后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折

目的探讨后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折的疗效。方法采用后外侧入路空心钉内固定治疗26例三踝骨折中下胫腓后韧带止点撕脱后踝骨折,先行内、外踝骨折内固定,再行后踝骨折固定。结果本组均获平均15(10~24)个月随访,未出现切口感染、皮肤坏死等并发症。术后随访X线片未见内固定失败、断裂。踝关节骨折均于术后3~4个月愈合,平均3.5个月。结论后外侧入路空心钉内固定治疗下胫腓后韧带止点撕脱后踝骨折操作方便、复位精确、固定可靠,值得进一步推广。     

俯卧位后外侧入路手术治疗旋后外旋型踝部骨折的疗效分析

目的研究俯卧位后外侧入路手术治疗旋后外旋型踝部骨折的临床疗效、术后并发症等。方法采用俯卧位后外侧入路手术治疗旋后外旋型踝部骨折32例,其中Ⅱ度损伤5例,Ⅲ度损伤8例,Ⅳ度损伤19例;术中腓骨接骨板均放置在腓骨后侧,后踝21例采用空心螺钉固定,6例采用接骨板固定,术中均未行下胫腓联合螺钉固定。记录患者的术后并发症情况及踝关节评分情况。结果所有切口均一期愈合,术后2周拆线。本组病例均得到随访,随访时间为12~14个月,平均12个月。1例患者术后出现腓骨后侧疼痛,考虑为内固定所致的腓骨肌腱刺激征,待骨折愈合拆除内固定后疼痛消失。无内固定松动断裂等并发症。12个月美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝关节功能评分:优23例,良8例,差1例,优良率为96.8%。结论俯卧位后外侧入路复位和固定旋后外旋型踝部骨折临床疗效满意,具有骨折复位满意,固定牢靠,手术创伤小等优点。     

全层修复三角韧带与下胫腓联合内固定治疗Lauge-Hansen旋后外旋型Ⅳ度踝关节骨折

目的探讨全层修复三角韧带联合下胫腓联合螺钉固定治疗Lauge-Hansen旋后外旋型Ⅳ度踝关节骨折的临床疗效。方法回顾性分析自2013-03—2018-03手术治疗的31例Lauge-Hansen旋后外旋型Ⅳ度踝关节骨折,先取仰卧位内侧入路探查三角韧带并评估损伤程度,在三角韧带深层止点预置锚钉,再取侧卧位后外侧入路复位腓骨、后踝固定或不固定,再取仰卧位前外侧小切口探查清理下胫腓联合并行下胫腓联合螺钉固定,最后依次修复三角韧带深层、浅层。结果 31例均获得随访,随访时间平均31(18~48)个月。骨折完全愈合时间为12~48周,无骨折延迟愈合、下胫腓螺钉断裂发生。末次随访时踝-后足AOFAS评分平均91(72~97)分,优27例,良3例,可1例。结论全层修复三角韧带联合下胫腓联合螺钉内固定治疗合并下胫腓联合及三角韧带损伤的Lauge-Hansen旋后外旋型Ⅳ度踝关节骨折可降低踝关节复位不良发生率,恢复踝关节稳定性,有利于患者进行早期功能锻练,达到快速康复的目的。     

联合入路手术治疗伴后踝骨折的踝关节骨折脱位

目的探讨采用联合入路手术治疗伴后踝骨折的踝关节骨折、脱位的疗效。方法对24例伴后踝骨折的踝关节骨折、脱位采用改良后外侧入路结合内侧入路手术治疗,从改良后外侧入路用钢板固定腓骨远端,多枚拉力钉固定后踝;从内侧入路用拉力螺钉或张力带固定内踝。结果腓骨远端、后踝、内踝复位好,关节面达到解剖复位,无皮瓣坏死。24例均获随访14~24个月,按Baird-Jaskson踝关节评分系统评估疗效:优20例,良2例,可2例,优良率91.67%。结论采用改良后外侧入路结合内侧入路手术治疗伴后踝骨折的踝关节骨折、脱位具有切口数少、解剖简单、创伤小、固定可靠的优点,关节面能解剖复位,减少了创伤性关节炎的发生。     

