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Combining Shelf Osteotomy With Proximal Femoral Reconstruction After Oncologic Resection 肿瘤切除后支架截骨联合股骨近端重建
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-11-14 DOI: 10.1097/BTO.0000000000000610
Joanne Y. Zhou, Cara H. Lai, S. Pun, Ann E. Richey, Holly B. Leshikar, R. Avedian, R. Steffner
Introduction: Oncologic proximal femoral resection and reconstruction in skeletally immature children remains a formidable task due to the risk of developing hip instability with patient growth or interval leg lengthening through the prosthesis. Shelf pelvic osteotomy increases femoral head coverage and containment, and favorable long-term results have been reported in the setting of developmental dysplasia of the hip and Perthes disease. We present a technique of combining shelf osteotomy with expandable proximal femoral endoprosthesis reconstruction in pediatric limb-sparing surgery. Materials and Methods: Four surgeons at 2 centers from 2012 to 2020 performed proximal femoral reconstruction with shelf osteotomy. Data were collected retrospectively on operative technique, radiographic measurements, and complications including dislocation, subluxation, implant loosening, pain, function, and radiographic outcomes. Results: Five patients were included in the study. The mean follow-up was 49 months (range: 17 to 104 mo). The mean lateral center edge angle status postproximal femoral resection and reconstruction shelf osteotomy was 56.1 degrees (±30.5). There were no reported incidences of subluxations, dislocations, periprosthetic fractures, or soft tissue complications. The 3 patients with the longest follow-up at 3, 5, and 8 years tolerated serial lengthening of the endoprosthesis totaling 1 cm, 7.25 cm, and 9 cm, respectively, and demonstrated earlier triradiate cartilage closure in the operative side compared with the nonoperative side. All patients have returned to independent ambulation. Discussion: Combining proximal femoral reconstruction with shelf osteotomy in limb salvage pediatric orthopedic oncology may help to improve hip stability with serial lengthening and patient growth.
导读:在骨骼发育不成熟的儿童中,肿瘤股骨近端切除和重建仍然是一项艰巨的任务,因为随着患者生长或通过假体进行间歇腿延长,存在髋关节不稳定的风险。盆腔骨架截骨术增加了股骨头的覆盖和控制,在髋关节发育不良和Perthes病的治疗中,有报道称其长期效果良好。我们提出了一种在儿童保肢手术中结合架子截骨术和可扩展股骨近端假体重建的技术。材料和方法:2012年至2020年,2个中心的4名外科医生进行了股骨近端骨架截骨重建。回顾性收集手术技术、影像学测量、并发症包括脱位、半脱位、植入物松动、疼痛、功能和影像学结果的资料。结果:5例患者纳入研究。平均随访时间为49个月(17 ~ 104个月)。股骨近端切除和重建骨架截骨后平均外侧中心边缘角为56.1度(±30.5)。没有报道发生半脱位、脱位、假体周围骨折或软组织并发症。随访时间最长的3例患者分别为3年、5年和8年,耐受假体连续延长1cm、7.25 cm和9cm,手术侧三放射软骨闭合较非手术侧早。所有患者均已恢复独立行走。讨论:股骨近端重建联合骨架截骨术在残肢儿童骨科肿瘤学中可能有助于改善连续延长和患者生长的髋关节稳定性。
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引用次数: 0
Idiopathic Tibialis Anterior Tendinopathy Necessitating Tendon Debridement With Adjunctive Autograft Fixation: A Unique Case 特发性胫骨前腱病需要肌腱清创与辅助自体移植物固定:一个独特的案例
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-11-10 DOI: 10.1097/bto.0000000000000606
T. Sanchez, Turner Sankey, S. Young, C. Willis, A. Wilson, Whitt M Harrelson, Ashish B. Shah
