Objective To analyze the short-term effectiveness of repairing musculus extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) tendon using suture anchor after debridement of extensor tendon insertion for recalcitrant lateral epicondylitis. Methods Between March 2009 and May 2011, 10 patients (10 elbows) with recalcitrant lateral epicondylitis received repair of the ECRB and EDC tendon to the lateral epicondyle using a single suture anchor after debridement of extensor tendon insertion. There were 6 males and 4 females with an average age of 45.4 years (range, 36-57 years). The dominant elbow was involved in 8 patients and nondominant elbow in 2 patients; there were 4 manual workers and 6 ordinary workers. The disease duration ranged from 8 to 24 months (mean, 12.3 months). All patients had epicondylus lateralis humeri pain, local swelling and tenderness, and positive Mill sign. The average elbow range of motion (ROM) was 11.3°(range, 0-30°) in extension and was 132.5°(range, 120-145°) in flexion. Preoperative MRI showed external humeral epicondylitis in all patients. ResultsPrimary wound healing was obtained in all patients without complications of infection, leakage of joint fluid, and stiffness of elbow. Ten patients were followed up 4 to 23 months with an average of 12 months (more than 12 months in 7 cases). The time to return to work was (3.75 ± 0.95) months for manual workers and was (2.91 ± 0.20) months for ordinary workers, showing no significant difference (t=1.715, P=0.180). Compared with preoperation, the mean visual analogue scale (VAS) score significantly decreased (P lt; 0.05), and Mayo score and the grip strength of dominant and nondominant significantly increased (P lt; 0.05), but no significant difference was found when compared with non-surgical side at last follow-up (P gt; 0.05). At last follow-up, the average ROM was —1.5° (range, 0-—10°) in extension and was 150.5°(range, 140-160°) in flexion. ConclusionTo suture anchor for repairing the ECRB and EDC after debridement is a satisfactory procedure to treat recalcitrant lateral epicondylitis. It can effectively prevent loss of the forearm extensor strength, relieve the pain, recover the grip strength, and obtain good results.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
ObjectiveTo compare the effectiveness between micro-anchor repair and modified pull-out suture in the treatment of mallet fingers. MethodsBetween June 2010 and March 2011, 33 patients with mallet fingers were treated by micro-anchor repair method (n=18, group A) and by modified pull-out suture method in which the broken tendons were sutured with double metal needle Bunnell’s suture and a knot was tied palmarly (n=15, group B). There was no significant difference in age, gender, and disease duration between 2 groups (P gt; 0.05). ResultsThe operation time was (62.5 ± 3.1) minutes in group A and (65.0 ± 4.6) minutes in group B, showing no significant difference (t=1.85, P=0.07). The treatment expense in group A [(8 566.2 ± 135.0) yuan] was significantly higher than that in group B [(5 297.0 ± 183.5) yuan] (t=58.92, P=0.00). Incision infection occurred in 2 cases of group A and 1 case of group B; the other patients obtained healing of incision by first intention. Relapsed mallet finger was observed in 1 case of group B. All patients in 2 groups were followed up 12-21 months. According to the Crawford functional assessment system, the results were excellent in 5 cases, good in 10 cases, fair in 2 cases, and poor in 1 case at the last follow-up with an excellent and good rate of 83.3% in group A; the results were excellent in 4 cases, good in 9 cases, fair in 1 case, and poor in 1 case with an excellent and good rate of 86.7% in group B. There was no significant difference in the excellent and good rate between 2 groups (χ2=0.23, P=0.97). ConclusionBoth micro-anchor repair and modified pull-out suture are simple and effective methods in the treatment of mallet finger. But compared with micro-anchor repair, pull-out suture has lower expense.
