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Core Decompression for Class I Avascular Necrosis of Humeral Head 肱骨头ⅰ类缺血性坏死的核心减压治疗
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/bte.0000000000000180
Andrew P. Wroblewski, Anthony T Machi, D. Klaus, S. Frangiamore
Supplemental Digital Content is available in the text. Avascular necrosis of the humeral head is a diagnosis of multiple etiologies and unclear prognosis. Prompt diagnosis and treatment are essential to prevent head collapse and avoid resurfacing or joint replacement procedures. Imaging modalities including standard radiography and magnetic resonance imaging establish the diagnosis and stage it according to the degree of necrosis, head collapse, or extension into the glenoid. If the patient stays persistently symptomatic despite conservative treatments and is still in the early stages of the disease course, humeral head core decompression is a reasonable option as it has been shown to decrease disease progression and provide symptomatic relief. Here, we present a case of a 52-year-old female with a history of adhesive capsulitis status postmanipulation and arthroscopic lysis of adhesions, now presenting with Cruess Stage I avascular necrosis of the humeral head. This technique (Supplemental Video, Supplemental Digital Content 1, http://links.lww.com/TSES/A36) demonstrates core decompression and grafting of the humeral head using a percutaneous expandable reamer. Level of Evidence: Level V (expert opinion).
补充数字内容可在文本中找到。肱骨头缺血性坏死是一种病因多样且预后不明确的诊断。及时诊断和治疗对于防止头部塌陷和避免表面置换或关节置换手术至关重要。成像方式包括标准x线摄影和磁共振成像,根据坏死程度、头部塌陷或伸入关节盂确定诊断和分期。如果患者在保守治疗后仍持续出现症状,且仍处于病程的早期阶段,肱骨头减压是一个合理的选择,因为它已被证明可以减少疾病进展并提供症状缓解。在此,我们报告了一例52岁的女性患者,她在操作和关节镜下粘连溶解后出现粘连性囊炎,现在表现为肱骨头Cruess期缺血性坏死。该技术(补充视频,补充数字内容1,http://links.lww.com/TSES/A36)演示了使用经皮可扩展铰刀对肱骨头进行核心减压和植骨。证据等级:V级(专家意见)。
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引用次数: 0
Reconstruction of Chronic Distal Biceps Tendon Rupture With Autogenous Semitendinosis Graft Using the “Anatomic Length Method” and Concomitant Bicipital Aponeurosis Repair “解剖长度法”自体半腱膜移植重建慢性二头远端肌腱断裂并同时修复二头腱膜
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/BTE.0000000000000177
W. Albishi, J. Lam, A. Elmaraghy
We present a novel variation of a surgical technique for reconstruction of chronic distal biceps tendon ruptures using the “Anatomic Length Method.” Graft length for chronic distal biceps tendon rupture reconstruction is extremely variable and typically empirically determined by elbow position during final fixation. These techniques do not account for chronicity and varying degrees of retraction and muscle shortening. For this unique variation in the surgical technique, the graft length used is based on previous anatomic cadaveric measurements done in our center with an external distal biceps tendon length mean of 6.3 cm. In addition, our technique routinely reconstructs the bicipital aponeurosis. This allows for a highly reproducible surgical technique and restores a more normal biceps anatomy and muscle length-tension relationship.
我们提出了一种新颖的手术技术,用于重建慢性肱二头肌远端肌腱断裂,使用“解剖长度法”。慢性二头肌远端肌腱断裂重建的移植物长度变化很大,通常由最终固定时肘关节的位置决定。这些技术没有考虑到慢性和不同程度的收缩和肌肉缩短。对于这种手术技术的独特变化,所使用的移植物长度是基于先前在我们中心完成的解剖尸体测量,二头肌外远端肌腱长度平均为6.3 cm。此外,我们的技术常规重建二头肌腱膜。这允许高度可复制的手术技术,并恢复更正常的二头肌解剖结构和肌肉长度-张力关系。
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引用次数: 2
Clinical Outcomes of Lateral Ulnar Collateral Ligament Repair of the Elbow Using a Cortical Button 应用皮质按钮修复尺骨外侧副韧带的临床疗效
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/BTE.0000000000000178
C. Zale, H. Kim
The purpose of this retrospective case series was to report a new surgical technique for lateral ulnar collateral ligament (LUCL) repair using a cortical button and the clinical results. Twenty patients underwent a LUCL repair using a cortical button at a single institution were included for evaluation of the demographic, radiologic, and clinical examination data. Nine patients returned for a separate study visit for further clinical examination and outcome surveys. Eighteen patients (mean age: 48 y, 10 males) received at least 1 additional procedure other than a LUCL repair. For the 9 patients who returned for a study visit (average follow-up: 27 mo), the mean QuickDASH score was 22.4 and the mean Mayo Elbow Performance Score 90. Six patients reported no pain, 1 moderate, and 2 mild. All 9 patients were satisfied. Average flexion-extension and supination-pronation arc of motion was 91% and 89% of the contralateral elbow, respectively. LUCL repair using a cortical button resulted in satisfactory clinical outcomes and can be a viable surgical option in acute elbow instability, especially in elderly patients with osteopenic bone.