T ibialis anterior tendinopathy (TAT) is a painful, debilitating injury commonly caused by inflammation of the tibialis anterior (TA) tendon or degeneration of its tendon sheath.1 Tibialis anterior rupture is classically caused by an acute eccentric contraction in the setting of preexisting tendinosis, and patients often recall immediate pain, swelling, loss of function in ankle dorsiflexion causing chronic equinus, and the presence of foot drop or “steppage gait.”1 Others are unaware because of the recruitment of the long toe extensors.1 If a diagnosis of TA tendon rupture is uncertain after history and physical exam, imaging studies such as an magnetic resonance imaging or ultrasound will help confirm. Nonoperative treatment options include ankle foot orthoses and tendo-achilles stretching. However, most patients benefit from surgery to restore active dorsiflexion and physical function. Options for reconstructing the TA tendon include primary repair, tendon transfers, or reconstruction with graft.1 Primary repair can be done with a primary end-to-end repair or a sliding anterior tibial tendon graft (utilized for deficits 2 to 4 cm in length).2,3 Tendon transfers are used when the deficit is larger than 4 cm.1 Techniques utilized include transfer of the extensor hallucis longus (EHL), extensor digitorum longus (EDL), posterior tibial, peroneus brevis, or allograft tendon. EHL tendon transfer is the most common transfer option reported in literature. In cases where tendon transfer is not available or insufficient, a free tendon autograft or allograft can be used. Techniques reported include harvesting the peroneus tertius, semitendinosus, gracilis, plantaris, or Achilles tendon.3,4 TA tendon rupture is an uncommon pathology, and the literature does not provide conclusive evidence for the best operative intervention. Huh and colleagues utilized allograft for an end-to-end interposition of the ruptured TA tendon with distal fixation in the medial cuneiform through a bone tunnel. Our study utilized plantaris autograft as an overlay on an end-to-end TA anastomosis without any additional fixation. Drawbacks associated with the plantaris tendon autograft have historically centered around the need for an extra incision and access to the superficial posterior compartment of the lower leg. The author’s proposed technique involves the convenient utilization of a plantaris tendon autograft for the anterior tibial tendon repair after the recommended gastrocnemius recession. Gastrocnemius recession is recommended to alleviate the associated chronic equinus positioning of the ankle associated with TAT or rupture and allows for easy access to the plantaris tendon. This procedure is hypothesized to have lower complication rates with equal patient outcomes.
胫骨前肌肌腱病变(TAT)是一种疼痛的、使人衰弱的损伤,通常由胫骨前肌(TA)肌腱炎症或其肌腱鞘退化引起胫骨前肌断裂通常是由先前存在的肌腱病引起的急性偏心收缩引起的,患者经常回忆起立即疼痛、肿胀、踝关节背屈功能丧失导致慢性马蹄炎,以及足下垂或“步进步态”的存在。另一些人不知道是因为长趾伸肌的招募如果病史和体格检查后不能确定TA腱断裂的诊断,磁共振成像或超声等影像学检查将有助于确诊。非手术治疗方案包括踝足矫形器和腱-跟腱拉伸。然而,大多数患者受益于手术恢复主动背屈和身体功能。TA腱重建的选择包括初级修复、肌腱转移或移植物重建初级修复可采用端到端初级修复或滑动胫骨前腱移植(用于长度为2至4厘米的缺损)。2、3当缺损大于4 cm时,采用肌腱转移术1使用的技术包括转移拇长伸肌(EHL)、指长伸肌(EDL)、胫骨后、腓骨短肌或同种异体移植肌腱。EHL肌腱转移是文献报道中最常见的转移选择。在肌腱转移不可行或不充分的情况下,可以使用自体肌腱或同种异体肌腱移植。报道的技术包括收获腓骨三腓肌、半腱肌、股薄肌、跖肌或跟腱。3,4 TA肌腱断裂是一种罕见的病理,文献没有提供最佳手术干预的确凿证据。Huh和他的同事利用同种异体移植物通过骨隧道对断裂的TA肌腱进行端到端植入,并在内侧楔形体中远端固定。我们的研究使用自体跖骨作为端到端TA吻合术的覆盖层,无需任何额外的固定。自体跖腱移植物的缺点历来集中在需要额外的切口和进入小腿后浅腔室。作者提出的技术包括方便地利用自体跖腱移植修复腓肠肌萎缩后的胫骨前腱。腓骨肌后退被推荐用于缓解与TAT或断裂相关的踝关节慢性马蹄形定位,并允许轻松进入足底肌腱。假设该手术具有较低的并发症发生率和相同的患者结果。
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引用次数: 0
Complete Capsular Repair Using a Knotless Barbed Suture With a Mini-direct Lateral Approach for Total Hip Arthroplasty: A Technique Note and Feasibility Study 全髋关节置换术采用小直接外侧入路无结倒刺缝线完全包膜修复:技术说明和可行性研究
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-10-10 DOI: 10.1097/BTO.0000000000000609
N. Kobayashi, Y. Yukizawa, S. Takagawa, Hideki Honda, Kensuke Kameda, Y. Inaba
