创伤后急性腓骨肌腱脱位10例诊疗分析

创伤后腓骨肌腱脱位在临床上是一种少见疾病[1,2],患者多有踝关节的外翻背屈性创伤史,最初的临床表现与急性外侧副韧带损伤相似.因而早期容易出现漏诊,使病人遗留有患侧踝关节不稳定,出现患足长期疼痛,活动受限.笔者自1998年6月～2007年6月收治10例此类患者.治疗后取得满意疗效,现报告如下.     

Torg氏改良的Bristow手术治疗肩关节复发性前脱位

目的介绍治疗肩关节复发性前脱位的Torg氏改良的Bristow术式,评价其临床效果。方法采用Torg改良Bristow方法治疗肩关节复发性前脱位31例,平均年龄22.3岁。结果术后随访1～6年(平均44个月),1例手术后2年时发生1次再脱位,3例术后发生过一次或多次的半脱位,8例患者诉肩关节运动时或运动后有轻度疼痛,1例患者因内固定螺钉处疼痛和弹响需去除螺钉。肩关节术后外旋受限10°～15°5例,外展受限10°2例,其余患者肩关节活动范围恢复至术前。其中21例运动员和教练中,有3名运动员虽无再脱位发生,但未能恢复到伤前训练水平,余均达到伤前训练水平。结论Torg改良的Bristow手术方法治疗肩关节多发性前脱位再脱位发生率低,术后肩关节活动受限程度轻,运动员患者恢复伤前训练水平的比例较高,且手术损伤小、步骤简单、易于实施。     

手术治疗复发性髌骨脱位的研究进展

复发性髌骨脱位是髌股关节疾病中的一种常见疾病.临床上大多以手术治疗该病居多,但术式种类繁多,仍没有任何一种固定术式可以满意的治疗所有患者.本文综合概述了治疗复发性髌骨脱位的多种实用手术方法的相关研究及进展.     

手术治疗腓骨肌腱滑脱一例并文献复习

腓骨肌腱滑脱症是指腓骨肌腱从外踝后方正常位置发生滑移,在腓骨远端的外侧面斜行向前滑出,从而产生疼痛、弹响等系列症状。Escalas等[1]发现腓骨肌腱滑脱症发病率为0.56%。本病发病率较低,国内外报道不多。笔者于2010年9月手术治     

肌腱沟加深联合支持带重建治疗腓骨肌腱滑脱症

[目的]探讨腓骨肌腱沟加深联合支持带重建治疗腓骨肌腱滑脱症的临床疗效。[方法]2014年6月~2018年10月本院共收治18例腓骨肌腱滑脱症患者,均采取腓骨肌腱沟加深联合支持带重建方法进行手术治疗,术后随访踝关节视觉疼痛模拟评分;踝关节主动背伸+跖屈活动范围、美国足踝外科协会踝与后足功能评分、脱位复发率。[结果]本组患者均顺利完成手术,术后无脱位复发患者。术后6个月的VAS评分、AOFAS-AH评分显著优于术前,差异有统计学意义(P<0.05),而AROM与术前差异无统计学意义(P>0.05)。术后12个月的VAS评分、AOFAS-AH评分与术后6个月比较,差异无统计学意义(P>0.05),AROM显著优于术后6个月,差异有统计学意义(P<0.05)。[结论]腓骨肌腱沟加深联合支持带重建治疗腓骨肌腱滑脱症,不仅为腓骨肌间提供足够的容积和骨性阻挡,而且联合重建上支持带可以保证肌腱在踝关节主动运动中的动态稳定。     

