Ligament Reconstruction In Treatment Research Articles

Effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction for Neer type Ⅱb distal clavicle fractures

To investigate the effectiveness of anatomical locking plate internal fixation combined with coracoclavicular ligament reconstruction in treatment of the Neer type Ⅱb distal clavicle fractures by comparing with the simple anatomical locking plate internal fixation. The clinical data of 40 patients with Neer type Ⅱb distal clavicle fractures who met the criteria between February 2013 and January 2017 were analyzed. Eighteen cases were treated with anatomical locking plate internal fixation and coracoclavicular ligament reconstruction by using a suture anchor (reconstruction group), and 22 cases were treated only with anatomical locking plate internal fixation (non-reconstruction group). There was no significant difference in gender, age, injured side, causes of injury, associated injuries, time from injury to operation between 2 groups ( P>0.05). The operation time, medical expense, postoperative coracoclavicular distance, Constant-Murley scores of injured side, and complications were recorded and compared between 2 groups. All patients were followed up 12-27 months (mean, 16.3 months). One patient in reconstruction group had superficial wound infection. One patient in non-reconstruction group had pullout of screws from the distal fragment and reduction loss at 1 month postoperatively. The operation time and medical expense in reconstruction group significantly increased when compared with those in non-reconstruction group ( P<0.05). All fractures in 2 groups achieved bony union at last follow-up. The rate of coracoclavicular distance increase of injured side in non-reconstruction group was significantly higher than that in reconstruction group ( t=2.371, P=0.023). The Constant-Murley scores at 1 month, 3 months after operation, and last follow-up were significantly improved when compared with preoperative values in 2 groups ( P<0.05), but no significant difference was observed between 2 groups ( P>0.05). Both anatomical locking plate internal fixation with and without coracoclavicular ligament reconstruction can achieve good effectiveness for the Neer type Ⅱb distal clavicle fractures. Therefore, the coracoclavicular ligament reconstruction does not need, except for comminuted fractures with the length of lateral fragment less than 1 cm or the patients with poor compliance.

Modified semitendinosus tendon transposition for medial patellofemoral ligament reconstruction in treatment of recurrent patella dislocation in children

目的 探讨改良半腱肌腱移位术重建内侧髌股韧带治疗儿童复发性髌股脱位的临床疗效。 方法 回顾性分析2010年6月至2013年9月郑州市骨科医院采用改良半腱肌腱移位术重建内侧髌股韧带治疗16例(21膝)复发性髌骨脱位患儿的临床资料。测量并比较术前及末次随访时患侧膝关节髌股吻合角、外侧髌股角及髌骨外移率，末次随访时采用国际膝关节文献委员会(IKDC)膝关节评估表、Lysholm评分评估临床疗效。 结果 患儿术后均获得随访，随访时间12～30个月，平均21.5个月。末次随访时所有患儿膝关节活动度正常，髌骨脱位均未复发，恐惧试验阴性。IKDC膝关节功能主观评分、Lysholm膝关节功能综合评分分别由术前的(38.81±8.73)分、(56.95±10.24)分改善为末次随访时的(91.43±6.08)分和(93.19±4.85)分，差异均有统计学意义(t＝34.40、21.71，均P<0.01)。术前及末次随访时髌股吻合角分别为(19.68±6.12)°和(5.72±3.63)°，外侧髌股角分别为(－2.72±4.19)°和(7.32±2.86)°，髌骨外移率分别为(0.61±0.26)%和(0.27±0.21)%，差异均有统计学意义(t＝14.73、13.93、6.91，均P<0.01)。 结论 采用改良半腱肌腱移位术重建内侧髌股韧带治疗儿童复发性髌骨脱位能够有效维持髌骨的稳定性和正常运动轨迹，改善膝关节功能，临床效果满意。

Proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction in treatment of Rockwood grades III-IVacromioclavicular joint dislocation

