个月,12例患者行X线复查均示骨性愈合,未出现塌陷、移位、膝关节畸形等;Rasmussen膝关节功能评分显示优4例,良6例,可2例,优良率为83.3％.结论 关节镜辅助下治疗Ⅴ、Ⅵ型胫骨平台骨折并ACL下止点撕脱骨折,具有创伤小、可同时处理关节内合并伤、获得良好复位及术后功能恢复快、效果好、并发症少等优点.     

关节镜下复位丝线固定治疗膝关节前交叉韧带下止点撕脱骨折

目的观察关节镜下钢丝引导5-0爱惜帮丝线固定治疗膝关节前交叉韧带下止点撕脱骨折的疗效。方法膝关节前交叉韧带下止点撕脱骨折18例,在关节镜下复位骨折片,用交叉韧带重建钻导器引导由关节外向关节内骨折床边缘钻孔制成两胫骨隧道,引入软钢丝;通过软钢丝从关节外引入5-0爱惜帮丝线,皮下打结固定骨折块。术后石膏外固定2周。随访时摄X线片,并进行Lysbolm评分。结果本组随访6—34个月,KT2000检查（膝关节前抽屉试验量化检查）结果正常,膝关节屈伸不受限,Lysholm评分平均98．3分,前抽屉试验、Lachman试验、轴移试验均阴性,无伤口感染或复位丢失等并发症。结论关节镜下复位丝线固定治疗膝关节前交叉韧带下止点撕脱骨折,创伤小、可恢复前交叉韧带的长度、固定牢靠、可早期进行功能锻炼、功能恢复良好,不需要二次手术取内固定物。     

关节镜下手术治疗前交叉韧带胫骨止点撕脱性骨折12例

2008年10月～2010年10月,我们采用关节镜下缝线Endobutton钢板悬吊固定治疗前交叉韧带（ACL）胫骨止点撕脱性骨折12例,效果满意.现报告如下.     

关节镜微创治疗膝关节前交叉韧带下止点撕脱骨折

目的探讨关节镜下微创治疗前交叉韧带下止点撕脱骨折。方法 2000年7月至2012年10月共完成45例手术。关节镜下进行骨折复位,利用前交叉韧带胫骨导向器在骨块上准确确定钻孔位置,钢丝横穿前交叉韧带基底并经骨块上的钻孔及骨隧道引出关节外打结、固定。结果术后随访时间6~24个月,平均16.5个月;膝关节活动正常41例,受限4例,但超过90;X线片示骨折全部愈合,均为解剖复位。结论关节镜手术治疗胫骨髁间棘骨折可最大限度地减少手术创伤,手术方法简便易行,膝关节功能恢复良好,可作为治疗此类骨折的常规方法。     

可吸收螺钉治疗带胫骨片的后十字韧带损伤23例疗效观察

1997年3月至2003年6月，我院共收治带胫骨片的后十字韧带损伤28例，应用可吸收螺钉治疗23例．远期疗效满意。现报告如下。     

关节镜下治疗髁间棘撕脱骨折13例效果观察

胫骨髁间棘骨折为前交叉韧带附着点的撕脱骨折，以前多采用切开复位内固定，但手术创伤大，影响术后关节早期活动，导致膝关节僵直。1998～2003年，我们采用关节镜下骨折复位钢丝固定治疗胫骨髁间棘撕脱骨折患者13例，获得了良好效果。现报告如下。     

关节镜下交叉钉固定胭绳肌腱重建前十字韧带的手术配合

2005年3月～2008年3月，我们在关节镜下行可吸收交叉钉固定胭绳肌腱前十字韧带重建术134例，疗效满意。现将手术配合方法及体会介绍如下。     

关节镜下后交叉韧带重建术骨道位置的分析研究

目的评价后交叉韧带（PCL）重建术骨道位置对术后患者膝关节功能恢复的影响,确定术中骨性定位标志。方法选取26例PCL重建术后患者,依据术后MRI显示的胫骨骨道出口中心位置分为3组,第1组胫骨骨道出口中心位置在胫骨后髁间凹上缘,第2组在胫骨后髁间凹中央,第3组在胫骨后髁间凹下缘。对所有患者进行Lysholm评分及应用Kneelax3进行PCL重建术后功能评定。结果三组Lysholm评分分别为（78．1±5．08）、（79．2±3．74）和（87．9±5．13）分;Kneelax3测定术后屈膝90°胫骨后移结果分别为（5．29±1．03）、（5．0±0．83）和（2．6±1．02）mm。结论胫骨后髁间凹下缘为最佳的胫骨骨道出口位置。     

半腱肌替代治疗膝关节后十字韧带断裂18例

半腱肌替代治疗后十字韧带断裂18例,经过2年8个月的随访,其优良率为94.4％。认为以半腱肌替代治疗后十字韧带取内侧弧形切口具有手术方法简单、容易掌握、组织损伤小、效果满意等优点。     

可吸收高分子聚合物治疗胫骨髁间前棘骨折

目的 观察可吸收高分子聚合物治疗胫骨髁间前棘骨折的临床疗效.方法 1998-07～2002-07,将54例胫骨髁间前棘骨折分为A组31例(可吸收螺钉内固定)和B组23例(可吸收缝线内固定),并对两组的手术时间和术后膝关节功能恢复的情况进行观察.结果 54例患者均获得随访,随访时间6个月～7年,平均3年6个月,52例膝关节功能恢复正常,A组1例术后出现创伤性关节炎,B组1例出现膝关节不稳.X线片示骨折全部愈合.结论 可吸收高分子聚合物治疗胫骨髁间前棘骨折可取得良好的临床疗效,患者无需二次手术,与金属内固定物相比具有明显的优势.     

