Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder

In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders) with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.     

Bilateral anterior shoulder dislocation with bilateral fractures of the greater tuberosity: A case report

Bilateral anterior dislocation of the shoulders with fractures of both greater tuberosities is very rare. A 76-year-old woman sustained a bilateral anterior dislocation of her shoulders with fractures of the greater tuberosity on both sides after a fall on stairs. Her arms were abducted and externally rotated. Radiological examination revealed the bilateral anterior dislocation and also the bilateral fractures of the greater tuberosity. Prompt closed reduction followed by a 3 weeks immobilization and subsequent rehabilitation allows a good outcome. Results at one-year follow-up were satisfactory with normal range of motion and no redislocations occurring. To our knowledge, this is the first reported case of bilateral anterior shoulder dislocation associated with fractures of both greater tuberosities in elderly woman.     

关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位

目的探讨关节镜下采用自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 2005年1月-2010年1月,对22例(22膝)复发性髌骨脱位患者采用关节镜下外侧支持带松解,取自体腘绳肌腱重建内侧髌股韧带治疗。男5例,女17例;年龄15～19岁,平均17.3岁。髌骨脱位3～8次,平均4次。主要临床症状为患膝关节疼痛、肿胀、无力,活动受限。髌骨倾斜试验、恐惧试验、内侧髌股韧带止点处压痛、髌骨向外推移时恐惧征均呈阳性。根据国际膝关节文献委员会(IKDC)评分标准,膝关节功能主观评分为(36.7±4.7)分,Lysholm评分为(69.3±3.8)分。X线片示患者髌骨向外倾斜。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18～49个月,平均34个月。术后患者关节疼痛、肿胀、无力等症状较术前明显改善。随访期间患者髌骨脱位无复发。末次随访时,IKDC膝关节功能主观评分为(92.4±5.3)分,Lysholm评分为(91.7±5.2)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下取自体腘绳肌腱重建内侧髌股韧带可明显改善髌骨稳定性,是治疗复发性髌骨脱位的有效方法之一。     

类风湿性关节炎肩关节病变的影像学测量

[目的]调查类风湿性关节炎( rheumatoid arthritis,RA)患者的肩关节功能及影像学改变,了解该类人群中肩关节病变现状,分析肩关节破坏的相关因素,为RA肩部疾病的预防和治疗提供临床依据.[方法]随机选择RA患者,记录发病年龄、病程,采用ASES肩关节评分量表评测肩关节功能;拍摄肩关节正位X线片,进行Larson分期,测量肩关节内侧距离(MD)、肩关节上移指数(UI)、肩关节内移指数(MI)、大结节关节面间距(GA),分析Larson分期与上述数据间的相关性.[结果]2010年3月～2010年11月,60人入选本研究,平均年龄(51.34±14.14)岁,男6人,女54人.ASES评分(72.69±24.76)分;完成116肩摄X线片,无明显骨性破坏的肩关节(Larson 0 ～1期)MD为(7.55±0.55) cm,UI为1.38±0.10,MI为1.04±0.29,GA为(0.60±0.22) cm.Larson 分期与ASES评分呈显著负相关(r=-0.028 3,P=0.001),与反映肩关节内移的MD、MI呈显著负相关(r=-0.177,P=0.029和r=-0.438,P＜0.001);与UI无显著相关性(r=-0.062,P=0.253);与GA呈显著负相关(r=-0.369,P＜0.001).与病程和年龄呈显著正相关(r=0.534和r=0.390,P＜0.001),与患病年龄无显著相关性(r =0.091,P=0.165).[结论]肩关节受累在RA患者中广泛存在,其受累程度随着病程增加而增加,随着破坏程度的加剧肩关节旋转中心发生内移,但是尚不明确旋转中心上移与骨性破坏是否同步发展.     

