关节镜下复位固定治疗髋关节盂唇骨性Bankart损伤致难复性髋关节后脱位临床分析

目的探讨髋关节盂唇骨性Bankart损伤致难复性髋关节后脱位的手术方法及效果。方法髋关节盂唇骨性Bankart损伤导致难复性髋关节后脱位患者16例,采用关节镜下手术复位固定髋关节盂唇骨性Bankart损伤方案治疗;手术前及术后12个月应用视觉模拟评分评估疼痛程度,应用改良Harris评分、美国西部Ontario与McMaster大学骨关节炎指数(WOMAC)评分评估患者髋关节功能。结果 16例手术过程顺利,其中6例为单纯盂唇损伤,行单排锚钉缝合固定,10例为骨块移位,行双排锚钉固定骨块+盂唇缝合复位;术后6个月,X线检查显示髋关节脱位矫正均成功,CT显示髋臼后壁盂唇骨性Bankart损伤处骨块复位良好,无骨性坏死及髋关节炎等并发症;术后12个月患者视觉模拟评分[(0.6±0.3)分]低于手术前[(5.2±0.9)分](P0.05),改良Harris评分[(64.9±8.8)分]、WOMAC评分[(66.8±8.9)分]高于手术前[(32.8±7.1)、(34.5±7.4)分](P0.05)。结论关节镜下复位固定治疗髋关节盂唇骨性Bankart损伤导致的难复性髋关节后脱位疗效确切,可有效缓解患者疼痛症状,恢复关节功能。     

隐匿性肱骨头骨折误漏诊七例分析

目的探讨隐匿性肱骨头骨折的误漏诊原因及防范措施。方法回顾性分析我院2013年1月—2017年1月收治的隐匿性肱骨头骨折误漏诊7例的临床资料。结果 7例首发症状均为肩关节局部疼痛伴活动受限,病初X线检查肱骨头均无明显骨折征象,3例诊断为肩关节脱位伴肱骨大结节撕脱性骨折,诊断为肱骨大结节撕脱性骨折及软组织伤各2例,均漏诊肱骨头骨折。误漏诊时间1 d~2周。7例均经肩关节CT检查确诊肱骨头骨折。确诊后,4例行手术内固定治疗,3例行石膏外固定保守治疗。随访6~24个月,骨折均愈合,肩关节功能明显改善。结论隐匿性肱骨头骨折极易误漏诊,对于高度怀疑隐匿性肱骨头骨折而X线检查无明显异常者应进一步行肩关节CT检查,防止误漏诊。     

肱骨头关节面直径对多层螺旋CT容积再现技术测量肱骨头扭转角的影响

目的探讨肱骨头关节面直径对多层螺旋CT容积再现测量肱骨头扭转角的影响。方法收集24侧成人肩关节标本,行16层螺旋CT扫描,容积再现技术三维重建测量肱骨头扭转角。肱骨头关节面直径确定采用画圆拟合确定法及目测法,两种方法测得的肱骨头扭转角与二维CT测量法测得的肱骨头扭转角对照研究,行统计学处理。结果肱骨头扭转角最小值11°,最大值53°,三组肱骨头扭转角数据为(26.4±9.9)°,(27.1±9.7)°,(27.3±9.7)°。经统计学检验三种方法测值无显著性差异。结论肱骨头扭转角变异较大;多层螺旋CT容积再现目测法确定肱骨头关节面直径是获得肱骨头扭转角近端定义线更简单、更快捷的方法。     

