目的 探讨肩关节镜下单排锚钉技术治疗急性骨性Bankart损伤的临床疗效.方法 回顾性分析我院2015年3月至2016年9月收治的12例急性骨性Bankart损伤病人的临床资料.所有病人均为初次肩关节前脱位造成的急性骨性Bankart损伤.其中男9例,女3例,平均年龄为38.8岁.Bigliani分型:Ⅰ型8例,Ⅱ型4例.均采用肩关节镜下单排锚钉缝合修复,锚钉数量为3～4颗.通过影像学资料评估骨折愈合情况;临床检查肩关节恐惧试验评估肩关节稳定性;比较病人术前术后的改良版肩功能Rowe评分和疼痛视觉模拟量表(visual analogue scale,VAS)评分.收集病人末次随访时对手术结果的整体满意情况.结果 12例病人平均随访时间为15.3个月.所有病人骨折愈合良好,无复发脱位出现,肩关节恐惧试验转为阴性,无半脱位出现.关节活动度较术前明显改善.术后Rowe评分和VAS评分分别为(96.170±3.215)分、(0.580±0.793)分,较术前的(54.670±12.702)分、(3.670±1.371)分显著改善,差异均有统计学意义(P均<0.05).末次随访时,12例病人中,9例(75.0％)表示非常满意,2例(16.7％)满意,1例(8.3％)部分满意.结论 肩关节镜下单排锚钉缝合治疗初次肩关节前脱位造成的急性骨性Bankart损伤可以取得优异的临床疗效.

Background: Acute Achilles tendon rupture (ATR) has increased in the past decade, and many new treatments and rehabilitation regimens have been introduced. But major complications in ATR management remain an unsolved problem. Purpose: To compare the risk of major complications of acute ATR after different combinations of treatments and rehabilitation regimens. Study Design: Systematic review and network meta-analysis. Method: The authors searched 4 databases (PubMed, Medline, Embase, and the Cochrane Library) from the date of inception until February 2018 for articles in English. The authors considered randomized controlled trials comparing interventions and rehabilitation protocols for acute ATR and restricted (1) interventions to nonoperative treatment, minimally invasive surgery, and open surgery and (2) rehabilitation protocols to accelerated rehabilitation and early immobilization. Major complications were assessed—namely, rerupture, deep infection, and deep vein thrombosis (DVT). Only patients with primary acute ATR were considered. Quality assessment was performed with the Cochrane “risk of bias” tool. A series of additional tests were conducted to ensure the validity of the results. Results: Twenty-nine randomized controlled trials with 2060 patients were included in this Bayesian network meta-analysis. The mean incidence of overall major complications from all managements was 9.13% (median, 6.67%). The mean incidence rates of rerupture, deep infection, and DVT from all managements were 5%, 1.50%, and 2.67%, respectively. According to relative risk, nonoperative treatment combined with early immobilization was significantly associated with a higher risk of major complications. According to the surface under the cumulative ranking curve, minimally invasive surgery with accelerated rehabilitation had the highest possibility (79.7%) of being the best management with regard to minimizing major complications. Conclusion: For treating acute ATR, management combining minimally invasive surgery with accelerated rehabilitation had the highest possibility of being superior in terms of major complication risks, according to the surface under the cumulative ranking curve. Management combining nonoperative treatment with early immobilization was statistically associated with a higher risk of complications as compared with the other methods of management.

目前对于肩袖分层撕裂的具体原因尚不清楚,已有部分文献报道分层肩袖的存在对肩袖愈合和功能恢复造成消极影响,然而如何准确的理解肩袖分层撕裂的生物力学和修复方式的选择至今尚未达成共识.肩袖分层撕裂主要由浅层的滑囊侧和深层的关节侧组成,分层撕裂发生后,关节侧比滑囊层承受张力更大,双侧的回缩方向均以向后内方为主.研究显示分层肩袖之间存在类似滑膜样组织,应在缝合前将其刮除.目前肩袖分层撕裂的诊断主要源于术中探查,治疗方式分为关节镜辅助下小切口治疗和全关节镜治疗.然而全关节镜下肩袖分层撕裂使用分层缝合或全层缝合仍未达成共识.因此,本文拟就肩袖分层撕裂的生物力学、治疗现状及研究进展作一综述.

目的 探讨股骨髓腔内使用微孔多聚糖止血球止血,对于减少全髋关节置换术失血的安全性和有效性.方法 选择初次单侧人工生物型假体全髋关节置换患者90侧.采用抛硬币法随机分为试验组(术中股骨髓腔内止血),对照组(不予股骨髓腔内止血)两组.两组均常规使用氨甲环酸(术前30 min,1g/100 mL静脉滴注,术毕术区灌注0.5 g/50 mL,术后6h,1 g/100 mL,静脉滴注)止血基础上,股骨髓腔内选用微孔多聚糖止血球止血.手术均采用后外侧入路(改良Gibson入路),由同一术者完成.结果 术中股骨髓腔内止血组的总出血量、术中出血量、隐性失血量、术后引流量均显著少于对照组,差异有统计学意义(P＜0.05),两组均无输血患者,均未发生感染,均有一例患者发生深静脉血栓,两组患者术后半年均无假体松动,术后半年患者髋关节功能评分(Harris评分)差异无统计学意义.结论 试验表明股骨髓腔使用微孔多聚糖止血球止血,能有效、安全地减少初次单侧人工生物型假体全髋关节置换的出血.