肘内侧副韧带损伤的诊断和治疗

肘内侧副韧带损伤的诊断和治疗刘继锁鲁成军⒇肘内侧副韧带损伤并非少见，自１９６２年Ｊｏｈａｎｓｏｎ〔１〕报道，此韧带急性断裂以后很少有其它报道。八十年代以来，国外这方面文章又逐渐出现，国内文献甚少。我院自１９８８年９月～１９９２年４月共收治１３例，均手...     

膝关节内侧副韧带损伤的治疗

自2001年以来,采用手术和石膏固定的方法治疗膝关节内侧副韧带损伤37例,收到了良好的效果。现报告如下。     

肘内侧副韧带损伤的诊断和治疗

肘内侧副韧带损伤并非少见 ,我们院自 1992年 9月～1995年 4月共收治 13例 ,均手术证实 ,现报道如下 :1　临床资料1 1　一般资料　本组 13例 ,其中男 5例 ,女 8例 ,年龄 2 3岁～ 5 1岁 ,左侧 5例 ,右侧 8例 ,均有肘内侧明显压痛及肿胀 ,肘关节伸屈功能受限以及肘外翻活动度异常。 6例肘内侧明显瘀血 ,7例作肘外翻应力位Ｘ线摄片均见肘内侧关节间隙增宽。本组 13例均在伤后 4天内施行肘内侧副韧带修补术。术中发现单纯内侧副韧带断裂 6例 ,此韧带断裂伴前臂屈肌起点撕裂 5例 ,此韧带断裂伴肱骨内上髁撕脱骨折 1例 ,此韧带断裂伴尺骨冠状突撕…     

膝内侧副韧带损伤治疗现状及进展

<正>内侧副韧带(MCL)损伤是膝部最常见的韧带损伤之一。随着运动伤和交通伤等增多,内侧副韧带损伤的发病率不断增高。膝MCL损伤后由于误诊或未采取适当治疗(如休息或石膏固定),损伤的内侧副韧带在被拉长的状态下愈合,使膝关节内侧结构松弛,继而导致韧带对胫骨的制导和限制作用功能缺     

前交叉韧带和内侧副韧带复合损伤的处理

本文讨论了前交叉韧带和内侧副韧带复合损伤处理的不同意见,即急诊处理此类损伤时修复所有受损的结构和非手术治疗内侧副韧带损伤,对前交叉韧带做延期的重建手术。旨在提出一个治疗前交叉韧带和内侧副韧带复合损伤的方针,使病人能有最好的机会获得一个稳定的、功能良好的、无术后关节僵硬或内侧副韧带残余松弛的膝关节。 1 诊断 前交叉韧带和内侧副韧带复合损伤常发生于膝关节受到直接暴力时,也可发生于间接损伤(非接触性外伤),此时多造成内侧副韧带的     

踝关节内侧韧带损伤的治疗

目的 探讨带线锚钉修补踝关节内侧韧带损伤的临床疗效.方法对18例踝关节内侧韧带结构损伤的患者行切开带线锚钉修补手术.结果 18例均得到随访,时间12～24个月.X线片显示胫距关节间隙正常.Baird踝关节功能评分为91～98（93.44±4.91）分,优12例,良6例.结论 带线锚钉修补踝关节内侧韧带损伤操作简单,可以避免踝关节不稳,疗效良好.     

关节镜辅助下治疗膝内侧副韧带损伤

膝关节内侧副韧带损伤是常见的运动性疾病，是膝关节不稳定的重要因素，常导致股部肌肉萎缩和膝关节骨性关节炎，早期正确诊断和治疗非常重要。本科自2001年以来，共收治13例患者，均在关节镜辅助下行韧带修补重建手术，获得良好效果。     

膝关节内侧副韧带损伤治疗体会

膝关节内侧副韧带损伤是膝在微屈位由来自膝外侧或后外侧暴力所引起,可造成不同程度的损伤。近年来发病率增高。我院自１９８５年～１９９７年收治内侧副韧带损伤６２例,疗效满意,报告如下。临床资料一、一般资料本组６２例中,男４８例,女１４例,年龄１５～５０岁,...     

