L'ostéonécrose primitive du condyle fémoral interne

Résumé Le remplacement unicompartimental par la prothèse Modulaire II a été utilisé pour 18 patients (18 genoux) porteurs d'une ostéonécrose primitive du condyle fémoral interne. L'âge moyen des sujets au moment de l'intervention était de 72 ans avec des extrêmes de 49 et 90 ans. Le recul minimal est de 2 ans, le maximal de 8 ans avec un recul moyen de 4 ans et 6 mois. Une seule complication a été observée, consistant en une détérioration isolée du compartiment opposé due à une hypercorrection par obliquité condylienne. Le résultat apprécié suivant une cotation basée sur la douleur, la mobilité, la stabilité et la fonction articulaire a été estimé satisfaisant pour 95% des cas. L'angle moyen de flexion obtenu a été de 115°. La déviation axiale résiduelle objective une moyenne de 4,5° de varus. Cette hypocorrection a été volontaire pour éviter la détérioration du compartiment opposé et n'a jamais été responsable d'un descellement prothétique. L'amélioration du flessum a été constante. La laxité et l'instabilité dues essentiellement à la perte de substance condylienne — «condyle carré» de l'ostéonécrose — et non à une insuffisance ligamentaire authentique, ont été corrigées régulièrement. Les déviations en varus importantes (supérieures à 10°), le flessum (supérieur á 15°) et les subluxations fémoro-tibiales frontales ou sagittales n'ont pas limité l'utilisation de ce type d'implant.

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Unicompartmental replacement for idiopathic osteonecrosis of the medial femoral condyle

Summary We have inserted 18 Mod II unicondylar knee replacements for idiopathic necrosis of the medial femoral condyle. The age of the patients at operation averaged 72 years, with a range of 49 to 90. The average length of follow up at review was 4 years 6 months, with a range of 2 to 8 years. The only notable complication was deterioration of the lateral compartment if operation had produced overcorrection of the tibiofemoral angle. The stability, level of pain, range of movement and function was satisfactory in 95% of the knees. The average flexion obtained was 115°, and was deliberately restricted to this level to diminish stress on the lateral side. It did not result in aseptic loosening. Most knee flexion deformities were corrected at operation. Laxity and instability before operation were usually due to bone loss rather than ligament insufficiency, and were corrected by the prosthesis. A varus deformity of more than 10°, a flexion deformity greater than 15° or femorotibial subluxation were not considered to be contraindications to this operation.

     

Fracture of the occipital condyle caused by minor trauma in child

We report a case of fractured occipital condyle caused by minor trauma accompanied by light pain on palpation at the lateral cervical trigonum. A 15-year-old boy complained of nuchal pain, particularly pain on palpation at the left lateral cervical trigonum in the absence of neurologic deficits after head deceleration trauma. Computed tomography demonstrated a unilateral nonluxated fracture of the occipital condyle. Owing to consequent immobilization by means of cervical orthosis, pain disappeared after the first 48 hours. Follow-up examination 4 weeks later showed no neurologic deficits. The boy had no severe impairment of movements at the cervical spine.     

前路经枕寰枢关节螺钉内固定的临床解剖学研究

[目的]探讨前路经枕寰枢关节螺钉的临床应用解剖学依据。[方法]取30具国人干燥枕颈部标本,测量与经枕寰枢关节螺钉内固定术相关的解剖径线及钉道参数;并以此类数据为依据,在所测量的干燥标本上模拟行经枕寰枢关节螺钉内固定术,经X线摄片检查内固定位置并测量钉道实际角度。[结果]前路经枕寰枢关节螺钉内固定的钉道在矢状面上呈后倾,在冠状面上呈外倾。左右两侧钉道角度大小差异无统计学差异,理想外倾角为(18.15±3.70)°,理想后倾角为(24.20±4.91)°,理想钉道长度为(34.45±2.9)mm;模拟行内固定验证,术后影像学及直视下检查结果显示,螺钉钉道均经过枕寰枢关节,角度均在此范围内,无穿出骨质者。[结论]采用前路经枕寰枢关节螺钉行枕颈融合内固定在解剖上是可行的。     

关节镜下治疗股骨髁撕脱性骨折

目的探讨关节镜下治疗膝关节后交叉韧带股骨髁起点处撕脱性骨折的效果。方法 21例交叉韧带股骨髁起点处撕脱性骨折患者在关节镜监控下,了解并处理半月板损伤,再进行骨折复位、空心可吸收螺钉内固定。结果 21例均获随访,时间12～18个月。完整随访12个月时按Lysholm标准评价膝关节功能:优19例,可2例。患者均获得满意疗效。结论关节镜治疗股骨髁撕脱性骨折创伤小,疗效好。     

空心钉治疗儿童陈旧性肱骨外髁骨折

2006年1月～2009年7月,我院应用空心钉内固定治疗儿童陈旧性肱骨外髁骨折9例,骨折愈合良好,报道如下。1材料与方法1.1病例资料本组9例,男6例,女3例,年龄5～10（7.6±1.1）岁。受伤至手术时间5～25（8±2.3）个月。肘关节屈伸功能障碍6例,屈伸度为45°～90°（68°±19°）,1例肘外翻畸形20°,无迟发性尺神经炎。X线片显示均为骨折不愈合,见图1A。     

左侧下颌骨髁突内陷性脱位1例

<正>1临床资料患者,女性,36岁,汉族。因"外伤致张闭口不能9 d"就诊。9 d前患者被石板砸倒后下颌着地致伤,伤后下颌不能活动,无法张闭口,影响进食。检查:左侧下颌面部皮肤可见一长约1 cm的     

Classification of surgical approaches to the mandibular condyle

Published articles on surgical approaches to the mandibular condyle seem to be confusing.We present a classification system that describes and differentiates between surgical approaches to the mandibular condyle and is based on the relation to the facial nerve, height of the approach, and choice of skin incision.     

Management of long-standing mandibular dislocation

Long-standing dislocation of the temporomandibular joint (TMJ) is rare. The management of this disorder is still controversial. This paper presents the authors’ experience of managing long-standing dislocation of the TMJ, and their attempt to develop guidelines for the management of this problem. They also show magnetic resonance images of two patients with long-standing dislocation of the TMJ.     

Fractures of the mandibular condyle: A comparison of patients,fractures and treatment characteristics between Groningen (The Netherlands) and Dresden (Germany)

Purpose

To explore differences in patient, fracture, accident and treatment characteristics between patients treated for a mandibular condyle fracture in the University Centres of Dresden and Groningen, as an explanation for differences treatment results.

Secondary chondrosarcoma in the mandibular condyle

We report the case of a woman who had secondary chondrosarcoma in an osteochondroma in the left mandibular condyle, presenting as a large lobulated bone density mass in the left condyle process, to illustrate the clinical characteristics and imaging findings.