改良张力带钢丝联合可吸收带线锚钉内固定治疗髌骨下极撕脱骨折疗效观察

目的观察改良张力带钢丝联合可吸收带线锚钉内固定治疗髌骨下极撕脱骨折的临床疗效。方法回顾性分析自2016-06—2019-08诊治的34例髌骨下极撕脱骨折,采用环形+8字形钢丝张力带联合可吸收带线锚钉内固定。术后6个月采用膝关节活动度、Bostman评分评定患肢功能恢复情况。结果 34例均获得随访,随访时间平均13.2(6～24)个月。切口均一期愈合,术后6周随访时骨折均达到临床愈合。术后即刻Insall-Salvati指数为0.97±0.09,术后6周InsallSalvati指数为0.97±0.06,无明显差异。术后6个月膝关节活动度为(130.2±4.3)°。术后6个月膝关节功能Bostman评分为(28.8±1.1)分,其中优29例,良5例。结论改良张力带钢丝联合可吸收带线锚钉内固定治疗髌骨下极撕脱骨折能够获得满意疗效,手术操作简便,骨折端固定牢靠,并发症发生率低,患者可以早期功能锻炼,膝关节功能恢复良好。     

锚钉技术治疗髌骨下极撕脱骨折11例近期疗效观察

[目的]评价锚钉技术治疗髌骨下极撕脱骨折的近期治疗效果并探讨髌骨下极撕脱骨折的外科治疗方法.[方法]回顾性分析2008年3月～ 2012年3月收治的髌骨下极撕脱骨折11例(男7例,女4例),年龄28～50岁,平均39岁,均采用锚钉技术固定治疗.术后平均随访18个月(12～34个月),并采用陆氏标准评价疗效.[结果]11例中优9例,良2例,疗效满意.[结论]采用锚钉技术治疗髌骨下极撕脱粉碎性骨折操作简便,疗效确切,避免二次手术.     

可吸收带线锚钉治疗髌骨上下极撕脱性骨折22例

目的总结可吸收带线锚钉治疗髌骨上下极撕脱性骨折的疗效。方法采用可吸收带线锚钉治疗髌骨上下极撕脱性骨折22例。其中髌骨上极骨折3例,髌骨下极骨折19例。结果本组获随访平均12个月,22例切口一期愈合,骨折全部愈合．平均愈合时间10周。采用Lysholm评分评定膝关节功能：优13例,良6例,可3例,优良率86．4％。结论采用可吸收带线锚钉治疗髌骨上下极骨折具有操作简单、创伤小、手术时间短、所用手术器械少、固定牢靠、并发症少、疗效肯定等优点。     

锚钉结合Krackow和Bunnell缝合法治疗髌腱起点断裂

目的 应用锚钉结合Krackow和Bunnell缝合法治疗髌腱起点断裂,探讨此技术的临床应用效果.方法 3例髌腱起点断裂患者急诊手术,髌骨下极拧入3枚锚钉.髌腱两侧采用Krackow缝合和水平褥式缝合,中间采用Bunnell缝合.术后第1天开始功能锻炼,6个月后了解膝关节功能情况.结果 3例患者均获随访,术后6个月无锚钉松动或拔出,无屈伸膝关节受限.Lysholm膝关节评分在91～95分.结论应用锚钉结合Krackow和Bunnell缝合法治疗髌腱断裂,固定可靠,能够早期进行功能锻炼,缩短切口长度、减少手术时间,效果满意.     

缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴内侧髌股韧带断裂

目的评价缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴内侧髌股韧带（MPFL）断裂的临床疗效。方法自2006-07—2012-01采用缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴MPFL断裂21例,术后12个月采用膝关节功能Lysholm评分标准评价膝关节功能。结果术后切口均一期愈合,无感染。本组均获得随访13~24个月,平均14.6个月。末次随访时髌股关节对合良好,解剖关系正常。术后12个月膝关节功能Lysholm评分78~100分,平均93.7分;疗效等级评价：优13例,良7例,可1例,优良率95.2%。结论缝合锚钉内固定治疗急性髌骨脱位后髌骨内缘撕脱骨折伴MPFL断裂临床疗效满意,手术操作简单、损伤小。     

带线锚钉内固定治疗髌骨上下极撕脱骨折

目的 探讨带线锚钉内固定治疗髌骨上下极撕脱骨折的方法和疗效.方法 应用带线锚钉内固定治疗21例髌骨上下极撕脱骨折,采用Bostman髌骨骨折疗效评定标准、X线检查和膝关节活动度评价术后疗效.结果 术后随访6～18个月,平均12个月.21例全部骨性愈合,膝关节活动度良好,术后Boatman评分:优19例,良2例.结论 带线锚钉内固定治疗髌骨上下极撕脱骨折具有创伤小、固定牢固、无需二次手术、并发症少等优点.     

