月骨无菌性坏死的临床治疗进展

月骨无菌性坏死是一种病因不明的腕部疼痛性疾病,好发于15～40岁的男性体力劳动者的优势手腕。1910年Kienbock最初对其做了系统性描述,因此又称Kienbock病。1解剖因素月骨位于近侧列腕骨的中心,呈新月形,它是腕关节中央列,即头—月—桡骨关节链的中心,易被扭曲或挤压。月骨与相邻骨块共构成五个关节,表面绝大部分为关节软骨覆盖,而无骨膜,仅在其掌侧及背侧腕关节韧带附着处有小血管进入。和全身多处骨相比,月骨血供较差,其血供破坏时很难借助相邻骨骼的血供来修复再生。2致病因素一些学者认为继发于创伤或反复微小创伤的循环改变为其病因[1…     

尺,桡骨远端解剖变异与月骨缺血性坏死关系的研究

了解月骨缺血坏死关节的尺肌负变异率，桡骨远端关节面尺偏角与正常人关节是否有明显的不同。方法；在年龄，性别，手别匹配以及投照体位标准化的条件下，对２８例月骨缺血性坏死的３１侧患腕，３１侧正常人腕关节正位Ｘ线平片进行对比观察，另外还观测了２５例单侧发病患者患，健腕的正位Ｘ线平片。     

与月骨缺血性坏死有关的骨骼因素

月骨缺血性坏死的发生与许多因素有关。其中骨骼因素，如尺骨负变异、桡骨远端关节面尺偏角，是文献中最常提及的，尺骨延长、桡骨短缩或楔形截骨等手术的流行与之不无关系。但新近一些研究结果却与传统观点相对立，应当引起我们的注意。     

桡骨远端骨瓣转移治疗晚期月骨无菌性坏死

目的 报告以桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗晚期月骨无菌性坏死的手术方法及初步疗效.方法 对2例晚期(Ⅳ期)月骨无菌性坏死患者,采用桡动脉腕背分支为蒂的桡骨远端骨瓣转移治疗.术后随访患者症状、腕关节活动度和腕关节影像学的改变,并用Krimmer 评分表和DASH评分表进行功能评定.结果 2例患者随访时间分别为3年和6个月,静息时疼痛均已消失,活动时疼痛程度减低.影像学表现:例1患者X线片月骨可见高密度坏死骨质已吸收,有新骨质形成;例2患者MRI显示坏死骨和腕骨塌陷无进一步进展.2例腕关节功能按Krimmer评分、DASH评分均较术前有明显的改善.结论 桡动脉腕背分支为蒂的桡骨远端骨瓣转移术治疗晚期月骨无菌性坏死.初步疗效良好.     

先天性尺桡骨融合的手术治疗

目的 总结尺桡骨截骨旋转矫形治疗先天性尺桡骨融合的临床经验.方法 自2000年8月-2004年6月共手术治疗先天性尺桡骨融合5例(9侧),对严重畸形(旋前70°～110°)7侧,行尺桡骨截骨旋转矫形术.结果 术后随访时间为18～64个月,平均35个月.截骨处骨折愈合时间平均为6.5周,无矫正丢失,前臂固定于旋前20°～25°的位置,患儿对目前手功能自觉满意.结论 尺桡骨截骨旋转矫形是治疗先天性尺桡骨融合简单而有效的方法.     

两种入路桡骨茎突骨瓣植入治疗陈旧性舟状骨骨折疗效分析

目的观察桡背侧和桡掌侧入路植入桡骨茎突骨瓣治疗陈旧性舟状骨骨折的疗效。方法选取2011年3月-2012年12月采用桡背侧和桡掌侧入路植入桡骨茎突骨瓣治疗陈旧性舟状骨骨折患者22例,对其进行回顾性分析．观察术后1个月、2个月、3个月、6个月的X线片,确定骨折愈合情况;观察术后6个月、1年时腕关节功能恢复情况。结果本组患者术后6个月时舟状骨骨折全部愈合,腕关节活动度良好。结论桡背侧和桡掌侧入路植入桡骨茎突骨瓣治疗舟状骨陈旧性骨折的手术时间短,疗效明确,术后腕关节功能恢复良好。     

尺骨截骨矫形术治疗桡骨小头陈旧性脱位

[目的]探讨应用尺骨截骨矫形术治疗桡骨小头陈旧性脱位的疗效.[方法]对11例应用尺骨截骨矫形术治疗的桡骨小头陈旧性脱位患者进行回顾性分析;年龄4～13岁,平均7岁;5例有明确外伤史,1例有脱位复位史.左肘5例,右肘6例;病例均无桡神经损伤,X线示无桡骨小头变形.[结果]术后随访时间5～24个月,平均16个月.无再次脱位病例,1例患者出现骨不连,再次手术植骨后愈合.1例患者屈曲活动度较前降低15°.X线检查复位良好、未发现桡骨小头坏死.[结论]此种方法,患者疼痛及活动度等均得到明显改善,且手术方法简单有效,术后并发症少,可在桡骨小头陈旧性脱位中应用.     

