晶状体不全脱位于玻璃体腔的手术治疗

目的：探讨晶状体不全脱位于玻璃体腔的处理方法。方法：回顾分析了3例（3眼）钝挫伤致晶状体不全脱位,采用经角巩膜缘切口,行前部玻璃体切割联合晶状体囊内摘内,同时行Ⅰ期人工晶状体缝线固定术,结果：3眼最终视力0．4－0．6,矫正视力0．4－0．8,1眼术后前房出血,经保这治疗吸收,无眼内炎、高眼压及角膜、视网膜等并发症。结论：因悬韧带的损伤是不均衡的,脱位的晶状体悬吊于玻璃体腔的中、前部,故经角巩膜切口,行前部玻璃体切割,摘除晶状体的方法是简捷、有效及安全的。     

超声生物显微镜诊断小范围晶状体不全脱位

目的探讨超声生物显微镜诊断小范围晶状体不全脱位的临床应用。方法回顾性分析晶状体不全脱位范围≤3个钟点位者62例（62只眼）。同时以正常人80例（80只眼）作为对照组。应用超声生物显微镜测量晶状体赤道部与睫状突的最远距离及最近距离,观察脱位晶状体、睫状体形态特点。结果晶状体不全脱位1个钟点位者10例,最远距离平均为（0．86±0．10）mm,最近距离为（0．41±0．05）mm,两者差值0．46±0．11;脱位2个钟点位者21例,最远距离为（0．88±0．15）mm,最近距离为（0．36±0．10）mm,两者差值0．52±0．14;脱位3个钟点位者31例,最远距离为（1．11±0．21）mm,最近距离为（0．42±0．14）mm,两者差值0．61±0．15。脱位患者与正常人品状体赤道部与睫状突的最远距离、最近距离及差值的差异有统计学意义,正常人与不同范围脱位者晶状体赤道部与睫状突间最远距离、最近距离及差值的差异有统计学意义。所有脱位者均出现不同程度的晶状体赤道部变圆或睫状体变平的表现。结论超声生物显微镜可以诊断小范围晶状体不全脱位。     

颈椎关节半脱位征像的诊断价值

目的：探讨颈椎Ｘ线片上半脱位征像的临床诊断意义；方法：对８７例颈痛和２１例无症状患者的颈椎Ｘ线片进行研究，内容包括齿突侧块间距、棘突偏歪和双边征等；结果：绝大多数左右齿突侧块间距不对称，棘突偏歪和双边征较为常见，多见于Ｃ５、Ｃ４和Ｃ６颈椎。两组间所谓颈椎半脱位的发生率相等。结论：对颈椎关节半脱位的提法值得商榷。颈椎关节半脱位的诊断应当有两种，一是单纯的Ｘ线学诊断，二是结合临床体查结果的临床诊断。     

寰枢关节半脱位临床诊断的研究进展（综述）

寰枢关节半脱位在临床上日益常见,自从报道以来,一直受到国内外学者的关注,但目前仍无统一的诊断标准。为进一步加深对寰枢关节半脱位的认识,该文从解剖生理、病因机制、临床表现和影像学方面对它的临床诊断进行综述。     

Pathologies of the Extensor Carpi Ulnaris (ECU) Tendon and its Investments in the Athlete

Those who have dedicated significant time to the study and care of stick-and-ball athletes have an appreciation for the unique anatomy, unusual forces, and proclivity for injury. It is imperative that hand surgeons involved in the care of baseball, hockey, tennis, and golf athletes appreciate the anatomic and mechanical elements of extensor carpi ulnaris (ECU) pathology. It is necessary to maintain a high level of suspicion for ECU problems, among other ulnar wrist pathologies, as well as acute diagnostic skill and a portfolio of therapeutic alternatives for their treatment.     

Posterolateral subluxation exposure of the elbow for injuries involving the lateral column

The posterolateral subluxation exposure of the elbow is a useful surgical technique for addressing complex radial head or capitellar fractures. It can be modified to allow for exposure of the distal humerus or elbow in more complex cases including those resulting in the terrible triad injury. In this approach, dissection to the radiocapitellar joint via a posterior incision provides great exposure and allows for reduction and internal fixation or placement of a radial head prosthesis. The authors in this video presentation demonstrate the posterolateral approach for radial head fractures and radial head replacement along with some technical caveats.     

Posterior bone block procedure for posterior shoulder instability

The posterior bone block procedure is an uncommon surgical procedure used in the treatment of posterior shoulder instability. The purpose of this study is to report the results of the posterior bone block procedure in the treatment of posterior shoulder instability. We retrospectively reviewed 21 shoulders that had undergone a posterior bone block procedure in the treatment of recurrent posterior shoulder instability between 1984 and 2001. Fifteen patients (16 shoulders) had a prior traumatic posterior glenohumeral dislocation and 5 patients (5 shoulders) had a prior traumatic posterior glenohumeral subluxation. The mean age at surgery was 24.8 years (range 17–40 years). Patients were evaluated with the Constant score, the Duplay score, a subjective result, and radiography. Preoperatively, ten shoulders had glenoid fractures, two shoulders had loss of the normal contour of the posterior osseous glenoid, and ten shoulders had humeral head impaction fractures (reverse Hill-Sachs lesion). Seventeen shoulders underwent preoperative computed tomography and had average glenoid retroversion of 9.6° (range 0–21°). At an average follow-up of 6 years, all patients reported their subjective results as good or excellent. At follow-up the mean Constant score was 93.3 points (range 80–103 points), and the mean Duplay score was 85.6 points (range 40–100 points). Fifteen patients returned to sports at their pre-injury level. Three patients were considered clinical failures; one with a recurrent posterior dislocation and two with substantial posterior apprehension on follow-up examination. Two shoulders had glenohumeral arthritis on radiographs at the latest follow-up. The posterior bone block is a good treatment option for posterior dislocation. The risk of recurrent dislocation is low following this procedure.     

Minor Shoulder Instability

The wide spectrum of shoulder instability is difficult to include in 1 classification. The distinction between traumatic, unidirectional, and atraumatic multidirectional instability is still widely used, even though this classification is not sufficiently precise to include all the different pathological findings of shoulder instability. We present “minor instability,” which is a pathological condition causing a dysfunction of the glenohumeral articulation, especially in combination with microtrauma, repetitive or not, or after a period of immobilization or inactivity. When “minor shoulder instability” is suspected, the patient’s history and detailed clinical examination represent the most important factors when establishing the diagnosis. In particular, the apprehension test stressing the middle glenohumeral ligament (MGHL)/labral complex in the position of midabduction and external rotation may be painful and may even reveal anterior instability or subluxation. Conventional radiographs are negative in most cases, as is magnetic resonance imaging arthrography. It is only after an accurate arthroscopic assessment that the pathological lesion can be found. The major pathological process can be identified at the level of the anterior superior labrum, in particular the MGHL complex, and appears as hyperemia, fraying, stretching, loosening, thinning, hypoplasia, or even absence. It may, however, be difficult to distinguish between a normal variant and a pathological lesion. Clinical symptoms and examination should always be correlated with arthroscopic findings. Recommended treatment is to restore shoulder stability and thereby prevent shoulder pain secondary to the increase in laxity. A reduction in range of motion should be expected during the postoperative phase, at least up to six to nine months. External rotation is usually permanently reduced by a few degrees.     

Tuina for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation

Objective： To observe theclinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation. Methods： A total of 60eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment. Results： The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference （P＆lt;0.05）. The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference （P＆lt;0.01）. The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference （P＆lt;0.01）. Conclusion： Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.