肘部尺神经滑脱──流行病学调查及病理解剖观察

通过流行病学调查和病理解剖观察，提示尺神经滑脱可能与组织结构发育缺陷有关，如肱骨内上髁较小，肘管三角韧带及尺神经系膜松弛等。男女之间尺神经滑脱发生率有显著性差异。肘部尺神经滑脱并非少见，鉴于尺神经滑脱者发生肘部尺神经损害的危险性较一般人群高，一旦尺神经损害其所支配的已挛缩的手内在肌很难恢复，尺神经滑脱者是值得人们注意的肘部尺神经损害的易感人群。因尺神经滑脱者除上述结构缺陷外，更重要的是尺神经滑脱过程为重复累积性损伤，故尺神经前移以免尺神经在肱骨内上髁反复摩擦损伤为首选的治疗方法。     

外伤性晶状体不全脱位的超声乳化手术

目的　探讨晶状体不全脱位的超声乳化及人工晶状体植入的手术方法。方法　对 32例 36眼晶状体不全脱位根据脱位程度选择不同术式 :脱位 <1 2 0°者 ,环行撕囊超声乳化植入后房型IOL ;脱位 1 2 0°～ 2 70°者 ,晶状体囊缝合至睫状沟 1针 ,环行撕囊 ,超声乳化 ,植入后房型IOL ;脱位≥2 70°者 ,囊缝合至睫状沟 2针后环行撕囊及超声乳化 ,植入后房型IOL。结果　随访 3～ 1 8月 ,平均 8月。术后裸眼视力 <0 0 5者 2眼占5 56 % ;0 0 5～ 0 2 5者 7眼占 1 9 44% ;0 3～ 0 5者 1 2眼占 33 33 % ;0 6～1 0者 9眼占 2 5 0 0 % ;>1 0者 6眼占 1 6 67%。结论　晶状体不全脱位根据其程度采用Adank和Hennekes的方法将晶状体囊缝合至睫状沟以固定囊袋 ,再进行超声乳化 ,植入后房型IOL是一种安全有效的治疗方法     

Screening and detection of blunt vertebral artery injury in patients with upper cervical fractures: The role of cervical CT and CT angiography

Objective

To evaluate the clinical utility of nonenhanced CT (NECT)-based screening criteria and CTA in detection of blunt vertebral artery injury (BVAI) in trauma patients with C1 and/or C2 fractures.

Methods

We retrospectively reviewed the clinical records of all blunt trauma patients with C1 and/or C2 fractures between 8/2006 and 9/2011. Cervical CTA was prompted by cervical fractures involving/adjacent to a transverse foramen, and/or subluxation on NECT. Two neuroradiologists independently reviewed the CTA studies, and graded the BVAI.

Results

210 patients were included; of these, 124 underwent CTA (21/124 with digital subtraction angiography, DSA), and 2 underwent DSA only. Overall, 30/126 suffered BVAI. Among 21 patients who underwent both CTA and DSA, there was 1 false negative and 1 false positive (both grade 1). There was strong interobserver agreement regarding CTA-based BVAI detection (kappa = 0.93, p < 0.001) and grading (kappa = 0.90, p < 0001). Only 3/30 BVAI patients suffered a posterior circulation stroke; none of the patients who had a negative CTA or were not selected for CTA, based on NECT screening criteria, suffered symptomatic stroke. While C1/C2 comminuted fracture was more common in patients with high grade BVAI (p = 0.039), simultaneous C3–C7 comminuted fracture increased the overall BVAI risk (p = 0.011).

Conclusion

CTA reliably detects symptomatic BVAI in patients with upper cervical fractures. Utilization of NECT-based screening criteria such as transverse foraminal involvement or subluxation may be adequate in deciding whether to perform CTA, as no patients who were not selected for CTA suffered a symptomatic stroke. However, CTA may miss lower grade, asymptomatic BVAI.     

Symptomatic anterior sternoclavicular joint secondary to a bicipital rib

This case report details the diagnosis and treatment of a previously unreported complication of a congenital chest wall anomaly. Our patient presented with a painful anterior sternoclavicular joint subluxation secondary to a bicipital rib. Thoracic magnetic resonance and computed tomographic imaging provided the diagnosis. Complete resolution of symptoms was achieved after resection of the bicipital rib.     

Modifications to Norman's procedure for hypermobility of the TMJ

Background

Norman''s procedure is a well known surgical technique for the hypermobility of temporomandibular joint. In this procedure after performing glenotemporal osteotomy the augmentation of the zygomatic root of the temporal bone is done by placing a bone graft from the iliac crest to prevent forward movement of the condyle beyond the eminence. This paper describes the clinical outcome of two modifications added to Norman''s procedure. In addition to the conventional procedure inferiorly based pedicled flap from the temporal fascia was sutured to the antero-lateral aspect of the capsule. Intraorally pterygoid disjunction was carried out only in those case in which hypermobility was associated with painful temporomandibular joint disorder.

Methods

Modified Norman’s procedure was performed in 10 patients (4 females & 6 males), 7 of them were bilateral and 3 cases were unilateral under general anesthesia.

Results

After one year follow up in none of the cases graft failed or rejected though recurrence along with TMJ pain was noticed in 2 cases.

Conclusion

This technique is versatile but long-term follow up on a larger number of patients is necessary to be able to draw definitive conclusions.     

Missed cervical spine subluxation leading to bilateral facet dislocation with severe deformity requiring 360 fixation

A 41 year-old male that presented after a fall downstairs and the initial imaging was misinterpreted, missing a subtle abnormality, C5/6 subluxation. The patient presented later with neck pain and further imaging demonstrated bilateral facet dislocation with severe deformity requiring 360 spinal fixation.