TightRope袢钢板治疗陈旧性下胫腓联合损伤1例

<正>患者,女,26岁,2015年3月25日因右腓骨下段及后踝骨折伴下胫腓联合损伤(Lauge-Hansen旋后-外旋型骨折,见图1A)在我院行切开复位内固定术。术后10周局麻下拆除胫腓联合螺钉,建议患者逐渐负重行走。术后5个月复查,患者右踝关节肿痛明显,X线片提示右踝穴间隙明显增大,诊断为陈旧性下胫腓联合损伤。行TightRope袢钢板治疗。硬膜外麻醉下手术,患者仰卧位。以右外踝原切口入路,逐层切开,显露内固定物,顺利拆除各枚螺钉和1块钢板,     

陈旧性下尺桡关节脱位的手术治疗

我院自１９９４年９月～１９９８年１月采用桡侧屈腕肌腱转位治疗陈旧性下尺桡关节脱位共９例,效果满意,现报告如下：１应用解剖１１桡侧屈腕肌腱桡侧屈腕肌位于前臂浅层,起于肱骨内上髁向外下止于第２掌骨底。腱性部分长度１４３ｃｍ±１１ｃｍ,宽度６２ｃｍ...     

陈旧性下尺桡关节脱位的治疗

目的介绍陈旧性下尺桡关节脱位的治疗方法及效果。方法对11例陈旧性下尺桡关节脱位,采用旋前方肌骨膜瓣移位术及尺骨节段截除术使下尺桡关节复位。结果术后随访1~24个月,前臂旋转功能、腕关节活动度恢复满意,X线片示下尺桡关节对位关系正常。结论对不同下尺桡关节陈旧性脱位治疗采用不同术式,分别治疗,才能获得良好效果。     

袢钢板弹性悬吊治疗下尺桡关节脱位的临床疗效

目的:探讨袢钢板弹性悬吊下尺桡关节(DRUJ)治疗DRUJ脱位的临床疗效。方法:选取于2016年1月至2020年6月于郑州大学第一附属医院收治的确诊为DRUJ脱位的患者15例,随访时间6~18个月,对比其术前术后腕关节评分Gartland-Werley腕关节评分、术后患侧及健侧腕关节功能、术后并发症。术后两侧关节功能比...     

掌长肌腱转位治疗下尺桡关节脱位

掌长肌腱转位治疗下尺桡关节脱位吴水培，吕揆有，马锁坤我院于１９８９年６月至１９９３年９月，应用掌长肌腱转位修复下几桡关节脱位，国内少见报道，现报告如·下：一般资料本组男性７例，女性３例；年龄最小２２岁，最大３２岁；部位：左侧４例，右侧６例；致伤原因：...     

桡骨延长术治疗桡骨缺损伴下尺桡关节脱位

采用桡骨延长加骨移植术治疗桡骨缺损伴下尺桡关节脱位，疗效满意。自１９８６年３月～１９９３年９月，共治疗１２例。手术方法：切除桡骨缺损处瘢痕组织及两骨端硬化骨，打通骨髓腔；将骨撑开器插入骨断端．旋转延长螺杆，边延长边观察下尺桡关节复位至满意为止。骨缺损处用修整成圆柱状的自体髂骨块移植修复，并应用钢板螺丝钉固定。术后５个月全部达骨性愈合。平均随访４年５个月，按蔡氏［１］评定标准：优７例，良５例。本术式的优点是在桡骨延长时下尺桡关节自行复位，为临床提供一个新的治疗方法。     

中西医结合治疗下桡尺关节脱位

下桡尺关节脱位约占全身关节脱位１４．４４％,多年来国内外文献单独报道的很少,多以并发症提及。由于下桡尺关节解剖结构的特点及对前臂旋转功能所起的作用,我们对损伤的程度、诊断标准及治疗方法上进行一些研究。１临床资料天津市天津医院（天津３００２１１）１．１...     