Introduction: How the hip joint capsule is processed during total hip arthroplasty (THA) and whether a capsular repair is needed, are important factors determining the success of the procedure. In this surgical technique report, we present a detailed technical discussion of the pearls and pitfalls of complete capsular repair using knotless barbed sutures for a mini-direct lateral approach THA. Materials and Methods: A total of 45 consecutive cases that underwent a mini-direct lateral approach for THA with a complete capsular repair were included. A historical control group of 169 cases with partial capsulectomy without repair were also reviewed. This technique is based on a modified mini-incision direct lateral approach. A T-shaped capsulotomy was performed. The margin to be seamed at the femoral side of the capsular ligament must be preserved. A knotless barbed suture was applied for repairing the capsular ligament and gluteus minimus. Results: In 42 cases (93.3%), a complete capsular repair was achieved successfully. The average operative time was 106±20 minutes. The average intraoperative bleeding was 369±241 mL. There was no major complication both intra and postoperatively. Conclusion: Complete capsular repair through a mini-direct lateral approach was feasible by using a knotless barbed suture. Preserving the margin used to seam the femoral side of the capsular ligament is a key requirement for reattachment of the capsule. In addition, a continuous knotless barbed suture facilitates gradual plication of the capsule without a cheese cut.
在全髋关节置换术(THA)中,髋关节囊如何处理以及是否需要进行囊修复是决定手术成功的重要因素。在这篇外科技术报告中,我们详细讨论了使用无结倒钩缝线进行小直接外侧入路全囊修复的优点和缺陷。材料和方法:共纳入了45例连续采用微型直接外侧入路进行全髋关节置换术并进行完整囊修复的病例。我们也回顾了历史对照组169例部分荚膜切除而不修复的病例。该技术基于改良的小切口直接外侧入路。行t型囊切开术。在股骨侧面缝合的边缘必须保留。应用无结倒刺缝合修复囊韧带及臀小肌。结果:42例(93.3%)患者囊膜完全修复成功。平均手术时间106±20分钟。平均术中出血369±241 mL,术中、术后均无重大并发症。结论:采用无结倒刺缝线经小直接外侧入路完全包膜修复是可行的。保留用于缝合包膜韧带股骨侧的边缘是包膜再附着的关键要求。此外,一个连续的无结倒钩缝合有利于逐渐应用胶囊没有奶酪切割。
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引用次数: 0
Anatomic Posterolateral Corner Reconstruction With Single Graft Tibial Socket Fixation 单植骨胫骨窝固定的解剖后外侧角重建
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-22 DOI: 10.1097/BTO.0000000000000607
B. Swift, M. Alzahrani, Jeffrey M Potter, M. Pickell
Introduction: The posterolateral corner (PLC) is comprised of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Injuries to the PLC are associated with significant morbidity and functional limitation, most frequently manifested through a varus thrust gait. In the previous 2 decades, advances have been made in understanding the importance of the PLC and as a result, many techniques have been developed to address its reconstruction. Material and Methods: The Laprade technique is a previously described anatomic reconstruction of the PLC. We propose some modifications to this technique, which involve dissection of the posterolateral tibia to allow direct protection of the popliteal neurovascular bundle while establishing tibial fixation. A single hamstring graft is utilized for the reconstruction, is routed through the fibular tunnel and subsequently secured with the use of a dual-expanding tenodesis anchor, placed in a tibial socket removing the need for a tibial tunnel. Conclusion: The present study describes a novel anatomic technique that allows for improved protection of neurovascular structures, better control of graft tensioning and tunnel management, and the judicious use of a single tendon autograft while maintaining the described benefits of the anatomic Laprade technique.