Objective To investigate the outcomes of arthroscopic reduction and internal fixation of tibial eminence avulsion fracture using absorbable double suture anchors. Methods Between February 2007 and August 2009, 18 patients with tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation using absorbable doublensuture anchors. There were 12 males and 6 females with an average age of 30.6 years (range, 17-48 years). The disease causes were traffic accident injury in 4 cases, sport injury in 8 cases, and fall ing from height injury in 6 cases; the locations were left side in 7 cases and right side in 11 cases. The results of the anterior drawer test and Lachman test were positive. According to Meyers-McKeever classification, 10 cases were rated as type II, 7 as type III, and 1 as type IV fractures. The time from injury to treatment was 6-20 days (mean, 10.2 days). Results Incision healed primarily. All the patients were followed up 29.1 months (range, 13-43 months). The X-ray films showed good reduction of fracture immediately after operation and fracture heal ing at 3 months. At the last follow-up, the range of motion of knee was 0-130°. The results of Lachman test and anterior drawer test were negative in 18 cases and 16 cases, repectively; and the results of anterior drawer test were weakly positive in 2 cases. The mean Lysholm score was significantly improved from 53.9 ± 6.7 preoperatively to 91.6 ± 4.2 postoperatively (t=22.100, P=0.000). The Inter national knee Documentation Commitee (IKDC) 2000 subject score improved from 58.1 ± 3.7 preoperatively to 92.8 ± 5.9 postoperatively (t=20.700, P=0.000). Conclusion Arthroscopic treatment using absorbable double suture anchors for tibial eminence avulsion fracture can provide satisfactory reduction, stable fixation, and good heal ing of the avulsed fragment, which is a minimally-invasive, simple, and effective treatment for patients with tibial eminence avulsion fracture.
Objective To investigate the surgical techniques and the cl inical outcomes of treating severe pronationexternal rotation ankle fractures combined with deltoid l igament injuries. Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries were treated by open reduction and internal fixation with l igament repair by using suture anchors. There were 13 males and 4 femaleswith an average age of 36.5 years (21-56 years). All cases were closed injuries with l imitation of motion after initial physical examination. The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and significant lateral shift of talus, but without medial malleous fracture before operation. All fractures were classified into grade-IV pronation- external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively. The disease course was from 4 days to 7 days with an average of 5.6 days. Results All incisions healed by first intention Seventeen patients were followed up 11-24 months (mean 15.6 months). The X-ray films showed that all patients achieved bony heal ing. The heal ing time was 11-16 weeks (mean 14.8 weeks). According to the Baird-Jackson’s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%. No operation compl ication occurred. Medial clear space was significantly decreased postoperatively compared with that before operation [(3.16 ± 0.37) mm vs. (4.87 ± 0.43) mm] (P lt; 0.01). In gravity stress radiographs, there was no significant difference in medial clear space between collateral ankle and injured ankle after operation [(3.47 ± 0.43) mm vs. (3.55 ± 0.44) mm] (P gt; 0.05). Conclusion It is emphasized that full attention should be given to reconstruction of medial l igament structures as well as open reduction and internal fixation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries.
Objective To evaluate the therapeutic effect of open-door cervical expansive laminoplasty (ELP) with anchor fixation on flurosis cervical stenosis (FCS). Methods From February 2005 to February 2006, 20 patients with FCS underwent ELP using anchor fixation (group A) and 24 patients with FCS received ELP using conventional silk thread fixation (group B). In group A, there were 11 males and 9 females aged (58.0 ± 11.2) years old, the course of disease ranged from 6 months to 5 years, and the stenosis involved 3 vertebral levels in 3 cases, 4 levels in 8 cases, and 5 levels in 9 cases, andthe sagittal diameter of the cervical spinal canal was (7.30 ± 5.23) mm. While in group B, there were 11 males and 13 females aged (61.0 ± 9.1) years old, the course of disease ranged from 5 months to 5 