可吸收螺钉结合缝线治疗交叉韧带胫骨止点撕脱性骨折

正2010年3月~2014年3月,我科应用可吸收螺钉结合缝线治疗29例膝关节交叉韧带胫骨止点撕脱性骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组29例,男23例,女6例,年龄19~62岁。均为新鲜单纯交叉韧带胫骨止点撕脱性骨折:前交叉韧带胫骨止点撕脱性骨折16例,后交叉     

膝后交叉韧带胫骨止点撕脱性骨折的治疗

后交叉韧带胫骨止点撕脱性骨折较少见,常属于严重暴力损伤,早期易误诊及漏诊,影响膝关节功能.本院自1998年1月至2003年10月共收治22例,效果满意.单纯后交叉韧带损伤经膝关节MRI检查后另予韧带重建术处理,本文着重对后交叉韧带胫骨止点撕脱性骨折的采用改良膝后直切口优点和内固定的选择进行分析讨论.     

关节镜下单股股薄肌加强固定后交叉韧带胫骨止点撕脱性骨折18例

目的 探讨关节镜下单股股薄肌加强固定后交叉韧带胫骨止点撕脱性骨折的临床疗效.方法 对18例后交叉韧带胫骨止点撕脱性骨折,在关节镜下行单股股薄肌加强固定,术后随访观察膝关节功能.结果 后抽屉试验术前16例阳性.术后减少到1例;Lachman 征术前18例阳性,术后1例阳性;术后Lysholm评分(89.5±9.4)分,较术前(57.2±7.1)分显著提高(t=2.14,P=0.03).结论 关节镜下单股股薄肌加强固定后交叉韧带胫骨止点撕脱性骨折,材料选择理想、固定方法 妥当.     

门形钉治疗后交叉韧带胫骨止点撕脱性骨折

目的探讨门形钉内固定治疗后交叉韧带(PCL)胫骨止点撕脱性骨折的方法及可行性。方法对20例PCL胫骨止点撕脱性骨折行切开复位门形钉内固定。结果本组获随访3～17个月,根据Lysholm膝关节评定标准:优16例,良3例,可1例。结论应用门形钉内固定治疗PCL胫骨止点撕脱性骨折,操作简单,固定牢靠,疗效满意。     

关节镜下应用不吸收逢线固定治疗急性后交叉韧带胫骨止点撕脱性骨折

目的 探讨关节镜下应用不吸收逢线捆扎后交叉韧带胫骨端并经胫骨双隧道复位固定撕脱骨折块的临床应用效果.方法 在关节镜下应用不吸收缝线固定治疗急性后交叉韧带胫骨止点撕脱性骨折16例.结果 16例随访时间平均6.5个月(3～15个月);术后3个月骨折均愈合,无再移位,膝关节活动范围均超过120°,无伸膝受限;后抽屉试验Ⅰ度阳性1例,其余为阴性;Lyshlon评分(91.6±3.5)分.结论 关节镜下应用不吸收逢线固定治疗急性后交叉韧带胫骨止点撕脱性骨折方法 可靠,可有效恢复膝关节功能.     

后交叉韧带胫骨止点撕脱骨折的手术治疗

1991～2002年笔者治疗后交叉韧带(PCL)胫骨止点撕脱性骨折31例,随访6个月～1年,疗效满意.     

运用可吸收螺钉治疗后交叉韧带胫骨止点撕脱骨折

<正>后交叉韧带是维持膝关节后向稳定的重要结构,其撕脱骨折多发生于胫骨止点。目前,对于后交叉韧带胫骨止点的撕脱骨折,多主张手术治疗,其固定方法     

关节镜下带线锚钉固定修复Meyers McKeever Ⅲ型前交叉韧带胫骨止点撕脱骨折

目的探讨前交叉韧带胫骨止点撕脱骨折在关节镜下使用带线锚钉固定的手术疗效。方法 2012年5月~2013年7月,对15例Meyers Mc KeeverⅢ型前交叉韧带胫骨止点撕脱性骨折,在关节镜下使用带线锚钉固定,术后早期功能锻炼,术后复查X线片了解骨折复位愈合情况,检查膝关节松弛度、活动度。结果随访12~22个月,平均17个月。15例前交叉韧带胫骨止点撕脱性骨折均满意复位愈合,无移位,术后Lachmann试验及前抽屉试验均阴性,膝关节功能正常。术前Lysholm评分(54.2±4.2)分,术后12个月提高至(91.8±2.2)分(配对t检验,t=2.242,P=0.000)。结论关节镜下应用带线锚钉固定治疗前交叉韧带胫骨止点撕脱性骨折,手术疗效满意,具有复位良好,固定牢靠,可早期行膝关节功能锻炼,缩短术后康复周期,避免膝关节僵硬,对于前交叉韧带止点撕脱骨折是一种可靠的方法。     

关节镜下治疗后交叉韧带胫骨止点撕脱性骨折近期疗效观察

[目的]探讨关节镜下缝线空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折的可行性及近期疗效.[方法]对10例后交叉韧带胫骨止点撕脱性骨折行关节镜下PCL胫骨止点缝合及空心钉固定术.术中使用2根5号Ethi-bond聚乙烯缝线,在韧带下方骨块上方从前往后拢住韧带,经韧带两侧胫骨骨隧道拉到胫骨内下方.在骨隧道下方2 cm处打入带垫圈的直径4.5mm空心钉.[结果]手术时间60～90 min,平均75 min.10例均随访12～18个月,平均15个月.术后6周,所有骨折均获愈合,未出现骨折移位.无胭窝部神经、血管损伤并发症.术后半年Lysholm膝关节功能评分83～95分(89.6±4.03)分.[结论]关节镜下通过双后内侧入路缝线空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折,术中关节镜监控可靠,操作简便,效果可靠,值得推广.     

