Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized,double‐blind,placebo‐controlled trial

Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo‐controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double‐blinded study to assess the effect of rESWT for treating CTS. Thirty‐four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross‐sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo‐controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:977–984, 2016.     

双Endobutton技术治疗Ⅲ型肩锁关节脱位的临床观察

目的回顾分析应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位的初步临床疗效。方法对12例TossyⅢ型肩锁关节脱位患者采用双Endobutton技术重建喙锁韧带治疗,全部病例获得8～14个月随访,平均12个月。结果按Lazzcano疗效评价标准进行评价,优10例,良2例,无再脱位及其他并发症。结论应用双Endobutton技术治疗TossyⅢ型肩锁关节脱位近期疗效满意,远期疗效有待长期随访。     

开放复位加股骨短缩术治疗小儿发育性髋关节脱位的临床研究

目的探讨开放复位加股骨短缩术治疗小儿发育性髋关节脱位（DDH）的临床疗效。方法回顾性分析本组11例（11髋）DDH患儿采用开放复位、股骨短缩术加Salter截骨术式治疗。其中男2例,女9例;左侧7例,右侧4例。患儿手术时年龄为2岁8个月～5岁3个月,平均3．5岁。按Tsnnis系统分级：Ⅲ度2例,Ⅳ度9例。术前患肢缩短1．5～3．5cm,平均2．4cm。结果患儿随访时间1～6年,平均2．8年。股骨颈前倾角术前测量30°～50°,术中皆矫正至20°左右。术前髋臼指数35°～55°,术后矫正至17°～32°。术中股骨截骨长度1．0～2．5cm,平均1．6cm。McKay评分,优7髋,良4髋。股骨头缺血性坏死1例。结论对2～6岁之间的高脱位DDH患儿,开放复位术中发现复位困难或复位后压应力大时应行股骨截骨短缩术。     

创伤性复发性腓骨肌腱脱位的手术治疗

目的研究创伤性复发性腓骨肌腱脱位的手术方法. 方法回顾分析1986年1月～2003年12月手术治疗的21例创伤性复发性腓骨肌腱脱位的病例,所有病例均应用Watson Jones手术. 结果 15例得到随访,随访时间1～15年,平均4.9年.1例因外伤再次脱位,其余14例未再出现脱位,均恢复正常运动或训练,比赛. 结论 Watson Jones手术治疗复发性脱位操作简单,损伤小,效果满意.     

Delayed Reduction of Irreducible Chronic Posterolateral Dislocation of the Knee with Buttonholing of the Medial Femoral Condyle

Abstract Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done.     

Chiari骨盆内移截骨并加盖术治疗大龄儿童发育性髋关节脱位术后效果影响因素分析

大龄儿童发育性髋关节脱位一般指6岁以上的儿童,由于患儿的持续负重,髋臼、股骨头的形态发生了较大的变化,软组织也随着股骨头的逐渐上移而变形明显。自2001年采用切开复位,Chiari骨盆内移截骨并加盖术,部分患儿合并股骨近端旋转截骨相结合的联合手术方式,疗效良好,报告如下。     

Traumatic posterior shoulder dislocation: a case with modification of Gerber procedure for humeral head reconstruction at 10-year follow-up

We report a case of acute traumatic posterior shoulder dislocation in a 41-year-old patient, which we treated surgically by a modification of the procedure described by Gerber for humeral head reconstruction in such cases. The diagnosis was confirmed by CT scan, which also helped us to assess the size of the antero-medial humeral head defect or impaction secondary to the dislocation; the size of this defect being a determinant element for the indication. Because the shoulder was unstable after closed reduction and almost 50% of the humeral head was impacted, we carried out a surgical treatment using an original technique as mentioned above. Radiologic and surgical features of acute traumatic posterior shoulder dislocation are discussed with special emphasis on diagnosis, indications and surgical aspects of this rare lesion, which represent 2–4% of acute traumatic shoulder dislocations.     

成人尺骨近端向后孟氏损伤的诊断与治疗

目的 探讨成人尺骨近端向后孟氏损伤的诊断、鉴别诊断及治疗策略.方法 2004年4月至2007年12月共手术治疗16例成人尺骨近端向后孟氏损伤患者,其中对13例患者获得随访,随访时间12～58个月,平均28个月.手术均采用肘关节后正中入路.术中尽量对桡骨头骨折和冠状突骨折进行复位和固定.对尺骨近端的固定,7例采用单纯钢板,2例钢板加克氏针,3例钢板加克氏针张力带,1例克氏针张力带加螺钉.结果 末次随访时均无明显疼痛及肘关节不稳定.患肢肘关节伸屈活动范围平均为100°(0°～145°),前臂旋转活动范围平均为119°(0°～170°).Mayo肘关节功能评分(MEPS评分)平均为93.1分(67～100分),优良率92.3%.Broberg-Morrey评分平均为88.8分(53～100分),优良率76.9%.结论 对尺骨近端向后孟氏损伤要注意正确的诊断与鉴别诊断.手术治疗的关键要重建尺骨近端长度和对线,尽量对其进行解剖复位并牢固固定.     

锁骨钩钢板加张力带和加锚钉重建喙锁韧带治疗肩锁关节脱位的比较研究

目的比较采用锁骨钩钢板加张力带重建和加锚钉重建喙锁韧带治疗肩锁关节脱位的临床疗效。方法回顾性分析2007年6月至2009年1月采用锁骨钩钢板加不同喙锁韧带重建治疗肩锁关节脱位患者42例,其中A组26例采用锁骨钩钢板加张力带重建喙锁韧带,男16例,女10例;年龄19～45岁,平均28.7岁;Rockwood分型Ⅲ型12例,Ⅳ型8例,Ⅴ型6例。B组16例采用锁骨钩钢板加锚钉重建喙锁韧带,男10例,女6例;年龄18～43岁,平均25.8岁;Rockwood分型Ⅲ型8例、Ⅳ型5例、Ⅴ型3例。比较两组患者肩关节功能恢复时间及术前、术后Lazzcano评分情况。结果全部获得随访,随访时间6～16个月,平均11.6个月。两组肩关节功能恢复时间分别为4.3周和4.6周,两组比较差异无统计学意义（P〉0.05）。A组术前Lazzcano评分优2例、良9例、差15例,术后优18例、良8例、差0例,术前、术后比较,差异有统计学意义（P〈0.05）。B组术前Lazzcano评分优1例、良5例、差10例,术后评分优11例、良5例、差0例,术前、术后比较,差异有统计学意义（P〈0.05）。术前、术后两组间比较无统计学差异（P〉0.05）。A组出现伤口感染2例,B组出现伤口感染1例,均无螺钉松动脱落和断裂。结论采用锁骨钩钢板加张力带或锚钉重建喙锁韧带治疗肩锁关节脱位都是可靠有效和安全的方法。