后外侧角(PLC)由腓骨副韧带、腘肌腱和腘-腓骨韧带组成。PLC的损伤与显著的发病率和功能限制有关,最常见的表现是内翻推力步态。在过去的20年里,在理解PLC的重要性方面取得了进展,因此开发了许多技术来解决其重建问题。材料和方法:Laprade技术是先前描述的PLC的解剖重建。我们建议对该技术进行一些修改,包括分离胫骨后外侧,以便在建立胫骨固定时直接保护腘神经血管束。单腿筋移植物用于重建,穿过腓骨隧道,随后使用双扩展肌腱固定术锚固定,放置在胫骨窝中,无需胫骨隧道。结论:本研究描述了一种新的解剖技术,可以改善神经血管结构的保护,更好地控制移植物张力和隧道管理,并在保持解剖拉普拉德技术所描述的优点的同时明智地使用单肌腱自体移植物。
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引用次数: 0
Femoral Reconstruction Using Long Tibial Autograft After Resection of Giant Aneurysmal Bone Cyst 巨动脉瘤性骨囊肿切除后自体长胫骨重建股骨
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-19 DOI: 10.1097/BTO.0000000000000608
Mohammed S Alisi, Freih O Abu Hassan, Mohammad N Alswerki, A. Abdulelah, M. Alshrouf
Introduction: Management of giant aneurysmal bone cyst in skeletally immature patients is challenging. The huge size can be destructive and can lead to significant deformity, disability, and limb-length discrepancy. Hence, reconstruction is warranted as a treatment option. Materials and Methods: Here, we present a case of giant aneurysmal bone cyst in the distal femur of a 9 year old obese child. After complete resection, we reconstructed the large distal femur defect by a 15 cm long-tibia autograft of the same limb. Fixation was done using hybrid (monoplanar and circular) external fixation. Detailed surgical techniques and several clinical and technical challenges have been discussed. Results: After 13 years of follow-up, the distal femur is well formed with preservation of the articular surface, and the site of the tibia autograft is completely regenerated. Conclusion: The tibia can be used as an autograft for the reconstruction of large-sized defects in skeletally immature patients.
骨未成熟患者巨动脉瘤性骨囊肿的处理具有挑战性。巨大的尺寸可能是破坏性的,并可能导致严重的畸形,残疾和肢体长度差异。因此,重建是一种治疗选择。材料和方法:在此,我们报告一例9岁肥胖儿童股骨远端巨大动脉瘤性骨囊肿。完全切除后,我们用同一肢体的15厘米长的自体胫骨移植物重建股骨远端大缺损。采用混合(单平面和圆形)外固定架进行固定。详细的手术技术和一些临床和技术挑战进行了讨论。结果:经过13年的随访,股骨远端形成良好,关节面保存完好,自体胫骨移植物部位完全再生。结论:胫骨可作为自体骨移植体用于骨未成熟患者的大面积缺损重建。
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引用次数: 0
A Suture Fixation Technique for Tibial Spine Avulsion Injuries 胫骨撕脱伤的缝合固定技术
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-19 DOI: 10.1097/BTO.0000000000000605
Samantha Tayne, Tram L Tran, N. Vij, J. Vaughn, Gehron P. Treme, H. Menzer
Introduction: Tibial spine fractures typically occur in skeletally immature patients between 8 and 14 years of age. Surgical treatment is generally pursued for displaced fractures that cannot be reduced with closed manipulation. Recent biomechanical evidence favors suture fixation over screw fixation. Current suture-only techniques largely revolve around double-crossed suture configuration and lack a description regarding a form of secondary fixation. The purpose of this manuscript is to describe 2 additions to the existing suture-only techniques for pediatric tibial spine avulsion injuries. Materials and Methods (Surgical Technique): Our technique involves a U-pattern and an X-pattern suture configuration for the primary fixation. Secondary fixation is achieved with an extra-articular knotless anchor. Results: This technical write-up describes a suture fixation technique for pediatric tibial spine injuries. Discussion: There has been a shift in the literature toward suture fixation over screw fixation in cartilaginous and comminuted tibial spine avulsion injuries. In this article, we describe an arthroscopic suture fixation technique. The proposed benefits include better anatomic reduction of the fracture and improved force dissipation. Suture fixation is not without complications, namely residual laxity, which can be minimized through the use of a self-tension/continuous compression suture.