15例肘内侧副韧带损伤的诊治体会

肘内侧副韧带损伤并非少见 ,如不及时正确诊治 ,将出现关节功能障碍、关节不稳定 ,临床医师对此往往认识不足。我科自 1993年 5月至 1999年 5月共收治 15例 ,经随访效果均满意 ,现报道如下。临床资料一、一般资料　本组 15例 ,男 9例 ,女 6例 ,年龄2 1～ 63岁 ,右侧 8例 ,左侧 7例。均为跌倒或高处摔下手着地间接暴力所致。入院时查肘部均明显肿胀、瘀斑 ,触压痛存在 ,以内侧为甚 ,均有肘关节伸屈功能受限以及异常外翻活动 ,外翻角度均大于 30°。本组15例均行双侧肘关节外翻应力位摄片 ,见伤肢肘内侧关节间隙增宽 ,正常肘关节常显示内侧关…     

膝关节内侧副韧带损伤修复方法改进

目的　探讨膝关节内侧副韧带损伤修复的新方法 ,以早期获得满意的功能效果。方法　对 11例早期膝关节内侧副韧带损伤患者行椎管麻醉下探查膝关节内侧副韧带损伤的病理改变 ,一期缝合修补断裂韧带 ,并切取 1/ 2宽的半腱肌腱 ,加强修复损伤韧带。 1例陈旧性损伤用股薄肌重建膝内侧副韧带。结果　平均随访 2 5个月 ,优 9例 ,良 2例 ,关节稳定有力 ,B彲ｈｌｅｒ征阴性 ,膝关节活动功能正常 ,恢复原工作。结论 :膝关节内侧副韧带损伤多在止点 ,早期修复为好 ,同时切取邻近腱性结构加强修复 ,更加稳定可靠 ,功能效果恢复较好     

踝关节骨折合并三角韧带完全断裂的手术治疗

目的 探讨踝关节骨折合并三角韧带完全断裂的手术治疗方法和临床疗效. 方法 对2006年1月至2010年12月收治的48例踝关节骨折合并三角韧带完全断裂患者的病例资料进行回顾性研究,男26例,女22例;年龄17～74岁,平均44.2岁.损伤按照Lauge-Hansen分类:旋后外旋型Ⅳ度损伤14例;旋前外旋型Ⅲ度损伤12例,Ⅳ度损伤16例;旋前外展型Ⅲ度损伤5例.骨折按照AO/OTA分型:43-B2型1例,44-B2型3例,44-B3型16例,44-C1型7例,44-C2型8例,44-C3型13例.所有患者在骨折复位固定的同时修复三角韧带.术后通过临床检查、影像学评估、美国足踝外科学会(AOFAS)踝-后足评分和视觉模拟评分(VAS)对临床结果进行评估. 结果 所有患者伤口均获一期愈合.43例患者术后获12 ～ 32个月(平均19个月)随访,骨折愈合时间为10～16周(平均13.2周).末次随访时AOFAS踝-后足评分为83～100分(平均93.4分),VAS评分为0～6分(平均1.2分),无踝关节不稳定表现. 结论 对踝关节骨折合并三角韧带完全断裂的患者,需要合理的临床评估后再选择治疗方案,根据断裂的部位选择适当的手术缝合方法,可以取得较满意的效果.     

Early radiographic outcomes following deltoid ligament repair in bimalleolar equivalent ankle fractures

BackgroundIndications for deltoid ligament repair in bimalleolar equivalent ankle fractures are unclear. This study compared radiographic outcomes in bimalleolar equivalent ankle fractures undergoing open reduction internal fixation (ORIF) +/? deltoid ligament repair.MethodsA retrospective review of 1024 ankle fractures was performed. Bimalleolar equivalent injuries treated with ORIF +/? deltoid ligament repair were included. Radiographic assessment was performed preoperatively, and at three months postoperatively.ResultsOne hundred and forty-seven ankle fractures met inclusion criteria with 46 undergoing deltoid ligament repairs. There was a significant decrease in medial clear space (1.93 ± 0.65 mm vs. 2.26 ± 0.64 mm, p = 0.01), and tibiofibular clear space (3.89 ± 1.20 mm vs. 4.87 ± 1.37 mm, p = 0.0001) at 3 months postoperative in the deltoid repair group compared to the no repair group. When syndesmotic fixation was performed, there were no differences between groups.ConclusionDeltoid ligament repair in bimalleolar equivalent ankle fractures resulted in reduced medial clear space, and tibiofibular clear space in the early postoperative period. These differences were small and remained within established normal limits.Level of clinical evidenceLevel III, retrospective cohort study.     