寰枢椎脱位翻修手术的临床疗效观察

目的 :探讨一期前路经口咽松解并后路复位固定融合术对寰枢椎脱位手术治疗失败病例翻修的手术要点及疗效。方法:2001年10月~2011年10月对29例寰枢椎脱位手术治疗失败病例行翻修手术,其中26例获得随访,男12例,女14例。初次手术时年龄4~56岁,平均33.5岁,齿状突骨折不愈合6例,齿状突发育畸形6例,横韧带断裂2例,先天性寰枕融合12例。翻修手术时年龄12~60岁,平均37.2岁。两次手术相隔11~158个月,平均44.2个月。8例初次手术后未复位,18例复位后因内固定失败再次脱位,脑干脊髓角平均101.8°。患者均有枕颈部持续性疼痛,其中19例伴脊髓神经功能障碍,JOA评分平均8.5分。均行一期前路经口咽松解、后路复位减压、寰枢椎或枕颈固定融合术,其中12例行C1-C2融合,6例C0-C2融合,3例C0-C3融合,3例C0-C4融合,2例C1-C4融合。随访患者临床疗效并进行影像学评估。结果:手术均顺利完成,手术时间210~340min,平均290min;失血量500~1100ml,平均700ml。术中未发生血管、神经和脊髓等损伤,术后无咽壁和椎管内感染发生。19例(73.1%)获得完全复位,7例不完全复位;脑干脊髓角恢复至平均143.0°,其中11例达到正常,15例小于正常。随访18～90个月,平均45个月,随访期间未见内固定松动表现,植骨均获得骨性融合;临床症状明显改善,19例伴有脊髓神经功能障碍患者末次随访时JOA评分平均12.6分。按Macnab疗效评估标准评定:优10例,良6例,无改善3例。结论:一期前路经口咽松解、后路复位减压、寰枢或枕颈固定融合术是一种具有较好临床疗效的寰枢椎脱位翻修术式。     

锁定加压钢板在不稳定肱骨近端骨折中的运用

目的 探讨锁定加压钢板治疗不稳定肱骨近端骨折的方法及疗效. 方法 自2007年2月～2010年3月,对46例肱骨近端Neer 2型以上不稳定骨折患者,采用肱骨近端骨折锁定加压钢板治疗.其中男18例,女28例,平均年龄51.3(32 ～84)岁.根据Neer分类,二部骨折21例,三部分骨折19例,四部分骨折6例. 结果 经术后平均14.5(10 ～22)个月随访,有1例患者术后5d发生内固定失效,予再次手术后获骨性愈合.应用Neer疗效评分系统进行评定,优21例,良16例,可7例,差2例,优良率80.4％. 结论 肱骨锁定加压钢板的螺钉锁定作用,能够提高对肱骨近端不稳定骨折的固定效果,做到骨折愈合与功能锻炼同步.但应注意对锁定加压钢板的合理操作,尽量避免因操作错误引起的内固定效果不佳.只有掌握锁定加压钢板的操作要点并加以灵活运用才能减少和正确处理各种术中失误.     

Caution Should be Taken in Performing Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in Patients Over the Age of 40

Background

Open and arthroscopic procedures are treatment options for patients with femoroacetabular impingement (FAI). Age has been found to be a predictive factor in the outcome of patients undergoing periacetabular osteotomy (PAO) for hip dysplasia. It is unclear if older age contraindicates joint preservation through a surgical hip dislocation (SHD).

Questions/Purpose

The purpose of this retrospective case series was to evaluate the short-term outcomes of patients over 40 years of age without radiographic evidence of end-stage arthritis who underwent SHD for the treatment of FAI and to determine whether older age should be a contraindication for joint-preserving procedures in these patients. Our specific aims included (1) documenting the intraoperative findings and procedures, (2) assessing pain relief provided, and (3) assessing treatment failures and postoperative complications, noting the number of patients that ultimately required total hip arthroplasty (THA).

Patients and Methods

All patients at age 40 and older who had SHD for the treatment of FAI were identified from a series of patients treated with SHD. Clinical notes, radiographs, and operative reports were reviewed to determine clinical results, complications, and the need for additional procedures. The minimum follow-up was 1 year (mean 3.9 years; range 1–8 years).

Results

At final follow-up, 11/22 (50%) of hips had pain relief, while 11/22 (50%) either continued having significant symptoms or required THA. Five (23%) reported nontrochanteric pain symptoms that were the same or worse than before surgery, and six hips (27%) underwent subsequent THA). The average time between SHD and THA was 1.9 years (0.9–6.2). The average age of patients who went on to require THA was 45 (42–50) years.

Conclusions

Surgical hip dislocation can be used for the treatment of FAI in patients over age 40, but strict selection criteria should be adhered to, as only half of the patients experienced significant improvement in their hip pain. THA was required in one-third of hips for continued pain and radiographic progression of arthritis. SHD for treatment of pathology that is not amenable to hip arthroscopy should remain a surgical option in older patients with FAI only if joint degeneration is not present.     

月骨周围脱位的X线分析

月骨周围脱位多发生于活跃的青壮年男性,是一种严重的腕部损伤,主要依靠腕关节X线检查和临床查体诊断。由于腕关节结构复杂,临床易误诊、漏诊,若诊断或治疗不当,极易引起骨缺血坏死、腕不稳及创伤性关节炎等严重并发症,     

Anterior dislocation of shoulder in eclampsia: a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia.This is an unusual mechanism of injury,but simila...     

Bilateral inferior dislocation of the hip---a case report

Inferior dislocation of the hip is the rarest type in hip dislocation.Very few cases have been reported in the anglophonic literature,most of which involved the pediatric age group.Surprisingly,we came...