L形钢板加螺钉骨栓髂骨植骨治疗股骨髁部粉碎骨折

目的：股骨髁部粉碎骨折保守治疗效果差,采用手术复位内固定以利恢复膝关节功能。方法：2005～2009年采用L形钢板和螺钉骨栓髂骨植骨内固定治疗股骨髁粉碎骨折52例。术中先用螺丝固定内处髁,然后用L形钢板固定髁和股骨干。结果：所有骨折愈合,骨折解剖复位47例。随访1～3.5年,总优良率88.5%。结论：股骨髁部粉碎骨折应早期手术。采用L形钢板和螺钉内固定能达到解剖复位,坚强固定,早期功能锻炼,有利膝关节功能恢复。     

逆行髓内钉与髁部钢板治疗股骨髁部粉碎性骨折的比较

目的比较逆行髓内钉与髁部钢板治疗股骨髁部粉碎性骨折的效果。方法回顾性分析2000-2005年收治的36例股骨髁部粉碎性骨折病例,分别采用逆行髓内钉（n=19）与髁钢板（n=17）两种内固定方法治疗,比较两种方法的骨折愈合时间及膝关节功能恢复情况。结果逆行髓内钉固定股骨髁部粉碎性骨折后,其骨折愈合时间平均为102天,膝关节功能评分为84．59,而踝部钢板固定骨折愈合时间平均为91．35天,膝关节功能评分为91．10,两组比较差异均有统计学意义（P〈0．05）。结论髁钢板对股骨髁部粉碎性骨折的固定效果优于逆行髓内钉。     

股骨髁上骨不连的治疗

目的　探讨动力髁螺钉(dynamiccondylarscrew, DCS)加自体髂骨移植技术治疗股骨髁上骨不连的疗效。方法　18例股骨髁上骨不连,内固定采用DCS,对严重骨质疏松或骨不连靠近关节面的患者加用髁支持钢板头部;植骨采用自体髂骨,骨移植形式为骨块与碎骨条相结合。术后短期采用术后连续被动活动(CPM)锻炼膝关节功能,持续1年的长期被动与主动锻炼。随访时间12~70个月,平均34个月。　结果　所有患者骨不连均治愈,愈合时间为3~6个月,平均5个月。膝关节活动范围从平均73°(5°~135°)增加至平均97°(30°~135°)。13例疗效优良, 4例满意, 1例差。　结论　采用具有坚强固定及断端加压作用的DCS,必要时加用多孔髁部固定钢板,结合有效的自体髂骨植骨技术,以及合理的术后长期膝关节功能锻炼,是治疗股骨髁部骨不连的有效方法之一。     

GSH钉和DCS固定治疗股骨髁上骨折的临床分析

目的总结GSH钉和DCS钢板内固定两种方法治疗股骨髁上骨折的效果。方法GSH钉组32例;DCS钢板组40例。平均伤后手术时间GSH钉和DCS钢板组分别为4 d和3.5 d。随访评估患者手术时间,术中出血量,术后膝关节活动度,术后膝关节功能评分,骨折愈合时间,术后并发症之间的差别。结果术后平均随访15个月(8~30个月)。平均手术时间:GSH钉组为100 min,DCS钢板组为90min。术中出血量:GSH钉组平均120 ml,DCS钢板组平均150 ml,愈合时间GSH钉组平均为20周,DCS钢板组平均为22周。结论治疗股骨髁上骨折,GSH钉和DCS钢板内固定两种方法都可以取得理想的效果。     