Objective To evaluate the curative effect of conjoined tendon transfer for coracoclavicular ligament reconstruction in the treatment of Rockwood grades Ⅲ-Ⅳ acromioclavicular joint dislocation. c Methods A retrospective case control study was performed for 64 cases of acromioclavicular joint dislocation admitted from October 2007 to August 2014. There were 53 males and 11 females, with age of (43.8±10.5)years (range, 23 to 65 years). Rockwood grade Ⅲ was seen in 27 cases and grade -Ⅳ in 37. According to the treatments, 26 cases underwent proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction combined with clavicular hook plate (ligament reconstruction group) and 38 cases only treated with clavicular hook plate (internal fixation group). Visual analogue scale (VAS), Constant shoulder score and postoperative complications were compared between the two groups before and after operation. Results All patients were available for a mean follow-up of 3.7 months (range, 2 to 4 months). VAS was (7.58±1.03)points in ligament reconstruction group and (7.15±1.03)points in internal fixation group before surgery (P>0.05), and was (2.38±0.94)points in ligament reconstruction group and (2.08±0.99)points in internal fixation group 3 months after operation (P>0.05). Constant shoulder score was (86.46±6.59)points in ligament reconstruction group and (87.68±6.59)points in internal fixation group after operation (P>0.05). Six cases (16%) had recurrent joint dislocation in internal fixation group, while none of the patients in ligament reconstruction group had recurrence (P<0.05). Conclusion Improved procedure of proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction can effectively reduce the recurrence rate of acromioclavicular joint dislocation. Key words: Acromioclavicular joint; Dislocations; Fracture fixation, internal

Dorsal ligament reconstruction for old dorsal dislocation of distal radioulnar joint

Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint. Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute, including 4 males and 3 females with a mean age of 37 years. All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures. During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch, which was parallelized to long axial of ulna, two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna. The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole. After the tips being crossed, put them through the holes of ulna, reduct the distal radioulnar joint by supinating the forearm, the strip of the tendon was sutured after being tightened, the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon. Postoperatively, the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks, then the below elbow cast was replaced for another 3 weeks. Results Patients were followed-up for 1 year and 8 months-4 years and 2 months with the average of 2 years and 9 months. The rotation of wrist was improved and the handgrip strength was increased significantly. A functional evaluation was performed using the modified Mayo wrist scoring system. All patients had better wrists scores postoperatively(mean, 93) compared to preoperatively(mean, 68). All patients satisfied with the final result. Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint. Key words: Carpal joints, ulnoradial; Dislocations, dorsal; Ligament reconstruction

Proximally based conjoined tendon transfer for coracoclavicular ligament reconstruction in treatment of acromioclavicular separation

目的 介绍应用联合腱反转移位重建喙锁韧带治疗肩锁关节脱位的手术方法,并通过临床病例随访分析其疗效.方法对 2001～ 2003年间经联合腱反转移位重建喙锁韧带治疗的 26例 Rockwood Ⅲ～Ⅴ型肩锁关节脱位患者进行随访.最终随访时应用放射学评估肩锁对应情况,并采用 ASES评分( American Shoulder & Elbow Surgeons score)、 SST问卷( Simple Shoulder Test Form)和 Constant- Murley评分对肩关节功能进行评估.结果术后平均随访 22.6个月.所有患者术中锁骨远端的高度均达到解剖复位.最终随访时, 26例中 21例维持锁骨远端复位.术后平均 ASES评分为 94.2,疼痛的主观 VAS(Visual Analog Scale)评分平均为 1.2,肩关节平均前屈上举 150°,外旋 35°.平均 Constant- Murley评分为 92.8.SST问卷的肯定答案平均为 11个.总体优良率为 88.5% (23/26).当被问及如果健侧肩关节出现相同脱位情况时是否仍愿意接受相同手术治疗时,均得到肯定回答.结论应用联合腱外侧半反转移位重建喙锁韧带并辅助缝合锚固定手术方式,是治疗移位较大的肩锁关节脱位的一种有效方法.联合腱外侧半作为移植物的来源有足够的长度,同时也避免了牺牲喙肩韧带,从而保存了完整的喙肩弓.对于同时合并或以前存在肩袖损伤的患者、以及那些体型较小因而喙肩韧带比较菲薄的患者,以及翻修手术时需要较长移植韧带的情况下,联合腱外侧半可作为一种很好的自体移植韧带来源。