月骨无菌性坏死的治疗进展

月骨无菌性坏死是一种腕关节疼痛性疾病,多发于青壮年体力劳动者。该文就月骨无菌性坏死的分期、治疗等的进展作一综述。     

带筋膜蒂桡骨远端骨瓣移植治疗腕舟状骨骨折疗效分析

目的 腕舟状骨骨折手术切开复位内固定用带筋膜蒂桡骨远端骨瓣移植,对其愈合效果评价和分析.方法 自2001年11月～2007年1月采用带筋膜蒂桡骨远端骨瓣治疗舟状骨骨折21例实验组,随机选取同期切开复位内固定游离骨条植骨16例作为对照组(对照组).结果 实验组21例骨折全部达到临床愈合标准.而对照组仅12例达到临床愈合标准,4例不愈合.结论 带筋膜蒂桡骨远端骨瓣是治疗手舟状骨骨折的一种较好方法,其效果明显优于对照组.     

Clinical results of the Keck and Kelly Wedge Osteotomy approach in Haglund's deformity: Minimum 3-year follow-up

Background and purposeThe Haglund’s deformity, which may be difficult to treat non-surgically, is caused by a prominent bone hump in the posterosuperior region of the calcaneus and may be associated with bursitis and foot pain. Many surgical treatments for resistant Haglund deformities have been described. Here, we evaluate the AOFAS scores, pain and other characteristics of patients undergoing removal of the dorsally based wedge from the posterior calcaneus with the Keck and Kelly procedure.Materials and methodsThe study included 20 patients who had undergone the Keck and Kelly procedure at our center, from 2011 to 2019, and had attended follow-up for at least three years. Analyses were performed retrospectively. Preoperative (immediately before surgery) and postoperative (at last assessment) American Orthopedic Foot and Ankle Society (AOFAS) and visual analog pain scale scores (VAS) were determined, and calcaneal inclination angles were radiologically measured. Additionally, calcaneal pitch angle (CPA), Fowler and Philip angle (FPA), and Bohler angle were recorded.ResultsFourteen patients were female, and six were male, mean age was 45.8 ± 8.1 years. AOFAS scores were significantly increased, whereas VAS scores were significantly decreased after surgery. Postoperative AOFAS scores were correlated with preoperative VAS, CPA, and FPA values. Preoperative VAS scores were correlated with CPA, FPA, and Bohler angle values. FPA and CPA values were correlated positively.ConclusionsIt was found that ankle functions improved, and pain levels decreased after Keck and Kelly Wedge Osteotomy was applied for the treatment of Haglund’s deformity. CPA and FPA were associated with both pain levels and ankle function. The Keck and Kelly Wedge Osteotomy procedure appears to be a preferable approach for the surgical treatment of Haglund’s deformity.     

Precise Patellar Tendon Insertion Protection and Osteotomy Surface Advantage of Transtibial Tuberosity–High Tibial Osteotomy

ObjectiveMedial opening wedge high tibial osteotomy (HTO) is successful in the treatment of knee osteoarthritis with medial compartment stenosis and tibial varus deformity, but patella infera is the main complication. This study aims to design a new medial tibial open osteotomy scheme, transtibial tuberosity‐high tibial osteotomy (TT‐HTO), which can fully protect the patellar tendon insertion. In addition, the area of the osteotomy surface and wedge volume were evaluated in TT‐HTO, biplanar distal tibial tuberosity osteotomy (biplanar‐DTO), and uniplanar‐DTO to evaluate the potential advantages of this technology in bone healing.MethodsThe tibial tubercle was divided into four equal sections from proximal to distal, which were defined as zones A, B, C, and D. From September to December 2020, the imaging examinations of 200 patients (95 males and 105 females) with a mean age of 40.6 years (range 19–60 years) were evaluated to observe the zonation of the tibial tubercle where the insertion of the patellar tendon is located. Then, 59 patients (23 males and 36 females) with a mean age 59.6 years (range 43–77 years), for a total of 69 knees (32 right and 37 left), who underwent routine knee surgery were observed and verified. According to the position of the patellar tendon insertion, TT‐HTO was designed. Fifteen tibial sawbones were divided equally into three groups: TT‐HTO; biplanar‐DTO; and uniplanar‐DTO. The total area of the osteotomy surface was compared using the graph paper method. The wedge volume at wedge heights of 10 mm was compared among osteotomy types using the plasticine Archimedes principle. One‐way repeated‐measures analysis of variance was used to compare the total area of the osteotomy surface and the wedge volume.ResultsThe osteotomy line of TT‐HTO passes through the boundary point of zones B and C of the tibial tubercle to fully protect the insertion point of the patellar tendon. The total area of the osteotomy surface in TT‐HTO and biplanar‐DTO was significantly larger than that in uniplanar‐DTO (P < 0.05). The wedge volume in uniplanar‐DTO was significantly smaller than that in TT‐HTO and biplanar‐DTO (P < 0.05). No significant differences in the osteotomy surface and the wedge volume were identified between TT‐HTO and biplanar‐DTO.ConclusionTT‐HTO can protect the patellar tendon insertion and avoid postoperative patella infera. The osteotomy surface is large and located in an area of cancellous bone, which ensures its good healing characteristics.     

