关节镜下微创逆行髓内钉治疗股骨髁上骨折

目的评价关节镜下微创逆行髓内钉治疗股骨髁上骨折不愈合的疗效。方法 2003年10月至2008年7月行关节镜下微创逆行髓内钉治疗不愈合的股骨髁上骨折12例,均行自体髂骨植骨。结果随访8~64个月（平均32.4个月）,12例骨折术后复位良好,临床愈合时间6个月,功能满意。HSS评分,优10例,良1例,中1例,优良率91.67%。结论较之于传统内固定及LISS,关节镜下逆行髓内钉治疗不愈合的股骨髁上骨折创伤小,骨折端血运破坏小,愈合率高,恢复快,可显著改善膝关节功能,疗效满意。     

Aneurysmal Bone Cyst of the Talus

Aneurysmal bone cysts localized in the talus are extremely rare. Such a case is described and the histological findings are analysed in relation to those in aneurysmal bone cysts in general. The pathomechanism of the lesion is discussed.     

Aneurysmal Bone Cyst of the Talus

Aneurysmal bone cysts localized in the talus are extremely rare. Such a case is described and the histological findings are analysed in relation to those in aneurysmal bone cysts in general. The pathomechanism of the lesion is discussed.     

关节镜辅助下小切口微创治疗急性髌骨脱位

目的探讨关节镜辅助下小切口微创治疗急性髌骨脱位的方法和疗效。方法 2008年7月至2011年9月,我科收治急性髌骨脱位14例,男9例,女5例;年龄16~28岁,平均(21.8±5.3)岁。患者入选条件:所有患者均有明确膝关节暴力外伤史,排除关节松弛和髌股关节发育异常。从发生髌骨脱位到手术的时间间隔为3~14 d,平均5.6 d。术中先行关节镜检查并清理关节腔内积血和处理关节软骨损伤后,在髌骨内侧做1个1.5 cm长纵行小切口,通过上下推移皮肤,在髌骨中上部拧入带线锚钉,使用过线方法折叠缝合髌内侧支持带,视髌骨复位情况行外侧支持带松解。结果 14例患者获得随访,术后随访24~60个月,平均36.1个月。全部病例未再次发生脱位,恐惧试验全部阴性。关节活动度均在正常范围,3例关节早期过屈时有轻度紧张感,随访患者均恢复伤前的生活状态。所有病例均未出现重度髌股关节退行性改变。结论关节镜辅助下小切口治疗急性髌骨脱位安全、可行,疗效显著。     

Transmalleolar Approach for Arthroscopy-Assisted Headless Screw Fixation of an Osteochondral Talar Dome Fracture

Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome.     

Endoscopic Excision of Symptomatic Os Trigonum in Professional Dancers

The present study reports the clinical results of excision of a symptomatic os trigonum using an endoscopic procedure in professional ballet dancers. The hypothesis was that posterior endoscopic excision of the os trigonum would be safe and effective in treating posterior ankle impingement syndrome related to the os trigonum. Twelve professional dancers underwent excision of a symptomatic os trigonum for PAIS using a posterior endoscopic technique after failure of conservative treatment. The patients were evaluated pre- and postoperatively according to the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner activity scale score, and the visual analog scale score. The surgical time, timing of a return to sports, patient satisfaction, and any complications related to the procedure were recorded. The average postoperative follow-up duration was 38.9 ± 20.6 (range 12 to 72) months. The mean Tegner activity scale score increased from 4.3 ± 0.8 (range 3 to 5) preoperatively to 9 ± 0.2 postoperatively (p < .05). The mean American Orthopaedic Foot and Ankle Society scale score increased from 67.8 ± 6.0 (range 58 to 76) preoperatively to 96 ± 5.1 (range 87 to 100) postoperatively, with 7 of 12 patients (58.3%) reporting the maximum score of 100 points (p < .05). The return to sports was 8.7 ± 0.7 (range 8 to 10) weeks. No major complications were recorded. The results of the present study demonstrate that the endoscopic excision of symptomatic os trigonum using a 2-portal technique after failure of conservative treatment is characterized by excellent results with low morbidity.     

膝关节前交叉韧带陈旧性损伤的诊治

目的探讨及总结陈旧性膝关节前交叉韧带损伤的诊治经验。方法回顾性分析2008年3月至2013年1月我院32例陈旧性膝关节前交叉韧带损伤患者的诊治及随访结果,并以Lysholm评分方法评价诊疗效果。结果 32例陈旧性膝关节前交叉韧带损伤患者经术前、麻醉后再次体检及X线片、MRI检查均得到确诊,经关节镜下重建并处理半月板损伤及软骨缺损等,治疗前平均lysholm评分为(75±2)分,随访1年平均为(95±3)分。结论陈旧性膝关节前交叉韧带损伤较新鲜损伤具有较大诊治难度,根据患者具体情况选择适当治疗方案是治疗的关键。     

Synovitis of the Tarsal Canal: An Uncommon Cause of Lateral Heel Pain After Triple Arthrodesis

Lateral heel pain after triple arthrodesis can have numerous causes, including nonunion of the fusion site, hindfoot malalignment, degenerative arthritis in adjacent joints, and deep infection. We present a case of lateral heel pain after triple arthrodesis due to synovitis of the tarsal canal that was successfully treated with anterior subtalar arthroscopy.     

