Knee Injuries Due to Blocking: A Continuing Problem

Legislation making hazardous football techniques illegal reduces certain injuries, but rule changesmust be evaluated after implementation to make sure that new techniques don't cause different injuries.     

Nonoperative treatment of the elbowin throwers

Nonoperative treatment of the injured elbow in throwers presents a unique challenge to the clinician. Rehabilitationplays an active role in the prevention, treatment, and outcome of injuries. The unique anatomy of the elbow, including its high degree of joint congruence and capsular configuration, contribute to the challenge presented to the physician and therapist towards restoration of normal function. Rehabilitation of the injured elbow in throwers should be based on a staged program that is progressive and founded on scientific research and clinical experience. Focus should be directed toward strengthening, endurance, and flexibility. The purpose of this paper is to outline and discuss a conservative approach to the more commonly encountered elbow injuries in the throwing athlete. The injuries discussed in this report will be presented depending on their occurrence within the various compartments of the elbow.     

肩锁关节脱位的诊断与治疗

肩锁关节脱位是临床常见的肩部运动损伤。目前,临床认为RockwoodⅠ、Ⅱ型急性脱位应行非手术治疗,Ⅳ、V及Ⅵ型急性脱位应行手术治疗,但对Ⅲ型急性脱位是采取非手术治疗还是手术治疗仍存在争议。本文对肩锁关节脱位的治疗现状进行综述。     

Clinical and radiographic evaluation of the acromioclavicular joint

The acromioclavicular (AC) joint is a diarthrodial joint. It is only one of the five joints that make up the complexarrangement of the shoulder. Together with the sternoclavicular joint, the AC joint provides the upper extremity with a connection to the axial skeleton. Injuries to the acromioclavicular joint are very common in athletes and are a source of significant morbidity. AC pathology particularly affects athletes whose sport demands overhead upper limb activity. These problems are most frequently encountered in contact sports, are far more common in males, and may be responsible not only for aesthetically unpleasant deformities of the clavicle, but also for pain, fatigue, and muscular weakness. The treatment of injuries to the AC joint has been controversial since the time o£ Hippocrates¹ (460 to 377 B.C.). The classification by Rockwood has been accepted and there are six types.² Many treatment options have been proposed in the literature, targeted toward the different types of injuries, but it is difficult to compare the different series. The understanding of the anatomy, as well as accurate clinical diagnosis, is critical for the development of a successful treatment plan for both injuries and degenerative changes that may occur in the AC joint. AC joint pain may masquerade as other conditions in the shoulder, therefore, the pathology must be thoughtfully sought out. Careful clinical examination and basic radiographic imaging helps direct a clinically and cost effective approach to these problems.     

锁骨钩钢板治疗肩锁关节脱位和锁骨远端骨折63例

目的探讨锁骨钩钢板对肩锁关节脱位和锁骨远端骨折的治疗效果。方法回顾性分析63例锁骨钩钢板治疗肩锁关节全脱位和NeerⅡ型锁骨远端骨折临床资料,其中肩锁关节全脱位41例(锁骨远端骨折合并肩关节脱位7例),锁骨远端骨折22例。结果所有患者获得良好复位和固定,X线片未见肩锁关节半脱位或钢板断裂和松动,肩关节功能恢复良好,内固定取出后无再脱位及再骨折现象。结论锁骨钩钢板是治疗肩锁关节脱位和锁骨远端骨折的一种良好方法。     

改良Weaver法治疗肩锁关节脱位

完全性肩琐关节脱位常伴有喙锁韧带断裂，我院自１９９１－１９９６年５年间对１８例Ⅲ度肩锁关节新鲜脱位伴喙锁韧带断裂者行切开复位克氏针内固定和喙肩韧带移行代替喙锁韧带（改良Ｗｅａｖｅｒ）手术，取得满意疗效。术后随访平均２４个月，无脱位或半脱位发生，依Ｌａｚｚｃａｎｏ标准评定：优１７例，良１例。     

Acromioclavicular joint injuries and treatment in overhead athletes

Acromioclavicular (AC) joint symptoms are common in athletes. In particular, overhead athletes place especially high demands on their shoulders. Despite this, these individuals infrequently have isolated AC joint pathology. Understanding the common pathology and associated injuries is important for a safe and quick return to competition.     