部分桡侧腕屈肌腱瓣转位治疗陈旧性下尺桡关节脱位的远期疗效

[目的]分析探讨应用部分桡侧腕屈肌腱瓣转位治疗陈旧性下尺桡关节脱位的远期疗效。[方法]采用桡侧腕屈肌腱的内侧半,于腱肌交界处离断,以远端为蒂转位固定下尺桡关节,重建其稳定,共36例。[结果]36例患者术后随访5~10年,平均6.5年,其中优23例,腕关节酸痛基本消失,旋转70°~120,°X线恢复正常;良12例,腕关节轻度酸痛,旋转度数改善,X线片示正常;差1例,腕关节仍有酸痛,旋转度数无明显改善,X线片示正常。优良率97.2%。[结论]采用部分桡侧腕屈肌腱瓣转位治疗陈旧性下尺桡关节脱位,临床远期效果理想可靠。     

TightRope带袢钢板与锁骨钩钢板内固定治疗肩锁关节脱位疗效比较的Meta分析

目的 通过Meta分析方法比较TightRope带袢钢板与锁骨钩钢板内固定治疗肩锁关节脱位的临床疗效。方法 检索Cochrane临床试验注册数据库、PubMed、Medline、Embase、CNKI、维普数据库、万方数据库关于TightRope带袢钢板与锁骨钩钢板内固定治疗肩锁关节脱位的随机对照研究。采用RevMan 5.3软件进行Meta分析,结局指标包括手术时间、术中出血量、切口长度、肩关节功能Constant-Murley评分、Karlsson分级优良率、疼痛VAS评分、术后并发症。结果 纳入10篇文献,合计566例,其中TightRope组260例,锁骨钩钢板组306例。Meta分析结果显示,TightTope组在手术时间、切口长度、术中出血量、术后Karlsson分级优良率、术后疼痛VAS评分、术后并发症发生率方面优于锁骨钩钢板组,差异有统计学意义（P<0.05）;TightRope组与锁骨钩钢板组肩关节功能Constant-Murley评分差异无统计学意义（P>0.05）。结论证据显示TightRope带袢钢板内固定治疗肩锁关节脱位在术后Karlsson分级优...     

Traumatic recurrent distal radioulnar joint dislocation: a case report

Isolated acute distal radioulnar joint (DRUJ) dislocation is a rare injury (Garrigues and Aldridge III in J Bone Joint Surg Am 89:1594–1597, 2007]. Reports of isolated DRUJ luxations, volair or dorsal, are often case reports and rarely a series of cases [Dameron Jr in Clin Orthop Relat Res 83:55–63, 1972]. We present a case of an acute traumatic dorsal DRUJ dislocation treated with cast immobilization with recurrence of the dislocation after a new trauma some months later. At follow-up, 17 months after the first dislocation and 9 months after the second, he experienced no pain and had no restrictions in work or sports-related activities.     

青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗

目的 探讨青年桡骨远端陈旧性骨折继发下尺桡关节重度脱位的手术治疗方法.方法 采用短缩尺骨、重建下尺桡关节法,对7例桡骨陈旧性骨折、短缩,下尺桡关节重度脱位患者进行治疗.术后对患者腕关节外形、功能进行随访.结果 所有患者外形恢复良好,功能评价优6例,良1例.结论 短缩尺骨、重建下尺桡关节法是治疗桡骨陈旧性骨折、短缩,下尺桡重度脱位的有效方法.     

TightRope带袢钛板系统治疗肩锁关节脱位的疗效

目的探讨TightRope带袢钛板系统治疗RockwoodⅢ、Ⅴ型肩锁关节脱位的临床疗效。方法对48例RockwoodⅢ、Ⅴ型肩锁关节脱位患者采用TightRope带袢钛板系统内固定治疗。术后6个月参照肩关节Karlsson和Constant-Murley评定标准进行疗效评估。结果48例均手术顺利,未发生血管、神经损伤,术后均未出现术口感染、皮肤坏死等并发症。患者均获得随访,时间9~24个月。术后6个月,采用Karlsson标准评定疗效:优40例,良7例,差1例,优良率97.9%;Constant-Murley肩关节功能评分总分(93.42±3.59)分,较术前(51.36±6.27)分明显提高(P<0.05)。结论TightRope带袢钛板系统治疗RockwoodⅢ、Ⅴ型肩锁关节脱位具有切口小、患者活动早、并发症少、无需取出内固定等优点。     

Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎

目的 评价Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎的临床疗效.方法 采用Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎12例.随访内容包括手术前后腕关节疼痛程度、腕关节活动度、握力以及术后患侧X线片情况.X线片检查观察桡尺远侧关节愈合及测量尺桡骨间距.Mayo腕关节评分法评价手术前、后腕关节功能恢复程度,DASH问卷调查表行手术前、后腕关节功能自我评价.结果 术后随访9～32个月,平均16个月.术前腕关节疼痛值在负重后为[(39.0±17.0),(x)±s,下同],术后疼痛值为(23.0±13.0).尺桡偏活动度术前为(26.0±11.0)°,术后为(41.0±12.0)°;旋前、旋后活动度术前为(84.0±21.0)°,术后为(139.0±33.0)°.握力术前为(12.8±3.6)kg,术后为(24.0±7.4)kg.Mayo评分结果术前为(43.0±13.0),术后为(73.0±16.0),优3例,良4例,中3例,差2例.DASH值术前为(57.0±14.0),术后为(31.0±10.0).X线片检查12例桡尺远侧关节及尺骨移植处全部愈合.结论 Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎,疼痛明显减轻,旋转活动度和握力增加,功能明显改善.     