关节镜下Bankart修复联合Remplissage手术治疗军人双极损伤型肩关节复发性前脱位的疗效分析

目的 评价关节镜下Bankart修复联合Remplissage手术治疗军人双极损伤型肩关节复发性前脱位的临床疗效。方法 选择2019年2月-2022年3月于该院实施手术的肩关节复发性前脱位患者15例,均为男性。年龄18～33岁,平均(23.07±4.39)岁;Beighton评分(4.40±1.89)分。左肩4例,右肩11例。术前CT评估Hill-Sachs损伤(16.93±2.17)%。记录肩关节活动度,采用美国肩肘关节外科协会(ASES)评分和Constant-Murley评分,评估肩关节功能与稳定性。结果所有患者获得随访,随访10～28个月,平均(18.47±6.46)个月。所有患者均未出现感染、血管神经损伤及关节再脱位等并发症。肩关节前屈上举：由术前的(152.41±14.28)°增加至末次随访的(167.48±10.23)°;内旋：术前棘突水平,T₅ 1例,T₆ 2例,T₇ 6例,T₈ 3例,T₉ 2例,T₁₀ 1例,术后棘突水平,T_5...     

X线和CT在桡骨远端粉碎骨折诊断和治疗中的应用

目的:比较X线和CT在桡骨远端粉碎骨折诊断和治疗中的应用价值。方法:选取我院2015年3月-2016年8月期间收治的50例桡骨远端粉碎骨折患者作为研究对象,对所有患者实施X线和CT检查,分析比较两种方法的检查结果。结果:X线和CT检查对尺偏角改变和桡骨缩短在5mm的检出率比较,差异无统计学意义(P0.05);X线对掌倾角改变、背侧半脱位、关节面粉碎性骨块≥3、关节面压缩塌陷以及关节面分离的检出率明显高低于CT检查,差异有统计学意义(P0.05)。结论:与X线相比,CT对桡骨远端粉碎骨折具有较高的诊断价值,能更加清晰的反映患者患肢骨折类型、严重程度、损伤程度,可为临床治疗提供合理、准确的依据。     

多层螺旋CT后处理测量肱骨头偏心距的试验研究

目的探讨多层螺旋CT后处理测量肱骨头偏心距的方法。方法收集51根干肱骨标本、50根肩关节防腐湿标本,行16层螺旋CT扫描,用厚层多平面重组(MPR)、容积再现(VRT)测量肱骨头偏心距,并进行统计学处理。结果肱骨头向内侧偏心距MPR测量值(4.42±1.27)mm(1.00～8.50mm),VRT测量值(4.36±1.43)mm(0.50～8.80mm);向后偏心距MPR测量值(3.32±1.38)mm(-1.00～7.50mm),VRT测量值(3.59±1.42)mm(0.00～7.20mm)。经统计学处理两种测量方法差异无统计学意义(P>0.05)。结论多层螺旋CT容积再现(VRT)测量肱骨头偏心距是更简单、更快捷的方法。     

CT在关节内骨折中的应用

目的提高CT在关节内骨折中重要性的认识.方法回顾性分析23例关节内骨折的X线和CT表现.结果关节内的骨折胫骨平台骨折5例,髋臼伴关节面骨折4例,踝关节胫距关节面骨折3例,肩关节盂骨折2例,肱骨头骨折1例,肱骨远端外髁骨折1例,桡骨远端骨折3例,舟状骨骨折2例,三角骨骨折1例,骶骨岬及髂骨骨折各1例,颈椎骨折2例,胸腰椎骨骨折各3例,其中附件同时有骨折3例,骨折线累及关节面X线平片确定有骨折者为20例(约87%).X平片与CT对照,关节面塌陷程度相符合者18例(90%).结论 CT在关节内骨折中的诊断和治疗有着很大的价值.     

关节镜治疗复发性肩关节前脱位的护理

肩关节是人体活动度最大的关节,也是脱位发生率最高的关节.肩关节软组织结构的完整性遭到破坏,肱骨头不能在肩关节运动全程中始终位于肩盂的中心位置,故复发性肩关节前脱位最为常见.目前盂唇关节囊韧带重建术(Bankart重建术)已成为治疗复发性肩关节前脱位较为公认和成熟的术式[1],而如何进行整体护理,尽快恢复肩关节的功能,影响手术效果.我院于2006年1月～2009年2月对28例肩关节前脱位行关节镜下Bankart重建术,取得良好的效果,现将护理体会介绍如下.     