带线锚钉手术治疗胫骨平台关节面后缘撕脱性骨折

胫骨平台关节面后侧撕脱性骨折常累及胫骨平台关节面后缘、内外髁,同时常合并有后交叉韧带止点骨折[1]。2006年7月～2009年7月,笔者采用后路切开复位双股带线锚钉内固定术治疗9例胫骨平台关节面后缘撕脱性骨折患者,     

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.     

Relationship of the posterior cricoarytenoid muscle to the posterior cricoid lamina.

OBJECTIVE: Early experiments in functional electrical stimulation of the posterior cricoarytenoid muscle (PCA) in human beings have involved placement of the electrode along the undersurface of the PCA. The anatomy of the posterior cricoid lamina (PCL) was examined to obtain a quantitative understanding of this region. METHODS: Thirty fresh-frozen cadaver larynges were dissected. Measurements of the cricoid cartilage and PCA were obtained with a caliper or calibrated probe. RESULTS: Twenty male and 10 female adult larynges were examined. Sex differences were found for the height of the PCL. All larynges had approximately 4 mm of exposed cartilage along the inferior surface of the PCL. The origin of the PCA on the PCL was thinner in the medial-vertical attachment than in the inferior-horizontal. The average inferolateral to superomedial diagonal width of the PCA was 4 mm greater in the male than in the female larynges. Asymmetry between the left and right sides was seen. CONCLUSIONS: The PCA can be divided into 2 muscle groups based on its origin on the PCL as well as its insertion into the muscular process of the arytenoid. The quantitative information obtained has implications for electrode design and placement for laryngeal stimulation.     

Minimal-invasive posterior approach in the treatment of the posterior wall fractures of the acetabulum

We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004–2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher–Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.     

Cervical ossification of the posterior longitudinal ligament: Anterior versus posterior approach

Background:

The optimal approach to provide satisfactory decompression and minimize complications for ossification of the posterior longitudinal ligament (OPLL) involving multiple levels (3 levels or more) remains controversial. The purpose of this study was to compare the results of two surgical approaches for cervical OPLL involving multiple levels; anterior direct decompression and fixation, and posterior indirect decompression and fixation. We present a retrospective review of 56 cases followed at a single Institution.

Materials and Methods:

We compared patients of multiple levels cervical OPLL that were treated at a single institution either with anterior direct decompression and fixation or with posterior indirect decompression and fixation. The clinical records of the patients with a minimum duration of follow-up of 2 years were reviewed. The associated complications were recorded.

Results:

Fifty-six patients constitute the clinical material. 26 cases were treated by anterior corpectomy and fixation and 30 cases received posterior laminectomy and fixation. The two populations were similar. It was found that both anterior and posterior decompression and fixation can achieve satisfactory outcomes, and posterior surgery was accomplished in a shorter period of time with lesser blood loss. Although patients had comparable preoperative Japanese Orthopaedics Association (JOA) scores, those with a canal occupancy by OPLL more than 50% and managed anteriorly had better outcomes. However, for those with more severe stenosis, anterior approach was more difficult and associated with higher risks and complications. Despite its limitations in patients with high occupancy OPLLs, through the multiple level laminectomy, posterior fixation can achieve effective decompression, maintaining or restoring stability of the cervical spine, and thereby improving neural outcome and preventing the progression of OPLL.

Conclusions:

The posterior indirect decompression and fixation has now been adopted as the primary treatment for cervical OPLL involving multiple levels with the canal occupancy by OPLL <50% at our institution because this approach leads to significantly less implant failures. Those patients with the occupancy ≥50% managed with anterior approach surgeries had better outcomes, but approach was more difficult and associated with higher risk and complications.     

Arthroscopic approach to the posterior compartment of the knee using a posterior transseptal portal

Arthroscopic surgery of the posterior compartment of the knee is difficult when only two anterior portals are used for access because of the inaccessibility of the back of the knee. Since its introduction, the posterior transseptal portal has been widely employed to access lesions in the posterior compartment. However, special care should be taken to avoid neurovascular injuries around the posteromedial, posterolateral, and transseptal portals. Most importantly, popliteal vessel injury should be avoided when creating and using the transseptal portal during surgery. Purpose of the present study is to describe how to avoid the neurovascular injuries during establishing the posterior three portals and to introduce our safer technique to create the transseptal portal. To date, we have performed arthroscopic surgeries via the transseptal portal in the posterior compartments of 161 knees and have not encountered nerve or vascular injury. In our procedure, the posterior septum is perforated with a 1.5-3.0-mm Kirschner wire that is protected by a sheath inserted from the posterolateral portal and monitored from the posteromedial portal to avoid popliteal vessel injury.