An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial disl...An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.展开更多
Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of aceta...Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.展开更多
Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secon...Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary展开更多
Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a t...Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom.Examination revealed the pathognomonic anteromedial "pucker" sign.Anklebrachial indices were greater than 1.0 and symmetrical.Radiographs showed a posterolateral dislocation of the right knee.He underwent emergency open reduction without an attempt at closed reduction.Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis.Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h.Instead,open reduction should be performed once vascular compromise is excluded.展开更多
Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful sw...Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.展开更多
Objective: To compare the risk angle and safety angle of n eedli ng Ya me n (GV 15) betwee n the atla nto-axial dislocati on (AAD) patients and healthy subjects. Methods: A total of 177 AAD patients diagnosed and trea...Objective: To compare the risk angle and safety angle of n eedli ng Ya me n (GV 15) betwee n the atla nto-axial dislocati on (AAD) patients and healthy subjects. Methods: A total of 177 AAD patients diagnosed and treated at the Center of Upper Cervical Vertebra of Beijing Chin a-Japa n Frie ndship Hospital betwee n January 2010 and January 2018 were in eluded in the AAD group. Ano ther 207 healthy subjects were included in the normal group. There were totally 191 males and 193 females. The MRI sean was performed for the cervical vertebrae to measure the risk angle and safety angle of acup un cture at Ya me n (GV 15) on the sagittal image. Results: In the AAD group, the risk angle was (13.14±3.99)° and the relative safety angle was (10.31±3.23)° for the perpendicular needling, while the oblique needling risk angle was (9.09±3.09)° for the male;the risk angle was (12.12±2.74)° and the relative safety angle was (10.56±2.09)° for the perpendicular needling, while the oblique needling risk angle was (9.70±2.95)° for the female. In the normal group, the risk angle was (7.89±1.59)° and the relative safety angle was (10.21±3.55)° for the perpendicular needling, while the oblique needling risk angle was (16.07±1.77)° for the male;the risk angle was (6.93±1.45)° and the relative safety angle was (10.70±2.94)° for the perpendicular needling, while the oblique needling risk angle was (14.89±2.18)° for the female. The perpendicular needling risk angles for the males and females in the AAD group were larger than those in the normal group, and the differences were statistically significant (both P<0.01);for the inner-group comparison, there was no sigrHficant difference in the perpendicular needling risk angle between the male and the female in the AAD group (P>0.05);however, the perpendicular needling risk angle for the male was larger than the female, and the differenee was statistically significant in the normal group (P<0.01). There were no sign讦icant differences in the relative safety angle for both the male and the female between the AAD group and the normal group (both P>0.05). For the inner-group comparison, there was no sign讦icant differenee in the relative safety angle between the male and the female (P>0.05). The oblique needling risk angles for both the males and females were smaller in the AAD group than those in the normal group, and the differences were statistically sign讦icant (both P<0.01);the oblique needling risk angle for the male was not significantly different from that for the female in the AAD group (P>0.05);in the normal group, the oblique needling risk angle for the male was larger than that for the female, and the differenee was statistically significant (P<0.01). Conclusion: Un der the AAD condition, the risk angle and safety angle of acup un cture at Ya me n (GV 15) cha nge significantly, perpe ndicular n eedli ng should be better if performed slightly lower tha n the horiz on tai di recti on, and the oblique needling should be safer across the occipital foramen toward the occipital bone.展开更多
目的:探讨后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位的临床疗效。方法:回顾性分析2010年1月~2020年1月于我院行后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位患者...目的:探讨后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位的临床疗效。方法:回顾性分析2010年1月~2020年1月于我院行后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位患者的资料,其中男11例,女8例,年龄37.4±13.9岁(13~69岁),随访时间为54.7±29.4个月(25~131个月)。术前、术后1周、术后6个月、末次随访时分别通过视觉模拟(visual analogue scale,VAS)评分和日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估患者的疼痛和神经功能情况。术前、术后1周、术后6个月、末次随访时在颈椎正中矢状位CT上测量寰齿前间距(atlantodental interval,ADI)、齿突尖至Chamberlain线的距离(distance of the top of odontoid to Chamberlain′s line,DOCL),在颈椎MRI上测量延髓脊髓角(cervico-medullary angle,CMA)。通过CT评估植骨融合情况,记录术后并发症。结果:所有患者手术顺利,手术时间136.1±29.0min(95~210min),出血量为189.7±85.0mL(100~455mL)。术前、术后1周、术后6个月及末次随访时VAS评分分别为6.06±1.21分、2.35±0.76分、1.24±0.81分、1.12±0.90分,JOA评分分别为9.26±2.24分、14.05±2.01分、15.05±1.57、15.16±1.42分;与术前相比,患者术后1周、术后6个月和末次随访时的VAS评分和JOA评分均显著改善(P<0.05)。影像学方面,术前、术后1周、术后6个月及末次随访时ADI分别为9.63±1.93mm、1.21±1.10mm、1.16±1.09mm、1.26±1.02mm,DOCL分别为11.47±3.93mm、2.53±3.30mm、2.32±3.20mm、2.26±2.73mm,CMA分别为114.31°±11.00°、144.16°±9.33°、145.31°±8.83、143.42°±9.12°;与术前相比,患者术后1周、术后6个月和末次随访时的ADI、DOCL和CMA均显著性改善(F=41.05,P<0.001)。所有患者均实现骨性融合,融合时间为10.3±2.7个月(5~15个月)。术后发生并发症2例(脑脊液漏1例,切口深部组织感染1例),给予对症支持治疗后均治愈。结论:后路松解复位侧块关节植骨融合枕颈内固定术是治疗颅底凹陷症合并难复性寰枢椎脱位安全有效的手术方式。展开更多
文摘An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.