胫骨骨折通常发生在骨骼发育不成熟的8至14岁的患者。对于无法通过闭合手法复位的移位性骨折,通常采用手术治疗。最近的生物力学证据表明,缝合固定优于螺钉固定。目前的仅缝合技术主要围绕双交叉缝合结构,缺乏关于二次固定形式的描述。这篇文章的目的是描述2个补充现有的缝合技术为儿童胫骨撕脱伤。材料和方法(手术技术):我们的技术包括u型和x型缝合配置用于初次固定。采用关节外无节锚钉实现二次固定。结果:这篇技术文章描述了一种缝合固定技术治疗小儿胫骨脊柱损伤。讨论:在软骨性和粉碎性胫骨撕脱伤的治疗中,文献中越来越倾向于采用缝合固定而非螺钉固定。在这篇文章中,我们描述了一种关节镜缝合固定技术。建议的好处包括更好的骨折解剖复位和改善的力消散。缝合固定并非没有并发症,即残余松弛,可通过使用自张力/连续压缩缝合将其最小化。
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引用次数: 0
Excision of a Superior Ramus Osteochondroma Through the Modified Stoppa Approach 改良Stoppa入路切除上支骨软骨瘤
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-19 DOI: 10.1097/bto.0000000000000604
Jessica A. McGraw-Heinrich, Omar H. Atassi, Paige N. Wheaton, Nicole I. Montgomery
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引用次数: 0
A Method for Intraoperative Decompression of Large Soft Tissue Tumors to Facilitate En Bloc Resection 大软组织肿瘤术中减压促进整体切除的方法
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-05 DOI: 10.1097/BTO.0000000000000602
Robby D. Turk, Landon R Bulloch, Joshua C. Patt, C. Anderson, Malcolm H Squires, J. Kneisl
anticipated focal positive margin along the anteromedial femur after resection, which did not appear to in fi ltrate the
切除后沿股骨前内侧的预期局灶性阳性边缘,似乎没有渗透
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引用次数: 0
Cement Capping of Prominent Spinal Implants to Prevent Skin Breakdown 突出脊柱植入物的水泥盖防止皮肤破裂
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-02 DOI: 10.1097/bto.0000000000000603
M. LaBarge, S. Braun, Jeffrey E. Martus
{"title":"Cement Capping of Prominent Spinal Implants to Prevent Skin Breakdown","authors":"M. LaBarge, S. Braun, Jeffrey E. Martus","doi":"10.1097/bto.0000000000000603","DOIUrl":"https://doi.org/10.1097/bto.0000000000000603","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"26 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87263803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PMMA Teeth-Pedicle Screw Spacers in Revision Spinal Surgery: A Technical Note PMMA牙-椎弓根螺钉垫片在脊柱翻修手术中的应用:技术说明
IF 0.3 Q4 ORTHOPEDICS Pub Date : 2022-09-02 DOI: 10.1097/bto.0000000000000601
M. Kelly, S. Khan, P. Kiely
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引用次数: 0
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Techniques in Orthopaedics
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