本回顾性病例系列的目的是报告一种使用皮质按钮修复尺侧副韧带(LUCL)的新手术技术和临床结果。在一个机构中,20名患者使用皮质按钮接受了LUCL修复,用于评估人口统计学、放射学和临床检查数据。9名患者返回进行单独的研究访问,以进行进一步的临床检查和结果调查。18名患者(平均年龄:48岁 y、 10名男性)接受了除LUCL修复之外的至少1次额外的手术。对于返回研究访视的9名患者(平均随访:27 mo),平均QuickDASH得分为22.4,平均Mayo肘部表现得分为90。6名患者报告无疼痛,1名中度疼痛,2名轻度疼痛。9例患者均满意。对侧肘部的平均屈伸和旋后-内旋运动弧分别为91%和89%。使用皮质按钮进行LUCL修复可获得令人满意的临床结果,并可作为治疗急性肘关节不稳定的可行手术选择,尤其是在患有骨质疏松的老年患者中。
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引用次数: 0
The Mini-open Plication of Medial Collateral Ligament of the Elbow: A New Arthroscopically Assisted Technique 肘关节内侧副韧带小开口扩张术:一种关节镜辅助下的新技术
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/BTE.0000000000000176
J. Lesman, F. Luceri, M. Domzalski, P. Randelli, P. Arrigoni
The stability of the medial elbow compartment is not only important for everyday life but also plays a key role in throwing gestures. Valgus stress is a fundamental part of popular sport activities (baseball, squash, tennis, and volleyball). Even the isolated medial collateral ligament (MCL) lesion might develop symptomatic medial instability, which interrupts everyday life. This instability may be symptomatic and patients may refer medial elbow pain. Several techniques for MCL treatment have been described. Most of them are reconstructions in which there are tunnels and free cylindrical grafts. The aim of our study is to describe step-by-step a new surgical procedure for minimally invasive plication of aMCL arthroscopically assisted. This procedure should be performed after 6 months of conservative treatment failure. After arthroscopic MCL laxity diagnosis, the standard bioabsorbable double-loaded anchor with high resistance sutures was inserted into the anteroinferior surface of the medial epicondyle. After adequate restraint and preparation of proximal aMCL, 2 bioresorbable sutures were passed through the ligament considering 1 to 1.5 cm of tissue to be plicated. The procedure is considered less invasive and safe in comparison with graft reconstructions of MCL.
肘部内侧隔室的稳定性不仅对日常生活很重要,而且在投掷姿势中也起着关键作用。外翻压力是流行体育活动(棒球、壁球、网球和排球)的基本组成部分。即使是孤立的内侧副韧带(MCL)病变也可能出现症状性的内侧不稳定,从而中断日常生活。这种不稳定可能是症状性的,患者可能会出现肘部内侧疼痛。已经描述了MCL治疗的几种技术。大多数是重建,其中有隧道和自由的圆柱形移植物。我们研究的目的是描述一种在关节镜辅助下微创应用aMCL的新手术方法。该程序应在保守治疗失败6个月后进行。在关节镜下诊断MCL松弛后,将具有高阻力缝线的标准生物可吸收双负载锚钉插入内侧上髁的前下表面。在充分约束和准备近端aMCL后,考虑1至1.5,2条生物可吸收缝线穿过韧带 厘米的组织要折叠。与MCL的移植物重建相比,该手术被认为是微创和安全的。
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引用次数: 5
High-grade Common Extensor Tendon Tears Maintaining Chronic Lateral Epicondylitis: Clinical and Structural Outcome Following Knotless Suture Anchor Repair 高级别总伸肌撕裂维持慢性外侧上髁炎:无结缝合锚修复后的临床和结构结果
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/BTE.0000000000000179
M. Glanzmann, J. Gleich, Dominik Rickenbacher, Jürg Oswald, C. Kolling, L. Audigé
We describe the reconstruction of high-grade extensor tendon tears using a knotless suture anchor and hypothesize that this will result in improved elbow pain and function with a high healing rate. Twenty chronic lateral epicondylitis patients with magnetic resonance imaging–confirmed high-grade extensor tendon tears underwent surgery using a knotless suture anchor technique. All underwent clinical and ultrasound assessments and completed the quick Disabilities of the Arm, Shoulder, and Hand and patient-rated tennis elbow evaluation questionnaires at final follow-up. Preoperative and postoperative Mayo Elbow Performance Scores were also determined. Mean patient age at surgery was 48 years with 11 women and 7 men available at final follow-up. Diagnostic arthroscopy was performed for all patients before repair; cartilage lesions were found in 8 patients. Mayo Elbow Performance Score improved from 55 to 100 points. At final follow-up, the median grip strength was 100% (range, 52 to 114) of the nonaffected side and patient-rated scores were almost 0. We did not observe any retears. Some tennis elbow patients may present with high-grade tears that contribute to chronic symptoms. Our repair technique resulted in a satisfactory outcome for these patients and may reduce the risk of secondary posterolateral instability following complete tendon release.