髋臼旋转截骨术治疗髋臼发育不良

目的：报告1组成年人髋臼发育不良(DDD)患者行髋臼旋转截骨术(RAO)的疗效。方法：采用王金成改良Ollier髋外侧入路，行大粗隆截骨，截骨块连同臀中肌一起向近端反转，在关节囊外距髋臼骨性边缘约1．5cm处做穹隆状截骨，将整个髋臼以球形方式截断并向前、外、下方旋转，覆盖股骨头。结果：12例患者经平均2．5年的随访，疗效满意。结论：RAO手术是治疗成年人DDD行之有效的方法，可有效改善临床症状，恢复髋关节的生物力学及生理特点，明显降低患髋的病残率。     

Radial head dislocation with acute plastic bowing of the ulna

Five radial head dislocations with acute plastic bowing of the ulna in patients aged 6–12 years were reviewed. Closed reduction was successful in two, and open reduction was required in three patients in whom treatment was started more than 2 weeks after injury. In one child who presented 2 months after injury, realignment by osteotomy of the ulna as well as open reduction of the radial head was necessary. Follow-up evaluations at 6–24 months revealed good clinical outcomes in all patients. Awareness of this type of radial head dislocation is important to avoid delays in diagnosis and treatment.     

Chinese Clinical Practice Guidelines in Treating Knee Osteoarthritis by Periarticular Knee Osteotomy

Unicompartmental knee osteoarthritis (UKOA) is the early stage of knee joint degeneration, which is characterized by unicompartmental degeneration and mostly occurs in medial compartment. Pain and limited motion are main symptoms, which affect patients'' life quality. Periarticular knee osteotomy (PKO) for lower extremity alignment correction is an effective treatment for UKOA with abnormal alignment, which could relieve pain and improve joint function by adjusting lower extremity alignment. At present, no clinical guidelines are available for the treatment of UKOA by PKO for lower extremity alignment correction. Experts from the Clinical New Technology Application Committee of the Chinese Hospital Association, Joint Surgery Study Group of the Chinese Orthopaedic Association of the Chinese Medical Association, and Osteoarthritis Study Group of the Chinese Association of Orthopaedic Surgeons of the Chinese Medical Doctor Association formulated these guidelines. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) grading system and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) were adopted to select 25 most concerning questions. Finally, 25 recommendations were formulated through evidence retrieval, evidence quality evaluation, and the determination of directions and strength of recommendations. Recommendation items 1–5 are indications and contraindications for PKO for lower extremity alignment correction, items 6–21 are surgical methods and principles, item 22 describes 3D printing corrective osteotomy technique, and items 23–25 address the perioperative period, follow‐up management, and other content. These guidelines are designed to improve the normalization and standardization of KOA treatment by PKO for lower extremity alignment correction.     

鼻骨截骨整形的分型和适应证

目的 探讨鼻骨截骨整形的分型和临床适应证.方法 本文将鼻骨截骨整形方法分为:侧鼻截骨,鼻骨正中截骨,和鼻局部截骨三型.本组72例鼻骨畸形患者中,43例行侧鼻截骨矫正歪鼻畸形,29例行鼻骨正中截骨或鼻骨凸出局部截骨治疗驼峰鼻畸形和鼻骨局部凸出畸形.结果 本组72例截骨整形的患者中,65例术后鼻骨复位或显著改善,占鼻骨截骨病例的90%(65/72);7例截骨后出现鼻骨骨质增生,占10%(7/72).结论 本文鼻骨截骨分型简单,对鼻畸形整复有指导作用;侧鼻截骨适用于歪鼻畸形的整复,鼻骨正中截骨和鼻局部截骨适用于驼峰鼻畸形和局部骨赘凸出畸形的治疗.