后外侧结构重建在新鲜股骨颈骨折人工股骨头置换术中的应用

目的探讨后外侧结构重建对后外侧入路人工股骨头置换术术后早期关节脱位的影响。方法选取2016年9月至2017年8月于我院行后外侧入路初次人工股骨头置换术的股骨颈骨折患者60例,根据术中是否修补关节囊及外旋肌群分为重建组(33例:舌形切开关节囊,术中将关节囊及外旋肌群原位缝合在大转子后方及臀中肌肌腱附着处)和对照组(27例:切除关节囊后,术中未进行外旋肌群修复重建)。比较两组的手术情况及术后近期关节功能情况。结果重建组的手术时间为(45.0±15.3) min,长于对照组的(35.0±12.4) min (P <0.05)。重建组术腔引流量为(200.0±80.0) m L,少于对照组的(420.0±120.6) m L (P <0.05)。重建组的早期脱位率为0.000%(0例),与对照组的7.407%(2例)比较无统计学差异(P>0.05)。重建组术后Harris评分为(92.0±3.4)分,高于对照组的(88.2±5.0)分(P <0.05)。结论在后外侧入路人工股骨头置换过程中行后外侧结构重建能够有效减少术腔引流量,提高髋关节Harris评分,对维持髋关节软组织平衡具有重要意义。     

Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results

The purpose of the study was to evaluate the mid-term results of surgical treatment in different groups of patients with multiple knee ligament injuries. Review of our patients’ records revealed that 48 acute and chronic patients were surgically treated for combined knee injury. Due to severe capsular damage in these injuries, open techniques were used. In our treatment protocol, avulsed ligaments and tears of the posterolateral and posteromedial corner were repaired if possible, whereas midsubstance tears of cruciate ligaments and chronic cases were reconstructed with autografts. Postoperatively, an accelerated program of rehabilitation was introduced, aiming to progressively mobilize the joint and improve muscle endurance. For the follow-up evaluation we designed a protocol composed of two parts. In the first part, anatomical lesions were recorded and in the second part, clinical evaluation was performed using the Lysholm score, the Tegner rating system, the IKDC evaluation form, and the KT1000. Student’s t tests and chi-square tests were used for data analysis. Forty-eight patients (mean age 28.6±11.9 years; 41 males) were classified according to the specific anatomical structures involved. Group A included 12 anterior cruciate ligament (ACL) and medial structure injuries, group B included 11 ACL or posterior cruciate ligament (PCL) ruptures combined with posterolateral injuries, and group C consisted of 25 knee dislocations (ACL and PCL ruptures which might be combined with damage of the collateral ligaments). Thirty-eight patients were surgically treated during the acute phase and ten patients were treated chronically. Forty-four patients (91.6%) were followed up at a mean of 51.3±29.9 months. Average Lysholm score was 87±12.3; average Tegner score was 5.09±2.19 before accident and 4.34±2.12 in re-examination; IKDC score was A in 10 cases, B in 22, C in 6, and D in 6. The mean range of motion was 129.9°±12.5°. The average loss of extension and flexion were 1.6°±2.5° and 7.6°±7.9°, respectively. The side-to-side difference in corrected anterior and posterior translation in quadriceps neutral angle and in anterior translation in 30° angle was <3 mm for about 65% of our patients. Surgical treatment of multiple knee ligament injuries, using autografts, provided satisfactory stability, range of motion, and subjective functional results. However, despite the improvement of the quality of life, the preinjury patients’ activity level was not fully obtained in re-examination. Patients underwent surgical treatment during the acute phase had better scores in several points, but finally there was no statistical significance between acute and chronic patients. Moreover, no statistically significant differences were observed among the groups with specific damaged anatomical structures.     

改良Frosch入路在累及后外侧柱的SchatzkerⅡ型骨折中的应用

目的: 探讨改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折中的临床疗效。方法: 自2019年1月至2020年9月,共收治累及后外侧柱的SchatzkerⅡ型胫骨平台骨折患者11例,男7例,女4例,年龄21~49岁,采用侧卧位改良Frosch入路,后外侧骨折块采用支撑钢板或由后向前螺钉固定,前外侧采用常规胫骨平台外侧锁定钢板固定。X线测量术后即刻及术后12个月时胫骨平台内翻角和后倾角,及术后12个月膝关节活动度,采用美国特种外科医院(Hospital for Specdial Surgery,HSS)膝关节评分评价术后12个月时膝关节功能恢复情况。结果: 11例患者获得随访,时间12~15个月。术后即刻内翻角、后倾角分别为76°~86°、6°~10°,术后12个月分别为79°~88°、6°~10°。术后12个月膝关节活动度,伸0°~5°,屈曲106°~137°。术后12个月HSS膝关节评分为74~94分,优8例,良3例。结论: 经改良Frosch入路在累及后外侧柱的SchatzkerⅡ型胫骨平台骨折是一种有效的手术方法,单一切口完成2个部位骨折显露固定,避免采用联合切口,可获得良好的术后膝关节功能。术中应熟悉掌握腘窝结构,注意保护腓总神经,避免损伤。     

经改良腓骨小头上入路L型钢板治疗累及后外侧髁的胫骨平台外侧骨折的临床研究

目的 探讨单一L型钢板治疗累及后外侧髁的胫骨平台外侧骨折的临床疗效。方法 回顾性分析2016年10月至2021年3月山东大学附属山东省立医院收治的23例累及后外侧髁的胫骨平台外侧骨折病人的临床资料,其中男12例,女11例,年龄为22～73岁,平均40.5岁。受伤原因：高处坠落10例,交通事故10例,重物挤压3例,均为闭合性骨折。病人受伤至入院时间为2～72 h,入院至手术时间为3～14 d。均采用改良的腓骨小头上入路,骨折复位后L型钢板固定,一期处理合并前交叉韧带及半月板损伤。末次随访采用美国特种外科医院（American Hospital for Special Surgery,HSS）膝关节评分评价膝关节功能。结果 平均手术时间为53 min(45～71 min),平均术中出血量为122 m L(55～150 m L),平均随访时间为16.1个月（11～20个月）。X线复查结果示骨折均愈合,愈合时间为12～17周。末次随访时膝关节伸直度为0°～35°,膝关节屈曲度为100°～150°,HSS评分平均为92.2分（81～100分）。结论 单一L型钢板可以同时有效地固定胫骨平台后外侧髁...     