基于CT三维重建容积再现技术对肩关节前脱位复发因素的临床分析

目的 探讨通过CT三维重建容积再现技术（VRT）对复发肩关节前脱位的影响因素进行临床分析。方法 回顾性分析2019年1月至2021年1月收治的124例肩关节前脱位患者,根据是否复发肩关节脱位分为复发组和非复发组,收集CT影像资料,进行去肱骨头三维重建,对图像进行分析、测量,对比患者基本情况、Hill-sachs损伤面积、骨性bankart损伤比值,采用单因素及Logistic回归分析,探讨复发肩关节脱位的危险因素。结果 两组患者年龄、性别及损伤侧别差异均无统计学意义（P>0.05）,骨性bankart损伤宽度比值、Hill-sachs损伤面积差异均有统计学意义（P<0.05）。Logistic回归分析显示,骨性bankart损伤宽度比值（OR=1.16,95%CI:1.07～1.27）、Hill-sachs损伤面积（OR=7.95,95%CI:3.64～17.36）是复发肩关节脱位的独立影响因素。结论 骨性bankart损伤和Hill-sachs损伤是发生肩关节复发脱位的危险因素,临床上应对其进行准确评估,及时采取有效治疗,降低复发率。     

分阶段渐进性康复训练对Ⅰ型骨性Bankart损伤肩关节镜修补效果、肩关节功能及预后研究

目的肩关节镜修补Ⅰ型骨性Bankart损伤患者应用分阶段渐进康复训练效果情况分析。方法选取2017年3月至2019年3月某院诊治110例Ⅰ型骨性Bankart损伤患者临床资料,按随机数表法分为两组,每组55例,对照组予以常规康复训练,研究组予以分阶段渐进康复训练,分析两组疗效、肩关节功能与预后生活质量。结果干预后,研究组总有效98.18%比对照组高(P<0.05,χ^2=7.0400);且研究组肌力(20.25±1.23)分、肢体活动度(31.14±2.18)分、疼痛(12.13±1.29)分等肩关节指标比对照组高(P<0.05,t=10.8304,13.1519,9.3823,13.7303);研究组生理机能(85.24±4.31)分、躯体疼痛(86.25±4.58)分、精力(86.13±3.59)分等质量评分高于对照组(P<0.05,t=9.9153,10.3398,12.4960,9.1647)。结论肩关节镜修补Ⅰ型骨性Bankart损伤患者应用分阶段渐进康复训练干预,更能改善肩关节功能,提高其临床疗效及预后的生活质量指标。     

Die Hill-Sachs-“Remplissage“

Glenohumeral bone stock insufficiency has been identified as an important negative factor for arthroscopic treatment of traumatic anterior shoulder instability. The Hill-Sachs “remplissage” is an all-arthroscopic technique to treat traumatic anterior shoulder instability with glenoid bone loss and an engaging Hill-Sachs lesion. The principle of the procedure is a capsulotenodesis of the infraspinatus muscle and the posterior joint capsule to fill (“remplissage”, french, to fill) the Hill-Sachs lesion. In lateral decubitus position, or alternatively in beach chair position, a posterior portal positioned directly over the Hill-Sachs lesion is established first. An anteroinferior and anterosuperior portal is established afterwards. With the arthroscope in the anterosuperior portal, a preparation and mobilization of the Bankart lesion is carried out followed by freshening of the Hill-Sachs lesion and two suture anchors are placed in the Hill-Sachs defect. The infraspinatus and posterior capsule are penetrated and then pulled into the defect with the knots remaining extra-articular. Finally, the Bankart repair can be finished through the two anterior portals.     

Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.     

Arthroskopisch assistierte Imprimatanhebung bei einer Reversed-Hill-Sachs-L?sion

Defect elevation in cases of acute reverse Hill-Sachs lesions is an appropriate treatment for instability after posterior dislocation of the shoulder without associated soft tissue lesions. It is possible to do this operation in a minimally invasive procedure. The arthroscopy-assisted technique is controlled by x-ray imaging and is a gentle and reproducible operation for reconstruction of the humeral head.     