肩锁关节Ⅲ°脱位手术治疗的临床价值

目的评估肩锁关节Ⅲ°脱位手术治疗的临床价值。方法 58例肩锁关节Ⅲ°脱位患者随机分成两组,保守治疗组行冰敷、应用止痛药、吊带制动,手术治疗组行切开复位内固定。结果手术治疗组优23例、良6例,保守治疗组良3例,差26例。结论恢复肩锁关节完整性、稳定性的手术治疗组,避免了肩关节慢性疼痛、功能严重下降、无力、不稳的发生,Ⅲ型肩锁关节脱位患者首选手术治疗。     

Diagnostic imaging of elbow injuries inthe throwing athlete

The elbow is a complex joint that connects the arm with the forearm. Injuries to the elbow in the throwing athlete aregenerally caused by acute trauma or repetitive stress. Diagnostic imaging of the elbow ranges from plain radiographs to magnetic resonance/arthrography. Because of the complex nature of the joint, a good history of the patient and physical exam should be obtained in an attempt to tailor the imaging workup for each individual. Most acute traumatic injuries can be diagnosed with plain radiographs. Computed tomography and magnetic resonance imaging (± intra-articular contrast) are generally obtained to confirm suspected pathology from the patient's history and physical exam. This article will discuss several pathologic conditions and will attempt to show the findings seen on the appropriate imaging modality. Where it is possible, the mechanism of injury will be described and correlated with the imaging findings.     

进一步提高关节损伤的诊治水平

关节损伤病例日益增多,提高其诊治水平十分重要。20世纪的磁共振成像(MR I)和关节镜诊断技术,关节镜下手术、骨关节微创手术和人工关节置换三大技术使关节损伤的诊治进入了全新时代,疗效大幅度提高。     

改良Dewar术治疗完全性肩锁关节脱位

目的探讨改良Dewar术在治疗完全性肩锁关节脱位的临床效果。方法应用改良Dewar术治疗Ⅲ型以上完全性肩锁关节脱位,即切除锁骨外端约1.5~2.0 cm,用骨刀凿断喙突的前半外侧1/3部,连同附着于其上的肌腱潜行上移,长度适宜的松质骨螺钉固定在锁骨前方相应位置处,由于联合肌腱的牵引和患臂本身的重力使锁骨自动复位。术后三角巾悬吊患臂4周,4周后患肩功能锻炼。结果本组31肩,手术时间为50~90 min,术后患肩X线片示复位成功率100%,随访12~60个月。31例肩关节功能均在术后2~3个月恢复,未发生螺钉脱落断裂和骨块不愈合者,按Karlsson术后疗效评价标准评价结果为:A级(佳)共28例,占90.3%;B级(满意)共3例,占9.7%;C级(差)本组无。结论改良Dewar手术通过将锁骨远端切除,形成肩锁之间的假关节,从而避免了肩锁关节退化、导致骨性关节病的发生,减少了肩痛的发生,肩关节活动度影响甚小。凿取带联合肌腱蒂的喙突骨块固定于锁骨可牵引患臂使锁骨自动复位。     

Natural history and nonoperative treatment of posterior cruciate ligament injuries

The posterior cruciate ligament (PCL) is a major stabilizer of the knee. It is a structure that can be injured both inhigh-energy situations (eg, road traffic accidents) and in low-energy environments such as sporting injuries. The PCL can be torn in isolation or in combination with other knee structures /ligaments with the mechanism of injury determining the structures damaged. The treatment of the PCL-injured knee is a controversial issue. The literature on PCL injuries is confusing and contradictory. The treatment should be based on the natural history of the PCL-deficient knee because this sets the baseline from which any interventions may be compared in terms of outcome. However, there are very few true natural history studies on the PCL-injured knee, with most of the literature being retrospective and including a mixture of patients and injuries. In this article, we review the relevant literature with an emphasis on the published true natural history studies, and we assess the healing potential of the torn PCL and outline our management thoughts on the PCL-injured knee, including possible future directions in PCL research and treatment.     

Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note

We present a new arthroscopic technique for chronic AC joint dislocations with coracoacromial ligament transposition and augmentation by the Tight Rope device (Arthrex, Naples, USA). First the glenohumeral joint is visualised to repair concomitant lesions, such as SLAP lesions, if needed. Once the rotator interval is opened and the coracoid is identified, the arthroscope is moved to an additional anterolateral portal. A 1.5 cm incision is made 2 cm medial to the AC joint. After drilling a 4 mm hole with a cannulated drill through the clavicle and coracoid a Tight Rope is inserted, the clavicule is reduced and stabilized with the implant. The arthroscope is moved to the subacromial space and a partial bursectomy is performed to visualise the CA ligament and lateral clavicle. The CA ligament is armed with a strong braided suture using a Lasso stitch and dissected from the undersurface of the acromion. It is then reattached to the distal part of the clavicle by transosseous suture fixation after abrasion of its undersurface. Although this combined arthroscopic procedure of AC joint augmentation with a Tight Rope combined with a ligament transposition is technically demanding, it is a safe method to reconstruct the coracoclavicular ligaments and achieve a sufficient reduction of the clavicle without the need of further implant removal or autologous tendon transplantation.     

