目的 分析关节镜下改良Brostr?m术治疗慢性踝关节不稳合并外踝撕脱骨折的临床疗效.方法 回顾性分析自2017-01-2020-06采用关节镜下改良Brostr?m术治疗的46例因训练伤导致的慢性踝关节不稳合并外踝撕脱骨折,比较术前与术后1年美国骨科足踝协会AOFAS评分、Karlsson踝关节功能评分、疼痛VAS评分.结果 46例均获得随访,随访时间平均31(12～65)个月.1例术中腓浅神经损伤,术后1年完全恢复;2例术后残留部分不稳,但未再手术治疗.随访期间未发生切口感染、下肢深静脉血栓形成、石膏并发症.术后1年美国骨科足踝协会AOFAS评分、Karlsson踝关节功能评分、疼痛VAS评分均较术前明显改善,差异有统计学意义(P＜0.05).末次随访时患者主观满意度评价:满意39例,一般5例,不满意2例.主要不满意为运动强度大时外踝前方轻度疼痛,分析其原因为线结反应引起;术后6个月内部分患者内翻、跖屈略降低,术后1年时基本恢复正常;其中2例术后未定期复查,末次随访评分与术前相当,满意度差,且疼痛评分较术前加重.结论 关节镜下改良Brostr?m术治疗慢性踝关节不稳合并外踝撕脱骨折疗效良好,患者接受度高,可有效恢复踝外侧稳定性,降低韧带重建率.

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.

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 access the effect of V+L-type high tibial osteotomy and plate fixation for the treatment of varus of knee.Methods After the screening before surgery,we measured the angle of varus deformity and then calculated the thickness of the V osteotomy,posterior tibial cortical bone is not cut off,was in near L shaped transverse cross-sectional bone,and then fixed with tibia plate.Results The effect is satisfactory in all the patients.Conclusion That the use of V+L-type proximal tibial osteotomy and internal fixation of varus knee surgery has good clinical result.

腋臭症是多汗症和臭汗症的统称,主要表现为腋部异味,其严重程度因人而异,多发于青少年,给患者生活带来诸多痛苦,严重影响生活和学习.目前,临床上治疗腋臭症的方法虽多,但手术去除部分腋部皮肤组织被认为是根治腋臭症的最佳方法[1].由于传统的手术治疗具有创伤大,容易遗留瘢痕的缺点,我科自1997-01至2006-12采用具有专利技术的双刃小镰刀对320例(592侧)腋臭患者行双刃小镰刀手术治疗,取得了显著疗效.

目的 观察自制双刃小镰刀治疗腋臭症的临床疗效.方法 采用自制双刃小镰刀治疗腋臭症41例.结果 41例患者中,39例痊愈,2例显效,患者术后即可活动、学习、工作,无1例发生感染、肢体挛缩及形成瘢痕.结论 自制双刃小镰刀对腋臭症有较好的疗效.

<正>原发性三叉神经痛是我们在日常生活中遇到的常见病,其特点是顽固、疼痛剧烈。有很多患者患病数年至数十年,经久不愈,疼痛性质为闪电样疼痛,阵发性。一旦出现疼痛难以忍受。有时吃饭、说话、洗脸或吹冷风时都可能发作。本病最大的特点是常规的镇痛药无效。治疗方

骨科切口感染是影响手术效果的重要因素.骨科切口感染的预防虽经临床医师的不懈努力,其感染发生率仍在0.7%～8.5%之间,甚至带来灾难性后果.近年来我院实施综合性切口感染的预防措施,获得了535例骨科无菌切口无感染的良好效果.