我们描述了使用无结缝合锚钉重建高度伸肌腱撕裂,并假设这将导致肘关节疼痛和功能的改善,并具有高治愈率。20例慢性外上髁炎患者经磁共振成像证实为高度伸肌腱撕裂,采用无结缝合锚定技术进行手术。所有患者均接受了临床和超声评估,并在最后随访时完成了手臂、肩部和手部的快速残疾和患者评定的网球肘评估问卷。术前和术后Mayo肘关节功能评分也被确定。手术时患者平均年龄为48岁,最终随访时为11名女性和7名男性。所有患者在修复前均行诊断性关节镜检查;软骨病变8例。梅奥肘部表现得分从55分提高到100分。在最后的随访中,未受影响侧的中位握力为100%(范围,52至114),患者评分几乎为0。我们没有观察到任何反弹。一些网球肘患者可能出现严重撕裂,导致慢性症状。我们的修复技术为这些患者带来了令人满意的结果,并可能降低完全肌腱释放后继发性后外侧不稳定的风险。
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引用次数: 0
An Approach to the Management of Bilateral Posterior Shoulder Dislocations Following Seizure: Case Report, Literature Review, and Proposed Treatment Algorithm 癫痫发作后双侧肩关节后脱位的治疗方法:病例报告、文献回顾和建议的治疗方法
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-12-01 DOI: 10.1097/BTE.0000000000000175
A. Ravindra, J. Barlow, E. Klag, Andrew S. Neviaser, J. Bishop
Bilateral posterior shoulder dislocations in patients with seizure disorders are an uncommon injury that is difficult to treat. Surgery is typically required and impaction lesions often require bone reconstruction procedures. Seizures in the early postoperative period can have disastrous consequences when bone restoration procedures are disrupted. However, delaying treatment of persistent instability can cause further joint damage and bone loss potentially leading to the need for humeral head replacement. Our purpose is to introduce an approach to treating the young patient who presents with bilateral posterior dislocations related to a seizure. We report a case, describe the surgical techniques used, and propose an algorithm for managing the treatment of a young patient who presents with bilateral posterior dislocations related to a seizure. At her most recent follow-up (57 mo postoperative for the left shoulder and 41 mo postoperative for the right shoulder), she denied any apprehension or instability in either shoulder and had no further dislocations. She reported mild chronic pain in both shoulders, worse in the right than the left. She has a smooth passive range of motion with no crepitus in either shoulder. Her range of motion in forward elevation/external rotation/internal rotation is 150/45/L3 on the left and 50/150/L3 on the right. Strength is 5/5 in all planes and her subscapularis is clinically intact bilaterally. Our case illustrates the importance of early surgical intervention, resulting in functional, stable shoulders even in the face of medically and surgically intractable epilepsy. This algorithm highlights the importance of multidisciplinary cooperation and early surgical intervention to minimize bone loss and avoid joint replacement.