years, the stenosis involved 3 vertebral levels in 5 cases, 4 levels in 10 cases, and 5 levels in 9 cases, and the sagittal diameter of the cervical spinal canal was (7.11 ± 4.92) mm. No significant differences were evident between two groups in terms of the general information (P gt; 0.05). Before operation and at 24 months after operation, the nerve function was assessed by JOA score, the axial symptom (AS) was evaluated using Chiba 12-point method, and the changes of cervical lordosis index (CLI) and cervical range of motion (CRM) were detected by imaging examination. Results All wounds healed by first intention. All patients were followed up for 24 months. JOA score: in group A, it was improved from 7.4 ± 1.5 before operation to 14.6 ± 2.1 at 24 months after operation with an improvement rate of 61% ± 3%; in group B, the score was increased from 7.1 ± 2.2 to 12.6 ± 2.5 with an improvement rate of 52% ± 5%; significant differences were evident in two groups between before and after operation, and between two groups in terms of the improvement rate (P lt; 0.05). AS score: in group A, it was improved from 6.2 ± 2.1 before operation to 10.8 ± 0.3 at 24 months after operation with an improvement rate of 74% ± 4%; in group B, the score was increased from 6.3 ± 1.9 to 8.8 ± 0.5 with an improvement rate of 39% ± 3%; significant differences were evident in two groups between before and after operation, and between two groups in terms of improvement rate (P lt; 0.05). X-ray films and CT scan at 24 months after operation displayed that there was no occurrence of “breakage of door spindle” or “re-close of door” in two groups, there was no occurrence of anchor loosing in group A, and the molding of the spinal canal was satisfactory in two groups. Preoperatively, the CLI was 11.9 ± 1.9 in group A and 11.3 ± 2.2 in group B and the CRM was (39.5 ± 2.4)° in group A and (40.2 ± 1.8)° in group B. While at 24 months after operation, the CLI was 9.5 ± 2.2 in group A and 8.2 ± 2.8 in group B, and the CRM was (30.6 ± 2.0)° in group A and (28.7 ± 2.4)° in group B, suggesting there was a significant decrease when compared with the preoperative value and group A was superior to group B (P lt; 0.05). The saggital diameter of the cervical spinal canal 24 months after operation was (13.17 ± 2.12) mm in group A and (12.89 ± 3.21) mm in group B, indicating there was a significant difference when compared with the preoperative value (P lt; 0.01). Conclusion Compared with conventional silk thread fixation, ELP using anchor fixation brings more stabil ity to vertebral lamina, less invasion to the posterior muscular-skeletal structure of the cervical spine, sl ight postoperative neck AS, andsatisfactory cl inical outcomes.
【摘要】 目的 探讨关节镜辅助下经腘窝小切口应用锚钉固定治疗后交叉韧带胫骨止点粉碎骨折的临床效果。 方法 2007年2月-2008年12月对22例急性后交叉韧带胫骨止点骨折患者，采用关节镜辅助下经腘窝小切口切开复位，利用缝合锚钉重建止点，固定治疗后测试交叉韧带的张力和稳定，采用Lysholm膝关节功能评分评定膝关节功能。 结果 骨折平均愈合时间为6周，平均屈膝活动度（120±3）°。Lysholm膝关节功能评分为（92±2）分。 结论 关节镜辅助经腘窝小切口锚钉固定治疗后交叉韧带胫骨止点粉碎骨折，可协助诊断关节内韧带及骨折损伤情况，对韧带止点进行重建，操作简便，早期功能锻炼有助于关节功能恢复。【Abstract】 Objective To explore surgical technique and the results of arthroscopic reduction and fixation for the treatment of comminuted fracture of the posterior cruciate ligament (PCL) from the tibia using suture anchor through an posterolateral portal via popliteal fossa. Methods Twenty-two patients who were operated through an posterolateral portal via popliteal fossa, the fragment was fixed by using suture anchor to reestablish the insertion, test the tension and stabilization of PCL. Lysholm score was used to evaluate the knee function. Results The bone union was confirmed by X-ray films at the 6 weeks postoperatively. The ROM of knee joint relaxation was 120±3°. The Lysholm score was 92±2. Conclusion The displaced fragment of the comminuted fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the suture anchor arthroscopicly. Using suture anchors demonstrate a reliable and easy to use technique. Operation under arthroscopy helps diagnose and treat other complications inside knee joint. In addition, early functional exercise contributes torapid recovery of knee joint’s function.
目的:探讨带线锚钉治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的疗效。方法:自2003年9月至2008年7月共收治28例急性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤患者。对28例患者均采用开放手术下带线锚钉固定髌骨骨折及修复内侧髌股韧带损伤。术后1年进行术后的髌骨骨折Levack功能评分。结果:所有患者术后随访时间12~30个月,平均(16±3.50)个月。术后1年的髌骨骨折Levack功能评分标准优23例,可3例,差2例,优秀率达82.14%。无再次髌骨脱位或伴脱位患者。结论:开放手术下带线锚钉治疗对髌骨骨折固定及内侧髌股韧带修复可靠,是治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的有效方法。