急性踝关节骨折伴三角韧带损伤术中诊断及治疗策略

目的探讨丝攻试验对三角韧带损伤的诊断价值,比较跨下胫腓联合螺钉固定与锚钉缝合修复三角韧带的疗效。方法 2011年6月至2013年12月,对我院收治的51例疑有三角韧带损伤的踝关节骨折患者进行丝攻试验,并将阳性患者随机分为锚钉缝合修补三角韧带组(A组)和跨下胫腓联合螺钉固定组(B组)。采用美国足踝骨科学会(AOFAS)踝-后足评分和疼痛视觉模拟评分(VAS)评价术后疗效。结果最终45例患者纳入统计学分析。A组21例,B组24例。A组有19例获得随访,平均随访14个月;B组有23例获得随访,平均随访18个月。末次随访时,A、B组患者均获得骨性愈合。A组AOFAS踝-后足评分和VAS评分分别为(87.50±6.30)分和(1.79±1.47)分,B组AOFAS踝-后足评分和VAS评分分别为(85.20±7.54)分和(1.56±1.20)分。两组AOFAS踝-后足评分和VAS评分差异无统计学意义。B组复位不良率达34.8%,A组仅为5.26%。结论三角韧带的完整性是影响下胫腓联合分离和内侧踝穴增宽的重要因素,修补三角韧带与跨下胫腓联合螺钉固定疗效相当,但其复位不良率低,且无二次取钉及断钉等问题。丝攻试验对于三角韧带损伤诊断和手术效果评估具有重要价值。     

三角韧带深层损伤是否影响旋前外旋型踝关节骨折的中期临床疗效

目的了解三角韧带深层损伤对PER型踝关节骨折中期临床疗效的影响。方法回顾性研究2013年1月至2014年12月北京积水潭医院创伤骨科手术治疗的50例PERⅢ度或Ⅳ度骨折患者。其中男37例,女13例;年龄16~68岁,平均30.2岁。根据踝关节内侧损伤类型分为两组:未修复组为内踝三角韧带深层损伤且无内踝骨折患者,未行三角韧带修复手术,共28例;对照组为内踝丘上骨折且三角韧带深层完整患者,行内踝丘上骨折切开复位内固定,共22例。两组患者均行腓骨骨折切开复位内固定和下胫腓螺钉固定。比较两组患者术后6个月以上影像学检查的内踝间隙和下胫腓间隙,以及中期随访的美国足踝外科协会的(AOFAS)的踝-后足评分和疼痛视觉模拟评分(VAS)。结果两组患者的性别、年龄、出现踝关节半脱位或脱位时的表现方式差异有统计学意义(P<0.05)。两组患者在损伤暴力程度、腓骨骨折线高度、是否完全脱位、后踝骨折率、后踝固定率、内固定物取出率、手术时间等差异均无统计学意义(P>0.05)。38例完成术后6个月影像学检查,21例未修复组的内踝间隙为3.7 mm,下胫腓间隙为4.5 mm;17例对照组的内踝间隙为3.4 mm;下胫腓间隙为4.4 mm。术后约3年时随访,未修复组和对照组的平均AOFAS评分分别为98.3分和94.6分,平均VAS评分分别为0.4分和1.5分。术后约5年时随访,未修复组和对照组的平均AOFAS评分分别为97.1分和93.6分,平均VAS评分分别为0.5分和1.2分。对于年龄<45岁的患者,术后约3、5年时随访的AOFAS评分、VAS评分与三角韧带完整与否均无相关性(P>0.05)。年龄与术后5年随访时AOFAS评分(P=0.021)相关。结论对于PER型Ⅲ、Ⅳ度踝关节骨折,在腓骨骨折及下胫腓螺钉固定后,残留三角韧带深层损伤不会影响45岁以内患者的中期疗效。     

三角韧带与下胫腓联合韧带对踝关节稳定的生物力学影响

目的探讨三角韧带与下胫腓联合对踝关节稳定性的生物力学影响。方法采用6例新鲜踝关节标本,常规制成骨-韧带模型(标本可重复利用)。分为:A组:踝关节各韧带均完整;B组:三角韧带离断,下胫腓联合完整;C组:下胫腓联合离断,三角韧带完整;D组:下胫腓联合及三角韧带均离断;E组:锚钉修复三角韧带、螺钉固定下胫腓联合韧带组。对标本施加600 N轴向加载。分别测量三种体位(中立位、背伸10°位、跖屈20°位)在各种状态下胫距关节的接触面积、接触压力、压应力分布等变化。对比分析三角韧带及下胫腓联合韧带修复前后对踝关节稳定的作用。结果在三种体位下均可发现,随着下胫腓联合及三角韧带的离断,胫距关节接触面积逐渐减小,接触压力逐渐增大,与正常A组对比差异有统计学意义(P<0.05),压应力分布逐渐集中并有向外侧移位趋势;三角韧带与下胫腓联合修复前后的胫距关节的接触面积、接触压力等差异有统计学意义(P<0.05);修复后的胫距关节接触面积增大、接触压力减少,与正常组A组对比差异无统计学意义(P>0.05),压应力分布分散。结论三角韧带与下胫腓联合断裂后,距骨发生移位,胫距关节面接触面积、接触压力及压应力分布发生剧烈变化。目前骨锚钉修复三角韧带、螺钉固定下胫腓联合能获得即刻稳定,且其生物力学强度与正常组相似,推荐对三角韧带伴下胫腓联合损伤者行手术治疗以恢复其正常解剖关系。     

