Objective:To investigate the therapeutic effect of arthroscopic Bankart repair combined with Remplissage surgery on Bankart lesion complicated by Hill-Sachs defect.Methods:Thirty-five patients with Bankart lesion complicated by Hill-Sachs defect admitted to No. 988 Hospital of the Joint Logistic Support Force from December 2018 to December 2021 were selected as the study subjects, and they were all treated by arthroscopic Bankart repair combined with Remplissage surgery. The clinical data of them were complete, and they were followed up for 6 months or more. The clinical effects were summarized.Results:All patients successfully underwent the operation completely, without serious complications during the operation. During the 6-month follow-up, 3 patients complained of tolerable joint sour pain when weather changed or rained, which did not affect their normal life or work; the postoperative pain score was lower than preoperative score ( P<0.05). Half a year after surgery, American Shoulder and Elbow Surgeons’ Form score and range of motion (external rotation of 90 ° elbow flexion, upward lifting of elbow forward flexion, upward lifting abductions) were higher, while Western Ontario shoulder instability index score was lower, compared with indexes before surgery ( P<0.05). Conclusions:Arthroscopic Bankart repair combined with Remplissage surgery, in the treatment of Bankart lesion complicated by Hill-Sachs defect, has a high success rate and fewer complications, moreover, it can improve postoperative shoulder stability and reduce the re-dislocation rate of shoulder joint.

目的 探讨跟腱断裂切开修复术后发生切口感染的影响因素及病原学特点.方法 回顾性分析2013年1月—2017年12月联勤保障部队第988医院骨科收治的102例跟腱断裂患者.根据是否伴有切口感染分为感染组(16例)与非感染组(86例).感染组男性13例,女性3例;年龄21～74岁,平均41.4岁;合并系统性红斑狼疮1例,合并类风湿性关节炎1例.术后随访2年以上无不良并发症的非感染组男性79例,女性7例;年龄18～68岁,平均36.0岁.收集患者初次跟腱断裂的伤口情况、术后切口感染情况以及伤口分泌物培养与药敏结果进行比较分析.结果 两组患者体质量指数(BMI)、血糖和尿酸方面差异无统计学意义[(24.29±4.20)kg/m2 vs.(24.40±2.67)kg/m2、(4.86±0.21)mmol/L vs.(5.05±0.47)mmol/L、(382.94±85.59)μmol/L vs.(391.35±83.93)μmol/L,P>0.05].感染组有8例(50.0％)为开放性损伤,非感染组3例(3.5％),差异有统计学意义(P<0.001).感染组吸烟患者占比(8例,50.0％)高于非感染组(16例,18.6％),P=0.017.春季发生初次断裂患者非感染组(45例,52.3％)多于感染组(3例,18.7％),P=0.013.冬季发生初次断裂患者感染组(6例,37.5％)多于非感染组(5例,5.8％),P=0.001.Logistic回归结果提示吸烟(OR=9.616,95％CI:1.725～53.600)以及开放性损伤(OR=53.589,95％CI:7.502～382.788)与跟腱断裂术后发生切口感染有关(P<0.05).感染组伤口分泌物培养结果提示有5例(31.3％)为金黄色葡萄球菌,7例(43.8％)伤口分泌物培养阴性,2例(12.5％)提示为铜绿假单胞菌,1例(6.2％)提示为路邓葡萄球菌,1例(6.2％)为粪肠球菌.结论 跟腱断裂术后切口感染多发生在冬季,吸烟及开放性损伤是切口感染的危险因素,切口病原菌以金黄色葡萄球菌为主.

〔目的〕通过对比体外冲击波作用于髌韧带腱骨组织前后MRI信号值,探讨MRI评估体外冲击波作用腱骨组织伤病疗效的敏感性及促进腱骨愈合的意义.〔方法〕选择10名健康成人志愿者,以右侧膝关节髌韧带与髌骨下极、胫骨结节移行区为腱骨交界观察区域,仅将体外冲击波干预因素作用于髌韧带胫骨结节移行区,另一腱骨交界区作空白对照,分别于体外冲击波干预前、干预后1 h、24 h、7 d行3.0T MRI扫描.对MRI进行阅片,于四个不同时间节点分别应用图像处理程序软件,测定MRI扫描图像压脂T2WI像在矢状位和横轴位腱骨移行区设定窗口内信号值,使用SPSS 19.0统计软件对获得的数据进行对比分析.〔结果〕于体外冲击波干预前、干预后1h、24h及7d时间节点,髌骨下极移行观察区皮下软组织和腱骨组织压脂T2WI像方差分析F值分别为:矢状位0.356、1.939,横轴位0.209、0.541,均P>0.05,无统计学意义.髌韧带胫骨结节移行观察区皮下软组织和腱骨组织压脂T2 WI像方差分析F值分别为:矢状位2333.355、522.171,横轴位1772.229、482.754,均P<0.05,差异具有显著统计学意义.〔结论〕体外冲击波作用于肌腱骨骼移行区后可在MRI上表现出信号值变化,证实MRI可作为评估体外冲击波作用于腱骨组织伤病疗效的一种敏感而有效的影像学检查方式,同时也提示体外冲击波可造成移行区皮下软组织和腱骨组织的微损伤,损伤后反应可能是促进腱骨愈合作用的原因之一.