旋前、后外旋型三踝骨折的手术治疗

目的总结旋前后外旋型（Ⅳ度)三踝骨折切开复位内固定的手术方法和疗效。方法1996年3月～2002年10月，对48例旋前、后外旋型（Ⅳ度)三踝骨折行切开复位内固定术．男27例，女21例；年龄l7～85岁．平均42.8岁。根据Lauge-Hansen分类．旋前外旋型Ⅳ度三踝骨折20例．旋后外旋Ⅳ度三躁骨折28例。受伤距手术时间2h～21d。内侧采用标准内踝切口显露内踝骨折，外侧采用腓骨后缘纵行切口显露外踝骨折。如需行后踝骨折处理．则将内踝的切口延长．外侧采用经腓骨的Gatellie-Chastang手术入路同时切开显露内、外及后踝。整复固定的顺序是后踝，内踝、外踝和下胫腓联合。骨折复位固定完成后，行踝部正侧位及踝榫(Mortise)位X线检查。满意复位的标准为：(1)踝榫的正常关系恢复，(2)踝的负重排列与下肢纵轴成直角．（3)关节面的外形轮廓光滑，结果仝部患者均获得随访，随访时间6～36个月．平均13个月，骨折愈台时间为12～16周。随访时疗效评定根据Baird-Jackson评分系统进行评定：优26例，良15例，可5例．差2例；优良率为85．4％。术后未发生感染、骨不连、骨折畸形愈合等并发症．但发生1例下胫腓三皮质固定螺钉断裂。结论躁关节的解剖复位可获得最佳的临床结果，采用切开复位内固定术治疗三踝骨折可保证踝关节获得解剖复位．最大限度地恢复踝关节功能。     

后外侧入路两种内固定治疗后踝骨折的疗效比较

目的比较后外侧入路空心螺钉和支撑钢板两种内固定治疗后踝骨折的疗效。方法将46例后踝骨折患者采用后外侧入路直接显露复位后踝,分别采用空心螺钉(22例)和支撑钢板(24例)固定。比较两组患者术后并发症情况及踝关节评分情况。结果空心螺钉组患者切口均一期愈合;支撑钢板组1例术后出现切口感染,给予清创、闭式持续冲洗2周后切口愈合。两组患者均获得12个月随访。支撑钢板组和空心螺钉组术后各有1例出现腓骨后侧轻度疼痛不适,注意休息并外用扶他林软膏后疼痛缓解,支撑钢板组1例取出钢板后不适消失。两组均未出现内固定松动、断裂、骨折再移位等情况。术后12个月踝-后足AOFAS评分:支撑钢板组为48.4~96.3(88.1±2.5)分,优良率为23/24;空心螺钉组为45.5~95.5(88.5±3.0)分,优良率为21/22。两组AOFAS评分及优良率比较差异无统计学意义(P0.05)。结论后外侧入路直接复位采用空心螺钉固定和支撑钢板固定均能获得满意的临床疗效,而空心螺钉固定创伤更小且便于取出。     

内固定治疗踝关节骨折的疗效

目的 探讨内固定治疗踝关节骨折的临床疗效。方法 采用内固定治疗33例伴后踝骨折累及胫骨远端关节面≥25%的踝关节骨折患者，其中后踝骨折采用经后外侧入路由后向前3枚空心螺钉三角分布固定。记录骨折愈合时间、并发症发生情况、踝关节活动度，根据AOFAS踝-后足评分标准评价踝关节功能。结果 患者均获得随访，时间12～48(20.5±2.1)个月。骨折均解剖复位，踝关节对位对线良好。骨折愈合时间7～12(11.2±1.1)周。未发生切口感染、骨不连及内固定物松动、退出等并发症。1例术后2个月X线片显示后踝移位>2 mm,于术后第11个月发生胫距关节炎。末次随访时，根据AOFAS踝-后足评分评价疗效：优18例，良12例，可2例，差1例，优良率90.9%(30/33);踝关节背伸20°～30°(20.1°±1.8°),跖屈38°～49°(42.8°±4.2°)。结论 在内固定治疗踝关节骨折中，采用经后外侧入路由后向前3枚空心螺钉三角分布固定治疗累及胫骨远端关节面≥25%的后踝骨折具有固定牢靠、并发症少、功能恢复较好等优点。     

