上胫腓关节液流注性囊肿致腓总神经卡压的外科治疗

目的 分析上胫腓关节液流注性囊肿致腓总神经损伤的发病机制、诊疗方法及预后情况.方法 对我科2008年6月至2010年12月收治的因上胫腓关节液流注致腓总神经卡压的9例患者进行分析.结果 6例神经外囊肿患者经神经松解、囊肿切除术后踝关节及各趾背伸肌力达M4～M5,平均恢复时间约3.5个月;3例神经内囊肿患者经同一术式治疗,背伸肌力达M3～M4,平均恢复时间7个月.未见复发病例.结论 上胫腓关节液流注可形成腓总神经内或外囊肿,神经内囊肿较神经外囊肿恢复时间长、效果差.此类疾病早诊治,早治疗,患肢功能恢复好.     

Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography

High-quality AP and lateral radiographs of both knees are essential to confirm the diagnosis. Computed tomography may help resolve diagnostic uncertainty and enable earlier closed reduction to be performed. Moreover, CT scans may be more consistently reproducible than the varied quality of emergency radiographs. In this case, the relative severity of the patient's pain and suggestive radiographs led us to obtain CT scans, which confirmed the diagnosis and enabled early successful closed reduction.     

Synovial cyst of the proximal tibiofibular joint with peroneal nerve compression after total knee arthroplasty.

Synovial or ganglion cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar manner and may be difficult to diagnose clinically. Although synovial cysts arising from the knee joint after prosthetic arthroplasty have already been described, we report a case in which a lateral knee mass compressing the peroneal nerve was found to be a synovial cyst arising from the tibiofibular joint.     

Compression of the common peroneal nerve by a synovial cyst

The authors report a successfully treated case of compression of the peroneal nerve by a simple (extraneural) ganglion. A brief review of the pathogenesis of intraneural and extraneural ganglions is exposed. The authors emphasize on considering this diagnosis in every patient who is complaining of pain or paralysis in the territory of the peroneal nerve. The treatment is always surgical. Prognosis depends on early diagnosis, non mutilating surgery for the nerve and ligation of an eventual stalk joining the ganglion to the articulation.     

Dislocation of the proximal tibiofibular joint

We introduce a new method for fixation of a rare, isolated, proximal tibiofibular dislocation. One third of the biceps femoris muscle tendon was used for fixation of the dislocated proximal fibular head. The fixation was achieved by using a soft threaded interference ACL screw. Received: 6 November 1997     

Instability of the proximal tibiofibular joint

Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. A closed reduction should be attempted in patients with acute dislocation. If this is unsuccessful, open reduction and stabilization of the joint with repair of the injured capsule and ligaments can be done. Patients with chronic dislocation or subluxation report lateral knee pain and instability with popping and catching, which may be confused with lateral meniscal injury. Symptoms of subluxation may be treated nonsurgically with physical therapies such as activity modification, supportive straps, and knee strengthening. For patients with chronic pain or instability, surgical options include arthrodesis, fibular head resection, and proximal tibiofibular joint capsule reconstruction.     

Unprecedented recurrence of carpal tunnel syndrome by metaplastic synovial cyst in the carpal tunnel

Metaplastic synovial cyst (MSC) is a benign cystic lesion observed after surgical intervention and recurrent skin trauma. Because of its rarity, the etiology is not fully understood. The most emphasized etiologic factors are recurrent surgical procedures and cutaneous pathologies, which cause cutaneous fragility and abnormal wound formation. In the literature, MSC is exemplified as a mass that can be observed by the naked eye and palpated. All patients had a history of previous surgical procedures in the area. In the present case, we report a 48 -year-old woman with recurrent carpal tunnel syndrome due to a MSC. This report showed that MSC can be detected at deeper locations than the regions described in the literature. To our knowledge, this is the first report of MSC causing carpal tunnel syndrome recurrence. It is thought that previous operations are the most important etiologic factor in MSC occurrence.     

Excision arthroplasty of superior tibiofibular joint for recurrent proximal tibiofibular cyst. A report of two cases

Synovial cysts originating from proximal tibiofibular joint are commonly symptomatic. They can progress to cause pressure effects over the common peroneal nerve. In order to prevent recurrence the importance of excision of the ganglion and its stalk is emphasised. In recurrent cases treatment can be difficult. We describe an operation where after recurrence superior tibiofibular joint excision along with the cyst led to complete recovery in two cases.     

