Objective:To assess the short-term radiographic and clinical outcomes of total arthroscopic Latarjet procedure for young activated patients with habitual anterior shoulder dislocation and a marked glenoid bone defect.Methods:We retrospectively reviewed the radiographic and clinical outcomes of 37 patients who had undergone a total arthroscopic Latarjet procedure from January 2017 to June 2019 for habitual anterior shoulder dislocation and a marked glenoid bone defect. They were all males, with an average age of 25.4 years(from 18 to 36 years). A total of 18 left and 19 right shoulders were involved. 3D CT scans of bilateral shoulders were performed before surgery and the glenoid defects calculated before total arthroscopic Latarjet procedure and repair of anterior joint capsule. Comparisons were made between preoperation and the final follow-up in terms of active range of motion (AROM), Rowe score, Walch-Duplay score and Subjective Shoulder Value (SSV). 3D CT reconstruction was conducted at the final follow-up to evaluate the location and absorption of bone grafts.Results:The duration of follow-up ranged from 6 to 36 months (average, 12.5 months). No recurrent dislocation occurred before the final follow-up. No significant differences were found between preoperation and the final follow-up in anteflexion elevation, external rotation at lateral body, internal rotation or external rotation at abduction 90° ( P>0.05). The differences between preoperation and the final follow-up were statistically significant in Rowe score (42.2±5.6 versus 91.1±3.3), Walch-Duplay score (31.5±8.0 versus 92.6±3.7), and SSV score (63.9%±6.1% versus 79.3%±5.0%) ( P<0.05). 3D CT reconstruction at the final follow-up observed bone absorption in 29 patients; 23 patients recovered to their pre-injury sports level 6 to 12 months after surgery. Conclusion:In young activated patients with anterior shoulder dislocation and a marked glenoid bone defect, the total arthroscopic Latarjet procedure plus anterior capsular repair can produce excellent early functional and radiographic outcomes.

目的 探讨应用后踝关节镜治疗踝关节后方病变的临床疗效.方法 自2015年11月至2017年4月采用后踝关节镜治疗患者17例,其中后踝关节撞击征7例,距骨骨软骨损伤4例,后踝关节游离体2例,Haglund畸形4例.采用疼痛视觉模拟评分(visual analogue scale,VAS)和美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分对踝关节进行综合评定.结果 本组均获随访,随访时间6～19个月,平均13.6个月.VAS评分从术前平均(6.7±1.3)分下降至末次随访时的(1.2±0.6)分,P＜0.05.AOFAS踝-后足功能评分从术前平均(49.8±6.9)分提升至末次随访时的(87.5±7.3)分,其中优11例,良4例,可2例,优良率为88.2％.结论 后踝关节镜治疗踝关节后方疾病可获得满意的临床疗效,手术创伤小,术后恢复快,是一种值得推广的技术方法.

[目的]探讨肩关节习惯性脱位Hill-Sachs (HS)损伤发生的临床特点.[方法]回顾性分析2015年1月～2016年10月共收治116例肩关节习惯性脱位患者,均为男性,年龄19～53岁,平均(25.73±5.10)岁.根据是否存在Hill-Sachs损伤分成HS组和非HS组.通过CT检查评估Hill-Sachs损伤情况,对比患者的一般情况、脱位次数、初次脱位距手术时间和合并骨性Bankart损伤的情况,分析发生Hill-Sachs损伤的危险因素.[结果]116例患者中,55例存在Hill-Sachs损伤,发生率为47.41％.HS组和非HS组平均年龄分别为(25.07±4.28)岁和(26.33±5.71)岁,差异无统计学意义(P＞0.05).HS组中18例患者为左肩,37例患者为右肩;非HS组中19例患者为左肩,42例患者为右肩,差异无统计学意义(P＞0.05).HS组和非HS组平均脱位次数分别为(16.76±11.26)次和(6.38±4.77)次,两组间差异有统计学意义(P＜0.05).两组患者初次脱位距手术的时间分别为(35.09±19.46)个月和(11.98±7.30)个月(P＜0.05).HS组中21例存在骨性Bankart损伤,占38.18％;非HS组中23例存在骨性Bankart损伤,占37.70％,两组间差异无统计学意义(P＞0.05).[结论]Hill-Sachs损伤是肩关节习惯性脱位的常见现象,脱位次数和初次脱位距手术时间是发生Hill-Sachs损伤的危险因素,而骨性Bankart损伤不是发生Hill-Sachs损伤的危险因素.

Objective To explore the effect of distal rearrangement and ligament arthrolysis combined with reconstruction in treatment of recurrent dislocation of the patella to provide certain reference basis for the clinical usage of ligament arthrolysis combined with reconstruction.Methods The distal rearrangement (distal rearrangement group) and ligament arthrolysis combined with reconstruction(ligament arthrolysis combined with reconstruction group) were used to treat 50 cases of recurrent dislocation of the patella respectively from January 2014 to January 2016.The Lysholm and HSS scores were used to evaluate knee joint function before and after surgery in 2 groups.The patella separately extrapolate experiment,fear experiment and number of dislocation were examined and number of positive cases was counted 1,3,6,12 months after surgery.Results The two groups were followed up for 12 months.Between two groups,there were no statistically significant differences in preoperative Lysholm,HSS evaluation and the positive rate of patella separately extrapolate experiment,fear experiment and number of dislocation(P ＞0.05).Lysholm score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group (P ＜0.05).HSS score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group(P ＜0.05).There were no significant differences between the two groups in the positive rate of patella separately extrapolate experiment and number of dislocation of the patella at 1,3,6,12 months after surgery (P ＞0.05).The positive ratio of fear experiment at 1,3 months after surgery was lower in the ligament arthrolysis combined with reconstruction group than the distal rearrangement group,the difference was statistically significant (P ＜0.05).Conclusion Treatment of recurrent dislocation of the patella with combined release of ligament and reconstruction is better than distal rearrangement,and it is worthy of clinical promotion.