清创修补手术治疗腓骨肌腱撕裂的临床疗效

目的探讨采用清创修补的手术方式治疗腓骨肌腱撕裂的临床效果。方法回顾性分析2014年7月至2016年7月于华中科技大学同济医学院附属武汉普爱医院足踝外科接受手术治疗的腓骨肌腱撕裂病人共21例。其中,男13例,女8例;腓骨短肌腱撕裂14例,腓骨长肌腱撕裂7例;手术方式均为肌腱周围清创和编织修补撕裂的肌腱。收集随访时记录的术后并发症、功能恢复情况,以及疼痛视觉模拟量表(visual analogue scale, VAS)评分、健康调查简表(The MOS 12-item short-form health survey, SF-12)评分、下肢功能量表(lower extremity function scale, LEFS)评分,并将其与术前评分比较,以评估临床疗效。结果 21例病人随访28~36个月,平均30个月。末次随访时,病人的VAS评分由术前的(38.0±10.4)分降低到(10.0±16.1)分,差异有统计学意义(t=23.347,P=0.001)。LEFS评分由术前的(46.2±15.0)分,提高至末次随访时的(70.0±13.2)分,差异有统计学意义(t=-9.812,P=0.003)。手术前后的SF-12生理健康评分和精神健康评分比较,差异均无统计学意义(P均>0.05)。所有病人均回归正常工作生活,没有经历再次手术。结论采用肌腱周围清创和编织修补的手术方式治疗腓骨肌腱撕裂,方法简单,临床效果良好,值得临床借鉴。     

改良Bristow手术治疗复发性肩关节前脱位

我们于１９９２年１０月～１９９５年４月用改良Ｂｒｉｓｔｏｗ手术治疗１３例（１５个肩）复发性肩关节前脱位,效果满意,现报告如下。临床资料本组１３例,男性１２例,女性１例;军人１２例,工人１例;年龄１９～２２岁;左侧６例,右侧５例,双侧２例。初次脱位至手...     

改良腓骨沟加深支持带重建治疗腓骨肌腱滑脱症

[目的]探讨改良腓骨沟加深支持带重建治疗腓骨肌腱滑脱症的手术疗效.[方法]回顾性分析2013年7月～2019年6月,手术治疗的腓骨肌腱滑脱症患者43例.依据术前医患沟通,22例接受改良腓骨沟加深支持带重建术,21例接受常规腓骨沟加深支持带重建术.比较两组手术时间、术中失血量、住院时间、围手术期并发症、VAS评分、AOF...     

The viernstein/kelly procedure for recurrent dislocation of the peroneal tendons

Surgical Principles A stable reduction of the peroneal tendons is achieved by combining a soft tissue reconstruction method, using the soft tissue stretched by the dislocation, and reshaping the peroneal groove. Revised Version from: Operat. Orthop. Traumatol. 2 (1990), 22–28 (German Edition).     

创伤性腓骨肌腱滑脱的诊治体会

创伤性腓骨肌腱滑脱非临床上常见病,易被很我医生忽略,未行适当治疗,至晚期形成习惯性腓骨肌腱滑脱,需手术治疗.2004年10月至2009年6月收治此类患者6例,均属晚期,行手术治疗后效果满意,现报告如下. 1 临床资料     

Surgical treatment of displacement of peroneal tendons

Surgical Principles The roof of the peroneal groove is reconstructed with a bone block from distal fibula. The bony wedge forms a checkrein against further displacement of the tendons. In our experience, the du Vries procedure (1959) [5] gives results superior to the Kelly operation (1920) [3]. Revised Version from: Operat. Orthop. Traumatol. 1 (1989), 75–79 (German Edition).     

Surgery for recurrent dislocation of the peroneal tendons

Thirty-five patients with recurrent dislocation of the peroneal tendons were operated a.m. Du Vries. One patient had bilateral dislocations. The dislocation was traumatic in 28 cases and idiopathic in eight. Peroperative complications occurred in eight of the 36 patients due to malposition of a screw, fracture of the malleolus and/or fracture of the bone graft.

The follow-up period was 5 years. In 31 cases the functional results were satisfactory. Five cases were unsatisfactory due to re-dislocation, subluxation or a vague feeling of instability. The inserted screw was the cause of moderate complaints in 15 cases.

The Du Vries' operation is technically difficult; the sliding bone graft must be of adequate size; the position of the screw should be checked radiographically during the operation; and the screw should be removed when the bone graft has healed.     