26例距下关节脱位诊治分析

目的分析距下关节脱位的临床诊断和治疗效果。方法选择2001年1月～2010年1月收治的26例距下关节脱位患者临床资料,内侧距下关节脱位22例,外侧距下关节脱位4例。闭合手法牵引复位17例,切开复位9例。结果本组全部获随访,随访时间14～22个月,平均(17.7±3.9)个月。关节功能根据美国足踝外科协会AOFAS后足评分标准,术后功能优14例,良8例,可4例;优良率84.62%。结论距骨脱位应早期明确诊断,经过闭合手法复位或切开复位均获得较满意的疗效。     

重度肩锁关节脱位的手术治疗

目的比较尼龙线法、锁骨钩钢板及克氏针张力带治疗重度肩锁关节脱位和锁骨远端骨折的疗效。方法66例重度肩锁关节脱位患者,22例采用锁骨钩钢板,18例采用克氏针张力带内固定,26例采用尼龙线固定。回顾性分析比较其治疗效果及并发症。结果术后平均随访15个月,3种手术方法的优良率分别为:克氏针张力带组77.8%,锁骨钩钢板组90.9%,尼龙线组100%,3组比较差异有统计学意义(P<0.05)。克氏针张力带固定组3例发生克氏针松动,其中2例断针并肩锁关节再脱位;锁骨钩钢板组术后出现肩峰下疼痛2例;尼龙线固定组无1例发生肩峰下疼痛或再脱位。结论锁骨钩钢板和尼龙线固定法治疗重度肩锁关节脱位比传统克氏针钢丝张力带法疗效确切。在减少并发症发生方面,尼龙线法更具优势。     

肩锁关节损伤影像研究

目的 探讨正常肩锁关节和肩锁关节脱位的影像表现. 方法 选取正常肩关节CR片68例、正常胸部正位CR片400例,测量肩锁关节间距距离和肩锁关节下皮质线关系.正常肩关节MRI 30例,临床证实肩锁关节脱位24例,肩撞击综合征7例,观察X线、MRI表现.结果 正常人肩锁关节间距为(3.36±0.44) mm;肩锁下皮质为一连续弧线.肩锁关节脱位24例中,按Rockwood分类,Ⅰ级7例,Ⅱ级5例,Ⅲ级12例;Ⅱ、Ⅲ级者肩锁关节间距增宽＞4.3 mm;Ⅲ级者肩锁关节下皮质弧线不连续.MRI发现Ⅱ级者关节软骨盘碎裂,关节囊和肩锁韧带撕裂,Ⅲ级者合并喙锁韧带撕裂.结论肩锁关节间距和下皮质弧线对诊断肩锁关节脱位分级有重要作用,MRI是确诊的有效方法.     

Open treatment of complete acromioclavicular dislocations

Acromioclavicular dislocations are ubiquitous in contact sports such as football, hockey, and rugby, however, their management is still controversial. Proponents of conservative, as well as operative treatment continue to discuss which form of treatment provides the best long-term functional result. The purpose of this paper includes 1) a brief review of the literature; 2) a treatment protocol; 3) illustrations of a surgical technique, and; 4) a study of that surgical technique and associated results.     

锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位

目的 探讨锁骨钩钢板治疗锁骨远端骨折和肩锁关节脱位的临床疗效和方法.方法 2002年8月～2009年6月治疗锁骨远端骨折(Rockwood分类Ⅲ型、Ⅳ型、Ⅴ型)和肩锁关节脱位(Neer Ⅱ)总计73例,均采用锁骨钩钢板固定.结果 本组病例随访时间6～22个月,平均14个月,无钢板断裂、螺钉松动和再脱位.按Karlsso...     

锁骨钩钢板治疗Ⅲ型肩锁关节脱位及锁骨肩峰端骨折的疗效分析

目的探讨锁骨钩钢板治疗Ⅲ型肩锁关节脱位及锁骨肩峰端骨折的疗效。方法对31例Ⅲ型肩锁关节脱位及锁骨肩峰端骨折应用锁骨钩钢板治疗的临床资料进行回顾性分析。结果31例患者中仅2例拆除内固定后出现了轻度脱位现象,对功能无影响,手术优良率达100%。结论锁骨钩钢板治疗Ⅲ型肩锁关节脱位及锁骨肩峰端骨折是一种快捷、有效的方法。