缝合锚钉技术治疗关节周围撕脱骨折及韧带损伤

目的评价缝合锚钉治疗关节周围撕脱性骨折及韧带损伤的临床效果。方法自2007年1月至2010年6月,采用缝合锚钉治疗关节周围撕脱性骨折及韧带损伤26例,其中可吸收锚钉18例,不可吸收锚钉8例。结果 26例均获随访,随访时间6~12个月,平均10个月。10例撕脱性骨折全部愈合,关节恢复正常功能,16例韧带损伤,关节稳定,无压痛,能胜任原来的体力劳动。无一例缝合锚钉脱落。结论采用缝合锚钉治疗关节周围撕脱性骨折及韧带损伤是一种较为理想的治疗方法,有助于关节功能的恢复。     

应用带线锚钉内固定治疗髌骨下极撕脱骨折效果观察

目的观察应用带线锚钉内固定治疗髌骨下极撕脱骨折的临床效果。方法对18例髌骨下极撕脱骨折患者实施切开复位、带线锚钉内固定治疗,观察治疗效果及术后并发症。结果 18例患者骨折愈合良好,愈合时间(12.10±1.18)周。患者均获随访6个月,无切口感染、锚钉松动、神经损伤、骨折再移位、深静脉血栓形成等并发症。根据Neer膝关节功能评分标准优良率100%。结论带线锚钉内固定治疗髌骨下极撕脱骨折固定牢靠,术后并发症发生率低,膝关节功能恢复满意。     

带线骨锚钉治疗髌骨下缘撕脱性骨折

目的讨论采用带线骨锚钉治疗髌骨下缘撕脱性骨折手术方法及临床疗效。方法对11例髌骨下缘撕脱性骨折患者,采用骨折端修整后以带线骨锚钉进行髌韧带修复。结果术后患者伤口均Ⅰ期愈合。随访6个月,2例关节强直并伴有创伤性关节炎,其余9例膝关节功能恢复良好。结论使用带线骨锚钉治疗髌骨下缘撕脱性骨折操作简便,所需手术时间短,无需取出内固定。     

双U型可吸收线缝合治疗成人髌骨下极套状撕脱骨折

目的 探讨双U型可吸收线缝合治疗成人髌骨下极套状撕脱骨折的疗效.方法 对7例髌骨下极套状撕脱骨折采用双U型可吸收线缝合治疗.结果 7例均获随访,随访时间6～12个月,全部骨性愈合,愈合时间8～12周,术后12周完全恢复膝关节功能,无并发症发生.结论 双U型可吸收线缝合治疗成人髌骨下极套状撕脱骨折,创伤小、固定可靠、减少了二次手术的再损伤、可早期恢复功能活动、愈合快、并发症少.     

Arthroscopic rotator cuff repair using a single-row of triple-loaded suture anchors with a modified suture configuration

Achieving an adequate restoration of the muscle–tendon–bone unit and the anatomical footprint is essential for a successful outcome in open and arthroscopic rotator cuff repair. The described suture grasping technique using triple-loaded suture anchors might combine high initial fixation strength with good footprint coverage. It describes two mattress’ stitches medial at the articular margin of the tendon. Additionally, a third mattress stitch is performed laterally to increase footprint contact and avoid dog-ear deformity. The triple-mattress repair is easy to perform and might be a good alternative in either arthroscopic or open rotator cuff repair.     