后外侧入路切开复位内固定治疗踝关节 骨折的疗效及并发症发生率研究

〔摘 要〕 目的：探讨踝关节骨折临床治疗中开展后外侧入路切开复位内固定术的应用价值及对并发症发生率的 影响。方法：选取 2016 年 10 月至 2021 年 4 月廉江市人民医院收治的踝关节骨折患者 60 例,根据治疗方案差异性分 两组,开展后外侧入路切开复位内固定 30 例（记作观察组）,实施复位石膏外固定 30 例（记作对照组）,对治疗优 良率、踝关节功能恢复情况、并发症率分析比较。结果：观察组患者治疗优良率更高,且负重行走时间、骨折愈合时 间均较对照组短,住院时间较对照组更长,差异均具有统计学意义（P ＜ 0.05）。治疗前两组患者美国矫形足踝协会 （AOFAS）评分比较,差异无统计学意义（P ＞ 0.05）;治疗后,两组患者 AOFAS 评分均提高,且观察组恢复情况 较对照组更优,差异具有统计学意义（P ＜ 0.05）。两组患者并发症发生率比较,差异无统计学意义（P ＞ 0.05）。 结论：后外侧入路切开复位内固定治疗踝关节骨折可取得显著疗效,固定效果佳,术后恢复快,促进患者踝关节功能 尽早恢复,且有效控制及预防并发症的发生,疗效及安全性兼顾。     

椎间盘摘除联合后外侧融合术治疗再发性腰椎间盘突出的疗效观察

目的观察椎间盘摘除联合外侧融合术治疗再发性腰椎间盘突出的临床疗效。方法 200例腰椎间盘突出患者根据腰椎有无失稳分为研究组和对照组各100例。对照组患者100例术前无腰椎失稳、退变性滑脱,研究组患者100例合并腰椎失稳、退变性滑脱或椎管狭窄,对照组给予患者椎间盘摘除术治疗,研究组患者给予椎间盘摘除联合外侧融合术治疗,应用JOA、ODI、LBOS、VAS评分表进行评分并记录手术优良率。结果 2组患者治疗后JOA、ODI、LBOS、VAS评分均显著优于治疗前(P<0.05),但组间比较差异无统计学意义(P>0.05)。研究组手术优良率为88%高于对照组的85%,但差异无统计学意义(P>0.05)。结论腰椎间盘突出症复发根据病情不同给予针对性治疗,椎间盘摘除联合外侧融合术可改善椎间盘功能,提高手术成功率。     

Is the popliteus tendon always inserted antero-inferiorly 18.5 mm from the lateral collateral ligament of the femur? Magnetic resonance imaging and cadaveric evaluations

BackgroundThe aim of this study was to analyze the locations of the femoral attachments of the popliteus tendon (PT) and lateral collateral ligament (LCL) via magnetic resonance imaging (MRI) and cadaveric dissection in a Korean population and compare with literature standards to determine whether variability exists.MethodsWe retrospectively analyzed knee MRIs from 87 cases selected from January 2017 to December 2018. The relationship between the femoral attachment of PT and LCL was analyzed by MRI using PACS and Image J. In addition, the femoral attachments of each structure were identified and marked in 14 unpaired human cadaveric knees. Three-dimensional models were reconstructed, and the surface area, location and distances were analyzed.ResultsOn MRI, the femoral attachment of PT was located at mean distances of 0.89 mm posterior and 9.35 mm inferior to the LCL femoral attachment. We identified three groups of PT locations relative to the LCL on MRI evaluation: parallel (63%), posterior (29%), and anterior (8%). On cadaveric evaluation, the femoral attachment of the PT was located at mean distances of 0.77 mm posterior and 8.90 mm inferior to the LCL femoral attachment. We also identified three groups of PT locations relative to the LCL on cadaveric evaluation: parallel (43%), posterior (36%), and anterior (21%).ConclusionsBased on both MRI and cadaveric evaluations in a Korean population, the femoral attachment of the PT is located just distal to and posterior to the LCL. The differences between the centroids of the femoral attachments of the two structures was approximately 9.7 mm, suggesting that racially based anatomical differences of the posterolateral corner may exist.     

膝关节后外侧结构损伤的诊治

膝关节后外侧结构(PLS)是维持膝关节稳定性的一个重要结构,对于防止膝关节过度外旋、内翻以及对于胫骨近端的稳定具有重要作用,同时后外侧角损伤的治疗,对于前交叉韧带或后交叉韧带损伤的重建手术能否成功,也具有重要的意义。根据PLS损伤时间长短、损伤类型及损伤程度,按Fanelli分型分为3型,治疗方法各异。对于手术治疗,目前主要有原位缝合修复、自体肌腱转移增强术或肌腱张力增强术和PLS重建术,本文对于膝关节后外侧结构的诊治作一综述。