Traumatic instability of the proximal tibiofibular joint

Proximal tibiofibular instability, seems to be an infrequently diagnosed abnormality, which occurs in isolation or in combination with fractures of the leg and ankle. Four types of instability are distinguished: subluxation, anterolateral dislocation, posteromedial dislocation and superior dislocation.The method of treatment depends on the type of dislocation and on the presence or absence of dysfunction of the peroneal nerve.The methods of treatment are described. Ten patients treated for this instability are presented. The use of radiographs to define the lesion is discussed. Radiographs, taken at follow-up, showed degenerative changes in the proximal tibiofibular joint in 8 of the 10 patients.     

Isolated dislocation of the proximal tibiofibular joint

We have reported the case of an anterolateral dislocation of the proximal tibiofibular joint in a soccer player, apparently the second case in the literature. As in that reported by O'Rourke and McManus, this patient was attempting to gain his balance and this may indeed be an important contributing factor. Ogden's classification is now well accepted and has been reviewed along with a discussion of the mechanisms of injury. The diagnosis can generally be made by clinical examination and confirmed by roentgenographs. Treatment usually consists of closed reduction with 3 weeks of casting. In complicated cases, however, resection of the fibular head may be required.     

Nerve compression syndrome caused by synovial cyst of the hip joint]

Synovitis of the iliopectineal bursa have been described in pigmented villanodular synovitis, synovial chondromatosis, rheumatoid arthritis, osteoarthritis and necrosis of the femoral head. We report a case of enlargement of such a cyst in necrosis of femoral head and consecutive osteoarthritis, leading to entrapment of the femoral nerve. Simple drainage of the cyst did resolve pain for a short period and only elimination of the primum pathologicum agens did definitively release pain, irradiating to the ipsilateral leg.     

Permanent anterior dislocation of the proximal tibiofibular joint

We report two patients with permanent dislocation of the proximal tibiofibular joint and no history of trauma. Both needed operation, one for persistent pain and the other for common peroneal nerve involvement, and both had a good result.     

Synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy: report of three cases and review of the literature

Introduction Synovial cyst of the proximal tibiofibular joint is a very rare condition, for which there is no consensus regarding treatment. Case presentation We present three patients who had synovial cysts of proximal tibiofibular joint that caused peroneal nerve palsy. We discuss the special features of synovial cysts and review the literature. Conclusion We consider the best treatment of synovial cysts originating from proximal tibiofibular joint and causing peroneal nerve palsy to be total surgical removal as soon as possible after the diagnosis is made. It should be kept in mind that despite surgical treatment the neurological symptoms may not recover.     

肘骨性关节炎合并囊肿致肘管综合征1例

<正>患者,男,51岁,左肘间断疼痛10年,左手环、小指麻木、无力半年。病史:患者10年来因双肘部高强度劳动,出现间断疼痛,以劳累后明显,症状逐年加重,并伴有功能障碍,近半年来因左肘部外伤出现左手环、小指感觉麻木、无力,并呈进行性加重,行保守治疗无效,于2009年3月4日前来就诊。查体:体型偏胖,肘关节伸屈活动-10°～120°,左手呈轻度     

Stabilization of chronic proximal tibiofibular joint instability with a semitendinosus graft

Although chronic proximal tibiofibular joint instability is a rare condition, it is associated with marked functional impairment. Various surgical options have been reported in literature, all associated with several problems and limitations. We describe a new technique of reconstruction of the proximal tibiofibular joint using the semitendinosus tendon. The key steps of the procedure are the preparation of a proximally released semitendinosus tendon, and its guidance through two transtibial tunnels and one transfibular tunnel. The semitendinosus tendon acts as a soft tissue sling and does not interfere with mobility at the proximal or distal tibiofibular joints as noted after fibular head resection or arthrodesis of the proximal tibiofibular joint. Further advantages are the easy accessibility of the semitendinosus graft and the small surgical scar with better cosmetic results as compared to ligamentous reconstructive procedures using a split biceps femoris tendon or a strip of the iliotibial band.     

Synovial chondromatosis and instability of the proximal tibiofibular joint.

A patient with synovial chondromatosis involving both posterior compartments of the right knee and proximal tibiofibular joint had continued pain and weakness after partial synovectomy. The "Helfet Test" for proximal tibiofibular joint instability was positive; the fibular head was prominent and tender. Following excision of the proximal fibula, the patient was symptom free. This case demonstrates that it is essential to evaluate all joints involved with a disease process prior to surgical intervention.