MSCT重建技术在肘关节创伤性骨折中的应用

目的探讨多层面螺旋CT(MSCT)多平面重建(MPR)结合三维重建(3D)在肘关节创伤性骨折中的临床诊断价值。方法回顾分析本院收治的31例肘关节创伤性骨折患者,对其使用多层螺旋CT扫描技术进行检查所得到的影像资料。结果 31例肘关节骨折中,共显示51处骨折。其中尺骨鹰嘴骨折12例,桡骨小头骨折11例,尺骨冠突骨折5例,肱骨外侧髁5例,肱骨髁上骨折10例,肱骨髁间骨折3例,肱骨内上髁骨折5例。结论 MPR及3D在微小骨折方面有较好显示,并能直观多角度显示肘关节的损伤,其在诊断肘关节的骨折及脱位中有重要的价值。     

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

Purpose of Review

The purpose of this study is to provide an update to the orthopedic field in regard to treatment of the Hill-Sachs lesion and anterior shoulder instability. The review highlights the most current knowledge of epidemiology, clinical evaluation, and surgical methods used to treat Hill-Sachs lesions. It also details the relevant clinical and surgical findings that have been made throughout the literature in the past couple of years.

Recent Findings

The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the “gold standard” for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions.

Summary

Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability.

     

Schulterinstabilität bei Epilepsie

Glenohumeral instability due to epilepsy is usually considered to be of the posterior type. In the literature, however, inconsistent data on the predominant direction of instability caused by epilepsy is provided. The largest reported series of 34 shoulders in 26 patients with primary dislocation caused by epileptic seizures showed a comparable incidence of anterior and posterior instability. We report the case of a 26-year-old woman with epilepsy and instability including hyperlaxity of both shoulders known since childhood who presented with a recurrent dislocation of the right shoulder after a fall downstairs. Clinical and radiological evaluation revealed unidirectional anteroinferior shoulder instability with hyperlaxity (type B3 according to Gerber). Thus, arthroscopic stabilization had to be considered. As pharmacological treatment of epilepsy was insufficient so far, conservative treatment was recommended including optimizing anticonvulsive medication and scapulothoracic dyskinesia. Four months later, symptoms of anterior instability had only slightly improved, and arthroscopic anteroinferior and posteroinferior stabilization was performed. Intraoperatively, a partial lesion of the anteroinferior labrum, a superficial Hill-Sachs lesion and extensive enlargement of the anterior and posterior capsular volume were found. In patients with shoulder instability due to epilepsy, recognition of unidirectional anterior instability with hyperlaxity is of importance regarding the high risk of recurrent instability.     

Treatment of lower part of glenoid fractures through a novel axillary approach: A case report

BACKGROUNDBased on the location and size of the fracture block, open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures. However, the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far. CASE SUMMARYA 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident. X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture. Three-dimensional (3D) computed tomography (CT) further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm × 16.2 mm. The patient was diagnosed as the fracture of the lower part of the glenoid, also known as bony Bankart lesion without shoulder dislocation. After general anesthesia, the patient was surgically treated with the open reduction internal fixation through a novel axillary approach. 3D CT and shoulder joint function were reexamined at 12 mo of follow-up, showing acceptable recovery.CONCLUSIONThis case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation. After a follow-up for more than 12 mo, 3D CT and shoulder joint function examinations display a good recovery.     

Recurrent anterior shoulder instability: Review of the literature and current concepts

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.     

Acute fracture of the proximal humerus superimposed on a chronic posterior dislocation of the humeral head

We have reported the case of a 73-year-old woman with a posterior shoulder dislocation and comminuted fracture of the proximal humerus occurring during a seizure. Surgery disclosed an acute humeral fracture superimposed on a chronically dislocated humeral head. Endoprosthetic replacement yielded a satisfactory clinical result. We found no similar report in the literature.