癫痫患者的双侧后肩脱位是一种罕见的难以治疗的损伤。通常需要手术,嵌塞病变通常需要骨重建手术。术后早期的癫痫发作可能会造成灾难性的后果,因为骨修复程序被打乱。然而,延迟治疗持续性不稳定可导致进一步的关节损伤和骨质流失,可能导致需要肱骨头置换术。我们的目的是介绍一种方法来治疗年轻患者谁提出与癫痫发作相关的双侧后侧脱位。我们报告了一个病例,描述了使用的手术技术,并提出了一个算法来管理治疗一个年轻的病人谁提出了与癫痫发作相关的双侧后侧脱位。在她最近的随访中(左肩术后57个月,右肩术后41个月),她否认双肩有任何忧虑或不稳定,也没有进一步的脱位。她报告双肩轻度慢性疼痛,右肩比左肩更严重。她有一个平稳的被动活动范围,在任何一个肩膀没有抖。患者前仰/外旋/内旋活动范围左为150/45/L3,右为50/150/L3。所有平面的强度为5/5,她的肩胛下肌在临床上是完整的。我们的病例说明了早期手术干预的重要性,即使面对医学和手术上难治性癫痫,也能使肩部功能稳定。该算法强调了多学科合作和早期手术干预的重要性,以减少骨质流失和避免关节置换。
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引用次数: 1
Reconstruction of the Acromioclavicular Joint With 360-degree Control 360度控制重建肩锁关节
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-09-01 DOI: 10.1097/BTE.0000000000000167
G. Hoy, Matthew A Yalizis, Mitchell L Smith, H. Anderson, S. Warby
Supplemental Digital Content is available in the text. Background: The TightRope/Endobutton techniques achieve good vertical reduction of the acromioclavicular joint, however anteroposterior and mediolateral stability may persist. Aims: The primary aim is to present our modification of the twin-tailed Dog Bone technique, using FibreTape and divergent clavicular limbs. The secondary aim is to report postsurgical outcomes. Hypothesis: By separating these divergent limbs widely the overall stability of the construct will be improved, limiting undesired mobility in all planes and assisting favorable postoperative outcomes. Materials and Methods: Included participants sustained acute Rockwood III to V acromioclavicular joint dislocations. Outcomes included the Oxford Shoulder Score (OSS), Nottingham Clavicle Score (NCS), the Specific Acromioclavicular Score (SACs), and return to sport time frames. Data were analyzed with descriptive statistics. Results: Forty-nine patients underwent this technique. Twenty-six patients returned their postoperative outcomes. Favorable results were shown by all outcomes after surgery (mean score: OSS, 46.3; NCS, 81.8; SACs, 15.9). The mean return to sport time was 17.5 weeks (contact sport) and 32.7 weeks (noncontact sport). There were no infections, no fractures, and 3 complications. Discussion/Conclusion: This modification of the twin-tailed Dog Bone technique using FibreTape resulted in a high patient self-rating of their shoulder function and a low rate of complications.
文本中提供了补充数字内容。背景:TightRope/内扣技术可实现肩锁关节良好的垂直复位,但前后和内侧稳定性可能会持续。目的:主要目的是介绍我们对双尾狗骨技术的改进,使用FibreTape和分叉的锁骨肢体。次要目的是报告术后结果。假设:通过广泛分离这些分叉的肢体,结构的整体稳定性将得到改善,限制了所有平面上不希望有的活动性,并有助于获得良好的术后结果。材料和方法:包括急性洛克伍德III至V型肩锁关节脱位的参与者。结果包括牛津肩关节评分(OSS)、诺丁汉锁骨评分(NCS)、特定肩锁关节评分(SAC)和重返运动时间框架。采用描述性统计方法对数据进行分析。结果:49名患者接受了该技术。26名患者返回了他们的术后结果。手术后的所有结果都显示出良好的结果(平均得分:OSS,46.3;NCS,81.8;SACs,15.9)。平均恢复运动时间为17.5周(接触性运动)和32.7周(非接触性运动。无感染,无骨折,3例并发症。讨论/结论:使用FibreTape对双尾狗骨技术进行的改进导致患者对其肩部功能的自我评价较高,并发症发生率较低。
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引用次数: 1
Glenoid Fractures Treated by Percutaneous Osteosynthesis Under Arthroscopic Control 关节镜控制下经皮骨融合术治疗关节盂骨折
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-09-01 DOI: 10.1097/BTE.0000000000000171
F. Anger, Samir Chaouche, A. Ecalle, L. Gaubert, Paul Tannyeres, M. Nguyen
Glenoid fractures are scarce and their treatment is discussed. Osteosynthesis under arthroscopy has been essentially described in bony Bankart lesions. Concerning bigger fractures of the glenoid cavity, eventually combined with a scapula body fracture, the arthroscopic treatment is difficult and still less practiced. Here, we describe 3 cases of external osteosynthesis by pins and/or cannulated screws under arthroscopic control. We put forward the case of a transclavicular approach for an associated fracture of the lateral quarter of the clavicle. The radiologic and functional results are good, with a rapid recovery of usual activities. The aim of this work is to highlight the feasibility of arthroscopic treatment for fractures of very different topology.