后外侧联合前内侧入路钢板内固定治疗后踝移位Ruedi-Allgower Ⅲ型Pilon骨折

目的探讨后外侧联合前内侧入路钢板内固定治疗Ruedi-AllgowerⅢ型Pilon骨折的手术方法和临床疗效。方法对12例合并后侧骨块移位的Ruedi-AllgowerⅢ型Pilon骨折采用后外侧入路显露、固定腓骨和后侧骨块。先经腓骨短肌前方行腓骨骨折复位固定,同一切口内沿拇长屈肌外缘显露胫骨后踝并固定,再取踝前内侧切口,直视下行胫骨关节面复位,充分植骨后胫骨前方行钢板固定。结果术后随访平均11.7个月。末次随访时按Mazur评分标准评定疗效：优8例,良3例,可1例。结论后外侧联合前内侧入路钢板内固定治疗合并后侧骨块移位Ruedi-AllgowerⅢ型Pilon骨折可充分显露和固定后侧骨块,为胫骨远端关节面复位提供标志,且不增加软组织并发症。     

改良后内与后外侧入路在三踝骨折内固定术中的应用

目的探讨改良后内、外侧手术入路在三踝骨折内固定中的应用效果。方法对36例三踝骨折采用改良的后外侧或后内侧入路内固定治疗。取后外侧入路,在腓骨肌与拇长屈肌之间显露后踝,复位后用2枚空心钉或松质骨螺钉固定。后、外踝固定完毕后改平卧位常规固定内踝。后踝骨折块偏内侧者,取内踝后内侧切口。结果 36例切口均一期愈合,均获得平均11(8~18)个月随访。骨折全部愈合。疗效根据踝关节功能Baid-Tackson评分标准评定:优28例,良5例,可3例,优良率91.7%。结论采用改良的后内、外侧切口显露三踝骨折,具有损伤小,显露充分,容易复位固定的优点。     

后外侧联合内侧入路急诊内固定治疗三踝骨折

目的 探讨后外侧联合内侧入路急诊内固定治疗三踝骨折的疗效.方法 对23例三踝骨折患者急诊采用后外侧入路行后踝骨折复位空心螺钉或支撑钢板内固定、外踝骨折复位钢板内固定,内侧入路行内踝骨折复位空心螺钉内固定.末次随访时采用AOFAS踝-后足功能评分标准评价疗效.结果 患者均获得随访,时间10～32个月.切口均一期愈合.骨折...     

Cerebellar hemangioblastoma simulating arachnoid cyst on imaging and surgery

A case of posterior fossa hemangioblastoma simulating arachnoid cyst on imaging and peroperatively is presented. In vivo proton MR spectroscopy showed evidence of large lactate and resonance at 2.37 ppm not observed earlier in the cystic lesions, including arachnoid cyst. The demonstration of this resonance may help in characterization of these lesions that may be confused with arachnoid cysts on imaging and during surgery. Electronic Publication     

Aplasia of the posterior arc of the atlas with persistent posterior tubercle: a case report

An unusual case of partial aplasia of the posterior arc of the atlas, with persistent posterior tubercle, is presented in a previously healthy individual who sustained a neck trauma. Both plain X-rays and CT findings specified the lesion. Dynamic X-rays in flexion and extension showed an immobile posterior tubercle. The patient did not develop neurological symptoms at any stage during follow-up (1 year).     

A comparison of various types of fixation devices for protection of the posterior cruciate ligament against a posterior drawer force

We compared four different fixation devices to determine which offers the greatest relative protection to the posterior cruciate ligament (PCL) against elongation with an applied posterior drawer force. We designed a system to monitor and record the change in distance between an approximate origin and insertion of the PCL as known forces were applied posteriorly to the tibia with the femur fixed. Six fresh cadaver knees were used in this investigative series. They were first tested with the PCL intact, then with the PCL transected, and then with the various fixation devices applied. After comparing the results with transarticular pins and quadrilateral and anterior half-frame external fixators, we found that transarticular fixation offers significantly greater protection to the PCL. This study may prove to be helpful to the orthopaedist when selecting ancillary fixation for posterior cruciate repair or reconstruction.     

Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study

An investigation was conducted into the effects of double-level T12-L2 posterior fixation on the mobility of neighboring unfused segments. The segmental mobility of adjacent segments above and below the fixation in ten cadaveric human thoracolumbar spine specimens was measured before and after fixation by biomechanical testing in flexion, extension, right lateral bending, and right rotation, and the data were compared. In flexion and extension, mobility of the segment above the double-level T12-L2 posterior fixation was significantly increased (P<0.05). In the adjacent segment below the fixation, there was no significant increased mobility after fixation for each moment applied. There is evidence that the adjacent segment above a double-level T12-L2 posterior fixation becomes more mobile, and this may lead to an accelerated degeneration in the facet joints due to increased stress at this point. This could be responsible for symptoms like low back pain after spinal surgery.     

后路半椎体切除节段固定矫正侧后凸畸形疗效初步观察

目的 :观察和评价由单个先天性半椎体引起的侧后凸畸形经一期后路半椎体切除及节段矫形内固定的初期手术效果。对象与方法 :对 10例由单个先天性半椎体引起的侧后凸畸形患者进行回顾性分析。年龄在 8～ 14岁之间 ,均经一期后路半椎体切除及节段性矫形内固定。随访 6个月～ 2年 (平均 1年 2个月 )。术前、术后及随访时摄站立位脊柱全长正侧位片进行观察。结果 :10例患者术前均有侧后凸畸形。术后侧凸角度由平均 69°改善至 2 8° (矫正率 60 %) ;后凸畸形由术前的平均 48°矫正至平均 19°。随访获初步或坚强融合 ,无神经系统损伤、感染及内固定失败等并发症发生。结论 :由先天性半椎体所引起的脊柱侧后凸畸形可经一期后路半椎体切除和节段矫形内固定而获得满意的矫形效果。手术适应证为由胸椎或胸腰段半椎体畸形所引起的青少年患者的结构性侧后凸畸形。     

髌骨鹰嘴化固定在后交叉韧带损伤中的应用

目的探讨髌骨鹰嘴化固定在后交叉韧带(PCL)损伤治疗中的作用.方法根据创伤病理不同,采用不同的手术方式.手术时均行髌骨鹰嘴化固定6～8周及术后石膏托固定4～6周,去石膏后开始CPM活动2～4周,取出固定斯氏针.结果随访1～3年,在单纯动力重建和单纯缝合实质部的损伤8例,后抽屉试验(PDT)(++);静力重建后2例,PDT(+);静力+动力重建及在后交叉韧带附丽点撕脱骨折的8例,PDT(～).术后2例出现退针,1例压迫皮肤.所有的病例膝关节的活动范围接近正常.结论认为髌骨鹰嘴化固定可以有效地防止胫骨上端下沉,有利于手术中调节修复或重建韧带的张力,利于早期的功能活动.     

The posterior cruciate ligament arthroscopic evaluation and treatment

The posterior cruciate ligament (PCL) is an anatomically and biomechanically complex structure. PCL injuries are reported to occur in 1–40% of acute knee injuries, with isolated PCL tears less common that PCL tears combined with other ligament injuries. Diagnosis of PCL injuries requires a high index of suspicion, careful physical examination, imaging studies, and systematic arthroscopic evaluation. Surgical reconstruction is recommended for acute PCL tears combined with other ligament or structural injuries, and when there is a negative tibial step off in an isolated PCL tear. Isolated acute PCL tears with a positive tibial step off or flat tibial step off may be treated with rehabilitation and observation and reconstructed later if symptomatic. Arthroscopic techniques of PCL reconstruction are becoming more refined and reproducible and may increase the predictability of this surgery. Carefully documented pre- and postoperative evaluations are required to judge the effectiveness of PCL reconstructive procedures.     

Posterior Scrotal Artery Flap to Cover a Groin Defect: A New Technique

Commonly, a groin defect is reconstructed with flaps from ipsilateral thigh or lower abdomen. Here we present a case report of use of a pedicled flap from the posterior scrotum based on posterior scrotal artery to cover a groin defect exposing femoral vessels. Posterior scrotal artery, to best of our knowledge, has not been described in the literature to cover a groin defect.