腹部切口全层缝合与分层缝合对照研究

目的 比较腹部切口全层缝合与分层缝合的疗效。方法 将2003年12月至2007年12月中山大学孙逸仙纪念医院行腹部手术的283例病人分为两组,分别采用全层连续缝合及分层缝合关腹,比较两组病人切口愈合情况及并发症发生率。结果 全层缝合组未出现切口全层裂开,分层缝合组有5例出现切口裂开;全层缝合组有3例出现切口液化,分层缝合组有7例出现切口液化,均经换药后痊愈;全层缝合组在Ⅲ类切口中有8例发生感染,分层缝合组有17例发生感染,其中5例为Ⅱ类切口,12例为Ⅲ类切口,两组间差异有统计学意义 (P <0.05)。在窦道形成方面,全层缝合组有2例Ⅲ类切口病人分别术后14d和28d出现,分层缝合组则有1例Ⅱ类切口及6例Ⅲ类切口病人出现,两者差异有统计学意义。全层缝合组有1例出现切口疝,为正中切口,分层缝合组有3例出现,其中2例为正中切口,1例为旁正中切口,两者差异无统计学意义。结论　全层缝合是一种安全,快捷,有效的方法,可降低术后切口裂开的发生率,在Ⅲ类切口病人中能降低切口感染及窦道形成的发生率。     

Intracutaneous butterfly suture – a horizontal buried interrupted suture for high tension

Background: Tension on surgical wound margins frequently results following the excision of skin lesions such as tumors, naevi or scars. This tension is commonly counteracted with buried, intracutaneous, interrupted sutures of absorbable or non-absorbable material anchored vertically in the corium. Method: A horizontal, buried, intracutaneous suture has now been developed which can be more firmly anchored in the corium. It adapts and everts wound margins nearly as broadly as two vertical sutures, particularly, when the wound edges are cut obliquely with a longer rim of epidermis. When finished, the suture has a butterfly shape, whence its name. It can also be laid as a double suture (double butterfly suture). In creating this sutures, the surgeon changes the customary direction of the needle holder from horizontal to vertical. Materials: Since 1985, this suture has been made with polydioxanon in more than 30000 skin lesion excisions with very good results. In most cases the resulting narrow and smoth scars were narrow and flat in the most cases. During the study, the following suture materials were tested prospectively in 1325 patients: polyglactin 910 (Vicryl^®) (n=390), polytrimethylcarbonate (Maxon^®) (n=95), poliglecaprone 25 (Monocryl^®) (n=175), and (PDS^®) (n=665). Results: The results were unsatisfactory in only 8% of procedures. Polyglactin 910 was accompanied by somewhat more inflammation and scar dehiscence, poliglecaprone 25 by a high rate of scar dehiscence. Polytrimethylcarbonate caused skin reactions in 23% and was discontinued. Suture perforation occurred in 9%. Polydioxanon yielded the best results (p-value of the difference <0.05). Conclusions: The butterfly suture has the advantages of withstanding tension better while everting wound margins and requiring fewer stitches for wound closure. However, it is important that the suture knot be deeply anchored beneath the corium.     

Modified arthroscopic suture fixation of displaced tibial eminence fractures using a suture loop transporter

Current arthroscopic suture fixation techniques of tibial eminence fractures are time consuming and the number of anchor sutures that can be placed is limited by the cumbersome and repetitive numerous needle threading steps. This occurs at 2 stages: first, when placing anchoring sutures through the avulsed anterior cruciate ligament stump with a suture punch, and second, when there is a need to traverse the tibial bone canal with the suture ends. We describe a modification that reduces the reliance on conventional rigid instruments and instead uses a loop transporter made from readily available suture material. The suture loop transporter being malleable reduces the necessary width of the tibial bone canal to be made and has a further advantage of minimizing the bone loss during the reaming of the bone tunnel. The subsequent potential for a stress fracture at these tunnel sites is also substantially reduced. Our technique is more user friendly, more accurate, and quicker to perform.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 101–106     

Meniscal suture: a simple method

A simple technique of meniscal suture is described. It avoids the main problem with most other outside-to-inside suture techniques, which is that knots either have to be left inside the joint or have to be pulled out through the meniscus. These knots often come undone or damage either the joint surface or meniscus. Essentially, a suture is inserted from outside to inside through the meniscus, using a cannulated needle. The end of this suture is then pulled back out through a separate hole in the meniscus, using a suture loop inserted with another cannulated needle. The two ends of the first suture are then tied together.     

Biomechanical performance of a braided absorbable suture

Lactomer and Polyglactin 910 sutures are both made of copolymers of lactide and glycolide. Biomechanical performance tests demonstrated superior handling characteristics of the Lactomer sutures. Using sutures comparable in size and knot construction, the Lactomer sutures exhibited knot holding force superior to the Polyglactin 910. Moreover, the low knot rundown forces encountered by the Lactomer sutures facilitated construction of secure knots that failed by breakage rather than by slippage.