胫骨平台后外侧髁骨折手术治疗的改良方法及临床应用

目的 探讨胫骨平台后外侧髁骨折治疗的难点及改良方法的临床优势.方法 回顾性分析2016年3月—2018年8月无锡市惠山区人民医院收治单纯胫骨平台后外侧髁骨折24例,根据治疗方法不同分为改良组和对照组,各12例.改良组男性8例,女性4例;年龄23～66岁,平均48.5岁;对照组男性7例,女性5例;年龄21～68岁,平均47.1岁.改良组采用腓骨头上方入路联合自制环抱支撑解剖钢板进行显露复位固定,对照组采用腓骨头上方入路联合普通L形钢板进行复位固定,术后定期复查,指导膝关节功能锻炼.比较两组相关指标,包括术中出血量、手术时间、骨折愈合时间、未次随访的Rasmussen放射评分、纽约特种外科医院(Hospital for Special Surgery,HSS)功能评分以及术后膝关节功能优良率.结果 术中出血量改良组(42.92±15.44)mL与对照组(51.25±14.64)mL比较差异无统计学意义(P>0.05),改良组与对照组手术时间(51.00±6.80)min vs.(63.58±7.79)min、骨折愈合时间[(10.75±1.48)周vs.(12.75±1.96)周]、末次随访的膝关节Rasmussen评分[(17.08±2.11)分vs.(12.58±4.38)分]和HSS评分[(88.42±7.69)分vs.(74.83±13.27)分]比较,差异有统计学意义(P<0.05).按膝关节HSS评分评定膝关节功能,改良组优10例,良1例,可1例,优良率为91.7％;对照组优4例,良2例,可4例,差2例,优良率为50.0％,两组差异有统计学意义(P<0.05).结论 腓骨头上方入路联合自制环抱支撑解剖钢板治疗胫骨平台后外侧髁骨折,具有简单安全、手术时间短、骨折固定可靠、术后功能恢复满意等优点,是一种值得推广应用的改良方法.     

双钢板内固定治疗老年肱骨髁上粉碎骨折效果分析

目的研究双钢板内固定用于治疗老年肱骨髁上粉碎骨折的临床效果。方法 2011年10月-2017年10月武警湖北省总队医院骨一科收治115例老年肱骨髁上粉碎骨折患者,采用随机数字表法分为双钢板内固定组(58例)和克氏针内固定组(57例),比较两组患者的手术时间、术中出血量、骨折愈合时间、疼痛、肘关节活动范围和功能评分以及骨折愈合优良率等指标,评价双钢板内固定用于治疗老年肱骨髁上粉碎骨折的临床效果。结果双钢板组患者手术出血量为(101.22±12.31)mL,手术时间为(88.91±18.09)min高于克氏针组(96.96±11.42)mL和(80.09±19.91)min,差异无统计学意义(P>0.05);双钢板组骨折愈合时间(7.01±1.31)周短于克氏针组(9.90±1.09)周,差异具有统计学意义(P<0.05)。术后3、6、12个月随访,双钢板组患者肘关节活动范围优于克氏针组,肘关节功能评价高于克氏针组,差异具有统计学意义(P<0.05);双钢板组轻度疼痛患者多于克氏针组,中度和剧烈疼痛患者少于克氏针组,差异具有统计学意义(P<0.05);双钢板组骨折愈合优良率为91.38%(53/58),高于克氏针组82.46%(47/57),差异具有统计学意义(P<0.05)。结论双钢板内固定治疗老年肱骨髁上粉碎骨折临床效果显著,骨折愈合时间较短,患者恢复较快,关节功能和活动范围恢复良好,值得推广。     

伸筋汤熏洗治疗股骨髁骨折术后膝关节僵直疗效分析

目的 探讨伸筋汤熏洗治疗股骨髁骨折术后膝关节僵直的临床疗效。方法 选取2019年3月至2021年9月郑州市第二人民医院收治的124例股骨髁骨折术后膝关节僵直患者作为研究对象,按照随机数表法将其随机分为观察组(62例)和对照组(62例),观察组患者采用伸筋汤熏洗联合膝关节运动康复器治疗,对照组患者单纯采用膝关节运动康复器治疗,对比观察两组患者膝关节活动度(ROM)等膝关节功能、股骨骨密度及临床疗效。结果 治疗4周后,观察组患者膝关节ROM及股骨骨密度均明显大于对照组(t=8.446、39.840,P均<0.001),美国特种外科医院(HSS)评分明显高于对照组(t=10.571,P<0.001);治疗4周后,观察组患者中显效32例、有效26例、无效4例,明显优于对照组患者的显效24例、有效17例、无效21例(Z=-2.627,P=0.009)。结论 伸筋汤熏洗可明显改善股骨髁骨折术后膝关节僵直患者的膝关节功能,增加骨密度,疗效显著。     