文摘Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.
文摘Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary
文摘Posterolateral dislocations of the knee are rare injuries.Early recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom.Examination revealed the pathognomonic anteromedial "pucker" sign.Anklebrachial indices were greater than 1.0 and symmetrical.Radiographs showed a posterolateral dislocation of the right knee.He underwent emergency open reduction without an attempt at closed reduction.Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis.Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h.Instead,open reduction should be performed once vascular compromise is excluded.
基金supported by the Basic Research Category Project of Yantai Science and Technology Innovation Development Plan (2022JCYJ037),China.
文摘Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.
文摘Objective: To compare the risk angle and safety angle of n eedli ng Ya me n (GV 15) betwee n the atla nto-axial dislocati on (AAD) patients and healthy subjects. Methods: A total of 177 AAD patients diagnosed and treated at the Center of Upper Cervical Vertebra of Beijing Chin a-Japa n Frie ndship Hospital betwee n January 2010 and January 2018 were in eluded in the AAD group. Ano ther 207 healthy subjects were included in the normal group. There were totally 191 males and 193 females. The MRI sean was performed for the cervical vertebrae to measure the risk angle and safety angle of acup un cture at Ya me n (GV 15) on the sagittal image. Results: In the AAD group, the risk angle was (13.14±3.99)° and the relative safety angle was (10.31±3.23)° for the perpendicular needling, while the oblique needling risk angle was (9.09±3.09)° for the male;the risk angle was (12.12±2.74)° and the relative safety angle was (10.56±2.09)° for the perpendicular needling, while the oblique needling risk angle was (9.70±2.95)° for the female. In the normal group, the risk angle was (7.89±1.59)° and the relative safety angle was (10.21±3.55)° for the perpendicular needling, while the oblique needling risk angle was (16.07±1.77)° for the male;the risk angle was (6.93±1.45)° and the relative safety angle was (10.70±2.94)° for the perpendicular needling, while the oblique needling risk angle was (14.89±2.18)° for the female. The perpendicular needling risk angles for the males and females in the AAD group were larger than those in the normal group, and the differences were statistically significant (both P<0.01);for the inner-group comparison, there was no sigrHficant difference in the perpendicular needling risk angle between the male and the female in the AAD group (P>0.05);however, the perpendicular needling risk angle for the male was larger than the female, and the differenee was statistically significant in the normal group (P<0.01). There were no sign讦icant differences in the relative safety angle for both the male and the female between the AAD group and the normal group (both P>0.05). For the inner-group comparison, there was no sign讦icant differenee in the relative safety angle between the male and the female (P>0.05). The oblique needling risk angles for both the males and females were smaller in the AAD group than those in the normal group, and the differences were statistically sign讦icant (both P<0.01);the oblique needling risk angle for the male was not significantly different from that for the female in the AAD group (P>0.05);in the normal group, the oblique needling risk angle for the male was larger than that for the female, and the differenee was statistically significant (P<0.01). Conclusion: Un der the AAD condition, the risk angle and safety angle of acup un cture at Ya me n (GV 15) cha nge significantly, perpe ndicular n eedli ng should be better if performed slightly lower tha n the horiz on tai di recti on, and the oblique needling should be safer across the occipital foramen toward the occipital bone.
文摘目的:探讨后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位的临床疗效。方法:回顾性分析2010年1月~2020年1月于我院行后路松解复位侧块关节植骨融合枕颈内固定术治疗颅底凹陷症合并难复性寰枢椎脱位患者的资料,其中男11例,女8例,年龄37.4±13.9岁(13~69岁),随访时间为54.7±29.4个月(25~131个月)。术前、术后1周、术后6个月、末次随访时分别通过视觉模拟(visual analogue scale,VAS)评分和日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估患者的疼痛和神经功能情况。术前、术后1周、术后6个月、末次随访时在颈椎正中矢状位CT上测量寰齿前间距(atlantodental interval,ADI)、齿突尖至Chamberlain线的距离(distance of the top of odontoid to Chamberlain′s line,DOCL),在颈椎MRI上测量延髓脊髓角(cervico-medullary angle,CMA)。通过CT评估植骨融合情况,记录术后并发症。结果:所有患者手术顺利,手术时间136.1±29.0min(95~210min),出血量为189.7±85.0mL(100~455mL)。术前、术后1周、术后6个月及末次随访时VAS评分分别为6.06±1.21分、2.35±0.76分、1.24±0.81分、1.12±0.90分,JOA评分分别为9.26±2.24分、14.05±2.01分、15.05±1.57、15.16±1.42分;与术前相比,患者术后1周、术后6个月和末次随访时的VAS评分和JOA评分均显著改善(P<0.05)。影像学方面,术前、术后1周、术后6个月及末次随访时ADI分别为9.63±1.93mm、1.21±1.10mm、1.16±1.09mm、1.26±1.02mm,DOCL分别为11.47±3.93mm、2.53±3.30mm、2.32±3.20mm、2.26±2.73mm,CMA分别为114.31°±11.00°、144.16°±9.33°、145.31°±8.83、143.42°±9.12°;与术前相比,患者术后1周、术后6个月和末次随访时的ADI、DOCL和CMA均显著性改善(F=41.05,P<0.001)。所有患者均实现骨性融合,融合时间为10.3±2.7个月(5~15个月)。术后发生并发症2例(脑脊液漏1例,切口深部组织感染1例),给予对症支持治疗后均治愈。结论:后路松解复位侧块关节植骨融合枕颈内固定术是治疗颅底凹陷症合并难复性寰枢椎脱位安全有效的手术方式。