Objective To explore the effect of high level tibial osteotomy combined arthroscopy in treatment of knee osteoarthritis.Methods Thirty-eight patients with knee osteoarthritis were treated by high level tibial osteotomy combined arthroscopic treatment and Tomofix internal fixation.All patients were followed-up for more than 3 years.The therapeutic effect was analyzed and compared by HSS knee function scores,femoral tibial angle (FTA) and lateral tibial dissection angle (aLPTA) analyses.Results The scores of HSS knee function (84.5±5.7) in 1 year after the operation were significantly higher than those of pre-operation (68.3±3.8).In 3 years follow-up period,the scores of HSS knee function (79.6±4.8) were significantly lower than those in 1 year after operation,but they were still significantly higher than those before operation.The results of FTA (173.52±1.09°) and aLPTA (88.01±1.09°) were significantly lower than those before operation (184.36±1.21° and 95.34±0.78°).In 3 years follow-up period,the results of FTA and aLPTA (174.42±0.98° and 89.15±0.98°) were increased,but they were still significantly lower than those before operation.Conclusion The therapeutic effect of knee osteoarthritis with high level of tibial osteotomy combined arthroscopic treatment is satisfactory without occurrence of any complication,and it has less influence on normal anatomy of the joint,hence it is worthy to be popularized.

Objective To investigate the therapeutic effect of modified Brostrom procedure combined with ankle arthroscopy for chronic ankle instability derived from ankle sprains. Methods A total of 23 cases of chronic ankle instability derived from ankle sprain were investigated. The modified Brostrom procedure combined with ankle arthroscopy were used for treatment. AOFAS score were respectively evaluated before surger-y and three months and one year after treatment. Results Ankle arthroscopy found varying degrees of synovial hyperplasia in all patients and carti-lage damage in 18 patients(mainly Ⅱ ~ Ⅲ degree). After one year of surgery,AOFAS score was significantly improved. Conclusion Short -term postoperative follow - up indicates the combination of modified Brostrom procedure and ankle arthroscopy exhibits good treatment effect and better recovery of ankle function in chronic ankle instability patients.

Objective To investigate the therapy of DHS,PFNA and Intertan nail for the treatment in elderly patients with intertrochanteric femoral fractures.Methods One hundred and one elderly patients with intertrochanteric fractures were collected.Thirty-four cases of them were undertaken DHS (DHS group),33 cases for PFNA (PFNA group),and 34 cases for Intertan nail (INTERTAN group).Operative time,blood loss and complications were observed.Results The Operative time of patients in DHS,PFNA and Intertan groups were (85.1 ± 8.9) min,(63.1 ± 8.2) min,(57.9 ± 9.2) min respectively and the difference was significant (F=12.761,P＜0.001).The blood loss amount in DHS group were (350.1 ±80.2)ml,lower that those in PFNA and Intertan groups ((137.5 ± 35.4) ml and (125.2 ± 38.2) ml,F =20.462,P ＜ 0.001).Meanwhile,the postoperative drainage in DHS group was (125.3 ± 20.4) ml,significantly higher than PFNA group and INTERTAN group ((69.4 ± 9.2) ml and (74.6 ± 10.4) ml; F =15.871,P ＜0.001).Operative time,blood loss amount in INTERTAN group were less than that in PFNA group,but no significant difference (P ＞0.05).Nonunion in DHS group was significantly higher than the other two groups (8.82％ vs 0％ and 0％,x2 =6.092,P =0.047).Excellent rate in DHS group,PFNA group and Intertan group were 82.3％ (28/ 34),87.8％ (29/33),85.3％ (29/34) respectively,and there was no significant difference (x2 =0.591,P ＞ 0.05).Conclusion Compared with DHS,Intertan nail and PFNA have advantage of shorter operative time,stronger anti-rotation capability and less various postoperative complication rates,thus they are more suitable for elderly osteoporotic intertrochanteric fracture.

Objective To explore the indication of retrograde nailing with hollow screw internal fixation in treatment of ipsilateral femoral shaft and neck fractures.Methods Clinical data of 11 patients with ipsilateral femoral shaft and neck fractures during January 2001 and January 2011 in our hospital,who were treated with retrograde nailing with hollow screw internal fixation,was retrospectively analyzed,and curative effect was also evaluated.Results All patients were operated successfully,and were followed up for 12-36 months.The average follow-up time was 26.4 months.Ten patients with fractures of shaft of femur had synostosis within stage Ⅰ,and the healing time was(6.0±5.4)months;patients with femoral neck fractures all had synostosis,and the average healing time was(5.6±3.7)months.There was 1 patient with delayed union of shaft fracture,3 patients with limb shortening of femoral neck fractures(average shortening was 1.8 cm),2 patients with combination of knee-joint pain,and 1 patient with straight knee joint adhesion devices.Friedman-Wyman evaluation showed good in 8 patients,ordinary in 2 and bad in 1 patient.Conclusion The best surgical indications of retrograde nailing with hollow screw internal fixation in treatment of ipsilateral femoral shaft and neck fractures are for patients with distal femoral shaft fractures,femoral neck fractures with osteoporosis,and combination of genual intraarticular damage and acroteric joint fractures.