股骨髁钢板治疗股骨髁上及髁间骨折48例

股骨髁上和髁间骨折治疗方法较多 ,但功能恢复满意常较困难。从 1998年 1月至 2 0 0 1年 3月 ,笔者应用股骨动力髁钢板 (ＤＣＳ)治疗股骨髁上、髁间骨折 4 8例 ,效果良好。临　床　资　料1.一般资料 :本组男 3 4例 ,女 14例 ;年龄 18～ 78岁 ,平均 3 8岁。左膝 2 2例 ,右膝 2 5例 ,双膝 1例 ,其中股骨髁上骨折 2 0例 ,髁间粉碎性骨折 2 8例。受伤原因 :交通伤 4 1例 ,高空坠落伤 7例。闭合性移位骨折 4 4例 ,开放性移位骨折4例。骨折分类 :采用ＡＯ分类法[1 ] ,Ａ型 18例 ,Ｂ型 2例 ,Ｃ型 2 8例。无论闭合移位或开放移位骨折 ,均采用切开复…     

单髁置换术治疗膝关节内侧间室骨性关节炎的疗效观察

目的 观察膝关节单髁置换术(unicompartmental knee arthroplasty,UKA)治疗膝关节内侧间室骨性关节炎的临床疗效.方法 选取自2013年5月至2018年11月期间收治病变累及膝关节内侧间室的膝关节骨性关节炎的患者85例,随机分为两组,观察组42例,行膝关节单髁置换术(UKA),对照组43...     

解剖钢板内固定治疗股骨髁部骨折56例

目的:评价解剖钢板内固定治疗股骨髁部粉碎性骨折的疗效及临床应用价值.方法:56例股骨髁部骨折患者均采用手术治疗,术中采用髁部解剖钢板固定,并用自体髂骨植骨;术后早期CPM仪进行功能训练,随访3个月～3年,评价治疗效果.结果:56例患者中,术后X 线片示骨折解剖复位48例,近解剖复位8例.切口Ⅰ期愈合53例,Ⅱ期愈合3例,无关节腔及深部感染;关节功能评分优22例,良24例,可7例,差3例,优良率为82.14%.结论:解剖钢板内固定治疗股骨髁部粉碎性骨折具有明显的疗效及广阔的临床应用前景.     

Aplasia of the mandibular condyle

A rare case of aplasia of the mandibular condyle is presented along with the tomographic findings. A 31-year-old Caucasian woman presented with a main complaint of facial asymmetry. No family history or any trauma was found. A CT study was performed and the sagittal CT view demonstrated a complete absence of the left condyle. This case of unknown aetiology was thoroughly examined and, based on clinical findings, we suggest that it could be of developmental origin.     

Bilateral bifid mandibular condyle

Bilateral bifid mandibular condyles are rare and may appear as a congenital or developmental anomaly. A case of bilateral bifid mandibular condyles is reported. The patient had no history of trauma and no link was apparent with respect to the patient's medical history. In this case, the condition was an incidental panoramic radiographic finding. Magnetic resonance imaging findings revealed bilateral anterior disc displacement without reduction. The radiographic appearance of this anomaly and the literature on bilateral bifid condyles are reviewed.     

Curvature analysis of the mandibular condyle

OBJECTIVE: To determine whether curvature analysis on high resolution CT images can be used as a tool for evaluation of mandibular condyle morphology. METHODS: Curvature analysis was performed on reconstructed oblique coronal CT images of 634 normal condyles from 317 patients (144 men and 173 women; age range 4-89 years) with inner or middle ear disease. The condyles were scanned with 1 mm collimation using helical CT. The CT images were analysed manually on a personal computer. RESULTS: The condyle CT images could be categorized into five curvature profile patterns: (1) bi-peak; (2) no peak; (3) tri-peak; (4) bi-peak with an intervening bottom above the base line (bi-peak with a col); and (5) bi-peak with an intervening negative phase. A separate evaluation using computer graphic condyle models indicated that these curvature patterns corresponded to flat (bi-peak), round (no peak), convex (bi-peak with a col), concave (bi-peak with a negative phase) and angled (tri-peak) contours of the condyle's superior surface. The curvature profiles were identical between bilateral condyles in 40% (126/317) of the patients. Gender-related differences in the incidence of the curvature profiles were also found, the bi-peak with a col profile being more frequently observed in women and the bi-peak with a negative phase profile being observed more frequently in men. CONCLUSION: Curvature analysis on CT images depicts condyle morphology effectively and may be an adjunctive tool for condyle morphometry.     