Case report of concomitant avulsion fractures of the medial meniscus and posterior cruciate ligament

Rationale:Posterior cruciate ligament (PCL) is the strongest ligament of the knee, and avulsion fractures of PCL are a very rare type of injury. These injuries occur as a result of high-energy traumas, and different accompanying pathologies may be seen. However, tibial avulsion fracture of the PCL associated with a medial meniscus (MM) avulsion fracture has never been reported before. We want to present this unique type of posteromedial knee injury as a case report.Patient concern:A 42-year-old man presented with severe pain and swelling due to a ski injury.Diagnosis:Concomitant avulsion fractures of PCL and MM were detected after imaging.Interventions:Both avulsion fractures were treated with open reduction and fixation with lag screws using the posterior approach.Outcomes:No complications were encountered, and the painless full range of motion and weight-bearing was achieved at the third month after the operation.Lessons:Anatomical reduction and stable fixation of these intra-articular fractures are essential for the stability of the knee. The posterior approach should be kept in mind to access these types of fractures safely. Care should be taken in terms of other injuries that may accompany the PCL avulsion fractures caused by high-energy traumas.     

自体骨—髌腱—骨前交叉韧带重建术后胫骨隧道的变化

目的观察电子计算机X射线断层扫描技术(CT)测量下自体骨—髌腱—骨(BPTB)前交叉韧带(ACL)重建术后胫骨隧道直径的变化。方法对52例(52膝)ACL损伤患者行自体BPTB ACL重建术。分别于术后1、10周、12个月用64层螺旋CT对患膝进行扫描,同时进行三维重建。测量胫骨骨隧道关节面下方1 cm、隧道外口上方1 cm及隧道中点的直径,计算骨隧道扩大百分比。结果 52例患者术后1周胫骨隧道扩大11.18%±3.39%,术后10周胫骨隧道扩大25.98%±4.36%,术后12个月为26.24%±4.44%。术后1、10周胫骨隧道扩大百分比相比,P<0.05,术后10周、12个月相比,P>0.05。结论 BPTB ACL重建术后胫骨隧道发生扩大,明显扩大发生在术后10周内,术后10周～12个月骨隧道直径比较稳定。     

老年胫骨远端骨折的临床治疗分析

目的通过对老年胫骨远端骨折的病例分析,探索提高老年胫骨远端骨折疗效的方法。方法选择本院2001．5—2004．5期间收治的老年胫骨远端骨折231例,所有骨折均按AO／OTA分型,A型99例、B型62例、C型74例,其中开放性骨折87例（软组织损伤程度按Gustilo分类,Ⅱ型36例、ⅢA型34例、ⅢB型10例、ⅢC型7例）,闭合骨折148例。分别给予保守、切复内固定、外固定、或有限内固定＋外固定支架术治疗。结果209病例获随访,平均19．5±1．5（11-28）个月;按照Baird临床与放射评分,优118例,良57例,可18例,差11例,优良率83．7％,创伤性骨关节炎23例,伤口表浅感染19例、深部感染4例（其中骨外露2例）．延迟愈合15例,不愈合5例。结论手术前合理分析骨折的类型、粉碎程度及移位情况、周围软组织损伤程度及患者全身情况,选择恰当的治疗方案和手术时机是提高老年胫骨远端骨折疗效的关键。     

膝关节镜辅助下微创手术治疗胫内平台骨折的疗效观察

目的观察胫内平台骨折患者接受膝关节镜辅助下微创手术治疗的疗效与安全性。方法选取玉林市中医院收治的78例胫骨平台骨折患者为研究对象,按照随机数字表法将其分为对照组和观察组各39例,对照组接受手术切开复位钢板内固定处理,观察组则在膝关节镜支持下实施经皮微创空心钉加压固定治疗,观察两组患者治疗效果、手术切口长度、手术时间、骨折愈合情况以及住院时间并作统计学分析比较。结果与对照组比较,观察组治疗优良率更高,手术切口长度、手术时间、住院时间更短,骨折愈合情况更优,组间比较差异有统计学意义(P0.01)。观察组术后并发症发生率为2.6%,显著低于对照组的33.3%(P0.01)。结论对于胫内平台骨折患者而言,膝关节镜辅助下微创手术治疗效果确切、术创较小,且手术时间更短,并发症较少,有利于加快愈合速度和关节功能的良好恢复,值得临床推广和使用。     

