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ONE-STAGE OPERATIVE TREATMENT OF ATLANTO-AXIAL INSTABILITY WITH STENOSIS OF LOWER CERVICAL LEVEL OF SPINAL CANAL

To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.

距骨骨折脱位32 例治疗

目的 探讨距骨骨折及距骨与周围关节脱位的处理方法。方法 1998年2月~2005年10月收治32例距骨骨折脱位。其中男23例，女9例；年龄19~56岁。车祸伤13例，坠落伤10例，压砸伤7例，扭伤2例。其中开放性损伤7例，伴同侧肢体或踝部骨折、韧带损伤10例，脾破裂1例。距骨颈骨折按Hawkins分类：Ⅰ型5例，Ⅱ型12例，Ⅲ型7例，Ⅳ型2例，距骨体骨折4例，距骨头骨折2例。伤后2~26 h进行治疗。手术切开复位者以2枚螺丝钉内固定，距骨体粉碎性骨折者行距下关节融合术。结果 32例均获随访6个月～7年，术后疗效按Kenwright 4级分类法评定，闭合性复位7例，优5例，良2例；切开复位内固定14例，优6例，良3例，可3例，差2例；开放性损伤7例，优1例，良2例，可2例，差2例；距下关节融合术4例，优1例，良2例，可1例。结论 距骨骨折或脱位后及时取得良好复位，恢复正确解剖关系对稳定足部非常重要，合理处理能最大限度恢复踝关节功能。

REPAIR OF ACROMIO-CLAVICULAR DISLOCATION BY TRANSPOSITION OF SHORT HEAD OF BICEPS BRACHII MUSCLE

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.

喙肩韧带重建喙锁韧带治疗肩锁关节Ⅲ度脱位

陈旧性跖跗关节脱位的足弓重建

目的 总结陈旧性跖跗关节脱位足弓重建的治疗方法及效果。 方法 2004 年9 月－ 2008 年1 月，收治陈旧性跖跗关节骨折脱位26 例。男19 例，女7 例；年龄18 ～ 56 岁，平均38.4 岁。交通伤8 例，重物砸伤10 例，高处坠落伤8 例。根据Myerson 分类法的X 线分型：A 型6 例，B 型5 例，C 型2 例，D 型6 例，E 型3 例，F 型4 例。受伤至手术时间4 周～ 9 个月，平均9 周。采取切开复位、内固定术9 例，足弓重建跖跗关节原位融合术 17 例。 结果 术后切口均Ⅰ期愈合。26 例均获随访，随访时间12 ～ 48 个月，平均22 个月。4 例术后5 个月发生足部转移性疼痛，应用足弓垫治疗，2 例1 年后疼痛缓解，2 例扩大关节融合后疼痛缓解。按Maryland 足部评分标准测定：优 5 例，良17 例，可4 例；优良率84.6%。关节融合全部愈合。 结论 伤后4 ～ 6 周的陈旧性跖跗关节脱位可行切开复位内固定术，疗效满意；6 周以上陈旧性跖跗关节脱位，宜行足弓重建跖跗关节原位融合术。

Ipsilateral Tibiofibular Fracture and Hip Fracture-Dislocation Associated with Posterior Cruciate Ligament Injuries:7 Cases Report

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。

Modified Hueter direct anterior approach for treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures

ObjectiveTo discuss the effectiveness of the modified Hueter direct anterior approach in treatment of Pipkin typeⅠ and Ⅱ femoral head fractures.MethodsBetween September 2014 and May 2016, 12 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures were treated with the modified Hueter direct anterior approach. There were 8 males and 4 females, aged from 32 to 60 years (mean, 40.2 years). The disease causes included traffic accident injury in 9 cases and falling from height injury in 3 cases. According to Pipkin typing, 8 cases were rated as type Ⅰ and 4 cases as type Ⅱ. The interval of injury and admission was 2-28 hours (mean, 7.2 hours). Reduction was performed in all patients within 6 hours after admission, and then bone traction was given. The operation was performed in 3-7 days (mean, 4.3 days) after redution. The modified Hueter direct anterior approach was applied to expose and fix femoral head fractures by Herbert screws compressively. The operation time and intraoperative blood loss were recorded, and the effectiveness was evaluated according to the Thompson-Epstein scale at last follow-up.ResultsThe operation time was 80-130 minutes (mean, 97.5 minutes), and the intraoperative blood loss was 100-200 mL (mean, 130.2 mL). All fractures achieved anatomical reduction and successful fixation. All 12 patients were followed up 12-32 months (mean, 24.3 months). All patients achieved bone union in 15-20 weeks (mean, 16.3 weeks) and no wound infection, lateral femoral cutaneous nerve injury, osteonecrosis of the femoral head, or heterotopic ossification occurred. Traumatic arthritis occured in 3 patients. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 5 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 83.3%.ConclusionThe modified Hueter direct anterior approach has the advantages of clear anatomic structure, less trauma, and shorter operation time, and it can effectively expose and fix the Pipkin typeⅠ and Ⅱ femoral head fractures.

锁骨钩钢板治疗重度肩锁关节脱位15例

TREATMENT OF OLD DISLOCATION OF INFERIOR RADIO-ULNAR JOINT BY SHORTENING OPERATION OF PRONATOR QUADRTUS MUSCLE

The dorsal dislocation inferior radio-ulnar joint was treated by the shortening operation of the pronator quadratus muscle by moving the muscle origin to its dorsum, so that the pronator quadratus muscle was always under tension whether the muscle was contracted or relaxed. Thus the anatomic position and stress distribution were improved. We had treated 11 patients in the past four years.The patients were followed from four months to four and half years and the results were 9 patients excellent and 2 good.

Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations

Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.