关节镜下可吸收空心界面螺钉固定、四股腘绳肌腱重建前交叉韧带

目的探讨关节镜下可吸收空心界面螺钉固定、四股自体腘绳肌肌腱重建前交叉韧带(anterior cruciate ligament,ACL)的方法及疗效. 方法关节镜下以四股自体腘绳肌肌腱作为ACL替代物,应用(96L-4D)SR-PLA聚丙交酯生物可降解界面螺钉进行移植物固定, 对42例ACL损伤行ACL重建术. 结果 42例术后随访3～22个月,平均11.4月,膝关节活动度均在正常范围.术后Lachman 试验:37例≤1 ,4例2 ,1 例3 .轴移试验:42 例均为阴性.术后Lysholm 评分(89.7 ±9.6)分较术前(49.4±9.1)分显著提高(t=2.12,P=0.038).术后Tegner 活动评分(5.3±1.1)分较术前(2.3±0.7)分显著提高(t=4.13,P=0.008).术后1年MRI示29例可吸收空心界面螺钉部分被吸收;27例重建的韧带位置良好、形态正常;2例韧带在股骨的止点偏前;3例胫骨止点偏前,有轻度顶撞击现象. 结论四股腘绳肌腱是ACL重建的理想替代材料,可吸收空心界面螺钉是ACL重建的理想内固定材料.     

关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析

目的分析比较关节镜下单束单隧道与双束股骨双隧道重建后十字韧带(PCL)术后的临床效果。方法1999年1月～2001年12月,采用单束前外束重建法重建PCL 18例,男14例,女4例;年龄18～50岁,平均35.5岁;右膝12例,左膝6例。移植物为骨-髌腱(中1/3)-骨的11例,半腱肌腱和股薄肌腱的7例。于PCL股骨附着点解剖中心的稍前方钻取股骨隧道,屈膝70°,拉紧并固定移植物。2000年1月～2002年12月,采用双束股骨双隧道法重建PCL12例,男10例,女2例;年龄21～47岁,平均33岁;右膝9例,左膝3例。移植物为半腱肌腱和股薄肌腱的7例,一端带髌骨块的股四头肌肌腱的5例。将肌腱编织分为两束。于股骨侧钻取双隧道。两束分别于屈膝70°和0°时拉紧并固定。结果采用前外束重建法的18例患者平均随访23个月,采用双束股骨双隧道重建法的12例患者平均随访17个月。前外束重建组与双束股骨双隧道重建组随访时的Lysholm评分分别为(92.4±3.7)分和(94.3±3.4)分,两组间差异无显著性(P>0.05)。屈膝0°和30°时,前外束重建组的胫骨后移距离是(5.9±0.4)mm和(6.2±0.5)mm,双束股骨双隧道重建组是(3.5±0.3)mm和(4.0±0.4)mm,两组间差异有显著性(P<0.05);屈膝60°和90°时,两组胫骨后移距离差异无显著性(P>0.05)。结论双束股骨双隧道重建PCL的方法优于前外     

三踝骨折合并下胫腓联合分离治疗

目的 :探讨三踝骨折合并下胫腓联合分离的治疗。方法 :对 3 9例三踝骨折合并下胫腓联合分离内固定治疗患者进行回顾分析。结果 :本组 3 9例均获随访 ,随访时间 1～ 4年。优 2 0例 ,良 13例 ,可 6例。优良率 84.6%。结论 :三踝骨折合并下胫腓联合分离内固定治疗的关键是恢复并稳定踝穴和距骨的解剖关系 ,强调稳定内固定及早期功能锻炼     

Double-bundle technique: Endoscopic posterior cruciate ligament reconstruction using tibialis posterior allograft

Recently, attention has been given to the double-bundle technique for treating the posterior cruciate ligament (PCL)-deficient knee. We present an arthroscopic PCL reconstruction using a double-bundle technique with 3-stranded tibialis posterior (TP) allograft that has not been described before. The anterolateral bundle of the PCL is reconstructed using 2-stranded TP allograft and the posteromedial bundle using 1-stranded TP allograft. Three-stranded TP allograft will be an alternative graft choice for PCL reconstruction.     