重建钢板联合可吸收线治疗粉碎性锁骨骨折的疗效分析

目的总结重建钢板联合可吸收线治疗粉碎性锁骨骨折的临床疗效。方法回顾性分析采用重建钢板联合可吸收线缝扎固定治疗的124例粉碎性锁骨骨折的临床疗效。结果骨折疗效评价:优107例,良12例,可3例,差2例,优良率为96.0%。2例术后伤口感染,经抗感染、清创后伤口愈合。2例螺钉松脱,骨折再移位,再次手术加强固定后骨折延迟愈合。结论采用重建钢板联合可吸收线治疗粉碎性锁骨骨折疗效好,具有骨膜及软组织剥离少,易复位固定,创伤小等优点。     

Prognostic value of pharmacologic stress echocardiography in patients with left bundle branch block

PURPOSE: Although coronary artery disease is a frequent cause of left bundle branch block, the prognostic value of myocardial ischemia in patients with this conduction abnormality has not been defined. We investigated the value of pharmacologic stress echocardiography in risk stratification of patients with left bundle branch block. PATIENTS AND METHODS: Three hundred eighty-seven patients [230 men and 157 women, mean (+/- SD) age, 64 +/- 9 years] with complete left bundle branch block on the resting electrocardiogram underwent dobutamine (n = 217) or dipyridamole (n = 170) stress echocardiography to evaluate suspected or known coronary artery disease. A summary wall motion score (on a one to four scale) was calculated. The primary end points were cardiac death and nonfatal myocardial infarction. RESULTS: A positive echocardiographic result (evidence of ischemia) was detected in 109 (28%) patients. During a mean follow-up of 29 +/- 26 months, there were 21 cardiac deaths and 20 myocardial infarctions, 63 patients underwent coronary revascularization, and 1 patient received a heart transplant. In a multivariate analysis, four clinical and echocardiographic variables were associated with increased risk of cardiac death: resting wall motion score index [hazard ratio (HR) = 7.5 per unit; 95% confidence interval (CI), 2.8 to 20; P = 0.001], previous myocardial infarction (HR = 2.9; 95% CI, 1.1 to 7.3; P = 0.02), diabetes (HR = 2.7; 95% CI, 1.1 to 6.6; P = 0.03), and the change in wall motion score index from rest to peak stress (HR = 3.0 per unit; 95% CI, 1.0 to 8.6; P = 0.04). The 5-year survival was 77% in the ischemic group and 92% in the nonischemic group (P = 0.02). Four variables were associated with increased risk of cardiac death or infarction: previous myocardial infarction (HR = 3.4; 95% CI, 1.7 to 6.8; P = 0.0005), diabetes (HR = 2.4; 95% CI, 1.2 to 4.6; P = 0.01), resting wall motion score index (HR = 2.2 per unit; 95% CI, 1.1 to 4.1; P = 0.02), and positive echocardiographic result (HR = 2.2; 95% CI, 1.1 to 4.5; P = 0.03). The 5-year infarction-free survival was 60% in the ischemic group and 87% in the nonischemic group (P < 0.0001). Stress echocardiography significantly improved risk stratification in patients without previous myocardial infarction (P = 0.0001), but not in those with previous myocardial infarction (P = 0.08). In particular, it provided additional value over clinical and resting echocardiographic findings in predicting cardiac events among patients without previous infarction. CONCLUSIONS: Myocardial ischemia during pharmacologic stress echocardiography is a strong prognostic predictor in patients with left bundle branch block, particularly in those without previous myocardial infarction.     

Prognostic value of gated SPECT in patients with left bundle branch block.

BACKGROUND: The aim of this study was to assess the prognostic value of quantitative gated technetium 99m tetrofosmin single photon emission computed tomography (SPECT) imaging in patients with left bundle branch block (LBBB). METHODS AND RESULTS: We followed up 101 consecutive patients with LBBB using Tc-99m tetrofosmin gated SPECT imaging. The mean follow-up was 1.24 years (maximum, 2.48 years). Hard endpoints were all-cause death and acute myocardial infarction. Event-free survival curves were obtained. Optimal cutoff points for left ventricular (LV) volumes and LV ejection fraction (EF) to predict outcome were determined by receiver operating characteristic curve analysis. Of the patients, 94 had an abnormal study. Fifteen hard events occurred (thirteen deaths). Perfusion abnormalities were similar for patients with or without events. For LV function parameters, the survival curves were maximally separated when we used cutoff values of 160 mL or greater for end-diastolic volume (P = .019 and hazard ratio [HR] of 1.04 for hard events, P = .024 and HR of 1.04 for all-cause death), 100 mL or greater for end-systolic volume (P = .043 and HR of 1.04 for hard events, P = .062 and HR of 1.04 for all-cause death), and lower than 35% for LVEF (P = .013 and HR of 0.81 for hard events, P = .047 and HR of 0.81 for all-cause death). CONCLUSION: By use of quantitative gated SPECT imaging, LBBB patients with an end-diastolic volume of 160 mL or greater, end-systolic volume of 100 mL or greater, or LVEF lower than 35% are at increased risk for subsequent cardiac events.