Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
【摘要】 目的 评价经皮冠状动脉成形术（percutaneous coronary interventions，PCI）术后，穿刺股动脉应用Perclose ProGlide血管缝合器止血的安全性、可靠性及对常见并发症的防范。 方法 2007年4月-2009年5月，收治217例经股动脉PCI术后患者，根据术后是否使用血管缝合器将患者随机分成血管缝合器组（105例）和对照组（经手法压迫止血112例）。观察记录两组患者下肢制动时间及血管并发症等。 结果 血管缝合器组103例操作成功（98.1%），2例失败；对照组成功112例（100%）。两组成功率比较，差异无统计学意义（Pgt;0.05）。血管缝合器组和对照组患者下肢制动时间分别为（4.1±1.2）和（25.0±3.1）h，两组比较，差异有统计学意义（Plt;0.01）。术后两组并发症发生率比较，差异无统计学意义（Pgt;0.05）。 结论 血管缝合器是一种安全、可靠的止血方法，可明显缩短制动时间，无明显的穿刺部位血管并发症，熟练操作可减少并发症的发生。【Abstract】 Objective To evaluate the safety of Perclose ProGlide Suture-Mediated Closure System applied to femoral artery puncture site after percutaneous coronary interventions (PCI) and to explore the prevention of possible common complications. Methods A total of 217 patients who underwent PCI from April 2007 to May 2009 were randomly divided into Perclose ProGlide group (105 patients, hemostasis by Perclose ProGlide Suture-Mediated Closure System) and control group (112 patients, hemostasis by compression). The Lower-limb braking time and the complications were recorded and analyzed. Results The successful rate was 98.1% (103 patients) in Perclose ProGlide group, and 100% (112 patients) in the control group; the difference between the two groups was not significant (Pgt;0.05). But there was a significant difference (Plt;0.01) in Lower-limb braking time between the two groups[(4.1±1.2) and (25±3.1) hours]. The post-operative complications between the two groups didn’t differ much. Conclusions Perclose ProGlide Suture-Mediated Closure System is a safe,effective and simple method after percutaneous coronary intervention to achieve immediate hemastasis. Skillfully processing may reduce the vascular complications.
目的探讨钢丝缝合固定胸骨骨折的治疗效果。 方法回顾性分析2010年1月至2014年12月我院使用钢丝缝合固定胸骨骨折患者16例的临床资料，其中男15例、女1例，年龄30～74（46.3±7.1）岁，采用胸部正中切口达骨折处，上下骨折端适当游离后，用成人型带针钢丝从下骨折端缝入2针，翻转上下骨折端后从上骨折端对应部位出针，骨折复位后扭紧钢丝，14例单处骨折均用此法固定，2例2处骨折用8字缝合固定。 结果16例患者均治愈，术后骨折部疼痛明显减轻，切口愈合良好。单纯性胸骨骨折手术时间50～90（68.46±12.31）min，手术费4 414～6 765（5 495.77±786.36）元。骨折复查发现1例对位稍差，其余患者对位对线均良好，无钢丝断裂及钢丝割裂胸骨病例。 结论钢丝缝合固定能快速恢复胸廓的稳定性，方法简单、安全、费用低、效果好，值得在基层医院推广应用。
Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
Objective To evaluate the biomechanical property of tendons repaired with the modified Kessler suture combined with " 8” suture, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture. Methods Forty frozen flexor digitorum longus tendons from fresh pork hind leg were randomly assigned into 4 groups, 10 specimens each group. In group A, the tendons were dissected transversely at the midpoint to forming the model of tendon with transversely cutting injury. The tendons in groups B, C, and D were dissected transversely at the midpoint, then a 2 cm segment of tendon from the incision in each side was dissected longitudinally with 1 mm internal to forming " frayed tendon” model. All the tendons were sutured with2-0 non-absorbable suture material with different suturing methods: in group A, the tendons with transversely cutting injury model with Krackow suture, and in the groups B, C, and D with Krackow suture, Kessler suture, and the modified Kessler suture combined with " 8” suture separately. All repaired tendons were fixed onto the biomechanical testing machine. The length, width, and thickness of each side and midpoint of the tendons were recorded, and the cross-sectional area was calculated. The tendons were stretched at a speed of 15 mm/minutes until failure (suture avulsion or rupture). The computer automatically recorded the maximum load, stress, strain, the failure displacement, and the stiffness. These biomechanical parameters of tendons in different groups were analyzed and compared. Results There was no significant difference in the length and cross-sectional area of each tendon among 4 groups (F=0.245, P=0.863; F=0.094, P=0.963). Two tendons in group B, 1 in group C, and 1 in group D were excluded because of tendon slipping; all tendons in group A and 8 tendons in group B failured due to suture rupture, 9 tendons in group C due to suture slipping, and 9 tendons in group D due to 3 sutures slipping from tendon tissue together. The maximum load, the maximum stress, the maximum strain, the failure displacement, and the stiffness of the tendons between groups A and B showed no significant difference (P>0.05). The maximum load, the maximum stress, and the stiffness of the tendons in group D were larger than those in both groups B and C (P<0.05), but no significant difference was found in the maximum strain and the failure displacement between groups B, C, and D (P>0.05). The maximum load, the maximum stress, the failure displacement, and the stiffness of the tendons in group B were larger than those in group C (P<0.05), but the difference of maximum strain between groups B and C was not significant (P>0.05). Conclusion The modified Kessler suture combined with " 8” suture can provide better biomechanical property of the repaired tendon compared with other suture approaches.
Objective To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle. Methods The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups (P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation. Results Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group (P<0.05). The operation time was significantly shorter in the FS group than in the ASS group (P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores (P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups (P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups (P>0.05). Conclusion Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.