High incidence of spring ligament laxity in ankle fractures with complete deltoid ruptures and secondary first ray instability

AimsTo assess the incidence of spring ligament failure in patients who have complete deltoid ruptures.Patients and methodsThe authors retrospectively analysed ankle fractures in our trauma database from January 2015 to January 2019. 61 patients who sustained ankle fractures with complete deltoid ligament ruptures based on an AP ankle radiographs with increased medial joint space were identified. 25 patients attended clinic for assessment. Of these, 5 were found to have gross planovalgus with pre-existing spring ligament laxity in the uninjured control foot and these were excluded from the analysis. 20 patients were assessed for spring ligament failure /laxity. For each patient, the uninjured foot was used as the control.ResultsThe TMT instability score and the lateral translation score showed statistically significant increases in the injured compared to the uninjured foot. The ratio of increase in both TMT instability and lateral translation scores (strain) in the injured versus the uninjured foot was assessed. A strong correlation (+0.62 pearson correlation coefficient) was found between the two ratios.ConclusionAll 20 patients showed increased spring ligament laxity and 19 patients showed increased TMT instability. Our results show that with complete deltoid rupture, there is likely greater disruption of the medial ligamentous structures of the foot than previously recognised. The degree of increase in the spring ligament strain also correlates with the degree of strain at the plantar TMT joint ligaments, and thus first ray instability. This finding has significant implications for the long-term assessment and management of ankle fractures involving complete deltoid disruption. Early intervention with orthotics in this cohort may prevent progressive destabilisation of the midfoot and the first ray. This evolving understanding may lead to the prospect of earlier surgical intervention to reconstitute the integrity of the spring ligament and protect the foot progressing to stage 2 AAFD.     

踝部骨折伴三角韧带损伤的手术治疗

[目的]比较不同手术方式对踝部骨折伴三角韧带损伤的治疗效果.[方法]回顾性分析2018年1月～2019年6月接受手术治疗的合并下胫腓分离和三角韧带损伤的踝关节骨折患者82例,依据术前医患沟通结果,将患者分两组.其中,41例开放复位骨折内固定同时行三角韧带修复(修复组),另外41例仅行开放复位骨折内固定,未修复三角韧带(...     

Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature

Background and purpose  Review the literature concerning modalities to evaluate the integrity of the deltoid ligament in patients with supination external rotation ankle fractures. Methods  The electronic databases Pubmed/Medline, CINAHL and Embase were searched from 1987 to November 2007 to identify all published original studies concerning diagnostic modalities to evaluate the integrity of the deltoid ligament in adult ankle fractures. Results  This review included nine studies involving 423 ankle fractures. Three trails investigated medial tenderness; two studies, ecchymosis; two studies, swelling; one study, an injury radiograph; six studies, a type of radiographic stress view; one study, the Lauge-Hansen classification; one study, MRI; and one article studied arthroscopy in the evaluation of the deltoid ligament integrity. Interpretation  Swelling, ecchymosis, medial tenderness, initial injury radiographs and the Lauge-Hansen classification are less adequate predictors of the integrity of the deltoid ligament. Manual or the less painful variant, the gravity external rotation stress radiographs are considered the gold standard. The amount of medial clear space widening indicative of a positive external rotation stress test has been somewhat variable in the literature but ≥5 mm is generally regarded as most reliable. Achieving adequate external rotation of the foot when obtaining stress radiographs is more important than positioning the ankle in the appropriate degree of ankle flexion. The amount of applied force necessary when performing an external rotation stress radiograph is not well defined and mainly determined by the patient’s pain level. The indication for surgery should not be based on the absolute value of one parameter but on the combination of several parameters. If nonoperative treatment is chosen despite a positive stress radiograph, close follow-up is critical because subluxation of the ankle joint is still possible. MRI could be useful in individual cases.     

Triplane ankle fracture with deltoid ligament tear and syndesmotic disruption

In patients with immature skeletons, ligamentous injuries rarely accompany ankle fractures. In this article, we report about deltoid ligament tears and syndesmotic disruptions accompanying triplane ankle fractures in two children, and make recommendations as to the evaluation and treatment of children with such injuries.     

中药外敷加改良“U”形石膏治疗踝关节外侧副韧带损伤并第5跖骨基底部骨折

踝关节外侧副韧带损伤并第5跖骨基底部骨折是骨伤科门诊常见病,2005年1月至2008年2月采用改良“U”形石膏制动配合如意金黄膏外敷治疗97例,效果满意,现报告如下。