【摘要】 目的 评价切开复位Herbert螺钉内固定加外支架治疗对亚急性和陈旧性舟状骨骨折的治疗效果。方法 2008年2月—2009年5月,对15例受伤后4周以上(平均7.6周)入院诊断为亚急性和陈旧性舟状骨骨折的患者均采用Herbert螺钉内固定加外支架治疗,术后随访5～16个月,平均12.5个月,按Gartland amp; Werley和改良Green amp; O’Brein评分系统进行评价治疗效果。结果 15例患者均进行有效随访,末次随访Gartland amp; Werley评分优8例,良5例,中2例,优良率为86.7％,改良Green amp; O’Brein评分优7例,良5例,中3例，优良率为80％。结论 此方法是治疗亚急性和陈旧性舟状骨骨折的有效措施,值得推广。
A total of 12 cases of old facet dislocations of cervical spine treated between december 1988 and 1993 were analyzed in order to evaluate the efficacy of various surgical modalities. In this series, there were 8 males and 4 females, with ages ranged from 16 to 50 years old (averaged 37.8 years old). The duration from injury to admission to our hospital was ranged from 1 to 8 months (averaged 3.7 months). Dislocation levels were as follows: C3,4 in 1 case, C4,5 in 4 cases, C5,6 in 4 cases and C6,7 in 3 cases. Unilateral facet dislocation was in 7 cases and bilateral facet dislocation in 5 cases. Neurological status on admission was as follows: spinal cord and nerve root lesion in 5 cases, nerve root lesion alone in 5 cases and neurologically intact in 2 cases. Besides all facets receiving facetectomy and iliac bone graft, other four kinds of adjuvant treatments were used, including internal fixation by stainless wires laminae or spinous processes in 4 cases, Luque rod in 1 cases, anterior fibrolysis combined with posterior laminoplasty in 1 cases and sustained skull traction without internal fixation in 6 cases. The reduction efficacy from postoperative stustained skull traction was better and the stainless wires fixation ranked the next. The patients only suffering from the nerve root lesion recovered better, but those who had spinal cord combined with nerve root lesion recovered badly. In conclusion, for the treatment of old facet dislocation, it is necessary to resect the facet and graft with iliac bone.
OBJECTIVE: To explore a new surgical treatment of old atlantoaxial dislocation. METHODS: 5 patients aged 12 to 45 years, who suffered from old atlantoaxial dislocation for 1 to 4.5 years, received the new surgical treatment by the transoccipitocervical posterolateral approach, and expansion of the foramen magnum, odontectomy and bony fusion of the occipitoatlantoid region were performed. Neurological examinations and CT scan were undertaken after operation. RESULTS: All 5 patients survived. Sensory function recovered almost completely and motor function was better more than 1 degree. CT scan showed the diameter of the spinal canal restored well. CONCLUSION: The transoccipitocervical posterolateral approach is an ideal and safe pathway to reach the site of old atlantoaxial dislocation and the operating field is exposed completely. Anterior-posterior decompression and occipitocervical spinal fusion can be performed simultaneously
Objective To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Methods A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T10-L2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. Results Except LL (P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX (P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated (P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. Conclusion Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
Old achilles tendon rupture accompanied by skin defect was a common amp; annoying problem in clinic. From June, 1985 to June, 1996, 18 cases with this kind of injury were treated by one stage repair of the tendon and skin defect. In this series, there were 15 males and 3 females, the length of tendon defects were ranged from 4 cm-6.1 cm, and the area of skin defect were ranged from 5.9 cm x 3 cm to 8.2 cm x 6 cm. The procedures were: (1) to debridement of the wound thoroughly; (2) to repair the achilles tendon; (3) to repair the skin defect with kinds of pedicle flap; (4) immobilization of ankle and knee for 6 weeks. No infection was occured after the operation. The flaps survived in all cases. After follow-up for one year in 15 cases, 12 patients went back to their work. It was concluded that (1) achilles tendon rupture should be treated carefully and properly during the emergency operation; (2) different methods should be selected according to the length of tendon defect; (3) because of its high survival and retained sensation after operation, the flap pedicled with posterior lateral malleolar artery is the best choice for repairing the skin defect.
ObjectiveTo evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. MethodsBetween January 2006 and June 2012, the intra-articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years (range, 22-54 years). The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months (range, 2-13 months). The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation (PRWE) (27.5±4.7). Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. ResultsAll patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months (mean, 20.6 months). Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8±2.1 at last follow-up, showing significant difference when compared with preoperative score (t=14.215, P=0.000). Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. ConclusionIntra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.
OBJECTIVE To evaluate the clinical results of Darrach’s procedure and Sauve-Kapandji’s procedure in the treatment of old derangement of distal radioulnar joint. METHODS Twenty-three patients with old derangement of distal radioular joint were divided into two groups, in which 11 patients received resection of distal end of ulna by Darrach’s procedure and 12 patients received pseudoarthrosis operation of the distal ulna by Sauve-Kapandji’s procedure. RESULTS Fifty-six months after Darrach’s procedure, complete relief of pain was obtained in 6 cases (P lt; 0.01), the flexion-extension movement improved from 104 degrees to 125 degrees (P lt; 0.01), rotation movement of the forearm improved from 106 degrees to 128 degrees (P lt; 0.01) and grippig strength improved from 17 kg to 28 kg (P lt; 0.01). Fifty-five months after Sauve-Kapandji’s procedure, complete relief of pain was obtained in 9 cases (P lt; 0.01), the movement flexion-extension improved from 108 degrees to 126 degrees (P lt; 0.01), rotation movement of the forearm improved from 101 degrees to 135 degrees (P lt; 0.01) and grippig strength improved from 17 kg to 35 kg (P lt; 0.01). CONCLUSION 1. The two operation showed no difference in relief of the wrist pain, improvement of the movement of the wrist and that of the forearm; 2. Sauve-Kapandji’s procedure was superior to Darrach’s procedure in increasing gripping strength; and 3. So the Sauve-Kapandji’s procedure was superior to Darrach’s procedure, especially in the long-term result, in the treatment of old derangement of the distal radioulnar joint.
Objective To investigate the effectiveness of the terminal extensor tendon reconstrution by palmaris longus tendon graft for the treatment of old mallet finger deformity. Methods Between February 2009 and February 2011, 32 patients with old mallet finger deformity were treated with palmaris longus tendon graft. There were 28 males and 4 females with an average age of 32.5 years (range, 22-58 years). The injury causes included sports injury in 26 cases and punctured injury in 6 cases. The index finger was involved in 8 cases, the middle finger in 3 cases, the ring finger in 16 cases, and the little finger in 5 cases. According to the Rockwell’s classification, all patients were classified as type I. The time from injury to operation was 4-16 weeks (mean, 6 weeks). Results Primary healing was obtained in all incisions; no necrosis, infection, or nail bed injury occurred. All patients were followed up 12-20 months (mean, 14 months). The patients had no pain or paresthesia of volar finger. According to Patel’s functional assessment system, the results were excellent in 8 cases, good in 21 cases, fair in 2 cases, and poor in 1 case at last follow-up, with an excellent and good rate of 90.6%. Conclusion Reconstruction of the terminal extensor tendon by palmaris longus tendon graft is a reliable method to treat old mallet finger deformity.