关节盂骨折是罕见的,其治疗方法进行了讨论。关节镜下的骨融合术主要描述了骨Bankart病变。对于较大的肩胛盂骨折,最终合并肩胛骨体骨折,关节镜治疗困难,实践较少。在此,我们报告3例在关节镜控制下用针和/或空心螺钉进行外固定的病例。我们提出的情况下,经锁骨入路为锁骨外侧四分之一的相关骨折。放射学和功能结果良好,正常活动恢复迅速。这项工作的目的是强调关节镜治疗非常不同拓扑骨折的可行性。
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引用次数: 1
Treatment of Sagittal Split Olecranon Fractures Using Dorsal Plates Combined With Tension Band Wiring or Cerclage Wires 背侧钢板联合张力带钢丝或环扎钢丝治疗鹰嘴矢状劈裂骨折
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-09-01 DOI: 10.1097/BTE.0000000000000173
G. Kıyak
We evaluated the results of olecranon fractures with an intra-articular sagittal plane fracture treated by dorsal plates in combination with tension band wiring or cerclage wires. We included patients with comminuted olecranon fractures with sagittal split treated with combination fixation. Postoperative functional assessment, Mayo Elbow Performance Score (MEPS) and complications were recorded. The mean age of patients was 52 years (SD±16). There were 7 female and 5 male patients. There were 2 1B, 7 2B, and 3 3B fractures according to Mayo classification. All patient’s fractures healed satisfactorily. There was one minor skin breakdown, which we managed conservatively. The most common problem was symptomatic hardware, which led us to implant removal surgery (33%). Mean loss of motion for the elbow and forearm were as follows: extension 7.5 degrees (SD±5.8 degrees), flexion 9.5 degrees (SD±3.9 degrees), pronation 4.5 degrees (SD±3.3 degrees), and supination 5 degrees (SD±3.7 degrees). The mean MEPS score was 93.7 (SD±7.7). We successfully treated these challenging fractures with our combination fixation technique in our case series. Level of Evidence: Level IV—diagnostic case series.
我们评估了尺骨鹰嘴骨折和关节内矢状面骨折的治疗结果,该骨折采用背侧钢板结合张力带钢丝或环扎钢丝进行治疗。我们纳入了矢状劈开的鹰嘴粉碎性骨折患者,采用联合内固定治疗。记录术后功能评估、Mayo肘关节功能评分(MEPS)和并发症。患者的平均年龄为52岁(SD±16)。其中女性7例,男性5例。Mayo分类有2 1B、7 2B和3 3B骨折。所有病人的骨折都痊愈了。有一次轻微的皮肤破裂,我们保守地处理了。最常见的问题是有症状的硬件,这导致我们进行了植入物移除手术(33%)。肘部和前臂的平均运动损失如下:伸展7.5度(SD±5.8度)、屈曲9.5度(SD士3.9度)、内旋4.5度(SD?.3度)和旋后5度(SD徒3.7度)。平均MEPS评分为93.7(SD±7.7)。在我们的病例系列中,我们使用组合固定技术成功地治疗了这些具有挑战性的骨折。证据级别:四级——诊断性病例系列。
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引用次数: 0
Anterior Capsular Reconstruction of the Shoulder for Chronic Instability Using a Dermal Allograft 同种异体皮肤移植重建肩关节前囊膜治疗慢性不稳定
Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2019-09-01 DOI: 10.1097/BTE.0000000000000172
T. Zink, J. Triplet, Devon M. Myers, Benjamin C. Taylor, Stephen P. Wiseman, Nathaniel K. Long
Chronic anterior shoulder instability after failed surgical stabilization procedures poses a significant challenge to orthopedic surgeons. Here, a novel technique of an anterior capsular reconstruction with a dermal allograft is presented. The shoulder remained stable with no recurrent dislocations at a final follow-up of 24 months. Excellent range of motion, strength, and good patient satisfaction is noted. Outcomes following the use of a dermal allograft for anterior capsular reconstruction have not been previously reported in the literature, and its use for chronic anterior shoulder instability shows promising initial results.
外科稳定手术失败后的慢性前肩不稳定对骨科医生来说是一个重大挑战。本文介绍了一种用真皮移植重建前囊的新技术。在最后24个月的随访中,肩部保持稳定,没有复发性脱位。注意到良好的运动范围、力量和良好的患者满意度。使用真皮同种异体移植物进行前囊重建后的结果先前在文献中没有报道,其用于慢性肩前不稳定显示出有希望的初步结果。
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引用次数: 3
期刊
Techniques in Shoulder and Elbow Surgery
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