The forgotten condyle: the appearance,morphology, and classification of occipital condyle fractures.

PURPOSETo evaluate the appearance, morphology, and treatment of occipital condyle fractures (OCF).METHODSCases were collected by a retrospective and prospective analysis of teaching files and case logs. Patients'' charts, when available, were reviewed for age, sex, mode of injury, physical examination, Glascow Coma Scale score, and associated injuries. Plain films and CT images were reviewed to determine OCF type and to assess for the presence of associated cervical spine and/or intracranial trauma.RESULTSFifteen patients with OCF, 13 occurring in a 43-month period, were identified. Ten patients were involved in motor vehicle accidents. Severity of closed head injury and associated clinical findings were variable. Three patients had associated cervical spine fracture. According to the Anderson and Montesano classification, two patients (13%) had type I OCF, eight patients (54%) had type II OCF, and five (33%) had type III OCF. Fourteen of the fractures were identified on screening trauma head CT scans. Treatment varied according to the presence of associated injuries and stability of the cervical spine.CONCLUSIONSAlthough OCFs are rare, they will be encountered by most radiologists who see a significant amount of trauma. Type II OCFs were the most common fracture type in our series. Type III fractures were the second most common and potentially unstable. CT should be initiated at the level of the C-1 ring to screen for the presence of OCF in all patients who have suffered trauma.     

Large osteochondral defects of the femoral condyle: press-fit transplantation of the posterior femoral condyle (MEGA-OATS)

BACKGROUND AND AIMS: Large osteochondral defects in the weight-bearing zone of the knee remain a challenging therapeutic problem. Surgical options include drilling, microfracturing, and transplantation of osteochondral plugs but are often insufficient for the treatment of large defects of the femoral condyle. PATIENTS AND METHODS: Large osteochondral defects of the femoral condyle (mean defect size 7.2 cm(2) range 3-20) were treated by transplantation of the autologous posterior femoral condyle. Between 1984 and 2000, 29 patients were operated on: in 22 the medial, in 6 the lateral femoral condyle, and in one the trochlear groove was grafted. Thirteen patients underwent simultaneous high tibial valgus osteotomy. In the first series (1984-1999) the graft was temporarily fixed with a screw ( n=12), but from 1999 we used a newly developed press-fit technique ( n=17) avoiding screw fixation of the graft. The operative technique comprising graft harvest, defect preparation, transplantation, and fixation is described. Patients were clinically evaluated using the Lysholm score, and magnetic resonance imaging with intravenous contrast was performed 6 and 12 weeks after surgery (mean follow-up 17.7 months (range 3-46). RESULTS: Pain and swelling were reduced in 26 patients. Three patients of the first series reported persistent problems and were subjectively not satisfied. The mean Lysholm score rose from preoperatively 52 to 77 points after 3 months, 74 after 6, 88 after 12, and 95 after 18. Magnetic resonance imaging showed good graft viability in all cases. We saw one arthrofibrosis after 6 months but noted no problems related to the loss of the missing posterior condyle. CONCLUSION: Large osteochondral defects of the femoral condyle can be treated by transplantation of the autologous posterior femoral condyle. The use of only one osteochondral piece renders better approximation of the femoral cartilage curvature and thus joint congruence than in mosaic plasty. However, whether loss of the posterior condyle has a long-term negative impact on the knee joint remains to be elucidated.     

Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion

Purpose

The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction.

Methods

Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction.

Results

No correlation was found between FTA and flexion angle (r = ?0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03).

Conclusion

For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle.

Level of evidence

Case–control study, Level III.     

Giant cell tumour of the mandibular condyle

The authors report a case of giant cell tumour of the mandibular condyle, which is a rare finding. This tumour, studied using the main three radiological modalities (plain radiography, CT and MRI), showed characteristic radiological features of giant cell tumour. Correspondence to: S. W. Della Sala