目的:对同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制及诊断进行分析探讨。方法:对2007年1月至2008年6月收治的7例同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤患者的临床资料、诊治经过和随访结果进行总结分析。结果: 胫腓骨开放性骨折3例(42.9%),闭合性骨折4例(57.1%);髋关节均有后脱位,其中伴有髋部骨折5例(71.4%)。膝后交叉韧带实质部断裂4例(57.1%),胫骨止点撕脱骨折3例(42.9%)。7例患者获平均14.7个月(12～18个月)随访。Lysholm膝关节功能评分术后6月95.8±3.71,术后12月97.6±2.7。结论:明确同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制,全面、准确、系统的问诊查体和完善的辅助检查是早期确诊、提高疗效的关键。
The short head of the biceps brachii muscle was removed from its origin with a thin piece of bone from the coronoid process and was transposed to the dislocated clavicle. From the action of muscle contraction from the biceps brachii muscle, the dislocated clavicle would be pulled downward. This method of repair was satisfactory in4 cases of acromioclavicular dislocation. Results obtained from the follow-up, there was no recurrence of dislocation, and the function and muscle power of the shoulder were completely normal.
Acetabuloplasty was used to treat 62 cases (76 hips) of congenital dislocation of hip in older children, with a period of follow-up for 1 to 7 years. The good results from operation rated 81.7 percent. It was considered that this type of operation could fulfil the physiological requirements, as the femoral head replaced into the acetabulum would accomplish the following benefits from establishing a stable joint, reducing the lumbar lordosis and minimizing development of hip and low back pain. The technique ...
Objective To investigate the operative method and cl inical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus. Methods From February 2006 to June 2008,12 cases of shoulder dislocation (6 left, 6 right) combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years (range 34-79 years). Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours (range 30 minutes-24 hours). X-ray films revealed greater tuberosity fractures with average 5.8 mm (range 5-12 mm) displacement, and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were fixed with canulated screws, 2 cases with absorbable screws, 7 cases with titanium suture anchor. Three cases were repaired under arthroscopy, and 9 cases were repaired under arthroscopic assistance mini-incision. Results All the incisions were healed at first intention without infection. All patients were followed up for 6-32 months (average 16 months). The shoulder joints were fixed stably without redislocation. Six months after operation, there were 3 cases with mild l imitation of abduction and 1 case with pain in flexion related with impingement. The X-ray films showed all fractures healed 2-6 months after operation (average 3.2 months). The American Shoulder and Elbow Surgeons and University of Cal ifornia at Los Angeles scores were 16.03 ± 1.03 and 32.65 ± 4.83, respectively. Eight cases were excellent, 3 were good, 1 were fair and the excellent and good rate was 91.7%. Conclusion For shoulder dislocation combined with fracture of greater tuberosity of humerus, the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperation diagnosis, satisfying therapeutic effect, good functional recovery, as well as obvious rel ief of pain.
Objective To investigate the feasibility of MRI three-dimensional (3D) reconstruction model in quantifying glenoid bone defect by comparing with CT 3D reconstruction model measurement. Methods Forty patients with shoulder anterior dislocation who met the selection criteria between December 2021 and December 2022 were admitted as study participants. There were 34 males and 6 females with an average age of 24.8 years (range, 19-32 years). The injury caused by sports injury in 29 cases and collision injury in 6 cases, and 5 cases had no obvious inducement. The time from injury to admission ranged from 4 to 72 months (mean, 28.5 months). CT and MRI were performed on the patients’ shoulder joints, and a semi-automatic segmentation of the images was done with 3D slicer software to construct a glenoid model. The length of the glenoid bone defect was measured on the models by 2 physicians. The intra-group correlation coefficient (ICC) was used to evaluate the consistency between the 2 physicians, and Bland-Altman plots were constructed to evaluate the consistency between the 2 methods. Results The length of the glenoid bone defects measured on MRI 3D reconstruction model was (3.83±1.36) mm/4.00 (0.58, 6.13) mm for physician 1 and (3.91±1.20) mm/3.86 (1.39, 5.96) mm for physician 2. The length of the glenoid bone defects measured on CT 3D reconstruction model was (3.81±1.38) mm/3.80 (0.60, 6.02) mm for physician 1 and (3.99±1.19) mm/4.00 (1.68, 6.38) mm for physician 2. ICC and Bland-Altman plot analysis showed good consistency. The ICC between the 2 physicians based on MRI and CT 3D reconstruction model measurements were 0.73 [95%CI (0.54, 0.85)] and 0.80 [95%CI (0.65, 0.89)], respectively. The 95%CI of the difference between the two measurements of physicians 1 and 2 were (–0.46, 0.49) and (–0.68, 0.53), respectively. Conclusion The measurement of glenoid bone defect based on MRI 3D reconstruction model is consistent with that based on CT 3D reconstruction model. MRI can be used instead of CT to measure glenoid bone defects in clinic, and the soft tissue of shoulder joint can be observed comprehensively while reducing radiation.