CD HORIZON 前路内固定系统治疗退行性腰椎管狭窄症

目的探讨CD HORIZON前路内固定系统治疗退行性腰椎管狭窄症的应用价值。方法对21例退行性腰椎管狭窄症患者经从前路行椎管扩大减压植骨、CD HORIZON内固定术，术后经3～30个月，平均9个月的随访。结果17例术前腰痛、间歇跛行症状完全消除，下肢乏力基本消除，术后1个月戴腰围行走800～1500m，2例术前双下肢肌力0级，术后2个月恢复至4级。手术优良率90．5％。结论前路CD HORIZON系统治疗退行性腰椎管狭窄症可以达到有限化的椎管扩大、融合和固定，不过多干扰脊髓，临床效果满意。     

不同康复方案在关节镜下ACL重建患者中的应用价值对比

目的探讨不同康复方案在关节镜下前交叉韧带（anterior cruciate ligament,ACL）损伤重建患者中的应用价值。方法对南京市第一医院于2007年7月至2012年6月收治的80例ACL损伤患者进行回顾性分析,按照不同时间段的康复训练方法,分为观察组40例与对照组40例,分别进行本体感觉康复训练与普通康复训练。结果观察组术后6个月与1年的屈膝15°、45°、75°等的本体感觉恢复程度,均显著优于对照组,差异具有统计学意义（P〈0．05）;两组患者在术前、术后6个月、1年的Lysholm膝关节功能评分对比,差异不具有统计学意义（P〉0．05）。结论采用动态平衡性、经皮电神经刺激以及变异适应性等康复训练方案,有利于关节镜下ACL重建患者本体感觉的恢复,具有临床推广价值。     

Design-related risk factors for revision of primary cemented stems

Background and purpose Even small design variables of the femoral stem may influence the outcome of a hip arthroplasty. We investigated whether design-related factors play any role in the risk of non-aseptic revision of the 3 most frequently used primary cemented stem designs in the Swedish Hip Arthroplasty Register.

Patients and methods We studied 71,184 primary cemented femoral stem implants (21,008 Exeter polished stems, 43,036 Lubinus SPII stems, and 7,140 Spectron EF Primary stems) that were inserted from 1999 through 2006. Design-specific characteristics were analyzed using separate Cox regression models that were adjusted for sex, age, diagnosis, incision, and number of operations (first vs. second).

Results The crude revision rate varied between 0.8% (Lubinus SPII) and 1.4% (Spectron Primary). For the Exeter stem, the smallest femoral head diameter (22 mm) was associated with a higher risk of revision. No other design-specific parameters influenced the risk of revision of the Exeter stem. The smallest Lubinus stem size, a stem with extended neck length combined with a femoral head with increasing neck length, or the use of a cobalt-chromium head had a negative influence on the outcome. For the Spectron stem, the risk of revision was elevated for the smallest stem and for increasing offset calculated as the combined effect of high offset design and increasing neck length.

Interpretation Overall revision rates were low, but for two of the stems studied design factors such as size and neck length or offset influenced the risk of non-aseptic revision.     

Elbow dislocation with irreparable fracture radial head

Background:

Treatment of elbow dislocation with irreparable radial head fracture needs replacement of radial head to achieve stability of elbow. An alternate method in cases of elbow dislocation with radial head fracture can be resection of radial head with repair of medial collateral ligament. We report a retrospective analysis of cases of elbow dislocation with irreparable radial head treated by excision head of radius and repair of MCL.

Materials and Methods:

Nine patients of elbow dislocation with associated irreparable fractures of the head of the radius were included in this analysis (6 F:3 M, Age: 35-47 years). Radial head excision was done through the lateral approach and MCL was sutured using no 3 Ethibond using medial approach. Above elbow plaster was given for 6 weeks and gradual mobilization was done thereafter. All patients were assessed at final followup using Mayo elbow performance score (MEPS).

Results:

Mean followup was 19.55 ± 7.12 months (range 14-36 months). There was no extension deficit when compared to opposite side with mean range of flexion of 138.8° ± 6.97° (range 130 -145°). Mean pronation was 87.7° ± 4.4° (range 80-90°) and mean supination was 87.7 ± 4.62° (range 80-90°). The mean MEPS was 98.8 ± 3.33 (range 90-100). No patient had pain, sensory complaints, subluxation or redislocation. All were able to carry out their daily activities without disability.

Conclusion:

Radial head excision with MCL repair is an acceptable option for treatment of patients with elbow dislocation and irreparable radial head fracture.