锁骨钩钢板治疗锁骨远端骨折及肩锁关节脱位

2003年6月～2007年5月,我院应用锁骨钩钢板治疗锁骨远端NeerⅡ型骨折及重度肩锁关节脱位患者36例,效果较好。     

Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report

PURPOSE: To report our experience using a distal ulnar head endoprosthesis to treat painful disorders of the distal radioulnar joint (DRUJ) secondary to (1) instability and (2) arthrosis. METHODS: Our experience with over 2 years of follow-up study consists of 19 wrists (17 patients). All patients presented complaining of pain and functional disability of the upper limb due to convergence instability or arthrosis of the DRUJ. The patients were studied prospectively. Thirteen patients had a total of 37 previous wrist or DRUJ surgical procedures. Standardized preoperative and postoperative assessments included a patient-reported pain score, a functional satisfaction score, forearm range of motion, grip strength as a percentage of that of the opposite limb, and clinical and radiographic examinations. The Mayo Wrist Score was calculated before surgery and at the last follow-up period. RESULTS: Overall, pain scores decreased 50%, and functional satisfaction scores improved 3-fold. Average grip strength improved by 4 kg, or 16% from preoperative measurements. Forearm rotation was unchanged. All wrists were clinically stable on the latest follow-up examination. Two failures occurred early, at 7 and 14 months. Currently, all prostheses remain clinically and radiographically stable. CONCLUSIONS: Implant arthroplasty of the distal ulna combined with an adequate soft-tissue repair is recommended to improve pain, function, and strength of the wrist and forearm. Prosthetic replacement of the distal ulna restored stability to the DRUJ in patients with partial or complete excision of the ulnar head or DRUJ arthrosis and corrected radioulnar impingement. Incidences of complications or revision surgery to date have been low. Larger clinical and radiographic assessments will be needed to determine the long-term success of distal ulna prosthetic replacement. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

经皮穿针固定治疗桡骨远端骨折合并下尺桡关节脱位

目的探讨经皮穿针固定治疗桡骨远端骨折合并下尺桡关节脱位的临床疗效。方法采用经皮穿针固定治疗42例桡骨远端骨折合并下尺桡关节脱位患者。结果 42例均获随访,时间4~24个月,骨折均获骨性愈合。疗效根据Green-O'Brien腕关节评分标准:优21例,良18例,一般3例,优良率92.9%。结论经皮穿针固定是治疗桡骨远端骨折合并下尺桡关节脱位的有效技术,疗效较可靠,并发症少。     

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.     

Biomechanical study of distal radioulnar joint ballottement test

We investigated the reliability and accuracy of the distal radioulnar joint (DRUJ) ballottement test using five fresh‐frozen cadaver specimens in triangular fibrocartilage complex (TFCC)‐intact, and TFCC‐sectioned wrists. The humerus and proximal ulna were fixed. The ulna was allowed to translate in dorsopalmar directions without rotation, and the radius was allowed to move freely. Four sensors of a magnetic tracking system were attached to the radius and ulna, and the nails of each examiner's thumbs. Five examiners conducted the DRUJ ballottement test before and after TFCC sectioning. We used two techniques: With holding and without holding the carpal bones to the radius (holding and non‐holding tests, respectively). We compared the magnitudes of bone‐to‐bone (absolute DRUJ) movement with that of the examiner's nail‐to‐nail (relative DRUJ) movement. The intrarater intraclass correlation coefficients (ICCs) were 0.92 (holding) and 0.94 (non‐holding). The interrater ICCs were 0.84 (holding) and 0.75 (non‐holding). Magnitudes of absolute and relative movements averaged 11.5 and 11.8 mm, respectively (p < 0.05). Before TFCC sectioning, the DRUJ movement during the holding and non‐holding techniques averaged 9.8 and 10.8 mm, respectively (p < 0.05). The increase in DRUJ movement after TFCC sectioning was greater with the holding technique (average 2.3 mm) than with the non‐holding technique (average 1.6 mm). The DRUJ ballottement test with magnetic markers is relatively accurate and reliable for detecting unstable joints. We recommend the holding technique for assessing DRUJ instability in clinical practice. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1123–1127, 2017.