距骨严重骨折——脱位的手术治疗(附24例报告)

作者对24例距骨严重骨折脱位行手术治疗,按Gillgust分类法,24例中Ⅲ°19例,Ⅱ°5例骨折伴踝部复合伤。19例切开复位内固定,2例距下关节融合,3例胫距和距踉两关节融合术。随诊3—25年,疗效优良率为79.2％。认为尽早复位和适当的内固定是治疗的关键。     

髌骨半脱位70例治疗分析

目的探讨髌骨半脱位的治疗方法及其预后。方法回顾性分析70例（130膝）髌骨半脱位患者的临床资料,其中男30例,女40例;年龄10～48岁,平均23岁。患者髌骨的形态均为WibergⅡ、Ⅲ型,其中伴有外侧髌股关节骨关节炎者58例108膝,高位髌骨23例46膝,外伤后股四头肌内侧头肌张力不良10例10膝。Q角20°～40°。全部行手术治疗,手术方式包括：髌外侧支持带充分松解（130膝）;髌内侧支持带紧缩、股内侧肌移位至髌骨前内侧（12膝）;髌骨外侧部分切除（17膝）;胫骨结节前、内侧移位（46膝）,平均内移1．0cm、前移1．2cm;缝匠肌前移（11膝）,半腱肌前移（13膝）;关节镜下髌外侧支持带松解,髌内侧支持带紧缩（31膝）。术中见全部病例髌外侧支持带均明显增厚。结果随访3～180个月,根据Insall等评分系统评估分析疗效,术后疗效优78膝,良33膝,可12膝,差7膝。患者术后疼痛、关节活动功能均得到明显改善,尤其是解除膝前痛效果显著。结论根据病因及病理改变选择恰当的手术方式治疗髌骨半脱位均可取得满意的效果,特别是关节镜手术具有创伤小、恢复快的特点,值得进一步推广应用。     

囊肿前壁开窗术治疗耳后皮脂腺囊肿伴感染脓肿形成的临床效果

目的 探究囊肿前壁开窗术治疗后耳后皮脂腺囊肿伴感染的效果。方法 选取我院于2021年 2月-2022年12月收治的76例耳后皮脂腺囊肿伴感染脓肿患者为研究对象,按照随机数字表法为对照组和探 究组,每组38例。对照组应用脓肿切开引流后手术切除治疗,探究组应用囊肿前壁开窗术治疗,比较两 组临床疗效、满意度、生活质量及创口愈合情况。结果 探究组治疗总有效率为97.37%,高于对照组的 84.21%（P＜0.05）;探究组满意度为100.00%,高于对照组的86.84%（P＜0.05）;探究组各维度生 活质量评分优于对照组（P＜0.05）;探究组创口愈合时间、瘢痕直径与脓肿长轴直径比值优于对照 组（P＜0.05）。结论 运用囊肿前壁开窗术治疗耳后皮脂腺囊肿伴感染脓肿形成效果确切,能够提高患者 满意度,改善其生活质量,促进创口尽快愈合,值得临床应用。     

Supramalleolar Osteotomy With Distraction Arthroplasty in Treatment of Varus Ankle Osteoarthritis With Large Talar Tilt Angle: A Case Report and Literature Review

We treated a 57-year-old female with modified Takakura stage 3B varus ankle osteoarthritis. Her preoperative talar tilt angle was 21.3°. The patient wished to avoid ankle joint arthrodesis or replacement. Therefore, medial opening wedge supramalleolar osteotomy with fibular osteotomy was used for her varus ankle osteoarthritis. Also, fixed medial distraction arthroplasty was performed to improve her talar tilt. After 3 months, the external device was removed, and the patient was allowed partial weightbearing and began full weightbearing 4 months postoperatively after the osteotomy site had reached bony union radiographically. At the 3-year follow-up visit, a radiograph showed the medial ankle joint space enlargement had been maintained. The talar tilt angle had decreased to 3.3°, and the modified Takakura stage had improved to stage 1. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score had improved from 26 points preoperatively to 85 points at 3 years postoperatively. Our findings suggested that good clinical and radiologic results can be achieved with supramalleolar osteotomy combined with distraction arthroplasty in the treatment of varus ankle osteoarthritis with a large talar tilt angle.