综合手术方案治疗复发性髌骨脱位的疗效观察

目的评价采用关节镜下外侧松解、内侧支持带紧缩缝合、半髌腱移位术的综合手术方案治疗复发性髌骨脱位的临床疗效。方法以1998～2004年收治的38例患者为研究对象,男17例,女21例。29例有明确外伤史,不包括髌骨完全性脱位且关节活动时髌骨始终不与股骨髁间构成关节面关系的病例。通过了解病史、体查以及CT或MRI资料分析确定髌骨脱位病因。关节镜下外侧支持带松解与内侧支持带紧缩缝合、髌腱外1／2连同外侧胫骨结节止点向内侧交叉移位。术后不制动,髌骨行保护性的康复疗程。术后3个月以及每年随访,检查髌骨轨迹、关节活动度以及行髌骨切线位片或CT检查。结果29例患者获3～60个月(平均40．2个月)随访,均无脱位复发,恐惧感消失,物理及影像学检查表明髌骨稳定。按Lysholm评分评价膝关节功能,29患者术后平均评分为(91．3±3．8)分,较术前的(58．1±5．4)分明显提高,差异有统计学意义(P<0．01)。结论关节镜下外侧松解、内侧支持带紧缩缝合、半髌腱移位术的综合手术方案治疗复发性髌骨脱位疗效确切。操作简便,易于掌握。     

旋髂深血管蒂骨瓣移植预防先髋术后股骨头坏死

目的探索发育性髋关节脱位术后股骨头坏死的预防措施。方法对20例发育性髋关节脱位分为A、B两组，A组常规切开复位加带旋髂深血管蒂骨瓣移植，B组单行常规切开复位。结果A组病例获1～6g随访，平均3．5年，股骨头坏死2例，Ficat分期I期，A组髋关节功能评定：优6例，良2例，差2例。B组病例获4～14年随访，平均7．8年，股骨头无菌坏死5例，Ficat分期：ⅡA期1例、ⅡB期2例、Ⅲ期2例，B组髋关节功能评定：优4例，良1例，差5例。结论带旋髂深血管蒂骨瓣移植能有效预防发育性髋关节脱位术后股骨头坏死，改善关节功能。     

改良蛙式石膏固定治疗发育性髋脱位

目的总结用改良蛙式石膏固定方法治疗发育性髋脱位（DDH）的临床经验。方法采用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗DDH患儿193例282髋,对患儿的临床资料进行回顾性分析。结果193例均获得随访,时间5年6个月～11年6个月,平均（8±3.2）年。参照周永德等发育性髋脱位疗效评价标准,239髋复位满意,远期优良率为84.8%。根据Salter评价标准,有10例发生股骨头缺血性坏死。结论改良蛙式石膏固定方法治疗DDH具有操作简单、住院时间缩短等优点,是一种有效的方法。固定后护理很重要。     

掌侧入路手术治疗急性月骨周围骨折-脱位

目的评价掌侧入路手术治疗急性月骨周围骨折-脱位的方法及疗效。方法对2010-2017年收治的11例急性月骨周围骨折-脱位患者采用掌侧入路,术中复位月骨周围脱位,固定合并的骨折,修复掌侧关节囊韧带,术中判断月骨周围关节稳定则不再行关节内固定术,术后石膏托制动4周。末次随访采用Mayo腕关节评分评定疗效。结果术中修复掌侧关节囊韧带及固定合并的骨折后,10例月骨周围关节稳定,1例仍存在舟月关节分离,加用克氏针固定。11例均获得随访,随访时间9~17个月,末次随访,所有患者均重返原工作岗位。患侧腕关节平均屈伸活动度为106.2°,平均握力相当于健侧的87%。采用Mayo腕关节评分评价腕关节功能:优6例,良4例,可1例。结论采用掌侧入路切开复位、修复掌侧关节囊韧带、不常规使用关节内固定的方法治疗急性月骨周围骨折-脱位疗效满意。     

Complete posterior dislocation of fractured lateral condyle of tibia with disruption of proximal tibiofibular joint: Technical note

Tibial plateau fracture-dislocations are relatively uncommon injuries. They represent instability patterns due to injured collateral ligaments or extensive condylar depression. Medial and lateral subluxations of the fractured fragments represent the majority of these injuries. Posterior dislocations with the tibial plateau fractures are extremely rare injuries. Moreover, isolated posterior dislocations of the tibial condyles with a normally maintained position of the remaining tibia have not been reported in literature. We describe a difficult case scenario in which whole of the articular segment of the lateral condyle of the tibia was separated from its anterolateral rim and completely dislocated posteriorly, with no contact with the lateral condyle of the femur. Besides this, there was a complete disruption of the proximal tibiofibular joint as well. To further add to the problem, the distal pulses in the affected limb had a reduced volume. Stepwise management of all aspects of this injury has been described in this technical note along with a six-month follow-up.     

锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位

目的探讨锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位的临床疗效。 方法回顾性分析本院骨科自2008年1月至2018年12月收治的15例肩峰骨折合并肩锁关节脱位患者的临床资料，其中男13例、女2例；患者年龄范围18 ~ 60岁，平均年龄（34.67±15.53）岁；致伤原因：交通伤8例，摔伤2例，坠落伤3例，运动伤2例。肩峰骨折分型，OgawaⅠ型5例，OgawaⅡ型10例；肩锁关节脱位分型，TossyⅡ型7例，TossyⅢ型8例。治疗方案均为肩峰骨折采用切开复位空心钉内固定治疗，肩锁关节脱位采用切开复位锁骨钩钢板内固定治疗。术后1年根据患者患侧肩关节活动范围及肩关节Constant-Murely评分对患者进行功能评价。 结果所有患者均获得至少1年以上随访，平均随访时间（21.60±9.83）个月，术后患者切口均一期愈合，未发生伤口感染、骨折愈合不良、骨折脱位复位丢失、肩峰下撞击、钢板螺钉松动等情况。术后1年肩关节活动范围：外展90° ~ 145°，平均（114.00±19.29）°；上举100°～180°，平均（136.67±27.10）°；后伸30° ~ 60°，平均（42.00±10.66）°；外旋30° ~ 45°，平均（38.00±6.76）°。术后1年Constant-Murely评分70 ~ 96分，平均（85.73±7.26）分，优5例，良7例，可3例，优良率80％。 结论锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位操作安全、简单、疗效确切，术后患者功能恢复满意，值得在临床中应用。     

Surgical strategy for long-standing dislocation of the temporomandibular joint: experience with 16 medically compromised patients

We evaluated the surgical outcomes in 16 patients with long-standing dislocation of the temporomandibular joint (TMJ): eight men and eight women, mean (range) age 72 (21-94) years. They all had multiple underlying diseases, either dementia or a mental disorder, and the joint had been dislocated for four weeks or longer. Manual reduction had been ineffective. They were operated on after assessments by the Department of Geriatric Medicine. The procedures were successful in 14 of the 16 patients: eminectomy (n = 5), eminectomy and discectomy or condylectomy (n = 2), eminectomy, discectomy, and condylectomy (n = 3), release of the lateral pterygoid muscle (n = 3), and curettage of a fibrotic scar in the mandibular fossa (n = 1). Reduction was “easy” (n = 4), “moderately difficult” (n = 3), or “very difficult” (n = 9). Complete reduction could not be achieved for two of the “very difficult” patients. After reduction, three patients had the mandibular condyle tethered to the mandibular fossa. Operation was successful in 12 of the 16 patients. Two patients died, one of cardiopulmonary arrest, and one of chronic pulmonary insufficiency, while reduction was incomplete in two. There were no recurrences. The difficulty of reducing the joint in most of our patients suggests that detailed preoperative surgical planning is essential, patients at risk should be carefully selected, and indications for techniques to prevent recurrence should be carefully evaluated.     

肩锁关节脱位钩钢板术后早期拆除的可行性

目的：探讨早期取出肩锁关节钩钢板的可行性及对治疗效果的影响。方法：回顾分析2017 年1月至2019年12月间在龙湾区第一人民医院接受治疗且符合纳排标准的32例肩锁关节脱位患者的临床资料。结果：本研究32例患者均在我院完成初次内固定植入手术、术后定期随访及内固定拆除手术。半年内拆除组钢板拆除前患者的VAS疼痛评分明显高于半年以上拆除组（4.58±1.08 vs. 2.20±1.36，P ＜0.001），半年内拆除组钢板拆除前患者的肩关节功能评分为72.92±7.13，显著低于半年以上拆除组的80.50±5.58（P =0.002）；当钢板拆除后，两组患者的疼痛及功能评分差异无统计学意义（P ＞0.05）。两组患者在内固定拆除后，喙锁关节间隙的增宽距离差异无统计学意义[（1.70±1.19）mm vs（. 2.20±2.02）mm，P =0.442]。结论：肩锁关节脱位行钩钢板固定后，早期拆除内固定能够改善部分合并疼痛不适及功能受限患者的症状，同时并未增加肩锁关节再次脱位的风险。     

Modified balanced two-string technique of internal scleral fixation of posteriorly dislocated intraocular lens

Posterior dislocation of the intraocular lens (IOL) is a rare but potentially dangerous complication encountered by a cataract surgeon. We describe a modified balanced two-string technique of internally fixing a posteriorly dislocated rigid IOL using the pars plana approach in eyes which lack adequate capsular support. Five eyes of five patients underwent the procedure. All eyes had successful IOL refixation. One eye had mild temporal decentration. BCVA improved in all patients. Our technique is an alternate method of scleral fixation of posteriorly dislocated IOL with advantages of minimal postoperative astigmatism, minimal anterior segment manipulation, and good IOL centration.