Superior retinaculoplasty for recurrent dislocation of peroneal tendons

BACKGROUND: Although dislocation of peroneal tendons is an uncommon injury, if it does occur, daily and sports activities may be restricted because of snapping of the tendons and pain in the posterolateral aspect of the ankle joint. Many operative procedures have been reported for this pathology, including anatomic reattachment of the retinaculum, bone block procedures, tissue-transfer procedures, and groove-deepening. However, no procedure has been established as the "gold standard." Successful results were reported after anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula. We have modified the procedure to reduce operative invasiveness and introduced a method to determine proper tension when suturing the retinaculum to the fibula. METHODS: In our retinaculoplasty, the false pouch was opened through one incision, and the retinaculum was sutured to the fibula while measuring the tension, avoiding too tight or too loose suturing. We performed this procedure in 20 patients with symptomatic dislocation of peroneal tendons in whom conservative treatment had failed. We followed them over 2 years, and clinical results were evaluated. RESULTS: No patient had re-dislocation of the peroneal tendons during the followup period. Fifteen of 18 patients who had been involved in sports activities returned to their previous activities without reducing their activity levels. All patients acquired full range of motion of the ankle joint postoperatively. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly (p value < 0.01) postoperatively. CONCLUSIONS: This study demonstrated that the described repair successfully treated patients with symptomatic dislocation of the peroneal tendon and should be considered for this pathology.     

Surgical treatment of dislocation of the peroneal tendons

Dislocation of the peroneal tendons is an uncommon condition. Ten cases are reviewed and the aetiology is discussed. The surgical technique is described. The long-term results were in all cases good.     

关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位

目的探讨关节镜下采用自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 2005年1月-2010年1月,对22例(22膝)复发性髌骨脱位患者采用关节镜下外侧支持带松解,取自体腘绳肌腱重建内侧髌股韧带治疗。男5例,女17例;年龄15～19岁,平均17.3岁。髌骨脱位3～8次,平均4次。主要临床症状为患膝关节疼痛、肿胀、无力,活动受限。髌骨倾斜试验、恐惧试验、内侧髌股韧带止点处压痛、髌骨向外推移时恐惧征均呈阳性。根据国际膝关节文献委员会(IKDC)评分标准,膝关节功能主观评分为(36.7±4.7)分,Lysholm评分为(69.3±3.8)分。X线片示患者髌骨向外倾斜。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18～49个月,平均34个月。术后患者关节疼痛、肿胀、无力等症状较术前明显改善。随访期间患者髌骨脱位无复发。末次随访时,IKDC膝关节功能主观评分为(92.4±5.3)分,Lysholm评分为(91.7±5.2)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下取自体腘绳肌腱重建内侧髌股韧带可明显改善髌骨稳定性,是治疗复发性髌骨脱位的有效方法之一。     

复发性髌骨外侧脱位的手术治疗现状及展望

目前对于复发性髌骨外侧脱位的外科治疗主要包括内侧髌股韧带重建、胫骨结节截骨、股骨滑车成形、外侧支持带松解及旋转截骨术等。临床报道显示:单独应用一种或者联合几种术式治疗复发性髌骨脱位都取得了理想的短中期临床疗效。但目前对个体髌骨脱位的术式选择尚缺乏统一标准、也未达成共识。同时随着内侧髌股韧带重建等术式应用愈加广泛,也有越来越多值得引起关注的手术并发症和失败率。本文旨在对当前各种术式的应用现状做一系统综述,汇总目前取得的疗效、阐述各种术式的应用要点,以期更精准的指导临床个体化治疗。     

A repair operation for recurrent dislocation of peroneal tendons

A lesion similar to that described by Bankart in recurrent dislocation of the shoulder was seen in seven patients with recurrent dislocation of the peroneal tendons. Detachment of the periosteum had resulted in the formation of a false pouch on the surface of the lower end of the fibula; into this pouch the peroneal tendons could easily dislocate. Reattachment of the periosteum to drill holes in the fibula prevented dislocation, and this anatomical method of repair is described. This lesion is one of the causes of recurrent dislocation of the peroneal tendons.     

Operative treatment of recurrent dislocation of the peroneal tendons

Summary Simple operation for refixation of the superior retinaculum of the peronaeal tendon for treatment of recurrent dislocations of the peronaeal tendon is described. The prepared retinaculum is fixed into a cleft of the lateral malleolus with a screw. This operation is also suitable for treatment of the recurrent dislocation of the posterior tibialis tendon.

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Zusammenfassung Es wird eine einfache Operation zur Refixation des Retinaculum superius tendinis peronaeum zur Behandlung der habituellen Peronäussehnenluxation beschrieben.Das auspräparierte Retinaculum wird in einem Knochenschlitz am Außenknöchel mit Hilfe einer Schraube fixiert. Die Operation eignet sich auch zur Behandlung der habituellen Tibialis-posterior-Sehnenluxation.